Does kidney transplantation with multiple arteries affect graft survival?

Introduction

We compared short- and long-term outcomes of renal transplants with single versus multiple arteries.

Patients and methods

We retrospectively analyzed data from kidney transplants from 208 living donors performed between 1994 and 2010. Renal grafts were divided into two groups: single renal artery (n = 164) versus multiple renal arteries (n = 44). The groups were compared regarding early and late vascular and urological complications. Patient and graft survivals were compared using Kaplan-Meier survivorship curves with comparisons using the log-rank test.

Results

Both groups were comparable regarding acute rejection episodes, posttransplant hypertension, postsurgery renal artery stenosis, and urologic complications. Only hemorrhagic complications and renal artery thrombosis were significantly higher in the multiple renal arteries group (P = .027 and .03, respectively). Warm ischemia time was significantly longer in the multiple renal arteries group without any influence on the incidence of acute tubular necrosis (P = .2). Mean creatinine clearance at 1 year was 65 versus 50 mL/min/1.73 m² (P = .5) and at 5 years, 60 versus 55 mL/min/1.73 m² (P = .1) for the single versus multiple renal arteries groups, respectively. Return to hemodialysis was necessary for 18.8% of the single and 16.1% of the multiple renal arteries group.

Conclusion

The use of an allograft with multiple renal arteries is a safe, successful surgical procedure, that does not influence patient or graft survivals or increase surgical complication rates provided the surgical team is evolved with technical skill.     

Antidiarrheal and antioxidant activities of chamomile (Matricaria recutita L.) decoction extract in rats

Ethnopharmacological relevance

Matricaria recutita L. (Chamomile) has been widely used in the Tunisian traditional medicine for the treatment of digestive system disorders. The present work aims to investigate the protective effects of chamomile decoction extract (CDE) against castor oil-induced diarrhea and oxidative stress in rats.

Methods

The antidiarrheal activity was evaluated using castor oil-induced diarrhea method. In this respect, rats were divided into six groups: Control, Castor oil, Castor oil+Loperamide (LOP) and Castor oil+various doses of CDE. Animals were per orally (p.o.) pre-treated with CDE during 1 h and intoxicated for 2 or 4 h by acute oral administration of castor oil.

Results

Our results showed that CDE produced a significant dose-dependent protection against castor oil-induced diarrhea and intestinal fluid accumulation. On the other hand, we showed that diarrhea was accompagned by an oxidative stress status assessed by an increase of malondialdehyde (MDA) level and depletion of antioxidant enzyme activities as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx). Castor oil also increased gastric and intestinal mucosa hydrogen peroxide (H₂O₂) and free iron levels. Importantly, we showed that chamomile pre-treatment abrogated all these biochemical alterations.

Conclusion

These findings suggested that chamomile extract had a potent antidiarrheal and antioxidant properties in rats confirming their use in traditional medicine.     

Mucopolysaccharidoses in children. Experience of a general pediatric service. 11 cases

The mucopolysaccharidosis are hereditary diseases. The neurological attack constitutes the principal factor of gravity of these affections. We conducted a retrospective study over a period of 12 years (1988-1999) in the pediatric department of Sfax University Hospital. This study allowed us to observe 11 cases of mucopolysaccharidosis confirmed by an enzymatic proportioning, with 3 cases of Hurler disease (IH), 3 cases of the disease of sanfilippo, (two II A and one III B), 3 cases of the disease of Morquio A (type IVA) and 2 cases of the disease of Maroteaux Lamy (type VI). A sex ratio of 1.75. The parents were cousins in 90% of the cases. The age of revelation ranged between 6 months to 4 years. The clinical examination has found a staturo-pondral delay in 81.8% of the cases, a craniofacial dysmorphy in 100%, deformations of the rachis in 63.6% of the cases, a psychomotor regression in 54.5% of the cases, a medullary compression in 18% of the cases, hepatosplenomegaly in 36.4%, and corneal opacities in 45.4% of the cases. The therapeutic treatment was limited to the symptomatic measures with genetic consulting and antenatal diagnosis.     

Modulating and opposite actions of two aqueous extracts prepared from Cinnamomum cassia L. bark and Quercus ilex L. on the gastrointestinal tract in rats

Cinnamon bark and evergreen oak acorns, natural sources of functional ingredients, are effective for those suffering from diarrhea, constipation and irritable bowel syndrome. This study aimed to evaluate the dissimilar phytochemical composition and the opposite potential actions of Cinnamomum cassia bark (ACCE) and Quercus ilex aqueous extracts (GIAE) on gastrointestinal (GI)-physiological activities and disruptions. An HPLC-PDA/ESI-MS assay was used to identify the distinctive qualitative and quantitative profiles of phenolic compounds. The GI-physiological action of both extracts on gastric emptying (GE) and gastrointestinal transit time (GIT) were evaluated using the phenol-red colorimetric method and a test meal containing charcoal/gum arabic in water. Loperamide (LOP)-induced colonic constipation and delayed emptying of the stomach were used to explore the reverse effects of ACCE/GIAE on GI disorders. HPLC-PDA/ESI-MS showed that the main phenolic compounds detected in ACCE are trans-cinnamic acid, quinic acid, protocatechuic acid and rosmarinic acid, while gallic acid, quinic acid and protocatechuic acid are the major chemical constituents found in GIAE. GIAE at two doses (150 and 300 mg kg⁻¹) exerted a reduction of GE (66.40% and 60.87%, respectively) compared to a control group (70.25%). However, ACCE at the same concentrations induced contradictory actions on GE/GIT in comparison to GIAE and antagonistic synthetic pharmacological drugs in rats. The protective effect of CCAE against constipation induced by LOP in rats was accompanied by a strong antioxidant property related to moderation of intracellular-mediator disorders. An absence of toxic actions was revealed in the case of the hematological profile and biochemical parameters. Hence, in-depth investigations of these nutrients of both extracts may help future researchers to derive the underlying mechanisms and potential molecular targets for the development of physiologically functional foods and future therapies.

Cinnamon bark and evergreen oak acorns, natural sources of functional ingredients, are effective for those suffering from diarrhea, constipation and irritable bowel syndrome.     

EEG epileptic seizure detection and classification based on dual-tree complex wavelet transform and machine learning algorithms

The visual analysis of common neurological disorders such as epileptic seizures in electroencephalography (EEG) is an oversensitive operation and prone to errors, which has motivated the researchers to develop effective automated seizure detection methods. This paper proposes a robust automatic seizure detection method that can establish a veritable diagnosis of these diseases. The proposed method consists of three steps: (i) remove artifact from EEG data using Savitzky-Golay filter and multi-scale principal component analysis (MSPCA), (ii) extract features from EEG signals using signal decomposition representations based on empirical mode decomposition (EMD), discrete wavelet transform (DWT), and dual-tree complex wavelet transform (DTCWT) allowing to overcome the non-linearity and non-stationary of EEG signals, and (iii) allocate the feature vector to the relevant class (i.e., seizure class "ictal" or free seizure class "interictal") using machine learning techniques such as support vector machine (SVM), k-nearest neighbor (k-NN), and linear discriminant analysis (LDA). The experimental results were based on two EEG datasets generated from the CHB-MIT database with and without overlapping process. The results obtained have shown the effectiveness of the proposed method that allows achieving a higher classification accuracy rate up to 100% and also outperforms similar state-of-the-art methods.     

Contribution of oxidative stress in acute intestinal mucositis induced by 5 fluorouracil (5-FU) and its pro-drug capecitabine in rats

This study was designed to examine the contribution of oxidative stress in gastrointestinal disorders after an intraperitoneal administration of 5 fluorouracil (5-FU; 100?mg/kg of body weight (b.w.)) and capecitabine oral administration (500?mg/kg b.w.). The animals were divided into three groups: Group A (NaCl,10?ml/kg of b.w.) considered as control group, group B was intoxicated by 5-FU and group C was the group of animals treated with capecitabine (CAP). To evaluate the secretory and enteropooling effects, we used magnesium sulfate (MgSO₄), 1?ml/100?g of b.w. as a hypersecretion agent . The mucosal gastro-intestinal specimens were scraped and examined for biological markers of oxidative stress and intracellular mediators. These anticancer drugs caused many intestinal damages manifested by an elevation of fluid accumulation and imbalance in electrolytes secretion. The intestinal tissues from treated rats not only showed a significant increase in malondialdehyde (MDA), protein carbonylation and hydrogen peroxide (H₂O₂) production. but also showed a significant depletion of enzymatic and non-enzymatic antioxidant, such as, glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT) and sulfhydryl groups (-SH). These effects were related with histopathological damage and a perturbation of intracellular mediators. As expected, these disturbances were observed in the group of rats poisoned by the MgSO₄. Data suggest the contribution of oxidative stress in chemotherapy-induced many disorders in intestinal tract.     

Evolution of impaired renal function after external continent urinary diversion (Mitrofanoff principle)

Objective

To study the evolution of impaired renal function after external continent urinary diversion (Mitrofanoff principle) (ECUD-M) associated with ileocystoplasty.

Patients and Methods

Over 18 years from 1992 to 2009, ECUD-M with ileocystoplasty was performed in 120 patients with mean age of 25.5 years. Renal impairment was evident in 43 patients (17 children and 26 adults).

Results

Ninety percent of patients demonstrated a neurologic bladder and mild to moderate renal failure. Initially, all patients underwent continuous bladder drainage for a mean of 3 weeks. Renal function improved in 35 patients, although with persistent mild renal insufficiency. The other patients demonstrated moderate persistent residual renal insufficiency. During a mean follow-up of 10 years (range, 1-18 years), renal function returned to normal in 13 patients, stabilized at lower values in 15, and remained moderate in 5. After a mean follow-up of 8 years (range, 6-12 years), renal failure gradually worsened, increasing to higher values in 6 patients and leading to hemodialysis in 4. One patient underwent living-donor kidney transplantation, with good evolution.

Conclusion

ECUD-M with ileocystoplasty can lead to normalization unless stabilizationof impaired residual renal function by eliminating the obstructive factor provides self-adequate management of the diversion. The procedure delays for the need forhemodialysis therapy, and enables patients to prepare for kidney transplantation into apreviously reconstructed lower urinary tract.