Prophylactic treatment of FSGS recurrence in patients who relapsed in a previous kidney graft.

BACKGROUND AND HYPOTHESIS: Recurrence of focal segmental glomerulosclerosis (FSGS) is common after kidney transplantation and is classically associated with a significant decrease in graft survival. A major risk factor is a prior history of FSGS recurrence on a previous graft. This analysis reports the impact of a prophylactic treatment of FSGS recurrence in very high-risk patients who experienced a recurrence on a previous graft. METHODS: We performed a retrospective multicentre observational study in 25 French transplantation centres. The inclusion criteria were patients aged more than 18 years who had undergone kidney transplant between December 31, 2004, and December 31, 2020, and who had a history of FSGS recurrence on a previous graft. RESULTS: We identified 66 patients: 40 received prophylactic treatment (PT+), including intravenous cyclosporine and/or rituximab and/or plasmapheresis, and 26 did not receive any prophylactic treatment (PT-). The time to progression to end-stage kidney disease was similar between groups. The PT + group was younger at FSGS diagnosis and at the time of kidney retransplantation and lost their previous graft faster. The overall recurrence rate was 72.7% (76.9% in the PT- group and 70.0% in the PT + group, P = 0.54). At least partial remission was achieved in 87.5% of patients. The 5-year graft survival was 67.7% (95% CI: 53.4 to 78.4%): 65.1% (95%CI: 48.7 to 77.4%) in patients with FSGS recurrence vs. 77.3% (95% CI: 43.8 to 92.3%) in patients without recurrence (P = 0.48). CONCLUSION: Our study suggests that prophylactic treatment should not be used routinely in patients receiving a second transplantation after recurrence of FSGS on a previous graft. The recurrence rate is high regardless of the use of prophylactic treatment. However, the 5-year graft survival remains satisfactory.

Posterior Cruciate Ligament Injury After Retrograde Nailing of Periprosthetic Distal Femur Fractures: A Report of 2 Cases.

CASE: A 51-year-old man and 64-year-old woman with bilateral cruciate-retaining total knee arthroplasties (CR-TKAs) who sustained unilateral periprosthetic distal femur fractures above their CR-TKA and experienced knee instability secondary to an iatrogenic posterior-cruciate-ligament (posterior cruciate ligament [PCL]) injury from retrograde intramedullary nailing. Both patients recovered knee stability after undergoing revision surgery. CONCLUSION: Many CR-TKA designs have sufficient medial-lateral intercondylar distance to place a retrograde nail, femoral components with a relatively posterior transition from the trochlear groove to the intercondylar box will necessitate a nail starting point closer to the PCL origin. This may contribute to iatrogenic postoperative knee instability for patients with CR-TKA designs.

Exploring the Detection of Cl- Penetration in Portland Cement Mortars via Surface Electrical Resistivity.

Surface electrical resistivity is a non-destructive technique that is sensitive to the microstructure of hydrated cement paste and the chemical composition of the pore solution in cement-based materials. In this study, a Wenner array was used to measure changes in mortar resistivity due to chloride ion diffusion as a function of electrode separation. Specimens were made from four mortar mixtures: 100% Ordinary Portland cement and 60% cement + 40% fly ash at two water/binder ratios of 0.55 and 0.40. The specimens were subjected to unidirectional chloride ion diffusion in a 2.8 M NaCl solution for 175 days. To determine the chloride penetration depth, three methods were used: silver nitrate spraying, chloride concentration profiles via potentiometric titration, and chloride concentration profiles via inversion of the resistivity data using the RES1D software (version 1.00.09 Beta). The results showed a linear relationship between the chloride ion penetration depth obtained via inversion of the surface electrical resistivity data versus the penetration depth from colorimetry and from chloride concentration profiling (both with R2 = 0.8612). Chloride penetration changed the conductivity of the pore solution; therefore, the resistivity decreased when increasing both the chloride concentration and the penetration depth. Inversion of surface resistivity data obtained with a Wenner array permitted non-destructive determination of chloride penetration. However, these results were obtained under laboratory environmental conditions and other scenarios must be addressed for wider applications.

Dissecting intra-tumor heterogeneity in the glioblastoma microenvironment using fluorescence-guided multiple sampling.

The treatment of the most aggressive primary brain tumor in adults, glioblastoma (GBM), is challenging due to its heterogeneous nature, invasive potential, and poor response to chemo- and radiotherapy. As a result, GBM inevitably recurs and only a few patients survive 5 years post-diagnosis. GBM is characterized by extensive phenotypic and genetic heterogeneity, creating a diversified genetic landscape and a network of biological interactions between subclones, ultimately promoting tumor growth and therapeutic resistance. This includes spatial and temporal changes in the tumor microenvironment, which influence cellular and molecular programs in GBM and therapeutic responses. However, dissecting phenotypic and genetic heterogeneity at spatial and temporal levels is extremely challenging, and the dynamics of the GBM microenvironment cannot be captured by analysis of a single tumor sample. In this review, we discuss the current research on GBM heterogeneity, in particular, the utility and potential applications of fluorescence-guided multiple sampling to dissect phenotypic and genetic intra-tumor heterogeneity in the GBM microenvironment, identify tumor and non-tumor cell interactions and novel therapeutic targets in areas that are key for tumor growth and the recurrence, and improve the molecular classification of GBM.

Dissecting Intra-tumor Heterogeneity in the Glioblastoma Microenvironment Using Fluorescence-Guided Multiple Sampling.

The treatment of the most aggressive primary brain tumor in adults, glioblastoma (GBM), is challenging due to its heterogeneous nature, invasive potential, and poor response to chemo- and radiotherapy. As a result, GBM inevitably recurs and only a few patients survive 5 years post-diagnosis. GBM is characterized by extensive phenotypic and genetic heterogeneity, creating a diversified genetic landscape and a network of biological interactions between subclones, ultimately promoting tumor growth and therapeutic resistance. This includes spatial and temporal changes in the tumor microenvironment, which influence cellular and molecular programs in GBM and therapeutic responses. However, dissecting phenotypic and genetic heterogeneity at spatial and temporal levels is extremely challenging, and the dynamics of the GBM microenvironment cannot be captured by analysis of a single tumor sample. In this review, we discuss the current research on GBM heterogeneity, in particular, the utility and potential applications of fluorescence-guided multiple sampling to dissect phenotypic and genetic intra-tumor heterogeneity in the GBM microenvironment, identify tumor and non-tumor cell interactions and novel therapeutic targets in areas that are key for tumor growth and recurrence, and improve the molecular classification of GBM.

Intraoperative Dysrhythmias Cease After Venting During Intramedullary Nailing of an Impending Femur Fracture: A Case Report.

CASE: A 76-year-old woman with multiple myeloma and osteoporosis presented with right hip pain and an impending atypical femoral fracture in the setting of chronic bisphosphonate use. After preoperative medical optimization, she was scheduled for prophylactic intramedullary nail fixation. Intraoperatively, the patient experienced episodes of severe bradycardia and asystole associated with intramedullary reaming, which ceased after distal venting of the femur. No additional intraoperative or postoperative complications were encountered, and the patient recovered uneventfully. CONCLUSION: Femoral canal venting may be an appropriate intervention for similar transient dysrhythmias caused by intramedullary reaming.

Congenital hydrocephalus diagnosed in a nonagenarian: Case report.

Congenital hydrocephalus after peripartum infection usually presents early in life; however, we present a 92-year-old female patient with newly diagnosed hydrocephalus secondary to peripartum infection. Intracranial imaging showed ventriculomegaly, calcifications bilaterally throughout the cerebral hemispheres, and findings suggesting a chronic process. This presentation is most likely to occur in low-resource settings, and given the risks of operation, conservative management was preferred.

Stiripentol and Lumasiran as a Rescue Therapy for Oxalate Nephropathy Recurrence After Kidney Transplantation in an Adult Patient With Primary Hyperoxaluria Type 1.

Primary hyperoxaluria type 1 is a rare cause of kidney failure. Stiripentol, an inhibitor of lactate dehydrogenase A, and lumasiran, a small interfering RNA targeting glycolate oxidase, have been proposed as therapeutic options, but clinical data are scarce, especially in adults and transplanted patients. We describe the case of a 51-year-old patient with a biopsy-proven recurrence of oxalate nephropathy after a kidney-only transplantation. He received stiripentol and lumasiran without adverse events. Fourteen months after transplantation, graft function, serum, and urinary oxalate levels have remained stable, and kidney biopsy showed a complete regression of oxalate crystals. Further studies are needed to assess whether this strategy is effective and could replace liver-kidney transplantation.

Experiencias adquiridas de las enseñanzas de procesos sustantivos en el enfrentamiento a la COVID-19 desde una perspectiva enfermera / Lessons Learned from Substantive Process Teachings in Coping with COVID-19 from a Nursing Perspective

Introducción: El personal de enfermería cumple un papel fundamental en tiempos de pandemia, porque aporta conocimientos, habilidades y experiencias de vida unido al equipo de salud. Objetivo: Comprender las experiencias adquiridas de las enseñanzas de los procesos sustantivos en el enfrentamiento a la COVID-19 en la práctica pediátrica, desde una perspectiva enfermera. Métodos: Estudio cualitativo fenomenológico transcendental, realizado en Hospital Pediátrico "Octavio de la Concepción", Holguín, Cuba, en el período febrero-abril de 2021. Se integraron experiencias de ocho enfermeras, siete médicos, cinco estudiantes de medicina y cinco de enfermería, seleccionados por muestreo no probabilístico. Se obtuvo la información a través de entrevistas semiestructuradas. Se recurrió a tres etapas, descriptiva (elección de técnica, entrevista, elaboración de la descripción), estructural (lectura, determinación del tema central, expresión en lenguaje científico) y discusión (comparación de hallazgos con los de otros investigadores) para entender diferencias y similitudes. Resultados: Del análisis de los datos emergieron tres categorías: a) Experiencias adquiridas en las enseñanzas durante la COVID-19 en los procesos sociales. b) Experiencias adquiridas en las enseñanzas durante la COVID-19 para los profesionales de la salud. c) Experiencias adquiridas en las enseñanzas durante la COVID-19 para el personal en formación. Conclusiones: Se evidenció la implementación de acciones sanitarias y de apoyo social en la accesibilidad a los sistemas de salud. La oportunidad de compartir experiencias con expertos que facilitaron el diseño de protocolos, generación continua de evidencia científica y la formación de estudiantes con métodos alternativos(AU)

Introduction: Nurses play a critical role in times of pandemic because they bring knowledge, skills, and life experiences together with the healthcare team. Objective: To understand the experiences gained from the lessons learned from the substantive processes in dealing with COVID-19 in pediatric practice, from a nursing perspective. Methods: Transcendental phenomenological qualitative study, carried out at the Pediatric Hospital "Octavio de la Concepción", Holguín, Cuba, in the period from February to April 2021. The experiences of eight nurses, seven physicians, five medical students and five nursing students, selected by non-probabilistic sampling, were integrated. Information was obtained through semi-structured interviews. Three stages were used: descriptive (choice of technique, interview, and formulation of the description), structural (reading, determination of the central theme, expression in scientific language) and discussion (comparison of findings with those of other researchers) to understand differences and similarities. Results: Three categories emerged from the data analysis: a) Experiences acquired in the teachings in the COVID-19 in social processes. b) Experiences acquired in the teachings in the COVID-19 for health professionals. c) Experiences acquired in the teachings in the COVID-19 for personnel in training. Conclusions: The implementation of health and social support actions in accessibility to health systems was evidenced. The opportunity to share experiences with experts facilitated the design of protocols, continuous generation of scientific evidence and the training of students with alternative methods(AU)

Representación social sobre gestión de servicios hospitalarios pediátricos para atender sospechosos de COVID-19 desde una perspectiva enfermera / Social Representation about Pediatric Hospital Services for Providing Care to Patients Suspected of COVID-19 from a Nursing Perspective

Introducción: Resulta indispensable la organización de los servicios pediátricos en el actual proceso de enfrentamiento a la pandemia COVID-19. Objetivo: Describir, desde una perspectiva enfermera, la representación social sobre gestión en la organización de los servicios hospitalarios pediátricos para la atención de pacientes sospechosos de COVID-19. Métodos: Estudio cualitativo de orientación metodológica fenomenológica transcendental, realizado en Hospital Pediátrico "Octavio de la Concepción de la Pedraja", Holguín, Cuba, entre enero y abril del 2021. Se integraron los conocimientos adquiridos de la experiencia de enfermeras, cinco supervisoras, tres jefas de áreas y ocho jefas de salas, seleccionadas por muestreo no probabilístico. Se recurrió a las etapas: descriptiva, estructural y discusión. La descriptiva constó de tres etapas: elección de técnica, entrevista semiestructurada y elaboración de la descripción. La etapa estructural: lectura, determinación del tema central, expresión en lenguaje científico y etapa de discusión de los resultados, se relacionaron con las conclusiones y hallazgos de investigadores para entender las posibles diferencias o similitudes para mayor enriquecimiento. Resultados: Del análisis de los datos emergieron cuatro categorías: Categoría I: diseño de los protocolos de atención de enfermería para pacientes sospechosos y positivos a COVID-19. Categoría II: reorganización, reclutamiento y capacitación de personal. Categoría III: organizar grupos de trabajo según cuadro clínico y resultado del test rápido y el PCR. Categoría IV: medidas generales. Conclusiones: La organización de los servicios de atención de enfermería por grupos evitó el colapso del recurso humano enfermero y garantizó la disponibilidad de camas, la seguridad propia y del paciente para minimizar la transmisibilidad intrahospitalaria(AU)

Introduction: The organization of pediatric services is essential in the current process of confronting the COVID-19 pandemic. Objective: To describe, from a nursing perspective, the social representation on management in the organization of pediatric hospital services for the care of patients suspected of COVID-19. Methods: A qualitative study of transcendental phenomenological methodological orientation was carried out at Octavio de la Concepción de la Pedraja Pediatric Hospital from Holguín, Cuba, between January and April 2021. The knowledge acquired from the experience of nurses, five supervisors, three area heads and eight ward chiefs, selected by nonprobabilistic sampling, was integrated. The following phases were used: descriptive, structural and discussion. The descriptive phase consisted of three stages: choice of technique, semistructured interview and elaboration of the description. The structural phase had the following stages: reading, determination of the central topic and expression in scientific language. In the results discussion phase, the results were related to the conclusions and findings of researchers to understand the possible differences or similarities for further enhancement. Results: Four categories emerged from the data analysis: design of nursing care protocols for COVID-19 positive and suspect patients; reorganization, recruitment and training of personnel; organization of working groups according to clinical picture and rapid test or PCR results; and general measures. Conclusions: The organization of nursing care services by groups avoided the collapse of the nursing human resource and guaranteed the availability of beds, as well as staff own safety and patient safety, to minimize in-hospital transmissibility(AU)

Weak antibody response to three doses of mRNA vaccine in kidney transplant recipients treated with belatacept.

Poor responses to mRNA COVID-19 vaccine have been reported after 2 vaccine injections in kidney transplant recipients (KTRs) treated with belatacept. We analyzed the humoral response in belatacept-treated KTRs without a history of SARS-CoV-2 infection who received three injections of BNT162b2-mRNA COVID-19 vaccine. We also investigated vaccine immunogenicity in belatacept-treated KTRs with prior COVID-19 and characterized symptomatic COVID-19 infections after the vaccine in belatacept-treated KTRs. Among the 62 belatacept-treated KTRs (36 [58%] males), the median age (63.5 years IQR [51-72]), without COVID-19 history, only four patients (6.4%) developed anti-SARS-CoV-2 IgG with low antibody titers (median 209, IQR [20-409] AU/ml). 71% were treated with mycophenolic acid and 100% with steroids in association with belatacept. In contrast, in all the 5 KTRs with prior COVID-19 history, mRNA vaccine induced a strong antibody response with high antibody titers (median 10 769 AU/ml, IQR [6410-20 069]) after two injections. Seroprevalence after three-vaccine doses in 35 non-belatacept-treated KTRs was 37.1%. Twelve KTRs developed symptomatic COVID-19 after vaccination, including severe forms (50% of mortality). Breakthrough COVID-19 occurred in 5% of fully vaccinated patients. Administration of a third dose of BNT162b2 mRNA COVID-19 vaccine did not improve immunogenicity in KTRs treated with belatacept without prior COVID-19. Other strategies aiming to improve patient protection are needed.

A kidney discard decision strategy based on zero-time histology analysis could lead to an unjustified increase in the organ turndown rate among ECD.

The utility of zero-time kidney biopsies (KB) in deciding to accept expanded criteria donor (ECD) kidneys remains controversial. However, zero-time histology is one of the main causes for discarding kidneys in the United States. In a single-centre study, we examined the utility and impact on outcome of the use of frozen section zero-time KB among ECD. Ninety-two zero-time KB were analysed for accept/discard decision between 2005 and 2015 among ECD. 53% of kidneys were rejected after zero-time KB analysis; there was no difference in individual clinical and biological data between accepted/rejected groups. However, histology of rejected kidneys showed more sclerotic glomeruli (20% vs. 8%; P < 0.001), increased interstitial fibrosis (1.25 ± 0.12 vs. 0.47 ± 0.09; P < 0.0001), more arteriosclerosis (2.14 ± 0.17 vs. 1.71 ± 0.11; P = 0.0032) and arteriolar hyalinosis (2.15 ± 0.12 vs. 1.55 ± 0.11; P = 0.0006). Using propensity score matching, we generated a group of 42 kidney allograft recipients who received a transplant matched for donor zero-time histology and clinical characteristics with donors whose kidneys were rejected. Interestingly, their 1- and 5-year graft survival and function were similar to the global cohort of ECD recipients. In conclusion, when performed, zero-time KB was a decisive element for kidney discard decision. However, adverse zero-time histology was not associated with poorer graft survival and kidney function among ECD.

Growth arrest of a refractory vestibular schwannoma after anti-PD-1 antibody treatment.

A 25-year-old man presented with left-sided hearing loss, blurred vision and papilloedema. Imaging revealed a large, left-sided, contrast-enhancing cerebellopontine mass causing obstructive hydrocephalus, consistent with vestibular schwannoma (VS). Following an incomplete resection via retrosigmoid craniotomy at an outside facility, he was referred to our department, and cerebrospinal fluid diversion followed by repeat resection was recommended. A subtotal resection was achieved, and the patient was subsequently treated with adjuvant stereotactic radiosurgery (SRS). Progressive interval growth was observed on serial post-SRS MRI studies; correspondingly, at 31 months after treatment, the patient was initiated on antiprogrammed-death receptor 1 (PD-1) antibody treatment with pembrolizumab. Growth arrest was noted on subsequent serial imaging studies, which have been maintained for a total of 30 months since initiation of a 18-month anti-PD-1 course of therapy. Additional case accumulation and translational study is required to better characterise this therapeutic strategy; however, PD-1/programmed death-ligand 1 inhibition may offer a promising salvage therapy for refractory VS.

[Contrast-induced acute kidney injury]. / Toxicité rénale des produits de contraste radiologiques.

The nephrotoxicity of iodinated contrast agent/media is defined by acute renal failure occurring within 48 to 72 hours after injection of iodized contrast product, in the absence of other etiology. The risk factors for contrast agent renal injury must systematically be sought before the exam. The presence of risk factors, including the existence of a renal failure defined by a creatinine clearance (eGFR) of less than 60 mL/min/1.73 m2, requires to take prevention measures including hydration. If eGFR is less than 30 mL/min/1.73 m2, the advice of a nephrologist is necessary.

Evaluación de la eficacia de los protocolos de recuperación mejorada en cirugía cardiaca. Protocolo de Ensayo Clínico Aleatorizado / Assessment of the efficacy of improved recovery protocols in cardiac surgery. Randomized Clinical Trial Protocol

Introducción: Múltiples son los artículos publicados que abordan el tema de la ciencia abierta y su importancia para la sociedad, especialmente para la comunidad de investigadores. Esta constituye, ineludiblemente, el presente y futuro de las revistas científicas como método de expandir las investigaciones con alta calidad y credibilidad. La ciencia abierta como movimiento, tiene varios componentes y dentro de ellos, la gestión de citas y referencias de datos, códigos y materiales, que fundamentan la necesidad de que los autores tengan disponibles los contenidos subyacentes a los artículos que se publican y que constituyen la base de los resultados obtenidos en cada investigación. Objetivo: Evaluación de la eficacia de los protocolos de recuperación mejorada en cirugía cardiaca. Métodos: El protocolo que se propone fue elaborado por la investigadora principal (registro público cubano de ensayos clínicos RPCEC00000304) y se describe acorde a las recomendaciones de la lista internacional de chequeo para ensayos clínicos (SPIRIT). Conclusiones: Estarían en relación a si se puede demostrar, después de terminada la investigación, si el protocolo motivo de la Intervención, es mejor, igual o peor que el protocolo de control(AU)

Introduction: There are multiple articles published that address the subject of open science and its importance for society, especially for the research community. This constitutes, inevitably, the present and future of scientific journals as a method of expanding research with high quality and credibility. Open science, as a movement, has several components including the management of citations and references of data, codes and materials, which support the need for authors to have available the underlying content of the articles published and constituting the base for the results obtained in each investigation. Objective: Assessment of the efficacy of improved recovery protocols in cardiac surgery. Methods: The proposed protocol was prepared by the main researcher (Cuban public registry of clinical trials: RPCEC00000304) and is described according to the recommendations of the international checklist for clinical trials (SPIRIT). Conclusions: They would be related to whether it can be demonstrated, after the end of the investigation, if the protocol reason for the intervention is better, equal to, or worse than the control protocol(AU)