University of Rouen

The increasing use of extended kidney grafts to bridge organ shortage has led to delayed and impaired graft function, warranting the development of new preservation strategies. In addition to hypothermic machine perfusion, the addition of pharmacological agents to preservation solutions has been primarily investigated, with a few promising agents making their way into clinical trials. This review aimed to identify and summarize current literature studies on pharmacological treatment additives for hypothermic kidney graft preservation. A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive literature search was performed using Medline and Cochrane Library databases until 1 December 2023. All studies published in English reporting on pharmacological supplementation of preservation solutions to improve hypothermic kidney graft preservation were included. A total of 67 records were retrieved, all of which were preclinical except one. Of these, 8 were conducted on cellular models, 21 on ex vivo kidneys, and 38 on animal kidney transplantations. A total of 40 pharmacological agents were evaluated based on the key markers of ischemia-reperfusion injury (IRI) pathophysiology, most of them showing promise in kidney preservation. Although promising, with numerous preclinical studies identifying various effective additives, the pharmacological treatment additive strategy to improve hypothermic kidney preservation has still not been translated into clinical practice. Clinical investigations should be promoted to support few ongoing trials offering encouraging outcomes.

Mentalization refers to an individual's ability to understand their own behaviours and those of others in terms of mental states. Its development is closely linked to a child's early life experiences. For its part, the development of the ability to play is also rooted in the relationship with a secure and supportive caregiver. Some children do not have this opportunity and grow up with a caregiver who repeatedly neglects or abuses them over time. These children may experience early relational trauma (ERT). In that situation, the acquisition of mentalization and play skills may be affected. The aim of this research is to describe the development of mentalization and play processes in children with and without ERT in the context of psychodynamic psychotherapy (PP). To achieve this, data concerning the mentalization processes and play of two children taking part in PP were examined: one child who had experienced ERT and another from the general population. Individual case protocols were used to observe the evolution of these two variables. The number and duration of play segments, as well as the mentalization precursors of the child with ERT, changed over the course of PP, whereas they remained stable for the child in the general population. In children who have experienced ERT, the presence of a non-linear evolution of traumatic play has been observed.

BackgroundFrontotemporal dementia (FTD) with right anterior temporal lobe (RATL) predominant atrophy is an emerging area of interest. Recent findings by the International Working Group (IWG) have identified this subtype as having a distinct clinical profile within the FTD spectrum (Ulugut et al., 2024, A&D). However, its genetic and pathological underpinnings remain unexplored in large, multicultural cohorts.MethodsRetrospective analyses encompassing clinical, genetic, pathological, and neuroimaging data from 23 IWG sites across 13 countries in Asia, Middle East, Europe, North and South America were conducted. The study included 444 patients with FTD exhibiting predominant RATL atrophy.ResultsGenetic screening was performed on 51% (n = 225) of the cohort for at least the major frontotemporal lobar degeneration (FTLD) mutations including microtubule‐associated protein tau (MAPT), progranulin (GRN), and chromosome 9 open reading frame 72 (C9orf72), or dementia panels encompassing extended sets of genes. Of these, 81% were sporadic, showing negative results for the screened genes and a modified Goldman Score of ≥ 3, indicating a negative family history for dementia. The MAPT mutation was the most common genetic variant, identified in 7% of the screened cases (Figure 1). Pathological confirmation was available for 63 patients. Among the sporadic cases, transactive response DNA‐binding protein 43 type C (TDP‐C) pathology was most prevalent (60%, n = 32), while tau‐MAPT pathology was most common in the genetic cases (38%, n = 16). Fifteen cases did not fit neatly into genetic or sporadic categories, displaying heterogeneous pathologies (Figure 2). At the initial visit, compared to genetic cases, patients with TDP‐C pathology were older, and more frequently exhibited semantic deficits, with less frequent attention difficulties and executive dysfunction. No differences were observed in sex distribution, symptom duration or disease severity between genetic and sporadic TDP‐C cases. However, left handedness was more common in TDP‐C cases (14%) compared to genetic cases (5%).ConclusionWhile FTD with RATL atrophy primarily appears sporadic, a significant proportion of cases exhibit genetic variants. These sporadic and genetic subtypes display distinct neuropathological features and clinical manifestations. Given the implications for therapeutic strategies, precise clinical and molecular subtyping is critical for enhancing patient management and ensuring appropriate enrollment in clinical trials.

We aimed to evaluate the efficacy of a prefabricated inflatable ankle orthotic brace (IAOB) to improve the 3-dimensional (3D) foot alignment of patients with progressive collapsing foot deformity (PCFD) using weightbearing computed tomography (WBCT). We prospectively enrolled a consecutive series of symptomatic PCFD patients and a healthy control group matched for mean age, sex, and BMI. The primary endpoint was the paired change in FAO (%) with brace vs no brace. Each PCFD foot underwent 2 WBCT scans with and without an IAOB. The foot 3D alignment was assessed using the foot and ankle offset (FAO) under the assumption that IAOBs could improve at least 50% of the surgical FAO correction (-4.25%). Dedicated 3D measurements allowed the assessment of PCFD classes (from A to D). Both PCFD and control groups included 24 feet. Overall, 48 feet underwent 72 WBCT (24 unbraced PCFD, 24 braced PCFD and 24 controls). Median age was 55.5 years (IQR 26.3) in the PCFD group and 51.0 years (IQR 32.2) in the control group (P = .58), with a median BMI of 33.5 (IQR 13.4) and 25.4 (IQR 8.3), respectively (P = .24). Females comprised 58.3% of the control group and 54.2% of the PCFD group (P = .99). The FAO in the unbraced (6.6 ± 3.7) and braced (5.5 ± 4.2) PCFD group was not significantly improved (P = .1). After bracing, only class C PCFD showed significant improvement of the forefoot arch angle (P = .001) and talus-first metatarsal angle (P = .002). The other PCFD classes were not improved by the brace (class A P = .66, class B P = .44, class D P = .17). These findings suggest device-specific efficacy was limited to class C PCFD on static WBCT measures; clinical benefit remains unproven and warrants PROMs/MCID-anchored studies.

AimsLeadless pacemakers (LLPs) offer a valuable option for selected patients requiring ventricular pacing. However, data on revision procedures—defined as any intervention on an implanted LLP to correct dysfunction or upgrade the system, with or without removal—remain scarce. This study aimed to evaluate the real-world incidence, characteristics, and outcomes of LLP revisions, with particular emphasis on the feasibility and safety of removal.Methods and resultsThis multicentre retrospective study involved 46 French centres performing LLP implantations between 2015 and 2023. Among 8994 Micra LLPs implanted, 100 revision procedures (1.1%) were performed in 100 patients, including 73 Micra VR and 27 Micra AV devices, at a median follow-up of 229 (68.5–629.8) days. Seventy revisions were managed without device removal, while 30 involved removal. Revision indications included device upgrade (55%), high pacing threshold (33%), battery depletion (3%), ventricular arrhythmias (3%), and miscellaneous causes (6%). No significant differences were observed in pacing indications, implantation characteristics, or initial device indication between the two groups. Revisions occurred significantly earlier in the removal group than in the group without removal [median 81.5 (8–211.5) days, vs. 334 (130.25–882.5) days, P < 0.001], with 80% occurring within 1 year. Device removal was successful in 97% of cases (one failure at 157 days of follow-up), with no major complications reported.ConclusionLLP revisions are infrequent and predominantly managed without device removal. However, given the high procedural success rate and the low complication rate, device removal appears to be underutilized and should be considered more frequently on a case-by-case basis.