The Liver Retransplantation Risk Score: a prognostic model for survival after adult liver retransplantation

High-risk combinations of recipient and graft characteristics are poorly defined for liver retransplantation (reLT) in the current era. We aimed to develop a risk model for survival after reLT using data from the European Liver Transplantation Registry, followed by internal and external validation. From 2006 to 2016, 85 067 liver transplants were recorded, including 5581 reLTs (6.6%). The final model included seven predictors of graft survival: recipient age, model for end-stage liver disease score, indication for reLT, recipient hospitalization, time between primary liver transplantation and reLT, donor age, and cold ischemia time. By assigning points to each variable in proportion to their hazard ratio, a simplified risk score was created ranging 0–10. Low-risk (0–3), medium-risk (4–5), and high-risk (6–10) groups were identified with significantly different 5-year survival rates ranging 56.9% (95% CI 52.8–60.7%), 46.3% (95% CI 41.1–51.4%), and 32.1% (95% CI 23.5–41.0%), respectively (P < 0.001). External validation showed that the expected survival rates were closely aligned with the observed mortality probabilities. The Retransplantation Risk Score identifies high-risk combinations of recipient- and graft-related factors prognostic for long-term graft survival after reLT. This tool may serve as a guidance for clinical decision-making on liver acceptance for reLT.     

Schädelschußverletzungen der Friedenszeit

Zusammenfassung Nach Darlegung technischer und ballistischer Einzelheiten über Handfeuerwaffen und eine klinische Einleitung wird über 20 eigene Fälle mit Schädelschußverletzungen berichtet. 16 Verletzungen gingen mit direkter Gehirnbeteiligung einher, 12 von denen verstarben. Es wird auf die Wichtigkeit der Kenntnis der Tatwaffen und des Schußkanalverlaufs im Röntgenbild verwiesen, und die besondere Bedeutung der Bewußtseinslage, der neurologischen Symptomatik und der Schocksituation zur prognostischen Bewertung dieser Verletzungen herausgestellt.

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Summary After setting out technical and ballistic details of small arms and after a clinical introduction, a series of 20 personal cases with gun-shot wounds of the head are described. Sixteen patients had direct involvement of the brain, of whom 12 died. The importance of a knowledge of the weapon used and of the course of the missile as seen in the radiographs is referred to. It is demonstrated that in these patients the level of consciousness, the neurological symptoms and the degree of shock are of especial importance in assessing prognosis.

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Resumen Después de un breve resumen de los detalles técnicos y balísticos de armas de fuego y tras una introduction clínica se analiza una serie de 20 casos personales de heridas craneales por arma de fuego. De 16 enfermos que tuvieron lesiones cerebrales 12 fallecieron. El autor insiste sobre la importancia del conocimiento del arma utilizada, así como del trayecto de la bala visto en las radiografías. En estos enfermos el nivel de conciencia, los signos neurológicos y el grado de shock tienen una gran importancia para el pronóstico.

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Résumé Après un bref rappel des détails techniques et ballistiques des armes légères, et après une introduction clinique, une série de 20 cas personnels de blessures cranielles par coup de fusil est rapportée. Sur 16 malades qui ont eu des lésions cérébrales: 12 sont décédés. L'auteur insiste sur l'importance de la connaissance de l'arme utilisée et du trajet de la balle vu sur les clichés. Chez ces malades, le niveau de conscience, les signes neurologiques et le degré du choc ont une grande importance dans le pronostic.

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Riassunto Vengono discussi venti casi di ferite craniche da arma da fuoco, 16 dei quali avevano una compromissione cerebrale. Di essi 12 sono morti. Viene praticamente discussa l'importanza della conoscenza della forza di penetrazione della pallottola nei radiogrammi e della localizzazione del canale di entrata e di uscita e della situazione neurologica e dello stato di shock per la prognosi di questi feriti.

     

Influence of acid-base alterations on myocardial sensitivity to catecholamines

Summary The influence of respiratory and metabolic acid-base alterations on the myocardial sensitivity to catecholamines was studied in the isolated rat atria. The ability of noradrenaline for increasing the atrial rate was enhanced during alkalosis and conversely, it was decreased by acidosis. These changes in sensitivity shifted the concentration-effect curve for noradrenaline to the right by about 0.5 log unit when the pH was lowered from 7.60 to 7.00. No changes in the maximum attainable response were detected. Essentially the same shifts of the concentration-effect curves were obtained with changes in pH brought about by altering the pCO₂ or at constant pCO₂. The decrease in the pH produced a similar shift to the right of the concentration-effect curve for isoprenaline, after the extraneuronal uptake inhibition by hydrocortisone and also in atria tissue with low content of endogenous noradrenaline (reserpine-pretreated and newborn rats). The ability of isoprenaline for increasing cyclic AMP levels in atrial tissue was also enhanced by alkalosis and decreased by acidosis. However, the shift to the right of the concentration-effect curve for cyclic AMP induced by the decrease in the pH was greater than the shift detected in the chronotropic-effect curve. In addition a decrease in the maximum increment of cyclic AMP was detected under acidosis, in spite of equal maximal chronotropic response.Our results support the hypothesis that the alterations in the sensitivity to catecholamines induced by the changes in pH are not due to a release of endogenous noradrenaline nor to alterations of the mechanisms which remove catecholamines from the biophase. The fact that cyclic AMP response to catecholamines was also reduced by acidosis strongly suggests that the mechanism(s) involved is located in the earlier steps of the events leading to the chronotropic effect of the -agonists.     

Alcohol and Sober Mood State in Female Social Drinkers

The goals of the present study were to measure the relationship between alcohol consumption in 93 female social drinkers and their cognitive functioning and mood in the sober state, and to investigate the possible causal effects of alcohol consumption on these variables. In the first test session, a limited relationship was seen between previous alcohol consumption and sober cognitive performance. A strong relationship was found between alcohol consumption and self-reported depression and anger in the sober state. Either a prolonged reduction in alcohol consumption or a prolonged maintenance of alcohol consumption was undertaken by random subsets of the original sample. In the second test session 6 weeks later, women who had been randomly selected to reduce their alcohol intake showed decreases in depression, anger, and mental confusion when they were sober, relative to women who maintained or increased their alcohol consumption over the same period of time. We found no changes in cognitive performance in these groups. We concluded that the simplest explanation of the findings is that relatively low levels of alcohol consumption produce substantial increases in depression and anger in the sober state in female social drinkers. The value of considering alcohol consumption as a continuous variable rather than a dichotomous variable with "safe" and "unsafe" zones was discussed.     

Polymorphisms and circulating levels in the insulin-like growth factor system and risk of breast cancer: a systematic review.

We reviewed all English-language articles on associations among circulating levels of the insulin-like growth factors (IGF) and their binding proteins (IGFBP), polymorphisms in their genes, and breast cancer risk. In premenopausal women, five of eight IGF-I studies and four of six IGFBP-3 studies of circulating levels found that women in the highest quantile had more than twice the risk of developing breast cancer of those in the lowest, although in some this effect was only apparent at young ages. In postmenopausal women, however, there was no consistent effect. A simple sequence length polymorphism 1 kb 5' to IGF-I was examined in relation to circulating levels of IGF-I (12 studies) or breast cancer risk (4 studies), but there was no convincing evidence of any effect. For an A/C polymorphism 5' to IGFBP-3, all three studies were consistent with a modest effect on circulating levels, but no evidence of a direct effect on breast cancer risk was seen in the only relevant study. Variation within the reference range of IGF-I and IGFBP-3 may confer only modest increases in breast cancer risk, and any single polymorphism may only account for a small proportion of that variation. Nevertheless, population attributable fractions for high circulating levels of IGF-I and IGFBP-3 and for common genetic variants could be substantial. Further large studies, or combined analysis of data from existing studies, are needed to quantify these effects more precisely.     

Psychosocial effect of mastectomy versus conservative surgery in patients with early breast cancer

Purpose To compare the quality-of-life (QoL) and psycho-social changes in a group of patients with early breast cancer who underwent conservative surgery (BCS) or modified radical mastectomy (MRM). Methods Self-administered questionnaire assessing body image perception, social habits, sexual attraction and self-consciousness with relatives/friends, was randomly assigned to 125 patients (61 BCS, 64 MRM; aged 53±8 and 50±9 years, respectively, p=NS). Results MRM patients reported a significantly higher frequency of changes in body image perception and other related social behaviour such as avoiding going to the beach or using low-cut clothes, and reticence with friends. Conversely, no differences were found regarding sexuality, denial of the disease by the husband/partner, or concealing the disease from family members. Also, no significant differences were found between patients above and below the age of 50 years, for all variables studied after adjustment for surgical procedure. Conclusions Modified radical mastectomy has a negative effect on body image perception and in social behaviour patterns of patients and with a concomitant decrease in QoL. The sexuality of the patient is not significantly affected.