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We analyzed the complication rates and outcomes in patients with gastrointestinal disorders who had undergone maxillofacial surgery. We retrospectively analyzed 289 patients with inflammatory bowel disease (IBD), 142 with gastroesophageal reflux disease (GERD), and 42 with celiac disease (452 total) who had undergone oral and/or maxillofacial surgery. We examined their characteristics, medications they had taken, surgeries they had undergone, and complications they had experienced. Based on the results of univariate analysis, we selected variables for multivariable logistic regression to identify independent predictors of postoperative complications. We found a complication rate of 10% in patients with IBD, 6.9% in patients with GERD, and 9.5% in patients with celiac disease. Dentoalveolar treatment was significantly associated with an increased risk of postoperative complications in patients with IBD and GERD. Oral and/or maxillofacial surgery is safe in most patients with IBD, GERD, and celiac disease. Preventive measures for postoperative complications should be considered in patients with IBD and GERD undergoing dentoalveolar treatment. [ABSTRACT FROM AUTHOR]

Radiation doses in dentomaxillofacial imaging are typically very low. However, diagnostic and follow-up protocols in orthognathic surgery result in a patient-specific risk in effective dose. Estimating the cancer risks from these exposures remains abstract for many maxillofacial surgeons. In this study, 40 orthognathic patients were randomly sampled and their cumulative effective dose (ED) calculated. The lifetime attributable risk of cancer (LAR) was calculated based on the standard radiological protocol for orthognathic surgery follow-up using methods described in the BEIR VII report and RadRAT. The mean cumulative ED of the 40 sampled patients at the end of their 2-year follow-up period was 1.91 ± 0.58 mSv. The LAR at the end of follow-up was 17.65 (90% confidence interval 6.46–32.90) per 100,000 person-years for male orthognathic patients and 13.93 (90% confidence interval 6.27–25.24) per 100,000 person-years for female orthognathic patients. This represents 0.70% and 0.68%, respectively, of the baseline cancer risk for oral, thyroid, and brain cancer combined. Although theoretical, these results provide a framework for interpreting radiation doses and cancer risks in patients undergoing orthognathic surgery. Considering the increased radiation sensitivity in children and adolescents, indication-oriented and patient-specific imaging protocols should be advised. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the prevalence and characteristics of systemic conditions in patients undergoing orthognathic surgery at a tertiary centre. Ninety of the 838 patients undergoing orthognathic surgery between 2013 and 2019 had a systemic condition (prevalence of 10.7%). The most prevalent categories of systemic conditions were inflammatory joint disorders, endocrinological disorders, and syndromes. Patients with syndromes were significantly younger at the time of surgery than patients with endocrinological (P < 0.001), inflammatory joint (P = 0.003), or gastrointestinal disorders (P = 0.033). Endocrinological disorders, syndromes, and malignancies were more frequently associated with a skeletal class III malocclusion (P = 0.009, P < 0.001, and P = 0.048 respectively). Further research is needed to clarify the role of systemic conditions in the aetiology of malocclusion and postoperative outcomes. [ABSTRACT FROM AUTHOR]

Objective: To describe the prevalence and characteristics of patients with systemic conditions in an orthognathic surgery population.Study Design: A retrospective review was conducted of 1653 patients undergoing orthognathic surgery between 2001 and 2020. Patients were grouped per category of systemic condition and relevant information was retrieved from medical records. Clinical and perioperative characteristics were compared between patients with and without systemic conditions using χ2 tests and 95% confidence intervals. Age was compared using a cumulative logit model.Results: The proportion of patients with systemic conditions undergoing orthognathic surgery was 16% (272 of 1653 patients). Patients with systemic conditions were on average 6 years older than patients without systemic conditions (P < .001). Significant differences in age compared to healthy patients were found for endocrinological (12 years; 95% confidence interval [CI], 8-16 years), gastrointestinal (10 years; 95% CI, 3-18 years), pneumological (5 years; 95% CI, 2-13 years), and cardiovascular disorders (17 years; 95% CI, 12-21 years).Conclusion: Nearly 1 out of 6 patients undergoing orthognathic surgery has a systemic condition. Knowledge of the prevalence and characteristics of these patients creates awareness among surgeons and a foundation for future studies on perioperative management. [ABSTRACT FROM AUTHOR]

Electrocardiogram (ECG) analysis trying to understand the mechanisms of QRS widening is often problematic. During WCTs, identification of P waves and atrioventricular relationship is often difficult and increasingly so if the number of recording leads available for examination is limited. For this reason, it is necessary to use every information available in an ECG tracing. The goal of this article is to focus on the reasons for QRS variations occurring during tachycardia. Correct interpretation of these data can offer the key to understand the arrhythmia mechanism. [ABSTRACT FROM AUTHOR]

Abstract Background The role of QTc-prolongation, in relation to the increased mortality in COPD, is unclear. Objectives To estimate the prevalence and prognostic impact, assessed as mortality, of QTc-prolongation in COPD, restrictive spirometric pattern (RSP), and normal lung function (NLF), respectively. Methods All individuals (n = 993) with COPD and age- and sex-matched non-obstructive referents were identified from well-defined population-based cohorts examined in Northern Sweden in 2002–04. In 2005, the study-sample was invited to re-examination including ECG; QTc was calculated and mortality data collected until 31st December 2010. Results The prevalence of QTc-prolongation was higher among people with RSP than among those with NLF and, although similar in NLF and COPD, the prevalence increased by COPD-severity. Among participants with COPD, those with QTc prolongation had higher mortality than those with normal QTc, while no such differences were found among participants with NLF or RSP. Conclusion Among participants with COPD, the prevalence of QTc-prolongation increased by disease-severity and was associated with mortality. [ABSTRACT FROM AUTHOR]

Background Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a difficult-to-diagnose cause of sudden cardiac death (SCD). We identified a family of 1400 individuals with multiple cases of CPVT, including 36 SCDs during youth. Objectives We sought to identify the genetic cause of CPVT in this family, to preventively treat and clinically characterize the mutation-positive individuals, and to functionally characterize the pathogenic mechanisms of the mutation. Methods Genetic testing was performed for 1404 relatives. Mutation-positive individuals were preventively treated with β-blockers and clinically characterized with a serial exercise treadmill test (ETT) and Holter monitoring. In vitro functional studies included caffeine sensitivity and store overload–induced calcium release activity of the mutant channel in HEK293 cells. Results We identified the p.G357S_RyR2 mutation, in the cardiac ryanodine receptor, in 179 family members and in 6 SCD cases. No SCD was observed among treated mutation-positive individuals over a median follow-up of 37 months; however, 3 relatives who had refused genetic testing (confirmed mutation-positive individuals) experienced SCD. Holter monitoring did not provide relevant information for CPVT diagnosis. One single ETT was unable to detect complex cardiac arrhythmias in 72% of mutation-positive individuals, though the serial ETT improved the accuracy. Functional studies showed that the G357S mutation increased caffeine sensitivity and store overload–induced calcium release activity under conditions that mimic catecholaminergic stress. Conclusion Our study supports the use of genetic testing to identify individuals at risk of SCD to undertake prophylactic interventions. We also show that the pathogenic mechanisms of p.G357S_RyR2 appear to depend on β-adrenergic stimulation. [ABSTRACT FROM AUTHOR]

Background Dilated cardiomyopathy (DCM), a cardiac heterogeneous pathology characterized by left ventricular or biventricular dilatation, is a leading cause of heart failure and heart transplantation. The genetic origin of DCM remains unknown in most cases, but >50 genes have been associated with DCM. We sought to identify the genetic implication and perform a genetic analysis in a Spanish family affected by DCM and sudden cardiac death. Methods and Results Clinical assessment and genetic screening were performed in the index case as well as family members. Of all relatives clinically assessed, nine patients showed clinical symptoms related to the pathology. Genetic screening identified 20 family members who carried a novel mutation in LMNA (c.871 G>A, p.E291K). Family segregation analysis indicated that all clinically affected patients carried this novel mutation. Clinical assessment of genetic carriers showed that electrical dysfunction was present previous to mechanical and structural abnormalities. Conclusions Our results report a novel pathogenic mutation associated with DCM, supporting the benefits of comprehensive genetic studies of families affected by this pathology. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore 15-year-old adolescents’ experiences of appearance-related cyberbullying. Twenty-seven adolescents participated in four focus groups. The adolescents in this study perceived that it is common to be targeted in appearance-related cyberbullying, especially for girls, and that appearance-related cyberbullying is considered to be a potent strategy when attempting to hurt girls. Girls often received comments about being fat, while among boys, it was common to receive comments about looking or seeming “gay.” According to the adolescents, an important reason for engaging in appearance-related cyberbullying was to attain higher social status in the peer group. The girls and boys reacted differently to appearance-related cyberbullying. Boys tended to act out or take no offence, while girls experienced lower self-esteem and feelings of depression. Findings in this study contribute to research on cyberbullying as well as to research on girls’ body esteem development. [ABSTRACT FROM AUTHOR]

Background Brugada syndrome is a cardiac disorder associated with a high risk of sudden cardiac death, especially in young subjects. The incidence and prevalence are likely underestimated. The diagnosis is based on a characteristic electrocardiography (ECG) pattern. The most commonly performed confirmatory test in cases of equivocal ECG is the intravenous ajmaline challenge. Although relatively safe, it carries the risk of ventricular arrhythmias that could potentially degenerate into a refractory electrical storm. Case report A 27-year-old man developed sustained ventricular fibrillation after ajmaline challenge. He was rescued on extracorporeal life support after 108 min of cardiopulmonary resuscitation. Extracorporeal life support allowed recovery of spontaneous circulation and resulted in a positive neurological outcome. < Learning objective: This case is an example of how extracorporeal life support was instituted after prolonged and unsuccessful cardiopulmonary resuscitation resulting in a positive central neurological outcome.> [ABSTRACT FROM AUTHOR]

Background: The identification of conducting channels (CCs) based on its relative high voltage or the presence of electrograms with delayed components has been proposed for substrate-guided scar-related ventricular tachycardia (VT) ablation. The relationship of these channels with the VT isthmuses remains unclear. Objective: To assess the link between CCs identified during sinus rhythm (SR) and VT isthmuses in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods: Twenty-two consecutive patients with ARVC undergoing substrate-guided VT ablation (scar dechanneling technique) were analyzed. High-density endocardial and epicardial electroanatomic maps were obtained during SR. Standard bipolar cutoff values (0.5–1.5 and <0.5 mV) were used to define border zone and dense scar. The CCs were identified by voltage threshold adjustment (voltage channels) or by tagging the electrograms with delayed components that are sequentially activated (late potential channels). Results: A total of 87 CCs were identified; 65 (74.7%) of them on the epicardial surface. Twenty-four (27.6%) CCs were voltage channels, and compared with late potential CCs, these had a higher bipolar voltage (0.96 [0.48–1.29] mV vs 0.39 [0.26–0.50] mV; P < .001] and required more radiofrequency applications (5 [4–7] vs 3 [2–5]; P = .048]. Eighteen (90%) of 20 identified VT isthmuses were located on the epicardium. Only 8 (40%) VT isthmuses were related to a voltage CC. The remaining 12 (60%) VT isthmuses were linked to a late potential CC. Conclusion: Late potential CCs more frequently act as the VT substrate in ARVC and therefore should also be considered to guide SR substrate-guided ablation. [Copyright &y& Elsevier]

Copyright of Revista Iberoamericana de Micologia is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Few studies have explored the association of COPD, based on GOLD definition, with heart diseases. The relationship between restrictive lung function impairment and heart diseases is still poorly studied on a population level. Objectives: To explore the association of COPD and restrictive lung function impairment, respectively, with heart diseases in the general population. Design: This is a cross-sectional study of 642 randomly selected 22- to 72-year-old subjects in northern Sweden. COPD was defined according to GOLD. Restrictive lung function was defined as pre-bronchodilator FVC <80% of predicted value and FEV1/FVC ≥ 0.7. Results: The prevalence of ischemic heart disease was 4% in subjects with normal spirometry, 13% in subjects with COPD, and 21% in those with restrictive lung function. The prevalence of heart diseases increased with COPD severity. On the other hand, the prevalence of COPD was particularly high in the group reporting myocardial infarction. In subjects reporting different heart diseases, the prevalence of restrictive lung function was high. In multivariate analyses including age, sex, smoking habits, family history of obstructive airway disease, body mass index, and socio-economic status as independent variables, COPD was associated with ischemic heart disease (odds ratio [OR] 2.61; 95% confidence interval [CI] 1.12 - 6.08) and ischemic heart disease with COPD (OR 2.40; 95% CI 1.03 - 5.61). Conclusion: The study shows a strong association between COPD and cardiovascular diseases and indicates a strong association between restrictive lung function and heart diseases. Both obstructive and restrictive lung function impairments were common among subjects with heart diseases and vice versa. [ABSTRACT FROM AUTHOR]

Abstract: The restructuring process of the tourism sector and of the distribution channels caused by Information and Communications Technologies (ICT) may have altered the power positions in the channels. In the literature, the relationship between structure and power has been analyzed under the structure-conduct-performance paradigm, and the structure-conduct-outcome framework. The question is if the structure is antecedent or consequence of power balance in the channel. Our objective and contribution is to provide a common framework for both approaches by including the two different conceptualizations of the structure and analyzing their cause-effect link with the power balance. Moreover, we show that the two concepts of structure have a strong link with power balance but that the nature of the link might be very different: market structure is exogenous and might be considered an antecedent and, channel structure is endogenous, suggesting that it is intimately interrelated with power balance and that the cause-effect link works in the two directions. [Copyright &y& Elsevier]

Abstract: Objective: Strokes, a major cause of disability, are often caused by embolism from unstable carotid plaques. The aim of this study was to validate a biobank of human carotid endarterectomies as a platform for further exploration of pathways for plaque instability. For this purpose, we investigated the relationship between clinical parameters of plaque instability and expression of genes previously shown to be associated with either plaque instability or healing processes in the vessel wall. Methods: A database of clinical information and gene-expression microarray data from 106 carotid endarterectomies were used. Results: Expression of matrix metalloproteinase (MMP)-9 and MMP-7 was 100-fold higher in plaques than in normal artery. In general, genes associated with inflammation (such as RANKL and CD68) were overexpressed in symptomatic compared with asymptomatic plaques. Plaques obtained from patients undergoing surgery within 2 weeks after an embolic event showed up-regulation of genes involved in healing reactions in the vessel wall (including elastin and collagen). Statin treatment, as well as echodense lesions, were associated with a more stable phenotype. Conclusion: Here, we demonstrate that gene-expression profiles reflect clinical parameters. Our results suggest that microarray technology and clinical variables can be used for the future identification of central molecular pathways in plaque instability. [Copyright &y& Elsevier]

Abstract: The objectives of the Geocarbone-Integrity program are to develop techniques, methodologies and knowledge concerning the long term confinement of CO2 in geological storage. Linked to other French programs such as Geocarbone Injectivity or Picoref, it is an integrated approach involving geochemistry, petrophysics, geology and geomechanics. Different scales must be considered in order to describe caprocks: from the pore or grain scale in petrophysics and geochemistry, to regional scale in geology and geomechanics. The program focused on a specific site of the Paris basin but the methodologies developed are general and can be applied elsewhere. At large scales, caprock formation were described using sismic and log data. They were available on the St Martin de Bossenay depleted oil field and the Dogger caprock was mainly studied. These data were compiled and analyzed in order to obtain the variation of thickness and detect possible discontinuities. At small scale, the identification of geological facies and the origin of the low porosity and permeability in terms of sedimentology and diagenesis is necessary. For clayey caprocks, the amount and type of clay is important and for tight carbonate formation, dolomitisation is a key element. The key petrophysical parameters are the entry pressure, permeability and diffusivity. Very low permeabilities, smaller than microDarcy’s, are difficult to evaluate using standard techniques and the results can vary by up to one order of magnitude depending on the method used. For the formation considered, a low permeability transition zone, the measured entry pressures were too low to prevent the CO2 migration. Finally, diffusivity of dissolved CO2 was also evaluated: There is a decrease typically of a factor of 20 compared to bulk diffusivity, despite very low permeabilities. When injecting CO2, mechanical constraints are generated in both the storage and caprock formations, and the bottom of the caprock can be affected by geochemical reactions. The effect of the increase of pressure on the stress field has been evaluated and the possibility of fault and fracture generation or reactivation is small for the injection conditions considered. At the laboratory, elastic moduli have been measured before and after alteration of caprock samples and very small effects were observed. From the geochemical point of view, the alteration by CO2 has been studied on two types of formation, either dominated by clays or by carbonate. Some reaction paths have been identified from the experiments performed at elevated temperature and pressure conditions (80/150 °C, 150 bar) during long periods of time (3 to 6 months). Finally reactive transport simulations were performed to assess the speed and extend of CO2 migration in an idealized homogeneous caprock. Considering different situations and all key parameters (diffusion, reaction, entry pressure, two phase transport), the results show that the CO2 migrates a few meters during one thousand years, and that the porosity mostly decreases by precipitation, and increases very locally at the base of the caprock by dissolution. [Copyright &y& Elsevier]

Background: A bloodless field is important for visualizing relevant anatomical structures and facilitating construction of high-quality coronary anastomoses during off-pump coronary artery bypass graft surgery (OPCABG). Currently employed devices can damage target arteries as well as myocardium and are not uniformly effective, especially with diseased arteries. Methods: LeGoo (Pluromed, Woburn, MA) is a thermosensitive polymer that is a viscous liquid at room temperatures and changes into a firm occlusive plug instantaneously when exposed to body temperatures. The polymer is nontoxic and neither metabolized nor absorbed. It dissolves spontaneously or can be dissolved at will by cooling. LeGoo was instilled through the arteriotomy of 99 coronaries in 50 patients during construction of OPCABG anastomoses. Results: LeGoo formed an occlusive endoluminal plug instantaneously and blocked blood flow into the surgical field. In 89 vessels with available information, the quality of bloodless field was satisfactory, without need for substantial use of blood removal systems or application of another device in 81 vessels (91%). Resort to other means was prompted by serious arrhythmia (1 case) epicardial bleeding (1 vessel), bleeding from collateral branches (3 vessels), and shortcomings in design of the injecting catheter (3 vessels) that has been corrected. Intraoperative and perioperative profiles of these patients were similar to those reported from other OPCABG series. Abnormal bleeding, coagulopathy, metabolic derangements, and evidence of LeGoo embolization were not observed. Conclusions: In this first large-scale human experience, LeGoo had been an atraumatic, safe, and effective temporary coronary artery occluder. It produced a bloodless field during OPCABG in 91% of target vessels. Improvements on these results with further experience is anticipated. [Copyright &y& Elsevier]

Introduction: The diagnosis of blunt cerebrovascular injuries (BCVI) has improved with widespread adaptation of screening protocols and more accurate multi-detector computed tomography (MDCT-A) angiography. The population at risk and for whom screening is indicated is still controversial. To help determine which blunt trauma patients would best benefit from screening we performed a comprehensive analysis of risk factors associated with BCVI. Methods: All patients with BCVI from June 12, 2000 (the date at which our institution began screening for these injuries) to June 30, 2009 were identified by the primary author (JDB) and recorded in a prospective database. Associated injuries were identified retrospectively by International Classification of Diseases, Ninth Revision (ICD-9) code and compared with similar patients without BCVI. Demographic information was also compared from data obtained from the trauma registry. Univariate analyses exploring associations between individual risk factors and BCVI were performed using Fisher''s exact test for dichotomous variables and Student''s t test for continuous variables. Additionally, relative risk (RR) was calculated for dichotomous variables to describe the strength of the relationship between the categorical risk factors and BCVI. Multivariate logistic regression models for BCVI, BCAI (blunt internal carotid artery injury), and BVAI (blunt vertebral artery injury) were developed to explore the relative contributions of the various risk factors. Results: One hundred two patients with BCVI were identified out of 9935 blunt trauma patients admitted during this time period (1.03% incidence). Fifty-nine patients (0.59% incidence) had a BVAI and 43 patients (0.43% incidence) had a BCAI. Univariate analysis found cervical spine fracture (CSI) (RR = 10.4), basilar skull fracture (RR = 3.60), and mandible fracture (RR = 2.51) to be most predictive of the presence of BCVI (P < .005). Independent predictors of BCVI on multivariate logistic regression were CSI (OR = 7.46), mandible fracture (OR = 2.59), basilar skull fracture (OR = 1.76), injury severity score (ISS) (OR = 1.05), and emergency department Glasgow Coma Scale (ED-GCS) (OR = 0.93): all P < .05. Conclusions: Blunt trauma patients with a high risk mechanism and a low GCS, high injury severity score, mandible fracture, basilar skull fracture, or cervical spine injury are at high risk for BCVI should be screened with MDCT-A. [Copyright &y& Elsevier]

Abstract: Diffusion of dissolved CO2 is a possible transport mechanism in caprocks which should be evaluated precisely for long term storage of CO2. It is also a mechanism controlling the caprock geochemical reactivity in the vicinity of the top of the storage where CO2 accumulates driven by gravity. As a first step, we studied the diffusion properties of water in two low porosity caprock samples, giving an upper limit of the diffusion of CO2 dissolved in water. Two methods were used and compared on the same sample: standard through diffusion experiments with tritiated water, and low field NMR experiments with deuterated water. In through diffusion experiments, the sample is placed between two reservoirs; tritiated water is injected in one reservoir and its concentration measured in the other. In the NMR experiments, the sample is immersed in deuterated water and the water concentration inside the sample measured as a function of time. The NMR experiments also provide a measurement of porosity and pore size distribution, gradually invaded by D2O; in the present experiments, we observed that a small porosity fraction could not be exchanged with D2O. Both techniques give a comparable value of pore diffusion, namely 2.4 10−10 m2/s and 1.5 10−10 m2/s respectively for NMR and through diffusion methods. The porosity of the sample was 6%. Finally, we give some arguments for modeling diffusivity, useful for numerical simulators. The effective diffusivity is primarily a function of porosity and we suggest a power law dependence. Due to the similarity between diffusion and electrical properties in porous media, the exponent of the power law can be inferred from existing literature. [Copyright &y& Elsevier]

Background: New topical treatments in scalp psoriasis are needed because many current topical treatments are disliked by patients and associated with poor compliance. Objective: To compare the efficacy and safety of once-daily, two-compound scalp formulation containing calcipotriene plus betamethasone dipropionate with the individual components in the same vehicle and the vehicle alone. Methods: In this 8-week, multicenter, randomized, double-blind study, patients with scalp psoriasis were randomized to treatment with the two-compound scalp formulation (calcipotriene 50 μg/g plus betamethasone 0.5 mg/g, as dipropionate) (n = 541), betamethasone 0.5 mg/g (as dipropionate) in the same vehicle (n = 556), calcipotriene 50 μg/g in the same vehicle (n = 272), or vehicle alone (n = 136). Results: More patients achieved “absent” or “very mild” disease at week 8 with the two-compound scalp formulation (71.2%) compared with betamethasone dipropionate in the same vehicle (64.0%, p = .011), calcipotriene in the same vehicle (36.8%, p < .0001), or the vehicle (22.8%, p < .0001). Limitations: Efficacy of the active comparators in the study has not been established in relation to calcipotriene and betamethasone formulations available for clinical use. Conclusion: Calcipotriene plus betamethasone dipropionate scalp formulation was more effective than either of the individual components or the vehicle alone. [Copyright &y& Elsevier]

Summary: The aim of this study was to analyze whether snoring and excessive daytime sleepiness (EDS), the main symptoms of obstructive sleep apnea syndrome (OSAS), are associated with hypertension and diabetes in women. A random sample of 6779 women aged 20–99 years answered questionnaires on sleep disturbances, daytime symptoms and somatic diseases. The women were categorized into four groups: “no EDS or snoring” (reference group), “snoring but no EDS”, “EDS but no snoring” and “snoring and EDS”. Prevalences of hypertension and diabetes were lowest in the reference group (8.7% and 1.6%, respectively) and highest among women with both snoring and EDS (hypertension: 26.3%, diabetes: 5.8%). In a multivariate model adjusting for age, body mass index, smoking, physical activity and alcohol dependency, “snoring and EDS” was a risk factor for hypertension (adjusted OR 1.82 (95% CI 1.30–2.55)) while isolated snoring or EDS was not. “Snoring and EDS” was more closely related to hypertension among women aged <50 years (adj. OR 3.41 (1.78–6.54) vs. 1.50 (1.02–2.19), P=0.01). For diabetes, both “EDS but no snoring” and “snoring and EDS” were risk factors and the associations were most pronounced in women aged >50 years (adj. OR 2.33 (1.28–4.26) for “EDS but no snoring” and 2.00 (1.05–3.84) for “snoring and EDS”). We conclude that the combination of snoring and EDS is a risk factor for hypertension and diabetes in women. For hypertension, the risk is partly age dependent and, for diabetes, EDS without snoring is a risk factor of similar magnitude. These differences might indicate differences in pathophysiologic mechanisms underlying the association between sleep-disordered breathing and hypertension and diabetes respectively. [Copyright &y& Elsevier]

Background Intraportal transplantation of pancreatic islets offers improved glycaemic control and insulin independence in type 1 diabetes mellitus, but intraportal thrombosis remains a possible complication. The thrombotic reaction may explain why graft loss occurs and islets from more than one donor are needed, since contact between human islets and ABO-compatible blood in vitro triggers a thrombotic reaction that damages the islets. We investigated the possible mechanism and treatment of such thrombotic reactions.Methods Coagulation activation and islet damage were monitored in four patients undergoing clinical islet transplantation according to a modified Edmonton protocol. Expression of tissue factor (TF) in the islet preparations was investigated by immunohistochemistry, immunoprecipitation, electron microscopy, and RT-PCR. To assess TF activity in purified islets, human islets were mixed with non-anticoagulated ABO-compatible blood in tubing loops coated with heparin.Findings Coagulation activation and subsequent release of insulin were found consistently after clinical islet transplantation, even in the absence of signs of intraportal thrombosis. The endocrine, but not the exocrine, cells of the pancreas were found to synthesise and secrete active TF. The clotting reaction triggered by pancreatic islets in vitro could be abrogated by blocking the active site of TF with specific antibodies or site-inactivated factor VIIa, a candidate drug for inhibition of TF activity in vivo.Interpretation Blockade of TF represents a new therapeutic approach that might increase the success of islet transplantation in patients with type 1 diabetes, in terms of both the risk of intraportal thrombosis and the need for islets from more than one donor.Lancet 2002 360: 2039-45See Commentary page 1999 [Copyright &y& Elsevier]

In Europe and the US demand for Internet access is growing rapidly. Recent data provide evidence that the gap between these regions is once again increasing. Controlling for selected structural and corporate strategic factors, this paper examines the effects of public policies towards traditional communications infrastructures on Internet access. We analyze the nexus between these variables at a qualitative and quantitative level. Based on a pooled set of data, our empirical results indicate a significant influence of policies affecting market entry and the pricing of services on Internet access. Thus, contrary to the view of the Internet as a regulation-free space, important direct and indirect effects originate from regulatory policy. [Copyright &y& Elsevier]

Background & Aims IgG subclass 4–related disease (IgG4-RD) is characterized by increased serum levels of IgG4 and infiltration of biliary, pancreatic, and other tissues by IgG4-positive plasma cells. We assessed the prevalence of allergy and/or atopy, serum, and tissue IgE antibodies, and blood and tissue eosinophils in patients with IgG4-RD. We investigated the association between serum IgE and diagnosis and relapse of this disease. Methods We performed a prospective study of 48 patients with IgG4-RD, 42 patients with an increased serum level of IgG4 with other inflammatory and autoimmune conditions (disease control subjects), and 51 healthy individuals (healthy control subjects) recruited from Oxford, United Kingdom from March 2010 through March 2014, and followed for a median of 41 months (range, 3–73 months). Serum levels of immunoglobulin were measured at diagnosis, during steroid treatment, and at disease relapse for patients with IgG4-RD; levels at diagnosis were compared with baseline levels of control subjects. Allergen-specific IgEs were measured using the IgE ImmunoCAP. Levels and distribution of IgG4 and IgE antibodies in lymphoid, biliary, and pancreatic tissues from patients with IgG4-RD and disease control subjects were measured by immunohistochemistry. We analyzed data using the Spearman rank correlation and receiver operating characteristic curves. Results Serum levels of IgG4 increased to 1.4 g/L or more, and IgE increased to 125 kIU/L or more, in 81% and 54% of patients with IgG4-RD, respectively, compared with 6% and 16% of healthy control subjects ( P < .0001). Peripheral blood eosinophilia was detected in 38% of patients with IgG4-RD versus 9% of healthy control subjects ( P = .004). Of patients with IgG4-RD, 63% had a history of allergy and 40% had a history of atopy with an IgE-specific response; these values were 60% and 53% in patients with increased serum levels of IgE ( P < .05). Level of IgE at diagnosis >480 kIU/L distinguished patients with IgG4-RD from disease control subjects with 86% specificity, 36% sensitivity, and a likelihood ratio of 3.2. Level of IgE at diagnosis >380 kIU/L identified patients with disease relapse with 88% specificity, 64% sensitivity, and a likelihood ratio of 5.4. IgE-positive mast cells and eosinophilia were observed in lymphoid, biliary, and pancreatic tissue samples from 50% and 86% of patients with IgG4-RD, respectively. Conclusions In a prospective study, we associated IgG4-RD with allergy, atopy, eosinophilia, increased serum levels of IgE, and IgE-positive mast cells in lymphoid, biliary, and pancreatic tissue. An IgE-mediated allergic response therefore seems to develop in most patients with IgG4-RD; levels of IgE might be used in diagnosis and predicting relapse. [ABSTRACT FROM AUTHOR]

Copyright of Proges en Urologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Common variable immunodeficiency (CVID) is a heterogeneous immune defect characterized by hypogammaglobulinemia, failure of specific antibody production, susceptibility to infections, and an array of comorbidities. Objective: To address the underlying immunopathogenesis of CVID and comorbidities, we conducted the first genome-wide association and gene copy number variation (CNV) study in patients with CVID. Methods: Three hundred sixty-three patients with CVID from 4 study sites were genotyped with 610,000 single nucleotide polymorphisms (SNPs). Patients were divided into a discovery cohort of 179 cases in comparison with 1,917 control subjects and a replication cohort of 109 cases and 1,114 control subjects. Results: Our analyses detected strong association with the MHC region and association with a disintegrin and metalloproteinase (ADAM) genes (P combined = 1.96 × 10−7) replicated in the independent cohort. CNV analysis defined 16 disease-associated deletions and duplications, including duplication of origin recognition complex 4L (ORC4L) that was unique to 15 cases (P = 8.66 × 10−16), as well as numerous unique rare intraexonic deletions and duplications suggesting multiple novel genetic causes of CVID. Furthermore, the 1,000 most significant SNPs were strongly predictive of the CVID phenotype by using a Support Vector Machine algorithm with positive and negative predictive values of 1.0 and 0.957, respectively. Conclusion: Our integrative genome-wide analysis of SNP genotypes and CNVs has uncovered multiple novel susceptibility loci for CVID, both common and rare, which is consistent with the highly heterogeneous nature of CVID. These results provide new mechanistic insights into immunopathogenesis based on these unique genetic variations and might allow for improved diagnosis of CVID based on accurate prediction of the CVID clinical phenotypes by using our Support Vector Machine model. [ABSTRACT FROM AUTHOR]

Abstract: Empyema necessitatis is a rare complication of empyema and is more commonly reported in adults. It is characterized by purulence in the pleural space extending into the overlying soft tissues. We report a rare case in an otherwise healthy 3-month-old girl who presented with right chest wall swelling and was subsequently found to have methicillin-resistant Staphylococcus aureus empyema necessitatis requiring thoracotomy with decortication. [Copyright &y& Elsevier]

Abstract: Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a rare cardiac genetic disease characterized by the presence of structural alterations in the right ventricle which may cause ventricular arrhythmias and may induce sudden cardiac death. ARVC/D has been associated with mutations in genes encoding myocyte adhesion proteins. However, only 30%–50% of patients have mutations in these genes. Genetic testing is useful in obtaining a diagnosis, particularly in individuals who do not completely fulfill clinical criteria, thereby also enabling the undertaking of preventive strategies in family members. The main goal of this study was to identify mutations in candidate genes associated with intercalate disks that could be potentially involved in ARVC/D pathogenesis. We analyze a cohort of 14 Spanish unrelated patients clinically diagnosed with ARVC/D without any genetic alteration in all previously known responsible genes. Thus, a genetic screening has been performed in 7 additional potential candidate genes (ACTC1 -actin alpha cardiac muscle 1-, CDHN -cadherin 2 type 1 or N-cadherin-, CTNNA1 -catenin alpha 1-, Cx43 or GJA1 -gap junction protein alpha 1-, MVCL -Metavinculin-, MYL2 -myosin light chain 2- and MYL3 -myosin light chain 3-) by direct sequencing analysis. Our genetic analysis did not identify any disease-causing mutation. Thirty single nucleotides polymorphisms were found, six of them novel. In conclusion, our ARVC/D Spanish cohort has not shown any mutations in the analyzed candidate genes despite their involvement in formation and maintenance of the intercalated disk. [Copyright &y& Elsevier]