Coughlinhenson7075

In addition to the PFP, many other metrics are currently used to assess pre- and post-KT vulnerability in research and clinical practice, underscoring the need for a disease-specific frailty metric that can be used to monitor KT candidates and recipients. Although frailty is an independent risk factor for post-transplant adverse outcomes, it is not factored into the current transplant program risk-adjustment equations. Future studies are needed to explore pre- and post-KT interventions to improve or prevent frailty. © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.BACKGROUND AND AIMS There is no consensus on the best management of the rectum after subtotal colectomy for refractory colitis complicating inflammatory bowel disease (IBD).The objective was to evaluate the impact of rectal stump management during laparoscopic subtotal colectomy (LSTC) for IBD. METHODS Patients who underwent LSTC with double-end ileo-sigmoidostomy (Gr.A) or end ileostomy with closed rectal stump (Gr.B) for IBD were included from a retrospective database of 6 European referral centres. RESULTS 314 patients underwent LSTC and were allocated into Gr.A (n=102) and B (n=212). After LSTC, stoma-related complications occurred more frequently in Gr.A (12%) than Gr.B (4%, p=0.01). CB1954 mw Completion proctectomy with ileal pouch-anal anastomosis (IPAA) was performed as a 3-stage procedure in all patients from Gr.A, and in 88 patients from Gr.B (42%; Gr.B1). The other 124 patients from Gr.B underwent a modified-2 stage procedure (58%; Gr.B2). The second stage was performed laparoscopically in all patients from Gr.A compared with 73% of Gr.B1 (p less then 0.0001) and 65% of Gr.B2 patients (p less then 0.0001). When laparoscopy was intended for 2nd stage IPAA, conversion to laparotomy occurred less frequently in Gr.A when compared with B1 (0 vs 5%, p=0.06) or B2 (10%, p=0.001). When all surgical stages were included (LSCT and IPAA), cumulative stoma-related complications occurred more frequently in Gr.A (n=19) than Gr.B1 (n=6, p=0.02) and Gr.B2 (n=6, p=0.001). CONCLUSION This study suggests that both techniques of double-end ileosigmoidostomy and end ileostomy with closed rectal stump are safe and effective for rectal stump management after laparoscopic subtotal colectomy. © The Author(s) 2020. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email journals.permissions@oup.com.BACKGROUND Few studies have investigated the association of magnesium levels with incident peripheral artery disease (PAD) despite emerging evidence of magnesium contributing to vascular calcification. Moreover, no data are available on whether the magnesium-PAD relationship is independent of or modified by kidney function. METHODS A cohort of 11 839 participants free of PAD in the Atherosclerosis Risk in Communities Study at Visit 2 (1990-92) was studied. We investigated the association of serum magnesium and other bone-mineral metabolism markers [calcium, phosphorus, intact parathyroid hormone (iPTH) and intact fibroblast growth factor-23] with incident PAD using multivariable Cox proportional hazards regression. RESULTS Over a median of 23 years, there were 471 cases of incident PAD. The hazard ratio for incident PAD in Quartile 1 (65 pg/mL was significantly related to PAD only in those with eGFR less then 60 mL/min/1.73 m2. CONCLUSIONS Lower magnesium was independently associated with incident PAD, but this association was significantly weaker in those with reduced kidney function. In contrast, higher iPTH levels were particularly related to PAD risk in this clinical population. © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.BACKGROUND AND AIMS Poor inflammatory bowel disease (IBD) pregnancy knowledge underlies unwarranted voluntary childlessness (VC), risks poorer obstetric outcomes and adverse foetal outcomes. IBD is increasing worldwide but education on IBD issues might be heterogeneous based on cultural differences and variations in models of care. METHODS Consecutive female IBD subjects aged 18-45 years were prospectively recruited from two dedicated IBD-pregnancy clinics, two multidisciplinary IBD clinics and nine general gastroenterology clinics. Subjects completed the validated CCPKnow (score 0-17) with questions on demographics, medical history and pregnancy knowledge. The primary outcome was knowledge per clinic-type and per-geographical region. RESULTS Surveys were completed by 717 subjects from thirteen hospitals across ten countries. Dedicated IBD-pregnancy clinics had the highest knowledge, followed by multidisciplinary IBD clinics then general IBD clinics (median CCPKnow 10.0 [IQR8.0-11.0], 8.0 [IQR5.0-10.5], 4.0 [IQR2.0-6.0]; P less then 0.001). The median CCPKnow in Western, Asian and Middle Eastern clinics were 9.0, 5.0, 3.0 respectively (P less then 0.001). Dedicated IBD-pregnancy clinics, IBD support organisation membership, childbearing after IBD diagnosis and employment independently predicted greater knowledge. Patient perception of disease severity (r=-0.18, P less then 0.01) and consideration of VC (r=-0.89, P=0.031) negatively correlated with CCPKnow score. CONCLUSIONS In this large international study we identified predictors of pregnancy-specific IBD knowledge. Dedicated IBD-pregnancy clinics had the greatest IBD-related pregnancy knowledge and lowest VC rates, reflecting the benefits of pre-conception counselling. © The Author(s) 2020. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email journals.permissions@oup.com.Importance Osteosarcoma, the most common malignant bone tumor in children and adolescents, occurs in a high number of cancer predisposition syndromes that are defined by highly penetrant germline mutations. The germline genetic susceptibility to osteosarcoma outside of familial cancer syndromes remains unclear. Objective To investigate the germline genetic architecture of 1244 patients with osteosarcoma. Design, Setting, and Participants Whole-exome sequencing (n = 1104) or targeted sequencing (n = 140) of the DNA of 1244 patients with osteosarcoma from 10 participating international centers or studies was conducted from April 21, 2014, to September 1, 2017. The results were compared with the DNA of 1062 individuals without cancer assembled internally from 4 participating studies who underwent comparable whole-exome sequencing and 27 173 individuals of non-Finnish European ancestry who were identified through the Exome Aggregation Consortium (ExAC) database. In the analysis, 238 high-interest cancer-susceptibility genes were assessed followed by testing of the mutational burden across 736 additional candidate genes.