Aortobifemoral graft infection: possibilities of treatment

ПРОТЕЗОМ ОБУСЛОВЛЕННЫЕ ИНФЕКЦИИАОРТОБИФЕМОРАЛЬНЫЕ ПРОТЕЗЫРЕВАСКУЛЯРИЗАЦИЯЭКСТРААНАТОМИЧЕСКОЕ ШУНТИРОВАНИЕВ статье описываются два клинических случая оказания помощи пациентам с инфицированными аортобифеморальными протезами. В обоих случаях протез был удален. В первом случае было принято решение сделать экстраанатомическую реваскуляризацию нижних конечностей после полного удаления протеза из-за вирулентной инфекции (Staphylococcus aureus и Гр+ бактерии) и протезо-энтеральной фистулы. Было выполнено аксило-бифеморальное шунтирование. Во втором случае, когда инфекция была не столь вирулентной (Staphylococcus epidermidis), было принято решение провести эндартерэктомию аорты и подвздошных артерий, а также для реконструкции использовали бедренную вену. Оперативные вмешательства прошли успешно. У обоих пациентов в настоящее время нет признаков инфекции и перемежающейся хромоты. Инфекция протеза является одним из наиболее серьезных осложнений аортобифеморального шунтирования, поэтому профилактика инфекции очень важна. Важно соблюдать все правила асептики и антисептики во время операции. Лечение инфекции протеза основано на внутривенном введении антибиотиков и удалении инфицированного синтетического материала. Реваскуляризация конечностей после удаления протеза может быть обеспечена путем экстраанатомического шунтирования или артериальной реконструкции "in situ".Authors describe two case reports of patients with infected aortobifemoral graft. Both were treated by total graft excision. In the first case they decided for extra anatomical revascularization of lower extremities after total graft excision, because of virulent infection (Staphylococcus aureus and G+ bacteries) and graft enteral fistula. They performed axilobifemoral bypass grafting. In the second case, where infection was not so virulent (Staphylococcus epidermidis) they decided for in situ reconstruction with desobliterated native aorta, iliac arteries and femoral vein. Both patients are now without signs of infection and they can walk without claudication pain. Graft infection is one of the most serious complications of aortobifemoral bypass surgery therefore the prevention of infection is very important. It is important to keep all rules of asepsis and antisepsis during surgery. Treatment of graft infection is based on intravenously administered antibiotics and excision of infected graft. Limb revascularization after graft removal can be provided by extra anatomical bypass or in situ arterial reconstruction

Non-Cholesterol Sterol Levels Predict Hyperglycemia and Conversion to Type 2 Diabetes in Finnish Men

Peer reviewe

Pleiotropy Analysis of Quantitative Traits at Gene Level by Multivariate Functional Linear Models

In genetics, pleiotropy describes the genetic effect of a single gene on multiple phenotypic traits. A common approach is to analyze the phenotypic traits separately using univariate analyses and combine the test results through multiple comparisons. This approach may lead to low power. Multivariate functional linear models are developed to connect genetic variant data to multiple quantitative traits adjusting for covariates for a unified analysis. Three types of approximate F‐distribution tests based on Pillai–Bartlett trace, Hotelling–Lawley trace, and Wilks's Lambda are introduced to test for association between multiple quantitative traits and multiple genetic variants in one genetic region. The approximate F‐distribution tests provide much more significant results than those of F‐tests of univariate analysis and optimal sequence kernel association test (SKAT‐O). Extensive simulations were performed to evaluate the false positive rates and power performance of the proposed models and tests. We show that the approximate F‐distribution tests control the type I error rates very well. Overall, simultaneous analysis of multiple traits can increase power performance compared to an individual test of each trait. The proposed methods were applied to analyze (1) four lipid traits in eight European cohorts, and (2) three biochemical traits in the Trinity Students Study. The approximate F‐distribution tests provide much more significant results than those of F‐tests of univariate analysis and SKAT‐O for the three biochemical traits. The approximate F‐distribution tests of the proposed functional linear models are more sensitive than those of the traditional multivariate linear models that in turn are more sensitive than SKAT‐O in the univariate case. The analysis of the four lipid traits and the three biochemical traits detects more association than SKAT‐O in the univariate case.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111259/1/gepi21895.pd

Cellular characterisation of the GCKR P446L variant associated with type 2 diabetes risk

Aims/hypothesis Translation of genetic association signals into molecular mechanisms for diabetes has been slow. The glucokinase regulatory protein (GKRP; gene symbol GCKR) P446L variant, associated with inverse modulation of glucose- and lipid-related traits, has been shown to alter the kinetics of glucokinase (GCK) inhibition. As GCK inhibition is associated with nuclear sequestration, we aimed to determine whether this variant also alters the direct interaction between GKRP and GCK and their intracellular localisation. Methods Fluorescently tagged rat and human wild-type (WT)- or P446L-GCKR and GCK were transiently transfected into HeLa cells and mouse primary hepatocytes. Whole-cell and nuclear fluorescence was quantified in individual cells exposed to low- or high-glucose conditions (5.5 or 25 mmol/l glucose, respectively). Interaction between GCK and GKRP was measured by sensitised emission-based fluorescence resonance energy transfer (FRET) efficiency