Stem cell therapy applied for digestive anastomosis: Current state and future perspectives

BACKGROUND Digestive tract resections are usually followed by an anastomosis.Anastomotic leakage,normally due to failed healing,is the most feared complication in digestive surgery because it is associated with high morbidity and mortality.Despite technical and technological advances and focused research,its rates have remained almost unchanged the last decades.In the last two decades,stem cells(SCs)have been shown to enhance healing in animal and human studies;hence,SCs have emerged since 2008 as an alternative to improve anastomoses outcomes.AIM To summarise the published knowledge of SC utilisation as a preventative tool for hollow digestive viscera anastomotic or suture leaks.METHODS PubMed,Science Direct,Scopus and Cochrane searches were performed using the key words“anastomosis”,“colorectal/colonic anastomoses”,“anastomotic leak”,“stem cells”,“progenitor cells”,“cellular therapy”and“cell therapy”in order to identify relevant articles published in English and Spanish during the years of 2000 to 2021.Studies employing SCs,performing digestive anastomoses in hollow viscera or digestive perforation sutures and monitoring healing were finally included.Reference lists from the selected articles were reviewed to identify additional pertinent articles.METHODS Given the great variability in the study designs,anastomotic models,interventions(SCs,doses and vehicles)and outcome measures,performing a reliable meta-analysis was considered impossible,so we present the studies,their results and limitations.RESULTS Eighteen preclinical studies and three review papers were identified;no clinical studies have been published and there are no registered clinical trials.Experimental studies,mainly in rat and porcine models and occasionally in very adverse conditions such as ischaemia or colitis,have been demonstrated SCs as safe and have shown some encouraging morphological,functional and even clinical results.Mesenchymal SCs are mostly employed,and delivery routes are mainly local injections and cell sheets followed by biosutures(sutures coated by SCs)or purely topical.As potential weaknesses,animal models need to be improved to make them more comparable and equivalent to clinical practice,and the SC isolation processes need to be standardised.There is notable heterogeneity in the studies,making them difficult to compare.Further investigations are needed to establish the indications,the administration system,potential adjuvants,the final efficacy and to confirm safety and exclude definitively oncological concerns.CONCLUSION The future role of SC therapy to induce healing processes in digestive anastomoses/sutures still needs to be determined and seems to be currently far from clinical use.     

湖北省玉米纹枯病病原丝核菌的种类和致病性*

从湖北省9个主要玉米产区采集玉米纹枯病标样,分离得到55个丝核菌菌株。融合群和致病性测定表明,这些分离菌分别属于AG1—IA、AG4、AG5、AGA、AGB(0)、AGE和WAG-Z等7个丝核菌融合群,其中AG1-IA是优势融合群,占分离菌株总数的61.82%,分布范围也最广。在致病性方面,除AGA不致病外,其它6群均致病,其中AG4致病力最强,AG1-IA次之,AG5最弱。研究同时表明,同一融合群内不同菌株致病性有差异,并且同一菌株对不同玉米自交系的致病力的强弱表现不完全一致。     

大隐静脉顺行序贯式吻合技术在冠心病患者中的应用

目的:探讨大隐静脉(SVG)顺行序贯式吻合技术在冠心病患者中的应用价值。方法:收集我院2011年1月至2014年6月收治的78例冠心病患者,回顾性分析患者非体外循环下行SVG顺行序贯式冠状动脉旁路移植术患者的临床资料,术后随访1~3.5年,平均(2.1±1.5)年,密切观察患者治疗效果以及相应的并发症的发生情况。结果:SVG双支桥48例,三支桥20例,四支桥10例,吻合口共196个。术后测定近段血流流速(37.14±11.78)m L/min,搏动指数(PI)值(3.00±1.25)。术后出现2例低心排血量综合征,2例迟发性心脏压塞,除1例因序贯出现多脏器功能衰竭而死亡外,其余均痊愈。术后复查,SVG桥的通畅率为100%。结论:SVG顺行序贯吻合能尽快恢复心脏供血,术后通畅率高,在医生严格掌握手术技巧的前提下,可安全用于冠心病的治疗。     

Computational Study of Anastomosis Angle of Arteriovenous Fistula for Hemodialysis

Arteriovenous fistula (AVF) is the endorsed method of vascular access for hemodialysis in end-stage renal disease (ESRD). However, more than 60% of AVF fail to mature for hemodialysis. Intimal hyperplasia leads to stenosis is the primary cause of fistula failure. Wall shear stress (WSS) is one of the important parameters that enact a crucial role in building of intimal hyperplasia. The prime purpose of this research work is to investigate the effect of anastomosis angle on WSS, pressure drop, venous outflow rate and identify the optimal angle of anastomosis of AVF, so that it helps to standardize the surgical technique. In this research work, three-dimensional idealized geometries of end-to-side type AVF for the four different angles of anastomosis are created. Numerical simulation performed using incompressible, Newtonian blood to calculate the WSS, blood flow rate at the distal end of the vein and pressure drop across the anastomosis for the three arterial inflow 350, 500 and 900 ml/min. For all three arterial inflow, the WSS is high at 75° compared to other angles and it is less at 60°. The WSS at 45° and 90° are moderate. The venous outflow is increasing with the increase in arterial inflow condition for all anastomosis angles except for 45°. The outflow rate at distal venous end is highest, 344.85 ml/min at 45° for 500 ml/min arterial inflow. Pressure drop high at 45° and lowest at 90°. The intensity of disturbed flow and recirculation zone was observed at the area of anastomosis and it is high at 75°. From the results and observations, it can be concluded that 45° angle is the best choice for the anastomosis of AVF. This finding will standardize the surgical technique and subsequently, it will help to mature the AVF early and for a long time.     

Genetic Diversity of Thanatephorus cucumeris Infecting Tomato in Iran

The necrotrophic fungus Thanatephorus cucumeris (anamorph Rhizoctonia solani) is among the most important soil‐borne pathogens which causes tomato foot and root rot worldwide. We investigated virulence and genetic relationships among and within different taxonomic groups of R. solani from the tomato‐growing regions in the north‐east of Iran. Characterization of R. solani taxonomic groups revealed that, of 56 isolates, four were AG‐2‐1, 16 were AG‐3 PT, 21 were AG‐4 HG‐I and 15 were AG‐4 HG‐II. Because interprimer binding site (iPBS), which is based on amplification of retrotransposons, is known as novel and powerful DNA fingerprinting technology, we selected four iPBS primers, which can detect polymorphisms of tomato foot root and root rot pathogen, for investigating genotypic variability of the isolates. The iPBS analyses separated various taxonomic groups of R. solani and showed great diversity among the isolates, demonstrating that the R. solani isolates obtained from tomato were not a clonal population. Crop rotation strategies and geographic location seem to be important factors affecting genetic structure of the isolates. Pathogenicity tests on tomato cultivar ‘Mobil’ showed significant differences in the virulence of various isolates. The overall results indicated that isolates of AG‐3 and AG‐4 were more virulent than AG‐2‐1. There was no significant correlation between genetic diversity and virulence of the isolates. This is the first report of R. solani AG‐4 HG‐II, causing tomato foot and root rot. Also, our research is the first in assessment of genetic diversity in fungal populations using iPBS molecular markers.     

分月扇舟蛾触角感觉器的扫描电镜观察

利用扫描电镜对分月扇舟蛾Clostera anastomosis(L.)成虫触角感觉器的形态、结构进行了观察。扫描电镜观察结果表明,分月扇舟蛾触角由柄节、梗节和鞭节组成,触角外侧面覆盖有鳞片,绝大部分触角感觉器位于触角的腹面和外侧面。雌、雄蛾触角上均存在以下8种感觉器,即毛形感器、刺形感器、腔形感器、腔锥形感器、栓锥形感器、锥形感器、柱形感器和鳞形感器。各种感觉器在雌、雄蛾触角上的分布大体相同,但数量有明显的区别。     

Genetic Characterization and Pathogenicity of Rhizoctonia solani Associated with Common Bean Web Blight in the Main Bean Growing area of Argentina

Common bean web blight (WB), caused by the fungus Rhizoctonia solani (teleomorph Thanatephorus cucumeris), is among the endemic fungal diseases of major impact in north‐western Argentina (NWA). This study aimed to analyse the genetic and pathogenic diversity of R. solani in Salta, NWA, where 97 isolates were recovered from commercial bean cultivars and wild beans showing WB symptoms in a major bean production area. The isolates were characterized on the basis of specific primers, rDNA‐ITS sequences and morphological characteristics. All the isolates were identified as R. solani AG 2‐2WB, and they exhibited considerable intragroup variation. The phylogenetic tree generated with the ITS sequences confirmed the isolates identification. Aggressiveness of the isolates towards bean seedlings was assessed in the greenhouse. A great variability in virulence was observed among the isolates analysed. On the basis of the disease reaction on foliar tissues, the isolates were grouped into three virulence categories as follows: weakly virulent (30%), moderately virulent (38%) and highly virulent (32%). However, no correlation between virulence and geographical origin was detected. The information generated in this study provides initial data on the population variability of the WB pathogen in north‐western Argentina and represents a valuable contribution to regional breeding programmes aimed to obtain cultivars with durable resistance.     

Rhizoctonia spp. Causing Root and Hypocotyl Rot in Phaseolus vulgaris in Cuba

Sixty isolates of Rhizoctonia spp. were obtained from Cuban bean fields during the period 2004–2007. Isolates were characterized with different techniques, including nuclei staining, pectic zymogram, PCR–RFLP analysis of the rDNA–ITS region and sequencing of the rDNA–ITS region. The majority of the isolates were identified as multinucleate Rhizoctonia solani isolates, representing two different anastomosis groups (AGs), AG 2‐2 WB and AG 4 HGI; the remaining isolates were binucleate Rhizoctonia isolates and belonged to AG F and AG A. AG 4 HGI isolates were equally distributed in all soil types; AG 2‐2 isolates were more frequently isolated from cambisols, whereas AG F isolates were related to calcisols. Pathogenicity experiments in vitro and in the greenhouse, revealed that binucleate isolates only caused root rot, whereas R. solani isolates were able to cause root rot and hypocotyl rot. Furthermore, differences in virulence level were observed between R. solani and binucleate isolates and among different AGs. Isolates of R. solani AG 4 HGI and R. solani AG 2‐2 WB were the most aggressive, binucleate isolates of AG F were intermediate aggressive, whereas a binucleate isolate of AG A was weakly aggressive. In contrast with other reports about R. solani in bean, web blight symptoms were never observed during this study.