Risk factors for mortality in diabetic nephropathy patients accepted for transplantation

BACKGROUND: There is a high incidence of silent coronary artery disease (CAD) in patients with diabetes. We wanted to investigate risk factors for mortality, and especially CAD, in a well-defined cohort of diabetic nephropathy transplant candidates accepted for transplantation. METHODS: From 1999 through 2004, 155 patients underwent work up for living or deceased kidney (KA) or simultaneous pancreas-kidney (SPK) transplantation. The work up included coronary angiography for all patients and 136 were accepted. Mean (SD) age was 50 (12) years, 62% had type 1 diabetes, 73% were males, and 34% were on dialysis. Mean follow-up from time of acceptance for transplantation was 3.6 (1.9) years. RESULTS: Survival of KA transplanted patients was 97% at 1 year, 89% at 3 years, and 76% at 5 years, whereas in SPK patients 100%, 94%, and 90%, respectively (P=0.065). One- and 3- year survival was only 57% and 20% in those remaining wait-listed (P<0.001). In univariate analysis mortality was associated with KA transplantation (hazard ratio [HR]=0.30, P=0.011) and SPK transplantation (HR=0.10, P=0.001), and age (HR=1.04, P=0.014). In multivariable analysis, KA transplantation (HR=0.28, P=0.006), SPK transplantation (HR=0.09, P=0.001), age (HR=1.06, P=0.002), type 2 diabetes (HR=0.14, P=0.003), and duration of diabetes (HR=0.94, P=0.019) were parameters associated with mortality. CONCLUSIONS: The only modifiable risk factor was transplantation with risk reduction up to 90%. CAD was not a risk factor for mortality when medically treated and revascularized according to standard guidelines.     

Similarities in stress physiology among patients with chronic pain and headache disorders: evidence for a common pathophysiological mechanism?

One common feature of chronic musculoskeletal pain and headaches are that they are both influenced by stress. Among these, tension-type headache (TTH), fibromyalgia (FMS) and chronic shoulder/neck pain (SNP) appear to have several similarities, both with regard to pathophysiology, clinical features and demographics. The main hypothesis of the present study was that patients with chronic pain (TTH, FMS and SNP) had stress-induced features distinguishing them from migraine patients and healthy controls. We measured pain, blood pressure, heart rate (HR) and skin blood flow (BF) during (1 h) and after (30 min) controlled low-grade cognitive stressor in 22 migraine patients, 18 TTH patients, 23 FMS patients, 29 SNP patients and 44 healthy controls. FMS patients had a lower early HR response to stress than migraine patients, but no differences were found among FMS, TTH and SNP patients. Finger skin BF decreased more in FMS patients compared to migraine patients, both during and after the test. When comparing chronic pain patients (chronic TTH, FMS and SNP) with those with episodic pain (episodic TTH and migraine patients) or little or no pain (healthy controls), different adaptation profiles were found during the test for systolic and diastolic blood pressure, HR and skin BF in the chronic group. In conclusion, these results suggest that TTH, FMS and SNP patients may share common pathophysiological mechanisms regarding the physiological responses to and recovery from low-grade cognitive stress, differentiating them from episodic pain conditions such as migraine.     

Trace elements in cerebrospinal fluid and blood from patients with a rare progressive central and peripheral demyelinating disease

A hereditary neurological disease in a family in Norway has been reported recently. The disease, which we refer to as Skogholt's disease, is a demyelinating disorder of both the central and the peripheral nervous system with adult onset. We investigated whether changes in trace element concentrations could play a role in Skogholt's disease. Using high resolution inductively coupled plasma mass spectrometry, we determined 31 elements in cerebrospinal fluid (CSF), blood plasma and whole blood from these patients, multiple sclerosis patients and a control group. More than threefold increased levels of Cu and Fe, and a twofold increase in Zn were found in the CSF of Skogholt patients compared to controls. Several other significant differences in trace element levels were also found. The increased levels of Cu and Fe in CSF may indicate an active role of these metals in the pathogenesis of Skogholt's disease. Apparently, these metal ions are transferred into the CSF through their protein chelation, as raised protein levels were also seen. We suggest that redistribution of metals from transport proteins into vulnerable sites in the central (and peripheral) nervous system may initiate critical lesions.     

Coping with life-threatening events was associated with better self-perceived health in a naval cross-sectional study

Objective

We studied the relationship between experiencing and coping with life-threatening events and self-perceived health in navy personnel operating mainly under peaceful circumstances.

Methods

The data were collected in a cross-sectional study from a questionnaire sent by mail at the end of 2002 to all employees in the Royal Norwegian Navy (N=3878) as part of a general health study. Both military and civilian personnel with different types of work on ships and ashore participated in the study. Logistic regression analyses were performed to study the relationship between the number of life-threatening events, occupational status, sex, age, and the extent of putting these events behind. The possible trends between the degree of putting the events behind and each of the eight SF-36 scales were calculated by bivariate correlations.

Results

Military personnel had experienced life-threatening events more often than civilians, but the military personnel appeared 5.5 times more likely to have put such events behind themselves than the civilians. The extent of having put life-threatening events behind oneself was clearly correlated to self-perceived health as measured by the SF-36 subscales bodily pain, general health, vitality, social functioning, role-emotional, and mental health. These associations had linear appearances.

Conclusion

Navy personnel who have experienced a life-threatening event and have not been able to put this event behind them are more likely to report a reduced self-perceived health.     

Does esophageal atresia influence the mother-infant interaction?

Purpose

Chronic illness in infancy may influence parent-infant interaction. We assessed quality of mother-infant interaction in children with esophageal atresia (EA) and searched for predictors for impaired interaction.

Methods

The study group comprised 37 one-year-old infants with EA born in 1999 to 2002 and their mothers. A comparison group comprised 10 infants with urologic problems without feeding difficulties and their mothers. Parent Child Early Relational Assessment was used to assess mother-child interaction in feeding and play situation. General Health Questionnaire and State Trait Anxiety Inventory were used to assess maternal psychological distress and anxiety.

Results

Many aspects of mother-EA infant interaction showed strength. However, mothers of EA children were compared to control-mothers significantly influenced in their ability to interact and the EA-mothers' “positive affective involvement, sensitivity, and responsiveness” during feeding was in range of concern. Small but significant effect of the mother's feeling of incompetence on their interaction was found.

Conclusion

Mothers' attitude during feeding was negatively influenced in interaction between mother and infant with EA. The results suggest possibility for improvement in mother infant interaction by enhancing mothers' welfare when caring for infants with EA in medical services.     

Are positive surgical margins in radical prostatectomy specimens an independent prognostic marker?

OBJECTIVE: A positive surgical margin (PSM) is considered an adverse prognostic indicator in patients undergoing radical prostatectomy (RP). However, there are discrepancies among studies concerning the effect of PSM on prognosis. In addition, the significance of PSM location and extent is uncertain. The aim of this study was to examine the impact of surgical margin status on serum prostate-specific antigen (sPSA) relapse in men consecutively receiving RP in a non-screened population. MATERIAL AND METHODS: In total, 219 prostatectomy specimens were examined microscopically. The mean follow-up time was 62 months (range 6-121 months). Tumour grade (Gleason score), pathological tumour stage and tumour involvement of the surgical margins were recorded. The 71 specimens with one or more PSM were re-examined with regard to location, number of locations and total linear extent of PSM. Kaplan-Meier plots and Cox proportional hazards regression were used in the univariate analyses. Multivariate analyses controlling for the known preoperative sPSA, pathological stage and Gleason score were also performed, using Cox proportional hazards regression. RESULTS: In the univariate analyses, PSM without regard to location, PSM at the anterior prostate or at the apex, PSM at three or more locations and linear extent of PSM > or =6mm were associated with a statistically significant higher hazard ratio of PSA relapse. However, none of these variables remained statistically significant when controlling for the known risk factors. CONCLUSIONS: In this non-screened prostate cancer population PSM status (linear extent, location and number of locations) had an impact on postoperative sPSA recurrence. In multivariate analyses PSM showed a strong trend (p approximately 0.06) towards having an independent statistically significant negative influence on the risk of PSA relapse following RP.     

Analysis of neurologic symptoms in deep diving: implications for selection of divers

Eighteen professional divers (age range 24-33 yr, mean 28.3) participated in one simulated dive to 360 meters of seawater (msw) in a helium-oxygen (heliox) atmosphere with equal compression and decompression profiles. All divers were given an extensive neurologic examination before diving. Clinical neurologic symptoms observed during the dives were equilibrium disorder, sleep disturbances, fatigue, nausea, loose stools, stomach pain, tremor, mental disturbances, reduced appetite, and headache. Symptoms were scored individually by each diver. The symptoms were analyzed statistically by factor analysis, which grouped them into four factors. These symptoms are presumably related to functional disturbances in the brain stem and the cerebellum. Factor 3 symptoms (tremor, mental disturbances, reduced appetite) correlated significantly to a history of predive decompression sickness (P = 0.006) and to cerebral concussion (P = 0.023). Three divers were periodically unable to work at bottom due to equilibrium disorder, diarrhea, or nausea. One diver with mild polyneuropathy and slight cerebral atrophy as seen by computerized tomography and another diver with abnormal electroencephalography were periodically unable to work due to equilibrium disorder and nausea, respectively. We advocate that divers with signs of central or peripheral nervous system dysfunction should not be selected for deep diving.     

Dietary intakes differ between renal transplant recipients living in patient hotels versus home.

OBJECTIVE: To compare dietary intake and health-related quality of life approximately 6 to 10 weeks after renal transplantation in patients living at home and at a patient hotel, and how the patients were following a heart-healthy diet according to the current American Heart Association guidelines. DESIGN: Cross-sectional observational study. SETTING: Outpatient clinic at Rikshospitalet University Hospital, Norway. PATIENTS: Forty renal transplant patients, 20 patients (14 men and 6 women) in both groups. There were 4 diabetic patients in each group. METHODS: Dietary intake was assessed by 4-day dietary records. Health-related quality of life was investigated by the SF-36 questionnaire. The main outcome variables were daily energy intake and intakes of protein, total fat, saturated fat, cholesterol, fiber, and fruit and vegetables. The variables were tested by 2-sample t-tests, and significance was set at.05. RESULTS: There was no statistically significant difference in daily energy intake between the groups (P =.08), but there were significantly higher daily intakes of protein (P =.003), total fat (P =.03), monounsaturated fat (P =.02), cholesterol (P =.04), fiber (P =.02), calcium (P =.03), and fruit and vegetables (P =.03) in the group living at the patient hotel. The mean intake of saturated fat was 14.5% of total energy in the group living at home and 14.6% in the group living at the patient hotel. There were no significant differences in health-related quality of life between the groups. CONCLUSION: The results suggest that there are differences in dietary intake in renal transplant patients living at home compared with those at a patient hotel. It seems that neither of the groups follows current guidelines for reducing the risk of cardiovascular disease.