We present new photometric and spectroscopic observations for 2M 1533+3759 (= NSVS 07826147), the seventh eclipsing subdwarf B star + M dwarf (sdB+dM) binary ever found. It has an orbital period of ...0.16177042 days, or ~3.88 hr, significantly longer than the 2.3-3.0 hr periods of the other known eclipsing sdB+dM systems. Spectroscopic analysis of the hot primary yields T eff = 29230 +/- 125 K, log g = 5.58 +/- 0.03, and log N(He)/N(H) = -2.37 +/- 0.05. The sdB velocity amplitude is K 1 = 71.1 +/- 1.0 km s-1. The only detectable light contribution from the secondary is due to the surprisingly strong reflection effect, whose peak-to-peak BVRI amplitudes are 0.1,0.1,0.15, and 0.19 mag, respectively. Light-curve modeling produced several solutions corresponding to different values of the system mass ratio, q (M 2/M 1), but only one is consistent with a core helium burning star, q = 0.301. The orbital inclination is 866. The sdB primary mass is M 1 = 0.376 +/- 0.055 M and its radius is R 1 = 0.166 +/- 0.007 R. 2M 1533+3759 joins PG 0911+456 (and possibly also HS 2333+3927) in having an unusually low mass for an sdB star. SdB stars with masses significantly lower than the canonical value of 0.48 M, down to as low as 0.30 M, were theoretically predicted by Han et al., but observational evidence has only recently begun to confirm the existence of such stars. The existence of core helium burning stars with masses lower than 0.40-0.43 M implies that at least some sdB progenitors have initial main-sequence masses of 1.8-2.0 M or more, i.e., they are at least main-sequence A stars. The orbital separation in 2M 1533+3759 is a = 0.98 +/- 0.04R. The secondary has M 2 = 0.113 +/- 0.017 M, R 2 = 0.152 +/- 0.005R, and K, consistent with a main-sequence M5 star. If 2M 1533+3759 becomes a cataclysmic variable (CV), its orbital period will be 1.6 hr, below the CV period gap.
Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease and death, yet little data exist regarding the comparative efficacy of coronary revascularization procedures ...in CKD patients with multivessel disease. We created a cohort of 4,687 adults who underwent cardiac catheterization, had a serum creatinine value measured within 30 days, and had more than one vessel with ≥50% stenosis. We used Cox proportional hazard regression modeling weighted by the inverse probability of treatment to examine the association between 4 treatment strategies (medical management, percutaneous coronary intervention PCI with bare metal stent, PCI with drug-eluting stent, and coronary artery bypass grafting CABG) and mortality among patients across categories of estimated glomerular filtration rate; secondary outcome was a composite of mortality, myocardial infarction, or revascularization. Compared with medical management, CABG was associated with a reduced risk of death for patients of any nondialysis CKD severity (hazard ratio HR range 0.43 to 0.59). There were no significant mortality differences between CABG and PCI, except a decreased death risk in CABG-treated CKD patients (HR range 0.54 to 0.55). Compared with medical management and PCI, CABG was associated with a lower risk of death, myocardial infarction, or revascularization in nondialysis CKD patients (HR range 0.41 to 0.64). There were similar associations between decreased estimated glomerular filtration rate and increased mortality across all multivessel coronary artery disease patient treatment groups. When accounting for treatment propensity, surgical revascularization was associated with improved outcomes in patients of all CKD severities. A prospective randomized trial in CKD patients is required to confirm our findings.
Objectives To examine health-related quality of life (HRQoL) among sibling pediatric hematopoietic stem cell donors from predonation through 1 year postdonation, to compare donor-reported HRQoL ...scores with proxy-reports by parents/guardians and those of healthy norms, and to identify predonation factors (including donor age) potentially associated with postdonation HRQoL, to better understand the physical and psychosocial effects of pediatric hematopoietic stem cell donation. Study design A random sample of 105 pediatric donors from US centers and a parent/guardian were interviewed by telephone predonation and 4 weeks and 1 year postdonation. The interview included sociodemographic, psychosocial, and HRQoL items. A sample of healthy controls matched to donors by age, gender, and race/ethnicity was generated. Results Key findings included (1) approximately 20% of donors at each time point had very poor HRQoL; (2) child self-reported HRQoL was significantly lower than parent proxy-reported HRQoL at all 3 time points and significantly lower than that of norms at predonation and 4 weeks postdonation; and (3) younger children were at particular risk of poor HRQoL. Conclusions Additional research to identify the specific sources of poorer HRQoL among at-risk donors (eg, the donation experience vs having a chronically ill sibling) and the reasons that parents may be overestimating HRQoL in their donor children is critical and should lead to interventions and policy changes that ensure positive experiences for these minor donors.
Objective We sought to estimate whether moderate/severe stress urinary incontinence (SUI) in middle-aged women is associated with overall lifetime physical activity (including leisure, household, ...outdoor, and occupational), as well as lifetime leisure (recreational), lifetime strenuous, and strenuous activity during the teen years. Study Design Recruitment for this case-control study was conducted in primary-care-level family medicine and gynecology clinics. A total of 1538 enrolled women ages 39-65 years underwent a Pelvic Organ Prolapse Quantification examination to assess vaginal support. Based on Incontinence Severity Index scores, cases had moderate/severe and controls had no/mild SUI. We excluded 349 with vaginal descent at/below the hymen (pelvic organ prolapse), 194 who did not return questionnaires, and 110 with insufficient activity data for analysis. In all, 213 cases were frequency matched 1:1 by age group to controls. Physical activity was measured using the Lifetime Physical Activity Questionnaire, in which women recall activity from menarche to present. We created separate multivariable logistic regression models for activity measures. Results SUI odds increased slightly with overall lifetime activity (odds ratio OR, 1.20 per 70 additional metabolic equivalent of task-h/wk; 95% confidence interval CI, 1.02–1.41), and were not associated with lifetime strenuous activity (OR, 1.11; 95% CI, 0.99–1.25). In quintile analysis of lifetime leisure activity, which demonstrated a nonlinear pattern, all quintiles incurred about half the odds of SUI compared to reference (second quintile; P = .009). Greater strenuous activity in teen years modestly increased SUI odds (OR, 1.37 per 7 additional h/wk; 95% CI, 1.09–1.71); OR, 1.75; 95% CI, 1.15–2.66 in sensitivity analysis adjusting for measurement error. The predicted probability of SUI rose linearly in women exceeding 7.5 hours of strenuous activity/wk during teen years. Teen strenuous activity had a similar effect on SUI odds when adjusted for subsequent strenuous activity during ages 21-65 years. Conclusion In middle-aged women, a slight increased odds of SUI was noted only after substantially increased overall lifetime physical activity. Increased lifetime leisure activity decreased and lifetime strenuous activity appeared unrelated to SUI odds. Greater strenuous activity during teen years modestly increased SUI odds.
Background Necrotizing soft-tissue infections (NSTI) are rare, potentially fatal, operative emergencies. We studied a national cohort of patients to determine recent trends in incidence, treatment, ...and outcomes for NSTI. Methods We queried the Nationwide Inpatient Sample (1998–2010) for patients with a primary diagnosis of NSTI. Temporal trends in patient characteristics, treatment (debridement, amputation, hyperbaric oxygen therapy HBOT), and outcomes were determined with Cochran-Armitage trend tests and linear regression. To account for trends in case mix (age, sex, race, insurance, Elixhauser index) or receipt of HBOT on outcomes, multivariable analyses were conducted to determine the independent effect of year of treatment on mortality, any major complication, and hospital length of stay (LOS) for NSTI. Results We identified 56,527 weighted NSTI admissions, with an incidence ranging from approximately 3,800–5,800 cases annually. The number of cases peaked in 2004 and then decreased between 1998 and 2010 ( P < .0001). The percentage of female patients decreased slightly over time (38.6–34.1%, P < .0001). Patients were increasingly in the 18- to 34–year-old (8.8–14.6%, P < .0001) and 50- to 64-year-old age groups (33.2–43.5, P < .0001), Hispanic (6.8–10.5%, P < .0001), obese (8.9–24.6%, P < .0001), and admitted with >3 comorbidities (14.5–39.7%, P < .0001). The percentage of patients requiring only one operative debridement increased somewhat (43.2–46.2%, P < .0001), whereas the use of HBOT was rare and decreasing (1.6–0.8%, P < .0001). The percentage of patients requiring operative wound closure decreased somewhat (23.5–20.8%, P < .0001). Although major complication rates increased (30.9–48.2%, P < .0001), hospital LOS remained stable (18–19 days) and mortality decreased (9.0–4.9%, P < .0001) on univariate analyses. On multivariable analyses each 1-year incremental increase in year was associated with a 5% increased odds of complication (odds ratio 1.05), 0.4 times decrease in hospital LOS (coefficient −0.41), and 11% decreased odds of mortality (odds ratio 0.89). Conclusion There were potentially important national trends in patient characteristics and treatment patterns for NSTI between 1998 and 2010. Importantly, though patient acuity worsened and complication rates increased, but LOS remained relatively stable and mortality decreased. Improvements in early diagnosis, wound care, and critical care delivery may be the cause.
Background
The association of community factors and outcomes after hematopoietic cell transplantation (HCT) has not been comprehensively described. Using the County Health Rankings and Roadmaps ...(CHRR) and the Center for International Blood and Marrow Transplant Research (CIBMTR), this study evaluated the impact of community health status on allogeneic HCT outcomes.
Methods
This study included 18,544 adult allogeneic HCT recipients reported to the CIBMTR by 170 US centers in 2014‐2016. Sociodemographic, environmental, and community indicators were derived from the CHRR, an aggregate community risk score was created, and scores were assigned to each patient (patient community risk score PCS) and transplant center (center community risk score CCS). Higher scores indicated less healthy communities. The impact of PCS and CCS on patient outcomes after allogeneic HCT was studied.
Results
The median age was 55 years (range, 18‐83 years). The median PCS was –0.21 (range, –1.37 to 2.10; standard deviation SD, 0.42), and the median CCS was –0.13 (range, –1.04 to 0.96; SD, 0.40). In multivariable analyses, a higher PCS was associated with inferior survival (hazard ratio HR per 1 SD increase, 1.04; 99% CI, 1.00‐1.08; P = .0089). Among hematologic malignancies, a tendency toward inferior survival was observed with a higher PCS (HR, 1.04; 99% CI, 1.00‐1.08; P = .0102); a higher PCS was associated with higher nonrelapse mortality (NRM; HR, 1.08; 99% CI, 1.02‐1.15; P = .0004). CCS was not significantly associated with survival, relapse, or NRM.
Conclusions
Patients residing in counties with a worse community health status have inferior survival as a result of an increased risk of NRM after allogeneic HCT. There was no association between the community health status of the transplant center location and allogeneic HCT outcomes.
A new community risk score for hematopoietic cell transplant recipients, derived from a large publicly available database (the County Health Rankings and Roadmaps), has been developed to describe the community health status of patients and transplant centers. A patient community risk score is associated with nonrelapse mortality and overall survival; however, a center community risk score is not associated with transplant outcomes.
The number of allogeneic hematopoietic SCTs performed globally each year continues to increase, paralleled by an increased demand for donors of therapeutic cells. Donor characteristics and collection ...procedures have undergone major changes during recent decades, and further changes are foreseen. Information on short- and long-term donor outcomes is of crucial importance to ensure maximal donor safety and availability. Current data, predominantly from unrelated donors, give reliable information on the frequent early events associated with donation-most of them of mild-to-moderate intensity. Information on the type and relative risk of serious adverse reactions is more limited. Moreover, only few data exist on long-term donor outcome. On the basis of this need, recommendations for a minimum data set for prospective donor follow-up were developed in a workshop with the participation of an international group of investigators actively involved in allogeneic stem cell donation under the auspices of and approved by the Worldwide Network for Blood and Marrow Transplantation. Establishment of a standardized global follow-up for both, related and unrelated, donors will enable monitoring of the short- and long-term safety profiles of hematopoietic cell donation and form a solid basis for future donor selection and counseling.
The World Marrow Donor Association (WMDA) fosters collaboration between international registries to facilitate the exchange of hematopoietic stem cell products for unrelated stem cell donor ...transplantation. As indications for hematopoietic SCT grow, the movement of products across the world will increase. Although competent authorities may regulate products within their country, there is a need to protect the best interests of donors and recipients by identifying universal donor medical suitability criteria. Within this report the WMDA provides a background to unrelated adult donor and recipient safety, recommends a common framework for assessing the health of unrelated adult donors at each stage of the donation pathway and presents a novel mechanism for sharing international consensus criteria for individual medical and lifestyle conditions. Wherever possible, these criteria are evidence-based. By establishing a donor medical suitability working group, the WMDA has developed a process through which donor centers and registries may request a consensus opinion on conditions not already listed, as well as challenge existing criteria. Guidance from the WMDA is intended to complement, not supersede, guidance from national competent authorities and international regulatory bodies.
Activation of unfolded protein responses (UPRs) in cancer cells undergoing endoplasmic reticulum (ER) stress promotes survival. However, how UPR in tumor cells impacts anti-tumor immune responses ...remains poorly described. Here, we investigate the role of the UPR mediator pancreatic ER kinase (PKR)-like ER kinase (PERK) in cancer cells in the modulation of anti-tumor immunity. Deletion of PERK in cancer cells or pharmacological inhibition of PERK in melanoma-bearing mice incites robust activation of anti-tumor T cell immunity and attenuates tumor growth. PERK elimination in ER-stressed malignant cells triggers SEC61β-induced paraptosis, thereby promoting immunogenic cell death (ICD) and systemic anti-tumor responses. ICD induction in PERK-ablated tumors stimulates type I interferon production in dendritic cells (DCs), which primes CCR2-dependent tumor trafficking of common-monocytic precursors and their intra-tumor commitment into monocytic-lineage inflammatory Ly6C+CD103+ DCs. These findings identify how tumor cell-derived PERK promotes immune evasion and highlight the potential of PERK-targeting therapies in cancer immunotherapy.
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•Kinase PERK in melanoma cells restricts protective tumor-specific T cell immunity•PERK targeting drives immunogenic melanoma cell death via SEC61β-linked paraptosis•PERK-null tumors promote the expansion of immune competent monocyte-derived DCs•Stroma-originated type I IFN reprograms myelopoiesis in PERK-null tumors via STAT1
How adaptation to endoplasmic reticulum (ER) stress in cancer cells modulates anti-tumor immunity remains elusive. Mandula et al. demonstrate that elimination of the ER stress-related kinase, PERK, in melanoma cells activates protective T cell responses through paraptosis-mediated immunogenic cell death, which primes expansion of monocytic-lineage inflammatory DCs via type-I IFN-STAT1.
Rising sea levels, subsidence, and decreased fluvial sediment load threaten river deltas and their wetlands. However, the feedbacks between fluvial and non‐fluvial (marsh) deposition remain weakly ...constrained. We investigate how non‐riverine, elevation‐controlled deposition typified by marshes impacts sediment partitioning between a delta's topset, coastal zone, and foreset by comparing a delta experiment with proxy marsh accumulation to a control. Marsh accumulation alters fluvial sediment distribution by decreasing the slope in the marsh window by ∼50%, creating a 78% larger marsh zone. Fluvial incursions into the marsh window trap 1.3 times more clastic volume. The volume exported to deep water remains unchanged. Marsh deposition shifts elevation distributions toward sea level, which produces a hypsometry akin to field‐scale deltas. The elevation‐lowering effect of marshes on an equilibrium delta shown here constitutes an unexplored feedback and an important aspect of coastal sustainability.
Plain Language Summary
Low‐lying coastal zones, often with abundant vegetation (wetlands), are threatened worldwide because of rising sea level and decreased sediment supply. Coastal sediment accumulation is a fundamental process that helps these regions keep pace with rising sea level. This sediment may be delivered directly from rivers, or as mud and plant material in wetlands (e.g., marshes and mangrove forests) and shallow bays. Our study shows that sediment accumulated in the second manner alters the elevation distribution of coastal regions and the spatial deposition of the river sediment. These results provide important information for plans to help sustain and restore coastal land area.
Key Points
Marsh deposition decreases delta slope, creating feedbacks that alter the spatial deposition of clastic material
A small addition of marsh material, almost doubled the area near sea level, which has significant implications for coastal restoration
The interaction of marsh and clastic deposition creates a delta hypsometry more akin to global deltas than experiments without marsh
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