Organ Donation: New Hope Through the Expected Amendment in Germany?

Introduction

The current organ donor shortage in Germany results in the death of 1000 patients on the transplant waiting list every year. In response, a recent amendment to the German Transplant Act aiming to increase donor rates was passed. Among a number of other measures, Germans are asked to decide whether they choose to donate organs or not in the event of a brain death or whether they would like to designate someone who should decide for them in this situation. The objective of this study was to collect and evaluate data on the public's attitude toward organ donation before the expected amendment.

Methods

A survey on the subject of organ donation was conducted in 2011 among clients of a public pharmacy in a major city in the federal state North Rhine-Westphalia, Germany. Data regarding sex, age, health behavior, and attitude toward the amendment were collected and association organ donor card possession was analyzed.

Results

A total of 1485 questionnaires were evaluated. Of those surveyed, only 14.1% had an organ donor card. No statistically significant associations between sex (P value .3045), age (P value .1453) and the possession of a donor card were observed. We found that 72.5% of respondents stated that they appreciated the expected amendment, and in the case of implementation, the majority would obtain an organ donor card.

Discussion

The future success of transplantation medicine relies on an increase in the public's overall willingness to donate organs. Educating the public and ensuring transparency in transplantation medicine are vital to achieving higher donation rates. The new German transplantation act may be an important step to increase society's awareness and participation in organ donation.     

Does scaphoid bone bruising lead to occult fracture? A prospective study of 50 patients

Introduction

Bone bruising of the scaphoid is a term reported when magnetic resonance imaging (MRI) is carried out for scaphoid injury. The aim of our study was twofold: to see if bone bruising alone without fracture of the scaphoid bone seen on initial MRI, in a clinically symptomatic (tender) patient at 10-14 days, progressed to fracture, and to define how this entity of bone bruising should be managed.

Methods

This was a prospective study looking at 170 patients with scaphoid injuries, of which 50 had bone bruising without fracture. These were followed up for at least 8 weeks to ascertain whether or not they had developed a fracture. They were assessed for continuity or resolution of their symptoms by way of clinical examination and/or a further MRI and X-ray (scaphoid views).

Results

Of the 170 scaphoid injuries identified, there were 120 scaphoid fractures seen on scaphoid view radiographs. The remaining 50 were clinically symptomatic and had MRI scaphoid imaging, which demonstrated various grades of bone bruising. All were treated in a scaphoid plaster, and re-examined at 8 weeks. There were four patients who remained symptomatic, for whom MRI scans were performed, which revealed all four with resolving scaphoid bone bruising, and one with a scaphoid fracture (p value = 0.0386). Incidentally, 2 further weeks of immobilisation resolved the symptoms of those four patients. The one patient with a fracture was offered further treatment for the risk of progressing to a nonunion.

Conclusion

Bone bruising detected on MRI without fracture is an important entity, and can lead to occult fracture (2%). It can take anywhere up to 8 weeks to declare. Treatment for bone bruising should be with a scaphoid cast and follow-up X-ray.     

MEK-ERK pathway modulation ameliorates disease phenotypes in a mouse model of Noonan syndrome associated with the Raf1(L613V) mutation

Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden death in children and young adults. Abnormalities in several signaling pathways are implicated in the pathogenesis of HCM, but the role of the RAS-RAF-MEK-ERK MAPK pathway has been controversial. Noonan syndrome (NS) is one of several autosomal-dominant conditions known as RASopathies, which are caused by mutations in different components of this pathway. Germline mutations in RAF1 (which encodes the serine-threonine kinase RAF1) account for approximately 3%-5% of cases of NS. Unlike other NS alleles, RAF1 mutations that confer increased kinase activity are highly associated with HCM. To explore the pathogenesis of such mutations, we generated knockin mice expressing the NS-associated Raf1(L613V) mutation. Like NS patients, mice heterozygous for this mutation (referred to herein as L613V/+ mice) had short stature, craniofacial dysmorphia, and hematologic abnormalities. Valvuloseptal development was normal, but L613V/+ mice exhibited eccentric cardiac hypertrophy and aberrant cardiac fetal gene expression, and decompensated following pressure overload. Agonist-evoked MEK-ERK activation was enhanced in multiple cell types, and postnatal MEK inhibition normalized the growth, facial, and cardiac defects in L613V/+ mice. These data show that different NS genes have intrinsically distinct pathological effects, demonstrate that enhanced MEK-ERK activity is critical for causing HCM and other RAF1-mutant NS phenotypes, and suggest a mutation-specific approach to the treatment of RASopathies.     

Effects of formalin fixation on magnetic resonance indices in multiple sclerosis cortical gray matter

Purpose

To characterize and evaluate functional and anatomic changes of visual pathway lesions during hyperbaric oxygen (HBO) treatment with blood‐oxygenation‐level‐dependent functional MRI (BOLD‐fMRI) and diffusion tensor imaging (DTI).

Materials and Methods

Sixteen patients with visual pathway lesions received HBO treatment. Both BOLD‐fMRI and DTI were performed before and after the treatment, while 12 healthy subjects were also studied with 2 examinations as control. The t‐tests were used for the comparison of number of activated voxels (AVs) and fractional anisotropy (FA) between the two groups, and within the patient group before and after HBO treatment. Visual acuity of the patient group before and after the treatment was compared using Wilcoxon signed‐rank test.

Results

Before the treatment, both AVs (P < 0.01) and FA (P < 0.05) in the bilateral cortexes of occipital lobes were significantly less in the patient group than in the control group. After the treatment, both AVs (P < 0.05) and FA (P < 0.05) were significantly increased. Moreover, The FA of 6 patients with lesions in the optical nerve was greater than the FA of the other 10 patients with lesions in the optic radiation (P < 0.05).

Conclusion

BOLD‐fMRI combined with DTI was useful for the characterization and evaluation of anatomic and functional changes of visual pathway lesions and their development during HBO treatment. J. Magn. Reson. Imaging 2010;31:1054–1060. © 2010 Wiley‐Liss, Inc.     

The relationship between the five minute Apgar score,mode of birth and neonatal outcomes

Objective: To investigate the relationship between the five-minute Apgar score categories (low, intermediate, and normal), mode of birth and neonatal outcomes.

Methods: This was a retrospective cross sectional study of term singleton deliveries at Mater Mothers’ Hospital in Brisbane, Australia between January 2007 and December 2015. The five minute score was subdivided in to three categories – low (0–3), intermediate (4–6), and normal (≥7). These were correlated with adverse neonatal outcomes and mode of birth. The referent cohort was the normal Apgar group.

Results: The study cohort consisted of 39,258 births with a recorded five minute Apgar score. Of these, 38,705 (98.6%) neonates had a normal (≥7) Apgar score, 439 (1.1%) had an intermediate score (4–6) and 114 (0.3%) had a low (0–3) score. Neonatal complications including respiratory distress, feeding problems, hypothermia, and seizures were all significantly associated with both low and intermediate Apgar scores. Emergency operative birth (caesarean and instrumental) conveyed a higher risk of low and intermediate scores and poorer neonatal outcomes.

Conclusions: Low and intermediate five minute Apgar scores were strongly associated with mode of birth and poorer neonatal outcomes.