Open infrainguinal revascularization for chronic arterial occlusions: techniques and short-time clinical results

Catedra de chirurgie generală semiologie nr. 3, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Spitalul Clinic Municipal nr.1, Chişinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: În pofida implementării active a tehnicilor endovasculare intervențiile arteriale deschise adresate leziunilor ocluzive cronice infrainghinale își păstrează utilitatea, reprezentând uneori chiar unica opțiune de revascularizare a extremității ischemizate. Scopul studiului a fost evidențierea ratei de aplicare în practica cotidiană a diverselor tehnici chirurgicale deschise de revascularizare în caz de ocluzii arteriale cronice infrainghinale și evaluarea rezultatelor clinice precoce ale acestora. Material și metode: Datele medicale referitoare la un grup constituit din 190 de pacienți revascularizați pentru leziuni aterosclerotice infrainghinale în cadrul Clinicii Chirurgie Generală – Semiologie nr.3, IMSP SCM nr.1 (Chișinău), au fost extrase din registrul electronic și supuse analizei retrospective. Rezultate: Vârsta medie a bolnavilor – 67,3±9,8 ani; bărbați – 83,2%. Repartizarea observațiilor conform gradului de ischemie (clasificarea Fontaine): IIB – 59 (31%), III – 52 (27,3%) și IV – 79 (41,5%). Ultrasonografia duplex/TC-angiografia au pus în evidență localizarea preponderentă a leziunilor ocluzive la nivelul arterei femurale (50%). Sediul ocluziei în 10,5% cazuri a fost artera femurală comună, iar în alte 10% – axul distal (trunchiul tibio-peronier, aa.tibiale). Revascularizarea s-a realizat prin: bypass femuropopliteu (46,4%), -infrapopliteu (13,3%) sau -distal (6,3%); endarterectomie cu angioplastie (18,4%); angioplastie cu petic (10,8%); arterializarea sistemului venos (2,5%) sau protezare arterială (1,9%). Rata amputațiilor secundare realizate în termen precoce (30 zile) de la revascularizare – 3,7%. Concluzii: La momentul adresării pacientului leziunile arteriale cronice ocluzive infrainghinale frecvent au caracter extins. Intervențiile deschise cu utilizarea întregului arsenal de tehnici de revascularizare oferă rezultate precoce acceptabile, în special la pacienții fără comorbidități critice.Introduction: Despite the active implementation of endovascular techniques, open arterial reconstructions for infrainguinal chronic occlusive arterial lesions (ICOAL) retain their usefulness, sometimes representing the sole option for revascularization and salvage of the affected extremity. Aim of study was to evaluate the rate of use in routine clinical practice of various open surgical techniques for revascularization in case of ICOAL and to assess their short-term clinical results. Material and methods: Medical data related to a group of 190 patients revascularized for ICOAL at the Department of General Surgery-Semiotics nr.3, Municipal Clinical Hospital no.1 (Chisinau), were extracted from the electronic registry and subjected to retrospective analysis. Results: The mean age of patients – 67.3±9.8 years; males – 83.2%. Distribution of cases according to the grade of ischemia (Fontaine classification): IIB – 59 (31%), III – 52 (27.3%) and IV – 79 (41.5%). Duplex ultrasound/CT-angiography revealed the predominant localization of ICOAL at the level of femoral artery (50%). The occlusion site in 10.5% cases was the common femoral artery, while in another 10% – the leg arteries (tibioperoneal trunk, tibial arteries). Revascularization was achieved by: femoro-popliteal (46.4%), -infrapopliteal (13.3%) or -distal (6.3%) bypasses; endarterectomy with angioplasty (18.4%); patch angioplasty (10.8%); venous arterialization (2.5%) or graft interposition (1.9%). The rate of secondary amputation within 30 days after revascularization was 3.7%. Conclusion: At the moment of patient presentation ICOAL frequently have extensive character. Open surgical procedures with utilization of all spectrum of techniques of revascularization provide acceptable short-term results, especially in patients without critical comorbidities

Assessment of promising agricultural management practices

iSQAPER project - Interactive Soil Quality Assessment in Europe and China for Agricultural Productivity and Environmental Resilience - aims to develop an app to advise farmers on selecting the best AgricultureManagement Practice (AMPs) to improve soil quality. For this purpose, a soil quality index has to be developed to account for the changes in soil quality as impacted by the implementation of the AMPs. Some promising AMPs have been suggested over the time to prevent soil degradation. These practices have been randomly adopted by farmers but which practices are most used by farmers and where they are mostly adopted remains unclear. This study is part of the iSQAPER project with the specific aims: 1) map the current distribution of previously selected 18 promising AMPs in several pedo-climatic regions and farming systems located in ten and four study site areas (SSA) along Europe and China, respectively; and 2) identify the soil threats occurring in those areas. In each SSA, farmers using promising AMP'swere identified and questionnaires were used to assess farmer's perception on soil threats significance in the area. 138 plots/farms using 18 promising AMPs, were identified in Europe (112) and China (26).Results show that promising AMPs used in Europe are Crop rotation (15%), Manuring & Composting (15%) and Min-till (14%), whereas in China areManuring & Composting (18%), Residuemaintenance (18%) and Integrated pest and disease management (12%). In Europe, soil erosion is the main threat in agricultural Mediterranean areas while soilborne pests and diseases is more frequent in the SSAs from France and The Netherlands. In China, soil erosion, SOM decline, compaction and poor soil structure are among the most significant. This work provides important information for policy makers and the development of strategies to support and promote agricultural management practices with benefits for soil quality.L. Barão and C. Ferreira were supported by the grants SFRH/BPD/115681/2016 and SFRH/BPD/120093/2016, respectively, from the Portuguese Fundação para a Ciência e TecnologiaiSQAPER is funded by the European Union's Horizon 2020 Programme for research & innovation under grant agreement no 635750the Chinese Ministry of Science and Technology (grant nr:2016YFE011270)the Chinese Academy of Sciences (grant nr:16146KYSB20150001)and the Swiss State Secretariat for Education, Research and Innovation. Contract: 15.0170-1

Evolution of Parallel Spindles Like genes in plants and highlight of unique domain architecture#

<p>Abstract</p> <p>Background</p> <p>Polyploidy has long been recognized as playing an important role in plant evolution. In flowering plants, the major route of polyploidization is suggested to be sexual through gametes with somatic chromosome number (2<it>n</it>). <it>Parallel Spindle1 </it>gene in <it>Arabidopsis thaliana </it>(<it>AtPS1</it>) was recently demonstrated to control spindle orientation in the 2nd division of meiosis and, when mutated, to induce 2<it>n </it>pollen. Interestingly, <it>AtPS1 </it>encodes a protein with a FHA domain and PINc domain putatively involved in RNA decay (i.e. Nonsense Mediated mRNA Decay). In potato, 2<it>n </it>pollen depending on parallel spindles was described long time ago but the responsible gene has never been isolated. The knowledge derived from <it>AtPS1 </it>as well as the availability of genome sequences makes it possible to isolate potato <it>PSLike </it>(<it>PSL</it>) and to highlight the evolution of <it>PSL </it>family in plants.</p> <p>Results</p> <p>Our work leading to the first characterization of <it>PSLs </it>in potato showed a greater <it>PSL </it>complexity in this species respect to <it>Arabidopsis thaliana</it>. Indeed, a genomic <it>PSL </it>locus and seven cDNAs affected by alternative splicing have been cloned. In addition, the occurrence of at least two other <it>PSL </it>loci in potato was suggested by the sequence comparison of alternatively spliced transcripts.</p> <p>Phylogenetic analysis on 20 <it>Viridaeplantae </it>showed the wide distribution of <it>PSLs </it>throughout the species and the occurrence of multiple copies only in potato and soybean.</p> <p>The analysis of PSL^FHAand PSL^PINcdomains evidenced that, in terms of secondary structure, a major degree of variability occurred in PINc domain respect to FHA. In terms of specific active sites, both domains showed diversification among plant species that could be related to a functional diversification among <it>PSL </it>genes. In addition, some specific active sites were strongly conserved among plants as supported by sequence alignment and by evidence of negative selection evaluated as difference between non-synonymous and synonymous mutations.</p> <p>Conclusions</p> <p>In this study, we highlight the existence of PSLs throughout <it>Viridaeplantae</it>, from mosses to higher plants. We provide evidence that <it>PSLs </it>occur mostly as singleton in the analyzed genomes except in soybean and potato both characterized by a recent whole genome duplication event. In potato, we suggest the candidate <it>PSL </it>gene having a role in 2<it>n </it>pollen that should be deeply investigated.</p> <p>We provide useful insight into evolutionary conservation of FHA and PINc domains throughout plant PSLs which suggest a fundamental role of these domains for PSL function.</p

Cell Encapsulation in Sub-mm Sized Gel Modules Using Replica Molding

For many types of cells, behavior in two-dimensional (2D) culture differs from that in three-dimensional (3D) culture. Among biologists, 2D culture on treated plastic surfaces is currently the most popular method for cell culture. In 3D, no analogous standard method—one that is similarly convenient, flexible, and reproducible—exists. This paper describes a soft-lithographic method to encapsulate cells in 3D gel objects (modules) in a variety of simple shapes (cylinders, crosses, rectangular prisms) with lateral dimensions between 40 and 1000 μm, cell densities of 105 – 108 cells/cm3, and total volumes between 1×10−7 and 8×10−4 cm3. By varying (i) the initial density of cells at seeding, and (ii) the dimensions of the modules, the number of cells per module ranged from 1 to 2500 cells. Modules were formed from a range of standard biopolymers, including collagen, Matrigel™, and agarose, without the complex equipment often used in encapsulation. The small dimensions of the modules allowed rapid transport of nutrients by diffusion to cells at any location in the module, and therefore allowed generation of modules with cell densities near to those of dense tissues (108 – 109 cells/cm3). This modular method is based on soft lithography and requires little special equipment; the method is therefore accessible, flexible, and well suited to (i) understanding the behavior of cells in 3D environments at high densities of cells, as in dense tissues, and (ii) developing applications in tissue engineering

Estimating food production in an urban landscape

There is increasing interest in urban food production for reasons of food security, environmental sustainability, social and health benefits. In developed nations urban food growing is largely informal and localised, in gardens, allotments and public spaces, but we know little about the magnitude of this production. Here we couple own-grown crop yield data with garden and allotment areal surveys and urban fruit tree occurrence to provide one of the first estimates for current and potential food production in a UK urban setting. Current production is estimated to be sufficient to supply the urban population with fruit and vegetables for about 30 days per year, while the most optimistic model results suggest that existing land cultivated for food could supply over half of the annual demand. Our findings provide a baseline for current production whilst highlighting the potential for change under the scaling up of cultivation on existing land

DIS3 isoforms vary in their endoribonuclease activity and are differentially expressed within haematological cancers

DIS3 is the catalytic subunit of the exosome, a protein complex involved in the 3’ to 5’ degradation of RNAs. DIS3 is a highly conserved exoribonuclease, also known as Rrp44. Global sequencing studies have identified DIS3 as being mutated in a range of cancers, with a considerable incidence in multiple myeloma. In this work, we have identified two proteincoding isoforms of DIS3. Both isoforms are functionally relevant and result from alternative splicing. They differ from each other in the size of their N-terminal PIN domain, which has been shown to have endoribonuclease activity and tether DIS3 to the exosome. Isoform 1 encodes a full-length PIN domain, whereas the PIN domain of isoform 2 is shorter and is missing a segment with conserved amino-acids. We have carried out biochemical activity assays on both isoforms of full-length DIS3 as well as the isolated PIN domains. We find that isoform 2, despite missing part of the PIN domain, has greater endonuclease activity compared to isoform 1. Examination of the available structural information allows us to provide a hypothesis to explain this altered behaviour. Our results also show that multiple myeloma patient cells and all cancer cell lines tested have higher levels of isoform 1 compared to isoform 2 whereas Acute Myeloid Leukemia (AML) and chronic myelomonocytic leukaemia (CMML) patient cells and samples from healthy donors have similar levels of isoforms 1 and 2. Together, our data indicate that significant changes in the ratios of the two isoforms could be symptomatic of haematological cancers

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold &gt;75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold &lt;0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold &lt;1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill &amp; Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

The burden of injury in Central, Eastern, and Western European sub-region: a systematic analysis from the Global Burden of Disease 2019 Study.

Background Injury remains a major concern to public health in the European region. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) assess inequalities in injury mortality and DALY rates across the countries. Methods We performed a secondary database descriptive study using the GBD 2019 results on injuries in 44 European countries from 2000 to 2019. Inequality in DALY rates between these countries was assessed by calculating the DALY rate ratio between the highest-ranking country and lowest-ranking country in each year. Results In 2019, in Eastern Europe 80 [95% uncertainty interval (UI): 71 to 89] people per 100,000 died from injuries; twice as high compared to Central Europe (38 injury deaths per 100,000; 95% UI 34 to 42) and three times as high compared to Western Europe (27 injury deaths per 100,000; 95%UI 25 to 28). The injury DALY rates showed less pronounced differences between Eastern (5129 DALYs per 100,000; 95% UI: 4547 to 5864), Central (2940 DALYs per 100,000; 95% UI: 2452 to 3546) and Western Europe (1782 DALYs per 100,000; 95% UI: 1523 to 2115). Injury DALY rate was lowest in Italy (1489 DALYs per 100,000) and highest in Ukraine (5553 DALYs per 100,000). The difference in injury DALY rates by country was larger for males compared to females. The DALY rate ratio was highest in 2005, with DALY rate in the lowest-ranking country (Russian Federation) 6.0 times higher compared to the highest-ranking country (Malta). After 2005, the DALY rate ratio between the lowest- and the highest-ranking country gradually decreased to 3.7 in 2019. Conclusions Injury mortality and DALY rates were highest in Eastern Europe and lowest in Western Europe, although differences in injury DALY rates declined rapidly, particularly in the past decade. The injury DALY rate ratio of highest- and lowest-ranking country declined from 2005 onwards, indicating declining inequalities in injuries between European countries

Hearing loss prevalence and years lived with disability, 1990–2019: findings from the Global Burden of Disease Study 2019

Background: Hearing loss affects access to spoken language, which can affect cognition and development, and can negatively affect social wellbeing. We present updated estimates from the Global Burden of Disease (GBD) study on the prevalence of hearing loss in 2019, as well as the condition's associated disability. Methods: We did systematic reviews of population-representative surveys on hearing loss prevalence from 1990 to 2019. We fitted nested meta-regression models for severity-specific prevalence, accounting for hearing aid coverage, cause, and the presence of tinnitus. We also forecasted the prevalence of hearing loss until 2050. Findings: An estimated 1·57 billion (95% uncertainty interval 1·51–1·64) people globally had hearing loss in 2019, accounting for one in five people (20·3% [19·5–21·1]). Of these, 403·3 million (357·3–449·5) people had hearing loss that was moderate or higher in severity after adjusting for hearing aid use, and 430·4 million (381·7–479·6) without adjustment. The largest number of people with moderate-to-complete hearing loss resided in the Western Pacific region (127·1 million people [112·3–142·6]). Of all people with a hearing impairment, 62·1% (60·2–63·9) were older than 50 years. The Healthcare Access and Quality (HAQ) Index explained 65·8% of the variation in national age-standardised rates of years lived with disability, because countries with a low HAQ Index had higher rates of years lived with disability. By 2050, a projected 2·45 billion (2·35–2·56) people will have hearing loss, a 56·1% (47·3–65·2) increase from 2019, despite stable age-standardised prevalence. Interpretation: As populations age, the number of people with hearing loss will increase. Interventions such as childhood screening, hearing aids, effective management of otitis media and meningitis, and cochlear implants have the potential to ameliorate this burden. Because the burden of moderate-to-complete hearing loss is concentrated in countries with low health-care quality and access, stronger health-care provision mechanisms are needed to reduce the burden of unaddressed hearing loss in these settings