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The Philistine culture (Iron Age, ca. 1200-604 BCE) profoundly impacted the southern Levant's cultural history, agronomy, and dietary customs. Nevertheless, our knowledge of the Philistines’ cultic praxis and deities, is limited and uncertain. Here, we combine archaeological data with a meticulous study of plant use at two successive temples at Tell eṣ-Ṣâfī/Gath. We provide a list of the plants used, their time of harvest, mode of offering, and possible symbolism. Analysis of the temples' macrobotanical (seed and fruits) plant assemblage reveals the offerings; that the inception date for rites was early spring; and sheds light on the date of the final utilization of the temples (late summer/early fall). Besides food crops, we note the earliest cultic use of chaste tree ( Vitex agnus-castus ), crown daisy ( Glebionis coronaria ), and scabious ( Lomelosia argentea ). These wide-spread Mediterranean plants were known so far only in later cults—of early Greek deities, such as Hera, Artemis, Demeter, and Asclepios. We discuss the data as reflecting that the Philistine religion relied on the magic and power of nature, such as fresh water and seasonality, which influence human life, health, and activity. In sum, our results offer novel insights into the culture of the Philistines.

BackgroundWe investigated the risk of kidney injury among adolescents with and without a congenital single functioning kidney (SFK).MethodsThis retrospective study is based on a medical evaluation database of 17-year-old Israeli conscripts, born during 1989–1999. Those with congenital SFK diagnosis, verified by a pediatric nephrologist’s review of the original military medical committee classifications, were compared to the rest of the cohort. Kidney injury (KI) was defined as proteinuria, high blood pressure (BP), or estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m2 prior to army recruitment. Risk factors for KI were examined using logistic regression.ResultsOf 979,630 screened candidates, 353 were diagnosed with SFK. The yearly incidence of SFK gradually increased in the first years of the study, reaching a plateau in 1995 (5.5 ± 1.2/10,000 births/year). The male to female ratio was 2.7:1. Concomitant genital malformations were documented in 5.5% of those with SFK. KI was more prevalent in the SFK than the control group (42.2% vs. 23.5%, p < 0.001). All three components of KI were more common in the SFK than the control group: high BP (31.7% vs. 23.1%, p < 0.001), proteinuria (18.2% vs. 0.4%, p < 0.001), and eGFR <90 ml/min/1.73m2 (12.0% vs 0.1%, p < 0.001). Multivariate analysis of the SFK group revealed associations of higher mean BMI, male sex, and smaller ultrasonographic kidney length with KI.ConclusionsThis large population-based study documents a significant risk for KI among adolescents with SFK. Obesity represents a major modifiable risk factor for KI, implicating the need for closer follow-up in this group during childhood.

BackgroundThis study aimed to evaluate short- and long-term outcomes of kidney transplantation over 37 years in a national referral center and compare outcomes between Israeli Jewish and Arab children.MethodsData on 599 pediatric transplantations performed in 545 children during 1981–2017, including demographic parameters, kidney failure disease profile, and pre-transplant dialysis duration, were retrieved from our computerized database and patient files. Patient and graft survival were estimated using the Kaplan-Meier method.ResultsTwenty-year patient survival was 91.4% for live donor (LD) and 80.2% for deceased donor (DD) kidney recipients. Respective 10-year and 20-year graft survival rates for first kidney-only transplants were 75.2% and 47.0% for LD and 60.7% and 38.4% for DD grafts. Long-term graft survival improved significantly (p < 0.001) over the study period for recipients of both LD and DD allografts and reached 7-year graft survival of 92.0% and 71.3%, respectively. The proportion of DD transplantations was higher in the Arab subpopulation: 73.8% vs. 48.4% (p < 0.001). Graft survival was not associated with age at transplantation and did not differ between the Arab (N = 202) and Jewish children (N = 343). Median (IQR) waiting time on dialysis did not differ significantly between the Arab and Jewish children: 18 (10–30) and 15 (9–30) months, respectively (p Mann-Whitney = 0.312).ConclusionsGood and progressively improving long-term results were obtained in pediatric kidney transplantation at our national referral center, apparently due to expertise gained over time and advances in immunosuppression. Equal access to DD kidney transplant and similar graft survival were found between ethnic groups.

Relapses of steroid-sensitive nephrotic syndrome are traditionally treated with prednisone 2 mg/kg/day or 60 mg/m2/day. Retrospective data support the use of lower doses. We designed a prospective randomized pilot study to investigate the efficacy of different doses in achieving remission of steroid sensitive nephrotic syndrome relapse. The cohort included 30 children with relapsed steroid sensitive nephrotic syndrome, mean age 6.3 ± 3 years and mean disease duration 2.2 ± 1.8 years. The children were randomized to receive 2, 1.5, or 1 mg/kg/day prednisone. The corresponding times to response, defined as the first of 3 consecutive days without proteinuria, were 7.2 ± 1.4, 10.2 ± 5.1, and 9 ± 3.3 days; the difference between the 1.5 and 2 mg/kg/day groups was statistically significant. One patient each in the 1 mg/kg/day and the 1.5 mg/kg/day groups failed to respond and were switched to 2 mg/kg/day, leading to a response after 3 and 10 days, respectively. Mean cumulative prednisone doses in the 3 groups were 45.5 ± 3.4, 42.7 ± 25.9, and 24.9 ± 7.4 mg/kg, respectively (P < 0.05).Conclusion: In the present study, treatment of childhood steroid sensitive nephrotic syndrome relapse with prednisone 1–1.5 mg/kg/day led to a significantly lower cumulative dose than the standard dose. Treatment with a lower dose may be equally safe and effective to the standard dose.What is Known:• Relapses of steroid-sensitive nephrotic syndrome are traditionally treated with standard-dose steroids.• Treatment with corticosteroids may have significant adverse effects mainly with long-term use.What is New:• Treatment of steroid sensitive nephrotic syndrome relapse with 1–1.5 mg/kg/day prednisone may lead to a significantly lower cumulative dose.• Treatment with a lower steroid dose may be as effective as the standard dose in achieving remission of steroid sensitive nephrotic syndrome relapse.

During the first decade of the Tell eṣ-Ṣâfi/Gath Excavation Project, various areas in the upper city were excavated. Based on the results of the surface survey, however, it was clear that there was extensive settlement in the area to the north of the upper city up until the Elah Valley riverbed. Ten years ago, the excavations were expanded to the lower city, commencing with Area D (fig. 1). Since then, Area D has been extensively excavated, with a broad range of finds mainly from the Iron Age (for additional excavations in Area K of the lower city, see Welch in this issue). Here we will describe some of these finds, with a particular focus on the Philistine cultic remains.

Faunal remains comprise a significant portion of finds recovered from most archaeological sites in Israel. Among other issues relating to factors such as animal evolution and ecology, their examination can elucidate past human diet, symbolic and cultural behavior, technology relating to animals and animal products, as well as the site's environment and even paleoclimate of a region (e.g., Reitz and Wing 2008; Russell 2011). These issues were considered when we examined the faunal assemblage recovered from the late Iron Age I (tenth century B.C.E.) through Iron Age IIA-B (post-830 B.C.E.) deposits excavated in Area D at Tell eṣ-Ṣâfi/Gath.

The widespread signs of destruction and fire seen at Tell eṣ-Ṣâfi/Gath in the upper and lower parts of the city (Namdar et al. 2011; Zukerman and Maeir 2012) include the charred skeletal remains of three women found in Area D, Stratum D3, and five individuals found in Area A, Stratum A3. All appear to have been victims of the same event, namely, the destruction of the city at the end of the ninth century B.C.E. by Hazael of Aram (Maeir 2012). We provide here a detailed description of these remains and the circumstances surrounding their deaths using standards published in Bass 1995 to determine their age and sex, and the Munsell color chart (Ellingham et al. 2015) to estimate the extent and pattern of burning on the bodies.

Objective. Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality. Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995–2013 at a single pediatric medical center. Results. 110 patients were enrolled in the study. Mean age was 10.7 ± 5 . 27 yrs. (range: 1 month–24 yrs). Forty-five children (42 % ) had dysplastic kidneys and 19 (17.5 % ) had focal segmental glomerulosclerosis. Twenty-five (22.7 % ) received peritoneal dialysis, 59 (53.6 % ) hemodialysis, and 6 (23.6 % ) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25–17.54 years). Mean follow-up was 13.5 ± 5 . 84 yrs. Seventy-nine patients (71.8 % ) underwent successful transplantation, 10 (11.2 % ) had graft failure, and 8 (7.3 % ) continued dialysis without transplantation. Twelve patients (10.9 % ) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84 % : 90 % for patients older than 5 years and 61 % for younger patients. Conclusions. Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications.

Background Incremental hemodialysis follows the concept of adjusting dialysis dose according to residual kidney function. Data on incremental hemodialysis in pediatric patients is lacking. Methods We conducted a retrospective analysis of children initiating hemodialysis between January 2015 and July 2020 in a single tertiary center, comparing the characteristics and outcomes of those who commenced with incremental hemodialysis vs with conventional thrice-weekly regimen. Results Data on forty patients, 15 (37.5%) on incremental hemodialysis and 25 (63%) on thrice-weekly hemodialysis were analyzed. No differences in age, estimated glomerular filtration rate and metabolic parameters were noted between groups at baseline, but there were more males (73 vs 40%, p  = 0.04), more patients with congenital anomalies of kidney and urinary tract (60 vs 20%, p  = 0.01), higher urine output (2.5 ± 1 vs 1 ± 0.8 ml/kg/h, p  < 0.001), lower use of antihypertensive medications (20 vs 72%, p  = 0.002) and lower prevalence of left ventricular hypertrophy (6.7 vs 32%, p  = 0.003) in the incremental hemodialysis group vs thrice-weekly hemodialysis. During follow up, 5 (33%) incremental hemodialysis patients were transplanted, 1 (7%) remained on incremental hemodialysis at 24 months, and 9 (60%) transitioned to thrice-weekly hemodialysis at a median (IQR) time of 8.7 (4.2, 11.8) months. At last follow up, fewer patients who initiated incremental hemodialysis had left ventricular hypertrophy (0 vs 32%, p  = 0.016) and urine output < 100 ml/24 h (20 vs 60%, p  = 0.02) compared to thrice-weekly hemodialysis, with no significant differences in metabolic or growth parameters. Conclusion Incremental hemodialysis is a viable option for initiating dialysis in selected pediatric patients, that may help improve patients’ quality of life and reduce dialysis burden without compromising clinical outcome. Graphical abstract

Background Genetic kidney diseases contribute a significant portion of kidney diseases in children and young adults. Nephrogenetics is a rapidly evolving subspecialty; however, in the clinical setting, increased use of genetic testing poses implementation challenges. Consequently, we established a national nephrogenetics clinic to apply a multidisciplinary model. Methods Patients were referred from different pediatric or adult nephrology units across the country if their primary nephrologist suspected an undiagnosed genetic kidney disease. We determined the diagnostic rate and observed the effect of diagnosis on medical care. We also discuss the requirements of a nephrogenetics clinic in terms of logistics, recommended indications for referral, and building a multidisciplinary team. Results Over 24 months, genetic evaluation was completed for a total of 74 unrelated probands, with an age range of 10 days to 72 years. The most common phenotypes included congenital anomalies of the kidneys and urinary tract, nephrotic syndrome or unexplained proteinuria, nephrocalcinosis/nephrolithiasis, tubulopathies, and unexplained kidney failure. Over 80% of patients were referred due to clinical suspicion of an undetermined underlying genetic diagnosis. A molecular diagnosis was reached in 42/74 probands, yielding a diagnostic rate of 57%. Of these, over 71% of diagnoses were made via next generation sequencing (gene panel or exome sequencing). Conclusions We identified a substantial fraction of genetic kidney etiologies among previously undiagnosed individuals which influenced subsequent clinical management. Our results support that nephrogenetics, a rapidly evolving field, may benefit from well-defined multidisciplinary co-management administered by a designated team of nephrologist, geneticist, and bioinformatician. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information