The Effect of Incidental Consolidation on Management and Outcomes in COPD Exacerbations: Data from the European COPD Audit

OBJECTIVE There is controversy regarding the significance of radiological consolidation in the context of COPD exacerbation (eCOPD). While some studies into eCOPD exclude these cases, consolidation is a common feature of eCOPD admissions in real practice. This study aims to address the question of whether consolidation in eCOPD is a distinct clinical phenotype with implications for management decisions and outcomes. PATIENTS AND METHODS The European COPD Audit was carried out in 384 hospitals from 13 European countries between 2010 and 2011 to analyze guideline adherence in eCOPD. In this analysis, admissions were split according to the presence or not of consolidation on the admission chest radiograph. Groups were compared in terms of clinical and epidemiological features, existing treatment, clinical care utilized and mortality. RESULTS 14,111 cases were included comprising 2,714 (19.2%) with consolidation and 11,397 (80.8%) without. The risk of radiographic consolidation increased with age, female gender, cardiovascular diseases, having had two or more admissions in the previous year, and sputum color change. Previous treatment with inhaled steroids was not associated. Patients with radiographic consolidation were significantly more likely to receive antibiotics, oxygen and non-invasive ventilation during the admission and had a lower survival from admission to 90-day follow-up. CONCLUSIONS Patients admitted for COPD exacerbation who have radiological consolidation have a more severe illness course, are treated more intensively by clinicians and have a poorer prognosis. We recommend that these patients be considered a distinct subset in COPD exacerbation.

The Role of the European Imperial Powers throughout the Armenian Schism in the 1870s

The Bull "Reversurus" (1867) and its dogmatic legitimization at the First Vatican Council in 1870 caused not only ecclesiastical controversy and Schism in the Armenian Catholic Church, but it had also wide political consequences for the Armenian Catholics in the Ottoman Empire. The conflict originally between the Armenian Catholics and Rome attracted very soon the attention of the European imperial Powers. France, the British Empire, the German Empire, Austria-Hungary and Russia were the main political powers who were involved in the Armenian affair. A full picture of the role of all these powers for the course of the Armenian Schism is missing. Mostly the role of France is foregrounded in the printed sources, as the main power, which supported the papacy to win during the Armenian affair. The role and the motives of the other imperial powers is almost missing. This article will try to describe as completely as possible the historical and political background, which brought to the escalation of the Armenian conflict beyond the national frontiers and led to number of conflicts at the international and transnational level. It will be shown that the imperial policy in Europe in the 19th century have played an enormous role throughout the Armenian Schism. It will be explained that several historical circumstances in Europe, especially the relation of the European imperial powers to each other as well as their expectations from the Ottoman Empire and its Armenian subjects were decisive for the duration and conclusion of the Armenian Schism.

Na+ channel function, regulation, structure, trafficking and sequestration.

This paper is the second of a series of three reviews published in this issue resulting from the University of California Davis Cardiovascular Symposium 2014: Systems approach to understanding cardiac excitation-contraction coupling and arrhythmias: Na(+) channel and Na(+) transport. The goal of the symposium was to bring together experts in the field to discuss points of consensus and controversy on the topic of sodium in the heart. The present review focuses on Na(+) channel function and regulation, Na(+) channel structure and function, and Na(+) channel trafficking, sequestration and complexing.

A Specific Mapping Study Using Fluorescence Sentinel Lymph Node Detection in Patients with Intermediate- and High-risk Prostate Cancer Undergoing Extended Pelvic Lymph Node Dissection.

Sentinel lymph node (SLN) detection techniques have the potential to change the standard of surgical care for patients with prostate cancer. We performed a lymphatic mapping study and determined the value of fluorescence SLN detection with indocyanine green (ICG) for the detection of lymph node metastases in intermediate- and high-risk patients undergoing radical prostatectomy and extended pelvic lymph node dissection. A total of 42 patients received systematic or specific ICG injections into the prostate base, the midportion, the apex, the left lobe, or the right lobe. We found (1) that external and internal iliac regions encompass the majority of SLNs, (2) that common iliac regions contain up to 22% of all SLNs, (3) that a prostatic lobe can drain into the contralateral group of pelvic lymph nodes, and (4) that the fossa of Marcille also receives significant drainage. Among the 12 patients who received systematic ICG injections, 5 (42%) had a total of 29 lymph node metastases. Of these, 16 nodes were ICG positive, yielding 55% sensitivity. The complex drainage pattern of the prostate and the low sensitivity of ICG for the detection of lymph node metastases reported in our study highlight the difficulties related to the implementation of SNL techniques in prostate cancer. PATIENT SUMMARY There is controversy about how extensive lymph node dissection (LND) should be during prostatectomy. We investigated the lymphatic drainage of the prostate and whether sentinel node fluorescence techniques would be useful to detect node metastases. We found that the drainage pattern is complex and that the sentinel node technique is not able to replace extended pelvic LND.

Veil: Mirror of Identity

The Islamic headscarf has become the subject of heated legal and political debate. France and Germany have legislated against it, and even the UK, long a champion of multiculturalism, has recently restricted the veil proper. Ever since home-grown Islamic terrorism struck Europe, these debates have become even more prominent, impassioned and wide-ranging, with vital global importance. In this concise and beautifully written introduction to the politics of the veil in modern societies, Christian Joppke examines why a piece of clothing could have led to such controversy. He dissects the multiple meanings of the Islamic headscarf, and explores its links with the global rise of Islam, Muslim integration, and the retreat from multiculturalism. He argues that the headscarf functions as a mirror of identity, but one in which national and liberal identities overlap, exposing the paradox that while it may be an affront to liberal values, its suppression is equally illiberal.