Neuropathic pain (NeP), redefined as pain caused by a lesion or a disease of the somatosensory system, is a disabling condition that affects approximately two million Canadians.
To review the ...randomized controlled trials (RCTs) and systematic reviews related to the pharmacological management of NeP to develop a revised evidence-based consensus statement on its management.
RCTs, systematic reviews and existing guidelines on the pharmacological management of NeP were evaluated at a consensus meeting in May 2012 and updated until September 2013. Medications were recommended in the consensus statement if their analgesic efficacy was supported by at least one methodologically sound RCT (class I or class II) showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment were based on the degree of evidence of analgesic efficacy, safety and ease of use.
Analgesic agents recommended for first-line treatments are gabapentinoids (gabapentin and pregabalin), tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors. Tramadol and controlled-release opioid analgesics are recommended as second-line treatments for moderate to severe pain. Cannabinoids are now recommended as third-line treatments. Recommended fourth-line treatments include methadone, anticonvulsants with lesser evidence of efficacy (eg, lamotrigine, lacosamide), tapentadol and botulinum toxin. There is support for some analgesic combinations in selected NeP conditions.
These guidelines provide an updated, stepwise approach to the pharmacological management of NeP. Treatment should be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Additional studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes and treatment of pediatric, geriatric and central NeP.
Swift and NuSTAR observations of GW170817 Evans, P. A.; Cenko, S. B.; Kennea, J. A. ...
Science (American Association for the Advancement of Science),
12/2017, Letnik:
358, Številka:
6370
Journal Article
Recenzirano
Odprti dostop
With the first direct detection of merging black holes in 2015, the era of gravitational wave (GW) astrophysics began. A complete picture of compact object mergers, however, requires the detection of ...an electromagnetic (EM) counterpart. We report ultraviolet (UV) and x-ray observations by Swift and the Nuclear Spectroscopic Telescope Array of the EM counter part of the binary neutron star merger GW170817. The bright, rapidly fading UV emission indicates a high mass (≈0.03 solar masses) wind-driven outflow with moderate electron fraction (Yₑ ≈ 0.27). Combined with the x-ray limits, we favor an observer viewing angle of ≈30° away from the orbital rotation axis, which avoids both obscuration fromthe heaviest elements in the orbital plane and a direct view of any ultrarelativistic, highly collimated ejecta (a γ-ray burst afterglow).
The presence of energetically low-lying triplet states is a hallmark of organic semiconductors. Even though they present a wealth of interesting photophysical properties, these optically dark states ...significantly limit optoelectronic device performance. Recent advances in emissive charge-transfer molecules have pioneered routes to reduce the energy gap between triplets and “bright” singlets, allowing thermal population exchange between them and eliminating a significant loss channel in devices. In conjugated polymers, this gap has proved resistant to modification. Here, we introduce a general approach to reduce the singlet–triplet energy gap in fully conjugated polymers, using a donor–orthogonal acceptor motif to spatially separate electron and hole wave functions. This new generation of conjugated polymers allows for a greatly reduced exchange energy, enhancing triplet formation and enabling thermally activated delayed fluorescence. We find that the mechanisms of both processes are driven by excited-state mixing between π–π*and charge-transfer states, affording new insight into reverse intersystem crossing.
Patients receiving novel oral anticoagulants (NOACs) frequently undergo interventional procedures. Short half-lives and rapid onset of action allow for short periods of NOAC interruption without ...heparin bridging. However, outcome data for this approach are lacking. We evaluated the peri-interventional NOAC management in unselected patients from daily care.
Effectiveness and safety data were collected from an ongoing, prospective, non-interventional registry of >2100 NOAC patients. Outcome events were adjudicated using standard event definitions. Of 2179 registered patients, 595 (27.3%) underwent 863 procedures (15.6% minimal, 74.3% minor, and 10.1% major procedures). Until Day 30 ± 5 post-procedure, major cardiovascular events occurred in 1.0% of patients 95% confidence interval (95% CI) 0.5-2.0 and major bleeding complications in 1.2% (95% CI 0.6-2.1). Cardiovascular and major bleeding complications were highest after major procedures (4.6 and 8.0%, respectively). Heparin bridging did not reduce cardiovascular events, but led to significantly higher rates of major bleeding complications (2.7%; 95% CI 1.1-5.5) compared with no bridging (0.5%; 0.1-1.4; P = 0.010). Multivariate analysis demonstrated diabetes odds ratio (OR) 13.2 and major procedures (OR 7.3) as independent risk factors for cardiovascular events. Major procedures (OR 16.8) were an independent risk factor for major bleeding complications. However, if major and non-major procedures were separately assessed, heparin bridging was not an independent risk factor for major bleeding.
Continuation or short-term interruption of NOAC is safe strategies for most invasive procedures. Patients at cardiovascular risk undergoing major procedures may benefit from heparin bridging, but bleeding risks need to be considered.
We present first results from a series of NuSTAR observations of the black hole X-ray binary V404 Cyg obtained during its summer 2015 outburst, primarily focusing on observations during the height of ...this outburst activity. The NuSTAR data show extreme variability in both the flux and spectral properties of the source. This is partly driven by strong and variable line-of-sight absorption, similar to previous outbursts. The latter stages of this observation are dominated by strong flares, reaching luminosities close to Eddington. During these flares, the central source appears to be relatively unobscured and the data show clear evidence for a strong contribution from relativistic reflection, providing a means to probe the geometry of the innermost accretion flow. Based on the flare properties, analogies with other Galactic black hole binaries, and also the simultaneous onset of radio activity, we argue that this intense X-ray flaring is related to transient jet activity during which the ejected plasma is the primary source of illumination for the accretion disk. If this is the case, then our reflection modeling implies that these jets are launched in close proximity to the black hole (as close as a few gravitational radii), consistent with expectations for jet launching models that tap either the spin of the central black hole, or the very innermost accretion disk. Our analysis also allows us to place the first constraints on the black hole spin for this source, which we find to be (99% statistical uncertainty, based on an idealized lamp-post geometry).
The flare of radiation from the tidal disruption and accretion of a star can be used as a marker for supermassive black holes that otherwise lie dormant and undetected in the centres of distant ...galaxies. Previous candidate flares have had declining light curves in good agreement with expectations, but with poor constraints on the time of disruption and the type of star disrupted, because the rising emission was not observed. Recently, two 'relativistic' candidate tidal disruption events were discovered, each of whose extreme X-ray luminosity and synchrotron radio emission were interpreted as the onset of emission from a relativistic jet. Here we report a luminous ultraviolet-optical flare from the nuclear region of an inactive galaxy at a redshift of 0.1696. The observed continuum is cooler than expected for a simple accreting debris disk, but the well-sampled rise and decay of the light curve follow the predicted mass accretion rate and can be modelled to determine the time of disruption to an accuracy of two days. The black hole has a mass of about two million solar masses, modulo a factor dependent on the mass and radius of the star disrupted. On the basis of the spectroscopic signature of ionized helium from the unbound debris, we determine that the disrupted star was a helium-rich stellar core.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We have studied similar to 2100 early-type galaxies in the SDSS DR3 which have been detected by the GALEX Medium Imaging Survey (MIS), in the redshift range 0 < z < 0.11. Combining GALEX UV ...photometry with corollary optical data from the SDSS, we find that, at a 95% confidence level, at least similar to 30% of galaxies in this sample have UV to optical colors consistent with some recent star formation within the last Gyr. In particular, galaxies with an NUV - r color less than 5.5 are very likely to have experienced such recent star formation, taking into account the possibility of a contribution to NUV flux from the UV upturn phenomenon. We find quantitative agreement between the observations and the predictions of a semianalytical Lambda CDM hierarchical merger model and deduce that early-type galaxies in the redshift range 0 < z < 0.11 have similar to 1%-3% of their stellar mass in stars less than 1 Gyr old. The average age of this recently formed population is similar to 300-500 Myr. We also find that "monolithically" evolving galaxies, where recent star formation can be driven solely by recycled gas from stellar mass loss, cannot exhibit the blue colors (NUV - r < 5.5) seen in a significant fraction ( similar to 30%) of our observed sample.
Abstract
Tilletia controversa
causing dwarf bunt of wheat is a quarantine pathogen in several countries. Therefore, its specific detection is of great phytosanitary importance. Genomic regions ...routinely used for phylogenetic inferences lack suitable polymorphisms for the development of species-specific markers. We therefore compared 21 genomes of six
Tilletia
species to identify DNA regions that were unique and conserved in all
T. controversa
isolates and had no or limited homology to other
Tilletia
species. A loop-mediated isothermal amplification (LAMP) assay for
T. controversa
was developed based on one of these DNA regions. The specificity of the assay was verified using 223 fungal samples comprising 43 fungal species including 11
Tilletia
species, in particular 39 specimens of
T. controversa,
92 of
T. caries
and 40 of
T. laevis
, respectively. The assay specifically amplified genomic DNA of
T. controversa
from pure cultures and teliospores. Only
Tilletia trabutii
generated false positive signals. The detection limit of the LAMP assay was 5 pg of genomic DNA per reaction. A test performance study that included five laboratories in Germany resulted in 100% sensitivity and 97.7% specificity of the assay. Genomic regions, specific to common bunt (
Tilletia caries
and
Tilletia laevis
together) are also provided.
We discuss the phenomenology of no-scale supergravity (SUGRA), in which the universal scalar mass is zero at the high scale, focussing on the recently updated muon g-2 measurement, and including dark ...matter and the correct Higgs boson mass. Such no-scale supergravity scenarios arise naturally from string theory and are also inspired by the successful Starobinsky inflation, with a class of minimal models leading to a strict upper bound on the gravitino mass m3/2<103 TeV. We perform a Monte Carlo scan over the allowed parameter space, assuming a mixture of pure gravity mediated and universal gaugino masses, using the SPheno package linked to FeynHiggs, MicrOmegas and CheckMate, displaying the results in terms of a Likelihood function. We present results for zero and non-zero trilinear soft parameters, and for different signs of gaugino masses, giving a representative set of benchmark points for each viable region of parameter space. We find that, while no-scale SUGRA can readily satisfy the dark matter and Higgs boson mass requirements, consistent with all other phenomenological constraints, the muon g-2 measurement may be accommodated only in certain regions of parameter space, close to the LHC excluded regions for light sleptons and charginos.
To compare the amount of myopia induced by same-size donor-to-host penetrating keratoplasty with that of the amount of myopia induced by over-sized donor-to-host penetrating keratoplasty.
Tertiary ...referral academic center.
Retrospective cohort study.
Charts from patients who underwent penetrating keratoplasty by the same technique at Bascom Palmer Eye Institute between Nov 1, 2002, and January 1, 2006, were reviewed. The patients underwent optical penetrating keratoplasty using 12 interrupted 10-0 nylon sutures and a 12-bite continuous 10-0 nylon suture by a single surgeon (R.K.F.). The surgical technique used would be considered standard of care at most institutions. The Institutional Review Board, University of Miami Human Subjects Research Office, approved the study protocol. The donor graft was over-sized by 0.25mm in eyes when the intended final refractive target was greater than -1.00 diopters spherical equivalent (SE). The same-size donor graft was used when the intended final refractive target was less than -1.00 diopters SE. The selection of donor graft size was entirely based upon clinical parameters, meaning that the intended final refractive target was determined per each patient's fellow eye refraction, with the intention of reducing anisometropia. All patients received postoperative refraction and corneal topography. These measurements were performed at 6-8 weeks when the initial removal of sutures commenced, then at 6 months, then after completion of selective suture removal, then again at 12 months.
At 12 months, the over-sized group resulted in -1.35 diopters (SD = 2.25) SE of refraction, and the same-size group resulted in -0.14 diopters (SD = 2.42) SE. This approached statistical significance (p = 0.052) in comparison to -1.00 diopters spherical equivalent.
Using a donor graft that is over-sized by 0.25mm results in refraction of -1.00 diopters SE or more of myopia. Using a same-size donor-graft results in refraction of less than -1.00 diopters SE. Therefore, careful graft-size selection can result in a more favorable clinical outcome-namely, reduction in anisometropia-in patients undergoing penetrating keratoplasty.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
