Prophylactic CMV therapy does not improve three‐yr patient and graft survival compared to preemptive therapy

Despite increasing evidence in favor of prophylactic valganciclovir treatment in kidney transplant recipients for the prevention of cytomegalovirus (CMV) infection, the impact of preemptive vs. prophylactic treatment on long‐term clinical outcomes is unclear. In this retrospective study, 187 kidney transplant recipients with serologic intermediate‐risk constellation (recipient CMV IgG positive) received either preemptive or prophylactic treatment with valganciclovir. Patient survival (primary endpoint), graft survival, viremia rates, and other CMV‐related outcomes were analyzed. Prophylactic therapy reduced the rates for CMV viremia during the first year (hazard ratio: 0.48, 95% confidence interval [CI] 0.30–0.75; p < 0.001). There was a trend for higher three‐yr patient mortality in the prophylactic group (hazard ratio: 5.08, 95% CI 0.62–41.3; p = 0.091), and the rate of graft loss was not reduced (hazard ratio: 0.93, 95% CI 0.32–2.68; p = 0.894). Estimated glomerular filtration rate over three yr was on average 6.8 mL/min/1.73 m² lower in the prophylactic group (95% CI −11.68 to −1.81; p = 0.007) using a multivariate random effects model but showed more improvement over time. Prophylactic valganciclovir treatment reduced the rate of CMV infections during the first year post‐transplant but no effects of prophylactic treatment on patient and graft survival or kidney function over three yr were observed.     

Härtemessungen an frischen menschlichen Femora

Zusammenfassung An 25 Individuen im Altersbereich von 2–86 Jahren, männlichen und weiblichen Geschlechts, wurden Härtemessungen an den rechten (frischen) Femora bei Belastungen in Axial- und Querrichtung systematisch durchgeführt. Dazu wurde der Femur mit einer Knochensäge bei 26, 38, 50, 62 und 74% der größten Femurlänge in etwa 2 cm dicke parallele Scheiben zerlegt. Für die Härtemessungen verwendeten wir die Vickers-Methode. Die faktoriell-hierarchische Varianzanalyse hat gezeigt, daß die Härte des Femurs unabhängig von der Querschnittshöhe ist. Ferner konnten keine Härteunterschiede in Abhängigkeit von der Querschnittslokalisation gesichert werden. In Übereinstimmung mit anderen Autoren konnte festgestellt werden, daß die Härte im Greisenalter nicht anders ist als im mittleren Alter. Die Hä rtewerte bei Querbelastung sind um 19% niedriger als die bei der Axialbelastung.

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Summary Hardness tests were systematically conducted on the fresh, right femur of 25 individuals in the age groups of 2–86 years (both males and females) with stresses in the axial and cross-sectional directions. Thereby the femur was cut up with a bone saw in approximately 2 cm thick parallel pieces at 26, 38, 50, 62 and 74% of the longest femur length. We used the Vickers method for the hardness measurements. The factorial-hierarchical variance analysis revealed that the hardness of the femur is independent of the cross-section height. Furthermore, no differences in hardness could be ascertained in dependence upon the cross-section localization. In agreement with other authors, it was established that the hardness is not different in old age than in middle age. The hardness values by cross-sectional stress are 19% lower than by those by axial stress.

Herrn Prof. Dr. med. Berthold Mueller zum 75. Geburtstag in Dankbarkeit gewidmet.     

Effects of beta-carotene supplementation on free radical mechanism in healthy adult subjects

AIM: The objective of this study was to examine whether increasing doses of beta-carotene supplements have effects on biological markers of lipid peroxidation in healthy volunteers. SUBJECTS AND METHODS: Forty-two healthy subjects were supplemented with 5 mg, 10 mg, 20 mg or 40 mg beta-carotene/day, respectively for five weeks. Plasma beta-carotene and tocopherol levels, malondialdehyde-thiobarbituric reactive substances (MDA-TBARS), and conjugated dienes were determined using high-performance liquid chromatography (HPLC). Concentrations of ascorbic acid, uric acid, and the total antioxidative capacity (TAC) in plasma were measured photometrically. RESULTS: Plasma beta-carotene levels increased significantly according to the intervention dose (p < 0.001), and concentrations of tocopherol equivalents and ascorbic acid were within the physiological range except in the 5 mg intervention group where a significant decrease of vitamin C was assessed (p < 0.05). Uric acid in plasma decreased significantly in all groups (p < 0.05) up to the end of investigation, but was within the normal range. Trolox equivalent antioxidative capacity (TEAC) decreased significantly (p < 0.001) in all groups during supplementation. MDA-TBARS remained unchanged after five weeks except for the 40 mg beta-carotene substitution group, where a significant decrease was observed (p < 0.05). CONCLUSION: Beta-carotene supplementation of healthy subjects significantly increased plasma beta-carotene status without inducing adverse biological effects. Beta-carotene did not especially protect against oxidative stress, except for the 40 mg group. These data suggest that additional effects of beta-carotene supplementation on well-nourished, healthy subjects are limited.