Interactions of Fungi and Algae from the Greenland Ice Sheet.

Heavily pigmented glacier ice algae Ancylonema nordenskiöldii and Ancylonema alaskanum (Zygnematophyceae, Streptophyta) reduce the bare ice albedo of the Greenland Ice Sheet, amplifying melt from the largest cryospheric contributor to eustatic sea-level rise. Little information is available about glacier ice algae interactions with other microbial communities within the surface ice environment, including fungi, which may be important for sustaining algal bloom development. To address this substantial knowledge gap and investigate the nature of algal-fungal interactions, an ex situ co-cultivation experiment with two species of fungi, recently isolated from the surface of the Greenland Ice Sheet (here proposed new species Penicillium anthracinoglaciei Perini, Frisvad and Zalar, Mycobank (MB 835602), and Articulospora sp.), and the mixed microbial community dominated by glacier ice algae was performed. The utilization of the dark pigment purpurogallin carboxylic acid-6-O-ß-D-glucopyranoside (C18H18O12) by the two fungi was also evaluated in a separate experiment. P. anthracinoglaciei was capable of utilizing and converting the pigment to purpurogallin carboxylic acid, possibly using the sugar moiety as a nutrient source. Furthermore, after 3 weeks of incubation in the presence of P. anthracinoglaciei, a significantly slower decline in the maximum quantum efficiency (Fv/Fm, inverse proxy of algal stress) in glacier ice algae, compared to other treatments, was evident, suggesting a positive relationship between these species. Articulospora sp. did uptake the glycosylated purpurogallin, but did not seem to be involved in its conversion to aglycone derivative. At the end of the incubation experiments and, in conjunction with increased algal mortality, we detected a substantially increasing presence of the zoosporic fungi Chytridiomycota suggesting an important role for them as decomposers or parasites of glacier ice algae.

Rectus abdominis activity, but not femoris, is similar in different core training exercises: A statistical parametric mapping analysis.

Rectus abdominis (RA) and rectus femoris (RF) differently activate in hip and trunk flexion movements. Previous studies using surface electromyography (sEMG) showed heterogenous results in mean and maximum activity of Upper (URA), Middle (MRA), and Lower (LRA) RA. Statistical Parametric Mapping (SPM) and Time-Varying Multi-muscle Co-activation function (TMCf) are emerging methods for whole-time-course continuous comparisons of muscle activity and co-activation. The aim was to analyse RA and RF activity in three core training exercises with continuous approach. Eight subjects performed Curl-up, Sit-up 45° and Sit-up 90° (where 45° is half and 90° is complete trunk flexion). sEMG from URA, MRA, LRA and RF were normalized to the maximum voluntary contraction root-mean-square (RMSMVC), and compared among muscles/exercises with SPM and TMCf. Angular displacement was assessed using stereophotogrammetry. Curl-up, Sit-up 45° and Sit-up 90° did not differently activate URA, MRA or LRA, and in their common range of motion (ROM) RA activity was similar among the three exercises. Conversely, Sit-up exercises elicited higher RF activity than Curl-up (on average 45% vs. 25% RMSMVC) mainly due to the wider ROM. RA-RF co-activation pattern was different in concentric and eccentric phases between Sit-up exercises and Curl-up, leading to significantly higher co-activation in Sit-up exercises.

Fungal and bacterial diversity of Svalbard subglacial ice.

The composition of fungal and bacterial communities in three polythermal glaciers and associated aquatic environments in Kongsfjorden, Svalbard was analysed using a combination of cultivation and amplicon sequencing. 109 fungal strains belonging to 30 mostly basidiomycetous species were isolated from glacial samples with counts up to 103 CFU/100 ml. Glaciozyma-related taxon and Phenoliferia psychrophenolica were the dominant species. Unexpectedly, amplicon sequencing uncovered sequences of Chytridiomycota in all samples and Rozellomycota in sea water, lake water, and tap water. Sequences of Malassezia restricta and of the extremely halotolerant Hortaea werneckii were also found in subglacial habitats for the first time. Overall, the fungal communities within a glacier and among glaciers were diverse and spatially heterogenous. Contrary to this, there was a large overlap between the bacterial communities of different glaciers, with Flavobacterium sp. being the most frequently isolated. In amplicon sequencing Actinobacteria and Proteobacteria sequences were the most abundant.

LGBTIQ, pensar la diversidad / LGBTIQ, Thinking About Diversity

Con el objetivo de analizar la percepción acerca del colectivo LGBTIQ por parte del personal de salud, administrativos y usuarios del siste-ma de salud en CeMAP CABA (Ciudad Autónoma de Buenos Aires) OsPeCon, así como identificar la discriminación, sus causas y consecuencias, se realizó un estudio cualitativo, de caso, etnográfico.Se realizaron cinco grupos focales y se analizó la información siguiendo los pasos de la teoría fundamentada. En los grupos focales surgieron dudas acerca de la definición de orientación sexual y las siglas I-Q. Se reconocieron prejuicios relacionados al VIH/SIDA, ETS y adicciones como base de la discriminación y la estigmatización. Se evidenció la persistencia de creencias populares como origen de la orientación sexual. Se vio reflejada la heteronormatividad como característica social y la diferencia generacional como postura negativa. Se identificó como forma de discriminación a la violencia verbal y el rechazo al contacto, teniendo como consecuencia depresión, consumo de sustancias y suicidio. Las cuestiones de géneros son temas en continua evolución en la sociedad, por lo que creemos importante estar informados, con una visión empática y de respeto para brindar una atención adecuada a las personas LGBTIQ, teniendo un rol que nos permite deconstruir los estereotipos (AU)

This qualitative ethnographic case study analyzes perceptions of the LGBTIQ community held biomedical professionals, administrative staff and patients in the Health center of OSPeCon, CABA.The purpose of this analysis is to identify discrimination, its causes and consequencesFive focus groups were carried out and the information was analyzed according to the grounded theory.Major themes that emerged from focus groups included confusion regarding the definition of sexual orientation and the acronym I-Q Beliefs related to HIV/AIDS, STD and addiction were noted to be the foundation for discrimination and stigmatization. Other beliefs identified included heteronormativity, which was more prevalent in older generations. The use of popular beliefs to explain the origin of sexual orientation was often justification for discrimination Means of discrimination included verbal violence and rejecting personal contact. Consequences of discrimination identified included depression, substance abuse and suicide. Gender issues continue to evolve and we hope to analyze our own beliefs, deconstruct stereotypes, and educate ourselves in the development of an empathic and respectful attitude to this vulnerable population (AU)

Migración y salud: una cuestión intercultural, 2018 / Migration and health: an intercultural question, 2018

Se realizó un estudio cualitativo, etnográfico para conocer y analizar la percepción de los pacientes extranjeros respecto de su vínculo con el sistema de salud en Argentina, considerando la cultura de origen y proceso migratorio mediante trece entrevistas semiestructuradas. Se incluyeron pacientes extranjeros mayores de 18 años que consultaron a un Centro de Atención Primaria de la Salud (CeMAP) de un agente del subsitema sanitario de la seguridad social argentina. Los mismos fueron seleccionados de manera intencional y por conveniencia. Las transcripciones se analizaron según la teoría fundamentada. En las entrevistas se destacó una relación médico-paciente más estrecha en comparación con la del país de origen, destacándose la calidez, compromiso y mayor comunicación con el binomio paciente-familia, siendo notables estas diferencias en la etapa del embarazo y en el ámbito de la salud sexual y reproductiva. Se han hallado diferencias sustanciales con el país de origen en temáticas como control prenatal y acompañamiento del parto, alimentación, medicinas tradicionales, accesibilidad al sistema sanitario, siendo influyente el tiempo de residencia en Argentina para lograr el empoderamiento en relación con el sistema de salud. Esto nos estimula a seguir trabajando en la cultura y proceso migratorio de los pacientes, explorar su cosmovisión, para propiciar un enfoque intercultural que permita adquirir herramientas para la atención de dicha población (AU)

A qualitative, ethnographic study was carried out to identify and analyze the perception and beliefs of foreign patients, regarding their experiences in Argentina ́s healthcare system, taking into consideration their culture of origin and migratory process through semi-structured interviews. It're included foreign patients over 18 years of age who consulted at a Primary Health Care Center (CeMAP) of an agent of the Argentine social security health system. They were selected intentionally and for convenience. Thirteen semi-structured in-depth interviews were recorded and the transcripts were analyzed according to the Fundamental Theory. In the interviews, a closer patient-physician relationship stood out when compared with the country of origin, highlighting the warmth, commitment and greater communication with the patient and its family, these differences were more notable during prenatal, reproductive and sexual care. Substantial differences have been found with the country of origin in topics such as prenatal post-partum care, nutrition, traditional medicines, and accessibility to the health system. There was a positive impact of length of residency in Argentina on patient empowerment within the healthcare system. This is an estimate to continue working on the culture and the migration process of patients, to explore their worldview, to propose an intercultural approach that allows us to acquire tools for the care of this population (AU)

Developments on a SEM-based X-ray tomography system: Stabilization scheme and performance evaluation.

Recent improvements in a SEM-based X-ray tomography system are described. In this type of equipment, X-rays are generated through the interaction between a highly focused electron-beam and a geometrically confined anode target. Unwanted long-term drifts of the e-beam can lead to loss of X-ray flux or decrease of spatial resolution in images. To circumvent this issue, a closed-loop control using FFT-based image correlation is integrated to the acquisition routine, in order to provide an in-line drift correction. The X-ray detection system consists of a state-of-the-art scientific CMOS camera (indirect detection), featuring high quantum efficiency (∼60%) and low read-out noise (∼1.2 electrons). The system performance is evaluated in terms of resolution, detectability, and scanning times for applications covering three different scientific fields: microelectronics, technical textile, and material science.

Linking trajectories of land change, land degradation processes and ecosystem services.

Land Degradation (LD) is a complex phenomenon resulting in a progressive reduction in the capacity of providing ecosystem services (ES). Landscape transformations promoting an unsustainable use of land often reveal latent processes of LD. An evaluation carried out in respect to the different ecosystem services is nowadays regarded as the most appropriate approach for assessing the effects of LD. The aim of this study is to develop an evaluation framework for identifying the linkages between land changes, LD processes and ES and suggesting Sustainable Land Management (SLM) options suited to reverse (or mitigate) LD impact. A SWOT analysis was carried out with the aim to identify internal and external factors that are favorable (or unfavorable) to achieve the proposed SLM actions. The study areas are the Fortore valley and the Valpadana, in Italy. The main trajectory identified for the Fortore valley is related to land abandonment due to population aging and the progressive emigration started in the 1950s. The most relevant LD processes are soil erosion and geomorphological instability, affecting regulating services such as natural hazard and erosion control. SLM options should consider interventions to contrast geomorphological instability, the promotion of climate smart agriculture and of typical products, and an efficient water resources management. The main trajectories identified for Valpadana are related to urban expansion and farmland abandonment and, as a consequence, land take due to anthropogenic pressure and woodland expansion as the main LD process. The reduction of food production was identified as the most relevant provisioning service affected. SLM should envisage best practices finalized to water saving and soil consumption reduction: efficient irrigation solutions, climate smart agriculture and zero sealing practices. This study highlights the diagnostic value of the suggested approach where LD processes are elicited from land change trajectories determining specific impacts on ES and providing operational support for the implementation of SLM options.

Distribution of Escherichia coli in a coastal lagoon (Venice, Italy): Temporal patterns, genetic diversity and the role of tidal forcing.

Despite its worldwide importance as fecal indicator in aquatic systems, little is known about the diversity of Escherichia coli in the environment and the factors driving its spatial distribution. The city of Venice (Italy), lying at the forefront of a large European lagoon, is an ideal site to study the mechanisms driving the fate of fecal bacteria, due to the huge fluxes of tourists, the city's unique architecture (causing poor efficiency of sewages treatment), and the long branching network of canals crossing the city. We summarize the results of a multi-year investigation to study the temporal dynamics of E. coli around the city, describe the population structure (by assigning isolates to their phylogenetic group) and the genotypic diversity, and explore the role of environmental factors in determining its variability. E. coli abundance in water was highly variable, ranging from being undetectable up to 10(4) Colony Forming Units (CFU) per 100 ml. Abundance did not display significant relationships with the water physico-chemical variables. The analysis of the population structure showed the presence of all known phylogroups, including extra-intestinal and potentially pathogenic ones. The genotypic diversity was very high, as likely consequence of the heterogeneous input of fecal bacteria from the city, and showed site-specific patterns. Intensive sampling during the tidal fluctuations highlighted the prominent role of tides, rather than environmental variables, as source of spatial variation, with a more evident influence in water than sediments. These results, the first providing information on the genetic properties, spatial heterogeneity and influence of tides on E. coli populations around Venice, have implications to manage the fecal pollution, and the associated waterborne disease risks, in coastal cities lying in front of lagoons and semi-enclosed basins.

Unraveling Landscape Complexity: Land Use/Land Cover Changes and Landscape Pattern Dynamics (1954-2008) in Contrasting Peri-Urban and Agro-Forest Regions of Northern Italy.

This study implements an exploratory data analysis of landscape metrics and a change detection analysis of land use and population density to assess landscape dynamics (1954-2008) in two physiographic zones (plain and hilly-mountain area) of Emilia Romagna, northern Italy. The two areas are characterized by different landscape types: a mixed urban-rural landscape dominated by arable land and peri-urban settlements in the plain and a traditional agro-forest landscape in the hilly-mountain area with deciduous and conifer forests, scrublands, meadows, and crop mosaic. Urbanization and, to a lesser extent, agricultural intensification were identified as the processes underlying landscape change in the plain. Land abandonment determining natural forestation and re-forestation driven by man was identified as the process of change most representative of the hilly-mountain area. Trends in landscape metrics indicate a shift toward more fragmented and convoluted patterns in both areas. Number of patches, the interspersion and juxtaposition index, and the large patch index are the metrics discriminating the two areas in terms of landscape patterns in 1954. In 2008, mean patch size, edge density, interspersion and juxtaposition index, and mean Euclidean nearest neighbor distance were the metrics with the most different spatial patterns in the two areas. The exploratory data analysis of landscape metrics contributed to link changes over time in both landscape composition and configuration providing a comprehensive picture of landscape transformations in a wealthy European region. Evidence from this study are hoped to inform sustainable land management designed for homogeneous landscape units in similar socioeconomic contexts.

The impact of land use/land cover changes on land degradation dynamics: a Mediterranean case study.

In the last decades, due to climate changes, soil deterioration, and Land Use/Land Cover Changes (LULCCs), land degradation risk has become one of the most important ecological issues at the global level. Land degradation involves two interlocking systems: the natural ecosystem and the socio-economic system. The complexity of land degradation processes should be addressed using a multidisciplinary approach. Therefore, the aim of this work is to assess diachronically land degradation dynamics under changing land covers. This paper analyzes LULCCs and the parallel increase in the level of land sensitivity to degradation along the coastal belt of Sardinia (Italy), a typical Mediterranean region where human pressure affects the landscape characteristics through fires, intensive agricultural practices, land abandonment, urban sprawl, and tourism concentration. Results reveal that two factors mainly affect the level of land sensitivity to degradation in the study area: (i) land abandonment and (ii) unsustainable use of rural and peri-urban areas. Taken together, these factors represent the primary cause of the LULCCs observed in coastal Sardinia. By linking the structural features of the Mediterranean landscape with its functional land degradation dynamics over time, these results contribute to orienting policies for sustainable land management in Mediterranean coastal areas.

White-matter abnormalities in the right posterior hemisphere in generalized anxiety disorder: a diffusion imaging study.

BACKGROUND: Prior imaging studies have shown structural, functional and biochemical impairments in patients with generalized anxiety disorder (GAD), particularly in the right hemisphere. In this study we investigated, for the first time to the best of our knowledge, the white-matter microstructure organization in GAD. METHOD: A total of 12 patients with DSM-IV GAD and 15 matched healthy controls underwent a magnetic resonance imaging session of diffusion weighted imaging, exploring white-matter water molecules by the means of apparent diffusion coefficients (ADCs). Regions of interests were placed in the frontal, parietal, temporal and occipital lobes and in the splenium and genu of the corpus callosum, bilaterally. RESULTS: ADC measures were significantly greater in patients with GAD in the right splenium and right parietal cortex compared with healthy controls (p⩽0.002). No significant correlations between ADCs and age or clinical variables were found. CONCLUSIONS: We provide evidence that GAD is associated with disrupted white-matter coherence of posterior right hemisphere regions, which may partly sustain the impaired cognitive regulation of anxiety. Future diffusion imaging investigations are expected to better elucidate the communication between the parietal cortex and other right hemisphere regions in sustaining the cognitive processing of social and emotional stimuli in patients with GAD.

Dynamic sonography of the forefoot in Morton's syndrome: correlation with magnetic resonance and surgery.

PURPOSE: The aim of this paper is to demonstrate the efficacy of the dynamic study of the forefoot during lateral compression of the metatarsal heads (Mulder's manoeuvre) in the visualisation of Morton's neuroma. The data were compared with clinical signs, conventional ultrasound (US), magnetic resonance (MR) and surgical findings. MATERIALS AND METHODS: Forty forefeet in 38 patients were investigated with conventional and dynamic US using a 10-MHz linear probe (Esaote Technos). MR was performed in 26 forefeet with a 0.2-T scanner (Esaote Artoscan). Twenty intermetatarsal spaces in 18 forefeet were explored surgically. RESULTS: Thirty-seven intermetatarsal masses were identified through dynamic US in the 40 forefeet investigated (two double localisations). This method was clearly more effective than conventional US, which could only locate 25. In those forefeet investigated with MR, it was possible to confirm dynamic US findings in 16 out of 22. In one of the six cases unconfirmed by MR, a neuroma was removed following surgery. Twenty masses (19 neuromas and one synovial ganglion) were found in the 18 forefeet treated by surgery. CONCLUSIONS: Clinical evaluation, which is fundamental for accurate diagnosis, can make use of dynamic US in the first instance in order to confirm clinical signs and identify the correct site and number of masses. In our opinion, MR maintains a primary role in differential diagnosis with other diseases (mainly stress fractures, bursitis, ganglion cysts or tendon tumour sheaths).

Pseudomalignant myositis ossificans in children. Description of a case and review of the literature.

The authors report a rare case of pseudomalignant myositis ossificans occurring during childhood. A female aged 10 years with no previous history of trauma came to their observation with findings of pain and progressive swelling in the gluteal region. The severity of the clinical findings and the absence of characteristic ossification in the x-rays obtained at the onset of the disease suggested that neoplastic pathology be excluded. Diagnosis (bone scan, CT scan, MRI, angiography, biopsy) and the progression of the disease, until its complete clinical resolution, are discussed in light of a review of the literature (44 cases of pseudomalignant myositis ossificans during pediatric age). All of the elements that may be of help in diagnosis and capable of avoiding surgical procedures that are either untimely or improper are emphasized.

[Causes and risks of hyperlipidemia during dialysis and after renal transplantation]. / Cause e rischi dell'iperlipidemia durante trattamento dialitico e dopo trapianto renale.

The most widely studied hyperlipidemies in patients affected by renal insufficiency or subsequent to kidney transplant present phenotype IIa, IIb or IV. The lipidic alteration most frequently observed in chronic renal insufficiency and/or dialytic treatment is represented by hypertrigliceridemia as a result of: 1) altered VLDL metabolism; 2) reduced activity of lecithin cholesterol acyltransferase (LCAT); 3) decrease in Apo-A1 and HDL3. Furthermore, marked anomalies in lipoprotein Lp (a) have been reported in hemodialysis. In patients undergoing peritoneal dialysis, hyperlipidemia arises from both an anomalous retrograde absorption of glucose and protein dispersion. Following kidney transplant the most frequent hyperlipidemia is hypercholesterolemia, consequent to immunosuppressive treatment (mainly steroids and cyclosporin). The documented significant increase of cardiovascular risk in the presence of hyperlipidemia points to the need for a clearer etiopathogenic definition of this anomaly, as well as the necessity to find an efficacious pharmacological treatment.

Benign nodular calcification and calciphylaxis in a haemodialysed patient.

Several types of soft tissue calcification can be detected from radiographic evaluation of patients with end-stage renal failure. The factors that predispose to such calcification include an increase in CaxP product in serum, the degree of secondary hyperparathyroidism, the level of blood magnesium, the degree of alkalosis, and the presence of local tissue injury. Three major varieties include calcification of medium-sized arteries, periarticular or tumoral calcification and visceral calcification. Calciphylaxis is a phenomenon consisting of acute ischemic necrosis in presence of calcification of dermohypodermic arterioles. It occurs mostly in chronic renal failure patients with secondary or tertiary hyperparathyroidism with a persistently elevated calcium-phosphorus product. There are few options in treating calciphylaxis and the outcome is generally poor. The authors report the case of a haemodialised patient with benign nodular calcification and calciphylaxis. The coexistence of both entities in the same patient has never been described.

Prosthetic replacement of the tricuspid valve: biological or mechanical?

BACKGROUND: Incidence of tricuspid prosthesis replacement was 1.9% of all valvular operations performed between June 6, 1966 and April 18, 1996. Many series report similar figures, but institutional experience is limited and the consensus on treatment modalities is lacking. METHODS: One hundred tricuspid operations were performed on 83 patients (46 female). A primary operation was performed in 64 cases, 13 patients had one previous operation, 4 patients had two previous operations, and 2 patients had three previous operations. Seventeen patients required a tricuspid prosthetic valve rereplacement. There were 2 emergent and 17 urgent operations. The New York Heart Association class was IV in 13 patients (mean pulmonary artery pressure, 41 mm Hg), III in 66 patients (mean pressure, 38 mm Hg), and II in 21 patients. The most frequent operation was simultaneous replacement of the mitral and tricuspid valve (41 patients). Seventy biological and 30 mechanical prostheses were used. Total follow-up time was 613 years, mean 7.4 years (median 4.2 years), with a maximum of 27.8 years, and was 92% complete. RESULTS: Operative mortality was 24%. Survival was 0.54 (0.48 to 0.59, n = 39) at 5 years, 0.38 (0.32 to 0.44, n = 27) at 10 years, 0.31 (0.25 to 0.36, n = 19) at 15 years, 0.29 (0.23 to 0.34, n = 11) at 20 years, and 0.17 (0.098 to 0.26, n = 3) at 25 years. Early mortality was increased from higher New York Heart Association class (hazard ratio = 2.2), congenital disease (hazard ratio = 6.9), and valvuloplasty failure (hazard ratio = 4.3). The constant risk phase (4%/patient-year) after 2 years was enhanced by older operative age (hazard ratio = 1.4). Prosthetic type had no independent effect. Biological prostheses were at risk for 300 years and had a reoperation incidence of 4.7%/ patient-year (14 events); mechanical prosthesis were at risk for 137 years with a rate of 2.2%/patient-year (3 events) (p = 0.21). Three valve thromboses were observed in old-design mechanical prosthesis. Bioprosthetic degeneration showed a steeper rate after 7 years. CONCLUSIONS: This study does not show a clear superiority of biological versus mechanical prostheses. In the long run survival with mechanical prostheses could be superior, given the high rate of bioprosthetic degeneration after 7 years.

Multivariate analysis of survival after malfunctioning biological and mechanical prosthesis replacement.

BACKGROUND: Results of valvular reoperations depend on extrinsic and patients' intrinsic risk factors. New prosthetic substitutes continue to appear and the clinical effect is difficult to evaluate. Randomized studies are limited by patient selection and follow-up time. We followed the patient-centric outcome research applied to a large database of valvular operations. METHODS: Between January 1, 1970 and January 1, 1995 755 patients underwent one reoperation, 96 a second reoperation, and 12 a third reoperation. On January 1, 1996 a common closing date follow-up was obtained in 98.7% of reoperated patients. Multivariable analysis in the hazard domain was applied to obtain an upgradable model of survival that could be used for predictions and treatment comparison. RESULTS: Postoperative death hazard showed an early phase merging within 6 months with a constant low hazard phase. The survival proportion was 0.65 (70% CL, 0.63 to 0.67) at 5 years, 0.51 (70% CL, 0.49 to 0.53) at 10 years, 0.47 (range, 0.44 to 0.49) at 15 years, 0.42 (70% CL, 0.39 to 0.46) at 20 and 25 years. Significant incremental risk factors for early mortality were reoperative era 1970 to 1980 (hazard ratio = 2.8), reoperation number (hazard ratio = 1.9), heart penetration on surgery (hazard ratio = 7.6), emergent operation (hazard ratio = 5.8), urgent operation (hazard ratio = 2.1), prosthetic thrombosis (hazard ratio = 2.4), acute prosthetic endocarditis (hazard ratio = 3.0), acute endocarditis of the natural valve at antecedent operation (hazard ratio = 3.2), original floppy valve pathology (hazard ratio = 3.2), and mitroaortic replacement (hazard ratio = 5.7). Isolated mitral reoperation had a lower risk (hazard ratio = 0.5). Significant incremental risk factors for constant phase were: operative era (1970 to 1980) (hazard ratio = 2.0), congestive heart failure (hazard ratio = 2.6), reoperation on tricuspid valve after previous mitral insertion (hazard ratio = 4.9), reoperation for recurring dehiscence (hazard ratio = 4.6), double-valve procedure (hazard ratio = 1.6), coronary artery bypass graft (hazard ratio = 2.7), aortic root disease at original operation (hazard ratio = 2.1), older operative age (hazard ratio = 1.1). Use of bileaflet prosthesis was found to decrease significantly (p = 0.0002) the death risk (hazard ratio = 0.2). CONCLUSIONS: There is no late uprising hazard, and surviving patients remain exposed to a low risk of death (4% of patients per year). Considering simultaneously the confounding from operative age and operative era and the many concomitant risk factors, survival appears favorably influenced by use of bileaflet valves on reoperation.

Autosomal dominant polycystic kidney disease linked to PKD2 locus in a family with severe extrarenal manifestations.

We report a large three-generation autosomal dominant polycystic kidney disease family from Northern Italy found to be associated with the PKD2 locus. Hepatic involvement (liver cysts, fibrosis, cholelithiasis or jaundice), subarachnoidal hemorrhage (1 case) and esophageal diverticula (1 case) were present in affected individuals. Among the older members, the males (aged 54-61 years) had hepatic cysts or fibrosis and were on chronic hemodialysis, the females (aged 69 and 70 years) had hepatic cysts, hepatomegaly, mild fibrosis and a mild and moderate renal impairment, respectively. In this family, clinical findings do not differ substantially from those reported for PKD1.