Living donor nephrectomy comprises a wide variety of different surgical techniques. Overall complication rates are low, and the choice of surgical technique depends on multiple factors such as the ...risk of complications, warm ischemia time, surgical time, and the surgeon’s expertise.
The use of living kidney donors is increasing and there are several surgical approaches for donor nephrectomy but it remains unknown which procedure is optimal for the patient and the graft.
To review different surgical techniques for living donor nephrectomy and compare complication rates, warm ischemia time, and delayed graft function.
A systematic review of prospective studies involving surgical complications following living donor nephrectomy was conducted in the MEDLINE/PubMed and EMBASE databases according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Baseline data, perioperative and postoperative parameters, and postoperative complications are reported. Overall complication rates between surgical techniques were compared via analysis of variance with post hoc analysis. We included 35 studies involving 6398 patients and representing six different surgical procedures for living donor nephrectomy.
Hand-assisted laparoscopic donor nephrectomy had a significantly higher overall complication rate compared to open, laparoscopic, retroperitoneoscopic, and laparoendoscopic single-site techniques (p < 0.005). The complication rates were low and no mortality was observed. The main limitation was varying reporting of complications, with only one-third of the studies using the Clavien-Dindo classification.
No specific surgical approach seems superior in terms of complications, which were generally low. Different factors such as warm ischemia time, blood loss, and surgeon expertise define which surgical approach should be chosen.
We looked at the different surgical methods for removing the kidney from a living kidney donor. Overall, the different surgical techniques were similar in terms of complications and no donors died in the studies we reviewed. The choice of procedure depends on multiple factors such as the expertise of the surgeon and the surgical center.
Diffuse large B cell lymphoma (DLBCL) is a genetically highly heterogeneous disease. Yet, to date, the vast majority of patients receive standardized frontline chemo-immune-therapy consisting of an ...anthracycline backbone. Using these regimens, approximately 65% of patients can be cured, whereas the remaining 35% of patients will face relapsed or refractory disease, which, even in the era of CAR-T cells, is difficult to treat. To systematically tackle this high medical need, it is important to design, generate and deploy suitable
model systems that capture disease biology, heterogeneity and drug response. Recently published, large comprehensive genomic characterization studies, which defined molecular sub-groups of DLBCL, provide an ideal framework for the generation of autochthonous mouse models, as well as an ideal benchmark for cell line-derived or patient-derived mouse models of DLBCL. Here we discuss the current state of the art in the field of mouse modelling of human DLBCL, with a particular focus on disease biology and genetically defined molecular vulnerabilities, as well as potential targeting strategies.
The cumulative incidence of recurrent urinary tract infections is 21.5% 5 yr after renal transplantation. Multiple pre- and postoperative risk factors were associated with this and should be focused ...on by clinicians.
Recurrent urinary tract infections (rUTIs) are common after renal transplantation (RTx), and the impact on graft and patient survival remains controversial.
In this study, we investigate the incidence and risk factors for rUTIs in a cohort of RTx recipients and evaluate the effect on graft and patient survival.
A retrospective cohort of adult patients who underwent RTx at Rigshospitalet, Denmark, between 2014 and 2021 was evaluated in this study.
Risk factors for rUTIs were explored with a multivariable cause-specific Cox proportional hazard analysis. The Kaplan-Meier estimate was used to assess overall survival.
A total of 571 RTx recipients were included. The median age was 52 yr (interquartile range: 42–62 yr). Of the cases, 62% were deceased donor RTx. A total of 103 recipients experienced rUTIs. We found increasing age (hazard ratio HR: 1.02 per year increase, 95% confidence interval 95% CI: 1.00–1.04, p = 0.02), female gender (HR: 2.1, 95% CI: 1.4–3.3, p < 0.001), history of lower urinary tract symptoms (HR: 2.3, 95% CI: 1.4–3.5, p = 0.001), and a UTI within 30 d of surgery (HR: 3.5, 95% CI: 2.1–5.9, p < 0.001) were associated with rUTIs. No influence of rUTIs on overall or graft survival was observed.
One in six patients experience rUTIs after RTx. Pre- and postoperative variables affect the risk of rUTIs, but none are easily modifiable. In this cohort, rUTIs did not affect the graft function or survival. The etiology of rUTIs remains poorly understood, and there is a continuous need to study how rUTIs can be reduced and treated optimally.
In this study, we looked at the risk factors for recurrent urinary tract infections in patients after kidney transplantation. We conclude that 21.5% of patients experience recurrent urinary tract infections 5 years after kidney transplantation. Multiple risk factors were found and should be taken into consideration by clinicians.
Successful renal transplantation (RTx) relies on immunosuppression and an optimal surgical course with few surgical complications. Studies reporting the postoperative complications after RTx are ...heterogeneous and often lack systematic reporting of complications. This study aims to describe and identify postoperative short-term and long-term complications after RTx in a large institutional cohort and identify risk factors for a complicated surgical course.
The study is a retrospective single-center cohort of 571 recipients who underwent living or deceased donor open RTx between 2014 and 2021. Data were collected on background information and perioperative and postoperative data. Complications were defined as short-term (<30 d) or long-term (>30 d) after transplantation and graded according to the Clavien-Dindo classification. Multivariable logistic regression was performed to evaluate risk factors for serious short-term complications and multivariable time-dependent Cox regression to evaluate risk factors for long-term complications.
A total of 351 patients received a graft from a deceased donor, and 144 of these grafts were on perfusion machine before transplantation. One or more short-term complications occurred in 345 (60%) patients. Previous RTx was associated with short-term Clavien-Dindo >2 complications in recipients (odds ratio = 2.08; 95% confidence interval CI, 1.18-3.69;
= 0.01). Being underweight (body mass index <18.5) in combination with increasing age increased the odds of short-term Clavien-Dindo >2 and vascular complications. Increasing blood loss per 100 mL was associated with increased odds of short-term Clavien-Dindo >2 (odds ratio = 1.11; 95% CI, 1.01-1.21;
= 0.032). No associations were found for long-term complications after RTx. The 5-y cumulative incidence of graft loss was 12.6% (95% CI, 8.9-16.3).
Short-term complications are common after RTx, and risk factors for severe short-term complications include previous RTx, increasing age, and low body mass index. No risk factors were identified for severe long-term complications. Further studies should explore whether new surgical techniques can reduce surgical complications in RTx.
A third of patients with diffuse large B-cell lymphoma (DLBCL) present with extranodal dissemination, which is associated with inferior clinical outcomes. MYD88L265P is a hallmark extranodal DLBCL ...mutation that supports lymphoma proliferation. Yet extranodal lymphomagenesis and the role of MYD88L265P in transformation remain mostly unknown. Here, we show that B cells expressing Myd88L252P (MYD88L265P murine equivalent) activate, proliferate, and differentiate with minimal T-cell costimulation. Additionally, Myd88L252P skewed B cells toward memory fate. Unexpectedly, the transcriptional and phenotypic profiles of B cells expressing Myd88L252P, or other extranodal lymphoma founder mutations, resembled those of CD11c+T-BET+ aged/autoimmune memory B cells (AiBC). AiBC-like cells progressively accumulated in animals prone to develop lymphomas, and ablation of T-BET, the AiBC master regulator, stripped mouse and human mutant B cells of their competitive fitness. By identifying a phenotypically defined prospective lymphoma precursor population and its dependencies, our findings pave the way for the early detection of premalignant states and targeted prophylactic interventions in high-risk patients.
Extranodal lymphomas feature a very poor prognosis. The identification of phenotypically distinguishable prospective precursor cells represents a milestone in the pursuit of earlier diagnosis, patient stratification, and prophylactic interventions. Conceptually, we found that extranodal lymphomas and autoimmune disorders harness overlapping pathogenic trajectories, suggesting these B-cell disorders develop and evolve within a spectrum. See related commentary by Leveille et al. (Blood Cancer Discov 2023;4:8-11). This article is highlighted in the In This Issue feature, p. 1.
RESUMEN Introducción y objetivo: El oído (órgano cócleovestibular) es un órgano multifrecuen-ciaL. Por lo tanto, debe verse a este órgano como lo que es: una unidad embriológica, anatómica, ...fisiológica y clínica. Objetivo: desarrollar una cartilla audiovestibular don-de se puedan volcar los resultados obtenidos en los diferentes estudios que valoran al oído como un todo. Método: Se tomó como base la cartilla audiométrica y su sim-bología clásica, extendiendo su rango frecuencial y colocando los diferentes estu-dios a documentar: audiometría tonal liminal, impedanciometría, reflejo estapedial, electrococleografía, potenciales miogénicos vestibulares, test vibracional, video head impulse test, prueba rotatoria, prueba calórica y comandos oculomotores centrales. Discusión: Esta forma de presentación de datos, si bien no es completa, otorga la mayoría de los estudios de diagnóstico audiovestibulares. A primera vista genera sobrecarga de información al especialista, requiriendo un mínimo de entrenamiento. Conclusiones: Se trata de una cartilla de documentación única de los principales estudios cócleovestibulares, con sus respectivas referencias de normalidad, para ser presentada ante el especialista en una sola imagen requiriendo un mínimo de entre-namiento.
The aim of this study was to investigate the association between exposure to electronic cigarette (e-cigarette) advertisements and use of e-cigarettes, combustible cigarettes and hookahs. A ...cross-sectional survey of 6902 German students (mean age 13.1 years, 51.3% male) recruited in six German states was performed. Exposure to e-cigarette advertisements was measured with self-rated contact frequency to three advertising images. Multilevel mixed-effect logistic regression models were used to assess associations between exposure to e-cigarette advertisement and use of e-cigarettes, combustible cigarettes and hookahs (ever and past 30 days). Overall, 38.8% of the students were exposed to e-cigarette advertisements; ever-use of e-cigarettes was 21.7%, of combustible cigarettes was 21.8% and of hookahs was 23.2%, and poly-use of all three products was 12.4%. Exposure to e-cigarette advertisements was positively related to ever and past 30-day use of e-cigarettes, combustible cigarettes, hookahs and combined use. We concluded that a considerable number of German teenagers are exposed to e-cigarette advertisement. There was a clear exposure-behaviour link, indicating that advertising contact was associated with different kinds of "vaping" and also smoking behaviour. Although causal interpretation is not possible due to the cross-sectional design, findings raise concerns about the current tobacco control policies.
In Germany, no other psychotropic substance is consumed as often and in such large quantities during adolescence as alcohol. This work aims to examine trends in binge drinking in early adolescence ...from 2016 to 2023.
Based on seven waves of the "Präventionsradar," which is a school-based epidemiological study in lower secondary education, the lifetime as well as the 30-day prevalence of binge drinking (for girls 4, for boys 5 alcoholic drinks on one occasion) were determined for the period from 2016 to 2023 for 12- to 15-year-olds.
The analyses were based on 44,713 questionnaires. The sex ratio was balanced (50% female), and the mean age was 13.8 years (SD = 1.02). From 2016 to 2023, lifetime prevalence of binge drinking increased significantly by 3.6 percentage points to 25.3% (95% confidence interval 24.1-26.5). The 30-day prevalence did not change statistically during the observation period and was 15.9% (95% CI 14.9-16.9) in 2023. Compared to the previous year, both lifetime prevalence (-2.5 percentage points) and 30-day prevalence of binge drinking (-3.5 percentage points) decreased significantly in the first year of the COVID-19 pandemic (2020/2021) and increased again in subsequent years. Systematic differences between the genders could not be found.
The German Youth Protection Act does not allow legal access to alcohol for the age group under study. Against this background, it is worrying that every fourth adolescent already reports experiences of binge drinking. Consistent structural and behavioral prevention measures are necessary to curb the high prevalence of binge drinking in childhood and adolescence.
Rauschtrinken in der frühen Adoleszenz Hanewinkel, Reiner; Hansen, Julia
Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz,
04/2024, Letnik:
67, Številka:
4
Journal Article
Recenzirano
Zusammenfassung
Einleitung
In Deutschland wird keine andere psychotrope Substanz schon im Jugendalter so oft und in so hohen Mengen konsumiert wie Alkohol. In dieser Arbeit sollen Trends des ...Rauschtrinkens in der frühen Adoleszenz von 2016 bis 2023 abgebildet werden.
Methode
Auf Grundlage von 7 Wellen des Präventionsradars, einer schulbasierten epidemiologischen Studie in der Sekundarstufe I, wurden für den Zeitraum 2016 bis 2023 für 12- bis 15-Jährige die Lebenszeit- sowie die 30-Tage-Prävalenzen des Rauschtrinkens (bei Mädchen 4, bei Jungen 5 alkoholische Getränke bei einer Gelegenheit) ermittelt.
Ergebnisse
Den Auswertungen lagen 44.713 Fragebögen zugrunde. Das Geschlechtsverhältnis war ausgeglichen (50 % weiblich), das mittlere Alter betrug 13,8 Jahre (SD = 1,02). Von 2016 bis 2023 stieg die Lebenszeitprävalenz des Rauschtrinkens signifikant um 3,6 Prozentpunkte auf 25,3 % (95 %-Konfidenzintervall 24,1–26,5) an. Die 30-Tage-Prävalenz veränderte sich im Beobachtungszeitraum statistisch nicht und lag 2023 bei 15,9 % (95 %-KI 14,9–16,9). Im Vergleich zum Vorjahr sanken im ersten Jahr der COVID-19-Pandemie (2020/2021) sowohl die Lebenszeitprävalenz (−2,5 Prozentpunkte) als auch die 30-Tage-Prävalenz des Rauschtrinkens (−3,5 Prozentpunkte) signifikant und stiegen in den Folgejahren wieder an. Systematische Unterschiede zwischen den Geschlechtern konnten nicht gefunden werden.
Diskussion
Das Jugendschutzgesetz sieht keinen legalen Zugang zu Alkohol für die untersuchte Altersgruppe vor. Vor diesem Hintergrund ist es besorgniserregend, dass jeder vierte Heranwachsende bereits über Rauscherfahrungen berichtet. Konsequente verhältnis- und verhaltenspräventive Maßnahmen sind erforderlich, um die hohe Verbreitung des Rauschtrinkens im Kindes- und Jugendalter einzudämmen.
To measure trends in the use of various smoking products among children and adolescents from 2016 to 2023.
The data is based on seven waves of the "Präventionsradar", a school-based epidemiological ...study in grades 5 to 10. The primary endpoints of the study were the lifetime and monthly prevalence of the use of tobacco cigarettes, e-cigarettes, shisha and the use of at least two of these smoking products (combined use). Prevalence estimates are based on logistic regression models.
The analysis was based on 94,127 questionnaires. The sex ratio was balanced (49% female), mean age was 13 years (SD=1.8). In 2022/2023, the lifetime prevalence of smoking tobacco cigarettes was 18.8% (95% CI 18.1-19.5), of e-cigarettes 23.5% (95% CI 22.8-24.3), of shisha 14.0% (95% CI 13.4-14.7) and combined use 19.0% (95% CI 18.3-19.7). The monthly prevalence of smoking tobacco cigarettes was 5.9% (95% CI 5.5-6.4), of e-cigarettes 7.0% (95% CI 6.5-7.4), of shisha 3.2% (95% CI 2.8-3.5) and combined use 4.8% (95% CI 4.4-5.2). The following trends in lifetime prevalence have emerged since 2016: tobacco cigarettes (-3.0 percentage points), e-cigarettes (+1.8 percentage points), shisha (-9.2 percentage points), combined use (-2.7 percentage points). In the years of the COVID-19 pandemic, youth smoking decreased and rose again post-COVID with the exception of shisha.
The use of smoking products in adolescence occurs frequently. Over the observational period, a trend reversal towards e-cigarettes as the most popular product among children and young people is most likely. In addition, the combined use of several smoking products has become a common pattern of consumption. Consistent preventive measures are required in order to achieve the goal of a smoke-free society in 2040.
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