Pediatric kidney transplantation in Europe, a clinical snapshot pilot

BackgroundPediatric kidney transplantations are rarely performed, and there is limited knowledge about the diversity in current clinical practices across Europe. This study aims to explore the utility of clinical snapshot studies in identifying these disparities, establishing a foundation for future snapshot studies and standardization efforts.MethodsA pilot clinical snapshot study was conducted, with invitations extended to all 109 pediatric kidney transplant centres in Europe. Each participating centre provided pre-, peri-, and postoperative data concerning their most recent thirty transplantations. The primary outcomes encompassed the evaluation of disparities in donor-recipient selection, surgical techniques, post-operative drainage procedures, and immunosuppressive therapy protocols. Secondary outcomes involved the analysis of rejection rates, incidence of infections, and graft survival.ResultsThe study involved 439 patients from fifteen centres (14%) in twelve countries, with varying transplant volumes (range 1–29 transplantations per year) and follow-up periods. Significant differences were found among centres in terms of donor types, cold and warm ischemia time, pre-emptive transplant rates, and kidney transplant drainage methods. The rate of living donors varied between 3% and 90% and the median duration of cold ischemia ranged was 770 min after deceased donation and 147 min after living donation. Basiliximab was the dominant induction therapy, yet steroid withdrawal varied widely. Infection, rejection, and graft survival rates also varied significantly between centres.ConclusionThis study revealed substantial variation in clinical practices among European centres performing pediatric kidney transplantations. These findings could serve as a stimulus for international dialogue and collaboration

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

publishedVersio

Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

Intérêt de la formation des internes en obstétrique

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Fabricating Ni–Mn–Ga Microtubes by Diffusion of Mn and Ga into Ni Tubes

Tubes of the ferromagnetic shape-memory alloy Ni–Mn–Ga of composition near the Ni2MnGa Heusler phase can be used, alone or combined in structures, in magnetic actuators or magnetic refrigerators. However, fabrication of Ni–Mn–Ga tubes with sub-millimeter diameter by classical cold or hot drawing methods is hampered by the brittleness of the alloy. Here, we demonstrate a new process, where Ni–Mn–Ga tubes are fabricated by interdiffusion of Mn and Ga into drawn, ductile Ni tubes with 500 and 760 μm inner and outer diameters. After interdiffusion and homogenization of Mn and Ga at 1000 °C for 24–36 h, Ni–Mn–Ga tubes with ~300 and ~900 μm inner and outer diameters were obtained with homogeneous radial composition distribution, independently of the diffusion sequences (i.e., Mn and Ga diffused sequentially or simultaneously). Longitudinal composition was uniform over lengths of ~1 mm, but variable over longer length due to incomplete process control. For two of the three diffusion sequences, a sizeable (20–80 μm) region exhibiting Kirkendall pores formed at the outer surface of the tubes. Magnetization values as high as ~60 emu/g were measured, which is comparable to the magnetization of the Ni2MnGa Heusler phase. X-ray diffraction on the tube with the highest magnetization confirmed the room-temperature structure as cubic austenite