Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

Objective. To assess the immunogenicity and safety of non-adjuvanted influenza A H1N1/2009 vaccine in patients with juvenile autoimmune rheumatic disease (ARD) and healthy controls, because data are limited to the adult rheumatologic population. Method's. A total of 237 patients with juvenile ARD [juvenile systemic lupus erythematosus (JSLE), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), juvenile scleroderma, and vasculitis] and 91 healthy controls were vaccinated. Serology for anti-H1N1 was performed by hemagglutination inhibition assay. Seroprotection rate, seroconversion rate, and factor-increase in geometric mean titer (GMT) were calculated. Adverse events were evaluated. Results. Age was comparable in patients and controls (14.8 +/- 3.0 vs 14.6 +/- 3.7 years, respectively; p = 0.47). Three weeks after immunization, seroprotection rate (81.4% vs 95.6%; p = 0.0007), seroconversion rate (74.3 vs 95.6%; p < 0.0001), and the factor-increase in GMT (12.9 vs 20.3; p = 0.012) were significantly lower in patients with juvenile ARD versus controls. Subgroup analysis revealed reduced seroconversion rates in JSLE (p < 0.0001), JIA (p = 0.008), JDM (p = 0.025), and vasculitis (p = 0.017). Seroprotection (p < 0.0001) and GMT (p < 0.0001) were decreased only in JSLE. Glucocorticoid use and lymphopenia were associated with lower seroconversion rates (60.4 vs 82.9%; p = 0.0001; and 55.6 vs 77.2%; p = 0.012). Multivariate logistic regression including diseases, lymphopenia, glucocorticoid, and immunosuppressants demonstrated that only glucocorticoid use (p = 0.012) remained significant. Conclusion. This is the largest study to demonstrate a reduced but adequate immune response to H1N1 vaccine in patients with juvenile ARD. It identified current glucocorticoid use as the major factor for decreased antibody production. The short-term safety results support its routine recommendation for patients with juvenile ARD. ClinicalTrials.gov; NCT01151644. (First Release Nov 15 2011; J Rheumatol 2012;39:167-73; doi:10.3899/jrheum.110721)

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.

Study of reactions induced by 6He on 9Be

We present the results of experiments using a 6He beam on a 9Be target at energies 7 − 9 times the Coulomb barrier. Angular distributions of the elastic, inelastic scattering (target breakup) and the -particle production in the 6He+9Be collision have been analysed. Total reaction cross sections were obtained from the elastic scattering analyses and a considerable enhancement has been observed by comparing to stable systems.

El mejor Viana gracias a Mª Rosa Alonso

Reseña al libro de María Rosa Alonso: Antonio de Viana: Antigüedades de las Islas Afortunadas

Geological evolution of the Monte Rosa

Eine detaillierte geochemische und geochronologische Studie an Gesteinen der Monte Rosa Decke (MR; Westalpen) wurde durchgeführt. Die MR wurde während der alpinen Orogenese zunächst eklogitfaziell und nachfolgend grünschieferfaziell überprägt.Eine detaillierte U-Pb geochronologische Studie an Zirkonen und Monaziten des MR Granits ergab ein Permisches Intrusionsalter (270 ± 4 Ma). Der MR Granit gehört zu den post-variszischen magmatischen Einheiten, welche die Instabilität der variszischen kontinentalen Kruste andeuten. Für die MR kann eine paläogeographische Position als Teil der 'Briançonnais-Schwelle' angenommen werden.Innerhalb des MR Granits treten Talk-Kyanit-Chloritoid-Gesteine ('Weißschiefer') auf. Diese stellen wesentliche Indikatoren für eine alpine Hochdruckmetamorphose in der MR dar. Massenbilanzberechnungen wurden durchgeführt, um den Massentransfer zu quantifizieren, welcher für die Bildung eines Weißschiefers aus einem granitischen Protolith notwendig ist. Ein Modell für die Entwicklung der Weißschiefer wurde entwickelt.Es wurde eine in-situ 40Ar/39Ar UV-Laser-Ablationsstudie an Hellglimmern der alpinen Mineralparagenese durchgeführt. Sie ergab eine heterogene Altersverteilung. Diese Alter können durch Glimmerrekristallisation unter relativ 'trockenen' hochdruckmetamorphen Bedingungen begleitet von partiellem Verlust von radiogenem Argon während der alpinen Metamorphose erklärt werden. Eine ähnlich komplexe Entwicklung mit partieller Homogenisierung des Isotopensystems kann in der Strontium-Isotopie beobachtet werden. Diese Isotopenstudien liefern Hinweise auf das Schließverhalten von Isotopensystemen unter hochdruckmetamorphen Bedingungen.

O fado português de Amália Rodrigues e a canção popular siciliana de Rosa Balistreri: comparação linguística e temática.

Nestes últimos três anos encontrei muitas semelhanças entre o Português e o Siciliano. Cada vez que ouvia palavras similares, ficava muito surpreendido porque eram palavras que na própria história deles não sempre tinham a raiz comum do latim. Foi por isso que comecei a perguntar-me qual fosse a língua que, junto com o latim, tivesse deixado rastos tão importantes. Comecei por fazer algumas pesquisas e descobri que Portugal e a Sicília, se bem que sejam bastante afastados geograficamente, não têm somente algumas palavras em comum, mas também muitos elementos culturais. É também uma coisa facilmente imaginável: são dois paises e dois povos muito ligados ao sol, ao mar, ao amor pela própria terra, à força dos seus cidadãos além da pobreza que impediu muitos momentos da história deles. Então, decidi escrever a minha tese de licenciatura sobre o tema da comparação línguistica entre português e o siciliano ocidental. Fazendo pesquisas mais aprofundadas não foi possível encontrar estudos de linguística comparativa que comparassem estas duas línguas. Por esta razão o trabalho preliminar foi muito complexo e todas as reflexões deduzidas são fruto de uma análise pessoal. Decidi concentrar-me sobre as semelhanças das canções populares portuguesas e sicilianas porque além de me darem a possibilidade de fazer uma comparação línguistica, põem em luz a proximidade das duas culturas através das temáticas e do estilo que distinguem ambas as canções e através de duas cantoras (Amália Rodrigues e Rosa Balistreri) que tiveram duas vidas muito difíceis e que foi somente com o canto que lhes permitiu que se encontrassem e que trablhassem juntas tendo sempre o objectivo de enfrentar a vida com mais força e de lutar pela própria terra tão amada.

Exposure dating of Late Glacial and pre-LGM moraines in the Cordon de Doña Rosa, Northern/Central Chile (~ 31°S)

Despite the important role of the Central Andes (15–30° S) for climate reconstruction, knowledge about the Quaternary glaciation is very limited due to the scarcity of organic material for radiocarbon dating. We applied 10Be surface exposure dating (SED) on 22 boulders from moraines in the Cordon de Doña Rosa, Northern/Central Chile (~31° S). The results show that several glacial advances in the southern Central Andes occurred during the Late Glacial between ~14.7±1.5 and 11.6±1.2 ka. A much more extensive glaciation is dated to ~32±3 ka, predating the temperature minimum of the global LGM (Last Glacial Maximum: ~20 ka). Reviewing these results in the paleoclimatic context, we conclude that the Late Glacial advances were most likely caused by an intensification of the tropical circulation and a corresponding increase in summer precipitation. High-latitude temperatures minima, e.g. the Younger Dryas (YD) and the Antarctic Cold Reversal (ACR) may have triggered individual advances, but current systematic exposure age uncertainties limit precise correlations. The absence of LGM moraines indicates that moisture advection was too limited to allow significant glacial advances at ~20 ka. The tropical circulation was less intensive despite the maximum in austral summer insolation. Winter precipitation was apparently also insufficient, although pollen and marine studies indicate a northward shift of the westerlies at that time. The dominant pre-LGM glacial advances in Northern/Central Chile at ~32 ka required lower temperatures and increased precipitation than today. We conclude that the westerlies were more intense and/or shifted equatorward, possibly due to increased snow and ice cover at higher southern latitudes coinciding with a minimum of insolation.