\n\nObjective: The aim of this study was to describe the features and clinical course of APS1 and correlate them with AIRE and HLA class II genotypes in a large homogeneous cohort

of Sardinian patients followed for up to 25 yr.\n\nPatients: Twenty-two pediatric APS1 patients were studied prospectively.\n\nResults: This Sardinian series(female/male ratio, 1.44; median current age, 30.7yr; range, 1.8-46yr) showed early disease onset (age range, 0.3-10 yr; CT99021 manufacturer median, 3.5 yr) and severe phenotype (on average, seven mani-festations per patient). Besides the classic triad of chronic mucocutaneous candidiasis, hypoparathyroidism, and Addison’s disease, autoimmune hepatitis was a serious and surprisingly common/early/presenting feature (27%; two deaths), with a 5: 1 female bias (median age, 6 yr; range, 2.5-11 yr). By contrast, type 1 diabetes was rare (one patient), and hypothyroidism was not seen. Additional disease components(several

of them potentially life-threatening) appeared in adulthood. The major BTSA1 in vitro nonsense mutation, R139X, was found in 93% of the mutant AIRE alleles. High-titer interferon (IFN)-omega and IFN-alpha autoantibodies were detected in all patients tested, even preclinically at 4 months of age in one sibling. HLA alleles appear to influence the exact phenotype-the most interesting apparent association being between HLA-DRB1*0301-DQB1* 0201, liver-kidney microsome autoantibodies (anti-CYP1A2), and autoimmune hepatitis.\n\nConclusion: APS1 in Sardinia is characterized by severe phenotype, marked clinical heterogeneity, and relative genetic homogeneity. The single AIRE mutation, R139X, and the anti-IFN-omega and IFN-alpha autoantibodies are helpful for earlier diagnosis, especially when APS1 presents unusually. HLA genotypes can modify the phenotype. (J Clin Endocrinol Metab

97: 1114-1124, 2012)”
“This systematic narrative review of randomised controlled trials (RCTs) identifies and evaluates the efficacy of behaviour-change techniques explicitly aimed at walking in individuals with intermittent claudication. An electronic database search was conducted up SYN-117 to December 2012. RCTs were included comparing interventions incorporating behaviour-change techniques with usual care, walking advice or exercise therapy for increasing walking in people with intermittent claudication. Studies were evaluated using the Cochrane Collaboration risk of bias tool. The primary outcome variable was maximal walking ability at least 3 months after the start of an intervention. Secondary outcome variables included pain-free walking ability, self-report walking ability and daily walking activity. A total of 3,575 records were retrieved. Of these, six RCTs met the inclusion criteria. As a result of substantial heterogeneity between studies, no meta-analysis was conducted.