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Protamine, first isolated from salmon fish sperm and now produced through recombinant biotechnology, is an antidote that neutralizes the anticoagulant properties of heparin. Protamine function is based on the capacity to dissociate the heparin–antithrombin III (AT III) complex (an important link that promotes blood fluidification by inhibiting coagulation), forming the inactive heparin–protamine complex. Protamine has itself dose-dependent anticoagulant properties: It interferes with coagulation factors and platelet function; it stimulates fibrinolysis; it can lead to thrombocytopenia and reduction in thrombin-related platelet aggregation; it decreases platelet response to thrombin receptor agonist in a dose-dependent manner. In this review, we will focus on protamine and its interaction with heparin. Notably, protamine is able to antagonize not only unfractionated heparin (UFH) but also low molecular weight heparins to various degrees. Protamine-allergic and anaphylactoid systemic reactions may affect up to 1 in 10 people and should be prevented and treated early.

The biomass of understory vegetation has an important role in several forest ecosystem processes, though it is not frequently included in forest inventory programs, which are commonly focused on the tree component. The objective of the study is to test a fast procedure for obtaining an accurate estimation of three components of the aboveground understory vegetation: herbaceous, bush, regeneration. For such a purpose a Volume Index has been calculated on the basis of the product between the percent coverage of vegetation and the average height of the three different components of understory vegetation. The index has been quantified in twenty clusters of four squared plots 1 m2 wide; clusters were located in two study areas in the northern part of Molise Region (southeastern Italy). For each plot, the dry biomass has been collected and weighted, and then transformed in carbon stock. This study presents the field protocol and the achieved results in terms of measured aboveground understorey carbon stock in six different forest and pre-forest types (the average carbon stock was 1.19 t C ha-1) and correlation between Volume Index and carbon stock (the Pearson’s correlation index was 0.8 on 309 field observations).

Abstract Background Local infiltration analgesia (LIA) is frequently administered to patient undergoing joint replacement surgical procedures. The aim of the present research was to verify the safety of collected shed blood to be reinfused postoperatively, by measuring levobupivacaine levels in drainage blood in patients undergoing LIA during knee replacement surgery. Patients and Methods 24 patients who underwent total knee arthroplasty (TKA) and 12 scheduled for total hip arthroplasty (THA) who received intraoperative LIA were considered. Blood samples were collected from shed blood which was present in drainage 2 and 5 hours after surgery and serum was analysed by liquid chromatography-tandem mass spectrometry. Results At 2 hours postoperatively, the median levobupivacaine serum concentration in the collected shed blood was 1.2 mg/L (SD: 4.2) for TKA and 17.13 mg/L (SD: 24.4) for THA. At 5 hours, levobupivacaine concentration was 1.84 mg/L (SD: 2.2) for TKA and 17.5 mg/L (SD: 25.2) for THA. Higher values of average serum levobupivacaine concentration were reported in drains collected from patients who had undergone THA compared to TKA (p

Modern and fossil pollen data are widely used in paleoenvironmental research to characterize past environmental changes in a given location. However, their discrete and discontinuous nature can limit the inferences that can be made from them. Deriving continuous spatial maps of the pollen presence from point-based datasets would enable more robust regional characterization of such past changes. To address this problem, we propose a comprehensive collection of European pollen presence maps including 194 pollen taxa derived from the interpolation of pollen data from the Eurasian Modern Pollen Database (EMPD v2) restricted to the Euro-Mediterranean Basin. To do so, we developed an automatic Kriging-based interpolation workflow to select an optimal geostatistical model describing the spatial variability for each taxon. The output of the interpolation model consists of a series of multivariate predictive maps of Europe at 25 km scale, showing the occurrence probability of pollen taxa, the predicted presence based on diverse probability thresholds, and the interpolation uncertainty for each taxon. Combined visual inspections of the maps and systematic cross-validation tests demonstrated that the ensemble of predictions is reliable even in data-scarce regions, with a relatively low uncertainty, and robust to complex and non-stationary pollen distributions. The maps, freely distributed as GeoTIFF files (https://doi.org/10.5281/zenodo.10015695, Oriani et al., 2023), are proposed as a ready-to-use tool for spatial paleoenvironmental characterization. Since the interpolation model only uses the coordinates of the observation to spatialize the data, the model can also be employed with fossil pollen records (or other presence/absence indicators), thus enabling the spatial characterization of past changes, and possibly their subsequent use for quantitative paleoclimate reconstructions.

Interactions are essential for the creation of correlated quantum many-body states. Although two-body interactions underlie most natural phenomena, three- and four-body interactions are important for the physics of nuclei1, exotic few-body states in ultracold quantum gases2, the fractional quantum Hall effect3, quantum error correction4 and holography5,6. Recently, a number of artificial quantum systems have emerged as simulators for many-body physics, featuring the ability to engineer strong interactions. However, the interactions in these systems have largely been limited to the two-body paradigm and require building up multibody interactions by combining two-body forces. Here we implement a scheme to create a higher-order interaction between photons stored in multiple electromagnetic modes of a microwave cavity. The system is dressed such that there is collectively no interaction until a target total photon number is reached across multiple distinct modes, at which point the photons interact strongly. In our demonstration, we create interactions involving up to three bodies and across up to five modes. We harness the interaction to prepare single-mode Fock states and multimode W states, which we verify by introducing a multimode Wigner tomography method.

Introduction: Growing evidence supports extracorporeal cardiopulmonary resuscitation (ECPR) for refractory out-of-hospital cardiac arrest (OHCA) patients, especially in experienced centres. We present characteristics, treatments, and outcomes of patients treated with ECPR in a high-volume cardiac arrest centre in the metropolitan area of Milan, Italy and determine prognostic factors. Methods: Refractory OHCA patients treated with ECPR between 2013 and 2022 at IRCCS San Raffaele Scientific Institute in Milan had survival and neurological outcome assessed at hospital discharge. Results: Out of 307 consecutive OHCA patients treated with ECPR (95% witnessed, 66% shockable, low-flow 70 [IQR 58–81] minutes), 17% survived and 9.4% had favourable neurological outcome. Survival and favourable neurological outcome increased to 51% (OR = 8.7; 95% CI, 4.3–18) and 28% (OR = 6.3; 95% CI, 2.8–14) when initial rhythm was shockable and low-flow (time between CPR initiation and ROSC or ECMO flow) ≤60 minutes and decreased to 9.5% and 6.3% when low-flow exceeded 60 minutes (72% of patients). At multivariable analysis, shockable rhythm (aOR for survival = 2.39; 95% CI, 1.04–5.48), shorter low-flow (aOR = 0.95; 95% CI, 0.94–0.97), intermittent ROSC (aOR = 2.5; 95% CI, 1.2–5.6), and signs of life (aOR = 3.7; 95% CI, 1.5–8.7) were associated with better outcomes. Survival reached 10% after treating 104 patients (p for trend

Objetivo: Se estimó la carga económica directa e indirecta de la hipercolesterolemia en población con alto riesgo de presentar un evento cardiovascular. Para ello se definieron específicamente cinco grupos de pacientes: 1) aquellos con hipercolesterolemia familiar; 2, 3 y 4) personas con hipercolesterolemia más el antecedente de diabetes, infarto o evento vascular cerebral; 5) pacientes con hipercolesterolemia más diabetes y antecedente de infarto agudo de miocardio (definidos como pacientes de muy alto riesgo cardiovascular). Los cálculos se hicieron desde la perspectiva de las instituciones de salud pública en México. Método: Para la estimación de los costos directos se incluyó la atención ambulatoria, el tratamiento farmacológico, la atención hospitalaria y las intervenciones quirúrgicas relacionadas con las enfermedades cardiovasculares. Para la carga económica indirecta, se consideraron las muertes reportadas específicamente por causa de hipercolesterolemia, en un momento anterior al final de la edad productiva (muerte prematura). Resultados: La carga económica directa de las cinco categorías de pacientes en riesgo consideradas es de MXN $39,601,464,154 (USD $1,987,526,432), mientras que la carga económica indirecta asciende a MXN $121,646,689 (USD $6,105,229). Conclusiones: El impacto económico de la hipercolesterolemia en población con alto riesgo cardiovascular correspondía a $39,723,110,843 en 2020 (equivalente a USD $1,993,631,661), equivalente al 0.16% del PIB nacional.

COVID-19 caused important consequences on public health, economy, physical, and mental health of people. The aim of this study was to evaluate the impact of COVID-19 on frontline workers, comparing them with their colleagues who had no contact with the patients and with the general population, by administering an online questionnaire based on the Distress Questionnaire—5 (DQ5). The study was carried out during the first Italian wave of COVID-19 pandemic from 1st to 30th of April. Participants were divided in 3 groups: group 1 is general population group that includes the general population which are quarantined but not isolated, group health care staff not working in COVID-19 hospitals, and group 3 healthcare staff group working in COVID-19 hospitals. The survey was carried with the Distress Questionnaire—5 (DQ5) as a tool to detect the psychological distress and mental health problems. A total of 2983 people participated in this survey. Seven hundred and twenty four out of 1123 (64%) were employers of the 4 hospitals included in this study. Particularly among the respondents, 2259 (75.7%) were general population, 502 (16.8%) were health care staff not working in COVID-19 hospitals, while 222 (7.4%) were health care staff working in covid-19 hospitals. Health care personnel working in COVID-19 hospitals (DQ-5 = 13, 10-16) had less psychological distress compared with health care staff not working in COVID-19 hospitals (DQ-5 = 14, 11-16) and general population (DQ-5 = 14, 11-17; P = .04). The regression model showed that people aged 26 to 35 (OR: 2.06, 95% CI: 1.21-3.48) and female (OR: 2.35, 95% CI: 1.95-2.83) were significantly at risk to develop a DQ-5 ≥ 11. During the first Italian wave of COVID-19 pandemic, healthcare personnel working in COVID-19 hospitals had less psychological distress compared with health care staff not working in COVID-19 hospitals and general population, probably because they were prepared to face situations like outbreak or emergencies.