Donor risk score and baseline biopsy CADI value predict kidney graft outcome

Different donor parameters and baseline biopsy have been used to assess the quality of donor organs. There is, however, no consensus which risk factors and chronic changes in the donor kidney can be accepted for transplantation. The study included 481 deceased organ donors and their 829 kidney recipients transplanted during 1995-2005. The biopsies were re-evaluated according to the Banff 97 classification. The prognostic significance of donor risk factors and Chronic Allograft Damage Index (CADI) was analyzed. We propose a new donor risk score, calculated as the count of positive risk factors from a defined set of factors in the medical history of the donor. This donor risk score predicts histological quality of the kidney, graft function, and survival. Transplantations from donors with donor risk score >4 had significantly decreased graft survival compared to those with donor risk scores 0-4; the five-yr death-censored graft survivals were 83% vs. 93%, respectively. High donor CADI score (>3) was associated with worse graft function and survival. Three-yr glomerular filtration rate declined from 82 to 49 mL/min with donor CADI increase from 0 to ≥4. Our results show that high donor risk score and CADI value reflect low functional reserve and risk for poor graft outcome.     

BARD1 variants Cys557Ser and Val507Met in breast cancer predisposition

BARD1 (BRCA1-associated RING-domain 1) is a tumor suppressor whose protein product interacts with BRCA1, and in which rare somatic and germline mutations have been reported in breast, uterine, and endometrial cancers. We aimed to evaluate whether there are BARD1 genetic variants that contribute to breast cancer risk by screening the gene for germline alterations in 45 Finnish familial breast cancer patients and in seven patients with both breast and ovarian cancer. Two of the missense alterations identified (Cys557Ser and Val507Met) were recently suggested to associate with an increased breast cancer risk. We also analyzed these variants in large and independent series of familial and unselected breast cancer patients and healthy controls. No clearly deleterious mutations were detected in the initial mutation screening. No association of the Cys557Ser and breast cancer risk was observed as the variant was found altogether in 1.4% (16/1181) of familial and 2.2% (34/1565) of unselected breast cancer patients, and in 2.5% (27/1083) of healthy controls. The frequency of the Val-allele of the Val507Met variant was modestly higher among breast cancer patients than among healthy controls, although the difference did not reach statistical significance. No statistically significant association of the Cys557Ser or Val507Met variants with any clinicopathologic parameters was observed. These results suggest that the contribution of the BARD1 germline variants to breast cancer predisposition is very limited, and that neither Cys557Ser nor Val507Met have an effect on familial breast cancer susceptibility.     

Neurocognitive test profiles of extremely low birth weight five-year-old children differ according to neuromotor status

The neurocognitive outcome of children born with extremely low birth weight (ELBW) is highly variable due to the complexity of morbidity. So far, no study has compared comprehensive neuropsychological test profiles in groups with different neuromotor status. In a national cohort of ELBW children neuropsychological test profiles were assessed in 4 groups defined according to a neurological examination at 5 years of age: normal neuromotor status (N = 56), motor coordination problems (N = 32), multiple subtle neuromotor signs including both motor coordination problems and deviant reflexes (N = 20), and spastic diplegia (N = 12). The neurocognitive assessment included a test of intelligence, the Wechsler Primary and Preschool Scale of Intelligence-Revised (WPPSI-R) and 14 subtests of attention and executive functions, verbal functions, manual motor functions, visuoconstructional functions and verbal learning (NEPSY). The children with normal neuromotor status performed within the average range; children with motor coordination problems had widespread impairment; and children with spastic diplegia and children with multiple minor neuromotor signs had uneven test profiles with stronger verbal results but weaknesses in attention and executive functions, and in manual motor and visuoconstructional tasks. In conclusion, very preterm children with neuromotor signs, including motor coordination problems, are at risk for neurocognitive impairment, in spite of average intelligence. More impaired children have more irregular test profiles. Follow-up and neuropsychological assessment of very preterm children with minor neuromotor signs are therefore indicated.     

RGS4 polymorphism and response to electroconvulsive therapy in major depressive disorder

We studied the association between RGS4 (rs951436) polymorphism and treatment response in electroconvulsive therapy (ECT) as well as risk of treatment-resistant depression. The study sample consisted of 119 patients with major depressive disorder (MDD) and 384 healthy control subjects. RGS4 polymorphism was not associated with treatment response in ECT or risk of MDD. According to the present data, the impact of RGS4 genotype is not decisive in major depressive disorder. The results provide preliminary data on the impact of RGS4 polymorphism in treatment response in ECT.     

Deceased donor neutrophil gelatinase-associated lipocalin and delayed graft function after kidney transplantation: a prospective study

Introduction  

Expanding the criteria for deceased organ donors increases the risk of delayed graft function (DGF) and complicates kidney transplant outcome. We studied whether donor neutrophil gelatinase-associated lipocalin (NGAL), a novel biomarker for acute kidney injury, could predict DGF after transplantation.     

The FAST in screening for at-risk drinking among middle-aged women

Objective: There is a need for brief methods to screen for at-risk drinking. The FAST is a two-stepped structured questionnaire. In the FAST-1, one question categorizes into three groups: low-risk drinking, potential at-risk drinking or at-risk drinking. In the FAST-2, those with potential at-risk drinking are asked three additional questions. The aim was to study its effectiveness in screening for at-risk drinking among women and to define an optimal cut-off score.

Method: The FAST was validated against the Timeline Followback (TLFB) utilizing data from a health check of a group of 40-year old women (response rate 69.2%; n = 907/1311). The TLFB-based definition of at-risk drinking was consuming ≥140 grams of alcohol weekly (6.1% reported at-risk drinking).

Results and conclusions: Of all women, 54.5% could be correctly classified either as having low-risk or at-risk drinking with the FAST-1. The optimal cut-off score was ≥2 (sensitivity 0.82, specificity 0.86) which is lower than has previously been reported. Only those with a FAST-1 score of one needed further evaluation with the FAST-2. A FAST-2 score of ≥1 resulted in a positive screen for at-risk drinking. The FAST seems to be a valid and feasible method in screening for at-risk drinking among middle-aged women.     

Amrinone versus dopamine-nitroglycerin after reconstructive surgery for complete atrioventricular septal defect

To compare the effectiveness and safety of amrinone and a combination of dopamine and nitroglycerin in infants after reconstructive surgery for congenital heart disease. A prospective, randomized, double-blind study. Pediatric intensive care unit in a university hospital. Thirty-two infants with complete atrioventricular septal defect. Amrinone loading dose, 2 mg/kg, followed by a maintenance infusion, 7.5 μg/kg/min, was given to 17 infants before separation from cardiopulmonary bypass. The remaining 15 patients received a combination of dopamine, 5 μg/kg/min, and nitroglycerin, 1 μg/kg/min. The circulatory state of the patients was evaluated from 4 to 18 hours after cardiopulmonary bypass. The systemic blood flow index, calculated using the Fick principle, was higher in the amrinone group (2.5 ± 0.7 L/min/m²) compared with the dopamine-nitroglycerin group (2.0 ± 0.6 L/min/m², mean ± SD). The pulmonary blood flow index in the amrinone group was higher (2.9 ± 0.6 L/min/m²) than in the dopaminenitroglycerin group (2.2 ± 0.6 L/min/m²); no significant difference was noted in the mean pulmonary artery pressure. The oxygen extraction ratio was higher in the dopamine-nitroglycerin group (0.41 ± 0.07) compared with the amrinone group (0.34 ± 0.08). Despite lower platelet counts in the amrinone group, no hemorrhagic complications were seen in any patient. With this dosage regimen, amrinone provides a higher cardiac output, more favorable oxygen dynamics, and lower pulmonary vascular resistance than dopamine and nitroglycerin.