Tool skill impacts the archaeological evidence across technological primates.

The archaeological record offers insights into our evolutionary past by revealing ancient behaviour through stone and fossil remains. Percussive foraging is suggested to be particularly relevant for the emergence of tool-use in our lineage, yet early hominin percussive behaviours remain largely understudied compared to flaked technology. Stone tool-use of extant primates allows the simultaneous investigation of their artefacts and the associated behaviours. This is important for understanding the development of tool surface modification, and crucial for interpreting damage patterns in the archaeological record. Here, we compare the behaviour and the resulting material record across stone tool-using primates. We investigate the relationship of nut-cracking technique and stone tool modification across chimpanzees, capuchins, and long-tailed macaques by conducting standardized field experiments with comparable raw materials. We show that different techniques likely emerged in response to diverse nut hardness, leading to variation in foraging success across species. Our experiments further demonstrate a correlation between techniques and the intensity of visible percussive damage on the tools. Tools used with more precision and efficiency as demonstrated by macaques, show fewer use wear traces. This suggests that some percussive techniques may be less readily identified in the archaeological record.

Prevalence and target attainment of traditional cardiovascular risk factors in patients with systemic lupus erythematosus: a cross-sectional study including 3401 individuals from 24 countries.

BACKGROUND: Systemic lupus erythematosus (SLE) is characterised by increased cardiovascular morbidity and mortality risk. We aimed to examine the prevalence of traditional cardiovascular risk factors and their control in an international survey of patients with systemic lupus erythematosus. METHODS: In this multicentre, cross-sectional study, cardiovascular risk factor data from medical files of adult patients (aged ≥18) with SLE followed between Jan 1, 2015, and Jan 1, 2020, were collected from 24 countries, across five continents. We assessed the prevalence and target attainment of cardiovascular risk factors and examined potential differences by country income level and antiphospholipid syndrome coexistence. We used the Systemic Coronary Risk Evaluation algorithm for cardiovascular risk estimation, and the European Society of Cardiology guidelines for assessing cardiovascular risk factor target attainment. People with lived experience were not involved in the research or writing process. FINDINGS: 3401 patients with SLE were included in the study. The median age was 43·0 years (IQR 33-54), 3047 (89·7%) of 3396 patients were women, 349 (10.3%) were men, and 1629 (48·1%) of 3390 were White. 556 (20·7%) of 2681 patients had concomitant antiphospholipid syndrome. We found a high cardiovascular risk factor prevalence (hypertension 1210 [35·6%] of 3398 patients, obesity 751 [23·7%] of 3169 patients, and hyperlipidaemia 650 [19·8%] of 3279 patients), and suboptimal control of modifiable cardiovascular risk factors (blood pressure [target of <130/80 mm Hg], BMI, and lipids) in the entire SLE group. Higher prevalence of cardiovascular risk factors but a better blood pressure (target of <130/80 mm Hg; 54·9% [1170 of 2132 patients] vs 46·8% [519 of 1109 patients]; p<0·0001), and lipid control (75·0% [895 of 1194 patients] vs 51·4% [386 of 751 patients], p<0·0001 for high-density lipoprotein [HDL]; 66·4% [769 of 1158 patients] vs 60·8% [453 of 745 patients], p=0·013 for non-HDL; 80·9% [1017 of 1257 patients] vs 61·4% [486 of 792 patients], p<0·0001 for triglycerides]) was observed in patients from high-income versus those from middle-income countries. Patients with SLE with antiphospholipid syndrome had a higher prevalence of modifiable cardiovascular risk factors, and significantly lower attainment of BMI and lipid targets (for low-density lipoprotein and non-HDL) than patients with SLE without antiphospholipid syndrome. INTERPRETATION: High prevalence and inadequate cardiovascular risk factor control were observed in a large multicentre and multiethnic SLE cohort, especially among patients from middle-income compared with high-income countries and among those with coexistent antiphospholipid syndrome. Increased awareness of cardiovascular disease risk in SLE, especially in the above subgroups, is urgently warranted. FUNDING: None.

Earliest Prepared core technology in Eurasia from Nihewan (China): Implications for early human abilities and dispersals in East Asia.

Organized flaking techniques to obtain predetermined stone tools have been traced back to the early Acheulean (also known as mode 2) in Africa and are seen as indicative of the emergence of advanced technical abilities and in-depth planning skills among early humans. Here, we report one of the earliest known examples of prepared core technology in the archaeological record, at the Cenjiawan (CJW) site in the Nihewan basin of China, dated 1.1 Mya. The operational schemes reconstructed from the CJW refit sets, together with shaping patterns observed in the retouched tools, suggest that Nihewan basin toolmakers had the technical abilities of mode 2 hominins, and developed different survival strategies to adapt to local raw materials and environments. This finding predates the previously earliest known prepared core technology from Eurasia by 0.3 My, and the earliest known mode 2 sites in East Asia by a similar amount of time, thus suggesting that hominins with advanced technologies may have migrated into high latitude East Asia as early as 1.1 Mya.

Characteristics and risk factors of COVID-19 breakthrough infections in Idiopathic Inflammatory Myopathies: Results from the COVAD study.

OBJECTIVES: To explore prevalence, characteristics and risk factors of COVID-19 breakthrough infections (BIs) in idiopathic inflammatory myopathies (IIM) using data from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. METHODS: A validated patient self-reporting e-survey was circulated by the COVAD study group to collect data on COVID-19 infection and vaccination in 2022. BIs were defined as COVID-19 occurring ≥14 days after 2 vaccine doses. We compared BIs characteristics and severity among IIMs, other autoimmune rheumatic and non-rheumatic diseases (AIRD, nrAID), and healthy controls (HC). Multivariable Cox regression models assessed the risk factors for BI, severe BI and hospitalisations among IIMs. RESULTS: Among 9449 included response, BIs occurred in 1447 (15.3%) respondents, median age 44 years (IQR 21), 77.4% female, and 182 BIs (12.9%) occurred among 1406 IIMs. Multivariable Cox regression among IIMs showed age as a protective factor for BIs [Hazard Ratio (HR)=0.98, 95%CI = 0.97-0.99], hydroxychloroquine and sulfasalazine use were risk factors (HR = 1.81, 95%CI = 1.24-2.64, and HR = 3.79, 95%CI = 1.69-8.42, respectively). Glucocorticoid use was a risk factor for severe BI (HR = 3.61, 95%CI = 1.09-11.8). Non-White ethnicity (HR = 2.61, 95%CI = 1.03-6.59) was a risk factor for hospitalisation. Compared with other groups, patients with IIMs required more supplemental oxygen therapy (IIM = 6.0% vs AIRD = 1.8%, nrAID = 2.2%, and HC = 0.9%), intensive care unit admission (IIM = 2.2% vs AIRD = 0.6%, nrAID, and HC = 0%), advanced treatment with antiviral or monoclonal antibodies (IIM = 34.1% vs AIRD = 25.8%, nrAID = 14.6%, and HC = 12.8%), and had more hospitalisation (IIM = 7.7% vs AIRD = 4.6%, nrAID = 1.1%, and HC = 1.5%). CONCLUSION: Patients with IIMs are susceptible to severe COVID-19 BI. Age and immunosuppressive treatments were related to the risk of BIs.

Time to diagnosis in systemic lupus erythematosus: Associated factors and its impact on damage accrual and mortality. Data from a multi-ethnic, multinational Latin American lupus cohort.

BACKGROUND: Systemic lupus erythematosus (SLE) often mimics symptoms of other diseases, and the interval between symptom onset and diagnosis may be long in some of these patients. Aims: To describe the characteristics associated with the time to SLE diagnosis and its impact on damage accrual and mortality in patients with SLE from a Latin American inception cohort. METHODS: Patients were from a multi-ethnic, multi-national Latin-American SLE inception cohort. All participating centers had specialized lupus clinics. Socio-demographic, clinical/laboratory, disease activity, damage, and mortality between those with a longer and a shorter time to diagnosis were compared using descriptive statistical tests. Multivariable Cox regression models with damage accrual and mortality as the end points were performed, adjusting for age at SLE diagnosis, gender, ethnicity, level of education, and highest dose of prednisone for damage accrual, plus highest dose of prednisone, baseline SLEDAI, and baseline SDI for mortality. RESULTS: Of the 1437 included in these analyses, the median time to diagnosis was 6.0 months (Q1-Q3 2.4-16.2); in 721 (50.2%) the time to diagnosis was longer than 6 months. Patients whose diagnosis took longer than 6 months were more frequently female, older at diagnosis, of Mestizo ethnicity, not having medical insurance, and having "non-classic" SLE symptoms. Longer time to diagnosis had no impact on either damage accrual (HR 1.09, 95% CI 0.93-1.28, p = 0.300) or mortality (HR 1.37, 95% CI 0.88-2.12, p = 0.200). CONCLUSIONS: In this inception cohort, a maximum time of 24 months with a median of 6 months to SLE diagnosis had no apparent negative impact on disease outcomes (damage accrual and mortality).

Mortality and adverse events of special interest with intravenous belimumab for adults with active, autoantibody-positive systemic lupus erythematosus (BASE): a multicentre, double-blind, randomised, placebo-controlled, phase 4 trial.

BACKGROUND: Belimumab is approved for the treatment of active systemic lupus erythematosus (SLE). Although clinical trials showed a favourable benefit-risk profile, numerical differences in the incidence of mortality and adverse events of special interest (AESIs) have been reported. We assessed the frequency of these events in patients with SLE receiving belimumab or placebo plus standard therapy. METHODS: BASE was a double-blind, randomised, placebo-controlled, phase 4 trial done in 33 countries. Adults with active SLE were randomly assigned (1:1) to receive intravenous belimumab (10 mg/kg) or placebo, plus standard therapy, for 48 weeks. The primary endpoints were incidences of all-cause mortality and AESIs during the on-treatment period (first-to-last study drug dose + 28 days). Safety analyses were done in the as-treated population (patients grouped by actual treatment received >50% of the time). This study was registered with ClinicalTrials.gov (NCT01705977). FINDINGS: Between Nov 27, 2012, and July 28, 2017, we randomly assigned 4018 patients. The as-treated population included 2002 patients in the belimumab group versus 2001 in the placebo group. Ten (0·50%) patients in the belimumab group died versus eight (0·40%) in the placebo group (difference 0·10%, 95% CI -0·31 to 0·51). Incidences were similar in the belimumab and placebo groups for serious infections (75 [3·75%] of 2002 vs 82 [4·10%] of 2001; difference -0·35%, 95% CI -1·55 to 0·85), opportunistic infections and other infections of interest (36 [1·80%] vs 50 [2·50%]; -0·70%, -1·60 to 0·20), non-melanoma skin cancers (4 [0·20%] vs 3 [0·15%]; 0·05%, -0·21 to 0·31) and other malignancies (5 [0·25%] vs 5 [0·25%]; 0·00%, -0·31 to 0·31). A higher proportion of patients in the belimumab group than in the placebo group had infusion and hypersensitivity reactions (8 [0·40%] vs 2 [0·10%]; 0·30%, -0·01 to 0·61), serious depression (7 [0·35%] vs 1 [0·05%]; 0·30%, 0·02 to 0·58), treatment-emergent suicidality (28 [1·42%] of 1972 patients vs 23 [1·16%] of 1986; 0·26%, -0·44 to 0·96), and sponsor-adjudicated serious suicide or self-injury (15 [0·75%] of 1972 patients vs 5 [0·25%] of 1986; post hoc difference 0·50%, 0·06 to 0·94). INTERPRETATION: In line with previously published data, incidences of all-cause mortality and AESIs were similar in patients given belimumab and placebo, except for serious infusion or hypersensitivity reactions, serious depression, treatment-emergent suicidality, and sponsor-adjudicated serious suicide or self-injury events. FUNDING: GSK.

Efecto de los antimaláricos sobre los diferentes dominios del índice de daño SLICC en pacientes de la cohorte GLADEL / Effect of antimalarials on the different domains of the SLICC damage index in patients of the GLADEL cohort

Objetivos: Estimar el efecto de los antimaláricos (AM) sobre los diferentes dominios del índice de daño SLICC (SDI). Métodos: Se estudiaron pacientes con diagnóstico clínico reciente (≤2 años) de lupus eritematoso sistémico (LES) de la cohorte GLADEL. Variable de estudio: aumento en los dominios del SDI desde el ingreso a la cohorte. Variables independientes: características sociodemográficas, clínicas, laboratorio y tratamientos. El efecto de los AM, como variable dependiente del tiempo, sobre los dominios más frecuentes del SDI (ajustado por factores de confusión) fue examinado con un modelo de regresión de Cox multivariado. Resultados: De 1466 pacientes estudiados, 1049 (72%) recibieron AM con un tiempo medio de exposición de 30 meses (Q1-Q3: 11-57) y 665 pacientes (45%) presentaron daño durante un seguimiento medio de 24 meses (Q1-Q3: 8-55); 301 eventos fueron cutáneos, 208 renales, 149 neuropsiquiátricos, 98 musculoesqueléticos, 88 cardiovasculares y 230 otros. Después de ajustar por factores de confusión, el uso de AM se asoció a un menor riesgo de daño renal (HR 0,652; IC 95%: 0,472-0,901) y en el límite de la significancia estadística (HR 0,701, IC 95%: 0,481-1,024) para el dominio neuropsiquiátrico. Conclusión: En GLADEL, el uso de AM se asoció independientemente a un menor riesgo de daño acumulado renal.

Objective: To assess the effects of antimalarials (AM) over the items of the SLICC Damage Index (SDI). Methods: Patients with recent (≤2 years) diagnosis of systemic lupus erythematosus (SLE) from the GLADEL cohort were studied. End-point: increase in items SDI since cohort entry. Independent variables (socio-demographic, clinical, laboratory and treatment) were included. The effect of AM as a time dependent variable on most frequent SDI items (adjusting for potential confounders) was examined with a multivariable Cox regression model. Results: Of the 1466 patients included in this analysis, 1049 (72%) received AM with a median exposure time of 30 months (Q1-Q3: 11-57). Damage occurred in 665 (45%) patients during a median follow-up time of 24 months (Q1-Q3: 8-55). There were 301 integument, 208 renal, 149 neuropsychiatric, 98 musculoskeletal, 88 cardiovascular and 230 others less frequently represented damages. After adjusting for potential confounders at any time during follow-up, a lower risk of renal damage (HR 0.652; 95% CI: 0.472-0.901) and borderline for neuropsychiatric damage (HR 0.701, 95% CI: 0.481-1.024) was found. Conclusion: In the GLADEL cohort, after adjustment for possible confounding factors, AM were independently associated with a reduced risk of renal damage accrual.

Experiencia en traumatismo torácico: Hospital Valparaíso / Experience in thoracic traumatism: Valparaiso Hospital

Las lesiones del tórax son el resultado de trauma cerrado o abierto, que generalmente ocurren como consecuencia de lesiones por arma de fuego, arma blanca, accidentes de tránsito o compresiones torácicas por aplastamientos, entre otros. Se revisaron 163 fichas clínicas del Servicio de Cirugía Torácica del Hospital de Valparaíso entre enero de 1998 y junio de 2001. Se confeccionó un protocolo con datos a obtener de la ficha. Se analizaron los datos en valores absolutos y porcentajes. Posteriormente se efectuó una comparación de algunas variables entre el grupo de trauma abierto y el de cerrado. El 94,5 por ciento (154 pactes) correspondió a hombres y 5,5 por ciento (9 pactes) a mujeres. El promedio de edad fue de 30,9 años (rango 16-86). El mecanismo de trauma más frecuente fueron lesiones por armas blancas, (125 casos), seguido de caídas de altura (19 casos), accidentes de tránsito (9 casos), y armas de fuego (6 casos). Ciento veintiséis pacientes presentaron traumatismo abierto y 37 cerrado. Las lesiones más frecuentes fueron: neumotórax, 116 casos; hemotórax, 92 casos; y fracturas costales, 28 casos. El 87,1 por ciento de los traumatismos se manejó con tubo pleural (142 pactes). Sólo 11 pacientes necesitaron toracotomía de urgencia.

Clinical and serological characteristics in a group of Mexican patients with juvenile dermatomyositis / Características clínicas e sorológicas em um grupo de pacientes mexicanos com dermatomiosite juvenil

Objetivo: Descrever as características clínicas e laboratoriais ao início e na evoluçäo de uma série de pacientes com dermatomiosite juvenil (DMJ) e compará-la com séries similares de outros países. Material e métodos: Foram incluídas 18 crianças com diagnóstico de dermatomiosite de acordo com os critérios de Bohan e Peter. Foram analisados 62 parâmetros clínicos e laboratoriais. As amostras séricas das crianças foram testadas para diferentes tipos de auto-anticorpos por imunofluorescência e imunodifusäo dupla. Os pacientes foram acompanhados em dois hospitais por vários anos. A análise estatística utilizou métodos descritivos e comparativos. Resultados: Foram incluídos 6 meninos e 12 meninas com idade média de 9,7 anos (variando de 3 a 16 anos). O seguimento foi por um período médio de 4,5 anos. Os dados clínicos foram semelhantes aos de outras séries com pequenas diferenças. Foi realizada biópsia muscular em todos os casos, que demonstrou alteraçöes compatíveis com miosite. Foram detectados anticorpos antinucleares em 7 casos (40 por cento). Um paciente tinha anticorpos anti-SS-B/La e outro tinha anti-U1-RNP. Anticorpos específicos de miosite (anti-Mi-2 e anti-Jo-1) näo foram encontrados em nenhum dos pacientes. O tratamento foi à base de esteróides e antimaláricos, tendo sido o metotrexato usado em casos selecionados. Conclusöes: Clinicamente, os achados em nossos pacientes com DMJ näo diferiram daqueles descritos em outras séries. Sorologicamente, fomos incapazes de detectar auto-anticorpos específicos de miosite nesta série de pacientes

Anticuerpos anticitoplasma de los neutrófilos (ANCA) en artritis reumatoide (AR) / Antineutrophils cytoplasmic antibodies in rheumatoid artritis

Los anticuerpos anticitoplasma de los neutrófilos (ANCA) son anticuerpos dirigidos contra componentes del citoplasma de los neutrófilos y monocitos. Por inmunofluorescencia indirecta (IFI) se distinguen dos patrones: p-ANCA y c-ANCA, los cuales se han relacionado con diferentes tipos de vasculitis. En pacientes con AR se han encontrado con una prevalencia del 15-20 por ciento. En nuestro medio no ha habido informes al respecto, por lo que en este trabajo investigamos la prevalencia de estos autoanticuerpos en un grupo de pacientes con AR. Estudiamos 48 pacientes con AR de nuestra consulta (38 mujeres y 10 hombres) investigando en ellos la presencia de ANCA por IFI, utilizando neutrófilos fijados con etanol y formol. Los sueros se incubaron a la dilusción de 1:20. Siete de los 48 pacientes (15 por ciento) tuvieron anti-ANCA positivos. De éstos, el patrón p-ANCA se observó en 4 casos (8.3 por ciento) y c-ANCA en 3 (6.3 por ciento). Ninguno de estos pacientes presentó algún evento clínico relacionado con vasculitis. En todos ellos, el factor reumatoide fue positivo y los anticuerpos antinucleares negativos. La prevalencia de anticuerpos anti-ANCA en nuestro grupo de pacientes estudiados con AR no difiere de lo informado en otras series. Por otro lado, aunque algunos de estos autoanticuerpos se han asociado con la presencia de vasculitis nosostros no encontramos esta asociación entre nuestros pacientes

Estudio doble-ciego paralelo, comparativo con tenoxican vs. placebo in acute gouty arthritis / A comparative, double-blind parallel. study with tenoxicam vs. placebo in acute gouth arthritis

En el presente trabajo se hizo un estudio doble-ciego paralelo en el que se utilizó tenoxicam vs placebo para el tratamiento de 30 pacientes con manifestaciones de artritis gotosa aguda. Se incluyeron al azar 15 pacientes en cada grupo y el medicamento se administró en una dosis única diaria de 40 mg, o placebo de aparencia idéntica, durante cuatro días. Al final del tratamiento con tenoxicam o placebo, se observó mejoría del síntoma dolor (espontáneo, a la palpación, y a la movilización de la articulación afectada) en la mayor parte de los pacientes, así como también de algunas manifestaciones clínicas objetivas como fueron calor local, inflamación y enrojecimiento articular. Sin embargo, el comienzo de la mejoría fue más rápido en el grupo tratado con tenoxicam, y esta diferencia fue estadísticamente significativa después de un día de tratamiento para el dolor en sus diferentes modalidades en que fue valorado. Aunque la eficacia juzgada por el médico reveló clara tendencia a favor de tenoxicam, el análisis de resultados no mostró una diferencia significativa entre los dos grupos al final de los cuatro días de tratamiento. Por último, tenoxicam fue bien tolerado y no se observaron reacciones clínicas adversas con el uso de este medicamento, por lo que puede anticiparse su administración con buenos resultados en los padecimientos reumáticos de tipo inflamatório

Enfermedad del criador de palomas: presentación de cinco casos / Pigeon breeder's disease: report of 5 patients

En este trabajo se describen las manifestaciones clínicas y de laboratorio de cinco pacientes con la Enfermedad del Criador de Palomas, los cuales fueron diagnosticados y atendidos en nuestro Hospital en los últimos dos años. Se hace énfasis en las diferentes formas de presentación clínica, así como la importancia que tiene el estudio serológico para el diagnóstico, al demostrarse la presencia de anticuerpos precipitantes en el suelo de estos pacientes en contra de antígenos presentes en el suero y en las excretas de las palomas. En uno de los casos, tuvimos la oportunidad además de estudiar a varios de sus familiares. Clínicamente nuestros pacientes tuvieron una evolución crónica (promedio 27.4 meses) lo que sugiere exposición prolongada a los antígenos aviarios y la falta de diagnóstico oportuno. Serológicamente, en los cinco pacientes detectamos la presencia de anticuerpos precipitantes en contra de antígenos de paloma. En los familiares del caso estudiado, aunque clínicamente estaban asintomáticos, en tres de los nueve encontramos los mismos anticuerpos precipitantes, por lo que consideramos la posibilidad de que algunos factores genéticos pueden ser importantes en la expresión de la respuesta inmune humoral a los antígenos aviarios, que ocurre en esta forma de neumonitis por hipersensibilidad