Arterial injuries following central venous catheterization (CVC) range between 0.1%-2.7%. The open surgical approach could be related to increased rates of morbidity and mortality. Vascular closure ...devices (VCD) are often used for the management of these patients with a success rate of up to 80%.
Describe our experience in managing arterial vascular injuries following central venous catheterization with Perclose ProGlide (Abbott Vascular IncSanta Clara, CA, USA).
A retrospective review of all patients over 18 years old who underwent percutaneous closure of arterial injuries following central venous catheterization in our center between January 2018 and May 2023 was included and reported with a 90-day follow-up.
3 Patients were included, in all cases, access to the CVC were right with a subclavian artery injury. Ultrasound and fluoroscopy guide was used in all cases. For the 3 cases, a percutaneous technique using Perclose ProGlide (Abbott Vascular IncSanta Clara, CA, USA) was performed. With a 100% success rate, and no complications evidenced after 90 days of follow-up.
Inadvertent arterial catheterization it's a non-negligible complication after CVC placement. VCD could be considered a safe and feasible approach for the management of these traumatic injuries.
Liver transplantation is the best treatment option for patients with end-stage liver disease of any etiology. The success of the clinical intervention depends on the proper selection of the donor and ...the recipient. Biopsychosocial determinants influence the rate of post-transplant complications and mortality. This study aimed to identify interventions and clinical outcomes in patients excluded from pre-liver transplant evaluation with a clinical indication for liver transplantation between January 2019 and December 2021 in a single-center experience in Bogotá.
A cross-sectional study of patients >18 years old with a clinical indication for liver transplantation that was not suitable during the social work and psychology assessment for pre-liver transplant evaluation between January 2019 to December 2021.
Between January 2019 to December 2022, 565 patients were considered candidates for pre-liver transplant evaluation. Of these, 122 patients were included in our study because they were excluded from evaluation by psychology and social work. 58.2% (n=71) were men, 77% (n=94) belonged to the private health system, 38.5% (n=47) had a primary education level, 34.4% (n=42) were unemployed, and the median monthly income was $250 USD (IQR 200 - 487 USD). 32.5% (n=37) become included in the pre-liver transplant study after some intervention. The activation of the extended family network showed a statistically significant difference in its frequency between the groups included and those not included in the pre-transplant study (p=0.011).
Interventions by the multidisciplinary liver transplantation support group allow access to pre-transplant evaluation, admission to the waiting list and transplantation to patients initially excluded for different reasons that can be modified with these tools.
Hepatocellular carcinoma (HCC) is the sixth most frequent type of cancer and the fourth cause of death related to cancer worldwide. Remarkably, HCC is the most common type of liver cancer. According ...to the International Agency for Research on Cancer (IARC), the incidence of liver cancer in Colombia was 2%, with a 4% mortality in 2020. This study aimed to describe the clinical characteristics of patients with HCC at a liver transplant center in Colombia in the period 2015 to 2020.
Descriptive study of consecutive patients with HCC. We developed an HCC registry from our outpatient Clinic in which we reported clinical status, imaging, and therapeutic management. The continuous variables were described as the mean and standard deviation, and nominal variables were evaluated based on frequencies and percentages. All analyses were done in Statistical Package for the Social Sciences (SPPS) v. 21.0.
In total, 131 HCC patients were included, 76 men and 37 women, with an average age of 65 years. Of these patients, 40% were classified as CHILD PUGH (CP) - A, 42% were CP-B and in less proportion, 16.7% were CP-C. The etiology of the cirrhosis was diverse; most cases had a history of alcoholism (34%) and a past medical history of B and C viral infection (23.6%). The radiological characteristics of patients with HCC are shown in table 1. Therapeutic interventions assessed were radiofrequency ablation (ARF 61.6%), microwave ablation (AMO, 7.53%), transarterial chemoembolization (TACE, 30.8%) and liver transplant after ablative treatment (20.5%). Different outcomes analyzed were complete responses for ARF (52.2%), AMO (72.7%) and TACE (4.4%).
In our historical cohort, liver function allowed the achievement of curative therapeutic interventions (ARF/AMO) with a complete response in more than 50% of patients intervened and 20% of patients taken for a liver transplant. Our results highlight the importance of premature detection of high-risk patients and early therapeutic interventions in this population of patients.
Penetrating aortic injuries are infrequent. Its incidence is unknown because most patients die of hemorrhage even before they receive adequate treatment. Aortic wounds generally require conventional ...thoracotomy/laparotomy repair and are related to high mortality rates. Recently with the advent of endovascular techniques, most authors prefer endovascular management when feasible due to better (still poor) outcomes. The short- and mid-term results of immediate endovascular repair of traumatic aortic injuries are promising, especially when compared with open surgical treatment, indicating that endovascular therapy is preferable in patients with multi-trauma and traumatic ruptures of the thoracic aorta. Here we present the diagnosis and treatment of a 30 years-old male patient with multiple traumatic stab wounds, including anterior aortic laceration with a grade II aortic lesion successfully managed with an endovascular stent graft.
Aβ (amyloid β) immunotherapy has been revealed as a possible tool in Alzheimer's disease treatment. In contrast with complete antibodies, the administration of scFvs (single-chain variable fragments) ...produces neither meningoencephalitis nor cerebral haemorrhage. In the present study, the recombinant expression of scFv-h3D6, a derivative of an antibody specific for Aβ oligomers, is presented, as well as the subsequent proof of its capability to recover the toxicity induced by the Aβ1-42 peptide in the SH-SY5Y neuroblastoma cell line. To gain insight into the conformational changes underlying the prevention of Aβ toxicity by this antibody fragment, the conformational landscape of scFv-h3D6 upon temperature perturbation is also described. Heating the native state does not lead to any extent of unfolding, but rather directly to a β-rich intermediate state which initiates an aggregation pathway. This aggregation pathway is not an amyloid fibril pathway, as is that followed by the Aβ peptide, but rather a worm-like fibril pathway which, noticeably, turns out to be non-toxic. On the other hand, this pathway is thermodynamically and kinetically favoured when the scFv-h3D6 and Aβ1-42 oligomers form a complex in native conditions, explaining how the scFv-h3D6 withdraws Aβ1-42 oligomers from the amyloid pathway. To our knowledge, this is the first description of a conformational mechanism by which a scFv prevents Aβ-oligomer cytotoxicity.
The single-chain variable fragment, scFv-h3D6, has been shown to prevent in vitro toxicity induced by the amyloid β (Aβ) peptide in neuroblastoma cell cultures by withdrawing Aβ oligomers from the ...amyloid pathway. Present study examined the in vivo effects of scFv-h3D6 in the triple-transgenic 3xTg-AD mouse model of Alzheimer disease. Prior to the treatment, five-month-old female animals, corresponding to early stages of the disease, showed the first behavioral and psychological symptoms of dementia -like behaviors. Cognitive deficits included long- and short-term learning and memory deficits and high swimming navigation speed. After a single intraperitoneal dose of scFv-h3D6, the swimming speed was reversed to normal levels and the learning and memory deficits were ameliorated. Brain tissues of these animals revealed a global decrease of Aβ oligomers in the cortex and olfactory bulb after treatment, but this was not seen in the hippocampus and cerebellum. In the untreated 3xTg-AD animals, we observed an increase of both apoJ and apoE concentrations in the cortex, as well as an increase of apoE in the hippocampus. Treatment significantly recovered the non-pathological levels of these apolipoproteins. Our results suggest that the benefit of scFv-h3D6 occurs at both behavioral and molecular levels.
On January 30th of 2020, the WHO declared the COVID-19 outbreak a health emergency. In Colombia the first case was reported on March 6th of 2020. The disease has unfavorable outcomes and mortality in ...patients with high risk factors like solid-organ transplant recipients. In Colombia the data of the behavior disease in liver transplant patients are limited.
To describe the prevalence, need of admission to hospital, complications and mortality of COVID-19 in liver transplant recipients.
A descriptive study of case series was performed from March 1st of 2020 to January 31st of 2021 in liver transplant recipients at Fundación Cardioinfantil-IC in Bogotá, Colombia. An analysis of clinical variables, severity laboratories, imaging and clinical follow-up were performed. Qualitative variables were described in percentage and quantitative variables were applied to a normality test using Kolmogorov Smirnov and Shapiro Wilk and the results were expressed as medians and IRQ or means and SD.
Out of 540 adults liver transplant recipients on Fundación Cardioinfantil-IC, 34 patients (6.2%) were diagnosed with Covid 19, median age 62 years (IQR: 26), 20 (58%) male, 13 (38.2%) were admitted to hospitalization, and 4 (11.7%) required ICU. More frequent symptoms were fever in 17/34 patients (50%), cough in 17/34 (50%) and dyspnea 10/34 (29.4%). Ten patients (29.4%) had pneumonia as radiographic findings. Four patients required mechanical ventilation. Complications like acute renal injury were found in 3 patients, 1 patient required renal replacement therapy and 1 patient had gastrointestinal bleeding. 3 patients died (8.8%) on average 14 days of hospital length in ICU.
Although the group of liver transplant patients is considered to be at high risk for unfavorable outcomes in SARS COV2 infection, the data on mortality and complications were similar to the few data described in the literature.
The therapeutic potential of scFv-h3D6 has recently been shown in the 3xTg-AD mice. A clear effect on amyloid β (Aβ) oligomers and certain apolipoproteins in the brain was found, but no effect was ...seen in the cerebellum. Here, cellular vulnerability of the 3xTg-AD cerebellum is described for the first time, together with its protection by scFv-h3D6. Neuron depletion in the DCN was regionally variable and followed a mediolateral axis of involvement that was greatest in the fastigial nucleus, lesser in the interpositus and negligible in the dentate nucleus. A sole and low intraperitoneal dose of scFv-h3D6 protected 3xTg-AD DCN neurons from death. Further studies might provide interesting information about both the potential of scFv-h3D6 as a therapeutic agent and the role of the cerebellum in AD.
FadD is an acyl-coenzyme A (CoA) synthetase specific for long-chain fatty acids (LCFA). Strains mutated in fadD cannot produce acyl-CoA and thus cannot grow on exogenous LCFA as the sole carbon ...source. Mutants in the fadD (smc02162) of Sinorhizobium meliloti are unable to grow on oleate as the sole carbon source and present an increased surface motility and accumulation of free fatty acids at the entry of the stationary phase of growth. In this study, we found that constitutive expression of the closest FadD homologues of S. meliloti, encoded by sma0150 and smb20650, could not revert any of the mutant phenotypes. In contrast, the expression of Escherichia coli fadD could restore the same functions as S. meliloti fadD. Previously, we demonstrated that FadD is required for the degradation of endogenous fatty acids released from membrane lipids. Here, we show that absence of a functional fadD provokes a significant loss of viability in cultures of E. coli and of S. meliloti in the stationary phase, demonstrating a crucial role of fatty acid degradation in survival capacity.
El síndrome hepatorrenal es una disfunción renal que ocurre en pacientes con enfermedad hepática crónica como cirrosis hepática o enfermedad hepática aguda, caracterizada por la activación de ...mecanismos reguladores que conducen a disminución de la tasa de filtrado glomerular. Clínicamente el síndrome hepatorrenal se divide en dos tipos, el tipo 1 y el tipo 2. El tipo 1 se caracteriza por una pérdida rápida y progresiva de la función renal mientras que el tipo 2 se caracteriza por ser de progresión lenta y de mejor pronóstico. No existen hallazgos clínicos específicos, sin embargo, sus manifestaciones clínicas reflejan la enfermedad hepática avanzada subyacente, la insuficiencia renal y las anomalías circulatorias presentes. La opción terapéutica más adecuada es el trasplante hepático, pero no todos los pacientes pueden recibirlo, mientras se accede a dicho manejo una opción es el tratamiento medicamentoso con vasoconstrictores y albúmina.
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