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01). Both corneal and scleral lens wear resulted in significant changes to the shape of the corneal periphery and sclera. In all 3 groups of keratoconus eyes, asymmetry of the peripheral cornea showed a very strong correlation with scleral asymmetry (R2 = 0.90, 0.86 and 0.85 for groups 1-3, respectively). Conclusion The corneal periphery and sclera have a distinctly different shape in keratoconus eyes compared to controls. Specialty lens wear induces significant regional changes to the shape of the anterior eye in keratoconus eyes.Background The characterization and clinical profiling of people affected by Idiopathic Pulmonary Fibrosis (IPF), based on clinical events occurring prior to the diagnosis of the fibrotic disease, may facilitate the understanding of events and comorbidities that occur before the diagnosis of IPF and aid in identifying patients at an earlier stage of the disease. Methods In this observational study, a cohort of 96 patients, obtained from a community-based pulmonary clinic, were studied retrospectively. These patients were diagnosed with IPF between January 2008 and November 2016, based on findings on lung biopsy and/or high-resolution CT. Using clinical data obtained within the five years before diagnosis and the two-step method of cluster analysis, patients were assigned to one of four groups. The distribution of clinical characteristics and comorbidities present prior to diagnosis was analyzed among the clusters. Results Cluster 1 is composed of male patients, smokers, with ischemic heart disease. Cluster 2 is composed of male patients, smokers with dyspnea at rest, dry cough and prevalent emphysema. Cluster 3 is composed of male patients without other significant comorbidities, half of whom had dyspnea at exertion. Cluster 4 includes female patients only, most of whom never-smokers and the largest portion of patients with hypothyroidism. The majority of patients had basal end-inspiratory crackles at time of diagnosis, equally distributed among clusters. Conclusion Different clinical phenotypes of IPF emerge years before time of diagnosis and if confirmed in larger cohorts may help in forming diagnostic algorithms that would allow earlier diagnosis of IPF.Objective To determine the opinion and describe the attitude of different health professionals on suitability of therapeutic effort. find more Method Multi-centre, cross-sectional observational study carried out with nurses and doctors who work in the paediatric intensive care units of four hospitals in the Madrid region. A self-administered questionnaire, previously piloted to assess its viability, was used and a sealed box was set up at the nursing station to hand it in. The analysis was performed using SPSS 21.0 software. Results The 98.9% of the respondents were in favour of suitability of therapeutic effort. Doctors consider that the decision is made with the agreement of the multidisciplinary staff and the child's parents (48.8%). Of the nurses, 51.1% believe that the decision is made by agreement with the doctors and parents. Of the nurses, 65.5% state that they are never asked about decision-making for their patients. Of the doctors, 75% are always or almost always asked. Fifty-seven percent of the nurses and 83% of the doctors feel capable of making decisions about suitability of therapeutic effort. Of the professionals, 77.2% believe that suitability is used less often than required. Conclusions There are differences between doctors and nurses both in the perception of the decision-making model and in the way to proceed. Professionals seem not to follow any protocols or circuits in the decision-making process.Fungal lung disease in the paediatric population occurs with distinct features in the immunocompetent, in immunocompromised patients and in people with cystic fibrosis. Pulmonary mycoses are the least prevalent in immunocompetent children, with the most common diseases being the endemic mycoses and Aspergillomas. Filamentous fungi such as Aspergillus and Scedosporium have been isolated with increased frequency in recent years from the respiratory secretions of individuals with cystic fibrosis. Undoubtedly, fungal respiratory infections are encountered with increased frequency and severity in patients with impaired immune systems, such as patients with malignancies, solid organ or bone marrow transplants and immunodeficiencies [1].The aim of this study was to explore whether variants in LRP10, recently associated with Parkinson's disease and dementia with Lewy bodies, are observed in 2 large cohorts (discovery and validation cohort) of patients with progressive supranuclear palsy (PSP). A total of 950 patients with PSP were enrolled 246 patients with PSP (n = 85 possible (35%), n = 128 probable (52%), n = 33 definite (13%)) in the discovery cohort and 704 patients with definite PSP in the validation cohort. Sanger sequencing of all LRP10 exons and exon-intron boundaries was performed in the discovery cohort, and whole-exome sequencing was performed in the validation cohort. Two patients from the discovery cohort and 8 patients from the validation cohort carried a rare, heterozygous, and possibly pathogenic LRP10 variant (p.Gly326Asp, p.Asp389Asn, and p.Arg158His, p.Cys220Tyr, p.Thr278Ala, p.Gly306Asp, p.Glu486Asp, p.Arg554∗, p.Arg661Cys). In conclusion, possibly pathogenic LRP10 variants occur in a small fraction of patients with PSP and may be overrepresented in these patients compared with controls. This suggests that possibly pathogenic LRP10 variants may play a role in the development of PSP.Accessory liver lobe (ALL) is a rare congenital anomaly of the liver and is related to the focal excessive development of liver tissue. Accessory liver lobe torsion (ALLT) is a rare condition that can present with acute abdominal pain. Delay in diagnosis can lead to life-threatening complications such as sepsis and systemic inflammatory response syndrome. Imaging methods, especially computed tomography (CT), are of great importance for prompt diagnosis of acute abdominal pain causes, and CT images should be carefully examined. Herein we present a case of ALLT that was occurred due to Morgagni hernia in a 54-year-old male patient who presented with acute abdominal pain. Contrast-enhanced thoracoabdominal computed tomography (CT) was performed and CT demonstrated the Morgagni hernia and herniation of the accessory liver lobe into the hernia sac. CT showed decreased contrast-enhancement in the accessory liver lobe, compatible with ischemia. We also aimed to emphasize the clinical and CT imaging findings of ALLT.