Study of psychosocial parameters related to the survival rate of renal transplantation in children

The purpose of the present study was to assess the effect of intelligence, schooling, psychomotor, emotional, and social status on renal graft survival in children. Sixty-two cadaver renal transplant recipients were evaluated retrospectively and the influence of sex, age, weight, and the use of cyclosporin A (CyA) on the success rate of the graft from 1 to 5 years later was analyzed. Psychological and social scores were devised and included as factors predictive of survival of the graft. Univariate analysis showed that the following variables predicted renal graft survival: the use of CyA (P = 0.0002), pre-transplant dialysis (P = 0.04), weight at the time of transplantation (P = 0.072), and psychological scores (P = 0.064). Association analysis demonstrated that pre-transplantation dialysis was only a chance association and therefore the parameter was discarded. Multivariate analysis showed that the predictive parameters were the use of CyA, sex, weight in kilograms, and the psychological score. An equation was then derived from variables that predict the probability that a specific patient’s graft will survive more than t months. This equation is the estimated survival distribution function and is as follow: S (t) = Exp {–Exp[–(0.8882x ₁–1.827x ₂+0.037x ₃–0.1746x ₄)+ln t–4.7862]} where S (t) = the survival at t months post transplantation, x ₁ = sex (male 1, female 2), x ₂ = CyA (yes 1, no 2), x ₃ = weight in kilograms, and x ₄ = psychological score. The major impact of psychological factors on renal graft survival was surprising. Received March 5, 1996; received in revised form and accepted March 11, 1997     

Psychometrics of a Brief Trauma Symptom Screen for Youth in Residential Care

Trauma screening is an important element for providing trauma‐informed services to youth in residential care. Unfortunately, lack of time and resources may deter clinicians from conducting trauma screening at intake. This study tested the psychometric properties of the Brief Trauma Symptom Screen for Youth (BTSSY), which could be used during intake into residential care. Participants included 572 youth, ages 10–18 years (M = 14.28 years, SD = 2.31), of whom 58.9% were boys, 78.7% were Caucasian, 51.7% were youth receiving services in residential care, 15.6% were youth with clinical needs, and 32.7% were typically developing youth from the local community. Participants completed the BTSSY; other questionnaires of psychopathology, childhood maltreatment, and symptomology of posttraumatic stress disorder (PTSD); and diagnostic interviews, which were conducted by licensed psychiatrists. The total BTSSY score had a good composite reliability (CR) of .80 and was valid based on a significant positive correlation, r = .64, with the UCLA PTSD–Reaction Index. The BTSSY score was also fair, area under the curve = .75, at detecting a diagnosis of PTSD from a psychiatrist. Significant group differences in the BTSSY scores were found between youth with a diagnosis of PTSD and the other two groups, with moderate‐to‐large effect sizes, ds = 0.73–1.22. Preliminary results indicated the BTSSY may be a useful screening tool for identifying youth at residential care intake who may need additional assessment for PTSD. Limitations and implications for future research and practice are discussed.     

Expression patterns and functional evaluation of the UNC5B receptor during the early phase of peripheral nerve regeneration using the mouse median nerve model

Introduction: In this study, we evaluated the role of the Netrin‐1 receptor UNC5b (Uncoordinated), a neuronal guidance molecule, during peripheral nerve regeneration using the mouse median nerve model. Materials and methods: Using Western blot analysis, we examined the expression changes of UNC5b after transection and microsurgical repair of the mouse median nerve distal to the transection site. We evaluated the histomorphometrical changes and functional recovery of the grasping force after median nerve transection and repair in wild‐type (WT) mice and UNC5b^+/? heterozygous mice. Results: In Western blot analysis, we could show a high increase of UNC5b in the nerve segment distal to the injury site at day 14. Histomorphometrical analysis did not show any significant differences between WT animals and heterozygous animals. Using the functional grasping test, we could demonstrate that peripheral nerve regeneration is significantly diminished in heterozygous UNC5b^+/? mice. Conclusion: By using the mouse median nerve model in transgenic animals, we demonstrate that the Netrin‐1 receptor UNC5b plays an important role during peripheral nerve regeneration. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013.     

Inpatient COVID-19 outcomes in solid organ transplant recipients compared to non-solid organ transplant patients: A retrospective cohort

Immunosuppression and comorbidities might place solid organ transplant (SOT) recipients at higher risk from COVID-19, as suggested by recent case series. We compared 45 SOT vs. 2427 non-SOT patients who were admitted with COVID-19 to our health-care system (March 1, 2020 - August 21, 2020), evaluating hospital length-of-stay and inpatient mortality using competing-risks regression. We compared trajectories of WHO COVID-19 severity scale using mixed-effects ordinal logistic regression, adjusting for severity score at admission. SOT and non-SOT patients had comparable age, sex, and race, but SOT recipients were more likely to have diabetes (60% vs. 34%, p < .001), hypertension (69% vs. 44%, p = .001), HIV (7% vs. 1.4%, p = .024), and peripheral vascular disorders (19% vs. 8%, p = .018). There were no statistically significant differences between SOT and non-SOT in maximum illness severity score (p = .13), length-of-stay (sHR: _0.91.1_1.4, p = .5), or mortality (sHR: _0.10.4_1.6, p = .19), although the severity score on admission was slightly lower for SOT (median [IQR] 3 [3, 4]) than for non-SOT (median [IQR] 4 [3–4]) (p = .042) Despite a higher risk profile, SOT recipients had a faster decline in disease severity over time (OR = _0.760.81_0.86, p < .001) compared with non-SOT patients. These findings have implications for transplant decision-making during the COVID-19 pandemic, and insights about the impact of SARS-CoV-2 on immunosuppressed patients.

     

Implementation of a transition model to adult care may not be enough to improve results: National study of kidney transplant recipients

Adolescents with a kidney transplant (KT) require special attention during the transition of care. Few longitudinal studies have assessed the effect of transition models (TM) on patient outcomes. Between 1986 and 2013, 239 pediatric patients underwent KT in Finland, of whom 132 have been transferred to adult care. In 2005, a TM was developed following international recommendations. We compared patient (PS) and graft survival (GS) rates before and after the introduction of the TM. PS and GS at 10 years were similar before and after the implementation of the TM (PS 85% and 90% respectively, P = 0.626; GS 60% and 58%, respectively, P = 0.656). GS was lower in patients transplanted at age 10‐18 than in patients transplanted at a younger age in the TM cohort (79% vs 95%, P < 0.001). During the first five years after transfer, 63% of patients had stable KT function, 13% had deteriorating function and 24% lost their KT. Altogether 32 out of 132 patients lost their kidney allograft within five years after transfer to adult care (13 before and 19 after TM implementation, P = 0.566). The implementation of this TM had no effect on PS or GS. Further measures to improve our TM are in progress.     

High airborne level of Aspergillus fumigatus and presence of azole-resistant TR34/L98H isolates in the home of a cystic fibrosis patient harbouring chronic colonisation with azole-resistant H285Y A. fumigatus

Azole-resistant Aspergillus fumigatus (ARAF) has been reported in the domestic environment of patients at risk for aspergillosis. Here, we assessed the mother's and father's homes of an 18-year-old cystic fibrosis patient harbouring chronic colonisation with H285Y CYP51A azole-resistant isolate, in order to explore the link between environmental exposure and ARAF infection. In one dwelling, a very high overall contamination level was found (710–7.240 CFU/m³), with a predominance of A. fumigatus (640–6.490 CFU/m³), and ARAF showing the TR₃₄/L98H mutation was isolated. Mycological follow-up of the patient showed the persistence of H285Y isolates, but no acquisition of TR₃₄/L98H isolates was observed. This could be due to the low proportion of TR₃₄/L98H isolates (<3%), or the establishment of preventative measures and dwelling remediation taken after the environmental investigation. Our data underlines the value of an environmental assessment to establish preventative measures and limit the risk of A. fumigatus exposure and ARAF acquisition.     

Reduced loading due to spinal-cord injury at birth results in “slender” bones: a case study

Introduction The present case study compared bone density, bone geometry and muscle cross-sectional area (CSA) in a male who sustained spinal-cord injury (SCI) at birth (from here called SCI-B) with two matched controls without SCI, and also with four individuals with SCI of similar level and injury completeness but sustained at age 15 or greater. Methods All subjects with SCI were at least 3 years post-injury and had experienced motor incomplete lesions at the cervical level. Computed tomography was used to measure volumetric bone density, indices of bone strength [CSA and maximum, minimum and polar area moments of inertia (I _max, I _min, I _pol)] and muscle CSA at the tibia (66% of tibia length, measured proximally from the distal end). Results Lower leg muscle CSA of SCI-B was 63±6% of values in non-SCI controls, and 72±12% of values in other males with SCI. In SCI-B, bone CSA was roughly half (52±4%) that of non-SCI controls and 73±16% of bone CSA values in other males with SCI. The magnitudes of the area moment of inertia variables (I _max, I _min, and I _pol) in SCI-B were ~25% of control values. Further, the moment of inertia variables in SCI-B were 27–54% of values obtained in other males with SCI, indicating that experiencing SCI in the early stages of life has a remarkable impact on bone shape. Interestingly, tibia bone density did not appear to be affected; the average difference in bone density between SCI-B and non-SCI controls was −1.2±0.7%. The bone densities of other males with SCI were 4–19% lower than in SCI-B. Conclusions Muscle atrophy and bone loss are commonly reported consequences of SCI. This case reveals that important changes in bone geometry occur after SCI, and that mechanical loading during growth plays a vital role in the development of bone size and shape.     

Derivation of Indices of Left Ventricular Contractility in the Setting of Continuous‐Flow Left Ventricular Assist Device Support

It is important to accurately monitor residual cardiac function in patients under long‐term continuous‐flow left ventricular assist device (cfLVAD) support. Two new measures of left ventricular (LV) chamber contractility in the cfLVAD‐unloaded ventricle include I_Q, a regression coefficient between maximum flow acceleration and flow pulsatility at different pump speeds; and K, a logarithmic relationship between volumes moved in systole and diastole. We sought to optimize these indices. We also propose RI_Q, a ratio between maximum flow acceleration and flow pulsatility at baseline pump speed, as an alternative to I_Q. Eleven patients (mean age 49 ± 11 years) were studied. The K index was derived at baseline pump speed by defining systolic and diastolic onset as time points at which maximum and minimum volumes move through the pump. I_Q across the full range of pump speeds was markedly different between patients. It was unreliable in three patients with underlying atrial fibrillation (coefficient of determination R² range: 0.38–0.74) and also when calculated without pump speed manipulation (R² range: 0.01–0.74). The K index was within physiological ranges, but poorly correlated to both I_Q (P = 0.42) and RI_Q (P = 0.92). In four patients there was excellent correspondence between RI_Q and I_Q, while four other patients showed a poor relationship between these indices. As RI_Q does not require pump speed changes, it may be a more clinically appropriate measure. Further studies are required to determine the validity of these indices.     

Effects of ketamine on voltage-dependent calcium currents and membrane potentials in single bullfrog atrial cells

Purpose. This study was undertaken to assess the effect of ketamine on L-type calcium channel current (I_Ca) and membrane action potential in the bullfrog single atrial myocyte. Methods. Bullfrog single atrial myocytes were prepared by enzymatic dispersion. Whole-cell voltage-clamp technique and current clamp technique were used to monitor I_Ca, membrane resting potential, and action potential. Results. Ketamine (10⁻⁵–10⁻³ M) showed dose-dependent inhibition of I_Ca in a reversible manner. The 50% inhibitory concentration (IC₅₀) of ketamine on I_Ca was estimated to be 0.92 × 10⁻⁵ M. Use-dependent block of I_Ca was not observed. The resting membrane potential was depolarized at a high concentration (10⁻⁴ M) of ketamine. Reduction of the plateau phase and prolonged duration of the action potential were observed in the presence of a high concentration of ketamine (10⁻⁴ M). Conclusion. Ketamine has an inhibitory effect on I_Ca in the bullfrog single atrial myocyte, and a high dose (10⁻⁴ M) of ketamine prolonges the duration of the action potential. The mechanism of inhibition of I_Ca seems to be a direct effect on the L-type calcium channel, not like an open channel blocker. Received: October 2, 2000 / Accepted: February 19, 2001     

Platelet-rich plasma versus corticosteroid injections in the management of patients with rotator cuff disease: A systematic review and meta-analysis

Platelet-rich plasma (PRP) is an alternative to corticosteroid (CS) injections in managing rotator cuff disease. This meta-analysis investigated differences between PRP and CS for function and pain scores in significance and minimal clinical important difference (MCID). A literature search of Ovid Cochrane Library, Medline, Embase, Epub, and Scopus was conducted from inception to October 28, 2021. Eligible studies reported patients older than 18 years with a diagnosis of rotator cuff disease. This review was registered in PROSPERO (ID: CRD42021278740). Twelve studies met eligibility criteria (n = 639) of patients receiving either PRP or CS. At short-term follow-up, a difference favored CS compared to PRP in baseline change for disability of arm, shoulder, and hand (DASH) score (MD = −5.08, 95% CI: −8.00, −2.15; p = 0.0007; I² = 0%) and simple shoulder test (SST) (MD = 1.25, 95% CI: 0.33, 2.18; p = 0.008; I² = 0%). At intermediate follow-up, a difference favored PRP to CS baseline change of the DASH score (MD = 3.41, 95% CI: 0.67, 6.15; p = 0.01; I² = 0%). At medium-term, a difference favored PRP to CS baseline change of the American Shoulder and Elbow Surgeons Shoulder (ASES) score (MD = −4.42, 95% CI: −8.16, −0.67; p = 0.02; I² = 0%). Both treatments achieved individual MCID for each score. Despite favoring CS at short-term follow-up and PRP at intermediate- and medium-term follow-up, functional and pain scores did not demonstrate any clinical difference between the two treatment modalities in management of rotator cuff disease at all follow-up periods.     

Nitrite/Nitrate Responses to Endotoxin in Calves*

Plasma concentrations and urinary excretions of nitrite plus nitrate (NO_x) increase in heifers after endotoxin‐induced nitric oxide synthase activation. The rise can be enhanced by administration of arginine, the substrate for the production of nitric oxide, whose effects may be modified by the iron status. In 10‐week‐old veal calves (six Simmental × Red Holstein) arginine (0.5 g/kg body weight for 6 h) was intravenously infused. At 2 h after the start of the infusions Escherichia coli endotoxin O26:B6 (2 μg/kg body weight) was intravenously injected. This caused a rise of rectal temperature, heart rate, respiration rate, and of urinary NO_x excretion, but not of plasma NO_x concentrations, in contrast to the experience with older cattle to which the same amounts of arginine were infused before and during endotoxin administration. In 8‐week‐old veal calves (18 Simmental × Red Holstein) the question of whether oral supplementation with arginine and iron modifies NO_x responses to endotoxin (2 μg/kg) was also investigated. The calves were divided between three groups (GrA⁻, GrA⁺, GrC) and before endotoxin injections GrA⁻ was fed 0.5 g arginine/kg for 4 days, GrA⁺ was fed 0.5 g arginine/kg for 4 days plus 80 mg iron/kg milk for 2 weeks, whereas GrC was not supplemented with arginine or iron. Iron supplementation increased plasma iron concentrations and arginine supplementation increased plasma arginine and urea concentrations and urinary urea excretion. Ensuing administration of endotoxin enhanced plasma tumour necrosis factor‐α concentrations, rectal temperature, heart rate, and respiration rate, but not plasma NO_x concentrations in GrC and GrA⁻ and only transiently and slightly increased plasma NO_x concentrations in GrA⁺ but did not affect urinary NO_x excretions. In conclusion, the expected stimulation of NO_x responses to endotoxin by intravenous arginine infusion appears to be much weaker in young veal calves than in older cattle. The NO_x responses in young veal calves were not modified if arginine was orally administered and plasma NO_x were barely enhanced by combined oral supplementation of arginine and iron.     

Book Reviews

Abstract

Background/Objective: The use of the American Spinal Injury Association (ASIA) motor score as an outcome measure requires metrological study. This paper tests the hypothesis that a more accurate representation of motor function is obtained using separate upper and lower extremity scales rather than combining all 20 key muscle ratings into a single ASIA motor score.

Methods: We analyzed archived data from 6,116 ASIA motor scale records extracted from the National Spinal Cord Injury Statistical Center Database.

Results: The hypothesis that separate scales more accurately represent motor function than a single motor scale was supported (X²(_indifference)= 2,596; df= 1; P < 0.0001). Two scales account for 87% of the variance, whereas a single scale accounts for only 82%. Lower extremity function is well represented in both solutions; however, upper extremity function is accurately represented only with the use of 2 separate scales.

Conclusions: The use of components of the ASIA standards for other than classification of spinal cord injury needs study. Several lines of study converge to provide strong support for the existence of 2 distinctive dimensions underlying the ASIA motor scale. The use of a single motor score in spinal cord injury research should be questioned and justified to the extent possible. The use of upper and lower extremity scales will lead to a reduction in measurement error when the motor score is used as an outcome measure. The confirmation of 2 separate dimensions underlying the ASIA motor score will enable more accurate representation of motor function in spinal cord injury research.     

Comparing Trauma Exposure,Mental Health Needs,and Service Utilization Across Clinical Samples of Refugee,Immigrant, and U.S.‐Origin Children

Most mental health services for trauma‐exposed children and adolescents were not originally developed for refugees. Information is needed to help clinicians design services to address the consequences of trauma in refugee populations. We compared trauma exposure, psychological distress, and mental health service utilization among children and adolescents of refugee‐origin, immigrant‐origin, and U.S.‐origin referred for assessment and treatment by U.S. providers in the National Child Traumatic Stress Network (NCTSN). We used propensity score matching to compare trauma profiles, mental health needs, and service use across three groups. Our sample comprised refugee‐origin youth (n = 60, 48.3% female, mean age = 13.07 years) and propensity‐matched samples of immigrant‐origin youth (n = 143, 60.8% female, mean age = 13.26 years), and U.S.‐origin youth (n = 140, 56.1% female, mean age = 12.11 years). On average, there were significantly more types of trauma exposure among refugee youth than either U.S.‐origin youth (p < .001) or immigrant youth (p ≤ .001). Compared with U.S.‐origin youth, refugee youth had higher rates of community violence exposure, dissociative symptoms, traumatic grief, somatization, and phobic disorder.  In contrast, the refugee group had comparably lower rates of substance abuse and oppositional defiant disorder (p s ranging from .030 to < .001).This clinic‐referred sample of refugee‐origin youth presented with distinct patterns of trauma exposure, distress symptoms, and service needs that merit consideration in services planning.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

三维椎间孔导向器的设计及其在经皮椎间孔镜下腰椎间盘切除术中的应用

目的:探讨三维椎间孔导向器在经皮椎间孔镜下腰椎间盘切除术的应用效果。方法:利用逆向定位原理,设计出三维椎间孔导向器。自2016年5月至2018年5月,将三维椎间孔导向器应用于临床,共40例单节段腰椎间盘突出症患者接受了经椎间孔入路腰椎间盘切除术,根据是否应用三维椎间孔导向器,分为导向器组和对照组,每组20例。导向器组男9例,女11例;年龄(46.0±11.0)岁;L_(3,4) 5例,L_(4,5) 15例;BMI(25.4±3.2) kg/m~2;使用三维导向器进行穿刺置管。对照组男10例,女10例;年龄(51.8±9.8)岁;L_(3,4) 4例,L_(4,5) 16例;BMI(24.8±3.5) kg/m~2;以术中经验进行常规穿刺置管。比较两组患者穿刺时间、透视次数和穿刺次数,以及手术前后下肢视觉模拟疼痛评分(visual analogue scale,VAS)及腰椎日本骨科协会评分(Japanese Orthopaedic Association,JOA)。结果:所有患者无严重手术并发症发生,并顺利完成手术。导向器组手术时间、透视次数和穿刺次数均小于对照组(P0.05)。两组患者术后3个月下肢VAS评分和腰椎JOA评分较术前均明显缓解(P0.05),但组间比较差异无统计学意义(P0.05)。结论:三维椎间孔导向器结构紧凑,操作简单,可以减少穿刺次数与辐射损伤,并能缩短初学者穿刺学习曲线,具有一定的临床可行性。     

Effects of ropivacaine on membrane potential and voltage-dependent calcium channel current in single guinea-pig ventricular myocytes

Purpose. This study was undertaken to assess the effects of ropivacaine on the membrane action potential and the voltage-dependent L-type calcium channel current (I _Ca) in guinea-pig single ventricular myocytes. Methods. Single ventricular myocytes were prepared by enzymatic dispersion. Whole-cell current and voltage-clamp techniques were used to monitor membrane potentials and I _Ca. Results. Ropivacaine (10⁻⁵ and 10⁻⁴ M) reduced the overshoot and shortened the duration of the action potential. Hyperpolarization of the resting membrane potential was observed in the presence of ropivacaine (10⁻⁴ M). Ropivacaine (10⁻⁵–10⁻³ M) reduced I _Ca dose-dependently and reversibly, and the 50% inhibitory concentration (IC₅₀) of ropivacaine was estimated as 4.3 × 10⁻⁴ M. Furthermore, the inhibition of I _Ca was not a use-dependent block. Conclusion. Ropivacaine has an inhibitory effect on I _Ca in the guinea-pig single ventricular myocyte. It is concluded that the mild negative inotropic effect induced by ropivacaine can be attributed in part to shortening of the duration of the action potential, which is caused by inhibition of I _Ca. Received: March 28, 2002 / Accepted: July 28, 2002 Address correspondence to: N. Hatakeyama     

Unanswered and uncounted items of the illness behavior questionnaire count: a comparison between patients who answered all the items in the questionnaire and those who left one or more items unanswered in a pain management program

Purpose. This study aimed to understand the significance of unanswered and uncounted items on the illness behavior questionnaire (IBQ) in the setting of the Mayo Clinic pain management program for patients with chronic pain. Methods. Three hundred and seventy-eight patients who completed the questionnaire were studied. The data included (1) age, (2) IQs, (3) IBQ score profiles, (4) litigation status, (5) admission status (inpatient vs outpatient), and (6) dismissal status ("graduates" vs "dropouts"). Results. Comparison between patients who answered all the items (n = 272) and those who left one or more items unanswered (n = 106) showed a significant difference in the completion rate of the Wechsler Adult Intelligence Scale (P < 0.05), Scale 5 (affective disturbance) score (P < 0.05), and the rate of dropout from the program (P < 0.05). Also, those who dropped out of the pain management program had a significantly lower score on Scale 5 (P < 0.001) and a significantly greater number of unanswered items that were not counted toward the scale score (P < 0.05). Conclusion. Unanswered and uncounted items of the IBQ seem to count toward a better understanding of patients' pain behavior. Received: January 28, 2000 / Accepted: July 10, 2000     

Pre-transplant factors associated with mortality after lung transplantation in cystic fibrosis: A systematic review and meta-analysis

BackgroundMortality risk stratification is essential in lung transplantation (LTx) to allow listing, prioritization and mitigating strategies. In cystic fibrosis (CF) patients, predictors of post-LTx mortality are not established.MethodsFor this systematic review and meta-analysis, seven databases were searched until January 3, 2018 to identify predictors of post-LTx mortality in CF. We excluded studies of multi-organ transplantation, re-transplantation and graft survival. For multiple studies assessing the same population during overlapping time-periods, the largest one was analyzed. Risk of bias was assessed with the Newcastle-Ottawa scale (NOS). Pooled hazard ratios were calculated using random-effects models.ResultsFifty-four studies were included in the systematic review and 11 studies in the meta-analyses (low-to-moderate bias risk, NOS score ≥ 5). Among 10 factors assessed in the meta-analysis, B. cepacia complex (BCC) (N = 1451, unadjusted HR = 2.35, 95%CI:1.80–3.06; I² = 20.4% and adjusted HR = 2.49, 95%CI:1.74–3.57; I² = 46.2%) and ascending chronological year of LTx (N = 4207, unadjusted HR = 0.98, 95%CI:0.97–0.98, I² = 4.8%) were predictors of post-LTx mortality. Male gender (N = 2903, adjusted HR = 1.12, 95%CI:1.0–1.26, I² = 0%) and age in adults (N = 3677, unadjusted HR = 0.99, 95%CI:0.97–1.00; I² = 64.1% and N = 2605, adjusted HR = 0.98, 95%CI:0.97–0.99; I² = 34.3%) had borderline significant associations with post-LTx mortality. P. aeruginosa colonization, forced expiratory volume in one second (FEV₁), pulmonary hypertension, body mass index (BMI), pancreatic insufficiency and CF-related diabetes (CFRD) were not predictors of mortality.ConclusionsBCC was associated with a higher post-LTx mortality whereas FEV₁, pulmonary hypertension, BMI, CFRD and female gender were not associated with post-LTx mortality. These findings indicate that CF-specific risk estimates of post-LTx mortality should be considered.     

Advancing age within established Gleason score categories and the risk of prostate cancer-specific mortality (PCSM)

Study Type – Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? There is limited data that suggests that men aged >70 years have a higher proportion of Gleason 8–10 prostate cancer than men aged <70 years, as well as a higher risk of PSA recurrence, distant metastases, and disease‐specific death on univariate analysis. The present study shows that older as compared with younger men with Gleason score 6 and 7 prostate cancer have an increased risk of prostate cancer‐specific mortality. This may be due to the presence of occult high‐grade disease and suggests further diagnostic studies, e.g. multiparametric MRI, may be indicated in these men to reduce biopsy sampling error.

OBJECTIVE

• ? To determine if advancing age is a risk factor for high‐grade prostate cancer due to occult high‐grade disease in elderly men with Gleason score 6 or 7 prostate cancer. We investigated whether advancing age is associated with the risk of prostate cancer‐specific mortality (PCSM) within established Gleason score categories adjusting for known predictors of PCSM.

PATIENTS AND METHODS

• ? Using data from the Surveillance, Epidemiology and End Results database between 1 January 2004 to 31 December 2007, 166 104 men with non‐metastatic prostate cancer were identified and formed the study cohort.
• ? Within established Gleason score categories, Fine and Gray's multivariable competing risk regressions were used to evaluate whether increasing age at diagnosis was significantly associated with an increased risk of PCSM, adjusting for prostate‐specific antigen level and T‐category at diagnosis and whether treatment was curative or non‐curative.

RESULTS

• ? After adjusting for treatment and prognostic factors, Gleason score 8–10 and 7 as compared with ≤6 was associated with an increased risk of PCSM (P < 0.001).
• ? Increasing age was associated with an increased risk of PCSM only in Gleason score 6 (adjusted hazard ratio [AHR] 1.06, 95% confidence interval [CI] 1.04–1.08, P < 0.001) and 7 (AHR 1.02, 95% CI 1.01–1.03, P < 0.001), but not with Gleason score 8–10 (AHR 0.999, 95% CI 0.995–1.003, P= 0.61).
• ? These risks were highest in men aged >70 years having Gleason score 6 (AHR 1.10, 95% CI 1.07–1.13, P < 0.001) and Gleason score 7 prostate cancer (AHR 1.04, 95% CI 1.02–1.06, P < 0.001).

CONCLUSIONS

• ? PCSM increases with advancing age in men with Gleason score 6 and 7 but not 8–10 prostate cancer.
• ? Techniques to reduce biopsy sampling error in men, particularly those aged >70 years and healthy with Gleason score 6 and 7 disease deserve further study.

     

Defining an extended criteria donor lung: an empirical approach based on the Eurotransplant experience1

The aim of this study was to design and validate a lung donor score that reflects experts’ perceived risk of allograft failure. All lung donors reported to Eurotransplant from 1999 to 2007 [N = 6080] were used to create a lung donor score. Based on observed discard rates and using multivariate regression, points were assigned for six preprocurement donor variables. Donors reported in 2008 were used to validate the score [N = 751]. All the six factors significantly predicted discard; as an example, the following donor with points: age 55–59 years: 2; compromised history: 4; smoking: 2; shadow on chest X‐ray: 2; purulent secretion during bronchoscopy: 2; and Pao₂/Fio₂ ratio below 300 mmHg: 3. Discard rates for donors with a lung donor score of 6 points (class 1) was 18%, while 36% and 54% of the donors with a score of 7–8 (class 2) and 9 + (class 3) were discarded (P < 0.001), respectively. In addition, the donor lung score was significantly associated with 1‐year survival: class 1: 91%; class 2: 80%; and class 3: 72% (P = 0.017). The lung donor score accurately reflects the likelihood of organ acceptance and predicts patient mortality, and its application at time of donor reporting may facilitate donor risk assessment and patient selection.