My kid went to brain MRI because of migraines (standard procedure here for kids to check if there is e.g. a tumor causing the headache). I was pretty nervous due to this kind of research and the preparatory material saying that they might need to use a contrast agent. In the end they didn’t use a contrast agent and I stressed unnecessarily.
Just as a heads up from a rando on the internet this sort of research is trying to understand mechanisms of things that happened 20-30 years ago and people who were exposed back then (sometimes many times with significant accumulation).
Gadolinium is toxic so contrasts trap it with protective molecules that hold the gadolinium until it leaves the body (most leave via the kidneys, but some also leave via liver/gallbladder). Some fraction of gadolinium escapes depending on the structure of the protective molecules. After the problems with the older contrasts were found kidney function became important (impaired kidney function allows more time for gadolinium to escape) and later new contrasts were designed that are much more stable. The gadolinium contrasts we use today are much more stable than the ones we used previously and there haven't been any cases of the sorts of things this article is about in over ten years. But there are a lot of people alive who received the old agents many times and in higher doses than we use today.
I don't want to diminish the concerns (and frankly I think this is important to understand what happens to gadolinium in the body), but the exposure and accumulation are significantly lower today than they have been in the past because reducing exposure has become a major focus of design safety for gadolinium contrast and the worst offenders have been voluntarily withdrawn from the market.
Anyway if my kid needed contrast for accurate diagnosis, I'd do it. I work at a pediatric hospital and generally the way it works is if contrast might be needed its ordered and consented so that it's an option. During the scan radiologists check the images and decide whether contrast is needed to answer the clinical question (although in general that's more a question of time management if the question has already been answered, there's no reason to keep imaging).
Appreciate this comment, thank you. (It's hard to gauge the recency of these concerns, the materials being used, or the prevalence of NSF -- and it can all get a bit overwhelming.)
Great! I am also about to donate my other kidney. The difference in the long term outcome of the patient between living and dead donation is significant enough for me to go through this. My total kidney function will drop to 50% and I will be sick for 2-3 weeks but if everything goes well I will be up to 70% after few months if the remaining kidney accomodates and back to work in about 4 weeks. Of course there are some other long term risks to consider. However, I probably would not agree on this if there was an abundant supply of working pig kidneys…
It is easier to agree to donate your lungs because ethically they're only going to take your lungs if you die. So then you don't care anyway. If you agree to donate a kidney they may ask when you're alive, because you have two kidneys and you can survive (though with some reduction in capability) with just one. This is called Living Kidney Donation, you don't have to offer to do this, and even if you offer, and it's a match you don't have to go through with the donation but obviously there are huge psychological impacts from deciding to perhaps save somebody's life as a conscious choice at a non-negligible risk to your own.
Note that you're not "saving somebody's life" by donating a kidney. What you are doing, at best, is increasing their quality of life and even that is hard to quantify:
Having a kidney transplant does not “cure” kidney disease. There are also risks, including the risks of surgery. After the transplant, you will need to take anti-rejection medicines, also called immunosuppressants, for as long as your new kidney is working, which can have side effects. You will have a higher risk for infections and certain types of cancer.
Although most transplants are successful and last for many years, how long they last can vary from one person to the next. Depending on your age, many people will need more than one kidney transplant during a lifetime.
The majority of kidney patients with end-stage kidney disease do not simply die: they can survive several years on dialysis. As far as I can tell, most indeed do: only a minority of kidney patients ever get transplants.
Source: relative with kidney disease who would not accept a living donour kidney because of ethical concerns.
A friend had kidney failure and now has one of her husband's kidneys. It's really striking how much the immunosuppression sucks (a lot!) versus how much dialysis sucked (far more) for the period between her diagnosis and them being able to perform a transplant.
The US has a problem where there are a bunch of outfits whose income is derived specifically from dialysis, so for them transplants are bad business. Sure, the patient will (statistically) have a longer life and enjoy higher quality of life, but their income will be reduced so...
This results in a rather... muted endorsement of qualitatively better outcomes and where there's obviously also going to be an ethical component I'd say that's undesirable.
We all die. People with kidney disease die significantly sooner statistically if they do not receive a transplant, so this is the sense in which I mean saving a life.
But that's not "saving someone's life". Try it like this:
"I decided to donate one of my kidneys to make someone's life a little bit easier for a little while".
And note that while dialysis is big business and I have no doubt that the people who are in it care far more about their profits than their patients, so are transplants. In fact transplants cost a lot more and make people a lot more money than dialysis and the only reason they're not as big business as dialysis is that there's just not enough donours, which makes a big honking red financial incentive to keep pushing for everyone to become a donour.
Meanwhile, like the National Kidney Foundation says, in my quote above, 'Having a kidney transplant does not “cure” kidney disease' and neither does dialysis. And because both treatments keep patients alive for longer than the typical five-year horizon of medical follow-up studies, they, both together, reduce the incentive to work on real "cures" of kidney disease (which, like cancer, is not one condition but many) which would make the sucking of dialysis and transplant both things of the past.
And I know this last one because I personally asked my relative's nephrologist and transplant surgeon about it and they were vague and hand-wavy, like "oh, sure, there's people working on that sort of thing somewhere".
But nobody's really trying because we can make millions keeping people tied up to machines or on immunosuppression until they give up the spirit and so who cares?
"Oh I didn't actually save the little old ladies when their nursing home burned down. I just made their life a bit easier for a little while, they still all died because they were human"
Nobody talks like this. It is understood that humans are mortal.
Yes, necessarily kidney disease cure research gets you fewer QALYs than figuring out a way to cure something we have no treatment for. But given we haven't eradicated polio it's not as though humans are very good at this whole cost-benefit analysis when it comes to medicine.
"Oh I didn't actually save the little old ladies when their nursing home burned down. I just made their life a bit easier for a little while, they still all died because they were human"
Is not analogous to this:
"I decided to donate one of my kidneys to make someone's life a little bit easier for a little while".
I am donating my other kidney to a child (1 year old with nephrosis). In any case he is living the rest of his life with this condition. I am doing this to minimize the risk of rejection during childhood. There are living people with this condition (since being babies) who are 40 years old and have families.
This doesn’t make any sense - chemically espresso and filtered coffee are very similar. There are some subtle differences which contribute to the differences in taste between them, but it seems unlikely those make any contribution to cholesterol
Drinking a lot of cappuccinos could potentially raise cholesterol levels due to heavy milk consumption. But if you have them with skim milk, that reduces that problem.
Plus I personally have abnormally low blood cholesterol (in spite of a heavy cappuccino habit). My doctor thinks it is a harmless genetic mutation in cholesterol metabolism. At least one of my siblings has the same thing which supports my doctor’s theory.
I believe this is the reason that the AeroPress uses paper filters to reduce the cafestol (https://en.wikipedia.org/wiki/Cafestol) significantly. Personally, I prefer using permanent metal filters in my AeroPress (for the flavour more than anything), but then I don't have high cholesterol so am not concerned about it and cafestol has been shown to be anti-carcinogenic and neuroprotective in animal studies.
Coffee does contain oils that will "increase cholesterol" (meaning increase LDL/bad cholesterol specifically). Filters reduce the oil significantly but unfiltered methods like cafetière and espresso (which is the basis of cappuccino etc) let it all through. It's something to think about if your drinking many unfiltered coffees a day. It is possible to add a filter to espresso if you brew it yourself.
> Cafestol, a diterpene present in unfiltered coffee brews such as Scandinavian boiled, Turkish, and cafetière coffee, is the most potent cholesterol-elevating compound known in the human diet.
This "buffer zone" demand is much older than 30+ years. Putin wants another Molotov-Ribbentrop pact to invade his neighbors, to be called 'Putin the Conqueror'. Everything we see are his ambitions to rewrite history. He won't resort to nukes because then there is a risk of no one reading the history of the new glorious Russian empire by Putin the Conqueror, and that's against his life goals.
Take a random group of students from the general population and one of those examples (Edit: or any single given example whatsoeve). Turns out 95% are not really interested.
Edit 2: The teacher probably gave some example from biology or something that you didn't care about and therefore forgot about it.
The core skill of the teacher lies in recognizing the interests of the pupil and then working on refining those skills so that the pupil can use those skills for at least their betterment, if not the society.
And that is one of the toughest things to get right. Children are extremely curious, that's how they learn and master absolutely anything including arts, dancing, music, history, skating, catching insects, street smarts etc. It's on us as teachers to not let that curiosity wither into nothingness.
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