Aortic pathologies, particularly aneurysms and dissections, are associated with high mortality, but their underlying biological mechanisms remain poorly understood. Aortic vascular smooth muscle cells (VSMCs), originating from neural crest cells and paraxial mesodermal cells, differ by anatomical location and may contribute to differences in the pathophysiology of ascending and abdominal aortic aneurysms. This study aims to explore the differences in VSMCs caused by mechanotransduction derived from these two cell types under various mechanical stresses. Mechanotransduction, the process by which cells convert mechanical stimuli into biochemical signals, plays a critical role in vascular health, influencing cellular behavior such as growth, differentiation, and apoptosis. The project will use induced pluripotent stem cells (iPSCs) differentiated into neural crest and paraxial mesodermal cells, and compare them with human aortic samples under conditions of cyclic stretch and fluid shear stress to mimic physiological and pathological environments. The findings are expected to reveal distinct mechanotransduction pathways that drive aortic aneurysms and dissections, potentially identifying new biomarkers for early detection and therapeutic intervention in aortic diseases.

Spinal cord ischemia (SCI) is a severe complication during thoracoabdominal aortic aneurysm repair, often leading to permanent neurological damage. This study investigates the neuroprotective potential of tetrahydrobiopterin (BH4), a cofactor of nitric oxide synthase, in a small animal model. Male rats were divided into six groups, including a BH4-treated group, a control group, and a sham group. SCI was induced via balloon occlusion of the thoracic aorta, and BH4 (50 mg/kg) was administered 15 minutes before the procedure. Neurological function was assessed using the Bassio-Beattie-Breshnahan (BBB) score at multiple time points, and tissue samples were collected at 6 hours (T6) and 24 hours (T24) post-SCI. Oxygen radical concentrations were measured using OxySelect™, while Western blot and immunofluorescence analyses were used to detect neuronal degeneration and inflammation. FluoroJade C staining was also performed to assess neuronal damage at different spinal cord levels. BH4 significantly improved early neurological outcomes, reduced oxidative stress, and decreased inflammatory markers. This study on animals demonstrated that BH4 has a neuroprotective effect in SCI. BH4 represents a potential new approach to prevent spinal ischemia in addition to established surgical and anesthesiological methods that reduce the risk of neurological complications in thoracoabdominal aortic surgery.

Open arch replacement is the standard approach for pathologies affecting the aortic arch, but is linked to significant morbidity and mortality, especially in elderly, frail and multimorbid patients. Hybrid procedures combining debranching of supra-aortic vessels without circulatory arrest and Zone 0 thoracic endovascular aortic repair (TEVAR) have been shown to provide good outcomes and may present a suitable alternative for complex aortic arch pathologies.

We included all patients who underwent hybrid thoracic aortic procedures at our institution from 2017 to 2023: Type 1) supra-aortic debranching and Zone 0 TEVAR, and Type 2) ascending aortic replacement and supra-aortic debranching and Zone 0 TEVAR. Pre- and postoperative computed tomography scans were evaluated for evidence of stent migration or other stent-related complications. We analysed post-operative outcomes including length of stay, neurological events, 30-day mortality and survival.

17 adult patients were included: 10 patients (59%) in Group 1, 7 patients (41%) in Group 2. Median length of stay after Zone 0 TEVAR was 7 and 5 days, respectively. 1 patient (6%) suffered a neurological event postoperatively (Group 2). 30-day mortality was 0% and length of follow-up is up to 1753 days. There was no evidence of stent migration in either group.

Hybrid aortic repair techniques present a safe option for high-risk surgical candidates and provide a feasible alternative to conventional open surgery.

Objective

The healthcare industry has witnessed a paradigm shift with the adoption of Electronic Patient Records (EPRs), transitioning from traditional Paper and Pencil (P&P) methods to sophisticated, technology-driven documentation systems. However, the integration of EPRs into clinical settings has introduced new challenges. This study investigates workflow consequences of switching from P&P to EPR systems.

Methods

In this study, two independent observers audited surgical ward rounds to assess the effects of transitioning from P&P to EPR. These audits captured number of medical personnel and five key aspects before and after EPR implementation. Additionally, the EPR system's usability was gathered through the System Usability Scale (SUS) and the Post Study System Usability Questionnaire (PSSUQ).

Results

A total of 192 observations using P&P and 160 with the EPR system were analyzed. Results indicated that physicians spent a lower proportion of time in patient rooms using the P&P modality (median = 0.14, IQR = [0.06, 0.24]) compared to the EPR system (median = 0.19, IQR = [0.12, 0.29]). Conversely, nurses spent more time with the P&P modality (median = 0.13, IQR = [0.08, 0.18]) than with the EPR system (median = 0.10, IQR = [0.06, 0.13]). The typical team in the P&P modality comprised two physicians and four nurses, while teams in the EPR system generally included two or three physicians and three nurses. Usability assessments yielded scores rated as "Not Acceptable."

Conclusion

The EPR is already known to contribute to an increased administrative burden. Our findings generally align with this view in the physician sample, whereas nurses did not encounter difficulties switching systems. However, usability scores indicated that the EPR system falls short of meeting user acceptance expectations. Given the continuous increase in administrative workload, our results suggest that ururcing administrative tasks could enhance the efficiency of medical duties performed at patient's bedside.

Einleitung:

Mesenchymale Stammzellen bzw. stromale Zellen (MSCs) sind seit den 2000-er Jahren zunehmend im Tiermodell eingesetzt werden. Darauf folgte ein logarithmischen Anstieg der klinischer Studien bis zu 150 neu registrierter klinischen Studien innerhalb eines Jahres. In der Anwendung der peripheren Nervenverletzungen zeigen sich die präklinische Daten vielversprechend. Währenddessen bestehen oftmals Zweifel an der klinischen Sicherheit und optimalen Applikation von MSCs.

Methoden:

Dieses systematische Review untersucht klinisch registrierter Studien zur Sicherheit in lokalen medizinischen Anwendungen von MSCs. Nach Screening der National Library of Medicine, Exkludierung von Duplikaten und Ergänzung durch weitere Quellen erfolgt die Analyse der Sicherheit in allen medizinischen Fachbereichen sowie der Anwendungsmethoden von MSCs in peripherer Nervenregeneration.

Resultate:

Es konnten 1482 klinische Studien identifiziert werden, darunter ist die Anwendung in muskuloskelettalen und neuralen Erkrankungen am häufigsten. Insgesamt erhielten in den Jahren 2012-2021 in registrierten Studien 105 PatientInnen MSCs. Im Schnitt schlossen 97,5% der PatientInnen die Studie ab und hatten bei 0% Mortalität eine Rate von 2% schweren unerwünschten Nebenwirkungen bei 12% postinterventionelle Komplikationen. Bei der Anwendung in peripherer Nervenschädigung war die häufigste MSC-Quelle aus dem Fettgewebe, gefolgt von Knochenmark, Amnion und Umbilicus. Die intraneurale Injektion war die häufigste Applikation, gefolgt von perineuraler Anwendung und Füllung eines Nervengraftes.

Schlussfolgerung:

Insgesamt kann nach über 105 geprüften randomisierten Empfängern bei der lokalen Anwendung von MSCs von einer klinischen Sicherheit ausgegangen werden, mit höherem Risikoprofil bei zentralnervöser Schädigung. In peripherer Nervenschädigung ist das Outcome noch ausständig. Bei vielversprechenden präklinischen Daten und bisher keinen Berichten von Studienabbrechern sind die weiteren Ergebnisse hoffnungsvoll abzuwarten. Diese könnten neue Applikationen zur Verbesserung des molekularbiologischen Microenvironments mit erhöhter Zellrekrutierung, verbesserter Schwann-Zell-Funktion und neuem trophischen Stimulus ermöglichen. In Kombination mit aufstrebenden Methoden wie Bioprinting, Smart-Materials, immortalisierten Zellen, transdifferenzierten und induzierten Stammzellen, könnte dies eine neue Ära in der molekularbiologischen Therapie peripherer Nervenverletzung eröffnen.