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Serum samples from 446 Italian blood donors between 18 and 65 years of age were analysed for the presence of IgG against parvovirus B19 capsid proteins VP1 and VP2 including conformational and linear epitopes. The overall prevalence of IgG against parvovirus B19 capsid proteins VP1 and VP2 against at least one antigen type was 79·1%. No significant difference was found between men and women. In the 18–27 years age group, 77·0% of the population had experienced infection with the virus, reaching 88·5% in the 48–57 years age group. The overall prevalence of IgG was 78·0% against conformational VP1+VP2 antigens, 74·9% against conformational VP2, 70·9% against linear VP1 and 23·3% against linear VP2 in the analysis of the IgG response against different conformational and linear epitopes of VP1 and VP2. Although IgG against conformational VP1+VP2, conformational VP2 and linear VP1 was present in more than 60% of subjects in all age groups, IgG against VP2 linear antigens was present in only 32% of subjects in the 18–27 years age group and then decreased to 20·5% in the 28–37 years age group. A different trend was noted when IgG positivity against linear and conformational epitopes was analysed separately in men and women. A significant increase was found in seroprevalence of IgG against VP2 conformational antigens with increasing age in males and a significant decrease in seroprevalence of IgG against VP2 linear antigens in women with increasing age.

We conducted a controlled trial to investigate the long-term effects of treatment with methylprednisolone and chlorambucil in patients with idiopathic membranous nephropathy. We have previously reported that after a mean of 31 months, treated patients did better. We now report the results of a longer follow-up. Eighty-one patients with proteinuria (≥3.5 g per day) and biopsy-proved membranous nephropathy were randomly assigned to receive either supportive therapy alone or a six-month course of corticosteroids alternated with chlorambucil (0.2 mg per kilogram of body weight per day) every other month. Methylprednisolone was first given intravenously in three pulses (1 g per day) and was then given orally (0.4 mg per kilogram per day) for 27 days. The patients were followed for 2 to 11 years (median, 5). Two patients in the control group and one in the treatment group died. At the last follow-up visit, 9 of 39 patients assigned to the control group (23 percent) and 28 of 42 patients assigned to the treatment group (67 percent) did not have the nephrotic syndrome. At five years there were more remissions of the nephrotic syndrome in treated patients than in controls (22 of 30 vs. 10 of 25; P = 0.026). Compared with base-line values, the mean reciprocal of the plasma creatinine level declined significantly in the control group (33 percent; P = 0.0002) but not in the treatment group (6 percent; P not significant). Plasma creatinine increased by 50 percent or more in 19 controls (49 percent) and in 4 treated patients (10 percent). We conclude that a six-month course of methylprednisolone and chlorambucil can bring about sustained remission of the nephrotic syndrome and help to preserve renal function in patients with idiopathic membranous nephropathy. (N Engl J Med 1989; 320:8–13.) IDIOPATHIC membranous nephropathy is one of the most common glomerular diseases in adults and occurs worldwide. Its treatment is still controversial. Both retrospective and prospective controlled trials have produced conflicting conclusions about the effectiveness of corticosteroids and cytotoxic agents. 1 2 3 4 5 6 7 In 1976 we started a multicenter, randomized, prospective trial in patients with idiopathic membranous nephropathy to assess the effects of a therapy consisting of methylprednisolone and chlorambucil, each given every other month for six months. We have published early results that show that treated patients had appreciably more remissions of the nephrotic syndrome and better-preserved renal function than untreated controls. 8 , 9 However, . . .

In animals with experimentally induced renal disease, drugs that inhibit angiotensin-converting enzyme reduce glomerular-capillary pressure, inhibit renal cellular growth, and reduce glomerular-capillary permeability to protein, thus reducing proteinuria and preventing the development of glomerulosclerosis. 1 – 4 Whether this protective effect also occurs in humans is less clear. In patients with diabetes and incipient nephropathy, angiotensin-converting–enzyme inhibitors prevent the progression from microalbuminuria to proteinuria, 5 , 6 whereas in patients with overt nephropathy, these drugs provide protection against a deterioration in renal function, an effect that is independent of their antihypertensive properties. 7 Small studies suggest that the drugs may have a similar kidney-protecting effect . . .

The D allele of the angiotensin-converting enzyme (ACE) gene has been linked with diabetic nephropathy and IgA glomerulonephritis and with faster renal disease progression. The association of this allele with nephroangiosclerosis has been scarcely investigated. We have tested this association in 45 hypertensive patients (all whites) with well defined nephroangiosclerosis (diagnosis established on the basis of renal biopsy in all cases) and moderate to severe renal failure. As studies of genetic association of small size often produce conflicting results, besides a control group of 343 Italian patients with essential hypertension and normal renal function, we elected to use also a very large control group of race-matched subjects taken from a meta-analysis of 27,565 whites. The proportion of patients with the D allele (64%) was higher in patients with nephroangiosclerosis than that in Italian hypertensives (54%) and in whites (54%). DD and DI genotypes were more prevalent in patients than in control groups. The dominant model (DD and DI v II: nephroangiosclerosis v Italian controls: χ 2 = 6.19, P = .012; nephroangiosclerosis v whites χ 2 = 6.86, P = .009) fitted the data better than the codominant and the recessive model ( P ≤ .022). The D allele is associated with nephroangiosclerosis with a dominant effect in the sample of patients studied. Although intervention studies are needed to see whether these findings imply a causal association, our data suggest that this allele may at least act as disease marker in nephroangiosclerosis.

The double-differential production cross-section of positive pions, , measured in the HARP experiment is presented. The incident particles are 8.9 GeV/c protons directed onto a beryllium target with a thickness of 5% of a nuclear interaction length. The measured cross-section has a direct impact on the prediction of neutrino fluxes for the MiniBooNE and SciBooNE experiments at Fermilab. After cuts, 13 million protons on target produced about 96000 reconstructed secondary tracks which were used in this analysis. Cross-section results are presented in the kinematic range 0.75 GeV/c≤pπ≤ 6.5 GeV/c and 30 mrad≤θπ≤ 210 mrad in the laboratory frame.

Sixty-seven adults with idiopathic membranous nephropathy and the nephrotic syndrome were randomly assigned to symptomatic treatment only or to a six-month course of methylprednisolone alternated with chlorambucil every other month. Patients were followed for one to seven years. At the end of follow-up (mean of 31.4±18.2 months for the treated group and 37.0±22.0 for the control group) 23 of 32 treated patients were in complete or partial remission, as compared with 9 of 30 control patients (P = 0.001). Twelve of the treated patients were in complete remission, as compared with only two of the controls. In the treated group there were no changes in renal function during follow-up, whereas in the control group the reciprocal of the plasma creatinine level, which is proportional to the creatinine clearance, decreased significantly (P = 0.00017) after two years of follow-up. Side effects were minimal in all treated patients except two, who were dropped from the study because of peptic ulcer and gastric intolerance to chlorambucil. We conclude that steroid and chlorambucil treatment for six months favors remission of the nephrotic syndrome in adults with idiopathic membranous nephropathy and can preserve renal function for at least some years. (N Engl J Med 1984; 310:946–50.) IDIOPATHIC membranous nephropathy is a frequent cause of the nephrotic syndrome in adults. The outcome of the disease may be variable. Spontaneous remission can occur in some patients and kidney function may be stable for years in others, but approximately half of all patients die or have end-stage renal failure within 10 to 15 years after the onset of symptoms. 1 , 2 The usefulness of therapy for intervening in the natural course of membranous nephropathy is still debated. Both uncontrolled 1 , 3 4 5 and controlled 6 trials have shown no benefit from the use of corticosteroids, but other studies have reported favorable results when high doses . . .

IDIOPATHIC membranous nephropathy is a primary glomerulonephritis that usually causes the nephrotic syndrome. Spontaneous remission of proteinuria may occur in some patients, but at least in whites, some 40 to 50 percent of the patients who are not treated may die or have chronic renal failure within 10 years. 1 2 3 4 The most appropriate treatment for patients with idiopathic membranous nephropathy is controversial. Two recent controlled trials did not reveal any benefit of alternate-day prednisone therapy, 5 , 6 but aggressive therapy with corticosteroids 7 or therapy with cytotoxic agents may be beneficial. 8 9 10 11 We found that treatment with methylprednisolone and chlorambucil for six months resulted in . . .

In a multicentre, randomised, prospective trial 89 patients (67 children and 22 adults) with the minimal change nephrotic syndrome were treated with three intravenous pulses of methylprednisolone followed by low dose oral prednisone for six months (group given methylprednisolone) or with high dose oral prednisone for four weeks followed by low dose oral prednisone for five months (control group). Five patients in the group given methylprednisolone and one in the control group did not respond initially. The time to response was shorter in children treated with methylprednisolone. No significant differences between the two groups were observed in the number of patients who relapsed or number of relapses per patient per year. Patients given methylprednisolone tended to relapse earlier than patients in the control group. Side effects related to treatment were significantly fewer in the group given methylprednisolone than in the control group. These data suggest that a short course of methylprednisolone pulses followed by low dose oral prednisone is only marginally less effective than a regimen of high dose oral steroids but can improve the ratio of risk to benefit associated with treatment of the minimal change nephrotic syndrome.

This study was undertaken to evaluate whether the pyrolytic carbon coating of polyethylene terephthalate induces complement activation. Complement activation induced by pyrolytic carbon-coated polyethylene terephthalate (PET+PC) in comparison with uncoated polyethylene terephthalate (PET) was assessed on whole blood collected with heparin. The activation of the classic pathway was evaluated by C4d fragment enzyme immunoassay. The activation of the alternative pathway was evaluated with Bb fragment enzyme immunoassay. The results show that uncoated PET activates the alternative pathway, but not the classic one. PET+PC does not induce complement activation, not even through the alternative pathway. Pyrolytic carbon coating therefore contributes to improving blood compatibility.

A measurement of the double-differential cross-section for the production of charged pions in proton–tantalum collisions emitted at large angles from the incoming beam direction is presented. The data were taken in 2002 with the HARP detector in the T9 beam line of the CERN PS. The pions were produced by proton beams in a momentum range from 3 GeV/c to 12 GeV/c hitting a tantalum target with a thickness of 5% of a nuclear interaction length. The angular and momentum range covered by the experiment (100 MeV/c ≤p< 800 MeV/c and 0.35 rad ≤θ< 2.15 rad) is of particular importance for the design of a neutrino factory. The produced particles were detected using a small-radius cylindrical time projection chamber (TPC) placed in a solenoidal magnet. Track recognition, momentum determination and particle identification were all performed based on the measurements made with the TPC. An elaborate system of detectors in the beam line ensured the identification of the incident particles. Results are shown for the double-differential cross-sections d2σ/dpdθ at four incident proton beam momenta (3 GeV/c, 5 GeV/c, 8 GeV/c and 12 GeV/c). In addition, the pion yields within the acceptance of typical neutrino factory designs are shown as a function of beam momentum. The measurement of these yields within a single experiment eliminates most systematic errors in the comparison between rates at different beam momenta and between positive and negative pion production.