PLoS One

Quantitative analysis of the vascular network anatomy is critical for the understanding of the vasculature structure and function. In this study, we have combined microcomputed tomography (microCT) and computational analysis to provide quantitative three-dimensional geometrical and topological characterization of the normal kidney vasculature, and to investigate how 2 core genes of the Wnt/planar cell polarity, Frizzled4 and Frizzled6, affect vascular network morphogenesis. Experiments were performed on frizzled4 (Fzd4-/-) and frizzled6 (Fzd6-/-) deleted mice and littermate controls (WT) perfused with a contrast medium after euthanasia and exsanguination. The kidneys were scanned with a high-resolution (16 μm) microCT imaging system, followed by 3D reconstruction of the arterial vasculature. Computational treatment includes decomposition of 3D networks based on Diameter-Defined Strahler Order (DDSO). We have calculated quantitative (i) Global scale parameters, such as the volume of the vasculature and its fractal dimension (ii) Structural parameters depending on the DDSO hierarchical levels such as hierarchical ordering, diameter, length and branching angles of the vessel segments, and (iii) Functional parameters such as estimated resistance to blood flow alongside the vascular tree and average density of terminal arterioles. In normal kidneys, fractal dimension was 2.07±0.11 (n = 7), and was significantly lower in Fzd4-/- (1.71±0.04; n = 4), and Fzd6-/- (1.54±0.09; n = 3) kidneys. The DDSO number was 5 in WT and Fzd4-/-, and only 4 in Fzd6-/-. Scaling characteristics such as diameter and length of vessel segments were altered in mutants, whereas bifurcation angles were not different from WT. Fzd4 and Fzd6 deletion increased vessel resistance, calculated using the Hagen-Poiseuille equation, for each DDSO, and decreased the density and the homogeneity of the distal vessel segments. Our results show that our methodology is suitable for 3D quantitative characterization of vascular networks, and that Fzd4 and Fzd6 genes have a deep patterning effect on arterial vessel morphogenesis that may determine its functional efficiency

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Mise au point sur la cardioplégie (une étude monocentrique comparant trois stratégies de cardioplégie)

Le chirurgien cardiaque est capable d'obtenir un arrêt électromécanique du coeur, d'ouvrir les cavités cardiaques, grâce à la perfusion d'une solution de cardioplégie. Si cette cardioprotection est la plus utilisée au bloc opératoire, elle peut être pourvoyeuse de lourdes conséquences, notamment par le déclenchement d'un syndrome d'ischémie-reperfusion. Quel paradoxe pour un chirurgien cardiaque de provoquer, tout en voulant protéger le coeur qu'il opère, des lésions parfois plus graves que son geste lui-même. Le but de notre travail, a été d'évaluer en 2010, les tactiques et techniques qui sont à disposition du chirurgien pour protéger de manière optimale le coeur opéré. En s'appuyant sur une revue de la littérature, nous décortiquons les bases fondamentales du métabolisme énergétique des cardiomyocytes, ainsi que les conséquences hysiopathologiques du syndrome d'ischémie-reperfusion afin de pouvoir interpréter ce que doit être une cardioplégie efficace. Dans le but d'améliorer nos pratiques, nous comparons, chez 705 patients opérés de pontages, 3 types de cardioplégies différentes (cristalloide froide Celsior®, sanguine hypothermique et sanguine normothermique) et évaluons les complications post-opératoires. Nos résultats ne montrent pas de différence significative sur les critères de décès, d'infarctus ou de taux de marqueurs d'ischémie myocardique. Nous retrouvons un délai d'extubation et un séjour en réanimation plus long, ainsi qu'une prescription de drogues tonicardiaques plus élevée dans le groupe Celsior®. S'il est complexe de pouvoir conclure sur le type optimal de cardioplégie, nous retrouvons dans nos pratiques des résultats similaires à ceux publiés dans la littérature.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Left ventricle reconstruction and heartmate3 implantation. The "double patch technique".

HeartMate 3 is a left ventricular assist device, composed of a centrifugal pump. It can be applied as a myocardial recovery, a bridge to transplant, or a destination therapy, in the treatment of patients with left ventricular heart failure. Herein we describe a technique applied against a giant aneurysmal dilatation, which combines a surgical device implantation and a left ventricular reconstruction using a double patch. The patch minimizes thrombotic risk thanks to its internal bovine pericardium layer, which is in contact with blood. The outlined technique is relatively reproducible and safe in a selected group of patients, as it employs a high-quality device and enables the restoration of an appropriate ventricular geometry

Rapid-deployment aortic valve replacement in high-risk patients with severe endocarditis.

Surgical management of aortic valve endocarditis in high risk patients is controversial and the ideal treatment has not been found yet. We describe a selected series of eight patients treated with rapid-deployment aortic valve prosthesis as a therapeutic solution for minimizing the risks associated with annulus manipulation in case of severe aortic infective endocarditis. Eight consecutive patients (five men and three women) with a mean age of 74.3 ± 7.2 years, mean logistic EuroSCORE II of 16.0 % ± 0.1 %, affected by aortic native (1 patient) , or prosthetic valve endocarditis (7 patients) , were treated with Edwards Intuity Elite implantation. Hemodynamic performance and infective data were collected pre-, intra-, and postoperatively with a mean follow-up of 2.7 ± 0.7 years. One case of in-hospital mortality was noted. None of the patients had any embolic or infective complication postoperatively. The cardiopulmonary bypass and aortic cross-clamp times were 148.4 ± 41.6 and 90.5 ± 25.3 min, respectively. The postoperative echocardiographic controls indicated a mean transvalvular gradient of 16.7 ± 3.0 mmHg and one case of paravalvular leaks (2 +). Two patients underwent epigastric permanent pacemaker implantation. During the follow- up, seven patients were alive, with no evidence of symptoms or recurrences of endocarditis or embolic episodes. No new paravalvular leaks were noted, and the mean gradient on the valves was 12.4 ± 3.4 mmHg. Rapid deployment aortic valve replacement in selected very high-risk patients affected by infective endocarditis could be a reasonable choice with acceptable results. However, further studies are needed to confirm these results

Unilateral versus bilateral cerebral perfusion during aortic surgery for acute type A aortic dissection: a multicentre study

The aim of this retrospective multicentre study was to investigate and compare clinical outcomes of unilateral and bilateral antegrade cerebral perfusion (ACP) strategies on cerebral protection during surgery for type A aortic dissection

Diameter and length distribution.

<p>A, B, C. Log-log plots of absolute (A) and relative (B) diameter distributions, and the average diameters in individual Strahler Orders (DDSO) (C). D, E, F. Log-log plots of absolute (D) and relative (E) vessel segment length distribution and average vessel segment lengths of individual Strahler Orders (F) for WT (black), <i>Fzd4</i>^-/-(blue) and <i>Fzd6</i>^-/-(red) phenotypes. Error bars stand for the SD.</p

Morphofunctional characteristics of vascular networks.

<p>Number of vessel segments (A), estimation of vessel resistance <i>R</i>_DDSO (B), shortest distance between terminal elements (C) and its frequency distribution (D) for the three sub-populations. In the box chart diagrams (C) the boxes determinate the interval within the 25th and 75th percentiles and whiskers denote the interval within the 5th and 95th percentiles, lines within the boxes indicate the medians, and the small squares stand for the average value. Black: WT, blue: <i>Fzd4</i>^-/-, red: <i>Fzd6</i>^-/-. The error bars in panels A and B stand for the SD.</p

Schematic representation of vessel network extraction and classification algorithm.

<p>A: 2D example of an artificial unprocessed vascular segment. Color intensity signifies the HU value of a given voxel. B: Binary image of the vessel after thresholding. Black voxels are foreground voxels, while white voxels characterize the background. C: The application of a morphological closing operator to the binary image. D: Skeletonization of the processed binary image. The skeleton is represented with a thin dotted line. E: Extracted individual centerline points as nodes of a disconnected network. F: Establishing connections between suitable nearest neighbors. G: Connecting close enough nodes with degrees 0 and 1 (red lines, colored segments characterize individual sub-networks). H: Establishing connections between unconnected sub-networks. Light gray nodes and edges signify removed components. I: An illustration of the Strahler classification scheme. The gray nodes have not yet prescribed SO values, whereas other colors of nodes correspond to the SO as given by the color-bar on the right.</p