Thrombosis in paroxysmal nocturnal hemoglobinuria at a glance: a clinical review.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired stem cell disorder, with its primary clinical manifestations being hemolytic anemia, marrow failure and thrombophilia. Chronic hemolysis, failures of the fibrinolytic system, increased leukocyte-derived tissue factor levels in plasma, procoagulant microparticles generated through complement-mediated damage of platelets and venous endothelium are related to the acquired hypercoagulable state. Visceral thrombosis (including hepatic veins and mesenteric veins), cerebrovascular events and pulmonary embolism predict a poor outcome. Thrombosis is also associated with significant morbidity during pregnancy. Depending on the sites of thrombosis, a score-based probability to predict outcome can be assigned. Abdominal vein thromboses account for the majority of morbidity and mortality related to thrombosis, and time-dependent trends suggest that mortality rates tend to decline, with the advent of evolution of therapeutic and diagnostic strategies. In contrast, mortality rates from cerebrovascular events display no significant decline. Prompt diagnosis requires both clinical suspicion and sophisticated imaging techniques, along with multidisciplinary therapeutic intervention. In the eculizumab era, a significant reduction of thrombotic events was observed during therapy, and long-term follow up is needed to establish any benefit in rates and pattern of this complication. However, up to now, only bone marrow transplantation permanently abolishes the coagulation defect.

PAR2 Promotes Vaccine-Induced Protection Against Helicobacter Infection in Mice.

BACKGROUND & AIMS: Protective immunization limits Helicobacter infection of mice by undetermined mechanisms. Protease-activated receptor 2 (PAR2) signaling is believed to regulate immune and inflammatory responses. We investigated the role of PAR2 in vaccine-induced immunity against Helicobacter infection. METHODS: Immune responses against Helicobacter infection were compared between vaccinated PAR2(-/-) and wild-type (WT) mice. Bacterial persistence, gastric pathology, and inflammatory and cellular responses were assessed using the rapid urease test (RUT), histologic analyses, quantitative polymerase chain reaction, and flow cytometry, respectively. RESULTS: Following vaccination, PAR2(-/-) mice did not have reductions in Helicobacter felis infection (RUT values were 0.01 ± 0.01 for WT mice and 0.11 ± 0.13 for PAR2(-/-) mice; P < .05). The vaccinated PAR2(-/-) mice had reduced inflammation-induced stomach tissue damage (tissue damage scores were 8.83 ± 1.47 for WT mice and 4.86 ± 1.35 for PAR2(-/-) mice; P < .002) and reduced T-helper (Th)17 responses, based on reduced urease-induced interleukin (IL)-17 secretion by stomach mononuclear cells (5182 ± 1265 pg/mL for WT mice and 350 ± 436 pg/mL for PAR2(-/-) mice; P < .03) and reduced recruitment of CD4(+) IL-17(+) T cells into the gastric mucosa of PAR2(-/-) mice following bacterial challenge (3.7% ± 1.5% for WT mice and 2.6% ± 1.1% for PAR2(-/-) mice; P < .05). In vitro, H felis-stimulated dendritic cells (DCs) from WT mice induced greater secretion of IL-17 by ovalbumin-stimulated OT-II transgenic CD4(+) T cells compared with DCs from PAR2(-/-) mice (4298 ± 347 and 3230 ± 779; P < .04), indicating that PAR2(-/-) DCs are impaired in priming of Th17 cells. Adoptive transfer of PAR2(+/+) DCs into vaccinated PAR2(-/-) mice increased vaccine-induced protection (RUT values were 0.11 ± 0.10 and 0.26 ± 0.15 for injected and noninjected mice, respectively; P < .03). CONCLUSIONS: PAR2 activates DCs to mediate vaccine-induced protection against Helicobacter infection in mice.

Iowa Department of Transportation Major Items - Preliminary Quantity Report, January 16, 2013; With Addendums

Weekly letting report.

Iowa Department of Transportation Major Items - Preliminary Quantity Report, May 21, 2013; With Addendums

Weekly letting report.

Horae secundum usum romanum.

F. A-B. Bifolium contenant la fin de l’office du Saint Esprit ; cf. le même texte aux ff. 156-156v. XVe siècle. Copie inachevée dont les initialesont été laissées en blanc. Le f. B réglé est blanc. La justification est la même que celle du corps du manuscrit.F. 1-12v. Calendrier écrit à l’encre rouge et bleue et à l’or: nombreux saints méridionaux, en particulier de la vallée du Rhône et du Languedoc : « Fulcrani ep. [Lodevensis] » (13 févr.) ; « translatio s. Pauli » (20 février) ; « translatio s.Augustini » (28 février) ; « Pauli archi. Narbo[nensis] » (22 mars) ; « translatio b. Ferreoli [ ?] (1er avril) ; « Baudilii mart. [Nemausiensis] (20 mai) ; « Quiterie (21 mai) ; « Eutropii [ep. Arausicani] (27 mai) ; « translatio s. Saturnini » (22 juin) ; « Petri de Lucemburgo » (5 juillet) ; « Roqui mart. [Montispessulani] » (16 août) ; « Ludovici regis fratris [ep. Toletani]» (19 août) ; « Privati conf. [ep. Gabalitanus (Gévaudan)] » (21 août) ; « Fereoli mart. [Viennae] (18 sept.) ; « Apolinaris ep. [Valentinensis] » (10 oct.) ; « Firmini ep. [Ucetensis] » (11 oct.] ; « Florencii ep. [Arausicani] » (17 oct.] ; « Amancii ep. [Ruthenensis] » (5 nov.) ; « Restituti ep. [Tricastini] » (8 nov.) ; « Rufi ep. [Avenionensis] » (14 nov.) ; « Pauli ep. [Narbonensis] » (11 déc.) ; « Dominici conf. [de Silos] » (20 déc.). Mentions zodiacales et de comput, parmi lesquelles on note une « renovatio indicionum », le 24 septembre. F. 13-17. Extraits des quatre Evangiles : Io (13-14) ; Lc (14-15) ; Mt (15-16v) ; Mc (16v-17).F. 17v-71. [Horae beatae Mariae virginis secundum usum romanum]. [Ad matutinas], psaumes répartis selon les jours de la semaine (18-32v) ; — « In laudibus » (32v-42v) ; — « Ad primam » (43-46v) ; — « Ad tertiam » (46v-49) ; — « Ad sextam » (49v-52) ; « Ad IXa » (52-55) ; — « Ad vesperas » (55-60) ; — « Ad comple[c]torium » (60-64) ; — Antiennes, psaumes, leçons et répons pour les différents temps de l’année (64v-71) .F. 71-77v. Messe votive. « Missa beate Marie virginis ». « Salve sancta parens... » F. 78-85. Prières et hymnes. [Septem gaudia spiritualia b. Mariae virginis], incomplet des quatre premiers vers par lacune matérielle. « [Gaude flore virginali...] et sanctorum decoratum//...-... per eterna secula » (AH, XXXI, n° 198) ; « O sponsa Dei electa// Esto nobis via recta... » ; « ...Oratio. Domine Jhesu Christe qui beatissimam gloriosam virginem...-... pervenire mereamur » ; « Gaudia. Gaude virgo mater Christi// Que per aurem concepisti// ...-... perhemni gaudio. » (AH, XXIV, n° 57) ; cf. Leroquais, Livres d’heures, I, XXVI-XXVII ; « ... Oratio. Deus qui beatissimam virginem Mariam in consceptu... pervenire. Per... » ; « Gaudia beate Marie spiritualia. Gaude stirpe regis nata// Ab angelo saluta[ta]...-... et celorum mansio » (AH, XXXI, n° 182) ; « Oratio. Consolator mitissime Deus... sempiternis perfrui. Per... » ; « Alia oratio. Deus qui Gabrielem archangelum... mereamur habere. Qui... » ; « Devota oratio ad beatam virginem Mariam. Obsecro te domina... et michi famulo tuo pauperrimo N. ... » (Leroquais, Livres d’heures, II, 346-347).F. 85v blanc.F.86-91v. [Horae Trinitatis].F.91v-93v. Messe votive. « Missa de Trinitate ».F. 93v-97. « Devota oratio. Deus omnipotens propicius esto michi peccatori, custos mei omnibus diebus et horis vite mee, Deus Abraham... Omnes sancti angeli et archangeli Dei succurrite et subvenite michi peccatori... horis vite mee » ; cf. Leroquais, Livres d’heures, II, 396 ; — « O bone Jhesu illumina oculos meos ne unquam obdormiam... impietatem peccati mei » ; cf. Leroquais, Livres d’heures, I, XXX-XXXI ; — « Omnipotens, sempiterne et clementissime Deus qui Ezechie regi ... merear et optinere. Per... », à la forme masculine ; cf. Leroquais, Livres d’heures, II, 438 ; — « Oratio. Omnipotens sempiterne Deus te supplices exoramus ut celesti... consequantur. Per... » (Corpus orationum, VI, n° 4076).F. 97v blanc.F. 98-108. [Psaumes de la pénitence]. F. 108-117v. « Letania ». A noter parmi les confesseurs, la séquence inattendue de trois évêques de Toul honorés en Lorraine : « ... s. Mansuete, s. Gerarde, s. Aper ». Parmi les saintes : « ... s. Martha, s. Eulalia... s. Radegundis... ». — Oraisons diverses : « Propicius esto, parce nobis Domine... ut michi indigno famulo tuo N... exaudire digneris » ; — ... « Omnipotens sempiterne Deus miserere michi indigno famulo tuo N.... perficiat. Per... » ; — « Pie et exaudibilis domine Jhesu Christe Deus noster clementiam tuam... digneris eternam » ; cf. Leroquais, Psautiers, I, 25 ; — « Pietate tua quesumus Domine nostrorum solve vincula delictorum et intercedente pro nobis... virgine Dei genitrice Maria cum beatis apostolis tuis Petro et Paulo atque Andrea... eternam concede. Per... » (Corpus orationum, VI, n° 4227)...F. 118-145. [Officium mortuorum secundum usum romanum]F. 145-147v. Messe votive. « Missa pro omnibus fidelibus defunctis ». F. 148-151. [Horae sancti Spiritus].F. 151-153v. Messe votive. « Missa de sancto Spiritu », incomplet de la fin par lacune matérielle.F. 154-156v. [Horae omnium sanctorum], incomplet du premier feuillet.F. 156v-159v. Messe votive. « Missa de omnibus sanctis. F. 160-162v. [Horae sancti Sacramentis], incomplet du début par lacune matérielle. F. 162v-164v. Messe votive. « Missa de corpore Christi ».F. 164v-169v. Prières et hymnes. « ... salutatio sacratissimi corporis domini nostri Jhesu Christi. Ave Jhesu Christe verbum Patris filius [Virginis] agnus Dei...-... requies nostra vita perhemnis » ; cf. ms NAL 3211, 342 ; — « Alia oratio. Salve sancta caro Dei per quam salvi...-... da michi sedem justorum. Qui... » (ed. Leroquais, Livres d’heures, II, 348) ; — In elevatione corporis Christi. Anima Christi sanctifica me // Corpus Christi salva me... secula seculorum. Amen » ; (ed. Leroquais, Livres d’heures, II, 340 variantes) ; — « Alia. Ave verum corpus natum... o pia... ora pro nobis » (AH, LIV, n° 257) ; — « Alia devota oratio. Domine Jhesu Christe qui hanc sacratissimam carnem tuam... et periculis et in eternum » ; cf.ms NAL 3203, 26v ; — « Dum volueris communicare dic orationem. Omnipotens et misericors Deus ecce accedo ad sacratissimum accedo inquam infirmus ad medicum...-... tutela finalis in morte. Qui... » ; — « Alia oratio ante communionem. Domine sancte Pater, omnipotens eterne Deus, da mihi corpus et sanguinem... in infinita secula... » ; cf. Leroquais, Livres d’heures, II, 108 ; — « Post communionem. Gratias tibi ago Domine sancte pater omnipotens eterne Deus qui me peccatorem indignum famulum tuum saciare... et gaudium sempiternum... » ; cf. Leroquais, Livres d’heures, I, 51 ; — « Post communionem ad beatam Virginem. Serenissima Virgo et inclita mater nostri Jhesu Christi, sancta Maria regina celi et terre que eundem creatorem... hodie veracis [incomplet de la fin par lacune matérielle] ; cf. Leroquais, Livres d’heures, I, 156, 299.F. 170-173. [Horae sanctae Crucis], incomplet du début.F. 173-178. Messe votive. « Missa in honore sancte Crucis ». « Crucem tuam adoramus et veneramur domine Jhesu Christe, et per ipsam tuam sanctissimam recolimus passionem...-...defunctis vitam et gloriam sempiternam... » ; — « Alia oratio. Domine Jhesu Christe plasmator tocius creature, rex glorie obsecro miserere mei quia locutus sum... semper benedictus... » ; — « Alia oratio. Domine Jhesu Christe qui voluisti pro redemptione mundi nasci et circumcidi... ego miserrimus, vilissimus, nequissimus atque indignissimus peccator...-... latronem crucifixum. Qui... » ; — « Alia oratio. Precor te, piissime domine Jhesu Christe, per illam eximiam caritatem qua tu rex celestis... mihi tribuere digneris. Qui... » ; — « Alia oratio. Deus propicius esto michi peccatori. Quid est Jhesus nisi salvator ergo Jhesus per te ipsum redemptus sum... miserere michi Deus » ; — « Dic totum deinde dic oracionem. Tribulacionem nobis [sic], quesumus, Domine propicius respice... clementer averte. Per... ». F. 178-200. « ... suffragia sanctorum ». « ... de Trinitate » ; — « De sancto Michaele archangelo » ; — « De sancto Johanne Baptista » ; — « De sancto Petro et Paulo » ; — « De sancto Andrea apostolo » ; — « De sancto Johanne evangelista » ; — « De sancto Jacobo minori » ; — « Sanctorum Philippi et Jacobi » ; — « De innocentibus » ; — « De apostolis et evvangelistis » ; — « De sancto Stephano » ; — « De sancto Laurencio » ; — « De sancto Eutropio... Eutropium martyrem tuum (f. 183v)... » ; — « De sancto Georgio » ; — « De sancto Blasio » ; — « De sancto Dyonisio » ; — « De sancto Yppolito » ; — « De sancto Christophoro » ; — « De sancto Sebastiano. Omnipotens sempiterne Deus qui meritis beati Sebastiani martyris gloriosissimi quemdam pestem epydimie generalem hominibus mortiferam revocasti, presta supplicibus tuis ut qui hanc orationem super se portavit aut in domibus vel mansionibus scriptam aut alias de ea in tuo nomine memoriam habuerint sive in die aut in nocte legerint a simili a peste et morbo epydimie sub ejus confidencia ad te confugerint ipsius meritis et precibus ab ipsis peste et morbo epydimie et ab omnibus nocumentis venenosis necnon ab omnibus periculis corporis et anime atque a subitanea et improvisa morte et ab omnibus inimicis visibilibus et invisibilibus singulis diebus et noctibus horis atque momentis liberemur. Per Dominum. Pater noster. Ave Maria. Credo. Salva regina. Ave stella matutina, rosa sine spinis, cum reliquis ». — « Unius martyris communis » ; — « De martyribus communis » ; — « De sancto Martino » ; — « De sancto Nicholao » ; — « De sancto Anthonio » ; — « De sancto Lazaro » ; — « De sancto Restituto... Deus qui per merita beati Restituti confessoris atque pontificis a multorum oculis dolorem sanas, labem removes et visum clarificas... (189v-190) » ; — « Unius confessoris » ; — « De confessoribus communis » ; — « De beata Maria Magdalena prosa. Gaude pia Magdalena // Spes salutis // Vite vena // Lapsorum fiducia // Gaude dulcis advocata // ... » ; — « De beata Catherina. Gaude virgo Catherina /// Quam refecit lux divina // Ter quaternis noctibus //... » ; — « De beata Lucia » ; — « De beata Apollonia » ; — « De beata Agatha » ; — « De virginibus » ; — « De omnibus sanctis » ; — « De pace » ; — « De sancto Petro de Lucemburgo » ; le suffrage commence par la prière attribuée à s. Pierre de Luxembourg : « Deus pater qui creasti // Mundum et illuminasti // Suscipe...-... requiescant in pace. Amen » ; cf.ms NAL 3196, 152.F. 200v-204, feuillets réglés blancs.

Chest pain in daily practice: occurrence, causes and management

QUESTIONS UNDER STUDY: We assessed the occurrence and aetiology of chest pain in primary care practice. These features differ between primary and emergency care settings, where most previous studies have been performed. METHODS: 59 GPs in western Switzerland recorded all consecutive cases presenting with chest pain. Clinical characteristics, laboratory tests and other investigations as well as the diagnoses remaining after 12 months of follow-up were systematically registered. RESULTS: Among 24,620 patients examined during a total duration of 300 weeks of observation, 672 (2.7%) presented with chest pain (52% female, mean age 55 +/- 19(SD)). Most cases, 442 (1.8%), presented new symptoms and in 356 (1.4%) it was the reason for consulting. Over 40 ailments were diagnosed: musculoskeletal chest pain (including chest wall syndrome) (49%), cardiovascular (16%), psychogenic (11%), respiratory (10%), digestive (8%), miscellaneous (2%) and without diagnosis (3%). The three most prevalent diseases were: chest wall syndrome (43%), coronary artery disease (12%) and anxiety (7%). Unstable angina (6), myocardial infarction (4) and pulmonary embolism (2) were uncommon (1.8%). Potentially serious conditions including cardiac, respiratory and neoplasic diseases accounted for 20% of cases. A large number of laboratory tests (42%), referral to a specialist (16%) or hospitalisation (5%) were performed. Twentyfive patients died during follow-up, of which twelve were for a reason directly associated with thoracic pain [cancer (7) and cardiac causes (5)]. CONCLUSIONS: Thoracic pain was present in 2.7% of primary care consultations. Chest wall syndrome pain was the main aetiology. Cardio - vascular emergencies were uncommon. However chest pain deserves full consideration because of the occurrence of potentially serious conditions.

Sex-chromosome differentiation parallels postglacial range expansion in European tree frogs (Hyla arborea).

Occasional XY recombination is a proposed explanation for the sex-chromosome homomorphy in European tree frogs. Numerous laboratory crosses, however, failed to detect any event of male recombination, and a detailed survey of NW-European Hyla arborea populations identified male-specific alleles at sex-linked loci, pointing to the absence of XY recombination in their recent history. Here, we address this paradox in a phylogeographic framework by genotyping sex-linked microsatellite markers in populations and sibships from the entire species range. Contrasting with postglacial populations of NW Europe, which display complete absence of XY recombination and strong sex-chromosome differentiation, refugial populations of the southern Balkans and Adriatic coast show limited XY recombination and large overlaps in allele frequencies. Geographically and historically intermediate populations of the Pannonian Basin show intermediate patterns of XY differentiation. Even in populations where X and Y occasionally recombine, the genetic diversity of Y haplotypes is reduced below the levels expected from the fourfold drop in copy numbers. This study is the first in which X and Y haplotypes could be phased over the distribution range in a species with homomorphic sex chromosomes; it shows that XY-recombination patterns may differ strikingly between conspecific populations, and that recombination arrest may evolve rapidly (<5000 generations).

The systematic profiling of false identity documents: method validation and performance evaluation using seizures known to originate from common and different sources

False identity documents constitute a potential powerful source of forensic intelligence because they are essential elements of transnational crime and provide cover for organized crime. In previous work, a systematic profiling method using false documents' visual features has been built within a forensic intelligence model. In the current study, the comparison process and metrics lying at the heart of this profiling method are described and evaluated. This evaluation takes advantage of 347 false identity documents of four different types seized in two countries whose sources were known to be common or different (following police investigations and dismantling of counterfeit factories). Intra-source and inter-sources variations were evaluated through the computation of more than 7500 similarity scores. The profiling method could thus be validated and its performance assessed using two complementary approaches to measuring type I and type II error rates: a binary classification and the computation of likelihood ratios. Very low error rates were measured across the four document types, demonstrating the validity and robustness of the method to link documents to a common source or to differentiate them. These results pave the way for an operational implementation of a systematic profiling process integrated in a developed forensic intelligence model.

Optimization and regeneration kinetics of lymphatic-specific photodynamic therapy in the mouse dermis.

Lymphatic vessels transport fluid, antigens, and immune cells to the lymph nodes to orchestrate adaptive immunity and maintain peripheral tolerance. Lymphangiogenesis has been associated with inflammation, cancer metastasis, autoimmunity, tolerance and transplant rejection, and thus, targeted lymphatic ablation is a potential therapeutic strategy for treating or preventing such events. Here we define conditions that lead to specific and local closure of the lymphatic vasculature using photodynamic therapy (PDT). Lymphatic-specific PDT was performed by irradiation of the photosensitizer verteporfin that effectively accumulates within collecting lymphatic vessels after local intradermal injection. We found that anti-lymphatic PDT induced necrosis of endothelial cells and pericytes, which preceded the functional occlusion of lymphatic collectors. This was specific to lymphatic vessels at low verteporfin dose, while higher doses also affected local blood vessels. In contrast, light dose (fluence) did not affect blood vessel perfusion, but did affect regeneration time of occluded lymphatic vessels. Lymphatic vessels eventually regenerated by recanalization of blocked collectors, with a characteristic hyperplasia of peri-lymphatic smooth muscle cells. The restoration of lymphatic function occurred with minimal remodeling of non-lymphatic tissue. Thus, anti-lymphatic PDT allows control of lymphatic ablation and regeneration by alteration of light fluence and photosensitizer dose.

Integrative analyses of speciation and divergence in Psammodromus hispanicus (Squamata: Lacertidae).

BackgroundGenetic, phenotypic and ecological divergence within a lineage is the result of past and ongoing evolutionary processes, which lead ultimately to diversification and speciation. Integrative analyses allow linking diversification to geological, climatic, and ecological events, and thus disentangling the relative importance of different evolutionary drivers in generating and maintaining current species richness.ResultsHere, we use phylogenetic, phenotypic, geographic, and environmental data to investigate diversification in the Spanish sand racer (Psammodromus hispanicus). Phylogenetic, molecular clock dating, and phenotypic analyses show that P. hispanicus consists of three lineages. One lineage from Western Spain diverged 8.3 (2.9-14.7) Mya from the ancestor of Psammodromus hispanicus edwardsianus and P. hispanicus hispanicus Central lineage. The latter diverged 4.8 (1.5-8.7) Mya. Molecular clock dating, together with population genetic analyses, indicate that the three lineages experienced northward range expansions from southern Iberian refugia during Pleistocene glacial periods. Ecological niche modelling shows that suitable habitat of the Western lineage and P. h. edwardsianus overlap over vast areas, but that a barrier may hinder dispersal and genetic mixing of populations of both lineages. P. h. hispanicus Central lineage inhabits an ecological niche that overlaps marginally with the other two lineages.ConclusionsOur results provide evidence for divergence in allopatry and niche conservatism between the Western lineage and the ancestor of P. h. edwardsianus and P. h. hispanicus Central lineage, whereas they suggest that niche divergence is involved in the origin of the latter two lineages. Both processes were temporally separated and may be responsible for the here documented genetic and phenotypic diversity of P. hispanicus. The temporal pattern is in line with those proposed for other animal lineages. It suggests that geographic isolation and vicariance played an important role in the early diversification of the group, and that lineage diversification was further amplified through ecological divergence.

[Pise. Habitations et monuments]

Référence bibliographique : Weigert, 347