To determine the incidence, risk factors, and consequences of AKI in patients undergoing surgery for esophageal cancer.
Esophageal cancer surgery is an exemplar of major operative trauma, with ...well-defined risks of respiratory, cardiac, anastomotic, and septic complications. However, there is a paucity of literature regarding AKI.
consecutive patients undergoing curative-intent surgery for esophageal cancer from 2011 to 2017 in 3 high-volume centers were studied. AKI was defined according to the AKI Network criteria. AKI occurred if, within 48 hours postoperatively, serum creatinine rose by 50% or by 0.3 mg/dL (26.5 μmol/L) from preoperative baseline. Complications were recorded prospectively. Multivariable logistic regression determined factors independently predictive of AKI.
A total of 1135 patients (24.7%:75.3% female:male, with a mean age of 64, a baseline BMI of 27 kg m-2, and dyslipidemia in 10.2%), underwent esophageal cancer surgery, 85% having an open thoracotomy. Overall in-hospital mortality was 2.1%. Postoperative AKI was observed in 208 (18.3%) patients, with AKI Network 1, 2, and 3 in 173 (15.2%), 28 (2.5%), and 7 (0.6%), respectively. Of these, 70.3% experienced improved renal function within 48 hours. Preoperative factors independently predictive of AKI were age P = 0.027, odds ratio (OR) 1.02 (1.00-1.04), male sex P = 0.015, OR 1.77 (1.10-2.81), BMI at diagnosis P < 0.001, OR 1.10 (1.07-1.14), and dyslipidemia P = 0.002, OR 2.14 (1.34-3.44). Postoperatively, AKI was associated with atrial fibrillation (P = 0.013) and pneumonia (P = 0.005). Postoperative AKI did not impact survival outcomes.
AKI is common but mostly self-limiting after esophageal cancer surgery. It is associated with age, male sex, increased BMI, dyslipidemia, and postoperative morbidity.
Wider use of timber has the potential to greatly reduce the embodied carbon of construction. Improved chemical treatment could help overcome some of the barriers to wider application of timber, by ...furthering the durability and/or mechanical properties of this natural material. Improving timber treatment by treating the whole volume of a piece of timber, or tailored sections thereof, requires sound understanding and validated modelling of the natural paths for fluid flow through wood. In this study we carry out a robust analysis of three-dimensional X-ray CT measurements on kiln-dried softwood in the presence of flow and identify small portions of early-wood which are uniquely capable of transporting fluids—herein ‘efficient transport pathways’. We successfully model the effects of these pathways on the liquid uptake by timber by introducing a spatial variability in the amount of aspiration of the bordered pits following kiln drying. The model demonstrates that fluid advances along these efficient transport paths between 10 and 30 times faster than in the remainder of the timber. Identifying these efficient transport pathways offers scope to improve and extend the degree to which timber properties are enhanced at an industrial scale through processes to impregnate timber.
We report results from an intensive multiwavelength monitoring campaign on the TeV blazar Mrk 421 over the period of 2003-2004. The source was observed simultaneously at TeV energies with the Whipple ...10 m telescope and at X-ray energies with the Rossi X-Ray Timing Explorer (RXTE) during each clear night within the Whipple observing windows. Supporting observations were also frequently carried out at optical and radio wavelengths to provide simultaneous or contemporaneous coverages. The large amount of simultaneous data has allowed us to examine the variability of Mrk 421 in detail, including cross-band correlation and broadband spectral variability, over a wide range of flux. The variabilities are generally correlated between the X-ray and gamma-ray bands, although the correlation appears to be fairly loose. The light curves show the presence of flares with varying amplitudes on a wide range of timescales at both X-ray and TeV energies. Of particular interest is the presence of TeV flares that have no coincident counterparts at longer wavelengths, because the phenomenon seems difficult to understand in the context of the proposed emission models for TeV blazars. We have also found that the TeV flux reached its peak days before the X-ray flux did during a giant flare (or outburst) in 2004 (with the peak flux reaching 6135 mcrab in X-rays, as seen by the RXTE ASM, and 63 crab in gamma rays). Such a difference in the development of the flare presents a further challenge to both the leptonic and hadronic emission models. Mrk 421 varied much less at optical and radio wavelengths. Surprisingly, the normalized variability amplitude in the optical seems to be comparable to that in the radio, perhaps suggesting the presence of different populations of emitting electrons in the jet. The spectral energy distribution of Mrk 421 is seen to vary with flux, with the two characteristic peaks moving toward higher energies at higher fluxes. We have failed to fit the measured spectral energy distributions (SEDs) with a one-zone synchrotron self-Compton model; introducing additional zones greatly improves the fits. We have derived constraints on the physical properties of the X-ray/gamma-ray flaring regions from the observed variability (and SED) of the source. The implications of the results are discussed.
Abstract
We report on the search for very-high-energy gamma-ray emission from the regions around three nearby supersonic pulsars (PSR B0355+54, PSR J0357+3205, and PSR J1740+1000) that exhibit long ...X-ray tails. To date there is no clear detection of TeV emission from any pulsar tail that is prominent in X-ray or radio. We provide upper limits on the TeV flux, and luminosity, and also compare these limits with other pulsar wind nebulae detected in X-rays and the tail emission model predictions. We find that at least one of the three tails is likely to be detected in observations that are a factor of 2–3 more sensitive. The analysis presented here also has implications for deriving the properties of pulsar tails, for those pulsars whose tails could be detected in TeV.
Abstract
We report the detection of very high energy gamma-ray emission from the blazar S3 1227+25 (VER J1230+253) with the Very Energetic Radiation Imaging Telescope Array System (VERITAS). VERITAS ...observations of the source were triggered by the detection of a hard-spectrum GeV flare on 2015 May 15 with the Fermi-Large Area Telescope (LAT). A combined 5 hr VERITAS exposure on May 16 and 18 resulted in a strong 13
σ
detection with a differential photon spectral index, Γ = 3.8 ± 0.4, and a flux level at 9% of the Crab Nebula above 120 GeV. This also triggered target-of-opportunity observations with Swift, optical photometry, polarimetry, and radio measurements, also presented in this work, in addition to the VERITAS and Fermi-LAT data. A temporal analysis of the gamma-ray flux during this period finds evidence of a shortest variability timescale of
τ
obs
= 6.2 ± 0.9 hr, indicating emission from compact regions within the jet, and the combined gamma-ray spectrum shows no strong evidence of a spectral cutoff. An investigation into correlations between the multiwavelength observations found evidence of optical and gamma-ray correlations, suggesting a single-zone model of emission. Finally, the multiwavelength spectral energy distribution is well described by a simple one-zone leptonic synchrotron self-Compton radiation model.
Abstract
The Breakthrough Listen Initiative is conducting a program using multiple telescopes around the world to search for “technosignatures”: artificial transmitters of extraterrestrial origin ...from beyond our solar system. The Very Energetic Radiation Imaging Telescope Array System (VERITAS) Collaboration joined this program in 2018 and provides the capability to search for one particular technosignature: optical pulses of a few nanoseconds in duration detectable over interstellar distances. We report here on the analysis and results of dedicated VERITAS observations of Breakthrough Listen targets conducted in 2019 and 2020 and of archival VERITAS data collected since 2012. Thirty hours of dedicated observations of 136 targets and 249 archival observations of 140 targets were analyzed and did not reveal any signals consistent with a technosignature. The results are used to place limits on the fraction of stars hosting transmitting civilizations. We also discuss the minimum pulse sensitivity of our observations and present VERITAS observations of CALIOP: a space-based pulsed laser on board the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observations. The detection of these pulses with VERITAS, using the analysis techniques developed for our technosignature search, allows a test of our analysis efficiency and serves as an important proof of principle.
TeV J2032+4130 was the first unidentified source discovered at very high energies (VHEs; E > 100 GeV), with no obvious counterpart in any other wavelength. It is also the first extended source to be ...observed in VHE gamma rays. Following its discovery, intensive observational campaigns have been carried out in all wavelengths in order to understand the nature of the object, which have met with limited success. We report here on a deep observation of TeV J2032+4130 based on 48.2 hr of data taken from 2009 to 2012 by the Very Energetic Radiation Imaging Telescope Array System experiment. The source is detected at 8.7 standard deviations (sigma) and is found to be extended and asymmetric with a width of 9'.5 + or - 1'.2 along the major axis and 4'.0 + or - 0'.5 along the minor axis. The spectrum is well described by a differential power law with an index of 2.10 + or - 0.14 sub(stat) + or - 0.21 sub(sys) and a normalization of (9.5 + or - 1.6 sub(stat) + or - 2.2 sub(sys)) x 10 super(-13) TeV super(-1) cm super(-2) s super(-1) at 1 TeV. We interpret these results in the context of multiwavelength scenarios which particularly favor the pulsar wind nebula interpretation.
Introduction: COPD is an inflammatory airway pathology associated with recurrent infection by nontypeable Haemophilus influenzae (NTHi) that is not effectively managed by macrolide antibiotic ...therapy. We hypothesised that NTHi is able to reside intracellularly within COPD-derived airway epithelial cells (AEC), and that the factors contained in cigarette smoke when coupled with exposure to erythromycin or azithromycin arrest autophagy, the principle mechanism responsible for clearing intracellular bacteria (called "xenophagy"). Methods: Cultures of bronchial airway epithelial cells derived from control and COPD participants were differentiated at an air-liquid interface and exposed to macrolide antibiotics, 10% cigarette smoke-extract (CSE) and NTHi. Markers of autophagic flux and intracellular NTHi were assessed using Western blot analysis and transmission electron microscopy. Results: AEC treated with macrolide antibiotics or 10% CSE exhibited a block in autophagic flux as evidenced by a concomitant increase in LC3-II and Sequestosome abundance (vs control; both P < 0.01). While control AEC showed no clear evidence of intracellular NTHi, COPD-derived cultures exhibited abundant NTHi within the cytoplasm. Further, intracellular NTHi that were encapsulated within vesicles propagated from the apical epithelial layer to the basal cell layer. Discussion: Taken together, our findings indicate that COPD, cigarette smoke and macrolide antibiotics potentiate the susceptibility to persistent intracellular NTHi. A major mechanism for this is arresting normal autophagic flux in airway epithelial cells. Hence, structural modifications that mitigate this off-target effect of macrolides have significant potential to clear intracellular NTHi and thereby reduce the influence of this pathogen in the airways afflicted by COPD. Keywords: antibiotic resistance, azithromycin, intracellular bacteria, macrolide, xenophagy
The radio source 3C 264, hosted by the giant elliptical galaxy NGC 3862, was observed with the Very Energetic Radiation Imaging Telescope Array System (VERITAS) between 2017 February and 2019 May. ...These deep observations resulted in the discovery of very high energy (VHE; E > 100 GeV) γ-ray emission from this active galaxy. An analysis of ∼57 hr of quality-selected live time yields a detection at the position of the source, corresponding to a statistical significance of 7.8 standard deviations above background. The observed VHE flux is variable on monthly timescales, with an elevated flux seen in 2018 observations. The VHE emission during this elevated state is well characterized by a power-law spectrum with a photon index Γ = 2.20 0.27 and flux F(>315 GeV) = ( cm−2 s−1, or approximately 0.7% of the Crab Nebula flux above the same threshold. 3C 264 (z = 0.0217) is the most distant radio galaxy detected at VHE, and the elevated state is thought to be similar to that of the famously outbursting jet in M87. Consequently, extensive contemporaneous multiwavelength data were acquired in 2018 at the time of the VHE high state. An analysis of these data, including Very Long Baseline Array, Very Large Array, Hubble Space Telescope, Chandra, and Swift observations in addition to the VERITAS data, is presented, along with a discussion of the resulting spectral energy distribution.
ABSTRACT The Galactic Center ridge has been observed extensively in the past by both GeV and TeV gamma-ray instruments revealing a wealth of structure, including a diffuse component and the point ...sources G0.9+0.1 (a composite supernova remnant) and Sgr A* (believed to be associated with the supermassive black hole located at the center of our Galaxy). Previous very high energy (VHE) gamma-ray observations with the H.E.S.S. experiment have also detected an extended TeV gamma-ray component along the Galactic plane in the >300 GeV gamma-ray regime. Here we report on observations of the Galactic Center ridge from 2010 to 2014 by the VERITAS telescope array in the >2 TeV energy range. From these observations we (1) provide improved measurements of the differential energy spectrum for Sgr A* in the >2 TeV gamma-ray regime, (2) provide a detection in the >2 TeV gamma-ray emission from the composite SNR G0.9+0.1 and an improved determination of its multi-TeV gamma-ray energy spectrum, and (3) report on the detection of VER J1746-289, a localized enhancement of >2 TeV gamma-ray emission along the Galactic plane.
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