Ureteral complications in the renal transplant recipient after laparoscopic living donor nephrectomy

OBJECTIVES: We report on ureteral and surgical complications in our first 110 consecutive recipients of kidneys procured with laparoscopic living donor nephrectomy (LLDN). METHODS: The records of all living donor transplants with LLDN performed between February 1999 and December 2004, including 10 pediatric transplants, were reviewed retrospectively. Three urologists performed LLDN using a pure laparoscopic non-hand-assisted transperitoneal technique. Kidney transplantation was performed in a standard fashion. For ureteroneocystostomy, the intravesical Politano-Leadbetter (P-L) technique was used. RESULTS: Two-year patient and graft survival was 99% and 98%, respectively. Serum creatinine at 12 months was 1.36+/-0.1mg/dl in adult and 0.99+/-0.23 mg/dl in pediatric recipients. Nineteen right donor kidneys were transplanted into adult recipients. Surgical complications included three symptomatic lymphoceles, one peritransplant haematoma and one kinking of a lower pole artery. All five (4.5%) ureteral complications occurred in adult recipients with a mean age of 33.2+/-2.8 years. The incidence of ureteral complications was not clustered around the early phase of our LLDN experience. Of the three (2.7%) patients diagnosed with ureteral obstruction, two required ureteral reimplantation, and one was managed conservatively. Another two patients (1.8%) with a urinary leak received a double J stent and a cystostomy catheter for 3 and 5 months, respectively. Of the five patients with a ureteral complication, three had received a donor kidney with more than one renal artery. CONCLUSIONS: LLDN combined with the intravesical (P-L) ureteral implantation technique provides excellent graft outcomes with low recipient morbidity. Renal artery multiplicity may increase the risk of ureteral complications.     

Doppler ultrasonographic and scintigraphic assessment of an auxiliary heterotopic liver transplantation with portal vein arterialization in pigs

OBJECTIVE: Our aim was to evaluate liver graft integrity and function using scintigraphy and ultrasonography in a porcine model of auxiliary heterotopic liver transplantation with portal vein arterialization (AHLT-PVA). MATERIALS AND METHODS: Using Doppler ultrasonography we evaluated eight AHLT-PVA by parenchymal echogenicity, portal and arterial anatomy, and portal and biliary system flow. Two types of scintigraphy were performed: microaggregated human albumin colloid scintigraphy and diisopropyl iminodiacetic acid (DISIDA) scintigraphy, both labeled with 99mTc. RESULTS: The animals were distributed into two groups. The first group consisted of three animals with clinical suspicion of graft dysfunction, in which the ultrasonographic study revealed areas of parenchymal destructuring. In the scintigraphic study, heterogenous uptake was observed; there was no uptake in one animal. Necropsy of these three animals revealed areas of graft necrosis. The second group consisted of five animals with good clinical evolutions, in which the ultrasonographic study showed portal dilation, portal flow with arterial spiculations, and homogenous echogenicity of the hepatic parenchyma. The scintigraphic study revealed homogenous uptake by the graft and an elimination speed of the hepatobiliary agent similar to that of the native liver. CONCLUSIONS: An heterogenous echostructure of the graft provided a sign of poor prognosis indicating necrosis in the same way as heterogenous uptake or nonuptake of radioisotope upon scintigraphy. Scintigraphy is a good method to evaluate biliary function and bile elimination. In an AHLT-PVA, the main ultrasound findings derived from arterialization were dilation of the portal system and portal flow with arterial spiculations.     

贵阳地区2013年手足口病非 EV71、非 CVA16型肠道病毒的检测分析

目的：了解贵阳地区引起手足口病（HFMD）的非肠道病毒71型（EV71）、非柯萨奇病毒 A（CVA）16型肠道病毒的病原构成及优势型别,为贵阳地区 HFMD 防治工作提供依据。方法收集2013年4～6月检测为非 EV71、非 CVA16型肠道病毒的 HFMD 患者肛拭子标本共107例。提取病毒核酸,用巢式 RT-PCR 法扩增病毒 VP4区序列,对 PCR 阳性扩增产物进行测序,通过与 GenBank 收录的序列 BLAST 比对确定病毒型别;并对优势型别进行序列和进化分析。结果107例标本中共有100例标本巢式 RT-PCR 检测为阳性（93％）,其中100例 PCR 产物测序成功,经 BLAST 比对后,100例标本病毒型别均得到确定：CVA6为46例,CVA10为30例,CVA5为10例,CVA2为6例,CVA3和 CVA4各2例,CVB2和 ECHO16各2例。 CVA6在型别确定的非 EV71、非 CVA16型肠道病毒中占42．99％,为优势肠道病毒型别。结论贵阳地区引起 HFMD 的肠道病毒型别多样,CVA6为非 EV71、非 CVA16型肠道病毒中的优势型别。     

Predicting donor,recipient and graft survival in living donor kidney transplantation to inform pretransplant counselling: the donor and recipient linked iPREDICTLIVING tool – a retrospective study

Although separate prediction models for donors and recipients were previously published, we identified a need to predict outcomes of donor/recipient simultaneously, as they are clearly not independent of each other. We used characteristics from transplantations performed at the Oslo University Hospital from 1854 live donors and from 837 recipients of a live donor kidney transplant to derive Cox models for predicting donor mortality up to 20 years, and recipient death, and graft loss up to 10 years. The models were developed using the multivariable fractional polynomials algorithm optimizing Akaike’s information criterion, and optimism-corrected performance was assessed. Age, year of donation, smoking status, cholesterol and creatinine were selected to predict donor mortality (C-statistic of 0.81). Linear predictors for donor mortality served as summary of donor prognosis in recipient models. Age, sex, year of transplantation, dialysis vintage, primary renal disease, cerebrovascular disease, peripheral vascular disease and HLA mismatch were selected to predict recipient mortality (C-statistic of 0.77). Age, dialysis vintage, linear predictor of donor mortality, HLA mismatch, peripheral vascular disease and heart disease were selected to predict graft loss (C-statistic of 0.66). Our prediction models inform decision-making at the time of transplant counselling and are implemented as online calculators.     

Distortion-product otoacoustic emissions study of the noise-induced toughening effect in rats

OBJECTIVE: To compare the toughening effects in rats induced by pure tones and a broadband noise (BBN). MATERIAL AND METHODS: Sprague-Dawley female albino rats (n = 148; 8-10 weeks old) were used. Three experimental groups were established as follows. Toughening only: 38 rats, divided into 3 subgroups, were exposed to different conditioning sounds (2 and 4 kHz and a BBN of 0.25-6 kHz, respectively) at 75-85 dB sound pressure limit (SPL) for 8 h/day for 10 days. Acoustic trauma only: 54 rats, divided into 3 subgroups, were exposed to different conditioning sounds as above for 24 h at 100-110 dB SPL. Toughening plus acoustic trauma: 56 rats, divided into 3 subgroups, were exposed to different conditioning sounds as above, followed 8 h later by traumatic exposure to the conditioning sound at 110 dB SPL for 24 h. 2f1-f2 distortion-product (DP) otoacoustic emission measurements were obtained from the right ear of each animal pre-exposure, immediately post-exposure and after 8 h of the traumatic or conditioning exposure. RESULTS: In our control DPgram response, the maximum amplitude occurred at the highest frequencies (2, 3, 4, 5 and 6 kHz). No statistical differences between the control DPgram and the DP toughening (2 and 4 kHz and BBN)responses were found. Only 2 and 4 kHz frequencies induced a protective effect against traumatic sound exposures to the same frequencies, and this finding was statistically significant. CONCLUSION: The toughening phenomenon induced using 2 and 4 kHz pure tones and BBN in rats does not modify the DPgram response. Nevertheless, only 2 and 4 kHz frequencies induce a protective effect against traumatic sound exposures to the same frequencies.     

艰难梭菌毒素A&B测定在医院腹泻患者中的应用 FREE

目的探讨艰难梭菌毒素A&B测定在医院腹泻患者中的应用价值。方法采用VIDAS 艰难梭菌A&B毒素检测试剂对某院47例住院的腹泻患者粪便标本进行毒素检测,并结合细菌常规培养、临床资料及治疗进行综合分析。结果47例腹泻患者中,7例（14.89%）艰难梭菌毒素检测阳性, 此7例阳性结果均与临床诊断和/或治疗相符。结论该院艰难梭菌感染形势较为严峻,VIDAS 艰难梭菌A&B毒素检测可提供简单、准确、快速的检测结果,值得推广应用。     

Isolated hair loss on the eyebrow: five cases with trichoscopic features

Alopecia areta (AA) and trichotillomania (TTM) are common causes for hair loss on the eyebrows. Yellow dots, vellus hairs, anisotrichosis, empty follicular openings, and black dots were observed in the present study’s patients with AA. Split hairs, question mark hairs, broken hairs, flame hairs, black dots, hairs with different lengths, and hemorrhagic areas were found in the patients with TTM. Trichoscopy is a very useful and helpful technic in distinguishing AA and TTM on the eyebrows.     

Checklist para pacientes con diabetes mellitus tipo 2 en consulta telemática

Las circunstancias actuales provocadas por la COVID-19 nos obligan a los profesionales de atención primaria a idear nuevas formas de garantizar la atención sanitaria de nuestros pacientes con diabetes tipo 2 (DM2). Existen evidencias que respaldan la eficacia de la telemedicina en el control glucémico de los pacientes con DM2. Ante la rápida adaptación de la práctica clínica al uso de la telemedicina, el Grupo de Trabajo de Diabetes de la Sociedad Española de Medicina Familiar y Comunitaria (SemFyC) optó por elaborar un documento de consenso plasmado en un algoritmo de actuación/seguimiento telemático en la atención de los pacientes con DM2.Palabras clave: Telemedicina, Diabetes mellitus tipo 2, COVID-19     

Impact of a Standardized Titration Protocol with Carvedilol in Heart Failure: Safety,Tolerability, and Efficacy—A Report from the GESICA Registry

Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA) studied whether a standardized protocol for the initiation and titration of the β-blocker carvedilol in a multicenter, open-label program would optimize β-blocker use in heart failure (HF) patients. The program included: (1) the carvedilol initiation and titration period, and (2) long-term follow-up at 6 and 12 months. Of 1299 patients in the registry, 504 were excluded due to current therapy; of the remaining 795 eligible patients, 293 were excluded due to contraindications. Of the included patients with follow-up data (n = 316), 93.3% tolerated carvedilol initiation and 47.7% of the patients reached the target dose of 50 mg/day for a mean dose of 39 mg/day. Rates were comparable in the elderly (n = 83), of which 53% achieved a target dose for a mean dose of 43.08 mg/day. This protocol improved therapy rates and achieved target doses quickly (average of 4 visits). Concomitant medications did not have to be adjusted and there were low withdrawal rates (10%) and hospital admissions (7.2%) for HF. Patients were able to maintain carvedilol therapy at 6 and 12 months. These results indicate that a standardized titration protocol, as used in GESICA, for the initiation and titration of β-blockers is well tolerated and may improve β-blocker use in carefully selected heart failure patients.The study authors are members of the GESICA Steering Committee and Subcommittees