Recurrence of nephrotic syndrome/focal segmental glomerulosclerosis following renal transplantation in children

The incidence of recurrence of nephrotic syndrome/focal segmental glomerulosclerosis (NS/FSGS) is variable (~30%). The incidence of recurrence is less in African-Americans than in whites and Hispanics. Graft survival rates are decreased in recipients with FSGS, especially if remission of the NS is not achieved in those with recurrence. Although controversial, the use of living donor (LD) transplants are not contraindicated; however, obligatory heterozygote parental grafts with a podocin mutation should be used with caution. Optimal treatment to induce a remission post-transplant has not been delineated. Pre-transplant and/or prophylactic post-transplant pre-operative plasmapheresis (PP) for high-risk patients—especially those with recurrence in a previous graft—may be promising. An international multicenter controlled study is required to delineate the optimal approach to prevent and/or treat the recurrence of NS/FSGS

The Birth of Jeru: Gerry Mulligan's Early Composing/Arranging Career (1945-1953)

Gerry Mulligan (1927-1996) is undoubtedly the most celebrated baritone saxophonist of all time. For decades, both popular and critics' polls consistently recognized him as the best on his instrument. He took first place for forty-three consecutive years (1953-1995) in Downbeat's Readers' Poll for best baritone saxophonist, and his reviews by critics and fellow performers were, for the most part, laudatory. He performed with such jazz icons as Chet Baker, Dave Brubeck, Miles Davis, Duke Ellington, Dizzy Gillespie, Thelonious Monk, and Ben Webster. Perhaps as a consequence of this recognition as a performer, Gerry Mulligan's contributions as a composer and arranger have been overshadowed and therefore less recognized. This is despite the importance of his writing and its influence on the history of modern jazz orchestration. It was as a composer/arranger that he first made his mark, and he would preoccupy himself with writing throughout most of his career. The purpose of this dissertation is to study the history of Gerry Mulligan's composing/arranging career starting with his earliest professional writing projects as a teenager (ca 1945) and ending with the dissolution of his first pianoless quartet with Chet Baker (1953). To date, despite the availability of a huge collection of primary sources that Franca Mulligan, Gerry's widow, has donated to the Library of Congress, no scholarly study has been undertaken to examine this material, particularly in the context of Mulligan's development as composer/arranger. A particularly invaluable source has been made available to me for this project through special permission by Mrs. Mulligan. In 1995, Gerry Mulligan recorded his oral history by way of a series of interviews. The memoirs address such topics as his childhood; his associations with Gil Evans, Miles Davis, Charlie Parker, Thelonious Monk, and Gene Krupa; his pianoless quartet with Chet Baker; his ideas about counterpoint; and his heroin addiction. The dissertation draws particular attention to Mulligan's unique creative and intellectual processes, their context in his collaboration with other musicians, their effect on the evolution of his style throughout his early career, and their influence on other modern jazz composer/arrangers.

Growth following solid organ transplantation in childhood

One of the ultimate goals of successful solid organ transplantation in pediatric recipients is attaining an optimal final adult height. This manuscript will discuss growth following transplantation in pediatric recipients of kidney, liver, heart, lung or small bowel transplants. Remarkably similar factors impact growth in all of these recipients. Age is a primary factor, with younger recipients exhibiting the greatest immediate catch-up growth. Graft function is a significant contributing factor, with a reduced glomerular filtration rate correlating with poor growth in kidney recipients and the need for re-transplantation with impaired growth in liver recipients. The known adverse impact of steroids on growth has led to modification of the steroid dose and even steroid withdrawal and avoidance. In kidney and liver recipients, this strategy has been associated with the development of acute rejection. In infant heart transplantation, avoiding maintenance corticosteroid immunosuppression is associated with normal growth velocity in the majority of patients. With marked improvements in patient and graft survival rates in pediatric organ recipients, quality of life issues, such as normal adult height, should now receive paramount attention. In general, normal growth following solid organ transplantation should be an achievable goal that results in normal adult height

Thermodynamics of weight loss diets

BACKGROUND: It is commonly held that "a calorie is a calorie", i.e. that diets of equal caloric content will result in identical weight change independent of macronutrient composition, and appeal is frequently made to the laws of thermodynamics. We have previously shown that thermodynamics does not support such a view and that diets of different macronutrient content may be expected to induce different changes in body mass. Low carbohydrate diets in particular have claimed a "metabolic advantage" meaning more weight loss than in isocaloric diets of higher carbohydrate content. In this review, for pedagogic clarity, we reframe the theoretical discussion to directly link thermodynamic inefficiency to weight change. The problem in outline: Is metabolic advantage theoretically possible? If so, what biochemical mechanisms might plausibly explain it? Finally, what experimental evidence exists to determine whether it does or does not occur? RESULTS: Reduced thermodynamic efficiency will result in increased weight loss. The laws of thermodynamics are silent on the existence of variable thermodynamic efficiency in metabolic processes. Therefore such variability is permitted and can be related to differences in weight lost. The existence of variable efficiency and metabolic advantage is therefore an empiric question rather than a theoretical one, confirmed by many experimental isocaloric studies, pending a properly performed meta-analysis. Mechanisms are as yet unknown, but plausible mechanisms at the metabolic level are proposed. CONCLUSIONS: Variable thermodynamic efficiency due to dietary manipulation is permitted by physical laws, is supported by much experimental data, and may be reasonably explained by plausible mechanisms

Semiparametric Methods for Semi-competing Risks Problem with Censoring and Truncation

Studies of chronic life-threatening diseases often involve both mortality and morbidity. In observational studies, the data may also be subject to administrative left truncation and right censoring. Since mortality and morbidity may be correlated and mortality may censor morbidity, the Lynden-Bell estimator for left truncated and right censored data may be biased for estimating the marginal survival function of the non-terminal event. We propose a semiparametric estimator for this survival function based on a joint model for the two time-to-event variables, which utilizes the gamma frailty specification in the region of the observable data. Firstly, we develop a novel estimator for the gamma frailty parameter under left truncation. Using this estimator, we then derive a closed form estimator for the marginal distribution of the non-terminal event. The large sample properties of the estimators are established via asymptotic theory. The methodology performs well with moderate sample sizes, both in simulations and in an analysis of data from a diabetes registry

Diamonds are Forever

We defend the thesis that every necessarily true proposition is always true. Since not every proposition that is always true is necessarily true, our thesis is at odds with theories of modality and time, such as those of Kit Fine and David Kaplan, which posit a fundamental symmetry between modal and tense operators. According to such theories, just as it is a contingent matter what is true at a given time, it is likewise a temporary matter what is true at a given possible world; so a proposition that is now true at all worlds, and thus necessarily true, may yet at some past or future time be false in the actual world, and thus not always true. We reconstruct and criticize several lines of argument in favor of this picture, and then argue against the picture on the grounds that it is inconsistent with certain sorts of contingency in the structure of time

Rhabdomyolysis in an HIV cohort: epidemiology, causes and outcomes.

BackgroundThe Literature on rhabdomyolysis in the HIV-positive population is sparse and limited. We aimed to explore the incidence, patient characteristics, etiologies and outcomes of rhabdomyolysis in a cohort of HIV-positive patients identified through the Johns Hopkins HIV clinical registry between June 1992 and April 2014.MethodsA retrospective analysis of 362 HIV-positive patients with non-cardiac CK elevation ≥1000 IU/L was performed. Both inpatients and outpatients were included. Incidence rate and potential etiologies for rhabdomyolysis were ascertained. The development of acute kidney injury (AKI, defined as doubling of serum creatinine), need for dialysis, and death in the setting of rhabdomyolysis were determined. Logistic regression was used to evaluate the association of peak CK level with the development of AKI.ResultsThree hundred sixty two cases of rhabdomyolysis were identified in a cohort of 7079 patients with a 38,382 person years follow-up time. The incidence rate was nine cases per 1000 person-years (95% CI: 8.5-10.5). Infection was the most common etiology followed by compression injury and drug/alcohol use. One-third of cases had multiple potential etiologies. AKI developed in 46% of cases; 20% of which required dialysis. Thirteen percent died during follow-up. After adjustment, AKI was associated with higher CK (OR 2.05 for each 1-log increase in CK [95% CI: 1.40-2.99]), infection (OR 5.48 [95% CI 2.65-11.31]) and higher HIV viral load (OR 1.22 per 1-log increase [95% CI: 1.03-1.45]).ConclusionRhabdomyolysis in the HIV-positive population has many possible causes and is frequently multifactorial. HIV-positive individuals with rhabdomyolysis have a high risk of AKI and mortality