Endolymphatic duct blockage surgery vs. intratympanic steroids for treatment of refractory Ménière's disease.

PURPOSE: To compare the effectiveness of the Endolymphatic duct blockage (EDB) and intratympanic methylprednisolone(ITMP) injection to control refractory Ménière's disease(MD) symptoms and evaluate their impact on hearing level. STUDY DESIGN: Retrospective study in a tertiary care center. METHODS: 36 received ITMP injection and 52 EDB. Mean outcome measures at 24 months included vertigo control, tinnitus, aural fullness and hearing level: pure-tone average (PTA), bone conduction average(BCA) and speech discrimination score(SDS). RESULTS: At 24 months postoperatively, 90.4% of the EDB group had complete control of vertigo and 43.4% of the ITMP group (p = 0.001). There was no significant difference in tinnitus or aural fullness control (p = 0.34 and p 0.21 respectively). In each group, the drop in tinnitus and aural fullness frequency at 24 months were significant for EDB (p = 0.03; p < 0.001 respectively) and for ITMP group in tinnitus (p = 0.03) but not aural fullness (p = 0.063). At 24 months, PTA, BCA and SDS were significantly worst in the ITMP group when compared to preoperative levels (p = 0.038, p = 0.027, p = 0.016). PTA in the EDB group was stable with no difference compared to ITMP group (p = 0.48). BCA and SDS in the EDB group were stable and better than the ITMP group (p = 0.032; p = 0.036). In each group, vestibular paresis was not significantly different before (p = 0.06) and after treatment (p = 0.68). CONCLUSION: EDB is more effective than the ITMP for controlling the vertigo symptoms of Ménière's disease and in preserving hearing function. It is a novel surgical technique with promising results for a complete treatment of Ménière's disease. ITMP decreases the frequency and the severity of the symptoms but only control vertigo in 27.8% of cases.

[SMARCB1-deficient renal medullary carcinoma with supra clavicular revealing location]. / Carcinome médullaire rénal SMARCB1-déficient révélé par une métastase ganglionnaire sus-claviculaire.

We report the case of a 14 year-old teenager who has SC hemoglobinosis and presented with a tumor syndrome with a retro-peritoneal mass, a supraclavicular lymph node and a mid-renal lesion. The microscopic examination revealed an undifferentiated tumor proliferation infiltrating the lymph node parenchyma. This tumor proliferation was INI1/SMARCB1-deficient, and expressed cytokeratins. Given the fact that the histopathological data showed an undifferentiated INI1-deficient carcinoma and that the patient has a kidney lesion and a sickle cell trait, the final diagnosis was lymph node metastasis of SMARCB1-deficient renal medullary carcinoma (OMS 2022).

[Renal synovialosarcoma: What about pyelic cytology to make a diagnosis?] / Synovialosarcome primitif du rein : si tout était déjà dans les urines pyéliques ?

Synovialosarcoma is a malignant mesenchymal tumor of young adults that occurs in the deep soft tissues, particularly around large joints. When it occurs in more unusual sites, it could present a significant diagnostic challenge. In this case, a 19-year-old girl was treated for a pyloric mass. A pyelic urine cytology performed simultaneously with a pyloric biopsy proved to be a significant element of orientation and perfectly concordant with the histopathological aspect of the pyelic mass after nephrectomy. We report here the first case of renal synovialosarcoma documented in pyelic urine.

The Association Between Perceived Injustice and Opioid Craving in Patients With Chronic Pain: The Mediating Role of Daily Pain Intensity, Negative Affect, and Catastrophizing.

OBJECTIVES: The first objective of this study was to examine the association between perceived injustice and opioid craving in patients with chronic pain who are prescribed opioids. We also examined whether pain intensity, negative affect, or catastrophizing mediated this association. METHODS: In this longitudinal diary study, patients (n = 103) completed a questionnaire assessing perceived injustice and then completed daily measures of pain intensity, negative affect, catastrophizing, and opioid craving for 14 consecutive days. RESULTS: A significant association was found between perceived injustice and opioid craving ( P < 0.01), with higher levels of perceived injustice being associated with heightened levels of opioid craving. A 2-1-1 multilevel mediation analysis indicated that the association between perceived injustice and craving was significantly mediated by catastrophizing ( P < 0.05). CONCLUSIONS: The present study provides new insights into the factors that might contribute to opioid craving in patients with chronic pain. Our findings suggest that perceived injustice might lead to increased catastrophizing and, in turn, heightened daily levels of opioid craving. These findings could have implications for chronic pain management clinicians who prescribe opioids.

Public and patients' perceptions of facial reanimation using lengthening temporalis myoplasty.

OBJECTIVES: To answer the clinical research questions: "Among facial paralysis patients (FPPs), did lengthening temporalis myoplasty (LTM) improve public's perceptions, patients' perceptions, as well as objective oral measurements of post-operative outcomes?" METHODS: To answer the research questions, we designed and implemented a hybrid cross-sectional and retrospective cohort study enrolling a cohort of laypersons and FPPs treated at a tertiary care center from 2011 to 2020. The primary predictor variables were LTM in FPPs (before/after) and medical background on medical care (FPPs/laypersons). The main outcome variable was post-operative outcomes (from a public's perspective, FPPs' perspective, and with objective measurements). Descriptive and univariate statistics were computed as appropriate, and P ≤ 0.05 was considered statistically significant. RESULTS: The sample consisted of 203 lay volunteers and 15 FPPs. After LTM, public perception voted the significant improvements in disfigured, important to repair, bothersome, severity (DIBS) score, and facial attractiveness. Patients' perspective was also significantly improved for global severity, oral function, and facial movement. Objective measurements of deviation at the oral commissure and the smile angle also significantly improved after LTM. CONCLUSION: Despite no control groups (i.e., other techniques to be compared) in this study, our study results suggest that LTM can be used to improve public's perception, patient's perception, and objective oral measurement of post-operative outcomes in FPPs. Because different questionnaires were used, it is unknown whether public and patient's perceptions are compatible.

Analysis of the Acoustic Transcranial Bone Conduction.

OBJECTIVES: (1) To analyze the preferential pathways of sound transmission and sound waves travelling properties in the skull and (2) to identify the location(s) on the skull where bone conduction to the cochlea is optimal. STUDY DESIGN: Basic research Methods: Nine cadaveric heads were placed in an anechoic chamber and equipped with six Bone Anchored Hearing Aids (BAHA™) implants (Cochlear™, Sydney, NSW, Australia) and fifteen accelerometers. A laser velocimeter was used to measure cochlear response by placing a reflector on the round window. Different frequency sweeps were applied to each implant, and measurements were recorded simultaneously by the laser velocimeter and accelerometers. RESULTS: Low-frequency sound waves mostly travel the frontal transmission pathways, and there is no clear predominant pattern for the high frequencies. The mean inter-aural time lag is 0.1 ms. Optimal sound transmission to the cochlea occurs between 1000 and 2500 Hz with a contralateral 5 to 10 dB attenuation. The implant location does not influence mean transmission to the cochlea. CONCLUSION: There is a pattern of transmission for low frequencies through a frontal pathway but none for high frequencies. We were also able to demonstrate that the localization of the BAHA™ implant on the skull had no significant impact on the sound transmission, either ipsi or contralaterally.

Day-to-day opioid withdrawal symptoms, psychological distress, and opioid craving in patients with chronic pain prescribed opioid therapy.

BACKGROUND: Research has shown that opioid craving is one of the strongest determinants of opioid misuse in patients with chronic pain. To date, however, little is known on the factors that contribute to opioid craving in these patients. It is possible that patients' physical dependence to opioids, manifested by opioid withdrawal symptoms in between daily opioid doses, contribute to opioid craving. Physical dependence symptoms might also lead to psychological distress, which in turn might contribute to opioid craving. The first objective of this study was to examine the day-to-day association between opioid withdrawal symptoms and opioid craving among patients with chronic pain. We also examined whether negative affect and catastrophic thinking mediated this association. METHODS: In this longitudinal study, chronic pain patients (n = 79) prescribed short-acting opioids completed daily diaries for 14 consecutive days. Diaries assessed a host of pain, psychological, and opioid-related variables. RESULTS: Day-to-day elevations in opioid withdrawal symptoms were associated with heightened opioid craving (p < .001). Results of a multilevel mediation analysis revealed that this association was mediated by patients' daily levels of negative affect and catastrophizing (p < .001). CONCLUSIONS: Our study provides valuable new insights into our understanding of factors that may contribute to prescription opioid craving among patients with chronic pain.

The potential of digital phenotyping to advance the contributions of mobile health to self-management science.

Digital phenotyping consists of moment-by-moment quantification of behavioral data from individual people, typically collected passively from smartphones and other sensors. Within the evolving context of precision health, digital phenotyping can advance the use of mobile health -based self-management tools and interventions by enabling more accurate prediction for prevention and treatment, facilitating supportive strategies, and informing the development of features to motivate self-management behaviors within real-world conditions. This represents an advancement in self-management science: with digital phenotyping, nurse scientists have opportunities to tailor interventions with increased precision. In this paper, we discuss the emergence of digital phenotyping, the historical background of ecological momentary assessment, and the current state of the science of digital phenotyping, with implications for research design, computational requirements, and ethical considerations in self-management science, as well as limitations.

Personalizing Sensor-Controlled Digital Gaming to Self-Management Needs of Older Adults with Heart Failure: A Qualitative Study.

Objectives: In older persons with heart failure (HF), an inability to self-manage their disease condition can result in poor health outcomes and quality of life. With the rise in smartphone use and digital game playing among older adults, digital tools such as sensor-controlled digital games (SCDGs) can offer accessible health-promoting tools that are enjoyable and easy to use. However, designing SCDGs that are compelling and aligned with their life values and self-management needs can be challenging. This article describes a qualitative study with older adults with HF who were recruited from a cardiac rehabilitation laboratory in central Texas to identify their perceptions and expectations regarding a SCDG for HF self-management. Materials and Methods: A low-fidelity prototype that demonstrated the features of a SCDG was used to obtain the participants' perceptions about the value of SCDGs for HF self-management with respect to content, customization, flexibility, and usability through qualitative interviews. Results: We interviewed 15 patients with HF (53% women; age range, 53-90 years; 60% white). The concept of SCDGs for HF self-management was highly acceptable (80%). Participants provided suggestions for game characters, progress in the game, and game notifications and incentives. Perceived benefits included helping users track their behaviors and establish routines, become informed on strategies to manage HF, and empower themselves to take charge of their health. Conclusions: The study's findings will guide personalization of SCDG development to motivate patient engagement in HF self-management behaviors.

What is the significance of end-stage renal disease risk estimation in living kidney donors?

Two end-stage renal disease (ESRD) risk calculators were recently developed by Grams et al., and Ibrahim et al. to calculate ESRD risk before donation among living kidney donors. However, those calculators have never been studied among potential donors for whom donation was refused due to medical contraindications and compared to a group of donors. We compared 15-year and lifetime ESRD risk of donors and nondonors due to medical cause as estimated by those two calculators. Nondonors due to medical cause (n = 27) had a significantly higher 15-year ESRD risk compared to donors (n = 288) with both calculators (0.25 vs. 0.14, P < 0.001 for that developed by Grams et al. and 2.21 vs. 1.43, P = 0.002 for that developed by Ibrahim et al.). On the contrary, lifetime ESRD risk was not significantly different between the two groups. At both times (15 years and lifetime), we observed a significant overlap of ESRD risk between the two groups. ESRD risk calculators could be complementary to standard screening strategy but cannot be used alone to accept or decline donation.

Use of computed tomography assessed kidney length to predict split renal GFR in living kidney donors.

OBJECTIVES: Screening of living kidney donors may require scintigraphy to split glomerular filtration rate (GFR). To determine the usefulness of computed tomography (CT) to split GFR, we compared scintigraphy-split GFR to CT-split GFR. We evaluated CT-split GFR as a screening test to detect scintigraphy-split GFR lower than 40 mL/min/1.73 m2/kidney. METHODS: This was a monocentric retrospective study on 346 potential living donors who had GFR measurement, renal scintigraphy, and CT. We predicted GFR for each kidney by splitting GFR using the following formula: Volume-split GFR for a given kidney = measured GFR*[volume of this kidney/(volume of this kidney + volume of the opposite kidney)]. The same formula was used for length-split GFR. We compared length- and volume-split GFR to scintigraphy-split GFR at donation and with a 4-year follow-up. RESULTS: A better correlation was observed between length-split GFR and scintigraphy-split GFR (r = 0.92) than between volume-split GFR and scintigraphy-split GFR (r = 0.89). A length-split GFR threshold of 45 mL/min/1.73 m2/kidney had a sensitivity of 100 % and a specificity of 75 % to detect scintigraphy-split GFR less than 40 mL/min/1.73 m2/kidney. Both techniques with their respective thresholds detected living donors with similar eGFR evolution during follow-up. CONCLUSION: Length-split GFR can be used to detect patients requiring scintigraphy. KEY POINTS: • Excellent correlation between kidney length and scintigraphy predicted GFR • Kidney length screening detects all donors with GFR lower than 40 mL/min/1.73 m 2 • Kidney length screening can replace scintigraphy screening.

[Transplant nurse coordinator, a key mission]. / Infirmière coordinatrice de greffe, une mission essentielle.

An essential link in the functioning of a transplant ward, the kidney transplant nurse coordinator plays a major role in supporting the donor and recipient along the living donor transplant pathway. Informing, organising, supporting are part of their daily practice.

Association of mGFR of the Remaining Kidney Divided by Its Volume before Donation with Functional Gain in mGFR among Living Kidney Donors.

BACKGROUND AND OBJECTIVES: The predictors of long-term renal function in living kidney donors are currently discussed. Our objectives were to describe the predictors of functional gain of the remaining kidney after kidney donation. We hypothesized that GFR of the remaining kidney divided by volume of this kidney (rk-GFR/vol) would reflect the density of functional nephrons and be inversely associated with functional gain of the remaining kidney. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a prospective monocentric study including 63 living donors (26 men; 50.3±11.8 years old) who had been evaluated for (51)Cr-EDTA and measured GFR, split renal function by scintigraphy before donation (between 2004 and 2009), and measured GFR at 5.7±0.5 years after donation. For 52 donors, volume of the remaining kidney (measured and estimated with the ellipsoid formula using renal computed tomography scannography) was determined before donation. We tested our hypothesis in an external validation cohort of 39 living donors (13 men; 51.0±9.4 years old) from another single center during the same time period. RESULTS: For the main cohort, the mean measured GFR was 97.6±13.0 ml/min per 1.73 m(2) before donation and 63.8±9.4 ml/min per 1.73 m(2) at 5 years. Functional gain averaged 16.2±7.2 ml/min per 1.73 m(2) (+35.3%±16.7%). Multivariate analysis showed that age, body mass index, and rk-GFR/vol at donation were negatively correlated with functional gain and had strong predictive power of the 5-year functional gain (adjusted 5-year functional gain for age: -0.4 [95% confidence interval (95% CI), -0.5 to -0.1]; body mass index: -0.3 [95% CI, -0.6 to -0.1]; rk-GFR/vol: -55.1 [95% CI, -92.3 to -17.9]). We tested this model in the external validation cohort (adjusted 5-year functional gain for age: -0.1 [95% CI, -0.5 to 0.3]; body mass index: -0.9 [95% CI, -1.8 to -0.1]; rk-GFR/vol: -97.6 [95% CI, -137.5 to -57.6]) and confirmed that rk-GFR/vol was inversely associated with 5-year functional gain. CONCLUSIONS: For given age and body mass index, the long-term functional gain of the remaining kidney is inversely associated with the new variable rk-GFR/vol at donation.

Intervention for improving comprehension in 4-6 year old children with specific language impairment: practicing inferencing is a good thing.

Few studies report on therapy to improve language comprehension in children with specific language impairment (SLI). We address this gap by measuring the effect of a systematic intervention to improve inferential comprehension using dialogic reading tasks in conjunction with pre-determined questions and cues. Sixteen children with a diagnosis of SLI aged 4-6 participated in 10 weekly treatment sessions carried out by their regular therapists. Baseline and maintenance periods were also tabulated. Two experimental measures and a standardized test revealed that children's total scores and the quality of their responses post-treatment were better than those obtained pre-treatment. However, perhaps due to the use of non-equivalent probes, this change could not be interpreted solely as a significant effect of intervention. These results nevertheless suggest that a systematically designed intervention focusing on the comprehension of specific types of questions requiring inferencing and using a carefully scaffolded cueing strategy can be beneficial.

Very long-term follow-up of living kidney donors.

Knowledge of the very long-term consequences of kidney donors has not been previously reported extensively. The 398 persons who had donated a kidney between 1952 and 2008 at Necker hospital were contacted. Among the 310 donors who were located, the survival probabilities for this population were similar to those of the general population and end stage renal disease incidence was 581 per million population per year. All located donors still alive were asked to complete a medico-psychosocial questionnaire and give samples for serum creatinine and urinary albumin assays. Among the 204 donors who responded to the questionnaire, mean eGFR was 64.4±14.6ml/min per 1.73m(2) and mean microalbuminuria was 27.0±83mg/g. Most donors never regretted the donation and consider that it has no impact on their professional or social lives. Among the 59 donors who gave a kidney more than 30years ago (mean 40.2years, range 30-48years) had a mean eGFR of 67.5±17.4µmol/l, a mean microalbuminuria level of 44.8±123.2mg/g and none was dialyzed. In conclusion, living kidney donation does not impact survival, kidney function, medical condition or psychological or social status over the very long-term.

Kidney function following nephrectomy: similitude and discrepancies between kidney cancer and living donation.

OBJECTIVES: The reported long-term safety of kidney donation is inconsistent with the impairment of kidney function observed following nephrectomy for renal cell cancer. We aimed to investigate if indication for nephrectomy (kidney cancer vs. living donation) was an independent risk factor for kidney function deterioration. MATERIALS AND METHODS: Between 1985 and 2008, 124 patients with localized renal cell carcinoma who meet the criteria used for living donation, underwent radical nephrectomy (group 1) at our institution. Group 1 was retrospectively compared with 124 consecutive living donor nephrectomies (group 2) performed from 2004 to 2008. Kidney function evaluation was performed preoperatively and at 1, 2, 3, and 4 years postoperatively with calculation of estimated glomerular filtration rate through the Modification of Diet in Renal Disease (MDRD-eGFR) and the adjusted Cockroft and Gault (CG-eGFR) formula. Multivariate logistic regression included patients' characteristics and indication for nephrectomy as predictors of kidney function deterioration. RESULTS: Mean decrease in MDRD-eGFR was 30.4% and 32.4% in groups 1 and 2 (P = 0.30). Prevalence of chronic kidney disease (CKD), defined by MDRD-eGFR < 60 mL/min/m(2), varied from 42.3% to 71% in group 1 and from 41.6% to 56% in group 2 at different time points (P = 0.073). Prevalence of CKD at 4 years defined by MDRD-eGFR < 45 mL/min/m(2) was significantly increased in group 1 compared with group 2 (16.2% and 5.3%, P < 0.005, respectively). Linear regression analysis showed only baseline kidney function and patient age predicted a significant decrease in postoperative kidney function (P < 0.001 and P = 0.04). CONCLUSIONS: Renal cell carcinoma is not an independent risk factor for kidney function impairment following nephrectomy. Selected kidney cancer patients with few morbidities face the same deterioration of meanly 30% of kidney function compared with living donors, but their lower baseline function results in an increased risk for CKD.

[Living donors for kidney transplantation: ethical and legal challenges]. / La transplantation rénale à partir de donneurs vivants: enjeux éthiques et juridiques.

Living donor kidney transplantation has developed very heterogeneously worldwide despite excellent results and without taking into account the context of global organ shortage. Such a heterogeneity highlights persistent ethical issues, whereas organ trafficking is emerging as an organized transplant tourism reinforcing the need for strong national legal frameworks. Despite its powerful regulation system, which ensures standardization, transparency and accountability of support for donation, France remains reluctant to enlarge the circle of legal donors, whereas it would be the first step to give a greater role to living organ donation.