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Concomitant presentation of thrombocytopenia along with massive primary tumor growth made Kasabach-Merritt syndrome also a probable diagnosis. However, neither secondary ITP nor Kasabach-Merritt syndrome has previously been associated with a retroperitoneal tumor in the literature. CONCLUSION Although management of thrombocytopenia depends on etiology, in our patient’s case the diagnosis of secondary ITP and directed management did not result in a successful outcome. selleck chemicals BACKGROUND Subphrenic abscess caused by Clostridium perfringens is rare after hepatic resection. selleck chemicals We herein report such a case after hepatic resection for hepatocellular carcinoma following treatment of emphysematous cholecystitis. CASE PRESENTATION A 69-years-old man with chronic hepatitis B, was admitted to our hospital for right subcostal pain and loss of appetite. Computed tomography (CT) revealed emphysematous cholecystitis, for which percutaneous transhepatic gallbladder drainage was performed. Clostridium perfringens was identified from the culture of the bile. Imaging studies immediately demonstrated hepatocellular carcinoma with right lobe of the liver, for which the patients underwent hepatic resection and cholecystectomy concomitantly. After operation, the patient developed emphysematous subphrenic abscess on postoperative day 15, for which CT-guided percutaneous drainage was performed. Clostridium perfringens was identified from the culture of the abscess fluid. The patient was given Ciprofloxacin and Clindamycin and made a satisfactory recovery. The patient was discharged on POD 95 and remains well with no evidence of tumor recurrence as of 8 years after resection. CONCLUSION We herein reported a subphrenic abscess due to Clostridium perfringens after hepatic resection for hepatocellular carcinoma following emphysematous cholecystitis. In this research, the influence of microstructure parameters on the residual stresses of ultrafine-grained sheets was investigated. For this purpose, the constrained groove pressing (CGP) process was carried out on the copper sheets with 3 mm thickness, and residual stresses of the CGPed sheets was measured using the contour method. Microstructure of the CGPed specimens was evaluated by the optical microscopy, micro x-ray diffraction (micro-XRD), and transmission electron microscopy (TEM) experiments. Microstructure parameters including crystallites size, dislocations density, and lattice strain were calculated using Williamson-Hall and Williamson-Smallman equations, and the calculated results were validated by the TEM images. The influence of these parameters on the residual stresses was investigated by analysis of variance (ANOVA) method, and two approaches were considered in this way. According to the results, the CGP process can create nanostructures in the CGPed sheets, and with increasing number of CGP passes, grains size, crystallites size, lattice strain, and residual stresses decrease, and density of dislocations increases. Microstructure parameters have a significant effect on the macro-residual stresses, and strain is the most effective parameter. Also, in the ultrafine-grained sheets, micro-parameters have an undeniable contribution, which is the same as that of macro-parameters on the macro-residual stresses. STUDY OBJECTIVES To analyze the association between sleep-related symptoms and sleep length in parents and their children in relation to other risk factors in both generations. METHOD The participants were parents (n = 5,855, age 54.3 ± 6.5 years, 45.2% men) who participated in the community-based Respiratory Health in Northern Europe (RHINE) study and one random member of their adult offspring (n = 5,855, age 30.2 ± 7.7 years, 41.5% men) who participated in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) study. Both generations responded to identical questionnaires on sleep symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), snoring, nocturnal sweating, nocturnal gastroesophageal reflux (nGER), sleep time and excessive daytime sleepiness (EDS). Insomnia was defined as either, or both, DIS and DMS in combination with EDS. RESULTS All sleep variables except nocturnal sweating were more common in offspring whose parents had reported the same symptom. After adjusting for age, gender, BMI, smoking, physical activity, education, center and parents’ total number of children, there were independent associations between sleep symptoms in parents and offspring for DIS (adj. OR, 95% CI 1.52, 1.20-1.93), DMS (1.34, 1.15-1.56), snoring (1.45, 1.15,1.83), nGER (1.65, 1.15-2.37), insomnia (1.39, 1.13-1.73), short sleep time (9 h/night). CONCLUSION The familiar aggregation of many sleep disturbances was not explained by investigated lifestyle and environmental factors. This supports a heritable factor in sleep problems. OBJECTIVE To investigate the validity of the Brief Infant Sleep Questionnaire (BISQ), in assessing sleep quality in childhood. METHODS This was a validation study with children from the Pelotas 2015 Birth Cohort. BISQ was applied to mothers when their children were 3, 6, 12, and 24 months of age. The poor sleep indicators analysed, as defined by BISQ, were >3 wakings per night, nocturnal wakefulness >1 h and total sleep duration  3 wakings at 24 months (84.5%). The sensitivity for the presence of at least one indicator decreased with age from 56.0% at three months to 35.8% at 24 months, whereas the specificity increased from 50.6% at three months to 63.8% at 24 months. CONCLUSION The high specificity of the BISQ sleep parameters supports the validity of parents’ reports on sleep-related problems in childhood for use in epidemiological studies. BACKGROUND We determined the relationships among the subjective symptoms of sleep apnea and daytime sleepiness, depressive symptoms, and anxiety in adults with obstructive sleep apnea (OSA). METHODS We developed the Subjective Apnea Severity Questionnaire (SASQ) to measure subjective OSA symptoms during the night and on waking in the morning. Construct validity and reliability were assessed. The Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and State Scale of State Trait Anxiety Inventory (STAI-S) were applied. Multiple linear regression analyses were performed, and the results were adjusted for several confounders. RESULTS A total of 337 OSA patients were included. The SASQ consists of eight items with three domains. Cronbach’s α for the SASQ was 0.657. The mean SASQ score was 1.35 ± 0.59. Symptoms related to nocturnal breathing difficulties were associated with polysomnographic (PSG) respiratory parameters. In the adjusted models, total SASQ scores were associated with ESS scores but not with BDI or STAI-S scores.