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Abstract Mortality related to femoral neck fractures remains a challenging health issue, with a high mortality rate at 1 year of follow-up. Three modifiable factors appear to be under control of the surgeon: the choice of the implant, the use of cement and the timing before surgery. The aim of this research project was to study the impact on mortality each of these risk factors play during the management of femoral neck fractures. A large retrospective epidemiological study was performed using a national database of the public healthcare system. The inclusion criteria were patients who underwent joint replacement surgery after femoral neck fracture during the years 2015 to 2017. All data points were available for at least 2 years after the fracture. The primary outcome was mortality within 2 years following the surgery. We evaluated the association between mortality and the type of the implant hemiarthroplasty (HA) versus total hip arthroplasty (THA), cemented versus non cemented femoral stem as well as the timing from fracture to surgical procedure. A multivariate analysis was performed including age, gender, comorbidities/autonomy scores, social category, and obesity. We identified 96,184 patients who matched the inclusion criteria between 2015 and 2017. 64,106 (66%) patients underwent HA and 32,078 (33.4%) underwent THA. After multivariate analysis including age and comorbidities, patients who underwent surgery after 72 h intra-hospital had a higher risk of mortality: Hazard Ratio (HR) = 1.119 (1.056–1.185) p = 0.0001 compared to the group who underwent surgery within 24 h. THA was found to be a protective factor HR = 0.762 (0.731–0.795) p

Background: It is estimated that surgical procedures account for 20%-30% of the greenhouse gases emissions from health-care systems. Total knee replacements (TKR) are one of the most frequently performed procedures in orthopaedics. The aim of this study was to identify and quantify the environmental impacts generated by TKRs, the factors that generate the most emissions, and those that can be easily modified. Methods: To calculate the life cycle carbon footprint of a posterior stabilized cemented TKR performed in a single orthopaedic surgery department, 17 TKRs performed between October 12 and 20, 2020 by 4 senior surgeons were analysed. The analysis of the life cycle included the manufacture of the implant, from raw materials to distribution; the journey made by patients and staff; and the surgery including all consumables required to facilitate the procedure. Results: The overall life cycle carbon footprint of a single TKR was 190.5 kg of CO2. This consisted of 53.7 kg CO2 (28%) for the manufacture of the prosthesis, 50.9 kg CO2 (27%) for travel, 57.1 kg CO2 (30%) for surgery, and 28.8 kg CO2 (15%) for waste management. This is comparable to a New York-Detroit direct flight. Conclusions: The production of a total knee prosthesis, throughout its life cycle, generates emissions with important consequences on the environment and therefore on our health. Although much data are currently missing to make precise estimates, and especially regarding benefits in terms of patient function and its impact on carbon emissions, these data serve as a starting point for other more detailed or comparative studies.

Aims: Two-stage exchange revision total hip arthroplasty (THA) performed in case of periprosthetic joint infection (PJI) has been considered for many years as being the gold standard for the treatment of chronic infection. However, over the past decade, there have been concerns about its safety and its effectiveness. The purposes of our study were to investigate our practice, collecting the overall spacer complications, and then to analyze their risk factors. Methods: We retrospectively included 125 patients with chronic hip PJI who underwent a staged THA revision performed between January 2013 and December 2019. All spacer complications were systematically collected, and risk factors were analyzed. Statistical evaluations were performed using the Student's t-test, Mann-Whitney U test, and Fisher's exact test. Results: Our staged exchange practice shows poor results, which means a 42% mechanical spacer failure rate, and a 20% recurrent infection rate over the two years average follow-up period. Moreover, we found a high rate of spacer dislocation (23%) and a low rate of spacer fracture (8%) compared to the previous literature. Our findings stress that the majority of spacer complications and failures is reflecting a population with high comorbid burden, highlighted by the American Society of Anesthesiology grade, Charlson Comorbidity Index, and Lee score associations, as well as the cardiac, pulmonary, kidney, or hepatic chronic conditions. Conclusion: Our experience of a two-stage hip exchange revision noted important complication rates associated with high failure rates of polymethylmethacrylate spacers. These findings must be interpreted in the light of the patient’s comorbidity profiles, as the elective population for staged exchange has an increasing comorbid burden leading to poor results. In order to provide better results for this specific population, our conclusion suggests that comparative strategy studies are required to improve our therapeutic indication. Cite this article: Bone Jt Open 2022;3(6):485–494.

Introduction: In cases of symptomatic knee valgum, in which deformity majorly originated in the femoral distal metaphysis, 2 main types of femoral osteotomy have been described: medial closing or lateral opening. We have been doing medial closing wedges with anterior second plane cut for years. The reason being a proven similar surgical accuracy associated to a higher and faster healing rate promoted by a larger contact area between the 2 sides of the osteotomy site. The aim of this article is to describe up-to-date closing wedge distal femoral osteotomy strategies: from indication, to ideal correction, surgical technique and patient recovery. Methods: Distal femoral varus osteotomy is indicated in painful valgus knee in which deformity originated majorly in the femoral distal metaphysis. The planning is digitally performed according to the Miniaci method using digital software to have a postoperative weight bearing line passing through the knee joint at 45% to 50% measured from the medial tibial plateau border (0%) to the lateral tibial plateau border (100%). The procedure is performed through medial closing wedges created with 2 medial to lateral and 1 posterior to anterior cutting planes creating an anterior biplanar cut. Results: Using our step-by-step way to perform closing wedge distal femoral osteotomy, we standardized our radiological and clinical outcomes. Knowing some tips and tricks to avoid intraoperative complications will help readers to master this procedure. Conclusions: Following simple intraoperative landmark and technical guidance bony deformity can be fully corrected by medial closing wedges using an anterior biplanar cut. Patients will demonstrate optimal clinical outcomes including high rate of return to recreational and professional activities.

Abstract Purpose The Pivot Shift (PS) test is a complex clinical sign that assesses the internal rotation and anterior tibial translation, which occurs abnormally in ACL deficient‐knees. Because of the high inter‐observer variability, different devices have been designed to characterize this complex movement in quantitative variables. The objective of this pilot study is to validate the reproducibility of intraoperative quantitative assessment of the PS with a smartphone accelerometer. Methods Twelve ACL‐injured knees were included and compared with the contralateral uninjured side. The PS was measured by two independent observers utilizing a smartphone accelerometer and graded according to the IKDC classification. Measurements were taken preoperatively, intraoperatively and postoperatively. Intraoperative readings were taken during each stage of reconstruction or repair of meniscoligamentous lesions including meniscal lesions, ramp lesions, ACL reconstruction and lateral tenodesis. Reproducibility of the measurements were evaluated according to an intraclass correlation coefficient (ICC). Results The intra‐observer reliability was good for the first examiner and excellent for the second examiner, with the ICC 0.89 [0.67, 0.98] p

Abstract Purpose The aim of our cadaveric study was to compare the mechanical properties of different parts of the quadriceps’ tendon in a load to failure analysis as compared to three other, and most common types of grafts that are used to perform ligament’s reconstruction. Methods Ten fresh-frozen cadavers (5 women, 5 men) were selected from our anatomical department. Mean age at death was 64 years (48–87 years). Tendons were harvested to prepare (1) different quadriceps tendon’s specimens: lateral portion (QTlat), medial portion superficial layer (QTMsup) and deep layer (QTMdeep) and central portion superficial (QTCsup) and deep layers (QTCdeep) (2) Patellar Tendon (PT), (3) Gracilis+Semi-Tendinosus specimens (GST). Specimens were stored at − 40 °C in a freezing solution. Specimens were securely attached to a dedicated loading platform, measurements were done using a validated software. Load to failure testing was then carried out. Young’s Elastic moduli, ultimate Stress (MPa) and Deformation (%) were analysed. Results The elastic moduli of the PT was significantly higher than all other grafts, all medial and central QT layers (superficial and deep) were significantly higher than its lateral part (QTlat). In terms of Ultimate Stress, all grafts were significantly greater than QTlat, PT and GST were significantly superior to QT central portions and to ITB but there did not differ with the medial portion of QT. ITB ultimate stress values were significantly higher than QTlat. The ultimate deformations of all grafts were similar. Conclusions This study provides reference values in in order to characterize different parts of the QT that presents anatomically and Mechanically with complex characteristics. Every Layer of Quadriceps Tendon’s Central and Medial Portion Offered Similar Mechanical Properties than Two Strand Hamstrings or Ilio-Tibial Band.

Background: Inadequate deformity analysis and planning before high tibial osteotomy (HTO) may result in correction errors with unsatisfactory clinical results. Indications: The purpose of this article is to describe the deformity analysis and preoperative planning before HTO. This surgery is effective for young patients with compartmental mild knee osteoarthritis. A partial deformity analysis without considering the femoral or intra-articular deformity may lead to overcorrection or excessive joint line obliquity. Preoperative planning using the Miniaci method with manual or semiautomated digital measures may help to prevent these types of errors. Technique Description: Landmarks are used at the proximal femoral side, distal condyles, proximal tibial plateau, and talus borders to define angles automatically on PeekMed software. Fujisawa point is determined to be 50% of the length of the proximal tibia, and Miniaci method is performed after defining the weightbearing line. The method can be performed manually or semiautomatically with the software. In this last case, the optimal procedure to be done to correct the malalignment is proposed by the software which automatically does the opening of the osteotomy to match the desired weightbearing axis and displays the size of the wedge in millimeters. Results: The intraobserver and interobserver reproducibility were performed by 2 different analyses and 2 different observers. The precision of the measures was confirmed based on computed tomographic (CT) scan 3-dimensional measures defined as the gold standard. All the intraobserver and interobserver reproducibility correlation coefficients and precision were satisfactory compared with the gold standard. Hip-knee-ankle angle may vary because of weightbearing situations between CT and long-axis x-rays. Discussion/Conclusion: The interest of semiautomated software for angular value measurements is now well recognized, and the inclusion of anatomical landmarks allows accurate and reproducible angular value measurements. Automatic knee osteotomy planning analyzes the metaphyseal deformity of both the tibia and the femur, and the software suggests the optimal procedure with the degree of openness to obtain the desired mechanical axis without creating excessive joint line obliquity

Medial opening wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. This article presents a technique of performing a minimally invasive OW-HTO using a patient-specific cutting guide (PSCG). Preoperative 3-dimensional planning with computed tomography imaging is essential. The correction parameters, the final plate position, as well as the 3-dimensional position of the hinge as well as wedge are verified preoperatively before the PSCG is produced. After exposure with an oblique incision over the posteromedial tibia, the hamstring tendons are released for later re-attachment and the medial collateral ligament is released slightly. The PSCG is then used to perform the OW-HTO with protection of the posterior neurovascular structures by a retractor placed posterior to the medial collateral ligament. The final fixation of the osteotomy is achieved with a low-profile locking plate and a femoral head allograft wedge.

Abstract The suspensory mechanism of the posterior horn of the lateral meniscus (PHLM) is an anatomically complex structure including the popliteomeniscal fascicles, the meniscotibial posterior root attachment and the meniscofemoral ligaments. Damage to one or several of these structures – either through knee trauma or congenital abnormalities—can result in an instability of the PHLM that may lead to lateral knee pain, locking sensations or lack of rotational control of the knee (e.g. after anterior cruciate ligament injuries). The diagnosis of PHLM instability is complex due to the lack of reliable clinical tests and imaging signs. Direct visual dynamic inspection via arthroscopy thus remains the gold standard. However, arthroscopic probing of the PHLM is not always reliable and the precise quantification of the amount of subluxation of the PHLM can be difficult. Therefore, the main objective of this report was to describe a quick and easy arthroscopic screening test called “the aspiration test” in order to help surgeons to detect PHLM instability. During the exploration of the lateral tibiofemoral compartment with the knee kept in the figure of 4 position, the arthroscope is placed in the antero‐lateral portal and directed towards the lateral tibiofemoral compartment. The aspiration test is then performed by activating the aspiration of the 4‐mm shaver when located in the intercondylar notch. In case of a PHLM instability, an excessive displacement of the PHLM is observed. After repair, a second aspiration test allows to verify that the PHLM has been stabilized.

Abstract Purpose The aim of this paper was to report the results presented in the session “Does practice of meniscus surgery change over time?” of the 2021 MENISCUS webinar held online on January 30th 2021. Method During the 2021 MENISCUS webinar, an evaluation of meniscus surgery practices was performed by analyzing: (1) The presentation of the results of a survey conducted among ESSKA members and assessing their current practices in the field of meniscus surgery, (2) Four reports by national experts analyzing the trends in Arthroscopic Partial Meniscectomy (APM) and meniscus repair procedures in their respective countries (France, Belgium, Germany and Japan). Results (1) ESSKA Survey: Among the 461 respondents, 75% of surgeons claimed to perform more meniscus repairs and 85% less APM than 5 years ago. In ACL‐associated meniscus injuries, a majority of surgeons (60%) indicated to perform a meniscal resection in less than 25% of cases. 25% declared to perform meniscus repair in ACL‐associated meniscus injuries in less than 25% of cases and 37% in more than 50% of cases. Half of the respondents repair medial or lateral root tears in less than 25% of cases. Less than 20% of respondents were not familiar with the ESSKA consensus. (2) National trends: In France, between 2005 and 2017, the APM rate decreased by 21.4%, while the repair rate increased by 320%. In Belgium, between 2007 and 2017, the APM rate decreased by 28.6%. In Germany, between 2010 and 2017 the number of APM decreased by 30%, while the number of repair procedures increased by 55%. Finally, in Japan, between 2011 and 2016, the APM ratio (APM/meniscus procedures) decreased by 16% from 91 to 75% while the repair ratio increased from 9 to 25%. Conclusion The 2021 ESSKA members' survey as well as statistics from 4 specifically examined countries (Belgium, France, Germany and Japan) suggest there has been a significant shift over the last years in the surgical management of meniscal lesions towards less APM and more conservative treatments.

Abstract Purpose The goal of this preliminary report was to show the use of novel Ultrasound (US) technology for anterior cruciate ligament (ACL) reconstruction surgery and evaluate its feasibility for the creation of a rectangular femoral bone tunnel during an arthroscopic procedure in a human cadaver model. Methods Two fresh frozen human cadaver knees were prepared for arthroscopic rectangular femoral tunnel completion using a prototype US device (OLYMPUS EUROPA SE & CO. KG). The desired rectangular femoral tunnel was intended to be located in the femoral anatomical ACL footprint. Its tunnel aperture was planned at 10 × 5 mm and a depth of 20 mm should be achieved. For one knee, the rectangular femoral tunnel was realized without a specific cutting guide and for the other with a 10 × 5 mm guide. One experienced orthopedic surgeon performed the two procedures consecutively. The time for femoral tunnel completion was evaluated. CT scans with subsequent three‐dimensional image reconstructions were performed in order to evaluate tunnel placement and configuration. Results In the two human cadaver models the two 10 × 5x20mm rectangular femoral tunnels were successfully completed and located in the femoral anatomical ACL footprint without adverse events. The time for femoral tunnel completion was 14 min 35 s for the procedure without the guide and 4 min 20 s with the guide. Conclusion US technology can be used for the creation of a rectangular femoral bone tunnel during an arthroscopic ACL reconstruction procedure. The use of a specific cutting guide can reduce the time for femoral tunnel completion. Additional experience will further reduce the time of the procedure.

Plant NF-Y transcription factors control a wide array of biological functions enabling appropriate reproductive and developmental processes as well as adaptation to various abiotic and biotic environments. In Medicago truncatula, MtNF-YA1 was previously identified as a key determinant for nodule development and establishment of rhizobial symbiosis. Here we highlight a new role for this protein in compatibility to Aphanomyces euteiches, a root pathogenic oomycete. The Mtnf-ya1-1 mutant plants showed better survival rate, reduced symptoms, and increased development of their root apparatus as compared to their wild type background A17. MtNF-YA-1 was specifically up-regulated by A. euteiches in F83005.5, a highly susceptible natural accession of M. truncatula while transcript level remained stable in A17, which is partially resistant. The role of MtNF-YA1 in F83005.5 susceptibility was further documented by reducing MtNF-YA1 expression either by overexpression of the miR169q, a microRNA targeting MtNF-YA1, or by RNAi approaches leading to a strong enhancement in the resistance of this susceptible line. Comparative analysis of the transcriptome of wild type and Mtnf-ya1-1 led to the identification of 1509 differentially expressed genes. Among those, almost 36 defence-related genes were constitutively expressed in Mtnf-ya1-1, while 20 genes linked to hormonal pathways were repressed. In summary, we revealed an unexpected dual role for this symbiotic transcription factor as a key player in the compatibility mechanisms to a pathogen.

Medicago truncatula lines resistant (A17) or susceptible (F83005.5) to the alfalfa pathogen Colletotrichum trifolii were used to compare defense reactions induced upon inoculation with C. trifolii or with the nonadapted pathogens C. lindemuthianum and C. higginsianum. Nonadapted Colletotrichum spp. induced a hypersensitive response (HR)-like reaction similar to the one induced during the host-incompatible interaction. Molecular analyses indicated an induction of PR10 and chalcone synthase genes in host and nonhost interactions but delayed responses were observed in the F83005.5 line. The clste12 penetration-deficient C. lindemuthianum mutant induced an HR and defense gene expression, showing that perception of nonadapted strains occurs before penetration of epidermal cells. Cytological and transcriptomic analyses performed upon inoculation of near-isogenic M. truncatula lines, differing only at the C. trifolii resistance locus, Ct1, with the nonadapted Colletotrichum strain, showed that nonhost responses are similar in the two lines. These included a localized oxidative burst, accumulation of fluorescent compounds, and transient expression of a small number of genes. Host interactions were characterized by a group of defense and signaling-related genes induced at 3 days postinoculation, associated with an accumulation of salicylic acid. Together, these results show that M. truncatula displays a rapid and transient response to nonadapted Colletotrichum strains and that this response is not linked to the C. trifolii resistance locus.

A pathosystem between Aphanomyces euteiches, the causal agent of pea root rot disease, and the model legume Medicago truncatula was developed to gain insights into mechanisms involved in resistance to this oomycete. The F83005.5 French accession and the A17-Jemalong reference line, susceptible and partially resistant, respectively, to A. euteiches, were selected for further cytological and genetic analyses. Microscopy analyses of thin root sections revealed that a major difference between the two inoculated lines occurred in the root stele, which remained pathogen free in A17. Striking features were observed in A17 roots only, including i) frequent pericycle cell divisions, ii) lignin deposition around the pericycle, and iii) accumulation of soluble phenolic compounds. Genetic analysis of resistance was performed on an F7 population of 139 recombinant inbred lines and identified a major quantitative trait locus (QTL) near the top of chromosome 3. A second study, with near-isogenic line responses to A. euteiches confirmed the role of this QTL in expression of resistance. Fine-mapping allowed the identification of a 135-kb sequenced genomic DNA region rich in proteasome-related genes. Most of these genes were shown to be induced only in inoculated A17. Novel mechanisms possibly involved in the observed partial resistance are proposed.

Medicago truncatula was used to characterize resistance to anthracnose and powdery mildew caused by Colletotrichum trifolii and Erysiphe pisi, respectively. Two isolates of E. pisi (Ep-p from pea and Ep-a from alfalfa) and two races of C. trifolii (races 1 and 2) were used in this study. The A17 genotype was resistant and displayed a hypersensitive response after inoculation with either pathogen, while lines F83005.5 and DZA315.16 were susceptible to anthracnose and powdery mildew, respectively. To identify the genetic determinants underlying resistance in A17, two F7 recombinant inbred line (RIL) populations, LR4 (A17 × DZA315.16) and LR5 (A17 × F83005.5), were phenotyped with E. pisi isolates and C. trifolii races, respectively. Genetic analyses showed that i) resistance to anthracnose is governed mainly by a single major locus to both races, named Ct1 and located on the upper part of chromosome 4; and ii) resistance to powdery mildew involves three distinct loci, Epp1 on chromosome 4 and Epa1 and Epa2 on chromosome 5. The use of a consensus genetic map for the two RIL populations revealed that Ct1 and Epp1, although located in the same genome region, were clearly distinct. In silico analysis in this region identified the presence of several clusters of nucleotide binding site leucine-rich repeat genes. Many of these genes have atypical resistance gene analog structures and display differential expression patterns in distinct stress-related cDNA libraries.

In this study, a new pathosystem was established using the model plant Medicago truncatula and Colletotrichum trifolii, the causal agent of anthracnose on Medicago sativa. Screening of a few M. truncatula lines identified Jemalong and F83005.5 as resistant and susceptible to Colletotrichum trifolii race 1, respectively. Symptom analysis and cytological studies indicated that resistance of Jemalong was associated with a hypersensitive response of the plant. The two selected lines were crossed, and inoculations with C. trifolii were performed on the resulting F1 and F2 progenies. Examination of the disease phenotypes indicated that resistance was dominant and was probably due to a major resistance gene. Molecular components of the resistance were analyzed through macroarray experiments. Expression profiling of 126 expressed sequence tags corresponding to 92 genes, which were selected for their putative functions in plant defense or signal transduction, were compared in Jemalong and F83005.5 lines. A strong correlation was observed between the number of up-regulated genes and the resistance phenotype. Large differences appeared at 48 h postinoculation; more than 40% of the tested genes were up-regulated in the Jemalong line compared with only 10% in the susceptible line. Interestingly, some nodulin genes were also induced in the resistant line upon inoculation with C. trifolii.

Cytokinins are phytohormones that regulate many developmental and environmental responses. The Medicago truncatula cytokinin receptor MtCRE1 (Cytokinin Response 1) is required for the nitrogen-fixing symbiosis with rhizobia. As several cytokinin signaling genes are modulated in roots depending on different biotic and abiotic conditions, we assessed potential involvement of this pathway in various root environmental responses. Phenotyping of cre1 mutant roots infected by the Gigaspora margarita arbuscular mycorrhizal (AM) symbiotic fungus, the Aphanomyces euteiches root oomycete, or subjected to an abiotic stress (salt), were carried out. Detailed histological analysis and quantification of cre1 mycorrhized roots did not reveal any detrimental phenotype, suggesting that MtCRE1 does not belong to the ancestral common symbiotic pathway shared by rhizobial and AM symbioses. cre1 mutants formed an increased number of emerged lateral roots compared to wild-type plants, a phenotype which was also observed under non-stressed conditions. In response to A. euteiches, cre1 mutants showed reduced disease symptoms and an increased plant survival rate, correlated to an enhanced formation of lateral roots, a feature previously linked to Aphanomyces resistance. Overall, we showed that the cytokinin CRE1 pathway is not only required for symbiotic nodule organogenesis but also affects both root development and resistance to abiotic and biotic environmental stresses.

N-acetylglucosamine-based saccharides (chitosaccharides) are components of microbial cell walls and act as molecular signals during host-microbe interactions. In the legume plant Medicago truncatula, the perception of lipochitooligosaccharide signals produced by symbiotic rhizobia and arbuscular mycorrhizal fungi involves the Nod Factor Perception (NFP) lysin motif receptor-like protein and leads to the activation of the so-called common symbiotic pathway. In rice and Arabidopsis, lysin motif receptors are involved in the perception of chitooligosaccharides released by pathogenic fungi, resulting in the activation of plant immunity. Here we report the structural characterization of atypical chitosaccharides from the oomycete pathogen Aphanomyces euteiches, and their biological activity on the host Medicago truncatula. Using a combination of biochemical and biophysical approaches, we show that these chitosaccharides are linked to β-1,6-glucans, and contain a β-(1,3;1,4)-glucan backbone whose β-1,3-linked glucose units are substituted on their C-6 carbon by either glucose or N-acetylglucosamine residues. This is the first description of this type of structural motif in eukaryotic cell walls. Glucan-chitosaccharide fractions of A. euteiches induced the expression of defense marker genes in Medicago truncatula seedlings independently from the presence of a functional Nod Factor Perception protein. Furthermore, one of the glucan-chitosaccharide fractions elicited calcium oscillations in the nucleus of root cells. In contrast to the asymmetric oscillatory calcium spiking induced by symbiotic lipochitooligosaccharides, this response depends neither on the Nod Factor Perception protein nor on the common symbiotic pathway. These findings open new perspectives in oomycete cell wall biology and elicitor recognition and signaling in legumes.

Aphanomyces euteiches is an oomycete pathogen that causes seedling blight and root rot of legumes, such as alfalfa and pea. The genus Aphanomyces is phylogenically distinct from well-studied oomycetes such as Phytophthora sp., and contains species pathogenic on plants and aquatic animals. To provide the first foray into gene diversity of A. euteiches, two cDNA libraries were constructed using mRNA extracted from mycelium grown in an artificial liquid medium or in contact to plant roots. A unigene set of 7,977 sequences was obtained from 18,864 high-quality expressed sequenced tags (ESTs) and characterized for potential functions. Comparisons with oomycete proteomes revealed major differences between the gene content of A. euteiches and those of Phytophthora species, leading to the identification of biosynthetic pathways absent in Phytophthora, of new putative pathogenicity genes and of expansion of gene families encoding extracellular proteins, notably different classes of proteases. Among the genes specific of A. euteiches are members of a new family of extracellular proteins putatively involved in adhesion, containing up to four protein domains similar to fungal cellulose binding domains. Comparison of A. euteiches sequences with proteomes of fully sequenced eukaryotic pathogens, including fungi, apicomplexa and trypanosomatids, allowed the identification of A. euteiches genes with close orthologs in these microorganisms but absent in other oomycetes sequenced so far, notably transporters and non-ribosomal peptide synthetases, and suggests the presence of a defense mechanism against oxidative stress which was initially characterized in the pathogenic trypanosomatids.