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Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease, and therefore, there is a lack of data regarding its clinical presentation, diagnosis, and management at a national basis. We aimed to describe the demographics and management of patients with CTEPH in Northern Greece. Methods: We conducted a retrospective, observational study by a joint collaboration between two pulmonary hypertension expert centers in Greece, and the study included patients diagnosed with CTEPH. The patient population was divided into two groups depending on their operability. Results: Overall, 27 consecutive patients were included (59% female, mean age 59.3±15.1 years). Dyspnea and fatigue were the most common presenting symptoms. History of pulmonary embolism was present in 82%. Of patients, 18 (67%) were assessed as operable, of whom 10 (55%) finally underwent pulmonary endarterectomy (PEA). There were no differences in symptoms, WHO functional class, 6-min walking test distance, and hemodynamics between the operable and nonoperable groups. At the end of follow-up, all non-operable and operable patients who did not receive surgical treatment were treated with at least one pulmonary hypertension-specific drug. Conclusion: This is the first report that presents data of patients diagnosed with CTEPH in Greece. The percentage of patients who underwent surgical treatment is lower but approaches the reported rates in large registries. Considering that PEA is a relatively safe and potentially curative surgical procedure, we emphasize the need for establishing a designated PEA center in Greece. Keywords: Chronic thromboembolic pulmonary hypertension, pulmonary endarterectomy, registry, riociguat.
nzidenz und Mortalität von Gebärmutterhalskrebs (C53 nach ICD-10) müssen signifikant nach oben korrigiert werden, wenn aus der betrachteten Referenzbevölkerung die Frauen ausgeschlossen werden, deren Gebärmutter operativ entfernt wurde. Diese Arbeit stützt sich auf die Studie zur Gesundheit Erwachsener in Deutschland (DEGS1), nach der die Hysterektomie-Prävalenz in Deutschland 2011 bei über 18-jährigen Frauen bei 17,4% lag. Auf Grundlage der Altersverteilung dieser Prävalenz werden die Inzidenz- und Mortalitätsraten von Gebärmutterhalskrebs entsprechend korrigiert. Maximale Korrekturen resultieren bei 70–79-jährigen Frauen mit einer Inzidenzkorrektur von 13,6 auf 22,5, d.h. um 65,4% und einer Mortalitätskorrektur von 7,5 auf 12,4, d.h. um 65,3%. Die mögliche Prävention durch eine HPV-Impfung gewinnt damit an Relevanz.
"En tierras bajas" de Herta Müller: mirada crítica hacia las cicatrices de una infancia irrespirable
(2016)
A través de la mirada y la voz narrativa de una niña rumana, la escritora Herta Müller nos acerca con su ópera prima Niederungen (En tierras bajas) a las cicatrices aún hoy vivas de su propia infancia en un pequeño pueblo ubicado en la región de Timisoara en la época de la dictadura de Nicolae Ceaucescu. Este artículo pretende una aproximación crítica a la recurrente temática centrada en la denuncia del país dejado atrás por la escritora tras su experiencia de exilio a la entonces Alemania occidental en el año 1987. Un análisis crítico de esta primera obra publicada por Müller en lengua alemana nos acerca a la literatura intercultural de la escritora migrante rumano-alemana cuya calidad y trayectoria literaria la hizo merecedora en 2009 del Premio Nobel de Literatura.
Introduction. The use of ultrasound during resuscitation is emphasized in the latest European resuscitation council guidelines of 2013 to identify treatable conditions such as pericardial tamponade. The recommended standard treatment of tamponade in various guidelines is pericardiocentesis. As ultrasound guidance lowers the complication rates and increases the patient’s safety, pericardiocentesis should be performed under ultrasound guidance. Acute care physicians actually need to train emergency pericardiocentesis. Methods. We describe in detail a pericardiocentesis ultrasound model, using materials at a cost of about 60 euros. During training courses of focused echocardiography n=67, participants tested the phantom and completed a 16-item questionnaire, assessing the model using a visual analogue scale (VAS). Results. Eleven of fourteen questions were answered with a mean VAS score higher than 60% and thus regarded as showing the strengths of the model. Unrealistically outer appearance and heart shape were rated as weakness of the model. A total mean VAS score of all questions of 63% showed that participants gained confidence for further interventions. Conclusions. Our low-cost pericardiocentesis model, which can be easily constructed, may serve as an effective training tool of ultrasound-guided pericardiocentesis for acute and critical care physicians.
Geoarchaeological reconstructions of land-use changes may help to reveal driving cultural factors and incentives behind these processes and relate them to supra-regional economic and political developments. This is particularly true in the context of complete abandonment of a settlement. Here we present a case study from the site of Faule Pfütze, a small catchment in the Eastern Ore Mountains (Saxony). The historical record of this site is confined to the report of a settlement called Hohenwalde in 1404 CE and two later references to the then-abandoned settlement in 1492 and 1524 CE in this area. Combined geoarchaeological studies allowed for the reconstruction of several phases of land use. While a first phase of alluvial sedimentation occurred during the late 12th century, archaeological evidence for a permanent settlement is absent during this period. The onset of settlement activity is identified during the late 14th century and included a hitherto unknown massive stone building. Mining features are present nearby and are dated to the early 15th century. The local palynological record shows evidence for reforestation during the mid 15th century and thereby corroborates the time of abandonment indicated by written sources. These processes are discussed in the context of a local political conflict (Dohna Feud) leading to the redistribution of properties and the development of a mining economy during this time. Later land use from the mid 16th century onwards appears restricted to charcoal production, probably in the context of smelting works operating in nearby Schmiedeberg as indicated by rising lead concentrations in the alluvial record.
During translation initiation, the heterotrimeric archaeal translation initiation factor 2 (aIF2) recruits the initiator tRNAi to the small ribosomal subunit. In the stationary growth phase and/or during nutrient stress, Sulfolobus solfataricus aIF2 has a second function: It protects leaderless mRNAs against degradation by binding to their 5′‐ends. The S. solfataricus protein Sso2509 is a translation recovery factor (Trf) that interacts with aIF2 and is responsible for the release of aIF2 from bound mRNAs, thereby enabling translation re‐initiation. It is a member of the domain of unknown function 35 (DUF35) protein family and is conserved in Sulfolobales as well as in other archaea. Here, we present the X‐ray structure of S. solfataricus Trf solved to a resolution of 1.65 Å. Trf is composed of an N‐terminal rubredoxin‐like domain containing a bound zinc ion and a C‐terminal oligosaccharide/oligonucleotide binding fold domain. The Trf structure reveals putative mRNA binding sites in both domains. Surprisingly, the Trf protein is structurally but not sequentially very similar to proteins linked to acyl‐CoA utilization—for example, the Sso2064 protein from S. solfataricus—as well as to scaffold proteins found in the acetoacetyl‐CoA thiolase/high‐mobility group‐CoA synthase complex of the archaeon Methanothermococcus thermolithotrophicus and in a steroid side‐chain‐cleaving aldolase complex from the bacterium Thermomonospora curvata. This suggests that members of the DUF35 protein family are able to act as scaffolding and binding proteins in a wide variety of biological processes.
Five new species of Hercostomus Loew, 1857 from Kenya, Namibia, Tanzania and South Africa are described and illustrated. They belong to the Hercostomus longiventris lineage, which also appears similar to the Palaearctic H. chetifer subgroup and the Oriental H. takagii and H. absimilis groups on the basis of the modified male fore tarsus. The male cercus of almost all Afrotropical species is remarkable in having ventral processes or projections and are conditionally divided into H. nectarophagus and H. perturbus subgroups on the basis of the presence of one or two ventral projections on the cercus, respectively. Hercostomus brandbergensis sp. nov. and H. fedotovae sp. nov. are associated with the H. nectarophagus subgroup; H. koshelevae sp. nov., H. vikhrevi sp. nov., and H. sanipass sp. nov. are associated with the H. perturbus subgroup. The new species differ by fine structures of the male fore tarsus, cercus and postgonite. An identification key to males of 23 Afrotropical species of Hercostomus is compiled for the first time. New records are given for some known species.
A legislação que fundamenta a inclusão da pessoa com deficiência na escola e na empresa vigora desde o final dos anos 1980. Devido à obrigatoriedade, pessoas com deficiência têm sido matriculadas nas escolas e contratadas por empresas. Esta pesquisa analisa tal processo de inclusão, sob a ótica da teoria do reconhecimento social de Honneth. Com base em seu conceito tridimensional de reconhecimento, mostramos, inicialmente, que a inclusão compreende dois processos articulados: individuação e inclusão. Em seguida, realizamos um estudo da legislação, finalidades e estratégias de consecução, mostrando que a perspectiva adotada permite interpretar a lei de modo mais generoso, desfazendo um equívoco positivista derivado de uma redação imprecisa. Por fim, desenvolvemos algumas considerações acerca da condição de escolas e empresas implementarem a legislação de maneira a efetivar a inclusão/individuação.
Background & Aims: Renal function assessed by creatinine is a key prognostic factor in cirrhotic patients. However, creatinine is influenced by several factors, rendering interpretation difficult in some situations. This is especially important in early stages of renal dysfunction where renal impairment might not be accompanied by an increase in creatinine. Other parameters, such as cystatin C (CysC) and beta‐trace protein (BTP), have been evaluated to fill this gap. However, none of these studies have considered the role of the patient's sex. The present study analysed CysC and BTP to evaluate their prognostic value and differentiate them according to sex.
Patients and methods: CysC and BTP were measured in 173 transjugular intrahepatic portosystemic shunt (TIPS)‐patients from the NEPTUN‐STUDY(NCT03628807) and analysed their relationship with mortality and sex. Propensity score for age, MELD, etiology and TIPS indication was used.
Results_ Cystatin C and BTP showed excellent correlations with creatinine values at baseline and follow‐up. CysC was an independent predictor of overall mortality (HR = 1.66(1.33‐2.06)) with an AUC of 0.75 and identified a cut‐off of 1.55 mg/L in the whole cohort. Interestingly, CysC was significantly lower in females, also after propensity score matching. In males, the only independent predictor was the creatinine level (HR = 1.54(1.25‐1.58)), while in females CysC levels independently predicted mortality (HR = 3.17(1.34‐7.52)).
Conclusion: This study demonstrates for the first time that in TIPS‐patients creatinine predicts mortality in males better than in females, whereas CysC is a better predictor of mortality in females. These results may influence future clinical decisions on therapeutic options for example, allocation for liver transplantation in TIPS‐patients.
Rationale: The clinical relevance of sensitization to Aspergillus (A) fumigatus in cystic fibrosis (CF) is unclear. Some researchers propose that specific A fumigatus IgE is an innocent bystander, whereas others describe it as the major cause of TH‐2‐driven asthma‐like disease.
Objectives: Lung function parameters in mild CF patients may be different in patients with and without A fumigatus sensitization. We aimed to ascertain whether allergen exposure to A fumigatus by bronchial allergen provocation (BAP) induces TH‐2 inflammation comparable to an asthma‐like disease.
Methods: A total of 35 patients, aged 14.8 ± 8.5 years, and 20 healthy controls were investigated prospectively. The patients were divided into two groups: group 1 (n = 18): specific (s)IgE negative, and group 2 (n = 17): sIgE positive (≥0.7 KU/L) for A fumigatus. Lung function, exhaled NO, and induced sputum were analysed. All sensitized patients with an FEV1 > 75% (n = 13) underwent BAP with A fumigatus, and cell counts, and the expression of IL‐5, IL‐13, INF‐γ, and IL‐8 as well as transcription factors T‐bet, GATA‐3, and FoxP3, were measured.
Results: Lung function parameters decreased significantly compared to controls, but not within the CF patient group. After BAP, 8 of 13 patients (61%) had a significant asthmatic response and increased eNO 24 hours later. In addition, marked TH‐2‐mediated inflammation involving eosinophils, IL‐5, IL‐13, and FoxP3 became apparent in induced sputum cells.
Conclusion: Our study demonstrated the clinical relevance of A fumigatus for the majority of sensitized CF patients. A distinct IgE/TH‐2‐dominated inflammation was found in induced sputum after A fumigatus exposure.