We model the ultraviolet spectra of the Seyfert 1 galaxy NGC 5548 obtained with the Hubble Space Telescope during the 6 month reverberation mapping campaign in 2014. Our model of the emission from ...NGC 5548 corrects for overlying absorption and deblends the individual emission lines. Using the modeled spectra, we measure the response to continuum variations for the deblended and absorption-corrected individual broad emission lines, the velocity-dependent profiles of Ly and C iv, and the narrow and broad intrinsic absorption features. We find that the time lags for the corrected emission lines are comparable to those for the original data. The velocity-binned lag profiles of Ly and C iv have a double-peaked structure indicative of a truncated Keplerian disk. The narrow absorption lines show a delayed response to continuum variations corresponding to recombination in gas with a density of ∼105 cm−3. The high-ionization narrow absorption lines decorrelate from continuum variations during the same period as the broad emission lines. Analyzing the response of these absorption lines during this period shows that the ionizing flux is diminished in strength relative to the far-ultraviolet continuum. The broad absorption lines associated with the X-ray obscurer decrease in strength during this same time interval. The appearance of X-ray obscuration in ∼2012 corresponds with an increase in the luminosity of NGC 5548 following an extended low state. We suggest that the obscurer is a disk wind triggered by the brightening of NGC 5548 following the decrease in size of the broad-line region during the preceding low-luminosity state.
Background Q-switched lasers are the gold standard for tattoo treatment. Allergic tattoo reactions present a treatment dilemma. We present the application of ablative fractional resurfacing (AFR) as ...a novel method for tattoo removal. Objective We describe two patients with tattoo allergies, referred to us for treatment. Methods AFR was used in a series of treatments to remove the allergic-ink portion of a multicolored tattoo on the upper extremity of a 52-year-old man. In a 31-year-old woman with a red and black tattoo on her lower extremity, AFR was combined with a Q-switched neodymium:yttrium-aluminum-garnet laser. Results After a series of treatments, both patients experienced significant to complete removal of the offending tattoo inks with substantial or complete resolution of their symptoms. Limitations This uncontrolled observational series is based on two patients. Conclusions AFR appears to be safe and effective for removal of allergic tattoos. AFR can be combined with other treatments such as Q-switched lasers. The potential for a series of AFR treatments to remove tattoos, including allergic tattoos and inks of any color, merits further study.
In our viral detection, we initially used a set of primers in seminested PCR that historically identified previously undetected strains of human RV now classified as RV-Cs.6 Moreover, our molecular ...typing assay was recently modified based on new sequence information to increase sensitivity and specificity of RV detection.7 We hypothesize that the molecular techniques utilized in our study more robustly detect RV, including novel RV-C types. Since RV-Cs are closely associated with lower respiratory infection and wheezing, incomplete RV-C detection could lead to an underestimate of how RV infections in early life are related to subsequent asthma.10 Additionally, the focus on wheezing episodes in COAST versus "troublesome lung symptoms" in COPSAC may also have contributed to the differences in study results.
Idiopathic pulmonary fibrosis is a progressive fibrotic lung disease that distorts pulmonary architecture, leading to hypoxia, respiratory failure, and death. Diagnosis is difficult because other ...interstitial lung diseases have similar radiological and histopathological characteristics. A usual interstitial pneumonia pattern is a hallmark of idiopathic pulmonary fibrosis and is essential for its diagnosis. We aimed to develop a molecular test that distinguishes usual interstitial pneumonia from other interstitial lung diseases in surgical lung biopsy samples. The eventual goal of this research is to develop a method to diagnose idiopathic pulmonary fibrosis without the patient having to undergo surgery.
We collected surgical lung biopsy samples from patients with various interstitial lung diseases at 11 hospitals in North America. Pathology diagnoses were confirmed by an expert panel. We measured RNA expression levels for 33 297 transcripts on microarrays in all samples. A classifier algorithm was trained on one set of samples and tested in a second set. We subjected a subset of samples to next-generation RNA sequencing (RNAseq) generating expression levels on 55 097 transcripts, and assessed a classifier trained on RNAseq data by cross-validation.
We took 125 surgical lung biopsies from 86 patients. 58 samples were identified by the expert panel as usual interstitial pneumonia, 23 as non-specific interstitial pneumonia, 16 as hypersensitivity pneumonitis, four as sarcoidosis, four as respiratory bronchiolitis, two as organising pneumonia, and 18 as subtypes other than usual interstitial pneumonia. The microarray classifier was trained on 77 samples and was assessed in a test set of 48 samples, for which it had a specificity of 92% (95% CI 81-100) and a sensitivity of 82% (64-95). Based on a subset of 36 samples, the RNAseq classifier had a specificity of 95% (84-100) and a sensitivity of 59% (35-82).
Our results show that the development of a genomic signature that predicts usual interstitial pneumonia is feasible. These findings are an important first step towards the development of a molecular test that could be applied to bronchoscopy samples, thus avoiding surgery in the diagnosis of idiopathic pulmonary fibrosis.
Veracyte.
Background Growing concerns regarding radiation exposure in children have led to recommendations to minimize computed tomography imaging for appendicitis. We hypothesized that within a metropolitan ...hospital system (1 children's hospital and 8 non–children's hospitals), use of preoperative computed tomography is much greater in non–children's hospitals. Methods We conducted a retrospective study of patients <18 years of age undergoing appendectomy for acute appendicitis from April 2012 to April 2015. Patient demographics, location, and imaging modality (computed tomography and ultrasonography) were evaluated. Results A total of 1,448 pediatric patients were identified (children's hospital = 215, 15%; non–children's hospitals = 1,233, 85%). Children's hospital patients had fewer computed tomography scans (23% vs 70%, P < .01) and more ultrasonography (75% vs 20%, P < .01). On multivariate regression, increased preoperative computed tomography use was significantly associated with non–children's hospitals (odds ratio 7.6, 95% confidence interval 5.4–10.8). At non–children's hospitals, older age (age >10: odds ratio 2.4, 95% confidence interval 1.8–3.1) and higher patient weight (>45 kg odds ratio 2.0, 95% confidence interval 1.4–2.8) predicted computed tomography use. Children presenting at a children's hospital were much more likely to undergo ultrasonography (odds ratio 11.7, 95% confidence interval 8.3–16.6). Conclusion There are significant differences in imaging modalities for pediatric appendicitis between a children's hospital and non–children's hospitals. Further investigation is needed to identify other factors contributing to imaging preference in the pediatric population in order to establish clinical practice guidelines to decrease or prevent unnecessary radiation exposure in children.
ABSTRACT
We place statistical constraints on Type Ia supernova (SN Ia) progenitors using 227 nebular-phase spectra of 111 SNe Ia. We find no evidence of stripped companion emission in any of the ...nebular-phase spectra. Upper limits are placed on the amount of mass that could go undetected in each spectrum using recent hydrodynamic simulations. With these null detections, we place an observational 3σ upper limit on the fraction of SNe Ia that are produced through the classical H-rich non-degenerate companion scenario of $\lt 5.5 {{\ \rm per\ cent}}$. Additionally, we set a tentative 3σ upper limit otan He star progenitor scenarios of $\lt 6.4 {{\ \rm per\ cent}}$, although further theoretical modelling is required. These limits refer to our most representative sample including normal, 91bg-like, 91T-like, and ‘super-Chandrasekhar’ SNe Ia but excluding SNe Iax and SNe Ia-CSM. As part of our analysis, we also derive a Nebular Phase Phillips Relation, which approximates the brightness of an SN Ia from 150 to 500 d after maximum using the peak magnitude and decline rate parameter Δm15(B).
Objective We sought to determine quality of life impairment in hidradenitis suppurativa. Methods Questionnaires were administered to 61 patients. Results Quality of life impact in hidradenitis was ...much greater than that of several other dermatologic conditions. Limitation This hospital-based population may not be representative. Conclusion Hidradenitis is one of the most distressing conditions observed in dermatology.
Background Previous studies support a strong association between viral respiratory tract infections and asthma exacerbations. The effect of newly discovered viruses on asthma control is less well ...defined. Objective We sought to determine the contribution of respiratory viruses to asthma exacerbations in children with a panel of PCR assays for common and newly discovered respiratory viruses. Methods Respiratory specimens from children aged 2 to 17 years with asthma exacerbations (case patients, n = 65) and with well-controlled asthma (control subjects, n = 77), frequency matched by age and season of enrollment, were tested for rhinoviruses, enteroviruses, respiratory syncytial virus, human metapneumovirus, coronaviruses 229E and OC43, parainfluenza viruses 1 to 3, influenza viruses, adenoviruses, and human bocavirus. Results Infection with respiratory viruses was associated with asthma exacerbations (63.1% in case patients vs 23.4% in control subjects; odds ratio, 5.6; 95% CI, 2.7- 11.6). Rhinovirus was by far the most prevalent virus (60% among case patients vs 18.2% among control subjects) and the only virus significantly associated with exacerbations (odds ratio, 6.8; 95% CI, 3.2-14.5). However, in children without clinically manifested viral respiratory tract illness, the prevalence of rhinovirus infection was similar in case patients (29.2%) versus control subjects (23.4%, P > .05). Other viruses detected included human metapneumovirus (4.6% in patients with acute asthma vs 2.6% in control subjects), enteroviruses (4.6% vs 0%), coronavirus 229E (0% vs 1.3%), and respiratory syncytial virus (1.5% vs 0%). Conclusion Symptomatic rhinovirus infections are an important contributor to asthma exacerbations in children. Clinical implications These results support the need for therapies effective against rhinovirus as a means to decrease asthma exacerbations.
Congenital long QT syndrome (LQTS) is a heritable cardiac disease whereby patients are at an increased risk for LQTS-triggered syncope, seizures, and sudden cardiac arrest. Seizure episodes are ...common in LQTS and most often seen in patients with type 2 LQTS (LQT2).
To determine the prevalence of electroencephalogram (EEG)-identified epileptiform activity among patients with LQTS.
A retrospective electronic medical record review of 610 patients with LQTS (250 41% men), evaluated between 2000 and 2012, was performed to identify (1) all patients with LQTS who presented with seizures/seizure-like episodes, (2) patients with LQTS who underwent a subsequent neurologic evaluation and EEG study, and (3) patients with LQTS and abnormal EEG recordings that showed epileptiform activity during sinus rhythm, confirming a seizure independent from cardiac arrhythmia.
Overall, seizures/seizure-like episodes were recorded in 68 of 610 (11%) patients with LQTS. Ten patients were diagnosed with a seizure disorder by an epileptologist on the basis of the clinical findings and EEG studies, giving a prevalence of 10 of 610 (1.6%; 95% confidence interval 0.8%-3%) among patients with LQTS. A diagnosis of epilepsy was overrepresented in patients with LQT2 (7 of 190 3.7%) in comparison to all other LQT subgroups (3 of 420 0.7%; P = .0126).
While the overall prevalence of epilepsy among patients with LQTS is low, 10 of 68 (15%) of the patients who presented with seizures/seizure-like episodes had EEG-identified epileptiform activity. Confirming earlier observational reports, epilepsy is more common in patients with LQT2, further supporting the shared pathogenetic link hypothesis of this KCNH2-encoded potassium channel that is expressed in both the heart and the brain.
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