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AbstractBackgroundWe explored whether the maximum predicted walking distance, assessed with six-minute walk test (6MWT) and reflecting submaximal functional exercise capacity, is decreased among patients with pectus excavatum (PEX).MethodsThis study comprised a retrospective analysis of patients with PEX who underwent a 6MWT for the assessment of functional capacity. The maximum distance walked was recorded and compared to reference values established for different populations, including a young and healthy South American population.ResultsWe included 43 patients with PEX who underwent 6MWT. The mean age was 17.8 ± 6.7 years. The mean maximum distance walked was significantly lower than the predicted distance (600.8 ± 67.6 metres vs. 729.8 ± 67.5 metres, p < 0.0001). Using the Enright reference equation including an older reference population, the mean negative difference was higher (PEX patients walked 190.4 ± 78.4 metres less than predicted, p < 0.0001). We also applied the Li et al. reference equation accounting for sex among other variables, detecting a decreased walked distance compared to the gender-adjusted predicted distance (PEX patients walked a mean 222.4 ± 87.4 metres less than predicted, p < 0.0001). Using the Ulrich et al. equation, PEX patients walked a mean 114.2 ± 85.1 metres less than predicted (p < 0.0001). Although of uncertain clinical relevance, there was a significant decrease in the mean oxygen saturation after exercise (baseline 97.4 ± 1.2%, vs. final 96.4 ± 2.1%, p = 0.006).ConclusionsIn this study, we identified a significant reduction in the maximum walked distance among patients with PEX compared to the predicted distance, thus potentially emerging as an unsophisticated means to evaluate and quantify functional exercise capacity.

The synthesis and structural characterization of seven systematically varied aromatic esters are reported. The compounds are analyzed using single-crystal X-ray diffraction, dynamic scanning calorimetry, and variable-temperature viscometry. The state of the compounds, i.e., liquid and solid, is controlled, in part, via sterics of the ester functionalities which influence the presence of specific noncovalent interactions in the solid state. Two distinct conformational polymorphs are observed in the solid state. To rationalize the formation of the conformational polymorphs, the intermolecular forces of the crystalline structures were studied via Hirshfeld surface analysis, leading to the conclusion that the unique geometries are controlled by a combination of halogen contacts, π interactions, and interactions involving the nitro group on the aromatic rings. These conclusions are further examined via computational studies of the conformers, analysis of packing efficiency, and assessment of the structure of the energy frameworks for the crystalline solids. Finally, the information derived from the analysis of the interactions is used to simulate the growth of the crystals, helping to rationalize the conclusions about which interactions are responsible for the phase behavior of the compounds.

Introduction:Kallmann syndrome (KS) is a genetically heterogeneous developmental disorder that most often manifests hypogonadotropic hypogonadism (HH) and hypo-/anosmia due to early embryonic impairment in the migration of gonadotropin-releasing hormone neurons. SOX10(SRY-Box 10; MIM*602229), a key transcriptional activator involved in the development of neural crest cells, has been associated with KS and is identified as one of the causative genes of Waardenburg syndrome (WS). Case Presentation:A 28-year-old female patient, who was clinically diagnosed with KS in her childhood, presented with HH and anosmia, mild bilateral sensorineural hearing loss (SNHL), and pigmentation abnormalities. Next-generation sequencing analysis detected a missense heterozygous SOX10pathogenic variant (NM_006941.4:c.506C>T) in the proposita and in her mother, whose phenotype included exclusively anosmia and hypopigmented skin patches. The same variant has been described by Pingault et al. [Clin Genet. 2015;88(4):352–9] in a patient with apparently isolated bilateral severe SNHL. Conclusion:Our finding substantiates the extreme phenotypic variability of SOX10-related disorders, which range from classical KS and/or WS to contracted endophenotypes that could share a common pathway in the development of neural crest cells and highlights the need for careful evaluation and long-term follow-up of SOX10patients, with special focus on atypical/additional and/or late-onset phenotypic traits.

Purpose: Calcium ions are involved in the regulation of several cellular processes and may also influence viral replication. Hypocalcemia has been frequently reported during infectious diseases and in critically ill patients, including also COVID-19 patients, significantly related with the pro-inflammatory state and mortality. The aim of this study is to investigate the prevalence of hypocalcemia at admission in patients hospitalized for COVID-19 (Coronavirus disease2019) and to evaluate association of hypocalcemia with in-hospital COVID-19 outcomes. Methods: Retrospective analysis on 118 consecutive patients, hospitalized for COVID-19 between March and May 2020. Clinical characteristics, inflammation markers, biochemical routine and mineral metabolism parameters at admission were collected. Hypocalcemia was defined as total serum calcium &lt;2.2 mmol/L. Population was stratified by tertiles of total serum calcium. Primary outcome was the composite of in-hospital death or admission to intensive care unit (ICU). Secondary outcomes included in-hospital death, admission to ICU and need for non-invasive ventilation as separate events. Associations were tested by logistic regression and Cox-regression analysis with survival curves. Results: Overall prevalence of hypocalcemia was 76.6%, with just 6.7% of patients reporting levels of 25-(OH)-vitamin D > 30 ng/ml. Total serum calcium was inversely related with selected inflammatory biomarkers (p&lt; 0.05) and poorer outcome of COVID-19 during hospitalization. Lower tertile of total calcium (≤2.02 mmol/L) had increased risk of in-hospital mortality (HR 2.77; 1.28–6.03, p= 0.01) compared with other groups. Conclusion: Total serum calcium detected on admission is inversely related with proinflammatory biomarkers of severe COVID-19 and is useful to better define risk stratification for adverse in-hospital outcome.

This paper reviews how different policies jointly affect employment among disabled individuals. I used Google Scholar to find literature on welfare systems, disability, health and employment. I found literature on flexicurity through snowballing. I evaluate the following hypotheses: (1) generous disability benefits constitute a disincentive to work; (2) high investments in activation policies have a positive effect on employment; (3) a flexible labour market fosters employment; (4) disabled workers are more likely to be in temporary employment in countries with a flexible labour market. Hypotheses 1 and 3 find no support in the selected literature. Literature on hypotheses 2 and 4 is inconclusive. Future research avenues are suggested.

Several studies have shown a strong correlation between the different types of diets and gut microbiota composition on glycemia and weight loss. In this direction, low-carbohydrate and ketogenic diets have gained popularity, despite studies published so far leading to controversial results on subjects with diabetes. In this narrative review, firstly, we aimed to analyze the role of very-low-calorie ketogenic diets (VLCKDs) in type 2 diabetes (T2DM) and obesity management. Secondly, in this context, we focused attention on gut microbiota as a function of VLCKD, particularly in T2DM and obesity treatment. Finally, we reported all this evidence to underline the importance of gut microbiota to exalt new nutritional strategies for “tailor-made” management, treatment, and rehabilitation in subjects with T2DM and obesity, even with diabetic complications. In conclusion, this narrative review outlined the beneficial impact of VLCKD on gut microbiota even in subjects with T2DM and obesity, and, despite inner VLCKD short-duration feature allowing no sound-enough provisions for long-term outcomes, witnessed in favor of the short-term safety of VLCKD in those patients.

AbstractNew thermomechanical models for saturated soils recently developed in the literature very well capture the thermal cyclic deformations of normally consolidated (NC) soils, but this is not the case for slightly overconsolidated (OC) soils. To improve this, a framework based on the reference line (RL) and thermal stabilisation line (TSL) is proposed in the e-ln(p) plane. Whatever the applied thermal solicitations, monotonic or cyclic, the thermoplastic volumetric strains of slightly OC soils are easily predicted from their NC states using the RL and TSL lines concept. It should be noted that the TSL already exists in the literature but requires at least three tests at different over consolidation ratios (OCRs) for its calibration. For this purpose, a simple method is also proposed for determining the TSL line explicitly from the total deformation recorded at the end of the thermal cyclic test (on NC sample). In this way, the number of tests is reduced from three to one. Besides, to better predicting the thermomechanical behaviour of saturated soils, the hardening law is calculated independently for both thermal and mechanical loading cases. Finally, the proposed model is compared with existing recent models as well as experimental data from the literature.

In Establishment and Fairness, Kent Greenawalt provides a rich account of the establishment clause, eschewing reliance on a single categorical test or overarching value. His method is "to develop a [...]

ABSTRACT Article III of the Constitution provides that the "judicial Power" of the United States extends to all cases "arising under" the Constitution, laws, and treaties of the United States. [...]

The possible relationship between the degree of ventilation during exercise and airway cells is described. Explanation of whether airway cell composition is affected by rowing is also mentioned.

The association of kyphosis with ventilatory dysfunction in older community dwellers of Dicomano, Italy is examined. Dyspnea and ventilatory dysfunction of a restrictive and an obstructive type was found to be associated with kyphosis.

Study objectives: To investigate whether the bronchodilatory effect of deep inspiration is impaired in subjects with COPD. Methods: We measured deep inspiration-induced bronchodilation in 19 patients with COPD and 17 [...]

Background: Inflammation in chronic obstructive pulmonary disease (COPD) is characterised by increased neutrophilic infiltration of the airways. Cilomilast, a navel selective phosphodiesterase 4 inhibitor in clinical development for COPD treatment, [...]

Study objectives: This study investigated to what extent a diagnosis of COPD is erroneously made or the disease remains unrecognized in elderly asthmatic patients, and identified factors leading to misdiagnosis [...]

Chronic inflammation and remodeling may follow acute inflammation or may begin insidiously as a low-grade smoldering response, especially in the case of immune reactions. The histologic hallmarks of chronic inflammation [...]

Study objective: We evaluated the longitudinal changes in lung function and the factors associated with FE[V.sub.1] changes over time in a sample of asthmatic subjects. Setting: FE[V.sub.1] measures were recorded [...]

INTRODUCTION "We can hardly expect that the lasting outgrowth of the steel controversy will be the Youngstown case." (1) This projection captures the sentiment of much of the early academic [...]

Objective: Vocal fold paralysis is an uncommon problem in children. Clinical presentation covers a wide range of signs and symptoms. Our objective is to evaluate de efficacy and security of the Endoscopic Arytenoid Abduction Lateropexy (EAAL) in pediatric patients with vocal cord paralysis and to present the results. Material and method: From January 2011 to September 2018 10 patients with vocal fold paralysis underwent examination and treatment. The mean age at treatment was 4.87 years old (2-16). The parameters considered at the pre-/postsurgical time for the clinical assessment of each patient were as follows: the presence or absence of stridor and respiratory distress, the existence or nonexistence of previous tracheostomy, voice alterations, and feeding aspiration events. The mean follow-up was 49.5 months (5-104). Results: EAAL were realized successfully in 10 patients. There were no complications associated with the surgical procedure. In terms of sequelae, we noted 2 cases of minimal liquid-feeding difficulties that were alleviated within three weeks of the surgery with the help of phoniatrics reeducation, and 5 cases of mild dysphonia. In 4 cases tracheostomy was avoided, in 4 cases patients with prior tracheostomy were successfully decannulated following EAAL. Conclusions: EAAL may be selected as a first-line technique in management of vocal cord paralysis, since it is minimally invasive, easy to perform, and produces satisfactory results. [ABSTRACT FROM AUTHOR]

Two crystals incorporating the thiamine·HCl cation and the fluorinated anion 1,3-disulfonylhexafluoropropyleneimide have been characterized via single-crystal X-ray diffraction. The host-guest interactions of thiamine with the anions are analyzed and characterized using Hirshfeld surface analysis. The cations in both structures form a dimer in the solid-state via reciprocal hydrogen bonding through the amine and hydroxyl moieties. Additional investigation into the interactions responsible for dimer formation found that the sulfur atom in the thiazolium ring interacting with several hydrogen atoms to form stabilizing interactions. These interactions in the dimer are further analyzed using reduced density gradient analysis and the results are correlated to the fingerprint plots derived from the Hirshfeld surfaces. Moreover, specific interactions are observed from the cyclical anions, with both the fluorine and sulfonyl oxygen atoms participating in bridging interactions, displaying the diverse host-guest properties of thiamine.

In order to investigate the role of hypoxia on the cyclic oscillation of transmural pulmonary artery pressure (PAP) in obstructive sleep apnea, oxygen was administered during one half of the night to six patients affected by obstructive sleep apnea syndrome during a nocturnal polysomnographic study. In each patient, transmural PAP measurements were were performed on 15 randomly selected apneas recorded while breathing room air, and on 15 during [O.sub.2] administration. During [O.sub.2] administration in all patients, apneas were associated with a higher oxyhemoglobin saturation ([SaO.sub.2]), a smaller ([SaO.sub.2]) swing, and a higher transcutaneous [Pco.sub.2]. The mean highest level of transmural PAP in the apneic episodes, commonly reached at their end, was significantly lower than while breathing room air in only two patients; however, due to a decrease in the mean lowest PAP level (at the beginning of apneas), the extent of the PAP increase within apneas did not differ between air and [O.sub.2] breathing these patients showed the smallest increase in transcutaneous [Pco.sub.2] in our sample. End-apneic transmural PAP during [O.sub.2] administration was significantly higher in one subject (for systolic values) and was not significantly different in the remaining three subjects. The extent of the increase in transmural PAP within apneas was greater in one patient; it was smaller in another one, but only for the diastolic values; it did not differ significantly with respect to the value of observed while breathing room air in all of the other subjects. The results suggest that hypoxia in obstructive apneas, at least in some patients, may lead to a steady increase in PAP, detectable both at the beginning and at the end of the episodes; conversely, the increase in PAP within apneas does not seem to be influenced by the simultaneous decrease in [SaO.sub.2]., In obstructive sleep apnea syndrome (OSAS), upper airway narrowing and sleep-associated loss of tone in related muscles result in recurrent occlusive episodes, with consequent falls in oxyhemoglobin saturation ([SaO.sub.2]). In [...]

Domestic violence (DV) and sexually transmitted infections (STIs) are major healthcare issues, with known detrimental health outcomes. Though evidence confirms that individuals who experience DV are at a greater risk of acquiring STIs, there is paucity in the literature focused on nurses’ knowledge of the relationship between DV and STIs.

ABSTRACTWe investigated the influence of 6 morphometric and geographic factors on the structure and composition of plant communities in 56 temporary freshwater rockpools from 7 pool landscapes in the Maltese Islands. The factors considered were water depth, sediment depth, surface area, shading, distance from the coast, and elevation above sea level. Coverage data for 30 plant taxa in 3 functional forms (aquatic, amphibious, and terrestrial) were collected during one hydrological cycle. The relationships between pool morphometry, pool location, and community composition were tested using multivariate analyses. The contribution of spatial variables to variation in community composition across pools was examined using principal coordinate analysis of neighbour matrices (PCNM). The results suggested that pool morphometry varied both within and across landscapes, reflected in similar differences in community composition. Moreover, 47.6% of the explained community variation in the whole dataset was contributed exclusively by space predictors, suggesting that pool “location” is an important determinant of community composition. The morphometric property that exerted the highest influence on the dominance of a given plant functional form was the pool surface area, with greater surface areas promoting the presence of amphibious species relative to obligate hydrophytes. Conversely, the presence of specific species was mainly controlled by water depth and sediment depth. The most influential predictors of community composition varied across landscape, suggesting that pool location can be an important determinant of community structure and composition, and pool morphometry would favour certain functional forms and species over others.

Introduction: The optimal postoperative adjuvant treatment for stage III endometrial cancer (EC) is controversial. The aim of the study was to evaluate the impact of cytoreductive surgery (CRS) and adjuvant chemoradiotherapy (CRT) on relapse-free survival (RFS) and overall survival (OS) in stage III EC.Methods: Data on 36 patients with stage III EC were reviewed. A review of the literature was performed.Results: Median follow-up was 31 months (range 3–195). All patients underwent radical surgery with lymph nodes assessment in 29 (80.6%). The histologic specimen revealed 27 (75%) type I and 9 (25%) type II cancers staged IIIA, IIIB, IIIC1, and IIIC2 in 9 (25%), 3 (8.3%), 17 (47.2%), and 7 (19.5%) patients, respectively. At the end of surgery, 32 (88.9%) had no residual tumor. Eighteen (50%) patients were treated with CRT (50% with sandwich approach, 50% with concurrent chemotherapy [CT]), 4 (11.1%) patients received radiotherapy (RT), and 14 (38.9%) had multiagent CT. Four patients (11.1%) with a residual tumor larger than 1 centimeter after surgery died of disease. The 5-year median recurrent free survival (RFS) for CRT, RT, and CT was 69.1%, 37.5%, and 23.8%, respectively (p= 0.05); the 5-year OS for CRT, RT, and CT was 83%, 35.7%, and 25%, respectively (p= 0.023). Multivariate analyses showed residual tumor as independent predictor for recurrence and death. CRT showed a borderline significance on OS.Conclusions: Our study demonstrated that optimal cytoreduction is the most significant prognostic factor and adjuvant CRT seems to be associated with a significant decreased risk of recurrence in stage III EC.

A study is conducted to verify the impact of not giving antibiotics to elderly patients, who frequently hospitalized for exacerbated chronic obstructive pulmonary disorder (COPD).

Bronchogenic cysts are congenital malformations of the tracheobronchial tree that are mainly located in the mediastinum or the pulmonary parenchyma. They often occur in early childhood, compressing the airway or the esophagus or by superinfection.

Las fístulas del seno piriforme son anomalías infrecuentes de los arcos branquiales. La mayoría se localizan en el lado izquierdo y se extienden desde el ápex del seno piriforme de la hipofaringe hasta la glándula tiroides o el espacio peritiroideo.

Objective: Infertility has a severe impact on quality of life and mental health. This condition could be exacerbated by the existence of comorbid medical disease, like endometriosis. The aim of this critical narrative review is the examination of the state of the art about the quality of life and mental health in infertile women with endometriosis. Methods: We performed a rigorous and systematic search for studies on multiple electronic databases. A total of 6 papers were included in the review and were subjected to interpretative and critical narrative synthesis. Results and Discussion: Major findings are resumed in the following points: (a) infertile women with endometriosis when compared to infertile ones without endometriosis show higher depression, stress perception, and anxiety, and lower general quality of life; (b) quality of life specifically related to infertility is similar among women with and without endometriosis and seems to be related to personality and beliefs factors; (c) giving birth to a child is related to better mental quality of life; (d) during assisted reproductive treatment (ART) stimulation, infertile women with endometriosis have a decrease of dysmenorrhea and dyspareunia; (e) satisfaction of ART is related to the number of attempts, treatment accomplishment and pregnancy test outcomes. Clinical implications of these findings and suggestions for future researches were discussed. Conclusion: Concluding, it is crucial to assess the psychological factors related to endometriosis and infertility to reduce the impact of these diseases on quality of life and mental health, provide adequate support to these patients, improve their satisfaction and increase the change to get pregnant.

In subjects with DFS we evaluated WHMs, PWV, RHI, and serum vaspin and omentin levels. DFS subjects compared with controls showed higher values of PWV, a lower RHI, and a higher degree of periventricular WHMs.

Background/Objectives:Few studies have investigated the long-term variation of nutritional parameters after bariatric surgery. We examined changes in weight, vitamin status, and patient-reported dietary supplement use up to 5 years after surgery.Subjects/Methods:Circulating vitamin levels and data on self-reported dietary supplement use were collected in patients undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (AGB). These parameters were reassessed 3 and 5 years after surgery.Results:Sixty subjects (48 women, mean age = 41.6 ± 11.3 years) completed the 5-year follow-ups after surgery (AGB n= 8; SG n= 36; RYGB n= 16). No early postsurgery complications were reported. Average weight loss after 60 months was 29.7 ± 12.4 kg, and excess body weight loss was 40.6 ± 20.4 kg. Percentage excess weight loss was 63.1% ± 26.1% (AGB 40.4% ± 31%; SG 61.7% ± 22.3%; RYGB 77.6% ± 22.6%). At 5 years, nutritional deficiencies were reported in 28%, 70%, and 87% of AGB, SG, and RYGB patients, respectively. Dietary supplement use was infrequent before surgery, whereas it was reported by 61% and 73% of patients at 3 and 5 years after surgery (AGB 37%; SG 75%; RYGB 94%).Conclusions:Despite the widespread recommendation to use multivitamin supplements, nutritional deficiencies cannot be ruled out, even after 5 years of follow-up postbariatric surgery. As a result, continuous intermittent surveillance of nutritional parameters is suggested in postbariatric surgery patients.

Due to the presence of tungsten, Fe-W alloys can be applied as anticorrosive coatings. However, the conditions in which they are obtained influence their polarization resistance. This paper investigates how to electrodeposit them in order to increase their anticorrosive properties. The Fe-W alloys were produced by electrodeposition in different experimental conditions. The samples were characterized by X-ray diffraction (XRD) and scanning electronic microscopy (SEM) with energy dispersive X-ray spectroscopy (EDX). The corrosion resistance was evaluated by Tafel extrapolation. This paper reports that alloys that have higher mass composition of tungsten have higher polarization resistance, up to 9924.05 ohm∙cm². Fe-W alloys had 38.85–69.59% tungsten in mass basis, and the alloys with most tungsten were obtained with temperature of 60°C, continuous direct electric current density of 50 mA/cm², 0.01 mol/L iron sulfate concentration, 0.1 mol/L ammonium citrate and 0.1 sodium tungstate concentration. This study obtained alloys with higher tungsten composition, up to 69.59%, in comparison to papers with similar results of faradaic efficiency (10–15%). Using 0.1 mo/L iron sulfate concentration, the decrease of the temperature and the current density increases the tungsten composition, making the FeW alloys more anticorrosive.

The Salute Respiratoria nell'Anziano (Sa.R.A.) Study Objectives: To compare the effects of asthma and COPD on health status (HS) in elderly patients, and to assess the correlation between disease-specific and [...]

Bronchial Hyperresponsiveness and Aging Study objective: We evaluated whether aging may produce changes in bronchial hyperresponsiveness, risk of enhanced bronchoconstriction, and changes of bronchoconstriction perception. Setting: Each subject underwent a [...]

Early-life stress and ovarian hormones contribute to increased female vulnerability to cocaine addiction. Here, we reveal molecular substrates in the reward area, the nucleus accumbens, through which these female-specific factors affect immediate and conditioning responses to cocaine. We find shared involvement of X chromosome inactivation-related and estrogen signaling-related gene regulation in enhanced conditioning responses following early-life stress and during the low-estrogenic state in females. Low-estrogenic females respond to acute cocaine by opening neuronal chromatin enriched for the sites of ΔFosB, a transcription factor implicated in chronic cocaine response and addiction. Conversely, high-estrogenic females respond to cocaine by preferential chromatin closing, providing a mechanism for limiting cocaine-driven chromatin and synaptic plasticity. We find that physiological estrogen withdrawal, early-life stress, and absence of one X chromosome all nullify the protective effect of a high-estrogenic state on cocaine conditioning in females. Our findings offer a molecular framework to enable understanding of sex-specific neuronal mechanisms underlying cocaine use disorder.

Several medications may interact with levothyroxine (LT4) intestinal absorption or metabolism, thus reducing its bioavailability. We investigated the variability of thyroid stimulating hormone (TSH) levels and prescribed daily dosages (PDDs) of LT4 before and during potential drug–drug interactions (DDIs) in users of tablets vs. oral liquid LT4 formulations. By using the Italian general practice Health Search Database (HSD), we retrospectively selected adult patients with at least one LT4 prescription from 2012 to 2015 and at least 1 year of clinical history recorded. The incident prescription of interacting medications (e.g., proton pump inhibitors, calcium or iron salts) was the index date. Analysis was carried out using a self-controlled study design. Overall, 3965 users of LT4 formed the study cohort (84.1% women, mean age 56 ± 16.5 years). TSH variability on the entry date was greater among liquid LT4 users than in those prescribed with tablets as shown by the difference between 75th and 25th centile, which were 3.01 and 3.8, respectively. The incidence rate ratio (IRR) for TSH variability did not differ between groups, before and during exposure to DDIs. In contrast, PDDs less likely increased during the exposure to DDI with oral liquid LT4 compared with tablets (IRR = 0.84; 95% CI: 0.77–0.92), especially in patients with post-surgical hypothyroidism (IRR = 0.75; 95% CI: 0.64–0.85). In clinical practice, the use of oral liquid LT4 is not associated with increased PDDs, compared with tablets formulation, during exposure to DDIs. These results support the need for individualizing LT4 formulation to prescribe, especially in patients with various comorbidities and complex therapeutic regimens.