Emerging importance of residual renal function in end-stage renal failure

Residual renal function (RRF) is well recognized as an important marker of outcomes in peritoneal dialysis (PD), and contributes vitally to solute clearance. Recently, its importance in hemodialysis (HD) has emerged with evidence that it is strongly associated with improved outcomes. The presence of RRF is associated with improved nutrition, reduced erythropoetin requirements, better potassium clearance, and improved quality of life. Retrospective and observational evidence is now available, which suggests that the presence of RRF is independently associated with survival and that this benefit goes beyond what is expected simply from augmentation of small solute clearance. Preservation of RRF is now considered by many to be an important aspect of dialysis strategy. Evidence in favor of one modality over another for preservation of RRF is conflicting, as are the potential benefits of biocompatible fluids in PD. In HD, the evidence in favor of biocompatible membranes is stronger. Emerging evidence is broadly in favor of angiotensin converting enzyme inhibitors for preservation of RRF. Diuretics appear to have a neutral effect. The complexities and practical difficulties in measurement of RRF have resulted in this important parameter being largely ignored in HD. Novel markers of renal function may provide alternative, simple methods of estimating RRF, which may remove the need for urine collections and simplify its measurement.     

Allogeneic hematopoietic stem cell transplantation for chronic myeloid leukemia in Europe 2006: transplant activity, long-term data and current results. An analysis by the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT)

The introduction of imatinib mesylate has changed attitudes towards hematopoietic stem cell transplantation (HSCT) for chronic myeloid leukemia (CML). Information on the current use and results of HSCT is warranted. Data from 592 teams in 42 European countries described their use of HSCT for CML from 1990 to 2004. Outcomes were analyzed for 13,416 patients, with a median age of 36 years (range 1-71 years); 60% were male. The analysis considered three time cohorts, 1980 to 1990, 1991 to 1999 and 2000 to 2003. Survival, transplant-related mortality and relapse incidence were assessed at 20 years for the first cohort and compared at 2 years between the three cohorts. The numbers of HSCT for CML increased from 540 allogeneic HSCT in 1990 to 1,396 HSCT in 1999 and declined to 802 in 2004. One third of all patients and half of those with a low risk were alive at 20 years. Survival at 2 years has improved from 53% to 61% in the most recent years due to a reduction in transplant-related mortality from 41% to 30% in all patients and from 31% to 17% in low-risk patients. Stage, donor type, time interval, age and donor-recipient sex combination remain the main risk factors; patients with a risk score of 0 or 1 have a survival probability of 80% at 2 years. HSCT remains an important treatment option for patients with CML. The data describe the current status of this option and the outcome a patient can expect today. They provide an objective basis for decision making.     

Serotonin transporter linked promoter (polymorphism) in the serotonin transporter gene may be associated with antidepressant-induced mania in bipolar disorder

OBJECTIVE: Several pharmacogenetic studies suggest that response to pharmacotherapy in bipolar disorder may be mediated by genetic factors. The aim of this study was to investigate further the association of the genetic variations of the serotonin transporter (5-HTT) gene with antidepressant-induced mania, already reported in recent studies. We also studied the possible association of these genetic variants with diagnosis expression and treatment response to lithium therapy. METHODS: The sample consisted of 103 and 85 outpatients with diagnosis of bipolar and unipolar disorder, respectively, and 101 controls. Two described polymorphisms of the 5-HTT, the variable number of tandem repeat (VNTR) and serotonin transporter linked promoter (5-HTTLPR) polymorphisms, were genotyped using standard procedures. RESULTS: The association analysis performed showed a significantly higher rate of homozygous s/s genotype for 5-HTTLPR among patients with a history of antidepressant-induced mania (60% patients s/s versus 40% l/l, chi, P=0.04). No significant difference in the distribution of genotypes of the two polymorphisms was observed between the three groups. We found no significant association between these polymorphisms and lithium response. CONCLUSIONS: The 5-HTTLPR polymorphism could be a useful contributor, among other clinical variables, to predict the risk for manic switches when a patient with bipolar disorder is treated with antidepressant drugs. The contribution of these genetic markers in diagnosis expression and treatment response to lithium is likely to be minor.     

Prognostic significance of the white coat hypertension in patients with type 1 diabetes mellitus

Despite the high prevalence of white coat hypertension (WCH) in diabetes mellitus and the evidence that hypertension is a clear risk factor for the development of microalbuminuria (MA) in these patients, there is no information on the long-term prognostic significance of this condition in the diabetic population. We studied the evolution of 40 patients with type 1 diabetes mellitus (Type 1 DM). Twenty patients with WCH (office blood pressure> or =140/90mmHg associated with mean daytime blood pressure<135/85mmHg) classified as the WCH group and 20 patients with type 1 DM with a similar age and disease evolution, but who were normotensive, (office blood pressure<140/90mmHg associated with mean daytime blood pressure<135/85mmHg) classified as the normotensive control group. After 5 years of follow-up, MA appeared in four subjects and sustained hypertension in another, with a total of 31% of events in the WCH group, with none in the normotensive group. Kaplan-Meier analysis showed that the relative risk of developing these hypertensive events was 25% higher in the WCH group. At baseline, the night time systolic and diastolic blood pressure levels were significantly higher in patients who further developed MA and sustained hypertension. The findings in this study highlight the clinical importance of careful follow-up of type 1 diabetic patients with WCH.     

Estimation of atmospheric water vapour content from direct measurements of radiance in the thermal infrared region

Atmospheric water vapour content is a required parameter in thermal infrared (TIR) to carry out processes such as atmospheric correction or retrieving atmospheric factors (downwelling or upwelling irradiance, transmittance of the atmosphere and so on). This study proposes an alternative method to the ones already in use to measure water vapour content from direct measurements of downwelling atmospheric radiance in the TIR range. It was possible to estimate a linear relationship between atmospheric water vapour and downwelling atmospheric radiance using a simulated study, based on data from a radiosounding database. A subsequent validation concludes that it is possible to obtain water vapour content with an uncertainty of 0.5 cm using in situ measurements of downwelling atmospheric radiance in the TIR range of 11.5–12.5 μm.