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BackgroundWork is an important outcome for people with inflammatory arthritis (IA including PsA, RA, AxSpA) and osteoarthritis (OA). It is known that people with IA and OA are at increased risk of sick leave and have to stop working early due to ill health. In addition to being at increased risk of becoming work disabled and increased absenteeism, high levels of presenteeism (i.e. reduced productivity/limited ability to work due to ill health whilst at work) have also been reported. Several instruments exist to measure presenteeism, including single-item global measures and multi-item instruments. In some studies using single-item global instruments may be more feasible. However, available global instruments differ in concept, recall period and reference. It is important to understand which of the measures have good psychometric properties before using them in clinical studies.ObjectivesTo assess the psychometric properties of four global presenteeism instruments.MethodsPatients with IA or OA were recruited via rheumatology outpatient clinics to a large international, longitudinal observational study including 8 European countries and Canada. Participants completed a survey at baseline, 1, 2, 3, 4 wks, 2 months and 3 months. The four global measures of presenteeism included: Work Productivity and Activity Impairment Questionnaire (WPAI), Work Productivity Scale–Rheumatoid Arthritis (WPS-RA), Work Ability Index (WAI) and the Quality*Quantity questionnaire (QQtotal/10) scale. To facilitate score interpretation the WAI and QQtotal were reversed. Pain was measured using an 11-point Likert scale. Spearman correlations were calculated between the presenteeism measures and the Workplace Activity Limitations Scale (WALS), a validated multi-item measure of presenteeism, and HAQ to evaluate construct validity (validity: r r >0.50-r >0.70=high). Test-retest reliability of the 4 presenteeism scales (baseline-1wk) was measured applying ICC in patients with stable disease (i.e. same pain score at baseline and 1wk) (reliability: ICC0.75=excellent). Responsiveness during 3 months was measured comparing patients with improvement in pain score (>1 point improvement in pain score (~MCID pain)) with patients with no change or worsening in pain score. The two groups were compared applying Mann Whitney U test.ResultsThis international study included 550 patients with a mean age of 47.8 (SD 9.9) yrs and 61.4% were female. Mean (SD) disease duration since diagnosis was 10.8 (10.4) yrs and 91.2% had IA. Mean (SD) presenteeism scores at baseline were: WPAI=2.9 (2.7); WPS-RA=3.4 (2.7); WAI=2.7 (2.4); and QQtotal=3.1 (3.2). The correlations between the global measures and with WALS and HAQ were moderate to good, except for QQtotal and HAQ which was low (Table 1). In patients with the same stable pain scores at baseline-1wk (n=141) ICC scores were good to excellent, respectively: WPAI (0.771), WPS-RA (0.752), WAI (0.663), and QQtotal (0.650). An improvement in pain during the 3 month study duration was observed in 145/381 (38%) of the patients. In these patients a significant reduction in mean (SD) change presenteeism was observed for all four presenteeism scales compared to those with no change or worsening of the pain score: WPAI (-1.0 (2.37) vs 0.68 (2.40), pTable 1.WPAIWPS-RAWAIQQtotalWALSHAQWPAI-0.81640.59920.51840.62690.5592WPS-RA-0.58360.52170.60550.5669WAI-0.58660.52310.5168QQtotal-0.50250.4367ConclusionThe psychometric properties of all 4 global presenteeism scales were moderate to good, with slightly better scores for both the WPS-RA and WPAI instruments both measuring the impact of OA and IA on productivity.Disclosure of InterestsSuzanne Verstappen Consultant of: EUOSHA, Grant/research support from: AbbVie, BMS. EULAR, Annelies Boonen Speakers bureau: Abbvie / Galapagos, Consultant of: Galapagos, Sarah Wilkinson: None declared, Dorcas Beaton: None declared, Ailsa Bosworth: None declared, José Canas da Silva: None declared, Gloria Crepaldi: None declared, Sabrina Dadoun: None declared, Cathie Hofstetter: None declared, Carina Mihai Speakers bureau: Boehringer-Ingelheim, Mepha, MED Talks Switzerland, Consultant of: Boehringer-Ingelheim, Janssen, Grant/research support from: Roche, Boehringer-Ingelheim, Sofia Ramiro Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: Grant: AbbVie, Galapagos, Novartis, Pfizer, UCB, Garifallia Sakellariou Consultant of: Abbvie, BMS and Galapagos., Grant/research support from: Abbvie, BMS and Galapagos., Sandra Meisalu: None declared, Johan K Wallman Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Grant/research support from: AbbVie, Amgen, Eli Lilly, Novartis, Pfizer., Diane Lacaille: None declared

BackgroundMusculoskeletal ultrasonography (MSUS) is a useful tool for the diagnosis of several Rheumatic and Musculoskeletal Diseases (RMDs) but its role in the diagnostic pathways in clinical practice is still unclear as feasibility issues limit its application as a bed side technique.ObjectivesTo optimize the use of US in clinical practice, the MSUS Study Group of the Italian Society for Rheumatology aimed to develop an algorithm combining US with clinical and laboratory findings to improve the differential diagnosis among patients presenting with joint swelling.MethodsBased on a systematic literature review1 and experts’ opinion, MSUS Study Group Members attempt to identify a set of statements including the main US elementary lesions useful for US scanning in the suspicion of Rheumatoid arthritis (RA), Psoriatic arthritis (PsA), Rheumatic Polymyalgia (PMR), Gout, Calcium Pyrophosphate Deposition Disease (CPPD), Osteoarthritis (OA). Then, the MSUS Study Group defined through a survey and ranked in a 1000minds exercise the most important clinical/laboratory findings for the differential diagnosis of those diseases. Higher-ranked items were fitted in an algorithm driving the differential diagnosis of RMDs to a reduced spectrum of 2 to 4 possible diseases. Finally, the algorithm supported the performance of US according to the established scans for those specific diseases. To assess the algorithm’s performance, a pilot study was conducted on 59 patients, comparing the algorithm-based diagnosis with the final diagnosis based on rheumatologist’s experience and/or on classification criteria.ResultsSets of elementary US lesions and a scanning protocol for each included pathology were created (Table 1), optimized towards high sensibility and specificity. Among the findings evaluated, the age (Table 1.Elementary ultrasound lesions and joints to be scanned for each included pathologyDiseaseSites to scanUS elementary lesionsRAII-IV MCPsSynovial Hypertrophy (SH), Power Doppler (PD), erosionsWristV MTPPsAII-III MCPsPeritendonitisPIPsEnthesitisSoft tissue oedemaFlexor tendons of the handsTenosynovitisSoft tissue oedemaAchille’s tendon enthesisPD, erosionsProximal patellar tendon enthesisCPPDKnees (menisci and Hyaline Cartilage)CPP depositsWrist (triangular fibrocartilage complex)Any involved sitesCPP deposits, SH, PDGoutKneesDouble contour, tophiI MTPInvolved sitesSHPDOAInvolved sitesOsteophytesCartilage changesPMRShouldersBursitisArthritisRotator cuff integrityFigure 1.The final algorithmConclusionThe diagnostic algorithm produced in this pilot study correctly classified patients with the most prevalent RMDs in clinical practice. A longitudinal study on a large sample size is ongoing to evaluate the added value of US when implemented in this algorithm regarding diagnostic certainty, accuracy and early diagnosis.References[1]Sakellariou G, Scirè CA, Adinolfi A, Batticciotto A, Bortoluzzi A, Delle Sedie A, et al. Differential Diagnosis of Inflammatory Arthropathies by Musculoskeletal Ultrasonography: A Systematic Literature Review. Front Med. 7 maggio 2020;7:141.Disclosure of InterestsNone declared

Within the general framework of investigating novel routes for solar hydrogen production, the idea of combining a solar centrifugal particle receiver with sulphur thermochemical cycles, involving SO3 dissociation to SO2 and O2 as key step, is pursued. In this perspective, the present work concerns the synthesis, development, evaluation and characterisation of particles suitable to operate as media for direct solar irradiation absorption, transfer and storage as well as catalysts for the SO3 dissociation reaction. Commercial bauxite-based proppants were modified to incorporate raw materials with elements known for their catalytic activity with respect to the SO3 dissociation, namely iron, copper, manganese and their combinations. The catalytic activity of such modified proppants was tested in fixed bed reactor test rigs at 850 °C and ambient pressure with concentrated liquid sulphuric acid as feedstock. Extensive screening tests complemented by physicochemical properties measurements before and after catalytic testing, identified systems that at 850 °C, 1 atm and Gas Hourly Space Velocity of 11,800 h−1 could achieve high SO3 conversions (60%, corresponding to 68% of equilibrium value) for over 125 h of continuous operation. This performance was achieved without degradation of their mechanical strength which, in fact exhibited a slight increase from 53 N in the fresh state to 55 N after long-term exposure to reaction conditions. However such systems were susceptible to colour alteration, affecting adversely their absorptance in the 1000–2500 nm wavelength range. Compositions with the best combination of properties are scheduled for large-scale synthesis and on-site testing in a pilot-scale solar receiver.

BackgroundUltrasound (US) has proven to be an excellent imaging technique for detecting calcium pyrophosphate (CPP) deposition disease (CPPD); it is also widely available and inexpensive and can be performed during the clinic visit making it the preferred imaging modality for many rheumatologists. However, no validated grading systems have yet been developed allowing for a quantification of the extent of crystal deposition in CPPD.ObjectivesThe aim of this study was to develop a scoring system for the quantification of CPP deposition at a patient level according to the OMERACT framework.MethodsAs part of the OMERACT methodology, we performed a systematic literature review (SLR) and meta-analysis aimed to estimate the prevalence of CPP deposition in peripheral joints by imaging, in order to identify relevant joints for CPPD monitoring. A preliminary survey was also circulated among the members of the OMERACT US – CPPD working group to collect their own suggestions according to their personal experience. Subsequently, a Delphi survey was prepared and circulated between members of the group, including statements that reflected both the results of the SLR and of the preliminary survey. In total, 32 statements were generated regarding the type of scoring for single structures, the sites to be included, the final scoring at patient level, and the scanning technique. Participants were asked to reply on a 5-point Likert scale (1, strongly disagree to 5, strongly agree) and agreement was achieved when 4 and 5 grades reached 75% or more of concordance. In case of disagreement, new statements were proposed according to the members’ suggestions and circulated for voting in a subsequent round. After agreement of a scoring system, the validation process began. Two rounds of a web-based exercise on static images were conducted on 120 images representing equally all sites under investigation and all degrees of crystal deposition, to assess the intra- and inter-reader reliability of the new scoring system. Representative images of the scoring system were visible throughout the entire exercise in order to facilitate the scoring of the lesions.ResultsThree Delphi rounds were needed to reach agreement on all items. 32/41 members of the OMERACT US-CPPD working group replied in the first round, 26/32 in the second, and 25/26 in the third round. Twenty statements were approved in the first round, 3 in the second, and 3 in the third round. Only the knees (menisci and hyaline cartilage) and the triangular fibrocartilage of the wrist were included in the final score, using a four-grade system (0-3). It was decided that each anatomical structure should be scored separately and then also summed in order to define the joint score. The sum of the assessed joints was the total score at patient level. The final scoring system with the definitions and the relative technical notes is represented in Figure 1. 33/41 members participated to the reliability exercise. The inter-reader reliability of the scoring was substantial (kappa of 0.72), and the intra-reader reliability was almost perfect (kappa of 0.82).ConclusionThis is the first study for developing a scoring system for the extent of CPP crystal deposition in patients with CPPD. The scoring system demonstrated to be reliable in static images. The next step of the validation process is to assess the reliability of the scoring system in a patient-based exercise. This study represents a fundamental step in the OMERACT process of validating US as an outcome measure instrument, and above proposed scoring system will hopefully provide a useful tool for clinical practice and research.Disclosure of InterestsNone declared

BackgroundOver the past 20 years, despite the widespread diffusion of dedicated early arthritis clinics (EAC) and more sensitive classification criteria, the percentage of patients seen within the window of opportunity remains low, and the new RA criteria, heavily weighted on autoantibodies, may have further hindered the recognition and treatment of seronegative patients.Objectiveswe analysed changes in the diagnostic delay and clinical presentation of patients with RA admitted to the EAC of the Division of Rheumatology of the San Matteo University Hospital, Pavia, Italy, from its institution in 2005 to 2017.MethodsReferral criteria to the EAC have remained stable over the years and include ≥3 swollen joints (SJs) or, in case of 30 min. From all early arthritis patients (n=1.553), we selected 668 patients fulfilling at enrolment at least the 1987 ACR criteria for RA before December 2010 (n=345, 88.4% also fulfilling 2010 criteria), and at least the 2010 ACR/EULAR criteria after January 2011 (n=323, 63.5% also fulfilling 1987 criteria). Time from first self-reported joint symptom to referral (diagnostic delay) was compared across different time periods: (i) 2005-2007; (ii) 2008-2010; (iii) 2011-2013; (iv) 2014-2017. Clinical characteristics were collected according to standardised assessments. Data were analysed in the total population and after stratification for the autoantibody status (double negative for rheumatoid factor, RF, and anti-citrullinated protein antibodies, ACPA vs RF and/or ACPA positive).ResultsIn all, the diagnostic delay collectively increased from a mean (SD) of 20.8 (20.5) weeks before 2010 to 24.4 (20.6) weeks thereafter (p=0.02), and the proportion of patients diagnosed within 12 weeks non-significantly decreased from 39.3% to 35.3%. Still, patients presented with progressively milder inflammatory markers despite unchanged joint tenderness and patient-reported outcomes (PROs). Trends were, however, remarkably different in different autoantibody subgroups. In RF/ACPA-positive patients, a stable proportion of 41-44% was diagnosed within 12 weeks (Figure 1A). At presentation, patients had fewer SJs and lower C-reactive protein (CRP) levels; the mean decrease of SJs and CRP from 2005-2007 to 2014-2017 were -5.6 and -1.1 mg/dl, respectively (Figure 1B). The improvement in PROs was smaller but still significant over time (Figure 1C). In contrast, in autoantibody-negative patients, the proportion of patients diagnosed within 12 weeks progressively decreased from 37.9% to 25.6% (p=0.08) (Figure 1D). Furthermore, the improvement over time of inflammatory features, especially of SJs, was significant but smaller than autoantibody-patients, and PROs such as pain and global assessment of disease activity remained severely impacting with mean values of up 60 mm even in recent times (Figure 1E,F).Figure 1.Time to diagnosis and clinical presentation of autoantibody-positive and –negative patients with early rheumatoid arthritis. (A, D) Proportion of patients diagnosed within 12 weeks from symptoms’ onset among autoantibody-positive (A) and autoantibody-negative (D) rheumatoid arthritis (RA) in different time periods. (B, C, E, F) Values of swollen joints (SJC28), C-reactive protein (CRP) (B, E), and visual analogue scales (VAS) for pain and patient global assessment (PGA) of disease activity (C, F) in autoantibody-positive (B, C) and autoantibody-negative (E, F) RA in different time periods. Values are expressed as means and standard errors.ConclusionCollectively, our data indicate that a large proportion of patients with RA still lack early diagnosis despite dedicated early access to rheumatology care; from 2010 onwards, autoantibody-positive patients are diagnosed with a milder and less disabling disease, while autoantibody-negative patients are at increased risk of delayed diagnosis, and remain burdened with severe diseaseDisclosure of InterestsLudovico De Stefano Speakers bureau: Gilead, Bernardo D’Onofrio: None declared, Garifallia Sakellariou: None declared, Antonio Manzo: None declared, Carlomaurizio Montecucco Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Gilead, Pfizer, Roche, Sanofi, Serena Bugatti Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Gilead, Pfizer, Sanofi, Grant/research support from: Pfizer

Experimental efforts have shown that thermo-chemical heat storage through cyclic hydration/dehydration of the CaO/Ca(OH)2 couple requires efficient CaO-based particles, in terms of both hydration capacity and structural robustness. Acknowledging the challenge caused by high fragmentation of pure CaO particles during multi-cyclic operation in bed reactors, the development of CaO-based materials with enhanced mechanical properties is essential. Promising results have been obtained for nearly spherical structured formulations using kaolinite as binder. The combination of natural limestone with 25 wt% kaolinite rendered mechanically strong materials with a hydration capacity of up to 50% compared to the maximum hydration capacity of pure CaO. These formulations remained intact and showed stable reactivity in the course of 10 hydration/dehydration cycles. In order to obtain valid conclusions for the suitability of these materials for the here suggested reaction scheme, examination upon multiple hydration/dehydration cycles was necessary. The current work is related to the assessment of CaO-kaolinite composite materials under three different evaluation protocols, as well as to the examination of their mechanical properties through crushing strength measurements and attrition tests. For most of the materials examined, more satisfactory results were obtained for hydration and dehydration reactions in vapor-rich atmosphere at 450 and 550 °C, respectively. Multi-cyclic evaluation (50–200 cycles) confirmed the initial findings of the 10-cycle tests. The final selected composition constituted a promising material for the suggested reaction scheme and was qualified as in-principle suitable for long-term operation in pilot scale units.

Being a relatively new but quite promising field in CSP, thermochemical energy storage could be the next generation solution towards the implementation of baseload cost-effective solar thermal plants. The present work, taking place within the framework of EU-funded project PEGASUS, aims at synthesizing, shaping and experimentally evaluating the catalytic activity and main physicochemical attributes of Fe2O3−based particles. These particles can be exploited as both heat transfer fluid of the CSP plant and highly active catalysts for the key step of the SO3 dissociation reaction to produce SO2 and O2 in the framework of a solid sulfur thermochemical energy storage cycle. The experimental campaign takes place in a purpose-built setup used to evaluate the materials in a fixed bed reactor formulation at a temperature of 850°C and ambient pressure while concentrated liquid sulfuric acid (H2SO4) was used as feedstock. Based on the findings, pure Fe2O3 particles sintered at 950°C offered the most promising compromise between high SO3 conversion on the one hand and crushing strength value (i.e. a preliminary measure of thermomechanical stability) and particles’ color before and after exposure at reaction conditions on the other hand.

The present study relates to the preparation of mixed calcium oxide–alumina compositions as candidate materials for a cyclic thermochemical hydration–dehydration scheme at moderate to high temperatures (e.g. 400–600 °C) that can offer the possibility of short and long term energy storage, particularly suitable for concentrated solar power installations. The synthesized materials were assessed in terms of their cyclic hydration–dehydration performance in the temperature range of 200–550 °C. Acknowledging the fact that the particular thermochemical scheme has been identified to result in substantial cycle-to-cycle fragmentation of pure CaO particles which is detrimental to particle reactor bed concepts, one of the main purposes of using Al as additive is related to materials structural enhancement. To this respect, preliminary studies related to macro-structural integrity assessment were also conducted. In addition, the performance of synthesized material is compared to the one of natural lime (benchmark material). The additive content spanned over a wide range of Ca/Al molar ratios, namely from 95/5 to 52/48, while two different calcium oxide precursors, i.e. calcium nitrate and calcium acetate, were employed. Fresh and hydrated compositions were characterized in-detail with respect to their physicochemical properties in order to correlate different behaviors with certain attributes of the materials. Synthetic materials, both calcium nitrate and calcium acetate derived, favored the formation of Ca/Al mixed phases. The latter led to materials with higher surface areas and, for a given Ca/Al ratio, resulted to higher hydration/dehydration performance. Mixed oxides, although capable of being hydrated at ambient temperature, did not participate in the reaction scheme at temperatures ⩾200 °C and thus presence of such phases resulted in considerable decrease of hydration/dehydration capacity versus the one of natural lime. On the other hand, the presence of such mixed compositions improved, albeit not dramatically, macro-structural integrity. A relatively good combination of hydration–dehydration performance with better-than-natural lime structural integrity was achieved for the mixed materials with a Ca/Al molar ratio equal to 89/11 and 81/19 molar ratio. The Ca-precursor used in these materials slightly affected their cyclic performance with the ex-CaN ones presenting better behavior.

Strong motion recordings are the key in many earthquake engineering applications and are also fundamental for seismic design. The present study focuses on the automated correction of accelerograms, analog and digital. The main feature of the proposed algorithm is the automatic selection for the cut-off frequencies based on a minimum spectral value in a predefined frequency bandwidth, instead of the typical signal-to-noise approach. The algorithm follows the basic steps of the correction procedure (instrument correction, baseline correction and appropriate filtering). Besides the corrected time histories, Peak Ground Acceleration, Peak Ground Velocity, Peak Ground Displacement values and the corrected Fourier Spectra are also calculated as well as the response spectra. The algorithm is written in Matlab environment, is fast enough and can be used for batch processing or in real-time applications. In addition, the possibility to also perform a signal-to-noise ratio is added as well as to perform causal or acausal filtering. The algorithm has been tested in six significant earthquakes (Kozani-Grevena 1995, Aigio 1995, Athens 1999, Lefkada 2003 and Kefalonia 2014) of the Greek territory with analog and digital accelerograms. © 2018, Institute of Geophysics, Polish Academy of Sciences & Polish Academy of Sciences.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most prevalent drugs inducing hypersensitivity reactions. The aim of this analysis was to estimate the prevalence of NSAID-induced respiratory symptoms in population across Europe and to assess its association with upper and lower respiratory tract disorders.The GAThe mean prevalence of NSAID-induced dyspnea was 1.9% and was highest in the three Polish centers [Katowice (4.9%), Krakow (4.8%), and Lodz (4.4%)] and lowest in Skopje, (0.9%), Amsterdam (1.1%), and Umea (1.2%). In multivariate analysis, the prevalence of respiratory reactions to NSAIDs was higher in participants with chronic rhinosinusitis symptoms (Odds Ratio 2.12; 95%CI 1.78-2.74), asthma symptoms in last 12 months (2.7; 2.18-3.35), hospitalization due to asthma (1.53; 1.22-1.99), and adults vs children (1.53; 1.24-1.89), but was not associated with allergic rhinitis.Our study documented significant variation between European countries in the prevalence of NSAID-induced respiratory hypersensitivity reactions, and association with chronic airway diseases, but also with environmental factors.

This study aimed to clarify the role of peritoneal T-lymphocytes in peritoneal immune defense mechanisms. This study was designed to examine the changes in T-cell subpopulations during peritonitis in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Our observations were correlated to responses to treatment and with outcomes. The present study was carried out in 20 patients (8 males, 12 females) under CAPD. Peritonitis was diagnosed according to the criteria defined by the Ad Hoc Advisory Committee on Peritonitis Management. Peritoneal dialysate effluent (PDE) samples were collected from our patients, and lymphocyte subsets (CD2+, CD3+, CD3+/4+, CD3+/8+, CD3-/16+56+, CD4/CD8 ratio) were quantitated by using monoclonal antibodies. CD4/CD8 ratio was measured every day during peritonitis until the patients had completely recovered. The serial measurements of the CD4/CD8 ratio made in the PDE during peritonitis followed two patterns: the first pattern was characterized by a progressive increase in the CD4/CD8 ratio. The CD4/CD8 ratios on days 5, 6, and 7 were significantly higher than those on day 1 (P < 0.05). Overall, the patients who exhibited pattern 1 had favorable clinical courses. The second pattern was characterized by high initial CD4/CD8 ratios, which progressively decreased significantly (P < 0.05). This second pattern was associated with a delayed clinical response to treatment. Symptoms and signs of peritonitis persisted beyond 72 h. The pattern of the CD4/CD8 ratio in PDE may determine the outcome of peritonitis in CAPD patients.

The existence of barrier beaches is crucial, as they act as a buffer zone to the associated wetlands, whilst they are sensitive to climate change. The present study offers an insight into the processes controlling the formation and evolution of the Gyra barrier beach (NW coast of the island of Lefkada) in the microtidal, tectonically very active Ionian Sea under the influence of regional climate change and human interference. Such investigations are sparse in the literature. Existing information regarding regional geology, sediment availability and human intervention is combined with the collection of geophysical data, field observations and simulations of nearshore hydro- and sediment dynamics, analysis of climatic variations with respect to offshore wind/wave patterns (including storminess), in situ measurements of recent morphometric changes (2006–2008) and historical shoreline changes (since the 1960s). The recent formation and evolution (mostly under retreat) of the Gyra barrier beach is shown to be the combined result of the regional seismotectonic setting, relative increase of sea level, coastal sediment transport patterns, as well as human impact (negative) on primarily terrestrial sediment influxes. The current erosional trend of the barrier beach is associated with a shift in the wind and wave direction (from SW to NW) of extreme storm events in the Ionian Sea since the 1980s. The regional climatic variations of the last decades are well correlated with the trend of the North Atlantic Oscillation. © 2014, Springer-Verlag Berlin Heidelberg.

Objective The clinical relevance of altered lymphocyte function and its possible relation with uremic toxins such as parathyroid hormone (PTH) is not well understood. We studied the changes in cellular immunity in patients on continuous ambulatory peritoneal dialysis therapy and examined the relationship between T-lymphocyte function and plasma levels of PTH. Patients and Methods Thirty-seven patients (16 male, 21 female) were enrolled in the study. The patients were divided into 2 groups: 22 patients with increased levels of PTH and 15 patients with normal levels of PTH. Lymphocyte subsets (CD2+, CD3+, CD3+/4+, CD3+/8+, CD19+, CD3−/16+56+, CD4/CD8 ratio) were quantitated in both groups using monoclonal antibodies and flow cytometric analysis. Analysis of variance testing was performed to analyze differences between the groups. Results A significant increase in CD3 was observed in patients with increased levels of PTH (71.6±7.9 vs. 57.5±28.1, p

The immune defect in hemodialysis (HD) patients is associated with a monocyte dysfunction, including an increase in the production of proinflammatory cytokines. Blood membrane contact leads to an increase in cellular activation and sequestration into the capillary bed of the lung. The influence of the sequestration on the number of mature monocytes was studied by analyzing the fate of monocytes, particularly, the CD14+CD16+ subpopulation, during HD treatment. In thirty stable HD patients, the distinct cell populations were determined by differential blood counts and flow cytometry. Patients with diabetes or systemic vasculitis, those showing evidence of infectious complications or malignancy, or those taking immunosuppressive medications were excluded from the study. Cells from this study population were analyzed before the start, 30 min thereafter, and at the end of HD treatment, each time using a different dialyzer: hemophan, methylmethacrylate (PMMA), triacetate membrane, cuprophane/vitamin E, acrylonitrile, and sodium methallylsulfonate polymer (AN69). The CD14+CD16+ subset decreased at 30 min and remained suppressed for the course of dialysis. To examine whether currently used biocompatible membranes differ in their effect on the sequestration of monocyte subpopulations, temporal monocytic changes were comparatively analyzed during HD with a different dialyzer. The drop in the first 30 min until the end of HD treatment was significant (p

The syntheses of a variety of substituted diaminomaleonitriles, with variable nitrogen substituents, were undertaken. Linstead macrocyclization of the resulting diaminomaleonitriles gave access to a wide range of functionalized porphyrazine-octaamines and hexamines and norphthalocyaninediamines. Conversion of these macrocycles into metallic derivatives and studies of their electronic absorption, solubility and electrochemistry are described. These flexible tetraazaporphyrins show potential in a range of applications including biomedical agents, novel charge–transfer complexes, chemical sensors, novel electronic materials and non-linear optics.

Objective: The clinical relevance of altered lymphocyte function and the possible relation with uremic toxins, such as parathyroid hormone (PTH) is not well understood. We studied the changes in cellular immunity in patients in hemodialysis (HD) therapy and examined the relationship between T-lymphocyte function and plasma levels of PTH. Patients and Methods: Thirty-four patients (14 male) were enrolled in this study (mean age: 63.20 ± 10.01 years, M ± SD, 12 h/week HD). Our study population was divided into two groups: 18 patients with increased levels of PTH and 16 patients with normal levels of PTH. Lymphocyte subsets (CD2 +, CD3 +, CD3 +/4 +, CD3 +/8 +, CD19 +, CD3-/16 + 56 +, CD4/CD8 ratio) were quantitated in both groups using monoclonal antibodies (Immunotech, Coulter) and flow cytometric analysis. Following analysis of variance (ANOVA) testing was performed to test differences between groups (SPSS version 10). Results: A significant increase of CD2 was noticed in patients with increased levels of ...

Purpose. The objective of this study was to evaluate the diagnostic value of serum procalcitonin (PCT) in hemodialysis (HD) patients and its correlation to other traditional inflammatory markers. M...

The syntheses of two novel CuI-bis(benzonitrile) complexes of the type [Cu(dCNn)2][PF6] {where dCNn = NCPhO(CH2)nOPhCN, n = 3, 4} are described. Both compounds have been characterized by X-ray crystallography. To our surprise, and although the two complexes were quite similar, two very distinct structures were obtained. For the [Cu(dCN4)2][PF6] complex, a tetrahedral geometry was observed whereas for [Cu(dCN3)2][PF6], a polymeric assembly was formed. A further extension of this work involved the syntheses of two threaded species bearing the M30 macrocycle, Cu metal and a dCNn ligand. The formation of the desired complexes was confirmed by means of mass spectrometry as well as 1-D and 2-D 1H NMR spectroscopy. Finally, the cyclic voltammograms of all 4 new species were recorded giving rise to redox potentials ranging from +0.88 to +1.25 V. These new threaded complexes are of particular interest since they can form the basis of novel rotaxane structures. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2004)

Objective. The clinical efficacy of therapeutic apheresis is still controversial. We undertook a retrospective review of apheresis treatment to ascertain its safety and efficacy. Methods. We reviewed 31 patients (13 male, 18 female). Plasmapheresis was performed on 7 patients with hematologic disorders, 5 patients with neurologic disorders, 6 patients with systemic diseases, and 3 patients with Lyell syndrome. Immunoadsorption onto protein A sepharose was evaluated as rescue therapy in 7 patients. Low-density lipoprotein (LDL) apheresis was performed on 3 patients. Results. There were five mortalities due to serious complications of their primary disease. Most complications were mild such as hypotension and hypocalcemia. Two patients who received LDL apheresis had severe anaphylactic reactions. Apheresis was effective in the remaining 24 patients. Conclusions. The therapeutic apheresis consists of a continuously improving therapeutic method for diseases with high mortality and morbidity, especially in cases with poor outcome by using current medications.

Co-macrocyclizations of 2,3-dipropylmaleonitrile and 2,3-di-(4-(methoxycarbonyl)phenyl)maleonitrile, respectively, with N , N ′-dibenzyl- N , N ′-di-(11-tetrahydropyranyloxy-3,6,9-trioxo-undecyl))maleonitrile and N , N , N ′, N ′-tetramethylmaleonitrile were used to prepare derivatives of the 4,5-diamino-porphyrazine systems including the zinc(II) complexes. Subsequent oxidation of the macrocycles with potassium permanganate gave the corresponding seco -porphyrazines. These were shown to be efficient sensitizers for the production of singlet oxygen ( Φ Δ =0.15–0.57) by the determination of their photophysical properties.

Base-catalyzed cross condensation of dipropylmaleonitrile 1 with bis(dimethylamino)maleonitrile 2 in an equimolar ratio afforded the porphyrazines 3a, 4a, 5a, 6a and 7a. Subsequent demetalation of 5a with TFA followed by remetalation with Zn(OAc)(2) gave ligand 5c in good yield. Compound 5c was, in turn, selectively oxidized and further peripherally functionalized using Pt(PhCN)(2)Cl(2) and PdCl(2) to yield the novel seco solitaire porphyrazines 10a and 10b. The photophysical profiles of the seco solitaire porphyrazines 10a and 10b were evaluated by means of absorption, emission, and transient absorption spectroscopy. The new pigments 10a and 10b were found to be photochemically more stable than the solitaire complexes 3d and 3e and mediated the generation of singlet oxygen with quantum yields of 0.59 and 0.45, respectively.

Objective ( s ): To present our 10 years experience in the management of ureteric injuries occurring during gynecological surgery. Study design : Seventy-six patients had a variety of injuries. In 29 cases, the ureteric damage was diagnosed intraoperatively. Management of early-diagnosed injuries included suturing, ligature removal, end-to-end anastomosis, and reimplantation of the ureter. In 47 cases, the injury was diagnosed postoperatively. Ureteric catheterization was attempted in all cases presenting with obstruction. Catheterization failures were managed with ureterolysis, and reimplantation. Small ureteric fistula were managed with catheterization, and large communications with reimplantation. Two cases with urinomas were treated with surgical evacuation and anastomoses. Results : Management of early-diagnosed injuries was relatively easy in most cases. Postoperatively-diagnosed injuries were more difficult to treat. Catheterization failed in 28/44 (65.9%) ureters and surgical re-exploration was necessary. Long-term morbidity was minimal and no relapses occurred. Conclusion ( s ): Early recognition of a ureteric injury is the key to a complications-free repair. Unrecognized injuries cause prolonged morbidity, and their management can be difficult. Treatment of these injuries by experienced teams may minimize long-term consequences.

Unsymmetrical porphyrazines (tetraazaporphyrins) bearing a single bidentate phenanthroline chelating group M[pz(t-butylphenyl)6phen] have been prepared by the base-catalyzed cross condensation of 3,4-bis(4-tert-butylphenyl)pyrroline-2,5-diimine (in excess) with 6,7-dicyanodipyridoquinoxaline. Treatment of these centrally metalated (M=Mg, Zn) ligands with various Ru(II) salts has yielded several bimetallic complexes including the first coordinatively linked porphyrazine trimer. The optical properties of these complexes are shown to be a function of the additional ligands surrounding the asymmetric ruthenium center.

The Sparta Fault system is a major structure approximately 64 km long that bounds the eastern flank of the Taygetos Mountain front (2407 m) and shapes the present-day Sparta basin. It was activated in 464 B.C., devastating the city of Sparta. This fault is examined and described in terms of its geometry, segmentation, drainage pattern and post-glacial throw, emphasising how these parameters vary along strike. Qualitative analysis of long profile catchments shows a significant difference in longitudinal convexity between the central and both the south and north parts of the fault system, leading to the conclusion of varying uplift rate along strike. Catchments are sensitive in differential uplift as it is observed by the calculated differences of the steepness index ksn between the outer (ksn

We report a case of retroperitoneal endometriosis involving the periureteral tissues of the left ureter. The patient suffered from cyclical symptoms of left ureteral obstruction during menstruation. Endometriosis of the ureter is not common and in this case the preoperative diagnosis presented difficulties due to the absence of any pathological findings during the clinicolaboratory evaluation of the patient before or after menstruation. The patient was managed with surgical resection of the affected ureteral segment and subsequent end-to-end anastomosis of the left ureter. A brief review of the subject is also presented.

Over the last 16 years the evolution of 24 pregnancies in 17 women with biopsy-proven glomerular disease was analyzed. The underlying renal histology was IgA nephropathy in 8 cases, lupus nephritis in 7, mesangiocapillary glomerulonephritis type I in 1, and focal segmental glomerulosclerosis in 1. All but 2 had normal renal function before conception and 3 were hypertensive. Fetal survival rate was 75%. There were 6 preterm deliveries (33.3%), 3 newborns small for gestational age (17%), 1 stillbirth, and 5 therapeutic abortions. The perinatal mortality was 5.5%. De novo hypertension occurred in 8 pregnancies (33.3%). In 11 pregnancies (46%) increased proteinuria was diagnosed and in 6 (25%) a decline in maternal renal function was recorded. Permanent impairment of renal function was seen in 2 women with renal insufficiency before conception. Maternal hypertension and renal function impairment were associated more frequently with obstetric complications. In conclusion, pregnancy is safe for normotensive mothers with glomerular diseases and normal renal function. Hypertension and impaired renal function at conception seem to carry increased risk for mothers and fetuses. Low-dose immunosuppressive treatment during pregnancy is not harmful for the fetus.

The clinical characteristics of 118 patients (60 male) with acute renal failure (ARF) admitted between 1980 and 1991, were retrospectively analyzed and compared with our earlier series of the 1960s. The mean age was 53 years (16-82 years). There was a marked decline in the hypotension-related cases (43% vs. 17%, p0.01) and a concomitant increase in the nephrotoxic cases (5% vs. 17%, p0.005) in recent years. The number of ARF cases significantly decreased after 1986 (31%) compared to the pre-1986 era (69%, p0.001). A complete (35%) or partial recovery (55%) was the rule in the majority of the patients. The overall mortality was 27%, virtually unchanged in comparison to the 1960s (30%). However, a tendency toward lower mortality was seen after 1986 (17%) in comparison to before (32%, p0.05). Sepsis and cardiovascular complications were the leading causes of death. Fewer deaths were observed among younger patients (30 years, 12.5%) compared to middle-aged patients (30-59 years, 34%, p0.05) and to these older than 60s (53.5%, p0.002). Also, deaths were rare in patients with only renal involvement (6%), increasing to 30% when 2 vital organ systems were affected (p0.005) and to 67% in cases with multiple organ failure (p0.001). Early institution of dialysis and the nonoliguric forms of the syndrome seem to be associated with better prognosis. In conclusion, the incidence of ARF has declined in recent years, with a concomitant tendency towards lower mortality. Death rate is mainly determined by the age and the number of organ involvement. Early dialysis seems to contribute to the lower mortality seen in recent cases.

Thirty-six patients with idiopathic membranous nephropathy were retrospectively studied. The mean age was 47 years and the male to female ratio 25 to 11. Twenty-eight patients (77.8%) had nephrotic syndrome at first investigation. Nineteen patients received corticosteroids alone (group A) and 17 received corticosteroids combined with cyclophosphamide (group B). The mean period of follow-up was 58.9 months (range, 12 to 156 months). The two groups did not differ in clinical or laboratory features at the time of biopsy or at the start of treatment. In the entire series a complete remission of proteinuria occurred in 13 of 36 patients (36.1%) and a partial remission occurred in 13 (36.1%); 10 patients (27.8%) had no response. Optimal remission of proteinuria was usually recorded 6 to 12 months after the start of treatment. The two groups showed no statistical differences regarding the rate of complete (seven v six patients; P = not significant) or partial (six v seven patients; P = not significant) remissions. Two patients (one from each group) entered end stage renal failure during follow-up. At last assessment, the number of patients with complete remission (four v three patients; P = not significant), nonnephrotic proteinuria (nine v nine patients; P = not significant), or nephrotic syndrome (five v four patients; P = not significant) was similar in both groups. In addition, final plasma creatinine did not differ significantly between the two groups (1.8 ± 2.3 mg/dL v 2.6 ± 2.6 mg/dL; P = not significant). In conclusion, both treatment regimens were found to be equally effective in decreasing proteinuria and preserving renal function in adult idiopathic membranous nephropathy. Cyclophosphamide appeared not to offer any definite advantage over corticosteroids alone in the treatment of the disease.

Between 1982 and 1992, 18 cases of pregnancy-related acute renal failure (PRARF) were observed (9% of the total number of ARF). Mean age of the women was 32 years (22-40 years). Uterine hemorrhage and preeclampsialeclampsia were the major causes of ARF, accounting for 61% of the cases. Patchy renal cortical necrosis was suspected in 2 cases whereas signs of disseminated intravascular coagulation (DIC) or microangiopathic hemolytic anemia were present in 6 (33%) and 9 (50%) cases, respectively. Ten women required hemodialysis; and 6 of them, additional plasma exchange sessions. Five patients (28%) died during the acute phase of the illness, mainly due to brain damage, hepatic failure, and sepsis. Among the survivors, a complete (61.5%) or partial recovery (23.1%) was usually seen, but irreversible renal failure was recorded in 2 cases with postpartum hemolytic uremic syndrome (HUS). Short-lasting oligoanuria (C 3 days) represents a good prognostic index. However, the presence of vascular injury (cortical necrosis, HUS) seems to carry a poor prognosis. In conclusion, PR-ARF is still a critical occurrence, associated with serious prognosis for both women and kidneys. So far, the most efSective measures remain the careful prevention and the aggressive management of the obstetric complications.

Background and objectives: This study examined the efficacy of C.E.R.A., a continuous erythropoietin receptor activator, for correcting anemia in patients who had chronic kidney disease (CKD) and were not on dialysis. Design, setting, participants, & measurements: In this open-label, randomized, parallel-group, Phase III study, 324 adult patients with CKD not on dialysis nor receiving treatment with erythropoiesis-stimulating agents (ESAs) were randomly assigned (1:1) to receive subcutaneous C.E.R.A. once every 2 wk or darbepoetin alfa once weekly during an 18-wk correction period and a 10-wk evaluation period. Thereafter, patients receiving C.E.R.A. were randomly assigned to C.E.R.A. once every 2 wk or once monthly, and patients receiving darbepoetin alfa could receive darbepoetin alfa once weekly or once every 2 wk for a 24-wk extension period. Dosage was adjusted to achieve a hemoglobin (Hb) response and to maintain Hb ±1 g/dl of the response level and 11 to 13 g/dl. Primary end points were Hb response rate during correction and evaluation and change in Hb concentration between baseline and evaluation. Results: Hb response rates were 97.5% for C.E.R.A. and 96.3% for darbepoetin alfa. Adjusted mean changes in Hb from baseline to evaluation were 2.15 g/dl (C.E.R.A.) and 2.00 g/dl (darbepoetin alfa). Analysis showed that C.E.R.A. once every 2 wk was as effective as darbepoetin alfa once weekly for correcting anemia. Hb levels remained stable in all groups during the extension period. C.E.R.A. and darbepoetin alfa were well tolerated. Conclusions: Subcutaneous C.E.R.A. once every 2 wk corrects anemia in ESA–naive patients who are not on dialysis.

The purpose of this study was to compare the characteristics of the blood immunophenotype of CAPD patients with and without peritonitis and to compare the phenotypes of peripheral blood lymphocytes (PBL) and peritoneal lymphocytes (PL) in CAPD patients with peritonitis.Fifty-seven CAPD patients (20 with peritonitis and 37 without peritonitis) were recruited in the study (mean age 66,88 +/- 13,48, male/ female 16/21). Lymphocyte subsets (CD2+, CD3+, CD3+/4+, CD3+/8+, CD3-/16 + 56+, CD4/CD8 ratio) were quantitated by using monoclonal antibodies and dual-color flow cytometric analysis. With the above method we measured PBL in patients with and without peritonitis. In patients with peritonitis we also measured PL.CD2 were slightly decreased in patients with peritonitis. Those patients also had more intense CD3 + / CD4+ lymphopenia (p0.05) and larger expansion of NK cells (p0.05). Patients with peritonitis appeared to have a lower ratio of CD4/CD8 (p0.05). All the above results are shown to Table 2. Following the onset of peritonitis, a consistent finding in all patients was a significant increase in CD2 population of PL compared with PBL (85.71 +/- 9.20 versus 82.60 +/- 7.34, p0.05) as well as in CD3 population (77.01 +/- 13.09 versus 68.74 +/- 13.43, p0.05). An increased number of CD3/8 in PL compared with PBL (33.70 +/- 9.34 versus 27.98 +/- 10.77, p0.05) was also noted.In the present study, we found important immune activation in asymptomatic CAPD patients. The activation increases during peritonitis. The causes and the clinical consequences of chronic activation remain unknown.

The objective of this study was to evaluate the diagnostic value of serum procalcitonin (PCT) in hemodialysis (HD) patients and its correlation to other traditional inflammatory markers.We measured plasma PCT levels in 120 patients on maintenance HD. PCT levels were compared with C-reactive protein (CRP), interleukin-6 (IL-6), prealbumin, and albumin. We also examined the above parameters subgroups, especially in diabetics and the elderly. Relations between parameters were studied by Spearman's correlation.PCT concentrations were higher than the upper normal limit of 0.5 ng/ mL in 38% of the patients. All patients with increased CRP had PCT concentrations higher than the upper normal limit. Plasma CRP concentrations were positively correlated to IL-6 (r = 0.304). Prealbumin was negatively correlated with CRP (r = 0.259) and with IL-6 (r = 0.388).The combination of elevated IL-6 and CRP levels was associated with an altered nutritional status. The concomitant elevations in PCT, CRP, and IL-6 could be more sensitive in the evaluation of inflammation.

The clinical relevance of altered lymphocyte function and the possible relation with uremic toxins, such as parathyroid hormone (PTH) is not well understood. We studied the changes in cellular immunity in patients in hemodialysis (HD) therapy and examined the relationship between T-lymphocyte function and plasma levels of PTH.Thirty-four patients (14 male) were enrolled in this study (mean age: 63.20 +/- 10.01 years, M +/- SD, 12 h/week HD). Our study population was divided into two groups: 18 patients with increased levels of PTH and 16 patients with normal levels of PTH. Lymphocyte subsets (CD2+, CD3+, CD3+/4+, CD3+/8+, CD19+, CD3-/16+56+, CD4/CD8 ratio) were quantitated in both groups using monoclonal antibodies (Immunotech, Coulter) and flow cytometric analysis. Following analysis of variance (ANOVA) testing was performed to test differences between groups (SPSS version 10).A significant increase of CD2 was noticed in patients with increased levels of PTH (84.8 +/- 5.5 vs. 79.8 +/- 4, p0.05). The CD3 population was also increased in patients with elevated PTH (72 +/- 8.6 vs. 68 +/- 9.2, p=NS). This group of patients had also significantly increased levels of CD3/8 (44.8 +/- 9.8 vs. 37.1 +/- 5.8, p0.05). The CD4/CD8 ratio levels were higher in patients with elevated PTH compared with those who had normal PTH (2.2 +/- 1.5 vs. 1.5 +/- 0.8, p=NS).The elevated level of PTH seems to affect the lymphocyte function and is associated with changes in cellular immunity in the hemodialysis population. Our study is in progress in order to enlarge our study population and collect more data, which will lead us to more solid conclusions.

Background The Hypertension Study in General Practice in Hellas (Hypertenshell) is a cross-sectional study (much like the National Health and Nutrition Examination Study) for assessing the prevalence, level of awareness, treatment, and control of hypertension in Greece. Methods The study was conducted with the collaboration of physicians in 98 Health Centers across Greece. Participants were interviewed about lifestyle, and blood pressure (BP) measurements were taken on two clinical visits for verification of diagnosis and control of hypertension. Hypertension was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or current treatment with antihypertensive drugs; the same threshold was used for assessing control of hypertension. Results A total of 11,950 individuals participated and data for 11,540 were analyzed, comprising 0.1% of the Greek population. The prevalence of hypertension was 31.1% (men 33.6%, women 28.4%); among elderly individuals (>65 years) the prevalence was higher (65.4%). Of the hypertensive individuals, 39.8% did not know that had hypertension, yielding an awareness of 60.2%; in addition, 12.4% were aware but not treated (men 13.1%, women 11.8%). In all, 51.2% (1838) of hypertensive subjects were treated; 67.2% (1235) were treated but not controlled (men 66.7%, women 67.7%); and 32.8% (603) were treated and controlled (men 33.3%, women 32.3%). Conclusions The results of the Hypertenshell Study indicate that hypertension is a common risk factor for cardiovascular disease in the Greek population. Awareness, treatment, and control of hypertension are comparable to the best rates of control of hypertension given for the problem, but there is a considerable potential for further improvement in the control of this disease.

Purpose The assessment of glomerular filtration rate (GFR) is the most commonly used test of renal function. Cystatin-C, a cysteine protease inhibitor, which can be measured by light-scattering immunoassay, possesses many of the attributes required of the ideal GFR marker. Conversely, many endogenous markers that are widely used for the estimation of GFR such as serum creatinine (SCr) are not ideal. The present study was undertaken to evaluate the clinical application of serum cystatin-C (CysC) as a new marker of GFR in renal transplant patients. Methods Eighteen patients (9 men) were enrolled in the study (mean age: 46.35, range: 31–67 years) to measure serum CysC levels and compare them, with SCr, creatinine clearance (CCr), as well as the Cockcroft-Gault equation (CG) or the MDRD as indicator of GFR. Spearman's correlation coefficient was used to determine the relationship between CysC and other markers. Results There was a significant negative correlation between serum CysC and CCr (r = −0.768). Moreover, the CysC level was negatively correlated with CG (r = −0.854), positively correlated with SCr (r = 0.629), and negatively correlated with MDRD (r = −0.604). Conclusions These results indicate that measurement of serum cystatin-C was useful and accurate to estimate GFR in renal transplant patients. The recent literature confirms our data although there are concerns about nonrenal influence on this test. Although serum CysC can generally be recommended as a marker for GFR, our study is still in progress seeking to validate the conclusions in a larger number of patients.

Mesodermal tumors of the urinary bladder are rare and the majority of them are malignant. We report a case of an intramural leiomyoma of the bladder presenting with symptoms of a mild lower urinary tract infection. The patient was managed with partial cystectomy and the outcome was excellent.

Toxic epidermal necrolysis (TEN) or Lyell's syndrome is a rare fulminating skin disease notorious for its rapidly progressive course and high mortality rate. TEN is characterized by the sudden onset of epithelial necrosis of skin with frequently associated involvement of the gastrointestinal, genitourinary tract and bronchopulmonary linings. We describe the clinical course of five patients with severe drug-induced TEN, treated with PE. The suspected drugs were carbamazepine in one patient, paracetamol in one, a combination of paracetamol and mefenamic acid in one, allopurinol in one and ciprofloxacin in one. Three had a skin involvement affecting almost the entire surface of the body. In addition to the skin lesions, mouth, esophagus and lungs were also involved. Steroids proved ineffective. PE was carried out because of the rapid deterioration of the clinical picture. The mean number of PE sessions was 3.22 (range 1-5). Complete remission of the syndrome was achieved in four patients. One patient died due to septic shock. As so far there is no treatment of proven value for this condition, controlled trials should be set up in order to assess the value of PE in TEN.

The differentiation between cyclosporine nephrotoxicity (CyN) and acute rejection (AR) still remains a matter of intensive research. In a retrospective study over the last 2 years, we assessed the clinical and histopathological data of 43 episodes of renal dysfunction in 39 renal transplant recipients immunosuppressed with cyclosporine (CyA). Ten episodes (23.2%) were identified as AR and 10 (23.2%) as acute CyN; in six cases (13.9%), signs of both AR and CyN were found. Fever (80%), oliguria (50%), and edema (50%) were prominent features in AR, but not in CyN. Renal blood flow was higher in the nephrotoxicity group and for corresponding degree of renal dysfunction. Significant hyperuricemia (greater than 8 mg/dL) was a prominent finding in CyN (80%) and to a lesser extent in AR (20%). The helper to suppressor cell ratio in the peripheral blood remained stable or slightly decreased in all cases with CyN, but increased in 70% of the cases with AR. CyN was associated with significantly higher whole blood CyA levels (P less than 0.005) and there was a positive correlation between plasma creatinine and CyA levels during the nephrotoxicity episodes (P less than 0.02). Diffuse mononuclear cell infiltrate was observed in 90% of the biopsies with AR and only in 20% with CyN (P less than 0.005). Concerning the extent of the tubular lesions, no significant differences were observed between the two groups. In contrast, vascular lesions such as arterial endothelial proliferation (P less than 0.05), hyalinosis (P less than 0.05), and glomerular capillary thrombi (P less than 0.05) were more commonly seen in nephrotoxicity biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)

Living related donors (LRD) still remain the main source of kidney transplants for several countries. The superiority of graft survival from LRD is undoubted. On the other hand, the shortage of cadaver kidneys and the better histocompatibility between relatives argue in favor of LRD [1]. Thus, in some centers in the United States, up to 25% of transplanted kidneys come from this source. In Europe, the center policy differs considerably regarding the potential donors. In Norway, 56% of all grafts performed in 1987 came from LRD, and in Sweden and Denmark more than 20% of all first grafts came from that origin. However, in other countries like the United Kingdom, Spain, France, and Germany, LRD are accepted only in a minority of the centers [2]. In Greece, out of a total of 758 renal transplantations performed over the last 20 years, 584 (77%) came from LRD.

The prolactin response to 5 mg haloperidol i.m. was studied in 12 schizophrenic patients in a drug-free state and after a month treatment with haloperidol, as a possible index of dopamine receptor sensitivity and occupancy. Blood samples were taken at times 0, 60, 90 and 120 minutes. The increase in PRL observed in the drug-free state disappeared after drug treatment. The PRL plasma levels after treatment with 60 mg haloperidol per os were higher than the maximal PRL responses after 5 mg i.m. The increases in baseline PRL caused by the treatment correlated positively to the reduction in the BPRS score. The test was also performed in a group of 11 patients chronically treated with haloperidol during a daily dose of 60 mg, and 15 days after reduction of the dose to 30 mg. PRL increases after 5 mg haloperidol i.m. were observed only after reduction of the dose. It is suggested that the prolactin response to haloperidol is an index of the occupancy of receptors that are involved in the PRL releasing mechanisms, and could be used to verify their blockade by the neuroleptics, especially in patients that do not respond positively to drug treatment.