Validation of a survival benefit estimator tool in a cohort of European kidney transplant recipients.

Pre-transplant prognostic scores help to optimize donor/recipient allocation and to minimize organ discard rates. Since most of these scores come from the US, direct application in non-US populations is not advisable. The Survival Benefit Estimator (SBE), built upon the Estimated Post-Transplant Survival (EPTS) and the Kidney Donor Profile Index (KDPI), has not been externally validated. We aimed to examine SBE in a cohort of Spanish kidney transplant recipients. We designed a retrospective cohort-based study of deceased-donor kidney transplants carried out in two different Spanish hospitals. Unadjusted and adjusted Cox models were applied for patient survival. Predictive models were compared using Harrell's C statistics. SBE, EPTS and KDPI were independently associated with patient survival (p ≤ 0.01 in all models). Model discrimination measured with Harrell's C statistics ranged from 0.57 (KDPI) to 0.69 (SBE) and 0.71 (EPTS). After adjustment, SBE presented similar calibration and discrimination power to that of EPTS. SBE tended to underestimate actual survival, mainly among high EPTS recipients/high KDPI donors. SBE performed acceptably well at discriminating post-transplant survival in a cohort of Spanish deceased-donor kidney transplant recipients, although its use as the main allocation guide, especially for high KDPI donors or high EPTS recipients requires further testing.

What binds us? Inter-brain neural synchronization and its implications for theories of human consciousness.

The association between neural oscillations and functional integration is widely recognized in the study of human cognition. Large-scale synchronization of neural activity has also been proposed as the neural basis of consciousness. Intriguingly, a growing number of studies in social cognitive neuroscience reveal that phase synchronization similarly appears across brains during meaningful social interaction. Moreover, this inter-brain synchronization has been associated with subjective reports of social connectedness, engagement, and cooperativeness, as well as experiences of social cohesion and 'self-other merging'. These findings challenge the standard view of human consciousness as essentially first-person singular and private. We therefore revisit the recent controversy over the possibility of extended consciousness and argue that evidence of inter-brain synchronization in the fastest frequency bands overcomes the hitherto most convincing sceptical position. If this proposal is on the right track, our understanding of human consciousness would be profoundly transformed, and we propose a method to test this proposal experimentally.

Role of the Furosemide Stress Test in Renal Injury Prognosis.

Risk stratification and accurate patient prognosis are pending issues in the management of patients with kidney disease. The furosemide stress test (FST) has been proposed as a low-cost, fast, safe, and easy-to-perform test to assess tubular integrity, especially when compared to novel plasma and urinary biomarkers. However, the findings regarding its clinical use published so far provide insufficient evidence to recommend the generalized application of the test in daily clinical routine. Dosage, timing, and clinical outcomes of the FST proposed thus far have been significantly different, which further accentuates the need for standardization in the application of the test in order to facilitate the comparison of results between series. This review will summarize published research regarding the usefulness of the FST in different settings, providing the reader some insights about the possible implications of FST in clinical decision-making in patients with kidney disease and the challenges that research will have to address in the near future before widely applying the FST.

Hypoglycemia following intravenous insulin plus glucose for hyperkalemia in patients with impaired renal function.

BACKGROUND: Hypoglycemia is a serious complication following the administration of insulin for hyperkalemia. We determined the incidence of hypoglycemia and severe hypoglycemia (blood glucose <70 or ≤40 mg/dl, respectively) in a cohort of AKI and non-dialysis dependent CKD patients who received an intravenous infusion of insulin plus glucose to treat hyperkalemia. METHODS: We retrospectively reviewed charts of all AKI and non-dialysis dependent CKD patients who received 10 U of insulin plus 50 g glucose to treat hyperkalemia from December 1, 2013 to May 31, 2015 at our Department. RESULTS: One hundred sixty four episodes of hyperkalemia were treated with insulin plus glucose and were eligible for analysis. Serum potassium levels dropped by 1.18 ± 1.01 mmol/l. Eleven treatments (6.1%) resulted in hypoglycemia and two (1.2%) in severe hypoglycemia. A lower pretreatment blood glucose tended to associate with a higher subsequent risk of hypoglycemia. Age, sex, renal function, an established diagnosis of diabetes or previous treatment were not associated with the development of this complication. We did not register any significant adverse events. CONCLUSION: Our intravenous regimen combining an infusion of insulin plus glucose effectively reduced serum potassium levels compared to previous studies and associated a low risk of symptomatic hypoglycemia and other complications.

Effects of men and recipients' age on the reproductive outcome of an oocyte donation program.

PURPOSE: The objective of this study was to evaluate the effect of men and recipient age on the reproductive outcome of our oocyte donation program. METHODS: We retrospectively analyzed 915 cycles, taking into account men and recipient age, separately and together. RESULTS: The significant cut off value for men and recipients age with incidence in the reproductive outcome was 39 years. Recipient older than 38 years presented a significantly lower pregnancy and implantation rates than others (44.92 vs. 55.75 +/- 1.53%, 25.66 vs. 32.79 +/- 1.64%). If men age was older than 38, a significant reduction in pregnancy and implantation rates was observed, too (46.0 vs. 54.65%, 26.00 +/- 1.52 vs. 32.43 +/- 1.65%). When men and recipient age was analyzed together, a reduction in pregnancy and implantation was detected only if both were older than 38. CONCLUSIONS: Present study suggests that age has a detrimental effect on the reproductive outcome of oocyte donation cycles when both men and recipient are > or = 39 years old.