Académie royale de Médecine de Belgique


Research Articles

Intestinal transplantation: from the laboratory to the clinics     PDF
Laurens J. Ceulemans     1-12

Intestinal transplantation (ITx) is a valuable treatment for patients suffering from irreversible short bowel syndrome and debilitating complications of total parenteral nutrition. However, the results of ITx remain inferior to other solid organ transplants due to the profound immunogenicity of the organ and the subsequent demand for high levels of immunosuppression with its associated side effects. Since 2000, 10 consecutive cadaveric intestinal transplantations have been performed in our center. All were treated with the same “... Tolerogenic Protocol” - an experimentally proven, multifactorial immunomodulatory regimen - which includes the administration of donor specific whole blood, low-dose steroids, low-dose tacrolimus, and limitation of peritransplant intestinal ischemia reperfusion injury.
The first patient transplanted in this series was the first successful ITx performed in the Benelux. The 5-year patient and graft survival rate is 90% (follow-up: 11 months – 11 years and 10 months), which compares favorably with the average 50% patient survival rate reported by the Intestinal Transplant Registry. Only one patient (10%) developed an early acute rejection, reversible with immediate steroid treatment. Three patients (30%) faced a later episode of acute rejection (at 4 months, 18 months and 46 months). Wider application of ITx depends upon the development of these immunosuppressive protocols which prohibit intestinal rejection while reducing the need for immunosuppression.

Modelling of the musculoskeletal system including its physiology: scientific and clinical applications     PDF
Serge Van Sint Jan     13-32


Modelling tools are available to increase our understanding related to the normal physiology of the musculoskeletal system (MSS) and clinical implications of MSS dysfunctions. Grossly, three modelling approaches can be adopted (direct, inverse and hybrid modelling).
Materials and methods:
Inverse modelling is based on validated data combined using data fusion methods. Direct modelling is processing more complex models based on Physics law and less on measurements. Hybrid models are built from measured data fused with direct-like models.
Modelling methods are illustrated in this paper on aponeurosis role, thorax behaviour during breathing, hand functions, etc.
From a physiological point-of-view, inverse modelling seems to bring more satisfactory results because all model data can be validated. The clinical usefulness from direct and hybrid modelling are more difficult to assess because result validation cannot be fully performed.
Before adopting a modelling strategy, one must carefully assess the aim of the research to be attempted. If validation is of importance, such as during clinical activities, then inverse modelling is advised. Direct and most hybrid models seem to be limited because of the lack of extensive validation. Some hybrid models can be used in applied research when results focus on the measured data.