Impact of Transplantation Timing on Renal Graft Survival Outcomes and Perioperative Complications

Nighttime organ transplantation aims to decrease cold ischemia duration, yet conflicting data exists on its impact on graft function and perioperative complications. This multicenter TRANSPLANT'AFUF study including 2,854 patients, transplanted between 1 January 2011, and 31 December 2022, investigated nighttime kidney transplantation's impact (8:00 p.m.-8:00 a.m.) versus daytime (8:00 a.m.-8:00 p.m.) on surgical complications and graft survival. Overall, 2043 patients (71.6%) underwent daytime graft, while 811 (28.4%) underwent nighttime graft. No impact was observed of timing of graft surgery on graft survival with a median survival of 98 months and 132 months for daytime and nightime grafting, respectively (p = 0.1749). Moreover, no impact was observed on early surgical complications (Clavien I-II = 20.95% for DG and 20.10% for NG; Clavien III-IV-V = 15.42% for DG and 12.94% for NG; p = 0.0889) and late complications (>30 days) (Clavien I-II = 6.80% for DG and 5.67% for NG; Clavien III-IV-V = 12.78% for DG and 12.82% for NG; p = 0.2444). Noteworthy, we found a significant increase in Maastricht 3 donors' rates in nighttime transplantation (5.53% DG vs. 21.45% NG; p < 0.0001). In conclusion, nighttime kidney transplantation did not impact early/late surgical complications nor graft survival.

How colonization bottlenecks, tissue niches, and transmission strategies shape protozoan infections

Protozoan pathogens such as Plasmodium spp., Leishmania spp., Toxoplasma gondii, and Trypanosoma spp. are often associated with high-mortality, acute and chronic diseases of global health concern. For transmission and immune evasion, protozoans have evolved diverse strategies to interact with a range of host tissue environments. These interactions are linked to disease pathology, yet our understanding of the association between parasite colonization and host homeostatic disruption is limited. Recently developed techniques for cellular barcoding have the potential to uncover the biology regulating parasite transmission, dissemination, and the stability of infection. Understanding bottlenecks to infection and the in vivo tissue niches that facilitate chronic infection and spread has the potential to reveal new aspects of parasite biology.

Molecular genetics of pulmonary hypertension in children

Until recently, the molecular aetiology of paediatric pulmonary hypertension (PH) was relatively poorly understood. While the TGF-β/BMP pathway was recognised as central to disease progression, genetic analyses in children were largely confined to targeted screening of risk genes in small cohorts, with clinical management extrapolated from adult data. In recent years, next-generation sequencing has highlighted notable differences in the genetic architecture underlying childhood-onset cases, with a higher genetic burden in children partly explained by comorbidities such as congenital heart disease. Here, we review recent genetic advances in paediatric PH and highlight important risk factors such as dysregulation of the transcription factors SOX17 and TBX4. Given the poorer prognosis in paediatric cases, molecular diagnosis offers a vital tool to enhance clinical care of children with PH.

Recurrent Strokes as the First Presentation of Occult Pancreatic Cancer; Trousseau Syndrome: A Case Report

Cerebrovascular disorders (CVDs) are widespread in cancer patients, exacerbating their condition and lowering their prognosis. Approximately 15% of cancer patients have a coexisting CVD. Stroke may occur after the initial cancer diagnosis or before the diagnosis of malignant disease. The underlying causes of stroke in cancer patients are distinct from those in noncancer patients and are related to both cancer itself and the type of treatment. Cardio-embolism, large vessel atherosclerosis, and small vessel occlusion have all been identified as important causes of ischemic stroke, but nonbacterial thrombotic endocarditis has been documented only infrequently. We present a case of a 64-year-old female with recurrent ischemic stroke of unknown cause and involving different arterial territories, who was discovered to have metastatic pancreatic cancer. The initial workup with brain imaging revealed multiple acute/subacute ischemic strokes and a negative cardiac assessment. Accordingly, she underwent a whole-body positron emission tomography-computed tomography which revealed a hypermetabolic mass lesion in the pancreaticoduodenal area. Our case indicates that cancer-associated stroke should be seriously evaluated. It demonstrates the critical nature of contemplating hidden cancer in survivors of ischemic stroke and identifies factors that may necessitate further investigation as part of a comprehensive approach to ischemic stroke, especially embolic stroke of unknown sources.

The correlation between smart device usage & sleep quality among UAE residents

BACKGROUND

The usage of smart-devices has increased considerably both globally and specifically in Middle Eastern countries. Recently, it has been shown that 65% of United Arab Emirates (UAE) residents lack proper sleep. Several health aspects of the relationship between over usage of smart-devices and poor sleep quality have not been thoroughly investigated. This study aims to determine the correlation between smart-device overuse and sleep quality among UAE residents.

METHODS

This is a cross-sectional, self-administered questionnaire-based study. Our sample comprised 494 participants, from the three major cities in the UAE. Statistical and regression analyses were conducted using SPSS.

RESULTS

Overall, 47.5% of the population were considered heavy users of smart-devices, of which 81% were poor sleepers. Furthermore, the physical proximity of the smart-device at night affected sleep quality; as the distance decreased, the sleep quality worsened, reaching a value of 86.8%. It was also found that 74.5% of the participants used their smart-device at bedtime.

CONCLUSION

Poor sleep is strongly correlated with smart-device overuse. Specifically, poor sleepers were five times more likely to be overusers. The intensity and duration of smart-device usage during the whole day impacted sleep quality more drastically than just before bedtime usage. With the increasing dependence and inappropriate use of smart-devices, future studies are needed to further understand the short and long term impact of this trend on the health and wellbeing of younger individuals as well as the whole community.

[The third dimension of the face aging, improvement of its understanding]

OBJECTIVES

Over the past 30 years, surface imaging has made tremendous progress. Surgical management has also been subject of numerous technical and strategic developments. For a better understanding of the curative strategies of face aging, the authors have put into perspective the three-dimensional data acquired up to date.

METHOD

A review of the literature focused on the three-dimensional study of facial aging was carried out.

RESULTS

Thanks to the precision of new surface acquisition systems and larger patient cohorts, our understanding of surfaces and volumes is now much more accurate. 3D, particularly highlights the major impact of aging on the perioral area, which was up to now neglected compared to other facial areas.

CONCLUSION

A technical discussion is needed to identify the best techniques to correct the defects and provide a natural result for those anatomical areas that are heavily impacted by aging but not corrected in the final.

Depression and the risk of autoimmune disease: a nationally representative, prospective longitudinal study

BACKGROUND

Autoimmune diseases are associated with substantial morbidity and mortality, yet the etiology remains unclear. Depression has been implicated as a risk factor for various immune-related disorders but little is known about the risk of autoimmune disease. This study examined the association between depression and the risk of autoimmune disease, and investigated the temporal and dose-response nature of these relationships.

METHOD

A prospective population-based study including approximately 1.1 million people was conducted using linked Danish registries. Depression and autoimmune diseases were diagnosed by physicians and documented in medical records. In total, 145 217 individuals with depression were identified between 1995 and 2012. Survival analyses were used to estimate the relative risk of autoimmune disease among those with, compared to without, depression. Analyses were adjusted for gender, age, and co-morbid mental disorders.

RESULTS

Depression was associated with a significantly increased risk of autoimmune disease [incidence rate ratio (IRR) 1.25, 95% CI 1.19-1.31], compared to those without a history of depression. Results suggest a general increased risk of autoimmune diseases following the onset of depression during first year (IRR 1.29, 95% CI 1.05-1.58), which remained elevated for the ensuing 11 years and beyond (IRR 1.53, 95% CI 1.34-1.76). Findings did not support a dose-response relationship.

CONCLUSIONS

Depression appears to be associated with an increased risk of a range of autoimmune diseases. Depression may play a role in the etiology of certain autoimmune conditions. If replicated, findings could highlight additional clinical implications in the treatment and management of depression. Future studies are needed to investigate the possible social, genetic, and neurobiological underpinnings of these relationships.

Médiatisation et «greffe de visage» ou «à qui appartient la greffe de visage»?

Mediatisation of a scientific event could be neither controlled, nor verifiable. The experience which has been lived through the first worldwide allotransplantation of composite tissues of the face confirms that the actors of a surgical innovation are not the owners. Because there is neither confidentiality nor possible patent. Curiously the scientific world, providing with a sharing ethic, which rightly privileges the free spreading of knowledge in the way that most people could benefit of it. Obviously it is made without denied controversy, for truth as purpose. This scientific word that way joins the media one, with a specific ethic of the duty of information, but also interested in mercantile preoccupations quick to cultivate controversy not to enlighten this truth but to better sell pictures or papers. Than the author should only sustain this instrumentation which could certainly flatter him, and from which he could used, but in reality that paralysed him a little to go on in serenity with his shadow worker way.

Effect of a clinical pathway on the hospitalisation rates of children with asthma: a prospective study

AIM

To determine the effect of implementing a clinical pathway, using evidence-based clinical practice guidelines, for the emergency care of children and adolescents with asthma.

METHODS

A prospective, before-after, controlled trial was conducted, which included patients aged 1-18 years who had acute exacerbations of asthma treated in a tertiary care paediatric emergency department. Data were collected for identical 2-month seasonal periods before and after implementation of the clinical pathway to determine hospitalisation rate and other outcomes. For 2 weeks after emergency visits, the rate at which patients returned to emergency care for worsening asthma was evaluated. A multidisciplinary panel, using national guidelines and a systematic review, developed the pathway.

RESULTS

267 patients were studied. The rate of hospitalisation was significantly lower in the post-implementation group (10/74; 13.5%) than in the pre-implementation control group (53/193; 27.5%; p = 0.02; number needed to treat 7.1). All reduction in hospitalisation occurred in children with moderate to severe asthma exacerbation. After implementation of the clinical pathway, the rate of administration of oral corticosteroids to patients with moderate or severe exacerbations increased from 71% to 92% (p = 0.01), and significantly more patients received beta2-agonists in the first hour (p = 0.02). No significant change in relapse to acute care occurred within 2 weeks (p = 0.19).

CONCLUSIONS

An evidence-based clinical pathway for children and adolescents with moderate to severe exacerbations of acute asthma markedly decreases their rate of hospitalisation without increased return to emergency care.

Comparison of two computerassisted surgery techniques to guide a mandibular distraction osteogenesis procedure Technical note

The accuracy of distracted facial bone displacement depends on the preoperative clinical assessment, surgical planning and technique. The aim of this study was to evaluate two different techniques to guide the mandibular distraction surgical procedure using an intraoral device. This study was performed on a fresh cadavre. 3D reconstructions from a computed tomographic (CT) acquisition were used for the two techniques. The first technique comprised a customised stereolithographic template and the second technique used a computer-assisted surgery (CAS) unit to guide the osteotomy and the positioning and screwing of the distractor device. Both methods were planned and compared with the same 3D software. The authors discuss the feasibility and reliability of the two techniques. The accuracy of the two techniques appears to be comparable for clinical applications, although the rapid prototyping template technique appears to be more satisfactory.

Three-dimensional imaging of the petrous bone for the middle fossa approach to the internal acoustic meatus: an experimental study

The goal of this study was to highlight the feasibility of creating three-dimensional (3D) pictures of the petrous bone from a routine CT examination which can be used for a middle fossa approach to the internal acoustic meatus, in order to secure this operation. The surgical aim is to reach the roof of the internal acoustic meatus directly without injuring the adjacent functional structures of the petrous bone. Two heads of embalmed cadavers were scanned every millimeter with a slice thickness of 1 mm centered on the petrous bones. The horizontal reference was the Frankfurt line and the frontal and sagittal planes were perpendicular to this line. This method is similar to routine examinations for surgical patients. The pictures were first loaded on an optical disk, then into a computer (Silicon Graphics System). Amira software was used to create 3D pictures. The anatomy of the temporal bone could easily be identified, notably the surgical landmarks of the middle fossa approach. Three-dimensional computer-assisted imaging can reveal the anatomy of the petrous bone in a realistic view. The main anatomic structures for a middle fossa approach can be recognized easily. This realistic view may be very useful for surgeons, and 3D images deserve to be developed further.

[Orthognathic surgery and stereolithographic models. A new technic of dental occlusion transfer]

Use of stereolithographic models in orthognathic surgery is limited by the difficult in considering the facial osteotomies and the dental occlusion at the same time. Different techniques allow the surgeon to perform the simulation using composite prototypes after including the dental casts on the models. These techniques require complex "stereotaxic" systems or a surgical approach before CT scanning in order to insert the reference screws. They cannot overcome the problem of mandibular movement during the CT session. Our technique is a simple way to include the dental casts in the stereolithographic model with high precision. This can easily be done in a maxillo-facial environment and does not require any further special knowledge other than that which can be aquired in a classical dental laboratory. The occlusion transfer is achieved with a silicon cast of the teeth and the bony structures of the sterolithographic model on which we include the plaster dental casts. The silicone cast of the dental occlusion can also be used to decrease the mandibular movement during CT scanning.

[Microsurgery and ballistic traumatology of the face]

The use of free flaps to fill and repair facial defects due to suicidal gunshot wounds has considerably extended and refined the possibilities available to reconstructive surgeon. The objective is no longer to close the defect at any cost, or "fill a hole", but to replace missing tissue by an identical tissue, able to restore an identical cosmetic appearance, support equivalent constraints, and restore analogous function. Retrospective analysis of 56 cases of large facial defects due to gunshot wounds revealed a total of 66 free flaps for 32 cases. The vascular quality of the flaps allowed better integration in a sometimes hostile recipient site and markedly reduced the treatment time. Although the objective results obtained in the treatment of these severe defects remain poor, the first-line use of these multiple flaps, exclusively reserved for deep repair, as the basis for reconstruction, has modified our behaviour. A real medium-term treatment strategy, based on a decision flow-chart, can be proposed which, despite several inevitable failures, leaves less room for improvisation and piecemeal surgery. Free flaps are only the hidden part of the reconstruction, as surface cover uses local flaps and other conventional reconstructive surgery techniques. However, this humble, hidden role is nevertheless fundamental, in the strict sense of the term, and guides the general approach to this surgery.