CC16 polymorphisms in asthma, asthma subtypes, and asthma control in adults from the Agricultural Lung Health Study.

BACKGROUND: The club cell secretory protein (CC16) has anti-inflammatory and antioxidant effects and is a potential early biomarker of lung damage. The CC16 single nucleotide polymorphism (SNP) rs3741240 risk allele (A) has been inconsistently linked to asthma; other tagging SNPs in the gene have not been explored. The aim was to determine whether CC16 tagging polymorphisms are associated with adult asthma, asthma subtypes or asthma control in the Agricultural Lung Health Study (ALHS). METHODS: The ALHS is an asthma case-control study nested in the Agricultural Health Study cohort. Asthma cases were individuals with current doctor diagnosed asthma, likely undiagnosed asthma, or asthma-COPD overlap defined by questionnaire. We also examined asthma subtypes and asthma control. Five CC16 tagging SNPs were imputed to 1000 Genomes Integrated phase 1 reference panel. Logistic regression was used to estimate associations between CC16 SNPs and asthma outcomes adjusted for covariates. RESULTS: The sample included 1120 asthma cases and 1926 controls of European ancestry, with a mean age of 63 years. The frequency of the risk genotype (AA) for rs3741240 was 12.5% (n = 382). CC16 rs3741240 was not associated with adult asthma outcomes. A tagging SNP in the CC16 gene, rs12270961 was associated with uncontrolled asthma (n = 208, ORadj= 1.4, 95% CI 1.0, 1.9; p = 0.03). CONCLUSION: This study, the largest study to investigate associations between CC16 tagging SNPs and asthma phenotypes in adults, did not confirm an association of rs3741240 with adult asthma. A tagging SNP in CC16 suggests a potential relationship with asthma control.

Esofagitis eosinofílica. Un caso clínico no tan raro / Eosinophilic esophagitis. A not so rare clinical case

La esofagitis eosinofílica es una enfermedad crónica de etiología multifactorial inmunomediada localmente en la cual la forma de presentación varía según la edad del paciente, siendo mayoritariamente signos de disfunción esofágica. El diagnóstico se realiza mediante criterio histológico y el tratamiento se fundamenta en dieta y corticoterapia tópica y en caso de presentar estenosis se realizan dilataciones. Un diagnóstico precoz frena la evolución, reduce complicaciones y mejora el pronóstico (AU)

Eosinophilic esophagitis is a chronic disease of multifactorial aetiology locally mediated immune in which the form of presentation varies according to the age of the patient, being mainly signs of esophageal dysfunction. Diagnosis is made by histological criteria and treatment is based on diet and topical corticosteroid therapy and, in the event of stenosis, dilations are performed. An early diagnosis slows down the evolution, reduces complications and improves the prognosis (AU)

[Eosinophilic esophagitis. A not so rare clinical case]. / Esofagitis eosinofílica. Un caso clínico no tan raro.

Eosinophilic esophagitis is a chronic disease of multifactorial aetiology locally mediated immune in which the form of presentation varies according to the age of the patient, being mainly signs of esophageal dysfunction. Diagnosis is made by histological criteria and treatment is based on diet and topical corticosteroid therapy and, in the event of stenosis, dilations are performed. An early diagnosis slows down the evolution, reduces complications and improves the prognosis.

Charge Density Waves in YBa_{2}Cu_{3}O_{6.67} Probed by Resonant X-Ray Scattering under Uniaxial Compression.

We report a comprehensive Cu L_{3}-edge resonant x-ray scattering (RXS) study of two- and three-dimensional (2D and 3D) incommensurate charge correlations in single crystals of the underdoped high-temperature superconductor YBa_{2}Cu_{3}O_{6.67} under uniaxial compression up to 1% along the two inequivalent Cu─O─Cu bond directions (a and b) in the CuO_{2} planes. We confirm the strong in-plane anisotropy of the 2D charge correlations and observe their symmetric response to pressure: pressure along a enhances correlations along b, and vice versa. Our results imply that the underlying order parameter is uniaxial. In contrast, 3D long-range charge order is only observed along b in response to compression along a. Spectroscopic RXS measurements show that the 3D charge order resides exclusively in the CuO_{2} planes and may thus be generic to the cuprates. We discuss implications of these results for models of electronic nematicity and for the interplay between charge order and superconductivity.

Surgical management of pelvic organ prolapse.

Despite pelvic organ prolapse being a universal problem experienced in nearly 50% of parous women, the surgical management of vaginal prolapse remains an enigma to many, with wide variation in the rates and types of intervention performed. As part of the 6th International Consultation on Incontinence (ICI) our committee, charged with producing an evidence-based report on the surgical management of prolapse, produced a pathway for the surgical management of prolapse. The 2017 ICI surgical management of prolapse evidence-based pathway will be presented and summarized. Weaknesses of the data and pathway will be discussed and avenues for future research proposed.

Uniaxial pressure control of competing orders in a high-temperature superconductor.

Cuprates exhibit antiferromagnetic, charge density wave (CDW), and high-temperature superconducting ground states that can be tuned by means of doping and external magnetic fields. However, disorder generated by these tuning methods complicates the interpretation of such experiments. Here, we report a high-resolution inelastic x-ray scattering study of the high-temperature superconductor YBa2Cu3O6.67 under uniaxial stress, and we show that a three-dimensional long-range-ordered CDW state can be induced through pressure along the a axis, in the absence of magnetic fields. A pronounced softening of an optical phonon mode is associated with the CDW transition. The amplitude of the CDW is suppressed below the superconducting transition temperature, indicating competition with superconductivity. The results provide insights into the normal-state properties of cuprates and illustrate the potential of uniaxial-pressure control of competing orders in quantum materials.

Resistivity in the Vicinity of a van Hove Singularity: Sr_{2}RuO_{4} under Uniaxial Pressure.

We report the results of a combined study of the normal-state resistivity and superconducting transition temperature T_{c} of the unconventional superconductor Sr_{2}RuO_{4} under uniaxial pressure. There is strong evidence that, as well as driving T_{c} through a maximum at ∼3.5 K, compressive strains ϵ of nearly 1% along the crystallographic [100] axis drive the γ Fermi surface sheet through a van Hove singularity, changing the temperature dependence of the resistivity from T^{2} above, and below the transition region to T^{1.5} within it. This occurs in extremely pure single-crystals in which the impurity contribution to the resistivity is <100 nΩ cm, so our study also highlights the potential of uniaxial pressure as a more general probe of this class of physics in clean systems.

Direct or indirect post crowns to restore compromised teeth: a review of the literature.

Post crowns are restorations which utilise the root canal space to improve the retention and resistance form of teeth which lack coronal tooth structure. In recent years there have been significant developments in the materials, systems and evidence-base surrounding the provision of post crowns. This review aims to refresh the general dental practitioner's (GDPs) knowledge of the different factors that must be considered when placing a post crown, and how these factors can help guide the dentist in their decision to provide either a direct or indirect post and core.

Validity of the Kirchhoff approximation for the scattering of electromagnetic waves from dielectric, doubly periodic surfaces.

Accuracy of Kirchhoff approximation (KA) for rough-surface electromagnetic wave scattering is studied by comparison with accurate numerical solutions in the context of three-dimensional dielectric surfaces. The Kirchhoff tangent plane approximation is examined without resorting to the principle of stationary phase. In particular, it is shown that this additional assumption leads to zero cross-polarized backscattered power, but not the tangent plane approximation itself. Extensive numerical results in the case of a bisinusoidal surface are presented for a wide range of problem parameters: height-to-period, wavelength, incidence angles, and dielectric constants. In particular, this paper shows that the range of validity inherent in the KA includes surfaces whose curvature is not only much smaller, but also comparable to the incident wavelength, with errors smaller than 5% in total reflectivity, thus presenting a detailed and reliable source for the validity of the KA in a three-dimensional fully polarimetric formulation.

An Integrated Ecological Modeling System for Assessing Impacts of Multiple Stressors on Stream and Riverine Ecosystem Services within River Basins.

We demonstrate a novel, spatially explicit assessment of the current condition of aquatic ecosystem services, with limited sensitivity analysis for the atmospheric contaminant mercury. The Integrated Ecological Modeling System (IEMS) forecasts water quality and quantity, habitat suitability for aquatic biota, fish biomasses, population densities, productivities, and contamination by methylmercury across headwater watersheds. We applied this IEMS to the Coal River Basin (CRB), West Virginia (USA), an 8-digit hydrologic unit watershed, by simulating a network of 97 stream segments using the SWAT watershed model, a watershed mercury loading model, the WASP water quality model, the PiSCES fish community estimation model, a fish habitat suitability model, the BASS fish community and bioaccumulation model, and an ecoservices post-processer. Model application was facilitated by automated data retrieval and model setup and updated model wrappers and interfaces for data transfers between these models from a prior study. This companion study evaluates baseline predictions of ecoservices provided for 1990 - 2010 for the population of streams in the CRB and serves as a foundation for future model development.

Developing and applying metamodels of high resolution process-based simulations for high throughput exposure assessment of organic chemicals in riverine ecosystems.

As defined by Wikipedia (https://en.wikipedia.org/wiki/Metamodeling), "(a) metamodel or surrogate model is a model of a model, and metamodeling is the process of generating such metamodels." The goals of metamodeling include, but are not limited to (1) developing functional or statistical relationships between a model's input and output variables for model analysis, interpretation, or information consumption by users' clients; (2) quantifying a model's sensitivity to alternative or uncertain forcing functions, initial conditions, or parameters; and (3) characterizing the model's response or state space. Using five models developed by the US Environmental Protection Agency, we generate a metamodeling database of the expected environmental and biological concentrations of 644 organic chemicals released into nine US rivers from wastewater treatment works (WTWs) assuming multiple loading rates and sizes of populations serviced. The chemicals of interest have log n-octanol/water partition coefficients (logKOW) ranging from 3 to 14, and the rivers of concern have mean annual discharges ranging from 1.09 to 3240m3/s. Log-linear regression models are derived to predict mean annual dissolved and total water concentrations and total sediment concentrations of chemicals of concern based on their logKOW, Henry's Law Constant, and WTW loading rate and on the mean annual discharges of the receiving rivers. Metamodels are also derived to predict mean annual chemical concentrations in fish, invertebrates, and periphyton. We corroborate a subset of these metamodels using field studies focused on brominated flame retardants and discuss their application for high throughput screening of exposures to human and ecological populations and for analysis and interpretation of field data.

Relationship between physical activity and hip pain in persons with and without cam or pincer morphology: a population-based case-control study.

OBJECTIVES: The purpose of the study was to determine if physical activity (PA) is a risk factor for persistent or recurrent hip pain in young and middle-aged persons with and without radiographic findings of cam or pincer morphology (CPM). METHODS: A population sample of persons aged 20-49 with (cases) and without (controls) hip pain in Metro Vancouver, Canada, was selected through random digit dialing (RDD). Self-reported PA was expressed as average energy expenditure (MET-hours) per year, over lifetime. CPM was defined as alpha angle >55°, lateral centre edge angle (LCE) >40°, or positive cross-over sign. RESULTS: Data were obtained for 500 subjects, 269 cases and 231 controls. Prevalence of radiographic CPM was 49% in the cases and 44% in the controls. In a logistic regression model adjusted for age, gender and CPM, total lifetime PA, including occupational, domestic and recreational activities, was significantly associated with hip pain (Odds ratio (OR) 1.30 per 1000 MET-hours, 95% CI 1.15-1.38). The effect of total PA was observed in those with CPM (1.44, 1.17-1.78) and without CPM (1.23, 1.04-1.45). For domestic activities, the association was seen only in those with CPM (significant interaction). When PA was categorized into quartiles, higher levels of PA were associated with a greater risk of pain. CONCLUSIONS: PA, as measured by average energy expenditure over lifetime is a risk factor for hip pain in young and middle-aged persons. For some activities, the risk is likely increased in persons with radiographic evidence of CPM.

Preventing the development of SLE: identifying risk factors and proposing pathways for clinical care.

Although challenging, developing evidence-based approaches to an early and accurate diagnosis of systemic lupus erythematosus is a key approach to preventing disease and lupus-associated morbidity and mortality. Advances in our understanding of preclinical and incomplete lupus erythematosus have enabled the identification of risk factors that may predict disease and the development of potential strategies aimed at primary prevention. Emerging data support the notion that there is a temporal disease progression from initial asymptomatic autoimmunity (preclinical lupus) through early clinical features of the disease (incomplete lupus erythematosus) to finally becoming fully classifiable systemic lupus erythematosus (complete lupus erythematosus). Here, we review the demographic, clinical, biomarker as well as genetic and environmental features that are reported to increase the risk of disease progression. Based on these risk factors, we propose a clinical care pathway for patients with early disease. We envisage that such a pathway, through early identification of disease, may improve patient outcomes, while reducing health care costs.

Changes in the physical activity of acute stroke survivors between inpatient and community living with early supported discharge: an observational cohort study.

OBJECTIVE: To describe and compare patterns of physical activity among stroke survivors during their hospital stay and community living with early supported discharge. DESIGN: Observational cohort study of physical activity before and after early supported discharge. SETTING: UK National Health Service stroke units and participants' homes. PARTICIPANTS: Forty-one stroke survivors with a mean age of 69 (standard deviation 11) years, and a median Modified Rivermead Mobility Index of 33.5 [interquartile range (IQR) 25.8 to 35.3]. MAIN OUTCOME MEASURES: The primary outcome measures were time spent in sitting/standing/walking and number of steps taken, as recorded by a physical activity monitor. RESULTS: There were statistical differences (P<0.001) for all categories of physical activity. After early supported discharge to the community, participants took more than twice the number of steps {median 474 (IQR 189 to 773) vs. 1193 (IQR 512 to 2856), median difference 636 [95% confidence interval (CI) 262 to 931]} and spent more than double the time in standing [median 51 (IQR 22 to 128) minutes vs. 100 (IQR 51 to 178) minutes, median difference 28 (95% CI 11 to 68)] compared with their hospital stay. CONCLUSION: Community living with early supported discharge promoted higher levels of physical activity in medically stable stroke survivors. The near-doubling of activity may serve as a guideline for what is achievable during stroke rehabilitation. CLINICAL TRIAL REGISTRATION: Number UKCRN 15472.

The validity of a non-radiologist reader in identifying cam and pincer femoroacetabular impingement (FAI) using plain radiography.

The purpose of this study was to evaluate the validity and reliability of a radiographic diagnosis of femoroacetabular impingement (FAI) by a non-radiologist. Symptomatic FAI is prevalent and thought to be a cause of hip osteoarthritis. However, the diagnosis is often delayed by 1-2 years, in large part because radiographic findings are often subtle and clinicians have been unaware of their significance. The purpose of this study was to evaluate the validity of a radiographic diagnosis of FAI by a non-radiologist. A population-based sample of 701 subjects was recruited in Vancouver, Canada. For the current study, 50 subjects were selected-40 randomly from the population sample and 10 from an orthopedic practice with confirmed FAI. An anterior-posterior pelvis and bilateral Dunn radiographs were acquired and read by a fellowship-trained musculoskeletal radiologist and a third-year medical student who received basic training in radiographic signs of FAI. Three radiographic signs were evaluated: the lateral center edge angle, alpha angle and crossover sign. Validity was assessed using sensitivity and specificity, Bland-Altman limits of agreement and kappa. The sample contained 65% women (n = 31), was 62% Caucasian and 38% Chinese and had a mean age of 38.3 years. For correctly diagnosing FAI, the non-radiologist reader had a sensitivity of 0.83 and specificity of 0.87. Intra-rater κ value was 0.72, and prevalence-adjusted bias-adjusted κ was 0.76. This study provides evidence that a non-radiologist can accurately and reliably identify FAI on plain films.

Forecasting fish biomasses, densities, productions, and bioaccumulation potentials of mid-atlantic wadeable streams.

Regional fishery conditions of Mid-Atlantic wadeable streams in the eastern United States are estimated using the Bioaccumulation and Aquatic System Simulator (BASS) bioaccumulation and fish community model and data collected by the US Environmental Protection Agency's Environmental Monitoring and Assessment Program (EMAP). Average annual biomasses and population densities and annual productions are estimated for 352 randomly selected streams. Realized bioaccumulation factors (BAF) and biomagnification factors (BMF), which are dependent on these forecasted biomasses, population densities, and productions, are also estimated by assuming constant water exposures to methylmercury and tetra-, penta-, hexa-, and hepta-chlorinated biphenyls. Using observed biomasses, observed densities, and estimated annual productions of total fish from 3 regions assumed to support healthy fisheries as benchmarks (eastern Tennessee and Catskill Mountain trout streams and Ozark Mountains smallmouth bass streams), 58% of the region's wadeable streams are estimated to be in marginal or poor condition (i.e., not healthy). Using simulated BAFs and EMAP Hg fish concentrations, we also estimate that approximately 24% of the game fish and subsistence fishing species that are found in streams having detectable Hg concentrations would exceed an acceptable human consumption criterion of 0.185 µg/g wet wt. Importantly, such streams have been estimated to represent 78.2% to 84.4% of the Mid-Atlantic's wadeable stream lengths. Our results demonstrate how a dynamic simulation model can support regional assessment and trends analysis for fisheries.

Restorative dentistry for the older patient cohort.

The ageing UK population presents a number of challenges to the restorative dentist as a result of complex treatment needs and a significant maintenance burden. This paper discusses how ageing may influence the provision of dental treatment and outlines a variety of conservative, periodontal, endodontic and prosthodontic considerations that are important in the management of the older patient cohort.