Late Episodes Research Articles

Renal Allograft Biopsies with Borderline Changes: Predictive Factors of Clinical Outcome

The clinical outcome and appropriate management for patients showing 'borderline changes' on allograft biopsy after renal transplantation is still controversial. In an attempt to identify predictive factors of clinical outcome of patients with such lesions, we reviewed the clinical course of 91 patients with borderline changes. Multivariate analysis revealed significant and independent effects of histological stage (i + t < or = or > 2) and time to borderline changes (< or = or > 3 months after transplant) on serum creatinine levels at 1 year from borderline changes episodes (respectively, p = 0.04 and p = 0.02) and only a significant effect of time to borderline changes on serum creatinine levels at 2 years (p = 0.005). Renal function at 1 year and 2 years as 5- and 8-year graft survival were not significantly different in the group of patients treated with antirejection therapy (T group, n = 49) compared with the untreated group (UT group, n = 42). This study strongly suggests that borderline changes with histological score (i + t) > 2 and late episodes of borderline changes should be considered to be of poor prognosis.

Combined propofol sedation with sub-Tenon's lidocaine/mercaine infusion for strabismus surgery in adults

To evaluate the safety and efficacy of propofol sedation combined with sub-Tenon's anaesthesia for strabismus surgery in adults. Thirty-two consecutive patients aged 31-85 years underwent strabismus surgery under general (n=16) or local (n=16) anaesthesia. In the local anaesthesia (study) group, sedation was induced with a loading dose of midazolam, fentanyl, and propofol, followed by continuous infusion of propofol, 3-6 mg/k/h to deep sedation. A nasal tube was inserted to prevent airway obstruction. Sub-Tenon's anaesthesia included infusion of a 3-4 ml mixture (50 : 50) of lidocaine 2%/mercaine 0.5%. General anaesthesia consisted of premedication with midazolam, followed by fentanyl, esmeron-bromate, propofol, and tracheal intubation. Duration of surgery and anaesthesia, intraoperative oculocardiac reflex and arrhythmias, time to discharge, postoperative pain, nausea and vomiting, and patient and surgeon satisfaction were evaluated. The local anaesthesia group had a significantly shorter operative and anaesthesia time, fewer episodes of oculocardiac reflex or arrythmia/bradycardia requiring treatment, fewer early or late episodes of nausea and vomiting, and less pain. The patients and surgeon in this group reported higher satisfaction. Propofol sedation with local sub-Tenon's injection of lidocaine/mercaine is recommended for the induction and maintenance of anaesthesia during unilateral or bilateral strabismus surgery in adults. The method is quick and effective, without systemic or ocular side effects.

Isotopic indicators of deformation in the Red Sea

Palaeostress analysis of spreading oceanic ridges requires data on extension over time and at different locations along strike so that mechanical models can be formulated and tested. The seafloor palaeomagnetic record provides average spreading rates but as the last (normal) chron measures 790,000 years an alternative method is required for identifying episodes of spreading at time scales of <10 3 yr which can be fused with seismic and geodetic sequences. On the assumption that the level of hydrothermal circulation on the sea floor is linked with tectonic activity, palaeotemperature and geochemical changes in the seawater determined from cores of the sea floor sediments should serve as proxies for episodes of extension provided they can be dated and alternative explanations for them ruled out. The Red Sea provides a study area for evaluating this proposal because it is a marginal sea with a shallow threshold which limits mixing with the open ocean especially during periods of low sea level, it receives little runoff from the arid lands that surround it, and its median ridge is hydrothermally active. Chemical evidence has been reported for two broadly synchronous late Quaternary hydrothermal episodes in the Atlantis II and Thetis deeps; 87Sr/ 86Sr ratios in the Atlantis II deep are thought to reflect variations in hydrothermal activity. Published δ 13C and δ 18O data from cores both within brine pools and outside them indicate fluctuations during the Holocene for which no climatic counterparts on bordering land areas or in the Arabian Sea are documented; moreover our study has revealed a major (positive) δ 18O excursion older than 40,000 yr in Globigerinoides ruber in Core CH10003-3 PC at a depth of 1374 m which is not associated with hardgrounds or a δ 13C fluctuation and which may have resulted from a hydrothermal pulse. There is no such signal in the core for events of magnitude up to 8.3 that are recorded in the palaeoseismic record of the last 50,000 yr in the Lisan Marls, which suggests that the δ 18O pulse from Core CH10003-3 corresponded with an event of M>8.3 in the RedSea-Dead Sea rift system Other isotopes may prove to be more sensitive and therefore responsive to smaller deformation.

Early post-transplant urinary IP-10 expression after kidney transplantation is predictive of short- and long-term graft function

The early identification of renal transplant recipients at enhanced risk of developing acute and subclinical rejection would allow individualized adjustment of immunosuppression before functional graft injury occurs and would exclude these patients from drug-weaning studies. Protein and reverse transcriptase-polymerase chain reaction-based analyses of candidate markers in urine open the opportunity to closely monitor kidney-transplanted patients non-invasively. The chemokine interferon-inducible protein 10 (IP-10; CXCL10) might be an interesting candidate to uncover ongoing immune processes within the graft. Urine samples from kidney-transplanted recipients were retrospectively analyzed for IP-10 mRNA and protein expression. IP-10 levels were correlated with the incidence of acute rejection episodes proven by histology and long-term graft function assessed by the glomerular filtration rate 6 months post transplantation. IP-10 expression in urine identified patients with ongoing acute rejection episodes several days before a biopsy was indicated by rising serum creatinine levels. Most importantly, elevated levels of urinary IP-10 protein within the first four postoperative weeks were predictive of graft function at 6 months even in the absence of acute rejection. These data reveal a correlation between elevated IP-10 expression in urine at early time points post-transplantation and intragraft immune activation that leads to acute rejection and compromised long-term graft function.

Identifying Late Miocene episodes of connection and isolation in the Mediterranean–Paratethyan realm using Sr isotopes

After decades of research, the timing and nature of Late Miocene connections between the Mediterranean, Paratethys and the global ocean are still speculative. The hydrologic flux implications of exchange or isolation are central to all hypotheses for generating the major lithological changes that represent the Messinian Salinity Crisis. Moreover, differences in the hydrologic fluxes envisaged are the primary distinction between models. Despite this, these fluxes remain largely unconstrained. This paper describes the basis for using Sr isotope data innovatively combined with salinity data through hydrologic budget modelling to determine the timing and nature of Mediterranean hydrologic connectivity. We examine the hypotheses for three Late Miocene events to illustrate how this approach allows us to test implied hydrologic scenarios and exclude incompatible models. 1) Pre-evaporite restriction of the Mediterranean; 2) the initiation of salt precipitation; 3) connection between the Sea of Marmara and both Paratethys and the Mediterranean during the Messinian. This process suggests that the Atlantic–Mediterranean exchange was significantly reduced up to three million years before evaporite precipitation. It also indicates that end-member hypotheses for initiating salt precipitation in the Mediterranean (desiccation and connected basin models) are inconsistent with Sr isotope data. A contrasting model where evaporite formation was triggered by Atlantic transgression into a strongly evaporation-dominated Mediterranean is shown to be more compatible with available datasets. The application to Sea of Marmara samples indicates that salinity changes in the basin were not caused by changes to the amount of inflow from either Paratethys or the Mediterranean. Other possible as yet untested applications important for constraining different aspects of the Messinian Salinity Crisis are highlighted.

Découverte de graptolites d'âge Caradocien dans quelques sondages du Tinrhert (Sahara algérien)

First record of Caradocian graptolites in the Tinrhert, Algerian Sahara. Caradocian graptolites have been recovered for the first time from several bore-holes in the Tinrhert region of the Algerian Sahara. Stratigraphically, they belong to the Oued Ahara upper Member of the Edjeleh Formation. The graptolites are assigned to the new sub-species Diplograptus foliaceus tinrherti that is briefly described. The occurrence of D. foliaceus ( sensu lato), whose upper stratigraphic limit is Upper Soudleyan, indicates a probable Burrellian (Middle Caradocian) age for a more or less important part of the upper Oued Ahara Member. This is an additional age constraint for the beginning of the Late Ordovician glacial episode in the region, since the first glacial sediments (Gara Louki Formation) lie in erosional disconformity on the Oued Ahara Member. To cite this article: F. Kichou-Braîk et al., C. R. Palevol 5 (2006) .

A Late Episode of Irradiation in the Early Solar System: Evidence from Extinct36Cl and26Al in Meteorites

Late-formed halogen-rich phases in a refractory inclusion and a chondrule from the Allende meteorite exhibit large S-36 excesses that linearly correlate with the chlorine concentration, providing strong evidence in support of the existence of the short-lived nuclide Cl-36 (mean life of 0.43 Myr) in the early solar system. The inferred Cl-36/Cl-35 ratios at the time when these phases formed are very high (similar to 4 x 10(-6)) and essentially the same for the inclusion and the chondrule and confirm the earlier report of S-36 excess in another meteorite. In addition, the Cl-36 is decoupled from Al-26. The observed and any possible higher levels of Cl-36 cannot be the result of a supernova or AGB stellar source but require a late episode of energetic particle bombardment by the early Sun, in support of the arguments based on the previous discovery of Be-10. It is now clear that a blend of several sources is required to explain the short-lived nuclei when the solar system formed.

Coblation-Tonsillektomie

The introduction of coblation tonsillectomy (CTE) may contribute to reduce the postoperative morbidity in terms of pain, delayed oral intake and bleeding. A prospective pilot study was undertaken to evaluate the clinical course by inpatient observation (5 days) and telephone contact 6 months after CTE. The data from 61 patients (aged 44 months-69 years) were analyzed. The patients were grouped into those with surgical care of bleeding (A), non-surgical care of bleeding (B), and no bleeding event (C). The study was terminated early due to major bleeding complications in seven patients (A). Fifteen patients experienced minor (B) and 41 no (C) bleeding episodes. In the interview, 29 patients identified pain, lasting 16.7 (A), 11.6 (B) and 11 (C) days, as the most significant complication of surgery. The introduction of CTE was followed by a dramatic increase in major bleeding complications, including late bleeding episodes. Pain following tonsillectomy remains a problem to be solved by further techniques. We will continue to perform the cold dissection technique.

The Greenian Moment: T.H. Green, Religion and Political Argument in Victorian Britain

The Greenian Moment: T.H. Green, Religion and Political Argument in Victorian Britain, by DENYS P. LEIGHTON (Exeter: Imprint Academic, 2004; pp. 376. £25) IF T.H. GREEN was traditionally identified as an important intellectual figure of the middle and late Victorian period, until relatively recently it was still common for scholars writing about him to apologise for devoting attention to such an outmoded thinker. For despite the increased attention paid to Green after Melvin Richter's pioneering biography, The Politics of Conscience: T.H. Green and his Age was published in 1964, the effect of the positivism of the post-war decades was nevertheless to establish Green's reputation as a rather eccentric philosopher, at best typical of a late nineteenth-century Idealist episode that was out of keeping with the normal empirical and positivist thrust of British philosophical and political thought. So, unlike the sober utilitarianism of his great contemporary and rival, Henry Sidgwick, which anticipated the analytic clarity of G.E. Moore, and which even John Rawls considered worthy of refutation in A Theory of Justice (1971), Green's work became regarded as at best an historical curiosity, and at worst as metaphysical philosophy at its most overblown. In these circumstances, scholarship on Green was usually accompanied by a ritual apology for concentrating on an Idealist thinker, and justified by referring to the great influence he had on contemporaries, both as an Oxford tutor and as a political activist.

Seismic multi-arch structures in East China

In previous papers (Wencai, 2002, 2003), the author has analyzed the deep seismic reflection profiles along some of the Mesozoic plutons in East China, and has pointed out that the crustal structures around these intrusions usually correlate with a special seismic fabric called the seismic multi-arch structure. This paper will continue to show main characteristics of the seismic multi-arch structures and discuss their relationship with mantle-origin magmatism and the lithospheric thinning process. Calibration of seismic reflectors in Chinese continental drilling sites shows that small-scale arch-like reflectors can be generated by fractured eclogites or other plutons, they do not belong to the multi-arch structure specially discussed in the paper. The multi-arch structure is characterized by several arch-like reflectors distributed in both the upper and lower crust with granitoid plutons or stocks exposed on the surface, which do not have obvious negative Europium anomalies. Based on the distribution pattern of arch reflectors, the multi-arch magmatic structures can be divided into three main types, namely the simple vertical combination type, the spread arch magmatic structure and the arch-bouquet structure. All of them correlate to mantle-origin magmatism, but occur in different places. The spread arch magmatic structures occur within a Mesozoic/Cenozoic rift zone with very thin and hot lithosphere. The vertical combination type of the multi-arch structures occurred near the rift zones where lithosphere was thin and hot. The arch-bouquet magmatic structures occur far from the rift zones where the lithosphere is not hot. The continental rifting acted as the late episode of the lithospheric thinning process seeing that the rift zones usually coincide with the thinnest parts of the lithosphere in East China. In different locations within the lithospheric thinning areas, mantle-origin magmatic activities have different characteristics, which might generate different types of crustal structures revealed by the different types of the multi-arch magmatic structures. Therefore, high-quality deep seismic reflection profiles can be used indirectly to identify the pattern and scale of Mesozoic/Cenozoic lithospheric thinning processes and characteristics of the corresponding man-tle-origin magmatic activities.

Palaeobiogeographical affinities of the Argentine Precordilleran Late Palaeozoic brachiopod faunas

Precordilleran Late Palaeozoic brachiopod genera considered for this palaeobiogeographical analysis belong to four faunal associations: the low diversity Early Carboniferous (Tournaisian) Protocanites scalabrinii-Azurduya chavelensis Zone; the Late Carboniferous (Bashkirian-Moscovian) Levipustula fauna, which appears in sequences associated with glacial intervals; the latest Carboniferous-earliest Permian (Gzhelian-Asselian) Rhipidomella-Micraphelia and Tuberculatella-Aseptella associations, and the Early Permian (mid to late Asselian) Tivertonia jachalensis-Streptorhynchus inaequiornatus Biozone. The brachiopod affinities of the Precordillera are compared with the biogeographical Late Palaeozoic regions previously suggested by other authors using cluster analysis. During the Bashkirian-Moscovian, the Precordilleran faunas show a high affinity with the Austral Realm because of the presence of the Levipustula faunal elements in Eastern Australia. At the same time the affinity with the central and North American Regions is very low. The Early Permian Precordilleran faunas demonstrate highest affinity with the Gondwanan Realm with several genera also linked to the Tethyan and Boreal Realms. After the Late Carboniferous glacial episodes that affected the southwestern Gondwanan margin, the Precordilleran region underwent climatic amelioration. Subsequently, the Early Permian Precordilleran brachiopod assemblages are characterized by typical cool to cold water genera widely developed in the core Gondwanan Realm, with fewer genera (such as Kochiproductus, Rhynchopora and Neochonetes) suggesting a warmer water influence. The Precordilleran faunas demonstrate an increase in brachiopod diversity from the Carboniferous to the Permian, related to water temperature changes and to the palaeogeographical evolution of the southwestern Gondwanan margin and the movement of Gondwana across the South Pole.

Major episodes of the hydrologic history in the region of Hesperia Planum, Mars

The High Resolution Stereo Color camera (HRSC) data over Hesperia Planum and its surroundings reveal important details of geologic episodes and water‐related processes in this region. (1) The Noachian fluvial events of Hesperia Planum depression included accumulation of water and formation of a water/ice reservoir there. Later, the reservoir was depleted in several phases reflecting diminishing amounts of water. Climate changes and/or volcanism were important in these volatile releases. (2) The massive, 0.45–1.5 × 106km3, erosion from the Hesperia depression before the main lava eruption possibly resulted in thick, 0.5–1.5 km, deposits in Hellas Planitia. (3) Measurements of the flooded craters within Hesperia Planum provide the estimates of the thickness of lavas there, about 250–500 m. The final volume of lavas within Hesperia Planum (0.4–0.7 × 106km3) is comparable with the range of some terrestrial igneous provinces such as Columbia River Basalts. (4) Extended magmatism possibly triggered formation of the outflow channel in a few locations after the lava emplacement. During this episode, about 0.04 × 106km3of material (about 4.5–8.9% of the volume eroded in the episode of massive erosion) were removed. The thickness of the composite lava layer exposed on the walls of the outflow channels, a few hundreds of meters, corresponds well to the thickness estimates made by the measurements of the flooded craters. (5) Dispersed viscous flows (debris aprons, flow‐like deposits) reflect the final fluvial events. Viscous flows from the subsurface sources in the Southwestern trough associate with Dao, Niger, and Harmakhis Valles. These flows represent the final volatile discharge from the Hesperia reservoir that mostly was depleted by the earlier events of massive erosion and formation of the outflow channels. Viscous surface flows are mostly associated with Reull Vallis and probably reflect redistribution of volatiles related to the late episodes of evolution of this outflow channel.

Health-Related Quality of Life in Two Hundred-Eighty Lung Transplant Recipients

Health-related quality of life (HRQoL) has increasingly been accepted as a supplementary outcome measure for patients after lung transplantation (LTx). Using a retrospective cross-sectional study design, 280 LTx recipients (3 months to 14 years after LTx) were asked to assess their HRQoL using a generic (Quality of Life Profile for Chronic Diseases) questionnaire, which was previously validated for this specific population. In addition, the questionnaire was also performed by 155 healthy participants. All sub-scale findings ranged from 2.40 to 3.08 (0 to 4) for all patients after LTx. A significantly reduced HRQoL was reported by the sub-cohort of patients living 5 to 6 years with the allograft for all sub-scales (p < 0.006), except for Social Functioning, and was associated with the incidence of bronchiolitis obliterans syndrome (BOS; p < 0.05). Cystic fibrosis patients (p < 0.05), single-lung transplant recipients (p < 0.05) and patients of older age (p < 0.05) showed significantly decreased physical ability ratings. Patients who remained free of infection and late acute rejection episodes scored themselves significantly higher with regard to their Relaxation Capabilities (p < 0.05 for rejection; p < 0.05 for infection) and Social Functioning (p < 0.01 for rejection; p < 0.05 for infection) vs patients who experienced infection or rejection episodes. Comparisons with a normative cohort showed similar HRQoL scales for LTx patients and the healthy population, except with regard to Social Functioning (p < 0.01). Self-ratings for HRQoL were high for all dimensions for the entire sample, and remained relatively similar even for medium- and long-term survivors. HRQoL was dependent on incidence of infections, rejections and the onset of BOS. Despite differences in life expectancy of LTx patients compared with the healthy population, HRQoL self-ratings were within similar ranges.

Prognostic Significance of Early Vaso-Occlusive Complications in Children Who Have Sickle Cell Anemia.

Sickle cell anemia (SS) is a phenotypically variable disease whose course is difficult to predict. The Cooperative Study of Sickle Cell Disease (CSSCD) found that dactylitis in the 1st year of life predicted adverse outcomes in later childhood. We aimed to determine whether early vaso-occlusive complications, including dactylitis, were prognostic in the Dallas Newborn Cohort. We studied all cohort members with SS or sickle-β0-thalassemia who were <1 yr of age at their first clinic visit, ≥5 yrs of age at last follow-up, and who had complete records. We defined 3 potential “early” (occurring in the first 3 yrs of life) predictors: any hospitalization for (1) pain crisis (non-dactylitis), (2) dactylitis, or (3) acute chest syndrome (ACS). We studied the associations of these predictors with the following “late” (occurring on or after the 3rd birthday) outcomes: death of any cause; overt stroke; use of hydroxyurea (HU), chronic transfusion (CT), or stem cell transplantation (SCT); and mean number of hospitalizations for late pain crisis and ACS. Late pain and ACS episodes were enumerated for each patient between the 3rd birthday and the last clinical encounter or the start date of a disease-modifying therapy (HU, CT, or SCT), whichever was first. Mean number of pain and ACS events was analyzed for the late follow-up period in total and in 2-yr intervals. Outcomes up to age 20 were included. Two-sided Fisher exact and t-tests were used appropriately. There were 264 subjects (256 SS; 54.9% male). Mean age at first visit was 4.1±2.3 mos (±S.D.) and mean follow-up was 12.1±4.3 yrs. The following early hospitalizations occurred: 53 subjects (20.1%) had pain crisis; 16 (6.1%) had dactylitis, and 85 (32.9%) had ACS. There were 5 deaths and 30 overt strokes. Sixty-six subjects were treated with HU (37), CT (40), and/or SCT (1). We found that subjects who had early pain, dactylitis, or ACS (compared with those who did not) were not more likely to die (1.7 vs. 2.1%; P>0.99) or have a stroke (12.2 vs. 10.3%; P=0.69). However, the use of a disease-modifying therapy was more common among subjects who had early pain (37.7 vs. 19.9%; P=0.01) and ACS (37.6 vs. 16.2%; P<0.001), but not dactylitis (18.8 vs. 23.6%; P>0.99). This prediction held only for HU use when the treatments (HU, CT, or SCT) were analyzed separately. Subjects who experienced early pain or ACS had on average a 2.2-fold (P=0.02) or 2.1-fold (P=0.01), respectively, higher number of late pain crises between ages 3 and 11, but not beyond (all P>0.05). Dactylitis did not predict a higher number of late painful events at any age (all P>0.05). Likewise, neither early pain nor dactylitis was associated with a higher number of hospitalizations for late ACS (all P>0.05). However, subjects who had early ACS had a 1.7 to 3.6-fold higher mean number of ACS events throughout all late age groups (all P<0.05). In summary, early hospitalization for pain, dactylitis, or ACS did not predict death or stroke. Early pain and ACS were associated with use of HU in later childhood, but not CT or SCT. Early pain and ACS predicted an increased number of hospitalizations for pain until age 11, but not beyond. Early ACS was a strong predictor of recurrent ACS throughout childhood. Notably, we found that hospitalization for dactylitis had no particular prognostic significance, unlike the CSSCD. In conclusion, the prognostic significance of early vaso-occlusive complications is limited.

Post-Engraftment Infections in Adult Patients Transplanted with Single Cord Blood Units Supported by Co-Infusion of Mobilized Purified Hematopoietic Stem Cells from a Third Party Donor.

We have co-infused mobilized purified hematopoietic stem cells (HSC) from a third party donor to shorten neutropenia in single unit cord blood transplantation (CBT). We describe post-engraftment infectious complications in 33 consecutive adults with high-risk hematologic malignancies. Median age was 30 (range 16–59), 22 were male. Patients were conditioned with TBI or busulfan, fludarabine, cyclophosphamide and ATG. GVHD prophylaxis included CyA and steroids. Non-bacterial prophylaxis included fluconazol, acyclovir, trimethoprim-sulfamethoxazole and azithromycin or Fansidar (toxopositive cases). Median total infused CB cell dose was 2.26 x 107/kg (1.31–3.7). Pre-CBT toxoplasma serology was positive in 12, negative in 13 (4 received HSC from a seropositive donor) and unknown in 8 cases. Pre-CBT CMV serology was positive in 30 cases. Pre-CBT, 7 patients were HBsAb(+), HBsAg(−) and 1 HBsAg(+) HBsAb(−). ANC>500/uL was achieved by 32/33, median time 10 days (9–36). Full CB chimerism was achieved in 32/33 cases. Most clinically significant infections occurred after ANC recovery (no major neutropenic infections).There were 34 episodes of CMV reactivation (3 patients developed CMV peumonitis and died <+60).Three patients developed CNS toxoplasmosis (2 seropositive pre-CBT): 1 died as a result (day +70); 1 died of acute GVHD (+120); 1 is alive on Fansidar (+547). One patient had visceral leishmaniasis (day +180) (BM aspirate for FUO; alive on amphotericin, day +379). Seven patients developed hemorrhagic cystitis, 6 related to polyomavirus (PCR on urine): 4 resolved without specific treatment and 2 with treatment (cidofovir, leflunomide). One had asymptomatic viruria. Reappearance of HBsAg occurred in 3/7 of the HBsAb (+) HBsAg(–) patients after day 100: 1 asymptomatic, 1 acute hepatitis and 1 cirrhosis. A HBsAg(+) patient was transplanted on adefovir (no increase in the viral load or liver enzymes). Four late (≥120) episodes of HZV were seen. A 27-year-old native Spaniard died (day +39) of tripanosomiasis (BM aspirate for FUO, positive PCR). Activation of pre-CBT transfusion-related infection is suspected.Short and long term results in adult CBT are improving. However we and others are reporting high incidence of post-engraftment unusual infections which seem related to delayed recovery of cell-mediated immunity. CMV, for which early diagnostic techniques and antiviral agents are available, heads the list. Our toxoplasma cases have prompted us to use prophylaxis in seropositive patients. HBV reactivation among HBsAb(+) HBsAg(−) patients raises the issue of prophylaxis during CBT versus close serological monitoring and pre-emptive therapy. Leishmaniasis is endemic among our city's dogs, so we actively search for it in FUO (BM examination and culture). Polyomavirus can be found in the urine of up to 50% of BM recipients, viruria preceding symptoms. The value of prospective monitoring and the role of antivirals are unknown. Other unusual infections (as tripanosomiasis in our country) require high index of awareness and consideration in FUO protocols (BM, PB smears). Adult CB recipients are at very high risk of fastidious non-bacterial infections requiring wide pre-BMT screening, close analytical and clinical monitoring, prophylactic/preemptive strategies or early aggressive therapy and innovative immunotherapeutic approaches.

Reading the Fossils of Faith: Thomas Henry Huxley and the Evolutionary Subtext of the Synoptic Problem

In a book loaded with metaphors of assault and retaliation, Andrew Dickson White'sA History of the Warfare of Science with Theology in Christendomsaved one of the best for Darwin. “Darwin'sOrigin of Species,” we are told, came “into the theological world like a plough into an ant-hill. Everywhere those thus rudely awakened from their old comfort and repose had swarmed forth angry and confused.” For White, the sometimes frenzied post-Darwinian controversies over providential design and divine creation were simply the latest episodes in an all-out struggle between theology and science that stretched back beyond Galileo's cheerless encounters with the Catholic Church. Though the voices may have been different, the song remained the same. Despite its continuing presence in the popular media, contemporary historians of religion and science now regard White's warfare thesis as an artifact of the constantly shifting relationships between these two cultural fields rather than a viable analysis of their engagement. The fundamental problem with the conflict model is that it is a bit like performing heart surgery with a Phillips head screwdriver: it is simply too blunt of an instrument for getting at the all-too-crucial particulars. As a result, it is likely to do more harm than good. To see why, consider what James Moore has called the “religious filiation” of Charles Darwin's evolutionary thought.

Episodic Cenozoic tectonism and the development of the NW European ‘passive’ continental margin

The North Atlantic margins are archetypally passive, yet they have experienced post-rift vertical movements of up to kilometre scale. The Cenozoic history of such movements along the NW European margin, from Ireland to mid-Norway, is examined by integrating published analyses of uplift and subsidence with higher resolution tectono-stratigraphic indicators of relative movements (including results from the STRATAGEM project). Three episodes of epeirogenic movement are identified, in the early, mid- and late Cenozoic, distinct from at least one phase of compressive tectonism. Two forms of epeirogenic movement are recognised, referred to as tilting (coeval subsidence and uplift, rotations <1° over distances of 100s of Kilometres) and sagging (strongly differential subsidence, rotations up to 4° over distances <100 km). Each epeirogenic episode involved relatively rapid (<10 Ma) km-scale tectonic movements that drove major changes in patterns of sedimentation to find expression in regional unconformity-bounded stratigraphic units. Early Cenozoic tilting (late Paleocene to early Eocene, c. 60–50 Ma) caused the basinward progradation of shelf-slope wedges from elongate uplifts along the inner continental margin and from offshore highs. Mid-Cenozoic sagging (late Eocene to early Oligocene, c. 35–25 Ma) ended wedge progradation and caused the onset of contourite deposition in deep-water basins. Late Cenozoic tilting (early Pliocene to present, <4±0.5 Ma) again caused the basinward progradation of shelf-slope wedges, from uplifts along the inner margin (including broad dome-like features) and from offshore highs. The early, mid- and late Cenozoic epeirogenic episodes coincided with Atlantic plate reorganisations, but the observed km-scale tectonic movements are too large to be accounted for as flexural deflections due to intra-plate stress variations. Mantle–lithosphere interactions are implied, but the succession of epeirogenic episodes, of differing form, are difficult to reconcile with the various syn-to post-rift mechanisms of permanent and/or transient movements proposed in the hypothetical context of a plume beneath Iceland. The epeirogenic movements can be explained as dynamic topographic responses to changing forms of small-scale convective flow in the upper mantle: tilting as coeval upwelling and downwelling above an edge-driven convection cell, sagging as a loss of dynamic support above a former upwelling. The inferred Cenozoic succession of epeirogenic tilting, sagging and tilting is proposed to record the episodic evolution of upper mantle convection during ocean opening, a process that may also be the underlying cause of plate reorganisations. The postulated episodes of flow reorganisation in the NE Atlantic region have testable implications for epeirogenic movements along the adjacent oceanic spreading ridge and conjugate continental margin, as well as on other Atlantic-type ‘passive’ margins.

Synchrony of Southern Hemisphere Late Pleistocene arid episodes: A review of luminescence chronologies from arid aeolian landscapes south of the Equator

Luminescence-dating chronologies that have been reported in various studies of Late Pleistocene arid-land aeolian sequences from Australia, southern Africa and South America are reviewed with the objective of determining whether any pan-hemispheric synchroneity existed in the timing of landscape responses to Late Quaternary climate changes south of the equator. The results broadly show that contemporaneous regional arid-land aeolian activity occurred in Australia and southern Africa during the periods ca 65–41 and 36–9 ka. The relatively limited luminescence data from the South American subcontinent also point to recurrent arid-land aeolian deposition between 63 and 8 ka, with increasing frequency in the period ca 32–8 ka. Records from all three continents suggest a period of reduced aeolian activity between 41 and 36 ka. Overall, the data are indicative of extensive landscape instability of the low to mid-latitudes in the Southern Hemisphere during the last glacial period, particularly at the Last Glacial Maximum, which accords with mainstream opinions. Aeolian activity during the Holocene has generally been localised. The rigour with which comparisons can be made between the different studies, however, is constrained by variations in practices between laboratories and changes that have occurred to luminescence dating procedures over the years.

Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: a literature review

This literature review summarizes the evidence on the prevalence, determinants, clinical and economic consequences of nonadherence with immunosuppressive drugs in renal transplant patients. A literature search yielded 38 articles measuring nonadherence by self-report, collateral report, assay, refill prescriptions or electronic monitoring. The weighted mean prevalence of self-reported nonadherence was 28%. Nonadherence is associated with poor clinical outcomes, contributing to 20% of late acute rejection episodes and 16% of the graft losses (weighted means). In addition, nonadherence results in lower lifetime costs because of shorter survival, yet also in a lower number of quality adjusted life years. Consistent determinants of nonadherence were younger age, social isolation, and cognitions (e.g. low self-efficacy, certain health beliefs). Determinants concerning the health care system/team seem to be under-investigated. Because the evidence summarized in this review is based on older immunosuppressive regimens, further research should focus on prevalence, determinants and consequences of nonadherence with newer immunosuppressive regimens.

Effects of Fish Oil Supplementation on Kidney Transplantation

The objective of this study was to assess the effects of omega-3 fatty acid supplementation on various kidney transplant-related outcomes. A systematic review and meta-analysis was performed of published randomized, controlled trials (RCT). There were 16 kidney transplant RCT with a total of 812 patients. All trials evaluated fish oil with dosages that ranged from 1.2 to 5.4 g/d. No consistent benefits were observed for any outcome with the exception of a modest benefit on triglycerides. A meta-analysis of rejection episodes found no significant benefit on either early (<6 mo posttransplantation) or late episodes. The overall relative risk of having at least one rejection episode in those who received fish oil was 0.91 (95% confidence interval 0.74 to 1.10) in four studies with a follow-up of 1 yr. A meta-analysis of eight RCT of graft survival found no significant benefit (relative risk 1.00, 95% confidence interval 0.96 to 1.05). The available data (mostly derived from older studies with important methodologic limitations) do not demonstrate a consistent, clinically important benefit of fish oil in kidney transplantation.