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This thesis has a threefold purpose. It is intended, firstly, to trace the development of the Epicurean and Stoic philosophies from their origins in Greece to their subsequent acceptance, with some modifications, in Rome; secondly, to ascertain the ways in which certain tenets of each philosophy agreed with the traditional character of the Roman people; and, thirdly, to determine the extent to vvhich the Julio-Claudian emperors were affected in their work and outlook by the Stoic and Epicurean doctrines of their day. To be effective, a philosophy must influence not only those who preach, but also those who hear; and this study has been undertaken in order to discover whether a philosophy like Stoicism; known to the world mainly, though not entirely, from the writings of its supporters, was powerful enough to affect the policies of administrators who professed adherence to no philosophic school. Owing to difficulties of reproducirig Greek originals in typed form, and in order to avoid breaking the continuity of the type-vvritten page, quotations from Greek authors have been incorporated into the body of the text in translation, and the originals written in footnotes. Since the field of literature in this subject is almost inexhaustible, the books and periodicals which I have consulted and which are listed in the bibliography can at best be regarded as a representative selection of the material available. My thanks are due to the staff of the Library of the University of Tasmania for providing this material over a number of years, and to the Department of Classics for many valuable suggestions.

OBJECTIVES: The aim of this study was to assess angiographic, imaging, and clinical outcomes following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with dissection and re-entry techniques (DART) and subintimal (SI) stenting compared with intimal techniques. BACKGROUND: Reliable procedural success and safety in CTO PCI require the use of DART to treat the most complex patients. Potential concerns regarding the durability of DART with SI stenting still need to be addressed. METHODS: This was a prospective, multicenter, single-arm trial of patients with appropriate indications for CTO PCI. RESULTS: Successful CTO PCI was performed in 210 of 231 patients (91% success). At 1 year, the primary endpoint of target vessel failure (cardiac death, myocardial infarction related to the target vessel, or any ischemia-driven revascularization) occurred in 5.7% of patients, meeting the pre-set performance goal. Major adverse cardiovascular events (all-cause mortality, myocardial infarction, or target vessel revascularization) occurred in 10% at 1 year and 17% by 2 years and was not influenced by DART. Quality-of-life measures significantly improved from baseline to 12 months. There was no difference in intravascular healing assessed using optical coherence tomography at 12 months for patients treated with DART and SI stenting compared with intimal strategies. CONCLUSIONS: Contemporary CTO PCI is associated with medium-term clinical outcomes comparable with those achieved in other complex PCI cohorts and significant improvements in quality of life. The use of DART with SI stenting does not adversely affect intravascular healing at 12 months or medium-term major adverse cardiovascular events. (Consistent CTO Trial; NCT02227771).

Background Limited information exists regarding procedural success and clinical outcomes in patients with previous coronary artery bypass grafting (CABG) undergoing percutaneous coronary intervention (PCI). We sought to compare outcomes in patients undergoing PCI with or without CABG. Methods and Results This was an observational cohort study of 123 780 consecutive PCI procedures from the Pan-London (UK) PCI registry from 2005 to 2015. The primary end point was all-cause mortality at a median follow-up of 3.0 years (interquartile range, 1.2-4.6 years). A total of 12 641(10.2%) patients had a history of previous CABG, of whom 29.3% (n=3703) underwent PCI to native vessels and 70.7% (n=8938) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. The risk of mortality during follow-up was significantly higher in patients with prior CABG (23.2%; P=0.0005) compared with patients with no prior CABG (12.1%) and was seen for patients who underwent either native vessel (20.1%) or bypass graft PCI (24.2%; P

The coronavirus disease 2019 (COVID-19) pandemic is unlike anything seen before by modern science-based medicine. Health systems across the world are struggling to manage it. Added to this struggle are the effects of social confinement and isolation. This brings into question whether the latest guidelines are relevant in this crisis. We aim to support urologists in this difficult situation by providing tools that can facilitate decision making, and to minimise the impact and risks for both patients and health professionals delivering urological care, whenever possible. We hope that the revised recommendations will assist urologist surgeons across the globe to guide the management of urological conditions during the current COVID-19 pandemic. (C) 2020 European Association of Urology. Published by Elsevier B.?V. All rights reserved.

This collection of essays examines the creative possibilities of stage directions and and their implications for actors and audiences, readers and editors, historians and contemporary critics.

This collection of essays examines the creative possibilities of stage directions and and their implications for actors and audiences, readers and editors, historians and contemporary critics.

Renal transplantation and peritoneal or hemodialysis are therapeutic options increasingly available to diabetic patients with uremia. We report a patient with insulin-dependent diabetes mellitus (IDDM) and advanced retinopathy and nephropathy who had three pregnancies. Her first pregnancy resulted in a living female with Pierre-Robin syndrome and arthrogryposis. The second pregnancy, 8 mo post-kidney transplantation, necessitated a therapeutic abortion for an anencephalic fetus. Her third pregnancy, 22 mo after kidney transplantation, was associated with intensive diabetes management and resulted in delivery by cesarean section of a healthy boy. Renal and retinal function remained stable during both her second and third pregnancies. As more patients with IDDM achieve fertility post-renal transplantation, aggressive principles of diabetes regulation need to be expanded to include consideration of the interaction of the post-kidney-transplant state and diabetes mellitus during pregnancy.

The fungal metabolite, cyclosporin A, is a potent immunosuppressive compound. Experiments were performed in vitro with both human and nonhuman primate peripheral blood lymphocytes to study the effect of this agent on suppressor cell activity. Cyclosporin A did not affect the generation or function of concanavalin A-induced suppressor lymphocytes as measured by their ability to suppress thymidine uptake of lymphocytes in secondary cultures. No evidence of suppressor cell induction was noted by incubation of lymphocytes with only cyclosporin A. We conclude that, although cyclosporin A does not generate or induce suppressor cell lymphocytes, it does spare them, while inhibiting other subpopulations. This effect may create an imbalance in the immune system which results in profound suppression.

A randomized and controlled study was conducted to evaluate the efficacy of adjunctive antithymocyte globulin (ATG) therapy for the treatment of the initial rejection episode in first cadaveric transplants. When compared to the control group (29), which received only standard antirejection treatment (SAT) of steroid pulsing and local irradiation, the adjunctive ATG treatment group (23) demonstrated significantly faster recovery rates (8.9 +/- 4.1 versus 6.9 +/- 3.7 days, P = 0.05, respectively) and better graft survival rates (62 +/- 9% versus 91 +/- 7%, respectively) after the first rejection. ATG treatment did not result in fewer subsequent rejection episodes than SAT but long-term allograft survival rates remained superior to controls for the entire 3-year study period. By avoiding ATG treatment in those patients who never experienced clinical rejection on maintenance immunosuppressive therapy, i.e., nonresponders (23 of 90), complications associated with excessive immunosuppression were minimized. The combined results of the non-responder group of patients and ATG-treated patients resulted in a 1-year patient survival of 97% and graft survival of 86%. These results suggest that the most efficacious use of ATG is therapeutic and not prophylactic in renal transplant patients.

Two transplant patients suffered Candida infections after receiving homografts from a cadaveric donor whose urine culture yielded Candida albicans greater than 100,000 colonies per ml. In both patients the infections became apparent after large doses of methylprednisolone were administered for acute rejection. Flucytosine proved to be inadequate therapy but modified doses of amphotericin B served to eradicate the infection in each case. Donor urine cultures yielding Candida albicans should be interpreted as representing a transmissible infection.

To elucidate the time course of glomerular and arterial endothelial injury resulting from pulsatile perfusion preservation of human kidneys, we examined two kidneys, one at 16 and the other at 42 hr, for which no suitable recipient could be found. The scanning electron microscope revealed subtle changes at 16 hr in the filtration barrier. These included mild endothelial swelling with an increase in the appearance of bulbous processes, and elongated fenestrae. The visceral epithelial surface was normal as was the arterial endothelial surface. By 42 hr the glomerular endothelial surface displayed very prominent cytoplasmic ridges and clearly distorted fenestrae. The arterial endothelium exhibited a tendency to separate from the vessel wall. The proximal tubular epithelium revealed scattered loss of microvilli. These changes are similar in kind to, albeit less severe than, those described after 60 hr of perfusion. They may represent cell swelling following ischemia, or be the result of altered cell permeability engendered by low temperature. The possibility remains that such changes could be minimized by modifying the perfusate. Scanning electron microscopy provides a versatile tool in the study of vascular and other surfaces of tissues stored with perfusion preservation.

Six potential renal donors were evaluated by both conventional and digital subtraction angiography to determine the number of renal arteries to each kidney. The digital examination missed an accessory renal artery in one of six patients for an error rate of 17%.

The pharmacodynamics of thiabendazole (TBZ) and its metabolite, 5OH-thiabendazole (5OH-TBZ), were studied in an anephric patient with Strongyloides stercoralis pneumonitis. No toxic manifestations were noted in the patient, and serum TBZ and 5OH-TBZ levels were comparable to those in eunephric patients. We conclude that thiabendazole, in the usual recommended dose of 25 mg/kg twice daily, given to patients with compromised renal function is reasonable and safe.

A 50-year-old renal transplant recipient had Salmonella sepsis. When antibiotic therapy failed to eradicate the infection, abdominal aortography revealed an unsuspected mycotic aneurysm. After ligation and aneurysmectomy the patient's blood stream became sterile. Mycotic aneurysm should be considered when Salmonella sepsis is unresponsive to antibiotic therapy.

Three groups of pullets--those lacking endogenous viral (ev) genes, those carrying ev3, which codes for avian leukosis virus (ALV) group-specific (gs) antigen but not complete virus, and those carrying ev2, which codes for complete endogenous virus--were reared to maturity free of exogenous ALV infection or reared separately after inoculation at 1 day with ALV. The enzyme-linked immunosorbent assay (ELISA) was used to detect gs antigen in feather pulp, cloacal swabs, sera, white blood cells, and albumens from the pullets and in embryos, combs, and meconia from their progeny. These results were used to identify methods to distinguish between endogenous ALV expression and exogenous ALV infection. Although the frequency and levels of gs antigen detection were higher in most of the ALV-positive than in ev-positive ALV-negative materials, albumens and cloacal swabs had the lowest frequency of gs antigen detection in the ev-positive ALV-negative materials. These two materials had a further advantage in that detection of gs antigen in them has been shown to be highly correlated with congenital transmission. Further studies using ELISA absorbance values and titer to quantitate gs antigen showed that ev-positive ALV-negative albumens had much lower levels of gs antigen than ALV-positive albumens. The same criteria were not useful for distinguishing cloacal swabs of these two types. We conclude that in these lines, high levels of gs antigen in albumen is a sensitive and practical means of identifying dams congenitally transmitting ALV, because there is a very low frequency of "false positives" due to endogenous gs antigen in this material.