ABSTRACT
We present the results of photometric and spectroscopic monitoring campaigns of the changing look AGN NGC 3516 carried out in 2018 to 2020 covering the wavelength range from the X-ray to the ...optical. The facilities included the telescopes of the CMO SAI MSU, the 2.3-m WIRO telescope, and the XRT and UVOT of Swift. We found that NGC 3516 brightened to a high state and could be classified as Sy1.5 during the late spring of 2020. We have measured time delays in the responses of the Balmer and He ii λ4686 lines to continuum variations. In the case of the best-characterized broad H β line, the delay to continuum variability is about 17 d in the blue wing and is clearly shorter, 9 d, in the red, which is suggestive of inflow. As the broad lines strengthened, the blue side came to dominate the Balmer lines, resulting in very asymmetric profiles with blueshifted peaks during this high state. During the outburst the X-ray flux reached its maximum on 2020 April 1 and it was the highest value ever observed for NGC 3516 by the Swift observatory. The X-ray hard photon index became softer, ∼1.8 in the maximum on 2020 April 21 compared to the mean ∼0.7 during earlier epochs before 2020. We have found that the UV and optical variations correlated well (with a small time delay of 1–2 d) with the X-ray until the beginning of 2020 April, but later, until the end of 2020 June, these variations were not correlated. We suggest that this fact may be a consequence of partial obscuration by Compton-thick clouds crossing the line of sight.
Abstract Background Non-crosslinked porcine acellular dermal grafts (NCPADG) are currently the mainstay biomaterial for abdominal wall reconstruction (AWR) in complex hernia patients. We report early ...clinical outcomes using a novel rifampin/minocycline-coated NCPADG for AWR. Study Design A multi-institutional retrospective review was performed of patients who underwent ventral hernia repair using XenMatrix™ AB Surgical Graft (XenAB). Patient demographics, hernia and procedure characteristics, and surgical site occurrences/postoperative complications were reviewed up to 6 months following AWR. Results Seventy-four patients underwent AWR using XenAB. Open AWR was performed in 52 patients (70.3%), and 22 patients (29.7%) underwent laparoscopic VHR. Median hernia size/area was 66.0 cm2 (range: 9.4–294.5 cm2 ). Sixteen patients (21.6%) had previous wound infections, and sixteen patients (21.6%) had violation of the gastrointestinal tract during hernia repair. The most common locations of NCPADG placement were within the intraperitoneal (32.4%) and onlay (21.6%) positions, respectively. Median hospital length of stay was 4 days. Within 30 days following AWR, 6 patients (8.1%) were readmitted, 4 patients (5.4%) developed postoperative seroma formation, 1 patient required percutaneous drainage, and 5 patients (6.8%) developed surgical site infections. At 6 months follow-up, four patients had developed hernia recurrence (5.4%). Conclusions Data suggest that use of a novel rifampin/minocycline-coated NCPADG was associated with a low rate of postoperative surgical site occurrences/postoperative complications during the first 30 days follow-up in complex AWR patients. Furthermore, data suggest a low rate of hernia recurrence at 6-month follow-up. Further study is warranted to determine whether early antimicrobial protection of the device translates into longer-term protection of the repair.
Our aim was to assess the utility of a novel machine learning software (Orbit Image Analysis) in the histological quantification of acute ischemic stroke (AIS) clots. We analyzed 50 AIS blood clots ...retrieved using mechanical thrombectomy procedures. Following H&E staining, quantification of clot components was performed by two different methods: a pathologist using a reference standard method (Adobe Photoshop CC) and an experienced researcher using Orbit Image Analysis. Following quantification, the clots were categorized into 3 types: RBC dominant (≥60% RBCs), Mixed and Fibrin dominant (≥60% Fibrin). Correlations between clot composition and Hounsfield Units density on Computed Tomography (CT) were assessed. There was a significant correlation between the components of clots as quantified by the Orbit Image Analysis algorithm and the reference standard approach (ρ = 0.944**, p < 0.001, n = 150). A significant relationship was found between clot composition (RBC-Rich, Mixed, Fibrin-Rich) and the presence of a Hyperdense artery sign using the algorithmic method (X2(2) = 6.712, p = 0.035*) but not using the reference standard method (X2(2) = 3.924, p = 0.141). Orbit Image Analysis machine learning software can be used for the histological quantification of AIS clots, reproducibly generating composition analyses similar to current reference standard methods.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Photodynamic therapy (PDT) is a treatment modality that utilizes a photosensitizing drug activated by laser generated light, and is proving effective for oncologic and nononcologic applications. This ...report provides an overview of photosensitizers, photochemistry, photobiology, and the lasers involved in photodynamic therapy. Clinical and preclinical PDT studies involving Photofrin and various second generation photosensitizers are reviewed.
To determine the impact of Sequential Organ Failure Assessment (SOFA) organ sub-scores for hospital mortality risk stratification in a contemporary cardiac intensive care unit (CICU) population.
...Adult CICU admissions between January 1, 2007 and December 31, 2015 were reviewed. The SOFA score and organ sub-scores were calculated on CICU day 1; patients with missing SOFA sub-score data were excluded. Discrimination for hospital mortality was assessed using area under the receiver-operator characteristic curve (AUROC) values, followed by multivariable logistic regression.
We included 1214 patients with complete SOFA sub-score data. The mean age was 67 ± 16 years (38% female); all-cause hospital mortality was 26%. Day 1 SOFA score predicted hospital mortality with an AUROC of 0.72. Each SOFA organ sub-score predicted hospital mortality (all p <0.01), with AUROC values of 0.53 to 0.67. On multivariable analysis, only the cardiovascular, central nervous system, renal and respiratory SOFA sub-scores were associated with hospital mortality (all p <0.01). A simplified SOFA score containing the cardiovascular, central nervous system and renal sub-scores had an AUROC of 0.72.
In CICU patients with complete SOFA sub-score data, risk stratification for hospital mortality is determined primarily by the cardiovascular, central nervous system, renal and respiratory SOFA sub-scores.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background This study sought to evaluate the 15-year national utilization, trends, predictors, disparities, and outcomes of palliative care services (PCS) use in cardiogenic shock complicating acute ...myocardial infarction. Methods and Results A retrospective cohort from January 1, 2000 through December 31, 2014 was analyzed using the National Inpatient Sample database. Administrative codes for acute myocardial infarction-cardiogenic shock and PCS were used to identify eligible admissions. The primary outcomes were the frequency, utilization trends, and predictors of PCS. Secondary outcomes included in-hospital mortality and resources utilization. Multivariable regression and propensity-matching analyses were used to control for confounding. In this 15-year period, there were 444 253 acute myocardial infarction-cardiogenic shock admissions, of which 4.5% received PCS. The cohort receiving PCS was older, of white race, female sex, and with higher comorbidity and acute organ failure. The PCS cohort received fewer cardiac procedures, but more noncardiac organ support therapies. Older age, female sex, white race, higher comorbidity, higher socioeconomic status, admission to a larger hospital, and admission after 2008 were independent predictors of PCS use. Use of PCS was independently associated with higher in-hospital mortality (odds ratio 6.59 95% CI 6.37-6.83; P<0.001). The cohort with PCS use had >2-fold higher in-hospital mortality, 12-fold higher use of do-not-resuscitate status, lesser in-hospital resource utilization, and fewer discharges to home. Similar findings were observed in the propensity-matched cohort. Conclusions PCS use in patients with acute myocardial infarction-cardiogenic shock is low, though there is a trend towards increased adoption. There are significant patient and hospital-specific disparities in the utilization of PCS.
Background
Optimal methods of mortality risk stratification in patients in the cardiac intensive care unit (CICU) remain uncertain. We evaluated the ability of the Sequential Organ Failure Assessment ...(SOFA) score to predict mortality in a large cohort of unselected patients in the CICU.
Methods and Results
Adult patients admitted to the CICU from January 1, 2007, to December 31, 2015, at a single tertiary care hospital were retrospectively reviewed. SOFA scores were calculated daily, and Acute Physiology and Chronic Health Evaluation (APACHE)‐III and APACHE‐IV scores were calculated on CICU day 1. Discrimination of hospital mortality was assessed using area under the receiver‐operator characteristic curve values. We included 9961 patients, with a mean age of 67.5±15.2 years; all‐cause hospital mortality was 9.0%. Day 1 SOFA score predicted hospital mortality, with an area under the receiver‐operator characteristic curve value of 0.83; area under the receiver‐operator characteristic curve values were similar for the APACHE‐III score, and APACHE‐IV predicted mortality (P>0.05). Mean and maximum SOFA scores over multiple CICU days had greater discrimination for hospital mortality (P<0.01). Patients with an increasing SOFA score from day 1 and day 2 had higher mortality. Patients with day 1 SOFA score <2 were at low risk of mortality. Increasing tertiles of day 1 SOFA score predicted higher long‐term mortality (P<0.001 by log‐rank test).
Conclusions
The day 1 SOFA score has good discrimination for short‐term mortality in unselected patients in the CICU, which is comparable to APACHE‐III and APACHE‐IV. Advantages of the SOFA score over APACHE include simplicity, improved discrimination using serial scores, and prediction of long‐term mortality.
This study sought to evaluate the clinical characteristics and outcomes of Takotusbo cardiomyopathy cardiogenic shock (TC-CS) in comparison to those of acute myocardial infarction cardiogenic shock ...(AMI-CS) among patients hospitalized in the United States. We additionally sought to compare the incidence of multiorgan failure and use of supportive therapies as well as the trends over time, given the increasing awareness and diagnosis of TC.
CS is a major complication of TC; however, there are limited data, especially as to how TC-CS compares to AMI-CS.
The National Inpatient Sample Database was used to identify adults hospitalized with CS in the setting of TC and AMI from 2007 to 2014. We required patients admitted with TC to have undergone coronary angiography without intervention. Clinical characteristics and in-hospital outcomes in TC-CS patients were compared with those in AMI-CS patients. Multivariate regression and propensity matching were used to adjust for potential confounding factors.
Between 2007 and 2014, there were 374,152 admissions for CS due to either TC or AMI, of which 4,614 patients (1.2%) had TC-CS. TC-CS admission patients were more likely to be younger, white females with fewer comorbidities. Rates of respiratory failure and mechanical ventilation were higher in TC-CS, but cardiac arrest and acute kidney injury were lower. There were no differences between cohorts in use of intra-aortic balloon pumps. TC-CS admissions had lower in-hospital mortality (15% vs. 37%, respectively) and hospital costs (U.S. dollars: $135,397 ± $127,617 vs. $154,827 ± $186,035, respectively) and were discharged home more often (45% vs. 36%, respectively) compared to AMI-CS admissions (all: p < 0.001). After adjustments for potential confounders, TC-CS was associated with lower in-hospital mortality (odds ratio OR: 0.35; 95% confidence interval CI: 0.32 to 0.38; p < 0.001). Similar findings were observed in the propensity-matched cohort (OR: 0.32; 95% CI: 0.25 to 0.39; p < 0.001).
There are key differences between the clinical characteristics and multiorgan failure patterns in TC-CS compared to those in AMI-CS. In-hospital mortality (15%) is lower in TC-CS.
The ability of steroid hormones to produce an LH or prolactin (PRL) surge was determined in rats ovariectomized at 6, 9 or 13 weeks of age and subjected to one, three or six cycles of estrogen and ...progesterone replacement. Sensitivity to steroid replacement was dependent on the age of the animal at the time of ovariectomy. Repeated cyclic steroid hormone replacement significantly increased the magnitude of the PRL response, but not the LH response, in animals ovariectomized at 6 weeks. The LH response was significantly altered by cyclic steroid replacement only in animals ovariectomized at 13 weeks. These results indicate that the mechanisms involved in the regulation of PRL secretion are influenced by steroid hormone replacement and that cyclic steroid hormone exposure increases the magnitude of the PRL secretory response.
High concentrations of electrophilic lipid alkenals formed during oxidative stress are implicated in cytotoxicity and disease. However, low concentrations of alkenals are required to induce ...antioxidative stress responses. An established clearance pathway for lipid alkenals includes conjugation to glutathione (GSH) via Michael addition, which is catalyzed mainly by glutathione transferase isoform A4 (GSTA4-4). Based on the ability of GSTs to catalyze hydrolysis or
-Michael addition of GSH conjugates, and the antioxidant function of low concentrations of lipid alkenals, we hypothesize that GSTA4-4 contributes a homeostatic role in lipid metabolism. Enzymatic kinetic parameters for
-Michael addition with trans-2-Nonenal (NE) reveal the chemical competence of GSTA4-4 in this putative role. The forward GSTA4-4-catalyzed Michael addition occurs with the rapid exchange of the C2 proton of NE in D
O as observed by NMR. The isotope exchange was completely dependent on the presence of GSH. The overall commitment to catalysis, or the ratio of first order k
for 'forward' Michael addition to the first order k
for H/D exchange is remarkably low, approximately 3:1. This behavior is consistent with the possibility that GSTA4-4 is a regulatory enzyme that contributes to steady-state levels of lipid alkenals, rather than a strict 'one way' detoxication enzyme.
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