In vitro induction of hair follicle signatures using human dermal papilla cells encapsulated in fibrin microgels.

Cellular spheroids have been described as an appropriate culture system to restore human follicle dermal papilla cells (hFDPc) intrinsic properties; however, they show a low and variable efficiency to promote complete hair follicle formation in in vivo experiments. In this work, a conscientious analysis revealed a 25% cell viability in the surface of the dermal papilla spheroid (DPS) for all culture conditions, questioning whether it is an appropriate culture system for hFDPc. To overcome this problem, we propose the use of human blood plasma for the generation of fibrin microgels (FM) with encapsulated hFDPc to restore its inductive signature, either in the presence or in the absence of blood platelets. FM showed a morphology and extracellular matrix composition similar to the native dermal papilla, including Versican and Collagen IV and increasing cell viability up to 85%. While both systems induce epidermal invaginations expressing hair-specific keratins K14, K15, K71, and K75 in in vitro skin cultures, the number of generated structures increases from 17% to 49% when DPS and FM were used, respectively. These data show the potential of our experimental setting for in vitro hair follicle neogenesis with wild adult hFDPc using FM, being a crucial step in the pursuit of human hair follicle regeneration therapies.

Composting post-anaerobic digestion for emerging contaminant biodegradation: Impacts of operating conditions.

Sustainable manure management technologies are needed, and combining anaerobic digestion (AD) for energy generation and aerobic composting (AC) to stabilize digestate and remove emerging contaminants (ECs), including veterinary pharmaceuticals and steroid hormones, is promising. This study identified post-AD, AC operating conditions that maximized degradation of study ECs, expected to be present in cattle manure digested using treated municipal wastewater as the water source. Study ECs included sulfamethoxazole (SMX), chlortetracycline (CTC), oxytetracycline (OTC), estrone (E1), and naproxen (NPX). Composting conditions were simulated in bench-scale reactors, with microorganisms from digestate produced in an AD system (25L scale), by varying temperatures, pH, and carbon source compositions (representing food waste/manure co-digestion with different residence times). Results indicate maximum SMX biodegradation occurred at 35°C, pH 7, and with high levels of easily degradable carbon (≥99%, 99%, and 98%), and maximum E1 biodegradation occurred at 35°C, and with low levels of easily degradable carbon (≥97% and 99%). Abiotic degradation was responsible for the nearly complete removal of tetracyclines under all conditions and for partial degradation of NPX (between 20% and 48%). Microorganisms originating from the AD system putatively capable of SMX and E1 biodegradation, or of contributing to biodegradation during the AC phase, were identified, including phylotypes previously shown to biodegrade SMX (Brevundimonas and Alcaligenes).

The Influence of the Socioeconomic Status and the Density of the Population on the Outcome After Peripheral Artery Disease.

BACKGROUND: Low socioeconomic status (SES) and living in a rural environment are associated with poorer health and a higher number of amputations among the population at large. The purpose of this study is to determine the influence of low SES and of the degree of urbanization on the short-term and long-term results of patients after revascularization for peripheral artery disease. METHODS: An observational retrospective follow-up study of 770 patients operated on for peripheral artery disease at three university centers in north-western Spain from January 2015 to December 2016. The events studied were Rutherford classification of severity upon admission, direct amputation, amputations in the follow-up period, new revascularization procedures, major adverse cardiovascular events (MACE), and overall mortality. Mean personal income and income of the household associated with the street in which each patient lived and the degree of urbanization in three areas as per Eurostat criteria: densely populated areas, intermediate density areas, and thinly populated areas. Comorbidity, surgical, and follow-up variables were also collected. Descriptive analysis and Cox regression were used. Approval was obtained from the regional ethics committee. RESULTS: Median follow-up was 47.5 months. MACE occurred in 21.5% of the series and overall mortality was 47.0%. Living in a thinly populated area is associated with a lower risk of MACE (adjusted subhazard ratio = 0.60; 95% confidence interval [CI]: 0.39-0.91). Overall survival is lower in intermediate density area patients (adjusted Hazard Ratio = 1.46; 95% CI: 1.07-2.00). The third quartile of mean personal and household income is associated with a higher risk of major amputation at follow-up (adjusted Odds Ratio 1.92, 95% CI: 1.05-3.52 and adjusted Odds Ratio 1.93, 95% CI: 1.0.3-3.61, respectively). CONCLUSIONS: Patients who live in a densely populated area run a higher risk of MACE. SES is neither associated with worse outcomes after surgery nor with MACE in long-term follow-up.

Evaluation of different methodologies for primary human dermal fibroblast spheroid formation: automation through 3D bioprinting technology.

Cell spheroids have recently emerged as an effective tool to recapitulate native microenvironments of living organisms in anin vitroscenario, increasing the reliability of the results obtained and broadening their applications in regenerative medicine, cancer research, disease modeling and drug screening. In this study the generation of spheroids containing primary human dermal fibroblasts was approached using the two-widely employed methods: hanging-drop and U-shape low adhesion plate (LA-plate). Moreover, extrusion-based three-dimensional (3D) bioprinting was introduced to achieve a standardized and scalable production of cell spheroids, decreasing considerably the possibilities of human error. This was ensured when U-shape LA-plates were used, showing an 85% formation efficiency, increasing up to a 98% when it was automatized using the 3D bioprinting technologies. However, sedimentation effect within the cartridge led to a reduction of 20% in size of the spheroid during the printing process. Hyaluronic acid (HA) was chosen as viscosity enhancer to supplement the bioink and overcome cell sedimentation within the cartridge due to the high viability values exhibited by the cells-around 80%-at the used conditions. Finally, (ANCOVA) of spheroid size over time for different printing conditions stand out HA 0.4% (w/v) 60 kDa as the viscosity-improved bioink that exhibit the highest cell viability and spheroid formation percentages. Besides, not only did it ensure cell spheroid homogeneity over time, reducing cell sedimentation effects, but also wider spheroid diameters over time with less variability, outperforming significantly manual loading.

Modulation of Fecal Metabolites by Heat Stress and Diet, and Their Association with Inflammation and Leaky Gut Markers in Dairy Cows.

The analysis of fecal metabolite profiles could provide novel insights into the mechanisms underlying animal responses to environmental stressors and diet. We aimed to evaluate the effects of a 14-day heat stress period and of dietary mineral and vitamin supplementation under heat stress on fecal metabolite profiles and to investigate their associations with physiological markers of heat stress, leaky gut, and inflammation in lactating dairy cows. Twelve multiparous Holstein cows (42.2 ± 5.6 kg milk/d; 83.4 ± 27.1 DIM) were enrolled in an experiment in a split-plot design. The main plot was the level of dietary vitamin E and Se, as follows: (1) low (L-ESe; 20 IU/kg vitamin E, 0.3 ppm Se) or (2) high (H-ESe 200 IU/kg vitamin E, 1.2 ppm Se). Within each plot, six cows were randomly assigned to either (1) heat stress (HS; Total Humidity Index (THI): 82), (2) pair-feeding in thermoneutrality (TNPF; THI = 64), or (3) HS with vitamin D3 and Ca supplementation (HS+DCa; 1820 IU/kg and 1.5% Ca; THI: 82) in a replicated 3 × 3 Latin square design with 14-day periods and 7-day washouts. The concentrations of 94 metabolites were determined in fecal samples, including amino acids, fatty acids, biogenic amines, and vitamins. Relative to the L-ESe group, the H-ESe group increased α-tocopherol by threefold, whereas δ-tocopherol was decreased by 78% (PFDR < 0.01). Nevertheless, correlation analysis between α-tocopherol and all the others fecal metabolites or physiological heat stress measures did not show significant associations. No interactions between main plot and treatments were observed. Relative to TNPF, HS increased plasma tumor necrosis factor-alpha (TNF-α), plasma lipopolysaccharide-binding protein (LBP), milk somatic cell counts (SCC), respiratory rates, rectal temperatures, fecal tridecylic and myristic acids, vitamin B7, and retinol, whereas it decreased fecal amino acids such as histidine, methyl histidine, acetyl ornithine, and arginine (PFDR < 0.05). In contrast, HS+DCa increased fecal methyl histidine concentrations and reduced milk SCC, plasma TNF-α, and LBP, as well as rectal temperatures. Discriminant analysis revealed fecal histidine, taurine, acetyl ornithine, arginine, ß-alanine, ornithine, butyric + iso-butyric acid, plasma non-esterified fatty acids, TNF-α, LBP, C-reactive protein, and milk SCC were predictive of HS. Several metabolites were predictive of HS+DCa, although only tryptophan was discriminant relative to HS. In conclusion, both heat stress and the supplementation of vitamin D3 and Ca can influence the fecal metabolome of dairy cows experiencing heat stress, independently of dietary levels of vitamin E and Se. Our results suggest that some fecal metabolites are well associated with physiological measures of heat stress and may thus provide insights into the gut-level changes taking place under heat stress in dairy cows.

Modulation of Plasma and Milk Sphingolipids in Dairy Cows Fed High-Starch Diets.

Bovine milk is a significant source of sphingolipids, dietary compounds that can exert anti-inflammatory actions, and which can modulate the host's microbiome. Because sphingolipid synthesis can be modified by diet, we hypothesized that dietary conditions which reduced FFA availability may result in reduced sphingolipid synthesis. Twelve ruminally cannulated cows (120 ± 52 DIM; 35.5 ± 8.9 kg of milk/d; mean ± SD) were randomly assigned to treatment in a crossover design with 21-d periods. Treatments were (1) High starch (HS), (2) Control. The HS diet contained 29% starch, 24% NDF, and 2.8% fatty acids (FA), whereas the Control diet contained 20% starch, 31% NDF, and 2.3% FA. Plasma and milk samples were obtained on d 21 of each period and sphingolipids were quantified using targeted metabolomics. Univariate and multivariate analyses of generalized log-transformed and Pareto-scaled data included ANOVA (fixed effects of treatment) and discriminant analysis. The lipidomics analysis detected 71 sphingolipids across plasma and milk fat, including sphinganines (n = 3), dihydro-ceramides (n = 8), ceramides (Cer; n = 15), sphingomyelins (SM; n = 17), and glycosylated ceramides (n = 28). Followed by Cer, SM were the most abundant sphingolipids detected in milk and plasma, with a preponderance of 16:0-, 23:0-, and 24:0-carbon sidechains. Although no effects of HS diets were observed on plasma sphingolipids, we detected consistent reductions in the concentrations of several milk Cer (e.g., 22:0- and 24:0-Cer) and SM (17:0- and 23:0-SM) in response to HS. Discriminant analysis revealed distinct metabolite separation of HS and Control groups, with several Cer and SM being distinctively predictive of dietary treatment. We conclude that HS diets can reduce the secretion of milk Cer and SM, even in the absence of changes in circulating sphingolipids.

Effects of serine palmitoyltransferase inhibition by myriocin in ad libitum-fed and nutrient-restricted ewes.

The fungal isolate myriocin inhibits serine palmitoyltransferase and de novo ceramide synthesis in rodents; however, the effects of myriocin on ceramide concentrations and metabolism have not been previously investigated in ruminants. In our study, 12 non-lactating crossbred ewes received an intravenous bolus of myriocin (0, 0.1, 0.3, or 1.0 mg/kg/body weight [BW]; CON, LOW, MOD, or HIGH) every 48 h for 17 d. Ewes consumed a high-energy diet from day 1 to 14 and were nutrient-restricted (straw only) from day 15 to 17. Blood was collected preprandial and at 1, 6, and 12 h relative to bolus and nutrient restriction. Tissues were collected following euthanasia on day 17. Plasma was analyzed for free fatty acids (FFAs), glucose, and insulin. Plasma and tissue ceramides were quantified using mass spectrometry. HIGH selectively decreased metabolizable energy intake, BW, and plasma insulin, and increased plasma FFA (Dose, P < 0.05). Myriocin linearly decreased plasma very-long-chain (VLC) ceramide and dihydroceramide (DHCer) by day 13 (Linear, P < 0.05). During nutrient restriction, fold-change in FFA was lower with increasing dose (P < 0.05). Nutrient restriction increased plasma C16:0-Cer, an effect suppressed by MOD and HIGH (Dose × Time, P < 0.05). Myriocin linearly decreased most ceramide and DHCer species in the liver and omental and mesenteric adipose, VLC ceramide and DHCer in the pancreas, and C18:0-Cer in skeletal muscle and subcutaneous adipose tissue (Linear, P ≤ 0.05). We conclude that the intravenous delivery of 0.3 mg of myriocin/kg of BW/48 h decreases circulating and tissue ceramide without modifying energy intake in ruminants.

Characterization of the Plasma Lipidome in Dairy Cattle Transitioning from Gestation to Lactation: Identifying Novel Biomarkers of Metabolic Impairment.

The discovery of novel biomarkers for peripartal diseases in dairy cows can improve our understanding of normal and dysfunctional metabolism, and lead to nutritional interventions that improve health and milk production. Our objectives were to characterize the plasma lipidome and identify metabolites associated with common markers of metabolic disease in peripartal dairy cattle. Multiparous Holstein cows (n = 27) were enrolled 30 d prior to expected parturition. Blood and liver samples were routinely collected through to d 14 postpartum. Untargeted lipidomics was performed using quadrupole time-of-flight mass spectrometry. Based on postpartum measures, cows were categorized into low or high total fatty acid area under the curve (total FAAUC; d 1-14 postpartum; 4915 ± 1369 vs. 12,501 ± 2761 (µmol/L × 14 d); n = 18), ß-hydroxybutyrate AUC (BHBAAUC; d 1-14 postpartum; 4583 ± 459 vs. 7901 ± 1206 (µmol/L × 14 d); n = 18), or liver lipid content (d 5 and 14 postpartum; 5 ± 1 vs. 12 ± 2% of wet weight; n = 18). Cows displayed decreases in plasma triacylglycerols and monoalkyl-diacylglycerols, and the majority of phospholipids reached a nadir at parturition. Phosphatidylcholines (PC) 32:3, 35:5, and 37:5 were specific for high total FAAUC, PC 31:3, 32:3, 35:5, and 37:5 were specific for high BHBAAUC, and PC 31:2, 31:3, and 32:3 were specific for high liver lipid content. PC 32:3 was specific for elevated total FA, BHBA, and liver lipid content. Lipidomics revealed a dynamic peripartal lipidome remodeling, and lipid markers associated with elevated total FA, BHBA, and liver lipid content. The effectiveness of nutrition to impact these lipid biomarkers for preventing excess lipolysis and fatty liver warrants evaluation.

Treating Acute Leukemia During the COVID-19 Pandemic in an Environment With Limited Resources: A Multicenter Experience in Four Latin American Countries.

PURPOSE: The COVID-19 pandemic is a colossal challenge for global health; nonetheless, specific subgroups face considerably higher risks for infection and mortality. Among patients with malignant diseases, those with hematologic neoplasms are at a higher risk for poor outcomes. The objective of this study was to register treatment modifications associated with the COVID-19 pandemic and their short-term consequences in Latin America. METHODS: Multicenter, prospective, observational, cohort study including patients older than 14 years from 14 centers in four countries (Mexico, Peru, Guatemala, and Panama) who had a confirmed diagnosis of acute leukemia, and who were undergoing active treatment since the first COVID-19 case in each country until the cutoff on July 15, 2020. RESULTS: We recruited 635 patients. Treatment modifications because of the COVID-19 pandemic were reported in 40.8% of cases. The main reason for such modifications was logistic issues (55.0%) and the most frequent modification was chemotherapy delay (42.0%). A total of 13.1% patients developed COVID-19 disease, with a mortality of 37.7%. Several factors were identified as independently associated with mortality, including a diagnosis of acute myeloid leukemia (odds ratio 2.38 [95% CI, 1.47 to 3.84]; P < .001), while the use of telemedicine was identified as a protective factor (odds ratio 0.36 [95% CI, 0.18 to 0.82]; P = .014). CONCLUSION: These results highlight the collateral damage of COVID-19 in oncology patients.

Inoculum microbiome composition impacts fatty acid product profile from cellulosic feedstock.

Conversion of organic wastes to fatty acids rather than methane through anaerobic digestion-based technologies has considerable promise. However, the relationships between microbiome structure and fatty acids produced from cellulosic feedstocks are not well understood. This study investigated the nature of those relationships for anaerobic digester sludge, bison rumen, and cattle rumen inocula grown on cellulose. Acetic acid production was highest in anaerobic sludge reactors, while propionic acid production was highest in cattle rumen reactors. Butyric and pentanoic acid were produced at the highest rates in bison rumen before Day 5. Reactor microbiomes remained distinct, despite identical operating conditions. Novel associations linked Alistipes with butyric acid production and Eubacterium nodatum and Clostridiales bacterium with pentanoic acid production. This study provides new insights into the ability of microbiomes to convert cellulose to different fatty acid mixtures and adds impetus for the rewiring of anaerobic digestion to generate high-value products.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, diagnóstico y manejo de la infección por SARS-CoV-2/COVID-19 en paciente pediátrico con enfermedad renal crónica o lesión renal aguda asociada a COVID-19 / Colombian consensus of experts on evidence-informed recommendations for the prevention, diagnosis, and management of SARS-CoV-2 / COVID-19 infection in pediatric patients with chronic kidney disease or acute kidney injury associated with COVID-19

resumen está disponible en el texto completo

Abstract Introduction: The numbers of SARS-CoV-2 infection in the pediatric population are low so far. There is limited information about the behavior of SARS-CoV-2 in a pediatric patient with chronic kidney disease. Objective: To formulate informed recommendations to the prevention, diagnosis, and management of SARS-CoV-2 infection in pediatric patients with kidney disease or acute kidney injury associated with COVID-19 in Colombia. Methodology: A rapid systematic review was performed in Embase and Pubmed databases and scientific societies, to answer questions prioritized by clinical experts in pediatric nephrology. The quality of the evidence was evaluated with validated tools according to the type of study. The preliminary recommendations were consulted by an expert group. The agreement was defined when approval was obtained from at least 70% of the experts consulted. Results: A response was obtained from ' 9 experts in pediatric nephrology in Colombia, who declared the conflict of interest before the consultation. The range of agreement for the recommendations ranged from 78.9% to '00%. The recommendations did not require a second consultation. Conclusion: The evidence-based recommendations for the management of a patient with kidney disease and COVID-19 in the Colombian context are presented.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, el diagnóstico y el manejo de la lesión renal aguda por SARS-CoV-2/COVID-19 / Colombian consensus of experts on recommendations informed in the evidence for the prevention, diagnosis and management of acute kidney injury by SARS-CoV-2/COVID-19

resumen está disponible en el texto completo

Abstract Introduction: Acute kidney injury is a frequent complication in patients with COVID-19 and its occurrence is a potential indicator of multi-organ dysfunction and disease severity. Objective: Develop, through an expert consensus, evidence-based recommendations for the prevention, diagnosis, and management of acute kidney injury in patients with SARS CoV2 / COVID-19 infection. Materials and methods: Based on a rapid systematic review in Embase and Pubmed databases and documents from scientific societies, we made preliminary recommendations and consulted with an expert group through an online tool. Then we defined agreement after at least 70 % consensus approval. Quality evidence was evaluated according to the type of document included. The strength of the recommendations was graded as strong or weak. Results: Fifty clinical experts declared their conflict of interest; the consultation took place between May 2 and 29, 2020. The range of agreement ranged from 75.5 % to 100 %. Recommendations for prevention, diagnosis and management of acute kidney injury in patients with SARS CoV2 infection are presented. Conclusions: Although the good quality information available regarding acute kidney injury in patients with COVID-19 is scarce, the recommendations of clinical experts will guide clinical decision-making and strategies around patients with this complication, guaranteeing care focused on the people, with high quality standards, and the generation of safety, health and wellness policies for multidisciplinary care teams.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, el diagnóstico y el manejo de la infección por SARS-CoV-2/COVID-19 en pacientes con Enfermedad Renal Crónica en diálisis / Colombian Expert Consensus on Evidence-Informed Recommendations for the Prevention, Diagnosis, and Management of SARS-CoV-2 / COVID-19 Infection in Patients with Chronic Kidney Disease on Dialysis

Resumen Introducción: Las personas con diálisis de mantenimiento se consideran una población en alto riesgo de infección por SARS-CoV-2, complicaciones y muerte. La periodicidad de la diálisis, la organización y la demanda en las unidades de diálisis y las limitaciones de alfabetización en salud poblacional limitan el cumplimiento del aislamiento y el distanciamiento social. Objetivo: Desarrollar, mediante un consenso de expertos, recomendaciones informadas en evidencia para la prevención, el diagnóstico y el manejo de la infección por SARS-CoV-2/COVID-19 en pacientes con enfermedad renal crónica. Materiales y métodos: Se realizó una revisión rápida de literatura en Pubmed, Embase y sociedades científicas. La calidad de evidencia fue evaluada según el tipo de estudio incluido. El acuerdo se definió para cada recomendación con umbral de al menos 70% de aprobación. La fuerza de las recomendaciones fue graduada como fuerte o débil. Resultados: El colectivo fue consultado entre el 17 y 19 de mayo de 2020. Se obtuvo respuesta de 44 expertos clínicos que declararon conflicto de interés previo a la consulta. El acuerdo de las recomendaciones estuvo entre 70,5 y 100%. Se presentan las recomendaciones de un colectivo experto para la prevención, el diagnóstico y el manejo de infección por SARS-CoV-2/COVID-19 en pacientes con enfermedad renal crónica. Conclusión: Debido a la reciente aparición de la infección por SARS-CoV-2 y las incertidumbres respecto a la prevención, el diagnóstico y el manejo, las recomendaciones presentadas se conciben como un estándar colombiano que permita garantizar un cuidado centrado en las personas con enfermedad renal crónica y la protección de los profesionales de la salud.

Abstract Introduction: People with chronic dialysis are considered a population at high risk of SARS CoV2 infection and its derived complications and death. The need to go to strict dialysis schedules, the high demand in the kidney facilities and the difficulties derived from the time and space organization in the rooms in the face to the pandemic added to the difficult learning, teaching and adapting new protocols manifest the needed of standard recommendation according to this problem in people who couldn't have an ideal isolation. Objective: Develop through an expert consensus, evidence-informed recommendations for the prevention, diagnosis, and management of SARS-CoV-2/COVID-19 infection in patients with chronic kidney disease on Dialysis. Materials and methods: We carried out a quick literature review, PubMed, Embase and scientific societies were consulted. The quality of the evidence was considered according to the type of study included. The agreement threshold defined for each recommendation was > 70% approval among experts. The strength of the recommendations was rated as strong or weak. Results: Between May 17 and 19, 2020, was conformed a team of 44 clinical experts who declared their interest conflict prior to the consultation. The agreement of the recommendations was between 70.5% and 100%. The recommendations were separated in prevention, early identification, and diagnostic, isolation in hemodialysis facilities and peritoneal dialysis, and team protection. Ethical considerations also were included. Conclusion: Due to the recent appearance of SARS-CoV-2 infection and the uncertainties regarding prevention, diagnosis and management, the recommendations presented are conceived as a Colombian standard that allows guaranteeing focused care for people with chronic kidney disease and the protection of health team.

Plasma Ceramides and Triglycerides Are Elevated during Pregnancy in Association with Markers of Insulin Resistance in Hutterite Women.

Changes in maternal insulin sensitivity and circulating lipids typically occur during the metabolic transitions of pregnancy and lactation. Although ceramides can cause insulin resistance in mammals, their potential roles during pregnancy and lactation are unknown. We hypothesized that changes in lipids like ceramide and triglycerides could occur across different reproductive states and relate to insulin resistance. Our objectives were to comprehensively characterize lipids in the plasma of pregnant, lactating, and nonpregnant and nonlactating (NPNL) women, and to evaluate the relationship between ceramides and the triglyceride index, a proxy of insulin resistance. Middle-aged Hutterite women from the South Dakota Rural Bone Health Study were classified by reproductive status as nonpregnant and nonlactating (NPNL; 19 observations), pregnant (14 observations), or lactating (31 observations). Several plasma lipids were elevated in pregnancy such as ceramides, triglycerides, and total- and high-density lipoprotein cholesterol. The triglyceride index was highest during pregnancy and was positively associated with long- and very long-chain ceramides. Lipidomics revealed lipid signatures specific to reproductive state, including triglycerides, phosphatidylcholines, sphingomyelins, and cholesteryl esters, which were also related to the triglyceride index. Our data support the possibility that ceramides contribute to the development of insulin resistance during pregnancy, and reveal distinct lipid signatures associated with pregnancy and lactation.

Effect of antiplatelet therapy on aneurysmal sac expansion associated with type II endoleaks after endovascular aneurysm repair.

OBJECTIVE: Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) has gained widespread use through a solid reputation of safety and effectiveness. However, some issues, such as endoleaks and sac growth over time, still arise as important concerns. Antiplatelet therapy, mandatory as secondary prevention of cardiovascular disease, may play a role in both phenomena by interfering with blood clotting properties and the inflammatory process associated with AAA. We analyzed whether different antiplatelet therapies were independent risk factors for type II endoleak (T2E) persistence and midterm sac growth after EVAR. METHODS: All patients with T2E detected in the first post-EVAR control were included, except those without at least 1 year of complete follow-up. Data for demographics, clinical comorbidities, EVAR devices, and antiplatelet therapies were recorded. All patients underwent routine follow-up with contrast-enhanced tomography at 1 month, 6 months, 12 months, and annually thereafter. A three-dimensional rendering of each endoleak was performed for detailed volumetry. Main outcomes were endoleak persistence at 6 months and sac growth >5 mm at end of follow-up. RESULTS: During a 9-year period, 87 patients with initial T2E were monitored for a mean of 41.5 months. On discharge, salicylates were prescribed to 50, clopidogrel to 16, and multiagent therapy or anticoagulation to 9; no therapy was given to 12. No significant differences in comorbidities or baseline AAA characteristics were found between groups. At 6 months thereafter, 59% (n = 51) of the initial T2Es persisted. At end of follow-up, 32 patients had sac growth >5 mm (37%). Sac growth was significantly less frequent in the group treated with salicylates (26% vs 60%; P = .004). Cox proportional hazards model reinforced the role of salicylates as protectors for sac growth over time (hazard ratio, 0.34; 95% confidence interval, 0.13-0.87; P = .024), whereas T2E nidus volume and endoleak complexity behaved like independent risk factors. CONCLUSIONS: Antiplatelet therapy with salicylates appears to be linked to a decreased risk of sac growth >5 mm over time in patients with T2Es detected right after EVAR. Population-based cohort studies are mandatory to confirm this finding and to guide a potential recommendation.

Endograft limb trimming and resheathing can be an alternative for emergent aortic repair without adequate stent graft availability.

Endograft limb trimming can be an easy customization to perform in some emergent setups and when alternative adequate covered stents are lacking. A man aged 74 years presented with aortoenteric fistula and hemodynamic instability years after an aortobifemoral bypass, and a 56-year-old woman was admitted with acute ischemia due to an aortic ulcer-like lesion. In both cases, tabletop deployment and removal of two stents from an Endurant iliac limb (Medtronic, Fridley, Minn), followed by resheathing and deployment, allowed successful repair as a bridging therapy for open surgery. Both patients are alive and without walking impairment 8 and 6 months later, respectively.

Aneurisma micótico de aorta abdominal por Campylobacter fetus / Mycotic aneurysm of the abdominal aorta caused by Campylobacter fetus

No disponible