Prospective Assessment of the Prevalence of Enter Hyperoxalosis in Kidney Transplant Candidates.

Enteric hyperoxalosis (EH) is an emerging cause of kidney transplantation (KT) dysfunction. We sought to determine the prevalence of EH and factors that affect plasma oxalate (POx) among at-risk KT candidates. Methods: We prospectively measured POx among KT candidates evaluated at our center from 2017 to 2020 with risk factors for EH namely bariatric surgery, inflammatory bowel disease, or cystic fibrosis. EH was defined by a POx ≥10 µmol/L. Period-prevalence of EH was calculated. We compared mean POx across 5 factors: underlying condition, chronic kidney disease (CKD) stage, dialysis modality, phosphate binder type, and body mass index. Results: Of 40 KT candidates screened, 23 had EH for a 4-y period prevalence of 58%. Mean POx was 21.6 ± 23.5 µmol/L ranging from 0 to 109.6 µmol/L. 40% of screened had POx >20 µmol/L. Sleeve gastrectomy was the most common underlying condition associated with EH. Mean POx did not differ by underlying condition (P = 0.27), CKD stage (P = 0.17), dialysis modality (P = 0.68), phosphate binder (P = 0.58), and body mass index (P = 0.56). Conclusions: Bariatric surgery and inflammatory bowel disease were associated with a high prevalence of EH among KT candidates. Contrary to prior studies, sleeve gastrectomy was also associated with hyperoxalosis in advanced CKD. POx concentrations observed in EH reached levels associated with tissue and potentially allograft deposition. Concentrations can be as high as that seen in primary hyperoxaluria. More studies are needed to assess if POx is indeed a modifiable factor affecting allograft function in patients with EH.

Clinician Perspectives on the Assessment of Short-Term Memory in Aphasia.

BACKGROUND: Verbal short-term memory (STM) and the related ability, working memory (WM), are widely understood to be integral components of language production and comprehension. However, assessment of these abilities in people with aphasia is hampered by a lack of valid, standardized measures that are clinically appropriate. Focusing primarily on verbal STM, we held a series of five focus groups with speech-language pathologists (SLPs) to understand better their current clinical practices and their beliefs and attitudes regarding assessment of verbal STM in aphasia. AIMS: The purpose of this study was to explore the attitudes, beliefs and preferences of clinical SLPs to determine: (1) current practices related to verbal STM assessment; (2) the extent to which practices reflect current theories of aphasia and the role of verbal STM in language processing; and (3) practical considerations regarding aphasia assessment in clinical practice. METHODS & PROCEDURES: Five focus groups were conducted using a semi-structured interview protocol with a total of 44 SLPs. Grounded theory methodology was used to collect, code and analyse the data. Codes were reviewed to identify emerging themes. Themes were compared to explore meta-themes, connections and potential theoretical frameworks. OUTCOMES & RESULTS: Five main themes were identified: (1) The theoretical understanding that clinical SLPs have regarding the role of verbal STM in aphasia is not always consistent with clinical practice; (2) Clinical SLPs highly value functionally relevant assessments; (3) The intense time constraints in clinical practice affect all aspects of assessment; (4) Clinical SLPs feel that there is a lack of appropriate tests for assessment of STM in aphasia; and (5) Clinical SLPs prefer tests that are comprehensive, easy to administer and psychometrically sound. CONCLUSIONS: Clinical SLPs report a lack of standardized measures to assess STM in individuals with aphasia. Researchers are met with several challenges in the development of these tests including effective communication with clinicians regarding the benefit of verbal STM assessments, especially as it relates to functional skills, and the creation of a test that is comprehensive yet simple, quick and easy to administer.

Identifying Verbal Short-Term Memory and Working Memory Impairments in Individuals With Latent Aphasia.

Purpose This study was undertaken to explore whether measures of verbal short-term memory and working memory are sensitive to impairments in people with latent aphasia, who score within normal limits on typical aphasia test batteries. Method Seven individuals with latent aphasia and 24 neurotypical control participants completed 40 tasks from the Temple Assessment of Language and Short-term Memory in Aphasia (TALSA) that assess various aspects of verbal short-term memory, working memory, and language processing. Subtests were identified that differentiated between the two groups of participants. Results Twenty-one TALSA tasks were identified on which the participants with latent aphasia had significantly different performance than the typical control participants. All of these subtests engaged verbal short-term memory, and some involved working memory as well. Furthermore, the TALSA detected individual differences in linguistic profiles among participants with latent aphasia. Conclusions People with latent aphasia may be identified by tests that tap verbal short-term memory and working memory. In addition, the TALSA was found to be sensitive to the heterogeneity of this population. Further development of these measures will improve identification and treatment of this challenging population.