Analysis of Risk Factors and Long-Term Outcomes in Kidney Transplant Patients with Identified Lymphoceles

The collection of lymphatic fluids (lymphoceles) is a frequent adverse event following renal transplantation. A variety of surgical and medical factors has been linked to this entity, but reliable data on risk factors and long-term outcomes are lacking. This retrospective single-center study included 867 adult transplant recipients who received a kidney transplantation from 2006 to 2015. We evaluated for patient and graft survival, rejection episodes, or detectable donor-specific antibodies (dnDSA) in patients with identified lymphoceles in comparison to controls. We identified 305/867 (35.2%) patients with lymphocele formation, of whom 72/867 (8.3%) needed intervention. Multivariate analysis identified rejection episode as an independent risk factor (OR 1.61, CI 95% 1.17-2.21, p = 0.003) for lymphocele formation, while delayed graft function was independently associated with symptomatic lymphoceles (OR 1.9, CI 95% 1.16-3.12, p = 0.011). Interestingly, there was no difference in detectable dnDSA between groups with a similar graft and patient survival in all groups after 10 years. Lymphoceles frequently occur after transplantation and were found to be independently associated with rejection episodes, while symptomatic lymphoceles were associated with delayed graft function in our cohort. As both are inflammatory processes, they might play a causative role in the formation of lymphoceles. However, development or intervention of lymphoceles did not lead to impaired graft survival in the long-term

Coastal transitions: Small-scale fisheries, livelihoods, and maritime zone developments in Southeast Asia

Across Southeast Asia, coastal livelihoods are becoming more diverse and more commodified, as maritime zone developments intensify. We review literature from the ten maritime states in Southeast Asia to assess how older and emerging forms of maritime zone developments influence the viability of small-scale fishing livelihoods. Applying a political economy lens to small-scale fisheries and maritime zone developments at regional scale, we show how small-scale fisheries persist as a significant coastal livelihood activity across the region, despite declining opportunities due to long-term intensification of fisheries exploitation. The paper further analyses the ways in which newer maritime zone developments, including aquaculture, land reclamation, special industrial zones, and tourism interact with fishing, and are reconfiguring coastal livelihoods in the region. Key trends that small-scale fishers and coastal communities must negotiate include deepening commodification, worsening environmental degradation, loss of access to fishing grounds, and an intensifying ‘squeeze’ on coastal space

A Piece of the Puzzle: The Bone Health Index of the BoneXpert Software Reflects Cortical Bone Mineral Density in Pediatric and Adolescent Patients.

INTRODUCTION:Suspected osteopathology in chronically ill children often necessitates the assessment of bone mineral density. The most frequently used methods are dual-energy X-ray-absorption (DXA) and peripheral quantitative computed tomography (pQCT). The BoneXpert software provides an automated radiogrammatic method to assess skeletal age from digitalized X-rays of the left hand. Furthermore, the program calculates the Bone Health Index (BHI), a measure of cortical thickness and mineralization, which is obtained from indices of three metacarpal bones. In our study, we analyzed the manner in which BHI information provided by BoneXpert compares with DXA or pQCT measurements in youths. STUDY DESIGN:The BHI was retrospectively obtained using digitalized X-rays of the left hand and compared with the results of 203 corresponding DXA readings (Lunar Prodigy, GE Healthcare) of the lumbar vertebrae and femur as well as 117 pQCT readings (XCT 900, Stratec) of the distal radius. RESULTS:The BHI values showed a strong positive correlation with the DXA readings at each and all lumbar vertebrae (L1 -L4: r = 0.73; P < 0.0001). The age-adjusted Z-score of L1 -L4 and the height-adjusted score showed a positive correlation with the BHI-SDS (standard deviation score, r = 0.23; P < 0.002 and r = 0.27; P < 0.001, respectively). Total bone mineral density, as assessed via pQCT, also positively correlated with the BHI (r = 0.39; P < 0.0001), but the trabecular values displayed only a weak correlation. CONCLUSIONS:The BHI obtained using BoneXpert can be a useful parameter in the assessment of bone health in children in most cases. This technique provides observer-independent information on cortical thickness and mineralization based on X-ray imaging of the hands

Results of the pQCT readings.

<p>Results of the pQCT readings.</p

Descriptive statistics of relevant patient clinical data.

<p>Descriptive statistics of relevant patient clinical data.</p

Positive association of BMD values obtained via BoneXpert and pQCT (XCT 900 Stratec®).

<p>A) BHI readings obtained using BoneXpert showed a positive correlation with BMD readings at the distal radius as measured via pQCT (XCT 900 Stratec®; r = 0.39; P < 0.0001). B) Accordingly, the SDS of the pQCT method (QCTOT SDS total, vertical axis) and the BoneXpert (BHI SDS, horizontal axis) were positively correlated (r = 0.3; P = 0.003). The predicted values based on bivariate regression analysis are indicated as a solid line. The dashed lines represent the 95% confidence interval.</p