The Use of Handheld Ultrasound Devices-An EFSUMB Position Paper

Publisher Copyright: © 2018 Georg Thieme Verlag KG Stuttgart New York.The miniaturization of ultrasound equipment in the form of tablet-or smartphone-sized ultrasound equipment is a result of the rapid evolution of technology and handheld ultrasound devices (HHUSD). This position paper of the European Federation of Societies in Ultrasound and Medicine (EFSUMB) assesses the current status of HHUSD in abdominal ultrasound, pediatric ultrasound, targeted echocardiography and heart ultrasound, and we will report position comments on the most common clinical applications. Also included is a SWOT (Strength-Weaknesses-Opportunities-Threats) analysis, the use for handheld devices for medical students, educational & training aspects, documentation, storage and safety considerations.Peer reviewe

Medical student ultrasound education, a WFUMB position paper, Part II. A consensus statement by ultrasound societies

Publisher Copyright: © 2020 Societatea Romana de Ultrasonografie in Medicina si Biologie. All rights reserved. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Ultrasound is becoming a fundamental first-line diagnostic tool for most medical specialties and an innovative tool to teach anatomy, physiology and pathophysiology to undergraduate and graduate students. However, availability of structured training programs during medical school is lagging behind and many physicians still acquire all their ultrasound skills during postgraduate training. There is wide variation in medical student ultrasound education worldwide. Sharing successful educational strategies from early adopter medical schools and learning from leading education programs should advance the integration of ultrasound into the university medical school curricula. In this overview, we present current approaches and suggestions by ultrasound societies concerning medical student education throughout the world. Based on these examples, we formulate a consensus statement with suggestions on how to integrate ultrasound teaching into the preclinical and clinical medical curricula.publishersversionPeer reviewe

Akkermansia muciniphila Reduces Peritonitis and Improves Intestinal Tissue Wound Healing after a Colonic Transmural Defect by a MyD88-Dependent Mechanism

Anastomotic leakage is a major complication following colorectal surgery leading to peritonitis, complications, and mortality. Akkermansia muciniphila has shown beneficial effects on the gut barrier function. Whether A. muciniphila reduces peritonitis and mortality during colonic leakage is unknown. Whether A. muciniphila can directly modulate the expression of genes in the colonic mucosa in humans has never been studied. We investigated the effects of a pretreatment (14 days) with live A. muciniphila prior to surgical colonic perforation on peritonitis, mortality, and wound healing. We used mice with an inducible intestinal-epithelial-cell-specific deletion of MyD88 (IEC-MyD88 KO) to investigate the role of the innate immune system in this context. In a proof-of-concept pilot study, healthy humans were exposed to A. muciniphila for 2 h and colonic biopsies taken before and after colonic instillation for transcriptomic analysis. Seven days after colonic perforation, A.-muciniphila-treated mice had significantly lower mortality and severity of peritonitis. This effect was associated with significant improvements of wound histological healing scores, higher production of IL22, but no changes in the mucus layer thickness or genes involved in cell renewal, proliferation, or differentiation. All these effects were abolished in IEC-MyD88 KO mice. Finally, human subjects exposed to A. muciniphila exhibited an increased level of the bacterium at the mucus level 2 h after instillation and significant changes in the expression of different genes involved in the regulation of cell cycling, gene transcription, immunity, and inflammation in their colonic mucosa. A. muciniphila improves wound healing during transmural colonic wall defect through mechanisms possibly involving IL22 signaling and requiring MyD88 in the intestinal cells. In healthy humans, colonic administration of A. muciniphila is well tolerated and changes the expression of genes involved in the immune pathways

The influence of Akkermansia muciniphila on intestinal wound healing

Colorectal anastomotic leakage is a serious surgical complication, and the local microbiota is suggested to have a strong influence on anastomosis healing. As the existing murine anastomotic leakage models have major limitations to assess the consequences of local microbiota manipulation, we developed and described a novel intestinal wound healing model called the “Colonoscopic Leakage Model”. Using this model, our experiments demonstrate that A. muciniphila, a next-generation beneficial bacterium, improves wound healing after transmural colonic wall defect through mechanisms possibly involving IL22 signaling and requiring MyD88 in the intestinal cells. Results of a proof-of- concept pilot study, show that in healthy humans, colonic administration of A. muciniphila is well-tolerated and changes the expression of genes involved in the immune pathways.(BIFA - Sciences biomédicales et pharmaceutiques) -- UCL, 202

Akkermansia muciniphila derived tripeptide jams the gear of sepsis, inflammation and mortality

Sepsis constitutes a global burden on medical care and accounts for nearly 20% of reported global mortality.1 The development of sepsis is complex, though the triggering of a disproportional systemic proinflammatory response is considered pivotal in driving organ dysfunction and subsequent mortality. As functional pattern recognition receptors, toll-like receptors (TLRs) play a predominant role in this context. Hence, approaches aimed at limiting their activation are considered valuable strategies for mitigating the organ damage and mortality occurring during the advancement of sepsis

Innovations en Chirurgie colorectale. Que retenir de 2015?

Cette année aura été marquée par le début de la chirurgie colorectale assistée par robot au sein des Cliniques universitaires Saint-Luc. La chirurgie assistée par robot est une technique chirurgicale nouvelle qui a été mise au point pour pallier les limitations techniques de la chirurgie laparoscopique. En effet, contrairement aux instruments rectilignes et rigides de la laparoscopie classique, les bras du robot ainsi que ses instruments permettent des mouvements imitant parfaitement ceux du poignet et de la main du chirurgien. Associées à une vision 3D du champ opératoire, à un grossissement de 10 fois et à un filtrage du tremblement physiologique, ces caractéristiques, et d’autres encore, sont la clé d’une chirurgie mini-invasive extrêmement précise et sûre.[Colorectal surgery in the robotic era] The year 2015 has been marked by the initiation of robotic-assisted colorectal surgery at the Cliniques universitaires Saint-Luc. Robotic surgery is a new surgical technology, which attempts to overcome the technical limitations of laparoscopic surgery. Contrary to the rectilinear and rigid instruments used in classical laparoscopy, the robot’s arms and instruments allow for intuitive movements that perfectly mimic those of the surgeon’s wrist and hand. Along with the 3D magnified vision of the operating field and filtering of physiological tremor, these features in addition to others are key to the precision and safety of minimally invasive surgery

Novel insight into the role of microbiota in colorectal surgery.

Recent literature undeniably supports the idea that the microbiota has a strong influence on the healing process of an intestinal anastomosis. Understanding the mechanisms by which the bacterial community of the gut influences intestinal healing could open the door for new preventive and therapeutic approaches. Among the different mechanisms, data have shown that the production of specific reactive oxygen species (ROS) and the activation of specific formyl peptide receptors (FPRs) regulate intestinal wound healing. Evidence suggests that specific gut microbes such as Lactobacillus spp and Akkermansia muciniphila help to regulate healing processes through both ROS-dependent and FPR-dependent mechanisms. In this review, we will discuss the current knowledge and future perspectives concerning the impact of microbiota on wound healing. We will further review available evidence on whether mechanical bowel preparation and the use of specific antibiotics are beneficial or harmful procedures, an ongoing matter of debate. These practices have a profound effect on the gut microbiota composition at the level of both the mucosal and the luminal compartments. Therefore, a key question remains unanswered: should we continue to prepare the gut before surgical intervention? Current knowledge and data do not clearly support the use of one technique or another to avoid complications such as anastomotic leak. There is an urgent need for appropriate interventions with a deep microbiota analysis to investigate both the surgical technical benefits of a proper anastomosis compared with the potential effect of the gut microbes (beneficial vs harmful) on the processes of wound healing and anastomotic leakage reduction

Single center experience with salvage surgery for chronic pelvic sepsis

Chronic pelvic sepsis eventually requires salvage surgery in half of all patients. The goal of surgery is to resolve pelvic inflammation while restoring intestinal continuity. Our salvage procedure achieves this by bringing a healthy conduit into the pelvis and creating an anastomosis beyond the source of sepsis. We aimed to review our single center experience with this procedure for the treatment of chronic pelvic sepsis. All patients requiring the procedure from 2010 to 2018 were retrospectively reviewed using a prospective database. Morbidity and mortality were evaluated, and restoration of bowel continuity at 1-year rate was the endpoint. Twenty patients were included. The main indication was pelvic sepsis after anastomotic leak (AL). The median age was 60 (42–86) years and the median BMI was 26 (18–37) kg/m2. The median time carrying a stoma before the intervention was 15 months, and median time to intervention was 32 months. All patients had a diverting stoma. There were no death and overall morbidity reached 60%, and AL rate was 10%. At 1 year, 70% of the patients had their intestinal continuity restored. In expert hands, salvage surgery for chronic pelvic sepsis has acceptable morbidity rates, an acceptable rate of AL, and a bowel restoration success rate 70% at 1 year, and is a valuable option for patients failing conservative treatment

Case report of multiple rectal neuroendocrine tumors in a context of ulcerative colitis.

Neuroendocrine tumors (NETs) of the rectum are rare, with an estimated incidence of 0.1% of all colorectal cancers. However, it is crucial to diagnose NET, particularly in patients with ulcerative colitis, who seem to have a higher risk of cancerization according to recent studies, given the aggressiveness and poor prognosis of these tumors. We report the case of a 54-year-old man who developed multiple rectal NETs (approximately 10), measuring 1-6 mm, only 2 years after a primary diagnosis of ulcerative colitis. In the literature, all reported cases of NETs present patients with a long history of several years of inflammatory bowel disease; however, very little literature exists on this subject. Herein, we discussed the outcomes and a literature review of the pathology, prognosis, and management of NETs. Despite advances in research on rectal NETs, many aspects about the disease remain unclear, partly due to its rarity