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Background While heritability has been shown for daytime sleepiness, the heritability of daytime capillary oxygen saturation (SpO.sub.2) has not been described in detail. Our aim was to estimate the role of genes and environmental factors-both shared and unshared-in the variation of daytime SpO.sub.2. Methods A total of 193 adult healthy twin pairs (138 monozygotic, 55 dizygotic) were recruited in Hungary and in the United States [age = 43.6 ± 15.6 years (mean ± SD)]. SpO.sub.2 was measured by pulse oximetry. Univariate quantitative genetic modeling was performed to decompose the phenotypic variance of the considered parameter into heritability (A), shared (C), and unshared (E) environmental effects. Results SpO.sub.2 twin correlation in monozygotic twins was stronger than in dizygotic twins (0.30 and -0.15, respectively, p < 0.05). Age-, sex-, country-, and body mass index-adjusted genetic effects accounted for 26 % (95 % CI 10, 45 %) of the variance of SpO.sub.2, and the unshared environmental component explained the remaining 74 % (95 % CI 59, 89 %). No shared environmental influence on SpO.sub.2 was detected. The heritability of SpO.sub.2 was not different between smokers and nonsmokers. Conclusion In summary, individual differences in daytime SpO.sub.2 are explained by genetic and unshared environmental effects. The strong unshared environmental influence highlights the role of prevention of known environmental risk factors., Author(s): David Laszlo Tarnoki[sup.1] , Emanuela Medda[sup.2] , Adam Domonkos Tarnoki[sup.1] , Zsofia Lazar[sup.3] , Corrado Fagnani[sup.2] , Maria Antonietta Stazi[sup.2] , Kinga Karlinger[sup.1] , Peter Torzsa[sup.4] , Laszlo Kalabay[sup.4] [...]

Background: Serum concentration of fetuin A/α2HS-glycoprotein (AHSG) is a good indicator of liver cell function and 1-month mortality in patients with alcoholic liver cirrhosis and liver cancer. We intended to determine whether decreased serum AHSG levels are associated with long-term mortality and whether the follow-up of serum AHSG levels can add to the predictive value of the Child-Pugh (CP) and MELD scores. Methods: We determined serum AHSG concentrations in 89 patients by radial immunodiffusion. Samples were taken at the time of enrolment and in the 1st, 3rd, 6th, and the 12th month thereafter. Results: Forty-one patients died during the 1-year follow-up period, 37 of them had liver failure. Data of these patients were analysed further. Deceased patients had lower baseline AHSG levels than the 52 patients who survived (293 ± 77 vs. 490 ± 106 µg/ml, mean ± SD, p < 0.001). Of all laboratory parameters serum AHSG level, CP and ME D scores showed the greatest difference between deceased and survived patients. The cutoff AHSG level 365 µg/ml could differentiate between deceased and survived patients (AUC: 0.937 ± 0.025, p < 0.001, sensitivity: 0.865, specificity: 0.942) better than the MELD score of 20 (AUC: 0.739 ± 0.052, p < 0.001, sensitivity: 0.595, specificity: 0.729). Initial AHSG concentrations < 365 µg/ml were associated with high mortality rate (91.4%, relative risk: 9.874, 95% C.I.: 4.258—22.898, p < 0.001) compared to those with = 365 µg/ml (9.3%). Fourteen out of these 37 fatalities occurred during the first month of observation. During months 1—12 low AHSG oncentration proved to be a strong indicator of mortality (relative risk: 9.257, 95% C.I.: 3.945-21.724, p < 0.001). Multiple logistic regression analysis indicated that decrease of serum AHSG concentration was independent of all variables that differed between survived and deceased patients during univariate analysis. Mu ltivariate analysis showed that correlation of low serum AHSG levels with mortality was stronger than that with CP and MELD scores. Patients with AHSG < 365 µg/ml had significantly shortened survival both in groups with MELD < 20 and MELD ≥ 20 (p < 0.0001 and p = 0.0014, respectively). Conclusion: Serum AHSG concentration is a reliable and sensitive indicator of 1-year mortality in patients with alcoholic liver cirrhosis that compares well to the predictive value of CP score and may further improve that of MELD score. [ABSTRACT FROM AUTHOR]

Representative studies indicate that prevalence of anxiety disorders among adults is between 12.6-17.2%, while in Hungary it is 17.7%. According to both international and national studies the point prevalence of diagnosed major depression requiring treatment is 6-10 % in general practice. As untreated depression is the most important risk factor for suicide, early detection and effective management of depression are critical in prevention. According to international and national studies the recognition of major depression in primary care significantly contributes to the decline of suicide mortality. In our article we review screening of anxiety and depressive disorders and treatment and management of these patients in primary care. We present two short questionnaires used for recognizing depression and acute suicide risk and describe their use in family/ general practice.