The Anglo-Saxon migration and the formation of the early English gene pool

The history of the British Isles and Ireland is characterized by multiple periods of major cultural change, including the influential transformation after the end of Roman rule, which precipitated shifts in language, settlement patterns and material culture1. The extent to which migration from continental Europe mediated these transitions is a matter of long-standing debate2-4. Here we study genome-wide ancient DNA from 460 medieval northwestern Europeans-including 278 individuals from England-alongside archaeological data, to infer contemporary population dynamics. We identify a substantial increase of continental northern European ancestry in early medieval England, which is closely related to the early medieval and present-day inhabitants of Germany and Denmark, implying large-scale substantial migration across the North Sea into Britain during the Early Middle Ages. As a result, the individuals who we analysed from eastern England derived up to 76% of their ancestry from the continental North Sea zone, albeit with substantial regional variation and heterogeneity within sites. We show that women with immigrant ancestry were more often furnished with grave goods than women with local ancestry, whereas men with weapons were as likely not to be of immigrant ancestry. A comparison with present-day Britain indicates that subsequent demographic events reduced the fraction of continental northern European ancestry while introducing further ancestry components into the English gene pool, including substantial southwestern European ancestry most closely related to that seen in Iron Age France5,6.

Ten millennia of hepatitis B virus evolution

[Figure: see text].

Can atrioventricular node ablation be safely performed in patients with permanent His bundle pacing? Data from a multicentric registry

Introduction

Ventricular rate control is essential in the management of atrial fibrillation. Atrioventricular node ablation (AVNA) and ventricular pacing can be an effective option when pharmacological rate control is insufficient. However, right ventricular pacing (RVP) induces ventricular desynchronization in patients with normal QRS and increases the risk of heart failure on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Observational studies have demonstrated the feasibility of HBP but there is still very limited data about the feasibility of AVNA after HBP.

Purpose

To evaluate feasibility and safety of HBP followed by AVNA in patients with non-controlled atrial arrhythmia.

Methods

We included in three hospitals between september 2017 and december 2019 all patients who underwent AVNA for non-controlled atrial arrhythmia after permanent His bundle pacing. No back-up right ventricular lead was implanted. AVNA procedures were performed with 8 mm-tip ablation catheter. Acute HBP threshold increase during AVNA was defined as a threshold elevation >1V. His bundle capture (HBC) thresholds were recorded at 3 months follow-up.

Results

AVNA after HBP lead implantation was performed in 45 patients. HBP and AVNA were performed simultaneously during the same procedure in 10. AVNA was successful in 32 of 45 patients (71%). Modulation of the AV node conduction was obtained in 7 patients (16%). The mean procedure duration was 42±24min, and mean fluoroscopy duration was 6.4±8min. A mean number of 7.7±9.9 RF applications (347±483 sec) were delivered to obtain complete / incomplete AV block. Acute HBC threshold increase occurred in 8 patients (18%) with return to baseline value at day 1 in 5 patients. There was no lead dislodgment during the AVNA procedures. Mean HBC threshold at implant was 1.26±0.69V@0.5ms and slightly increased at 3 months follow-up (1.34±0.86V@0.5ms). AV node re-conduction was observed in 5 patients (16% of the successful procedures) with a second successful ablation procedure in 4 patients. No ventricular lead revision was required during the follow-up period. The baseline native QRS duration was 102±21 ms and the paced QRS duration was 107±18 ms.

Conclusion

AVNA combined with HBP for non-controlled atrial arrhythmia is feasible and does not compromise HBC but seems technically difficult with significant AV nodal re-conduction rate. The presence of a back-up right ventricular lead could have changed our results and therefore would require further evaluation.

Unipolar HBP after AV node ablation

Funding Acknowledgement

Type of funding source: None

P6018Can chronic his bundle pacing be safely started in centers with lack of experience of this technique? Data from a multicentric registry

Introduction

Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the risk of heart failure and atrial fibrillation on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Interest in HBP has been hampered in part by technical challenges and limited implantation tool set. Recent studies assessed feasibility and safety in expert centers with a vast experience of HBP. These results may not apply to less experienced centers.

Purpose

To evaluate feasibility and safety of permanent his bundle pacing in hospitals with limited technical training to this technique and to evaluate stability of his bundle capture thresholds at 3 months follow up.

Methods

We included all patients who underwent pacemaker implantation with attempt of HBP in three hospitals between September 2017 and December 2018. All the 5 operators were novice for HBP at the beginning of the study. Selective his bundle capture (HBC) was defined as concordance of QRS and T waves complexes with the native ECG (patients with underlying bundle branch block may normalize), presence of a delay between spike and QRS complex, absence of widening of the QRS at a low pacing output, and recordable his bundle electrogram. At 3 months follow-up, his bundle capture thresholds, R-wave amplitudes and pacing impedances were recorded.

Results

HPB was successful in 51 of 58 patients (87.9%); selective HBC was obtained in 40 patients while nonselective HBC occurred in 11 patients. Indication for pacemaker implantation was atrioventricular conduction disease in 31 patients (53%), sinus node dysfunction in 5 patients (9%) and AV nodal ablation for non-controlled atrial arrhythmias in 22 patients (38%). AV nodal ablation was performed during the same procedure in 14 patients. The mean procedure duration was 75±8 min, and mean fluoroscopy duration was 10±2 min. The mean HBP threshold was 1.47±0.27 V and did not increase after a 3 months follow-up (1.12±0.18 V). Only 7 patients (14%) had HBP threshold >2V/0.5ms. The mean impedance was 477±37 Ω and slightly decreased at 3 months (364±24Ω). The mean R-wave amplitude was 4.1±1 mV at implantation and 3.2±0.6 mV at 3 months. Bundle branch block correction was achieved in 5 of 7 patients with underlying left bundle branch block. There was no pericardial effusion, no pneumothorax and no device infection. Ventricular lead revision was required at 3 months in one patient for sudden threshold increase, without obvious dislodgement.

LBBB correction after HBP

Conclusion

His bundle pacing performed by novice operators to this technique appeared feasible and safe. The mean HBP threshold did not increase at 3 months follow-up.

Iron Age and Anglo-Saxon genomes from East England reveal British migration history

British population history has been shaped by a series of immigrations, including the early Anglo-Saxon migrations after 400 CE. It remains an open question how these events affected the genetic composition of the current British population. Here, we present whole-genome sequences from 10 individuals excavated close to Cambridge in the East of England, ranging from the late Iron Age to the middle Anglo-Saxon period. By analysing shared rare variants with hundreds of modern samples from Britain and Europe, we estimate that on average the contemporary East English population derives 38% of its ancestry from Anglo-Saxon migrations. We gain further insight with a new method, rarecoal, which infers population history and identifies fine-scale genetic ancestry from rare variants. Using rarecoal we find that the Anglo-Saxon samples are closely related to modern Dutch and Danish populations, while the Iron Age samples share ancestors with multiple Northern European populations including Britain.

Pathologic crossroads: cardio-vascular diseases, periodontal diseases and calcium antagonists

RATIONALE

During the last decennium a more focused attention has been directed to the presence of chronic inflammation in cardiovascular diseases (CVD), but mainly to the high impact that this one has in generating and fastening the atherosclerotic process.

OBJECTIVE

To highlight the causal relationship between periodontal diseases (PD) and CVD. One of the most important chronic inflammations, present in the modern societies in the vast majority of the population, is represented by the periodontal diseases (PD). Both types of diseases are characterized by a high and continuously increasing prevalence. It is now clear that they share some common risk factors, but it would be of great interest, not only for a scientific purpose, but also from a possible health benefit, as PD can be prevented and treated efficiently, to prove that there is a causal link between these two pathologies.

METHODS

We will present a review of the actual data concerning their relationship.

DISCUSSION

The study of this causal relationship is made more difficult due to the increased utilization, due to the guides' recommendations of the calcium antagonists (CA) in treating CVD.

Correlation between the immunophenotypical presentation of dendritic cells and the clinical response to anti-rheumatic treatment in rheumatoid arthritis

BACKGROUND

Dendritic cells (DCs) are potent antigen-presenting cells (APC) that are deeply implicated in the initiation and exacerbation of rheumatoid arthritis (RA). Active RA is associated with an activated DCs population as demonstrated by high expression of adhesion and co-stimulatory molecules.

PURPOSE

To compare the expression of adhesion and co-stimulatory molecules on DCs from synovial tissue (ST) in patients (pts) with RA and the clinical status before and after treatment with disease modifying antirheumatic drugs (DMARDs).

METHODS

Samples of ST were obtained from RA patients at the time of hip or knee replacement or arthroscopy. Clinical status (assessed by the American College of Rheumatology - ACR - core set and the DAS28) and co-stimulatory and adhesion molecules on DCs were evaluated before and after treatment. Immunophenotype of DCs was analyzed by two-color immunofluorescence microscopy.

RESULTS

In patients with active RA we found a highly differentiated subpopulation of DCs that expressed an activated phenotype. After treatment, the expression of adhesion and co-stimulatory molecules on ST DCs was correlated with the ACR and DAS28 clinical response.

CONCLUSION

Clinical outcome and the immunophenotypical presentation of ST DCs after DMARDs treatment are closely correlated in pts with RA. The co-stimulatory activity in the synovium is important in determining the course of the disease and provide new therapeutic targets for immune intervention.

[Temporomandibular ankylosis. A treatment method using the interposition of a Dacron device]

BACKGROUND

Temporomandibular ankylosis with its multiple anatomo-clinical forms is a relatively rare disease. Its major morphopathological, therapeutical and psychological implications rank it among severe illnesses. Its treatment is exclusively surgical. The major therapeutical indication in ankylosis of type I and II Topazian is the neoarticular modelling osteotomy with interposition.

MATERIAL AND METHODS

As a material for interposition, over the last 7 years, we have used in 15 patients with 18 ankylosis, concave rectangular Dacron fragments adequately shaped after being taken from a vascular prothesis.

RESULTS

The qualities of this material are confirmed by the obtained results: quick resuming of the normal mobility of the mandible, lack of postoperative complications and recurrences. The material is cheap and easy to be obtained. The technique to be used is simple.

DISCUSSION

The Dacron texture is soft, elastic in all respects, thick enough, resistant, with long lasting elasticity and integrity, physically and chemically sTable, well tolerated by the body and without foreign body rejection. It is easy to be cut, shaped, modelled and adapted to the bone stump. It is sterilized by autoclaving. It is also well integrated into the host tissue being penetrated by the connective tissue which fastens it to the surface of the neocondyle preventing a relapse. It plays the role of a joint cartilage.

[The treatment of segmental fractures of the middle face]

During the past two decades new methods and techniques for the treatment of middle floor facial fractures have been developed. The orthopedic approach alone or associated with various procedures of internal suspension gradually became obsolete. Nowadays, a successful treatment implies the early surgical exploration and a careful restoration of bone skeletal structure. Osteosynthesis with mini-plates provides for the reduction and tridimensional stability of bone fragments. Moreover, in the communicative fractures and in those accompanied by substance loss, the titanium mini-plates are the best method for the immediate fixation of bone grafts.

[Post-therapeutic complications in mandibular fractures: a retrospective study]

The analysis in based on 12,096 patients with fractures of the mandible admitted to and treated in the Clinical of Oral and Maxillofacial Surgery of Iaşi in the interval 1951-1995. Posttreatment complications were found in 10.52% of the cases, 9.81% of them being of inflammatory type. Anatomo-clinically these consisted in suppurations of the soft tissues, osteitis and osteomyelitis. The prejudices caused by these complications were multiple: longer hospital stay, additional suffering for the patient, temporary work inability, higher treatment costs.

Some seroepidemiological data on HIV-antibody and HBs-antigen prevalence in children and infants of Craiova (Romania)

By testing 2362 children and infants from Craiova (Romania), for both HIV-antibody and HBs-antigen presence in the blood, a high rate of positivity was noticed in orphanages and in dystrophia units. A rate of "signal" (i.e. about 4% for HIV-antibodies, and 2.5% for HIV-antibody/HBs antigen), in hospitalized patients (pediatric service), was found as well. Four reasons support the horizontal way of virus transmission as the main route: most of seropositive subjects belong to 1-to-3-year age range, suggesting a virtual contamination before introduction of disposable syringes in Romania care units and hospitals; many HIV-seropositive cases have received frequent parenteral treatments, during repeated hospitalizations for acute respiratory disease; only few of the mothers of seropositive infants exhibited HIV-antibody presence; a relatively high rate of "double" seropositivity, i.e. HIV-antibody/HBs antigen, within tested serum samples was noticed.

[The late results of short-term chemotherapy in benign forms of tuberculosis in children]

The study included 359 cases of primary tuberculosis (benign forms) in children aged 0-14 years, out of which 181 non-complicated and 178 complicated forms. The therapeutical regimens were: 3HEZ2/3HE2 (study subgroup) and 6HE2/3H2 (control) for non-complicated forms, and 3HRZ2/3HR2 (study subgroup) and 3HES2/3HE2/3H2 (control) for complicated ones. Late results (5 years after treatment end) were very good (from clinical, radiological, bacteriological points of view) in 100% of cases. Thus, short-course regimens are preferable to longer ones (over 6 months) in the chemotherapy of the benign forms of pulmonary tuberculosis in children.

[Surgical prosthetic restoration after bilateral maxillectomy]

In 6 cases of tumors, two gigantic benign and four malignant in T4 having palatal and gingivo-alveolar starting point with invasive evolution into the structure of facial mass, surpassing the median alignment, the authors consider the problem concerning the indications for exeresis, possibilities of removal of healthy tissue and the reconstruction of massive losses of substance. The surgical treatment of reconstruction that completes the exeresis of the tumor is meant to sustain the ocular globe through a aponeurotic-muscular flap form the temporal muscle, with the aid of nasal septum or a skin graft also used to obtain a good coating of the cavity, and is also meant to a plastic reconstruction of the soft palate as well as to retention modelling of the cavity fields which resulted postsurgically. The main role in maxillofacial reconstruction in held by the obturator prosthesis that avoids morphofunctional prejudices and restores facial contour, without aesthetic and psychic prejudices. The results obtained in our 6 cases shown here have been fully satisfactory.

[Choristomas]

The authors present 21 cases of aberrant pancreas with gastric and duodenal location (heterotopias under the shape of inclusions, nodules or true adenomas) included besides the rare cases of adenoma developed from Brunner and Lieberkühn glands in the "choristomas" category. Asymptomatic or with clinical phenomena and complications "borrowed" from the associated peptic ulcers (15 cases) the diagnosis of pancreatic heterotopias is usually an interoperatory or even histopathological surprise, the X-ray examination with the classical image "in cocard" and the endoscopy being rarely evocative. The surgical treatment is generally conservative and is dominated by the presence or lack of the concomitant peptic ulcer.

[Plastic surgery for losses of facial substance by cheek rotation]

New diversified plastic surgery methods have been introduced into practice in the last decades, aimed at repairing the loss of facial tissues involving the upper lip (with or without co-involvement of the lateral parts of the nose), and the lower eyelid area, that cannot be repaired by flaps prepared in the surrounding regions. In view of avoiding the disadvantages of 2- or 3-stage techniques the authors have re-evaluated the method introduced by Esser in 1918 for plastic repair of the facial tissues by rotation of the cheek, which is economical, efficient, rapid, and elegant, providing fully satisfactory esthetic results. Two cases are presented, one with loss of facial tissue following removal of an achromic recidivating melanoma, and another one following removal of a recidivating baso-cellular carcinoma, in which this method was employed with excellent results.

[Suppurative cervico-mediastinitis of odontogenic origin]

Five cases are presented, of suppurated cervico-mediastinitis developed after acute suppurated apical parodontitis of a lower molar tooth. In two cases the severity and the extension of the lesions resulted in a fatal outcome. In one of the cases the patient also had pericarditis, pleurisy and purulent meningitis, and in the second case the necrotizing mediastinitis extended to the pleural and pericardic cavities, and was associated to bilateral bronchopneumonia. In three cases the patients were cured following cervical mediastinotomy, efficient mediastinal aspiration of the anterior and of the posterior mediastinum, in association with antiinfectious and resuscitation therapy. Since the prognosis of these major complications is still severe the risk of diffusion of odontogenic suppurations should not be ignored or minimized since in all the cases iatrogenic factors have occurred over the evolution of the patients. Knowledge of stomatologists should be improved and they should be aware of the risks of odontogenic suppuration involving parapharyngeal and cranio-encephalic extension, or the risk of cervico-mediastinal diffusion.

[Isolated traumatic lesions of the abdominal wall musculature]

Six cases of isolated traumatic lesions of the abdominal wall muscles (2 ruptures of the right abdominal muscle and 4 of the anterolateral muscles) are reported. The presence of a "fixed" hematoma or even of a true subcutaneous eventration, the case history (for finding out the injury mechanism or unusual muscular effort), the X-ray examination of the abdomen and especially the ultrasonography can establish the diagnosis. The treatment of this lesion is usually conservative, surgery (performed in 3 cases) being indicated only in those ruptures with large parietal defects or hematomas or in case of diagnostic doubts.