Systemic thrombolysis for acute pulmonary embolism (PE) carries up to a 20% risk of major bleeding, including a 2% to 5% risk of hemorrhagic stroke. We evaluated the safety and effectiveness of ...catheter-directed therapy (CDT) as an alternative treatment of acute PE.
One hundred one consecutive patients receiving CDT for acute PE were prospectively enrolled in a multicenter registry. Massive PE (n = 28) and submassive PE (n = 73) were treated with immediate catheter-directed mechanical or pharmacomechanical thrombectomy and/or catheter-directed thrombolysis through low-dose hourly drug infusion with tissue plasminogen activator (tPA) or urokinase. Clinical success was defined as meeting all the following criteria: stabilization of hemodynamics; improvement in pulmonary hypertension, right-sided heart strain, or both; and survival to hospital discharge. Primary safety outcomes were major procedure-related complications and major bleeding events.
Fifty-three men and 48 women (average age, 60 years range, 22-86 years; mean BMI, 31.03 ± 7.20 kg/m2) were included in the study. The average thrombolytic doses were 28.0 ± 11 mg tPA (n = 76) and 2,697,101 ± 936,287 International Units for urokinase (n = 23). Clinical success was achieved in 24 of 28 patients with massive PE (85.7%; 95% CI, 67.3%-96.0%) and 71 of 73 patients with submassive PE (97.3%; 95% CI, 90.5%-99.7%). The mean pulmonary artery pressure improved from 51.17 ± 14.06 to 37.23 ± 15.81 mm Hg (n = 92) (P < .0001). Among patients monitored with follow-up echocardiography, 57 of 64 (89.1%; 95% CI, 78.8%-95.5%; P < .0001) showed improvement in right-sided heart strain. There were no major procedure-related complications, major hemorrhages, or hemorrhagic strokes.
CDT improves clinical outcomes in patients with acute PE while minimizing the risk of major bleeding. At experienced centers, CDT is a safe and effective treatment of both acute massive and submassive PE.
ClinicalTrials.gov; No.: NCT01097928; URL: www.clinicaltrials.gov.
(Abridged.) We present F435W (B), F606W (Broad V), and F814W (Broad I)
coronagraphic images of the debris disk around Beta Pictoris obtained with
HST's Advanced Camera for Surveys. We confirm that ...the previously reported warp
in the inner disk is a distinct secondary disk inclined by ~5 deg from the main
disk. The main disk's northeast extension is linear from 80 to 250 AU, but the
southwest extension is distinctly bowed with an amplitude of ~1 AU over the
same region. Both extensions of the secondary disk appear linear, but not
collinear, from 80 to 150 AU. Within ~120 AU of the star, the main disk is ~50%
thinner than previously reported. The surface-brightness profiles along the
spine of the main disk are fitted with four distinct radial power laws between
40 and 250 AU, while those of the secondary disk between 80 and 150 AU are
fitted with single power laws. These discrepancies suggest that the two disks
have different grain compositions or size distributions. The F606W/F435W and
F814W/F435W flux ratios of the composite disk are nonuniform and asymmetric
about both projected axes of the disk. Within ~120 AU, the m_F435W-m_F606W and
m_F435W-m_F814W colors along the spine of the main disk are ~10% and ~20%
redder, respectively, than those of Beta Pic. These colors increasingly redden
beyond ~120 AU, becoming 25% and 40% redder, respectively, than the star at 250
AU. We compare the observed red colors within ~120 AU with the simulated colors
of non-icy grains having a radial number density ~r^-3 and different
compositions, porosities, and minimum grain sizes. The observed colors are
consistent with those of compact or moderately porous grains of astronomical
silicate and/or graphite with sizes >0.15-0.20 um, but the colors are
inconsistent with the blue colors expected from grains with porosities >90%.
Astrophys.J.640:574-578,2006 A five square arcminute region around the luminous radio-loud quasar SDSS
J0836+0054 (z=5.8) hosts a wealth of associated galaxies, characterized by very
red (1.3 < i_775 ...- z_{850} < 2.0) color. The surface density of these z~5.8
candidates is approximately six times higher than the number expected from deep
ACS fields. This is one of the highest galaxy overdensities at high redshifts,
which may develop into a group or cluster. We also find evidence for a
substructure associated with one of the candidates. It has two very faint
companion objects within two arcseconds, which are likely to merge. The finding
supports the results of a recent simulation that luminous quasars at high
redshifts lie on the most prominent dark-matter filaments and are surrounded by
many fainter galaxies. The quasar activity from these regions may signal the
buildup of a massive system.
The combination of obesity and hypertension is associated with high morbidity and mortality because it leads to cardiovascular and kidney disease. Potential mechanisms linking obesity to hypertension ...include dietary factors, metabolic, endothelial and vascular dysfunction, neuroendocrine imbalances, sodium retention, glomerular hyperfiltration, proteinuria, and maladaptive immune and inflammatory responses. Visceral adipose tissue also becomes resistant to insulin and leptin and is the site of altered secretion of molecules and hormones such as adiponectin, leptin, resistin, TNF and IL-6, which exacerbate obesity-associated cardiovascular disease. Accumulating evidence also suggests that the gut microbiome is important for modulating these mechanisms. Uric acid and altered incretin or dipeptidyl peptidase 4 activity further contribute to the development of hypertension in obesity. The pathophysiology of obesity-related hypertension is especially relevant to premenopausal women with obesity and type 2 diabetes mellitus who are at high risk of developing arterial stiffness and endothelial dysfunction. In this Review we discuss the relationship between obesity and hypertension with special emphasis on potential mechanisms and therapeutic targeting that might be used in a clinical setting.
Astrophys.J. 630 (2005) 68-81 We present deep optical imaging of the z=4.1 radio galaxy TN J1338--1942
obtained using the ACS on-board HST. The radio galaxy is known to reside within
a large galaxy ...overdensity (both in physical extent and density contrast).
There is good evidence that this `protocluster' region is the progenitor of a
present-day rich galaxy cluster. TN J1338 is the dominant galaxy in the
protocluster, in terms of size and luminosity and therefore seems destined to
evolve into the brightest cluster galaxy. The high spatial-resolution ACS
images reveal several kpc-scale features within and around the radio galaxy.
The continuum light is aligned with the radio axis and is resolved into two
clumps in the i-band and z-band bands. These components have luminosities ~10^9
L_sun and sizes of a few kpc. The estimated star-formation rate for the whole
radio galaxy is ~200 M_sun/yr. A simple model in which the jet has triggered
star-formation in these continuum knots is consistent with the available data.
An unusual feature is seen in Lyman-alpha emission. A wedge-shaped extension
emanates from the radio galaxy perpendicularly to the radio axis. This `wedge'
naturally connects to the surrounding, asymmetric, large-scale (~100 kpc)
Lyman-alpha halo. We posit that the wedge is a starburst-driven superwind,
associated with the first major epoch of formation of the brightest cluster
galaxy. The shock and wedge are examples of feedback processes due to both AGN
and star-formation in the earliest stages of massive galaxy formation.
We present deep Chandra and XMM obervations of the galaxy cluster
RDCS1252.9-2927, which was selected from the ROSAT Deep Cluster Survey (RDCS)
and confirmed by extensive spectroscopy with the VLT at ...redshift z=1.237. With
the Chandra data, the X-ray emission from the intra-cluster medium is well
resolved and traced out to 500 kpc, thus allowing a measurement of the physical
properties of the gas with unprecedented accuracy at this redshift. We detect a
clear 6.7 keV Iron K line in the Chandra spectrum providing a redshift within
1% of the spectroscopic one. By augmenting our spectroscopic analysis with the
XMM data (MOS detectors only), we significantly narrow down the 1 sigma error
bar to 10% for the temperature and 30% for the metallicity, with best fit
values kT = 6.0(+0.7,-0.5) keV, Z = 0.36(+0.12,-0.10) Z_sun. In the likely
hypothesis of hydrostatic equilibrium, we measure a total mass of M_{500} =
(1.9+-0.3)10^14 h_70^{-1}M_sun within R_{Delta=500} = 536 kpc. Overall, these
observations imply that RDCS1252.9-2927 is the most X-ray luminous and likely
the most massive bona-fide cluster discovered to date at z>1. When combined
with current samples of distant clusters, these data lend further support to a
mild evolution of the cluster scaling relations, as well the metallicity of the
intra-cluster gas. Inspection of the cluster mass function in the current
cosmological concordance model (h,Omega_m,Omega_Lambda)=(0.7,0.3,0.7) and
sigma_8=0.7-0.8 shows that RDCS1252.9-2927 is an M* cluster at z=1.24, in
keeping with number density expectations in the RDCS survey volume.
Astrophys.J. 621 (2005) 651-662 We combine imaging data from the Advanced Camera for Surveys (ACS) with
VLT/FORS optical spectroscopy to study the properties of star-forming galaxies
in the z=0.837 ...cluster CL0152-1357. We have morphological information for 24
star-forming cluster galaxies, which range in morphology from late-type and
irregular to compact early-type galaxies. We find that while most star-forming
galaxies have $r_{625}-i_{775}$ colors bluer than 1.0, eight are in the red
cluster sequence. Among the star-forming cluster population we find five
compact early-type galaxies which have properties consistent with their
identification as progenitors of dwarf elliptical galaxies. The spatial
distribution of the star-forming cluster members is nonuniform. We find none
within $R\sim 500$ Mpc of the cluster center, which is highly suggestive of an
intracluster medium interaction. We derive star formation rates from OII
$\lambda\lambda 3727$ line fluxes, and use these to compare the global star
formation rate of CL0152-1357 to other clusters at low and intermediate
redshifts. We find a tentative correlation between integrated star formation
rates and $T_{X}$, in the sense that hotter clusters have lower integrated star
formation rates. Additional data from clusters with low X-ray temperatures is
needed to confirm this trend. We do not find a significant correlation with
redshift, suggesting that evolution is either weak or absent between z=0.2-0.8.
We examine the distribution of stellar masses of galaxies in MS 1054-03 and RX J0152.7-1357, two X-ray selected clusters of galaxies at z=0.83. Our stellar mass estimates, from spectral energy ...distribution fitting, reproduce the dynamical masses as measured from velocity dispersions and half-light radii with a scatter of 0.2 dex in the mass for early-type galaxies. When we restrict our sample of members to high stellar masses, > 1e11.1 Msun (M* in the Schechter mass function for cluster galaxies), we find that the fraction of early-type galaxies is 79 +/- 6% at z=0.83 and 87 +/- 6% at z=0.023 for the Coma cluster, consistent with no evolution. Previous work with luminosity-selected samples finds that the early-type fraction in rich clusters declines from =~80% at z=0 to =~60% at z=0.8. The observed evolution in the early-type fraction from luminosity-selected samples must predominately occur among sub-M* galaxies. As M* for field and group galaxies, especially late-types, is below M* for clusters galaxies, infall could explain most of the recent early-type fraction growth. Future surveys could determine the morphological distributions of lower mass systems which will confirm or refute this explanation.
We present imaging and spectroscopic observations with HST (WFPC2, ACS/HRC and STIS), VLT (FORS2) and Keck (HIRES) of the dM8 ultra-cool dwarf DENIS-P J185950.9-370632, located in the R-CrA region. ...The presence of lithium absorption at 670.8 nm and the strong Halpha emission indicate a young age and a sub-stellar mass. Our diffraction-limited images resolve a companion at the separation limit of HST/ACS (~0.06"). The 2.1 mJy flux in the LW2 filter (5.0-8.5 microns) of the Infrared Space Observatory (see 1999A&A...350..883) likely corresponds to an infrared excess, suggesting the presence of circumstellar material. Proper motion and photometric measurements, as well as the Halpha activity, confirm membership in the R-CrA star forming region. If confirmed by further observations, DENIS-P J185950.9-370632 would be the first accreting sub-stellar multiple system observed to date.
PDF
