Pitch production during the Roman period: an intensive mountain industry for a globalised economy?

The authors’ research project in the Pyrenees mountains has located and excavated Roman kilns for producing pitch from pine resin. Their investigations reveal a whole sustainable industry, integrated into the local environmental cycle, supplying pitch to the Roman network and charcoal as a spin-off to the local iron extractors. The paper makes a strong case for applying combined archaeological and palaeoenvironmental investigations in upland areas, showing mountain industries to have been not so much marginal and pastoral as key players in the economy of the Roman period and beyond it into the seventh century AD

Climatic and land use changes on the NW of Iberian Peninsula recorded in a 1500-year record from Lake Sanabria

L'estudi de diversos descriptors paleoambientals com ara el pol·len, les diatomees i la sedimentologia, realitzat en sediments procedents del llac de Sanabria (NO de la península Ibèrica), ha aportat informació sobre les oscil·lacions climàtiques atribuïdes als períodes càlids tardoromà i medieval, així com a la petita edat del gel. Entre els anys 440 i 950 dC, el clima es caracteritzà per temperatures suaus i un règim de precipitacions mediterrani, malgrat l'existència de pulsacions més fredes vers els anys 530 i 700 dC. Les evidències pol·líniques dels usos del sòl indiquen l'extensió d'activitats ramaderes i agrícoles. Aquesta fase correspon al final del període càlid romà i al període càlid medieval. El canvi de condicions climàtiques es produeix entre els anys 950 i 1100 dC, moment en què els valors mínims de matèria orgànica, pol·len arbori, concentració de diatomees, nitrogen total (TN) i mida del gra indiquen temperatures més baixes i un règim de precipitacions més regular. Aquest període correspon a la petita edat del gel, que finalitzà vers l'any 1590 dC. Posteriorment, la productivitat del llac tendeix a recuperar els valors previs, malgrat que es produeixen episodis freds i curts. Els valors de carbó orgànic total, TN i diatomees covarien amb els índexs de temperatura del NO de la península Ibèrica i posarien de manifest que, amb anterioritat a l'era industrial, el sistema lacustre de Sanabria estava controlat principalment per les condicions climàtiques. Des de l'any 1920 dC, la productivitat del llac està influenciada per l'activitat humana.This multi-proxy paleoenvironmental study from Lake Sanabria (NW Iberian Peninsula), based on pollen, diatom, and sedimentology, provides evidences of climatic oscillations attributed to the Late Roman and Medieval Warm Periods as well as the Little Ice Age (LIA). From 440 to 950 AD, the climate was characterized by mild temperatures and a Mediterranean rainfall regime, although climatic cold periods were recorded at ca. 530 and 700. Evidence from pollen indicators of land-use suggests that grazing and farming were widespread activities. This period corresponds to the end of the Roman Warm Period and the Medieval Warm Period. The onset of new climate conditions occurred between 950 and 1100 AD, as minimum values of organic matter, arboreal pollen, diatom concentration, total nitrogen (TN), and grain size indicate low temperatures and a more regular rainfall regime. This period corresponds to the LIA and ended at 1590 AD, when lake productivity tended to recover to previous values in spite of the occurrence of cool events. Total organic carbon, TN, and diatom content covary with the temperature index for the NW Iberia, suggesting that Lake Sanabria was mainly controlled by climate before the industrial period. Since 1920 AD, lake productivity has been mainly influenced by human activity

Mediterranean polyculture revisited: olive, grape and subsistence strategies at Palaikastro, East Crete, between the Late Neolithic and Late Bronze Age

This paper examines agriculture, farming and dietary resources in east Crete, and re-evaluates the role of grape and olive in its prehistoric economy, these being key in debates on the emergence of social complexity. To do so bioarchaeological, paleoenvironmental and landscape survey data from the Bronze Age town at Palaikastro and its territory are combined. The results indicate a highly compartmentalised landscape, including intensive crop cultivation and extensive animal herding with careful monitoring to maintain productivity. A heightened specialisation in ovicaprine management at Palaikastro and east Crete seems to be delineated. Marine resources were regularly exploited from easily accessible coastal areas. Other activities included viticulture since the Early Minoan period, with the possible involvement of several houses in wine-making. A final important activity in the area was large-scale olive tree management since the Final Neolithic period and through to the Late Bronze Age, that seems to be entangled with ovicaprine herding and grazing. Thus, the demand for olive oil production does not seem to have been the driving force behind the intensification of the tree management, at least initially, but a corollary of its use in other aspects of the local economy

Current HHT genetic overview in Spain and its phenotypic correlation: Data from RiHHTa registry

Background: Hereditary hemorrhagic telangiectasia (HHT) is a rare vascular disease with autosomal dominant inheritance. Disease-causing variants in endoglin (ENG) and activin A receptor type II-like 1 (ACVRL1) genes are detected in more than 90% of cases submitted to molecular diagnosis. Methods: We used data from the RiHHTa (Computerized Registry of Hereditary Hemorrhagic Telangiectasia) registry to describe genetic variants and to assess their genotype-phenotype correlation among HHT patients in Spain. Results: By May 2019, 215 patients were included in the RiHHTa registry with a mean age of 52.5 ± 16.5 years and 136 (63.3%) were women. Definitive HHT diagnosis defined by the Curaca¸o criteria were met by 172 (80%) patients. Among 113 patients with genetic test, 77 (68.1%) showed a genetic variant in ACVRL1 and 36 (31.8%) in ENG gene. The identified genetic variants in ACVRL1 and ENG genes and their clinical significance are provided. ACVRL1 mutations were more frequently nonsense (50%) while ENG mutations were more frequently, frameshift (39.1%). ENG patients were significantly younger at diagnosis (36.9 vs 45.7 years) and had pulmonary arteriovenous malformations (AVMs) (71.4% vs 24.4%) and cerebral AVMs (17.6% vs 2%) more often than patients with ACVRL1 variants. Patients with ACVRL1 variants had a higher cardiac index (2.62 vs 3.46), higher levels of hepatic functional blood tests, and anemia (28.5% vs 56.7%) more often than ENG patients. Conclusions: ACVRL1 variants are more frequent than ENG in Spain. ACVRL1 patients developed symptomatic liver disease and anemia more often than ENG patients. Compared to ACVRL1, those with ENG variants are younger at diagnosis and show pulmonary and cerebral AVMs more frequently

Gender differences in Hereditary Hemorrhagic Telangiectasia severity

Background: Gender differences in organ involvement and clinical severity have been poorly described in hereditary hemorrhagic telangiectasia (HHT). The aim of this study was to describe differences in the severity of HHT manifestations according to gender. Methods: Severity was measured according to Epistaxis Severity Score (ESS), Simple Clinical Scoring Index for hepatic involvement, a general HHT-score, needing for invasive treatment (pulmonary or brain arteriovenous malformations -AVMs- embolization, liver transplantation or Young's surgery) or the presence of adverse outcomes (severe anemia, emergency department -ED- or hospital admissions and mortality). Results: One hundred forty-two (58.7%) women and 100 (41.3%) men were included with a mean age of 48.9 ± 16.6 and 49 ± 16.5 years, respectively. Women presented hepatic manifestations (7.1% vs 0%) and hepatic involvement (59.8% vs 47%), hepatic AVMs (28.2% vs 13%) and bile duct dilatation (4.9% vs 0%) at abdominal CT, and pulmonary AVMs at thoracic CT (35.2% vs 23%) more often than men. The Simple Clinical Scoring Index was higher in women (3.38 ± 1.2 vs 2.03 ± 1.2), and more men were considered at low risk of harboring clinically significant liver disease than women (61% vs 25.3%). These differences were mantained when considering HHT1 and HHT2 patients separetely. Duodenal telangiectasia were more frequent in men than women (21% vs 9.8%). Invasive treatments were more frequently needed in women (28.2% vs 16%) but men needed attention at the ED more often than women (48% vs 28.2%), with no differences in ESS, HHT-score, anemia hospital admissions or mortality. Conclusions: HHT women showed more severe hepatic involvement than men, also among HHT1 and HHT2 patients. Women had higher prevalence of pulmonary AVMs and needed invasive procedures more frequently, while men needed attention at the ED more often. These data might help physicians to individualize HHT patients follow-up

Blood Rheological Characterization of β-Thalassemia Trait and Iron Deficiency Anemia Using Front Microrheometry

The purpose of this work is to develop a hematocrit-independent method for the detection of beta-thalassemia trait (β-TT) and iron deficiency anemia (IDA), through the rheological characterization of whole blood samples from different donors. The results obtained herein are the basis for the development of a front microrheometry point-of-care device for the diagnosis and clinical follow-up of β-TT patients suffering hematological diseases and alterations in the morphology of the red blood cell (RBC). The viscosity is calculated as a function of the mean front velocity by detecting the sample fluid-air interface advancing through a microfluidic channel. Different viscosity curves are obtained for healthy donors, β-TT and IDA samples. A mathematical model is introduced to compare samples of distinct hematocrit, classifying the viscosity curve patterns with respect to the health condition of blood. The viscosity of the fluid at certain shear rate values varies depending on several RBC factors such as shape and size, hemoglobin (Hb) content, membrane rigidity and hematocrit concentration. Blood and plasma from healthy donors are used as reference. To validate their potential clinical value as a diagnostic tool, the viscosity results are compared to those obtained by the gold-standard method for RBC deformability evaluation, the Laser-Optical Rotational Red Cell Analyzer (LoRRCA).LM-M and JF-T received funding from programs Doctorat Industrial (2018 DI 068) and (2018 DI 064) from AGAUR (Generalitat de Catalunya). EK receives funding from Institut Josep Carreras (IJC) under program Equality Plus, project number 2019-1-TR01-KA202-076789. TA acknowledges funding under grant numbers MTM2015-71509-C2-1-R and MDM-2014-0445. TA has been partially funded by the CERCA Program of the Generalitat de Catalunya. AH-M acknowledges funding under project FIS2016-78883-C2-1P, Ministerio de Ciencia e Innovacion (Spain) under project PID2019-106063GB-100 and AGAUR (Generalitat de Catalunya) under project 2017 SGR-1061. CT-S and AH-M acknowledge partial support from ANID/PCI (Chile) under project MEC80180021

Adrenomedullin as a potential biomarker involved in patients with hereditary hemorrhagic telangiectasia

Background: Adrenomedullin (AM) is a vasoactive peptide mostly secreted by endothelial cells with an important role in preserving endothelial integrity. The relationship between AM and hereditary hemorrhagic telangiectasia (HHT) is unknown. We aimed to compare the serum levels and tissue expression of AM between HHT patients and controls. Methods: Serum AM levels were measured by radioimmunoassay and compared between control and HHT groups. AM levels were also compared among HHT subgroups according to clinical characteristics. The single nucleotide polymorphism (SNP) rs4910118 was assessed by restriction analysis and sequencing. AM immunohistochemistry was performed on biopsies of cutaneous telangiectasia from eight HHT patients and on the healthy skin from five patients in the control group. Results: Forty-five HHT patients and 50 healthy controls were included, mean age (SD) was 50.7 (14.9) years and 46.4 (9.9) years (p = 0.102), respectively. HHT patients were mostly female (60% vs 38%, p = 0.032). Median [Q1-Q3] serum AM levels were 68.3 [58.1-80.6] pg/mL in the HHT group and 47.7 [43.2-53.8] pg/mL in controls (p<0.001), with an optimal AM cut-off according to Youden's J statistic of 55.32 pg/mL (J:0.729). Serum AM levels were similar in the HHT subgroups. No patient with HHT had the SNP rs4910118. AM immunoreactivity was found with high intensity in the abnormal blood vessels of HHT biopsies

Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan

La sobrecarga asistencial y los cambios organizativos frente a la pandemia de COVID-19 podrían estar repercutiendo en la atención al ictus agudo en la Comunidad de Madrid. Métodos: Encuesta estructurada en bloques: características del hospital, cambios en infraestructura y recursos, circuitos de código ictus, pruebas diagnósticas, rehabilitación y atención ambulatoria. Análisis descriptivo según el nivel de complejidad en la atención del ictus (disponibilidad o no de unidad de ictus y de trombectomía mecánica). Resultados: De los 26 hospitales del SERMAS que atienden urgencias en adultos, 22 cumplimentaron la encuesta entre el 16 y 27 de abril. El 95% han cedido neurólogos para atender a pacientes afectados por la COVID-19. Se han reducido camas de neurología en el 89,4%, modificado los circuitos en urgencias para ictus en el 81%, con circuitos específicos para sospecha de infección por SARS-CoV2 en el 50%, y en el 42% de los hospitales los pacientes con ictus agudo positivos para SARS-CoV2 no ingresan en camas de neurología. Ha mejorado el acceso altratamiento, con trombectomía mecánica las 24 h en el propio hospital en 10 hospitales, y sehan reducido los traslados interhospitalarios secundarios. Se ha evitado el ingreso de pacientescon ataque isquémico transitorio o ictus leve (45%) y se han incorporado consultas telefónicaspara seguimiento en el 100%.Conclusiones: Los cambios organizativos de los hospitales de la Comunidad de Madrid frente ala pandemia por SARS-Co2 han modificado la dedicación de recursos humanos e infraestructurasde las unidades de neurología y los circuitos de atención del ictus, realización de pruebasdiagnósticas, ingreso de los pacientes y seguimientoThe overload of the healthcare system and the organisational changes made inresponse to the COVID-19 pandemic may be having an impact on acute stroke care in the Regionof Madrid.Methods: We conducted a survey with sections addressing hospital characteristics, changes ininfrastructure and resources, code stroke clinical pathways, diagnostic testing, rehabilitation,and outpatient care. We performed a descriptive analysis of results according to the level ofcomplexity of stroke care (availability of stroke units and mechanical thrombectomy).Results: The survey was completed by 22 of the 26 hospitals in the Madrid Regional HealthSystem that attend adult emergencies, between 16 and 27 April 2020. Ninety-five percent ofhospitals had reallocated neurologists to care for patients with COVID-19. The numbers of neuro-logy ward beds were reduced in 89.4% of hospitals; emergency department stroke care pathwayswere modified in 81%, with specific pathways for suspected SARS-CoV2 infection established in50% of hospitals; and SARS-CoV2-positive patients with acute stroke were not admitted to neu-rology wards in 42%. Twenty-four hour on-site availability of mechanical thrombectomy wasimproved in 10 hospitals, which resulted in a reduction in the number of secondary hospitaltransfers. The admission of patients with transient ischaemic attack or minor stroke was avoi-ded in 45% of hospitals, and follow-up through telephone consultations was implemented in100%.Conclusions: The organisational changes made in response to the SARS-Co2 pandemic in hos-pitals in the Region of Madrid have modified the allocation of neurology department staff andinfrastructure, stroke units and stroke care pathways, diagnostic testing, hospital admissions,and outpatient follow-u

Acute stroke care during the COVID-19 pandemic. Ictus Madrid Program recommendations

La pandemia por COVID-19 ha obligado a una reorganización de los sistemas sanitarios y ha comportado una saturación excepcional de sus recursos. En este contexto es vital asegurar la atención al ictus agudo y optimizar los procesos asistenciales del código ictus para reducir el riesgo de contagios y racionalizar el uso de recursos hospitalarios. Para ello, desde el Grupo Multidisciplinar Ictus Madrid proponemos una serie de recomendaciones. Métodos Revisión bibliográfica no sistemática de las publicaciones disponibles con los términos «stroke» y «COVID-19» o «coronavirus» o «SARS-CoV-2», así como otras conocidas por los autores. En base a esta se redacta un documento de recomendaciones que es sometido a consenso por el Grupo Multidisciplinar Ictus Madrid y su Comité de Neurología. Resultados Las recomendaciones se estructuran en cinco líneas fundamentales: 1) coordinar la actuación para garantizar el acceso a la asistencia hospitalaria de los pacientes con ictus; 2) reconocer a los pacientes con ictus potencialmente infectados por COVID-19, 3) organización adecuada para garantizar la protección de los profesionales sanitarios frente al riesgo de contagio por COVID-19, 4) en la realización de neuroimagen y otros procedimientos que conlleven contactos de riesgo de infección COVID-19 hay que procurar reducirlos y asegurar la protección, y 5) alta y seguimiento seguros procurando optimizar la ocupación hospitalaria. Resumimos el procedimiento de forma esquemática con el acrónimo CORONA (COordinar, Reconocer, Organizar, Neuroimagen, Alta). Conclusiones Estas recomendaciones pueden servir de apoyo para la organización del sistema sanitario en la atención al ictus agudo y la optimización de sus recursos, garantizando la protección de sus profesionalesThe COVID-19 pandemic has forced a reorganization of healthcare systems and an exceptional saturation of their resources. In this context, it is vital to ensure acute stroke care and optimize the care processes of the stroke code to reduce the risk of contagion and rationalize the use of hospital resources. To do this, the Ictus Madrid Multidisciplinary Group proposes a series of recommendations. Methods Non-systematic bibliographic review of the available publications with the terms «stroke» and «COVID-19» or «coronavirus» or «SARS-CoV-2», as well as other already known for the authors. We provide a document of recommendations as a result of the consensus of the Ictus Madrid Multidisciplinary Group and its Neurology Committee. Results Our recommendations are structured on five lines: (1) coordinate to guarantee the access to hospital care for stroke patients, (2) recognize potentially COVID-19 infected stroke patients, (3) organize to ensure the protection of healthcare professionals from COVID-19 infections, (4) neuroimaging and other procedures potentially associated to risks for COVID-19 infection should be reduced and secured to avoid contagion, and (5) at home as soon as possible and supported follow-up to optimize hospital occupancy. The procedure is shown summarized under the acronym CORONA (COordinate, Recognize, Organize, Neuroimaging, At home). Conclusions These recommendations can support the organization of healthcare services for acute stroke care and the optimization of their resources, guaranteeing the protection of healthcare professional