Department of Digestive, Oncologic and Bariatric Surgery,AP-HP, Hôpital Européen Georges Pompidou and UFR Paris Descartes,Université de Paris, 20 Rue Leblanc, 75015 Paris, France
Dr. Tigran Poghosyan
Department of Digestive, Oncologic and Bariatric Surgery,AP-HP, Hôpital Européen Georges Pompidou and UFR Paris Descartes,Université de Paris, 20 Rue Leblanc, 75015 Paris, France
TIThe AP‐HP / Universities / Inserm COVID‐19 research collaboration and AP‐HP Covid CDR Initiative
The AP‐HP / Universities / Inserm COVID‐19 research collaboration and AP‐HP Covid CDR Initiative
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Objective: Preliminary data from different cohorts of small sample size or with short follow‐up indicate poorer prognosis in people with obesity compared with other patients. This study aims to precisely describe the strength of association between obesity in patients hospitalized with coronavirus disease 2019 (COVID‐19) and mortality and to clarify the risk according to usual cardiometabolic risk factors in a large cohort.Methods: This is a prospective cohort study including 5,795 patients aged 18 to 79 years hospitalized from February 1 to April 30, 2020, in the Paris area, with confirmed infection by severe acute respiratory syndrome coronavirus 2. Adjusted regression models were used to estimate the odds ratios (ORs) and 95% CIs for the mortality rate at 30 days across BMI classes, without and with imputation for missing BMI values.Results: Eight hundred ninety‐one deaths had occurred at 30 days. Mortality was significantly raised in people with obesity, with the following ORs for BMI of 30 to 35 kg/m2, 35 to 40 kg/m2, and >40 kg/m2: 1.89 (95% CI: 1.45‐2.47), 2.79 (95% CI: 1.95‐3.97), and 2.55 (95% CI: 1.62‐3.95), respectively (18.5‐25 kg/m2 was used as the reference class). This increase holds for all age classes.Conclusions: Obesity doubles mortality in patients hospitalized with COVID‐19.
Tissue engineering appears promising as an alternative technique for esophageal replacement. Mesenchymal stem cells (MSCs) could be of interest for esophageal regeneration. Evaluation of the ability of an acellular matrix seeded with autologous MSCs to promote tissue remodeling toward an esophageal phenotype after circumferential replacement of the esophagus in a mini pig model. A 3 cm long circumferential replacement of the abdominal esophagus was performed with an MSC-seeded matrix (MSC group, n = 10) versus a matrix alone (control group, n = 10), which has previously been matured into the great omentum. The graft area was covered with an esophageal removable stent. A comparative histological analysis of the graft area after animals were euthanized sequentially is the primary outcome of the study. Histological findings after maturation, overall animal survival, and postoperative morbidity were also compared between groups. At postoperative day 45 (POD 45), a mature squamous epithelium covering the entire surface of the graft area was observed in all the MSC group specimens but in none of the control group before POD 95. Starting at POD 45, desmin positive cells were seen in the graft area in the MSC group but never in the control group. There were no differences between groups in the incidence of surgical complications and postoperative death. In this model, MSCs accelerate the mature re-epitheliazation and early initiation of muscle cell colonization. Further studies will focus on the use of cell tracking tools in order to analyze the becoming of these cells and the mechanisms involved in this tissue regeneration.