Background and purpose
Patients with neuromuscular conditions are at increased risk of suffering perioperative complications related to anaesthesia. There is currently little specific anaesthetic ...guidance concerning these patients. Here, we present the European Neuromuscular Centre (ENMC) consensus statement on anaesthesia in patients with neuromuscular disorders as formulated during the 259th ENMC Workshop on Anaesthesia in Neuromuscular Disorders.
Methods
International experts in the field of (paediatric) anaesthesia, neurology, and genetics were invited to participate in the ENMC workshop. A literature search was conducted in PubMed and Embase, the main findings of which were disseminated to the participants and presented during the workshop. Depending on specific expertise, participants presented the existing evidence and their expert opinion concerning anaesthetic management in six specific groups of myopathies and neuromuscular junction disorders. The consensus statement was prepared according to the AGREE II (Appraisal of Guidelines for Research & Evaluation) reporting checklist. The level of evidence has been adapted according to the SIGN (Scottish Intercollegiate Guidelines Network) grading system. The final consensus statement was subjected to a modified Delphi process.
Results
A set of general recommendations valid for the anaesthetic management of patients with neuromuscular disorders in general have been formulated. Specific recommendations were formulated for (i) neuromuscular junction disorders, (ii) muscle channelopathies (nondystrophic myotonia and periodic paralysis), (iii) myotonic dystrophy (types 1 and 2), (iv) muscular dystrophies, (v) congenital myopathies and congenital dystrophies, and (vi) mitochondrial and metabolic myopathies.
Conclusions
This ENMC consensus statement summarizes the most important considerations for planning and performing anaesthesia in patients with neuromuscular disorders.
This consensus statement summarizes the most important recommendations concerning anaesthesia in patients with neuromuscular disorders.
A multicenter cross‐sectional study was conducted to determine the current heart transplant (HTx) outcomes in Spain. Clinical and functional status, health‐related quality of life (HRQoL), social ...support, and caregiver burden were analyzed in 303 adult transplant recipients (77.9% males) living with one functioning graft. Mean age at time of HTx (SD) was 56.4 (11.4) years, and the reason for transplantation in all patients was congestive heart failure. All patients had received a first heart transplant 6 (±1), 12 (±2), 36 (±6), 60 (±10), or 120 (±20) months previously. Participants completed the Kansas City Cardiomyopathy Questionnaire (KCCQ), the EQ‐5D, the Duke‐UNC Functional Social Support Questionnaire, and the Zarit Caregiver Burden Scale. Reasonable HRQoL, social support, and caregiver burden levels were found at all time points, although a slight decrease in HRQoL was recorded at 120 months (p ≤ 0.033). Multivariate regression analyses showed that complications, comorbidities, and hospitalizations were associated with HRQoL (EQ‐5D: 48.4% of explained variance, F4,164 = 38.46, p < 0.001; KCCQ overall summary score: 45.0%, F3,198 = 54.073, p < 0.001). Patient functional capabilities and complications affected caregiver burden (p < 0.05). In conclusion, HTx patients reported reasonable levels of HRQoL with low caregiver burden. Clinical variables related to these outcomes included functional status, complications, and number of admissions.
Large area surveys with a high number of galaxies observed have undoubtedly marked a milestone in the understanding of several properties of galaxies, such as star-formation history, morphology, and ...metallicity. However, in many cases, these surveys provide fluxes from fixed small apertures (e.g. fibre), which cover a scant fraction of the galaxy, compelling us to use aperture corrections to study the global properties of galaxies. In this work, we derive the current total star formation rate (SFR) of Sloan Digital Sky Survey (SDSS) star-forming galaxies, using an empirically based aperture correction of the measured Hα flux for the first time, thus minimising the uncertainties associated with reduced apertures. All the Hα fluxes have been extinction-corrected using the Hα/ Hβ ratio free from aperture effects. The total SFR for ~210 000 SDSS star-forming galaxies has been derived applying pure empirical Hα and Hα/ Hβ aperture corrections based on the Calar Alto Legacy Integral Field Area (CALIFA) survey. We find that, on average, the aperture-corrected SFR is ~0.65 dex higher than the SDSS fibre-based SFR. The relation between the SFR and stellar mass for SDSS star-forming galaxies (SFR-M⋆) has been obtained, together with its dependence on extinction and Hα equivalent width. We compare our results with those obtained in previous works and examine the behaviour of the derived SFR in six redshift bins, over the redshift range 0.005 ≤ z ≤ 0.22. The SFR-M⋆ sequence derived here is in agreement with selected observational studies based on integral field spectroscopy of individual galaxies as well as with the predictions of recent theoretical models of disc galaxies.
The star formation rate (SFR) is one of the main parameters used to analyze the evolution of galaxies through time. Integral field spectroscopy (IFS) is clearly the way to overcome this kind of ...limitation. We obtain integrated Halpha, ultraviolet (UV) and infrared (IR)-based SFR measurements for 272 galaxies from the C ALIFA survey at 0.005 < z < 0.03 using single-band and hybrid tracers. We aim to determine whether the extinction-corrected Halpha luminosities provide a good measure of the SFR and to shed light on the origin of the discrepancies between tracers. In the local Universe, the Halpha luminosity derived from IFS observations can be used to measure SFR, at least in statistically-significant, optically-selected galaxy samples, once stellar continuum absorption and dust attenuation effects are accounted for. The analysis of the SFR calibrations by galaxies properties could potentially be used by other works to study the impact of different selection criteria in the SFR values derived, and to disentangle selection effects from other physically motivated differences, such as environmental or evolutionary effects.
Our objective was to assess the therapeutic noninferiority of dual therapy with darunavir/ritonavir and lamivudine compared to triple therapy with darunavir/ritonavir plus 2 nucleos(t)ides for ...maintenance of human immunodeficiency virus type 1 (HIV-1) suppression.
This was a multicenter, open-label, noninferiority trial (margin 12%). Patients with HIV-1 RNA <50 copies/mL for 6 months or longer on triple therapy with darunavir/ritonavir and 2 nucleos(t)ides (tenofovir disoproxil fumarate and emtricitabine or abacavir and lamivudine) and with no resistance were randomized to continue therapy (n = 128) or switch to darunavir/ritonavir and lamivudine (n = 129). The primary endpoint was the proportion of participants with HIV-RNA <50 copies/mL after 48 weeks of follow-up according to the snapshot algorithm.
A total of 249 participants received study drugs (intention-to-treat exposed). The proportion of participants with HIV-RNA <50 copies/mL in the dual- and triple-therapy arms was 88.9% (112/126) and 92.7% (114/123; difference, -3.8%; 95% confidence interval, -11.0 to 3.4), respectively. Four participants in the dual-therapy arm and 2 in the triple-therapy arm developed protocol-defined virological failure. Switching to dual therapy was associated with a significant increase in total, low-density lipoprotein, and high-density lipoprotein (HDL) cholesterol, but not in the total-to-HDL cholesterol ratio. Serious adverse events and study drug discontinuations due to adverse events occurred in 4.8% vs 4.9%P = .97) and in 0.8% (1/126) vs 1.6% P = .55) in dual therapy vs triple therapy, respectively.
Dual therapy with darunavir/ritonavir and lamivudine demonstrated noninferior therapeutic efficacy and similar tolerability compared to triple therapy.
NCT02159599.
We have studied the radial structure of the stellar mass surface density (μ∗) and stellar population age as a function of the total stellar mass and morphology for a sample of 107 galaxies from the ...CALIFA survey. We applied the fossil record method based on spectral synthesis techniques to recover the star formation history (SFH), resolved in space and time, in spheroidal and disk dominated galaxies with masses from 109 to 1012 M⊙. We derived the half-mass radius, and we found that galaxies are on average 15% more compact in mass than in light. The ratio of half-mass radius to half-light radius (HLR) shows a dual dependence with galaxy stellar mass; it decreases with increasing mass for disk galaxies, but is almost constant in spheroidal galaxies. In terms of integrated versus spatially resolved properties, we find that the galaxy-averaged stellar population age, stellar extinction, and μ∗ are well represented by their values at 1 HLR. Negative radial gradients of the stellar population ages are present in most of the galaxies, supporting an inside-out formation. The larger inner (≤1 HLR) age gradients occur in the most massive (1011 M⊙) disk galaxies that have the most prominent bulges; shallower age gradients are obtained in spheroids of similar mass. Disk and spheroidal galaxies show negative μ∗ gradients that steepen with stellar mass. In spheroidal galaxies, μ∗ saturates at a critical value (~7 × 102 M⊙/pc2 at 1 HLR) that is independent of the galaxy mass. Thus, all the massive spheroidal galaxies have similar local μ∗ at the same distance (in HLR units) from the nucleus. The SFH of the regions beyond 1 HLR are well correlated with their local μ∗, and follow the same relation as the galaxy-averaged age and μ∗; this suggests that local stellar mass surface density preserves the SFH of disks. The SFH of bulges are, however, more fundamentally related to the total stellar mass, since the radial structure of the stellar age changes with galaxy mass even though all the spheroid dominated galaxies have similar radial structure in μ∗. Thus, galaxy mass is a more fundamental property in spheroidal systems, while the local stellar mass surface density is more important in disks.
Abstract
Nebular He
ii
emission implies the presence of energetic photons (
E
≥ 54 eV). Despite the great deal of effort dedicated to understanding He
ii
ionization, its origin has remained ...mysterious, particularly in metal-deficient star-forming (SF) galaxies. Unfolding He
ii
-emitting, metal-poor starbursts at
z
∼ 0 can yield insight into the powerful ionization processes occurring in the primordial universe. Here we present a new study on the effects that X-ray sources have on the He
ii
ionization in the extremely metal-poor galaxy IZw18 (
Z
∼ 3%
Z
⊙
), whose X-ray emission is dominated by a single high-mass X-ray binary (HMXB). This study uses optical integral field spectroscopy, archival Hubble Space Telescope observations, and all of the X-ray data sets publicly available for IZw18. We investigate the time-variability of the IZw18 HMXB for the first time; its emission shows small variations on timescales from days to decades. The best-fit models for the HMXB X-ray spectra cannot reproduce the observed He
ii
ionization budget of IZw18, nor can recent photoionization models that combine the spectra of both very low metallicity massive stars and the emission from HMXB. We also find that the IZw18 HMXB and the He
ii
-emission peak are spatially displaced at a projected distance of ≃200 pc. These results reduce the relevance of X-ray photons as the dominant He
ii
ionizing mode in IZw18, which leaves uncertain what process is responsible for the bulk of its He
ii
ionization. This is in line with recent work discarding X-ray binaries as the main source responsible for He
ii
ionization in SF galaxies.
This paper describes the Second Public Data Release (DR2) of the Calar Alto Legacy Integral Field Area (CALIFA) survey. The data for 200 objects are made public, including the 100 galaxies of the ...First Public Data Release (DR1). Data were obtained with the integral-field spectrograph PMAS/PPak mounted on the 3.5 m telescope at the Calar Alto observatory. Two different spectral setups are available for each galaxy, (i) a low-resolution V500 setup covering the wavelength range 3745-7500 Angstrom with a spectral resolution of 6.0 Angstrom (FWHM); and (ii) a medium-resolution V1200 setup covering the wavelength range 3650-4840 Angstrom with a spectral resolution of 2.3 Angstrom (FWHM). The sample covers a redshift range between 0.005 and 0.03, with a wide range of properties in the color-magnitude diagram, stellar mass, ionization conditions, and morphological types. All the cubes in the data release were reduced with the latest pipeline, which includes improvedspectrophotometric calibration, spatial registration, and spatial resolution. The spectrophotometric calibration is better than 6% and the median spatial resolution is 2."4. In total, the second data release contains over 1.5 million spectra.
Blood troponins are used to diagnose perioperative myocardial injury and infarction. During liver transplantation, a passive donor-recipient troponin transfer with the graft may result in an increase ...of troponins in the transplant recipient questioning the diagnosis of myocardial injury. We present a case of liver transplantation with sudden elevation of recipient's serum troponin levels immediately after graft reperfusion and its subsequent normalization in which myocardial damage and other non-ischaemic potential causes were ruled out. Patient consent for publication was obtained prior to submission of the manuscript.
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