Background: Severe neurological involvement in systemic lupus erythematosus (NPSLE) is one of the most dreadful complications of the disease. Objective: To identify the best drug, dose, and ...treatment. Patients and methods: The study was a controlled clinical trial at two tertiary care centres of patients with SLE according to the ACR criteria, with incident (no more than 15 days) onset of severe NP manifestations such as seizures, optic neuritis, peripheral or cranial neuropathy, coma, brainstem disease, or transverse myelitis. Induction treatment with 3 g of IV methylprednisolone (MP) followed by either IV monthly cyclophosphamide (Cy) versus IV MP bimonthly every 4 months for 1 year and then IV Cy or IV MP every 3 months for another year. The primary end point was response to treatment: at least 20% improvement from basal conditions on clinical, laboratory, or specific neurological testing variables. Results: Overall, a response rate of 75% was observed. Of the 32 patients studied, 18/19 receiving Cy and 7/13 receiving MP responded to treatment (p<0.03). Conclusions: Cy seems to be more effective than MP in the treatment of acute, severe NPSLE.
The Ecuadorian electricity sector has undergone several changes during the past decade. The objective of this paper is twofold: a) to show how the Ecuadorian electricity sector has evolved from 2007 ...to 2017, and b) to discuss the relationship between energy policies and their impacts on electricity supply, management, tariffs, and the country's economy. Although oil remains as the main energy source and the leading driver for economic revenue, several hydropower projects have been built or are under construction intending in part to reduce the country's dependence on oil. The installed hydropower capacity in the country in 2017 is approximately 81% higher than in 2007 and it is expected that, by 2018, approximately 93% of the electricity will be produced from hydropower. Currently, biomass and biogas contribute with 1.8% of the total electricity generation, but only 0.6% of the electricity is produced in wind and solar farms. Adoption of smart grid technologies is key to transform the Ecuadorian electricity network and to positively impact the quality of the electricity supply. The future of the Ecuadorian electricity sector relies on the successful implementation of the new Organic Law of Public Service of Electricity and on external financing for new energy projects.
•Ecuador's electricity sector has established a new legal framework that fosters State control.•Hydropower has become the main source of electricity generation.•Non-conventional renewable energies have increased their installed capacity since 2005.•Distribution losses have been reduced in the last decade.•A Smart Grid Road Map was launched in 2013 and faces opportunities and challenges.
We present the first statistical study of magnetic structures and associated energy dissipation observed during a single period of turbulent magnetic reconnection, by using the in situ measurements ...of the Magnetospheric Multiscale mission in the Earth's magnetotail on 26 July 2017. The structures are selected by identifying a bipolar signature in the magnetic field and categorized as plasmoids or current sheets via an automated algorithm which examines current density and plasma flow. The size of the plasmoids forms a decaying exponential distribution ranging from subelectron up to ion scales. The presence of substantial number of current sheets is consistent with a physical picture of dynamic production and merging of plasmoids during turbulent reconnection. The magnetic structures are locations of significant energy dissipation via electric field parallel to the local magnetic field, while dissipation via perpendicular electric field dominates outside of the structures. Significant energy also returns from particles to fields.
Plain Language Summary
Magnetic reconnection is an important mechanism for generating energetic particles in space and solar environments. Turbulent magnetic reconnection causes the development of many small‐scale magnetic structures, such as locally helical or loop‐like magnetic fields (plasmoids), or areas where oppositely directed magnetic fields are sandwiched together (current sheets). The exact formation and distribution of the structures, as well as the role the structures play in particle energization and the evolution of magnetic reconnection, is still unknown. Using data from the Magnetospheric Multiscale (MMS) mission, we developed an algorithm that is able to detect and identify the magnetic structures present in a region of turbulent magnetic reconnection. The number of structures was found to decrease with size as a decaying exponential, which is consistent with previous theories. The structures contributed strongly to the energization of particles parallel to the local magnetic field, but were not significant sites of energization overall. Overall energization is dominated by energization perpendicular to the local field outside of these structures. There is also significant energy return from particles to the fields.
Key Points
An automated method to locate and identify plasmoids and current sheets in turbulent magnetotail reconnection regions has been developed
Plasmoids in a region of turbulent magnetotail reconnection have a decaying exponential size distribution from subelectron to ion scale
Plasmoids and current sheets are significant contributors to parallel particle energization, but not to overall particle energization
Magnetic reconnection is a fundamental process in magnetized plasma where magnetic energy is converted to plasma energy. Despite huge differences in the physical size of the reconnection layer, ...remarkably similar characteristics are observed in both laboratory and magnetosphere plasmas. Here we present the comparative study of the dynamics and physical mechanisms governing the energy conversion in the laboratory and space plasma in the context of two-fluid physics, aided by numerical simulations. In strongly asymmetric reconnection layers with negligible guide field, the energy deposition to electrons is found to primarily occur in the electron diffusion region where electrons are demagnetized and diffuse. A large potential well is observed within the reconnection plane and ions are accelerated by the electric field toward the exhaust region. The present comparative study identifies the robust two-fluid mechanism operating in systems over six orders of magnitude in spatial scales and over a wide range of collisionality.
Abstract Phylogenetic methods have long been used in biology and more recently have been extended to other fields—for example, linguistics and technology—to study evolutionary histories. Galaxies ...also have an evolutionary history and fall within this broad phylogenetic framework. Under the hypothesis that chemical abundances can be used as a proxy for the interstellar medium’s DNA, phylogenetic methods allow us to reconstruct hierarchical similarities and differences among stars—essentially, a tree of evolutionary relationships and thus history. In this work, we apply phylogenetic methods to a simulated disk galaxy obtained with a chemodynamical code to test the approach. We found that at least 100 stellar particles are required to reliably portray the evolutionary history of a selected stellar population in this simulation, and that the overall evolutionary history is reliably preserved when the typical uncertainties in the chemical abundances are smaller than 0.08 dex. The results show that the shapes of the trees are strongly affected by the age–metallicity relation, as well as the star formation history of the galaxy. We found that regions with low star formation rates produce shorter trees than regions with high star formation rates. Our analysis demonstrates that phylogenetic methods can shed light on the process of galaxy evolution.
Some local protocols suggest using intermediate or therapeutic doses of anticoagulants for thromboprophylaxis in hospitalized patients with coronavirus disease 2019 (COVID-19). However, the incidence ...of bleeding, predictors of major bleeding, or the association between bleeding and mortality remain largely unknown.
We performed a cohort study of patients hospitalized for COVID-19 that received intermediate or therapeutic doses of anticoagulants from March 25 to July 22, 2020, to identify those at increased risk for major bleeding. We used bivariate and multivariable logistic regression to explore the risk factors associated with major bleeding.
During the study period, 1965 patients were enrolled. Of them, 1347 (69%) received intermediate- and 618 (31%) therapeutic-dose anticoagulation, with a median duration of 12 days in both groups. During the hospital stay, 112 patients (5.7%) developed major bleeding and 132 (6.7%) had non-major bleeding. The 30-day all-cause mortality rate for major bleeding was 45% (95% confidence interval CI: 36%-54%) and for non-major bleeding 32% (95% CI: 24%-40%). Multivariable analysis showed increased risk for in-hospital major bleeding associated with D-dimer levels >10 times the upper normal range (hazard ratio HR, 2.23; 95% CI, 1.38-3.59), ferritin levels >500 ng/ml (HR, 2.01; 95% CI, 1.02-3.95), critical illness (HR, 1.91; 95% CI, 1.14-3.18), and therapeutic-intensity anticoagulation (HR, 1.43; 95% CI, 1.01-1.97).
Among patients hospitalized with COVID-19 receiving intermediate- or therapeutic-intensity anticoagulation, a major bleeding event occurred in 5.7%. Use of therapeutic-intensity anticoagulation, critical illness, and elevated D-dimer or ferritin levels at admission were associated with increased risk for major bleeding.
•Poor reproducibility an bulk FeRh alloys produced by arc melting.•Fe100−xRhx alloys with x = 50, 50.5 and 51 prepared by induction melting.•Comparison of the magnetocaloric responses and phase ...transition features.•Induction melting is advantageous to prepare FeRh binary alloys.•Fe content influences the reproducibility of the phase transition features•Further studies about the impact of synthesis parameters are necessary.
Magnetoelastic transitions (METs) in bulk in nearly equiatomic Fe-Rh alloys produced by arc melting may show poor reproducibility related to insufficient chemical homogeneity and presence of impurity phases in variable concentrations. To better understand the synthesis conditions that reliably yield bulk FeRh materials with reproducible MET characteristics, Fe100-xRhx alloys with x = 50, 50.5 and 51 at. % were prepared by induction melting and thermal annealing under identical conditions. The fabricated samples were cut into several slices, followed by characterization of METs in each of the slices using isothermal and isofield magnetization measurements, differential scanning calorimetry, and direct measurements of the magnetocaloric effect. All of the slices exhibit METs between the AFM and FM states, but the transitions are abrupt with nearly the same change of magnetization, ΔM, when x = 50.5 and 51, whereas for the x = 50 alloy the transition spreads over a wide temperature interval and ΔM may fluctuate by as much as 10 % from one specimen to another. A comparison of the magnetocaloric responses of x = 50 and 51 materials is presented. The clearly different effect of the magnetic field on the transition in both directions leads to significant differences in the reversibility and maximum values of the magnetic field-induced entropy and adiabatic temperature changes, as well as average hysteresis losses. In terms of reproducibility, our results suggest that induction melting is a more appropriate technique to prepare these binary alloys.
The association between cancer and autoimmune disease is unexplained, exemplified by T cell large granular lymphocytic leukemia (T-LGL) where gain-of-function (GOF) somatic STAT3 mutations correlate ...with co-existing autoimmunity. To investigate whether these mutations are the cause or consequence of CD8+ T cell clonal expansions and autoimmunity, we analyzed patients and mice with germline STAT3 GOF mutations. STAT3 GOF mutations drove the accumulation of effector CD8+ T cell clones highly expressing NKG2D, the receptor for stress-induced MHC-class-I-related molecules. This subset also expressed genes for granzymes, perforin, interferon-γ, and Ccl5/Rantes and required NKG2D and the IL-15/IL-2 receptor IL2RB for maximal accumulation. Leukocyte-restricted STAT3 GOF was sufficient and CD8+ T cells were essential for lethal pathology in mice. These results demonstrate that STAT3 GOF mutations cause effector CD8+ T cell oligoclonal accumulation and that these rogue cells contribute to autoimmune pathology, supporting the hypothesis that somatic mutations in leukemia/lymphoma driver genes contribute to autoimmune disease.
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•Autoimmune-associated STAT3 GOF mutations pathologically dysregulate CD8 T cells•STAT3 GOF somatic mutations in CD8 T cells are a cause, not effect, of autoimmunity•STAT3 GOF mutant CD8 T cell accumulation depends on NKG2D and CD122/IL-15RB•STAT3/NKG2D/IL-15 inhibitors may have utility in CD8-mediated autoimmune pathology
Whether somatic mutations are a cause or consequence of the autoimmune pathology associated with leukemia remains an unresolved issue. Here, Masle-Farquhar et al. show that leukemia and autoimmune-associated STAT3 gain-of-function mutations dysregulate CD8+ T cells, driving oligoclonal expansion of cytotoxic CD8+ T cells and lethal inflammation.
The relationship between cancer and venous thromboembolic disease (VTD) are complex because the activated coagulation factors are not only involved in thrombosis but also in malignant processes, such ...as angiogenesis and metastasis.
To compare phenotypes of extracellular vesicles (EVs), and levels of D-dimer, soluble P-selectin (sP-selectin) and antigenic tissue factor (TF) between unprovoked VTD patients, who did not develop cancer during one-year follow-up, and those with advanced stage of cancer but not associated with VTD.
A prospective study in which we included 138 unprovoked VTD patients and 67 advanced cancer patients, who did not develop thrombosis. Levels of EVs of different cellular origin (platelet, endothelium and leukocyte), EVs positive for tissue factor (TF) and P-selectin glycoprotein ligand 1 were quantified by flow cytometry. D-dimer, soluble P-selectin (sP-selectin) and antigenic TF were determined by ELISA.
TF-positive EVs, D-dimer, and sP-selectin were markedly elevated in unprovoked VTD patients compared to cancer patients without association with thrombosis.
Levels of TF-positive EVs, D-dimer and sP-selectin are able to discriminate between unprovoked VTD patients not related to cancer and cancer patients not associated with VTD. These results could lead to the application of EVs as biomarkers of both diseases.
Key messages: Circulating EVs, specifically TF-positive EVs, in combination with plasmatic markers of hypercoagulable states, such as D-dimer, sP-selectin and antigen TF, are able to discriminate between cancer patients without thrombosis and patients with unprovoked VTD. Research fields could be opened. Future studies will assess if these biomarkers together serve as predicting thrombotic events in cancer populations
Aim To compare the diagnostic performance of breast elastography versus conventional ultrasound in the assessment of breast lesions. Materials and methods The study was approved by the hospital’s ...institutional review board. A prospective study involving 99 consecutive women who gave informed consent were enrolled from September 2007 to March 2008. One hundred and ten breast lesions were evaluated separately by conventional ultrasound, elastography and combined conventional ultrasound with elastography. Ultrasound assessment was based on the BIRADS classification, whereas elastographic assessment was based on strain pattern and the elastographic size ratios. Histological diagnosis was used as the reference standard. The sensitivity, specificity, and accuracy of each technique were compared. Results The mean age of the patients was 46.7 years. Twenty-six lesions were malignant and 84 were benign. Sensitivity, specificity, and accuracy were 88.5, 42.9 and 53.6%, respectively, for conventional ultrasound, 100, 73.8, and 80%, respectively, for elastography, and 88.5, 78.6, and 80.9%, respectively, for combined imaging. The specificity and accuracy of elastography and combined imaging were significantly better than that of conventional ultrasound ( p <0.0001), whereas there was no statistically significant difference in the sensitivity between all three groups. Two-thirds (66.7%) of sonographic false-positive lesions had benign elastogram findings, which might have been spared from biopsy. Conclusion This initial experience with ultrasound breast elastography showed that it was more specific and more accurate than conventional ultrasound. Combining elastography with ultrasound improved specificity and accuracy of ultrasound and can potentially reduce unnecessary breast biopsies.
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