Eculizumab to treat antibody-mediated rejection in a 7-year-old kidney transplant recipient.

We report on successful early eculizumab administration to treat acute antibody-mediated rejection (ABMR) in a highly sensitized kidney transplant recipient. The recipient is a 7-year-old boy who received, 6 months after a desensitization protocol with monthly intravenous immunoglobulin infusion, a second kidney transplant in the presence of low donor-specific antibodies (DSAs). Both pretransplant lymphocytotoxic and flow cytometric crossmatch were negative. Allograft function recovered promptly, with excellent initial function. On postoperative day (POD) 4, the child developed significant proteinuria with an acute rise in serum creatinine. Allograft biopsy showed severe acute ABMR. Intravenous eculizumab (600 mg), preceded by a single session of plasmapheresis, was administered on POD 5 and 12 along with a 4-day thymoglobulin course. After the first dose of eculizumab, a strikingly rapid normalization of allograft function with a decrease in proteinuria occurred. However, because circulating DSA levels remained elevated, the child received 3 doses of intravenous immunoglobulin (POD 15, 16, and 17), with a significant subsequent decrease in DSA levels. At 9 months after transplant, the child continues to maintain excellent allograft function with undetectable circulating DSA levels. This unique case highlights the potential efficacy of using early eculizumab to rapidly reverse severe ABMR in pediatric transplantation, and therefore it suggests a novel therapeutic approach to treat acute ABMR.

The girl from the Church of the Sacrament: a case of congenital syphilis in XVIII century Lisbon

Syphilis is a sexually or congenitally transmitted infectious disease with an impact on the health of human populations that has undergone important cycles in different countries and periods of history. Its presence was first diagnosed in Europe in the late XIV century. In Portugal, although there are various written records of the infection in the last centuries, there are rare references to it in archeological findings (mummified bodies are also rare in Portugal). The current study describes a probable case of congenital syphilis in an 18-month-old girl buried in the Church of the Sacrament in Lisbon. Her body, dating to the XVIII century, was found mummified together with dozens of others, still not studied. Symmetrical periostitis of the long bones, osteitis, metaphyseal lesions, left knee articular, and epiphyseal destruction, and a rarefied lesion with a radiological appearance compatible with Wimberger's sign all point to a diagnosis of congenital syphilis. The diagnosis of this severe form of the infection, possibly related to the cause of death in this upper-class girl, calls attention to the disease's presence in XVIII century Lisbon and is consistent with the intense mobilization at the time in relation to the risks posed by so-called heredosyphilis. It is the first case of congenital syphilis in a child reported in archeological findings in Portugal, and can be correlated with other cases in skeletons of adults buried in cemeteries in Lisbon (in the XVI to XVIII centuries) and Coimbra (XIX century). Finally, this finding highlights the need to study the entire series of mummified bodies in the Church of the Sacrament in order to compare the paleopathological findings and existing historical documents on syphilis, so as to expand the paleoepidemiological knowledge of this infection in XVIII century Lisbon.

Th1 and Th17 hypercytokinemia as early host response signature in severe pandemic influenza.

INTRODUCTION Human host immune response following infection with the new variant of A/H1N1 pandemic influenza virus (nvH1N1) is poorly understood. We utilize here systemic cytokine and antibody levels in evaluating differences in early immune response in both mild and severe patients infected with nvH1N1. METHODS We profiled 29 cytokines and chemokines and evaluated the haemagglutination inhibition activity as quantitative and qualitative measurements of host immune responses in serum obtained during the first five days after symptoms onset, in two cohorts of nvH1N1 infected patients. Severe patients required hospitalization (n = 20), due to respiratory insufficiency (10 of them were admitted to the intensive care unit), while mild patients had exclusively flu-like symptoms (n = 15). A group of healthy donors was included as control (n = 15). Differences in levels of mediators between groups were assessed by using the non parametric U-Mann Whitney test. Association between variables was determined by calculating the Spearman correlation coefficient. Viral load was performed in serum by using real-time PCR targeting the neuraminidase gene. RESULTS Increased levels of innate-immunity mediators (IP-10, MCP-1, MIP-1beta), and the absence of anti-nvH1N1 antibodies, characterized the early response to nvH1N1 infection in both hospitalized and mild patients. High systemic levels of type-II interferon (IFN-gamma) and also of a group of mediators involved in the development of T-helper 17 (IL-8, IL-9, IL-17, IL-6) and T-helper 1 (TNF-alpha, IL-15, IL-12p70) responses were exclusively found in hospitalized patients. IL-15, IL-12p70, IL-6 constituted a hallmark of critical illness in our study. A significant inverse association was found between IL-6, IL-8 and PaO2 in critical patients. CONCLUSIONS While infection with the nvH1N1 induces a typical innate response in both mild and severe patients, severe disease with respiratory involvement is characterized by early secretion of Th17 and Th1 cytokines usually associated with cell mediated immunity but also commonly linked to the pathogenesis of autoimmune/inflammatory diseases. The exact role of Th1 and Th17 mediators in the evolution of nvH1N1 mild and severe disease merits further investigation as to the detrimental or beneficial role these cytokines play in severe illness.

Topics in public finance: social security and taxation

Summary The field of public finance focuses on the spending and taxing activities of governments and their influence on the allocation of resources and distribution of income. This work covers in three parts different topics related to public finance which are currently widely discussed in media and politics. The first two parts deal with issues on social security, which is in general one of the biggest spending shares of governments. The third part looks at the main income source of governments by analyzing the perceived value of tax competition. Part one deals with the current problem of increased early retirement by focusing on Switzerland as a special case. Early retirement is predominantly considered to be the result of incentives set by social security and the tax system. But the Swiss example demonstrates that the incidence of early retirement has dramatically increased even in the absence of institutional changes. We argue that the wealth effect also plays an important role in the retirement decision for middle and high income earners. An actuarially fair, but mandatory funded system with a relatively high replacement rate may thus contribute to a low labor market participation rate of elderly workers. We provide evidence using a unique dataset on individual retirement decisions in Swiss pension funds, allowing us to perfectly control for pension scheme details. Our findings suggest that affordability is a key determinant in the retirement decisions. The higher the accumulated pension capital, the earlier men, and to a smaller extent women, tend to leave the workforce. The fact that early retirement has become much more prevalent in the last 15 years is a further indicator of the importance of a wealth effect, as the maturing of the Swiss mandatory funded pension system over that period has led to an increase in the effective replacement rates for middle and high income earners. Part two covers the theoretical side of social security. Theories analyzing optimal social security benefits provide important qualitative results, by mainly using one general type of an economy. Economies are however very diverse concerning numerous aspects, one of the most important being the wealth level. This can lead to significant quantitative benefit differences that imply differences in replacement rates and levels of labor supply. We focus on several aspects related to this fact. In a within cohort social security model, we introduce disability insurance with an imperfect screening mechanism. We then vary the wealth level of the model economy and analyze how the optimal social security benefit structure or equivalently, the optimal replacement rates, changes depending on the wealth level of the economy, and if the introduction of disability insurance into a social security system is preferable for all economies. Second, the screening mechanism of disability insurance and the threshold level at which people are defined as disabled can differ. For economies with different wealth levels, we determine for different thresholds the screening level that maximizes social welfare. Finally, part three turns to the income of governments, by adding an element to the controversy on tax competition versus tax harmonization.2 Inter-jurisdictional tax competition can generate at least two potential benefits or costs: On a public level, tax competition may result in a lower or higher efficiency in the production of public services. But there is also a more private benefit in the form of an option for individuals to move to a community with a lower tax rate in the future. To explore the value citizens attach to tax competition we analyze a unique popular vote for a complete tax harmonization between communities in the third largest Swiss canton, Vaud. Although a majority of voters would have seemingly benefited from replacing the current tax rate by a revenue-neutral average tax rate, the proposal was rejected by a large margin. Our estimates suggest that the estimated combined perceived benefit from tax competition is in the range of 10%.

Metastasis of renal cell carcinoma to the buccal mucosa 19 years after radical nephrectomy

Renal cell carcinoma (RCC) has high metastatic potential, which requires early diagnosis to optimize the chance of cure. Metastasis of RCC to the head and neck region is less common and metastasis to the buccal mucosa is extremely rare. This phenomenon occurs mostly in patients with generalized dissemination, especially with lung metastases. In this article we report a case of buccal mucosa metastasis from RCC in a 65-year-old man who presented 19 years after undergoing a left radical nephrectomy for clear cell RCC. Surgical excision of the buccal lesion was performed without evidence of recurrence or new metastatic lesions after 6 years of followup. To our knowledge, this is the first case of metastasis to the buccal mucosa from a RCC reported in the literature.

Tax incentives and direct support for R&D: What do firms use and why?

This paper studies whether firms' use of R&D subsidies and R&D tax incentives is correlated to two sources of underinvestment in R&D, financing constraints and appropriability. We find that financially constrained SMEs are less likely to use R&D tax credits and more likely to obtain subsidies. SMEs using legal methods to protect their intellectual property are more likely to use tax incentives. Results are ambiguous for large firms. For both having previous experience in R&D increases the likelihood of using tax incentives, while it reduces the likelihood of using exclusively subsidies, suggesting that the latter induce entry into R&D. Results imply that direct funding and tax credits do not have the same ability to address each source of R&D underinvestment, and that on average subsidies may be better suited than tax credits at least for SMEs. From a policy perspective these tools may be complements rather than substitutes.

Iowa Tax Expenditures Report 2000

Exemptions, exclusions, credits against tax and reductions in tax base that are tied to specific provisions in tax law; estimation of the annual dollar effect for each of those provisions. Phase 1 Report including Corporate Income, Individual Income, Sales Tax Use Tax.

Iowa Tax Expenditures Report 2005

Exemptions, exclusions, credits against tax and reductions in tax base that are tied to specific provisions in tax law; estimation of the annual dollar effect for each of those provisions.

Reconstructing mid-to-recent Holocene paleoenvironments in the vicinity of ancient Amarynthos (Euboea, Greece).

This article examines the shoreline evolution and human occupation in the vicinity of the important archeological site of Amarynthos (Euboea Island, Greece) over the last six millennia. Archeological evidence indicates a continuous occupation of the site from the Bronze Age to the Roman period and the site is well-known, thanks to the existence of a sanctuary dedicated to the goddess Artemis. Based on the study of four boreholes, a paleogeographic reconstruction of the coastal landscape is proposed. Facies were determined based on mollusc identification, and sedimentology based on grain-size measurements (hand sieving for the fraction above 2 mm and LASER technique for particles below 2 mm) and loss-on-ignition. In addition, a series of 12 AMS radiocarbon dates define a reliable chronostratigraphy. Results suggest the presence of a fully marine environment from the early Holocene to ca. 2600-2400 cal. BC, which developed into a brackish environment from ca. 2600-2400 cal. BC to ca. 750 cal. BC due to the deltaic progradation of the nearby stream (Sarandapotamos River). From ca. 750 cal. BC onward, coastal swamps prevailed in the study area. Human-environmental interaction is discussed and particular attention is paid to the paleolandscape configuration of Amarynthos.

Stratigraphy, sedimentology and depositional environments of the Permian to uppermost Cretaceous Batain Group, eastern-Oman

Permian to Late Cretaceous allochthonous sedimentary and volcanic rocks exposed in the Batain area (eastern Oman Margin) have received comparably little attention in the past. They largely were considered as part of the Hamrat Duru Group (Hawasina Complex) of the northern Oman Mountains. Structural, kinematic and biostratigraphic results from our mapping campaign in the Batain area have now revealed, that emplacement of these units occurred in a WNW direction during latest Cretaceous/Early Paleogene time. This clearly contrasts with previous models that postulated a S-ward directed obduction in Campanian times such as recorded from the Hawasina Complex and Semail Ophiolite in the Oman Mountains. We herewith establish the `'Batain Group'' comprising all Permian to Late Cretaceous allochthonous units in the Batain Area. These are: 1.) the Permian Qarari Formation deposited in the toe of a slope setting; 2.) the Late Permian to late Liassic Al Jil Formation comprising periplatform detritus and very coarse breccias; 3.) the Scythian to Norian Matbat Formation formed by slope deposits; 4.) the Early Jurassic to early Oxfordian Guwayza Formation with high energy platform detritus; 5.) the Mid-Jurassic to earliest Cretaceous Ruwaydah Formation seamount; and 6.) the Oxfordian to Santonian Wahrah Formation, mainly radiolarites; and 7.) the Santonian to latest Maastrichtian Fayah Formation built by flysch-type sediments. These sedimentary and volcanic rocks represent deposits of the former ``Batain basin'' off eastern-Oman, destroyed by compressional tectonics at the Cretaceous/Paleogene transition. For tectono-stratigraphic reasons the Batain Group does not form part of the Hawasina Complex.

Fsp27/CIDEC is a CREB target gene induced during early fasting in liver and regulated by FA oxidation rate

FSP27 (CIDEC in humans) is a protein associated with lipid droplets that downregulates the fatty acid oxidation (FAO) rate when it is overexpressed. However, little is known about its physiological role in liver. Here, we show that fasting regulates liver expression of Fsp27 in a time-dependent manner. Thus, during the initial stages of fasting a maximal induction of 800-fold was achieved, while during the later phase of fasting, Fsp27 expression decreased. The early response to fasting can be explained by a canonical PKA-CREB-CRTC2 signaling pathway since: i) CIDEC expression was induced by forskolin, ii) Fsp27 promoter activity was increased by CREB, and iii) Fsp27 expression was upregulated in the liver of Sirt1 knockout animals. Interestingly, pharmacological (etomoxir) or genetic (Hmgcs2 interference) inhibition of the FAO rate increases the in vivo expression of Fsp27 during fasting. Similarly, CIDEC expression was upregulated in HepG2 cells by either etomoxir or HMGCS2 interference. Our data indicate that there is a kinetic mechanism of auto-regulation between short- and long-term fasting, by which free fatty acids delivered to the liver during early fasting are accumulated/exported by FSP27/CIDEC, while over longer periods of fasting they are degraded in the mitochondria through the carnitine palmitoyl transferase (CPT) system.

Is there a connection between the tax administration and the political power?

This paper offers empirical evidence from Spain of a connection between the tax administration and the political power. Firstly, the regional tax administration is not immune to the budgetary situation of regional government, and tends to exert a greater (or lesser) effort in tax collection the greater (or lower) the (expected) public deficit. At the same time, the system of unconditional grants from the central layer of government provokes an ¿income effect¿ which disincentivises the efforts of the tax administration. Secondly, these efforts also decrease when the margin to lose a parliamentary seat in an electoral district is cut, although the importance of this disincentive decreases according to the parliamentary strength of the incumbent

Top income shares in Portugal over the twentieth century

[cat] L’objectiu d’aquest article és presentar nova evidència estadística sobre l’evolució de les desigualtats econòmiques a Portugal a llarg termini. L’explotació de les fonts fiscals portugueses ha permès l’estimació annual de les top income shares des de 1936. La construcció d’aquesta nova sèrie s’ha fet seguint la metodologia emprada per Piketty (2001). Aquesta nova sèrie revela una caiguda de les top income shares durant la Segona Guerra Mundial, seguida d’una recuperació fins a principis dels anys cinquanta. Des de mitjans dels cinquanta fins a principis dels anys vuitanta hi ha una caiguda dràstica de les top income shares. Per acabar, durant els anys noranta les top income shares tornen a augmentar. Aquesta pauta és molt similar a la viscuda en altres països: la reducció de les top income shares durant l’època daurada és compartida per tots els països estudiats i el seu increment als anys noranta sembla que alinea Portugal amb la pauta seguida pels països Anglosaxons.

La licitud de l’interès: evolució històrica d’un tema de moral econòmica

[cat] El problema de la consideració de qualsevol interès com a usura i les formes per a evitar la condemna eclesiàstica foren uns dels principals temes econòmics i morals de l’Europa tradicional. Aquest paper mostra els orígens i fonaments de la doctrina eclesiàstica sobre la usura, l’aparición dels instruments comercials i financers que evitaven la condemna de l’església i les excepcions i noves doctrines que consideraven lícit el benefici procedent del préstec.

Is there a connection between the tax administration and the political power?

This paper offers empirical evidence from Spain of a connection between the tax administration and the political power. Firstly, the regional tax administration is not immune to the budgetary situation of regional government, and tends to exert a greater (or lesser) effort in tax collection the greater (or lower) the (expected) public deficit. At the same time, the system of unconditional grants from the central layer of government provokes an ¿income effect¿ which disincentivises the efforts of the tax administration. Secondly, these efforts also decrease when the margin to lose a parliamentary seat in an electoral district is cut, although the importance of this disincentive decreases according to the parliamentary strength of the incumbent