Predictors of atherosclerotic events in patients on haemodialysis: post hoc analyses from the AURORA Study

Background: Patients on haemodialysis (HD) are at high risk for cardiovascular events, but heart failure and sudden death are more common than atherosclerotic events. The A Study to Evaluate the Use of Rosuvastatinin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events (AURORA) trial was designed to assess the effect of rosuvastatin on myocardial infarction and death from any cardiac cause in 2773 HD patients. We studied predictors of the atherosclerotic cardiovascular events in AURORA. Methods: We readjudicated all deaths and presumed myocardial infarctions according to the criteria used in the Study of Heart and Renal Protection (SHARP); these were specifically developed to separate atherosclerotic from non-atherosclerotic cardiovascular events. The readjudicated atherosclerotic end point included the first event of the following: non-fatal myocardial infarction, fatal coronary heart disease, non-fatal and fatal non-haemorrhagic stroke, coronary revascularization procedures and death from ischaemic limb disease. Stepwise Cox regression analysis was used to identify the predictors of such events. Results: During a mean follow-up of 3.2 years, 506 patients experienced the new composite atherosclerotic outcome. Age, male sex, prevalent diabetes, prior cardiovascular disease, weekly dialysis duration, baseline albumin [hazard ratio (HR) 0.96; 95% confidence interval (CI) 0.94–0.99 per g/L increase], high-sensitivity C-reactive protein (HR 1.13; 95% CI 1.04–1.22 per mg/L increase) and oxidized low-density lipoprotein (LDL) cholesterol (HR 1.09; 95% CI 1.03–1.17 per 10 U/L increase) were selected as significant predictors in the model. Neither LDL cholesterol nor allocation to placebo/rosuvastatin therapy predicted the outcome. Conclusions: Even with the use of strict criteria for end point definition, non-traditional risk factors, but not lipid disturbances, predicted atherosclerotic events in HD patients

Doctor can I buy a new kidney? I've heard it isn't forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney?

Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments. In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient (and, with several caveats, of the donor) may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of “reverse” informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles (beneficence, non-maleficence, justice and autonomy) to the donor and recipient parties

Avlsprogrammet for fjellrev – Årsrapport 2020

Ulvund, K., Miller, A.L., Meås, R., Mjøen, T., Rød-Eriksen, L., Flagstad, Ø., Eide, N.E., Landa, A. & Jackson C.R. 2021. Avlsprogrammet for fjellrev – Årsrapport 2020. NINA Rapport 1964. Norsk institutt for naturforskning. Avlsprogrammet for fjellrev ble opprettet i nåværende form i 2005 som et tiltaksbasert FoU-prosjekt på oppdrag fra Miljødirektoratet, for å bidra til bevaring av den kritisk utrydningstruede fjellreven i Norge. Programmet drifter avlsstasjonen på Sæterfjellet (Oppdal), med åtte store hegn i et naturlig fjellrevhabitat. Minst mulig håndtering av avlsdyrene og maksimering av trivsel er vektlagt. Programmet ble bygd på viltfangede valper med en geografisk spredning som speilet den genetiske variasjonen som var igjen i Norge og Sverige. Siden oppstarten er det hentet inn 32 viltfødte valper som avlsdyr til avlsstasjonen. I tillegg har 31 valper født i stasjonen gått inn i avl. Rekruttering av viltfødte valper er viktig for å opprettholde avlslinjene i stasjonen og av hensyn til å unngå negative effekter av avl i fangenskap. I 2020 ble to viltfødte valper fra Snøhetta-området rekruttert som nye avlsdyr. Minst 25 valper ble født på avlsstasjonen i 2020. Tap av et helt kull, bestående av syv valper, og ytterligere dødelighet i andre innhengninger reduserte årets produksjon til 14 valper. To valper ble rekruttert til avlsdyr, og 12 fjellrever ble satt ut i Reisa sør (Troms og Finnmark) i februar 2021. Siden 2006 har avlsprogrammet satt ut totalt 434 fjellrevvalper i ni forskjellige fjellområder i Norge. Programmet har lyktes med å både gjenopprette utdødde bestander og styrke andre delbestander. I løpet av 2020 ble det registrert minst 43 fjellrevkull i Norge og halvparten av disse ble registrert i områder hvor arten har blitt reetablert etter lokal utrydding. For å kunne måle etableringssuksess og reproduksjon hos fjellrever som settes ut har Avlsprogrammet årlig merket valper på hi i utvalgte fjellområder. Valpene blir merket med mikrochip og det tas en vevsprøve for DNA-analyse. I 2020 ble totalt 55 valper fanget og merket. Bruk av chiplesere i fôrautomatene gir gjennfangst av merka individene, som har gitt verdifull informasjon om overlevelse, reproduksjonssuksess og etablering, samt fjellrevens bruk av fôrautomater. En gjennomgang av metodene som bidrar til gjenfangst av individer viser at vi får langt mer igjen for systematisk innsamling av DNA-prøver gjennom det nasjonale overvåkingsprogrammet for fjellrev enn vi får gjennom chiplesere. Vær, vind og mørketid utfordrer også funksjonaliteten til de tekniske anleggene, og derigjennom behovet for tilsyn. I tillegg innebærer merkingen av valper en viss risiko og forstyrrelse av fjellrevene. Nye DNA-analysemetoder gir dessuten helt andre muligheter for å kartlegge slektskap og overlevelse, som styrker mulighetene til å følge individene uten å merke dem i felt. Som en konsekvens av dette vil vi fra nå av basere oss på den DNA-kartleggingen som gjøres gjennom overvåkingsprogrammet for fjellrev. Vi vil i tillegg bruke viltkamera til å kartlegge faktiske kullstørrelser i et utvalg av utsettingsområdene. Du kan følge fjellrevene i et av hegnene via «live streaming». Lenke til videostrømming er: http://www.nina.no/Forskning/Fjellrev/Avlsprogrammet-for-fjellre

Long-term risks after kidney donation : how do we inform potential donors? A survey from DESCARTES and EKITA transplantation working groups

Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA.BACKGROUND: Publications from the last decade have increased knowledge regarding long-term risks after kidney donation. We wanted to perform a survey to assess how transplant professionals in Europe inform potential kidney donors regarding long-term risks. The objectives of the survey were to determine how they inform donors and to what extent, and to evaluate the degree of variation. METHODS: All transplant professionals involved in the evaluation process were considered eligible, regardless of the type of profession. The survey was dispatched as a link to a web-based survey. The subjects included questions on demographics, the information policy of the respondent and the use of risk calculators, including the difference of relative and absolute risks and how the respondents themselves understood these risks. RESULTS: The main finding was a large variation in how often different long-term risks were discussed with the potential donors, i.e. from always to never. Eighty percent of respondents stated that they always discuss the risk of end-stage renal disease, while 56% of respondents stated that they always discuss the risk of preeclampsia. Twenty percent of respondents answered correctly regarding the relationship between absolute and relative risks for rare outcomes. CONCLUSIONS: The use of written information and checklists should be encouraged. This may improve standardization regarding the information provided to potential living kidney donors in Europe. There is a need for information and education among European transplant professionals regarding long-term risks after kidney donation and how to interpret and present these risks.Peer reviewe

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration

Objective The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study. Study Design Demographic and injury data were recorded for each patient who was a victim of an assault. Results Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures. Conclusions Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study

European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries

European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study

Objective The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year. Study Design The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years. Results The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures. Conclusions Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site

European Maxillofacial Trauma (EURMAT) project: A multicentre and prospective study

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres.The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture.The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents.The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved