Sleep Apnea Is Associated with Cardiovascular Risk Factors among Kidney Transplant Patients

Background and objectives: We assessed the prevalence of obstructive sleep apnea (OSA) and its clinical correlates in a large sample of patients who received a kidney transplant (Tx). We also compared the prevalence of the disorder between dialysis patients who were on the waiting list for a Tx (WL) and Tx patients.Design, setting, participants, & measurements: This was a cross-sectional study of 100 Tx and 50 WL patients who underwent one-night polysomnography (SLeep disorders Evaluation in Patients after kidney Transplantation [SLEPT] Study). Sociodemographic information and data about medication, comorbidity, and laboratory parameters were collected.Results: The prevalence of mild (apnea-hypopnea index [AHI] ≥5/h and <15/h), moderate (AHI ≥15/h and <30/h), and severe OSA (AHI ≥30/h) was 18, 11, and 14% in the Tx group and 28, 16, and 10% in the WL group, respectively. The AHI was significantly correlated with age (ρ = 0.34), body mass index (ρ = 0.45), neck circumference (ρ = 0.4), abdominal circumference (ρ = 0.51), and hemoglobin (ρ = 0.24) in the Tx group. The proportion of Tx patients who were treated with three or more antihypertensive drugs was significantly higher in the OSA group (56 versus 31%; P = 0.022). Despite taking significantly more antihypertensive drugs, the average systolic BP was still higher in patients with versus without OSA (147 ± 21 versus 139 ± 18 mmHg; P = 0.059).Conclusions: The prevalence of OSA is similar in Tx and WL patients and it may contribute to presence of hypertension in patients who receive a Tx.Obstructive sleep apnea (OSA) is the most clinically important form of sleep-related breathing disorders. The severity of OSA is generally characterized by the apnea-hypopnea index (AHI), which is the number of apneic and hypopneic events per hour of sleep.The prevalence of moderate and severe OSA syndrome (OSAS; AHI ≥15 and the presence of daytime symptoms of OSA) is 2 to 4% in the general population (1) and is associated with increased cardiovascular morbidity and mortality (2,3). OSAS is reportedly associated with higher risk for stroke, hypertension, diabetes, congestive hearth failure, arrhythmias, and the metabolic syndrome and also with fatal and nonfatal cardiovascular events (4–7)Previous studies have shown high prevalence of OSA (16 to 54%) in patients with chronic kidney disease (CKD) (8,9). Unruh et al. (10) showed that OSA is more common in hemodialysis patients than in general population.Although OSA may contribute to the increased cardiovascular risk seen in Tx patients, consistent information about OSA in patients who have received a kidney transplant (Tx) is scarce. Previously, we found that the prevalence of high risk for OSAS is approximately 30% in both WL and Tx patients (11). A case series indicated that AHI did not change after transplantation in 73% of the patients (12). Conversely, Mallamaci et al. (13) recently reported that 22% of renal Tx recipients had a respiratory disturbance index >5, which was similar to results seen in the general population.We designed this cross-sectional study to determine the prevalence and clinical correlates of OSA in a large, randomly selected sample of Tx patients using polysomnography. On the basis of our previous findings, we hypothesized that the prevalence of OSA would be similarly high in Tx and WL patients. Finally, we expected to find an increased cardio- and cerebrovascular risk in patients with versus without OSA in the Tx population.     

Calcium,phosphate and parathyroid metabolism in kidney transplanted patients

Introduction  

Impaired kidney function is common in kidney-transplanted patients and complications of chronic kidney disease (CKD), such as mineral and bone disorders (MBD) are also prevalent in this population. Similarly to other stages of CKD, increasing evidence supports the association between MBD and cardiovascular risk after kidney transplantation as well. Still, little is known about the prevalence, clinical correlates of MBD and its management in transplanted patients. In this study, we aimed to examine the characteristics of MBD and its associations with clinical parameters in a large prevalent cohort of patients after kidney transplantation.     

Time of sunrise and hours with daylight may have an effect on the seasonality and diurnal variation of heart attack

Background The time of onset of myocardial infarction shows seasonal and daily variation. We aimed to investigate whether the number of hours with daylight has an effect on the seasonal variation of heart attack, and whether the time of sunrise has an effect on the diurnal rhythm of myocardial infarction. Methods We carried out a retrospective database study covering all patients admitted to any acute care hospital with the diagnosis of myocardial infarction in Hungary between January 2004 and December 2005 （n=32 329）. Data were collected from the National Health Insurance Fund Administration （OEP） according to the International Classification of Diseases （ICD 121, 122） and National Meteorology Service （OMSZ）. In case of patients who occurred in the database several times the events have been considered as a separate case. Results With consideration to seasonal variation, the peak period of heart attack was found in the spring, with the lowest number of events in the summer. The number of hours with daylight showed a weak negative correlation with the occurrence of myocardial infarction （r=-0.108, P 〈0.05）. With respect to diurnal variation, the peak period of daily events was between 6-12 in the morning （35.57%）. We have found a positive correlation between the time of sunrise and sunset and the occurrence of myocardial infarction （P 〈0.01）. Conclusion Based on our findings, the number of hours with daylight and the time of sunrise may be connected with the chances of having heart attack; however other factors, such as high blood pressure, diabetes or smoking may also have an influence.     

Vulvar intraepithelial neoplasia

HPV infections of the lower genital tract are associated with the increasing incidence of vulvar intraepithelial neoplasia. The new classification divides vulvar intraepithelial neoplasia according to its incidence into two groups: usual and differentiated type. The usual type occurs mainly in young women and is associated with HPV infection, the differentiated type is HPV-negative and occurs in older women. The diagnosis is based on biopsy from a suspicious lesion. The standard treatment involves surgical excision. Topical treatment is now being preferred in young women in order to preserve appearance of the genitalia and sexual function. The high risk of recurrence is the reason for strict monitoring of patients after treatment completion.     

PET-CT Imaging and Reality

The spectrum of human diseases caused by members of the Aspergillus genus is extensive. It ranges from allergic reactions to colonization of preexisting pulmonary cavities to invasion and destruction of lung parenchyma with pyemic spread to brain, skin, and other organs, causing rapid death. The immune status of the host is a crucial factor in determining the phenotype and severity of the disease. In this case report Chronic Necrotizing Pulmonary Aspergillosis (CNPA), a rare, locally- or semi-invasive variant of pulmonary Aspergillosis, mimicking lung metastasis is presented. The 60-year-old male patient had earlier received multiple cycles of systemic chemotherapy due to colorectal carcinoma. Our case report focuses on the benefits and the possible disadvantages of PET-CT imaging in CNPA.     

Validation and use of a computer-assisted counting procedure to quantify BrdU-labeled proliferating cells in the early postnatal mouse hippocampus

The dentate gyrus is one of the few brain regions that show proliferation of neuronal precursors postnatally and in adult life. Proliferation in the dentate gyrus has been shown to be influenced by exercise, stress and drugs such as antidepressants. Traditionally, proliferation studies rely on the time consuming and subjective manual count of labeled cells. Here we adapted the Metamorph software to automatically count cells labeled in the S phase in the developing dentate gyrus of mice. The validity of the computer-assisted method was established by showing an outcome similar to that obtained with the established manual counting procedure. In addition, by using a genetically modified mouse line with increased proliferation, the ability of the computer-assisted method to detect changes in proliferation was demonstrated.     

Substance P neurokinin 1 receptor activation within the dorsal raphe nucleus controls serotonin release in the mouse frontal cortex

Preclinical studies suggest that substance P (SP) neurokinin 1 (NK1) receptor antagonists are efficient in the treatment of anxiety and depression. This therapeutic activity could be mediated via stimulation of serotonin (5-HT) neurons located in the dorsal raphe nucleus (DRN), which receive important SP-NK1 receptor immunoreactive innervations. The present study examined the effects of intraraphe injection of SP on extracellular 5-HT levels in the frontal cortex, ventral hippocampus, and DRN by using intracerebral microdialysis in conscious mice. Intraraphe SP injection dose dependently decreased cortical 5-HT release, whereas no effects were detected in the ventral hippocampus. Cortical effects were blocked by the selective NK1 receptor antagonist N-[[2-methoxy-5-[5-(trifluoromethyl)tetrazol-1-yl]phenyl]methyl]-2-phenylpiperidin-3-amine (GR205171) and completely dampened in mice lacking NK1 receptors. Furthermore, genetic (in knockout 5-HT1A(-/-) mice) or pharmacological inactivation of 5-HT1A autoreceptors blocked cortical responses to SP. Contrasting with its cortical effects, intraraphe SP injection increased 5-HT outflow in the DRN in wild-type mice; this effect was potentiated by a local perfusion of the selective 5-HT1A antagonist N-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-N-2-pyridinylcyclohexanecarboxamide (WAY100635). Finally, SP-induced changes in frontal cortex and DRN dialysate 5-HT levels were blocked by the DRN perfusion of the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)/kainate ionotropic receptor antagonist 6,7-dinitroquinoxaline-2,3-dione (DNQX). These data support the hypothesis that SP-induced over-activation of 5-HT1A autoreceptors within the DRN limits cortical 5-HT release. A better knowledge of the complex relationship between tachykininergic, serotonergic, and glutamatergic systems within the DRN might help better understand the pathophysiology and subsequent treatment of depression.     

Dose reduction of epoetin-alpha in the prevention of chemotherapy-induced anaemia

Introduction  

Anaemia during chemotherapy is often left untreated. Erythropoiesis-stimulating agents are frequently used to treat overt anaemia. Their prophylactic use, however, remains controversial and raises concerns about cost-effectiveness. Therefore, we assessed the efficacy of a dose-reduction schedule in anaemia prophylaxis.