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Induction treatment with rabbit polyclonal antithymocyte globulins (ATGs) is frequent used in kidney transplant recipients with donorspecific HLA antibodies and shows acceptable outcomes. The two commonly used ATGs, Thymoglobulin and ATG-F have slightly different antigen profile and antibody concentrations. The two compounds have never been directly compared in a prospective trial in immunological high-risk recipients. Therefore we performed a prospective randomized controlled study comparing the two compounds in immunological high-risk kidney recipients in terms of safety and efficacy. Immunological high-risk kidney recipients, defined as the presence of HLA DSA but negative CDC-B and T-cell crossmatches were randomized 1:1 to receive ATG-F or Thymoglobulin. Maintenance immunosuppressive therapy consisted of tacrolimus, mycophenolate mofetil and steroids. The per-protocol analysis included 35 patients. There was no immediate infusion reaction observed with both compounds. No PTLD or malignancy occurred during the follow-up in both groups. The incidence of viral and bacterial infections was similar in both groups (p = 0.62). The cumulative incidence of clinical and subclinical antibody mediated allograft rejection as well as T-cell mediated allograft rejection during the first year between ATG-F and Thymoglobulin was similar (35% versus 19%; p = 0.30 and 11% versus 18%; 0.54 respectively). The two-year graft function was similar with a median eGFR of 56 ml/min/1.73m2 (range 21-128) (ATG-F-group) and 51 ml/min/1.73m2 (range 22-132) (Thymo-group) (p = 0.69). We found no significant differences between the compared study drugs for induction treatment in immunological high-risk patients regarding safety and efficacy during follow-up with good allograft function at 2 years after transplantation.

Nephrotic syndrome is common in immunoglobulin light-chain (AL) amyloidosis and successful therapy may pose a challenge. We report the case of a 63-year-old patient with severe nephrotic syndrome due to primary renal AL-amyloidosis with well-preserved renal function at first presentation. Therapy with high dose steroids, loop diuretics, and ACE-inhibitors did not affect his proteinuria and he was seriously disabled because of symptomatic orthostatic hypotension and anasarca. With the patient’s informed consent, medical nephrectomy was tried with nonsteroidal-anti-inflammatory drugs (NSAIDs), cyclosporine, and aminoglycosides, with significant deterioration of his renal function, but without relevant effect on his proteinuria. Despite adequate anticoagulation life threatening thrombotic and bleeding complications occurred. Total renal ablation was finally achieved using an Amplatzer vascular plug Typ IV (AVP 4) with a self-expanding Nitinol mesh design, which was placed in both main renal arteries in the same intervention. The patient became completely anuric, protein loss stopped, and serum albumin slowly rose to normal levels. The patient’s clinical condition dramatically improved and he regained his full mobility at the price of a lifelong renal replacement therapy. To our knowledge, this is the first reported usage of such a vascular occluder in the setting of refractory nephrotic syndrome with normal kidney function at the time of first presentation.

A 67-year-old woman was admitted to the hospital due to progressive mental changes, nausea and vomiting after a dose increase of an intrathecal morphine pump. We found severe hypercalcaemia due to milk alkali syndrome (MAS). Her symptoms resolved quickly after normalisation of hypercalcaemia.Similar to the original and the modern versions of the syndrome, ingested carbonate was the main source of bicarbonate in our case. The main trigger was a morphine overdose with volume contraction due to vomiting and a further aggravation of chronic compensatory elevation of bicarbonate due to hypoventilation leading to MAS; thus, suggesting hypoventilation as a risk factor for MAS.

Les auteurs antiques ont accordé plus d'attention au phénomène naturel de la crue du Nil qu'au réseau de canaux qui favorisaient la production agricole égyptienne. L'article considère les données relatives au rythme et à la hauteur de la crue, et le système appliqué aux époques ptolémaïque et romaine pour calculer les revenus de la terre et fixer l'assiette des impôts. Il étudie le fonctionnement des canaux d'irrigation, et met en évidence la nécessité d'un état fort pour assurer la surveillance et l'entretien du réseau hydraulique. La documentation papyrologique est fondamentale pour comprendre l'organisation des travaux; les textes juridiques font ressortir l'importance des sanctions prévues contre ceux qui portaient atteinte au système. Le coût de l'irrigation était élevé, mais l'importance du blé égyptien pour le ravitaillement de Rome explique l'attention et les efforts mis en œuvre par l'administration romaine pour la contrôler. Those who have written in Antiquity have always focused their attention on the natural phenomenon of the floods of the Nile, rather than the network of canals that favoured Egyptian agricultural production. This article takes into consideration data relative to the rhythm and the depth of the floods, and to the system applied during the Ptolemaic and Roman eras in order to calculate land income, and to set the tax rates. This article will also study how the water canals worked, and will show clearly the need for a strong body to watch over and maintain the hydraulic network. The papyrological documentation is essential for understanding how the works were organised, and the judicial texts underline the sanctions brought against those who tried to attack the system. The cost of irrigation was high, but the importance of the Egyptian wheat supply to Rome was such, that it explains the attention and the efforts that were invested by the Roman Administration to control it.

Taking the position that when the Christian people live close to God the unsaved will be easily converted, Evangelist M. F. Ham Wednesday night pleaded that the members of the Baptist churches of Nashville glye God first claim upon their rives and become real factors in the promotion of His...

Charges that heresies are being taught in at least one Baptist school of Tennessee and that some of the text books employed in both the state nnd denominational schools are calculated to undermine the faith of young men and women in the Bible as the inspired word of God will be investigated by...

Hearis of the Baptist men and women of Tennessee, in attendance upon the forty-seventh annual session of their state convention at immanuci Church Thursday were thrilled throughout the day as reports of marked progress were made upon every phase of the denomination's organized work...

Resolutions were unanimously adopted by the Tennessee Baptist convention before final adjournment Friday afternoon at 5 o'clock, calling upon the national Congress to submit to a vote of the people at this session the pending constitutonal amendment prohibiting the appropriation by federal, state.