Refractory Hypercalcemia in Sarcoidosis: Exacerbation by thiazide diuretics, differentiation from primary hyperparathyroidism, and possible role of prolactin

Hypercalcemia in a patient with sarcoidosis was made worse by a thiazide diuretic initially given to control hypercalciuria alone. The hypercalcemia was unusually resistant to corticosteroid treatment during the summer even after the thiazide diuretic had been discontinued. Lack of response to corticosteroid together with decreased tubular reabsorption of phosphate and increased tubular reabsorption of calcium suggested associated primary hyperparathyroidism, but PTH was undetectable by immunoassay, and nephrogenous cyclic AMP excretion was zero. Amenorrhea, galactorrhea and hyperprolactinemia were found to be due to a pituitary tumor which was removed. The experience with this patient suggests that: 1) exacerbation of hypercalcemia by thiazides does not discriminate between its different causes; 2) finding low values for plasma parathyroid homone (PTH) and nephrogenous cyclic AMP is the most certain way of excluding primary hyperparathyroidism in patients with hypercalcemia from other causes; 3) prolactin excess, by increasing the synthesis of 1,25 dihydroxycholecalciferol, may have intensified the calcium metabolism disorder

Irreversibility of advanced osteoporosis: Limited role for pharmacologic intervention

Osteoporosis is of medical interest only because it increases bone fragility and risk of fracture, and except for relief of symptoms, preventing fracture is the only purpose of intervention. To prevent the first fracture, adequate bone density must be accumulated and conserved, but to prevent subsequent fracture, bone density must be augmented so that the supportive function of the skeleton can be restored. Almost 50 years after the recognition of post menopausal osteoporosis as a clinical entity, not one of the many treatments that have been used has been demonstrated to be efficacious in reducing subsequent fracture risk. My purpose is not to recite this chronicle of disappointment, but to account for it in terms of bone biology, to consider some possible exceptions, and to reiterate the importance of preventing damage to the skeleton rather than belatedly attempting its repair

Use of shallow samples to estimate the total carbon storage in pastoral soils

Using data from pastoral soils sampled by horizon at 56 locations across New Zealand, we conducted a meta-analysis. On average, the total depth sampled was 0.93 ± 0.026 m (± SEM), and on a volumetric basis, the total C storage averaged 26.9 ± 1.8, 13.9 ± 0.6 and 9.2 ± 1.4 kg C m⁻² for allophanic (n=12), non-allophanic (n=40) and pumice soils (n=4), respectively. We estimated the total C storage, and quantified the uncertainty, using the data for samples taken from the uppermost A-horizon whose depth averaged 0.1 ± 0.003 m. For A-horizon samples of the allophanic soils, the mean C content was 108 ± 6 g C kg⁻¹ and the bulk density was 772 ± 29 kg m⁻³, for non-allophanic soils they were 51 ± 4 g C kg⁻¹ and 1055 ± 29 kg m⁻³, and for pumice soils they were 68 ± 9 g C kg⁻¹ and 715 ± 45 kg m⁻³. The C density —a product of the C content and bulk density —of the A-horizon samples was proportional to their air-dried water content, a proxy measure for the mineral surface area. By linear regression with C density of the A-horizon, the total C storage could be estimated with a standard error of 3.1 kg C m⁻², 19% of the overall mean

Effective use of Pupil Premium Plus to improve educational outcomes for looked after children

This publication reports on research funded by the National Association of Virtual School Heads and presents insights into the use of Pupil Premium Plus (PP+) to support educational outcomes for looked after children. Using data generated from Virtual School Heads, Designated Teachers and other stakeholder professionals, supported by available academic and policy texts, these insights together with emerging evidence of gaps in guidance and support inform a set of recommendations for stakeholders to consider to support educational outcomes for looked after children; specifically relating to: 1) The guidance and support available for effective use of PP+; 2) How PP+ is used and allocated; and 3) How impact of PP+-funded interventions is evidenced

Irrigação por inundação intermitente para culturas em rotação ao arroz em áreas de várzea do Rio Grande do Sul.

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Drenagem superficial para diversificação do uso de solos de várzea do Rio Grande do Sul.

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Earliest Directly-Dated Human Skull-Cups

The use of human braincases as drinking cups and containers has extensive historic and ethnographic documentation, but archaeological examples are extremely rare. In the Upper Palaeolithic of western Europe, cut-marked and broken human bones are widespread in the Magdalenian (∼15 to 12,000 years BP) and skull-cup preparation is an element of this tradition

Taphonomic and technological analyses of Lower Palaeolithic bone tools from Clacton-on-Sea, UK

The exceptional survival of Middle Pleistocene wooden spears at Schöningen (Germany) and Clacton-on-Sea (UK) provides tantalizing evidence for the widespread use of organic raw materials by early humans. At Clacton, less well-known organic artefacts include modified bones that were identified by the Abbé Henri Breuil in the 1920s. Some of these pieces were described and figured by Hazzledine Warren in his classic 1951 paper on the flint industry from the Clacton Channel, but they have been either overlooked in subsequent studies or dismissed as the product of natural damage. We provide the first detailed analysis of two Clactonian bone tools found by Warren and a previously unrecognized example recovered in 1934 during excavations directed by Mary Leakey. Microscopic examination of percussion damage suggests the bones were used as knapping hammers to shape or resharpen flake tools. Early Palaeolithic bone tools are exceedingly rare, and the Clacton examples are the earliest known organic knapping hammers associated with a core-and-flake (Mode 1) lithic technology. The use of soft hammers for knapping challenges the consensus that Clactonian flintknapping was undertaken solely with hard hammerstones, thus removing a major technological and behavioural difference used to distinguish the Clactonian from late Acheulean handaxe (Mode 2) industries

Molecular markers for grape characterization

Research NoteFive cultivars and 9 Pinot noir clones were used to test the usefulness of RFLP and RAPD markers and determine whether clonal selections could be differentiated

Non-masticatory striations on human teeth from the British Upper Palaeolithic to the Neolithic

Non-masticatory labial striations on human anterior teeth are a form of cultural dental wear well recorded throughout the Pleistocene, which has been interpreted as resulting from the use of the mouth as a ‘third hand’ when processing different materials during daily activities, such as cutting meat or working hides with stone tools. Non-masticatory scratches have also been reported on the buccal surface of molars and premolars, although at a far lower frequency compared to the anterior dentition. Previous studies observed an apparent decrease through time in the occurrence of non-masticatory scratches on human teeth, with labial striations appearing to be rare for the Neolithic compared to earlier periods. This study further tests this previously observed pattern through the analysis of over 900 human teeth from 20 sites across England and Wales dating from the Upper Palaeolithic, Mesolithic, and Neolithic, to discuss the distribution and aetiology of non-masticatory striations in the British archaeological record. To record and assess the micro-morphometric characteristics of these dental alterations, macroscopic and microscopic analytical techniques were used. Results show that non-masticatory labial striations are still found on Neolithic teeth, although at a decreased frequency when compared to hunter-gatherer (Upper Palaeolithic and Mesolithic) samples. This may be partly due to changes in diets and food processing methods, as well as types of processed materials and changes in manual handling arising from the inception of the Neolithic in Britain. The sample also includes Upper Palaeolithic, Mesolithic and Neolithic teeth with non-masticatory striations likely associated with funerary practices or cannibalistic treatment of cadavers. Analyses of these marks suggest that striations inflicted during the post-mortem cutting of cadavers from cannibalism or funerary practices differ in their location and micro-morphology, compared with non-masticatory striations produced during the life of an individual using the mouth as a ‘third hand’