Oral valganciclovir prophylaxis in kidney transplant recipients

Background: Immunosuppressive and antivira[ prophy[ actic drugs are needed to prevent acute rejection and infection after organ transplantation. We assessed the effectiveness of a new combined regimen introduced at our transplantation center. Methods: We reviewed at[ consecutive patients who underwent kidney transplantation at our institution over a 5.5-year period, with a follow-up of at [east 6 months. Patients transplanted from 1/2000 to 3/2003 (Period 1) were compared to patients transplanted from 4/2003 to 7/2005 (Period 2). In period 1, patients were treated with Basi[iximab, Cic[osporin, steroids and Mycophenotate or Azathioprine. Prophylaxis with Va[acic[ ovir was prescribed in CMV D+/R- patients; otherwise, a preemptive antivira[ approach was used. In period 2, immunosuppressive drugs were Basi[- iximab, Tacro[imus, steroids and Mycopheno[ate. A 3-month CMV prophylaxis with Va[gancic[ovir was used, except in D-/R- patients. Results: Sixty-three patients were transplanted in period 1 and 70 patients in period 2. Baseline characteristics of both groups were comparable; in particular 17% of patients were CMV D+/R- in period 1 compared to 23% in period 2 (p=0.67). Acute rejection was more frequent in period 1 than in period 2 (40% of patients vs 7%, respectively p<0.001). Nineteen patients (30%) in period 1 were diagnosed with CMV infection/disease that required treatment, compared with 8 patients (11.4%) in period 2 (p = 0.003). Of these 8 patients, at[ had CMV infection/disease after discontinuation of Va[gancic[ovir prophylaxis, 6 were D+/R- (75%), and at[ were treated with oral Va[gancic[ovir. There was no difference between periods in terms of incidence of BK nephropathy, post-transplant [ymphopro[ iferative disease, graft toss, and mortality. Conclusions: These results indicate that a 3-month course of oral Va[gancic[ovir is very effective to prevent CMV infection/disease in kidney transplantation. Late-onset CMV disease is a residual problem in D+/R- patients receiving VGC prophylaxis.

Anti-tumor necrosis factor drug survival in axial spondyloarthritis is independent of the classification criteria.

To compare the impact of meeting specific classification criteria [modified New York (mNY), European Spondyloarthropathy Study Group (ESSG), and Assessment of SpondyloArthritis international Society (ASAS) criteria] on anti-tumor necrosis factor (anti-TNF) drug retention, and to determine predictive factors of better drug survival. All patients fulfilling the ESSG criteria for axial spondyloarthritis (SpA) with available data on the axial ASAS and mNY criteria, and who had received at least one anti-TNF treatment were retrospectively retrieved in a single academic institution in Switzerland. Drug retention was computed using survival analysis (Kaplan-Meier), adjusted for potential confounders. Of the 137 patients classified as having axial SpA using the ESSG criteria, 112 also met the ASAS axial SpA criteria, and 77 fulfilled the mNY criteria. Drug retention rates at 12 and 24 months for the first biologic therapy were not significantly different between the diagnostic groups. Only the small ASAS non-classified axial SpA group (25 patients) showed a nonsignificant trend toward shorter drug survival. Elevated CRP level, but not the presence of bone marrow edema on magnetic resonance imaging (MRI) scans, was associated with significantly better drug retention (OR 7.9, ICR 4-14). In this cohort, anti-TNF drug survival was independent of the classification criteria. Elevated CRP level, but not positive MRI, was associated with better drug retention.

A web-based pilot study of inter-pathologist reproducibility using the ISHLT 2004 working formulation for biopsy diagnosis of cardiac allograft rejection: The European experience.

BACKGROUND: The aim of this study was to assess, at the European level and using digital technology, the inter-pathologist reproducibility of the ISHLT 2004 system and to compare it with the 1990 system We also assessed the reproducibility of the morphologic criteria for diagnosis of antibody-mediated rejection detailed in the 2004 grading system. METHODS: The hematoxylin-eosin-stained sections of 20 sets of endomyocardial biopsies were pre-selected and graded by two pathologists (A.A. and M.B.) and digitized using a telepathology digital pathology system (Aperio ImageScope System; for details refer to http://aperio.com/). Their diagnoses were considered the index diagnoses, which covered all grades of acute cellular rejection (ACR), early ischemic lesions, Quilty lesions, late ischemic lesions and (in the 2005 system) antibody-mediated rejection (AMR). Eighteen pathologists from 16 heart transplant centers in 7 European countries participated in the study. Inter-observer reproducibility was assessed using Fleiss's kappa and Krippendorff's alpha statistics. RESULTS: The combined kappa value of all grades diagnosed by all 18 pathologists was 0.31 for the 1990 grading system and 0.39 for the 2005 grading system, with alpha statistics at 0.57 and 0.55, respectively. Kappa values by grade for 1990/2005, respectively, were: 0 = 0.52/0.51; 1A/1R = 0.24/0.36; 1B = 0.15; 2 = 0.13; 3A/2R = 0.29/0.29; 3B/3R = 0.13/0.23; and 4 = 0.18. For the 2 cases of AMR, 6 of 18 pathologists correctly suspected AMR on the hematoxylin-eosin slides, whereas, in each of 17 of the 18 AMR-negative cases a small percentage of pathologists (range 5% to 33%) overinterpreted the findings as suggestive for AMR. CONCLUSIONS: Reproducibility studies of cardiac biopsies by pathologists in different centers at the international level were feasible using digitized slides rather than conventional histology glass slides. There was a small improvement in interobserver agreement between pathologists of different European centers when moving from the 1990 ISHLT classification to the "new" 2005 ISHLT classification. Morphologic suspicion of AMR in the 2004 system on hematoxylin-eosin-stained slides only was poor, highlighting the need for better standardization of morphologic criteria for AMR. Ongoing educational programs are needed to ensure standardization of diagnosis of both acute cellular and antibody-mediated rejection.

Ethnic minority-majority asymmetry in national attitudes around the world: A multilevel analysis

Using data from the International Social Survey Programme, this research investigated asymmetric attitudes of ethnic minorities and majorities towards their country and explored the impact of human development, ethnic diversity, and social inequality as country-level moderators of national attitudes. In line with the general hypothesis of ethnic asymmetry, we found that ethnic, linguistic, and religious majorities were more identified with the nation and more strongly endorsed nationalist ideology than minorities (H1, 33 countries). Multilevel analyses revealed that this pattern of asymmetry was moderated by country-level characteristics: the difference between minorities and majorities was greatest in ethnically diverse countries and in egalitarian, low inequality contexts. We also observed a larger positive correlation between ethnic subgroup identification and both national identification and nationalism for majorities than for minorities (H2, 20 countries). A stronger overall relationship between ethnic and national identification was observed in countries with a low level of human development. The greatest minority-majority differences in the relationship between ethnic identification and national attitudes were found in egalitarian countries with a strong welfare state tradition.

From the vendor in the hemp shop to the dealer in the alleyway? A comparison of the sources of supply of cannabis in a time of 'de-normalising' cannabis use.

Objectives: After several years of increasing 'normalisation' of cannabis use in Switzerland at the beginning of the new millennium, a reversed tendency, marked among others by a more stringent law-enforcement, set in. The presentation examines the question of where adolescents and young adults obtained cannabis, within the context of this societal change. In addition, it compares the sources of supply for cannabis with those found in studies of other European countries. Methods: Analyses are based on data from the Swiss Cannabis Monitoring Study. As part of this longitudinal, representative population survey, more than 5000 adolescents and young adults were interviewed by telephone on the topic of cannabis. Within the total sample, 593 (2004) or 554 (2007) respectively, current cannabis users replied to the questions on sources of supply. Changes in law-enforcement and societal climate concerning cannabis are assessed based on relevant literature, media reports and parliamentary discussions. Results: Whereas 22% of cannabis users stated in 2004 that they bought their cannabis from vendors in hemp shops, this proportion drastically decreased to 6% three years later. At the same time, cannabis was obtained increasingly from friends, while the proportion of users who purchased cannabis from dealers in the alleyway, more than doubled from 6% (2004) to 13% (2007). It was male cannabis users, and in particular, young adult and frequent users, who have moved into the alleyways. Generally, users who buy cannabis in the alleyway show more cannabis-related problems than those who mainly name other sources of supply, even when adjusted for sex, age and frequency of cannabis use. Discussion: Possible consequences of these changes in cannabis supply, like the risk of merging a previously cannabis-only market with other 'harder' drugs markets, are discussed.

L'écrit sacerdotal comme réplique au récit deutéronomiste des origines. Quelques remarques sur la "bibliothèque" de P

(Résumé de l'ouvrage) Cet ouvrage présente les résultats du premier Colloque international consacré à l'analyse narrative de la Bible (Lausanne, mars 2002). De la Genèse à l'Apocalypse, la Bible est un immense trésor d'histoires. Une nouvelle lecture explore depuis peu cet art du raconter. Ses outils sont empruntés à Paul Ricoeur, Gérard Genette, Meir Sternberg ou Jan Fokkelman. Les biblistes sont ainsi à même d'exhumer la stratégie narrative des auteurs bibliques: temporalité du récit, gestion de l'espace, construction des personnages, point de vue du narrateur. Certains des plus grands spécialistes de l'Ancien comme du Nouveau Testament explicitent ici ces texte fondateurs à la lumière de la narratologie.

Le discours, lieu de (re)lecture du récit

(Résumé de l'ouvrage) Cet ouvrage présente les résultats du premier Colloque international consacré à l'analyse narrative de la Bible (Lausanne, mars 2002). De la Genèse à l'Apocalypse, la Bible est un immense trésor d'histoires. Une nouvelle lecture explore depuis peu cet art du raconter. Ses outils sont empruntés à Paul Ricoeur, Gérard Genette, Meir Sternberg ou Jan Fokkelman. Les biblistes sont ainsi à même d'exhumer la stratégie narrative des auteurs bibliques: temporalité du récit, gestion de l'espace, construction des personnages, point de vue du narrateur. Certains des plus grands spécialistes de l'Ancien comme du Nouveau Testament explicitent ici ces texte fondateurs à la lumière de la narratologie

L'exégèse biblique à l'heure du lecteur

(Résumé de l'ouvrage) Cet ouvrage présente les résultats du premier Colloque international consacré à l'analyse narrative de la Bible (Lausanne, mars 2002). De la Genèse à l'Apocalypse, la Bible est un immense trésor d'histoires. Une nouvelle lecture explore depuis peu cet art du raconter. Ses outils sont empruntés à Paul Ricoeur, Gérard Genette, Meir Sternberg ou Jan Fokkelman. Les biblistes sont ainsi à même d'exhumer la stratégie narrative des auteurs bibliques: temporalité du récit, gestion de l'espace, construction des personnages, point de vue du narrateur. Certains des plus grands spécialistes de l'Ancien comme du Nouveau Testament explicitent ici ces texte fondateurs à la lumière de la narratologie.

La Bible en récits. L'exégèse biblique à l'heure du lecteur

Cet ouvrage présente les résultats du premier Colloque international consacré à l'analyse narrative de la Bible (Lausanne, mars 2002). De la Genèse à l'Apocalypse, la Bible est un immense trésor d'histoires. Une nouvelle lecture explore depuis peu cet art du raconter. Ses outils sont empruntés à Paul Ricoeur, Gérard Genette, Meir Sternberg ou Jan Fokkelman. Les biblistes sont ainsi à même d'exhumer la stratégie narrative des auteurs bibliques: temporalité du récit, gestion de l'espace, construction des personnages, point de vue du narrateur. Certains des plus grands spécialistes de l'Ancien comme du Nouveau Testament explicitent ici ces texte fondateurs à la lumière de la narratologie.

Histopathology of peripapillary choroidal neovascularization.

The different therapeutic responses observed among choroidal neovascularization (CNV) of different etiologies, ages, and locations might be related to the presence of varied mediators. Two surgically removed peripapillary CNVs from two different patients were analyzed. One of the patients had received one intravitreous injection of bevacizumab 3 months earlier. CNV was analyzed using conventional histology and immunohistochemistry. Histological analysis showed intense neovascularization and epithelial and glial components. Vascular endothelial growth factor (VEGF) receptors were found in the endothelial cells and the epithelial cells of the CNV. VEGF was expressed in the patient who had not been previously treated with anti-VEGF. The CNV was deeply infiltrated by glial cells and invaded by microglial cells in one case. VEGF and VEGF receptors may be expressed, suggesting that therapies aiming at VEGF may be efficient only for a subtype of CNV and at a certain time point of their evolution.