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The study shows that, in waveguide (WG) configuration, the coupling of a 2D plasmonic metamaterial grating (MMG) having a conventional Bragg period along the guide but a distinct period along the transverse axis can lead to Electromagnetically‐Induced‐Transparency (EIT) behavior. This epitomizes that metamaterials, as functional photonic building blocks, can lead to low losses in many standard devices if properly designed. The study reported the observation in passive WGs of a marked Fano‐type EIT resonance with record high‐quality factor: Q = 5000 and contrast >20 dB. Unlike any standard metal grating, MMG‐assisted waveguides exhibit strong grating coupling strength and low‐loss properties simultaneously. This concept is further applied to demonstrate single‐frequency‐emission electrically‐injected Distributed Feedback (DFB) lasers in the near‐infrared telecom domain. The key point is that laser emission occurs at the peak of EIT, i.e., the maximum in transmission. It therefore addresses one of the main critical issues of DFB lasers related to the single frequency yield. The laser performances are state‐of‐the‐art (Ith < 20 mA, Pmax > 20 mW at I = 200 mA, SMSR > 50 dB, optical feedback tolerance >−21 dB compliant with IEEE 802.3 standard). The presented approach, compatible with existing industrial technologies, is promising for real‐life telecom applications. [ABSTRACT FROM AUTHOR]

Introduction: The project Student Athletes Erasmus+ Mobility in Europe identified and defined a total of 31 benefits offered to dual-career student athletes who are combining their university studies with high-level training. The project was co-funded by the European Union and carried out by five universities: Chalmers University of Technology (Sweden), Institut national des sciences appliquées de Lyon (France), University of Jyväskylä (Finland), Karlsruhe Institute of Technology (Germany), and Universitat Jaume I (Spain). Methods: The purpose of the study was to rank these benefits by combining the perspectives of the university staff and the student athletes from each university in the consortium. The university staff included experts from sports services and the international relations office. A questionnaire was also sent to the dualcareer athletes enrolled at the consortium's universities. Of the 514 dualcareer athletes, 208 (116 women) completed the questionnaire. The overall response rate was 40.47%. The university staff assessed the importance of each benefit, how easy it was to implement at the institution, and whether or not the university offered the benefit to its students. The dual-career students rated each of the 31 benefits and indicated whether or not they had used them. A specific methodology was designed to rank these benefits using the ratings of the university staff and the student athletes. Intra-group and inter-group Pearson correlations were performed. Results: The results show a strong and significant correlation between the benefits from the perspective of the university staff (r = 0.710, p = 7.76E-7) and from the perspective of the students (r = 0.715, p = 2.44E-6). The correlation is moderate and significant when the benefits are correlated from the perspective of the two groups as a whole (0.363, p = 0.045), with the three most important benefits being the free use of sports facilities, justification for absences, and the adaptation of the pace of studies. Discussion: The study makes visible the commitment of higher education institutions to facilitating the dual career of student athletes and identifies those benefits that may be of greater interest to European universities as a whole. The European perspective has been considered, while respecting the specificities of each university and the country in which it is located. [ABSTRACT FROM AUTHOR]

Pathogenic germline variants in the FOXL2 gene are associated with Blepharophimosis, Ptosis, and Epicanthus Inversus syndrome (BPES) in humans, an autosomal dominant condition. Two forms of BPES have emerged: (i) type I (BPES‐I), characterized by ocular signs and primary ovarian failure (POI), and (ii) type II (BPES‐II) with no systemic associations. This study aimed to compare the distribution of FOXL2 variants in idiopathic POI/DOR (diminished ovarian reserve) and both types of BPES, and to determine the involvement of FOXL2 in non‐syndromic forms of POI/DOR. We studied the whole coding region of the FOXL2 gene using next‐generation sequencing in 1282 patients with non‐syndromic POI/DOR. Each identified FOXL2 variant was compared to its frequency in the general population, considering ethnicity. Screening of the entire coding region of the FOXL2 gene allowed us to identify 10 different variants, including nine missense variants. Of the patients with POI/DOR, 14 (1%) carried a FOXL2 variant. Significantly, six out of nine missense variants (67%) were overrepresented in our POI/DOR cohort compared to the general or specific ethnic subgroups. Our findings strongly suggest that five rare missense variants, mainly located in the C‐terminal region of FOXL2 are high‐risk factors for non‐syndromic POI/DOR, though FOXL2 gene implication accounts for approximately 0.54% of non‐syndromic POI/DOR cases. These results support the implementation of routine genetic screening for patients with POI/DOR in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Critically injured patients need rapid and appropriate hemostatic treatment, which requires prompt identification of trauma-induced coagulopathy (TIC) upon hospital admission. We developed and validated the performance of a clinical score based on prehospital resuscitation parameters and vital signs at hospital admission for early diagnosis of TIC. Methods: The score was derived from a level-1 trauma center registry (training set). It was then validated on data from two other level-1 trauma centers: first on a trauma registry (retrospective validation set), and then on a prospective cohort (prospective validation set). TIC was defined as a PTratio > 1.2 at hospital admission. Prehospital (vital signs and resuscitation care) and admission data (vital signs and laboratory parameters) were collected. We considered parameters independently associated with TIC in the score (binomial logistic regression). We estimated the score's performance for the prediction of TIC. Results: A total of 3489 patients were included, and among these a TIC was observed in 22% (95% CI 21–24%) of cases. Five criteria were identified and included in the TIC Score: Glasgow coma scale < 9, Shock Index > 0.9, hemoglobin < 11 g.dL−1, prehospital fluid volume > 1000 ml, and prehospital use of norepinephrine (yes/no). The score, ranging from 0 and 9 points, had good performance for the identification of TIC (AUC: 0.82, 95% CI: 0.81–0.84) without differences between the three sets used. A score value < 2 had a negative predictive value of 93% and was selected to rule-out TIC. Conversely, a score value ≥ 6 had a positive predictive value of 92% and was selected to indicate TIC. Conclusion: The TIC Score is quick and easy to calculate and can accurately identify patients with TIC upon hospital admission. [ABSTRACT FROM AUTHOR]

Background: Gastric poorly cohesive carcinoma (PCC) in advanced stages has a poor prognosis. Total gastrectomy (TG) remains the common treatment for distal gastric PCC, but subtotal gastrectomy (SG) may improve quality of life without compromising outcomes. Currently, no clear recommendation on the best surgical strategy for distal PCC is available. This study aimed to compare overall survival (OS) and disease-free survival (DFS) at 5 years for patients with antropyloric PCC treated by total versus subtotal gastrectomy. Methods: A large retrospective European multicenter cohort study analyzed 2131 patients treated for gastric cancer between 2007 and 2017 by members of the French Association of Surgery (AFC). The study compared a group of patients who underwent TG with a group who underwent SG for antropyloric PCC. The primary outcomes were 5 year OS and DFS. Results: The study enrolled 269 patients: 140 (52.0%) in the TG group and 129 (48.0%) in the SG group. The baseline characteristics and pTNM stage were similar between the two groups. According to Dindo-Claven classification, the patients treated with TG had more postoperative complications than the patients treated with SG (p < 0.001): grades I to IIIa (77.1% vs 59.5%) and grades IIIb to IVb (14.4% vs 9.0%). No difference in 5-year OS was observed between TG (53.8%; 95 % confidence interval [CI], 43.2–63.3%) and SG (53.0%; 95% CI, 41.4–63.3%) (hazard ratio [HR], 0.94; 95% CI, 0.68–1.29). The same was observed for 5-year DFS: TG (46.0%; 95% CI, 35.9–55.5%) versus SG (45.3%; 95% CI, 34.3–55.6%) (HR, 0.97; 95% CI, 0.70–1.34). Conclusions: At 5 years, SG was not associated with worse OS and DFS than TG for distal PCC. Surgical morbidity was higher after TG. Subtotal gastrectomy is a valuable option for distal PCC gastric cancer. [ABSTRACT FROM AUTHOR]

Only 30% of patients with McCune–Albright syndrome (MAS)–associated acromegaly achieve biochemical control under first-generation somatostatin receptor ligands (fg-SRLs), while pegvisomant fails to normalize insulin-like growth factor 1 (IGF-I) in >20% of cases. Here, we report all the patients with MAS-associated acromegaly treated with pasireotide long-acting release (LAR) in our center. Pasireotide LAR 20 mg/month resulted in rapid and long-term IGF-I normalization in patients #1 and #3. Patient #3 was resistant to fg-SRLs, while patient #1 was also controlled on fg-SRLs. In patient #2, resistant to fg-SRLs and uncontrolled on pegvisomant 40 mg/day combined with cabergoline 0.5 mg/day, pegvisomant was replaced with pasireotide LAR 40 mg/month, resulting in the near normalization of IGF-I levels. All 3 patients developed intermittent impaired fasting glucose, without the need for glucose-lowering drugs. Thus, pasireotide LAR is clearly useful as third-line therapy, and potentially even as second-line therapy, in MAS-associated acromegaly. [ABSTRACT FROM AUTHOR]

Purpose: Premature ovarian insufficiency (POI) affects approximately 1% of women before the age of 40. Genetic contribution is a significant component of POI. The NOBOX gene was considered one of the major genetic causes of POI. However, the pathogenicity and the penetrance of NOBOX variants remain unclear. Methods: We studied the whole coding region of the NOBOX gene by next generation sequencing in a cohort of 810 patients with POI, and we compared the frequency of each identified NOBOX variant to the general population taking into account the ethnicity of each individual. Results: Screening of the whole coding region of the NOBOX gene allowed us to identify 35 different variants, including 5 loss-of-function variants. In total, 171 patients with POI (25%) carried out at least one NOBOX variant. Regarding missense variants, we observed a significant overrepresentation of the most frequent ones in our 810 POI patients as compared to the general, except for p.(Arg117Trp). However, taking into account the ethnic origin of the individuals, we observed no significant OR difference for p.(Arg44Leu) and p.(Arg117Trp) in African subgroup and for p.(Asp452Asn) in European subgroup. Conclusion: This population study suggests that the p.(Arg44Leu) variant could be considered benign variant and that the p.(Asp452Asn) and p.(Arg117Trp) variants could be considered moderate risk pathogenic variants with probably partial and very low penetrance and/or expressivity. In contrast, p.(Gly91Trp) and p.(Gly152Arg) variants could be considered pathogenic variants with a moderate functional impact. [ABSTRACT FROM AUTHOR]

Introduction: Congenital hypothyroidism with gland-in-situ (CH-GIS) is usually attributed to mutations in the genes involved in thyroid hormone production. The diagnostic yield of targeted next-generation sequencing (NGS) varied widely between studies. We hypothesized that the molecular yield of targeted NGS would depend on the severity of CH. Methods: Targeted NGS was performed in 103 CH-GIS patients from the French national screening program referred to the Reference Center for Rare Thyroid Diseases of Angers University Hospital. The custom targeted NGS panel contained 48 genes. Cases were classified as solved or probably solved depending on the known inheritance of the gene, the classification of the variants according to the American College of Medical Genetics and Genomics, the familial segregation, and published functional studies. Thyroid-stimulating hormone at CH screening and at diagnosis (TSHsc and TSHdg) and free T4 at diagnosis (FT4dg) were recorded. Results: NGS identified 95 variants in 10 genes in 73 of the 103 patients, resulting in 25 solved cases and 18 probably solved cases. They were mainly due to mutations in the TG (n = 20) and TPO (n = 15) genes. The molecular yield was, respectively, 73% and 25% if TSHsc was ≥ and < 80 mUI/L, 60% and 30% if TSHdg was ≥ and < 100 mUI/L, and 69% and 29% if FT4dg was ≤ and > 5 pmol/L. Conclusion: NGS in patients with CH-GIS in France found a molecular explanation in 42% of the cases, increasing to 70% when TSHsc was ≥ 80 mUI/L or FT4dg was ≤ 5 pmol/L. [ABSTRACT FROM AUTHOR]

Background: Peri-implantitis, a bacteria-associated inflammatory disease, is characterized by inflammation of the peri-implant mucosa and progressive loss of the supporting bone, thereby reducing the chances of dental implant survival. The absence of progressive marginal bone loss is crucial for implant success. The aim of this study is to assess the peri-implantitis resolution by measuring the absence of progressive bone loss rate around the implant over a period of one year to more than three years after surgical reconstructive (REC) treatment, apically repositioned flap (ARP) surgery, or combined (COM) treatment of peri-implantitis with implantoplasty. Methods: Peri-implantitis patients, that underwent surgical therapy with implantoplasty and that enrolled in a regular peri-implant supportive care program with a follow up of ≥12 months, were recruited in this study. ARP, REC, or COM surgical therapy was performed depending on the anatomy of the bone defect. For REC and COM groups, intraosseous defects were filled with a bone substitute. The ARP group consisted of an apically positioned flap without osseous surgery. Absence of progressive marginal bone loss was evaluated on radiographs of the treated implants. Results: A total of 57 patients (91 implants) were included. The study occurred over a follow-up period of 12 to 42 months (mean = 24 months). The surgical treatment with implantoplasty yielded an absence of progressive bone loss rate of 96.7% at implant level (100% REC, 98% COM, 92.9% ARP) and 96.5% at patient level. Three implants had to be removed in two patients due to relapse or progression of peri-implantitis. Conclusions: This case series demonstrated that implantoplasty during surgical treatment of peri-implantitis lesions resulted in favorable biological conditions to maintain functional implants with 96.7% of implants that did not show bone loss over time from one year to more than three years. [ABSTRACT FROM AUTHOR]

Here we describe the bone histology of a femur of Araripesuchus wegeneri, using both cross and longitudinal thin sections. The parasagittal stance and high maximum metabolic rate inferred for this taxon is often linked to the capacity of formation of sustained fibrolamellar complex (FLC), as it occurs in extant endotherms. This paper aims to test this hypothesis. The cross section of the sampled specimen MNHN.F.GDF660 revealed it was subadult, an ideal ontogenetic stage to check the presence of FLC as this tissue is formed mainly during early ontogenetic stages and is often eroded or remodelled in the adult stage. Although localized areas of FLC have been described in other Notosuchia, no evidence was found here for the presence of this tissue type in A. wegeneri. The hypothesis of the formation of sustained FLC in this taxon was, thus, ruled out, even though these animals were characterized by an upright position and very high maximum metabolic rates. These organisms have, therefore, no extant equivalences. [ABSTRACT FROM AUTHOR]

Purpose: Data about incidence, biological, and clinical characteristics of oligometastatic breast cancer (OMBC) are scarce. However, these data are essential in determining optimal treatment strategy. Gaining knowledge of these elements means observing and describing large, recent, and consecutive series of OMBC in their natural history. Methods: We collected data retrospectively at our institution from 998 consecutive patients diagnosed and treated with synchronous or metachronous metastatic breast cancer (MBC) between January 2014 and December 2018. The only criterion used to define OMBC was the presence of one to five metastases at diagnosis. Results: Of 998 MBC, 15.8% were classified OMBC. Among these, 88% had one to three metastases, and 86.7% had only one organ involved. Bone metastases were present in 52.5% of cases, 20.9% had progression to lymph nodes, 14.6% to the liver, 13.3% to the brain, 8.2% to the lungs, and 3.8% had other metastases. 55.7% had HR+/HER2− OMBC, 25.3% had HER2+OMBC, and 19% had HR−/HER2− OMBC. The HR+/HER2− subtype statistically correlated with bone metastases (p = 0.001), the HER2+subtype with brain lesions (p = 0.001), and the HR−/HER2− subtype with lymph node metastases (p = 0.008). Visceral metastases were not statistically associated with any OMBC subtypes (p = 0.186). OMBC-SBR grade III was proportionally higher than in the ESME series of 22,109 MBC (49.4% vs. 35.1%, p < 0.001). Conclusion: OMBC is a heterogeneous entity whose incidence is higher than has commonly been published. Not an indolent disease, each subgroup, with its biological and anatomical characteristics, merits specific management. [ABSTRACT FROM AUTHOR]

Our patient's case prompted a retrospective assessment of DPD-deficiency patients, with available phenotype and genotype data, to identify any discordant results. Fluoropyrimidine (FP)-derived anti-metabolite cytotoxic drugs such as intravenous 5-Fluorouracil (5-FU) and oral capecitabine are currently the mainstay, (neo)adjuvant and metastatic, treatments for several solid tumors. It is crucial to consider DPD activity in clinical practice as 3%-15% of patients are partially DPD deficiency[5] and nearly 0.5% of European patients are completely DPD deficient.[6] The most commonly used techniques to screen for DPD deficiencies[7] are targeted I DPYD i genotyping or indirect DPD phenotyping by measuring the plasma uracil (U) concentration, since endogenous DPD metabolizes U to UH SB 2 sb (dihydrouracil). Uracil concentrations (A) and UH2/U ratios (B) of 15 heterozygous DPYD*2A patients (14 retrospective patients and the present case report patient). [Extracted from the article]

Objective: Poorly controlled salt-wasting (SW) congenital adrenal hyperplasia (CAH) patients often require high 9α-fluorocortisol doses as they show high levels of 17-hydroxyprogesterone (17OHP), which is a mineralocorticoid (MC)-receptor antagonist. Design: We investigated the renin--angiotensin--aldosterone system in patients with SW-CAH receiving twice daily modified-release hydrocortisone (MR-HC, Efmody) compared with standard glucocorticoid (GC) therapy. Methods: Data were analyzed from the 6-month, phase 3 study of MR-HC (n =42) versus standard GC therapy (n=41). MC replacement therapy remained unchanged throughout the study. Blood pressure, serum potassium, serum sodium, plasma renin activity (PRA), and serum 17OHP and androstenedione concentrations were analyzed at baseline, 4, 12, and 24 weeks. Results: The median serum 17OHP in the morning was significantly lower on MR-HC compared with standard GC at 24 weeks (2.5 nmol L-1 (IQR 8.3) versus 10.5 nmol L-1 (IQR 55.2), P=.001). PRA decreased significantly from baseline to 24 weeks in patients on MR-HC (0.83 ng L-1 s-1 (IQR 1.0) to 0.48 ng L-1 s-1 (IQR 0.61), P=.012) but not in patients on standard GC (0.53 ng L-1 s-1 (IQR 0.66) to 0.52 ng L-1 s-1 (IQR 0.78), P=.613). Serum sodium concentrations increased from baseline to 24 weeks in patients on MR-HC (138.8±1.9 mmol L-1 to 139.3±1.8 mmol L-1, P = .047), but remained unchanged on standard GC (139.8±1.6 mmol L-1 to 139.3±1.9 mmol L-1, P=.135). No significant changes were seen in systolic and diastolic blood pressure and serum potassium levels. Conclusion: 6 months of MR-HC therapy decreased PRA and increased sodium levels indicating a greater agonist action of the 9α-fluorocortisol dose, which may be due to the decreased levels of the MC-receptor antagonist 17OHP. [ABSTRACT FROM AUTHOR]

Introduction: A gonadectomy is currently recommended in patients with Turner syndrome (TS) and a 45,X/46,XY karyotype, due to a potential risk of gonadoblastoma (GB). However, the quality of evidence behind this recommendation is low. Objective: This study aimed to evaluate the prevalence of GB, its characteristics, as well as its risk factors, according to the type of Y chromosomal material in the karyotype. Methods: Our study within French rare disease centers included patients with TS and a 45,X/46,XY karyotype, without ambiguity of external genitalia. Clinical characteristics of the patients, their age at gonadectomy, and gonadal histology were recorded. The regions of the Y chromosome, the presence of TSPY regions, and the percentage of 45,X/46,XY mosaicism were evaluated. Results: A total of 70 patients were recruited, with a median age of 29.5 years (21.0-36.0) at the end of follow-up. Fifty-eight patients had a gonadectomy, at a mean age of 15 ± 8 years. GB was present in nine cases. Two were malignant, which were discovered at the age of 14 and 32 years, without metastases. Neither the percentage of XY cells within the 45,X/46,XY mosaicism nor the number of TSPY copies was statistically different in patients with or without GB (P = 0.37). However, the entire Y chromosome was frequent in patients with GB (6/9). Conclusions: In our study, including a large number of patients with 45,X/46,XY TS, the prevalence of gonadoblastoma is 12.8%. An entire Y chromosome appears as the main risk factor of GB and should favor early gonadectomy. Significant statement: About 10% of patients with TS have a karyotype containing Y chromosomal material: 45,X/46,XY. Its presence is related to the risk of GB. Therefore, a prophylactic gonadectomy is currently recommended in such patients. However, the quality of evidence is low. Our objective was to evaluate the prevalence of GB according to the type of Y-chromosomal material. We found a prevalence of GB of 12.8% in a cohort of 70 TS patients. No sign of hyperandrogenism was observed. The entire Y chromosome was the most frequent type of Y-material in patients with GB. As the prognosis of these tumors was good, a delay of surgery might be discussed. [ABSTRACT FROM AUTHOR]

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Aim: To assess the effect of surgical root coverage (RC) on dentin hypersensitivity (DH) associated with gingival recession. Materials and Methods: Two independent reviewers conducted electronic literature searches in MEDLINE (PubMed), EMBASE, Cochrane Library, Web Of Science, Dentistry & Oral Sciences Source, ScienceDirect, and ClinicalTrials.gov databases as well as a manual search to identify eligible clinical studies from January 2000 to March 2022. Randomized controlled trials (RCTs) comparing two surgical RC techniques or a surgical RC technique with or without adjuvant were included. Meta‐analyses were performed on data provided by RCTs. Results: Thirteen RCTs with a total of 701 patients (1086 recessions) were included. The percentage of DH suppression was 70.8% (95% confidence interval [CI] [64.4–76.6]; I2 = 39.2% [3.5–61.8], Q‐test = 0.02) after surgical RC. Recession reduction and percentage of RC were both statistically significantly associated with DH suppression (estimate = 0.66 [0.10–1.23], p =.022, R2 = 14.45% and estimate = 0.04 [0.01–0.08], p =.012, R2 = 29.54%, respectively). Coronally advanced flap (CAF) + connective tissue graft showed results statistically more effective than CAF + xenogeneic collagen matrix in DH suppression (73.3% [65.6–79.8] and 61.4% [51.7–70.3], respectively; p =.048). Conclusions: Success of surgical RC is associated with DH suppression. [ABSTRACT FROM AUTHOR]

Objective: Women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH) may have poor quality of life (QoL) and low satisfaction with body appearance. We investigated the influence of the patients' satisfaction with their support on their QoL and body image. Design: Retrospective, comparative, Europe-wide study as part of the multicenter dsd-LIFE study. Methods: 203 women with CAH were included in this study. We investigated the patients' QoL and body image compared to a healthy control group. The patients' satisfaction with their treatment and support in childhood and adolescence as well as in adulthood was assessed by questionnaire and its influence on the patients' body image and QoL was analyzed by multiple regression models. Results: Women with CAH showed worse body image and poorer physical, psychological and social QoL compared to a healthy reference population. The patients' satisfaction with professional care in the last 12 months was a significant positive predictor for all four domains of QoL (psychological, physical, social, environmental). Dissatisfaction with care in childhood and adolescence and with general support through different stages of life was a significant negative predictor for QoL and body image. Conclusions: These results show that women with CAH have poor QoL and body image compared to a healthy reference population. Psychosocial factors such as general and family support, and social interactions with professionals have a substantial impact on QoL and body image in adult females with CAH. This should be taken into account regarding patient care and multimodal therapy. [ABSTRACT FROM AUTHOR]

Context: Standard glucocorticoid therapy in congenital adrenal hyperplasia (CAH) regularly fails to control androgen excess, causing glucocorticoid overexposure and poor health outcomes.Objective: We investigated whether modified-release hydrocortisone (MR-HC), which mimics physiologic cortisol secretion, could improve disease control.Methods: A 6-month, randomized, phase 3 study was conducted of MR-HC vs standard glucocorticoid, followed by a single-arm MR-HC extension study. Primary outcomes were change in 24-hour SD score (SDS) of androgen precursor 17-hydroxyprogesterone (17OHP) for phase 3, and efficacy, safety and tolerability of MR-HC for the extension study.Results: The phase 3 study recruited 122 adult CAH patients. Although the study failed its primary outcome at 6 months, there was evidence of better biochemical control on MR-HC, with lower 17OHP SDS at 4 (P = .007) and 12 (P = .019) weeks, and between 07:00h to 15:00h (P = .044) at 6 months. The percentage of patients with controlled 09:00h serum 17OHP (< 1200 ng/dL) was 52% at baseline, at 6 months 91% for MR-HC and 71% for standard therapy (P = .002), and 80% for MR-HC at 18 months' extension. The median daily hydrocortisone dose was 25 mg at baseline, at 6 months 31 mg for standard therapy, and 30 mg for MR-HC, and after 18 months 20 mg MR-HC. Three adrenal crises occurred in phase 3, none on MR-HC and 4 in the extension study. MR-HC resulted in patient-reported benefit including menses restoration in 8 patients (1 on standard therapy), and 3 patient and 4 partner pregnancies (none on standard therapy).Conclusion: MR-HC improved biochemical disease control in adults with reduction in steroid dose over time and patient-reported benefit. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess on videographs the intra- and inter-rater reproducibility of the Smile Esthetic Index (SEI) that has been previously validated on photographs. Smile videographs were obtained using a smartphone associated with the Smile Lite MDP mounted on a tripod. They were then randomized and evaluated twice consecutively at a 1-week interval by three periodontists according to the SEI based on 10 variables. Cohen's Kappa and Fleiss' Kappa tests were performed to measure intra- and inter-rater agreement. Sixty-five smile videographs of 24 men and 41 women (mean age 33 ± 11.3 years) were scored. A mean intra-rater agreement of 0.68 (0.64–0.73) was obtained, representing substantial agreement. The inter-rater agreement calculated for each variable ranged from 0.31 for the variable "absence of visible excessive gingiva" to 0.90 for the variable "absence of diastema and/or missing inter-dental papilla." Within the limits of this study, we have demonstrated that it was possible to use videographs to reproducibly evaluate an aesthetic score (SEI) previously validated on photographs. [ABSTRACT FROM AUTHOR]

Objectives: To report the long‐term follow‐up outcomes of masculinizing surgery in disorders/differences of sex development (DSD), including both physicians' and patients' perspectives on appearance and functional outcome, including sexuality. Patients and Methods: In total, 1040 adolescents (age ≥16 years) and adults with a DSD took part in this multicentre cross‐sectional clinical study in six European countries in 2014/2015. Of those, 150 living in other than the female gender had some kind of masculinizing surgery: hypospadias repair, orchidopexy, breast reduction and/or gonadectomy. The study protocol included medical data collection, an optional genital examination, and patient‐reported outcomes including satisfaction with appearance and current sexual functioning. Results: Diagnoses included partial and mixed gonadal dysgenesis (45,XO/46,XY; n = 38), Klinefelter syndrome/46,XX males (n = 57), and various 46,XY DSDs (n = 42; e.g. partial androgen insensitivity syndrome, severe hypospadias) and 13 with other diagnoses. Of the participants, 84 underwent hypospadias surgery, 86 orchidopexy, 52 gonadectomy and 32 breast reduction (combinations possible). Physicians evaluated anatomical appearance at genital examination as poor in approximately 11% of patients. After hypospadias surgery, 38% of participants reported that they were (very) dissatisfied with anatomical appearance and 20% with function. The physician and patient evaluations were moderately correlated (r = 0.43). Conclusion: The majority of participants were neutral to satisfied with the appearance and function in the long‐term after masculinizing surgery. Given the initial severe phenotype and a risk of unsatisfactory results after masculinizing surgery in DSD, treatment should be handled by experienced multidisciplinary teams in order to optimize the postoperative results. [ABSTRACT FROM AUTHOR]

Background: Two definitions of a positive circumferential resection margin (CRM) in esophageal cancer coexist: one by the College of American Pathologists (CAP) (CRM = 0 mm) and another by the Royal College of Pathologists (RCP) (CRM ≤ 1 mm). This study aimed to evaluate the prognostic value of both definitions in esophageal cancer and to identify a new cutoff value for the CRM to predict survival. Methods: Patients who underwent curative esophageal resection for locally advanced (≥ pT3) adenocarcinoma or squamous cell carcinoma were selected from 2007 to 2016. The CRM was reassessed using an ocular micrometer. Overall survival (OS) and disease-free survival were estimated with uni- and multivariate analyses. Results: The study enrolled 283 patients: 48 with a positive CRM according to the CAP definition and 171 with a positive CRM according to the RCP definition. In the multivariate analysis, a positive CRM according to both definitions was significantly associated with a poor OS (CAP: hazard ratio [HR], 2.26, p < 0.001; RCP: HR, 1.42, p = 0.035). A CRM of 0 mm was predictive of a worse OS and DFS than a CRM of 1 mm or less (p < 0.0001), whereas no significant difference was found between a CRM greater than 1 mm and a CRM of 1 mm or less, indicating that the CAP definition was more accurate for predicting prognosis and recurrence. New cutoff CRM values of 100 µm in squamous cell carcinoma and 200 µm in adenocarcinoma were optimal for predicting OS. Conclusion: The CAP definition was more accurate for predicting prognosis and recurrence. The study identified a new cutoff value of CRM according to histologic type. [ABSTRACT FROM AUTHOR]

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) is a disorder of adrenal steroid biosynthesis, leading to hypocortisolism, hypoaldosteronism, and hyperandrogenism. Impaired quality of life (QoL) has been demonstrated in women with CAH, but data on men with CAH are scarce. We hypothesized that disease severity and poor treatment control are inversely associated with QoL. In this study, 109 men (16-68 years) with 21OHD were included. The WHOQOL-BREF questionnaire was used to measure self-reported QoL domain scores on a 0-100 scale, where higher scores reflect better QoL. QoL domain scores were compared to published data on healthy and chronically ill reference populations from France, Germany, the Netherlands, and the United Kingdom. Differences in QoL scores among groups of disease severity and treatment control were tested within the study population. Overall, the men with CAH in this study appeared to rate their QoL as good. Median domain scores were 78.6 (IQR: 67.9-85.7) for physical health, 79.2 (IQR: 66.7-87.5) for psychological health, 75.0 (IQR: 58.3-83.3) for social relationships, and 81.3 (IQR: 71.9-90.6) for environment. In general, these scores were similar to WHOQOL-BREF domain scores in healthy references and higher compared to chronically ill reference populations. The domain scores did not differ among genotype groups, but patients with undertreatment or increased 17-hydroxyprogestrone concentrations scored higher on several QoL domains (p<0.05). Patients treated with dexamethasone or prednisone scored higher on the physical health, psychological health, and social relationships domains, but not on the environmental domain. In conclusion, QoL domain scores appeared to be comparable to healthy reference populations and higher compared to patients with a chronic illness. QoL was not influenced by genotype, but undertreatment and use of dexamethasone or prednisone were associated with higher QoL. [ABSTRACT FROM AUTHOR]

The requirements on service life of reinforced concrete structures, as prescribed by design codes, may be difficult to be fulfilled in highly aggressive environments such as marine ones, in which premature degradation is most likely to occur. In the aforementioned situations, to avoid expensive repair activities, different protective systems, including, among the others, self-healing concrete, could be adopted. Researchers have found self-healing as a way to face degradation problems in chloride-rich environments. If a significant degree of crack sealing can be achieved, the physical properties of a cracked element can trend back to those of an identical uncracked element, which may also result in a slower penetration rate of aggressive substances. The main problem in exploiting this methodology is related to its reliability. In this context, an experimental program aimed at investigating the effectiveness of crystalline admixtures as healing stimulating agent in chloride-rich environments was carried out. The influence of the exposure conditions on the compressive strength development and on its recovery in predamaged specimens was first analyzed. Afterwards, crack sealing and chloride permeability of sealed cracks were evaluated for specimens continuously immersed or subjected to wet/dry cycles in a 16.5% NaCl aqueous solution. Both an enhanced recovery of compressive strength and an improved crack sealing ability were observed for samples containing the healing agent. A microstructure study of the healing products was conducted by means of scanning electron microscope (SEM) and energy dispersive X-ray spectroscopy (EDS) analysis as well. [ABSTRACT FROM AUTHOR]

The new paradigm of parity-time symmetry in quantum mechanics has readily been applied in the field of optics with numerous demonstrations of exotic properties in photonic systems. In this work, we report on the implementation of single frequency electrically injected distributed feedback (DFB) laser diodes based on parity-time symmetric dual gratings in a standard ridge waveguide configuration. We demonstrate enhanced modal discrimination for these devices as compared with index or gain coupled ones, fabricated in the same technology run. Optical transmission probing experiments further show asymmetric amplification in the light propagation confirming the parity-time symmetry signature of unidirectional light behavior. Another asset of these complex coupled devices is further highlighted in terms of robustness to optical feedback. [ABSTRACT FROM AUTHOR]

Most Notosuchia were active terrestrial predators. A few were semi-aquatic, or were insectivorous, omnivorous or herbivorous. A question relative to their thermometabolism remains to be answered: were Notosuchia warm-blooded? Here we use quantitative bone palaeohistology to answer this question. Two variables were used as proxies to infer thermometabolism: resting metabolic rate and red blood cell dimensions. Resting metabolic rate was inferred using relative primary osteon area and osteocyte size, shape and density. Blood cell dimensions were inferred using harmonic mean canal diameter and minimum canal diameter. All inferences were performed using phylogenetic eigenvector maps. Both sets of analyses suggest that the seven species of Notosuchia sampled in this study were ectotherms. Given that extant Neosuchia (their sister group) are also ectotherms, and that archosaurs were primitively endotherms, parsimony suggests that endothermy may have been lost at the node Metasuchia (Notosuchia–Neosuchia) by the Early Jurassic. Semi-aquatic taxa such as Pepesuchus may have had thermoregulatory strategies similar to those of recent crocodylians, whereas the terrestrial taxa (Araripesuchus , Armadillosuchus , Iberosuchus , Mariliasuchus , Stratiotosuchus) may have been thermoregulators similar to active predatory varanids. Thermal inertia may have contributed to maintaining a stable temperature in large notosuchians such as Baurusuchus. [ABSTRACT FROM AUTHOR]

The acquisition of mammalian endothermy is poorly constrained both phylogenetically and temporally. Here, we inferred the resting metabolic rates (RMRs) and the thermometabolic regimes (endothermy or ectothermy) of a sample of eight extinct synapsids using palaeohistology, phylogenetic eigenvector maps (PEMs), and a sample of 17 extant tetrapods of known RMR (quantified using respirometry). We inferred high RMR values and an endothermic metabolism for the anomodonts (Lystrosaurus sp., Oudenodon bainii) and low RMR values and an ectothermic metabolism for Clepsydrops collettii, Dimetrodon sp., Edaphosaurus boanerges, Mycterosaurus sp., Ophiacodon uniformis and Sphenacodon sp. A maximum-likelihood ancestral states reconstruction of RMRs performed using the values inferred for extinct synapsids, and the values measured using respirometry in extant tetrapods, shows that the nodes Anomodontia and Mammalia were primitively endotherms. Finally, we performed a parsimony optimization of the presence of endothermy using the results obtained in the present study and those obtained in previous studies that used PEMs. For this, we assigned to each extinct taxon a thermometabolic regime (ectothermy or endothermy) depending on whether the inferred values were significantly higher, lower or not significantly different from the RMR value separating ectotherms from endotherms (1.5 ml O2 h-1 g-0.67). According to this optimization, endothermy arose independently in Archosauromorpha, Sauropterygia and Therapsida. [ABSTRACT FROM AUTHOR]

Objective: Changes of sex hormone levels in disorders of sex development (DSD) can affect the body, including the vocal folds, during and after foetal development. The voice is a gender characteristic that may also be affected. There is a lack of knowledge on voice alteration in DSD. To explore this in different forms of DSD, we describe the prevalence of voice alterations and investigate patient satisfaction with voice. Design: The study is part of dsd‐LIFE, a multicentre cross‐sectional clinical evaluation project assessing the long‐term outcomes of surgical, hormonal and psychological interventions in individuals with DSD. Patients: The study included 1040 individuals with different forms of DSD, that is Turner and Klinefelter syndromes, different degrees of gonadal dysgenesis and 46 XY DSD. Participants were recruited through patient advocacy groups and health care. Measurements: Satisfaction with voice, Adam's apple, if patient's self‐identified gender was mistaken on the phone leading to distress. Results: A vast majority of the participants with DSD (between 58.3% to 82% in various groups) were not satisfied with their voice, and approximately 15% (n = 147) were mistaken on the phone in accordance with self‐identified gender. For 102 participants, this caused distress. Conclusions: We have identified that voice problems are a cause of distress in all forms of DSD. This result needs to be confirmed and compared with controls. We recommend that evaluation of the voice should be included in future international guidelines for management of DSD. [ABSTRACT FROM AUTHOR]

Introduction: Colorectal surgery is complicated by postoperative collections in up to 25% of cases depending on local conditions. The aim of this study was to identify predictive factors of success of percutaneous drainage of collections in order to avoid follow-up imaging.Patients and methods: All consecutive patients between January 2009 and December 2016, who had undergone elective or emergency colorectal surgery (colorectal surgery and appendectomy) complicated by a postoperative collection treated by percutaneous drainage with follow-up imaging prior to drain removal, were included in this single-center and retrospective study. The primary objective was to assess predictive factors of success of the first attempt of percutaneous drainage of collections. Secondary objectives were to describe the natural history of percutaneous drainage of postoperative collections after colorectal surgery and the overall success rate of percutaneous drainage.Results: Fifty-three patients underwent percutaneous drainage of a postoperative collection during the study period and were included in this study. Complete resolution of the collection was observed on the first follow-up radiological examination in 36 patients (58%). In multivariate analysis, post-appendectomy collections (OR = 3.19 (1.14-9.27), p = 0.002) and reduction of the leukocyte count (OR = 3.22 (1.28-8.1), p = 0.013) were significantly associated with success of percutaneous drainage.Conclusion: This is the first study to address that follow-up imaging prior to drain removal might not be necessary in patients undergoing drainage of post-appendectomy collections and/or with more than 30% reduction of the leukocyte count at the first follow-up examination. [ABSTRACT FROM AUTHOR]

Study Question: What are the prevalence and the outcomes of spontaneous pregnancies (SP) in a large cohort of French women with Turner syndrome (TS)?Summary Answer: Amongst 480 women with TS, 27 women (5.6%) had a total of 52 SP, with 30 full-term deliveries for 18 women.What Is Known Already: Primary ovarian insufficiency is a classic feature of TS. So far, few studies have evaluated the rate of SP in these patients.Study Design, Size, Duration: The French Ministry of Health set up a National Reference Centre for Rare Growth Disorders (CRMERC), including TS. We studied a cohort of adult TS patients from seven endocrine units (Saint-Antoine, Pitié-Salpêtrière, Bicêtre, Lyon, Marseille, Brest, Reims Hospitals) belonging to this centre, between January 1999 and January 2014.Participants/materials, Setting, Methods: A total of 480 adult patients with TS were included. The patients' clinical characteristics, karyotypes and reproductive histories had been collected, after informed consent, in a web database called CEMARA. Our reference population was issued from a database belonging to the French Health Ministry, collecting pregnancy outcomes in the French general population. In order to find predictive characteristics of SP, TS with spontaneous pregnancies were compared with non-pregnant TS patients from our cohort.Main Results and the Role Of Chance: There were 27 patients (5.6%) who had a total of 52 SP. The two predictive factors which correlated with occurrence of a SP were spontaneous menarche and mosaic karyotype. The median delay to conception was 6 months (range 0-84). Miscarriage occurred in 16 pregnancies, 30.8% versus 15% in the general French population (P < 0.01). The remaining pregnancy outcomes were legal abortion (n = 2), medical interruption (n = 3), intrauterine fetal death (n = 1) and delivery at term (n = 30). Caesarean section rates were higher than in the general population, respectively 46.7% versus 21% (P < 0.001). Pregnancy-induced hypertensive disorders (PHDs) occurred in four cases (13.3%), including two cases of mild pre-eclampsia (6.7%). Neither aortic root dilatation nor aortic dissection were observed. The median birthweight was 3030 g (range 2020-3460). Two cases of TS were identified in the 17 daughters issued from this cohort.Limitations, Reasons For Caution: It would have been interesting to evaluate AMH levels and SP occurrence, as a predictive factor. Unfortunately, hormonal measurements were missing for some patients. Prospective studies are necessary to display prognostic values of AMH for SP and thus better target fertility preservation programmes in TS patients.Wider Implications Of the Findings: This study suggests that pregnancy outcomes in SPs are more favourable than those after oocyte donation in TS patients. However, the risk of fetal chromosomal abnormalities remains high. Our study will be useful in order to give patients with TS, their families, paediatricians and physicians involved in reproduction, better counselling concerning their fertility.Study Funding/competing Interests: Funding was provided by the Association pour la recherche Claude Bernard, Paris France All authors claim no competing interests.Trial Registration Number: NA. [ABSTRACT FROM AUTHOR]

This paper presents the results of a preliminary study aimed at assessing the crack sealing capacity in chloride environments of different concrete mixtures, incorporating supplementary cementitious materials as well as self-healing enhancing crystalline admixtures. For each addition, also including pulverized fuel ash and silica fume, different contents were taken into consideration. Cylinder specimens were precracked in splitting up to three different crack-opening ranges, simulating different service conditions, and then exposed to different conditioning environments, also containing different concentrations of sodium chloride and including both permanent immersion and wet/dry cycles. Healing conditioning was performed up to three months and crack sealing was visually inspected and quantified via image analysis procedures, monthly. Optimum dosages of each cement substitute/addition were quantified, also considering, besides the healing capacity, also the fresh state performance and compressive strength development. The good performance of mixes with crystalline admixture even under open-air exposure, as well as of other investigated mixes with reference to crack openings and exposure conditions, paves the way to revise the significance of a serviceability design parameter such as the maximum allowable crack width as a function of the exposure with the concept of a sealable crack width. [ABSTRACT FROM AUTHOR]

Measuring total testosterone level is the first-line approach in assessing androgen excess in women. The main pitfalls in measuring testosterone relate to its low concentration and to the structural similarity between circulating androgens and testosterone, requiring accurate techniques with high specificity and sensitivity. These goals can be achieved by immunoassay using a specific anti-testosterone monoclonal antibody, ideally after an extraction step. Liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) will be commonly used for measuring testosterone, providing optimal accuracy with a low limit of detection. Yet, the pitfalls of these two techniques are well identified and must be recognized and systematically addressed. In general, laboratories using direct testosterone immunoassay and mass spectrometry need to operate within a quality framework and be actively engaged in external quality control processes and standardization, so as to ensure appropriate interpretation irrespective of the particular laboratory. Circulating testosterone is strongly bound to sex-hormone-binding globulin (SHBG), and SHBG levels are typically low in overweight hyperandrogenic patients. Thus, low SHBG may decrease circulating testosterone to normal values, which will mask androgen excess status. One way to avoid this pitfall, awaiting direct free testosterone assays that are yet to be developed, is to measure SHBG and calculate free testosterone. A few other pitfalls will be discussed in this review, including those of adrenal androgen exploration, with the aim of helping clinicians to better handle laboratory investigation of androgen excess disorders in women. [ABSTRACT FROM AUTHOR]

Objective: Triple-A or Allgrove syndrome is an autosomal recessive disorder due to mutations in the AAAS gene, which encodes a nucleoporin named ALADIN. It is characterized by a classical clinical triad: alacrima, achalasia and adrenal insufficiency, the canonic symptoms that are associated with progressive peripheral neuropathy. Only a few cohorts have been reported. The objective of the present study was to characterize the various spectra of adrenal function in Triple-A patients. Methods: A retrospective clinical and biological monitoring of 14 patients (10 families) was done in a single multidisciplinary French center. All had AAAS gene sequenced and adrenal function evaluation. Results: Nine different AAAS mutations were found, including one new mutation: c.755G>C, p.(Trp252Ser). Regarding adrenal function, defects of the zona fasciculata and reticularis were demonstrated by increased basal ACTH levels and low DHEAS levels in all cases regardless of the degree of glucocorticoid deficiency. In contrast, mineralocorticoid function was always conserved: i.e., normal plasma renin level associated with normal aldosterone level. The main prognostic feature was exacerbation of neuropathy and cognitive disorders. Conclusions: These data suggest that, in Triple-A patients, adrenal function can be deficient, insufficient or compensated. In our cohort after the first decade of life, there does not appear to be any degradation of adrenal function over time. However, patients with compensated adrenal function should be informed and educated to manage a glucocorticoid replacement therapy in case of stressful conditions, with no need for systematic long-term treatment. [ABSTRACT FROM AUTHOR]

Summary: Objectives: To describe and investigate the hormone treatments in individuals with different forms of disorders of sex development (DSD) and the patients’ own views on their treatment. Design: Multicentre cross‐sectional clinical evaluation, dsd‐LIFE in 6 European countries from February 2014 to September 2015. Participants: A total of 1040 adolescents and adults (≥16 years) with different DSD conditions. Main outcomes measures: Hormone replacement, information received and patient satisfaction. Results: Included were women with Turner syndrome (301), 46,XX GD (n = 20), and women with 45,X/46XY (n = 24). Individuals with Klinefelter syndrome (n = 218), 46,XX males (n = 6), individuals with different forms of 46,XY DSD (n = 243): 46,XY DSD conditions (n = 222), men with 45,X/46XY (n = 21) 46,XX CAH, (n = 226). Oestrogen ± progestin was used by 306 (81%) individuals, 72 (19%) received ethinylestradiol and 198 had testosterone treatment. The overall adherence was good, with 10% of women with oestrogen and 5% of those on testosterone had stopped the medication despite 20% reporting dissatisfaction with the treatment, mostly because of psychological side effects. Glucocorticoid replacement in patients with CAH was very seldom stopped. More than 75% were satisfied with the information about the treatment, but the satisfaction with information about treatment options and side effects was lower. Conclusions: More than 50% in the total cohort had hormone replacement. Although adherence was generally good, this study shows that hormone replacement therapy may be improved. This may be achieved by better individualization of the treatment and by providing specific information to patients regarding both long‐term and short‐term hormonal effects and side effects. [ABSTRACT FROM AUTHOR]

In Buddhist Burma, a variety of ritual has been found pertaining to quite differentiated aspects of religion. This rich ritual landscape remains under-examined due partly to the Buddhist-studies bias of most of the scholars looking at religion in Burma. In this paper, I develop comparative analysis of a class of ritual, namely that of initiation, in three components of Burmese religion: Buddhist monasticism, Buddhist esotericism, and spirit worship. At least from the present analytic perspective, the three components considered could be taken as encompassing the entire Buddhist religious sphere in Burma. Looking at initiation rituals in these three 'paths' is a means of understanding how they frame contrasting kinds of differently valued religious practice, and of showing that, although not often discussed, rituals do matter in Burma because they help to distinguish categories of action according to their relative religiosity. By doing so, I aim to give a sense of the real diversity of the Burmese ritual landscape, which until recently was rarely taken into account, and to contribute to the on-going debate in the field of Buddhist studies on what could be encapsulated as the question of Buddhism and spirit cults in Southeast Asian Theravada. [ABSTRACT FROM AUTHOR]

The article reports on the study of Korans in Bihari script and existence of manuscripts and mentions study of corpus with textual and formal characteristics in Bihari script, demonstration of conformism through arts in Islamic and non-Islamic traditions; and rules enumerated by the manuscripts.

In this paper, the religious donation-meaning oriented interactions that occur between a lay donor and his or her monastic recipient or between laypeople and religious institutions as a whole-is first examined in the Burmese Buddhist context, in regard to the Maussian theory of the gift. The formal analysis of 'serving rice' to monks during their daily alms tour, the main form of religious donation, demonstrates that it is in keeping with the definition of a free gift rather than involving reciprocity, although it is supposed to be rewarded by merit through an impersonal process. Then, moving from a formal analysis of the ethnography of religious donation ( ahlu) to the contextual analysis of the differentiated uses of various forms of giving in contemporary Burma, the discussion aims at highlighting differences with practices of 'ritual offering' ( kadaw bwe) and 'humanitarian aid'( ke hse yay) showing how these different forms of interaction shape contrasted fields of practice. The transaction occurring in religious donations then emerges as setting into motion a crucial social process, the enactment and reproduction of the difference in status between monastics and laypeople that is one of the main social processes contributing to the differentiation of a Buddhist-defined 'religious field'. [ABSTRACT FROM AUTHOR]

This paper focuses on the career of a Burmese preaching monk and on what happened to him in November 2011, following a particularly successful series of sermons on the ‘ten duties of a Buddhist king’. Belonging to the lineage of the Mogok abbot, this monk was known as the ‘Frying pan’ abbot and had gained a considerable influence through the combination of systematic preaching and of humanitarian aid and social action. The turn to mass preaching was aimed, in his case, to implement moral reform and located him in the monastic lineages that contest established powers to such an extent that, eventually, he was banned from large public preaching in the region of Rangoon by the religious body administrating the Sangha. This case is examined from the point of view of renunciation that defines the position occupied by monks in Theravadin societies as opposed to that of the laity, and as representative of a specific moment in the articulation of religion and politics in Myanmar. [ABSTRACT FROM PUBLISHER]

Burmese conceptions manifested by death rituals reveal a variety of concepts related to spiritual components of the self, such as leikpya, wignan, wignin, nam and manaw and a complementarity of beliefs and practices linked to the soul stuff (leikpya) and the karmic theory. These concepts are further examined in the opposite extreme situations of bad and good deaths that both produce beings, inconsistent with the Buddhist karmic theory, ghosts or spirits (nat) on the one hand, weikza or saints on the other hand. Nat and weikza, equally anomalous from the point of view of the Buddhist theory, are nevertheless the object of institutionalized cults and display strongly contrasted features. This is exemplified by the comparison of the performing sessions in which they manifest in this world through contrasted forms of possession. Finally, too good or too bad deaths both similarly prevent rebirth and thus leave the space for various after-death agencies in this world. [ABSTRACT FROM AUTHOR]

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