Early anti IL-1 treatment replaces steroids in refractory Kawasaki disease: clinical experience from two case reports

Refractory Kawasaki disease (KD) is related to a major risk of coronary arteries abnormalities and its treatment is not standardized. In this regard, anakinra (ANA), an interleukin (IL)-1 receptor antagonist, represents an emerging therapeutic option. We report two cases of children, diagnosed with KD, nonresponsive to two doses of intravenous immunoglobulins, successfully treated with ANA, without a prior use of steroids. Patient 2 developed a coronary dilatation, that improved significantly after ANA therapy. Our experience highlights IL-1 blockade effectiveness in reducing KD inflammation and suggests ANA adoption as second-line therapy, with a timesaving and steroid-sparing strategy. Our results, combined with the evidence of the IL-1 key role in KD and coronary arteritis pathogenesis and to the recent clinical evidence reported by the KAWAKINRA trial, encourage an earlier recourse to ANA in patients with refractory KD, in order to fight inflammation, and to treat and prevent the development of coronary artery aneurysms. Further studies are needed to better define the place of IL-1 blockade in KD step-up treatment

Thermal Transient Measurements of an Ultra-Low-Power MOX Sensor

This paper describes a system for the simultaneous dynamic control and thermal characterization of the heating of an Ultra Low Power (ULP) micromachined sensor. A Pulse Width Modulated (PWM) powering system has been realized using a microcontroller to characterize the thermal behavior of a device. Objectives of the research were to analyze the relation between the time period and duty cycle of the PWM signal and the operating temperature of such ULP micromachined systems, to observe the thermal time constants of the device during the heating phase and to measure the total thermal conductance. Constant target heater resistance experiments highlighted that an approximately constant heater temperature at regime can only be obtained if the time period of the heating signal is smaller than 50 s. Constant power experiments show quantitatively a thermal time constant that decreases during heating in a range from 2.3 ms to 2 ms as a function of an increasing temperature rise between the ambient and the operating temperature. Moreover, we calculated the total thermal conductance. Finally, repeatability of experimental results was assessed by guaranteeing the standard deviation of the controlled temperature which was within C in worst case conditions

The Geometric Phase and Ray Space Isometries

We study the behaviour of the geometric phase under isometries of the ray space. This leads to a better understanding of a theorem first proved by Wigner: isometries of the ray space can always be realised as projections of unitary or anti-unitary transformations on the Hilbert space. We suggest that the construction involved in Wigner's proof is best viewed as an use of the Pancharatnam connection to ``lift'' a ray space isometry to the Hilbert space.Comment: 17 pages, Latex file, no figures, To appear in Pramana J. Phy

Pd2Si surfaces thermally enriched in silicon: Evidence of new Si:Pd bonds

Thermally induced Si accumulation onto Pd2Si surfaces has been studied for the first time with synchrotron radiation photoemission. Evidence is given of the formation of strong bonds between Si and Pd in the transition region between Pd2Si and Si. The results are discussed in view of the Pd-Si interfaces prepared by annealing in device technology

Geometrization of Quantum Mechanics

We show that it is possible to represent various descriptions of Quantum Mechanics in geometrical terms. In particular we start with the space of observables and use the momentum map associated with the unitary group to provide an unified geometrical description for the different pictures of Quantum Mechanics. This construction provides an alternative to the usual GNS construction for pure states.Comment: 16 pages. To appear in Theor. Math. Phys. Some typos corrected. Definition 2 in page 5 rewritte

Subclinical liver fibrosis in patients with idiopathic 1 pulmonary fibrosis.

Background - Data on the presence of subclinical fibrosis across multiple organs in patients with idiopathic lung fibrosis (IPF) are lacking. Our study aimed at investigating through hepatic transient elastography (HTE) the prevalence and clinical impact of subclinical liver fibrosis in a cohort of patients with IPF. Methods - Patients referred to the Centre for Rare Lung Disease of the University Hospital of Modena (Italy) from March 2012 to February 2013with established diagnosis of IPF and without a documented history of liver diseases were consecutively enrolled and underwent HTE. Based on hepatic stiffness status as assessed through METAVIR score patients were categorized as \u201c with liver fibrosis \u201d (corresponding to a METAVIR score of F1-F4) and \u201c without liver fibrosis\u201d (METAVIR F0). Potential predictors of liver fibrosis were investigated through logistic regression model among clinical and serological variables. The overall survival (OS) was assessed according to liver fibrosis and multivariate Cox regression analysis was used to identify independent predictors. Results - In 13 out of 37 patients (35%) with IPF a certain degree of liver fibrosis was documented.No correlation was found between liver stiffness and clinical-functional parameters. OS was lower in patients \u2018 with liver fibrosis\u2019 than in patients \u2018 without liver fibrosis\u2019 (median months 33[23-55] vs. 63[26-94], p=0.038). Patients \u2018 with liver fibrosis\u2019 presented a higher risk of death at seven years as compared to patients \u2018without liver fibrosis\u2019 (HR=2.6, 95%CI[1.003\u20136.7],p= 0.049). Higher level of AST to platelet ratio Index (APRI)was an independent predictor of survival (HR=4.52 95%CI[1.3\u201315.6], p=0.02). Conclusions - In our cohort, more than one third of IPF patients had concomitant subclinical liver fibrosis that negatively affected OS. These preliminary claims further investigation aimed at clarifying the mechanisms beyond multiorgan fibrosis and its clinical implication in patients with IPF

Model Exact Low-Lying States and Spin Dynamics in Ferric Wheels; Fe6_6 to Fe12_{12}

Using an efficient numerical scheme that exploits spatial symmetries and spin-parity, we have obtained the exact low-lying eigenstates of exchange Hamiltonians for ferric wheels up to Fe$_{12}$. The largest calculation involves the Fe$_{12}$ ring which spans a Hilbert space dimension of about 145 million for M$_s$=0 subspace. Our calculated gaps from the singlet ground state to the excited triplet state agrees well with the experimentally measured values. Study of the static structure factor shows that the ground state is spontaneously dimerized for ferric wheels. Spin states of ferric wheels can be viewed as quantized states of a rigid rotor with the gap between the ground and the first excited state defining the inverse of moment of inertia. We have studied the quantum dynamics of Fe$_{10}$ as a representative of ferric wheels. We use the low-lying states of Fe$_{10}$ to solve exactly the time-dependent Schr\"odinger equation and find the magnetization of the molecule in the presence of an alternating magnetic field at zero temperature. We observe a nontrivial oscillation of magnetization which is dependent on the amplitude of the {\it ac} field. We have also studied the torque response of Fe$_{12}$ as a function of magnetic field, which clearly shows spin-state crossover.Comment: Revtex, 24 pages, 8 eps figure

Calculating the energy spectra of magnetic molecules: application of real- and spin-space symmetries

The determination of the energy spectra of small spin systems as for instance given by magnetic molecules is a demanding numerical problem. In this work we review numerical approaches to diagonalize the Heisenberg Hamiltonian that employ symmetries; in particular we focus on the spin-rotational symmetry SU(2) in combination with point-group symmetries. With these methods one is able to block-diagonalize the Hamiltonian and thus to treat spin systems of unprecedented size. In addition it provides a spectroscopic labeling by irreducible representations that is helpful when interpreting transitions induced by Electron Paramagnetic Resonance (EPR), Nuclear Magnetic Resonance (NMR) or Inelastic Neutron Scattering (INS). It is our aim to provide the reader with detailed knowledge on how to set up such a diagonalization scheme.Comment: 29 pages, many figure

Dirac's Observables for the Rest-Frame Instant Form of Tetrad Gravity in a Completely Fixed 3-Orthogonal Gauge

We define the {\it rest-frame instant form} of tetrad gravity restricted to Christodoulou-Klainermann spacetimes. After a study of the Hamiltonian group of gauge transformations generated by the 14 first class constraints of the theory, we define and solve the multitemporal equations associated with the rotation and space diffeomorphism constraints, finding how the cotriads and their momenta depend on the corresponding gauge variables. This allows to find quasi-Shanmugadhasan canonical transformation to the class of 3-orthogonal gauges and to find the Dirac observables for superspace in these gauges. The construction of the explicit form of the transformation and of the solution of the rotation and supermomentum constraints is reduced to solve a system of elliptic linear and quasi-linear partial differential equations. We then show that the superhamiltonian constraint becomes the Lichnerowicz equation for the conformal factor of the 3-metric and that the last gauge variable is the momentum conjugated to the conformal factor. The gauge transformations generated by the superhamiltonian constraint perform the transitions among the allowed foliations of spacetime, so that the theory is independent from its 3+1 splittings. In the special 3-orthogonal gauge defined by the vanishing of the conformal factor momentum we determine the final Dirac observables for the gravitational field even if we are not able to solve the Lichnerowicz equation. The final Hamiltonian is the weak ADM energy restricted to this completely fixed gauge.Comment: RevTeX file, 141 page