High prevalence of falsely declaring nicotine abstinence in lung transplant candidates

Real-time and non-invasive acute lung rejection diagnosis using confocal LASER Endomicroscopy in lung transplant recipients: Results from the CELTICS study

BACKGROUND AND OBJECTIVE

Traditionally, the diagnosis of acute rejection (AR) relies on invasive transbronchial biopsies (TBBs) to obtain histopathological samples. We aimed to evaluate the diagnostic yield of probe-based confocal laser endomicroscopy (pCLE) as a complementary and non-invasive tool for ACR screening, comparing its results with those obtained from TBBs.

METHODS

Between January 2015 and April 2022, we conducted a retrospective study of all lung transplant recipients aged over 18 years at Toulouse University Hospital (France). All patients who underwent bronchoscopies with both TBBs and pCLE imaging were included. Two experienced interpreters (TV and MS) reviewed the pCLE images independently, blinded to all clinical information and pathology results.

RESULTS

From 120 procedures in 85 patients, 34 abnormal histological samples were identified. Probe-based confocal laser endomicroscopy revealed significant associations between both alveolar (ALC) and perivascular (PVC) cellularities and abnormal histological samples (p<0.0001 and 0.003 respectively). Alveolar cellularity demonstrated a sensitivity (Se) of 85.3 %, specificity (Spe) of 43 %, positive predictive value (PPV) of 37.2 % and negative predictive value (NPV) of 88.1 %. For PVC, Se was 70.6 %, Spe 80.2 %, PPV 58.5 % and NPV 87.3 %. Intra-interpreter correlation (TV) was 88.3 % for the number of vessels (+/-1), 98.3 % for ALC and 90 % for PVC. Inter-interpreter correlation (TV and MS) was 80 % for vessels (+/-1), 97.5 % for ALC and 83.3 % for PVC.

CONCLUSION

Our study demonstrates the feasibility of incorporating pCLE into clinical practice, demonstrating good diagnostic yield and reproducible outcomes in the screening of AR in lung transplant recipients.

Testing or Trusting? Urine Cotinine Levels in Plastic Surgery

BACKGROUND

Preoperative laboratory examinations are a common practice throughout all surgical disciplines. Smoking prior to and shortly after elective aesthetic surgery is generally discouraged, but abstinence is rarely examined. Nicotine's major metabolite is cotinine, which is distributed in various body fluids, including blood, saliva, and urine. Urine cotinine levels are a useful short-term marker of nicotine exposure, whether active or passive, and correlate with daily tobacco use. Urinary levels are precise, rapid, easy to examine, and accessible.

OBJECTIVES

The aim of this literature review was to describe the current body of knowledge relevant to cotinine levels in the fields of general and plastic surgery. It was hypothesized that the current available data are enough to support the judicial use of such tests in high-risk surgical candidates, especially in aesthetic surgeries.

METHODS

A literature review via PubMed was conducted to identify publications that used the terms "cotinine" and "surgery," according to the PRISMA standard flowchart.

RESULTS

After subtracting duplications, the search results yielded 312 papers. After a reduction process as per exclusion criteria, 61 articles were identified and fully reviewed by both authors. Fifteen full-text articles were eligible for qualitative synthesis.

CONCLUSIONS

Enough data have accumulated to strongly support the judicial use of cotinine tests prior to elective surgery and specifically in aesthetic surgery.

2022 Update of indications and contraindications for lung transplantation in France

Lung transplantation (LTx) is a steadily expanding field. The considerable developments have been driven over the years by indefatigable work conducted at LTx centers to improve donor and recipient selection, combined with multifaceted efforts to overcome challenges raised by the surgical procedure, perioperative care, and long-term medical complications. One consequence has been a pruning away of contraindications over time, which has, in some ways, complicated the patient selection process. The Francophone Pulmonology Society (Société de Pneumology de Langue Française, SPLF) set up a task force to produce up-to-date working guidelines designed to assist pulmonologists in managing end-stage respiratory insufficiency, determining which patients may be eligible for LTx, and appropriately timing LTx-center referral. The task force examined the most recent literature and evaluated the risk factors that limit patient survival after LTx. Ideally, the objectives of LTx are to prolong life while also improving quality of life. The guidelines developed by the task force apply to a limited resource and are consistent with the ethical principles described below.