present in posttransplant biopsies from 1 alcohol user The purposes of this study were to determine among only. Alcohol use by alcoholics is uncommon in the first 5 a cohort of long-term alcoholic survivors after liver years after liver transplantation, and alcohol-associated transplantation (1) the incidence of alcohol use, (2) its liver injury is unusual. Mild nonspecific hepatitis is comeffect on allograft integrity and extrahepatic health, and mon in both alcohol users and nonusers alike. Orthotopic liver transplantation is an efficacious therapy center. Fifty alcoholic, long-term liver transplant recipi-for severe liver failure associated with alcoholism. Survival ents. The frequency of alcohol relapse, defined as any rates after liver transplantation are similar among alcoholics alcohol use in the period after transplantation, was de-and nonalcoholics.1,2 There is a significant survival advantermined by two questionnaire studies and by clinical tage among alcoholics with transplants compared with alcofollow-up. Allograft integrity was assessed by coded re-holic patients refused transplants on psychiatric grounds or view of serial percutaneous allograft biopsies. Potential compared with alcoholic controls with severe liver disease in systemic effects of alcohol relapse were assessed by a simulated mathematical model. 2,3 We have shown that chart review. The alcohol prognosis screening process more than 50% of alcoholics referred to our program are rewas evaluated by retrospectively comparing pretrans-fused transplants on either medical, surgical, or psychiatric plant estimates of putative indicators of alcoholism grounds, a rate of refusal that exceeds that for most other prognosis in posttransplant alcohol users and abstain-chronic liver diseases (unpublished observations). ers. Thirty-three recipients (66%) consistently deniedAlcoholics with end-stage liver disease undergo careful asany alcohol use throughout the duration of posttrans-sessment of the risk of recidivism in the future. 4 There is a plant follow-up, whereas 17 (34%) were identified as hav-relatively low incidence of recidivism in short-term periods ing consumed alcohol at least once since the transplant. of observation after transplantation.2,5-8 More recent studies There were no significant differences at the time of eval-have suggested that the incidence of recidivism, although uation between abstainers and alcohol users in age, sex still low compared with incidence with other forms of therapy distribution, severity of liver dysfunction, median dura-for alcoholism, increases with longer follow-up. tion of abstinence, or University of Michigan alcoholismIt remains uncertain whether alcohol use after liver transprognosis score. The median interval from transplanta-plantation has untoward consequences for allograft function. tion to alcohol relapse was 17 months, with a range of 3 Indeed, Bonet et al. have proposed that a relapse of alcohol to 45 months. Recurrent alcohol use was associated with abuse by alcoholics after liver transplantation...

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The ε4 allele of the APOE gene is associated with poorer cognition in later life. This study aimed to advance understanding of how environments potentially moderate this genetic risk by focusing on childhood socioeconomic status (SES). Previous research across diverse national contexts has found that older adults from higher-SES families in childhood demonstrate better cognitive functioning than their lower-SES counterparts. Nevertheless, few studies have examined whether higher childhood SES might also promote later life cognition by mitigating the effects of ε4 carrier status. To address this gap, we used data from 3017 participants in the Wisconsin Longitudinal Study, which has followed a random sample of people who graduated from Wisconsin high schools in 1957. Childhood SES included parents' educational attainment, father's occupational status, and household income in adolescence. We constructed measures of memory and of language/executive functioning using scores from neurocognitive tests administered when participants were approximately ages 65 and 72. APOE ε4 status was measured through saliva samples. Results from cross-controlled multilevel models indicated that APOE ε4 status-and not childhood SES-independently predicted memory, whereas childhood SES-and not APOE ε4 status-independently predicted language/executive functioning. Moreover, a statistical interaction between APOE ε4 status and childhood SES for memory indicated that at baseline, higher childhood SES protected against the risk of APOE ε4 status, whereas lower childhood SES exacerbated the risk of APOE ε4 status. However, by follow-up, these moderating effects dissipated, and APOE ε4 status alone was associated with memory. We interpret these results in light of theorizing on differential susceptibility for poorer cognition across the life course.

We present a case of a 25-year-old patient at term pregnancy who presented with a bilateral ovarian neoplasm that was histologically and immunohistochemically indistinguishable from ependymoma of the central nervous system. Progesterone receptors were detected in primary and recurrent neoplasms by immunohistochemistry. This is the first case of this rare neoplasm to present during pregnancy as well as with bilateral ovarian involvement. Together with a previously reported case of recurrent ovarian ependymoma with estrogen and progesterone receptors, this case suggests that hormonal responsiveness of this rare neoplasm may be pathogenically significant.

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