Decellularized homograft for aortic valve replacement two years after lung transplantation

Cardiac valvular surgery in patients after lung transplantation is a challenging procedure, reports are scarce. We report a 29-year-old patient who underwent concomitant mitral valve reconstruction and implantation of a decellularized aortic homograft two years after bilateral lung transplantation.Cardiac valvular surgery in patients after lung transplantation is a challenging procedure, reports are scarce. We report a 29-year-old patient who underwent concomitant mitral valve reconstruction and implantation of a decellularized aortic homograft two years after bilateral lung transplantation

Removal of xenoantigenic glycosylation patterns from porcine pulmonary heart valve matrices is dependent of the applied decellularization method

Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover Germany and Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Matrix guided tissue regeneration (GTR) based on allogeneic decellularized matrices has been shown as an overall convincing method for heart valve replacement. Nevertheless, a substantial donor shortage prevents an unlimited clinical application of human GTR-valves. Utilization of porcine decellularized heart valve matrices could offer a possible solution for overcoming this considerable limitation. In the past, implantation of xenogeneic valve tissues considered to be acellularinto human recipients, however, mostly lead to severe immune responses usually ending up into graft rejection. This study addresses the question whether potential xenoantigenic glycosylation of extracellular matrix components, like the major xenoantigen α-Gal, which served as model epitope for this study, can be removed by adjusted decellularization procedures. Materials and methods: Fresh porcine pulmonary heart valve conduits were decellularized by application of different detergent- and enzyme-based decellularization protocols. Subsequent cleavage of remaining matrix-related α-Gal epitopes was performed by enzymatic deglycosylation treatment on matrix samples of each decellularization group. Resulting tissues, mainly composed from insoluble extracellular matrix proteins, were afterwards divided into the relevant sections pulmonary artery wall specimens and pulmonary valve leaflets, frozen in liquid nitrogen, minced and finally solubilized by protease digestion. Evaluation of thus prepared solutions regarding to α-Gal contents was finally performed using a novel designed lectin-based immunoblot technique. Discussion results: Sole decellularization lead to significant removal of α-Gal, substantial varying in strong dependency to applied protocols between 30 to 50% compared to α-Gal contents of porcine native control tissues. An additional decrease of residual α-Gal in a range of another 15 to 30% was achievable by additional α-Galactosidase treatment. Combining decellularization and subsequent enzymatic digestion resulted in reductions of matrix related α-Gal contents down to levels, which could be measured for respective pulmonary valve tissues of α-Gal-KnockOut pigs. Conclusion: Residual xenoantigenic carbohydrates are detectable on insoluble matrix components of porcine pulmonary heart valves, substantially varying dependent on applied decellularization protocols. Combined with glycolytic digestions, remaining glycosylation contents are reducible to background levels. Impacts of these novel insights have to be evaluated in further in vitro as well as in vivo studies

Căile aeriene dificile în chirurgia maxilo-facială (Caz clinic)

Catedra Anesteziologie şi Reanimatologie Nr 1 „Valeriu Ghereg”, USMF „Nicolae Testemiţanu”, Centrul Naţional Ştiinţifico-Practic de Medicină de Urgenţă, Chişinău, Moldova, Catedra Chirurgie Orală şi Maxilo-Facială, USMF „Nicolae Testemiţanu”, Congresul II Internaţional al Societăţii Anesteziologie Reanimatologie din Republica Moldova 27-30 august 2009Confruntarea cu un pacient neventilat şi neintubat reprezintă o încercare serioasă pentru anestezist. Identificarea pacienţilor cu risc de intubare dificilă este un pas esenţial în examenul preanestezic ce poate reduce morbiditatea şi mortalitatea legată de căile aeriene dificile. Aplicarea anesteziei generale, a sedării intravenoase induce depresie respiratorie, care necesită asistenţă respiratorie cu protejarea căilor aeriene. Intubarea dificilă este definită ca necesitatea de a efectua mai mult de 3 încercări de intubare, sau mai mult de 10 minute, utilizând laringoscopie clasică. Laringoscopia dificilă este atunci, când nu este posibil de a vedea nici o porţiune a corzilor vocale prin laringoscopie clasică. În prezicerea căilor aeriene dificile sunt importante următoarele: anamnesticul, examinarea, măsurările, sistemele de scoruri, eşecurile

Diagrammatic analysis of the Hubbard model:Stationary property of the thermodynamic potential

Diagrammatic approach proposed many years ago for strong correlated Hubbard model is developed for analyzing of the thermodynamic potential properties. The new exact relation between such renormalized quantities as thermodynamic potential, one-particle propagator and correlation function is established. This relation contains additional integration of the one-particle propagator by the auxiliary constant. The vacuum skeleton diagrams constructed from irreducible Green's functions and tunneling propagator lines are determined and special functional is introduced. The properties of such functional are investigated and its relation to the thermodynamic potential is established. The stationary properties of this functional with respect to first order changing of the correlation function is demonstrated and as a consequence the stationary properties of the thermodynamic potential is proved.Comment: 6 pages, 4 figure

Immobilization methods in the treatment of the patient with zygomatic complex associated trauma

Catedra de chirurgie oro-maxilo-facială, Catedra de chirurgie oro-maxilo-facială şi Protetică dentară, FPM, USMF ”Nicolae Testemiţanu”Aeschylus fracture of the zygomatic complex in the clinic of Oral and Maxillofacial Surgery from Chisinau often is fixed via osteosynthesis methods as one of the safest methods and more perfect. Immobilization with Kirschner brooches are used in exceptional cases (single cases). Endooral access and temporally immobilization of the fractured fragments permit an aesthetic recovery of the patient with trauma of the zygomatic complex. Fractura eschiloasă a complexului zigomatic în Clinica de Chirurgie OMF din Chişinău mai des se fixează prin osteosinteză fiind una din metodele cele mai sigure şi cele mai perfecte. Imobilizarea cu broşa Kirschner sunt utilizate în cazuri excepţionale(cazuri unice) rar. Accesul endobucal şi temporal de imobilizare a fragmentelor fracturate permite recuperarea estetică a bolnavului cu traumatism al complexului zigomatic

Decellularized tissue engineered pericardium as replacement for tricuspid valve in cardiac surgery

Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover Germany and Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Tricuspid valve replacement is the last treatment choice in tricuspid valve pathology. The choice to insert mechanical or bioprosthetic valve remains controversial. Both prostheses have some limitations such as infection, risk of thromboembolism, need for life-long anticoagulation or limited durability. The following study aimed to develop a novel tissue-engineered tricuspid valve based on decellularized pericardium allograft. Materials and methods: Fresh ovine pericardium was harvested at the local slaughter house and decellularized using detergents. For disinfection all samples were treated for 24h with Phosphate Buffered Solution supplemented with 1% gentamicin and 1% streptomycin. The effectiveness of decellularization was evaluated by histological staining (hematoxylin-eosin, Movat’s Pentachrom and Van Gieson), Isolectin B4 staining (a-gal xenoantigen) and by DNA-quantification. Two valvular leaflets were manufactured out of decellularized pericardium and sutured ex-vivo into the tricuspid annulus of an ovine heart and suspended on papillary muscles. Hydraulic test were performed to prove valve competency. Discussion results: After detergent treatment pericardial tissue has been converted in a cell-free scaffold as proven by standard histological analysis. Immunofluorescent examinations revealed the absence of a-gal xenoantigens. DNA-quantification showed a substantial reduction in DNA content compared to the normal tissue. The alignment of collagenous fibers in decellularized scaffolds appeared well-preserved and was not affected by detergent decellularization procedure as proven by histological staining. Graft disinfection and storage in antibiotic solution after decellularization did not affect the texture of the scaffold. Furthermore, two leaflet structure created out of decellularized pericardium and surgically sutured in tricuspid position of ovine heart resulted in a competent valve prosthesis. Conclusion: The present results have shown successful decellularization of the ovine pericardium using detergents. Decellularized pericardial allograft can be used in cardiac surgery as a scaffold for valvular tissue engineering or for in-vivo guided tissue regeneration in tricuspid valve replacement

A European study on decellularized homografts for pulmonary valve replacement: initial results from the prospective ESPOIR Trial and ESPOIR Registry data\u2020

OBJECTIVES: Decellularized pulmonary homografts (DPH) have shown excellent results for pulmonary valve replacement. However, controlled multicentre studies are lacking to date.METHODS: Prospective European multicentre trial evaluating DPH for pulmonary valve replacement. Matched comparison of DPH to bovine jugular vein (BJV) conduits and cryopreserved homografts (CH) considering patient age, type of heart defect and previous procedures.RESULTS: In total, 121 patients (59 female) were prospectively enrolled (August 2014-December 2016), age 21.3 +/- 14.4 years, DPH diameter 24.4 +/- 2.8 mm. No adverse events occurred with respect to surgical handling; there were 2 early deaths (30 + 59 years) due to myocardial failure after multi-valve procedures and no late mortality (1.7% mortality). After a mean follow-up of 2.2 +/- 0.6 years, the primary efficacy end points mean peak gradient (16.1 +/- 12.1 mmHg) and regurgitation (mean 0.25 +/- 0.48, grade 0-3) were excellent. One reoperation was required for recurrent subvalvular stenosis caused by a pericardial patch and 1 balloon dilatation was performed on a previously stented LPA. 100% follow-up for DPH patients operated before or outside the trial (n = 114) included in the ESPOIR Registry, age 16.6 +/- 10.4 years, diameter 24.1 +/- 4.2 mm, follow-up 5.1 +/- 3.0 years. The combined DPH cohort, n = 235, comprising both Trial and Registry data showed significantly better freedom from explantation (DPH 96.7 +/- 2.1%, CH 84.4 +/- 3.2%, P = 0.029 and BJV 82.7 +/- 3.2%, P = 0.012) and less structural valve degeneration at 10 years when matched to CH, n = 235 and BJV, n = 235 (DPH 61.4 +/- 6.6%, CH 39.9 +/- 4.4%, n.s., BJV 47.5 +/- 4.5%, P = 0.029).CONCLUSIONS: Initial results of the prospective multicentre ESPOIR Trial showed DPH to be safe and efficient. Current DPH results including Registry data were superior to BJV and CH.Thoracic Surger

Evaluation of Suppressed Mite Reproduction (SMR) Reveals Potential for Varroa Resistance in European Honey Bees (Apis melliferaL.)

Simple Summary The miteVarroa destructorrepresents a great threat to honey bees and the beekeeping industry. The opportunity to select and breed honey bees that are naturally able to fight the mite stands a sustainable solution. This can be achieved by evaluation of the failure of mite reproduction (SMR, suppressed mite reproduction). We conducted a large European experiment to assess the SMR trait in different populations of honey bees spread over 13 different countries, and representing different honey bee populations. The first goal was to standardize and validate the SMR evaluation method, and then to compare the SMR trait between the different populations. Our results indicate that it is necessary to examine at least 35 brood cells infested by a single mite to reliably estimate the SMR score of any given colony. Several colonies from our dataset display high SMR scores, indicating that this trait is present within the European honey bee populations. No major differences could be identified between countries for a given population, or between populations in different countries. This study shows the potential to increase selection efforts to breedV. destructorhoney bee resistant populations. In the fight against theVarroa destructormite, selective breeding of honey bee (Apis melliferaL.) populations that are resistant to the parasitic mite stands as a sustainable solution. Selection initiatives indicate that using the suppressed mite reproduction (SMR) trait as a selection criterion is a suitable tool to breed such resistant bee populations. We conducted a large European experiment to evaluate the SMR trait in different populations of honey bees spread over 13 different countries, and representing different honey bee genotypes with their local mite parasites. The first goal was to standardize and validate the SMR evaluation method, and then to compare the SMR trait between the different populations. Simulation results indicate that it is necessary to examine at least 35 single-infested cells to reliably estimate the SMR score of any given colony. Several colonies from our dataset display high SMR scores indicating that this trait is present within the European honey bee populations. The trait is highly variable between colonies and some countries, but no major differences could be identified between countries for a given genotype, or between genotypes in different countries. This study shows the potential to increase selective breeding efforts ofV. destructorresistant populations

Vilnius Declaration on chronic respiratory diseases : multisectoral care pathways embedding guided self-management, mHealth and air pollution in chronic respiratory diseases

Correction: Volume: 10 Issue: 1 Article Number: 49 DOI: 10.1186/s13601-020-00357-4 Published: DEC 17 2020Background: Over 1 billion people suffer from chronic respiratory diseases such as asthma, COPD, rhinitis and rhinosinusitis. They cause an enormous burden and are considered as major non-communicable diseases. Many patients are still uncontrolled and the cost of inaction is unacceptable. A meeting was held in Vilnius, Lithuania (March 23, 2018) under the patronage of the Ministry of Health and several scientific societies to propose multisectoral care pathways embedding guided self-management, mHealth and air pollution in selected chronic respiratory diseases (rhinitis, chronic rhinosinusitis, asthma and COPD). The meeting resulted in the Vilnius Declaration that was developed by the participants of the EU Summit on chronic respiratory diseases under the leadership of Euforea. Conclusion: The Vilnius Declaration represents an important step for the fight against air pollution in chronic respiratory diseases globally and has a clear strategic relevance with regard to the EU Health Strategy as it will bring added value to the existing public health knowledge.Peer reviewe