[Ambulatory laparoscopic colectomy : First experiences at the CHU of Liège]. / Colectomie cœlioscopique ambulatoire. Premières expériences au CHU de Liège.

CONTEXT: For many years, enhanced recovery programs (ERP) for colorectal surgery have been developed in many hospitals around the world. Recently, our institution took a new step forward in colonic surgery : ambulatory laparoscopic colectomies. METHODS: Our eligibility criteria for our ambulatory colectomy program were defined and our perioperative ERP protocol was adapted to the ambulatory setting. Five patients consented to inclusion in this program. RESULTS: Patients' characteristics were as follows : four women, one male, age : 48 years (range 21-67); surgical indication : cancer in two patients, diverticulitis in two patients, and Crohn disease in one patient. The surgical site was the left colon in four cases and the right colon in one case. Four out of the five patients left the hospital 5-8 h after the end of the surgery. No postoperative complication occurred, no readmission was necessary. DISCUSSION: This article discusses the benefits and risks of ambulatory colectomy. We emphasize that such outpatient management must not be pursued at the expense of the patient's safety and well-being.

Contexte : Depuis de nombreuses années, les programmes de réhabilitation améliorée après chirurgie (RAC) colorectale ont été développés dans de nombreux centres hospitaliers à travers le monde. Récemment, notre institution a franchi une nouvelle étape en chirurgie colique : la réalisation de colectomies coelioscopiques en ambulatoire. Méthodes : Après avoir déterminé nos critères d'inclusion dans le programme de colectomie ambulatoire et adapté notre protocole péri-opératoire de RAC au contexte ambulatoire, nous y avons inclus cinq patients. Résultats : Les caractéristiques des patients étaient les suivantes : quatre femmes et un homme; âge : 48 ans (range 21-67); indications chirurgicales : deux patients pour cancer, deux patients pour diverticulite et un patient pour maladie de Crohn. La colectomie concernait le côlon gauche dans quatre cas et le côlon droit dans un cas. Quatre des cinq patients ont quitté l'hôpital 5-8 h après la fin de l'intervention chirurgicale. Aucune complication postopératoire n'est survenue, aucune réadmission n'a été nécessaire. Discussion : Cet article discute les bénéfices et risques de la colectomie ambulatoire. Nous insistons sur le fait qu'une prise en charge ambulatoire ne doit pas être poursuivie au détriment du bien-être et de la sécurité du patient.

[Enhanced recovery after surgery in colorectal surgery]. / La réhabilitation améliorée après chirurgie colorectale.

Enhanced recovery after surgery (ERAS) in colorectal surgery consists of multidisciplinary, multimodal, and patient-centred care. The implementation of pre-, intra-, and post-operative measures mitigates the surgical stress, the inflammatory reaction, and their consequences. The elements of this protocol are evidence-based medicine. This allows improved and accelerated recovery. Consequently, ERAS reduces the incidence of medical complications by 50 %, including fewer infectious complications, and a possible positive impact on survival after oncologic surgery. Hospital length of stay is shortened. There is no contraindication to ERAS, which must be used for all patients undergoing colorectal surgery. Adaptation of the protocol will nevertheless be necessary in the event of urgent surgery.

La réhabilitation améliorée après chirurgie (RAC) colorectale est une prise en charge multidisciplinaire et multimodale, centrée sur le patient. La mise en place de mesures pré-, per- et postopératoires réduit la réponse au stress chirurgical, la réaction inflammatoire et leurs conséquences. Ce protocole de soins, basé sur des preuves scientifiques, permet une récupération améliorée et accélérée. L'incidence des complications médicales est, secondairement, réduite de 50 %. La réhabilitation améliorée se traduit par une diminution significative de la durée d'hospitalisation, une diminution des complications infectieuses et, probablement, par un impact positif sur la survie après chirurgie oncologique. Il n'y a pas de contre-indication à la RAC qui doit donc être proposée à tous les patients devant subir une chirurgie colorectale. Une adaptation du protocole sera néanmoins nécessaire en cas de chirurgie urgente.

[Update in abdominal surgery]. / Evolution en chirurgie abdominale. Avancées techniques, collaboration intra et inter hospitalière.

During the last decade minimal invasive approach progressed in all sectors of abdominal surgery. Technological improvements allowed to perform more complex procedures laparoscopically with increased safety. The implementation of pre-, per- and postoperative protocols with an adaptation of surgical, anesthetic and analgesia methods and the patient's involvement in the healing process led to enhanced recovery after surgery. The centralization of complex esophageal and pancreatic surgery established the CHU of Liège as a tertiary referral institution for complex oncological surgery thanks to a large cooperation with regional hospitals.

La dernière décennie a vu progresser l'approche mini-invasive dans tous les domaines de la chirurgie abdominale. Les améliorations technologiques permettent de réaliser des interventions toujours plus complexes en laparoscopie avec une sécurité accrue. La systématisation de la prise en charge pré-, per- et postopératoire, avec une adaptation des techniques de chirurgie, d'anesthésie et d'analgésie, et une implication du patient dans ce processus ont abouti à une réhabilitation accélérée. La centralisation de la chirurgie complexe de l'oesophage et du pancréas a permis de créer une structure de référence en chirurgie oncologique complexe au CHU de Liège grâce à une large collaboration interhospitalière régionale.

[Influence of clinical and pathological factors on lymph node harvesting in surgical specimens of colorectal cancer]. / Facteurs anatomo-cliniques influençant la collecte ganglionnaire dans les pièces de résection chirurgicale pour cancer colorectal.

In colorectal cancer staging, pathologic lymph node analysis is a crucial information for the clinician and must be performed with a maximal level of accuracy. Therefore, the surgical sample analysis needs harvesting of as many lymph nodes as possible from the mesentery. In this study, we analysed the influence of a series of clinical and pathological factors which could influence lymph node harvesting. A total of 239 patients were included in our study. The factors with a statistically significant influence on lymph node collection (pinferior to0.05) were the age, gender of the patient, size of the primitive neoplasm, size of the surgical specimen, expertise of the surgeon and the pathology department. The presence of a radiochimiotherapy did not have any influence on the lymph node collection. This study highlights the importance of lymph node harvesting in colorectal surgical specimens of colo-rectal cancers.

Dans la stadification de l'adénocarcinome colorectal, le statut ganglionnaire anatomopathologique constitue une information capitale pour le clinicien et doit être défini avec un maximum d'exactitude. L'analyse de la pièce de résection chirurgicale requiert la collecte au sein du méso du plus grand nombre possible de ganglions lymphatiques. Dans cette étude, nous avons analysé une série de facteurs anatomo-cliniques pouvant influencer la collecte ganglionnaire. Un total de 239 patients a été inclus dans notre étude. Les facteurs avec une influence statistiquement significative sur la collecte ganglionnaire (p inf�rieur a 0,05) ont été l'âge et le sexe du patient, la taille de la tumeur primitive, la taille de la pièce d'exérèse, le degré d'activité du chirurgien et le laboratoire d'anatomie pathologique. La présence ou non d'une radiochimiothérapie néo-adjuvante n'a pas eu d'impact sur le nombre de ganglions prélevés. Cette étude souligne l'importance de la collecte ganglionnaire au sein des pièces de résection chirurgicale d'un cancer colo-rectal.

On a causal dispersion model for the optical properties of metals.

A causal model that is fully compliant with the Kramers-Kronig relations (KKRs) is used for characterizing the optical response of metals exhibiting sharp, non-Lorentzian regions of interband absorption. This consistent model also recovers the Gaussian character of the broadened peaks observed in the infrared response of amorphous materials. A reductive procedure for optimal fitting of KKR-compliant composite models to the permittivity data of metals over the intraband and interband energetic regimes is introduced and applied to eleven metals: Ag, Au, Cu, Al, Be, Cr, Ni, Pd, Pt, Ti, and W. We show that results obtained using this optimal procedure outperform-both qualitatively and quantitatively-those obtained by previous non-causal (KKR non-compliant) models that are widely used for approximating the permittivity of metals. A comparative analysis reveals a simultaneous increase in performance (as characterized by the error objective) and a reduction in the cardinality of the parameterization, often yielding more physically meaningful interpretations. These results are obtained without compromising model fidelity in regions of sharp Gaussian interband character, indicating that the proposed model provides an excellent alternative to previously proposed models.

[How I explore Crohn's disease by various imaging modalities]. / Comment j'explore la maladie de Crohn par imagerie.

Crohn's disease is a chronic inflammatory condition characterized by recurrent and/or chronic lesions, leading to cumulative structural bowel damage. It is established that the correlation between symptoms and intestinal lesions is weak. Therefore, monitoring by frequent cross-sectional imaging is proposed to assess the disease activity. There is no consensus about the preferred imaging option. Priority is given to non-radiating modalities, such as ultrasonography and MRI. Tomodensitometry will be reserved for emergency cases. Ultrasonography can be useful, in emergency as well as for the monitoring of lesions of known topography. Entero-MRI is henceforth considered the standard imaging technique for the diagnosis and follow-up of Crohn's disease. Its high contrast resolution allows an accurate assessment of disease activity, therapeutic efficacy, cumulative structural bowel damage and complications.

La maladie de Crohn est une maladie inflammatoire intestinale dont les manifestations récurrentes ou chroniques entraînent des dommages tissulaires cumulatifs. Il est avéré que la corrélation entre la symptomatologie clinique et les lésions intestinales est faible. Par conséquent, des examens d'imagerie fréquents sont nécessaires pour déterminer l'activité de la maladie. Il n'existe pas de consensus quant à l'utilisation de l'une ou l'autre technique. La priorité sera donnée à des examens peu irradiants comme l'échographie et l'IRM. La tomodensitométrie sera réservée aux situations d'urgence ou en cas de contre-indication à l'IRM. L'échographie est un outil à ne pas négliger, tant en urgence que pour le suivi de lésions de topographie connue. L'entéro-IRM est dorénavant l'examen de choix pour le diagnostic et le suivi de la maladie de Crohn. Son excellente résolution en contraste permet d'évaluer l'activité de la maladie, l'efficacité thérapeutique, les dommages tissulaires cumulés et la présence de complications.

[Pseudotumoral pelvic actinomycosis : one should think of it]. / Le cas clinique du mois - Actinomycose pelvienne pseudo-tumorale : il fallait y penser.

Actinomycosis is a rare chronic disease caused by a group of anaerobic Gram positive bacteria. It may mimic a neoplasia at various anatomical levels. A pelvic localization is exceptional but has an increasing incidence since the use of intrauterine devices. In such cases, pelvic actinomycosis may present as a gynecological or a lower colonic malignancy. For all atypical clinical, with a prominent infectious or inflammatory context, the diagnosis of actinomycosis must be suggested and discussed with the pathologist to whom the biopsy will be submitted. In the absence of a preoperative diagnosis, an inadequately aggressive pelvic surgery might be performed and rendered particularly complex due to the adherent and diffusely inflammatory pattern of the disease. The treatment of choice remains a long-term therapy with antibiotics that leads to a complete clinical and radiological response in the majority of cases. We report the case of a 27-year-old woman with a clinical and radiological diagnosis of rectal carcinoma but with limited preoperative biopsy that revealed a pelvic actinomycosis and allowed a conservative and successful antibacterial treatment.

L'actinomycose est une pathologie bactérienne rare pouvant prendre un aspect pseudo-tumoral. La localisation pelvienne est exceptionnelle, mais d'incidence croissante depuis l'utilisation des dispositifs intra-utérins. La présentation peut alors évoquer une néoplasie gynécologique ou colique basse. Devant tout tableau clinique atypique suggérant une malignité pelvienne mais dominé par un contexte infectieux et/ou inflammatoire, le diagnostic d'actinomycose doit être évoqué et discuté avec le collègue anatomo-athologiste auquel les prélèvements histologiques seront soumis. En l'absence de diagnostic pré-opératoire, une chirurgie radicale peut être pratiquée de manière inadéquate et se révéler particulièrement délabrante en raison du caractère adhérent et diffusément inflammatoire de la lésion. Le traitement de choix est une antibiothérapie au long cours amenant à une résolution clinique et radiologique complète dans la majorité des cas. Nous rapportons le cas d'une patiente de 27 ans chez laquelle un diagnostic de néoplasie rectale primitive est suggéré cliniquement et radiologiquement, mais chez qui les biopsies pré-opératoires limitées ont permis un diagnostic d'actinomycose pelvienne et un traitement conservateur.

Wheat gluten intake increases weight gain and adiposity associated with reduced thermogenesis and energy expenditure in an animal model of obesity.

BACKGROUND/OBJECTIVES: The association between gluten and body weight is inconsistent. Previously, we showed that a gluten-free diet reduces weight gain without changing food intake in mice fed high-fat diets. In the present study, we investigated the effects of gluten intake on fat metabolism, thermogenesis and energy expenditure in mice fed a standard or high-fat diet. METHODS: Mice were fed four different experimental diets during 8 weeks: a control-standard diet (CD), a CD added with 4.5% of wheat gluten (CD-G), a high-fat diet (HFD) and a HFD added with 4.5% of wheat gluten (HFD-G). After 8 weeks, the mice received (99m)Tc-radiolabeled gluten orally to study gluten absorption and biodistribution or they underwent indirect calorimetry. After killing, subcutaneous and brown adipose tissues (SAT and BAT) were collected to assess thermogenesis-related protein expression. Lipid metabolism was studied in adipocyte cultures from the four groups. RESULTS: Despite having had the same energy intake, CD-G and HFD-G mice exhibited increased body weight and fat deposits compared with their respective controls. (99m)Tc-GLU or its peptides were detected in the blood, liver and visceral adipose tissue, suggesting that gluten can even reach extraintestinal organs. Uncoupling protein-1 expression was reduced in the BAT of HFD-G and in the SAT of CD-G and HFD-G mice. Indirect calorimetry showed lower oxygen volume consumption in CD-G and HFD-G groups compared with their controls. In HFD mice, daily energy expenditure was reduced with gluten intake. Gluten also reduced adiponectin, peroxisome proliferator-activated receptor (PPAR)-α and PPARγ and hormone-sensitive lipase in cultures of isolated adipocytes from HFD mice, whereas in the CD-G group, gluten intake increased interleukin-6 expression and tended to increase that of tumor necrosis factor. CONCLUSIONS: Wheat gluten promotes weight gain in animals on both HFD and CD, partly by reducing the thermogenic capacity of adipose tissues.

[STRICTURING CROHN'S DISEASE: CLINICAL FEATURES, DIAGNOSIS AND TREATMENT]. / LA MALADIE DE CROHN STÉNOSANTE: Présentation clinique, diagnostic et modalités de traitement.

Crohn's disease (CD) is a chronic inflammatory bowel disease which mainly affects young people. This disease evolves in successive steps and is often complicated by strictures which express characteristic signs of occlusive syndrome, more often in case of ileal than colonic involvement. The nature and localisation of strictures should be precisely defined by different techniques like endoscopy, entero-(colo)-scanner or entero-(colo)-MRI. This work-up is essential to best adapt the therapeutic care. Indeed, the fibrosing evolution of inflammatory strictures causes medical treatment's failure which may lead to endoscopic dilatation or surgical resection. To avoid this negative evolution, it is mandatory to adopt early therapeutic strategy to control inflammation.

[FROM EVIDENCE-BASED MEDICINE TO PERSONALIZED MEDICINE IN CROHN'S DISEASE]. / DE L'"EVIDENCE-BASED MEDICINE" À LA MÉDECINE PERSONNALISÉE DANS LA MALADIE DE CROHN.

The therapeutic armamentarium in Crohn's disease includes mesalazine, steroids (including topical drugs), anti-metabolites (purines, methotrexate), anti-TNFα antibodies and, more recently, selective inhibitors of lymphocytes homing (vedolizumab). The efficacy of these drugs has been shown in pivotal phase 3 placebo-controlled trials and meta-analyses. However, the use of these drugs in routine practice still remains ill-defined. Those are rather the cohort studies, natural history data and therapeutic strategy trials that help the clinician to determine, for each individual patient, the treatment leading to an optimal benefit/risk profile, aiming at moving from evidence-based medicine towards personalized medicine.

Whole body vibration and post-activation potentiation: a study with repeated measures.

The objective of this study was to assess the acute effect of different intensities of whole body vibration (WBV) on muscle performance. 8 recreationally trained males were randomly subjected to one of 3 experimental conditions: (A) WBV 2 mm [45 Hz and 2 mm], (B) WBV 4 mm [45 Hz and 4 mm], and (C) no WBV. To assess PAP, the peak concentric torque of knee flexors and extensors was measured during a set of 3 unilateral knee flexor-extensions at 60°/s(-1) in an isokinetic dynamometer. The power output and height during vertical jumps were also evaluated. These measurements were performed both before and after the experimental conditions and then compared. Comparing the knee flexion data from the conditions with and without WBV indicate that WBV potentiated the peak torque during unilateral knee flexion in the isokinetic test (p < 0.05). In addition, the power output (p = 0.01) and vertical height of jump (p = 0.03) were also potentiated by WBV. However, increasing the vibratory stimulus did not further potentiate the results. Thus, it is suggested that WBV be used before explosive events competition because WBV promotes post-activation potentiation.

[Radiotherapy in rectal cancer: when, why and how?]. / La radiothérapie dans le cancer du rectum: quand, comment et pourquoi?

Since several decades, radiotherapy plays a crucial role in the management and local control of the rectal adenocarcinoma. The local recurrences pattern of the rectal tumor has completely changed with the systematic use of the Total Mesorectal Excision surgery (TME). In this context, the rate of radiotherapy needs to be reviewed. In this article we propose an overview of the main studies using radiotherapy in a pre- or post-operative setting in the context ofTME surgery. This will help to better define the indications of radiotherapy in rectal cancer.

[Radiotherapy for elderly patient with rectal cancer: which benefit?]. / La radiothérapie dans le cancer du rectum chez la personne âgée: quel bénéfice pour quel traitement?

Age acts as a major risk factor of cancer. In the near future, with the aging of the population, we will treat more and more elderly patients with oncologic disease. Unfortunately, these patients are often excluded from randomized trials. How can we, therefore, define guidelines for this particular population of patients? Moreover, older patients often present multiple morbidities synchronously with the oncologic disease. This constellation of diseases makes the therapeutic strategy even more difficult. The highest incidence of rectal cancer is observed at 80 years old or above. This is significantly older than the mean age of the population included in clinical trials. Although, the prognosis of young patients with rectal cancer has improved over the past few decades, this is not the case for patients over 75 years old. A geriatric evaluation, as a part of a multidisciplinary approach, may allow to better select patient able to benefit from a combined treatment. Radiotherapy plays a crucial role in the treatment of rectal cancer. There are no solid data currently available on the real impact of radiotherapy on survival in an elderly population with rectal cancer. Do these patients really benefit from this treatment and what is the impact of radiotherapy on their quality of life? This review will try to give some answers to these important questions.

[Fifteen years of use of anti-TNF antibodies in moderate to severe Crohn's disease: how to make the best of this experience]. / Quinze ans d'anti-TNF dans la maladie de Crohn: comment tirer le meilleur de cette révolution thérapeutique?

After fifteen years of use, the anti-TNF antibodies have become the corner stone of the treatment of moderate and severe Crohn's disease. The skill acquired over the years through experimental trials and clinical experience leads to increased therapeutic efficacy and minimized risks. These antibodies are introduced increasingly earlier in Crohn's disease as well as in a broader range of patients, aiming at changing the natural history of the diseases by avoiding the development of intestinal tissue damage and complications.

Unusual intra-rectal "laterally spreading tumour" in immunosuppressed patient with ulcerative colitis.

Condyloma acuminatum (CA) is a manifestation of Human Papillomavirus (HPV) infection which usually occurs in genital and perianal regions. We report a 46-year-old man with an ulcerative proctitis diagnosed four years earlier, asymptomatic for a long time under azathioprine but without any follow-up for three years. A colonoscopy was performed prior to potential immunosuppressive treatment discontinuation and showed a circumferential "laterally spreading tumour" in the rectum. Surprisingly biopsies revealed a CA with a very focally high-grade intra-epithelial lesion. Azathioprine was stopped and a transanal surgical resection was performed. At guided anamnesis, patient confirmed to be a former active "men who have sex with men". No recurrence of proctitis occurred despite azathioprine discontinuation. A retrospective review of the histological sections suggests that it was, in fact, an intestinal spirochetosis misdiagnosed as inflammatory bowel disease. Involvement of the rectal mucosa by HPV is a rare condition and this may have been promoted by inappropriate immunosuppressive treatment.

Physical exercise-induced cardiovascular adjustments are modulated by muscarinic cholinoceptors within the ventromedial hypothalamic nucleus.

The effects of blocking ventromedial hypothalamic nucleus (VMH) muscarinic cholinoceptors on cardiovascular responses were investigated in running rats. Animals were anesthetized with pentobarbital sodium and fitted with bilateral cannulae into the VMH. After recovering from surgery, the rats were familiarized to running on a treadmill. The animals then had a polyethylene catheter implanted into the left carotid artery to measure blood pressure. Tail skin temperature (T(tail)), heart rate, and systolic, diastolic and mean arterial pressure were measured after bilateral injections of 0.2 microl of 5 x 10(-9) mol methylatropine or 0.15 M NaCl solution into the hypothalamus. Cholinergic blockade of the VMH reduced time to fatigue by 31 % and modified the temporal profile of cardiovascular and T(tail) adjustments without altering their maximal responses. Mean arterial pressure peak was achieved earlier in methylatropine-treated rats, which also showed a 2-min delay in induction of tail skin vasodilation, suggesting a higher sympathetic tonus to peripheral vessels. In conclusion, muscarinic cholinoceptors within the VMH are involved in a neuronal pathway that controls exercise-induced cardiovascular adjustments. Furthermore, blocking of cholinergic transmission increases sympathetic outflow during the initial minutes of exercise, and this higher sympathetic activity may be responsible for the decreased performance.

Elderly patients over 70 years benefit from enhanced recovery programme after colorectal surgery as much as younger patients.

AIM OF THE STUDY: Enhanced recovery programme (ERP) reduces length of hospital stay (LOS) and postoperative complications after colorectal surgery. ERP is feasible and effective in elderly patients. We tested the hypothesis of non-inferiority for elderly patients as compared to younger patients with regard to LOS. PATIENTS AND METHODS: The first 302 consecutive patients scheduled for colorectal surgery and prospectively introduced in our audit database were retrospectively analysed. LOS (primary endpoint), postoperative complications, and adherence to the ERP of elderly (≥70 years, n=100) were compared with those of younger patients (n=202). The same ERP was used in all patients. Non-inferiority hypothesis for LOS was tested using the confidence interval method. Secondary endpoints were compared using the Mann-Whitney U and the Chi2 tests. RESULTS: Except for age patients' demographic data were not different in both groups: 53.8 (17-69) vs. 76.8 (70-90) years. The actual LOS were 3.5 [2-7] and 4.0 [3-7] days in the young and elderly group, respectively. The difference in median LOS between the two groups was 0 (95% CI, -0.97-0.97), demonstrating non-inferiority. Although with more risk factors (anaemia, COPD, cardiac disease, and cancer, P<0.05), elderly patients experienced neither more postoperative medical (17.0 vs. 16.3 %) nor surgical (19.0 vs. 22.3 %) complications than young patients. The adherence to protocol was slightly less in elderly (16 [15-18] vs. 17 [16-18], P=0.05). CONCLUSION: Not only ERP is feasible in seniors, but elderly patients benefit from this perioperative care as much as younger patients. CLINICAL TRIALS REGISTRATION: NCT03620851.

Liver transplant donation after cardiac death: experience at the University of Liege.

OBJECTIVE: Donation after cardiac death (DCD) has been proposed to overcome in part the organ donor shortage. In liver transplantation, the additional warm ischemia time associated with DCD procurement may promote higher rates of primary nonfunction and ischemic biliary lesions. We reviewed the results of liver transplantation from DCD. PATIENTS AND METHODS: From 2003 to 2007, we consecutively performed 13 controlled DCD liver transplantations. The medical records of all donors and recipients were retrospectively reviewed, evaluating in particular the outcome and occurrence of biliary complications. Mean follow-up was 25 months. RESULTS: Mean donor age was 51 years, and mean intensive care unit stay was 5.4 days. Mean time between ventilation arrest and cardiac arrest was 9.3 minutes. Mean time between cardiac arrest and arterial flushing was 7.7 minutes. No-touch period was 2 to 5 minutes. Mean graft cold ischemia time was 295 minutes, and mean suture warm ischemia time was 38 minutes. Postoperatively, there was no primary nonfunction. Mean peak transaminase level was 2546 UI/mL. Patient and graft survival was 100% at 1 year. Two of 13 patients (15%) developed main bile duct stenosis and underwent endoscopic management of the graft. No patient developed symptomatic intrahepatic bile duct strictures or needed a second transplantation. CONCLUSIONS: Our experience confirms that controlled DCD donors may be a valuable source of transplantable liver grafts in cases of short warm ischemia at procurement and minimal cold ischemia time.

Efficient bioaccumulation of tungsten by Escherichia coli cells expressing the Sulfitobacter dubius TupBCA system.

Tungsten (W) is a valuable element with considerable industrial and economic importance that belongs to the European Union list of critical metals with a high supply risk. Therefore, the development of effective and new methods for W recovery is essential to ensure a sustainable supply. In the present study, the Sulfitobacter dubius W transport system TupABC was explored in order to demonstrate both its functionality in Escherichia coli cells and to construct a bioaccumulator (EcotupW). The complete gene cluster tupBCA or partial gene cluster tupBC were cloned in an expression vector and transformed into E. coli. Metal accumulation was evaluated when each construct strain was grown with three separate metal oxyanions (tungstate, molybdate or chromate). The specificity of the bioaccumulator was determined by competition assays using cells grown with mixed solutions of metal oxyanions (W/Mo and W/Cr). The results showed the relevance of the TupA protein in the TupABC transporter system to W-uptake and also allowed Mo and Cr accumulations, although with amounts 1.7 and 2.9-fold lower than W, respectively. To identify the importance of the valine residue in the accumulation efficiency of the VTTS motif, site-directed mutagenesis of tupA was performed. A mutant with a threonine residue, instead of the respective valine, confirmed that W was internalized by nearly double the amount compared to the native form. The findings indicated that cells carrying the native S. dubius TupABC system were great W-bioaccumulators and could be promising tools for W recovery.

Evidence that exercise-induced heat storage is dependent on adrenomedullary secretion.

To investigate the influence of medullary adrenal secretion on thermoregulation during exercise, Phy (Eserine, 5x10(-3) M) was injected into the lateral cerebral ventricle of normal (INT) or bilaterally adrenodemedullated (ADM) untrained rats. Body temperature (Tb) and metabolic rate were measured in the rats while they were exercising on a treadmill (20 m min(-1), 5% inclination) until fatigue or while they were at rest after drug injection. In resting rats, Phy increased oxygen consumption in both INT or ADM rats without any effect on core temperature. During the dynamic phase of exercise (first 20 min), ADM attenuated the exercise-induced increase in core temperature (0.86+/-0.12 degrees C ADM Sal vs 1.48+/-0.21 degrees C INT Sal), thus reducing heat storage (HS) levels. Icv injection of Phy in ADM rats significantly reduced the increase in Tb (0.012+/-0.10 degrees C min(-1) Phy vs 0.042+/-0.006 degrees C min(-1) Sal; p<0.02) and HS (65.8+/-56.1 cal Phy vs 207.7+/-32.7 cal Sal; p<0.04) compared to ADM Sal rats. In conclusion, the exercise-induced increase in heat storage was attenuated by adrenodemedullation in rats. Furthermore, the activation of heat loss mechanisms by the central cholinergic system during exercise occurs independently of adrenal medullary secretion suppression and can be improved by previous adrenodemedullation. Our data indicate the existence of a dual mechanism of heat loss control during the dynamic phase of exercise: one involving sympathoadrenal system activation that impairs heat loss and another that counteracts the increased sympathoadrenal activity through the hypothalamic cholinergic system to promote heat loss.