Increased incidence and unusual presentations of CMV disease in kidney transplant recipients after conversion to belatacept

Belatacept may increase cytomegalovirus (CMV) disease risk after conversion from CNI-based therapy. We analyzed CMV disease characteristics after belatacept conversion. Propensity score matching was used to compare CMV disease incidence in belatacept- and CNI-treated kidney transplant recipients (KTRs). CMV disease characteristics and risk factors under belatacept were analyzed. In total, 223 KTRs (median age [IQR] 59.2 years [45.4–68.5]) were converted to belatacept (median of 11.5 months [2.5–37.0] post-transplantation); 40/223 (17.9%) developed CMV disease. Independent risk factors included increased age (p = .0164), D+/R− CMV serostatus (p = .0220), and low eGFR at conversion (p = .0355). Among 181 belatacept-treated patients matched to 181 controls, 32/181 (17.7%) experienced CMV disease (vs. 5/181 controls [2.8%]). CMV disease cumulative incidences were 6.33 and 0.91/100 person-years (p-y) in belatacept and control groups, respectively. CMV disease risk was particularly high in elderly patients (converted >70 years) and those with eGFR <30 ml/min; cumulative incidences were 18.4 and 5.2/100 p-y, respectively. CMV diseases under belatacept were atypical, with late-onset disease (24/40 patients [60%]), high CMV seropositivity (27/40, 67%), increased severe and tissue-invasive disease rates (gastrointestinal involvement in 32/40 [80%]) and life-threatening diseases (4/40 [10%]). These findings should stimulate further research to secure the use of belatacept as a valuable rescue therapy in KTRs.     

Effect of age and care organization on sources of variation in kidney transplant waiting list registration

Despite national guidelines, medical practices and kidney transplant waiting list registration policies may differ from one dialysis/transplant unit to another. Benefit risk assessment variations, especially for elderly patients, have also been described. The aim of this study was to identify sources of variation in early kidney transplant waiting list registration in France. Among 16 842 incident patients during the period 2016–2017, 4386 were registered on the kidney transplant waiting list at the start of, or during the first year after starting, dialysis (26%). We developed various log-linear mixed effect regression models on three levels: patients, dialysis networks, and transplant centers. Variability was expressed as variance from the random intercepts (± standard error). Although patient characteristics have an important impact on the likelihood of registration, the overall magnitude of variability in registration was low and shared by dialysis networks and transplant centers. Between-transplant center variability (0.23 ± 0.08) was 1.8 higher than between-dialysis network variability (0.13 ± 0.004). Older age was associated with a lower probability of registration and greater variability between networks (0.04, 0.20, & 0.93 in the 18–64, 65–74, and 75–84 age groups). Targeted interventions should focus on elderly patients and/or certain regions with greater variability in waiting list access.     

Feasibility of health-related quality of life (HRQoL) assessment for cancer patients using electronic patient-reported outcome (ePRO) in daily clinical practice

Quality of Life Research - Routine Electronic Monitoring of Health-Related Quality of Life (HRQoL) (REMOQOL) in clinical care with real-time feedback to physicians could help to enhance...     

Effects of local fatigue of the lower limbs on postural control and postural stability in standing posture

Postural stability and postural control were studied before and after a fatigue protocol of soleus muscles. Postural stability was assessed by the centre of gravity motion, which was computed from the motion of the centre of pressure, evaluating the postural control. Ten healthy male subjects were asked to stand as still as possible with eyes open before and after the fatigue protocol, performed in a sitting position. Fatigue was assumed on the basis of a shortening of the exertion time of the soleus muscles at 60% of their maximal voluntary contraction. Results of the whole group showed that fatigue modified postural control but did not change postural stability. The same results were observed only for some subjects. However, these results indicate an increase of the neuromuscular activity in high frequencies.     

多道听觉脑干植入的临床应用

目的　探讨多道听觉脑干植入的手术方法及其对恢复双侧听神经瘤所致全聋患者听力的效果。方法　 7例双侧听神经瘤患者 ,在肿瘤摘除后将 2 1道听觉脑干植入 (auditorybrainstemimplant,ABI)电极植入于第四脑室外侧隐窝内 ,直接刺激脑干耳蜗核 ,术中以面神经电图、舌咽神经肌电图及电诱发听觉脑干反应 (electricallyevokedauditorybrainstemresponses,EABR)确定电极的正确位置。术后 6周开通装置并调试 ,定期行言语识别能力测试。结果　 6例患者术中均能准确定位外侧隐窝 ,并能记录到典型的EABR ;术后均能获得不同程度的言语识别能力 ,其中 2例获得开放句识别能力。另 1例患者术中解剖定位困难 ,术中未能记录到EABR。术后电极刺激 1例无非听觉反应、5例部分电极产生非听觉反应、1例全部电极均产生非听觉反应 ,有非听觉反应的相应电极被关闭。结论　多道听觉脑干植入能使因双侧听神经瘤而全聋的患者产生有意义的听觉 ,术中正确定位脑干耳蜗核为手术成功的关键。     

Local pharmacological manipulations of prefrontal dopamine affect conflict behaviour in rats

Several lines of research have implicated the prefrontal cortex (PFC) and its dopaminergic (DA) innervation in an animal's response to stress and anxiety. To extend these findings we evaluated the effects of bilateral infusions of DA drugs into the medial PFC of rats, in a modified conflict test, consisting of Reward, Conflict and Time-out components. In experiment 1, the effects of infusions of the DA receptor agonist apomorphine (APO) were compared to the effects of systemic injections of the same drug. APO infusions induced a dose-dependent decrease of responding in the Conflict component, indicative of an anxiogenic-like effect. However, response rates in the Reward component were simultaneously decreased, casting some doubt on the specificity of the effect. In comparison, i.p injections of APO in a second group of animals did not affect responding in the Conflict component, but dose-dependently decreased response rates during Time-out and Reward components. In experiment 2, we evaluated the effects of infusions of APO and the DA receptor antagonist cis-flupenthixol (FLU) into the medial PFC in the conflict test, and in one of its variants, the extinction of conflict test. Although both APO and FLU decreased response rates during Reward components, responding in the Conflict components of both tests was differentially affected. APO infusions decreased Conflict responses, the effect being more pronounced in the extinction of conflict test. In contrast, infusions of FLU increased responding in the Conflict components. The respective pro- and anti-conflict effects of APO and FLU infusions are in favour of a direct involvement of prefrontal DA in anxiety-related behavioural responses.     

Epidemiology of lyme disease in France: Lyme borreliosis in the region of Berry sud: A six year retrospective

The purpose of this epidemiologic retrospective is to recognize the endemic nature of Lyme borreliosis in Berry, region of France. Fifty-nine cases have been reported here during the past six years (1988–1994). An erythema migrans (EM), or a late manifestation concurrent with positive ELISA-test represents the main inclusion criterion (case definition used by the CDC). The results reveal a high incidence considering the limited information available in France. The farmer has been found to be mainly at risk, with EM being observed in 49% of cases. In general, late manifestations are rarely described. Peripheral neurological manifestations occur more frequently than those reported in the USA. The steps taken as a result of our study of Lyme disease are in accordance with the recommendations of the World Health Organization.Participants in this survey: GEEP, Groupe d'Etudes Epidémiologiques et Prophylactiques, Centre Hospitalier Intercommunal de Villeneuve Saint Georges, France; and ORMAT, Observatoire Rural des Maladies Transmissibles, Antenne du GEEP, Centre Hospitalier de La Châtre, France}