Memory functioning in post‐traumatic stress disorder: objective findings versus subjective complaints

Although memory complaints are common in post‐traumatic stress disorder (PTSD), the only published study of objective and subjective memory in PTSD by Roca and Freeman indicates that subjective complaints may not accurately reflect objective performance. The present study examined memory in 21 PTSD patients, 20 combat controls and 23 non‐combat controls using two objective memory measures (Rey Auditory Verbal Learning Test; Backward Digit Span) and one subjective measure (Memory Functioning Questionnaire). Analysis of variances (ANOVAs) and analysis of co‐variances generally did not reveal group differences for objective memory performance. For subjective memory complaints, ANOVAs indicated group differences; PTSD participants reported more memory problems than controls. These differences disappeared, however, when depression was included as a covariate. Also, we provide some preliminary evidence that depression may mediate the relationship between PTSD symptomatology and subjective memory complaints. Findings suggest that reductions in depressive symptomatology in PTSD may be associated with decreased subjective memory complaints. Copyright © 2010 John Wiley & Sons, Ltd.     

Low prevalence of HBV DNA in the liver allograft from anti‐HBc‐positive donors: a single‐center experience

Pan J‐J, Oh S‐H, Soldevila‐Pico C, Nelson DR, Liu C. Low prevalence of HBV DNA in the liver allograft from anti‐HBc‐positive donors: a single‐center experience.
Clin Transplant 2011: 25: 164–170. © 2010 John Wiley & Sons A/S. Abstract: Allografts from donors positive for antibody to hepatitis B core antigen (anti‐HBc⁺) can transmit hepatitis B virus (HBV) to the recipients. We aimed to study the prevalence of HBV DNA in liver allografts from anti‐HBc⁺ donors. Between January 2003 and December 2008, this retrospective study identified 18 patients who received a liver from an anti‐HBc⁺ donor. Pre‐ and post‐transplantation HBV serology and serum HBV DNA level of the study subjects were reviewed. DNA extracted from liver biopsy tissue was used for PCR assay. Immunohistochemistry was also performed to determine viral protein expression. We observed a low prevalence of HBV DNA in allografts from anti‐HBc⁺ donors even among patients who did not receive prophylaxis. Only one of 18 patients had detectable HBV DNA in the liver allograft. This recipient was seronegative for HBV before transplantation and did not receive prophylaxis after transplantation, and developed de novo hepatitis B. Of the five patients who were positive for both antibody to hepatitis B surface antigen and anti‐HBc before transplantation and did not receive prophylaxis after transplantation, none developed HBV infection. Prophylaxis for HBV is important for seronegative recipients receiving a liver from an anti‐HBc⁺ donor. Such prophylaxis may not be necessary for recipients who do not have detectable HBV DNA in the liver allograft.     

Kidney transplantation from donation after cardiac death donors: lack of impact of delayed graft function on post‐transplant outcomes

Singh RP, Farney AC, Rogers J, Zuckerman J, Reeves‐Daniel A, Hartmann E, Iskandar S, Adams P, Stratta RJ. Kidney transplantation from donation after cardiac death donors: lack of impact of delayed graft function on post‐transplant outcomes.
Clin Transplant 2011: 25: 255–264. © 2010 John Wiley & Sons A/S. Abstract: Introduction: Delayed graft function (DGF) is more common in recipients of kidney transplants from donation after cardiac death (DCD) donors compared to donation after brain death (DBD) donors. Methods: Single‐center retrospective study to evaluate the impact of DGF on controlled (Maastricht category III) DCD donor kidney transplant outcomes. Results: From 10/01 to 6/08, 578 adult deceased donor kidney transplants were performed including 70 (12%) from DCD and 508 (88%) from DBD donors. Mean follow‐up was 36 months. DCD donor kidney transplants had significantly greater rates of DGF (57% DCD vs. 21% DBD, p < 0.0001)) and acute rejection (29% DCD vs. 16% DBD, p = 0.018) compared to DBD donor kidney transplants, but patient and graft survival rates were similar. DBD donor kidney transplants with DGF (n = 109) had significantly greater rates of death‐censored graft loss (12.5% DCD vs. 31% DBD), primary non‐function (0 DCD vs. 10% DBD) and higher 2 year mean serum creatinine levels (1.4 DCD vs. 2.7 mg/dL DBD) compared to DCD donor kidney transplants with DGF (n = 40, all p < 0.04). On univariate analysis, the presence of acute rejection and older donor age were the only significant risk factors for death‐censored graft loss in DCD donor kidney transplants, whereas DGF was not a risk factor. Conclusion: Despite higher rates of DGF and acute rejection in DCD donor kidney transplants, subsequent outcomes in DCD donor kidney transplants with DGF are better than in DBD donor kidney transplants experiencing DGF, and similar to outcomes in DCD donor kidney transplants without DGF.     

Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death

The purpose of this study was to analyze the possible effects of machine perfusion (MP) versus cold storage (CS) on delayed graft function (DGF) and early graft survival in expanded criteria donor kidneys (ECD). As part of the previously reported international randomized controlled trial 91 consecutive heart‐beating deceased ECDs – defined according to the United Network of Organ Sharing definition – were included in the study. From each donor one kidney was randomized to MP and the contralateral kidney to CS. All recipients were followed for 1 year. The primary endpoint was DGF. Secondary endpoints included primary nonfunction and graft survival. DGF occurred in 27 patients in the CS group (29.7%) and in 20 patients in the MP group (22%). Using the logistic regression model MP significantly reduced the risk of DGF compared with CS (OR 0.460, P = 0.047). The incidence of nonfunction in the CS group (12%) was four times higher than in the MP group (3%) (P = 0.04). One‐year graft survival was significantly higher in machine perfused kidneys compared with cold stored kidneys (92.3% vs. 80.2%, P = 0.02). In the present study, MP preservation clearly reduced the risk of DGF and improved 1‐year graft survival and function in ECD kidneys. (Current Controlled Trials number: ISRCTN83876362).     

Current situation of donation after circulatory death in European countries

The aim of the present study was to describe the current situation of donation after circulatory death (DCD) in the Council of Europe, through a dedicated survey. Of 27 participating countries, only 10 confirmed any DCD activity, the highest one being described in Belgium, the Netherlands and the United Kingdom (mainly controlled) and France and Spain (mainly uncontrolled). During 2000–2009, as DCD increased, donation after brain death (DBD) decreased about 20% in the three countries with a predominant controlled DCD activity, while DBD had increased in the majority of European countries. The number of organs recovered and transplanted per DCD increased along time, although it remained substantially lower compared with DBD. During 2000–2008, 5004 organs were transplanted from DCD (4261 kidneys, 505 livers, 157 lungs and 81 pancreas). Short‐term outcomes of 2343 kidney recipients from controlled versus 649 from uncontrolled DCD were analyzed: primary non function occurred in 5% vs. 6.4% (P = NS) and delayed graft function in 50.2% vs. 75.7% (P < 0.001). In spite of this, 1 year graft survival was 85.9% vs. 88.9% (P = 0.04), respectively. DCD is increasingly accepted in Europe but still limited to a few countries. Controlled DCD might negatively impact DBD activity. The degree of utilization of DCD is lower compared with DBD. Short‐term results of DCD are promising with differences between kidney recipients transplanted from controlled versus uncontrolled DCD, an observation to be further analyzed.     

Prompt reversal of a severe complement activation by eculizumab in a patient undergoing intentional ABO‐incompatible pancreas and kidney transplantation

Summary We describe the presumably first intentional ABO‐incompatible deceased‐donor kidney and pancreas transplantation with a severe antibody‐mediated rejection during a rebound of isoagglutinins. Rejection was successfully treated with eculizumab, which inhibits the terminal pathway of complement. Complement analysis (C3, C3d,g, and a modified assay of classical complement‐related hemolytic function) documented complement activation and confirmed that eculizumab completely blocked complement function. At 6 months, the patient had normal kidney and pancreas function, and histological evaluations revealed no evidence of sustained graft damage. This successful transplantation suggests that ABO barriers can safely be overcome without extensive preconditioning, when the complement inhibitor eculizumab is included.     

Effect of hyaluronic acid on urine nerve growth factor in cyclophosphamide‐induced cystitis

Objectives: To investigate how hyaluronic acid (HA) affects nerve growth factor (NGF) production and bladder overactivity in a cyclophosphamide (CYP)‐induced cystitis rat model. Methods: Female Sprague–Dawley rats received three intermittent intraperitoneal injections of CYP (75 mg/kg) or saline. Before or after CYP injection, HA was given intravesically and urine NGF was checked with creatinine correction. Bladder function was evaluated by cystometrograms under Zoletil anesthesia. Furthermore, the effect of HA was counteracted with hyaluronidase (HYAL). Bladder structural change was compared among groups with trichrome stain. Results: The intercontraction interval (ICI) significantly decreased in CYP‐injected rats in comparison to the saline‐injected controls. In the CYP‐injected groups, bladder HA instillation significantly increased the ICI, but did not change the maximum voiding pressure in comparison to the saline instillation. NGF production significantly increased in CYP‐injected rats, but decreased significantly with HA treatment. Treatment with HA had a more significant effect on urine NGF and the use of HYAL would eliminate this effect. Specific staining showed mucosa swelling after CYP treatment. Little HA coating on bladder mucosa could be found in HA‐treated rats. Conclusions: Present findings raise the possibility that HA could be an effective treatment for CYP‐related bladder overactivity through the involvement of NGF signaling.     

Pedicle screw instrumentation plus augmentation vertebroplasty using calcium sulfate for thoracolumbar burst fractures without neurologic deficits

Objective: To evaluate the efficacy of posterior instrumentation plus vertebroplasty and posterolateral fusion using calcium sulfate for thoracolumbar burst fractures without neurologic deficits. Methods: Between July 2005 and January 2008, a total of 45 patients who had been diagnosed as having thoracolumbar burst fractures without neurologic deficits were treated with pedicle screw instrumentation plus vertebroplasty using calcium sulfate in our unit. The Cobb angles and loss rates of anterior‐middle columns height at different time intervals were measured on lateral radiographs, and the preoperative and postoperative functional outcomes were evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Results: The Cobb angles and loss rates of anterior‐middle columns height postoperatively period were restored significantly compared with those noted preoperatively. The angles and heights were well maintained for at least two years using this technique. The mean postoperative VAS (back pain) score was 2.1 ± 0.8, which was significantly better (P < 0.001) than the mean preoperative VAS score 7.9 ± 1.1. The average preoperative ODI was 66.6 ± 8.1% and this had improved significantly to 15.5 ± 4.5% by the latest follow‐up (P < 0.001). No instrumentation failure was detected in this study. The calcium sulfate had been absorbed completely by 3–6 months postoperatively. Conclusion: Pedicle screw instrumentation plus augmentation vertebroplasty with calcium sulfate is an economic, efficient and reliable technique for treating unstable thoracolumbar fractures without neurologic deficits.     

Management of femoral diaphyseal nonunion after nailing with augmentative locked plating and bone graft

Objectives: Exchange nailing (EN) for aseptic femoral shaft nonunion is currently a standard orthopaedic treatment modality. However, according to recent studies there is occasionally a high failure rate when EN is used. In the present study, augmentative locked plating and bone graft was used as an alternative method for treating such cases. The purpose of this study was to report the treatment outcomes of selected femoral diaphyseal nonunions that had initially been treated by nailing. Methods: Thirteen patients with femoral diaphyseal nonunions underwent revision surgery with locked plate and bone graft. The inclusion criteria were: (a) nonisthmic nonunion; (b) atrophic/oligotrophic nonunion. All patients were managed by augmentative locked plating and bone graft. Results: All patients were followed up for a mean of 1.2 years (range, 1–2 years). After revision surgery all nonunions achieved bony union, the average union time being 7.5 months (range, 6–12 months). No major complications were observed in this case series. Conclusion: Augmentative locked plating is an effective and simple technique for treatment of femoral diaphyseal nonunion after nailing in selected cases.     

Comparison of complications and results of early versus delayed surgery for Gartland type III supracondylar humeral fractures in pediatric patients

Objective: To investigate the effect of timing of surgery on clinical results and perioperative complications in pediatric patients with Gartland III type supracondylar humeral fractures without neurovascular compromise. Methods: Eighty‐six c onsecutive children treated surgically at our hospital from April 2005 to June 2007 for displaced supracondylar humeral fractures were reviewed. All these patients were treated by the same group of doctors. The children were divided into two groups: early if treated within 12 hours after injury and delayed if treated later than that. Perioperative complications and clinical results, especially for open surgery, were compared between the two groups. Results: Forty pediatric patients underwent surgery in the early group and 46 in the delayed group. There were no significant differences between the two groups in perioperative complications such as pin tract infection, iatrogenic nerve injury, compartment syndrome and conversion to open surgery. For open surgery, both the clinical results and perioperative complications were not affected by delaying for more than 12 hours after injury. However, blood loss and operation time were greater in the early than in the delayed group, possibly due to relatively more edema. Conclusion: Delay in surgery, regardless of whether it is closed or open, for more than 12 hours after injury does not influence the perioperative complications and clinical results for displaced supracondylar humeral fractures in children. However early open reduction and pinning may increase intra‐operative blood loss and take longer.