Personality Characteristics among Patients Waiting for Liver or Kidney Transplants

Introduction: Personality characteristics are believed to predict post-transplant adherence and outcome. However, data concerning the prevalence and type of personality disorders (PDs) among transplant populations are sparse. Objectives: To evaluate the prevalence and types of PDs among patients waiting for liver or kidney transplants, to compare the results obtained between the two groups and to identify predictors of the prevalence of PDs. Method: In a prospective cohort study, 629 patients waiting for liver (n = 196) or kidney (n = 433) transplants were assessed by the Personality Diagnostic Questionnaire, fourth edition (PDQ-4+). Results: The 629 pre-transplant patients were 46.1 years old on average (SD: 11.5). The PDQ total score was 25.5 (SD: 13.7). 36.5% had a total score equal to or greater than 30. Paranoid (42.1%), avoidant (31.1%) and obsessive-compulsive (29.8%) were the most common possible PDs identified. Patients waiting for a kidney transplant had a higher total score than those waiting for a liver transplant (p 0.001) and they also had significantly more paranoid (p = 0.001), obsessive-compulsive (p = 0.002) and avoidant (p = 0.001) PDs. Comment: In case of possible PDs, an assessment of other clinical variables for helping patients is needed so that a specific treatment could be offered to patients at the time of their inclusion on the waiting list, during the waiting period and after the organ transplant.

Dental pulp stem cells as a promising model to study imprinting diseases

Parental imprinting is an epigenetic process leading to monoallelic expression of certain genes depending on their parental origin.Imprinting diseases are characterized by growth and metabolic issues starting from birth to adulthood.They are mainly due to methylation defects in imprinting control region that drive the abnormal expression of imprinted genes.We currently lack relevant animal or cellular models to unravel the pathophysiology of growth failure in these diseases.We aimed to characterize the methylation of imprinting regions in dental pulp stem cells and during their differentiation in osteogenic cells(involved in growth regulation)to assess the interest of this cells in modeling imprinting diseases.We collected dental pulp stem cells from five controls and four patients(three with Silver-Russell syndrome and one with Beckwith-Wiedemann syndrome).Methylation analysis of imprinting control regions involved in these syndromes showed a normal profile in controls and the imprinting defect in patients.These results were maintained in dental pulp stem cells cultured under osteogenic conditions.Furthermore,we confirmed the same pattern in six other loci involved in imprinting diseases in humans.We also confirmed monoallelic expression of H19(an imprinted gene)in controls and its biallelic expression in one patient.Extensive imprinting control regions methylation analysis shows the strong potential of dental pulp stem cells in modeling imprinting diseases,in which imprinting regions are preserved in culture and during osteogenic differentiation.This will allow to perform in vitro functional and therapeutic tests in cells derived from dental pulp stem cells and generate other cell-types.

Early hemodynamic resuscitation of septic shock:what do the new Surviving Sepsis Campaign guidelines really provide?

A new version of the Surviving Sepsis Campaign(SSC)guide-lines for sepsis and septic shock[1]has been published a few months ago.In this editorial,we aim to focus on similarities and differences between the 2021 and 2016 SSC guidelines,[2]in terms of hemodynamic management.The first striking differ-ence concerns blood lactate measurements.It is now suggested to guide resuscitation to decrease serum lactate but not normal-ize it as previously suggested.Indeed,as stated in an editorial by Hernandez and Teboul,“since non-hypoperfusion-related causes of hyperlactatemia might predominate in an unknown number of patients,aiming at strictly normalizing lactate might lead to excessive resuscitation with inherent fluid and vasopressor over-load,and eventually to increased morbidity and mortality”.[3]In a recent multicenter randomized controlled trial in septic shock called ANDROMEDA-SHOCK,an early resuscitation strat-egy guided on capillary refill time(CRT)was shown to result in lesser organ dysfunction at 72 h than a strategy based on decrease in blood lactate.[4]In a subsequent Bayesian analysis of ANDROMEDA-SHOCK,the CRT-based strategy was shown to reduce mortality as compared to the lactate-based strategy.[5]These data support the new SSC recommendations stating that CRT can be used to guide resuscitation.[1]