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Introduction: Unrefreshing sleep is one of the diagnostic criteria in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which could be explained by sleep disorders, for example obstructive sleep apnea, reported in our previous study with polysomnography. Our previous findings also indicate difficulties in emotional regulation when measuring alexithymia by TAS-20 (Toronto Alexithymia Scale) and level of emotional awareness by LEAS (Level of Emotional Awareness Scale) in ME/CFS patients. However, the reasons for this are unknown. The purpose of this study was to investigate correlations between data from subjective emotional regulation and polysomnography.
Methods: Twenty-three ME/CFS patients (5 men and 18 women) of mean age 43, and 30 matched healthy controls (9 males and 21 women) of mean age 45, filled in TAS-20, LEAS, and Hospital Depression and Anxiety Scale (HADS). A polysomnography was performed on patients but not on healthy controls. Thus, values of normal population were used for sleep evaluation in ME/CFS patients.
Result: There were significant differences between patients and controls in several aspects of emotional regulation, for example LEAS-self and LEAS-total. Seventy percent of the patients had increased numbers of awakenings (shifts from any sleep stage to awake), 22% had obstructive sleep apneas, and 27% had periodic limb movements. Correlation analysis showed that number of awakenings significantly correlated with LEAS-self and LEAS-total, p < 0.01, respectively. There were no other significant correlations.
Conclusion: This pilot study demonstrated significant correlations between reduced emotional awareness and number of awakenings in polysomnography. Future studies with larger cohorts need to be conducted.
BACKGROUND: Adenotonsillectomy (ATE) is a well-established and effective treatment of pediatric obstructive sleep apnea (OSA). In recent years, a more conservative method, adenotonsillotomy (ATT), has gained popularity because it is associated with less postoperative morbidity. Yet no previous randomized study has compared these 2 methods regarding their effectiveness in treating pediatric OSA in terms of polysomnographic data, which was the primary aim of this study. The hypothesis was that ATT is noninferior to ATE after 1 year.
METHODS: Seventy-nine children, aged 2 to 6 years, with OSA (Apnea-Hypopnea Index [AHI] 5–30) were randomized to ATT (n = 40) or ATE (n = 39). Polysomnography (PSG) and questionnaire OSA-18 were assessed at baseline and 1 year postsurgery.
RESULTS: Mean difference between groups in the primary outcome, change in AHI, was 0.83, 95% confidence interval –3.2 to 4.9, not exceeding the noninferiority margin of 5. After ATE, AHI decreased from median 12.7 (interquartile range 8.3–19.1) to 2.0 (1.2–3.1) and after ATT from 15.8 (8.5–21.2) to 4.0 (1.2–5.1). For both groups, significant improvements of PSG and OSA-18 questionnaire outcomes were observed, with no significant differences between groups. Five children (13%) in the ATT group needed repeated surgery for tonsil regrowth and recurrence of OSA.
CONCLUSIONS: The results suggest that ATT is noninferior to ATE in treating pediatric OSA regarding PSG outcomes after 1 year. ATT could be considered an alternative to ATE for treatment of pediatric OSA. However, after ATT, there is a nonnegligible risk of recurrence of OSA, and this should be taken into account when selecting surgical method.
PURPOSE: Our previous randomized controlled trial (RCT) of children with obstructive sleep apnea (OSA) showed no significant differences between adenotonsillectomy (ATE) and adenotonsillomy (ATE) in improving nocturnal respiration and symptoms after one year. This is the continuous report with the evaluation of postoperative morbidity concerning bleeding and pain.
METHODS: A double-blinded RCT including 79 children, aged 2-6 years, with moderate to severe OSA, randomized to either ATE (n = 40) or ATT (n = 39). From one to ten days postoperatively, parents filled in a logbook with six pain-related outcomes (parent and child grading pain at different levels, days of analgesic use and return to normal diet). Peri- and postoperative bleeding were also registered.
RESULTS: 63 patients (80%) returned the logbook. There were significant differences between groups in only two of the six pain-related outcomes in favor of the ATT group; first day when the children graded themselves as pain free (p = 0.021, Log Rank Test), and first day the caregiver estimated pain VAS ≤ 5 (p = 0.007, Log Rank Test). Two (5%) cases of postoperative bleeding occurred in the ATE group, one of which needed a return to theatre. No case of postoperative bleeding was seen in the ATT group.
CONCLUSIONS: The results from this RCT are in line with previous comparative studies between ATT and ATE. Children operated with ATT had significantly less postoperative pain in one-third of the outcomes, and less bleeding than ATE. However, as the differences in morbidity between the surgical methods were minor the clinical significance is uncertain.
TRIAL REGISTRATION: This study was approved by the Swedish Regional Ethics Board in Stockholm, Sweden (Dnr 2011/925-32 and 2013/2274-32) and registered at ClinicalTrials.gov (Trial registration number NCT01676181).
Objectives The objective of this study was to longitudinally describe the history of tonsil surgery in Swedish children and adolescents regarding incidence, indications for surgery, surgical methods and the age and gender distributions.
Setting A retrospective longitudinal population-based cohort study based on register data from the Swedish National Patient Register (NPR) and population data from Statistics Sweden.
Participants All Swedish children 1–<18 years registered in the NPR with a tonsil surgery procedure 1987–2013.
Results 167 894 tonsil surgeries were registered in the NPR 1987–2013. An increase in the total incidence rate was observed, from 22/10 000 person years in 1987 to 47/10 000 in 2013. The most marked increase was noted in children 1–3 years of age, increasing from 17 to 73/10 000 person years over the period. The proportion children with obstructive/sleep disordered breathing (SDB) indications increased from 42.4% in 1987 to 73.6% in 2013. Partial tonsillectomy, tonsillotomy (TT), increased since 1996 and in 2013 55.1% of all tonsil procedures were TTs.
Conclusions There have been considerable changes in clinical practice for tonsil surgery in Swedish children over the past few decades. Overall, a doubling in the total incidence rate was observed. This increase consisted mainly of an increase in surgical procedures due to obstructive/SDB indications, particularly among the youngest age group (1–3 years old). TT has gradually replaced tonsillectomy as the predominant method for tonsil surgery.
Our previous study showed that modified uvulopalatopharyngoplasty (UPPP), including tonsillectomy, significantly improved nocturnal respiration in obstructive sleep apnea syndrome (OSAS) patients. This is a continuous study of changes in daytime sleepiness and quality of life.
Study Design
Prospective randomized controlled trial (RCT), two parallel arms.
Sixty‐five patients with apnea‐hypopnea index ≥ 15, body mass index < 36, Epworth Sleepiness Scale (ESS) ≥ 8, Friedman stage I or II, failing nonsurgical treatment. The intervention group (n = 32) underwent surgery, and the controls (n = 33) had no treatment. At baseline and the 7‐month follow‐up, polysomnography, questionnaires, and vigilance tests were implemented.
All patients answered the questionnaires, and 48 took the vigilance test. Epworth Sleepiness Scale decreased significantly in the intervention group, from a mean (standard deviation) of 12.5(3.2) to 6.8(3.9), but nonsignificantly in the control group, from 12.9(3.1) to 12.5(3.9), a significant group difference (P < 0.001). The physical and mental component score on the Short Form‐36 questionnaire increased significantly in the intervention group, from a mean 47.8(8.3) to 51.2(8.8) and from 42.1(10.6) to 48.1(9.7), respectively, but with nonsignificant changes in the controls: 49.0(9.0) to 48.3(9.1) and 41.0(10.2) to 42.7(11.5), significant group differences (P = 0.007, P = 0.031), respectively. The sleep latency/vigilance test showed a significant mean increase in the intervention group of 7(12.4) minutes and a decrease in the controls of 2.2(10.6), a significant group difference (P = 0.011). There were significant correlations between changes in subjective outcomes and nocturnal respiration.
This RCT shows that modified UPPP was effective in improving daytime sleepiness and quality of life in OSAS patients. It strengthens the body of evidence on the potential effect of surgery offered to selected patients.
BACKGROUND: Preterm birth (gestational age <37 weeks) has previously been associated with cardiometabolic and neuropsychiatric disorders into adulthood, but has seldom been examined in relation to sleep disorders. We conducted the first population-based study of preterm birth in relation to sleep-disordered breathing (SDB) from childhood into mid-adulthood.
METHODS: A national cohort study was conducted of all 4 186 615 singleton live births in Sweden during 1973-2014, who were followed for SDB ascertained from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth in relation to SDB while adjusting for other perinatal and maternal factors, and co-sibling analyses assessed for potential confounding by unmeasured shared familial factors.
RESULTS: There were 171 100 (4.1%) persons diagnosed with SDB in 86.0 million person-years of follow-up. Preterm birth was associated with increased risk of SDB from childhood into mid-adulthood, relative to full-term birth (39-41 weeks) [adjusted hazard ratio (aHR), ages 0-43 years: 1.43; 95% confidence interval (CI), 1.40, 1.46; P <0.001; ages 30-43 years: 1.40; 95% CI, 1.34, 1.47; P <0.001]. Persons born extremely preterm (<28 weeks) had more than 2-fold risks (aHR, ages 0-43 years: 2.63; 95% CI, 2.41, 2.87; P <0.001; ages 30-43 years: 2.22; 95% CI, 1.64, 3.01; P <0.001). These associations affected both males and females, but accounted for more SDB cases among males (additive interaction, P = 0.003). Co-sibling analyses suggested that these findings were only partly due to shared genetic or environmental factors in families.
CONCLUSIONS: Preterm-born children and adults need long-term follow-up for anticipatory screening and potential treatment of SDB.
The purpose of this study was to detect treatable sleep disorders among patients complaining of chronic fatigue by using sleep questionnaires and polysomnography.
Patients were referred to hospital for investigations and rehabilitation because of a suspected diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The criteria for further referral to full‐night polysomnography (PSG) were symptoms of excessive daytime sleepiness and/or tiredness in the questionnaires.
Of a total of 381 patients, 78 (20.5%) patients underwent PSG: 66 women and 12 men, mean age 48.6 years, standard deviation ±9.9 years. On the basis of the PSG, 31 (40.3%) patients were diagnosed with obstructive sleep apnoea, 7 (8.9%) patients with periodic limb movement disorder, 32 (41.0%) patients with restless legs syndrome and 54 (69.3%) patients had one or more other sleep disorder. All patients were grouped into those who fulfilled the diagnostic criteria for ME/CFS (n = 55, 70.5%) and those who did not (n = 23, 29.5%). The latter group had significantly higher respiratory (P = .01) and total arousal (P = .009) indexes and a higher oxygen desaturation index (P = .009).
More than half of these chronic fatigue patients, who also have excessive daytime sleepiness and/or tiredness, were diagnosed with sleep disorders such as obstructive sleep apnoea, periodic limb movement disorder and/or restless legs syndrome. Patients with such complaints should undergo polysomnography, fill in questionnaires and be offered treatment for sleep disorders before the diagnose ME/CFS is set.
Obstructive sleep apnea (OSA) is a risk factor for hypertension. The SKUP3 study showed that modified uvulopalatopharyngoplasty (UPPP) significantly improved nocturnal respiration, sleepiness, and quality of life. The aim of this study was to evaluate the impact of surgery on blood pressure in patients with OSA.
We used a single-center randomized controlled trial to compare modified UPPP with controls at baseline and after six months. The controls received delayed surgery with an additional six-month follow-up. All operated patients also had a follow-up after 24 months. Polysomnography was performed at each follow-up, with systolic and diastolic blood pressure (SBP, DBP) measured the morning after.
A total of 65 patients were randomized to intervention (n = 32) or control (n = 33). At follow-up (n = 61/65, 94%), there were significant differences between the groups in both mean SBP (−9.4 mmHg [95% CI: −17.9, −0.83], p < 0.05) and mean DBP (−6.4 mmHg [95% CI: −12.8, −0.04], p < 0.05), in favor of UPPP. Blood pressure and respiratory parameters at follow-up correlated. The analyses of all operated patients showed a significant decrease in mean (SD) blood pressure after six months (n = 49/65, 75%; SBP: −4.5 [9.0], p = 0.001; DBP: −2.2 [6.6], p = 0.030) as well as after 24 months (n = 35/65, 54%; SBP: −8.9 [11.5], p < 0.0001; DBP: −4.2 [9.4], p = 0.012).
Blood pressure was significantly decreased after surgery, indicating that modified UPPP decreases the blood pressure, in a selected group of patients with moderate to severe OSA. The long-term effect was also significant, but these results are uncertain due to a high proportion of missing values.
IMPORTANCE Adenotonsillectomy (ATE) is the primary surgical method for treating obstructive sleep apnea (OSA) in children. However, children with severe OSA have an increased risk for residual OSA after ATE. Previous studies indicate that adenopharyngoplasty (APP), a modified ATE with closure of the tonsillar pillars, might improve the surgical outcome, but the overall evidence is weak. OBJECTIVE To determine whether APP is more effective than ATE for treating severe OSA in otherwise healthy children. DESIGN, SETTING. AND PARTICIPANTS A blinded randomized clinical trial was conducted at the otorhinolaryngology department at Karolinska University Hospital, Stockholm, Sweden. Eighty-three children, aged 2 to 4 years, with an obstructive apnea-hypopnea index (OAHI) score of 10 or higher, were randomized to APP (n = 36) or ATE (n = 47). Participants were recruited from December 1, 2014, through November 31, 2016. INTERVENTIONS Adenotonsillectomy was performed in all 83 patients in both groups by the cold steel technique. The APP group also underwent closure of the tonsillar pillars with 2 inverted sutures on each side. MAIN OUTCOMES AND MEASURES The primary outcome was the difference between the groups in OAHI score change before and after surgery. A higher score indicates worse problems and a score of 10 or higher is defined as severe OSA. The outcome was evaluated per protocol and with intention-to-treat analysis. Secondary outcomes were other polysomnography variables and the Obstructive Sleep Apnea-18 (OSA-18) questionnaire (possible total symptom score range, 18-126; higher scores indicate worse quality of life). Polysomnography was performed and the OSA-18 questionnaire was completed preoperatively and 6 months postoperatively. RESULTS A total of 83 children (49 [59%] boys; mean [SD] age, 36.6 [9.2] months) were included in the study. Of these, 74(89%) (APP, n = 30; ATE, n = 44) completed the study. The mean (SD) preoperative OAHI score was 23.8 (11.8) for APP and 23.8 (11.5) for ATE. Both the APP and ATE groups had a significant decrease in mean OAHI score after surgery (-21.7; 95% CI, -26.3 to -17.2; and -21.1; 95% CI, -24.5 to -17.7, respectively), but there was no significant difference between the groups (0.7; 95% CI, -4.8 to 6.1). Furthermore, no significant differences between the groups were seen regarding other polysomnography variables (eg, respiratory distress index: mean, 0.6; 95% CI, -5.0 to 6.3) or the OSA-18 questionnaire (eg, total symptom score: -0.5; 95% CI, -13 to12). One patient from each group was readmitted owing to postoperative bleeding, but no other complications were seen. CONCLUSIONS AND RELEVANCE This trial did not show that APP was more effective than ATE alone to treat otherwise healthy children with severe OSA. This finding suggests that ATE should continue to be the primary treatment for OSA in children.
Recent studies have demonstrated extraordinary diversity in peripheral blood human natural killer (NK) cells and have suggested environmental control of receptor expression patterns on distinct subsets of NK cells. However, tissue localization may influence NK cell differentiation to an even higher extent and less is known about the receptor repertoire of human tissue-resident NK cells. Advances in single-cell technologies have allowed higher resolution studies of these cells. Here, the power of high-dimensional flow cytometry was harnessed to unravel the complexity of NK cell repertoire diversity in liver since recent studies had indicated high heterogeneity within liver NK cells. A 29-color flow cytometry panel allowing simultaneous measurement of surface tissue-residency markers, activating and inhibitory receptors, differentiation markers, chemokine receptors, and transcription factors was established. This panel was applied to lymphocytes across three tissues (liver, peripheral blood, and tonsil) with different distribution of distinct NK cell subsets. Dimensionality reduction of this data ordered events according to their lineage, rather than tissue of origin. Notably, narrowing the scope of the analysis to the NK cell lineage in liver and peripheral blood separated subsets according to tissue, enabling phenotypic characterization of NK cell subpopulations in individual tissues. Such dimensionality reduction, coupled with a clustering algorithm, identified CD49e as the preferred marker for future studies of liver-resident NK cell subsets. We present a robust approach for diversity profiling of tissue-resident NK cells that can be applied in various homeostatic and pathological conditions such as reproduction, infection, and cancer.
Human innate lymphoid cells have been described to exist in different organs, with functional deregulation of these cells contributing to several disease states. Here, we performed the first detailed characterization of the phenotype, tissue‐residency properties, and functionality of ILC1s, ILC2s, and ILC3s in the human adult and fetal liver. In addition, we investigated changes in the ILC compartment in liver fibrosis. A unique composition of tissue‐resident ILCs was observed in nonfibrotic livers as compared with that in mucosal tissues, with NKp44− ILC3s accounting for the majority of total intrahepatic ILCs. The frequency of ILC2s, representing a small fraction of ILCs in nonfibrotic livers, increased in liver fibrosis and correlated directly with the severity of the disease. Notably, intrahepatic ILC2s secreted the profibrotic cytokine IL‐13 when exposed to IL‐33 and thymic stromal lymphopoetin (TSLP); these cytokines were produced by hepatocytes, hepatic stellate cells (HSCs), and Kupffer cells in response to TLR‐3 stimulation. In summary, the present results provide the first detailed characterization of intrahepatic ILCs in human adult and fetal liver. The results indicate a role for ILC2s in human liver fibrosis, implying that targeting ILC2s might be a novel therapeutic strategy for its treatment.
To estimate sibling risk of hospitalization for children with sleep disordered breathing (SDB), diagnosed with (1) obstructive sleep apnea syndrome (OSAS), or (2) adenotonsillar hypertrophy in the total Swedish population.
Design, Setting, and Participants:
Using the MigMed database at the Karolinska Institute, we divided the population of Sweden aged 0–18 years into sibling groups based on a shared mother and father and presence of a primary hospital diagnosis of OSAS or adenotonsillar hypertrophy for each individual born between 1978 and 1986, during the follow-up period 1997–2004. Individuals with at least one affected sibling were identified and the incidence rates were computed, using standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). Reference groups were boys and girls with unaffected siblings of 2 or more.
After accounting for socioeconomic status, age, and geographic region, boys with at least one sibling with OSAS had an increased risk of having OSAS (SIR, 33.2; 95% CI, 16.5–64.8), and in girls the SIR was 40.5 (19.4–81.4). For hypertrophy of the tonsils or hypertrophy of the adenoids and tonsils the corresponding SIRs were 4.53 (3.0–6.8) for boys and 4.94 (3.3–7.4) for girls.
The study indicate an increased sibling risk of sleep disordered breathing in children, which may be due to heritable genes and/or shared environment such as increased awareness among family members or referring doctors. Caregivers should ask parents if siblings have similar symptoms, and thus offer them early treatment.
Previous studies have found associations between pediatric sleep-disordered breathing (SDB) and socioeconomic status (SES), as well as a neighborhood-related disadvantage. This study analyzes the association among familial SES, parental occupation, and SDB in Swedish offspring.
A nationwide dataset was constructed by linking Swedish census data to hospital discharge register data on all first hospitalizations of children and adolescents aged 0–18 years during the study period 1997–2007. The outcome was SDB, defined as diagnostic codes for obstructive sleep apnea (OSA), adenotonsillar hypertrophy, or tonsillar hypertrophy. Familial SES was defined as family income and maternal education. The odds ratio (OR) was calculated with a 95% confidence interval (CI).
34,933 of three million children had a first hospital diagnosis of SDB. The OR was significantly increased in offspring in families with a low income (1.79) and maternal education (1.21). Significantly increased ORs were found in 14 of 38 maternal (37%) and 13 of 48 paternal (27%) occupations, and six of them involved both parents: drivers, welders, and workers in mechanics and iron metalware, chemical processing, and manufacture of food and glass. A significantly decreased OR was found in 12 (25%) of the paternal occupations, e.g., scientists, physicians, teachers, artists, administrators, and farmers, as well as in maternal occupations, such as artists and farmers, with offspring aged 0–6 years.
This study indicates that low familial SES and parental occupations associated with a low educational level increased, whereas academic parental occupations and farmers decreased the risk of SDB in offspring.
Conclusion: The Friedman tongue position demonstrated only a slight inter-examiner agreement among 15 medical doctors, indicating that the method is difficult to perform and could be an uncertain method to select patients for uvulopalatopharyngoplasty.
Objective: The Friedman staging system is a clinical tool for selecting patients with obstructive sleep apnea who are appropriate for uvulopalatopharyngoplasty. The objective of this study was to evaluate the staging system by determining the inter-examiner agreement of one of its key components, the Friedman tongue position.
Methods: Eleven residents and four specialists in Otorhinolaryngology were recruited from a course in surgical management of obstructive sleep apnea. They examined each other's tongue positions, resulting in a total of 210 evaluations. Cohen's kappa analysis was performed to assess the inter-examiner agreement. The range of kappa is usually between 0–1, where 0 is complete disagreement and 1 is complete agreement.
Results: The median kappa was 0.36 (1st and 3rd quartile, 0.23 and 0.42), corresponding to only a slight agreement.
Understanding the genetic transmission of obstructive sleep apnea syndrome (OSAS) will help clinicians identify patients at risk and offer opportunities for intervention and treatment at specialist clinics.
To estimate familial risk of hospitalization for OSAS in the adult population of Sweden, and to determine if there are any differences by age and sex.
Design, setting, and participants:
Using the MigMed database at the Karolinska Institute, we divided the population of Sweden into sibling groups based on a shared mother and father and ascertained the presence or absence of a primary hospital diagnosis of OSAS in each individual during the follow-up period, 1997 to 2004. Individuals were categorized as having or not having a sibling with OSAS, based on the presence or absence of the disorder in at least 1 of their siblings. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were estimated for men and women with a sibling with OSAS, compared with men and women in the reference group (SIR = 1).
After accounting for socioeconomic status, age, geographic region, and period of diagnosis, men with at least 1 sibling who had OSAS had a SIR of 3.42 (95% CI, 2.18–5.36); the corresponding SIR in women was 3.25 (95% CI, 1.84–5.65).
Our results indicate that physicians should consider family history of OSAS when deciding whether to refer a patient for further sleep examinations.
Conclusions: Uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnoea syndrome (OSAS) who had failed treatment with continuous positive airway pressure (CPAP) and mandibular retaining device (MRD) was effective and safe. The satisfaction rate was high. We recommend UPPP in selected OSAS patients, especially younger patients. Objectives: To evaluate the efficacy and complication rate of UPPP. Patients and methods: This was a non-randomized prospective study of 139 men and 19 women, median age 45 years (range 20–75), median body mass index (BMI) 29 (range 20–48), who underwent UPPP. One year follow-up comprised ambulant sleep apnoea recordings and questionnaires with the Epworth Sleepiness Scale (ESS). Results: In all, 76% of the patients underwent sleep recordings preoperatively and postoperatively. The oxygen desaturation index (ODI4) decreased from median 23 (range 6–100) to 8 (range 0–60), p<0.001. Criteria of success (>50% reduction and ODI<20), was 64%. The ESS value decreased from median 12 (range 0–21) to 6 (0–22), p<0.001. In all, 88% of the patients were satisfied. Four of 158 patients (2.5%) had serious postoperative complications. There was neither sequel of complications nor mortality.
Conclusions: The results indicate that conservative uvulopalatopharyngoplasty with tonsillectomy (UPPP) did not change the degree of pharyngeal disturbances in patients with obstructive sleep apnea syndrome (OSAS). Objectives: To investigate if the symptom scores of pharyngeal disturbances in OSAS patients were changed 1 year after UPPP, by using a questionnaire pre- and postoperatively, and to compare with healthy non-snoring controls. Methods: Fifty men and eight women, median age 46 years (range 25–75), median body mass index (BMI) 28 kg/m2 (20–38), and median preoperative oxygen desaturation index 16 (7–100) were included as they had all failed non-surgical treatment and wanted pharyngeal surgery. The questionnaire consisted of 10 questions with 4 degrees of disturbances; the maximum score was 30 and was evaluated before and 1 year after surgery. Fifteen age-, gender- and BMI-matched controls responded to the same questionnaire. Results: Responses to the questionnaire were provided pre- and postoperatively by 47 of 58 patients (81%). Their median score was unchanged from 5 (range 0–17) to 5 (0–19), compared with controls 1 (0–3). Analyses of separate questions showed a significant decrease in the score for 'globus sensation' and 'swelling' postoperatively.
To estimate the incidence of hospitalization for paediatric obstructive sleep apnoea syndrome (OSAS) or sleep-disordered breathing (SDB) caused by adenotonsillar or tonsillar hypertrophy without infection in children with a parent affected by OSAS.
Patients and methods
Using the MigMed database at Lund University, hospital data on all children aged 0–18 years in Sweden between 1997 and 2007 (total of 3 million individuals) were used to identify all first hospital admissions for OSAS or either adenotonsillar or tonsillar hypertrophy. Next, individuals were categorized as either having or not having a parent affected by OSAS. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were estimated for boys and girls with a parent affected by OSAS. Children with OSAS or adenotonsillar or tonsillar hypertrophy without a parent affected by OSAS acted as the reference group (SIR = 1).
After accounting for socio-economic status, age, and geographic region, the SIRs of OSAS in boys and girls with a parent affected by OSAS were 3.09 (95% CI 1.83–4.90) and 4.46 (95% CI 2.68–6.98), respectively. The SIRs of adenotonsillar or tonsillar hypertrophy in boys and girls with a parent affected by OSAS were 1.82 (95% CI 1.54–2.14) and 1.56 (95% CI 1.30–1.87), respectively.
This study indicates familial clustering of sleep-disordered breathing, which is important information for clinicians.
Background: Group 2 innate lymphoid cells (ILC2s) are involved in the initial phase of type 2 inflammation and can amplify allergic immune responses by orchestrating other type 2 immune cells. Prostaglandin (PG) E-2 is a bioactive lipid that plays protective roles in the lung, particularly during allergic inflammation.
Objective: We set out to investigate how PGE(2) regulates human ILC2 function.
Methods: The effects of PGE(2) on human ILC2 proliferation and intracellular cytokine and transcription factor expression were assessed by means of flow cytometry. Cytokine production was measured by using ELISA, and real-time quantitative PCR was performed to detect PGE(2) receptor expression.
Results: PGE(2) inhibited GATA-3 expression, as well as production of the type 2 cytokines IL-5 and IL-13, from human tonsillar and blood ILC2s in response to stimulation with a combination of IL-25, IL-33, thymic stromal lymphopoietin, and IL-2. Furthermore, PGE(2) downregulated the expression of IL-2 receptor alpha (CD25). In line with this observation, PGE(2) decreased ILC2 proliferation. These effects were mediated by the combined action of E-type prostanoid receptor (EP) 2 and EP4 receptors, which were specifically expressed on ILC2s.
Conclusion: Our findings reveal that PGE(2) limits ILC2 activation and propose that selective EP2 and EP4 receptor agonists might serve as a promising therapeutic approach in treating allergic diseases by suppressing ILC2 function.
Objective: We set out to examine PG production in human ILC2s and the implications of such endogenous production on ILC2 function. Methods: The effects of the COX-1/2 inhibitor flurbiprofen, the hematopoietic prostaglandin D2 synthase (HPGDS) inhibitor KMN698, and the CRTH2 antagonist CAY10471 on human ILC2s were determined by assessing receptor and transcription factor expression, cytokine production, and gene expression with flow cytometry, ELISA, and quantitative RT-PCR, respectively. Concentrations of lipid mediators were measured by using liquid chromatography-tandem mass spectrometry and ELISA. Results: We show that ILC2s constitutively express HPGDS and upregulate COX-2 upon IL-2, IL-25, and IL-33 plus thymic stromal lymphopoietin stimulation. Consequently, PGD2 and its metabolites can be detected in ILC2 supernatants. We reveal that endogenously produced PGD2 is essential in cytokine-induced ILC2 activation because blocking of the COX-1/2 or HPGDS enzymes or the CRTH2 receptor abolishes ILC2 responses. Conclusion: PGD2 produced by ILC2s is, in a paracrine/autocrine manner, essential in cytokine-induced ILC2 activation. Hence we provide the detailed mechanism behind how CRTH2 antagonists represent promising therapeutic tools for allergic diseases by controlling ILC2 function.
Amniotic fluid (AF) surrounds the growing fetus, and cells derived from AF are commonly used for diagnosis of genetic diseases. Intra-amniotic infections are strongly linked to preterm birth, which is the leading cause of perinatal mortality worldwide. Surprisingly little is known, however, about mature hematopoietic cells in AF, which could potentially be involved in immune responses during pregnancy. In this study, we show that the dominating population of viable CD45+ cells in AF is represented by a subset of fetal CD103+ group 3 innate lymphoid cells (ILCs) producing high levels of IL-17 and TNF. Fetal CD103+ ILC3s could also be detected at high frequency in second-trimester mucosal tissues (e.g., the intestine and lung). Taken together, our data indicate that CD103+ ILC3s accumulate with gestation in the fetal intestine and subsequently egress to the AF. The dominance of ILC3s producing IL-17 and TNF in AF suggests that they could be involved in controlling intra-amniotic infections and inflammation and as such could be important players in regulating subsequent premature birth.
The Ikaros family of transcription factors (TFs) are important regulators of lymphocyte function. However, their roles in human innate lymphoid cell (ILC) function remain unclear. Here, we found that Ikaros (IKZF1) is expressed by all ILC subsets, including NK cells, in blood, tonsil, and gut, while Helios (IKZF2) is preferentially expressed by ILC3 in tonsil and gut. Aiolos (IKZF3) followed the expression pattern of T-bet and Eomes, being predominantly expressed by ILC1 and NK cells. Differentiation of IFN-γ-producing ILC1 and NK cells from ILC3 by IL-1β plus IL-12-stimulation was associated with upregulation of T-bet and Aiolos. Selective degradation of Aiolos and Ikaros by lenalidomide suppressed ILC1 and NK cell differentiation and expression of ILC1 and NK cell-related transcripts (LEF1, PRF1, GRZB, CD244, NCR3, and IRF8). In line with reduced ILC1/NK cell differentiation, we observed an increase in the expression of the ILC3-related TF Helios, as well as ILC3 transcripts (TNFSF13B, IL22, NRP1, and RORC) and in the frequency of IL-22 producing ILC3 in cultures with IL-1β and IL-23. These data suggest that suppression of Aiolos and Ikaros expression inhibits ILC1 and NK cell differentiation while ILC3 function is maintained. Hence, our results open up for new possibilities in targeting Ikaros family TFs for modulation of type 1/3 immunity in inflammation and cancer.
Conclusions.Elective tracheostomy with custom-made tubes was tolerated in a majority of patients with severe obstructivesleep apnoea syndrome (OSAS), as it reduced daytime symptoms and served as a link to other treatments.Objectives.Toevaluate the tolerability of elective tracheostomy and changes in excessive daytime sleepiness and nocturnal oxygendesaturations (ODI) in patients with severe OSAS and obesity.Patients and methods.The medical records of 10 patients,median age 53.5 years (range 3177), BMI 36 kg/m2(3150), ODI 81 (55126) during a 5-year period were reviewed.Inclusion criteria were failure of continuous positive airway pressure (CPAP), acceptance of tracheostomy, excessivedaytime sleepiness and ODI50. All patients received a custom-made tube. Sleep apnoea recordings and questionnaireswith Epworth sleepiness scale (ESS) were performed before and after tracheostomy.Results.Eight of 10 patients toleratedthe tube for more than 6 months. The ESS score was reduced from median 18 (range 823) to 5 (07) and the ODI valuesfrom 81 (55126) to 13 (187). Two patients insisted on decannulation because they had nocturnal breathing problems,two underwent palatal surgery and were decannulated, and five still have their tubes. Severe cough, sputum infections andstoma granuloma were seen in all patients.
Our previous randomized controlled trial of patients with obstructive sleep apnea syndrome (OSAS) showed that modified uvulopalatopharyngoplasty (UPPP), including tonsillectomy, significantly improved nocturnal respiration, daytime sleepiness, and quality of life in the intervention group compared to controls who had delayed surgery after 6 months. This is the continuous report with the 6‐ and 24‐month postoperative results.
Single‐center prospective cohort study.
Sixty‐five patients with apnea–hypopnea index (AHI) ≥ 15, body mass index (BMI) < 36, Epworth Sleepiness Scale (ESS) ≥ 8, and Friedman stage I or II underwent UPPP after failing nonsurgical treatment. The results from polysomnography and ESS at 6 and 24 months were compared to baseline.
Eight percent and 20% dropped out from the 6‐ and 24‐month follow‐ups, respectively. The AHI value decreased significantly from mean (standard deviation) 52.9 (20.5) at baseline to 23.6 (20.2) after 6 months, and to 24.1 (20.9) after 24 months (P < 0.001). Patients with tonsil size 2, and 3 to 4, had significant reductions in the AHI after both follow‐ups. The median ESS score decreased significantly from 13 (range 8–21) to 6.5 (1–18) after 6 months, and to 5 (2–17) after 24 months (P < 0.001). The BMI remained unchanged. There were significant modest correlations for the reductions in AHI and ESS after 24 months.
Modified UPPP was effective in improving nocturnal respiration and daytime sleepiness in OSAS patients at both 6‐ and 24‐month follow‐up. Patients with tonsil size 2, and 3 to 4, benefitted similarly from surgery with improved respiration.
Objective To assess the 6-month efficacy of uvulopalatopharyngoplasty (UPPP) compared with expectancy in selected patients with obstructive sleep apnoea syndrome (OSAS).
Design A prospective single-centre randomised controlled trial with two parallel arms stratified by Friedman stage and body mass index (BMI).
Participants 65 consecutive patients with moderate to severe OSAS (apnoea-hypopnoea index (AHI) ≥15 events/h sleep), BMI <36 kg/m2, Epworth sleepiness scale ≥8, Friedman stage I or II.
Intervention Surgical treatment with UPPP. The control group underwent UPPP after a delay of 6 months.
Outcomes Changes in AHI and other polysomnography parameters at baseline compared with the 6-month follow-up.
Results All patients (32 in the intervention group and 33 in the control group) completed the trial. The mean (SD) AHI in the intervention group decreased significantly (p<0.001) by 60% from 53.3 (19.7) events/h to 21.1 (16.7) events/h . In the control group the mean AHI decreased by 11% from 52.6 (21.7) events/h to 46.8 (22.8) events/h, with a significant difference between the groups (p<0.001). The mean time in the supine position and the BMI were unchanged in both groups. Subgroup analyses for Friedman stage, BMI group and tonsil size all showed significant reductions in AHI in the intervention group compared with controls. There were no severe complications after surgery.
Conclusions This trial demonstrates the efficacy of UPPP in treating selected patients with OSAS with a mean reduction in AHI of 60% compared with 11% in controls, a highly significant and clinically relevant difference between the groups.
Trial registration number NCT01659671.
Randomized controlled pilot study of the effect of weight reduction on nocturnal respiratory parameters in obese patients with obstructive sleep apnoea syndrome (OSAS).
Twenty consecutive obese male patients fulfilling OSAS criteria at Karolinska University Hospital were randomized into two groups. Intervention with an 8-week weight reduction programme consisting of a low-calorie diet, together with group meetings, was evaluated compared to expectancy alone for the control group, followed by a crossover. Follow-up at 3 months included anthropometrics and ambulant sleep apnoea recordings.
Eleven of twenty men completed the protocol. There were significant differences between the intervention group (n = 6) and the control group (n = 5) in changes of weight (p < 0.01) and oxygen desaturation index (ODI4) (p < 0.05). We also found a significant positive correlation in these 11 males after the crossover between their reduction in weight and their reduction in ODI4 (p < 0.05).
This pilot study indicates that weight reduction improves nocturnal respiration in obese OSAS patients after 3 months' dietary treatment compared to expectancy.
Study Objectives:
To evaluate the effects of a 2-year weight reduction program on respiratory disturbances, arousal index, daytime sleepiness, metabolic status, and quality of life in obese patients with obstructive sleep apnea syndrome (OSAS).
Prospective intervention study of 33 consecutive obese OSAS patients (24 men, 9 women); 19 subjects used continuous positive airway pressure and 4 used mandibular retaining device, except during nights with sleep recording. The program consisted of 8 weeks of low calorie diet followed by group meetings with behavioral change support.
Seventy percent of the patients completed the program; 67% completed the sleep recordings. The success rate for the apnea-hypopnea index (AHI) (< 20 and reduction ≥ 50%) was 15% in the intention to treat (ITT) analysis. The AHI showed a nonsignificant decrease in mean values, from 43 to 28. The oxygen desaturation index (ODI) decreased from 42 to 23 (p = 0.010), arousal index from 24 to 11 (p = 0.019), body mass index from 40 to 35 (p = 0.003) and the Epworth Sleepiness Scale (ESS) from 9 to 5 (p = 0.026), all ITT. Metabolic status, physical functioning, and vitality evaluations improved only in the per protocol analysis. Reduction in weight correlated significantly to reductions in ESS (p = 0.038) and insulin levels (p = 0.002), respectively. There were no differences based on gender or use/non-use of OSAS treatment device.
Our weight reduction program showed a limited success in reducing AHI. However, there were significant improvements in weight, ODI, arousal index, and subjective symptoms. We recommend the program as an adjunct treatment for well-motivated obese OSAS patients.
Nerfeldt P; Nilsson BY; Mayor L; Uddén J; Friberg D. A two-year weight reduction program in obese sleep apnea patients. J Clin Sleep Med 2010;6(5):479-486.
Keywords: Sleep apnea, obesity, weight reduction, diet, quality of life, sleepiness, behavioral therapy
In this prospective intervention study, 33 obese patients with obstructive sleep apnoea syndrome (OSAS) (24 men, 9 women) were consecutively enrolled for a weight reduction program at the Obesity Unit, Karolinska University Hospital. 23 of 33 patients used OSAS-device, 19 with Continuous Positive Airway Pressure and 4 with Mandibular Retaining Device. The patients were investigated with questionnaires, blood tests and ambulant nocturnal polysomnography before and after a 6-month program. Patients with OSAS-device slept without it during the sleep studies. The intervention consisted of 8 weeks low calorie diet and group meetings, followed by a day-care program of behaviour change support.
27 of 33 patients (82%, 21 men and 6 women) completed the study. After the intervention there were highly significant decreases (p < 0.001) in Body Mass Index from mean(S.D.) 40(5) to 34(3), apnoea–hypopnoea index from 43(24) to 26(20) and Epworth Sleepiness Scale (ESS)-score from 9(4) to 6(4). Sleep quality (arousal index, sleep efficiency, percentage deep sleep) and metabolic status (blood pressure, blood glucose levels, lipidemia) were also significantly improved. There was a significant correlation between increased percentage deep sleep and reduced ESS-score. There were no differences due to gender or use/no use of OSAS-device.
The results suggest that weight loss, induced by low calorie diet and behaviour change support, significantly improves nocturnal respiratory parameters, sleep quality, daytime sleepiness and metabolic status in obese OSAS patients after 6 months.
Study Objectives
To compare adherence and treatment effects with an oral appliance (OA) in patients with different types of obstructive sleep apnea (OSA): those with mainly respiratory arousals ("arousers"), and those with oxygen desaturations ("desaturaters") at polysomnography (PSG).
A prospective intervention study on 72 "tired snorers" with "normal" home sleep study (HSS), but later diagnosed as OSA with PSG, who accepted OA treatment. They were offered evaluation with a follow-up PSG and questionnaires, including the Epworth Sleepiness Scale (ESS), general health (GH), satisfaction, and side effects.
Sixty-six patients, 33 arousers and 33 desaturaters, were adapted to OA. The 1-year adherence rate was significantly higher among arousers (85%) than desaturaters (55%) (p = 0.034). Thirty-six of 66 patients underwent follow-up PSG; the apnea-hypopnea index was significantly reduced in 22 arousers from a median of 14 to 3 (p < 0.001), and in 14 desaturaters from 18 to 7 (p = 0.002; no significant group difference). ESS and GH showed no significant improvements in either group, although sleepy "arousers" (ESS ≥ 10) significantly improved their ESS. In total, 77% reported side effects, while 63% were still satisfied with the OA treatment. Gender analysis showed a significant dominance of females classified as "arousers" (p = 0.025).
OSA patients with mainly arousals at PSG showed higher adherence to OA treatment, compared to patients with desaturations. Both groups responded similarly to treatment: improved nocturnal respiration, but only a small reduction of symptoms. We suggest that "tired snorers" with "normal HSS" should be offered PSG, and if OSA, also OA treatment.
Natural killer (NK) cells are cytotoxic lymphocytes and play a vital role in controlling viral infections and cancer. In contrast to B and T lymphopoiesis where cellular and regulatory pathways have been extensively characterized, the cellular stages of early human NK cell commitment remain poorly understood. Here we demonstrate that a Lin−CD34+CD38+CD123−CD45RA+CD7+CD10+CD127− population represents a NK lineage-restricted progenitor (NKP) in fetal development, umbilical cord blood, and adult tissues. The newly identified NKP has robust NK cell potential both in vitro and in vivo, generates functionally cytotoxic NK cells, and lacks the ability to produce T cells, B cells, myeloid cells, and innate lymphoid-like cells (ILCs). Our findings identify an early step to human NK cell commitment and provide new insights into the human hematopoietic hierarchy.
The Friedman staging system is a clinical method for selecting patients with obstructive sleep apnoea who are likely to benefit from uvulopalatopharyngoplasty. The objective of this study was to evaluate the system by determining its inter-examiner agreement. Twelve patients with obstructive sleep apnoea were examined by 14 doctors. The Friedman stage was derived from tonsil size and tongue position, and a Cohen's kappa analysis was performed to assess inter-examiner agreement. One hundred and sixty-eight ratings were performed. The median kappa for tongue position was 0.32 (first and third quartiles: 0.21 and 0.44) and was 0.62 (0.50 and 0.63) for tonsil size. The median kappa for the Friedman stage was 0.38 (0.24 and 0.55), which corresponds to only a slight or fair agreement. The Friedman staging system demonstrated a low inter-examiner agreement, indicating that the system is an uncertain method for selecting patients for uvulopalatopharyngoplasty. Level of evidence: 2B.
Study Objectives: To investigate whether uvulopalatopharyngoplasty (UPPP) improves sleep quality in patients with obstructive sleep apnea (OSA) using the Functional Outcomes of Sleep Questionnaire (FOSQ) and the Karolinska Sleep Questionnaire (KSQ).
Methods: Randomized controlled trial used to compare modified UPPP with controls at baseline and after 6 months. The controls received delayed surgery and a 6-month postoperative follow-up. All operated patients were offered a 24-month follow-up. At each follow-up, patients underwent polysomnography and vigilance testing and completed questionnaires. Nine scales were evaluated: five subscales and the total score in the FOSQ and three subscales in the KSQ.
Results: Sixty-five patients, mean 42.3 years (SD 11.5), Friedman stage I and II, body mass index < 36 kg/m(2), and moderate-to-severe OSA, were randomized to intervention (n = 32) or control (n = 33). In the FOSQ and in the KSQ, the mean rate of missing values was 6.2% (range 0%-19%) and 20.5% (3%-38%), respectively. In 8 of 9 scales, significant differences were observed between the groups in favor of UPPP. There were significant correlations between results from the questionnaires and objective measures from polysomnography and the vigilance test. At the 6- and 24-month postoperative follow-ups, eight of nine scales were significantly improved compared with baseline.
Conclusions: In selected patients with OSA, subjective sleep quality was significantly improved 6 months after UPPP compared with controls, with stable improvements 24 months postoperatively. The correlations between subjective and objective outcomes and the long-term stability suggest a beneficial effect from surgery, although a placebo effect cannot be excluded.
Vitamin D deficiency is a risk factor for inflammatory bowel disease (IBD). The IL-23–driven tissue-resident group 3 innate lymphoid cells (ILC3s) play essential roles in intestinal immunity, and targeting IL-23/12 is a promising approach in IBD therapy.
We set out to define the role of 1α,25-dihydroxy vitamin D3 (1,25D) in regulating functional responses of human mucosal ILC3s to IL-23 plus IL-1β stimulation.
Transcriptomes of sorted tonsillar ILC3s were assessed by using microarray analysis. ILC3 cytokine production, proliferation, and differentiation were determined by means of flow cytometry, ELISA, and multiplex immunoassay. Intestinal cell suspensions and ILC3s sorted from gut biopsy specimens of patients with IBD were also analyzed along with plasma 25-hydroxy vitamin D3 (25D) detection.
ILC3s stimulated with IL-23 plus IL-1β upregulated the vitamin D receptor and responded to 1,25D with downregulation of the IL-23 receptor pathway. Consequently, 1,25D suppressed IL-22, IL-17F, and GM-CSF production from tonsillar and gut ILC3s. In parallel, 1,25D upregulated genes linked to the IL-1β signaling pathway, as well as the IL-1β–inducible cytokines IL-6, IL-8, and macrophage inflammatory protein 1α/β. The 1,25D-triggered skewing in ILC3 function was not accompanied or caused by changes in viability, proliferation, or phenotype. Finally, we confirmed low 25D plasma levels in patients with IBD with active inflammation.
In light of the beneficial targeting of IL-23/12 in patients with IBD, 1,25D appears as an interesting therapeutic agent that inhibits the IL-23 receptor pathway, providing a novel mechanism for how ILC3s could be manipulated to regulate intestinal inflammation.
Influenza A virus (IAV) infection constitutes an annual health burden across the globe. Plasmacytoid dendritic cells (PDCs) are central in antiviral defense because of their superior capacity to produce type I IFNs in response to viruses. Dendritic cells (DCs) differ depending on their anatomical location. However, only limited host-pathogen data are available from the initial site of infection in humans. In this study, we investigated how human tonsil PDCs, likely exposed to virus because of their location, responded to IAV infection compared with peripheral blood PDCs. In tonsils, unlike in blood, PDCs are the most frequent DC subset. Both tonsil and blood PDCs expressed several genes necessary for pathogen recognition and immune response, generally in a similar pattern. MxA, a protein that renders cells resistant to IAV infection, was detected in both tonsil and blood PDCs. However, despite steady-state MxA expression and contrary to previous reports, at high IAV concentrations (typically cytopathic to other immune cells), both tonsil and blood PDCs supported IAV infection. IAV exposure resulted in PDC maturation by upregulation of CD86 expression and IFN-alpha secretion. Interestingly, blood PDCs secreted 10-fold more IFN-alpha in response to IAV compared with tonsil PDCs. Tonsil PDCs also had a dampened cytokine response to purified TLR ligands compared with blood PDCs. Our findings suggest that tonsil PDCs may be less responsive to IAV than blood PDCs, highlighting the importance of studying immune cells at their proposed site of function.


text:
Una paz europea – A European Peace
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Por la parte de Paxumal, los abedules techan el camino
y nos oscurecen.
Sólo al pasar Riparape vuelve a abrirse
y vemos el valle, otra vez, estrecho y hondo,
entre los huecos que dejan las colinas, encajadas como nudillos.
Tenemos poco prado y es empruno. Repartos de repartos familiares que disminuyen de hermano a hermano, de primo en primo, por todo el monte.
Cada árbol tiene su tiempo. Cuando le toca, descarga. O suben los gusanos. O las nubes de la fábrica coinciden con la lluvia y el fruto cuece en la rama.
Vamos de un árbol a otro, pisando fruta podre, viendo qué nos queda: prunos, piescos, manzanas de sidra, manzanas de asar, manzanas de compota.
Mi abuelo saca dos sillas de la chabola. Sabes tú que nun soy de muchu charrar, pero le gusta que nos sentemos fuera, hacia los montes.
De cerca veo otra vez su lunar, el que se mueve. Una esquirla que le saltó en el taller, cuando hacían hexágonos:
uno tenía por la forma, otro descargaba el pilón.
La esquirla entró en el labio y aún avanza con la sangre, azulada.
(En el monte no se entiende el camino.
Las curvas se pliegan y se estiran, a golpes.)
Una vez me enseñaron el árbol de familia, las fechas, los pueblos de los que fuimos bajando: Perabeles en el XVIII,
Les Pieces al cruzar el XX
y, monte abajo, raleando entre la maquinaria,
por El Trabanquín,
hasta El Llungueru.
Treinta quilómetros en trescientos años,
como si lleváramos el valle a cuestas.
On the way to Paxumal, the birches roof the road
and darken us.
Only passing Riparape does it open up again
and we see the valley, once more, narrow and deep,
between the hollows that the hills leave, fitted like
What little land we have slopes steeply. Divided and divided between families, diminishing from brother to brother, cousin to cousin, right across the mountain.
Each tree has its time. When its turn comes, it disburdens. Or the worms crawl up. Or the clouds from the factory coincide with the rain, and the fruit stews on the branches.
We go from tree to tree, treading on rotten fruit, seeing what we're left with: Sloes, peaches, cider apples, cooking apples, apples for compote.
My grandfather takes two chairs from the lean-to. You know I'm not much of a one for chatter, but he likes us to sit outside, facing the mountains.
Close up I see his mole again, the one that moves. A splinter which flew at him in the workshop, while they were making hexagons:
One held the shape, another was driving the hammer.
The splinter entered his lip and still shifts with the blood, bluish.
(In the mountains you can't fathom the road.
The curves fold and stretch, in jolts.)
Once they showed me the family tree, the dates, the villages from which we descended: Perabeles in the 18th Century,
Les Pieces crossing into the 20th
and, down the mountain, dispersing among the machinery,
through El Trabanquín,
up to El Llungueru.
Thirty kilometres in three hundred years,
As if we carried the valley on our shoulders.
THE POEM (Fruela Fernández)
This is the opening section to Una paz europea (Pre-Textos, 2016), a book-length poem that had been a long time in the making, but not in the writing. While my previous book, Folk (Pre-Textos, 2013), interrogated the meaning of belonging, Una paz europea retraces the experience of displacement. Shortly after publishing Folk, I arrived in Britain on a temporary contract, an unwilling move that brought back memories and echoes from my family's time in Belgium in the 1960s (the day before leaving, my grandfather advised me to check for job advertisements in the newspaper, as he had done in Le Soir). In a political and historical sense, I knew I had to complete the narrative of my family, and yet I encountered a personal resistance in the autobiographical, as if my writing was unfit yet: the feelings were there, but the places and the faces were absent, and they reclaimed their right to return. I spent a couple of years away from poetry, focusing on other texts —especially a memory of Northern England through the music of The Smiths—, waiting for the form. It came shortly after a summer visit with my grandfather to our family plot near Les Pieces, a small village on one of the hills forming the coal-mining valley of Langreo in Northern Spain. My grandmother grew up in one of the nearby houses, where her grandfather had founded the local committee of the socialist party PSOE at the beginning of the 20th century, and where he also hid during the first years after the Civil War. Listening to my grandfather on the way back, I had the intuition that the form I needed was emerging with his recollections, with our code-switching between Asturian and Spanish, with the historical burden of the landscape. The pieces fell into place after Les Pieces, so to speak.
THE TRANSLATION (Sarah Hartley)
Reading though the opening section of Una Paz Europea, I was moved and drawn in by the narrative. Despite the differences between my urban English background and the rural Spain depicted here, it brought back my own memories: of collecting raspberries from my grandma's back garden each summer, the familiarity of Hull after living away, and tracing my own family's history. It is at once specific and personal, yet also universal; the themes of homecoming, the connection between generations and to nature, a sense of belonging and tradition transcend language boundaries. Nevertheless, word meanings and connotations do not overlap precisely across languages such that some translation loss is inevitable. For example, the verb descargar (literally discharge), used here to describe the fruit dropping from the tree, can also be used for rain falling suddenly from the clouds, thereby leading to the image of rainfall in the next line. Later the verb describes the action of working a hammer. This web of meanings ties together different images within the poem whereas in English no equivalent word exists which carries all these associations.
The mixture of Asturian and Spanish was also impossible to capture; I toyed with the idea of using English dialect but as the narrative is so deeply embedded in the geography of Asturias, the effect would have been jarring. Another challenge was not only the sense, but the sounds of the words, such as the plosive rhythm of the line tenemos poco prado y es empruno, which can only be partially echoed with other alliteration and assonance. Where possible though, I have tried to mirror the linguistic choices as closely as possible in the target language, juggling meaning, sound and syllables to create something that is alike, although never an exact replica of the original. Finally, there is always some gap between the author's intention and a translator's interpretation. Working with Fruela Fernández on the translation helped enormously in narrowing this gap, but my own ideas and language preferences have invariably come into play. Equally the reader brings their own experiences and interpretations to bear on the text and this is as true of the translation as of the original. That this work can reach a new audience means perhaps that what is found in translation, far outweighs what is lost.

subset: commoncrawl


text:
Title: Red Hot Obsessions (Boxed Set)
Genre: Contemporary Romance
Wordcount: 800000+ or about 3000 pages
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- His Wicked Games (Ember Casey): Lily would do anything to save her father's failing business- even take on the infamous billionaire Calder Cunningham. But she's not prepared for the wicked
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Some of my favs? Were actually the first two I read. His Wicked Games and Fierce. I really liked these two the best because they had such great storylines, and made my heart pound, but they were completely different stories.
His Wicked Games is the adult love story, and it was so fun watching the main character, Lily, as she journeys her way through the man that is Calder, who was one FINE man. 😉 What I loved most about this story was that it didn't oversell anything or anyone. The story ran very smoothly, and usually, when I read short stories, I sometimes feel as if the stories are forced and authors are clamoring to put huge story into less words, and that just annoys me at times. But His Wicked Games was really smooth in that Lily's and Calder's stories weren't rushed at all. In fact, they took their time exploring each other and, even though I felt it was a litttle predictable ;), I still really enjoyed their story and YAY for happy endings 🙂 🙂 I would give it 3.5/4 STARS!
Next, we have Fierce, which was some seriously good reading material 😉 It follows the story of college freshman, Autumn who meets other college freshman, Hunter, but theirs isn't the typical college romance, because Hunter is a bad boy. And when I say bad, I mean BAD. But, I mean bad boys are always the best right? 😉 Hehe. I actually really felt the chemistry between the two, and at times I was feeling for Autumn, because I was like, "What the hell is Hunter doing right now?!", but it all worked out. The thing I liked most about Fierce? The intricately woven story. I had my doubts in the beginning, but it was a great ride. All the plot twists and events had me guessing until the very end and speaking, of the end, YAY! I absolutely loved the ending on Fierce. It was in no way abrupt. Rather, it brought the entire story to an end while bringing the entire story together and giving me and the rest of the audiences the closure needed 😉 It was a GREEAT ending and I LOVED LOVED LOVED HUNTER ❤ 🙂 I give Fierce 4 STARS!
- Olivia Rigal sings every Wednesday night in the karaoke club
- Olivia Rigal went to dog grooming school
- Lacey Silks had a passion for acting when she was a teen. As an extra she met Marlon Brando, Matthew Broderick, Ricky Lake, Brendan Fraser, Jerry O'Connell and Shirly MacLain
- Lacey Silks is afraid of flying. If you ever sit beside her on a plane, don't mind the Hail Mary's. And good luck getting to the bathroom. She will not unbuckle her seat belt through the entire flight
- Before she was an author, Ember casey worked as a pastry chef. She's never met a cake (or puff pastry, or tart, or chocolate truffle) she didn't love
- Ember Casey started writing Romance because her critique group kept telling her that her attempts at Young Adult were too, uh, "adult"
- J.C. Valentine is a reality TV junkie. The Kardashians hold her prisoner often and without mercy
- J.C. Valentine loves thunderstorms. They're perfect for writing
- Clarissa Wild always drinks tea when writing, and she needs at least 2 cups of earl grey tea a day
- Like the main character in her book Fierce, Clarissa Wild is actually quite a book-nerd, and not just that … she loves playing videogames as well
- Sky Corgan actually participates in the BDSM lifestyle as a dominant
- Sky Corgan has to have complete silence while writing, so no coffee shop writing
- V.J. Chambers still watches The Vampire Diaries, and she's still on Team Damon
- V.J. Chambers has a cat called Isis, and she does not like to relinquish the keyboard for her to actually write. She would rather lie on it
- Blair Babylon has lived in 5 US states: Arizona, Connecticut, Iowa, New Jersey and New York
- Blair Babylon was a child actor and model who did over 30 TV commercials and a short-lived PBS series
- During her tween years, Molly McLain began writing while listening to Wednesday night dedications and requests on radio. Since no one ever dedicated a romantic song to her, she made up her own love stories instead. To this day, all it takes to get the creative juices flowing is a little REO Speedwagon
- Molly McLain is a closet WWE fan. She may or may not fangirl over Randy Orton to the point her children refer to him as her boyfriend. They're also kind enough to pause the TV when he's on so she can drool
- Although Daizie Draper's pretty kinky, she's more of a switch than a straight-up sub. The BDSM in Sorority Pledge veers into many untested areas for her because Addison, the sub in the story, learns she's masochistic, which I Daizie is not
- One of Daizie's quirky things is that she hates crumbs, like stepping on them with her bare feet. It just irks her like nothing else
A Kindle is up for grabs!!


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A few obvious examples:
Aggression: too much, and you go to jail. Historically, prison conditions were awful enough in the West that this likely exerted an upper bound on the population's criminality by eliminating violent people from the gene pool.
But too little, and you get taken advantage of. You can't compete in job interviews, get promoted, make friends, or ask people out on dates. Aggressive people take your stuff, and you can't protect against them.
From getting jobs to getting mates to not being mugged, a little bit of aggression is clearly a good thing.
Intelligence: High IQ is tremendously mal-adaptive in modern society. (This may always have been true.) The upper end of the IQ curve basically does not have children. (On both micro and macro levels.) I'm not prepared to say whether this is a bug or a feature.
But, low IQ appears to also maladaptive. This was certainly true historically in the West, where extremely high death rates and intense resource competition left the dumber members of society with few surviving offspring. Dumb people just have trouble accomplishing the things necessary for raising lots of children.
Somewhat above average IQ appears to be the most adaptive, at least in the present and possibly historically.
Height: Really tall men have health problems and die young. Really short men are considered undateable and so don't have children. So the pressure is to be tall, but not too tall.
(Speculatively) Depression: Too much depression, and you commit suicide. Not enough, and you're a happy-go-lucky person who drops out of school and punches people. Just enough, and you work hard, stay true to your spouse, don't get into fights, and manage to do all of the boring stuff required by Western society. (Note: this could have changed in the past hundred years.)
Sickle Cell Anemia: I don't think I need to explain this one.
(Also speculative) Tay Sach's: Tay Sach's is a horrible neurological disease that shows up in populations with evidence of very high recent pressure to increase IQ, such as Ashkenazim (one of the worlds' highest IQ groups) and Quebecois. There is therefore speculation that in its heterozygous form, Tay Sach's may enhance neural development, instead of killing you hideously.


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Yesterday was my 29th birthday. We celebrated small, which is what I want...I like celebrating other people's birthdays much more than my own (except I will take presents, hee hee). Not because I don't want to get older, but because I don't want a day focused on me, it feels weird. Thankfully I share this birthday with someone else...although I don't remember the last time we were together on our birthday? Oh maybe a couple years ago...well anyways, next year my twin, Phillip and I need to do it up big for 30. Maybe Vegas??
Aislynn drew me a picture with 29 ice cream scoops and gave me xoxo and i <3 u silly bandz. From K, A, and S I am getting a massage, facial, and some scrappy things. Instead of cake, we got some ice cream from Kilwins, put it in a big bowl, and stuck 2 candles (for each decade, I guess there will be 3 next year) in it. Shaun made me steak, potatoes, and carrots ( he has a new way of making them with butter and brown sugar, yuuuummm).
It was a nice day:) And no....I don't feel different than 28:)


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As you may know, thousands of people fall victim to identity theft every year. In 2015, 16 percent of the inquiries the Federal Trade Commission (FTC) received were linked to this fast-growing crime.
What should you do if your identity is stolen?
Following the steps below can help you contain the damage:
Ways to keep your identity safe
Of course, the best way to avoid the emotional and financial pain of identity theft is to avoid having your identity stolen in the first place. To help stay safe, follow these guidelines:
Remaining vigilant


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The briefing has concluded.
The briefing has concluded.
Can they at least make Medicare a voluntary program for those of us who don't want to be forced to sign up for it?
Over the years Congress has gotten away with making laws that mandate Medicare coverage if one collects Social Security. You want to collect your Social Security? Well then you are going on Medicare. No option out for you. That certainly can't be constitutional, but since when do they care about that old piece of paper…
In addition to the social security catch your own insurance company makes you go on Medicare so they save on your premiums. You keep your old insurance but Medicare becomes your primary insurance. Since I have gov't insurance from MA I haven't noticed any difference just more paperwork.
Maccabeats Performance..Wow!
What a beautiful sentiment; no more wars so our children can play.
I can't beleive that Carney doesn't even 'Blush' when asked about all the Waiver's. He learned well from Biden.


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In his Sunday column, Michael Smyth characterizes rookie MLA Bowinn Ma's question of Premier Christy Clark, "Why doesn't she recognize that parents don't trust her to fix the problems that she created," as being a devastating fastball.
Indeed, it's a question that is impossible to answer. My question about her question is what purpose does it serve other than to demonstrate an ability to ask a loaded question? Questions, honestly asked and in the interests of seeking greater knowledge, will generally be honestly answered. Those designed for superficial purposes will, invariably, only receive superficial answers.
Whenever I read about a young person getting elected, I am always hopeful that a new breed of politician is making its way into leadership roles and that the way we do politics will actually change for the better. Sadly, I will have to keep waiting.
Bob Elliott, Port Coquitlam
What does Sajjan think?
The silence is deafening from Defence Minister Harjit Sajjan on the awarding of $10.5 million to convicted terrorist Omar Khadr.
As a three-tour veteran of the fighting in Afghanistan, and considering that it could have been him or some of his troops killed by Khadr, I would really like to know his thoughts on the apology and award
Ross Doherty, North Vancouver
Secret mean it's wrong
Re: Secret Omar Khadr deal
The only reason people — assuming politicians belong in that category — try to keep things secret is because they know what they're doing is wrong.
Marguerite Caunt, West Vancouver
Canadians won't forget
Justin Trudeau is not even halfway through his first mandate and continues to make the kind of grievous decisions that will almost surely guarantee he will never see a second term as prime minister.
His government's decision to give a $10.5-million settlement and an official apology to terrorist Omar Khadr, who murdered American soldier, U.S. Sgt. First Class Christopher Speer, is about as wrong as it gets. Millions of Canadians will surely remember this outrage come election time in 2019.
This is nothing less than a slap in the face for not only to Speer's grieving widow and family but also the Canadian and U.S. military and all freedom-loving Canadians and Americans.
Gerald Hall, Nanoose Bay
Notwithstanding clause needed
Given the de facto if not de jure stranglehold the Supreme Court has over popular democratic politics, judicial activism in Canada won't be checked as long as we fail to address the question of who is in charge of our deeply flawed Charter of Rights and Freedoms which, by way of political default, effectively transferred governance from parliament to the Supreme Court and all but guaranteeing the domination of special-interest groups.
While all Charter rights are intended to be subject to "such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society," our all-purpose Charter under the courts' jurisdiction has opened the floodgates of virtually unrestrained litigation on every conceivable claim of perceived rights violations.
The extraordinary circumstances related to Omar Khadr clearly beyond Charter rights subject to "reasonable limits prescribed by law" should have led the federal government to use the notwithstanding clause.
Edward Bopp, Tsawwassen
Ban barbaric 'sports'
After reading the July 2 article on Rick Klassen's concussion-related damage, I find it unfathomable that our society condones such so-called sports as boxing and mixed martial arts, where the sole intent is to inflict physical injury on one's opponent. Indeed, in boxing, a knockout that is most likely to cause a concussion, and in some cases death, is seen as the ultimate success.
In Roman times, such sports would have been seen as acceptable to the masses, in fact the bloodier the better. But in light of current and ongoing research, we should be ashamed of allowing these sports to flourish.
Anne Hazon, Richmond
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Edenbridge U3A
Edenbridge U3A was set up in 2013 and has over 240 members and around 60 groups covering everything from mah-jong and latin to gardening, photography, wine and books. There is something for everyone and, if there isn't something that appeals to you, we are always open to new ideas.
We have monthly meetings in Crockham Hill Village Hall with speakers on a wide range of subjects.They are a great opportunity to learn and meet people.


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Platz and Associates Inc. http://platzandassociates.com/
Offers online solutions such as psychometric assessments, a proprietary employee satisfaction survey system (www.employeesatisfactionsurveyonline.com) and subscription-based toolboxes
Global Hospitality Search Consultants www.globalhospitality.com
Global Hospitality is a leading international hospitality recruitment and executive search firm. We specialize in identifying, evaluating, and placing leadership and management talent in the hospitality industry. Our hospitality recruiters have made senior-level placements in all sectors of the hospitality industry.
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Awareness and demand for sustainable design and construction are rising in Israel in the last few years. Until recently, there was no opportunity for professional and clients to engage with new materials and technological innovations in this field.
SID Centre, a new initiative in the local professional landscape, was developed to provide these opportunities and respond to the growing interest in contemporary sustainable design.
SID Centre
The centre is active since January 2015, aiming to deliver simple, clear information on 'Sustainable & Innovative Design' for the building sector. The centre offers:
- Display of innovative technologies in real-life & hands-on demonstrations;
- Training for construction/design professionals, embedding principles and practices of 'Intelligent Architecture' for healthy, comfortable and efficient environments;
- A meeting place for building professional consultants and clients.
Since its opening, the centre hosted hundreds of visitors and trainees from various professional disciplines and backgrounds.


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As the debate around factory safety and the future of Bangladesh Accord on Fire and Building Safety in Bangladesh rages on, it is often forgotten that the readymade garments (RMG) industry in the country has made huge progress in recent years. A full-fledged technological upgrade is ongoing in the sector.
There is a growing trend of global apparel companies adopting supply chain transparency starting with publishing the names, addresses, and other important information about factories manufacturing their branded products. This transparency is a powerful tool for promoting corporate accountability for garment workers' rights in global supply chains. Transparency in this context means letting consumers know who makes their apparel - from who farmed the cotton and who stitched them, right down to who dyed the fabric, and so on (CPD-RMG Study, 2018). The demand for transparency in the textile and garment supply chains is growing as consumers are becoming more socially and environmentally conscious every day.
In fact, after sustainability, transparency is probably the most talked about topic in the fashion world at present and will be so in the years to come. The glimmer of hope is in the fact that global giants have already started practising transparency in global supply chain. For instance: H&M in its new high-end product Arket introduced "transparent tagging," where they mention the supplying factory names as well as some other key details of manufacturing. This move by one of the largest fashion brands in the world is actually a reflection of a trend in the global fashion towards transparency, unlike any time in the past.
Fashion Transparency Index 2018 reviewed and ranked 150 of the biggest global apparel brands and retailers based on how much information they disclose about their suppliers, supply chain policies and practices, and social and environmental impacts. The report found that the number of businesses publishing details about supplier lists, at least for the first tier, has also risen from 32 per cent to 37 per cent. So have the numbers of firms that publish details about processing facilities, rising from 14 to 18 per cent, according to Fashion Revolution Foundation.
The downside is that far too many companies still disclose virtually nothing about their operations and practices. Nearly a third of global apparel businesses were in the 0 to 10 per cent score range when it came to disclosing details. According to the index, there are dozens of brands still not making their supply chains information public including Forever 21, Lacoste, Kohl's, Valentino, Ross Stores, and Amazon. Many brands continue to disclose nothing of their supply chains, yet somehow manage to escape the spotlight.
It would be not be an exaggeration to say that the Bangladeshi apparel industry has made far better and tangible progress in the area of transparency compared to other apparel producing countries. This should be advertised to Western buyers and consumers. This can be used as a branding strategy. The engagement of the country's development partners through the "Sustainability Compact" and the active participation of local and global stakeholders like the International Labour Organisation (ILO) in the process of legal and administrative reforms is a unique example of transparency that Bangladesh has set.
It is also heartening to learn that the Bangladesh Garment Manufacturers & Exporters Association (BGMEA) is collaborating with C&A Foundation and BRAC University to establish a Digital RMG Factory Map where we can see the entire industry and its status. This is an excellent initiative and will help to ensure further transparency in operation as well as in the supply chain of the RMG industry. The project collects comprehensive and accurate data on factories across Bangladesh - the names, locations, numbers of workers, product type, export country, certifications and brand customers - and discloses it in a publicly available online map. Verification is crowd-sourced from the public to ensure that the information remains up-to-date and accurate.
The biggest barrier to transparency, which can significantly change the fashion landscape, is cost. Despite all the efforts that manufacturers are making for positive transformation, costs are eventually pushed towards them. If the apparel retailers and brands do not practise transparent pricing and purchasing, an enabling environment for transparency across the supply chain cannot be created.
In the global supply chain, transparency cannot be a stand-alone responsibility for the manufacturers and suppliers only. For ensuring transparency throughout the entire apparel supply chain, a trusted and predictable relationship between all the stakeholders is the key.
According to the report titled 'Changes in the Governance of Garment Global Production Networks: Lead Firm, Supplier and Institutional Responses to the Rana Plaza Disaster', Bangladeshi suppliers are facing difficulties in meeting the demands of global buyers due to lack of shared responsibility. The study further unveiled that industry insiders observed a stronger concern for worker safety and labour standards on the one hand and continued tensions between buyers' demands for low production costs and delivery deadline on the other.
As such, transparency is the first step towards a different culture for fashion and everybody has to be equally transparent. To ensure this is followed accordingly, high level of engagement and support from brands, retailers and consumers is required in order to make transparency practices a reality. However, plenty of changes are still needed. It is quite evident that a couple of organisations are working hard, but this is not enough. All stakeholders need to step up. Otherwise, there will be no real change.
Therefore, a level-playing field is needed to ensure transparency in the global supply chain for the sake of the RMG sector of the country. Last but not the least, capitalising on the need for formulating unified standards to practise transparency in reality and hold all involved in the supply chain accountable is necessary. Much work needs to be done so that the RMG sector can get the opportunity to open its doors to the outside world. A discussion needs to begin regarding the future direction of the country's apparel sector, which is of huge strategic relevance to garment supply chains worldwide.
Views expressed in this article are those of the author and do not necessarily reflect the official policy or position of any particular party.
Sabbir Rahman Khan is Assistant Secretary (R&D) at DCCI.
© 2017 - All Rights with The Financial Express


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Preparation time: 25 minutes
Cooking time: 1 hour
Serves: 6
1 cup polenta / 2 cups water
6 peppers (red or green)(I prefer red, they are sweeter!)
1/2 onion
1/4 cup banana peppers rings (mild)
2 Tblsp. jalapeno rings
2 cups strong cheese of your choice (grated)
1/2 lb Italian sausage ground
cook dry polenta in water 1/2 hour stirring regularly to keep from getting lumpy (follow package instructions)
cook sausage - drain (set aside)
chop onion and both peppers in food processor.
prepare peppers, cut off tops and clean out insides.
When polenta is done stir in the cheese, onion, the chopped up hot/mild pepper rings and the sausage.
Stuff the peppers with the mix leaving room for a topper of cheese.
Place in 350 degree oven for 1 hour.
(you may want to carefully peel the skin from the peppers after they cook)


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New #1
No external devices issue-why?
I suspect it's because of some update windows dl without me knowing, but just yesterday when I plugged my phone via USB or tablet or any external device for that matter, it did pop up in Windows Explorer as new usb device connected and I could transfer data to and from it. Today when I plug in any of those devices(phone, tablet, flash drive) they don't. I can't even see them in Disk Managment.
Now I haven't made any tweaks in my system, I didn't installed anything new, what's more - I haven't made any changes on my phone as well. And yet, yesterday it worked, today it doesn't.
What could be an issue here? Is it indeed some broken update?
And most of all how to fix this?


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Does your calendar include a dental visit sometime in the next six months? Just 62 percent of Americans ages 18 - 64 visit the dentist over the course of a year, according to the Centers for Disease Control and Prevention. If you're one of them, you could be putting your oral health at risk. Our Carbondale, IL, dentist, Dr. Mazhar Butt, explains why it's important to make dental visits a priority.
Why are regular dental visits important?
Do your teeth feel a little fuzzy when you wake up? That unpleasant feeling occurs when plaque builds up on the teeth. Plaque is dangerous because it contains bacteria, a microorganism that cause tooth decay. When you eat foods that contain either sugar or carbohydrates that are converted into sugars, the combination of the bacteria and the sugar creates an acid. The acid is so strong that eats through tooth enamel, causing a cavity.
Brushing and flossing removes plaque, which prevents the chemical reaction from occurring. Unfortunately, sometimes it's difficult to remove plaque from every nook and cranny of your teeth. The longer the bacterial film remains on your teeth, the greater the chance that it will turn into tartar. The hard deposit is not only unsightly, but also increases your gum disease risk.
Cleanings, an important part of every twice-yearly dental appointment, remove plaque and tartar, which helps you avoid tooth decay and gum disease.
You may not even know you have tooth decay if you don't visit the dentist regularly. When a cavity is small, it can't be seen outside your tooth and usually doesn't cause any pain. Thanks to dental X-rays, cavities can be spotted when they're small. Small areas of decay do less damage to your teeth, which means you won't need a large filling.
During your visit to our Carbondale, IL, office, Dr. Mazhar Butt will also look for signs that may indicate a dental problem, such as swollen gums, cracks in teeth or faulty crowns. If you have any of these issues, prompt treatment will protect your teeth and your oral health.
If a dental visit isn't on your calendar, call your Carbondale, IL, dentist Dr. Mazhar Butt at (618) 457-2123 to schedule an appointment.


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This was shot near the end of long crew (the 100 or so who work over a month on the festival crew) - this is a moment of inspirational improvisation...or an example of what can happen when you are deprived of t.v. for a month.
Saturday, October 07, 2006
The Gatorade? Commercial - Michfest 2006
Posted by Lukas Blakk at 10:30 PM
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Customer Service 11-7pm EST M-F, 11-5 Sat
406 Rosemont Garden
Lexington, KY 40503
Taylor 412ce V-Class (072)
The solid ovangkol/spruce 412ce features Taylor's compact Grand Concert body shape, a short-scale neck, and V-Class bracing, which delivers an overall boost to the volume and sustain produced by this small-bodied guitar. Ovangkol shares rosewood's full-spectrum tonal range, with a slightly fuller midrange and a bright, focused top end. The smaller body will curb the overtones and fit well in a mix with other instruments. Taylor's Expression System® 2 pickup delivers clear, natural sounding amplified tone for gigging or recording. Aesthetic details include white binding, Italian acrylic dot fretboard inlays, a three-ring rosette, and a full-gloss body. The guitar ships in a Taylor deluxe hardshell case.
s/n 1106249072
All items listed with serial numbers, show the actual instrument in the photographs.
Questions about this item? Contact us by email or by phone at 859.276.0675 to speak with a representative.


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I have always loved Batman. Always. Once of the greatest thrills I have encountered as a parent has been my son's love of Batman. It sure seems easier now to be a fan at a young age, what with all the cartoons on the tube or the toys at the fast food joints. For this … Continue reading
Broken records
I like to think that there are two kinds of broken records, the first being the overplayed. Ask anyone to name three or four Jimi Hendrix songs and there is a strong chance that those songs would be off his debut, Are You Experienced. To me, that is an overplayed record, which was vaulted into the high and mighty rock playlists where it will stay throughout time alongside "Stairway to Heaven," "Baba O'Reilly," and "You Shook Me All Night Long."
The second kind of broken record is the opposite—a record that contains a song that is so devastating, so great, that you simply cannot listen to the rest of the LP.