This retrospective study investigated the nature and severity of venom-induced consumption coagulopathy (VICC) and determined the clotting factors involved in VICC in patients after envenomation by ...South Korea's snakes. Additionally, we studied the effectiveness of antivenom for the treatment of VICC after envenomation.
Included patients were divided into three groups according to the severity of VICC (no VICC, partial VICC, and complete VICC). Data, including changes in coagulation parameters during hospitalization and clotting factors at presentation, were collected and analyzed.
One hundred nineteen patients who presented at our emergency department within 3 h after snake envenomation were included. VICC developed in 34 patients (27 patients with partial VICC and 7 patients with complete VICC). Two of 34 patients with VICC required blood transfusions. Five patients with complete VICC had an undetectable fibrinogen concentration at presentation. Three patients with complete VICC had an unmeasurable INR and aPTT within 24 h. The median times of the most extreme values were 10 h for INR, 12 h for aPTT, and 16 h for fibrinogen after presentation in the VICC group. The D-dimer concentration peaked at a median of 63.5 h after presentation. The activities of factors II and X were significantly reduced in the complete VICC group (factor II: 88 (84-99.3)% in the non-VICC group vs. 69 (49.5-83.5)% in the complete VICC group; factor X:94 (83-102) in the non-VICC group vs. 70 (66.5-79.8)% in the complete VICC group), while there was no difference in factor V activity at presentation. The time from bite to first antivenom administration did not correlate with the time course and most extreme concentrations for fibrinogen and D-dimer within the VICC groups.
VICC occurs in approximately one-quarter of snakebite patients in South Korea; however, VICC itself does not appear to lead to clinical deterioration. Fibrinogen is an early diagnostic maker for complete VICC. Clotting factors II and X are involved in VICC. Future investigations should explore the mechanism of VICC from Korean snakebites and the effect of antivenom on VICC.
Historically, variable and transient sources have both surprised astronomers and provided new views of the heavens. Here we report the discovery of an optical transient in the outskirts of the ...lenticular galaxy Messier 85 in the Virgo cluster. With a peak absolute R magnitude of -12, this event is distinctly brighter than novae, but fainter than type Ia supernovae (which are expected in a population of old stars in lenticular galaxies). Archival images of the field do not show a luminous star at that position with an upper limit in the g filter of about -4.1 mag, so it is unlikely to be a giant eruption from a luminous blue variable star. Over a two-month period, the transient source emitted radiation energy of almost 1047 erg and subsequently faded in the optical sky. It is similar to, but six times more luminous at peak than, an enigmatic transient in the galaxy M31 (ref. 1). A possible origin of M85 OT2006-1 is a stellar merger. If so, searches for similar events in nearby galaxies will not only allow study of the physics of hyper-Eddington sources, but also probe an important phase in the evolution of stellar binary systems.
Of the 14 gamma-ray bursts (GRBs) localized to better than 2' radius with the SXC on HETE-2, only two lack optical afterglow detections, and the high recovery rate among this sample has been used to ...argue that the fraction of truly dark bursts is 610%. While a large fraction of earlier dark bursts can be explained by the failure of ground-based searches to reach appropriate limiting magnitudes, suppression of the optical light of these SXC dark bursts seems likely. Here we report the discovery and observation of the radio afterglow of GRB 020819, an SXC dark burst, which enables us to identify the likely host galaxy (probability of 99.2%) and hence the redshift (z = 0.41) of the GRB. The radio light curve is qualitatively similar to that of several other radio afterglows and may include an early-time contribution from the emission of the reverse shock. The proposed host is a bright, R = 19.5 mag barred spiral galaxy, with a faint R - 24.0 mag "blob" of emission, 3" from the galaxy core (16 kpc in projection), that is coincident with the radio afterglow. Optical photometry of the galaxy and blob, beginning 3 hr after the burst and extending over more than 100 days, establishes strong upper limits to the optical brightness of any afterglow or associated supernova. Combining the afterglow radio fluxes and our earliest R-band limit, we find that the most likely afterglow model invokes a spherical expansion into a constant-density (rather than stellar wind-like) external environment. Within the context of this model, a modest local extinction of A sub(V) - 1 mag is sufficient to suppress the optical flux below our limits.
We present optical, near-IR, and radio follow-up of 16 Swift bursts, including our discovery of nine afterglows and a redshift determination for three. These observations, supplemented by data from ...the literature, provide an afterglow recovery rate of 52% in the optical/near-IR, much higher than in previous missions (BeppoSAX, HETE-2, INTEGRAL, and IPN). The optical/near-IR afterglows of Swift events are on average 1.8 mag fainter at t = 12 hr than those of previous missions. The X-ray afterglows are similarly fainter than those of pre-Swift bursts. In the radio the limiting factor is the VLA threshold, and the detection rate for Swift bursts is similar to that for past missions. The redshift distribution of pre-Swift bursts peaked at z 6 1, whereas the six Swift bursts with measured redshifts are distributed evenly between 0.7 and 3.2. From these results we conclude that (1) the pre-Swift distributions were biased in favor of bright events and low-redshift events, (2) the higher sensitivity and accurate positions of Swift result in a better representation of the true burst redshift and brightness distributions (which are higher and dimmer, respectively), and (3) 610% of the bursts are optically dark, as a result of a high redshift and/or dust extinction. We remark that the apparent lack of low-redshift, low-luminosity Swift bursts and the lower event rate than prelaunch estimates (90 vs. 150 per year) are the result of a threshold that is similar to that of BATSE. In view of these inferences, afterglow observers may find it advisable to make significant changes in follow-up strategies of Swift events. The faintness of the afterglows means that large telescopes should be employed as soon as the burst is localized. Sensitive observations in RIz and near-IR bands will be needed to discriminate between a typical z 6 2 burst with modest extinction and a high-redshift event. Radio observations will be profitable for a small fraction (610%) of events. Finally, we suggest that a search for bright host galaxies in untriggered BAT localizations may increase the chance of finding nearby low-luminosity GRBs.
Given a looming shortage of surgeons and currently inadequate pipelines into our specialty for under-represented groups, there is an urgent need to identify and foster interest in young individuals ...who may have great potential as future surgeons. We aimed to explore the utility and feasibility of a novel survey instrument to identify high-school students well suited for careers in surgery based on personality profiling and grit.
An electronic screening tool was developed, combining components of the Myers-Briggs personality profile, the Big-Five Inventory 10, and the grit scale. This brief questionnaire was electronically distributed to surgeons and students across two academic institutions and three high schools (one private and two public). Wilcoxon rank-sum test and Chi-squared/Fisher's exact test were performed to evaluate variations between groups.
Surgeons (n = 96) displayed mean Grit score of 4.03 (range: 3.08-4.92; standard deviation: 0.43), while high-schoolers’ (n = 61) mean score was 3.38 (range: 2.08-4.58; standard deviation: 0.62) (P < 0.0001). Surgeons showed Myers-Brigg Type Indicator trait-dominance toward extroversion, intuition, thinking, and judging, while students displayed greater breadth of traits. Students were much less likely to show dominance in introversion versus extroversion (P < 0.0001) as well as perceiving versus judging (P < 0.0001). Big-Five Inventory 10 traits of neuroticism and conscientiousness were more prevalent among surgeons (P < 0.0001 for both).
Importantly, there exists a subgroup of high-school students with personality and grit similar to those of surgeons. Moreover, we have demonstrated the feasibility of using this novel screening tool for future studies aimed to create pipelines for early exposure opportunities and mentorship.
Stellar occultations-the passing of a relatively nearby body in front of a background star-can be used to probe the atmosphere of the closer body with a spatial resolution of a few kilometres (ref. ...1). Such observations can yield the scale height, temperature profile, and other information about the structure of the occulting atmosphere. Occultation data acquired for Pluto's atmosphere in 1988 revealed a nearly isothermal atmosphere above a radius of ∼1,215 km. Below this level, the data could be interpreted as indicating either an extinction layer or the onset of a large thermal gradient, calling into question the fundamental structure of this atmosphere. Another question is to what extent Pluto's atmosphere might be collapsing as it recedes from the Sun (passing perihelion in 1989 in its 248-year orbital period), owing to the extreme sensitivity of the equilibrium surface pressure to the surface temperature. Here we report observations at a variety of visible and infrared wavelengths of an occultation of a star by Pluto in August 2002. These data reveal evidence for extinction in Pluto's atmosphere and show that it has indeed changed, having expanded rather than collapsed, since 1988.
We report the results of a high spatial resolution search for the progenitor of Type Ic supernova SN 2004gt, using the newly commissioned Keck laser guide star adaptive optics (LGSAO) system along ...with archival Hubble Space Telescope data. This is the deepest search yet performed for the progenitor of any Type Ib/c event in a wide wavelength range stretching from the far-UV to the near-IR. We determine that the progenitor of SN 2004gt was most likely less luminous than M sub(V) = -5.5 mag and M sub(B) = -6.5 mag. The massive stars exploding as hydrogen-deficient core-collapse supernovae should have lost their outer hydrogen envelopes prior to their explosion, either through winds--such stars are identified within our Galaxy as Wolf-Rayet (W-R) stars--or to a binary companion. The luminosity limits we set rule out more than half of the known Galactic W-R stars as possible progenitors of this event. In particular, they imply that a W-R progenitor should have been among the more evolved (highly stripped, less luminous) of these stars, a concrete constraint on its evolutionary state just prior to core collapse. The possibility of a less luminous, lower mass binary progenitor cannot be constrained. This study demonstrates the power of LGS observations in furthering our understanding of core collapse and the physics powering supernovae, gamma-ray bursts, and X-ray flashes.
Summary
Botulinum toxin type A (BTA) (also known as onabotulinum toxin A) injection is widely used in the field of cosmetic dermatology. Although a few adverse events related to intramuscular BTA ...injection have been reported, no life‐threatening adverse reaction has been documented to date. We report a case of anaphylaxis induced by intramuscular BTA injection into the masseter muscles of a 35‐year‐old woman. She had previously received injections of the identical BTA product into the same muscles without incident. However, during the reported procedure, symptoms suggestive of angio‐oedema and anaphylaxis developed about 5 min after BTA injection. Intramuscular epinephrine was used to manage the reaction. Following this, the patient was found to have an elevated total serum IgE level. We could not perform testing with BTA because of the risk of triggering another episode of anaphylaxis; however, intradermal tests using the identical sterile saline and patch test using the topical anaesthetic cream both showed negative results, thus we strongly suspect BTA as being the cause of anaphylaxis in this case.
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