Light chain deposition disease presenting as paroxysmal atrial fibrillation: a case report

<p>Abstract</p> <p>Introduction</p> <p>Light chain deposition disease (LCDD) can involve the heart and cause severe heart failure. Cardiac involvement is usually described in the advanced stages of the disease. We report the case of a woman in whom restrictive cardiomyopathy due to LCDD presented with paroxysmal atrial fibrillation.</p> <p>Case presentation</p> <p>A 55-year-old woman was admitted to our emergency department because of palpitations. In a recent blood test, serum creatinine was 1.4 mg/dl. She was found to have high blood pressure, left ventricular hypertrophy and paroxysmal atrial fibrillation. An ACE-inhibitor was prescribed but her renal function rapidly worsened and she was admitted to our nephrology unit. On admission serum creatinine was 9.4 mg/dl, potassium 6.8 mmol/l, haemoglobin 7.7 g/dl, N-terminal pro-brain natriuretic peptide 29894 pg/ml. A central venous catheter was inserted and haemodialysis was started. She underwent a renal biopsy which showed kappa LCDD. Bone marrow aspiration and bone biopsy demonstrated kappa light chain multiple myeloma. Echocardiographic findings were consistent with restrictive cardiomyopathy. Thalidomide and dexamethasone were prescribed, and a peritoneal catheter was inserted. Peritoneal dialysis has now been performed for 15 months without complications.</p> <p>Discussion</p> <p>Despite the predominant tubular deposition of kappa light chain, in our patient the first clinical manifestation of LCDD was cardiac disease manifesting as atrial fibrillation and the correct diagnosis was delayed. The clinical management initially addressed the cardiovascular symptoms without paying sufficient attention to the pre-existing slight increase in our patient's serum creatinine. However cardiac involvement is a quite uncommon presentation of LCDD, and this unusual case suggests that the onset of acute arrhythmias associated with restrictive cardiomyopathy and impaired renal function might be related to LCDD.</p

A cross-sectional study evaluating hospitalization rates for chronic limb-threatening ischemia during the COVID-19 outbreak in Campania, Italy

The expansion of coronavirus disease 2019 (COVID-19) prompted measures of disease containment by the Italian government with a national lockdown on March 9, 2020. The purpose of this study is to evaluate the rate of hospitalization and mode of in-hospital treatment of patients with chronic limb-threatening ischemia (CLTI) before and during lockdown in the Campania region of Italy. The study population includes all patients with CLTI hospitalized in Campania over a 10-week period: 5 weeks before and 5 weeks during lockdown (n = 453). Patients were treated medically and/or underwent urgent revascularization and/or major amputation of the lower extremities. Mean age was 69.2 +/- 10.6 years and 27.6% of the patients were women. During hospitalization, 21.9% of patients were treated medically, 78.1% underwent revascularization, and 17.4% required amputations. In the weeks during the lockdown, a reduced rate of hospitalization for CLTI was observed compared with the weeks before lockdown (25 vs 74/100,000 inhabitants/year; incidence rate ratio: 0.34, 95% CI 0.32-0.37). This effect persisted to the end of the study period. An increased amputation rate in the weeks during lockdown was observed (29.3% vs 13.4%; p &lt; 0.001). This study reports a reduced rate of CLTI-related hospitalization and an increased in-hospital amputation rate during lockdown in Campania. Ensuring appropriate treatment for patients with CLTI should be prioritized, even during disease containment measures due to the COVID-19 pandemic or other similar conditions

Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2

26th Annual Computational Neuroscience Meeting (CNS*2017): Part 3 - Meeting Abstracts - Antwerp, Belgium. 15–20 July 2017

This work was produced as part of the activities of FAPESP Research,\ud Disseminations and Innovation Center for Neuromathematics (grant\ud 2013/07699-0, S. Paulo Research Foundation). NLK is supported by a\ud FAPESP postdoctoral fellowship (grant 2016/03855-5). ACR is partially\ud supported by a CNPq fellowship (grant 306251/2014-0)

Selection of Tanned-Leather Waste in Recovering Novel Raw Material for Manufacturing Rubber Artifacts: Towards a Zero-Waste Condition

Zero-waste is an ambitious goal to encourage sustainable production, consumption optimum recycling and resource recovery. The recycling and resource recovery of chrome-tanned leather waste is a difficult proposition because of the three-dimensional chemical network of collagen, which renders leather waste incompatible to polymer matrices. Many attempts have been undertaken to reuse leather waste, most of them require technological processes and challenging chemical pretreatments, which make the reuse an economically disadvantageous industrial operation. The paper aims to show how a very fine separation of leather solid waste leads to raw materials suitable for mixtures with natural rubber, without any chemical pretreatment. In other words, the paper intends to be a stimulus to manage leather solid waste carefully to start a cleaner and more profitable production. In particular, various industrial compounds containing different concentrations of post-tanning dyeing, or chrome shaving or oil-tanning and natural rubber were vulcanized through a standard preparation. Some compounds were also reinforced with carbon black and the vulcanization kinetics were monitored through rheometer. Experimental results indicate that there exists an optimal concentration of waste such that post-tanning dyeing post-tanning and chrome shaving are suitable for manufacture floor mats, soles and heels while oil-tanning waste can be used for making hose or conveyor belts. The mechanical performances of the articles prepared by direct mixing with leather waste are the same as those of commercially distributed rubber products

A Novel Approach to Optimize the Industrial Process of Membrane Concentration of Grape Musts

Nanofiltration and reverse osmosis are used in the concentration of grape musts in winemaking. Both technologies offer an effective way to concentrate the grape musts, reducing the volume and the solids content to achieve desired characteristics in the final wine. The choice between nanofiltration and reverse osmosis depends on the specific needs of the winemaker and the desired characteristics. It is important to carefully consider the properties of the grape musts and the performance of the selected membranes to optimize the concentration process and ensure the desired outcome. Herein, we present a novel approach that allows us to choose a suitable membrane for an optimal industrial process for the concentration of musts, both in reverse osmosis and nanofiltration. The proposed method consists of combining the fitting equations of laboratory results with the balance equations on the industrial plant. Specifically, a full-scale plant has been designed and assembled with which grape musts of Trebbiano, Verdeca, Black Bombino, and White Bombino varieties have been concentrated through the selected best-performing membranes. Results of the proposed approach show that grape musts with sugar content commercially appreciated when the membranes work at high pressure can be obtained

Optimal Regulation of Pumping Station in Water Distribution Networks Using Constant and Variable Speed Pumps: A Technical and Economical Comparison

Greenhouse gas emission is one of the main environmental issues of today, and energy savings in all industries contribute to reducing energy demand, implying, in turn, less carbon emissions into the atmosphere. In this framework, water pumping systems are one of the most energy-consuming activities. The optimal regulation of pumping systems with the use of variable speed drives is gaining the attention of designers and managing authorities. However, optimal management and operation of pumping systems is often performed, employing variable speed drives without considering if the energy savings are enough to justify their purchasing and installation costs. In this paper, the authors compare two optimal pump scheduling techniques, optimal regulation of constant speed pumps by an optimal ON/OFF sequence and optimal regulation with a variable speed pump. Much of the attention is devoted to the analysis of the costs involved in a hypothetical managing authority for the water distribution system in order to determine whether the savings in operating costs is enough to justify the employment of variable speed drives