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.

Livres numériques et bibliothèques publiques en Europe francophone : quelle offre ?

En 2014 apparaissent en France les premières plateformes de prêt numérique du système PNB (Prêt numérique en bibliothèques). Le système est basé sur une architecture en étoile et les libraires indépendants font partie intégrante du projet.

Se sont posés rapidement des freins techniques (majoritairement liés au verrou numérique d’Adobe) et économiques (coût de l’infrastructure et des acquisitions). Le projet fait pourtant montre d’un caractère novateur, avec un modèle qui permet la simultanéité des prêts.

À ce jour, plus de 500 réseaux de bibliothèques ont rejoint le dispositif, notamment grâce aux espoirs qui reposent sur le nouveau verrou numérique « LCP » et aux négociations de l’association Réseau Carel, qui défend les intérêts des bibliothécaires. Des négociations économiques importantes demeurent néanmoins à mener, et un très grand groupe éditorial reste à convaincre de l’adoption de la simultanéité.

Le manque d’approche globale du projet initial a été partiellement comblé par l’ouverture du projet aux bibliothèques départementales de prêt, mais dont beaucoup hésitent encore à s’engager. Quant à lui, le réseau de lecture publique belge francophone suit, au sein de PNB, une approche coopérative originale qui permet à l’ensemble de sa population d’accéder au même catalogue global.

Hemoperitoneum in peripartum: A case-series

Hemorrhages are the first cause of perinatal deaths in French women. Thirteen percent of these deaths are not linked to obstetrical problems but rather to hemoperitoneum. These incidents are under-diagnosed and as a result, treatment is delayed and fetal and maternal mortality increases. We report three cases of patients, all White female in their last trimester of a non-problematic pregnancy presenting with hemoperitoneum and resulting in different outcomes. The analysis of published materials and of our cases leads us to infer that a diagnosis of hemoperitoneum must be considered in pregnant women when abdominal pain, symptoms of shock and a decrease in hemoglobin are associated. An immediate response and intensive care followed by hemostatic surgery give these patients the best chance to survive.

Necroptosis and parthanatos are involved in remote lung injury after receiving ischemic renal allografts in rats

Early renal graft injury could result in remote pulmonary injury due to kidney-lung cross talk. Here we studied the possible role of regulated necrosis in remote lung injury in a rat allogeneic transplantation model. In vitro, human lung epithelial cell A549 was challenged with TNF-α and conditioned medium from human kidney proximal tubular cells (HK-2) after hypothermia-hypoxia insults. In vivo, the Brown-Norway rat renal grafts were extracted and stored in 4 °C Soltran preserving solution for up to 24 h and transplanted into Lewis rat recipients, and the lungs were harvested on day 1 and day 4 after grafting for further analysis. Ischemia-reperfusion injury in the renal allograft caused pulmonary injury following engraftment. PARP-1 (marker for parthanatos) and receptor interacting protein kinase 1 (Rip1) and Rip3 (markers for necroptosis) expression was significantly enhanced in the lung. TUNEL assays showed increased cell death of lung cells. This was significantly reduced after treatment with necrostatin-1 (nec-1) or/and 3-aminobenzamide (3-AB). Acute immune rejection exacerbated the remote lung injury and 3-AB or/and Nec-1 combined with cyclosporine A conferred optimal lung protection. Thus, renal graft injury triggered remote lung injury, likely through regulated necrosis. This study could provide the molecular basis for combination therapy targeting both pathways of regulated necrosis to treat such complications after renal transplantation.

[Enophtalmos of the anophtalmic socket: incidence of the orbital morphology and therapeutic implications. Clinical study of 86 cases]

AIM OF THE STUDY

From a light asymmetry to a sunken eye aspect, a great disparity between the results after anophtalmic socket rehabilitation is noticeable: what are the factors involved in the degree of residual enophtalmos following excision of the eye? The litterature's response is based on physiopathological considerations around intraorbital architectural disturbance. We propose a geometrical approach related to the existence of different morphological types of orbit.

PATIENTS AND METHOD

Eighty-six records of eviscerated and enucleated patients have been studied and submitted to a statistical analysis. A preliminary study has defined four types of orbit depending on the shape and operture of the orbital "window": two opposite types IA and III, a type II intermediate and a particular one, the type IB. A classification of enophtalmos' degree allows to analyze the parameters chosen and to identify the predictive factors.

RESULTS

The statistical analysis confirms the incidence of the orbital morphology on the degree of enophtalmos but do not support the theories based on the intraorbital septal architecture changes. Depending on the orbital shape and the container-content relation, the volume loss is more visible on the whole orbitopalpebral surface of opened and high orbit but remains centered on the anteroposterior position of the implant of a closed and lengthened orbit. At the contrary to the type III, the type IA is not favorable for the anophtalmic patient and predispose to a higher degree of enophtalmos. This new approach has therapeutic implications on primary and secondary surgery for volume loss replacement.

CONCLUSION

The success of anophtalmic socket rehabilitation is influenced by the orbital morphological type that has to be considered in the therapeutic strategy.

[Erectile dysfunction, sexuality and sociocultural aspects]

Perception of sexuality varies considerably from population to population and their cultural inheritance, depending on whether you consider occidental, oriental or African cultures. In a wider concept of environment, worries, anxiety or stress induced by work, family, social and economic factors may have a negative impact on sexual functions. Quantitative surveys on sexuality try to measure the incidence of love feelings on sexual behaviour but they cannot determine the close overlaps between mind and body. To give his partner satisfaction, men do not always need performing well. Men also have right to love women, their own ways and according to their means. Impotence or erectile dysfunction (ED) is nowadays a subject that is more and more studied on conceptual, epidemiological as much as clinical levels. Taking this trouble into consideration is relatively new for the general public and seems to coincide with the launching towards the end of the last decade of the first real effective oral treatment, the phosphodiesterase 5 (PDE5) inhibitors and of the communication developed around this event. Demand for sexual problems management seems to be on the increase.

[Erectile dysfunction in diabetic patients]

Because of its frequency, erectile dysfunction must be systematically screened for in diabetic patients because, according to a survey by the ADIRS-AFD, it has affected 66% of patients for a mean of 6 years, and 77% wish it could be treated. From a physiopathological point of view, erectile disorders in diabetic patients are related to the vascular and neurological complications of diabetes and the various associated risk factors. The treatment to propose is at first iPDE5, although there is a risk of lesser efficacy in a diabetic patient and potential contraindications with the administration of derived nitrates. Intracavernous injections of PGE1 are efficient and safe second line and specialised advice is only required in the case of failure.

[Couple, sexuality and sexual health]

Sexuality remained for a long time in the intimacy domain, judged worthy of a consultation reason only and yet as an illness cause or a male failure. Besides, dyspareunia and various women's illnesses took more time to be worthy of interest and care. And now it seems almost as if a turnaround were taking place. This mutation will probably induce some cultural changes. This paper focuses on the fifty-year-old man, in a world in which sexuality, from a universal right, becomes an obligation with the need for means and results, a requirement for performance. In order to discover how to approach these old problems with nowadays tools, we carried out a Medline review on sexuality and impotence, or erectile dysfunction (ED), which is a real problem in public health policy concerning more than 150 million men all over the world and more than 2 million in France. The analysis of the main papers associated with our own experience, allows us to better understand the changes in men/women relationship and the disclosure of male fragility, visible in the management of their well-being, their state of anxiety fowards this new women's control which probably influences their attitude in front of ageing and its consequences.

Acceptance, efficacy and preference of Sildenafil in patients on long term auto-intracavernosal therapy: a study with follow-up at one year

PURPOSE

To assess the acceptance, long term efficacy and preference of Sildenafil in impotent patients previously on auto-intracavernosal therapy.

MATERIALS AND METHODS

The patients were the 107 men (mean age 58.4 y) on auto-intracavernosal therapy (auto-IC) for more than 6 months (mean duration 32.7 months >12 months in 100) who were consecutively seen within 6 months of the launch of Sildenafil in France. If there was no contra-indications to Sildenafil they were proposed a trial of Sildenafil at home. Following this trial they were given the possibility to change their therapy and were followed for 1 y at 3 months intervals.

RESULTS

Three patients had contra-indications to Sildenafil. Of the remaining 104, 45 (43%) refused the trial, mainly because they were afraid of possible cardiac risks (n=21, including 51% of the psychogenic and mixed patients compared to 8% of the predominantly organic ones). Among the 59 who tried it, Sildenafil gave good results in 46 (78%), including 100% of the predominantly psychogenic and 61.5% of the predominantly organic ones) with minimum effective doses of 25 mg in 7, 50 mg in 18 and 100 mg in 21. It failed in 9 (15%) and gave average results in 4 (penetration with a non fully satisfying erection). There was a clear relationship between the sensitivity to Sildenafil and that to Alprostadil, the vasoactive agent predominantly used for the auto-ICIs. Every 46 patients with good result of Sildenafil elected to continue with this drug, including 3 who used both Sildenafil and auto-ICIs in alternance. Every 4 patients with average results elected to continue with auto-ICI including 1 who also used Sildenafil in alternance. Five of the 50 patients with good or average results were lost to follow-up within 6 months. At the 1 y follow-up visit, 43 of the 45 others were still using Sildenafil, in alternance with auto-ICI in 1. No one reported a decrease in efficacy with time. The 2 patients with average results still in the study were on auto-ICIs.

CONCLUSION

Sildenafil is highly effective in the impotent men previously treated with auto-ICI and its efficacy is maintained at least for 1 y. When tried and effective it is preferred by most men but almost half of our patients refused trying it.

[Heart rupture by closed chest trauma]

Cardiac rupture is certainly unrecognised in the context of closed chest trauma. There have been few reports in the literature despite the fact that autopsy series show that it is the second cause of death after serious thoracic injury. The authors report three cases of traumatic rupture of the heart. The clinical presentation, apart from cardiogenic shock, differs according to whether there is an associated rupture of the pericardium. When the pericardium is intact, the diagnosis is suggested by the signs of tamponade: With earlier treatment of trauma by medical teams, this lesion should be diagnosed as soon as possible. Echocardiography has many indications in closed chest trauma. Early surgical intervention is the only treatment of these lesions.

[Sexuality of the diabetic woman]

Diabetes Mellitus frankly increases the prevalence of sexual problems in men, mainly in the form of erectile dysfunctions. Its effects on sexual function of the diabetic women have been less objectively studied, due to cultural reasons and methodological difficulties. The different phases of the sexual cycle, as well as their physiological control, are similar in human males and females. Several studies suggest an increased prevalence of sexual problems also in diabetic females. Their rate seems similar to that of the males. An increased prevalence of Female Sexual Arousal Disorder has been found in 6 studies of 6 comparing diabetic to non diabetic females. Its main symptom was a deficient vaginal lubrication, making sexual intercourse unpleasant. This disorder is the female equivalent to erectile dysfunction. It probably results from similar mechanisms, involving damages in the vascular and autonomic nervous systems, as well as alteration in the nitric oxide production and efficacy. The prevalence of Hypoactive Sexual Desire Disorder was also increased in most studies (5 of 8, significantly in 3). This could result from the increased prevalence of depression in diabetic females. The Dyspareunia's prevalence was not significantly increased (0 of 6 studies). Available figures are not consistent as regards the orgasmic disorders (prevalence increased in only 4 of 8 studies). No significant correlation of female sexual dysfunction with diabetes duration, balance, or complications has been found. Conversely some significant correlations with depression or poor acceptance of diabetes have been found, supporting a causative role of psychological factors. Although still limited the therapeutic options should not be neglected. Merely prescribing a water soluble lubricating gel may greatly improve the sexual life of couples. Doctors should talk themselves about sexual function with their female diabetic patients. Most of these are too much embarrassed to ask themselves their doctor, although their sexual problems may seriously interfere with their quality of life and that of their partner.

Epidemiological analysis of patients with Type 2 diabetes in France

This paper presents the baseline epidemiological data from 5548 patients with type 2 diabetes enrolled in a French observational study that aims to examine the safety, tolerability and use of acarbose as prescribed by general practitioners (GPs). Patients were recruited and monitored by a representative sample of GPs. Recruitment did not depend on a patient's suitability for acarbose treatment. The data revealed that the mean age of the patient population was 63 years, and that more than 50% of patients were over 65 years old. The population was markedly overweight [mean body mass index(BMI): males, 28.4 kg/m(2); females, 29.1 kg/m(2)] and the mean duration of diabetes was 10 (+/-7.3) years. Over 37% of patients had at least one diabetic complication, and the frequency of complications increased with both age and the duration of diabetes. The most frequently reported complications were cardiac (17.8%), vascular (14.5%) and ocular (12%). At recruitment, almost 90% of patients were being treated with oral antidiabetic agents (OADs). Sulphonylureas (74%) and biguanides (50%) were the most commonly prescribed agents. Acarbose was used to treat 17% of patients and 1% were receiving insulin. GPs set glycaemic treatment goals for 44% of patients in the study. Fasting glycaemia was the primary goal for 37% of the total study population, and HbA(1c) levels for 21% of patients. Postprandial glycaemia was generally given as a secondary or tertiary goal. In conclusion, this study provides the most up-to-date epidemiological data for patients with type 2 diabetes in France.

Parallel synthesis of a library of 1,4-naphthoquinones and automated screening of potential inhibitors of trypanothione reductase from Trypanosoma cruzi

Solid- and solution-phase parallel syntheses of 1,4-naphthoquinones (1,4-NQ) are described. A library of 1360 amides was constructed from the combination of 12 newly synthesised 1,4-NQ carboxylic acid and 120 amines, and was screened for inhibition of trypanothione reductase (TR) from Trypanosoma cruzi. The most active hits from a primary screening were re-synthesised and confirmed. This approach proves that it is possible to design potent and highly specific TcTR inhibitors deriving from menadione, juglone and plumbagin.

[Erectile response to intracavernous injection of linsidomine in 38 impotent patients. Comparison with prostaglandin E1]

OBJECTIVE

To test the effects of intracavernous injection of Linsidomine, an NO donor, and to compare the results to those obtained after injection of PGE1.

MATERIAL AND METHODS

38 subjects with erectile insufficiency received an intracavernous injection of 10 micrograms of PGE1, followed by an intracavernous injection of 1 mg of linsidomine at least 3 days later. The erectile response after linsidomine was compared to that obtained after PGE1. 21 patients were investigated by Duplex ultrasound after each injection.

RESULTS

Linsidomine induced complete rigidity in 4 subjects considered to suffer from psychogenic impotence (versus 11 subjects with PGE1) and 1 subject considered to suffer from arterial disease (versus 8 subjects with PGE1). The maximal systolic velocities recorded after linsidomine were significantly correlated with those measured in the same subject after PGE1. The resistance index was not modified after linsidomine injection.

CONCLUSION

Our study confirms the impact of linsidomine on the local mechanisms of erection. It shows that linsidomine is much less effective than PGE1, but nevertheless has a place in the therapeutic armamentarium of impotence.

Endocrine screening in 1,022 men with erectile dysfunction: clinical significance and cost-effective strategy

PURPOSE

We reviewed the results of serum testosterone and prolactin determination in 1,022 patients referred because of erectile dysfunction and compared the data with history, results of physical examination, other etiological investigations and effects of endocrine therapy to refine the rules of cost-effective endocrine screening and to pinpoint actual responsibility for hormonal abnormalities.

MATERIALS AND METHODS

Testosterone and prolactin were determined by radioimmunoassay. Every patient was screened for testosterone and 451 were screened for prolactin on the basis of low sexual desire, gynecomastia or testosterone less than 4 ng./ml. Determination was repeated in case of abnormal first results. Prolactin results were compared with those of a previous personal cohort of 1,340 patients with erectile dysfunction and systematic prolactin determination. Main clinical criteria tested regarding efficiency in hormone determination were low sexual desire, small testes and gynecomastia. Endocrine therapy consisted of testosterone heptylate or human chorionic gonadotropin for hypogonadism and bromocriptine for hyperprolactinemia.

RESULTS

Testosterone was less than 3 ng./ml. in 107 patients but normal in 40% at repeat determination. The prevalence of repeatedly low testosterone increased with age (4% before age 50 years and 9% 50 years or older). Two pituitary tumors were discovered after testosterone determination. Most of the other low testosterone levels seemed to result from nonorganic hypothalamic dysfunction because of normal serum luteinizing hormone and prolactin and to have only a small role in erectile dysfunction (definite improvement in only 16 of 44 [36%] after androgen therapy, normal morning or nocturnal erections in 30% and definite vasculogenic contributions in 42%). Determining testosterone only in cases of low sexual desire or abnormal physical examination would have missed 40% of the cases with low testosterone, including 37% of those subsequently improved by androgen therapy. Prolactin exceeded 20 ng./ml. in 5 men and was normal in 2 at repeat determination. Only 1 prolactinoma was discovered. These data are lower than those we found during the last 2 decades (overall prolactin greater than 20 ng./ml. in 1.86% of 1,821 patients, prolactinomas in 7, 0.38%). Bromocriptine was definitely effective in cases with prolactin greater than 35 ng./ml. (8 of 12 compared to only 9 of 22 cases with prolactin between 20 and 35 ng./ml.). Testosterone was low in less than 50% of cases with prolactin greater than 35 ng./ml.

CONCLUSIONS

Low prevalences and effects of low testosterone and high prolactin in erectile dysfunction cannot justify their routine determination. However, cost-effective screening strategies recommended so far missed 40 to 50% of cases improved with endocrine therapy and the pituitary tumors. We now advocate that before age 50 years testosterone be determined only in cases of low sexual desire and abnormal physical examination but that it be measured in all men older than 50 years. Prolactin should be determined only in cases of low sexual desire, gynecomastia and/or testosterone less than 4 ng./ml.

[Role of hormones in sexual dysfunctions, homosexuality, transsexualism and deviant sexual behavior: diagnostic and therapeutic consequences]

Hormones only play a minor role in sexual dysfunctions. They are clearly involved only in erectile dysfunction. Total testosterone is low in 8% of those patients, but only 32% of them are improved with androgen therapy. Free testosterone is also electively decreased in 30% and bioavailable (non SHBG bound) testosterone in 15%. However androgen-therapy is still less effective in these subgroups. Plain hyperprolactinemia is found in only 0,7% of the cases. Half of them result from a pituitary adenoma. The other endocrine dysfunctions are still scarcer. This data cannot justify a systematic determination of serum prolactin and testosterone in sexual dysfunctions. A cost effective hormonal screening is proposed, whereas the role of androgen-therapy in erectile dysfunction with or without hypogonadism is discussed. The hypothesis of an "inverted brain sexual differentiation" in homosexuality and for transsexualism, resulting from an abnormal antenatal endocrine milieu is reviewed. It cannot obviously explain by itself these conditions, but some amazing morphological findings in transsexual people do not permit to totally refute it. Lastly the role of androgens in paraphilia and parapaphilia related disorders seems limited to the arousal of an abnormal sexual behaviour previously scheduled by non hormonal mechanisms. However anti-androgens are in such cases one of the main effective treatment.

Intracavernous pharmacotherapy: comparison of Moxisylyte and prostaglandin E1

We report in this retrospective study the results obtained with the first two drugs proposed to reduce the relatively high rates of priapism and fibrosis bound to the papaverine intracavernous injections, i.e. the alpha-blocking agent Moxisylyte (Mox), and prostaglandin E1 (PGE1). Each drug was used for auto-injections in 130 patients with a comparable mean follow up (14.8 months with Mox compared to 14.6 with PGE1). PGE1 proved to be significantly more efficacious (good results in 71% of the patients vs 50% with Mox), especially in the arteriogenic patients (respectively 96% vs 46%). Conversely PGE1 induced prolonged erections in significantly more patients (11 vs 1 with Mox), including 2 priapisms, and also induced pain in more patients (12 vs 1 with Mox). The rate of fibrotic nodules and plaques was low (2 and 3 patients). Despite the better tolerance of Mox, its continuation rate was significantly lower than that of PGE1, PGE1 can be the first choice agent in most cases. Mox is mainly indicated in the patients with supersensitivity to the injections and in those with significant pain following PGE1.

[Strategy of clinical intervention in families of alexithymic patients]

Authors study psychiatric symptoms coexisting with psychosomatic disorders and artistic behaviours, in alexithymia. Building genealogy brings informations on their family system, and opens way to psychotherapeutic treatment.

[Treatment of impotence with intracavernous auto-injections: moxisylyte diminishes the risks compared to papaverine]

The alpha-blocking agent Moxisylyte was tested in auto-intracavernous injections (auto-ICI) in 72 impotent patients. The side-effects were compared to those observed in a group of 34 impotent patients treated with auto-ICI of Papaverine during the same period of time. The Moxisylyte auto-ICI improved 83% of the patients including 68% reporting a complete and durable success. Moxisylyte proved to be safer due to a reduced rate of prolonged erections (1.3% of the patients versus 8.8% with Papaverine) and corporeal fibrosis (1.3% versus 32% with Papaverine). Though less potent than Papaverine, and often seeming insufficient when tested in the office, this type of alpha-blocking agent could be tried in a first time in most candidates to auto-ICI before resorting to Papaverine or Prostaglandin E1 if it fails.

Septicemias in cancer patients during parenteral nutrition: Contributing factors and detection by weekly blood cultures

Infections constitute the main complication of parenteral nutrition, particularly in cancer patients, but prediction of catheter-related septicemias (CRS) has been little investigated. We have evaluated, in 200 consecutive episodes of parenteral nutrition (PN) in cancer patients, the factors contributing to infectious complications, and the predictive value of weekly blood cultures performed through the nutrition catheter. The median duration of PN was 22 days with a total of 5816 patient-days of PN, neutropenia (neutrophils < 1,000/microl) being present in 872 (15%). Catheters were placed either in a jugular vein (71% single-lumen silicone catheters, 18.5% double-lumen Hickman-Broviac catheters) or in a femoral vein (10.5%). We observed 62 episodes of septicemia of which 22 were CRS (11% incidence for the 200 cycles) and 40 were non-CRS (20% incidence); CRS were mostly due to Staphylococcus epidermidis (14/22). Neutropenic patients as a group did not suffer more CRS than non-neutropenic patients, but the risk of CRS was slightly increased when expressed per day of neutropenia (8 CRS/872 days vs 14 CRS/4942 days without neutropenia, P < 0.05). On the other hand, a femoral insertion site was associated with a much higher incidence of CRS (9 CRS/21 femoral catheters vs 13 CRS/179 jugular catheters, P < 0.0001). It was possible to evaluate 20 episodes of CRS for their predictability by weekly blood cultures: the sensitivity for detecting CRS due to Staphylococcus epidermidis was 67%, the specificity 92%, the negative predictive value 98% and the positive predictive value 36%. The simple and widely available procedure of routine surveillance blood cultures performed through the PN catheter should be further investigated, because it could help the clinician to determine the origin of recent fever, particularly to exclude CRS and avoid unnecessary removal of PN catheters.