Elizabeth Johnson

Elevated false recollection of emotional pictures in young and older adults.

Current theories predict opposing effects of emotionally arousing information on false memory. If emotion enhances true recollection, then false recollection might be lower for emotional than for neutral pictures. However, if emotion enhances conceptual relatedness, then false recollection might increase for nonstudied but emotionally related pictures. We contrasted these 2 factors in young and older adults, using the International Affective Pictures Systems set (Lang, Bradley, & Cuthbert, 2005). Although both age groups used recollection in our task, false recollection was greatest for emotional pictures, supporting a conceptual relatedness account. Finally, even after accuracy differences were controlled, age was related to high-confidence false recollection of emotional pictures.

Age-related positivity effects and autobiographical memory detail: evidence from a past/future source memory task.

This study investigated whether the age-related positivity effect strengthens specific event details in autobiographical memory. Participants retrieved past events or imagined future events in response to neutral or emotional cue words. Older adults rated each kind of event more positively than younger adults, demonstrating an age-related positivity effect. We next administered a source memory test. Participants were given the same cue words and tried to retrieve the previously generated event and its source (past or future). Accuracy on this source test should depend on the recollection of specific details about the earlier generated events, providing a more objective measure of those details than subjective ratings. We found that source accuracy was greater for positive than negative future events in both age groups, suggesting that positive future events were more detailed. In contrast, valence did not affect source accuracy for past events in either age group, suggesting that positive and negative past events were equally detailed. Although ageing can bias people to focus on positive aspects of experience, this bias does not appear to strengthen the availability of details for positive relative to negative past events.

Predicted postoperative lung function is associated with all-cause long-term mortality after major lung resection for cancer

OBJECTIVES Preoperative lung function is an independent predictor of long-term survival after lung resection for non-small-cell lung cancer (NSCLC). The extent of resection has an impact on operative mortality, determines postoperative lung function and may influence both overall- and cancer-specific survival. We sought to determine the impact of predicted postoperative (ppo) lung function on long-term survival after lung cancer resection. METHODS We previously reported long-term survival analyses for patients who underwent major lung resection for NSCLC 1980-2006. For this study, we calculated ppo spirometry (forced expiratory volume in the first second, FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) in the same cohort using the functional segment technique or quantitative perfusion scans when available, and updated survival data; missing data were imputed. We assessed the relationship of ppoFEV1 and ppoDLCO to long-term survival using Cox regression. RESULTS Of 854 patients, 471 (55%) were men, the mean age was 63 years and median survival was 42 months. At the time of analysis, 70% of patients had died. On regression analysis, all-cause mortality was related to age, stage, performance status, renal function and prior myocardial infarction. Preoperative lung function was marginally associated with mortality [DLCO (10-percentage point decrease): HR (hazard ratio) 1.04, 95% confidence interval (95% CI) 1.00-1.08, P = 0.056; FEV1 (10-percentage point decrease): HR 1.04, 95% CI 1.00-1.09, P = 0.067]. In contrast, ppo lung function was strongly associated with mortality (ppoDLCO: HR 1.06, 95% CI 1.01-1.12, P = 0.024; ppoFEV1: HR 1.06, 95% CI 1.01-1.12, P = 0.031). CONCLUSIONS Ppo lung function is strongly associated with long-term survival after major lung resection and is more strongly related to survival than preoperative lung function. Surgeons struggle with challenging decisions about the appropriate extent of resection for early-stage cancer, balancing factors such as operative morbidity/mortality, local recurrence and postoperative quality of life. Ppo lung function and its relation to survival also should be taken into consideration during such deliberations.

Association of body mass index and outcomes after major lung resection

OBJECTIVES Obesity has been thought to predispose patients to excess morbidity after lung resection because of decreased diaphragm excursion, reduced lung volumes and relative immobility. We assessed the relationship of body mass index (BMI) to acute outcomes after major lung resection. METHODS Information from our database of lung resections was evaluated for the period 1980-2011. Univariate analysis for adverse events (pulmonary, cardiovascular, other and overall) was used to select variables for inclusion in multivariate logistic regression analyses. Missing values were imputed. BMI was categorized as underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), obese (30-34.9) and very obese (≥ 35). RESULTS Among 1369 patients, there were 703 males (51%) and the mean age was 62 ± 11 years. Complications included the following: pulmonary 12%, cardiovascular 15%, other 16%, mortality 5% and any 29%. The incidence of complications decreased during each decade of study (40, 30, 26, 20%; P < 0.0001) and the incidence of obese/very obese increased during the same intervals (11, 22, 30, 25%; P = 0.0007). Adjusting for age, performance status, coronary artery disease, smoking status, diffusing capacity of the lung for carbon monoxide, forced expiratory volume in 1 s and operation year, being overweight/obese/very obese did not increase the risk of postoperative complications in any category. In fact, patients in this group showed a lower rate of cardiovascular complications than those with BMI ≤ 25 (odds ratio (OR): 0.72; 95% confidence interval (CI): 0.51-1.00; P = 0.048). However, being underweight was importantly associated with an increased risk of pulmonary complications (OR: 2.5; 95% CI: 1.3-4.9; P = 0.0087) and of operative mortality (OR: 2.96; 95% CI: 1.28-6.86; P = 0.011). CONCLUSION Being overweight or obese does not increase the risk of complications after major lung resection. In contrast, patients who are underweight are at significantly increased risk of pulmonary complications and mortality. Knowledge of the relationship of BMI to perioperative risk for major lung resection is essential in proper risk stratification.

Local Allocation of Lung Donors Results in Transplanting Lungs in Lower Priority Transplant Recipients

BACKGROUND Under the current lung allocation system, if organs are accepted for a candidate within the local donor service area (DSA), they are never offered to candidates at the broader regional level who are potentially more severely ill, even if the nonlocal candidate has a higher lung allocation score (LAS). The purpose of this study was to determine the frequency with which organs were allocated to a local lung recipient while a blood group-matched and size-matched candidate with a higher LAS existed in the same region. METHODS United Network for Organ Sharing (UNOS) provided deidentified patient-level data. The study population included all locally allocated organs for double-lung transplants (DLTs) performed in 2009 in the United States (n=580). All occurrences of an ABO blood group-matched, height-matched (±10 cm), double-lung candidate in the same region, with a higher LAS than the local candidate who actually received the organs, were calculated; these occurrences were termed events. RESULTS In 2009, 3,454 events occurred when a local DLT recipient candidate received a DLT while a DLT candidate in the same region had a higher LAS. With a mean of 5.96 events per transplant, this impacted 480 (82.8%) of the 580 DLTs. Further, 555 (16.1%) of these events involved 1 (or more) of the 185 regional candidates who ultimately did not receive transplants and died while on the waiting list. CONCLUSIONS This analysis suggests that the locally based lung allocation system results in a high frequency of events whereby an organ is allocated to a lower-priority candidate while an appropriately matched higher priority candidate exists regionally.

Evidence supports severe renal insufficiency as a relative contraindication to heart transplantation

BACKGROUND This study was conducted to determine whether survival after orthotopic heart transplant (OHT) is associated with pre-transplant estimated glomerular filtration rate (eGFR) and to define ranges of pre-OHT eGFR associated with differences in post-transplant survival. The 2006 International Society for Heart and Lung Transplantation revised listing criteria for OHT stated that chronic kidney disease, defined by an eGFR <40 ml/min is a relative contraindication for OHT alone. The committee noted that this recommendation was supported by consensus opinion of experts and not data derived from a randomized trial or non-randomized studies. METHODS The United Network for Organ Sharing provided deidentified patient-level data. The study population included 17,459 OHT recipients aged ≥18 years who received allografts between January 1, 2001, and December 31, 2009. Logistic regression was used to assess the effect of multiple variables on survival after OHT. Receiver operating characteristic curves and stratum-specific likelihood ratios were generated to compare 1-year survival at eGFR thresholds. The primary outcomes measure was actuarial post-transplant survival expressed in years. RESULTS Regression analysis showed that a lower pre-transplant eGFR is associated with worse post-transplant survival. Threshold analysis demonstrated 3 distinct survival strata: eGFR ≤ 34 ml/min, eGFR 35 to 49 ml/min, and eGFR > 49 ml/min. Graft survival at all times is decreased for patients with eGFR ≤ 34 ml/min. They are also more likely to have in-hospital and long-term complications. CONCLUSIONS eGFR is a strong predictor of post-transplant survival and should be considered when assessing patients for OHT. This analysis supports current International Society for Heart and Lung Transplantation guidelines and suggests that end-stage heart failure patients with an eGFR ≤ 34 ml/min is a relative contraindication for heart transplantation alone.