Effectiveness of haemodialysis access with an autologous tissue-engineered vascular graft: a multicentre cohort study.

BACKGROUND: Application of a tissue-engineered vascular graft for small-diameter vascular reconstruction has been a long awaited and much anticipated advance for vascular surgery. We report results after a minimum of 6 months of follow-up for the first ten patients implanted with a completely biological and autologous tissue-engineered vascular graft. METHODS: Ten patients with end-stage renal disease who had been receiving haemodialysis through an access graft that had a high probability of failure, and had had at least one previous access failure, were enrolled from centres in Argentina and Poland between September, 2004, and April, 2007. Completely autologous tissue-engineered vascular grafts were grown in culture supplemented with bovine serum, implanted as arteriovenous shunts, and assessed for both mechanical stability during the safety phase (0-3 months) and effectiveness after haemodialysis was started. FINDINGS: Three grafts failed within the safety phase, which is consistent with failure rates expected for this high-risk patient population. One patient was withdrawn from the study because of severe gastrointestinal bleeding shortly before implantation, and another died of unrelated causes during the safety period with a patent graft. The remaining five patients had grafts functioning for haemodialysis 6-20 months after implantation, and a total of 68 patient-months of patency. In these five patients, only one intervention (surgical correction) was needed to maintain secondary patency. Overall, primary patency was maintained in seven (78%) of the remaining nine patients 1 month after implantation and five (60%) of the remaining eight patients 6 months after implantation. INTERPRETATION: Our proportion of primary patency in this high-risk cohort approaches Dialysis Outcomes Quality Initiative objectives (76% of patients 3 months after implantation) for arteriovenous fistulas, averaged across all patient populations.

Conocimientos sobre las tecnologías ómicas y medicina personalizada en estudiantes de Medicina / Knowledge about omic technologies and personalized medicine in medical students

RESUMEN Fundamento: la medicina personalizada integra los datos de las tecnologías ómicas con el conjunto de datos clínicos del paciente para una atención adaptada a sus características individuales. Objetivo: explorar los conocimientos y opiniones de estudiantes de segundo año de la carrera de Medicina en relación con las tecnologías ómicas y la medicina personalizada. Métodos: se realizó un estudio exploratorio, cuanticualitativo en la Universidad de Ciencias Médicas de Las Tunas durante el segundo semestre del curso académico 2018-2019. Se aplicaron métodos teóricos para la fundamentación: análisis-síntesis e inductivo-deductivo; entre los empíricos una prueba de conocimientos y una encuesta en forma de cuestionario para la recogida de la información; y la estadística descriptiva para los valores en cifras. Resultados: el 17,2 % de los estudiantes definió correctamente en qué consiste la edición del genoma, y 10,3 % lo hizo para la secuencia. Solo uno pudo mencionar un medicamento con implicaciones farmacogenéticas. Ninguno refirió saber sobre bases de datos biológicos ni leyes que regulen los estudios del genoma humano. Genética Médica fue la asignatura que ofreció mayor tratamiento a los contenidos relacionados con estos temas. La mayoría de los estudiantes estuvo a favor de la manipulación del genoma para tratar las enfermedades e informar los hallazgos que se relacionen con la salud. Conclusiones: se corroboró que es bajo el nivel de conocimientos en los estudiantes de segundo año de Medicina en relación con las tecnologías ómicas y la medicina personalizada.

ABSTRACT Background: personalized medicine integrates the data of the omic technologies with the set of clinical data of the patient for a care adapted to their individual characteristics. Objective: to explore the knowledge and opinions of second-year students of the medical degree in relation to omic technologies and personalized medicine. Methods: an exploratory, quantitative study was carried out at Las Tunas University of Medical Sciences during the second semester of the 2018-2019 academic year. Theoretical methods for the foundation were applied: analysis-synthesis, and inductive-deductive; among the empirical ones a knowledge test and a survey in questionnaire form for the collection of the information; and descriptive statistics for values in figures. Results: 17.2% of the students correctly defined what the genome edition is, and 10.3% did it for the sequence. Only one could mention a drug with pharmacogenetic implications. None reported knowing about biological databases or laws regulating studies of the human genome. Medical Genetics was the subject that gave the most treatment to the contents related to these topics. The majority of the students were in favor of genome manipulation to treat diseases and report findings that are related to health. Conclusions: the low level of knowledge on omic technologies and personalized medicine in second year students of Medicine was confirmed.

Conocimientos sobre tecnologías ómicas en médicos que inician estudios de especialidad en la atención secundaria / Knowledge about Omic Technologies in Physicians Who Are Starting their Specialty Studies in Secondary Care

Introducción: La introducción de las tecnologías ómicas en la práctica clínica requiere que los profesionales de la salud incorporen conocimientos al respecto. Objetivo: Evaluar los conocimientos sobre tecnologías ómicas de los médicos que inician los estudios de especialidad en el nivel secundario de atención médica. Métodos: Se aplicó un cuestionario a 53 profesionales de la salud, quienes comenzaron sus residencias médicas, tanto clínicas como quirúrgicas, en el Hospital General Docente "Dr. Ernesto Guevara de la Serna" de Las Tunas, Cuba. Se indagó por cuestionario y de forma anónima acerca del conocimiento sobre las pruebas de biología molecular, genéticas y farmacogenéticas, la secuenciación del genoma y las bases de datos de información biológica disponibles en internet. Resultados: El 37,7 por ciento de los participantes no conocía acerca de las pruebas de biología molecular y solo el 3,8 por ciento refirió saber sobre la secuenciación de nueva generación. Aunque el 90,6 por ciento de los interrogados estaban al tanto de alguna prueba genética, ninguno pudo mencionar una correctamente. Solo el 20,8 por ciento declaró su conocimiento de algún gen de susceptibilidad a enfermedades. La posibilidad de secuenciar el genoma completo fue reconocida por el 49,1 por ciento de la muestra. El 90,6 por ciento de los encuestados manifestó interés en recibir información al respecto. Conclusiones: Existe un insuficiente conocimiento sobre las tecnologías ómicas en los participantes en la investigación. Se requiere capacitar a los profesionales de la salud para enfrentar la introducción de la medicina genómica en la práctica clínica, lo que puede y debe hacerse desde la formación médica inicial(AU)

Introduction: The introduction of omic technologies into the clinical practice requires that health professionals incorporate knowledge in this field. Objective: To assess the knowledge about omic technologies of the physicians who are starting their specialty studies in the secondary level of healthcare. Methods: A questionnaire was conducted on 53 health professionals who started their medical residences, both clinical and surgical, at Dr. Ernesto Guevara de la Serna General Teaching Hospital in Las Tunas, Cuba. Both anonymously and by means of the questionnaire, inquiries were made regarding the knowledge about tests in the fields of molecular biology, genetics and pharmacogenetics, about genome sequencing, and about the biological information databases available on the internet. Results: 37.7 percent of the participants did not know about molecular biology tests and only 3.8 percent reported to have some knowledge about next generation sequencing. Although 90.6 percent of the respondents were aware of some genetic test, none could mention one correctly. Only 20.8 percent declared their knowledge about some disease-susceptibility genes. The possibility of sequencing the entire genome was recognized by 49.1 percent of the sample; 90.6 percent of respondents expressed some interest in receiving information about it. Conclusions: There is insufficient knowledge about omic technologies in the research participants. It is required to train health professionals to face the introduction of genomic medicine into the clinical practice, which can and should be done from the beginning ofthe medical training(AU)

Mechanical properties of completely autologous human tissue engineered blood vessels compared to human saphenous vein and mammary artery.

We have previously reported the initial clinical feasibility with our small diameter tissue engineered blood vessel (TEBV). Here we present in vitro results of the mechanical properties of the TEBVs of the first 25 patients enrolled in an arterio-venous (A-V) shunt safety trial, and compare these properties with those of risk-matched human vein and artery. TEBV average burst pressures (3490+/-892 mmHg, n=230) were higher than native saphenous vein (SV) (1599+/-877 mmHg, n=7), and not significantly different from native internal mammary artery (IMA) (3196+/-1264 mmHg, n=16). Suture retention strength for the TEBVs (152+/-50 gmf) was also not significantly different than IMA (138+/-50 gmf). Compliance for the TEBVs prior to implantation (3.4+/-1.6%/100 mmHg) was lower than IMA (11.5+/-3.9%/100 mmHg). By 6 months post-implant, the TEBV compliance (8.8+/-4.2%/100 mmHg, n=5) had increased to values comparable to IMA, and showed no evidence of dilation or aneurysm formation. With clinical time points beyond 21 months as an A-V shunt without intervention, the mechanical tests and subsequent lot release criteria reported here would seem appropriate minimum standards for clinical use of tissue engineered vessels.