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Infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia, admission to a neonatal intensive care unit (NICU), and not being exclusively breastfed. Many clinicians encourage women with diabetes in pregnancy to express and store breastmilk in late pregnancy, yet no evidence exists for this practice. We aimed to determine the safety and efficacy of antenatal expressing in women with diabetes in pregnancy.We did a multicentre, two-group, unblinded, randomised controlled trial in six hospitals in Victoria, Australia. We recruited women with pre-existing or gestational diabetes in a singleton pregnancy from 34 to 37 weeks' gestation and randomly assigned them (1:1) to either expressing breastmilk twice per day from 36 weeks' gestation (antenatal expressing) or standard care (usual midwifery and obstetric care, supplemented by support from a diabetes educator). Randomisation was done with a computerised random number generator in blocks of size two and four, and was stratified by site, parity, and diabetes type. Investigators were masked to block size but masking of caregivers was not possible. The primary outcome was the proportion of infants admitted to the NICU. We did the analyses by intention to treat; the data were obtained and analysed masked to group allocation. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000217909.Between June 6, 2011, and Oct 29, 2015, we recruited and randomly assigned 635 women: 319 to antenatal expressing and 316 to standard care. Three were not included in the primary analysis (one withdrawal from the standard care group, and one post-randomisation exclusion and one withdrawal from the antenatal expressing group). The proportion of infants admitted to the NICU did not differ between groups (46 [15%] of 317 assigned to antenatal expressing vs 44 [14%] of 315 assigned to standard care; adjusted relative risk 1·06, 95% CI 0·66 to 1·46). In the antenatal expressing group, the most common serious adverse event for infants was admission to the NICU for respiratory support (for three [1%] of 317. In the standard care group, the most common serious adverse event for infants was moderate to severe encephalopathy with or without seizures (for three [1%] of 315).There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breastmilk from 36 weeks' gestation.Australian National Health and Medical Research Council.

Four patients who had been on regular haemodialysis for periods of 31/2 to 7 years became hypophosphataemic with plasma-phosphate concentrations of 2.5 mg/dl or less before dialysis. None of them had been taking oral phosphate-binders for 2 years or more. Histologically all the patients had an excess of osteoid on bone biopsy. Intestinal absorption of phosphate and calcium was impaired, despite normal or high serum-25-hydroxycholecaliferol concentrations. Treatment with oral dihydrotachysterol resulted in corrections of the phosphate malabsorption and increases in plasma-phosphate concentration. The initial low plasma-phosphate values in these patients before dialysis probably reflected a state of phosphate depletion caused by the combination of malabsorption, loss during dialysis, and a low dietary intake.

Patients on continuous ambulatory peritoneal dialysis (CAPD) were studied for three years. 29 of them who had been on CAPD for six months or more were compared with patients on intermittent peritoneal dialysis (IPD) and on haemodialysis (HD). CAPD patients had significantly higher levels of HDL-cholesterol than HD patients. Urea, potassium, phosphate, and urate levels were significantly lower, and haemoglobin levels significantly higher, than in the IPD and HD groups. 43 CAPD patients studied had a peritonitis rate of 2.22 episodes per patient-year. CAPD offers an alternative form of dialysis to those unsuitable for HD, but until peritonitis rates can be reduced CAPD cannot rival HD as a long-term treatment.

Patients with end-stage chronic renal failure on maintenance haemodialysis treatment show both a progression and an increased incidence of metabolic bone disease and soft-tissue calcification. The biochemical variables associated with calcium homœostasis have been measured in a group of 80 patients with end-stage chronic renal failure on haemodialysis. The patients were classified into two groups, those with and those without disordered calcium homœostasis, on the basis of a radiological survey. There were no significant differences in the biochemical variables measured between the two groups, except for plasma-alkaline-phosphatase activity, and even this was of limited discriminatory value. The patients with disordered calcium homœostasis had been receiving maintenance haemodialysis treatment over significantly more months than had the other patients. It is proposed that haemodialysis itself may play an important role in the aetiology of the progressive metabolic bone disease and extraosseous calcification in patients with end-stage chronic renal failure receiving this treatment.

Between March, 1969, and December, 1970, the London and Regional Transplant Group, which includes twenty-one centres in the United Kingdom and Eire, has been concerned with the exchange of 162 cadaver kidneys for transplantation. By December, 1970, the number of potential recipients awaiting kidneys had increased to over 300, and the proportion of well to poorly matched transplants had become greater, so that more than 55% are now in the well-matched category. The results indicate that the ante-mortem management of the donor is much more important than ischaemic times per se for the subsequent performance of the transplants, in that kidneys from mechanically ventilated individuals were functionally superior. The findings with regard to the influence of the level of HL-A matching support the concept that this system is of major importance with regard to kidney-graft survival.

Kidney-graft survival in 349 cadaver renal transplants followed up for between six months and two years after transplantation has been analysed. A significantly better survival is seen when donor and recipient are matched for three or more of the HL-A antigen sites, and a better prediction of graft survival is obtained when matching for 2nd locus antigens alone than for 1st locus antigens alone. The existence of a gene or series of genes controlling immune responses to HL-A antigens is postulated and a possible means of identifying its effects is presented with a view to the selection of potentially unresponsive recipients for whom an HL-A incompatible kidney graft may be acceptable. Preliminary results of the mixed-lymphocyte-culture tests performed between well-matched donors and recipients shows that the degree of stimulation parallels HL-A match grade.

It is hypothesised that chronic progressive kidney disease may be mediated by abnormalities of lipid metabolism. A series of self-perpetuating secondary events follows an initial glomerular injury. Increased glomerular basement membrane permeability leads to loss of lipoprotein lipase activators, resulting in hyperlipidaemia. Circulating low-density lipoprotein binds with glycosaminoglycans in the glomerular basement membrane and increases its permeability. Filtered lipoprotein accumulates in mesangial cells and stimulates them to proliferate and produce excess basement membrane material. The proximal tubular cells metabolise some of the filtered lipoprotein and the remainder are altered on passage down the nephron. Luminal apoprotein precipitates, initiating or aggravating tubulo-interstitial disease, if the intraluminal pH is close to the isoelectric point of the apoprotein. The hypothesis offers new approaches to the study of chronic progressive kidney disease by proposing a major pathogenetic role for lipid abnormalities.

Between April, 1970, and June, 1971, 32 cadaveric kidneys were exchanged between centres on the Continent of Europe and the United Kingdom and Eire, primarily on the basis of HL-A matching. 87 % of the kidneys were transplanted into recipients with one or no detectable donor incompatibilities, including 3 " full house ", fourantigen-identical matches. 23 kidneys (72%) are still functioning. The ischaemia-time did not adversely affect the outcome of the transplant. This matching of donors and recipients was better than could be achieved locally within the country of origin, and consisted largely of kidneys of rare HL-A phenotype or commoner HL-A phenotypes when these were associated with less common ABO blood-groups. The results are encouraging and lead to the hope that future exchanges will include all European donors and recipients within a unified collaborative scheme.