We present an X-ray spectral analysis of the nearby double radio relic merging cluster Abell 3376 (z = 0.046), observed with the Suzaku XIS instrument. These deep (∼360 ks) observations cover the ...entire double relic region in the outskirts of the cluster. These diffuse radio structures are amongst the largest and arc-shaped relics observed in combination with large-scale X-ray shocks in a merging cluster. We confirm the presence of a stronger shock (ℳW = 2.8 ± 0.4) in the western direction at r ∼ 26′, derived from a temperature and surface brightness discontinuity across the radio relic. In the east, we detect a weaker shock (ℳE = 1.5 ± 0.1) at r ∼ 8′, possibly associated with the “notch” of the eastern relic, and a cold front at r ∼ 3′. Based on the shock speed calculated from the Mach numbers, we estimate that the dynamical age of the shock front is ∼0.6 Gyr after core passage, indicating that Abell 3376 is still an evolving merging cluster and that the merger is taking place close to the plane of the sky. These results are consistent with simulations and optical and weak lensing studies from the literature.
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Children with neurologic and neuromuscular handicaps frequently have various symptoms related to gastroesophageal reflux (GER) disease. The long-term efficacy of antireflux surgery remains ...controversial in such children with GER. The clinical results of such patients who underwent laparoscopic fundoplication were examined in the current study.
Between 1997 and 2003, laparoscopic fundoplication was performed in 56 handicapped children (mean age, 6 years), and gastrostomy was performed concurrently in 52. The main symptoms were emesis/hematemesis in 40 and respiratory symptoms, including repeated respiratory infection and distress, in 31.
There were no severe postoperative complications or operative mortality. Emesis/hematemesis was controlled adequately in those without recurrence. Respiratory symptoms were controlled unsuccessfully in 16 patients (52%), 8 of whom required further respiratory care including nasal airway tube, tracheostomy, and laryngotracheal separation. Recurrence of GER disease occurred in 10 patients, 7 of whom underwent a second Nissen fundoplication successfully. Thirteen died within the median follow-up period of 14 months.
Laparoscopic fundoplication is effective in controlling emesis/hematemesis, but its efficacy is limited in terms of respiratory problems in handicapped children. Further refinements in diagnostic and treatment strategies are mandatory to improve the quality of life in such patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objective
To develop a claims-based algorithm to identify undiagnosed chronic migraine among patients enrolled in a healthcare system.
Methods
An observational study using claims and patient survey ...data was conducted in a large medical group. Eligible patients had an International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) migraine diagnosis, without a chronic migraine diagnosis, in the 12 months before screening and did not have a migraine-related onabotulinumtoxinA claim in the 12 months before enrollment. Trained clinicians administered a semi-structured diagnostic interview, which served as the gold standard to diagnose chronic migraine, to enrolled patients. Potential claims-based predictors of chronic migraine that differentiated semi-structured diagnostic interview-positive (chronic migraine) and semi-structured diagnostic interview-negative (non-chronic migraine) patients were identified in bivariate analyses for inclusion in a logistic regression model.
Results
The final sample included 108 patients (chronic migraine = 64; non-chronic migraine = 44). Four significant predictors for chronic migraine were identified using claims in the 12 months before enrollment: ≥15 versus <15 claims for acute treatment of migraine, including opioids (odds ratio = 5.87 95% confidence interval: 1.34–25.63); ≥24 versus <24 healthcare visits (odds ratio = 2.80 confidence interval: 1.08–7.25); female versus male sex (odds ratio = 9.17 confidence interval: 1.26–66.50); claims for ≥2 versus 0 unique migraine preventive classes (odds ratio = 4.39 confidence interval: 1.19–16.22). Model sensitivity was 78.1%; specificity was 72.7%.
Conclusions
The claims-based algorithm identified undiagnosed chronic migraine with sufficient sensitivity and specificity to have potential utility as a chronic migraine case-finding tool using health claims data. Research to further validate the algorithm is recommended.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We present the results of deep 140 ks Suzaku X-ray observations of the north-east (NE) radio relic of the merging galaxy cluster Abell 2255. The temperature structure of Abell 2255 is measured out to ...0.9 times the virial radius (1.9 Mpc) in the NE direction for the first time. The Suzaku temperature map of the central region suggests a complex temperature distribution, which agrees with previous work. Additionally, on a larger-scale, we confirm that the temperature drops from 6 keV around the cluster center to 3 keV at the outskirts, with two discontinuities at r ~ 5′ (450 kpc) and ~12′ (1100 kpc) from the cluster center. Their locations coincide with surface brightness discontinuities marginally detected in the XMM-Newton image, which indicates the presence of shock structures. From the temperature drop, we estimate the Mach numbers to be ℳinner ~ 1.2 and, ℳouter ~ 1.4. The first structure is most likely related to the large cluster core region (~350–430 kpc), and its Mach number is consistent with the XMM-Newton observation (ℳ ~ 1.24: Sakelliou & Ponman 2006, MNRAS, 367, 1409). Our detection of the second temperature jump, based on the Suzaku key project observation, shows the presence of a shock structure across the NE radio relic. This indicates a connection between the shock structure and the relativistic electrons that generate radio emission. Across the NE radio relic, however, we find a significantly lower temperature ratio (T1/T2 ~ 1.44 ± 0.16 corresponds to ℳX−ray ~ 1.4) than the value expected from radio wavelengths, based on the standard diffusive shock acceleration mechanism (T1/T2> 3.2 or ℳRadio> 2.8). This may suggest that under some conditions, in particular the NE relic of A2255 case, the simple diffusive shock acceleration mechanism is unlikely to be valid, and therefore, more a sophisticated mechanism is required.
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In this study, we attempted to define the lower esophageal sphincter (LES) motor events associated with the occurrence of gastroesophageal reflux (GER) in neurologically impaired children in whom of ...GER disease recurred after laparoscopic Nissen fundoplication (LNF).
Of 45 neurologically impaired children who had previously undergone LNF, six children in whom recurrence of GER disease was documented by 24-h esophageal pH monitoring were studied. Concurrent esophageal manometry and pH monitoring were conducted for 1 h both before and after the administration of apple juice (10 ml/kg).
A total of 89 reflux episodes were recorded in the course of the study. Of these, 51 episodes (57%) were associated with transient LES relaxation. In the remainder, reflux occurred across a contracted LES in 21 episodes (24%) and during absent basal LES tone in 15 episodes (17%). In four of six patients, transient LES relaxation was responsible for more than half of the reflux episodes.
Transient LES relaxation is the predominant mechanism of reflux in neurologically impaired children with recurrent GER after LNF.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
An interference-free representation of the instantaneous frequency of constituent harmonic components of periodic signals is introduced. The power weighted average instantaneous frequency of a ...band-pass filter yields this property when the effective passband of the filter covers up to two harmonic components and the two windows used in averaging are separated by a half pitch period. The proposed representation eliminates the abrupt changes found in usual instantaneous frequency representations and is applicable to any periodic signals consisting of multiple harmonic components. An F0 extractor of voiced sounds based on this representation is introduced as an example of prospective applications.
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