Comparison of human telomerase RNA and telomerase activity in urine for diagnosis of bladder cancer

Currently the demand for transplant organs far outstrips the supply in the UK. This problem is even more severe for the Asian population, who have been shown to be disproportionately over-represented on transplant waiting lists in some regions of the UK. Several commentators have suggested that religious and cultural traditions may be the major determinant preventing Asians from donating organs. An exploratory qualitative study was undertaken with the aim of examining the influence of religious beliefs, amongst other things, on the extent and direction of public attitudes towards organ donation in a cross-section of the Asian population in Luton. This study indicates that, in the population studied, culture and religion play a much less prohibitive part in determining the level of organ donation than previously suggested. However, there is a desire to be aware of the religious stances so that people can make a more informed decision. The emphasis should clearly been a reconsideration of the presently inadequate approaches to organ procurement and on devising and supplementing these with more appropriate ones. An example of the failure to inform effectively the relevant populations about important developments is that only two of the 32 Muslims in the survey had heard of the 'fatwa' by the Muslim Legislative Council permitting organ donation.     

Liver transplantation: dentistry is an essential part of the team

Liver transplantation has become a commonplace procedure, with more than 3,000 livers being transplanted annually. Patient demand remains much greater than availability of donor organs, resulting in many deaths per year. Due to the nature of hepatic function, unique concern exists regarding susceptibility to infection and rejection during the post-transplant period, placing great importance on vigilant oral health maintenance. Patients are severely immunocompromised and must be well educated and treated pretransplant and for the rest of their post-transplant lives; however, even though patients are on waiting lists for matching donor livers for an adequate amount of time to provide definitive dental treatment, this is not a major priority on the protocols of some transplant centers. This paper addresses these concerns and illustrates a patient who presented shortly post-transplant with severe dental problems requiring immediate definitive treatment. As these patients may present in any office, general dentists should be aware of the unique concerns involving their assessment, education, treatment and maintenance.     

The great success of Asian kidney transplant recipients

BACKGROUND: Little has been written about allograft survival in non-African-American minority groups. We examine the success of kidney transplantation in 1900 Asian recipients. METHODS: Data from 42,252 cadaveric and 16,115 live donor kidney transplant recipients were monitored from the United Network for Organ Sharing Scientific Renal Transplant Registry from 1991 through 1996. RESULTS: Asian recipients exhibited the highest cadaveric allograft survival rates (89% 1-year and 83% 3-year survival) and the longest mean allograft half-life (18 years). Asian women had the highest mean graft half-life (23 years). Asians were less likely to be broadly sensitized and had a high incidence of IgA nephropathy causing end-stage renal disease. Although it has been suggested that their low body weights may help explain the excellent allograft outcome, Asians exhibited superior graft survival rates even when compared with low body weight recipients of other races. CONCLUSION: Asian renal allograft recipients, particularly Asian females, have the highest allograft survival rates of all racial groups.     

High turnover bone disease following lung transplantation

OBJECTIVE: To evaluate the validity of recommending coronary artery bypass grafting (CABG) in preparation for renal transplantation in asymptomatic peritoneal dialysis (PD) patients with evidence of reversible myocardial ischemia. DESIGN: Retrospective review in a single PD unit. PARTICIPANTS: Ten asymptomatic PD patients who underwent CABG to be placed on the transplant list comprised the study group. Ten age-, sex-, and disease-matched PD patients who did not receive CABG were used as a comparison group. MEASUREMENTS: Clinical outcome from 1990 to the present. RESULTS: Only 1 patient in the study group has received a transplant. Seven patients (70%) have died or have been removed from the list because of comorbid illness. Only 2 patients are still on the waiting list. CONCLUSION: As a result of the long waiting time for cadaveric renal transplant and the high risk of interim development of comorbid disease, only a minority of patients come to transplantation. The presence of coronary disease is likely a surrogate for more generalized cardiac and vascular disease in this population. In light of these findings, the policy of prophylactic revascularization in asymptomatic dialysis patients in preparation for renal transplantation needs to be reconsidered.     

Birth weights of infants of first generation Asian women in Britain compared with second generation Asian women

OBJECTIVES: To compare birth weights of infants of first generation Asian women (women born in the Indian subcontinent) with those of infants of second generation Asian women (born in the United Kingdom). DESIGN: Retrospective case note study. SETTING: Bolton District General Hospital. SUBJECTS: 331 Asian women who gave birth between January 1989 and December 1989: 220 of these women were first generation Asians and 111 were second generation Asians. MAIN OUTCOME MEASURE: Birth weights of babies born to first and second generation Asian women. RESULTS: At all gestational ages at delivery, babies born to second generation Asian women were heavier than those born to first generation women. The mean birth weight for babies of second generation women was 3196 g, 249 g more than the mean birth weight of 2946 g of babies of first generation women (P < 0.001). After a stepwise multiple regression analysis was carried out the adjusted difference in birth weights was 280 g, greater than the crude difference. CONCLUSION: Birth weights are important in relation to perinatal mortality, which is notoriously high among Asians. The results of this study indicate that there is hope for lowering of perinatal mortality and improving postnatal growth in babies of second generation Asians.     

What if socioeconomics made no difference?: access to a cadaver kidney transplant as an example

OBJECTIVES: Several studies have noted the impact of socioeconomic factors on access to expensive medical care, but none of those studies controlled for self-reported health and functional status or attitudes about treatment alternatives when analyses were completed. Because these factors may be correlated with socioeconomic status, the failure to control for them may have led to bias in other studies. The authors merged data from secondary sources with telephone survey data from a national sample of 456 end-stage renal disease patients to show how estimates of the effects of socioeconomic factors change when self-reported health and functional status and attitudes about treatment are incorporated into statistical models. The authors also showed how kidney transplant rates would change if socioeconomic factors no longer influences organ allocation decisions. METHODS: Weibull proportional hazard analyses were used to show relationships between socioeconomic measures and waiting list entry and kidney transplant rates, before versus after accounting for self-reported health and functional status, attitudes about treatment, and other variables. Simulation analyses were used to estimate the number of waiting list spots and transplant operations that would move from economically advantaged to disadvantaged persons if socioeconomics no longer influenced organ allocation decisions. RESULTS: Incorporating information about health and functional status, attitudes about treatment, and other factors into the hazard models often reduced the estimated impact of socioeconomic measures on the odds of (1) being on a waiting list for a cadaver kidney transplant and (2) receiving a transplant. Simulations showed that 30 to 65 waiting list spots or transplant operations per 1,000 patients would shift from economically advantaged to disadvantaged persons if socioeconomics no longer influenced organ allocation decisions. CONCLUSIONS: Successful efforts to level the playing field would result in substantial redistributions of kidney transplants from economically advantaged to disadvantaged persons.     

The retrieval of thoracic organs: donor assessment and management

The optimal management of the multi-organ donor is critical to the successful outcome of transplantation. It is a complex challenge demanding careful attention to detail, and requiring a shift in emphasis, since the pathophysiological processes have far reaching effects which many clinicians do not see on a day-to-day basis. The optimal management of haemodynamic and respiratory status is essential in order to maximise the yield of suitable thoracic donor organs, yet this process will also improve the condition of other organs at the time of procurement and thus enable prompt recovery of function following hepatic and renal transplantation. The process commences when a potential donor is identified, and is only complete after successful transplantation of all possible organs. In order to achieve this end, a dedicated, multi-disciplinary team is necessary, consisting not only of medical staff, but also support workers who organise logistics, and who play their own part in vital areas, such as transport of the donor team and organs. The co-ordinator's role is pivotal in bringing together, in harmony, teams from different centres. It is important to remember that the effort of every person involved in the management and procurement of donor organs is primarily directed towards maximisation of the donor pool, and that our main responsibility is to the recipients on our waiting lists.     

Asian-American educational achievements: A phenomenon in search of an explanation.

Considerable attention has been paid to the academic achievements of Asian Americans because there is convergent evidence that this population has attained high educational mobility. In trying to explain the achievement patterns, researchers have largely limited their investigations to one of two contrasting hypotheses involving (a) hereditary differences in intelligence between Asians and Whites and (b) Asian cultural values that promote educational endeavors. Research findings have cast serious doubt over the validity of the genetic hypothesis. Yet, there has been a failure to find strong empirical support for the alternative hypothesis concerning cultural values. It is proposed, under the concept of relative functionalism, that Asian Americans perceive, and have experienced, restrictions in upward mobility in careers or jobs that are unrelated to education. Consequently, education assumes importance, above and beyond what can be predicted from cultural values. Research and policy implications of this view are noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Extended donor criteria: use of cardiac allografts after carbon monoxide poisoning

BACKGROUND: An increasing demand for cardiac allografts for the treatment of end-stage cardiac failure has led to a shift in the traditional views about donor criteria. The use of allografts exposed to high concentrations of carbon monoxide is still under discussion. The current literature on this topic is contradictory. We describe our experience with orthotopic cardiac transplantation, using cardiac allografts after carbon monoxide poisoning. METHODS: Between March 13, 1989 and August 1, 1996, 770 orthotopic heart transplantations were performed in our center. Within this period, we accepted five cardiac allografts from brain-dead, carbon monoxide-poisoned donors. Donor history showed carbon monoxide intoxication in all cases. At the time of organ explantation, donor hemodynamic parameters were feeble in all patients. RESULTS: The postoperative course was uneventful in three of the five recipients. The overall 3-year survival rate in this small group is 40%. Induction therapy or rescue therapy with mono/polyclonal antibodies was not necessary. Myocardial right-ventricular biopsies did not show any specific signs of carbon monoxide poisoning. CONCLUSIONS: In our opinion, cardiac allografts from donors exposed to carbon monoxide can be transplanted successfully in infants and adults, if there are no signs of severe hemodynamic dysfunction in the presence of a normal central venous pressure and low-dose support with catecholamines and there are no electrocardiographic changes in combination with elevated transaminase. With extended donor criteria, the hearts of carbon monoxide-poisoned victims could increase the number of suitable organs and lower the death rate of patients on the United Network for Organ Sharing and Eurotransplant International Foundation waiting lists.     

Renal replacement therapy in the elderly

Before 1980 few patients over the age of 65 started chronic dialysis, despite the fact that the incidence of advanced chronic renal failure was approximately ten times greater in this group compared to young and middle aged adults. Since that time the number of elderly patients starting renal replacement has increased markedly and accounted for 38% of new dialysis patients in Scotland in 1995. (Data supplied by the Scottish Renal Registry). In order to meet the needs of older patients with chronic renal failure there has been considerable expansion in renal services and it has been predicted that this will continue to increase in Scotland until 2010.     

Prevalence of diabetic nephropathy in adult patients with chronic kidney failure

Diabetic nephropathy is a frequent cause of end-stage renal failure in patients admitted for renal replacement therapy. PURPOSE: To evaluate the prevalence of DN, as the underline disease, in patients with ESRF. METHODS: 1,303 [male (M) = 767 and female (F) = 536] patients with ESRF who were on a waiting list for cadaver kidney transplant at Nephrology Unit-University Hospital (HC-UNICAMP), from August/90 to June/93--group 1--and 193 (M = 112 and F = 81) patients admitted for renal replacement therapy in a year period (April/92 to March/93), in the city of Campinas, State of S?o Paulo, Brazil, were studied. RESULTS: The prevalence of DN was 10.1% in group 1 and 17.6% in group 2 (x2 = 7.15; p = 0.007), being the third cause of ESRF in both groups, and it was preceded by glomerulonephritis and arterial hypertension. In group 1 the reduction of number of patients with increase in duration of dialysis was significantly greater in patients with diabetic nephropathy (x2 = 30.9; p < 0.001). Among patients with DN 35 (26%) in group 1 and 6 (18%) in group 2 had less than 35 years when they were admitted for renal replacement therapy and are likely to be type 1 (insulin-dependent) diabetic patients. CONCLUSION: In our studied groups DN was a frequent cause of ESRF.     

Photochemical and photobiological studies with acridine and phenanthridine hydroperoxides in cell-free DNA

The main problem in organ transplantation is the continuing shortage of organ donors. Despite all efforts no major significant increases in organ availability are observed during the year 1996 in the participating Eurotransplant counties, while the demand i.e. the waiting lists are still increasing. Shortage of organs will also have its effects and constraints on the distribution i.e. the allocation of scarce organs. To meet the demand of the renal transplantation programs a special kidney allocation system was designed based upon many simulation studies. Already a few months after implementation of the new system very promising results were observed i.e. the discrepancies between the different countries in terms of kidney procurement and transplantation frequencies disappeared. Furthermore, twice as much long waiting kidney patients have been transplanted as previously and the percentage of well matched HLA donor-recipient combinations remained surprisingly high, nearly 24%.     

The critical care of the severely injured patient--II. Pulmonary and renal support

The management of pulmonary support in trauma patients is a balance of risk versus benefit. Decisions must be based upon the patient's physiologic needs, with constant attention to the potential complications of the therapy. The avoidance of renal failure by volume replacement, careful attention to the use of potentially nephrotoxic agents, and close monitoring of renal function can reduce the incidence and severity of this serious complication of trauma. If renal failure does occur, aggressive renal replacement therapy with either intermittent hemodialysis or CRRT should be tailored to the clinical situation.     

CT angiography of potential renal transplant donors

Renal transplantation has grown rapidly over the past 30 years, resulting in an inadequate supply of organs to meet the ever-increasing demand. This has led to an increase in the number of living-related donors. Advances in imaging technology now allow safe, rapid, and relatively noninvasive evaluation of potential donors. Helical computed tomographic (CT) angiography is a fast, minimally invasive procedure that is quickly becoming the imaging modality of choice for preoperative evaluation of potential renal transplant donors. Helical CT, combined with low-osmolar intravenous contrast materials, has enabled CT angiography to depict arterial and venous anatomy accurately. Between July 1995 and March 1997, CT angiography was performed in 205 potential renal donors. Correlation with surgical findings in 136 donor nephrectomies helped confirm a high level of accuracy for CT angiography in the assessment of the renal vasculature: Sensitivity and specificity for identifying specific vessels was 99.6% and 99.6% for main renal arteries, 76.9% and 89.9% for polar arteries, and 98.7% and 95.5% for main renal veins, respectively. CT angiography allows the radiologist to provide the transplant surgeon with precise preoperative anatomy of the renal vasculature, thus reducing the risks and complications associated with the harvesting procedure and improving the chances for a successful outcome. However, accurate radiologic interpretation depends on the radiologist's experience level, attention to detail, and commitment to careful image evaluation.     

The structure and analysis of neonatal mortality in twins in 1991-1995 at the State University Hospital Maternity Home, Sofia

Until recently, the families of patients who have given the gift of life have been the invisible group in the transplant circle. They donated the organs and tissues of their loved ones to unknown transplant recipients and then were to grieve alone. As transplantation has matured and become the treatment of choice for end stage organ failure and for other life-enhancing procedures, the importance of the donor and the donor family is being recognised and their needs and expectations identified.     

The effect of the photopolymerization method on the quality of composite resin samples

Although heart transplantation is by now considered an established procedure in patients with terminal heart failure, there has been a stagnation or even a decline in the number of transplantations performed due to the decreased willingness of the public to provide organs. As a consequence of this development patients have to wait for a donor organ for a much larger time. The aim of this study was to examine patients especially during this very stressful period. From July 1995 to February 1997, 62 patients who had been continuously added to the waiting list were examined regarding their quality of life and emotional state. Completely assessed were 53 patients (participation rate: 85%). As compared to a healthy control group, patients with terminal heart failure on the waiting list reported their quality of life in the physical as well as the psychological area as significantly lower (p < 0.001). The areas of depression (p < 0.001) and anxiety (p < 0.001) also showed a significant difference. There was an obvious correlation (p < 0.01) between the key symptom of terminal heart failure-- dyspnoea--and the measured level of depression. This served to support the notion that there is a connection between the psychological and the somatic state in these severely ill patients. These results point to the necessity of supportive psychotherapeutic treatment during this very stressful time.     

Prognosis after primary renal transplant failure and the beneficial effects of repeat transplantation: multivariate analyses from the United States Renal Data System

BACKGROUND: Survival of transplant recipients after primary renal allograft failure has not been well studied. METHODS: A cohort of 19,208 renal transplant recipients with primary allograft failure between 1985 and 1995 were followed from the date of allograft loss until death, repeat transplantation, or December 31, 1996. The mortality, wait-listing, and repeat transplantation rates were assessed. The mortality risks associated with repeat transplantation were estimated with a time-dependent survival model. RESULTS: In total, 34.5% (n=6,631) of patients died during follow-up. Of these deaths, 82.9% (n=5,498) occurred in patients not wait-listed for repeat transplantation, 11.9% (n=789) occurred in wait-listed patients, and 5.2% (n=344) occurred in second transplant recipients. Before repeat transplantation, the adjusted 5-year patient survival was 36%, 49%, and 65% for type I diabetes mellitus (DM), type II DM, and nondiabetic end-stage renal disease, respectively (P<0.001; DM vs. nondiabetics). The adjusted 5-year patient survival was lower in Caucasians (57%, P<0.001) compared with African-Americans (67%) and other races (64%). The 5-yr repeat transplantation rate was 29%, 15%, and 19%, whereas the median waiting time for a second transplant was 32, 90, and 81 months for Caucasians, African-Americans, and other races, respectively (P<0.0001 each). Repeat transplantation was associated with 45% and 23% reduction in 5-year mortality for type I DM and nondiabetic end-stage renal disease, respectively, when compared with their wait-listed dialysis counterparts with prior transplant failure. CONCLUSIONS: The loss of a primary renal allograft was associated with significant mortality, especially in recipients with type I DM. Repeat transplantation was associated with a substantial improvement in 5-year patient survival. Recipients with type I DM achieved the greatest proportional benefit from repeat transplantation.     

Acute renal failure--which treatment modality is the best?

Despite the progress in animal research concerning the pathophysiology and the progress in clinical practice regarding the methods of therapy, the incidence and mortality of acute renal failure remain high, especially when other organs are involved. New pharmacological interventions have led to the perspective that in the near future it may be possible to prevent and/or ameliorate this devastating syndrome. Continuous dialysis therapy and the selection of a biocompatible membrane may possibly help the critically ill patient especially when parenteral nutrition and correction of electrolyte and acid-base disturbances are important. Nevertheless, more solid data are needed and one should take into consideration that acute renal failure is a multifactorial syndrome. The type of dialysis itself is not the only matter which has to be evaluated since the mortality rate can be correlated with the number of involved organs before or after the initiation of acute renal failure and with the severity of the original disease. In clinical practice, a large number of prospective studies and more sophisticated statistical methodology are needed in order to evaluate the proper treatment modality.     

Nonassertiveness of Asian Americans: An inaccurate assumption?

Tested the view that Asian Americans are nonassertive and the possibility that they display differential assertiveness depending on situational variables. To determine if race of the individual with whom they are interacting is an influencing variable on assertion in Asian Americans, 51 Chinese-American and 25 Caucasian undergraduate males were randomly assigned to 1 of 2 conditions: role playing a series of 13 situations requiring assertion with an Asian experimenter or role playing the same situations with a Caucasian experimenter. Ss also completed the Social Avoidance and Distress Scale, Fear of Negative Evaluation Questionnaire, and Rathus Assertiveness Schedule. Results indicate that Chinese-Americans were as assertive as Caucasians on all behavioral measures and that the race of experimenter was not an important variable in the performance of Asians. Consistent with previous studies, significant differences on self-report measures were obtained. Chinese-Americans were more likely to report anxiety in social situations, greater apprehension in evaluative situations, and lower assertiveness than Caucasians. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biocompatible dialysis membranes and acute renal failure: a study in post-operative acute tubular necrosis in cadaveric renal transplant recipients

Previous experimental and human data suggests a detrimental effect on the course of acute renal failure related to exposure of blood to artificial dialysis membranes of poor biocompatibility. We performed a 2.5-year prospective randomized trial to compare the clinical course of acute renal failure (post-operative ischemic acute tubular necrosis, ATN) in patients receiving a cadaveric renal transplant requiring supportive hemodialysis in the immediate post-transplant setting. Patients were randomized to either a cuprophane or polymethylmethacrylate (PMMA) conventional hollow fiber dialyzer. All patients received a standard immunosuppressive regimen which included induction therapy with either horse anti-thymocyte gamma globulin (ATGAM) or the murine anti-CD3 monoclonal antibody (OKT3). Of 53 patients randomized, 17 were excluded (2 for intervening biopsy-proven rejection prior to recovery from ATN, 10 for primary graft nonfunction and 5 for other reasons), leaving 36 evaluable cases of uncomplicated ATN, 18 in each group. There was no difference by age, race, gender, cause of ESRD, immunosuppressive regimen, cold or warm ischemia time, use of pre-transplant dialysis, percent oliguria or the incidence of intra-dialytic hypotension between the 2 groups. There was no difference in the mean time to recovery from ATN posttransplant (8.9 days in the cuprophane group vs 9.5 days in the PMMA group, p = NS) or in the average number of hemodialysis treatments required (3.6 in both groups, p = NS). There was also no difference in long term allograft outcome in terms of the nadir serum creatinine, the number of episodes of subsequent acute rejection or in the development of chronic rejection. An intent-to-treat analysis of all 53 originally randomized patients similarly yielded no significant differences. A subsequent, non-randomized study using a membrane of intermediate biocompatibility (Hemophan) also showed no difference in recovery time from ATN. Bioincompatible membranes do not seem to have a significant clinical impact on the course of recovery of this form of acute renal failure. The striking benefits of biocompatibility in the course of ARF seen in other human trials may relate more to the non-renal systemic toxic effects of bioincompatibility.