Innovative ochre processing and tool use in China 40,000 years ago.

Homo sapiens was present in northern Asia by around 40,000 years ago, having replaced archaic populations across Eurasia after episodes of earlier population expansions and interbreeding1-4. Cultural adaptations of the last Neanderthals, the Denisovans and the incoming populations of H. sapiens into Asia remain unknown1,5-7. Here we describe Xiamabei, a well-preserved, approximately 40,000-year-old archaeological site in northern China, which includes the earliest known ochre-processing feature in east Asia, a distinctive miniaturized lithic assemblage with bladelet-like tools bearing traces of hafting, and a bone tool. The cultural assembly of traits at Xiamabei is unique for Eastern Asia and does not correspond with those found at other archaeological site assemblages inhabited by archaic populations or those generally associated with the expansion of H. sapiens, such as the Initial Upper Palaeolithic8-10. The record of northern Asia supports a process of technological innovations and cultural diversification emerging in a period of hominin hybridization and admixture2,3,6,11.

Pituitary metastases from neuroendocrine neoplasms: case report and narrative review.

PURPOSE: Pituitary metastases (PM) are uncommon findings and are mainly derived from breast and lung cancers. No extensive review of PM from neuroendocrine neoplasms (NENs) is on record. Here we describe a clinical case of PM from pancreatic NEN and review the clinical features of PM from NENs reported in the literature. METHODS: A case of PM from a pancreatic NEN followed at our institution is described. We also reviewed the 43 cases of PM from NENs reported in the literature. RESULTS: A 59-year old female patient, previously submitted to duodeno-cephalo-pancreasectomy for a well-differentiated pancreatic NEN, with known hepatic metastases, underwent a 68 Ga-DOTATOC PET/CT that revealed an uptake in the pituitary gland. A subsequent MRI displayed a pituitary lesion, with suprasellar extension. After a hormonal and genetic diagnostic workup that excluded the diagnosis of MEN 1, the worsening of headache and visual impairment and the growth of the lesion lead to its surgical removal. A pituitary localization of the pancreatic NEN was identified. Regarding the published cases of PM from NENs, the most common tumour type was small cell lung cancer (SCLC), accounting for nearly half of the cases, followed by bronchial and pancreatic well differentiated NENs. The most frequent symptom was a variable degree of visual impairment, while headache was reported in half of the cases. Partial or total anterior hypopituitarism was present in approximately three quarters of the cases, while diabetes insipidus was less common. The most frequent treatment for PM was surgical resection, followed by radiotherapy and chemotherapy. The clinical outcome was in line with previous reports of PM from solid tumours, with a median survival of 14 months. Surgery of PM was associated with prolonged survival. CONCLUSIONS: PM from NENs have clinical features similar to metastases derived from other solid tumours, albeit the involvement of the anterior pituitary seems more frequent; a thorough pituitary hormonal evaluation is mandatory, after focused radiological studies, particularly if a surgical approach is considered. The optimal management of PM remains disputed and seems mainly driven by the aggressiveness of the primary tumour and the presence of symptoms. In well-differentiated NENs, particularly in the case of symptomatic PM, surgical removal may be a reasonable approach.

Urea in cancer patients with chronic SIAD-induced hyponatremia: Old drug, new evidence.

BACKGROUND: Syndrome of inappropriate antidiuresis (SIAD) is the main cause of hyponatremia in cancer patients. International guidelines indicate urea as an interesting option for chronic SIAD. Nevertheless, strong data to support its use are lacking, and its role in oncologic patients has not been described so far. MATERIAL AND METHODS: We retrospectively analysed 36 cancer patients affected by moderate or profound SIAD-induced chronic hyponatremia, who started oral urea (initial daily dose 15 g or 30 g) without fluid restriction between July 2013 and July 2018. We analysed mean serum sodium (sNa) increase after 24 hours and percentages of patients who reached eunatremia within 14, 30 and 60 days of treatment, stratifying according to the degree of hyponatremia at diagnosis. Clinical evaluation and biochemical assessment were periodically performed. RESULTS: Mean sNa was 123 [±4] mmol/L at baseline; after 24 hours of treatment, a mean increase of 5 [±3] mmol/L was observed. Eunatremia was reached by 55.6%, 86.1% and 91.7% patients within 14, 30 and 60 days of treatment, respectively. Trends in sNa normalization were similar in patients with moderate and profound hyponatremia at diagnosis. Rapid sNa overcorrection was avoided in all cases. Urea  was interrupted within  the first  2 months  of treatment in 10 patients, in half cases for rapid neoplastic progression and in the remaining patients for the drug taste. CONCLUSIONS: In our study, urea was effective in correcting chronic hyponatremia among cancer patients with SIAD. Almost all patients reached eunatremia within the first month of therapy, and urea was globally well tolerated.

Pituitary Hyperplasia Due to Longstanding Primary Hypothyroidism: A Case Report and Comprehensive Review of the Literature.

Hypothyroidism is a frequently diagnosed endocrine disorder. Common signs and symptoms include fatigue, cold intolerance, hoarseness, dry skin, constipation, a slow relaxation phase of deep tendon reflexes, and bradycardia. However, some patients may exhibit atypical signs and symptoms, which can result in diagnostic confusion. Pituitary hyperplasia resulting from longstanding primary hypothyroidism was first described by Niepce in 1851. It is usually asymptomatic, but sometimes, in addition to symptoms of overt hypothyroidism, patients may complain of headaches, hypopituitarism, visual field impairment, and hyperprolactinemia. Furthermore, on imaging, pituitary hyperplasia can be mistaken for a pituitary adenoma. Distinguishing between the two is crucial, as their management differs; the former often responds to thyroid hormone replacement therapy, while the latter might need treatment with surgery and/or radiotherapy. Here we describe a patient who developed pituitary hyperplasia in the setting of longstanding uncompensated primary hypothyroidism due to a lack of compliance with levothyroxine replacement therapy. We also review the clinical, laboratory, and radiologic findings of the case reports available in the literature up to now in order to improve the knowledge and the care of the disease.

First identification of an evolving Middle Stone Age ochre culture at Porc-Epic Cave, Ethiopia.

The use of mineral pigments, in particular iron-rich rocks, holds significant importance in understanding the emergence and evolution of human cultures. However, sites that have yielded a number of pieces large enough to precisely identify how the use of this material changed through time are rare. In this study, we examine one of the largest known Middle Stone Age (MSA) ochre collections, from Porc-Epic Cave, Ethiopia, consisting of more than 40 kg of ochre (n = 4213 pieces), 21 ochre processing tools and two ochre-stained artefacts. By combining the analysis of the elemental and mineralogical composition of the archaeological material with that of natural ochre collected in the surroundings of the site, and correlating this information with shifts in ochre modification techniques over time, we unveil how MSA inhabitants of Porc-Epic Cave exploited mineral resources. We show that they could predict the properties of different ochre types accessible in their environment, and gradually adapted their technology to cope with changes in raw material availability. Furthermore, the analysis of ochre residues on a painted pebble, likely used to produce red dots on a surface, identifies an ochre type that was specifically employed for symbolic purposes.

18F-Fluorocholine PET/CT in the Detection of Hyperfunctioning Transplanted Parathyroid Tissue.

ABSTRACT: A 54-year-old woman diagnosed with multiple endocrine neoplasia syndrome type 1 and primary hyperparathyroidism underwent total parathyroidectomy with autotransplantation of parathyroid tissue fragments in the right forearm in 1999. Since several years later, follow-up laboratory examinations showed the relapse of hypercalcemia; the patient started cinacalcet therapy. To exclude the presence of hyperfunctioning parathyroid glands in ortotopic or ectopic sites, a PET/CT scan with 18F-fluorocholine was performed. The PET/CT scan excluded the presence of ortotopic and ectopic parathyroid glands but showed a hyperplastic parathyroid fragment in the right forearm, responsible for the patient's persistent hypercalcemia.

The first uses of colour: what do we know?

Colour strongly shapes our perception of the world and plays a main role in the emergence of language and in the transmission of information. It has been shown that systematic use of ochre, along with other cultural traits that reflect cognitive complexity, disappear and reappear from the archaeological record, suggesting that cultural transmission follows discontinuous trajectories that to this day are unknown to us. Understanding when humans started using colour and how this feature evolved may therefore be instrumental to understand the evolutionary paths followed by members of our lineage towards cultural complexity. The earliest secure evidence for ochre use is found at 300.000-year-old archaeological sites from Africa and Europe. It usually consists of iron-rich rocks characterized by a red, orange, yellow or brown colour and/or streak, modified by grinding, scraping and knapping to produce red or yellow powder, ochre residues adhering to different types of artefacts or sediment stained with ochre or rich in ochre microfragments. Around 160 ka, ochre use becomes a recurrent feature. Although analyses of ochre collections have become increasingly frequent, there is still very little information on the first instances of ochre use and on how this cultural feature evolved through time. Most cases of early evidence for colour use by different human fossil species were recovered during excavations conducted several decades ago, when ochre was not documented systematically. Excluding a few recently studied cases, there is often a lack of evidence to support the anthropogenic nature of these findings. The aim of this paper is to summarise what we know on ochre use during the Lower Palaeolithic / Early Stone Age (ESA) and Middle Palaeolithic / Middle Stone Age (MSA), review techniques currently used for the analysis of this material and highlight analytical and theoretical issues surrounding this complex cultural feature.

Fire and grass-bedding construction 200 thousand years ago at Border Cave, South Africa.

Early plant use is seldom described in the archaeological record because of poor preservation. We report the discovery of grass bedding used to create comfortable areas for sleeping and working by people who lived in Border Cave at least 200,000 years ago. Sheaves of grass belonging to the broad-leafed Panicoideae subfamily were placed near the back of the cave on ash layers that were often remnants of bedding burned for site maintenance. This strategy is one forerunner of more-complex behavior that is archaeologically discernible from ~100,000 years ago.

Patterns of change and continuity in ochre use during the late Middle Stone Age of the Horn of Africa: The Porc-Epic Cave record.

Ochre is found at numerous Middle Stone Age (MSA) sites and plays a key role in early modern human archaeology. Here we analyse the largest known East African MSA ochre assemblage, comprising 40 kg of ochre, found at Porc-Epic Cave, Ethiopia, spanning a period of at least 4,500 years. Visual characterisation of ochre types, microscopic identification of traces of modification, morphological and morphometric analysis of ochre pieces and modified areas, experimental reproduction of grinding processes, surface texture analysis of archaeological and experimentally ground ochre facets, laser granulometry of ochre powder produced experimentally on different grindstones and by Hamar and Ovahimba women from Ethiopia and Namibia respectively, were, for the first time, combined to explore diachronic shifts in ochre processing technology. Our results identify patterns of continuity in ochre acquisition, treatment and use reflecting both persistent use of the same geological resources and similar uses of iron-rich rocks by late MSA Porc-Epic inhabitants. Considering the large amount of ochre processed at the site, this continuity can be interpreted as the expression of a cohesive cultural adaptation, largely shared by all community members and consistently transmitted through time. A gradual shift in preferred processing techniques and motions is interpreted as reflecting cultural drift within this practice. Evidence for the grinding of ochre to produce small quantities of powder throughout the sequence is consistent with a use in symbolic activities for at least part of the ochre assemblage from Porc-Epic Cave.

Middle Stone Age Ochre Processing and Behavioural Complexity in the Horn of Africa: Evidence from Porc-Epic Cave, Dire Dawa, Ethiopia.

Ochre is a common feature at Middle Stone Age (MSA) sites and has often been interpreted as a proxy for the origin of modern behaviour. However, few ochre processing tools, ochre containers, and ochre-stained artefacts from MSA contexts have been studied in detail within a theoretical framework aimed at inferring the technical steps involved in the acquisition, production and use of these artefacts. Here we analyse 21 ochre processing tools, i.e. upper and lower grindstones, and two ochre-stained artefacts from the MSA layers of Porc-Epic Cave, Dire Dawa, Ethiopia, dated to ca. 40 cal kyr BP. These tools, and a large proportion of the 4213 ochre fragments found at the site, were concentrated in an area devoted to ochre processing. Lower grindstones are made of a variety of raw materials, some of which are not locally available. Traces of use indicate that different techniques were employed to process ochre. Optical microscopy, XRD, µ-Raman spectroscopy, and SEM-EDS analyses of residues preserved on worn areas of artefacts show that different types of ferruginous rocks were processed in order to produce ochre powder of different coarseness and shades. A round stone bearing no traces of having been used to process ochre is half covered with residues as if it had been dipped in a liquid ochered medium to paint the object or to use it as a stamp to apply pigment to a soft material. We argue that the ochre reduction sequences identified at Porc-Epic Cave reflect a high degree of behavioural complexity, and represent ochre use, which was probably devoted to a variety of functions.

Negociação inteligente: a prática e os princípios de negociação no dia-a-dia das organizações de saúde / Intelligent Negotiation - Negotiation Practices and Principles in the Daily Lives of Health Organizations

Propõe a discussão sobre as práticas e os princípios da negociação dentro dos hospitais e demais instituições de saúde. A discussão pauta-se pelas estratégias e usos inteligentes dos quais um profissional dessa área (médicos, enfermeiros, administradores etc.) pode e deve se valer nas negociações interdepartamentais ou interfuncionais na complexa teia hospitalar. Lembrando-seque a visão filosófica de Sócrates (“conhece-te a ti mesmo”) é sempre o princípio de tudo.

O que você negociou hoje? Considerações sobre o processo de negociação / The multiple aspects involving a negotiation process in peoplesïs daily life

Este artigo apresenta uma discussão teórica, baseada em investigação bibliográfica e na prática das autoras sobre os múltiplos aspectos implicados em um processo de negociação no dia-a-dia das pessoas. Tem por objetivo propiciar a reflexão sobre aspectos conceituais esclarecendo as diversas fases da negociação com suas respectivas características...