Changes in IPCC Scenario Assessment Emulators Between SR1.5 and AR6 Unraveled.

The IPCC's scientific assessment of the timing of net-zero emissions and 2030 emission reduction targets consistent with limiting warming to 1.5°C or 2°C rests on large scenario databases. Updates to this assessment, such as between the IPCC's Special Report on Global Warming of 1.5°C (SR1.5) of warming and the Sixth Assessment Report (AR6), are the result of intertwined, sometimes opaque, factors. Here we isolate one factor: the Earth System Model emulators used to estimate the global warming implications of scenarios. We show that warming projections using AR6-calibrated emulators are consistent, to within around 0.1°C, with projections made by the emulators used in SR1.5. The consistency is due to two almost compensating changes: the increase in assessed historical warming between SR1.5 (based on AR5) and AR6, and a reduction in projected warming due to improved agreement between the emulators' response to emissions and the assessment to which it is calibrated.

A hyperacute immune map of ischaemic stroke patients reveals alterations to circulating innate and adaptive cells.

Systemic immune changes following ischaemic stroke are associated with increased susceptibility to infection and poor patient outcome due to their role in exacerbating the ischaemic injury and long-term disability. Alterations to the abundance or function of almost all components of the immune system post-stroke have been identified, including lymphocytes, monocytes and granulocytes. However, subsequent infections have often confounded the identification of stroke-specific effects. Global understanding of very early changes to systemic immunity is critical to identify immune targets to improve clinical outcome. To this end, we performed a small, prospective, observational study in stroke patients with immunophenotyping at a hyperacute time point (< 3 h) to explore early changes to circulating immune cells. We report, for the first time, decreased frequencies of type 1 conventional dendritic cells (cDC1), haematopoietic stem and progenitor cells (HSPCs), unswitched memory B cells and terminally differentiated effector memory T cells re-expressing CD45RA (TEMRA). We also observed concomitant alterations to human leucocyte antigen D-related (HLA-DR), CD64 and CD14 expression in distinct myeloid subsets and a rapid activation of CD4+ T cells based on CD69 expression. The CD69+ CD4+ T cell phenotype inversely correlated with stroke severity and was associated with naive and central memory T (TCM) cells. Our findings highlight early changes in both the innate and adaptive immune compartments for further investigation as they could have implications the development of post-stroke infection and poorer patient outcomes.

Carboxylic Sulfuric Anhydrides.

Carboxylic acids react with sulfur trioxide to form carboxylic sulfuric anhydrides, RCOOSO2OH. In this article, new supersonic jet microwave spectra are presented for the anhydride derived from propiolic acid (HCCCOOH), and recent work on a series of carboxylic sulfuric anhydrides is reviewed. For the propiolic acid derivative, computed minimum-energy structures are reported for both the anhydride (HCCCOOSO2OH) and its precursor complex (HCCCOOH-SO3), and additional CCSD(T)/CBS(D-T)//M06-2X/6-311++G(3df,3pd) calculations indicate that, after zero-point energy corrections, the barrier to anhydride formation is effectively zero. These results are similar to those for other carboxylic sulfuric anhydrides studied and are consistent with their rapid production under supersonic jet conditions. Carboxylic sulfuric anhydrides, as a class, have not been widely characterized in the chemical literature and thus their study represents a new feature of the chemistry of sulfur oxides and oxyacids. As such, structural and energetic features of the carboxylic sulfuric anhydrides derived from formic, acetic, acrylic, trifluoroacetic, propiolic, pinic, and benzoic acids are compared. Computed vibrational frequencies are provided as Supporting Information and should be useful for possible future observation by infrared and/or Raman spectroscopy. Statistical thermodynamics is used to estimate the equilibrium constants for the formation reactions at a series of temperatures, and the results indicate values ranging from ∼104 atm-1 for formic acid at 288 K to over 1011 atm-1 for benzoic acid at 217 K. We speculate that carboxylic sulfuric anhydrides could be active species in the Earth's atmosphere and atmospheric concentrations have, therefore, been estimated assuming an equilibrium state. These estimates are subject to significant uncertainties in the atmospheric SO3 and carboxylic acid concentrations but may be as high as 107 molecules/cm3 in some locations. Related calculations suggest that equilibrium anhydride concentrations may exceed those of the sulfuric acid precursors SO3-H2O and SO3-(H2O)2 by several orders of magnitude. Kinetic modeling will ultimately be necessary to fully assess the role, if any, of carboxylic sulfuric anhydrides in atmospheric processes.

'Warning: allergic to penicillin': association between penicillin allergy status in 2.3 million NHS general practice electronic health records, antibiotic prescribing and health outcomes.

BACKGROUND: The prevalence of reported penicillin allergy (PenA) and the impact these records have on health outcomes in the UK general population are unknown. Without such data, justifying and planning enhanced allergy services is challenging. OBJECTIVES: To determine: (i) prevalence of PenA records; (ii) patient characteristics associated with PenA records; and (iii) impact of PenA records on antibiotic prescribing/health outcomes in primary care. METHODS: We carried out cross-sectional/retrospective cohort studies using patient-level data from electronic health records. Cohort study: exact matching across confounders identified as affecting PenA records. Setting: English NHS general practices between 1 April 2013 and 31 March 2014. Participants: 2.3 million adult patients. Outcome measures: prevalence of PenA, antibiotic prescribing, mortality, MRSA infection/colonization and Clostridioides difficile infection. RESULTS: PenA prevalence was 5.9% (IQR = 3.8%-8.2%). PenA records were more common in older people, females and those with a comorbidity, and were affected by GP practice. Antibiotic prescribing varied significantly: penicillins were prescribed less frequently in those with a PenA record [relative risk (RR)  = 0.15], and macrolides (RR = 4.03), tetracyclines (RR = 1.91) nitrofurantoin (RR = 1.09), trimethoprim (RR = 1.04), cephalosporins (RR = 2.05), quinolones (RR = 2.10), clindamycin (RR = 5.47) and total number of prescriptions were increased in patients with a PenA record. Risk of re-prescription of a new antibiotic class within 28 days (RR = 1.32), MRSA infection/colonization (RR = 1.90) and death during the year subsequent to 1 April 2013 (RR = 1.08) increased in those with PenA records. CONCLUSIONS: PenA records are common in the general population and associated with increased/altered antibiotic prescribing and worse health outcomes. We estimate that incorrect PenA records affect 2.7 million people in England. Establishing true PenA status (e.g. oral challenge testing) would allow more people to be prescribed first-line antibiotics, potentially improving health outcomes.

A Perfluorinated Carboxylic Sulfuric Anhydride: Microwave and Computational Studies of CF3COOSO2OH.

Trifluoroacetic sulfuric anhydride (CF3COOSO2OH, TFASA) and its deuterated isotopologue have been observed by pulsed-nozzle Fourier transform microwave spectroscopy. TFASA was generated in situ in a supersonic expansion from the reaction of CF3COOH or CF3COOD with SO3. The spectrum, which was notably weaker than those of previously studied carboxylic sulfuric anhydrides, is that of a simple asymmetric rotor with no evidence of internal rotation of the CF3 group. Calculations at the M06-2X/6-311++G(3df,3pd) level indicate that the title compound is produced via a mechanism involving a concerted cycloaddition, analogous to that found for other carboxylic sulfuric anhydrides. The calculations further show that the equilibrium orientation of CF3 relative to the C═O bond changes upon formation of the anhydride, indicating that any path connecting the equilibrium structures of CF3COOH and CF3COOSO2OH necessarily includes both cycloaddition and internal rotation. CCSD(T)/complete basis set with double and triple extrapolation [CBS(D-T)] single-point energy calculations at key points on the potential surface indicate that the barrier to form TFASA from a putative CF3COOH···SO3 complex is about 1.2 kcal/mol after zero-point energy corrections. This value is significantly larger than the near-zero or slightly negative barriers previously reported for the reactions of SO3 with nonfluorinated carboxylic acids and likely accounts, at least in part, for the reduced spectral intensity. Thus, TFASA is a somewhat unique addition to the series of carboxylic sulfuric anhydrides studied to date. Theoretical values of certain structural parameters, atomic charges, and vibrational frequencies also support this point of view. Despite the differences, however, this work clearly demonstrates that the reaction RCOOH + SO3 → RCOOSO2OH readily occurs in the gas phase and is not restricted to acids with hydrocarbon R groups.

A strong dependence of the CH3 internal rotation barrier on conformation in thioacetic acid: Microwave measurements and an energy decomposition analysis.

Rotational spectra of thioacetic acid (CH3COSH) have been observed by pulsed-nozzle Fourier transform microwave spectroscopy. Spectroscopic constants are reported for both the syn and anti conformers of the parent species, as well as the 34S and 13C carbonyl isotopologues. Transitions arising from the lowest A and E internal rotor states of the methyl group have been observed and analyzed. Experimental values of the three-fold internal rotation barrier, V3, for the syn and anti conformers of the parent isotopologue are 76.300(12) and 358.056(51) cm-1, respectively, indicating a large effect of the S-H orientation on the CH3 internal rotation potential. M06-2X/6-311+G(d,p) calculations are in good agreement with these results. The block localized energy decomposition method has been applied to understand the origins of this strong dependence of V3 on conformation. The results indicate that π conjugation from the SH to the carbonyl group and steric repulsion between the SH and the methyl group in the anti form are main contributors to the difference.

Climate Impacts From a Removal of Anthropogenic Aerosol Emissions.

Limiting global warming to 1.5 or 2.0°C requires strong mitigation of anthropogenic greenhouse gas (GHG) emissions. Concurrently, emissions of anthropogenic aerosols will decline, due to coemission with GHG, and measures to improve air quality. However, the combined climate effect of GHG and aerosol emissions over the industrial era is poorly constrained. Here we show the climate impacts from removing present-day anthropogenic aerosol emissions and compare them to the impacts from moderate GHG-dominated global warming. Removing aerosols induces a global mean surface heating of 0.5-1.1°C, and precipitation increase of 2.0-4.6%. Extreme weather indices also increase. We find a higher sensitivity of extreme events to aerosol reductions, per degree of surface warming, in particular over the major aerosol emission regions. Under near-term warming, we find that regional climate change will depend strongly on the balance between aerosol and GHG forcing.

Quantifying the Importance of Rapid Adjustments for Global Precipitation Changes.

Different climate drivers influence precipitation in different ways. Here we use radiative kernels to understand the influence of rapid adjustment processes on precipitation in climate models. Rapid adjustments are generally triggered by the initial heating or cooling of the atmosphere from an external climate driver. For precipitation changes, rapid adjustments due to changes in temperature, water vapor, and clouds are most important. In this study we have investigated five climate drivers (CO2, CH4, solar irradiance, black carbon, and sulfate aerosols). The fast precipitation responses to a doubling of CO2 and a 10-fold increase in black carbon are found to be similar, despite very different instantaneous changes in the radiative cooling, individual rapid adjustments, and sensible heating. The model diversity in rapid adjustments is smaller for the experiment involving an increase in the solar irradiance compared to the other climate driver perturbations, and this is also seen in the precipitation changes.

Understanding Rapid Adjustments to Diverse Forcing Agents.

Rapid adjustments are responses to forcing agents that cause a perturbation to the top of atmosphere energy budget but are uncoupled to changes in surface warming. Different mechanisms are responsible for these adjustments for a variety of climate drivers. These remain to be quantified in detail. It is shown that rapid adjustments reduce the effective radiative forcing (ERF) of black carbon by half of the instantaneous forcing, but for CO2 forcing, rapid adjustments increase ERF. Competing tropospheric adjustments for CO2 forcing are individually significant but sum to zero, such that the ERF equals the stratospherically adjusted radiative forcing, but this is not true for other forcing agents. Additional experiments of increase in the solar constant and increase in CH4 are used to show that a key factor of the rapid adjustment for an individual climate driver is changes in temperature in the upper troposphere and lower stratosphere.

Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome.

OBJECTIVES: Stroke-associated pneumonia (SAP) is common and associated with adverse outcomes. Data on its impact beyond 1 year are scarce. MATERIALS AND METHODS: This observational study was conducted in a cohort of stroke patients admitted consecutively to a tertiary referral center in the east of England, UK (January 2003-April 2015). Logistic regression models examined inpatient mortality and length of stay (LOS). Cox regression models examined longer-term mortality at predefined time periods (0-90 days, 90 days-1 year, 1-3 years, and 3-10 years) for SAP. Effect of SAP on functional outcome at discharge was assessed using logistic regression. RESULTS: A total of 9238 patients (mean age [±SD] 77.61 ± 11.88 years) were included. SAP was diagnosed in 1083 (11.7%) patients. The majority of these cases (n = 658; 60.8%) were aspiration pneumonia. After controlling for age, sex, stroke type, Oxfordshire Community Stroke Project (OCSP) classification, prestroke modified Rankin scale, comorbidities, and acute illness markers, mortality estimates remained significant at 3 time periods: inpatient (OR 5.87, 95%CI [4.97-6.93]), 0-90 days (2.17 [1.97-2.40]), and 91-365 days (HR 1.31 [1.03-1.67]). SAP was also associated with higher odds of long LOS (OR 1.93 [1.67-2.22]) and worse functional outcome (OR 7.17 [5.44-9.45]). In this cohort, SAP did not increase mortality risk beyond 1 year post-stroke, but it was associated with reduced mortality beyond 3 years. CONCLUSIONS: Stroke-associated pneumonia is not associated with increased long-term mortality, but it is linked with increased mortality up to 1 year, prolonged LOS, and poor functional outcome on discharge. Targeted intervention strategies are required to improve outcomes of SAP patients who survive to hospital discharge.

Hydration of an Acid Anhydride: The Water Complex of Acetic Sulfuric Anhydride.

The complex formed from acetic sulfuric anhydride (CH3COOSO2OH, ASA) and water has been observed by pulsed nozzle Fourier transform microwave spectroscopy. ASA was formed in situ in the supersonic jet via the reaction of SO3 and CH3COOH, and subsequently complexed with water using a concentric, dual injection needle that allows reagents to be introduced at different points along the expansion axis. Spectroscopic constants for the parent, fully deuterated, and CH313COOSO2OH species are reported. Both A and E internal rotor states have been observed and analyzed. The fitted internal rotation barrier of the methyl group is 219.598(21) cm-1 for the parent species, indicating that complexation with water lowers the internal rotation barrier of the methyl group by 9% relative to that of the free ASA. M06-2X/6-311++G(3df,3pd) calculations predict at least two distinct isomeric forms of ASA···H20. Spectroscopic constants for the observed species agree with those for the lower energy isomer in which the water inserts into the intramolecular hydrogen bond of the ASA monomer. CCSD(T)/CBS(D-T) calculations place the binding energy of this isomer at 13.3 kcal/mol below that of the isolated ASA and H2O monomers. The calculations further indicate that the doubly hydrogen bonded complex CH3COOH···H2SO4, which contains the hydrolysis products of ASA, lies even lower in energy, but this species was not observed in this study. This system represents the first stage of microsolvation of an acid anhydride, and the results indicate that a single water molecule does not induce spontaneous hydrolysis in a cold molecular cluster.

Observation of Two Conformers of Acrylic Sulfuric Anhydride by Microwave Spectroscopy.

The rotational spectrum of acrylic sulfuric anhydride (CH2═CHCOOSO2OH, AcrSA) has been observed using pulsed-nozzle Fourier transform microwave spectroscopy. The species was produced from the reaction between acrylic acid and sulfur trioxide in a supersonic jet. Spectroscopic constants are reported for both the s-cis- and s-trans-AcrSA conformers of the parent and monodeuterated (OD) isotopologues. Geometries were optimized for both conformers using M06-2X/6-311++G(3df,3pd) methods. Single-point energy calculations at the M06-2X geometries were calculated using the CCSD(T)/complete basis set method with double and triple extrapolation [CBS(D-T)]. Further calculations indicate that the anhydride results from a π2 + π2 + σ2 cycloaddition reaction within the acrylic acid-SO3 complex. Because the C═O double bond of the acrylic acid migrates from one of the COOH oxygens to the other during the reaction, the s-cis form of acrylic acid leads to the s-trans form of the anhydride and vice versa. With zero-point energy corrections applied to the CCSD(T) energies, the s-cis and s-trans forms of CH2═CHCOOSO2OH are 19.0 and 18.8 kcal/mol lower in energy than that of SO3 + their corresponding CH2═CHCOOH precursor conformation. The zero-point-corrected transition state energies for formation of the s-trans and s-cis anhydrides are 0.22 and 0.33 kcal/mol lower than those of the complexes of SO3 with s-cis and s-trans acrylic acid, respectively, indicating that the reaction is essentially barrierless. This system adds to a growing body of examples demonstrating that carboxylic acids readily add to SO3 in the gas phase to produce the corresponding carboxylic sulfuric anhydride.

Facile Formation of Acetic Sulfuric Anhydride: Microwave Spectrum, Internal Rotation, and Theoretical Calculations.

Acetic sulfuric anhydride, CH3COOSO2OH, was produced by the reaction of SO3 and CH3COOH in a supersonic jet. Four isotopologues were observed by microwave spectroscopy. Spectra of both A and E internal rotor states were observed and analyzed, yielding a value of 241.093(30) cm-1 for the methyl group internal rotation barrier of the parent species. Similar values were obtained for the other isotopologues studied. M06-2X/6-311++G(3df,3pd) calculations indicate that the formation of the anhydride proceeds via a π2 + π2 + σ2 cycloaddition reaction within the CH3COOH-SO3 complex. The equilibrium orientation of the methyl group relative to the O═C-C plane is different in the anhydride and in the CH3COOH-SO3 complex, indicating that the -CH3 internal rotation accompanies the cycloaddition reaction. The energies of key points on the potential energy surface were calculated using CCSD(T)/complete basis set with double and triple extrapolation [CBS/(D-T)], and the transformation from the CH3COOH-SO3 complex to CH3COOSO2OH is shown to be nearly barrierless regardless of the orientation of the methyl group. This study provides the second experimental observation of the reaction between a carboxylic acid and SO3 to form a carboxylic sulfuric anhydride in the gas phase. Possible connections to atmospheric aerosol formation are discussed.

Multidimensional Large Amplitude Dynamics in the Pyridine-Water Complex.

Aqueous pyridine plays an important role in a variety of catalytic processes aimed at harnessing solar energy. In this work, the pyridine-water interaction is studied by microwave spectroscopy and density functional theory calculations. Water forms a hydrogen bond to the nitrogen with the oxygen tilted slightly toward either of the ortho-hydrogens of the pyridine, and a tunneling motion involving in-plane rocking of the water interconverts the resulting equivalent structures. A pair of tunneling states with severely perturbed rotational spectra is identified and their energy separation, ΔE, is inferred from the perturbations and confirmed by direct measurement. Curiously, values of ΔE are 10404.45 and 13566.94 MHz for the H2O and D2O complexes, respectively, revealing an inverted isotope effect upon deuteration. Small splittings in some transitions suggest an additional internal motion making this complex an interesting challenge for theoretical treatments of large amplitude motion. The results underscore the significant effect of the ortho-hydrogens on the intermolecular interaction of pyridine.

Does gender or mode of HIV acquisition affect virological response to modern antiretroviral therapy (ART)?

OBJECTIVES: Previous UK studies have reported disparities in HIV treatment outcomes for women. We investigated whether these differences persist in the modern antiretroviral treatment (ART) era. METHODS: A single-centre cohort analysis was carried out. We included in the study all previously ART-naïve individuals at our clinic starting triple ART from 1 January 2006 onwards with at least one follow-up viral load (VL). Time to viral suppression (VS; first viral load < 50 HIV-1 RNA copies/mL), virological failure (VF; first of two consecutive VLs > 200 copies/mL more than 6 months post-ART) and treatment modification were estimated using standard survival methods. RESULTS: Of 1086 individuals, 563 (52%) were men whose risk for HIV acquisition was sex with other men (MSM), 207 (19%) were men whose risk for HIV acquisition was sex with women (MSW) and 316 (29%) were women. Median pre-ART CD4 count and time since HIV diagnosis in these groups were 298, 215 and 219 cells/µL, and 2.3, 0.3 and 0.3 years, respectively. Time to VS was comparable between groups, but women [adjusted hazard ratio (aHR) 2.32; 95% confidence interval (CI) 1.28-4.22] and MSW (aHR 3.28; 95% CI 1.91-5.64) were at considerably higher risk of VF than MSM. Treatment switches and complete discontinuation were also more common among MSW [aHR 1.38 (95% CI 1.04-1.81) and aHR 1.73 (95% CI 0.97-3.16), respectively] and women [aHR 1.87 (95% CI 1.43-2.46) and aHR 3.20 (95% CI 2.03-5.03), respectively] than MSM. CONCLUSIONS: Although response rates were good in all groups, poorer virological outcomes for women and MSW have persisted into the modern ART era. Factors that might influence the differences include socioeconomic status and mental health disorders. Further interventions to ensure excellent response rates in women and MSW are required.

Short-term weight gain after antiretroviral therapy initiation and subsequent risk of cardiovascular disease and diabetes: the D:A:D study.

OBJECTIVES: The aim of the study was to assess the impact of the gain in body mass index (BMI) observed immediately after antiretroviral therapy (ART) initiation on the subsequent risk of cardiovascular disease (CVD) and diabetes. METHODS: We analysed data from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cohort study. Outcomes were development of (i) CVD (composite of myocardial infarction/stroke/coronary procedure) and (ii) diabetes. The main exposure variable was change in BMI from ART initiation (pre-ART) to 1 year after initiation (continuous variable) in treatment-naïve individuals initiating ART with no history of CVD or diabetes (for respective outcomes). BMI [weight (kg)/(height (m))(2)] was categorized as underweight (< 18.5), normal (18.5-25), overweight (25-30) and obese (> 30). Poisson regression models were fitted stratified for each pre-ART BMI category to allow for category-specific estimates of incidence rate ratio (IRR). Models were adjusted for pre-ART BMI and CD4 count, key known risk factors (time-updated where possible) and calendar year. RESULTS: A total of 97 CVD events occurred in 43,982 person-years (n = 9321) and 125 diabetes events in 43,278 person-years (n = 9193). In fully adjusted analyses for CVD, the IRR/unit gain in BMI (95% confidence interval) in the first year of ART, by pre-ART BMI category, was: underweight, 0.90 (0.60-1.37); normal, 1.18 (1.05-1.33); overweight, 0.87 (0.70-1.10), and obese, 0.95 (0.71-1.28) (P for interaction = 0.04). For diabetes, the IRR/unit gain in BMI was 1.11 (95% confidence interval 1.03 to 1.21), regardless of pre-ART BMI (P for interaction > 0.05). CONCLUSIONS: Short-term gain in BMI following ART initiation appeared to increase the longer term risk of CVD, but only in those with pre-ART BMI in the normal range. It was also associated with increased risk of diabetes regardless of pre-ART BMI.

The impact of birth weight on cardiovascular disease risk in the Women's Health Initiative.

BACKGROUND AND AIMS: Cardiovascular disease (CVD) is among the leading causes of morbidity and mortality worldwide. Traditional risk factors predict 75-80% of an individual's risk of incident CVD. However, the role of early life experiences in future disease risk is gaining attention. The Barker hypothesis proposes fetal origins of adult disease, with consistent evidence demonstrating the deleterious consequences of birth weight outside the normal range. In this study, we investigate the role of birth weight in CVD risk prediction. METHODS AND RESULTS: The Women's Health Initiative (WHI) represents a large national cohort of post-menopausal women with 63,815 participants included in this analysis. Univariable proportional hazards regression analyses evaluated the association of 4 self-reported birth weight categories against 3 CVD outcome definitions, which included indicators of coronary heart disease, ischemic stroke, coronary revascularization, carotid artery disease and peripheral arterial disease. The role of birth weight was also evaluated for prediction of CVD events in the presence of traditional risk factors using 3 existing CVD risk prediction equations: one body mass index (BMI)-based and two laboratory-based models. Low birth weight (LBW) (<6 lbs.) was significantly associated with all CVD outcome definitions in univariable analyses (HR = 1.086, p = 0.009). LBW was a significant covariate in the BMI-based model (HR = 1.128, p < 0.0001) but not in the lipid-based models. CONCLUSION: LBW (<6 lbs.) is independently associated with CVD outcomes in the WHI cohort. This finding supports the role of the prenatal and postnatal environment in contributing to the development of adult chronic disease.

Cereal-derived arabinoxylans as biological response modifiers: extraction, molecular features, and immune-stimulating properties.

Arabinoxylans are of significant importance to human health due to their potential to modulate both the adaptive and innate immune systems. Arabinoxylans of various structures and sources have been shown to affect different immune cells to augment a wide range of immune responses in vitro and in vivo in animals and humans. This review article discusses current research on the immune-enhancing activities of arabinoxylans and other cereal polysaccharides in relation to their structural heterogeneity. There are inconsistencies in the literature regarding the relationships between the immunomodulatory effects and the structure and source of arabinoxylans. Possible mechanisms underlying these relationships which might explain the effects of such bioactive polysaccharides are proposed.

Maternal lipid levels during pregnancy and gestational diabetes: a systematic review and meta-analysis.

BACKGROUND: Lipid levels during pregnancy in women with gestational diabetes mellitus (GDM) have been extensively studied; however, it remains unclear whether dyslipidaemia is a potential marker of preexisting insulin resistance. OBJECTIVE: To evaluate the relationship between lipid measures throughout pregnancy and GDM. SEARCH STRATEGY: We searched PubMed-MedLine and SCOPUS (inception until January 2014) and reference lists of relevant studies. SELECTION CRITERIA: Publications describing original data with at least one raw lipid (total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], or triglyceride) measurement during pregnancy in women with GDM and healthy pregnant controls were retained. DATA COLLECTION AND ANALYSIS: Data extracted from 60 studies were pooled and weighted mean difference (WMD) in lipid levels was calculated using random effects models. Meta-regression was also performed to identify sources of heterogeneity. MAIN RESULTS: Triglyceride levels were significantly elevated in women with GDM compared with those without GDM (WMD 30.9, 95% confidence interval [95% CI] 25.4-36.4). This finding was consistent in the first, second and third trimesters of pregnancy. HDL-C levels were significantly lower in women with GDM compared with those without GDM in the second (WMD -4.6, 95% CI -6.2 to -3.1) and third (WMD -4.1, 95% CI -6.5 to -1.7) trimesters of pregnancy. There were no differences in aggregate total cholesterol or LDL-C levels between women with GDM and those without insulin resistance. AUTHOR'S CONCLUSIONS: Our meta-analysis shows that triglycerides are significantly elevated among women with GDM compared with women without insulin resistance and this finding persists across all three trimesters of pregnancy.

Host response to EBV infection in X-linked lymphoproliferative disease results from mutations in an SH2-domain encoding gene.

X-linked lymphoproliferative syndrome (XLP or Duncan disease) is characterized by extreme sensitivity to Epstein-Barr virus (EBV), resulting in a complex phenotype manifested by severe or fatal infectious mononucleosis, acquired hypogammaglobulinemia and malignant lymphoma. We have identified a gene, SH2D1A, that is mutated in XLP patients and encodes a novel protein composed of a single SH2 domain. SH2D1A is expressed in many tissues involved in the immune system. The identification of SH2D1A will allow the determination of its mechanism of action as a possible regulator of the EBV-induced immune response.