Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents.

The direct-acting antivirals (DAAs) constitute an emerging group of small molecule inhibitors that effectively treat hepatitis C virus (HCV) infection, a common comorbidity in end-stage renal disease patients. To date, there are no data to guide use of these agents in kidney transplant patients. The authors collected data from 20 consecutive kidney recipients treated with interferon-free treatment regimens for HCV at their center: 88% were infected with genotype 1; 50% had biopsy-proved advanced hepatic fibrosis on their most recent liver biopsy preceding treatment (Metavir stage 3 fibrosis [F3] or F4); and 60% had failed treatment pretransplantation with interferon-based therapy. DAA treatment was initiated a median of 888 days after renal transplantation. All patients cleared the virus while on therapy, and 100% have achieved a sustained virologic response at 12 weeks after completion of DAA therapy. The most commonly used regimen was sofosbuvir 400 mg daily in combination with simeprevir 150 mg daily. However, four different treatment approaches were used, with comparable results. The DAAs were well tolerated, and less than half of patients required calcineurin inhibitor dose adjustment during treatment. Eradication of HCV infection with DAAs is feasible after kidney transplantation with few treatment-related side effects.

Evidence for flow from hydrodynamic simulations of p-Pb collisions at 5.02 TeV from v2 mass splitting.

We show that a fluid dynamical scenario, already well tested against identified particle p(t) spectra, describes quantitatively the observed mass splitting of the elliptical flow coefficients v(2) for pions and protons. This provides a strong argument in favor of the existence of a fluid dynamical expansion in p-Pb collisions at 5.02 TeV.

Novel mechanism of H0 dibaryon production in proton-proton interactions from parton-based Gribov-Regge theory.

A novel mechanism of H0 and strangelet production in hadronic interactions within the Gribov-Regge approach is presented. In this approach the H0 is produced by the same mechanism as usual hadrons, namely, by disintegration of the remnant formed by the exchange of pomerons between the two protons. Rapidity and transverse momentum spectra of the observed hadrons are well described in this approach. In contrast to traditional distillation approaches, here the production of multiple (strange) quark bags does not require large baryon densities or a quark gluon plasma. We calculate the rapidity and transverse momentum distributions as well as the 4pi multiplicity of the H0 for sqrt[s]=17 GeV (Super Proton Synchrotron) and 200 GeV (Relativistic Heavy Ion Collider). In both cases the H0, if it exists, should be observable by the present experiments.

Overpopulation of Omega; in pp collisions: a way to distinguish statistical hadronization from string dynamics.

The Omega/Omega ratio originating from string decays is predicted to be larger than unity in proton-proton interactions at SPS energies ( E(lab) = 160 GeV). The antiomega dominance increases with decreasing beam energy. This surprising behavior is caused by the combinatorics of quark-antiquark production in small and low-mass strings. Since this behavior is not found in a statistical description of hadron production in proton-proton collisions, it may serve as a key observable to probe the hadronization mechanism in such collisions.

Endogenous production of specific antibodies does not decrease hypocalcemic response to calcitonin in young rabbits.

In order to evaluate the potential inhibition of the acute anti-osteoclastic activity of salmon calcitonin (SCT) by specific antibodies (Ab), we compared the SCT-induced hypocalcemic effect in young male rabbits with significant titers of high affinity Ab and in matched animals without Ab. Immunization of rabbits was performed by repetitive s.c. injections of SCT and Freund adjuvant. Ab were present in four-fifths of SCT-treated rabbits (Ab+). Their titer varied from 0.8 x 10(-9) to 30 x 10(-9) M/liter and their constant of affinity from 0.97 x 10(9) to 4.2 x 10(9) L/M. Intravenous injection of 1 IU/kg SCT to Ab+ rabbits induced a significant decrease (P less than 0.01) of ionized serum calcium (Ca2+) after 30 minutes (mean +/- SD: -9 +/- 0.6%) and until the 240th minute of the test (-16.7 +/- 4.7%), with a maximum after 120 minutes (-22.6 +/- 2%). This was not significantly different from the hypocalcemic effect measured after the same procedure performed in matched animals without Ab (Ab-): significant decrease in Ca2+ (P less than 0.01) after 30 minutes (-8.2 +/- 2.2%), maximal after 150 minutes (-23.2 +/- 4.9%), and lasting until 210 minutes (-14.5 +/- 3.7%). We conclude that, in the particular model of the male young rabbit, specific anti-SCT Ab do not block or reduce the acute anti-osteoclastic activity of SCT.

Chylous ascites: an etiology of peritonitis in infancy.

Fifty-six cases of chylous ascites in patients under the age of fifteen have been reported in the last three hundred years. A case of chylous ascites that presented with the signs and symptoms of peritonitis is reviewed. The normal anatomy and physiology of the intraabdominal lymphatic system, pathophysiology of the entity, as well as a mechanism for diagnosis, are addressed and a treatment algorithm is presented.

Treatment of primary undifferentiated sarcoma of the liver with surgery and chemotherapy.

Primary undifferentiated sarcoma of the liver is a rare tumor with survival reliant on total excision of the tumor. The authors report such a tumor, initially nonresectable, in a 7-year-old girl whose tumor was successfully excised following treatment with cisplatin and Adriamycin (doxorubicin). The light and electron microscopic details of this patient's tumor are presented.

Mucosal proctectomy without reservoir.

Mucosal proctectomy with endorectal pull-through allows the removal of all colonic mucosa with preservation of continence. This operation was performed in 19 patients with familial polyposis coli and ulcerative colitis. A temporary loop ileostomy was used to defunctionalize the anastomosis. Intestinal continuity was restored in 17 of the 19 patients. Mean duration of follow-up was 29 months. All patients are continent, and the mean number of bowel movements per 24 hours is 6. Follow-up barium studies revealed a gradual dilatation of the terminal ileum within the rectal cuff which accounts for the decrease in the number of bowel movements. This operation eliminates the risk of carcinoma without compromising sphincter function.

Cryptogenic hepatic abscess in two uncompromised children.

A pre-mortem diagnosis of cryptogenic liver abscess in children is rare, but this diagnosis must be considered in the evaluation for pyrexia of unknown origin. Two previously healthy children were suspected of harboring liver abscesses. Radioisotopic, sonographic, and angiographic evidence supported the clinical diagnosis. Operative drainage was performed in each case. No source for either abscess was found and no cause established. Anaerobic bacteria, microaerophilic streptococcus and Fusobacterium necrophorum, each in pure culture, were retrieved on culture of the pus from each child's abscess. Experience gleaned from these two cases emphasizes the possibility of an hepatic abscess existing in the uncompromised child with fever of unknown origin. A cryptogenic hepatic abscess may occur in a child with only mild gastrointestinal complaints and in a child with sickle cell disease. Recovery is attributed to suspicion of diagnosis, prompt investigation, operative drainage, effective culture technique with isolation of organism and appropriate antibiotic coverage.

A case of neonatal intussusception.

A case of ileocotic intussusception in a 48-hr-old neonate due to saccular duplication of the terminal ileum is presented. The unique nature of intussusception due to a leading point is underscored and the case for early surgical intervention is emphasized. Barium enema examination is stressed as a prime diagnostic tool whenever intussusception is suspected.

Extraordinary hyperbilirubinemia in a neonate with idiopathic hypertrophic pyloric stenosis.

This case describes an extraordinarily elevated total bilirubin level that reverted to normal 9 1/2 wk after Fredet-Ramstedt pyloromyotomy. Although the etiology of jaundice occurring in patients with IHPS remains uncertain, theories implicating inhibition of the glucuronyl transferase system have been proposed. Infants with IHPS have a documented hypergastrinemia. An hypothesis is offered, illustrated by this case, to explain the inhibition of the glucuronyl transferase system with resultant hyperbilirubinemia by the hypergastrinemia of idiopathic hypertrophic pyloric stenosis.

Increased serum immunoreactive gastrin levels in idiopathic hypertrophic pyloric stenosis.

The serum immunoreactive gastrin (IRG) level in infants with confirmed idiopathic hypertrophic pyloric stenosis (IHPS) has been determined and compared to that found in vomiting infants without IHPS, in normal infants, and in normal adults. The mean serum IRG level of normal infants (103 +/- 9 pg/ml (mean +/- SEM) exceeded that of normal adults (28 +/- 5 pg/ml). The preoperative mean serum IRG level in IHPS infants (256 +/- 26 pg/ml) was significantly higher than that of both normal infants and vomiting infants without IHPS (93 +/- 9 pg/ml). Twenty-five per cent (5/20) of the IHPS infants had serum IRG levels within the upper range of normal infants. Fasting serum IRG levels in IHPS infants were not altered immediately by pyloromyotomy. The results from this study suggest a relationship between gastrin and idiopathic hypertrophic pyloric stenosis.