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A national program of controlled donation after circulatory death (cDCD) began in France in 2014 involving the use of a standardized national protocol, which involves systematic use of normothermic regional perfusion (NRP). In this article, we describe in detail the French cDCD program. Between January 1st , 2015, and December 31th , 2018, 225 livers were offered for donation, resulting in 123 cDCD liver transplants (LTs). The overall 90-day graft survival rate was 93.1% (95% CI 85.9%-96.6%). Twenty-one of 123 LTs (17%) did not adhere strictly to the national protocol. One-year graft survival was significantly lower in the group deviating from the national protocol compared to those patients following the national protocol 68.4% (95% CI 42.8%-84.4%) versus 94.8% (95%CI 86.5%-98.0%) (p less then 0.01). Fifteen patients died, including 2 after primary graft dysfunction and 10 related to liver cancer recurrence. Only one case of ischemic cholangiopathy was observed at Month-18 in this series; it necessitated a successful retransplant. During the first four years, excellent LT results were observed where the national protocol was followed. Systematic use of NRP limits Functional warm ischemic time (FWIT) and provides excellent cDCD organs.Background Comorbidities are associated with higher health care costs, complex management, and poorer health outcomes. Identification and treatment of comorbid conditions in pediatric alopecia areata (AA) patients could provide an opportunity to improve health outcomes. Objectives To determine the prevalence of comorbidities among pediatric patients with AA using a large de-identified aggregated patient database. Methods This is a cross-sectional study using aggregated health record data through April 1, 2019. Patients ≤18 years of age, with alopecia areata (n=3,510) and without alopecia areata (n=8,310,710) were identified. The primary outcome was the prevalence of comorbidities among AA patients. Results Of the 8,314,220 pediatric patients, 3,510 (1,570 males and 1,940 females) had a diagnosis of alopecia areata. The most common comorbidities included atopic dermatitis (17.4% vs. 2.2% controls, OR 9.2, 95%CI 8.55-10.18, p less then 0.001), anemia (7.7% vs. 2.4% controls, OR 3.4, 95%CI 3.06-3.92, p less then 0.001), obesity (5.7% vs. 1.1% controls, OR 5.6, 95%CI 4.76-6.34, p less then 0.001), vitamin D deficiency (5.1% vs. 0.4% controls, OR 14.7, 95%CI 13.5-18.1, p less then 0.001), hypothyroidism (2.6% vs. 0.2% controls, OR 12, 95%CI 10.73-15.9, p less then 0.001), vitiligo (1.4% vs. 0.04% controls, OR 32.2, 95%CI 24.01-42.1, p less then 0.001), psoriasis (1.4% vs. 0.07% controls, OR 20.6, 95%CI 15.55-27.2, p less then 0.001), hyperlipidemia (1.4% vs. 0.2% controls, OR 5.9, 95%CI 4.4-7.7, p less then 0.001), and depression (2.6% vs. 0.6% controls, OR 4.8, 95%CI 5.09-9.45, p less then 0.001). Conclusions Findings from this study suggest that children with AA are more likely to have certain autoimmune and metabolic disorders than the general pediatric population. selleck chemicals llc Pediatric AA patients display a severe burden of autoimmune and metabolic diseases, thus in daily practice, dermatologists might consider multidisciplinary management in these patients.Background and aim Impella is frequently used to unload the left ventricle in patients with cardiogenic shock on venoarterial extracorporeal membrane oxygenation (VA-ECMO). There is limited data regarding the use of this strategy. This study aims to evaluate the safety and efficacy of the said strategy. Methods A systematic search for studies comparing Impella plus VA-ECMO (ECVAD) vs VA-ECMO alone was performed using Pubmed, Cochrane Library, and Scopus. Studies meeting inclusion criteria were then used to perform a meta-analysis. Results Three studies involving 448 patients were included in the final analysis. In total, 117 (26%) patients were female, mean age was 57 years. VA-ECMO was placed in 355 out of 448 (79%) patients, while ECVAD was placed in 93 out of 448 (21%). Death occurred in 49 out of 93 (52.6%) patients on ECVAD and 226 out of 355 (63.6%) on ECMO, relative risk (RR) 0.76, confidence interval (CI), 95% (0.62-0.94) P = .01. Hemolysis was present in 46 (49.4%) patients in the ECVAD vs 67 (18%) in the ECMO group, RR 2.64, CI, 95% (1.97-3.55) P less then .01. Bleeding was present in 42 (45.2.%) patients in the ECVAD group and 135 (38%) in the ECMO group, RR 1.25, CI, 95% (0.95-1.63) P = .11. CVVHD was used on 31 (33.3%) patients in the ECVAD group while 89 (25%) in the ECMO group, RR 1.35, CI, 95% (0.95-1.91) P = .10. Conclusion This study suggests that the use of Impella as an unloading strategy in patients with VA-ECMO decreased mortality, increased rate of hemolysis, neutral bleeding risk, and similar rates of acute kidney injury requiring CVVHD.Background Patient selection and cannulation arguably represent the key steps for the successful implementation of extracorporeal membrane oxygenation (ECMO) support. Cannulation is traditionally performed in the operating room or the catheterization laboratory for a number of reasons, including physician preference and access to real-time imaging, with the goal of minimizing complications and ensuring appropriate cannula positioning. Nonetheless, the patients' critical and unstable conditions often require emergent initiation of ECMO and preclude the safe transport of the patient to a procedural suite. Aims Therefore, with the objective of avoiding delay with the initiation of therapy and reducing the hazard of transport, we implemented a protocol for bedside ECMO cannulation. Matherial and methods A total of 89 patients required ECMO support at Hennepin County Medical Center between March 2015 and December 2019. Twenty-eight (31%) required veno-venous support and were all cannulated at the bedside. Overall survival was 71% with no morbidity or mortality related to the cannulation procedure. Conclusion In the current pandemic, the strategy of veno-venous bedside cannulation may have additional benefits for the care of patients with refractory acute respiratory distress syndrome due to coronavirus-disease-2019, decreasing the risk of exposure of health care worker or other patients to the novel severe acute respiratory syndrome coronavirus-2 occurring during patient transport, preparation, or during disinfection of the procedural suite and the transportation pathway after ECMO cannulation.selleck chemicals llc