Randomized trial of FK 506/prednisone vs FK 506/azathioprine/prednisone after renal transplantation: preliminary report.

FK 506 was used as a primary immunosuppressive agent in 125 cases of renal transplantation in a randomized trial comparing FK 506/prednisone with FK 506/azathioprine/prednisone. With a mean follow-up of 5.5 +/- 2.5 months, there has been a 6-month actuarial patient survival of 99% and graft survival of 88%. There is no difference thus far between the two-drug and three-drug groups, although there may be less rejection and diabetes in the three-drug group. These results suggest that FK 506 is a useful immunosuppressive agent in kidney transplantation

Temporal and spatial dynamics of CO2 air-sea flux in the Gulf of Maine

Ocean surface layer carbon dioxide (CO2) data collected in the Gulf of Maine from 2004 to 2008 are presented. Monthly shipboard observations are combined with additional higher‐resolution CO2 observations to characterize CO2 fugacity ( fCO2) and CO2 flux over hourly to interannual time scales. Observed fCO2 andCO2 flux dynamics are dominated by a seasonal cycle, with a large spring influx of CO2 and a fall‐to‐winter efflux back to the atmosphere. The temporal results at inner, middle, and outer shelf locations are highly correlated, and observed spatial variability is generally small relative to the monthly to seasonal temporal changes. The averaged annual flux is in near balance and is a net source of carbon to the atmosphere over 5 years, with a value of +0.38 mol m−2 yr−1. However, moderate interannual variation is also observed, where years 2005 and 2007 represent cases of regional source (+0.71) and sink (−0.11) anomalies. We use moored daily CO2 measurements to quantify aliasing due to temporal undersampling, an important error budget term that is typically unresolved. The uncertainty of our derived annual flux measurement is ±0.26 mol m−2 yr−1 and is dominated by this aliasing term. Comparison of results to the neighboring Middle and South Atlantic Bight coastal shelf systems indicates that the Gulf of Maine exhibits a similar annual cycle and range of oceanic fCO2 magnitude but differs in the seasonal phase. It also differs by enhanced fCO2 controls by factors other than temperature‐driven solubility, including biological drawdown, fall‐to‐winter vertical mixing, and river runoff

Dynamics of a two-level system strongly coupled to a high-frequency quantum oscillator

Recent experiments on quantum behavior in microfabricated solid-state systems suggest tantalizing connections to quantum optics. Several of these experiments address the prototypical problem of cavity quantum electrodynamics: a two-level system coupled to a quantum harmonic oscillator. Such devices may allow the exploration of parameter regimes outside the near-resonance and weak-coupling assumptions of the ubiquitous rotating-wave approximation (RWA), necessitating other theoretical approaches. One such approach is an adiabatic approximation in the limit that the oscillator frequency is much larger than the characteristic frequency of the two-level system. A derivation of the approximation is presented and the time evolution of the two-level-system occupation probability is calculated using both thermal- and coherent-state initial conditions for the oscillator. Closed-form evaluation of the time evolution in the weak-coupling limit provides insight into the differences between the thermal- and coherent-state models. Finally, potential experimental observations in solid-state systems, particularly the Cooper-pair box--nanomechanical resonator system, are discussed and found to be promising.Comment: 16 pages, 11 figures; revised abstract; some text revisions; added two figures and combined others; added references. Submitted to Phys. Rev.

Hypotrophic roots of the upper central incisors – a proposed new dental discrete trait

This paper describes a newly de-fined nonmetric trait in the human dentition, i.e., Hypotrophic Roots of the Upper Central Incisors (HRUCI). Teeth presenting HRUCI are character-ized by abnormally short roots whose crowns exhibit no apparent morphological alterations. The trait was observed in six samples from collec-tive funerary sites in the Iberian Peninsula dated from the Late Neolithic to the Chalcolithic period

Image-guided fluorescence tomography in head & neck surgical models

Clinical indications for fluorescence-guided surgery continue to expand, and are being spurred by the rapid development of new agents that improve biological targeting.1 There is a corresponding need to develop imaging systems that quantify fluorescence - not only at the tissue surface, but at depth. We have recently described an image-guided fluorescence tomography system that leverages geometric data from intraoperative cone-beam CT and surgical navigation,2 and builds on finite-element method software (NIRFAST) for diffuse optical tomography (DOT).3 DOT systems have most commonly been used for sub-surface inclusions buried within tissue (e.g., breast and neurological tumors). Here, we focus on inclusion models relevant to tumors infiltrating from the mucosal surface (an “iceberg” model), as is most often the case in head and neck cancer, where over 85% of tumors are squamous cell carcinoma.4 This work presents results from simulations, tissue-simulating anatomical phantoms, and animal studies involving infiltrative tumor models. The objective is to characterize system performance across a range of inclusion diameters, depths, and optical properties. For example, Fig. 1 shows a fluorescence reconstruction of a simulated tonsil tumor in an oral cavity phantom. Future clinical studies are necessary to assess in vivo performance and intraoperative workflow. Please click Additional Files below to see the full abstract

A prospective randomized trial of FK506-based immunosuppression after renal transplantation

A group of 204 adult patients was entered into a prospective, randomized trial comparing FK506/pred-nisone with FK506/azathioprine/prednisone after renal transplantation between August 1, 1991 and October 11,1992. The purpose of the study was to see if the addition of azathioprine would reduce the incidence of rejection and improve graft survival. The recipient population was unselected, with 61 (30%) patients undergoing retransplantation, 37 (18%) having a panel-reactive antibody greater than 40%, and 33 (16%) over 60 years of age. The mean recipient age was 43.8±13.7 years (range 17.6-78). The mean donor age was 34.0±20.1 years (range 0.3-75); 13% of the cadaveric kidneys were from pediatric donors less than 3 years of age and were transplanted en bloc. The mean cold ischemia time was 31.4±8.4 hr. Living donors were the source of 13% of the kidneys. The mean follow-up was 22±4 months (range 12-29). Overall one-year actual patient survival was 94%. Overall one-year actual graft survival was 87%. Patients starting on double therapy had a one-year actual patient survival of 96% and a one-year actual graft survival of 92%. Patients starting on triple therapy had a one-year actual patient survival of 91% (P=ns compared with double therapy), and a one-year actual graft survival of 82% (P<0.02, compared with double therapy). Overall results with first cadaver transplants included a one-year actual patient survival of 94% and one-year actual graft survival of 88%, with no differences between double and triple therapy. The overall incidence of rejection was 48%, with 54% in the double therapy group and 41% in the triple therapy group (P<.07). The incidence of steroid-resistant rejection requiring antilymphocyte therapy (OKT3 or ATGAM) was 13%, and was not different between the double and triple therapy groups. The mean serum creatinine was 1.8±0.8 mg/dl. The mean BUN was 33±21 mg/dl, with no significant difference between the therapy groups. The mean serum cholesterol was 192 ±49 mg/dl. A total of 56% of the patients are off prednisone, and 35% of the patients are not taking any antihypertensive medications. Other complications included cytomegalovirus—14%; new-onset diabetes—16% (half of which was reversible); and posttransplant lymphoproliferative disorder—1%. There was a high incidence of crossover between the two groups, 27% of the patients in the double therapy group requiring the addition of azathioprine, and 45% of the patients in the triple therapy group requiring its discontinuation (usually tempoгагу). These results show that FK506 is an excellent immunosuppressive agent after renal transplantation and that azathioprine is not routinely effective as a third agent. A high quality of life resulted from the ability to use no (56%) or low-dose maintenance steroids. © 1995 by Williams and Wilkins

Improving results of pediatric renal transplantation

BACKGROUND: Outcome after renal transplantation in children has been variable. We undertook a retrospective study of our experience over the past five years. STUDY DESIGN: From January 1, 1988, to October 15, 1992, 60 renal transplantations were performed upon 59 children at the Children's Hospital of Pittsburgh. Twenty-eight (47 percent) of the kidneys were from cadaveric donors, and 32 (53 percent) were from living donors. The recipients ranged in age from 0.8 to 17.4 years, with a mean of 9.8 ± 4.8 years. Forty-six (77 percent) recipients were undergoing a first transplant, while 14 (23 percent) received a second or third transplant. Eight (13 percent) of the patients were sensitized, with a panel reactive antibody of more than 40 percent. Eleven of the 14 patients undergoing retransplantation and seven of the eight patients who were sensitized received kidneys from cadaveric donors. Thirty- three (55 percent) patients received cyclosporine-based immunosuppression, and 27 (45 percent) received FK506 as the primary immunosuppressive agent. RESULTS: The median follow-up period was 36 months, with a range of six to 63 months. The one- and four-year actuarial patient survival rate was 100 and 98 percent. The one- and four-year actuarial graft survival rate was 98 and 83 percent. For living donor recipients, the one- and four-year actuarial patient survival rate was 100 and 100 percent; for cadaveric recipients, it was 100 and 96 percent. Corresponding one- and four-year actuarial graft survival rates were 100 and 95 percent for the living donor recipients and 96 and 69 percent for the cadaveric recipients. Patients on cyclosporine had a one- and four-year patient survival rate of 100 and 97 percent, and patients on FK506 had a one- and three-year patient survival rate of 100 and 100 percent. Corresponding one- and four-year actuarial graft survival rates were 100 and 85 percent in the cyclosporine group, while one- and three-year actuarial graft survival rates were 96 and 84 percent in the FK506 group. The mean serum creatinine level was 1.24 ± 0.64 mg per dL; the blood urea nitrogen level was 26 ± 13 mg per dL. The incidence of rejection was 47 percent; 75 percent of the rejections were steroid-responsive. The incidence of cytomegalovirus was 10 percent. The incidence of post-transplant lymphoproliferative disorder was 8 percent. None of the patients on cyclosporine were able to be taken off prednisone; 56 percent of the patients receiving FK506 were taken off prednisone successfully. Early growth and development data suggest that the patients receiving FK506 off prednisone had significant gains in growth. CONCLUSIONS: These results support the idea that renal transplantation is a successful therapy for end-stage renal disease in children. They also illustrate the potential benefits of a new immunosuppressive agent, FK506