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When liver graft procurements take place in the late afternoon or in the evening, transplantation is often performed at night when alertness and psychomotor abilities may be altered. Our objective was to determine whether liver transplantation performed at night increases severe 90-day postoperative complication rates. In this observational study, we analyzed all consecutive patients who were transplanted between January 1, 2012 and December 31, 2018. Outcomes were compared according to whether all or part of the liver transplantation was performed or not (control group) at late night, i.e., between midnight and 5 a.m. The main outcome was rate of Clavien–Dindo ≥ IIIb complications within 90 days post-transplantation. 790 liver transplantations were analyzed. In a multivariable analysis adjusted for cold ischemic time, late-night procedures required more blood transfusions (P = 0.010) and had higher odds of severe complication occurrence than controls (odds ratio 1.67; 95% CI, [1.10–2.54]). One-year graft and patient survival was similar. We conclude that the organization of liver transplant surgery should be reconsidered to avoid LN surgery as much as can be done. Except to create teams dedicated to night work (which represents a considerable cost), such organization may require safe extension of liver graft preservation times. The alternative could be to extend the use of oxygenated machine perfusion preservation with the unique purpose of safely extending the graft preservation time. [ABSTRACT FROM AUTHOR]

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Background: Worldwide, chronic obstructive pulmonary disease (COPD) remains largely underdiagnosed. Aim: To assess whether the use of Global Initiative for Chronic Obstructive Lung Disease (GOLD) questions and COPD coordination, either alone or combined, would detect new COPD cases in primary care. Design and setting: GPs in Brittany, France, systematically enrolled patients aged 40–80 years over a 4-month period in this French multicentre cluster randomised controlled study. Method: GPs were randomly allocated to one of four groups: control (standard of care), GOLD questions (adapted from symptoms and risk factors identified by GOLD), COPD coordination, and GOLD questions with COPD coordination. New cases of COPD were those confirmed by spirometry: post-bronchodilator forced expiratory volume in 1 second over forced vital capacity of <0.7. Results: In total, 11 430 consultations were conducted by 47 GPs, who enrolled 3162 patients who did not have prior diagnosed asthma or COPD. Among these, 802 (25%) were enrolled in the control, 820 (26%) in the GOLD questions, 802 (25%) in the COPD coordination, and 738 (23%) in the GOLD questions with COPD coordination groups. In the control group, COPD was not evoked, and no spirometry was prescribed. All new cases of COPD diagnosed (n = 24, 0.8%) were in the intervention groups, representing 6.8% of patients who performed spirometry. Statistically significantly more new cases of COPD were detected with COPD coordination (P = 0.01). Conclusion: Interventions that can be easily implemented, such as the GOLD questions and COPD coordination, can identify new cases of COPD. Studies are needed to identify the most appropriate case-finding strategies for GPs to detect COPD in primary care for each country. [ABSTRACT FROM AUTHOR]

Background: Restoring plasma arginine levels through enteral administration of L-citrulline in critically ill patients may improve outcomes. We aimed to evaluate whether enteral L-citrulline administration reduced organ dysfunction based on the Sequential Organ Failure Assessment (SOFA) score and affected selected immune parameters in mechanically ventilated medical intensive care unit (ICU) patients. Methods: A randomized, double-blind, multicenter clinical trial of enteral administration of L-citrulline versus placebo for critically ill adult patients under invasive mechanical ventilation without sepsis or septic shock was conducted in four ICUs in France between September 2016 and February 2019. Patients were randomly assigned to receive enteral L-citrulline (5 g) every 12 h for 5 days or isonitrogenous, isocaloric placebo. The primary outcome was the SOFA score on day 7. Secondary outcomes included SOFA score improvement (defined as a decrease in total SOFA score by 2 points or more between day 1 and day 7), secondary infection acquisition, ICU length of stay, plasma amino acid levels, and immune biomarkers on day 3 and day 7 (HLA-DR expression on monocytes and interleukin-6). Results: Of 120 randomized patients (mean age, 60 ± 17 years; 44 [36.7%] women; ICU stay 10 days [IQR, 7–16]; incidence of secondary infections 25 patients (20.8%)), 60 were allocated to L-citrulline and 60 were allocated to placebo. Overall, there was no significant difference in organ dysfunction as assessed by the SOFA score on day 7 after enrollment (4 [IQR, 2–6] in the L-citrulline group vs. 4 [IQR, 2–7] in the placebo group; Mann‒Whitney U test, p = 0.9). Plasma arginine was significantly increased on day 3 in the treatment group, while immune parameters remained unaffected. Conclusion: Among mechanically ventilated ICU patients without sepsis or septic shock, enteral L-citrulline administration did not result in a significant difference in SOFA score on day 7 compared to placebo. Trial registration: ClinicalTrials.gov Identifier NCT02864017 (date of registration: 11 August 2016). [ABSTRACT FROM AUTHOR]

Background: Restoring plasma arginine levels through enteral administration of L-citrulline in critically ill patients may improve outcomes. We aimed to evaluate whether enteral L-citrulline administration reduced organ dysfunction based on the Sequential Organ Failure Assessment (SOFA) score and affected selected immune parameters in mechanically ventilated medical intensive care unit (ICU) patients. Methods: A randomized, double-blind, multicenter clinical trial of enteral administration of L-citrulline versus placebo for critically ill adult patients under invasive mechanical ventilation without sepsis or septic shock was conducted in four ICUs in France between September 2016 and February 2019. Patients were randomly assigned to receive enteral L-citrulline (5 g) every 12 h for 5 days or isonitrogenous, isocaloric placebo. The primary outcome was the SOFA score on day 7. Secondary outcomes included SOFA score improvement (defined as a decrease in total SOFA score by 2 points or more between day 1 and day 7), secondary infection acquisition, ICU length of stay, plasma amino acid levels, and immune biomarkers on day 3 and day 7 (HLA-DR expression on monocytes and interleukin-6). Results: Of 120 randomized patients (mean age, 60 ± 17 years; 44 [36.7%] women; ICU stay 10 days [IQR, 7–16]; incidence of secondary infections 25 patients (20.8%)), 60 were allocated to L-citrulline and 60 were allocated to placebo. Overall, there was no significant difference in organ dysfunction as assessed by the SOFA score on day 7 after enrollment (4 [IQR, 2–6] in the L-citrulline group vs. 4 [IQR, 2–7] in the placebo group; Mann‒Whitney U test, p = 0.9). Plasma arginine was significantly increased on day 3 in the treatment group, while immune parameters remained unaffected. Conclusion: Among mechanically ventilated ICU patients without sepsis or septic shock, enteral L-citrulline administration did not result in a significant difference in SOFA score on day 7 compared to placebo. Trial registration: ClinicalTrials.gov Identifier NCT02864017 (date of registration: 11 August 2016). [ABSTRACT FROM AUTHOR]

Acute liver failure (ALF) is a rare but life-threatening condition mostly requiring intensive care unit (ICU) admission. ALF induces immune disorders and may promote infection acquisition. However, the clinical spectrum and impact on patients' prognosis remain poorly explored. We conducted a retrospective single-centre study on patients admitted for ALF to the ICU of a referral University Hospital from 2000 to 2021. Baseline characteristics and outcomes according to the presence of infection until day 28 were analysed. Risk factors for infection were determined using logistic regression. The impact of infection on 28-day survival was assessed using the proportional hazard Cox model. Of the 194 patients enrolled, 79 (40.7%) underwent infection: community-acquired, hospital-acquired before ICU and ICU-acquired before/without and after transplant in 26, 23, 23 and 14 patients, respectively. Most infections were pneumonia (41.4%) and bloodstream infection (38.8%). Of a total of 130 microorganisms identified, 55 were Gram-negative bacilli (42.3%), 48 Gram-positive cocci (36.9%) and 21 were fungi (16.2%). Obesity (OR 3.77 [95% CI 1.18–14.40]; p =.03) and initial mechanical ventilation (OR 2.26 [95% CI 1.25–4.12]; p =.007) were independent factors associated with overall infection. SAPSII > 37 (OR 3.67 [95% CI 1.82–7.76], p <.001) and paracetamol aetiology (OR 2.10 [95% CI 1.06–4.22], p =.03) were independently associated with infection at admission to ICU. On the opposite, paracetamol aetiology was associated with lower risk of ICU-acquired infection (OR 0.37 [95% CI 0.16–0.81], p =.02). Patients with any type of infection had lower day 28 survival rates (57% versus 73%; HR 1.65 [1.01–2.68], p =.04). The presence of infection at ICU admission (p =.04), but not ICU-acquired infection, was associated with decreased survival. The prevalence of infection is high in ALF patients which is associated with a higher risk of death. Further studies assessing the use of early antimicrobial therapy are needed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare quality of life (QOL) in small unilateral vestibular schwannoma (VS) patients managed by microsurgery, radiotherapy or observation. Study design: A retrospective chart review. Methods: The study included a total of 142 patients with VS stage 1 or 2 according to the Koos classification and treated between January 2004 and December 2015. Microsurgery, radiotherapy and observation groups comprised 43, 46 and 53 patients, respectively. All patients completed four QOL (questionnaires: Short‐Form Health Survey 36, Hearing Handicap Inventory, Tinnitus Handicap Inventory and Dizziness Handicap Inventory Short‐Form). Clinical symptoms and QOL were compared among groups. Results: The average time interval between management and filling in the questionnaires was 66 months. There was no difference in QOL between the three groups on any of the four questionnaires. The most debilitating symptom was vertigo for all three groups. Tinnitus was a pejorative factor in the surgery group. Hearing level was deteriorated after microsurgery but there was no significant difference between the radiotherapy group and the middle fossa approach. Conclusion: Patients with small VS stage 1 and 2 had similar QOL, irrespective of management by observation, radiotherapy or microsurgery. The overall predictor for long‐term reduced QOL was vertigo. Vestibular rehabilitation could improve QOL in symptomatic patients. [ABSTRACT FROM AUTHOR]

Prevalence of PAD was 44%, 32% and 34% using post-exercise ABI decrease, post-exercise ankle pressure decrease and exercise oximetry, respectively. In conclusion, post-exercise ABI, post-exercise ankle pressure and exercise oximetry tests did not identify the same patients. [Extracted from the article]

Background: Pseudoxanthoma elasticum (PXE) is an inherited metabolic disease characterized by elastic fiber fragmentation and ectopic calcification. There is growing evidence that vascular calcification is associated with inflammatory status and is enhanced by inflammatory cytokines. Since PXE has never been considered as an inflammatory condition, no incidence of chronic inflammation leading to calcification in PXE has been reported and should be investigated. In atherosclerosis and aortic stenosis, positron emission tomography combined with computed tomographic (PET-CT) imaging has demonstrated a correlation between inflammation and calcification. The purpose of this study was to assess skin/artery inflammation and calcification in PXE patients. Methods: 18F-FluroDeoxyGlucose (18F-FDG) and 18F-Sodium Fluoride (18F-NaF) PET-CT, CT-imaging and Pulse wave velocity (PWV) were used to determine skin/vascular inflammation, tissue calcification, arterial calcium score (CS) and stiffness, respectively. In addition, inorganic pyrophosphate, high-sensitive C-reactive protein and cytokines plasma levels were monitored. Results: In 23 PXE patients, assessment of inflammation revealed significant 18F-FDG uptake in diseased skin areas contrary to normal regions, and exclusively in the proximal aorta contrary to the popliteal arteries. There was no correlation between 18F-FDG uptake and PWV in the aortic wall. Assessment of calcification demonstrated significant 18F-NaF uptake in diseased skin regions and in the proximal aorta and femoral arteries. 18F-NaF wall uptake correlated with CS in the femoral arteries, and aortic wall PWV. Multivariate analysis indicated that aortic wall 18F-NaF uptake is associated with diastolic blood pressure. There was no significant correlation between 18F-FDG and 18F-NaF uptake in any of the artery walls. Conclusion: In the present cross-sectional study, inflammation and calcification were not correlated. PXE would appear to more closely resemble a chronic disease model of ectopic calcification than an inflammatory condition. To assess early ectopic calcification in PXE patients, 18F-NaF-PET-CT may be more relevant than CT imaging. It potentially constitutes a biomarker for disease-modifying anti-calcifying drug assessment in PXE. [ABSTRACT FROM AUTHOR]