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El beso del traidor, 1ª Parte

La enseñanza bíblica en profundidad de John MacArthur lleva la verdad transformadora de la Palabra de Dios a millones de personas cada día.




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Los juicios ilegales, injustos de Jesús, 1ª Parte

La enseñanza bíblica en profundidad de John MacArthur lleva la verdad transformadora de la Palabra de Dios a millones de personas cada día.




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Los juicios ilegales, injustos de Jesús, 2ª Parte

La enseñanza bíblica en profundidad de John MacArthur lleva la verdad transformadora de la Palabra de Dios a millones de personas cada día.

 




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Gracia salvadora, 3ª Parte

La enseñanza bíblica en profundidad de John MacArthur lleva la verdad transformadora de la Palabra de Dios a millones de personas cada día.

 




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Gracia salvadora, 3ª Parte B

La enseñanza bíblica en profundidad de John MacArthur lleva la verdad transformadora de la Palabra de Dios a millones de personas cada día.

 




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Food Sector to face European cartel enforcement in 2014

The director of cartels in the EU’s antitrust department, Eric Van Ginderachter, stated last week that the food sector in Europe will see increased cartel enforcement activity in 2014 by the European antitrust regulator, the European Commission (“Co...




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Germany: Federal Cartel Office bans food retail giant EDEKA from squeezing suppliers, Edeka goes to Court

The German Federal Cartel Office (“Bundeskartellamt”, BKartA) has issued a decision stating that attempts by Germany’s largest supermarket, EDEKA, to force suppliers to grant it so called “wedding rebates”, in the form ...




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Germany: Bundeskartellamt blocks takeover by food retailer EDEKA of Kaiser’s Supermarkets, Parties apply for ministerial authorization

On 31 March 2015, the German Federal Cartel Office (“Bundeskartellamt”, BKartA) announced that it has blocked the proposed takeover of approximately 450 Kaiser’s Tengelmann supermarket branches by EDEKA, the leading German food ret...




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Shipping: BIMCO launch new LNG voyage charterparty

On 6 April 2016, BIMCO and the International Group of Liquified Natural Gas (“LNG”) Importers (“GIIGNL”) jointly issued a standard form voyage charterparty designed for use in the LNG trade. Its introduction is said to be spe...




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Shipping: incorporation of time charterparty terms into a bill of lading

Reviewing the law and the impact on it of both the arguments in the Anna Bo [2015] 2 Lloyd’s Rep 578 and the Congenbill 2016 form The issue Bills of lading often include wording which purports to incorporate charterparty terms. Attempts to inc...




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Harmonising corporate governance framework for South African mining companies: King IV, companies act and the mining charter

  The BEE Commission’s report 2018, between 2017 and 2018, had no significant change in the levels of transformation, with black ownership reflecting a decline to 25.2% from 27% and current management control still sitting at 38% for blac...




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Artis Real Estate Investment Trust (ARESF) CEO Armin Martens on Q1 2020 Results - Earnings Call Transcript




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Initial AFRICOM Civilian Casualty Assessment Quarterly Report

[Africom] As part of the command's commitment to transparency, U.S. Africa Command is implementing a quarterly report on the status of ongoing and completed civilian casualty allegations and assessments. This initiative was directed by U.S. Army Gen. Stephen Townsend, commander, U.S. Africa Command, to increase transparency regarding civilian casualty allegations that are reported to the command while demonstrating the U.S. military's constant commitment to minimizing collateral damage in the pursuit of




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La Palabra suficiente de Dios, 1ª Parte

Es significativo que uno de los nombres bíblicos de Cristo sea Admirable, Consejero (Isaías 9:6). Él es el Consejero Supremo y Definitivo a quien podemos acudir en busca de consejo; y Su Palabra es la fuente desde donde podemos extraer sabiduría divina. ¿Qué podría ser más admirable que eso? 

De hecho, uno de los aspectos más gloriosos de la perfecta suficiencia de Cristo es el consejo admirable y gran sabiduría que Él suple en tiempos de desesperación, confusión, miedo, ansiedad y tristeza. Él es el Consejero por excelencia. 

Ahora, esto no es para menospreciar la importancia de los cristianos aconsejándose unos a otros. Hay ciertamente una necesidad crucial de consejería bíblica sana dentro del cuerpo de Cristo. No debatiría ni por un momento el importante rol de quienes están dotados espiritualmente para dar aliento, discernimiento, consuelo, consejo, compasión y ayuda a otros. 

De hecho, uno de los problemas que ha llevado a la actual plaga de mala consejería es que las iglesias no han hecho tanto bien como deberían, permitiendo que las personas con esos dones espirituales ministren con excelencia. Las complejidades de esta época moderna hacen mucho más difícil que nunca el tomar el tiempo necesario para escuchar con atención, servir a otros a través de la entrega personal compasiva y proveer la comunión cercana, necesaria para que el cuerpo de la iglesia disfrute de salud y vitalidad.  

 Las iglesias han mirado a la psicología para llenar el vacío, pero no va a funcionar. Los psicólogos profesionales no son sustitutos de gente dotada espiritualmente; y el consejo que la psicología ofrece no puede reemplazar la sabiduría bíblica y el poder divino. Por otra parte, la psicología tiende a volver a la gente dependiente de un terapista, mientras que aquellos que ejercitan dones espirituales verdaderos, llevan a la gente hacia un Salvador todo suficiente y Su Palabra toda suficiente.  

Un Salmo sobre la Suficiencia de la Palabra de Dios 

El rey David fue un ejemplo de alguien quien ocasionalmente buscó consejo de consejeros humanos, pero al final, siempre recurría a Dios en busca de respuestas. Como muchos de los salmos revelan, él era especialmente dependiente únicamente de Dios cuando luchaba con problemas o emociones personales (Salmos 18). Cuando le golpeó la depresión o confusión interna, se volvió hacia Dios y luchó en oración (Salmos 73). Cuando el problema era su propio pecado, él se mostró arrepentido, quebrantado y contrito (Salmos 51). La persona madura espiritualmente siempre se vuelve a Dios por ayuda en tiempos de ansiedad, angustia, confusión o inquietud en el alma ––y se aseguran consejo sabio y liberación. 

Eso es debido a que toda necesidad del alma humana es básicamente espiritual. No existe algo llamado ‘problema psicológico’ no relacionado a causas espirituales o físicas. Dios suple recursos divinos suficientes para suplir todas esas necesidades por completo. David entendió eso. 

Sus escritos reflejaron la profundidad de la experiencia humana, emoción y conocimiento espiritual de alguien quien ha experimentado plenamente los extremos de la vida. Él conoció el regocijo de pasar de pastor a rey. Él escribió acerca de todo, desde el triunfo absoluto, hasta el desaliento amargo. Él luchó con un dolor tan profundo que apenas podía soportar vivir. 

Su propio hijo Absalón intentó matarlo y luego, fue asesinado. Él sufrió una culpabilidad horrible debido a la inmoralidad y asesinato. Sus hijos le trajeron constante aflicción. Él luchaba por entender las dos cosas ––la naturaleza de Dios y su propio corazón. De Dios, él dijo: “Grande es Jehová” (Salmos 145:3), mientras que de sí mismo él dijo: “Lávame más y más de mi maldad, y límpiame de mi pecado” (Salmos 51:2). Él le dijo a Dios lo qué sentía y clamó por alivio ––a pesar que admitió que Dios tenía todo el derecho de castigarlo. 

Al final de algunos de los salmos de David, él miró por una ventana de esperanza, y otras veces, no. Pero David siempre fue a Dios, porque entendió la soberanía de Dios y su propia depravación. Él sabía que sólo su todo-suficiente Salvador tenía las respuestas a sus necesidades y el poder de aplicar las respuestas. Y sabía que esas respuestas eran encontradas en la verdad acerca de Dios revelada en Su Palabra, que es en sí misma perfectamente suficiente. El Dios suficiente se reveló a Sí mismo en Su Palabra suficiente. 

El Salmo 19:7-14 es la declaración más monumental sobre la suficiencia de las Escrituras, que jamás se haya hecho en términos concisos. Escrito por David bajo la inspiración del Espíritu Santo, ofrece un testimonio inquebrantable de Dios mismo acerca de la suficiencia de Su Palabra para cada situación. Refuta las enseñanzas de aquellos que creen que debemos ampliar la Palabra de Dios con verdad obtenida de la psicología moderna. 

En los versículos 7 al 9, David hace seis afirmaciones acerca de las Escrituras. Cada una de las seis afirmaciones resalta una característica de la Palabra de Dios y describe su efecto en la vida de quien la recibe. 

La Escritura es perfecta, convierte el alma. 

En la primera afirmación (v.7), él dice: “La ley de Jehová es perfecta, que convierte el alma”. La Palabra hebrea traducida “ley” es torah, que enfatiza la naturaleza didáctica de la Escritura. Aquí, David la usa para referirse a la suma de lo que Dios ha revelado para nuestra instrucción, sea un credo (lo que creemos), carácter (lo que somos) o conducta (lo que hacemos). 

“Perfecta” es la traducción de una palabra hebrea que significa “entero”, “completo” o “suficiente”. Comunica la idea de algo que es integral, al punto de cubrir todos los aspectos de un problema. La Escritura es integral, corporizando todo lo que es necesario para la vida espiritual de uno. El contraste implícito de David es con el razonamiento imperfecto, insuficiente e incorrecto de los hombres. 

La ley perfecta de Dios, dijo David, afecta a las personas porque “convierte el alma” (v.7). La palabra hebrea traducida “convierte” puede significar “restaura”, “revive” o “refresca”; pero mi sinónimo favorito es “transforma”. La palabra “alma” (en hebreo, nephesh) se refiere a la persona de uno, uno mismo o el corazón. Es traducida de todas esas maneras (y muchas más) en el Antiguo Testamento. La esencia de ella es la persona interior, la persona completa, el verdadero usted. 

Parafraseando las palabras de David, las Escrituras son tan poderosas e integrales que pueden convertir o transformar toda la persona, convirtiendo a alguien exactamente en la persona que Dios quiere que sea. La Palabra de Dios es suficiente para restaurar mediante la salvación incluso a la vida más destrozada, un hecho del que David mismo dio abundante testimonio. 

La Escritura es digna de confianza, imparte sabiduría. 

David desarrolla aún más el alcance de la suficiencia de las Escrituras en el Salmo 19:7, “El testimonio de Jehová es fiel, que hace sabio al sencillo”. “Testimonio” habla de la Escritura como un testigo divino. La Escritura es el testimonio seguro de Dios sobre quién Él es y lo que Él requiere de nosotros. “Fiel” significa que su testimonio es inquebrantable, inamovible, inconfundible, confiable y digno de confianza. Proporciona una base sobre la cual construir nuestras vidas y destinos eternos. 

La Palabra fiel de Dios convierte al sencillo en sabio (v.7). La palabra hebrea traducida “sencillo” viene de una expresión que significa “una puerta abierta”. Evoca la imagen de una persona inocente que no sabe cuándo cerrar su mente a la enseñanza falsa o impura. Él es falto de discernimiento, ignorante, crédulo. Pero la Palabra de Dios lo hace sabio. “Sabio” no habla simplemente de alguien que conoce algunos hechos, sino de uno que es hábil en el arte de la vida piadosa. Él se somete a las Escrituras y sabe cómo aplicarla a sus circunstancias. De esta manera, la Palabra de Dios toma una mente simple y sin discernimiento, y la capacita en todas las cuestiones de la vida. Esto también es en contraste con la sabiduría de los hombres, que en realidad es necedad. 

La Escritura es recta, produce gozo 

David agrega una tercera declaración acerca de las Escrituras. Él escribe: “Los mandamientos de Jehová son rectos, que alegran el corazón”. Los mandamientos son principios divinos y guías para el carácter y la conducta. Ya que Dios nos creó y sabe cómo debemos vivir para ser productivos para Su gloria, Él ha puesto en las Escrituras todos los principios que necesitamos para vivir una vida piadosa. 

Los mandamientos de Dios, dijo David, son “rectos”. En lugar de indicar simplemente qué es correcto y qué es erróneo, la Palabra tiene el sentido de enseñarle a alguien el camino verdadero. Las verdades de la Escritura establecen el camino correcto a través del difícil laberinto de la vida. Esa es una confianza maravillosa. Muchas personas hoy están angustiadas o abatidas porque carecen de dirección y propósito. La mayoría busca respuestas en las fuentes equivocadas. La Palabra de Dios no solamente provee la luz para nuestro camino (Salmo 119:105), sino que establece la ruta enfrente nuestro. 

Debido a que nos conduce a través del camino recto en la vida, la Palabra de Dios trae gran gozo. Si usted está deprimido, ansioso, temeroso o dudoso, aprenda a obedecer el consejo de Dios y comparta el deleite resultante. No recurra a actividades autoindulgentes como la autoestima y la autorrealización. Enfóquese en la verdad divina. Ahí encontrará el gozo verdadero y duradero. Todas las otras fuentes son temporales y fugaces. 

¿No es la Palabra de Dios asombrosa en su suficiencia? Es perfecta, no le falta nada, es confiable y establece el rumbo para una vida productiva. Como tal, nos transforma a la imagen de Cristo, nos otorga sabiduría para cada momento y nos llena con gozo eterno.

¡Qué trágico que es cuando dejamos de lado la fuente de sabiduría divina, prefiriendo la sabiduría del hombre, que es impotente e insuficiente! 

La próxima vez, veremos las siguientes tres declaraciones de la suficiencia de las Escrituras, y saborearemos la dulzura de la Palabra de Dios. 

Únase a la conversación                                                                                                                           

¿Qué Escrituras han tenido un impacto profundo en su vida durante tiempos de lucha con el pecado o el sufrimiento? 

(Adaptado de Nuestra Suficiencia en Cristo




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Kindergarten comes up short: Capacity up to 3 year olds is 20,000 shy

Prague Daily Monitor

The Ministry of Labor has prepared and made available to the public a study showing that the Czech Republic is not doing enough for kindergarten capacity according to EU norms. Pre-school care thus is not available to three in ten girls and boys up to the age of three years old, which parents need.

read more




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'Cartels are scrambling': Lockdown hits the global drug trade

Traffic over the Mexican-US border has slowed and supplies from China have dried up, but the drug cartels are still finding a way to sell their wares.




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Over 19,000 artefacts seized in international art trafficking crackdown, says Europol

1




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For sale—cheap: farms, buildings, cinemas, kindergartens and more -- by Rafael Abbasov

State-owned enterprises, including power utilities, in many countries have collected a menagerie of assets unrelated to their core business. And they are selling cheap.




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ADB Sanitation Dialogue 2020 - Postponed to first quarter of 2021

The ADB Sanitation Dialogue 2020, to be held on 29 June to 1 July 2020 in Manila, engages ADB's developing members and other development partners toward achieving Sustainable Development Goal 6.2 on sanitation for all.




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Getting Started Guide: Microchip PIC-IoT WA (Wireless for Amazon Web Services) Application

Getting Started Guide: Microchip PIC-IoT WA (Wireless for Amazon Web Services) Application




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Benin's partial withdrawal from African Charter of Human Rights is a retreat from democracy

Benin drops 17 places in the 2020 World Press Freedom Index, following the withdrawal from a key document of the African Charter of Human and People's Rights.




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ADB Sanitation Dialogue 2020 - Postponed to first quarter of 2021

The ADB Sanitation Dialogue 2020, to be held on 29 June to 1 July 2020 in Manila, engages ADB's developing members and other development partners toward achieving Sustainable Development Goal 6.2 on sanitation for all.




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We may have started keeping lapdogs as pets 2000 years ago

A 2000-year-old skeleton found in Spain belonged to a lapdog that may have been born thousands of kilometres to the east and traded during Roman times




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Volcano behind huge eruption that kick-started mini ice age identified

A mini ice age that lasted 125 years started in the 6th century. Now we may have identified the volcano that kicked it all off




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Plate tectonics may have started on Earth 3.2 billion years ago

Rocks from a 3.2-billion-year-old formation in Australia show changes in the direction of their magnetism over time that suggest plate tectonics started earlier than we thought




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How to make a sourdough starter and delicious sourdough bread

To make your own sourdough bread, you need to create an environment where wild yeast and bacteria want to hang out. Sam Wong explains how




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Engineering Leaders & Innovators at HARMAN’s Novi Headquarters

As a leading technology company with applications across a range of industries including automotive, audio and enterprise technology, HARMAN has a strong focus on recognizing our talented in-house engineers, developers and designers who help bring ...




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Potbelly postpones quarterly filing due to COVID-19 crisis

Potbelly Corp said on Friday it is unable to file its quarterly report with the U.S. SEC by the May 8 deadline due to the COVID-19 crisis, adding to the restaurant chain's pandemic-led woes.




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Plate tectonics may have started on Earth 3.2 billion years ago

Rocks from a 3.2-billion-year-old formation in Australia show changes in the direction of their magnetism over time that suggest plate tectonics started earlier than we thought




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Secondhand Smoke Blocks Artery Repair

Title: Secondhand Smoke Blocks Artery Repair
Category: Health News
Created: 4/30/2008 2:00:00 AM
Last Editorial Review: 4/30/2008 12:00:00 AM




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Arteries Age Twice as Fast in Smokers

Title: Arteries Age Twice as Fast in Smokers
Category: Health News
Created: 4/26/2010 6:10:00 PM
Last Editorial Review: 4/27/2010 12:00:00 AM




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Calcium in Arteries May Predict Heart Risk

Title: Calcium in Arteries May Predict Heart Risk
Category: Health News
Created: 4/28/2010 9:30:00 AM
Last Editorial Review: 4/28/2010 9:30:07 AM




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Health Tip: Coping With Hardening of the Arteries

Title: Health Tip: Coping With Hardening of the Arteries
Category: Health News
Created: 5/4/2017 12:00:00 AM
Last Editorial Review: 5/4/2017 12:00:00 AM




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Red Wine Antioxidant Might Help Diabetics' Arteries

Title: Red Wine Antioxidant Might Help Diabetics' Arteries
Category: Health News
Created: 5/4/2017 12:00:00 AM
Last Editorial Review: 5/5/2017 12:00:00 AM




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Job Strain May Boost Odds of Serious Artery Disease

Title: Job Strain May Boost Odds of Serious Artery Disease
Category: Health News
Created: 4/28/2020 12:00:00 AM
Last Editorial Review: 4/28/2020 12:00:00 AM




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E-Cigarettes as Bad for Arteries as Regular Smokes, Study Finds

Title: E-Cigarettes as Bad for Arteries as Regular Smokes, Study Finds
Category: Health News
Created: 4/29/2020 12:00:00 AM
Last Editorial Review: 4/30/2020 12:00:00 AM




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AHA News: Estrogen Therapy in Early Menopause May Help Keep Arteries Clear

Title: AHA News: Estrogen Therapy in Early Menopause May Help Keep Arteries Clear
Category: Health News
Created: 3/3/2020 12:00:00 AM
Last Editorial Review: 3/4/2020 12:00:00 AM




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Phosphoregulation within the Photorespiratory Cycle: Regulate Smarter, Adapt Better?




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Magnetic resonance imaging of pulmonary arterial compliance after pulmonary endarterectomy

Pulmonary endarterectomy (PEA) is the treatment of choice of chronic thromboembolic pulmonary hypertension (CTEPH) [1]. However, successfully operated patients may continue to suffer from dyspnoea and limitation of exercise capacity, despite improvement or even normalisation of pulmonary artery pressure (PAP), cardiac output (CO) and pulmonary vascular resistance (PVR) [2]. This absence of complete symptomatic recovery has been explained by a decreased right ventricular (RV) function reserve due to persistent increased afterload [3, 4], related to decreased pulmonary arterial compliance (PCa) more than to mildly increased PVR [5, 6]. There is therefore interest in assessing PCa in patients during the follow-up of PEA.




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Systemic Sclerosis Sine Scleroderma With Pulmonary Arterial Hypertension in a 3-Year-Old Girl

Systemic sclerosis sine scleroderma (ssSSc) is a rare variant of systemic sclerosis, with only one pediatric case reported in the medical literature to date. Pulmonary arterial hypertension as the presenting feature of ssSSc is extremely rare, even in adults, and so far has never been reported in children. We report, for the first time, a case of pediatric ssSSc in a 3-year-old girl, who presented with interstitial lung disease and pulmonary hypertension. The patient was prescribed early aggressive pulmonary vasodilators combined with anti-inflammatory medications. The clinical response was good, and her current condition at 12 years of age is remarkable, considering the high mortality rates reported in adults. We underscore the importance of early aggressive treatment in future cases of similar presentation.




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In Utero Antidepressants and Neurodevelopmental Outcomes in Kindergarteners

OBJECTIVES:

To determine if in utero selective serotonin reuptake inhibitor (SSRI) or selective serotonin norepinephrine inhibitor (SNRI) exposure is associated with developmental vulnerability in kindergarten among children whose mothers were diagnosed with prenatal mood or anxiety disorder.

METHODS:

Linkable administrative data were used to create a population-based cohort of 266 479 mother-child dyads of children born in Manitoba, Canada, between 1996 and 2014, with follow-up through 2015. The sample was restricted to mothers who had a mood or anxiety disorder diagnosis between 90 days before conception (N = 13 818). Exposed women had ≥2 SSRI or SNRI dispensations during pregnancy (n = 2055); unexposed mothers did not have a dispensation of an SSRI or SNRI during pregnancy (n = 10 017). The Early Development Instrument (EDI) was used to assess developmental health in kindergarten children. The EDI is a 104-component kindergarten teacher-administered questionnaire, encompassing 5 developmental domains.

RESULTS:

Of the 3048 children included in the study who met inclusion criteria and had an EDI, 21.43% of children in the exposed group were assessed as vulnerable on 2 or more domains versus 16.16% of children in the unexposed group (adjusted odds ratio = 1.43; 95% confidence interval 1.08–1.90). Children in the exposed group also had a significant risk of being vulnerable in language and/or cognition (adjusted odds ratio = 1.40; 95% confidence interval 1.03–1.90).

CONCLUSIONS:

Exposure to SSRIs or SNRIs during pregnancy was associated with an increased risk of developmental vulnerability and an increased risk of deficits in language and/or cognition. Replication of results is necessary before clinical implications can be reached.




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Metal ions confinement defines the architecture of G-quartet, G-quadruplex fibrils and their assembly into nematic tactoids [Chemistry]

G-quadruplex, assembled from a square array of guanine (G) molecules, is an important structure with crucial biological roles in vivo but also a versatile template for ordered functional materials. Although the understanding of G-quadruplex structures is the focus of numerous studies, little is known regarding the control of G-quartet stacking...




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Atorvastatin Reduces In Vivo Fibrin Deposition and Macrophage Accumulation, and Improves Primary Patency Duration and Maturation of Murine Arteriovenous Fistula

Background

Arteriovenous fistulas placed surgically for dialysis vascular access have a high primary failure rate resulting from excessive inward remodeling, medial fibrosis, and thrombosis. No clinically established pharmacologic or perisurgical therapies currently address this unmet need. Statins’ induction of multiple anti-inflammatory and antithrombotic effects suggests that these drugs might reduce arteriovenous fistula failure. Yet, the in vivo physiologic and molecular effects of statins on fistula patency and maturation remain poorly understood.

Methods

We randomized 108 C57Bl/6J mice to receive daily atorvastatin 1.14 mg/kg or PBS (control) starting 7 days before end-to-side carotid artery–jugular vein fistula creation and for up to 42 days after fistula creation. We then assessed longitudinally the effects of statin therapy on primary murine fistula patency and maturation. We concomitantly analyzed the in vivo arteriovenous fistula thrombogenic and inflammatory macrophage response to statin therapy, using the fibrin-targeted, near-infrared fluorescence molecular imaging agent FTP11-CyAm7 and dextranated, macrophage-avid nanoparticles CLIO-VT680.

Results

In vivo molecular-structural imaging demonstrated that atorvastatin significantly reduced fibrin deposition at day 7 and macrophage accumulation at days 7 and 14, findings supported by histopathologic and gene-expression analyses. Structurally, atorvastatin promoted favorable venous limb outward remodeling, preserved arteriovenous fistula blood flow, and prolonged primary arteriovenous fistula patency through day 42 (P<0.05 versus control for all measures).

Conclusions

These findings provide new in vivo evidence that statins improve experimental arteriovenous fistula patency and maturation, indicating that additional clinical evaluation of statin therapy in patients on dialysis undergoing arteriovenous fistula placement is warranted.




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Getting started: altering promoter choice as a mechanism for cell type differentiation [Outlook]

In this issue of Genes & Development, Lu and colleagues (pp. 663–677) have discovered a key new mechanism of alternative promoter choice that is involved in differentiation of spermatocytes. Promoter choice has strong potential as mechanism for differentiation of many different cell types.




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Facial Nerve Arterial Arcade Supply in Dural Arteriovenous Fistulas: Anatomy and Treatment Strategies [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Endovascular treatment of petrous dural AVFs may carry a risk of iatrogenic facial nerve palsy if the facial nerve arterial arcade, an anastomotic arterial arch that supplies the geniculate ganglion, is not respected or recognized. Our purpose was to demonstrate that the use of a treatment strategy algorithm incorporating detailed angiographic anatomic assessment allows identification of the facial nerve arterial arcade and therefore safe endovascular treatment.

MATERIALS AND METHODS:

This was a retrospective cohort study of consecutive petrous dural AVF cases managed at Toronto Western Hospital between 2006 and 2018. Our standard of care consists of detailed angiographic assessment followed by multidisciplinary discussion on management. Arterial supply, primary and secondary treatments undertaken, angiographic outcomes, and clinical outcomes were assessed by 2 independent fellowship-trained interventional neuroradiologists.

RESULTS:

Fifteen patients had 15 fistulas localized over the petrous temporal bone. Fistulas in all 15 patients had direct cortical venous drainage and received at least partial supply from the facial nerve arterial arcade. Following multidisciplinary evaluation, treatment was performed by endovascular embolization in 8 patients (53%) and microsurgical disconnection in 7 patients (47%). All patients had long-term angiographic cure, and none developed iatrogenic facial nerve palsy.

CONCLUSIONS:

By means of our treatment strategy based on detailed angiographic assessment and multidisciplinary discussion, approximately half of our patients with petrous AVFs were cured by endovascular treatment, half were cured by an operation, and all had preserved facial nerve function.




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Treatment Outcomes of Endovascular Embolization Only in Patients with Unruptured Brain Arteriovenous Malformations: A Subgroup Analysis of ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Endovascular embolization only has been advocated for treatment of brain arteriovenous malformations in recent trials. Our aim was to evaluate the results of embolization only in a cohort of patients who were enrolled in the A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) study at 39 clinical sites in 9 countries.

MATERIALS AND METHODS:

We analyzed the rates and severity of stroke and death in patients who underwent embolization only. Events were identified through in-person neurologic follow-up visits performed at 6-month intervals during the first 2 years and annually, with telephone contact every 6 months thereafter. All event-related data were reviewed by independent adjudicators.

RESULTS:

Among 30 patients who had embolization planned, 26 underwent embolization only. A total of 13 stroke events were reported in the follow-up period among 26 subjects (ischemic, hemorrhagic, or both in 4, 7, and 2 subjects, respectively). The adverse event occurred after the first embolization in 11 of 13 patients. One patient had a major motor deficit, and 2 patients developed major visual field deficits. One event was fatal. The modified Rankin Scale score was 0–2 at last follow-up in 11 of the 12 stroke survivors. Estimated stroke-free survival was 46% at 12 months.

CONCLUSIONS:

Although the rates of stroke and/or death were high in patients treated with embolization only in ARUBA, the rates of favorable outcomes following stroke were high during follow-up.




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Complications of Endovascular Treatments for Brain Arteriovenous Malformations: A Nationwide Surveillance [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Embolization is widely performed to treat brain arteriovenous malformations, but little has been reported on factors contributing to complications. We retrospectively reviewed a nationwide surveillance to identify risk factors contributing to complications and short-term clinical outcomes in the endovascular treatment of brain arteriovenous malformations.

MATERIALS AND METHODS:

Data for endovascular treatment of brain arteriovenous malformations were extracted from the Japanese nationwide surveillance. Patient characteristics, brain arteriovenous malformation features, procedures, angiographic results, complications, and clinical outcomes at 30 days postprocedure were analyzed.

RESULTS:

A total of 1042 endovascular procedures (788 patients; mean, 1.43 ± 0.85 procedures per patient) performed in 111 institutions from 2010 to 2014 were reviewed. Liquid materials were used in 976 procedures (93.7%): to perform presurgical embolization in 638 procedures (61.2%), preradiosurgical embolization in 160 (15.4%), and as sole endovascular treatment in 231 (22.2%). Complete or near-complete obliteration of brain arteriovenous malformations was obtained in 386 procedures (37.0%). Procedure-related complications occurred in 136 procedures (13.1%), including hemorrhagic complications in 59 (5.7%) and ischemic complications in 57 (5.5%). Univariate analysis identified deep venous drainage, associated aneurysms, infratentorial location, and preradiosurgical embolization as statistically significant risk factors for complications. Multivariate analysis showed that embolization of brain arteriovenous malformations in the infratentorial location was significantly associated with complications. Patients with complications due to endovascular procedures had worse clinical outcomes 30 days after the procedures than those without complications.

CONCLUSIONS:

Complications arising after endovascular treatment of brain arteriovenous malformations are not negligible even though they may play a role in adjunctive therapy, especially in the management of infratentorial brain arteriovenous malformations.




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MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Vessel wall imaging is increasingly performed in the diagnostic work-up of patients with ischemic stroke. The aim of this study was to compare vessel wall enhancement after intra-arterial thrombosuction with that in patients not treated with thrombosuction.

MATERIALS AND METHODS:

From 2009 to 2017, forty-nine patients with an ischemic stroke underwent 7T MR imaging within 3 months after symptom onset as part of a prospective intracranial vessel wall imaging study. Fourteen of these patients underwent intra-arterial treatment using thrombosuction (intra-arterial treatment group). In the intra-arterial treatment group, vessel walls were evaluated for major vessel wall changes. All patients underwent pre- and postcontrast vessel wall imaging to assess enhancing foci of the vessel wall using coregistered subtraction images. A Wilcoxon signed rank test was performed to test for differences.

RESULTS:

In the intra-arterial treatment group, 11 of 14 patients (79%) showed vessel wall enhancement compared with 17 of 35 patients without intra-arterial treatment (49%). In the intra-arterial treatment group, more enhancing foci were detected on the ipsilateral side (n = 18.5) compared with the contralateral side (n = 3, P = .005). Enhancement was more often concentric on the ipsilateral side (n = 8) compared with contralateral side (n = 0, P = .01). No differences were found in the group without intra-arterial treatment between the number and configuration of ipsilateral and contralateral enhancing foci.

CONCLUSIONS:

Patients with intra-arterial treatment by means of thrombosuction showed more (concentric) enhancing foci of the vessel wall ipsilateral compared with contralateral to the treated artery than the patients without intra-arterial treatment, suggesting reactive changes of the vessel wall. This finding should be taken into account when assessing vessel wall MR images in patients with stroke.




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