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.     

Probing nano-scale adhesion force between AFM and acid demineralized intertubular dentin: Moist versus dry dentin

Objective

The aim of this study was to investigate the effect of dentin dryness on the variation in the probed nano-scale adhesion force between an AFM silicon nitride tip and demineralized intertubular dentin collagen fibrils network surface.

Methods

Dentin specimens were etched with 37% phosphoric acid for 15 s and then divided into three groups. Specimens of the first two groups were air-dried for 5 or 10 s (DH5s and DH10s), respectively, whereas specimens of the third group were left in the hydrated condition (H). For each group, Force curves were characterized by contact-mode AFM and the adhesion force (Fad) was calculated. The structure of the demineralized collagen fibrils network was characterized by tapping mode AFM. The tensile bond strength (TBS) to dentin was evaluated using one alcohol-based dentin self-priming adhesive. The dentin/resin interface was investigated by SEM.

Results

Dentin specimens in the wet-hydrated condition (H) showed significantly higher adhesion force and TBS values than dry-dehydrated specimens (DH5s and DH10s). AFM images showed open collagen fibrils network structure in wet-hydrated specimens (H), while the dry-dehydrated specimens (DH5s and DH10s) showed a collapsed appearance to varying degrees. SEM images revealed minimum resin infiltration in dry-dehydrated specimens.

Significance

The nano-scale adhesion force between the AFM probe and demineralized intertubular dentin surface was shown to be sensitive to surface air-drying. The decrease in the nano-scale adhesion force with the increase in the time of air-dryness is related to dehydration of the demineralized collagen fibrils network surface.     

Investigation of mtDNA control region sequences in an Egyptian population sample

The sequences of mitochondrial DNA (mtDNA) control region were investigated in 101 unrelated individuals living in the northern region of Nile delta (Gharbia, N = 55 and Kafrelsheikh, N = 46). DNA was extracted from blood stained filter papers or buccal swabs. HV1, HV2 and HV3 were PCR amplified and sequenced; the resulted sequences were aligned and compared with revised Cambridge sequence (rCRS). The results revealed presence of total 93 different haplotypes, 86 of them are unique and 7 are shared haplotypes, the most common haplotype, was observed with a frequency, 2.97% of population sample. High mtDNA diversity was observed with genetic diversity and power of discrimination, 0.9982 and 0.9883, respectively. In this dataset the west Eurasian haplogroups predominated over the African haplogroups. The results would be useful for forensic examinations and human genetic studies.     

Supplementation of general anaesthesia with tramadol or fentanyl in parturients undergoing elective Caesarean section

Purpose

Tramadol has been recommended for analgesia in parturients undergoing vaginal delivery. The present report investigated the effect of tramadol versus fentanyl on umbilical vein (UV) blood gases and Apgar scores of neonates delivered via elective Caesarean section under general anaesthesia.

Methods

Forty ASA I or II parturients undergoing elective Caesarean section were included in a randomized double-blinded study. The patients were divided into a tramadol (n = 20) and fentanyl groups (n =.20). During preoxygenation, one group received 100 mg tramadoliv, while the second received 100 μg fentanyl. Anaesthesia was induced in both groups by 3 mg·kg^?1 thiopentone and 1.5 mg·kg^?1 succinylcholine was given to facilitate tracheal intubation. Anaesthesia was maintained during the induction-delivery period with nitrous oxide 50% in oxygen.

Results

The umbilical vein PO₂ was higher in the fentanyl (34 ± 5 mmHg) than in the tramadol group (24 ± 6 mmHg) (P < 0.01), while the UV PCO₂ was higher in the tramadol group (50 ± 5vs 45 ± 4 mmHg) (P 0.01). The Apgar scores at one and five minutes were not different between the two groups. Post operatively, two patients in the tramadol group recalled the crying of their newborn at delivery.

Conclusion

Tramadol is associated with a high incidence of intraoperative maternal recall and can result in lower umbilical vein PO₂ and higher PCO₂ than in the fentanyl group.