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Current Era (current + era)
Selected AbstractsA Risk Prediction Model for Delayed Graft Function in the Current Era of Deceased Donor Renal TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2010W. D. Irish Delayed graft function (DGF) impacts short- and long-term outcomes. We present a model for predicting DGF after renal transplantation. A multivariable logistic regression analysis of 24 337 deceased donor renal transplant recipients (2003,2006) was performed. We developed a nomogram, depicting relative contribution of risk factors, and a novel web-based calculator (http://www.transplantcalculator.com/DGF) as an easily accessible tool for predicting DGF. Risk factors in the modern era were compared with their relative impact in an earlier era (1995,1998). Although the impact of many risk factors remained similar over time, weight of immunological factors attenuated, while impact of donor renal function increased by 2-fold. This may reflect advances in immunosuppression and increased utilization of kidneys from expanded criteria donors (ECDs) in the modern era. The most significant factors associated with DGF were cold ischemia time, donor creatinine, body mass index, donation after cardiac death and donor age. In addition to predicting DGF, the model predicted graft failure. A 25,50% probability of DGF was associated with a 50% increased risk of graft failure relative to a DGF risk <25%, whereas a >50% DGF risk was associated with a 2-fold increased risk of graft failure. This tool is useful for predicting DGF and long-term outcomes at the time of transplant. [source] Pulmonary Zygomycosis in Solid Organ Transplant Recipients in the Current EraAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009H.-Y. Sun Fifty-eight solid organ transplant recipients with zygomycosis were studied to assess the presentation, radiographic characteristics, risks for extra-pulmonary dissemination and mortality of pulmonary zygomycosis. Pulmonary zygomycosis was documented in 31 patients (53%) and developed a median of 5.5 months (interquartile range, 2,11 months) posttransplantation. In all, 74.2% (23/31) of the patients had zygomycosis limited to the lungs and 25.8% (8/31) had lung disease as part of disseminated zygomycosis; cutaneous/soft tissue (50%, 4/8) was the most common site of dissemination. Pulmonary disease presented most frequently as consolidation/mass lesions (29.0%), nodules (25.8%) and cavities (22.6%). Patients with disseminated disease were more likely to have Mycocladus corymbifer as the causative pathogen. The mortality rate at 90 days after the treatment was 45.2%. In summary, pulmonary zygomycosis is the most common manifestation in solid organ transplant recipients with zygomycosis, and disseminated disease often involves the cutaneous/soft tissue sites but not the brain. [source] Case-only genome-wide interaction study of disease risk, prognosis and treatmentGENETIC EPIDEMIOLOGY, Issue 1 2010Brandon L. Pierce Abstract Case-control genome-wide association (GWA) studies have facilitated the identification of susceptibility loci for many complex diseases; however, these studies are often not adequately powered to detect gene-environment (G×E) and gene-gene (G×G) interactions. Case-only studies are more efficient than case-control studies for detecting interactions and require no data on control subjects. In this article, we discuss the concept and utility of the case-only genome-wide interaction (COGWI) study, in which common genetic variants, measured genome-wide, are screened for association with environmental exposures or genetic variants of interest. An observed G-E (or G-G) association, as measured by the case-only odds ratio (OR), suggests interaction, but only if the interacting factors are unassociated in the population from which the cases were drawn. The case-only OR is equivalent to the interaction risk ratio. In addition to risk-related interactions, we discuss how the COGWI design can be used to efficiently detect G×G, G×E and pharmacogenetic interactions related to disease outcomes in the context of observational clinical studies or randomized clinical trials. Such studies can be conducted using only data on individuals experiencing an outcome of interest or individuals not experiencing the outcome of interest. Sharing data among GWA and COGWI studies of disease risk and outcome can further enhance efficiency. Sample size requirements for COGWI studies, as compared to case-control GWA studies, are provided. In the current era of genome-wide analyses, the COGWI design is an efficient and straightforward method for detecting G×G, G×E and pharmacogenetic interactions related to disease risk, prognosis and treatment response. Genet. Epidemiol. 34:7,15, 2010. © 2009 Wiley-Liss, Inc. [source] Pharmacological prophylaxis of venous thromboembolism in contemporary radical retropubic prostatectomy: Does concomitant pelvic lymphadenectomy matter?INTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2008Benjamin C Jessie Abstract The prevention of venous thromboembolism is a major concern in cancer patients undergoing pelvic surgery. Radical retropubic prostatectomy is a common treatment for localized prostate cancer and has been identified as a high risk procedure for postoperative venous thromboembolism. However, most patients diagnosed with prostate cancer in the current era have clinically localized, low volume disease and the risk of venous thromboembolism is very low. Multiple guidelines exist for the prevention of venous thromboembolism in patients undergoing radical retropubic prostatectomy and pharmacological venous thromboembolism prophylaxis is recommended. Most urological surgeons in the USA however, do not routinely utilize pharmacological prophylaxis. A major concern arises when radical retropubic prostatectomy is performed with a concomitant pelvic lymphadenectomy. Pharmacological prophylaxis is known to increase the rate of lymph drainage and the rate of lymphocele formation. Evidence suggests that lymphocele may be an independent risk factor for venous thromboembolism in the postoperative period. These factors raise concern over current guidelines calling for routine use of pharmacological venous thromboembolism prophylaxis in radical retropubic prostatectomy especially when lymphadenectomy is performed simultaneously. [source] Our experience with third renal transplantation: Results, surgical techniques and complicationsINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2007Mohammad Hossein Nourbala Background: Despite the popularity of kidney transplantation in the current era, second and third kidney transplantation are not yet widely accepted and practiced. Each center has its own regulations and experiences and there is no accepted protocol for third kidney transplantation. We report here our 15 years of experience with third kidney transplantation. Methods: This is a report of all the third kidney transplantations performed in Baqiyatallah Hospital, Tehran, Iran, between 1991 and 2006. Demographic data, surgical techniques, complications and outcomes are reported. Results: Of the nine third kidney transplant patients, six were male. The median age was 43 years (32,52). All of the patients received kidney from living donors. All operations were performed by a midline incision and the grafts were placed at the midline, in the intraperitoneal space. For arterial anastomosis, we used internal iliac, right common iliac and both the right external iliac and inferior mesenteric artery in 4, 4 and 1 case(s), respectively. For venous anastomosis, we used vena cava, common iliac and external iliac veins in 3, 5 and 1 case(s), respectively. During the follow up period (38 months), 6 grafts (66.6%) were functioning. None of the graft rejections were due to surgical complications. Wound dehiscence occurred in two patients. No other surgical complications including infection, lymphocele or hemorrhage were observed. Conclusion: Third kidney transplantation is a field that has not been fully explored. The rate of complications seems to be not much higher than the first transplantation. Defining a standard protocol seems necessary. [source] Psychodynamic and Neurological Perspectives on ADHD: Exploring Strategies for Defining a PhenomenonJOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR, Issue 4 2001Adam Rafalovich This article is a discourse analysis of two historical inquiries into what clinici-ans today call attention deficit hyperactivity disorder (ADHD). Of primary con-cern in this regard are psychodynamic perspectives towards ADHD symptoms, championed by psychoanalysts and psychologists, and neurological perspectives towards ADHD, which continue to favor a purely physiological approach to understanding the disorder. Those within the psychodynamic camp are inclined to view ADHD as an interactional difficulty between self and social environment - a condition best remedied by psychotherapy. Those within the neurological camp see ADHD as a specific brain process, whose effective treatment depends upon adequate psychopharmacology. This essay argues that both psychodynamic and neurological perspectives towards ADHD have strategized to legitimate one perspective through the expulsion of the other. Within the current era of ADHD nomenclature and treatment it is clear that neurological perspectives dominate the debate. However, neurological perspectives continue to be haunted by a considerable amount of skepticism, both nationally and internationally. Because of this it would be difficult to assert that neurological perspectives, though winning the "legitimation race" in contemporary understandings of ADHD, are entirely monolithic sources of ADHD knowledge. [source] Safety and Efficacy of Arterial Switch Operation in Previously Inoperable PatientsJOURNAL OF CARDIAC SURGERY, Issue 4 2010Liu Ying-long M.D. This study aimed to evaluate the safety and efficacy of ASO in these selected subset patients. Methods: The records of 86 patients older than six months with complete transposition of the great arteries and ventricular septal defect or Taussig-Bing anomaly and severe PAH who underwent ASO at our institution from May 2000 to October 2008 were reviewed retrospectively. Eighty survivors were followed-up. Results: There were six hospital deaths (7.0%, 95% confidence limit 1.6 to 12.4%). From January 2006 to October 2008, 46 consecutive ASOs were performed with no death. Operative mortality and mobility decreased significantly (p = 0.008 and p = 0.046, respectively). The median duration of follow-up was 42.1 ± 28.8 months (range, 2.0 to 99.5). Two late deaths occurred. Latest follow-up data showed that 2.8% of survivors were in New York Heart Association (NYHA) class II and 97.2% were in NYHA class I. Conclusions: Excellent early and mid-term results of ASO are obtained from patients older than six months with complete transposition of the great arteries and ventricular septal defect or Taussig-Bing anomaly and severe PAH in current era, and ASO is safe and effective in these selected subset patients. (J Card Surg 2010;25:400-405) [source] Analysis of recent pediatric orthotopic liver transplantation outcomes indicates that allograft type is no longer a predictor of survivals,LIVER TRANSPLANTATION, Issue 8 2008Natasha S. Becker Two strategies to increase the donor allograft pool for pediatric orthotopic liver transplantation (OLT) are deceased donor segmental liver transplantation (DDSLT) and living donor liver transplantation (LDLT). The purpose of this study is to evaluate outcomes after use of these alternative allograft types. Data on all OLT recipients between February 2002 and December 2004 less than 12 years of age were obtained from the United Network for Organ Sharing database. The impact of allograft type on posttransplant survivals was assessed. The number of recipients was 1260. Of these, 52% underwent whole liver transplantation (WLT), 33% underwent DDSLT, and 15% underwent LDLT. There was no difference in retransplantation rates. Immediate posttransplant survivals differed, with WLT patients having improved 30-day patient survivals compared to DDSLT and LDLT patients (P = 0.004). Although unadjusted 1-year patient survivals were better for WLT versus DDSLT (P = 0.01), after risk adjustment, 1-year patient survivals for WLT (94%), DDSLT (91%), and LDLT (93%) were similar (P values > 0.05). Unadjusted allograft survivals were better for WLT and LDLT in comparison with DDSLT (P = 0.009 and 0.018, respectively); however, after adjustment, these differences became nonsignificant (all P values > 0.05). For patients , 2 years of age (n = 833), the adjusted 1-year patient and allograft survivals were also similar (all P values > 0.05). In conclusion, in the current era of pediatric liver transplantation, WLT recipients have better immediate postoperative survivals. By 1 year, adjusted patient and allograft survivals are similar, regardless of the allograft type. Liver Transpl 14:1125,1132, 2008. © 2008 AASLD. [source] Left ventricular dysfunction: A hidden risk in patients undergoing liver transplantationLIVER TRANSPLANTATION, Issue 1 2007James D. Perkins M.D. Special Editor With improved survival after liver transplantation (LT), the referral of older candidates has increased. The increasing demand for, and the decreased supply of, liver donors makes careful preoperative cardiac risk assessment imperative. There is a paucity of information regarding the cardiac characteristics of patients being referred for LT in the current era. This study aimed to describe the cardiac hemodynamic and coronary angiographic characteristics of a cohort of patients with end-stage liver disease without known coronary artery disease (CAD) being evaluated for LT. One hundred sixty-one consecutive patients aged ,45 years with end-stage liver disease who were referred for right- and left-sided cardiac catheterization as part of a liver transplant evaluation were identified. There was a high prevalence of atherosclerotic risk factors; half had hypertension or diabetes, and more than half had ,2 coronary risk factors other than age. There was a high prevalence of CAD, with 26% having unknown moderate to severe coronary narrowing. Patients with moderate to severe CAD were older, were more likely to be men, and were more likely to have hypertension or diabetes mellitus. Right- and left-sided filling pressures were elevated, suggesting abnormalities in left ventricular diastolic compliance. In conclusion, this study showed a high prevalence of coronary risk factors and unknown moderate to severe CAD in patients with end-stage liver disease being referred for LT. [source] AASLD/ILTS transplant course: Is there an extended donor suitable for everyone?LIVER TRANSPLANTATION, Issue S2 2005Andrew Cameron Key Points 1The clinical success of liver transplantation coupled with the current era of organ shortage has caused many centers to expand their criteria for acceptable donors. 2The definition of "Extended Criteria Donor" (ECD) is becoming better understood and quantified. 3Recipient factors that portend poor outcome must be recognized and factored in as well. Grafts and recipients must be "matched" to manage and minimize the risk from ECDs. 4Maintaining acceptable outcomes as ECD concepts evolve is paramount. 5Absolute risk factors for poor graft function still exist and must be respected, but relative risk factors are now well identified, quantified, accepted, and managed as an alternative to high waiting list mortality. (Liver Transpl 2005;11:S2,S5.) [source] Review Article: Probiotics for allergic diseases: Realities and mythsPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 6 2010Tsung-Chieh Yao Yao T-C, Chang C-J, Hsu Y-H, Huang J-L. Probiotics for allergic diseases: Realities and myths. Pediatr Allergy Immunol 2010: 21: 900,919. © 2009 John Wiley & Sons A/S The prevalence of allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis has increased sharply over the past two to three decades in many countries, and allergies are now the most common chronic disease among children throughout the world. In the past few years, probiotics have been advocated for the management of allergic diseases in many parts of the world. Physicians have a responsibility to ensure the efficacy and safety of any products they prescribe or recommend. This article provides a comprehensive overview and a critical interpretation of currently available evidence regarding the role of probiotics in the prevention and treatment of allergic diseases in humans and also discusses several major myths and potential risks associated with the use of probiotics. In the current era of evidence-based medicine, there is still insufficient evidence to recommend probiotics for the prevention of allergic diseases or as part of standard management for any allergic conditions in children. [source] Recent Trends in Early Outcome of Adult Patients after Heart Transplantation: A Single-institution Review of 251 Transplants Using Standard Donor Organs,AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2002Feng-Chun Tsai Older age, prior transplantation, pulmonary hypertension, and mechanical support are commonly seen in current potential cardiac transplant recipients. Transplants in 436 consecutive adult patients from 1994 to 1999 were reviewed. There were 251 using standard donors in 243 patients (age range 18,69 years). To emphasize recipient risk, 185 patients who received a nonstandard donor were excluded from analysis. The indications for transplant were ischemic heart disease (n = 123, 47%), dilated cardiomyopathy (n = 82, 32%), and others (n = 56, 21%). One hundred and forty-nine (57%) recipients were listed as status I; 5 and 6% were supported with an intra-aortic balloon and an assist device, respectively. The 30-d survival and survival to discharge were 94.7 and 92.7%, respectively; 1-year survival was 89.1%. Causes of early death were graft failure (n = 6), infection (n = 4), stroke (n = 4), multiorgan failure (n = 3) and rejection (n = 2). Predictors were balloon pump use alone (OR = 11.4, p =,0.002), pulmonary vascular resistance > 4 Wood units (OR = 5.7, p =,0.007), pretransplant creatinine > 2.0 mg/dL (OR = 6.9, p =,0.004) and female donor (OR = 8.3, p =,0.002). Recipient age and previous surgery did not affect short-term survival. Heart transplantation in the current era consistently offers excellent early and 1-year survival for well-selected recipients receiving standard donors. Early mortality tends to reflect graft failure while hospital mortality may be more indicative of recipient selection. [source] Toward a Framework for Achieving a Sustainable GlobalizationBUSINESS AND SOCIETY REVIEW, Issue 3 2010JOHN F. PREBLE ABSTRACT Widespread trade liberalization and economic integration characterize the current era of globalization. While this approach has resulted in significant job creation, improved living standards, and a wider variety of cheaper consumer goods and services, opponents question if globalization's benefits outweigh the dislocations and downsides that it causes. Protestors are intent on stalling or rolling back globalization's progression and our review of the history of globalization reveals that a backlash is not without precedent. The article carefully examines the myth and reality of these two opposing positions on four key areas of the globalization debate: jobs; inequality and poverty; national sovereignty and cultural diversity; and the natural environment. This information is then utilized to derive a broad set of feasible policy recommendations that could help bring about a more sustainable form of globalization. [source] The NDP Regime in British Columbia, 1991,2001: A Post-Mortem*CANADIAN REVIEW OF SOCIOLOGY/REVUE CANADIENNE DE SOCIOLOGIE, Issue 2 2005WILLIAM K. CARROLL Cette étude porte sur les relations entre la social-démocratie, les mouvements sociaux et l'État au cours d'une période de dix ans dans la province de Colombie-Britannique, au Canada. À l'aide d'une analyse de textes d'interviews en profondeur de représentants de l'État de six ministères importants et de membres du Nouveau Parti démocratique de l'Assemblée législative, les auteurs examinent de façon approfondie les difficultés rencontrées par le régime social-démocrate. Celui-ci tente de remplir un mandat de réforme sociale en partie inspirée par les programmes de militants de mouvements sociaux, mais il est également limité par les contraintes imposées par la mondialisation économique et par les politiques budgétaires néolibérales. En étudiant les dilemmes et les obstacles structurels, les auteurs tentent de clarifier les profonds défis auxquels sont confrontés les mouvements sociaux à l'époque actuelle. This study focuses on the relationship between social democracy, social movements and the state over a ten-year period in the province of British Columbia, Canada. Through textual analysis of in-depth interviews with state officials from six key ministries and New Democratic Party members of the Legislative Assembly, we probe the difficulties faced by a social democratic regime attempting to carry out a mandate for social reform partly driven by the agendas of social movements supporters but also bounded by the constraints imposed by economic globalization and neo-liberal fiscal policies. In examining the dilemmas and structural obstacles, our study clarifies the profound challenges confronting social movements in the current era. [source] | ||||||||||