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Due to its size and high altitude, the growth of the Tibetan Plateau remains an enigma. Based on a synthesis of anterior collisions, paleoaltimetric data, geochemistry of ultrapotassic lava and their rare mantle enclaves, combined with a reinterpretation of tomographic data, we suppose that Tibet's growth took take place in two main stages. Initially, the accretion of Gondwana terranes to the margin of South Asia, especially during the Early Triassic-Cretaceous period, resulted in the first episode of plateau growth, which affected an area of about 2/3 of the current plateau. We suppose that during the Late Cretaceous, the Tibetan crust reached a thickness of about 50-55 km, which is equivalent to an altitude of about 2500 to 3000 m, with local landforms that could have exceeded 4000 m. Another important consequence of these successive accretions was a strong metasomatism and a softening of the upper part of the Tibetan cover. The P wave low-velocity anomaly currently observed under the central part of Tibet would correspond not to a temperature anomaly but to a composition anomaly. From 50 Ma onwards, the convergence between India and Asia, estimated at about 1000 km on the Tibetan side, led to a shortening of the plateau by about 40%. We suppose that this additional shortening, which has led to the current thickness of the Earth's crust of about 70 km and an average altitude of 4800 m, has been compensated by the reactivation of the continental slabs along the previous sutures and by the homogeneous shortening of the crust. [ABSTRACT FROM AUTHOR]

The Longmen Shan belt (eastern border of the Tibetan plateau) constitutes a tectonically active region as demonstrated by the occurrence of the unexpected 2008 Mw 7.9 Wenchuan and 2013 Mw 6.6 Lushan earthquakes in the central and southern parts of the belt, respectively. These events revealed the necessity of a better understanding of the long‐term geological evolution of the belt and its effect on the present dynamics and crustal structure. New structural and thermobarometric data offer a comprehensive data set of the paleotemperatures across the belt and P‐T estimates for low‐grade metamorphic domains. In the central Longmen Shan, two metamorphic jumps of 150–200 °C, 5–6 kbar and ~50 °C, 3–5 kbar acquired during the Early Mesozoic are observed across the Wenchuan and Beichuan faults, respectively, attesting to their thrusting movement and unrevealing a major decollement between the allochtonous Songpan‐Garze metasedimentary cover (at T > 500 °C) and the autochtonous units and the basement (T < 400 °C). In the southern Longmen Shan, the only greenschist facies metamorphism is observed both in the basement (360 ± 30 °C, 6 ± 2 kbar) and in the metasedimentary cover (350 ± 30 °C, 3 ± 1 kbar). Peak conditions were reached at ca. 80–60 Ma in the basement and ca. 55–33 Ma in the cover, ca. 50 Ma after the greenschist facies metamorphic overprint observed in the central Longmen Shan (ca. 150–120 Ma). This along‐strike metamorphic segmentation coincides well with the present fault segmentation and reveals that the central and southern Longmen Shan experienced different tectonometamorphic histories since the Mesozoic. Key Points: Metamorphic jumps of ~150 °C, 5 kbar and ~50 °C, 3 kbar are observed across the Wenchuan and Beichuan faults, respectivelyP‐T‐t conditions for the southern Longmen Shan, lower than for central Longmen Shan, do not exceed 395 °C and 6 ± 2 kbar (at 80–33 Ma)Different segments of the Longmen Shan underwent different tectonometamorphic evolution since the Mesozoic [ABSTRACT FROM AUTHOR]

We discuss the case of a rare and often unrecognized neurologic syndrome, called Acquired Hepatocerebral Degeneration (AHD), observed in patients with advanced liver disease and portosystemic shunts. The clinical manifestations can be very heterogeneous and in our case included a combination of cerebellar and extrapyramidal signs, arisen in a period of few days. Brain Magnetic Resonance Imaging (MRI) showed, in T1-weighted images, diffuse bilateral hyper intensities in basal ganglia and biemispheric brain and cerebellar cortices, resembling paramagnetic deposits. No other neurological impairments, like stroke, infection or neoplasia, were found. It was excluded an episode of acute hepatic encephalopathy. We also ruled out Wilsonian degeneration, iron overload and autoimmune encephalitis and we lastly found high manganese levels as the possible cause of the brain paramagnetic deposits. Even though either serum Mn determination or its accumulation in the brain are not specific for AHD, however the chronic and progressively worsening of the neurological manifestations advocated a degenerative condition, possibly AHD. We finally opted for the early restoration of liver function by OLT, and we observed complete clinical symptoms' resolution and partial MRI reversal after a follow up of 6 months. [ABSTRACT FROM AUTHOR]

Our purpose was to determine the prevalence and features of metabolic syndrome (MS) in a series of long-term hematopoietic stem cell transplantation (HSCT) survivors. We assessed the clinical, metabolic and endocrinological data, and plasma TNF, leptin, resistin and adiponectin levels relating to 85 HSCT recipients. MS was diagnosed on the basis of the National Cholesterol Education Program-Adult Treatment Panel III criteria. Its prevalence was compared with that observed in an Italian population, and its relationship with the clinical and laboratory parameters was assessed univariately and multivariately. Twenty-nine HSCT recipients had MS instead of the 12.8 expected (P<0.0001), with hypertriglyceridemia being the most common feature. Univariate analysis indicated that high insulin and leptin levels, low-adiponectin levels and hypogonadism were significantly related to a diagnosis of MS; multivariate analysis indicated plasma leptin, insulin resistance, age and hypogonadism. We conclude that HSCT recipients are at increased risk of a form of MS that has particular clinical features. Plasma leptin levels are independently related to MS, thus suggesting that leptin resistance may play a role as a pathogenetic clue, as in other conditions in which MS occurs as a secondary phenomenon. MS deserves consideration as a life-threatening complication in patients who are probably cured of their underlying disease.Bone Marrow Transplantation (2008) 41, 797–804; doi:10.1038/sj.bmt.1705972; published online 14 January 2008 [ABSTRACT FROM AUTHOR]

Lymphadenitis is the most common presentation of extra pulmonary tuberculosis, whereas gastrointestinal localization, particularly duodenal involvement, is rare. We report a case of extra pulmonary tuberculosis with association between cervical lymphadenitis and duodenitis with multiple ulcers, not responsive to treatment with protonic pump inhibitors, in a human immunodeficiency virus-seronegative adult woman of Eritrean origin. Clinical patterns of duodenal TB, diagnostic difficulties and aetiopathogenesis are discussed according to the literature. In this case report it is suggested that tuberculous infection must be considered when duodenal ulcers fail to respond to proton pump inhibitors, especially when the patient comes from an endemic area. [ABSTRACT FROM AUTHOR]

A few reports have suggested the beneficial effect of high-dose intravenous immunoglobulin (IVIG) in the treatment of acute myocarditis and cardiomyopathy. We describe a 49-year-old woman in which acute myocarditis was diagnosed on the basis of clinical and echocardiographic findings. Conventional treatment with captopril and frusemide was administered: intravenous heparin and, subsequently, oral anticoagulants were added because of the appearance of an apical thrombus. On the fifth day of hospitalization, treatment with high-dose (400 mg kg(-1) day(-1)) IVIG was started and prosecuted for 5 days. A dramatic improvement of clinical conditions was observed, with increase of the left ventricular ejection fraction (LVEF) from 30% to 75% within 1 week. One year after the diagnosis the patient is in good health, with steady normal LVEF. The rapid recovery, which was immediately subsequent to the administration of high-dose IVIG, suggests that this kind of treatment has been effective in our patient with acute myocarditis. [ABSTRACT FROM AUTHOR]

Systemic capillary leak syndrome (SCLS) is a rare condition characterized by recurrent episodes of generalized oedema and severe hypotension, associated with paraproteinaemia. In addition to the acute form, a few cases of chronic SCLS have been reported. We describe a 64-year-old woman who was hospitalized because of a 6-month history of progressive generalized oedema with pericardial and pleural effusions, associated with a serum paraprotein. Clinical and laboratory findings were consistent with a chronic form of SCLS. Treatment with prednisone, furosemide and theophylline was started, which led to a gradual improvement in 2 weeks and a persistent remission after 9 months. This report indicates that SCLS may occur in a chronic form, which seems to be responsive to a therapeutic regimen with prednisone, furosemide, and theophylline. [ABSTRACT FROM AUTHOR]

Host responses to infectious and inflammatory stimuli are altered with aging. Because cytokines and their antagonists are significant factors in these host responses, the present research on aged subjects was designed to investigate plasma concentrations of the cytokines interleukin 1 beta (IL-1 beta) and tumor necrosis factor alpha (TNF alpha) and those of their antagonists IL-1 receptor antagonist (IL-1ra) and soluble TNF receptor (sTNFr). For this research, 122 apparently healthy aged subjects (79.6 +/- 5.8 yr), 39 aged individuals with documented urinary tract infections (UTIs) (81.6 +/- 6.3 yr), and 100 young controls (39.32 +/- 11.2 yr) were included. Plasma IL-1 beta, TNF alpha, IL-1ra, sTNFr (55 kDa), and neopterin were measured using enzyme-linked immunosorbent assay techniques. In subsets of normal aged subjects and UTI patients, we investigated relations between plasma concentrations of cytokine antagonists and IL-2 production by phytohemagglutinin-stimulated peripheral blood mononuclear cells. The results show that plasma concentrations of both IL-1ra and sTNFr were greater in healthy aged subjects than in young controls. Plasma neopterin, a product of activated monocytes/macrophages, was likewise elevated in the aged. IL-1 and TNF were not detectable in the majority of plasma samples. There was a positive correlation between neopterin concentration and both IL-1ra and sTNFr. There was a significant negative correlation between plasma IL-1ra and IL-2 production by phytohemagglutinin-stimulated peripheral blood mononuclear cell in healthy aged subjects. IL-1ra and sTNFr concentrations were significantly greater in patients with UTI than in the healthy aged subjects. In UTI patients IL-2 production in vitro was lower than in healthy subjects, but there was no significant correlation with IL-1ra in plasma. Therefore, plasma concentrations of cytokine antagonists are increased in plasma of apparently healthy aged subjects. Elevated concentrations of neopterin suggest that this increase can be traced to monocyte activation. The negative correlation between plasma IL-1ra and IL-2 production in vitro suggests that enhancement of this cytokine antagonist can contribute to immunodepression of aging. We propose that unapparent infections in aged subjects cause monocyte activation and release of cytokine antagonists. These cytokine antagonists reduce IL-2 production and the capability of T cells to proliferate, thereby inhibiting responses in the elderly. [ABSTRACT FROM AUTHOR]

In the last decades of the 20th century, the incidence rate of type 1 diabetes increased in affluent countries. The pattern of occurrence of this autoimmune disease over time could provide helpful information to discriminate between alternative aetiologic hypotheses. In addition to genetic disposition, the incidence of type 1 diabetes seems to be conditioned by environmental factors and lifestyle. One theory proposes that the increase in the prevalence of autoimmune diseases is a result of the decrease in the incidence of childhood infections. To investigate the relationship between the incidence of type 1 diabetes and the decline of infectious diseases, we calculated the correlation between the occurrence of type 1 diabetes and tuberculosis in several European and non-European countries. The results of our analysis demonstrate an inverse correlation between the occurrences of type 1 diabetes and tuberculosis. A possible interpretation of this negative association is that a high socio-economic status and a westernised way of life imply a reduced or delayed exposure to infectious agents and so a reduced or delayed “pressure” on the immune system, which is free to mount inappropriate responses against self-antigens, as happens in type 1 diabetes. [ABSTRACT FROM AUTHOR]

Describes a patient whose chronic autoreactive urticaria has been successfully treated with the leukotriene-receptor antagonist montelukast. Medical history of the patient; Characteristics of the urticaria of the patient.

The "glucocorticoid cascade hypothesis" for pathological ageing of the brain is supported by strong experimental data, but the clinical correlates are far less clear. The basal ACTH and cortisol secretion have been studied before and after the dexamethasone suppression test in patients in the early stages of clinically probable Alzheimer's disease and in controls, and the results were all normal. These findings do not support the hypothesis that the pathological brain ageing of Alzheimer's type is caused by hyperactivity of the pituitary-adrenal axis. [ABSTRACT FROM AUTHOR]

Reports the case of cutaneous hypersensitivity to human insulin that was successfully treated with the human insulin analog aspart. Information on the insulin analog aspart; Details on the subject; Significance of the results of the skin prick tests.