BACKGROUND.: Anti-human leukocyte antigen antibodies (a-HLA) cause graft injury identified by C4d in peritubular capillaries. We investigated whether a-HLA relate to episodes of C4d negative acute rejection (AR). METHODS.: We analyzed 878 kidney recipients transplanted from January 2000 to December 2006. Pretransplant, 36% of these crossmatch negative recipients had a-HLA measured by solid phase assays. RESULTS.: AR occurred in 154 patients (18%) and 11 of them (9.4%) were C4d+. Forty-six percent of ARs were diagnosed by protocol biopsy. The risk of C4d-AR was increased in patients with a-HLA class I with donor specificity (DSA-I)(hazard ratio=1.519; confidence interval, 1.02-2.26; P=0.039). DSA-II were not associated with an increased risk of C4d-AR. The relationship between DSA-I and C4d-AR was independent of recipient age, BK nephropathy, and HLA mismatches. Compared with DSA-, in DSA+ recipients C4d-AR were most often histologically "borderline." DSA+ was associated with capillaritis in the biopsy (glomerulitis, 6.1% vs. 32%, P=0.003; peritubular capillaritis: 13% vs. 40%, P=0.0009). Compared with no AR, C4d-AR with capillaritis was associated with reduced graft survival (hazard ratio=4.164; confidence interval, 1.763-9.832; P=0.001), independent of other variables. This association was observed even in the cases of borderline AR. CONCLUSIONS.: DSA-I increases the risk of C4d-AR. The presence of DSA-I or II is associated with capillaritis during AR. Capillaritis is associated with reduced graft survival.

This paper presents an evaluation of two types of Geiger-mode avalanche photodiodes (G-APDs) for their potential to be used in a positron emission tomography (PET) detector. While the MPPC G-APD had only 3600 cells, the solid state photomultiplier (SSPM)-type G-APD had 8100 cells. In a single-channel G-APD/LSO setup, the energy resolution [Formula: see text] of the SSPM at 511 keV was 25%, while the [Formula: see text] of the MPPC was 13.5%(FWHM). No influences were observed while the detectors were inside a 7 T magnetic resonance (MR) scanner. A time resolution of 2.7 ns (FWHM) was measured for the LSO/SSPM and 0.9 ns for the LSO/MPPC detector setup. Although the linearity was superior for the SSPM in the single detector readout, the inferior energy and time resolution excluded them to be used for the block detector readout. All 12 x 12 LSO crystals of the block could be resolved in a crystal map using a 3 x 3 MPPC G-APD array. The time resolution of the block detector was 950 ps. While the energy spectra for the MPPC-based single-channel setup were nonlinear, they reached linearity better than 5% in the block detector. A high number of G-APD cells provide a linear signal in a single-channel detector setup, but not necessarily a good timing or [Formula: see text] due to a larger inactive surface resulting in lower photon detection efficiency. G-APDs with a low number of cells provide a good timing and [Formula: see text] and linear signals in block detector designs, where the scintillation light is shared over many G-APDs.

On examination of the records of 1321 patients following kidney transplant over an 11-year period, we found that 29 patients had recurrent membranoproliferative glomerulonephritis (MPGN). We excluded from this analysis patients who had MPGN type II, those with clear evidence of secondary MPGN, and those lacking post-transplant biopsies. During an average of 53 months of follow-up, we found using protocol biopsies that 12 of these patients had recurrent MPGN diagnosed 1 week to 14 months post-transplant. In 4 of the 12 patients this presented clinically, whereas the remaining had subclinical disease. The risk of recurrence was significantly increased in patients with low complement levels. Serum monoclonal proteins were found in a total of six patients; appeared to be associated with earlier, more aggressive disease; and were more common in recurrent than non-recurrent disease. The recurrence of MPGN was marginally higher in recipients of living-donor kidneys. Some patients developed characteristic lesions within 2 months post-transplant, whereas others presented with minimal, atypical histological changes that progressed to MPGN. Of 29 patients, 5 lost their allograft and 2 patients remain on chronic plasmapheresis. Our study shows the risk of MPGN recurrence and progression depends on identifiable pretransplant characteristics, has variable clinical impact, and can result in graft failure.Kidney International advance online publication, 3 February 2010; doi:10.1038/ki.2010.1.

BACKGROUND AND OBJECTIVES: Management of incidental renal artery and kidney abnormalities in patients undergoing computed tomography scans is a clinical challenge because their frequency in healthy subjects has not been precisely estimated. Therefore, the prevalence and management of these abnormalities were determined among a large cohort of potential kidney donors undergoing protocol evaluations. DESIGN, SETTING, PARTICIPANTS,& MEASUREMENTS: All patients at the Mayo Clinic who underwent computed tomographic angiography and urography as part of their kidney donor evaluation between 2000 and 2008 were identified. Radiographic reports were abstracted for abnormalities of the renal arteries and kidneys. The prevalence of radiographic abnormalities was stratified by age and gender, and the effect on approval for kidney donation was determined. RESULTS: Among 1957 potential kidney donors, the mean +/- SD age was 43 +/- 12 years, and 58% were women. The most common abnormalities were kidney stones (11%), focal scarring (3.6%), fibromuscular dysplasia (2.8%), and other renal artery narrowing or atherosclerosis (5.3%). Fibromuscular dysplasia, focal scarring, parenchymal atrophy, and upper tract dilation were more common in women. Renal artery narrowing, focal scarring, and indeterminate masses increased with age. Overall, 25% of potential donors had at least one abnormality. However, these incidental radiographic abnormalities contributed to exclusion from donation in only 6.7% of potential donors. CONCLUSIONS: Incidental radiographic abnormalities of the renal arteries and kidneys are common. The majority of imaging findings are not perceived to be harmful enough to prevent kidney donation, but future studies are needed to determine their clinical relevance.

Renal dysfunction commonly occurs in multiple myeloma (MM) and is caused by deposition of abnormal light chain within various compartments of the kidney. Renal pathologic findings are diverse and include cast nephropathy (CN), amyloidosis and light-chain deposition disease (LCDD). We report a case of renal failure in a patient with MM caused by concurrent CN, amyloidosis and LCDD which has not been previously described.

BACKGROUND : Eosinophilic esophagitis is increasingly recognized as a cause of dysphagia or food impaction in pediatric patients. It has a high male predominance and is often associated with a history of allergy or asthma. OBJECTIVE : To correlate fluoroscopic findings in eosinophilic esophagitis with the endoscopic and histologic findings. MATERIALS AND METHODS : We retrospectively reviewed the upper gastrointestinal (UGI) findings of eosinophilic esophagitis and correlated them with the clinical, endoscopic and histologic findings in a series of 17 children (12 boys, 5 girls). RESULTS : UGI findings were normal in 12 children, including 4 who had a normal UGI exam after endoscopic disimpaction for an obstructing food bolus. Five children had strictures identified on UGI: one was demonstrated with endoscopy. This suggests that the impactions and strictures were due to an esophageal dysmotility rather than a fixed anatomic abnormality. CONCLUSION : Because the UGI findings are frequently normal in eosinophilic esophagitis, radiologists need to have a high index of suspicion for this disease. In children with a strong clinical history, especially impaction in the absence of an esophageal stricture, endoscopy and biopsy are indicated for further evaluation.

INTRODUCTION:: To study the results in cervical carcinoma after a combined treatment with surgery and radiotherapy with regard to survival and side effects. METHODS:: A retrospective analysis of 71 patients who underwent radical hysterectomy and postoperative radiotherapy between January 1, 1987, and December 31, 2001, was performed. RESULTS:: Median follow-up periods were 162 months for surviving patients and 62 months for deceased patients. The 5-year overall survival and disease-specific survival for all stages were 80.3% and 82.7%, respectively. The 5-year actuarial incidence of late reactions for grade 1 + 2 was as follows: for upper gastrointestinal tract, 36%; for rectum, 37%; for urinary tract, 19%; for vagina, 26%; and for lymph edema, 19%. The 5-year actuarial incidence of late reactions for grade 3 + 4 was as follows: for upper gastrointestinal tract, 12%; and for rectum, 3%. CONCLUSIONS:: Careful pretreatment workup and well-defined criteria for postoperative radiotherapy are essential, and new treatment options such as intensity-modulated radiation therapy should be considered.

The intensity of mitogenetic radiation was estimated from data given by Gurwitsch. The sensitivity of the biological method and of the physical methods were compared. With onion-base pulp and onion roots as mitogenetic inductors, the photographic method gave no perceptible blackening for exposures up to 184 hours. A photoelectric counter tube was described with cadmium as photoelectric metal. Its sensitivity was such that a radiation intensity of 10 to 15 quanta per cm.(2) per second of the Hg line 2536 A was detectable. Spurious effects produced by the counter tube were described and means for their avoidance given. A number of different biological materials, all supposed to be excellent mitogenetic radiators, were investigated by means of the counter tube. No mitogenetic radiation could be detected.

OBJECTIVES: Dichlorodiphenyltrichloroethane (DDT) was used worldwide until the 1970s, when concerns about its toxic effects, its environmental persistence, and its concentration in the food supply led to use restrictions and prohibitions. In 2001, more than 100 countries signed the Stockholm Convention on Persistent Organic Pollutants (POPs), committing to eliminate the use of 12 POPs of greatest concern. However, DDT use was allowed for disease vector control. In 2006, the World Health Organization and the U.S. Agency for International Development endorsed indoor DDT spraying to control malaria. To better inform current policy, we reviewed epidemiologic studies published from 2003 to 2008 that investigated the human health consequences of DDT and/or DDE (dichlorodiphenyldichloroethylene) exposure. DATA SOURCES AND EXTRACTION: We conducted a PubMed search in October 2008 and retrieved 494 studies. DATA SYNTHESIS: Use restrictions have been successful in lowering human exposure to DDT, but blood concentrations of DDT and DDE are high in countries where DDT is currently being used or was more recently restricted. The recent literature shows a growing body of evidence that exposure to DDT and its breakdown product DDE may be associated with adverse health outcomes such as breast cancer, diabetes, decreased semen quality, spontaneous abortion, and impaired neurodevelopment in children. CONCLUSIONS: Although we provide evidence to suggest that DDT and DDE may pose a risk to human health, we also highlight the lack of knowledge about human exposure and health effects in communities where DDT is currently being sprayed for malaria control. We recommend research to address this gap and to develop safe and effective alternatives to DDT.

The accretion of matter onto a massive black hole is believed to feed the relativistic plasma jets found in many active galactic nuclei (AGN). Although some AGN accelerate particles to energies exceeding 10(12) electron Volts (eV) and are bright sources of very-high-energy (VHE) gamma-ray emission, it is not yet known where the VHE emission originates. Here, we report on radio and VHE observations of the radio galaxy M 87, revealing a period of extremely strong VHE gamma-ray flares accompanied by a strong increase of the radio flux from its nucleus. These results imply that charged particles are accelerated to very high energies in the immediate vicinity of the black hole.