Natural History Research Articles

Acute Hepatitis C: Current Status and Future Perspectives

The hepatitis C virus (HCV) infection continues to represent a significant public health threat and is a leading cause of liver cirrhosis, liver cancer, and liver-related mortality. The World Health Organization (WHO) has set a goal for 2030: to eliminate HCV infection as a public health threat by reducing new HCV infections by 90% and mortality by 65%. The early phase of HCV infection represents a pivotal point in the evolution of hepatitis C. Despite a favourable course in the majority of patients, approximately 50–70% of individuals with recently acquired hepatitis C will develop a chronic infection, defined as the persistence of viremia for a period exceeding six months. The diagnosis and treatment of a recent HCV infection should facilitate engagement in multidisciplinary care, prevent the development and complications of chronic liver disease, and reduce ongoing transmission in key populations. Therefore, early treatment in the early phase of infection compared with deferring treatment until the chronic infection remains a valid approach in the era of direct antiviral agents (DAAs). This approach is supported by a cost-effectiveness analysis. The aim of this review is to synthesise the existing knowledge on the early phase of hepatitis C virus infection, with a particular focus on the current risk factors, natural history, therapeutic management, and future perspectives.

Biphenotypic Sinonasal Sarcoma: Literature Review of a Peculiar Pathological Entity—The Neurosurgical Point of View

Background: Biphenotypic sinonasal sarcoma (BSNS) is a low-grade tumor of the sinonasal tract with frequent extension to the orbit and skull base. Due to its rare incidence and recent histopathological and molecular characterization, little data are available in regard to its natural history, treatment and surveillance protocol. Methods: A comprehensive literature review in Embase online electronic databases on BSNS was made. The analyzed factors included the patients’ sex and age, presenting symptoms and signs, anatomical origin and pattern of growth of the tumor, immunohistochemical and molecular features, time to treatment, type of treatment, surgical approach, extent of resection, peri- and post-operative complications, adjuvant therapies, clinical outcome, recurrence and overall survival rates. Results: This literature review involved 34 studies for an overall series of 149 cases of BSNS. The female (66.9%) and middle-aged populations (median 54.88 years old) were mainly affected. The most frequent clinical onset was nasal obstruction (81%), followed by facial discomfort (44%), epistaxis (15.5%) and ocular impairment (14.3%). Ethmoid sinus (67.8%) and nasal cavity (45.4%) were the most common anatomical site of tumor origin, while an extension to the orbit and skull base was registered in 28.7% and 24.5% of cases. Surgery was the main treatment, especially in the form of endoscopic endonasal approach (56.9%), and allowed for gross total resection in 79% of cases. The recurrence rate was 26.2%; three cases of tumor-related death were reported. Median follow-up was 4.6 years. Conclusions: Biphenotypic sinonasal sarcoma is a rare and unique tumoral entity in terms of biological and clinical behavior. Based on the current knowledge, surgery plays the leading role in treatment, accounting for gross total tumor resection in most cases, allowing for clinical symptom and sign resolution and presenting a low rate of perioperative complications. The type of approach and the aim of surgery should be assessed case by case according to patient and pathology features and the surgeon’s experience, as well as the aim of the treatment. Further studies including large surgical series and with long follow-up are required to define prognostic factors and guidelines of treatment for this peculiar pathological entity.

Clinical and radiological features of atypical adrenal masses- a multicenter retrospective study.

The natural history and malignant potential of cases classified as atypical adrenal masses (AAMs) are unknown. To describe the radiological characteristics and clinical outcomes of AAMs. A multicenter retrospective study. Patients ≥18 years old with AAMs (diameter of 10-39 mm on first imaging study and pre-contrast attenuation of >10 Hounsfield units [HU] on computed tomography) were studied. We excluded adrenal metastasis, pheochromocytoma, sarcoma, lymphoma, infiltrative lesions, and adrenal hemorrhage, as well as patients with genetic predisposition to adrenal neoplasms. Data are presented as percentages and median values with interquartile ranges (IQRs). . We included 217 patients with 224 adrenal masses (61.3% women); the median age was 58 years (IQR, 49-65 years). The median size was 20.5 mm (IQR, 15-27 mm), with a median pre-contrast attenuation of 23.5 HU (IQR, 17-30 HU). The median AAM growth rate was 0.3 mm/year (IQR, 0-1.8 mm/year). Seventy-one masses (31.7%) underwent pathological evaluation. Adrenal adenoma (n=38; 17%) and adrenocortical carcinoma (ACC) (n=25; 11.2%) were the two most common diagnoses. For the adenomas, the growth rate was 0.3 mm/year (IQR, 0-2.3 mm/year) and for ACCs, the growth rate was 12.9 mm/year (IQR, 3.5-22 mm/year). The absolute contrast washout was >60% in 5 out of 7 (71.4%) ACC cases. The best growth rate cutoff for predicting malignancy was 2.68mm/year (AUC 0.939; sensitivity 87.5%, specificity 88.8%). AAMs carry significant malignant potential, and long-term follow-up is warranted when surgery is not pursued. Contrast washout is not reliable in predicting malignant potential of AAMs.

Geotourism Potentiality of Fossil Park Using Swot Matrix and Analytical Hierarchy Process (AHP) for Amkhoi Wood Fossil Park, Birbhum District, West Bengal, India

Geoparks are a new tourism form integrating geography and local development, focusing on geological conservation, marketing, and local culture. Geotourism Ecosystem aims to build a stronger network of geoparks. Amkhoi Wood Fossil Park in Birbhum, India, houses 20 million-year-old angiosperm wood fossils. It has been designated a Biodiversity Heritage Site, which aims to protect natural heritage, educate tourists, preserve fossils, and create jobs. Wood fossils from West Bengal, India's, Amkhoi Fossil Park are well known for offering insights into the natural history of the area. The transformation of wood into stone through the process of petrification brings to light natural occurrences such as tree falls and mineral infiltration. The most well-known fossils in the park are from the Glossopteris genus, which represents the Permian period's prehistoric vegetation. Miocene angiosperm wood fossils shed light on the ecological dynamics and evolutionary history of the area. The fossil record of the Anacardiaceae family indicates the warm, humid environment of the area. Using the Saaty scale, the study analyzed the SWOT components and used Eigenvalues to determine each factor's significance. At 54.4%, opportunities have the most weight, followed by vulnerabilities, threats, and strengths. The development of geotourism in the research area is least affected by risk factors. Each SWOT group's high local priority SWOT variables were selected. The greatest potential existed for government officials to give tourism planning more attention. Some of the weaknesses were unusual geological features, insufficient infrastructure, and low awareness. Particularly rare fossils and a geological fossil park are two of the study area's advantages.

TUR2021 3rd International Conference on Tourmaline Elba Island, Italy September 9-11, 2021

This volume contains 52 abstracts and keynote abstracts presented at the 3a International Conference on Tourmaline (TUR2021), held on Elba Island, Italy, from 9 to 11 September 2021 (https://www.tur2021.com). The Conference has been organized along with the sponsorship of SIMP (Italian Society of Mineralogy and Petrology), and support of the Sapienza University of Rome and Natural History Museum of Milan.The abstract volume is the joint effort of all conference participants and covers many aspects of tourmaline regarding the latest discoveries across the range of crystallography, mineralogy, petrology, geochemistry, isotopic analyses, ore-deposits research, gem science, and much more. All the abstracts published in this volume were critically read and approved by the scientific committee for presentation at TUR2021.

Pioneering Museum Data Transformation: Unifying Legacy Systems and Enhancing Data Integrity

In the digital era, museums confront the challenge of modernising legacy data systems to align with current standards. Part of the RECODE (Rethinking Collections Data Ecosystems) Programme (Dupont et al. 2022) examines the complex transition from disparate departmental object models to a unified system, reflecting the broader museum community's struggle with data standardisation. The case study centres on consolidating five distinct data models accumulated over two decades, each tailored to different departmental needs under various constraints. The data mapping process identifies and aligns similar fields across models, facilitating the integration of analogous data points and exposing redundancies and unique practices embedded over years. Major challenges include data complexity, diversity, and quality issues (cleaning, standardizing, and deduplicating), compounded by the massive scale of the data: currently, the Natural History Museum London (NHM) has 262,831,590 records across 8,175 fields, and a total volume of 12 TB of data, which define both the ongoing data modelling work and our future data migration. A key innovation in our process is the immediate visibility of data issues that became apparent upon migrating to Amazon Web Services (AWS). AWS serves as the staging environment for our transition to the new NHM Collections Management System (CMS) and offers an unprecedented platform for directly addressing these challenges. It enables us to query all our data—across all departments and fields—in just seconds. This capability provides a comprehensive view that was previously unattainable. The core of this presentation is sharing "lessons learned" from navigating the intricacies of an ongoing CMS transition within a museum. The endeavor to untangle and unify diverse data models is a common challenge (IEEE Big Data Governance and Metadata Management Industry Connections Activity 2020,Wu et al. 2022, Wu et al. 2021,Little et al. 2022,Woodburn et al. 2022) highlighting the importance of community engagement and knowledge exchange. Our findings underscore the necessity of cross-departmental collaboration and the benefits of a data-driven data modelling approach. By sharing our journey and the developed comprehensive object model (Collier and Woodburn 2022), we aim to contribute valuable insights to museums undergoing similar transformations. The RECODE Programme sheds light on the practical aspects of CMS modernisation through the analytics and knowledge derived from over two decades of collections data and data use.

Management and outcome of fetal abdominal cyst in first trimester: systematic review of the literature.

The detection of a fetal abdominal cyst at the first-trimester ultrasound scan is a rare event, for which the natural history and prognosis are often unknown and unpredictable, owing to various underlying etiologies. The aim of this study was to evaluate the outcome of fetal abdominal cysts detected in the first trimester to better understand their possible clinical significance and improve their clinical management. We present a case report of a fetal abdominal cyst detected in the first trimester, with subsequent diagnosis of congenital multiple arthrogryposis. We also performed a systematic review of the literature to determine the incidence and outcome of similar cases, which was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered with PROSPERO (CRD42023491729). PubMed, Web of Science and EMBASE were searched from inception to December 2023 to identify case reports and case series documenting an ultrasound diagnosis of a single fetal abdominal cyst in the first trimester. Our case presented at 12 + 6 weeks' gestation with an isolated fetal abdominal cyst, which underwent spontaneous resolution in the second trimester, when multiple congenital arthrogryposis was observed. Data on a total of 60 cases of fetal abdominal cyst detected in the first trimester were extracted from the literature. Of these, 35% were associated with concurrent or late-onset structural anomalies, as in our case, and 65% were isolated. In pregnancies with an isolated fetal abdominal cyst, 54% had a live birth with a normal outcome. A fetal abdominal cyst in the first trimester is usually an isolated finding with a moderate-to-good prognosis, but it could also be an early sign of other associated abnormalities, including arthrogryposis. Increased ultrasound surveillance and additional genetic testing to rule out possible associated anomalies are necessary to assess the risk of adverse pregnancy outcome and provide appropriate parental counseling. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Chronotopes of exile and loss in Philip O'Sullivan Beare's Zoilomastix (c. 1626)☆

AbstractThis essay explores the relationship between an early modern exile and his native environment, as depicted in Philip O'Sullivan Beare's unfinished natural history Zoilomastix. Writing by turns in Latin, Spanish and Gaelic from the safety of the Habsburg court, O'Sullivan Beare marshalled Ciceronian rhetoric and Plinian wonder to argue for the conservation of interwoven natural and cultural environments. One of the earliest examples of national historiographies written from exile by erudite Irish figures, Zoilomastix has most often been read in terms of its political theology. Though understandable, such readings obscure O'Sullivan Beare's idiosyncratic treatments of self, state and nature. Additionally, such readings only partially consider the author's attempts to engage with the debates on ethnicity, natural law and resource capture which directed the actions of the English state. Adopting the dialogic framework of Mikhail Bakhtin's chronotope, this essay therefore explores the extent to which the genre of natural history was utilized to inform and influence contested narratives. It argues that O'Sullivan Beare's autobiographical account, and its relevance to the forthcoming ‘loss’ of his Gaelic world, has much to tell us in a time of ecological crisis.

Natural History of Auditory Function in Patients with Alport Syndrome: A Case Series Study

Background: Alport syndrome (AS) is a genetic disorder characterized by progressive renal disease, ocular abnormalities, and sensorineural hearing loss. However, the audiological profile of patients with AS remains elusive. Thus, this study aims to evaluate the natural history of auditory function in patients with AS. Methods: Exome or targeted sequencing for deafness genes was performed to confirm the pathogenic variants in patients with AS. Results: We identified fifteen individuals with AS who carried pathogenic variants of COL4A3, COL4A4, or COL4A5. Among fifteen, twelve (80%) showed hematuria, and six (40%) showed proteinuria. The patients exhibited bilateral sensorineural hearing loss, which was progressive and symmetric. The hearing thresholds increased according to age and plateaued at the level of 53 dB HL, indicating the hearing loss did not reach the severe-to-moderate level. The auditory dysfunction showed a distinct natural history depending on the inheritance pattern, but there was no remarkable difference between males and females among X-linked AS. Conclusions: Auditory dysfunction in AS is progressive up to the level of moderate hearing loss. Precise auditory rehabilitation for patients with AS is warranted depending on the inheritance pattern and genetic predisposition.

Pre-emptive therapeutic decisions based on measurable residual disease status in acute myeloid leukemia: ready for prime time?

The use of measurable residual disease (MRD) as a biomarker for prognostication, risk stratification, and therapeutic decision-making in acute myeloid leukemia (AML) is gaining prominence. MRD monitoring for NPM1-mutated and core-binding factor AML using PCR techniques is well-established for assessing disease after intensive chemotherapy. AML with persistent FLT3-ITD MRD post-intensive chemotherapy and pre-allogeneic hematopoietic cell transplantation (pre-allo-HCT) is associated with an increased risk of relapse and lower survival. Pre-allo-HCT MRD is an independent risk factor for post-allo-HCT outcomes, including relapse and death. Therefore, preemptive interventions on the natural history of MRD positivity are an active area of research beyond its initial prognostic function. Targeting MRD in AML with innovative treatment strategies can improve patient outcomes.

Ensemble automated approaches for producing high‐quality herbarium digital records

AbstractPremiseOne of the slowest steps in digitizing natural history collections is converting labels associated with specimens into a digital data record usable for collections management and research. Here, we address how herbarium specimen labels can be converted into digital data records via extraction into standardized Darwin Core fields.MethodsWe first showcase the development of a rule‐based approach and compare outcomes with a large language model–based approach, in particular ChatGPT4. We next quantified omission and commission error rates across target fields for a set of labels transcribed using optical character recognition (OCR) for both approaches. For example, we find that ChatGPT4 often creates field names that are not Darwin Core compliant while rule‐based approaches often have high commission error rates.ResultsOur results suggest that these approaches each have different strengths and limitations. We therefore developed an ensemble approach that leverages the strengths of each individual method and documented that ensembling strongly reduced overall information extraction errors.DiscussionThis work shows that an ensemble approach has particular value for creating high‐quality digital data records, even for complicated label content. While human validation is still needed to ensure the best possible quality, automated approaches can speed digitization of herbarium specimen labels and are likely to be broadly usable for all natural history collection types.

Strategic Dual Approach for the Management of a Symptomatic Giant Partially Thrombosed Aneurysm at the Basilar Tip - Integrating Intrasaccular Flow Diversion and Endovascular Flow Reversal.

Managing giant partially thrombosed intracranial aneurysms presents significant challenges due to their unfavorable natural history and the lack of standardized treatment approaches. Conventional treatments, whether open surgical or endovascular, often struggle to manage these aneurysms effectively, resulting in high recurrence rates or significant morbidity. The patient was a 62-year-old male with a symptomatic giant partially thrombosed aneurysm at the tip of the basilar artery, presenting with left-sided hemiparesis and dysarthria. Diagnostic imaging revealed a giant aneurysm with a wide-necked, canalized portion. A two-stage endovascular treatment was conducted, involving a balloon occlusion test (BOT) and intraoperative monitoring (IOM) for maximum patient safety. The treatment utilized stent-assisted Woven EndoBridge (WEB) embolization and serial bilateral vertebral artery trapping. The procedure successfully isolated the aneurysm and postoperative imaging confirmed the absence of recanalization, preserving the intact posterior circulation. The patient showed stable recovery and no neurological deficits during the 12-month follow-up period. This technical note demonstrates the feasibility and efficacy of strategically integrating intrasaccular flow diversion using a WEB device and flow reversal through bilateral vertebral artery trapping for treating giant partially thrombosed aneurysms.

Early subclinical stages of the inflammatory bowel diseases - insights from human and animal studies.

The inflammatory bowel diseases (IBD) occur in genetically susceptible individuals that mount inappropriate immune responses to their microbiota leading to chronic intestinal inflammation. The natural history of IBD progression begins with early subclinical stages of disease that occur before clinical diagnosis. Improved understanding of those early subclinical stages could lead to new or improved strategies for IBD diagnosis, prognostication or prevention. Here we review our current understanding of the early subclinical stages of IBD in humans including studies from first-degree relatives of IBD patients and members of the general population who go on to develop IBD. We also discuss representative mouse models of IBD that can be used to investigate disease dynamics and host-microbiota relationships during these early stages. In particular, we underscore how mouse models of IBD that develop disease later in life with variable penetrance may present valuable opportunities to discern early subclinical mechanisms of disease before histological inflammation and other severe symptoms become apparent.

Morbidity Burden in Patients With Ebstein Anomaly: The Natural History.

The lifetime morbidity burden of patients with Ebstein anomaly (EA) has not been well described. Through an extensive 2-country register-based collaboration, patients diagnosed with EA who were born between 1930 and 2017 were identified in Danish and Swedish nationwide medical registries. Each patient was matched by age and sex with 10 control subjects from the general population. Cox proportional-hazards regression, Fine-Gray competing risk regression, and Kaplan-Meier failure function were used to estimate the morbidity burden. The study included 794 patients diagnosed with EA and 7940 controls, with a median follow-up period of 33 years. Among patients with EA, approximately half (n=442) had isolated EA, and 28% (n=218) had concomitant atrial septal defect. Patients with complex anatomy demonstrated the highest cardiovascular morbidity burden, followed by those with concomitant atrial septal defect and isolated EA. The lifetime cumulative incidence of supraventricular arrhythmia and ventricular preexcitation in patients with EA, with or without atrial septal defect, was approximately 70% and 19%, respectively. Supraventricular arrhythmia substantially increased the risk of ischemic stroke (hazard ratio [HR] 22.6 [95% CI, 11.1-45.9]). Presence of atrial septal defect significantly affected arrhythmia and heart failure burden compared with isolated EA. In the total cohort of patients with EA, supraventricular arrhythmia onset led to an immediate high incidence of heart failure, with a 10-year cumulative incidence of 18%. The natural history of EA, whether isolated or not, involves a substantial burden of cardiovascular morbidity and thus a highly vulnerable long-term prognosis.

Long-Term Changes in Composition and Distribution of Bumblebees in Urban Areas

Abstract The distribution of bumblebee species in Wrocław (SW Poland) was studied based on data from ten UTM grid squares between 1879 and 2018, and the composition and abundance of bumblebee species between 2011 and 2018. The results were compared with historical data available for the last 139 years, including published materials and collections of the Museum of Natural History (University of Wrocław). Twenty-six bumblebee species,including six species of cuckoo bumblebees of the subgenus Psithyrus, were recorded. One species was not confirmed during the later period, nine were strongly decreasing both in the range of distribution, seven other were expanding significantly in Wrocław and three were new in the Wrocław city boundaries. Negative and positive tendencies resulted from both anthropogenic and natural factors. All bumblebees that appeared in the city of Wrocław and increased their abundance were species that prefered forest and shrub areas, while species that disappeared from the city and decreased in numbers were species who prefered open areas.

Shifts in the spatiotemporal profile of inflammatory phenotypes of innate immune cells in the rat brain following acute intoxication with the organophosphate diisopropylfluorophosphate

Acute intoxication with cholinesterase inhibiting organophosphates (OP) can produce life-threatening cholinergic crisis and status epilepticus (SE). Survivors often develop long-term neurological consequences, including spontaneous recurrent seizures (SRS) and impaired cognition. Numerous studies implicate OP-induced neuroinflammation as a pathogenic mechanism contributing to these chronic sequelae; however, little is known about the inflammatory phenotype of innate immune cells in the brain following acute OP intoxication. Thus, the aim of this study was to characterize the natural history of microglial and astrocytic inflammatory phenotypes following acute intoxication with the OP, diisopropylfluorophosphate (DFP). Adult male and female Sprague–Dawley rats were administered a single dose of DFP (4 mg/kg, sc) followed by standard medical countermeasures. Within minutes, animals developed benzodiazepine-resistant SE as determined by monitoring seizures using a modified Racine scale. At 1, 3, 7, 14, and 28 d post-exposure (DPE), neuroinflammation was assessed using translocator protein (TSPO) positron emission tomography (PET) and magnetic resonance imaging (MRI). In both sexes, we observed consistently elevated radiotracer uptake across all examined brain regions and time points. A separate group of animals was euthanized at these same time points to collect tissues for immunohistochemical analyses. Colocalization of IBA-1, a marker for microglia, with iNOS or Arg1 was used to identify pro- and anti-inflammatory microglia, respectively; colocalization of GFAP, a marker for astrocytes, with C3 or S100A10, pro- and anti-inflammatory astrocytes, respectively. We observed shifts in the inflammatory profiles of microglia and astrocyte populations during the first month post-intoxication, largely in hyperintense inflammatory lesions in the piriform cortex and amygdala regions. In these areas, iNOS+ proinflammatory microglial cell density peaked at 3 and 7 DPE, while anti-inflammatory Arg1+ microglia cell density peaked at 14 DPE. Pro- and anti-inflammatory astrocytes emerged within 7 DPE, and roughly equal ratios of C3+ pro-inflammatory and S100A10+ anti-inflammatory astrocytes persisted at 28 DPE. In summary, microglia and astrocytes adopted mixed inflammatory phenotypes post-OP intoxication, which evolved over one month post exposure. These activated cell populations were most prominent in the piriform and amygdala areas and were more abundant in males compared to females. The temporal relationship between microglial and astrocytic responses suggests that initial microglial activity may influence delayed, persistent astrocytic responses. Further, our findings identify putative windows for inhibition of OP-induced neuroinflammatory responses in both sexes to evaluate the therapeutic benefit of anti-inflammation in this context.

Natural history of a newly developed calcified nodule: incidence, predictors, and clinical outcomes.

Calcified nodules (CNs) are an increasingly important, high-risk lesion subset. We sought to identify the emergence of new CNs and the relation between underlying plaque characteristics and new CN development. Patients who had undergone two optical coherence tomography (OCT) studies that imaged the same untreated calcified lesion at baseline and follow-up were included. New CNs were an accumulation of small calcium fragments at follow-up that were not present at baseline. Cardiac death, myocardial infarction (MI), or clinically driven revascularisation related to OCT-imaged, but untreated, calcified lesions were then evaluated. Among 372 untreated calcified lesions, with a median of 1.5 (first and third quartiles: 0.7-2.9) years between baseline and follow-up OCTs, new CNs were observed in 7.0% (26/372) of lesions at follow-up. Attenuated calcium representing residual lipid (odds ratio [OR] 3.38, 95% confidence interval [CI]: 1.15-9.98; p=0.03); log10 calcium volume index (length×maximum arc×maximum thickness; OR 2.76, 95% CI: 1.10-6.95; p=0.03); angiographic Δangle between systole and diastole, per 10° (OR 2.30, 95% CI: 1.25-4.22; p=0.01); and time since baseline OCT, per year (OR 1.36, 95% CI: 1.05-1.75; p=0.02) were all associated with new CN development. Clinical events were revascularisation and/or MI and were more frequent in lesions with versus without a new CN (29.3% vs 15.3%; p=0.04). New CNs developed in untreated, lipid-containing, severely calcified lesions with a larger angiographic hinge motion (between systole and diastole), compared with lesions without CNs, and were associated with worse clinical outcomes.

Emily Lawless, Natural History, and the Possibilities of Enchantment

Natural History – including entomology, marine zoology, and botany – enjoyed a significant vogue in the late nineteenth century, coinciding with the much more widely celebrated and discussed literary and cultural revival. These, I argue, are not distinct but rather entwined movements. Placing the Irish novelist, poet and scientist Emily Lawless (1845–1913) within this context, and examining both her scientific research and novels including Major Lawrence F.L.S (1885) and The Book of Gilly (1906), this article explores the overlapping modes of science and literature in the work, and suggests that Lawless’s sustained and committed engagement in naturalist study in Ireland led to an attempt to harness the discourses of natural science into narratives of spiritual and national resurgence. Whereas many contemporaries – Yeats among them – rejected science as a disenchanting force, Lawless provides an illuminating counter-example, whose scepticism regarding the occult spiritualities of her Revival contemporaries led her to develop an alternative form of positivist spirituality which foregrounded the materiality of the natural world and the spiritual potential of close, detailed scientific study.

The Clinical Trajectory of NYHA Functional Class I Patients With Obstructive Hypertrophic Cardiomyopathy.

An improved understanding of the natural history in NYHA functional class I patients with obstructive hypertrophic cardiomyopathy (oHCM) is needed. Using a multicenter registry (SHaRe [Sarcomeric Human Cardiomyopathy Registry]), this study described the natural history in patients with oHCM who were classified as NYHA functional class I at the initial visit compared with patients classified as NYHA functional class II and reported baseline characteristics associated with incident clinical events. Incident events assessed included a composite of NYHA functional class III to IV symptoms, left ventricular ejection fraction<50%, atrial fibrillation, stroke, ventricular arrhythmias, septal reduction therapy, ventricular assist device or transplantation, or death. Factors associated with incident events were determined using Kaplan-Meier, Cox proportional hazards, and restricted cubic spline models. Of 7,964 patients with HCM in SHaRe, 1,239 patients with oHCM met inclusion criteria; 598 were in NYHA functional class I at the initial visit (age 48 ± 17 years; 31.1% female; peak gradient, 75 ± 40mmHg). At 5-year follow-up, the composite event rate of NYHA functional class I patients was 28% compared with 44% (P< 0.001) in 641 NYHA functional class II patients with oHCM (age 54 ± 16 years; 46.5% female; peak gradient, 83 ± 39mmHg). Left atrial (LA) diameter≥45mm (HR: 1.56 [95%CI: 1.14-2.12]; P = 0.005), female sex (HR: 1.61 [95%CI: 1.16-2.24]; P = 0.003), and older age (HR: 1.21 per 10 years [95%CI: 1.09-1.34]; P< 0.001), but not the magnitude of left ventricular outflow tract obstruction, were associated with a higher risk of the composite outcome in NYHA functional class I patients. Although NYHA functional class I patients with oHCM fared better than NYHA functional class II patients, more than one-fourth experienced adverse events over 5-year follow-up, especially if they were older, female, and/or had LA enlargement. Strategies to reduce the rate of clinical outcomes in NYHA functional class I patients warrant further study.

Intraductal papillary mucinous neoplasm: Overview of management.

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is increasingly being diagnosed incidentally on imaging. Ithas malignant potential, making it vitalto establish the correct diagnosis, assessits malignant risk and follow a management strategy to prevent development of invasive carcinoma ofthe pancreas. This review focuses on the epidemiology, natural history, risk factors, diagnosis and management of IPMN of the pancreas, and will provide practical points for general practitioners. IPMN of the pancreas can transform into invasive pancreatic carcinoma at a low rate of approximately 2%/year. Upon diagnosis of IPMN, it is risk stratified based on the presence of worrisome or high-risk stigmata, which guides further management. Management needs to be individualised based on IPMN and patient factors due to limitations with the current diagnostic tools.