(Appendix) Petrographic record from excavation profiles in Old-Luebeck (Liubice), north Germany

Die Frage einer Küstensenkung spielt seit Jahrzehnten bei der geologischen Erforschung des norddeutschen und niederländischen Flachlandes eine große Rolle. Der Schwerpunkt der bisherigen Arbeiten lag im südlichen Nordseeraum. Gerade dieses Gebiet bereitet aber wegen seines Aufbaues aus jungen, teilweise stark setzungsfähigen Gesteinen, des von Ort zu Ort und im Laufe der Zeit unterschiedlichen Einflusses der Gezeiten sowie wegen mancher anderer Bedingungen sehr große methodische Schwierigkeiten. Deshalb überrascht es nicht, daß die einzelnen Untersuchungen noch in den letzten beiden Jahrzehnten für die verschiedenen Abschnitte zu sehr abweichenden Folgerungen kamen, so daß die heute bekannten Einzeltatsachen nur ein recht widerspruchsvolles Gesamtbild ergeben. Da eine Klärung der Probleme durch eine Neubearbeitung an der Nordsee zunächst wenig erfolgversprechend erscheint, wird die Aufmerksamkeit unvermeidlich auf die Verhältnisse im südwestlichen Ostseeraum gelenkt. Hier bestehen in mancher Hinsicht einfachere Bedingungen, die eine derartige Untersuchung begünstigen. Vor allem die Nachbarschaft des skandinavischen Hebungsgebietes am gleichen Wasserbecken, die sehr geringen Gezeitenwirkungen und die hier weit verbreiteten Sandschüttungen bieten bessere Vergleichsmöglichkeiten und schalten viele Fehlerquellen aus. In der voliegenden Arbeit wurden die litorinazeitlichen und die nachlitorinazeitlichen Vertikalbewegungen des Landes und die eustatischen Schwankungen des Wasserstandes im südwestlichen Ostseeraum mit geologisch-morphologischen Methoden und durch die Auswertung von Lage und Verbreitung ur- und frühgeschichtlicher Funde sowie unter Auswertung von pollenanalytisch datierten Bohrprofilen und Pegelaufzeichnungen untersucht.

Strontium isotopes and sedimentology of a marine Triassic succession (upper Ladinian) of the westernmost Tethys, Spain

Chemical Stratigraphy, or the study of the variation of chemical elements within sedimentary sequences, has gradually become an experienced tool in the research and correlation of global geologic events. In this paper 87Sr/ 86Sr ratios of the Triassic marine carbonates (Muschelkalk facies) of southeast Iberian Ranges, Iberian Peninsula, are presented and the representative Sr-isotopic curve constructed for the upper Ladinian interval. The studied stratigraphic succession is 102 meters thick, continuous, and well preserved. Previous paleontological data from macro and micro, ammonites, bivalves, foraminifera, conodonts and palynological assemblages, suggest a Fassanian-Longobardian age (Late Ladinian). Although diagenetic minerals are present in small amounts, the elemental data content of bulk carbonate samples, especially Sr contents, show a major variation that probably reflects palaeoenvironmental changes. The 87Sr/86Sr ratios curve shows a rise from 0.707649 near the base of the section to 0.707741 and then declines rapidly to 0.707624, with a final values rise up to 0.70787 in the upper part. The data up to meter 80 in the studied succession is broadly concurrent with 87Sr/86Sr ratios of sequences of similar age and complements these data. Moreover, the sequence stratigraphic framework and its key surfaces, which are difficult to be recognised just based in the facies analysis, are characterised by combining variations of the Ca, Mg, Mn, Sr and CaCO3 contents

De la moral del sacrificio a la conciencia de la precariedad. Un análisis cualitativo de los discursos sobre la evolución de la crisis en España

La larga crisis económica que padece España está teniendo importantes consecuencias sociales. La más comentada por académicos, mass media y parte del arco político es la fractura social que se está abriendo en el país, ante el aumento de las desigualdades económicas que generan el enorme desempleo y las duras políticas de ajuste del gasto público. Sin embargo, más allá de cuestiones económicas la crisis está haciendo mella de forma muy profunda en el imaginario social del país en relación a las razones y consecuencias de la crisis, tanto a corto como a largo plazo. El objetivo de este artículo es el realizar una valoración de esas percepciones sociales de la ciudadanía en relación con la crisis, centrándonos en un aspecto como es el de la relación de la población española con el consumo de bienes y servicios públicos, en un escenario de hegemonía de la austeridad como única receta anti-crisis. Para ello, realizaremos un análisis de los discursos recogidos en una investigación cualitativa realizada en el año 2014 mediante grupos de discusión. Los resultados muestran un pesimismo enorme de la población en relación al futuro del Estado del Bienestar y de la propia clase media española, junto a una frustración que puede anunciar futuros ciclos de movilización social.

La biblioteca del predicador Pere Dorchal (1419)

A partir del inventario post mortem de los libros de Pere Dorchal, sacerdote beneficiado en la catedral de Valencia, datado en 1419, se estudia la composición de la biblioteca de un predicador. Al mismo tiempo, se recompone su biografía.

Cercanía y distancia como elementos dramáticos en "Odysseus. Verbrecher" de Ransmayr y "Odisej" de Stefanovski

La función dramática de los conceptos mentales y geográficos ‚cercanía‘ y ‚distancia‘ se pone a prueba de forma exitosa en el término ‚Heimat‘. Se analizan Odysseus. Verbrecher de Christoph Ransmayr y Odisej de Goran Stefanovskis. Se ve que un retorno puede ser decepcionante porque la idea mental de ‚Heimat‘ no coincide con la geográfica. El repatriado permanece en esta distancia mental, lo cual daña a su entorno y la formación de su identidad. El concepto alemán de ‚Heimat‘, tal y como lo explica Peter Blickle, se puede aplicar a ambos textos. En el texto de Ransmayr se puede observar, no obstante, que crea su posición y crítica a raíz de este concepto, mientras que la comparación con el texto de Stefanovski solo muestra semejanzas, pero ninguna congruencia con el concepto cultural de ‚Heimat‘.

Sellar Spine Associated with Endocrine and Neuro-Ophthalmological Manifestations

A case of sellar spine, associated with neuro-ophthalmological and endocrine abnormalities, is reported. The case described is a rare malformation, of which the authors found only six cases in the literature.

Progressive Multifocal Leukoencephalopathy and Systemic Lupus Erythematosus: Focus on Etiology

Progressive multifocal leukoencephalopathy (PML) caused by reactivation of the JC virus (JCV), a human polyomavirus, occurs in autoimmune disorders, most frequently in systemic lupus erythematosus (SLE). We describe a HIV-negative 34-year-old female with SLE who had been treated with immunosuppressant therapy (IST; steroids and azathioprine) since 2004. In 2011, she developed decreased sensation and weakness of the right hand, followed by vertigo and gait instability. The diagnosis of PML was made on the basis of brain MRI findings (posterior fossa lesions) and JCV isolation from the cerebrospinal fluid (700 copies/ml). IST was immediately discontinued. Cidofovir, mirtazapine, mefloquine and cycles of cytarabine were sequentially added, but there was progressive deterioration with a fatal outcome 1 year after disease onset. This report discusses current therapeutic choices for PML and the importance of early infection screening when SLE patients present with neurological symptoms. In the light of recent reports of PML in SLE patients treated with rituximab or belimumab, we highlight that other IST may just as well be implicated. We conclude that severe lymphopenia was most likely responsible for JCV reactivation in this patient and discuss how effective management of lymphopenia in SLE and PML therapy remains an unmet need.

Improvement of Mineral and Bone Metabolism Markers Is Associated with Better Survival in Haemodialysis Patients: the COSMOS Study

BACKGROUND: Abnormalities in serum phosphorus, calcium and parathyroid hormone (PTH) have been associated with poor survival in haemodialysis patients. This COSMOS (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) analysis assesses the association of high and low serum phosphorus, calcium and PTH with a relative risk of mortality. Furthermore, the impact of changes in these parameters on the relative risk of mortality throughout the 3-year follow-up has been investigated. METHODS:COSMOS is a 3-year, multicentre, open-cohort, prospective study carried out in 6797 adult chronic haemodialysis patients randomly selected from 20 European countries. RESULTS:Using Cox proportional hazard regression models and penalized splines analysis, it was found that both high and low serum phosphorus, calcium and PTH were associated with a higher risk of mortality. The serum values associated with the minimum relative risk of mortality were 4.4 mg/dL for serum phosphorus, 8.8 mg/dL for serum calcium and 398 pg/mL for serum PTH. The lowest mortality risk ranges obtained using as base the previous values were 3.6-5.2 mg/dL for serum phosphorus, 7.9-9.5 mg/dL for serum calcium and 168-674 pg/mL for serum PTH. Decreases in serum phosphorus and calcium and increases in serum PTH in patients with baseline values of >5.2 mg/dL (phosphorus), >9.5 mg/dL (calcium) and <168 pg/mL (PTH), respectively, were associated with improved survival. CONCLUSIONS:COSMOS provides evidence of the association of serum phosphorus, calcium and PTH and mortality, and suggests survival benefits of controlling chronic kidney disease-mineral and bone disorder biochemical parameters in CKD5D patients.

EULAR Recommendations for Women's Health and the Management of Family Planning, Assisted Reproduction, Pregnancy and Menopause in Patients with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome

OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). METHODS: Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. RESULTS: Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease. CONCLUSIONS: Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.

Vaccination of Adult Patients with Systemic Lupus Erythematosus in Portugal

In the wake of the Portuguese vaccination program 50th anniversary it seems appropriate to review vaccination in patients with systemic lupus erythematosus. Controversial issues as regards the association between autoimmune diseases, infections, and vaccines are discussed as well as vaccine safety and efficacy issues as regards chronic immunosuppressant (IS) drug therapy. After a brief overview of national policies, specific recommendations are made as regards vaccination for adult patients with SLE with a particular focus on current IS therapy and unmet needs.

IL10 Low-Frequency Variants in Behçet's Disease Patients

To explain the missing heritability after the genome-wide association studies era, sequencing studies allow the identification of low-frequency variants with a stronger effect on disease risk. Common variants in the interleukin 10 gene (IL10) have been consistently associated with Behçet's disease (BD) and the goal of this study is to investigate the role of low-frequency IL10 variants in BD susceptibility.

Dabigatran-Related Nephropathy in a Patient with Undiagnosed IgA Nephropathy

Dabigatran is a direct thrombin inhibitor used as an alternative to warfarin for long term anticoagulation. Warfarin-related nephropathy is an increasingly recognized entity, but recent evidence suggests that dabigatran can cause a WRN-like syndrome. We describe a case of a biopsy-proven anticoagulant nephropathy related to dabigatran in a patient with IgA nephropathy and propose that, despite the base glomerular disease, acute kidney injury was due to tubular obstruction by red blood cells and heme-associated tubular injury, and through a mechanism involving inhibition of anticoagulation cascade and barrier abnormalities caused by molecular mechanisms.

CURB-65 and Other Markers of Illness Severity in Community-Acquired Pneumonia Among HIV-Positive Patients

As the relative burden of community-acquired bacterial pneumonia among HIV-positive patients increases, adequate prediction of case severity on presentation is crucial. We sought to determine what characteristics measurable on presentation are predictive of worse outcomes. We studied all admissions for community-acquired bacterial pneumonia over one year at a tertiary centre. Patient demographics, comorbidities, HIV-specific markers and CURB-65 scores on Emergency Department presentation were reviewed. Outcomes of interest included mortality, bacteraemia, intensive care unit admission and orotracheal intubation. A total of 396 patients were included: 49 HIV-positive and 347 HIV-negative. Mean CURB-65 score was 1.3 for HIV-positive and 2.2 for HIV-negative patients (p < 0.0001), its predictive value for mortality being maintained in both groups (p = 0.03 and p < 0.001, respectively). Adjusting for CURB-65 scores, HIV infection by itself was only associated with bacteraemia (adjusted odds ratio [AOR] 7.1, 95% CI [2.6-19.5]). Patients with < 200 CD4 cells/µL presented similar CURB-65 adjusted mortality (aOR 1.7, 95% CI [0.2-15.2]), but higher risk of intensive care unit admission (aOR 5.7, 95% CI [1.5-22.0]) and orotracheal intubation (aOR 9.1, 95% CI [2.2-37.1]), compared to HIV-negative patients. These two associations were not observed in the > 200 CD4 cells/µL subgroup (aOR 2.2, 95% CI [0.7-7.6] and aOR 0.8, 95% CI [0.1-6.5], respectively). Antiretroviral therapy and viral load suppression were not associated with different outcomes (p > 0.05). High CURB-65 scores and CD4 counts < 200 cells/µL were both associated with worse outcomes. Severity assessment scales and CD4 counts may both be helpful in predicting severity in HIV-positive patients presenting with community-acquired bacterial pneumonia.