Long-term Basis Research Articles

Integrated water resource management in the Segura Hydrographic Basin: An artificial intelligence approach

Managing resources effectively in uncertain demand, variable availability, and complex governance policies is a significant challenge. This paper presents a paradigmatic framework for addressing these issues in water management scenarios by integrating advanced physical modelling, remote sensing techniques, and Artificial Intelligence algorithms. The proposed approach accurately predicts water availability, estimates demand, and optimizes resource allocation on both short- and long-term basis, combining a comprehensive hydrological model, agronomic crop models for precise demand estimation, and Mixed-Integer Linear Programming for efficient resource distribution. In the study case of the Segura Hydrographic Basin, the approach successfully allocated approximately 642 million cubic meters (hm3) of water over six months, minimizing the deficit to 9.7% of the total estimated demand. The methodology demonstrated significant environmental benefits, reducing CO2 emissions while optimizing resource distribution. This robust solution supports informed decision-making processes, ensuring sustainable water management across diverse contexts. The generalizability of this approach allows its adaptation to other basins, contributing to improved governance and policy implementation on a broader scale. Ultimately, the methodology has been validated and integrated into the operational water management practices in the Segura Hydrographic Basin in Spain.

Multi-criteria Evaluation of Madagascar's Regions in the Context of Employment Using the CoCoFISo Method

The evaluation of regions in terms of employment provides decision-makers with a valuable tool for pursuing the development of each region. Furthermore, it facilitates the decision-making process for the working-age population, enabling them to identify locations where they wish to settle on a long-term basis to pursue employment opportunities. The objective was to evaluate Madagascar's twenty-three regions under thirteen pre-established criteria. The multi-criteria mean weight (MW) and Combined Compromise For Ideal Solution (CoCoFISo) decision-making methods were employed to calculate the criteria's relative importance and perform a comparative ranking of the regions. The weights of the criteria were equalized using the MW result. The CoCoFISo method revealed that the first seven regions are successively Atsimo Andrefana, Analanjirofo, Boeny, Vakinakaratra, Alaotra Mangoro, Diana and Analamanga. Our analysis of the results demonstrates that these regions display elevated percentages, with 54% to 69% of the criteria exhibiting above-average values. Additionally, the values of their criteria are generally stable in comparison to the others, which are dispersed.

3D designed and manufactured retainers

The increased adoption of CAD-CAM technology parallels the expansion of digital dentistry internationally with orthodontics forecast to experience the highest level of associated growth. We aim to provide an overview of CAD-CAM workflows including different methods and materials for retainer manufacturing underpinned by best-available contemporary evidence. CAD-CAM approaches to fixed retention have led to streamlined workflows potentially reducing manpower issues while broadening both the material and design options. The ability to customize retainers also promotes improved anatomical adaptation. These advantages may translate into improved longevity and effectiveness of CAD-CAM retainers. Further studies are however required to evaluate the relative merits of CAD-CAM retainers on a long-term basis.

Environmental study and stress-related biomarkers modifications in a crew during analog astronaut mission EMMPOL 6.

Human presence in space is increasingly frequent, but we must not forget that it is a hostile environment. We aimed to study the characteristics of experimental scenarios, to obtain data on human response to isolation, disruption of circadian rhythm and high levels of psychophysical stress. In these experiments, we evaluated stress response in five young healthy subjects inside an earth-based moon-settlement-like habitat during a 1-week long analog astronaut mission. Wearable devices were used to monitor daily step count of the subjects, physical activity, heart rate during physical exercise and at rest, and sleep parameters. From saliva and urine samples collected every day at awakening, we studied oxy-inflammation biomarkers and hormones (stress and appetite) were studied too. At the end of the week, all subjects revealed an increase in oxidative stress and cortisol levels but no inflammation biomarkers variations, in conjunction with increasing time/daily exercise. Furthermore, a significant decrease in hours of sleep/day, sleep quality, and REM phase of sleep was recorded and correlated with the increase of reactive oxygen species. Oxidative stress increased in a short period of time and may be attributed to the influence of psychological stress during confinement, as well as increased exercise and decreased amount of sleep. On a long-term basis, this could impact performance.

Comparative overall survival analysis of chordomas of the base of the skull from the Surveillance, Epidemiology, and End Results (SEER) program between 2000 and 2020

Chordomas of the skull base are rare, slow growing, locally invasive cancers with limited long-term survival analysis reported in the literature. We seek to provide comparative survival analysis of patients on a long-term (20-year) basis using population-level data. The Surveillance, Epidemiology, and End Results (SEER) program was queried for cases of chordoma relegated to the base of the skull, diagnosed between 2000 and 2020. Demographic, disease, and treatment information were analyzed using Cox proportional hazards and log-rank comparisons. 630 patients with chordoma of the skull base were identified. Age ≤ 49 years at diagnosis was associated with increased five-, 10-, and 20-year overall survival (hazard ratio (HR) = 0.39, 0.33, and 0.30, respectively; p < 0.001 for all). Treatment with surgery and adjuvant radiotherapy was associated with increased five-, 10-, and 20-year survival (HR = 0.71, 0.79, and 0.79, respectively; p < 0.001 for all). On univariate analysis, widowed patients had decreased survival (20-year overall survival = 34.8% [15.3%-34.8%] compared to married patients (74.4% [68.1%-80.8%]. Surgery remains the primary treatment associated with increased survival among patients with chordoma of the skull base, with adjuvant radiotherapy serving a complimentary role. Demographic factors such as marital status are also associated with changes in survival.

Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Myeloproliferative Neoplasms.

Myeloproliferative neoplasms (MPNs) are a group of rare chronic progressive blood cancers that vary widely in clinical presentation, yet all patients have a risk of disease progression and thrombotic complications. Diseases include primary myelofibrosis, polycythemia vera, and essential thrombocythemia. With current treatment approaches, most patients live a prolonged life, but many experience a complex of symptoms that negatively influence their functional status and quality of life. Although significant advances have been made in preventing arterial and venous complications while mitigating inflammatory processes, comprehensive palliative care can help address unmet complex physical and psychosocial needs on a long-term basis. This article, created by a multidisciplinary group of providers, offers an overview of MPNs so palliative care clinicians can better support patients with these hematologic cancers.

Impact of postoperative cerebral hyperperfusion on 2-year cognitive outcomes of patients undergoing carotid endarterectomy.

In 10% of patients undergoing carotid endarterectomy (CEA), the cognitive function declines postoperatively, primarily in association with postoperative cerebral hyperperfusion. In contrast, in the majority of patients undergoing CEA, long-term cognitive outcomes remain unclear. Furthermore, it is not known whether the decline in cognition due to cerebral hyperperfusion recovers on a long-term basis. This study aimed to understand how postoperative cerebral hyperperfusion affects the cognitive outcomes of patients who undergo CEA. The participants in this prospective observational study were patients with internal carotid artery stenosis who underwent CEA. Cerebral hyperperfusion syndrome or asymptomatic cerebral hyperperfusion following CEA was determined based on brain perfusion SPECT scans and symptomatology before and after surgery. Neuropsychological testing was performed preoperatively, at 1-2 months postoperatively, and at 2 years postoperatively to investigate cognitive decline. A logistic regression analysis revealed that asymptomatic cerebral hyperperfusion (95% CI 13.0-84.5, p < 0.0001) and cerebral hyperperfusion syndrome (95% CI 449.7-14,237.4, p < 0.0001) were significantly associated with cognitive decline at 1-2 months postoperatively. The incidence of cognitive decline was significantly decreased at 2 years postoperatively (7%) in comparison to 1-2 months postoperatively (11%) (p = 0.0461). A logistic regression analysis also revealed that asymptomatic cerebral hyperperfusion (95% CI 3.7-36.7, p < 0.0001), cerebral hyperperfusion syndrome (95% CI 128.0-6183.6, p < 0.0001), and further strokes during the 2-year follow-up period (95% CI 1.5-78.7, p = 0.0167) were significantly associated with cognitive decline at 2 years postoperatively. The incidence of cognitive decline at 1-2 months postoperatively was significantly higher in patients with cerebral hyperperfusion syndrome (100%) than in those with asymptomatic cerebral hyperperfusion (44%) (p < 0.0001). No significant difference in incidence was observed in the former patients at 2 years postoperatively (88%), but significant reduction was found in patients with asymptomatic cerebral hyperperfusion and cognitive decline between the timepoints of 1-2 months postoperatively (100%) and 2 years postoperatively (39%) (p = 0.0001). Postoperative cerebral hyperperfusion causes prolonged cognitive decline at 2 years postoperatively in patients undergoing CEA.

A Three-Month Probiotic (the Streptococcus salivarius M18 Strain) Supplementation Decreases Gingival Bleeding and Plaque Accumulation: A Randomized Clinical Trial.

S. salivarius M18 administration has been proven to provide positive effects on periodontal health; however, there is still no consensus on the optimum duration of probiotic administration. This study aimed to evaluate the effect of three months of probiotic supplementation on bleeding on probing, signs of gingival inflammation, and dental biofilm. Sixty-two eligible individuals with gingivitis were enrolled in this placebo-controlled, double-blind trial and randomly allocated to the M18 or control groups. Primary outcomes were changes in gingival condition (gingival index, GI; gingival bleeding index, GBI) after 1, 2, and 3 months of lozenges administration and after a one-month washout. Secondary outcomes included changes in the Quigley-Hein plaque index (modified by Turesky et al.) after 1, 2, and 3 months of lozenges administration and after a washout. In total, 60 individuals completed the study (31 and 29 in the M18 group and the control group, respectively). No severe adverse events were reported. Probiotic supplementation resulted in a significant decrease in gingival bleeding at 1 month (effect size 1.09 [CI95%: 0.55-1.63]), 2 months (effect size 0.78 [CI95%: 0.26-1.30]), and 3 months (effect size 0.67 [CI95%: 0.15-1.18]) and a significant reduction in dental plaque accumulation at 2 months (effect size 0.63 [CI95%: 0.12-1.14]) and 3 months (effect size 0.55 [CI95%: 0.03-1.05]). A three-month supplementation with the probiotic resulted in a significant reduction in gingival bleeding and biofilm accumulation; however, a long-lasting effect is not expected, indicating the need for probiotic intake on a long-term basis.

Long-term adenoma recurrence and development of colorectal cancer following endoscopic mucosal resection in large non-pedunculated colonic polyps ≥4 cm

ObjectivesData of long-term follow up for large non pedunculated colorectal polyps (LNPCPs) ≥4 cm removed with piecemeal wide field endoscopic mucosal resection (PWF-EMR) are limited. We primarily evaluated the recurrence rates and secondarily the rates of post colonoscopic polypectomy colorectal cancer (PCPCRC) on a long-term basis. MethodsWe retrospectively reviewed a prospectively-stored electronic database of all patients who underwent PWF-EMR for LNPCPs at the Venizeleion General Hospital, between 2009 and 2020. Eligible patients were those with LNPCPs ≥4 cm, deemed completely removed by endoscopic means and followed-up for a minimum of 36 months with at least two surveillance colonoscopies, the first one (SC1) (4–6) months after the initial PWF-EMR procedure and the second one (SC2) after (12–18) months. In 2023, all cases were checked for PCPCRC development. ResultsResidual/early recurrent tissue was detected in 44 (31 %) cases among the 142 (82 males, 60 females) assessed during SC1. Late recurrent tissue was detected in 9 (6.6 %) cases among the 137 surveyed during SC2. Investigation did not reveal any case of PCPCRC . ConclusionsThis historical cohort shows that the PWF-EMR for LNPCPs ≥4 cm is a safe and definitive removal method while it is not associated with the appearance of PCPCRC.

Monitoring potential impacts of climate change on the biodiversity of springs and springbrooks in the Central Alps

Headwaters in alpine regions and their biodiversity are particularly threatened by climatic changes. Most predictions on their response to climate change are based on modeling approaches. Empirically gained data rarely exist for glacially influenced and groundwater-fed headwaters. In 2019, long-term monitoring was initiated at 15 springs, 8 springbrooks and 2 brooks in the UNESCO Biosphere Reserve Engiadina Val Müstair. The goal was to gain data on hydro-ecological aspects over several decades to understand whether (1) the environmental conditions change over time and (2) how these changes influence the composition of the species assemblages. Water temperature loggers were installed, pH, electrical conductivity, oxygen, nutrients and discharge were measured three times per year, and ecomorphological features were mapped two times per year. The meio- and macrofauna was sampled in 2019, 2020 and 2021 with a semi-quantitative approach. The results of the first 5 years of monitoring show that the physico-chemistry, water temperature and discharge confirm the stable character typical for groundwater-fed systems. Certain seasonal variability is evident, which possibly indicates an influence of permafrost or snow meltwater. The composition of the species assemblages differs significantly between sites but stays relatively constant over time within a site. Elevation and the availability of wood—parameters indicating forestation—significantly influence the species composition. This study provides a solid baseline on the environmental conditions and the fauna in springs and springbrooks in the Central Alps, which is needed for a proper interpretation of changes identified on a long-term basis.

Consistent Support Group Attendance is Vital for Clinically Sustained Weight Loss in a Community Gastroenterology Clinic

Introduction: The increasing prevalence of obesity places a high burden on the economy with annual medical expenses approximating 150 billion dollars. Obesity-related gastrointestinal disorders, including non-alcoholic fatty liver disease (NAFLD), account for over 30% of patient visits to community GI practices. Total body weight loss (TBWL) of 10% or more is associated with reversal of NAFLD-associated fibrosis and steatosis. However, achieving this goal alone can be difficult. Support groups have proven to be vital in allowing individuals to recover from other lifestyle diseases like alcohol overuse. The aim of this study was to assess the impact of support group attendance on a patient achieving 10% TBWL while enrolled in a structured, community-based weight loss program. Methods: Patients enrolled in the weight-loss program participated in a 6 month support group with weekly online meetings. These sessions included discussions of shared experiences and education on the 4 pillars of the program - nutrition, exercise, sleep, and mindfulness. TBWL was calculated by taking the difference of the patients starting weight and their 6 month weight divided by the starting weight. Data was collected retrospectively through chart review. By April 2023, a total of 95 patients completed the support group program. Statistical analysis was performed using ANOVA and Tukey-Kramer post-hoc tests. Results: The mean percent weight loss was 6.30% for the group with 0-50% attendance, 9.30% for the group with 51-75% attendance, and 13.15% for the group with 76-100% attendance. A one-way ANOVA revealed a statistically significant difference in the percent weight loss across the three groups (F(2,92) = 8.66, p &lt;0.001). Further analysis with a Tukey-Kramer post-hoc test revealed a significant difference in percent weight loss between the group with 76-100% attendance and groups with 0-50% attendance (p&lt;0.05) and 51-75% attendance (p&lt;0.05). There was no significant difference in percent weight loss between the groups with 0-50% and 51-75% attendance (p&gt;0.05). Conclusions: The results of this study indicate that patients with more than 75% attendance at support group meetings across a six-month period reported significantly higher percent weight loss than patients with lower attendance. This study supports the efficacy of support group meetings toward achieving weight loss. Further studies with larger sample sizes are ongoing to measure the efficacy of support groups on a long-term basis.

Fighting for Better Representation of Women in and on RT&amp;Eacute;: Women&amp;rsquo;s Work in Promoting Gender Equality at Ireland&amp;rsquo;s National Broadcaster, 1979-1981

This article examines the role that women’s activism and advocacy played in early Irish television and the opportunities for and representation of women in national broadcaster Radio Telefís Éireann (RTÉ). It focuses on two groups: RTÉ’s own Working Group on Women in Broadcasting, which reported in 1981, and the Women in Broadcasting Study Group of 1980, headed by Senator Gemma Hussey. Both investigated practices of employment of women and the roles that they undertook as well as the role of women in RTÉ programs and in television advertising on RTÉ. The article argues that, although there were tensions between the two groups and each group had different interests, different methodological approaches in their reports and were received in the public and by RTÉ very differently, they effectively worked together to compel RTÉ to implement their recommendations and take the issue of gender equality more seriously on a long-term basis.

Mother-Child Conversations about the Impact of Nutrition and Activities on a Short and Long-Term Basis

The following two studies examined mother-child conversations about the outcomes of engaging in healthy and unhealthy eating and physically active and sedentary activities. Study 1 (n= 29 mother-child dyads, M age = 4.6 years) examined the impact of healthy and unhealthy eating on a short and on a long term basis. Study 2 (n = 34 mother-child dyads, M age = 4 years 8 months) examined the impact of physically active and sedentary activities on a short and on a long term basis. Overall for Study 1, preschoolers elicited significantly more physiological and physical responses. For Study 2, preschoolers gave significantly more physiological and physical utterances than their mothers did. The results of these two studies demonstrate that preschoolers draw predominantly on the biological domain when reasoning about the impact of engaging in healthy/unhealthy nutrition and physically active and sedentary activities on a short and on a long-term basis.

Electromagnetic Field Monitoring by Fixed Stations in Romania: Data Processing Methods and Outcomes

Abstract Electromagnetic field (EMF) monitoring activities provide transparent information to the public interested in the safety levels of human exposure when using various radiofrequency (RF) emitting technologies. In the present work, we investigate different methods of data processing that enable relevant knowledge extraction from the databases gathered by the Romanian EMF-fixed monitoring network. Four categories of methods are proposed and illustrated by investigating the situation of electromagnetic exposure at three locations in Bucharest, during 25 months. The conducted application methods enables field level distributions and trends, time-variability on the short- and long-term basis, cumulative influence comparison and sensing of the significant changes in the environment.

Remote Delivery of Partial Meal Replacement for Weight Loss in People Awaiting Arthroplasty.

Background: Obesity is linked to higher rates of complications; lower absolute recovery of mobility, pain, and function; and increased costs of care following total knee or hip arthroplasty (TKA, THA). The aim of this prospective cohort study was to evaluate the effectiveness of a 12-week partial meal replacement (PMR) weight loss program for people awaiting TKA or THA and living with obesity (body mass index (BMI) ≥ 30 kg/m2). Methods: The intervention was delivered remotely and included a 12-week PMR plan of 1200 calories/day, incorporating two meal replacement shakes/soups and a third suitable simple meal option. The intervention support was provided through online group education sessions, one-to-one teleconsultation with a dietitian, and access to a structured PMR App with functions for goal setting and providing educational content on diet, physical activity, and behaviour changes. Results: Of the 182 patients approached, 29 provided consent to participate, 26 participants commenced the program, and 22 participants completed the 12-week PMR plan. Completers exhibited statistically significant weight loss from baseline to 12 weeks, with a paired difference of 6.3 kg (95% CI: 4.8, 7.7; p < 0.001), with 15 out of 22 (68.2%) participants achieving at least 5% weight loss. Statistically significant reductions in HbA1c and low density lipoprotein (LDL) were observed at 12 weeks compared to baseline. Moreover, a significant increase in the proportion of participants in the action and maintenance phases of the readiness to change diet, physical activity, and weight were observed at 12 weeks. The majority of program completers (18 out of 22) expressed willingness to pay for the service if offered on a long-term basis following the arthroplasty. Conclusions: This study's findings demonstrated that significant weight loss is achievable for people living with obesity awaiting arthroplasty following a 12-week PMR weight loss program. The remote delivery of the intervention was feasible and well accepted by people awaiting TKA or THA.

Investigating the socio-demographic characteristics and smoking cessation incidence among smokers accessing smoking cessation services in primary care settings of Qatar, a Historical Cohort Study

BackgroundTobacco dependence is a chronic disease that often requires repeated interventions and multiple attempts to quit. Cigarette smoking is the leading preventable cause of mortality. Globally, an estimated 1.3 billion people smoke.In Qatar, Smoking cessation services (SCSs) are provided free of charge to citizens and at a minimal cost to non-citizens. This study aimed to measure the effectiveness of the smoking cessation program adopted by the Primary Health Care Corporation (PHCC) of Qatar. This was achieved through calculating the percentage of smoking cessation service users (survival probabilities) who maintained the non-smoking status after selected follow up periods. Moreover, the study highlighted the possible association of selected explanatory variables with smoking cessation survival probabilities.MethodsIn this historical cohort study 490 participants were recruited by simple random sampling who attended the smoking cessation clinics (SCCs) in PHCC prior to 30/06/2021. The participants were contacted by phone and invited to participate in the study. The participants who agreed to participate in the study were interviewed utilizing a structured questionnaire.ResultsInitially 311 (63.5%) of the participants quitted smoking after receiving SCSs. There were statistically significant differences between quitting smoking and the nationality and the educational level of participants (p ≤ 0.001 and 0.02 respectively). About one fourth (23.3%) of individuals who initially quitted smoking relapsed and resumed smoking as early as 6 months after completing their SCC visits. This relapse rate increased to 38.7, 47.2 and 51.1% after 12, 24 and 36 months respectively. Less than a half (45.8%) maintained the non-smoking status after 42 months from their initially quitting.Conclusion and recommendationsThe findings of the study substantiate the effectiveness of SCSs designed within PHCC both in short- and long-term basis. Younger individuals, smokers with Arab ethnicity, smokers falling within high income and education groups were identified as high-risk groups and need highest focus. The accessibility to the service among the local population can be increased by upscaling the advertisement of the existing services.

Gradually tapering off antipsychotics: lessons for practice from case studies and neurobiological principles.

There has been an increasing focus on deprescribing in psychiatry recently, particularly of antipsychotic medication, with recognition that not all patients with psychotic disorders require lifelong medication. We summarize some empirical and theoretical papers, and examine case studies to provide instruction on this topic. Recent studies have found that slower tapering (over months or longer) of antipsychotics is associated with a lower relapse rate than quicker tapering (weeks). Case studies presented suggest that the process of reduction is associated with the precipitation or exacerbation of psychotic symptoms and that a slower process of reduction may minimize this effect. This may be because faster reductions cause greater disruption of homeostatic equilibria, provoking psychotic symptoms either as direct withdrawal symptoms or consequences of nonpsychotic withdrawal symptoms (e.g. insomnia) - although not all patients will experience withdrawal symptoms. This suggests that smaller dose reductions, especially at lower doses, made very gradually, may minimize the risk of psychotic symptoms. Slower tapering of antipsychotics may provide time for adaptations made to the presence of the medications to resolve, thus reducing the disruption to homeostatic equilibrium caused by dose reduction, potentially reducing the risk of relapse. Exacerbation of psychotic symptoms on antipsychotic reduction may not represent evidence of the need for a higher dose of antipsychotic on a long-term basis but may indicate the need for more gradual reduction. Gradual reduction of antipsychotics, especially after long-term use in clinical practice is prudent.

Ambient Air Quality Assessment through Air Quality Index and Air Quality Health Index for Eastern Coastal Region, Gandhidham, Gujarat, India

The impact of coastal developmental projects such as ports on regional air quality has been a matter of concern, as they are known to induce rapid industrialization and urbanization as collateral development on a long-term basis. Gandhidham-Kachchh, Gujarat, India is hub for industrialization, thus various developmental activities and port activities may release toxic gases into the environment. Thus, an attempt was made to assess the present ambient air quality in and around eastern coastal region of Gandhidham, Gujarat using Air Quality Index (AQI) and Air Quality Health Index (AQHI). The primary focus was on respirable particulate matter (PM10) and fine particulate matter (PM2.5) along with other gaseous pollutants. In total 134 samples were collected from 11 stations during January to December 2018. Sampling was carried out 24 hourly on a monthly basis. Respirable particulate matter (PM10), fine particulate matter (PM2.5), sulphur dioxide and nitrogen dioxide ranged from 29-401 µg/m3, 13-184 µg/m3, 5.9-92.6 µg/m3and 3.7-33 µg/m3, respectively. The annual mean concentrations varied from 118-227 µg/m3, 47-82 µg/m3, 10-51 µg/m3, 11-41 µg/m3 for PM10, PM2.5, sulphur dioxide and nitrogen dioxide, respectively. In most of the sampling locations both the particulate matter fractions exceeded the permissible limit as prescribed in National Ambient Air Quality Standard (NAAQS). The AQI ranged from 28 to 106, which falls under Good and Satisfactory category of pollution as per the Central Pollution Control Board (CPCB) standards except at A-11 which falls under Moderate category. The AQHI was in the range of 5.9 to 15.8, which was alarming indicating Moderate to Very Higher Risk to the people. The present findings throw light on the prevailing scenario in the ambient air quality of the studied region, thereby suggesting for strict implementation and thorough control measures for reduction of particulate matters in the air.

Management of immunosuppressive therapy after functional renal graft failure: results of a practice survey of French-speaking nephrologists

The management of patients with kidney transplant failure (KTF) remains a complex process involving multiple stakeholders. A working group of the Transplantation Commission of the French-speaking Society of Nephrology, Dialysis and Transplantation (SFNDT) conducted a survey on the management of immunosuppressants (IS) after KTF among nephrologists at transplant centres and general nephrologists in France, Switzerland and Belgium between March and June 2023. We analysed 232 replies from 58 nephrologists at transplant centres and 174 general nephrologists, aged 43.6 (+10.6) years. In the first three months following KTF, nephrologists reported discontinuing antimetabolite, calcineurin inhibitor (CNI) and corticosteroid treatment in 83%, 39.9% and 25.8% of cases respectively. Conversely, some nephrologists reported that they were continuing to use CNI (14%) and corticosteroids (19.1%) on a long-term basis. The patient’s comorbidities associated with the discontinuation of IS treatment are cancer and opportunistic infections as KT’s complications and presence of diabetes mellitus at KTF, whereas humoral rejection encourages the IS to be maintained. Transplantectomy is proposed by nephrologists most often for graft intolerance syndrome (86.5%), more rarely to discontinue IS (17.6%) or in the absence of plans of new transplantation (9.3%). In multivariate analyses, the presence of a protocol in the centre facilitated the management of IS by the general nephrologists. The management of IS after AFG by French-speaking nephrologists is heterogeneous. Specific prospective studies are needed to establish new best practice recommendations, based on more robust evidence, which could encourage better adherence by nephrologists.

Growing evidence that endometriosis is a systemic disease

The pathophysiology of endometriosis remains unclear. Retrograde menstruation could be a phenomenon that initiates the process, but it may not explain the entire pathophysiology of endometriosis. Current evidence suggests that endometriosis is a type of chronic inflammatory disease. Many conditions that affect the vascular endothelium, including atherosclerosis, cardiovascular disease and pre-eclampsia, have been shown to be associated with endometriosis. Evidence to date suggests a complex interaction in endometriosis between angiogenesis, hormones and immunological changes stemming from chronic inflammation, with the inflammatory cells releasing cytokines and chemokines including tumour necrosis factor-α (TNF-α). Indeed, TNF-α is considered to be one of the possible markers of endometriosis in the blood, endometrium or menstrual blood. We emphasize the importance of pursuing research for novel and safer anti-inflammatory and immunomodulatory drugs that can be used by patients with endometriosis on a long-term basis.