The clinical outcomes of kidney transplantation from deceased donors have seen significant improvements with the use of machine perfusion (MP), now a standard practice in transplant centers. However, the use of perfusate biomarkers for assessing organ quality remains a subject of debate. Despite this, some centers incorporate them into their decision-making process for donor kidney acceptance. Recent studies have indicated that lactate dehydrogenase (LDH), glutathione S-transferase, interleukin-18, and neutrophil gelatinase-associated lipocalin (NGAL) could predict post-transplant outcomes. Between August 2016 and June 2017, 31 deceased-donor after brain death were included and stroke was the main cause of death. Pediatric patients, hypersensitized recipients were excluded. 43 kidneys were subjected to machine perfusion. Perfusate samples were collected just before the transplantation and stored at -80ºC. Kidney transplant recipients have an average age of 52 years, 34,9% female, with a BMI 24,6±3,7. We employed receiver operating characteristic analysis to investigate associations between these perfusate biomarkers and two key clinical outcomes: delayed graft function and primary non-function. The incidence of delayed graft function was 23.3% and primary non-function was 14%. A strong association was found between NGAL concentration and DGF (AUC=0.766, 95% CI, P=0.012), and between LDH concentration and PNF (AUC=0.84, 95% CI, P=0.027). Other perfusate biomarkers did not show significant correlations with these clinical outcomes. The concentrations of NGAL and LDH during machine perfusion could assist transplant physicians in improving the allocation of donated organs and making challenging decisions regarding organ discarding. Further, larger-scale studies are required.

ABSTRACT Backgroundː This study addresses the elevated prevalence of skin and soft tissue infections (SSTIs) within the pediatric demographic, necessitating a comprehensive inquiry into their varied clinical manifestations. The primary objectives involve the assessment of clinical and laboratory characteristics of SSTIs in children and an exploration of their correlation with treatment efficacy. Methodsː From April 2022 to June 2023, a prospective observational study was conducted on 87 pediatric bacterial SSTI cases at a Tertiary Paediatric Centre in Central Vietnam. Resultsː SSTIs were most common in children ages 1-4, 48.3%. Seasonal trends showed a peak incidence in summer (43.7%). In 93.1% of patients, febrile presentation and edema predominated. About 40.2% of people had lower extremity involvement. Analysis showed significant rates of severe (73.6%) and purulent (67.8%) SSTIs. Leukocytosis was found in 39.1% of patients, mostly due to 72.4% increased CRP. Even though only 2.4% of blood cultures were positive, Staphylococcus aureus caused 76.9% of infections. About 42.5% of patients had shorter treatments. Significantly, purulent SSTIs required longer antibiotic therapy than nonpurulent infections (p < 0.05). 27.6% of children needed surgery, and most received intravenous antibiotics. Most importantly, all patients recovered. Conclusionsː Predominantly observed among pediatric cases were purulent SSTIs, exhibiting a proclivity for the lower limbs, with Staphylococcus aureus as the predominant etiological agent. Treatment duration for purulent SSTIs exceeded that for nonpurulent infections. Intravenous antibiotic administration emerged as the predominant therapeutic modality, yielding favorable outcomes.

To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology.

ABSTRACT Objective: To describe the characteristics of patients with HER2-positive breast cancer and to identify the proportion of patients using anti-HER2 therapy, and treatment-making related factors. Methods: An analytical cross-sectional study was conducted on 79 patients with BC and HER2-positive diagnosed by immunohistochemistry (IHC) or with FISH at the Oncology Department of Hue University of Medicine and Pharmacy Hospital and Oncology Center of Hue Central Hospital from 1/2021 to 12/2022. Clinical and pathological features, type of drug, number of cycles using anti-Her2 therapy were recorded using medical documents. The decision-making related factors were recorded by questionnaire interviewing patients and relatives. Exclusion criteria included recurrent or previously treated tumors; having contraindications with anti-HER2 therapy; not being willing to participate in the study. SPSS 22.0 was used for the analysis. Results: Mean age was 54.14 ± 11.03. Patients with right-sided BC accounted for 53.1%. 60.8% of tumors were located in the upper right quadrant of the breast. Patient’s self-report of lumps was the most common cause of hospitalization (77.2%). By ultrasound, 60.2% of participants had a tumor size of 2 - 5cm. Abnormal lymph nodes were identified in 40.8% of patients. Histopathologically, invasive ductal carcinoma was found in the majority of tumors (75.9%). Stage II was predominant with 59.5% and 7.6% of patients with stage IV. The rate of treatment with Trastuzumab in our study was 27.8%. The main reason that patients refused anti-HER-2 therapy was financial problems (96.5%). The awareness of anti-HER2 therapy among patients and their relatives was significantly associated with the treatment decision (p = 0.007). Conclusion: Regarding the positive-HER2 BC patients, invasive ductal carcinoma was the major histopathological finding. More than half of the patients were classified as stage II of the disease. The rate of patients undergoing antiHER2 therapy was 27.8%. Financial problems were found to be the main reason for refusal of treatment. Awareness of anti-HER2 therapy is significantly associated with the patient’s decision on treatment.

We assessed the prognostic impact of the 2012 Briganti nomogram on prostate cancer (PCa) progression in intermediate-risk (IR) patients presenting with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b treated with robot assisted radical prostatectomy eventually associated with extended pelvic lymph node dissection. From January 2013 to December 2021, data of surgically treated IR PCa patients were retrospectively evaluated. Only patients presenting with the above-mentioned features were considered. The 2012 Briganti nomogram was assessed either as a continuous and a categorical variable (up to the median, which was detected as 6%, vs. above the median). The association with PCa progression, defined as biochemical recurrence, and/or metastatic progression, was evaluated by Cox proportional hazard regression models. Overall, 147 patients were included. Compared to subjects with a nomogram score up to 6%, those presenting with a score above 6% were more likely to be younger, had larger/palpable tumors, presented with higher PSA, underwent tumor upgrading, harbored non-organ confined disease, and had positive surgical margins at final pathology. PCa progression, which occurred in 32 (21.7%) cases, was independently predicted by the 2012 Briganti nomogram both considered as a continuous (Hazard Ratio [HR]:1.04, 95% Confidence Interval [CI]:1.01-1.08;p=0.021), and a categorical variable (HR:2.32; 95%CI:1.11-4.87;p=0.026), even after adjustment for tumor upgrading. In IR PCa patients with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b, the 2012 Briganti nomogram independently predicts PCa progression. In this challenging subset of patients, this tool can identify prognostic subgroups, independently by upgrading issues.

ABSTRACT Fulminant myocarditis in children is rare, but it has the potential for high morbidity and mortality. In this report, we review articles demonstrating the role of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the fulminant myocarditis, and describe the clinical course of a healthy 11-year-old girl who rapidly deteriorated into cardiogenic shock. The patient was weaned from mechanical ventilation on day 7 and she was discharged from the ICU on day 12. VA-ECMO is considered as a life-saving therapy in patients with hemodynamic instability prior to recovery or other escalation therapy.