Outcome after heart-lung or lung transplantation in patients with Eisenmenger syndrome

Objective The optimal timing for transplantation is unclear in patients with Eisenmenger syndrome (ES). We investigated post-transplantation survival and transplantation-specific morbidity after heart-lung transplantation (HLTx) or lung transplantation (LTx) in a cohort of Nordic patients with ES to aid decision-making for scheduling transplantation. Methods We performed a retrospective, descriptive, population-based study of patients with ES who underwent transplantation from 1985 to 2012. Results Among 714 patients with ES in the Nordic region, 63 (9%) underwent transplantation. The median age at transplantation was 31.9 (IQR 21.1-42.3) years. Within 30 days after transplantation, seven patients (11%) died. The median survival was 12.0 (95% CI 7.6 to 16.4) years and the overall 1-year, 5-year, 10-year and 15-year survival rates were 84.1%, 69.7%, 55.8% and 40.6%, respectively. For patients alive 1 year post-transplantation, the median conditional survival was 14.8 years (95% CI 8.0 to 21.8), with 5-year, 10-year and 15-year survival rates of 83.3%, 67.2% and 50.0%, respectively. There was no difference in median survival after HLTx (n=57) and LTx (n=6) (14.9 vs 10.6 years, p=0.718). Median cardiac allograft vasculopathy, bronchiolitis obliterans syndrome and dialysis/kidney transplantation-free survival rates were 11.2 (95% CI 7.8 to 14.6), 6.9 (95% CI 2.6 to 11.1) and 11.2 (95% CI 8.8 to 13.7) years, respectively. The leading causes of death after the perioperative period were infection (36.7%), bronchiolitis obliterans syndrome (23.3%) and heart failure (13.3%). Conclusions This study shows that satisfactory post-transplantation survival, comparable with contemporary HTx and LTx data, without severe comorbidities such as cardiac allograft vasculopathy, bronchiolitis obliterans syndrome and dialysis, is achievable in patients with ES, with a conditional survival of nearly 15 years.Peer reviewe

VLT identification of the optical afterglow of the gamma-ray burst GRB 000131 at z=4.50

We report the discovery of the gamma-ray burst GRB 000131 and its optical afterglow. The optical identification was made with the VLT 84 hours after the burst following a BATSE detection and an Inter Planetary Network localization. GRB 000131 was a bright, long-duration GRB, with an apparent precursor signal 62 s prior to trigger. The afterglow was detected in ESO VLT, NTT, and DK1.54m follow-up observations. Broad-band and spectroscopic observations of the spectral energy distribution reveals a sharp break at optical wavelengths which is interpreted as a Ly-alpha absorption edge at 6700 A. This places GRB 000131 at a redshift of 4.500 +/- 0.015. The inferred isotropic energy release in gamma rays alone was approximately 10^54 erg (depending on the assumed cosmology). The rapid power-law decay of the afterglow (index alpha=2.25, similar to bursts with a prior break in the lightcurve), however, indicates collimated outflow, which relaxes the energy requirements by a factor of < 200. The afterglow of GRB 000131 is the first to be identified with an 8-m class telescope.Comment: 8 pages, 7 figures, accepted to A&A Letter

Histological confirmation of breast cancer registration and self-reporting in England and Wales: a cohort study within the UK Collaborative Trial of Ovarian Cancer Screening

In research studies, accurate information of cancer diagnosis is crucial. In women with breast cancer (BC), we compare cancer registration (CR) in England/Wales and self-reporting with independent confirmation

Air pollution from traffic and cancer incidence: a Danish cohort study

<p>Abstract</p> <p>Background</p> <p>Vehicle engine exhaust includes ultrafine particles with a large surface area and containing absorbed polycyclic aromatic hydrocarbons, transition metals and other substances. Ultrafine particles and soluble chemicals can be transported from the airways to other organs, such as the liver, kidneys, and brain. Our aim was to investigate whether air pollution from traffic is associated with risk for other cancers than lung cancer.</p> <p>Methods</p> <p>We followed up 54,304 participants in the Danish Diet Cancer and Health cohort for 20 selected cancers in the Danish Cancer Registry, from enrolment in 1993-1997 until 2006, and traced their residential addresses from 1971 onwards in the Central Population Registry. We used modeled concentration of nitrogen oxides (NO_x) and amount of traffic at the residence as indicators of traffic-related air pollution and used Cox models to estimate incidence rate ratios (IRRs) after adjustment for potential confounders.</p> <p>Results</p> <p>NO_xat the residence was significantly associated with risks for cervical cancer (IRR, 2.45; 95% confidence interval [CI], 1.01;5.93, per 100 μg/m³NO_x) and brain cancer (IRR, 2.28; 95% CI, 1.25;4.19, per 100 μg/m³NO_x).</p> <p>Conclusions</p> <p>This hypothesis-generating study indicates that traffic-related air pollution might increase the risks for cervical and brain cancer, which should be tested in future studies.</p

Mycoplasma genitalium: An Emerging Cause of Sexually Transmitted Disease in Women

Mycoplasma genitalium is an emerging sexually transmitted pathogen implicated in urethritis in men and several inflammatory reproductive tract syndromes in women including cervicitis, pelvic inflammatory disease (PID), and infertility. This comprehensive review critically examines epidemiologic studies of M. genitalium infections in women with the goal of assessing the associations with reproductive tract disease and enhancing awareness of this emerging pathogen. Over 27,000 women from 48 published reports have been screened for M. genitalium urogenital infection in high- or low-risk populations worldwide with an overall prevalence of 7.3% and 2.0%, respectively. M. genitalium was present in the general population at rates between those of Chlamydia trachomatis and Neisseria gonorrhoeae. Considering more than 20 studies of lower tract inflammation, M. genitalium has been positively associated with urethritis, vaginal discharge, and microscopic signs of cervicitis and/or mucopurulent cervical discharge in seven of 14 studies. A consistent case definition of cervicitis is lacking and will be required for comprehensive understanding of these associations. Importantly, evidence for M. genitalium PID and infertility are quite convincing and indicate that a significant proportion of upper tract inflammation may be attributed to this elusive pathogen. Collectively, M. genitalium is highly prevalent in high- and low-risk populations, and should be considered an etiologic agent of select reproductive tract disease syndromes in women

A comparative population-based study of prostate cancer incidence and mortality rates in Singapore, Sweden and Geneva, Switzerland from 1973 to 2006

10.1186/1471-2407-12-222BMC Cancer12-BCMA

Evolution of the observed Ly-alpha luminosity function from z = 6.5 to z = 7.7: evidence for the epoch of reionization ?

Aims. Ly-alpha emitters (LAEs) can be detected out to very high redshifts during the epoch of reionization. The evolution of the LAE luminosity function with redshift is a direct probe of the Ly-alpha transmission of the intergalactic medium (IGM), and therefore of the IGM neutral-hydrogen fraction. Measuring the Ly-alpha luminosity function (LF) of LAEs at redshift z = 7.7 therefore allows us to constrain the ionizing state of the Universe at this redshift. Methods. We observed three 7.5'x7.5' fields with the HAWK-I instrument at the VLT with a narrow band filter centred at 1.06 $\mu$m and targeting LAEs at redshift z ~ 7.7. The fields were chosen for the availability of multiwavelength data. One field is a galaxy cluster, the Bullet Cluster, which allowed us to use gravitational amplification to probe luminosities that are fainter than in the field. The two other fields are subareas of the GOODS Chandra Deep Field South and CFHTLS-D4 deep field. We selected z=7.7 LAE candidates from a variety of colour criteria, in particular from the absence of detection in the optical bands. Results. We do not find any LAE candidates at z = 7.7 in ~2.4 x 10^4 Mpc^3 down to a narrow band AB magnitude of ~ 26, which allows us to infer robust constraints on the Ly-alpha LAE luminosity function at this redshift. Conclusions. The predicted mean number of objects at z = 6.5, derived from somewhat different LFs of Hu et al. (2010), Ouchi et al. (2010), and Kashikawa et al. (2011) are 2.5, 13.7, and 11.6, respectively. Depending on which of these LFs we refer to, we exclude a scenario with no evolution from z = 6.5 to z = 7.7 at 85% confidence without requiring a strong change in the IGM Ly-alpha transmission, or at 99% confidence with a significant quenching of the IGM Ly-alpha transmission, possibly from a strong increase in the high neutral-hydrogen fraction between these two redshifts.Comment: 14 pages, 6 figures, accepted for publication in A&A. Added references, minor changes applied in text and figures after the first referee repor

Is the Concept of Quality of Life Relevant for Multiple Sclerosis Patients with Cognitive Impairment? Preliminary Results of a Cross-Sectional Study

Background: Cognitive impairment occurs in about 50 % of multiple sclerosis (MS) patients, and the use of self-reported outcomes for evaluating treatment and managing care among subjects with cognitive dysfunction has been questioned. The aim of this study was to provide new evidence about the suitability of self-reported outcomes for use in this specific population by exploring the internal structure, reliability and external validity of a specific quality of life (QoL) instrument, the Multiple Sclerosis International Quality of Life questionnaire (MusiQoL). Methods: Design: cross-sectional study. Inclusion criteria: MS patients of any disease subtype. Data collection: sociodemographic (age, gender, marital status, education level, and occupational activity) and clinical data (MS subtype, Expanded Disability Status Scale, disease duration); QoL (MusiQoL and SF36); and neuropsychological performance (Stroop color-word test). Statistical analysis: confirmatory factor analysis, item-dimension correlations, Cronbach’s alpha coefficients, Rasch statistics, relationships between MusiQoL dimensions and other parameters. Principal Findings: One hundred and twenty-four consecutive patients were enrolled. QoL scores did not differ between the 69 cognitively non-impaired patients and the 55 cognitively impaired patients, except for the symptoms dimension. The confirmatory factor analysis performed among the impaired subjects showed that the structure of the questionnaire matched with the initial structure of the MusiQoL. The unidimensionality of the MusiQoL dimensions was preserved, and th