To describe the epidemiology, management and outcome of individuals with mucormycosis; and to evaluate the risk factors associated with mortality.
We conducted a prospective observational study ...involving consecutive individuals with proven mucormycosis across 12 centres from India. The demographic profile, microbiology, predisposing factors, management and 90-day mortality were recorded; risk factors for mortality were analysed.
We included 465 patients. Rhino-orbital mucormycosis was the most common (315/465, 67.7%) presentation followed by pulmonary (62/465, 13.3%), cutaneous (49/465, 10.5%), and others. The predisposing factors included diabetes mellitus (342/465, 73.5%), malignancy (42/465, 9.0%), transplant (36/465, 7.7%), and others. Rhizopus species (231/290, 79.7%) were the most common followed by Apophysomyces variabilis (23/290, 7.9%), and several rare Mucorales. Surgical treatment was performed in 62.2% (289/465) of the participants. Amphotericin B was the primary therapy in 81.9% (381/465), and posaconazole was used as combination therapy in 53 (11.4%) individuals. Antifungal therapy was inappropriate in 7.6% (30/394) of the individuals. The 90-day mortality rate was 52% (242/465). On multivariate analysis, disseminated and rhino-orbital (with cerebral extension) mucormycosis, shorter duration of symptoms, shorter duration of antifungal therapy, and treatment with amphotericin B deoxycholate (versus liposomal) were independent risk factors of mortality. A combined medical and surgical management was associated with a better survival.
Diabetes mellitus was the dominant predisposing factor in all forms of mucormycosis. Combined surgical and medical management was associated with better outcomes. Several gaps surfaced in the management of mucormycosis. The rarer Mucorales identified in the study warrant further evaluation.
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Emerging evidence suggests that the mechanical behavior of the brain plays a critical role in development, disease, and aging. Recent studies have begun to characterize the mechanical ...behavior of gray and white matter tissue and to identify sets of material models that best reproduce the stress-strain behavior of different brain regions. Yet, these models are mainly phenomenological in nature, their parameters often lack clear physical interpretation, and they fail to correlate the mechanical behavior to the underlying microstructural composition. Here we make a first attempt towards identifying general relations between microstructure and mechanics with the ultimate goal to develop microstructurally motivated constitutive equations for human brain tissue. Using histological staining, we analyze the microstructure of brain specimens from different anatomical regions, the cortex, basal ganglia, corona radiata, and corpus callosum, and identify the regional stiffness and viscosity under multiple loading conditions, simple shear, compression, and tension. Strikingly, our study reveals a negative correlation between cell count and stiffness, a positive correlation between myelin content and stiffness, and a negative correlation between proteoglycan content and stiffness. Additionally, our analysis shows a positive correlation between lipid and proteoglycan content and viscosity. We demonstrate how understanding the microstructural origin of the macroscopic behavior of the brain can help us design microstructure-informed material models for human brain tissue that inherently capture regional heterogeneities. This study represents an important step towards using brain tissue stiffness and viscosity as early diagnostic markers for clinical conditions including chronic traumatic encephalopathy, Alzheimer’s and Parkinson’s disease, or multiple sclerosis.
The complex and heterogeneous mechanical properties of brain tissue play a critical role for brain function. To understand and predict how brain tissue properties vary in space and time, it will be key to link the mechanical behavior to the underlying microstructural composition. Here we use histological staining to quantify area fractions of microstructural components of mechanically tested specimens and evaluate their individual contributions to the nonlinear macroscopic mechanical response. We further propose a microstructure-informed material model for human brain tissue that inherently captures regional heterogeneities. The current work provides unprecedented insights into the biomechanics of human brain tissue, which are highly relevant to develop refined computational models for brain tissue behavior or to advance neural tissue engineering.
Context. The unification scheme of Seyfert galaxies predicts that the observed differences between types 1 and 2 Seyfert galaxies are solely due to the differing orientations of the toroidal-shaped ...obscuring material around AGN. The observed X-ray spectra of Seyfert type 2s compared to type 1s are expected to be affected by higher absorbing column density owing to the edge-on view of the obscuring torus. Aims. We study the 0.5–10 keV X-ray spectral properties of Seyfert type 1s and type 2s with the aim of testing the predictions of Seyfert unification scheme in the X-ray regime. Methods. We use an optically selected Seyfert sample in which type 1s and type 2s have matched distributions in parameters that are independent of the orientation of AGN and the host galaxy. Results. The 0.5–10 keV XMM-Newton pn X-ray spectra of Seyfert galaxies are in general best fitted with a model that consists of (i) an absorbed powerlaw; (ii) a narrow Gaussian fitted to the Fe Kα emission line; and (iii) an often seen soft-excess component characterized by either a thermal plasma model with temperature kT ~ 0.1–1.0 keV or a steep powerlaw or both. The 2.0–10 keV hard X-ray continuum emission in several Seyfert type 2s is dominated by reflection and suggests the Compton-thick obscuration. Results of the statistical comparison between the distributions of (i) the observed X-ray luminosities in the soft (0.5–2.0 keV) and hard (2.0–10.0 keV) bands; (ii) the X-ray absorbing column densities; (iii) the equivalent widths of Fe Kα line; and (iv) the flux ratios of hard X-ray to OIII λ5007 Å , for the two Seyfert subtypes are consistent with the obscuration and orientation-based unification scheme.
Context. The unification scheme of Seyfert galaxies hypothesizes that Seyfert type 1s and type 2s are intrinsically similar and the observed differences between the two subtypes are solely due to the ...differing orientations of toroidal-shaped obscuring material around the AGN. In the framework of the unification scheme, both the Seyfert subtypes are expected to show similar intrinsic nuclear properties such as the absorption-corrected AGN X-ray luminosity, bolometric luminosity, accretion rate and the mass of the supermassive black hole. Aims. To test the predictions of the Seyfert unification scheme, we make statistical comparison of the distributions of: (i) the absorption-corrected 2.0–10 keV X-ray luminosities; (ii) the bolometric luminosities; (iii) the black hole masses and; (iv) the Eddington ratios, of Seyfert type 1s and type 2s. Methods. We use an optically selected Seyfert sample in which type 1s and type 2s are matched in properties that are independent to the orientation of the obscuring torus, the AGN axis and the host galaxy. Results. The distributions of the absorption-corrected 2.0–10 keV X-ray luminosities (\hbox{$L_{\rm 2.0 {-} 10~keV}^{\rm c}$}L2.0−10 keVc), the bolometric luminosities (LBol), the black masses (MBH) and, the Eddington ratios (λ) are statistically similar for the two Seyfert subtypes, consistent with the orientation and obscuration based Seyfert unification scheme. The Eddington ratio distributions suggest that both the Seyfert subtypes are accreting at sub-Eddington level with wide span of Eddington ratios i.e.,10-4–10-1.
Aim
To examine change in the gut community of rats fed high amylose maize starch (HAMS).
Methods and Results
Rats were fed AIN93G diets containing HAMS (5% resistant starch type 2) or alphacell ...(control). HAMS increased faecal short‐chain fatty acid output, faecal propionate and total bacteria output but reduced gut pH and blood urea concentrations compared with rats ingesting the control diet. Feeding HAMS resulted in a gut community dominated by four phylotypes homologous with Ruminococcus bromii, Bacteroides uniformis and with yet to be cultivated organisms aligning into the Family Porphyromonadaceae. Enrichment of phylotypes aligning within the Bacteroidetes occurred primarily in the caecum, whereas those homologous with R. bromii were found primarily in the faeces. HAMS altered community structure such that the phylum Bacteroidetes represented the dominant gut lineage and progressively reduced faecal community phylotype richness over the duration of feeding.
Conclusions
Feeding HAMS resulted in a caecal and faecal community dominated by organisms that require ammonia as a primary nitrogen source. Gut ammonia derived from endogenous urea represents an important factor contributing to caecal community composition in addition to the ability to utilize HAMS. Increases in faecal propionate, rather than butyrate as is often observed following resistant starch feeding, reflected a gut community dominated by the Bacteroidetes.
Significance
Diet‐mediated change is often viewed strictly in terms of available carbohydrate. Here, we have shown that ammonia derived from endogenous urea is an important factor contributing to gut community composition and structure in rats fed this substrate.
Aims. We present low-frequency radio imaging and spectral properties of a well-defined sample of Seyfert galaxies using GMRT 240/610 MHz dual frequency observations. Radio spectra of Seyfert galaxies ...over 240 MHz to 5.0 GHz are investigated using 240 MHz, 610 MHz flux densities derived from GMRT, and 1.4 GHz and 5.0 GHz flux densities mainly from published VLA data. We test the predictions of Seyfert unification scheme by comparing the radio properties of Seyfert type 1s and type 2s. Methods. We chose a sample such that the two Seyferts subtypes have matched distributions in parameters that are independent of the orientation of AGN, obscuring torus, and the host galaxy. Our sample selection criteria allowed us to assume that the two Seyfert subtypes are intrinsically similar within the framework of the unification scheme. Results. The new observations at 240/610 MHz, together with archival observations at 1.4 GHz, 5.0 GHz show that types 1s and 2s have statistically similar radio luminosity distributions at 240 MHz, 610 MHz, 1.4 GHz, and 5.0 GHz. The spectral indices at selected frequency intervals (α240 MHz610 MHz, α610 MHz1.4 GHz, and α1.4 GHz5.0 GHz), as well as index measured over 240 MHz to 5.0 GHz (αint) for the two Seyfert subtypes, have similar distributions with median spectral index (α) ~ −0.7 (Sν ∝ να), consistent with the synchrotron emission from optically thin plasma. In our snapshot 240/610 MHz GMRT observations, most of the Seyfert galaxies primarily show an unresolved central radio component, except for a few sources in which faint kpc-scale extended emission is apparent at 610 MHz. Our results on the statistical comparison of the multifrequency radio properties of our sample Seyfert galaxies agree with the predictions of the Seyfert unification scheme.
We present the results of a parsec-scale polarization study of three FRI radio galaxies-3C66B, 3C78, and 3C264-obtained with Very Long Baseline Interferometry at 5, 8, and 15 GHz. Parsec-scale ...polarization has been detected in a large number of beamed radio-loud active galactic nuclei, but in only a handful of the relatively unbeamed radio galaxies. We report here the detection of parsec-scale polarization at one or more frequencies in all three FRI galaxies studied. We detect Faraday rotation measures (RMs) of the order of a few hundred rad m-2 in the nuclear jet regions of 3C78 and 3C264. In 3C66B, polarization was detected at 8 GHz only. A transverse RM gradient is observed across the jet of 3C78. The inner-jet magnetic field, corrected for Faraday rotation, is found to be aligned along the jet in both 3C78 and 3C264, although the field becomes orthogonal further from the core in 3C78. The RM values in 3C78 and 3C264 are similar to those previously observed in nearby radio galaxies. The transverse RM gradient in 3C78, the increase in the degree of polarization at the jet edge, the large rotation in the polarization angles due to Faraday rotation, and the low depolarization between frequencies suggest that a layer surrounding the jet with a sufficient number of thermal electrons and threaded by a toroidal or helical magnetic field is a good candidate for the Faraday rotating medium. This suggestion is tentatively supported by Hubble Space Telescope optical polarimetry but needs to be examined in a greater number of sources.
We investigate the nature of the point-like optical nuclei that have been found in the centres of the host galaxies of a majority of radio galaxies by the Hubble Space Telescope. We examine the ...evidence that these optical nuclei are relativistically beamed, and look for differences in the behaviour of the nuclei found in radio galaxies of the two Fanaroff-Riley types. We also attempt to relate this behaviour to the properties of the optical nuclei in their highly beamed counterparts (the BL Lac objects and radio-loud quasars) as hypothesized by the simple Unified Scheme. Simple model-fitting of the data suggests that the emission may be coming from a non-thermal relativistic jet. It is also suggestive that the contribution from an accretion disk is not significant for the FRI objects and for the narrow-line radio galaxies of FRII type, while it may be significant for the Broad-line objects, and consistent with the idea that the FRII optical nuclei seem to suffer from extinction due to an obscuring torus while the FRI optical nuclei do not. These results are broadly in agreement with the Unified Scheme for radio-loud AGNs.
We present very long baseline interferometry polarization images of an X-ray-selected sample of BL Lacertae objects belonging to the first HEAO-1 and the ROSAT–Green Bank (RGB) surveys. These are ...primarily high-energy-peaked BL Lacs (HBLs) and exhibit core–jet radio morphologies on pc scales. They show moderately polarized jet components, similar to those of low-energy-peaked BL Lacs (LBLs). The fractional polarization in the unresolved cores of the HBLs is, on average, lower than in the LBLs, while the fractional polarizations in the pc-scale jets of HBLs and LBLs are comparable. However, a difference is observed in the orientation of the inferred jet magnetic fields – while LBL jets are well known to preferentially exhibit transverse magnetic fields, the HBL jets tend to display longitudinal magnetic fields. Although a ‘spine-sheath’ jet velocity structure, along with larger viewing angles for HBLs could produce the observed magnetic field configuration, differences in other properties of LBLs and HBLs, such as their total radio power, cannot be fully reconciled with the different-angle scenario alone. Instead it appears that LBLs and HBLs differ intrinsically, perhaps in the spin rates of their central black holes.
Mental health problems will contribute significantly to the global burden of disease in the 21st century, and for adolescents, mental health hurdles are already as common as some physical health ...problems such as asthma. Mental health service delivery demands effective partnerships between agencies, joint protocols to be agreed at senior officer level between the local, state and national bodies, social service organizations and educational institutions. Equal opportunities for development to all children during the period of growth should be our aim, for this would serve our larger purpose of reducing inequality and ensuring social justice.\n We must assist the implementation of innovative and effective mental health initiatives in this relatively new field in mental health services for children and adolescents across India.
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