Background
Coronary artery calcification (CAC) and Metabolic Syndrome (MS) have been associated with increased cardiovascular risk. The study objective was to examine the association of MS with CAC presence and progression in renal transplant recipients.
Methods
We measured CAC progression in asymptomatic recipients who had no prior history of coronary artery disease.
Results
MS was common (55.4%). Median CAC scores were 0, 33.1, 98, and 261.9 for patients with 1, 2, 3, and 4 or more positive components of the MS, respectively. Severe CAC scores were more common in recipients with MS (p=0.04). Although recipients with MS had higher mean CAC scores at baseline and significant CAC progression [483 (590.6) vs. 619(813.8), p=0.01 ], MS was not an independent predictor of annualized rate of CAC change in a multivariate model
Conclusion
Future studies to evaluate if MS treatment improves cardiovascular outcomes are imperative.
Following primary hindlimb amputations dividing the lower femur or the central tibiofibula, the neonatal rat innately regenerates the distal growth plate(s) with a frequency of about 20-30%. One or two reamputation procedures were performed in an effort to increase the frequency of physeal regeneration, noting that such procedures, and related forms of tissue stimulation, have been repeatedly shown to induce regenerative growth at limb amputation sites of some amphibians that display little innate regenerative capacity. The present reamputation sequences divided the skeletal stump through the cartilaginous mass arising at its distal end. Following first reamputation an approximate three fold increase in the frequency of growth plate cartilage regeneration was observed at transfemoral and transtibiofibular sites. Only after second reamputation, however, did tibiofibular physeal cartilage regeneration equal in frequency that observed after first reamputation through the lower femur. Ectopic growth plate cell architecture was identified in cartilaginous extensions arising from the side of the distal femoral shaft, and also within the regrown secondary cartilage body, which unites the lower tibia and fibula in the shank of the rat. Moreover, among 3 of 11 femoral amputees that had sustained reamputations, regrowth of the distal femoral condylar mass and profile were achieved to varying degrees. It is concluded that a regimen of reamputation, known to induce regenerative growth in the amphibian limb, also induces skeletal regneration in the mammalian limb, and lead to the appearance of ectopic growth plate cell architecture at adjacent sites.
We have undertaken a prospective study to examine the effect of recombinant human erythropoietin (rHuEpo) therapy during dialysis on Epo levels after renal transplantation and to evaluate the impact of this therapy on the immediate graft function. Between December 1991 and December 1993, 91 renal transplant recipients were studied. There were 34 females and 57 males and the mean age was 38 years. Forty-two patients were treated during dialysis with rHuEpo due to anemia and 49 patients did not receive it. Endogenous Epo (eEpo), hemoglobin concentration, hematocrit level and serum creatinine were determined on days 0, 2, 4, 8, 15, 30, 60 and 180 after transplantation. Ferritin level was determined pretransplant and on day 60. Results: Patients not treated with rHuEpo during dialysis experienced a transient increase in endogenous Epo after renal transplant that was not observed in treated patients (26 ± 3.3 vs. 9 ± 1.5 mU/ml, p < 0.001). The eEpo peak was similar in patients with early or delayed graft function (23 ± 4.3 vs. 32 ± 5.4 mU/ml, NS). The recovery of the anemia after a successful renal transplant took place in patients treated as well as those not treated with rHuEpo without significant differences. In the treated group, the pretransplant hematocrit level was similar in patients with early or delayed graft function (31 ± 3.5%vs. 32 ± 4.8%), but in the untreated group, the hematocrit level was lower in patients with early renal function (28.5 ± 4% vs. 32 ± 3%, p < 0.05). However, these patients also had a significantly shorter warm ischemia time (53 ± 13.8 vs. 64 ± 14.5 min). Fifty-two percent of the rHuEpo-treated patients and 36% of the untreated patients had delayed graft function. In conclusion, different courses of eEpo levels after renal transplant were observed depending on whether or not patients had been treated with rHuEpo during dialysis. Untreated patients experienced a transient increase which was not observed in the treated group. Immediate or delayed graft function did not modify eEpo levels. No association was found between rHuEpo therapy during dialysis and delayed graft function.
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