Optimal donation of kidney transplants after controlled circulatory death

Controlled donation after circulatory death (cDCD) is used for “extended criteria” donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain-dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI] 1.12–1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20–2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31–2.44). The 1-year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol.     

The behavioral summarized evaluation: Validity and reliability of a scale for the assessment of autistic behaviors

The Behavioral Summarized Evaluation (BSE), is a 20-item paper- and-pencil rating scale specifically designed for the measurement of behavioral parameters which could be related to biological data in autistic children involved in educational programs, neurophysiological studies, and therapeutic trials. The development of the scale, the validity, and reliability studies are presented in this paper. The results suggest that the BSE is an acceptable tool for the assessment of autistic behaviors, easy to handle, and accessible to both professionals and paraprofessionals of the medico-educative staff. It is a useful addition to the bioclinical researcher's evaluation battery for bioclinical and therapeutic studies. However, more work is suggested to further investigate the psychometric properties of this behavior assessment instrument.This study was supported by CNRS, by INSERM U 316 Nervous System from the Foetus to the Child, Development, Circulation, Metabolism, L. Pourcelot, CNAMTS No. 2748/88, FRM 1986, Conseil Régional Région Centre, Contrat No.7.040.000, INSERM, and Fondation Langlois. The authors thank S. Lancrenon, Department of Biophysics and Biomathematics (J. Fermanian), C.H.U. Pitie-Salpetriere, Paris, for her helpful suggestions and assistance. They also thank Mrs. Barre and Miss Lioret for their technical work.     

Surgical pitfalls in a patient with type IV Ehlers-Danlos syndrome and spontaneous colonic rupture

PURPOSE: This paper intends to stress the importance of early diagnosis and discuss surgical treatment of Type IV Ehlers-Danlos syndrome (EDS-4), an autosomal dominant connective tissue disease characterized by typical features of the face and extremities, inappropriate and easy bruising, and extreme tissue fragility, which may lead to dramatic and often fatal complications, mostly spontaneous arterial or intestinal rupture. METHODS: We report the case of a 41-year-old female who presented with spontaneous perforation of the sigmoid colon. RESULTS: The patient was seen over a nine-year period, during which time she required six operations and presented with a great number of surgical complications including stenosis of an end-colostomy, repeated subocclusive episodes caused by intraperitoneal adhesions, and enterocutaneous fistulas, finally ending with an ileostomy and short bowel syndrome. It is only after a difficult laparotomy for ovarian cyst excision, marked by numerous adhesions and friable bowel, that the diagnosis of EDS-4 was considered and established. CONCLUSIONS: In case of “idiopathic” spontaneous perforation of the colon in a young adult, features of EDS-4 should be thoroughly looked into and, if found, skin fibroblast culture with collagen Type III analysis performed. The surgical treatment of choice consists of subtotal colectomy and permanent endileostomy. In case of patient refusal, a second-stage ileorectal anastomosis can be performed but carries the high risk of anastomotic leakage.     

Insulin acutely regulates the expression of the peroxisome proliferator-activated receptor-gamma in human adipocytes

Peroxisome proliferator-activated receptor (PPAR)-gamma is one of the key actors of adipocyte differentiation. This study demonstrates 1) that PPAR-gamma mRNA expression is not altered in subcutaneous adipose tissue (n = 44) or in skeletal muscle (n = 19) of subjects spanning a wide range of BMIs (20-53 kg/m2) and 2) that insulin acutely increases PPAR-gamma mRNA expression in human adipocytes both in vivo and in vitro. The effect of insulin was investigated in abdominal subcutaneous biopsies obtained before and at the end of a 3-h euglycemic-hyperinsulinemic clamp. Insulin significantly increased PPAR-gamma mRNA levels in lean subjects (88 +/- 17%, n = 6), in type 2 diabetic patients (100 +/- 19%, n = 6), and in nondiabetic obese patients (91 +/- 20%, n = 6). Both PPAR-gamma1 and PPAR-gamma2 mRNA variants were increased (P < 0.05) after insulin infusion. In isolated human adipocytes, insulin induced the two PPAR-gamma mRNAs in a dose-dependent manner, with half-maximal stimulation at a concentration of approximately 1-5 nmol/l. However, PPAR-gamma2 mRNA was rapidly (2 h) and transiently increased, whereas a slow and more progressive induction of PPAR-gamma1 was observed during the 6 h of incubation. In explants of human adipose tissue, PPAR-gamma protein levels were significantly increased (42 +/- 3%, P < 0.05) after 12 h of incubation with insulin. These data demonstrate that PPAR-gamma belongs to the list of the insulin-regulated genes and that obesity and type 2 diabetes are not associated with alteration in the expression of this nuclear receptor in adipose tissue.     

Long-term enhancement of REM sleep by the pituitary adenylyl cyclase-activating polypeptide (PACAP) in the pontine reticular formation of the rat

In rats, rapid eye movement (REM) sleep can be elicited by microinjection of vasoactive intestinal polypeptide (VIP) into the oral pontine reticular nucleus (PnO). In the present study, we investigated whether this area could also be a REM-promoting target for a peptide closely related to VIP: the pituitary adenylyl cyclase-activating polypeptide (PACAP). When administered into the posterior part of the PnO, but not in nearby areas, of freely moving chronically implanted rats, PACAP-27 and PACAP-38 (0.3 and 3 pmol) induced a marked enhancement (60-85% over baseline) of REM sleep for 8 h that could be prevented by prior infusion of the antagonist PACAP-(6-27) (3 pmol) into the same site. Moreover, injections of PACAP into the centre of the posterior PnO resulted in REM sleep enhancement which could last for up to 11 consecutive days. Quantitative autoradiography using [125I]PACAP-27 revealed the presence in the PnO of specific binding sites with high affinity for PACAP-27 and PACAP-38 (IC50 = 2.4 and 3.2 nM, respectively), but very low affinity for VIP (IC50 > 1 microM). These data suggest that PACAP within the PnO may play a key role in REM sleep regulation, and provide evidence for long-term (several days) mechanisms involved in such a control. PAC1 receptors which have a much higher affinity for PACAP than for VIP might mediate this long-term action of PACAP on REM sleep.     

Meningococci throughout the world : Phenotypic and molecular markers.

The first markers of meningococci were serogroup, defined by different polyosidic capsular immunospecifities (12 are described at present), and are still of great importance. Several other antigenic structures such as outer membrane proteins (OMPs) are used as markers : OMP serotypes of classes 2 and 3, OMP subtype of class 1. Serogroups, serotypes, subtypes and sometimes immunotypes (based on LPS) are associated in an antigenic formula (AF). At a world-wide level, the Electrophoretic Type (ET) defined by Multilocus Enzyme Electrophoresis (MLEE) is the most useful marker. For instance, the ET-5 and ET-37 have been described. The ET-5 was constituted primarily, but not exclusively, by strains of AF:B:15:P1.7,16 and B:4:P1.15. The ET-37 was constituted mostly by strains C:2a:P1.2,5. Two pandemics were due to Neisseria meningitidis serogroup A. They were mainly defined by MLEE. The first began in China in 1966, crossed Europe, and ended in Brazil in 1974 where it was responsible for a particularly widespread outbreak. The second pandemic, due to the same epidemic invasive strain A:4:P1.9/clone III-1 also began in China in 1983, spreading through Nepal, northern India. It was responsible for a severe oubreak in Mecca in August of 1987. It spread all around the world when the pilgrims returned to their countries. In countries with adequate health care facilities, the pandemic was stropped within two or three weeks. Unfortunately, in countries without these health care facilities, the spreading continues. For instance in Africa, specifically Niger, strains of this type continued to be isolated through the beginning of 1996. Molecular epidemiology markers like pulsotype and ribotype for instance, are able to demonstrate genetic variability between strains.     

Effects of bistramide A on a non-small-cell bronchial carcinoma line

Summary The antiproliferative effects of bistramide A, a nitrogenous dilactam polyether fromLissoclinum bistratum Sluiter (Urochordata), were studied at the level of the cell cycle in asynchronous cells of the NSCLCN6-L16 line. Bistramide A has a dual mechanism that induces blockade in the G1 phase (compatible with differentiation properties reported elsewhere) and causes polyploidy that is suggestive of inaptitude for cytokinesis. These effects confirm the results of cytomorphology studies in electron microscopy.