Dabigatran overload in acute kidney injury: haemodialysis or idarucizumab? A case report and proposal for a decisional algorithm

Dabigatran overload has been reported in acute kidney injury (AKI), leading to occasional major bleeding. Haemodialysis (HD) was the method used for reversing dabigatran anticoagulant effects before the approval of idarucizumab, which is now indicated for dabigatran reversal in major bleeding or surgical emergencies. There have been reports of rebound of dabigatran levels following idarucizumab administration in AKI, requiring HD to achieve effective dabigatran clearance. However, a decisional algorithm to individualize treatments for dabigatran overload seems lacking. We present a case of dabigatran accumulation in obstructive AKI with minor bleeding that was successfully treated with HD and tranexamic acid without using idarucizumab, and propose a decision-making algorithm including different pathways in the management of suspected dabigatran overload in AKI

The Harvesting Memories Project: Historical ecology and landscape changes of the Sicani Mountains in Sicily

The Harvesting Memories project aims to investigate the historical landscape dynamics in an inner area of the Sicani Mountains district in Western Sicily (Contrada Castro, Corleone-Palermo). The interdisciplinary approach of the project allowed us to combine and integrate methods from different disciplines such as historical ecology, landscape archaeology, archaeobotany and GIS-based spatial analysis. In this paper some results have been summarized. The comparison between land mosaic change during the last 60 years, the relationship between site catchment area and land suitability and the correlation between archaeobotanical and phytosociological data. This approach underlined the relevance of the historical ecology for understanding landscape trajectories and planning strategy of suitable development of rural areas

Sources of geomaterials in the Sicani Mountains during the Early Middle Ages: A case study of Contrada Castro, central western Sicily

From 2017, an unknown rural settlement in Contrada Castro at Corleone (Palermo Province, western Sicily) was investigated as part of the ‘Harvesting Memories Project’. The stratigraphic sequence, supported by radiocarbon dating, has demonstrated a reoccupation of a pre-Roman site during the transition between the Byzantine and Islamic periods. In particular, the main occupation occurred in the late 8th–9th century when pottery kilns and a probable warehouse were constructed. During the 10th–11th century, a new structure with different orientations replaced the previous buildings that had already collapsed. Specifically focusing on a perspective of the household production and its relationship to the surrounding landscapes of this site, this paper presents the results of a geological survey and petrographic analysis of ceramic finds and lithic samples to identify the source area of the geomaterials used in the studied settlement. The ceramic finds were divided into different Paste Groups based on the characteristics of a polarizing microscope study. The use of some locally available raw materials was recorded both for ceramic and lithic samples. Such an approach enables us to better understand ceramic craft technology, clay and lithic procurement strategies and, more broadly, the consumption of household pottery in the Early Medieval site in Contrada Castro. Furthermore, this study verifies the close relationship that this rural settlement had with the surrounding resources in the area and reveals a connection with the city of Palermo during the Early Middle Ages

The Case of AB Aurigae's Disk in Polarized Light: Is There Truly a Gap?

Using the NICMOS coronagraph, we have obtained high-contrast 2.0 micron imaging polarimetry and 1.1 micron imaging of the circumstellar disk around AB Aurigae on angular scales of 0.3-3 arcsec (40-550 AU). Unlike previous observations, these data resolve the disk in both total and polarized intensity, allowing accurate measurement of the spatial variation of polarization fraction across the disk. Using these observations we investigate the apparent "gap" in the disk reported by Oppenheimer et al. 2008. In polarized intensity, the NICMOS data closely reproduces the morphology seen by Oppenheimer et al., yet in total intensity we find no evidence for a gap in either our 1.1 or 2.0 micron images. We find instead that region has lower polarization fraction, without a significant decrease in total scattered light, consistent with expectations for back-scattered light on the far side of an inclined disk. Radiative transfer models demonstrate this explanation fits the observations. Geometrical scattering effects are entirely sufficient to explain the observed morphology without any need to invoke a gap or protoplanet at that location.Comment: Accepted to ApJ Letter

Undifferentiated connective tissue disease: a seven-center cross-sectional study of 184 patients

The purpose of this study was to characterize the clinical and serological features of a large cohort of patients with antinuclear antibody (ANA) positive undifferentiated connective tissue disease (UCTD). Consecutive patients with UCTD, followed up at the Rheumatology Clinic of the participating centers, were included. Data from these patients were obtained by clinical evaluation and chart review. All patients were diagnosed as having UCTD on basis of the following criteria: positive ANA plus at least one clinical feature of connective tissue disease, but not fulfilling classification criteria for any differentiated connective tissue disease. One hundred eighty-four patients were studied (female patients-94.5%; mean age at time of evaluation-47 years). The most prevalent manifestations were arthralgia (66%), arthritis (32%), Raynaud's phenomenon (30%), sicca symptoms (30%), and leukopenia (19%). The prevalence of ANA was 100%, anti-SSA 20%, anti-dsDNA 14%, and anti-SSB 7%. Patients with anti-dsDNA/anti-Sm, anticentromere/anti-Scl70, or anti-SSA/anti-SSB antibodies more frequently presented a set of manifestations close to systemic lupus erythematosus (SLE), systemic sclerosis, or Sjögren syndrome, respectively. We analyze a large cohort of UCTD. Seventy-two percent of these UCTD patients present lupus-, scleroderma-, or Sjögren-like features but do not fulfill classification criteria and mostly present a mild disease

Predictors of response to TNF blockers in patients with polyarticular psoriatic arthritis

Psoriatic arthritis (PsA) is a chronic inflammatory rheumatic disease with a broad clinical spectrum. PsA can affect the axialskeleton, peripheral joints, entheses, synovial sheaths of tendons, skin, nails and extra-articular organs. Tumour necrosis factor alpha blockers (TNF blockers) were a breakthrough development in the treatment of PsA. Identifying predictors of response to biological therapiesin patients with PsA is of utmost importance, especially in view of the costs and potential side effects of these agents. The aims of the present study were to determine baseline predictive factors of response to biological therapies, at 3 and 6 months, in PsA patients with polyarticular involvement (with or without axial involvement). Data were collected from the RheumaticDiseases Portuguese Register(Reuma.pt). Eligible patients had to be anti-TNF-naive at baseline and to have at least 3 months of follow-up after the beginning of TNF blocker therapy. Only patients with information on at least one of the response measures (at 3 or 6 months of follow-up) were included in the analysis. Univariable logistic regression analysis of potential baseline predictors of European League Against Rheu-matism (EULAR) good clinical response, EULAR good/ /moderate response, 28-joint Disease Activity Score with three variables including the erythrocyte sedimentation rate (DAS28-3V-ESR) remission and Health Assessment Questionnaire (HAQ) response were performed. Multivariable logistic regression using a forward selection procedure was used until the best-fit model was obtained, taking confounding effects into account. A total of 180 patients were eligible for the study (mean age 52 years, 54% women). In multivariable analysis at 3 months, females were less likely to attain a good EULAR response [OR=0.082 (95% CI=0.024, 0.278)], a DAS28-3V-ESR remission [OR=0.083 (95% CI=0.017, 0.416)], a moderate or good EULAR response [OR=0.091 (95% CI=0.011, 0.091)] and a HAQ response [OR=0.074 (95% CI=0.009, 0.608)]. At 6 months, female gender was also less likely to achieve a good EULAR response [OR=0.060 (95% CI=0.011, 0.325)], DAS28-3V-ESR remission [OR=0.060 (95% CI=0.012, 0.297)], and a HAQ response [OR=0.138 (95% CI= 0.029, 0.654)]. In this study we found that gender was the most consistent predictor of response to TNF blocker therapy in patients with polyarticular PsA, with females having a lower probability ofresponse compared to males. These findings suggest that gender-related biochemical, hormonal and psychological factors could play an importantrole in the response to TNF blockertherapy in PsA

Estudo do tubo de vórtices no torneamento

O tubo de vórtices é um dispositivo mecânico utilizado na conversão de energia cinética do ar em energia térmica. O objetivo deste trabalho é analisar o tubo de vórtices no processo de torneamento, especificamente, no faceamento rápido de um aço ABNT 1045 utilizando ferramentas de aço rápido com 10% de Co. Os resultados mostraram que no faceamento rápido utilizando o tubo de vórtices, a vida da ferramenta aumentou em 20% em relação ao processo a seco, uma vez que o colapso da ferramenta ocorreu com diâmetro de usinagem de 198,20 mm

A Disk Around the Planetary-Mass Companion GSC 06214-00210 b: Clues About the Formation of Gas Giants on Wide Orbits

We present Keck/OSIRIS 1.1-1.8 um adaptive optics integral field spectroscopy of the planetary-mass companion to GSC 06214-00210, a member of the ~5 Myr Upper Scorpius OB association. We infer a spectral type of L0+/-1, and our spectrum exhibits multiple signs of youth. The most notable feature is exceptionally strong PaBeta emission (EW=-11.4 +/- 0.3 A) which signals the presence of a circumplanetary accretion disk. The luminosity of GSC 06214-00210 b combined with its age yields a model-dependent mass of 14 +/- 2 MJup, making it the lowest-mass companion to show evidence of a disk. With a projected separation of 320 AU, the formation of GSC 06214-00210 b and other very low-mass companions on similarly wide orbits is unclear. One proposed mechanism is formation at close separations followed by planet-planet scattering to much larger orbits. Since that scenario involves a close encounter with another massive body, which is probably destructive to circumplanetary disks, it is unlikely that GSC 06214-00210 b underwent a scattering event in the past. This implies that planet-planet scattering is not solely responsible for the population of gas giants on wide orbits. More generally, the identification of disks around young planetary companions on wide orbits offers a novel method to constrain the formation pathway of these objects, which is otherwise notoriously difficult to do for individual systems. We also refine the spectral type of the primary from M1 to K7 and detect a mild (2-sigma) excess at 22 um using WISE photometry.Comment: 25 pages, 13 figures; Accepted by Ap