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Horner Syndrome (HS) is a rare but benign complication with epidural analgesia in parturients. It is caused by the cephalad spread of local anesthetic with an overflow to the superior cervical sympathetic chain. We present 2 patients, a 28-year old woman and a 23-year old woman, both without any major medical comorbidity. Each patient received a lumbar epidural catheter with the conventional labor pain treatment of our hospital. The first patient developed HS after the administration of 10 ml of lidocaine 1% when a unilateral block occurred. At this time, the patient was placed in genupectoral position. The second patient developed HS directly after the first bolus of 10 ml of the standard epidural solution of our center when the patient was in supine position. A spontaneous resolution of HS was observed in both patients. The exact incidence of HS in parturients is not known and probably underreported by patients as well as by caregivers. Clinical vigilance and appropriate teaching of obstetrics caregivers is very important. We demonstrate that an accidental subdural placement of the catheter and the dose of the epidural solution can play a major role in the development of HS.Horner Syndrome (HS) is a rare but benign complication with epidural analgesia in parturients. It is caused by the cephalad spread of local anesthetic with an overflow to the superior cervical sympathetic chain. We present 2 patients, a 28-year old woman and a 23-year old woman, both without any major medical comorbidity. Each patient received a lumbar epidural catheter with the conventional labor pain treatment of our hospital. The first patient developed HS after the administration of 10 ml of lidocaine 1% when a unilateral block occurred. At this time, the patient was placed in genupectoral position. The second patient developed HS directly after the first bolus of 10 ml of the standard epidural solution of our center when the patient was in supine position. A spontaneous resolution of HS was observed in both patients. The exact incidence of HS in parturients is not known and probably underreported by patients as well as by caregivers. Clinical vigilance and appropriate teaching of obstetrics caregivers is very important. We demonstrate that an accidental subdural placement of the catheter and the dose of the epidural solution can play a major role in the development of HS.

Human protein glycosylation is a complex process, and its in vivo regulation is poorly understood. Changes in glycosylation patterns are associated with many human diseases and conditions. Understanding the biological determinants of protein glycome provides a basis for future diagnostic and therapeutic applications. Genome-wide association studies (GWAS) allow to study biology via a hypothesis-free search of loci and genetic variants associated with a trait of interest. Sixteen loci were identified by three previous GWAS of human plasma proteome N-glycosylation. However, the possibility that some of these loci are false positives needs to be eliminated by replication studies, which have been limited so far. Here, we use the largest set of samples so far (4,802 individuals) to replicate the previously identified loci. For all but one locus, the expected replication power exceeded 95%. Of the sixteen loci reported previously, fifteen were replicated in our study. For the remaining locus (near the KREMEN1 gene) the replication power was low, and hence replication results were inconclusive. The very high replication rate highlights the general robustness of the GWAS findings as well as the high standards adopted by the community that studies genetic regulation of protein glycosylation. The fifteen replicated loci present a good target for further functional studies. Among these, eight genes encode glycosyltransferases: MGAT5, B3GAT1, FUT8, FUT6, ST6GAL1, B4GALT1, ST3GAL4, and MGAT3. The remaining seven loci offer starting points for further functional follow-up investigation into molecules and mechanisms that regulate human protein N-glycosylation in vivo.

This paper decomposes aggregate and individual stock returns into cash flow news, interest rate news, and risk premium news. We then extend the “good beta, bad beta” approach of Campbell and Vuolteenaho (2004) by allowing for a third beta: exposure to interest rate news. Using various stock portfolio sorts, we find that interest rate betas carry a higher price of risk than the betas for cash flow news and risk premium news. We also find that interest rate news explains over 1/3rd of all variation in stock market returns, and that interest rates negatively affect future risk premiums.

This study explores the cross-sectional integration of stock and corporate bond markets by comparing a firm’s expected stock return, as implied by corporate bond spreads, to its realized stock return. We compute expected corporate bond returns by correcting credit spreads for expected losses due to default, which are then transformed into expected stock returns. We find, surprisingly, a strong negative cross-sectional relation between these expected and realized stock returns over the period 1994-2015. This effect is stronger for firms with higher default risk, as measured by probability of default, leverage or credit rating, and cannot be explained by differences in the pricing of risk factors in stock and bond markets, limits to arbitrage or liquidity premiums.

Reformer und Moderate um Präsident Hassan Ruhani sind die Gewinner der Parlamentswahl im Iran. In der Hauptstadt Teheran können die Reformer sogar alle Sitze holen.

Introduction Chronic low back pain (CLBP) produces considerable direct costs as well as indirect burdens for society, industry and health systems. CLBP is characterised by heterogeneity, inclusion of several pain syndromes, different underlying molecular pathologies and interaction with psychosocial factors that leads to a range of clinical manifestations. There is still much to understand in the underlying pathological processes and the non-psychosocial factors which account for differences in outcomes. Biomarkers that may be objectively used for diagnosis and personalised, targeted and cost-effective treatment are still lacking. Therefore, any data that may be obtained at the-omics' level (glycomics, Activomics and genome-wide association studies-GWAS) may be helpful to use as dynamic biomarkers for elucidating CLBP pathogenesis and may ultimately provide prognostic information too. By means of a retrospective, observational, case-cohort, multicentre study, we aim to investigate new promising biomarkers potentially able to solve some of the issues related to CLBP. Methods and analysis The study follows a two-phase, 1:2 case-control model. A total of 12 000 individuals (4000 cases and 8000 controls) will be enrolled; clinical data will be registered, with particular attention to pain characteristics and outcomes of pain treatments. Blood samples will be collected to perform-omics studies. The primary objective is to recognise genetic variants associated with CLBP; secondary objectives are to study glycomics and Activomics profiles associated with CLBP. Ethics and dissemination The study is part of the PainOMICS project funded by European Community in the Seventh Framework Programme. The study has been approved from competent ethical bodies and copies of approvals were provided to the European Commission before starting the study. Results of the study will be reviewed by the Scientific Board and Ethical Committee of the PainOMICS Consortium. The scientific results will be disseminated through peer-reviewed journals. Trial registration number NCT02037789; Pre-results.

Complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy is a pain syndrome with an unclear pathophysiology and unpredictable clinical course. The disease is often therapy resistant, the natural course not always favorable. The diagnosis of CRPS is based on signs and symptoms derived from medical history and physical examination. Pharmacological pain management and physical rehabilitation of limb function are the main pillars of therapy and should be started as early as possible. If, however, there is no improvement of limb function and persistent severe pain, interventional pain management techniques may be considered. Intravenous regional blocks with guanethidine did not prove superior to placebo but frequent side effects occurred. Therefore this technique receives a negative recommendation (2 A-). Sympathetic block is the interventional treatment of first choice and has a 2 B+ rating. Ganglion stellatum (stellate ganglion) block with repeated local anesthetic injections or by radiofrequency denervation after positive diagnostic block is documented in prospective and retrospective trials in patients suffering from upper limb CRPS. Lumbar sympathetic blocks can be performed with repeated local anesthetic injections. For a more prolonged lumbar sympathetic block radiofrequency treatment is preferred over phenol neurolysis because effects are comparable whereas the risk for side effects is lower (2 B+). For patients suffering from CRPS refractory to conventional treatment and sympathetic blocks, plexus brachialis block or continuous epidural infusion analgesia coupled with exercise therapy may be tried (2 C+). Spinal cord stimulation is recommended if other treatments fail to improve pain and dysfunction (2 B+). Alternatively peripheral nerve stimulation can be considered, preferentially in study conditions (2 C+).

Background: Anatomical validation studies of cervical ultrasound images are sparse. Validation is crucial to ensure accurate interpretation of cervical ultrasound images and to develop standardized reliable ultrasound procedures to identify cervical anatomical structures. The aim of this study was to acquire validated ultrasound images of cervical bony structures and to develop a reliable method to detect and count the cervical segmental levels. Methods: An anatomical model of a cervical spine, embedded in gelatin, was inserted in a specially developed measurement device. This provided ultrasound images of cervical bony structures. Anatomical validation was achieved by laser light beams projecting the center of the ultrasound image on the cervical bony structures through a transparent gelatin. Results: Anatomically validated ultrasound images of different cervical bony structures were taken from dorsal, ventral, and lateral perspectives. Potentially relevant anatomical landmarks were defined and validated. Test/retest analysis for positioning showed a reproducibility with an intraclass correlation coefficient for single measures of 0.99. Besides providing validated ultrasound images of bony structures, this model helped to develop a method to detect and count the cervical segmental levels in vivo at long-axis position, in a dorsolateral (paramedian) view at the level of the laminae, starting from the base of the skull and sliding the ultrasound probe caudally. Conclusions: Ultrasound bony images of the cervical vertebrae were validated with an in vitro model. Anatomical bony landmarks are the mastoid process, the transverse process of C1, the tubercles of C6 and C7, and the cervical laminae. Especially, the cervical dorsal laminae serve best as anatomical bony landmarks to reliably detect the cervical segmental levels in vivo.

Een 28-jarige patiënt met recidiverende subacute lumbo-ischialgie ten gevolge van een lumbale discushernia wordt naar een pijncentrum verwezen voor lumbale epidurale steroïdinfiltraties. Het klinisch-neurologische beeld varieert en een week na de tweede infiltratie treedt er gevoelloosheid op in het perineum, samen met erectiele disfunctie en een minder controleerbare mictie. De diagnose van een cauda-equinasyndroom (CES) wordt uiteindelijk gesteld, gevolgd door een urgente chirurgische decompressie. Postoperatief bestonden er weinig restklachten van een verminderd gevoel in de genitale regio. Het klinische verloop, de technische beeldvorming, het ziekte-inzicht, de patiëntenscreening en de patiëntenopvolging, alsook het beleid worden verder besproken.