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

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

Spin dynamics in molecular ring nanomagnets: Significant effect of acoustic phonons and magnetic anisotropies

The nuclear spin-lattice relaxation rate 1/T_1_ is calculated for magnetic ring clusters by fully diagonalizing their microscopic spin Hamiltonians. Whether the nearest-neighbor exchange interaction J is ferromagnetic or antiferromagnetic, 1/T_1_ versus temperature T in ring nanomagnets may be peaked at around k_B_T=|J| provided the lifetime broadening of discrete energy levels is in proportion to T^3^. Experimental findings for ferromagnetic and antiferromagnetic Cu^II^ rings are reproduced with crucial contributions of magnetic anisotropies as well as acoustic phonons.Comment: 5 pages with 5 figures embedded, to be published in J. Phys. Soc. Jpn. 75, No. 10 (2006

Percutaneous radiofrequency ablation in intrahepatic cholangiocarcinoma: a retrospective single-center experience

Background & aims: Very few data are available in literature about the role of radiofrequency ablation (RFA) in intrahepatic cholangiocarcinoma (ICC) and previous studies are mainly case reports and case series on a very small number of patients and nodules. In this study, we aimed to evaluate effectiveness and safety of RFA for the treatment of unresectable ICC. Methods: This is a retrospective observational cohort study comprising all consecutive patients treated with RFA for unresectable ICC at Policlinico Sant’Orsola Malpighi Hospital, Bologna, Italy. Primary endpoint was Local Tumor Progression-Free Survival (LTPFS) while Overall Survival (OS) was also assessed as secondary endpoint. Results: From January 2014 to June 2019, 29 patients with 117 nodules underwent RFA. Technique effectiveness 1 month after RFA was 92.3%; median LTPFS was 9.27 months. Univariate analysis and multivariate analysis showed that LTPFS was significantly related to tumor size ≥20 mm. At a median follow up of 39.9 months, median OS from the date of RFA was 27.5 months, with an OS of 89%, 45% and 11% at 1, 2 and 4 years, respectively. Number of overall lesions and the sum of their diameter at the moment of the first RFA significantly affected OS in multivariate analysis. Minor and major complication rates were 14% and 7%, respectively. Conclusion: Tumor size ≥20 mm was associated with lower LTPFS, representing a potential useful threshold value. A careful evaluation of tumor burden appears as a crucial element in choosing the best therapeutic strategy in unresectable ICC

Trend of incidence, subsite distribution and staging of colorectal neoplasms in the 15-year experience of a specialised cancer registry

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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

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

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

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

Transfer-free electrical insulation of epitaxial graphene from its metal substrate

High-quality, large-area epitaxial graphene can be grown on metal surfaces but its transport properties cannot be exploited because the electrical conduction is dominated by the substrate. Here we insulate epitaxial graphene on Ru(0001) by a step-wise intercalation of silicon and oxygen, and the eventual formation of a SiO$_2$ layer between the graphene and the metal. We follow the reaction steps by x-ray photoemission spectroscopy and demonstrate the electrical insulation using a nano-scale multipoint probe technique.Comment: Accepted for publication in Nano Letter