A retrospective analysis of the horizontal video head impulse test (vHIT) results and caloric testing results was undertaken on 644 patients who attended a neuro-otology outpatient facility. ...Presenting symptoms included spontaneous vertigo, positional vertigo, imbalance or chronic subjective dizziness. For 570 patients, the results of vHIT and caloric testing were concordant. Both tests were normal in 500 subjects with an average vHIT gain = 0.92 ± 0.09 (L); 0.98 ± 0.10 (R) and canal paresis (CP) = 7.88 ± 6.12; (range 0–28%). 54 had concordant asymmetries, average ipsilesional vHIT gain = 0.56 ± 0.15, average contralesional vHIT gain = 0.88 ± 0.12. CP = 68.02 ± 24.38 (range 31–100%). 16 subjects had bilateral vestibular hypofunction with average vHIT gains of 0.42 ± 0.20 (L); 0.41 ± 0.19 (R), peak slow phase velocity (SPV) on warm caloric testing = 2.68 ± 2.08, range 0–6°/s (L) and 3.75 ± 3.43 range, 0–10°/s (R). 36 patients showed a dissociation of results between the two tests. In these subjects, the vHIT gain was normal (0.93 ± 0.06 left and 0.98 ± 0.07 right) and the caloric test showed a CP > 30% (48 ± 13.8%). Their final diagnoses included clinically definite Meniere’s disease (MD) (
n
= 27), vestibular schwannoma (VS) (
n
= 2) vestibular migraine (VM) (
n
= 1), vestibular neuritis (VN) (
n
= 5) and unknown (
n
= 1). No patient with abnormal HSCC gain on vHIT had a normal caloric result. The caloric test complements the vHIT in the assessment of vestibular disorders and is most useful in suspected endolymphatic hydrops. Asymmetric caloric function in the presence of normal horizontal head impulse tests is most commonly associated with Meniere’s disease and may function as a diagnostic marker.
ABSTRACT
Using images from the
Spitzer
Galactic Legacy Infrared Mid-Plane Survey Extraordinaire (GLIMPSE), we have identified more than 300 extended 4.5 μm sources (Extended Green Objects (EGOs), for ...the common coding of the 4.5 band as green in three-color composite InfraRed Array Camera images). We present a catalog of these EGOs, including integrated flux density measurements at 3.6, 4.5, 5.8, 8.0, and 24 μm from GLIMPSE and the Multiband Imaging Photometer for
Spitzer
Galactic Plane Survey. The average angular separation between a source in our sample and the nearest
IRAS
point source is greater than 1′. The majority of EGOs are associated with infrared dark clouds (IRDCs), and where high-resolution 6.7 GHz CH
3
OH maser surveys overlap the GLIMPSE coverage, EGOs and 6.7 GHz CH
3
OH masers are strongly correlated. Extended 4.5 μm emission is thought to trace shocked molecular gas in protostellar outflows; the association of EGOs with IRDCs and 6.7 GHz CH
3
OH masers suggests that the extended 4.5 μm emission may pinpoint outflows specifically from massive protostars. The mid-IR colors of EGOs lie in regions of color–color space occupied by young protostars still embedded in infalling envelopes.
Background
Nystagmus generated during bithermal caloric test assesses the horizontal vestibulo-ocular-reflex. Any induced symptoms are considered unwanted side effects rather than diagnostic ...information.
Aim
We hypothesized that nystagmus slow-phase-velocity (SPV) and subjective symptoms during caloric testing would be higher in vestibular migraine (VM) patients compared with peripheral disorders such as Meniere’s disease (MD) and non-vestibular dizziness (NVD).
Methods
Consecutive patients (
n
= 1373, 60% female) referred for caloric testing were recruited. During caloric irrigations, patients scored their subjective sensations. We assessed objective-measures, subjective vertigo (SVS), subjective nausea (SNS), and test completion status.
Results
Nystagmus SPV for VM, MD (unaffected side), and NVD were 29 ± 12.8, 30 ± 15.4, and 28 ± 14.2 for warm irrigation and 24 ± 8.9, 22 ± 10.0, and 25 ± 12.8 for cold-irrigation. The mean SVS were 2.5 ± 1.1, 1.5 ± 1.33, and 1.5 ± 1.42 for warm irrigation and 2.2 ± 1.1, 1.1 ± 1.19, and 1.1 ± 1.16 for cold-irrigation. Age was significantly correlated with SVS and SNS, (
p
< 0.001) for both. The SVS and SNS were significantly higher in VM compared with non-VM groups (
p
< 0.001), and there was no difference in nystagmus SPV. VM patients SVS was significantly different to the SVS of migraineurs in the other diagnostic groups (
p
< 0.001). Testing was incomplete for 34.4% of VM and 3.2% of MD patients. To separate VM from MD, we computed a composite value representing the caloric data, with 83% sensitivity and 71% specificity. Application of machine learning to these metrics plus patient demographics yielded better separation (96% sensitivity and 85% specificity).
Conclusion
Perceptual differences between VM and non-VM patients during caloric stimulation indicate that subjective ratings during caloric testing are meaningful measures. Combining objective and subjective measures could provide optimal separation of VM from MD.
Diabet. Med. 30, 46–55 (2013)
Aims Whether long‐term cardiovascular risk is reduced by the Diabetes Prevention Program interventions is unknown. The aim of this study was to determine the long‐term ...differences in cardiovascular disease risk factors and the use of lipid and blood pressure medications by the original Diabetes Prevention Program intervention group.
Methods This long‐term follow‐up (median 10 years, interquartile range 9.0–10.5) of the three‐arm Diabetes Prevention Program randomized controlled clinical trial (metformin, intensive lifestyle and placebo), performed on 2766 (88%) of the Diabetes Prevention Program participants (who originally had impaired glucose tolerance), comprised a mean of 3.2 years of randomized treatment, approximately 1‐year transition (during which all participants were offered intensive lifestyle intervention) and 5 years follow‐up (Diabetes Prevention Program Outcomes Study). During the study, participants were followed in their original groups with their clinical care being provided by practitioners outside the research setting. The study determined lipoprotein profiles and blood pressure and medication use annually.
Results After 10 years’ follow‐up from Diabetes Prevention Program baseline, major reductions were seen for systolic (−2 to −3) and diastolic (−6 to −6.5 mmHg) blood pressure, and for LDL cholesterol (−0.51 to −0.6 mmol/l) and triglycerides (−0.23 to −0.25 mmol/l) in all groups, with no between‐group differences. HDL cholesterol also rose significantly (0.14 to 0.15 mmol/l) in all groups. Lipid (P = 0.01) and blood pressure (P = 0.09) medication use, however, were lower for the lifestyle group during the Diabetes Prevention Program Outcomes Study.
Conclusion Overall, intensive lifestyle intervention achieved, with less medication, a comparable long‐term effect on cardiovascular disease risk factors, to that seen in the metformin and placebo groups.
Thermal inversions have long been predicted to exist in the atmospheres of ultra-hot Jupiters. However, the detection of two species thought to be responsible – titanium oxide and vanadium oxide – ...remains elusive. We present a search for TiO and VO in the atmosphere of the ultra-hot Jupiter WASP-121b (
T
eq
≳ 2400 K), an exoplanet with evidence of VO in its atmosphere at low resolution which also exhibits water emission features in its dayside spectrum characteristic of a temperature inversion. We observed its transmission spectrum with the UV-Visual Echelle Spectrograph at the Very Large Telescope and used the cross-correlation method – a powerful tool for the unambiguous identification of the presence of atomic and molecular species – in an effort to detect whether TiO or VO were responsible for the observed temperature inversion. No evidence for the presence of TiO or VO was found at the terminator of WASP-121b. By injecting signals into our data at varying abundance levels, we set rough detection limits of VO ≲−7.9 and TiO ≲−9.3. However, these detection limits are largely degenerate with scattering properties and the position of the cloud deck. Our results may suggest that neither TiO or VO are the main drivers of the thermal inversion in WASP-121b; however, until a more accurate line list is developed for VO, we cannot conclusively rule out its presence. Future works will consist of a search for other strong optically-absorbing species that may be responsible for the excess absorption in the red-optical.
The Bubbling Galactic Disk Churchwell, E; Povich, M. S; Allen, D ...
Astrophysical journal/The Astrophysical journal,
10/2006, Letnik:
649, Številka:
2
Journal Article
Recenzirano
Odprti dostop
A visual examination of the images from the Galactic Legacy Infrared Mid-Plane Survey Extraordinaire (GLIMPSE) has revealed 322 partial and closed rings that we propose represent partially or fully ...enclosed three-dimensional bubbles. We argue that the bubbles are primarily formed by hot young stars in massive star formation regions. We have found an average of about 1.5 bubbles per square degree. About 25% of the bubbles coincide with known radio H II regions, and about 13% enclose known star clusters. It appears that B4-B9 stars (too cool to produce detectable radio H II regions) probably produce about three-quarters of the bubbles in our sample, and the remainder are produced by young O-B3 stars that produce detectable radio H II regions. Some of the bubbles may be the outer edges of H II regions where PAH spectral features are excited and may not be dynamically formed by stellar winds. Only three of the bubbles are identified as known SNRs. No bubbles coincide with known planetary nebulae or W-R stars in the GLIMPSE survey area. The bubbles are small. The distribution of angular diameters peaks between 1' and 3' with over 98% having angular diameters less than 10' and 88% less than 4'. Almost 90% have shell thicknesses between 0.2 and 0.4 of their outer radii. Bubble shell thickness increases approximately linearly with shell radius. The eccentricities are rather large, peaking between 0.6 and 0.7; about 65% have eccentricities between 0.55 and 0.85.
Summary Background Rovalpituzumab tesirine is a first-in-class antibody-drug conjugate directed against delta-like protein 3 (DLL3), a novel target identified in tumour-initiating cells and expressed ...in more than 80% of patients with small-cell lung cancer. We aimed to assess the safety and activity of rovalpituzumab tesirine in patients who progressed after one or more previous regimen. Methods We conducted a phase 1 open-label study at ten cancer centres in the USA. Eligible patients were aged 18 years or older and had histologically or cytologically confirmed small-cell lung cancer or large-cell neuroendocrine tumours with progressive measurable disease (according to Response Evaluation Criteria in Solid Tumors RECIST, version 1.1) previously treated with one or two chemotherapeutic regimens, including a platinum-based regimen. We assigned patients to dose-escalation or expansion cohorts, ranging from 0·05 mg/kg to 0·8 mg/kg rovalpituzumab tesirine intravenously every 3 weeks or every 6 weeks, followed by investigation of the dose schedules 0·3 mg/kg and 0·4 mg/kg every 6 weeks and 0·2 mg/kg every 3 weeks. Primary objectives were to assess the safety of rovalpituzumab tesirine, including the maximum tolerated dose and dose-limiting toxic effects. The primary activity endpoint was objective response by intention-to-treat analysis. This study is registered with ClinicalTrials.gov , number NCT01901653 . The study is closed to enrolment; this report focuses on the cohort with small-cell lung cancer. Findings Between July 22, 2013, and Aug 10, 2015, 82 patients were enrolled, including 74 patients with small-cell lung cancer and eight with large-cell neuroendocrine carcinoma, all of whom received at least one dose of rovalpituzumab tesirine. Dose-limiting toxic effects of rovalpituzumab tesirine occurred at a dose of 0·8 mg/kg every 3 weeks, including grade 4 thrombocytopenia (in two of two patients at that dose level) and grade 4 liver function test abnormalities (in one patient). The most frequent grade 3 or worse treatment-related adverse events in 74 patients with small-cell lung cancer were thrombocytopenia (eight 11%), pleural effusion (six 8%), and increased lipase (five 7%). Drug-related serious adverse events occurred in 28 (38%) of 74 patients. The maximum tolerated dose of rovalpituzumab tesirine was 0·4 mg/kg every 3 weeks; the recommended phase 2 dose and schedule is 0·3 mg/kg every 6 weeks. At active doses of rovalpituzumab tesirine (0·2 mg/kg or 0·4 mg/kg every 3 weeks or 0·3 mg/kg or 0·4 mg/kg every 6 weeks), 11 (18%) of 60 assessable patients had a confirmed objective response. 11 (18%) of 60 assessable patients had a confirmed objective response, including ten (38%) of 26 patients confirmed to have high DLL3 expression (expression in 50% or more of tumour cells). Interpretation Rovalpituzumab tesirine shows encouraging single-agent antitumour activity with a manageable safety profile. Further development of rovalpituzumab tesirine in DLL3-expressing malignant diseases is warranted. Funding Stemcentrx Inc.
Although evidence‐based approaches have become commonplace for determining the success of conservation measures for the management of threatened taxa, there are no standard metrics for assessing ...progress in research or management. We developed 5 metrics to meet this need for threatened taxa and to quantify the need for further action and effective alleviation of threats. These metrics (research need, research achievement, management need, management achievement, and percent threat reduction) can be aggregated to examine trends for an individual taxon or for threats across multiple taxa. We tested the utility of these metrics by applying them to Australian threatened birds, which appears to be the first time that progress in research and management of threats has been assessed for all threatened taxa in a faunal group at a continental scale. Some research has been conducted on nearly three‐quarters of known threats to taxa, and there is a clear understanding of how to alleviate nearly half of the threats with the highest impact. Some management has been attempted on nearly half the threats. Management outcomes ranged from successful trials to complete mitigation of the threat, including for one‐third of high‐impact threats. Progress in both research and management tended to be greater for taxa that were monitored or occurred on oceanic islands. Predation by cats had the highest potential threat score. However, there has been some success reducing the impact of cat predation, so climate change (particularly drought), now poses the greatest threat to Australian threatened birds. Our results demonstrate the potential for the proposed metrics to encapsulate the major trends in research and management of both threats and threatened taxa and provide a basis for international comparisons of evidence‐based conservation science.
Medidas de Progreso en el Entendimiento y el Manejo de las Amenazas que Enfrentan las Aves Australianas
Resumen
Aunque los métodos basados en evidencias se han vuelto muy comunes para la determinación del éxito de las medidas de conservación del manejo de los taxones amenazados, hoy en día no existen medidas estandarizadas para la evaluación del progreso de la investigación o el manejo. Desarrollamos cinco medidas para cumplir con esta necesidad que tienen los taxones amenazados y para cuantificar la necesidad de una mayor acción y un alivio efectivo de las amenazas. Estas medidas (falta de investigación, éxito de la investigación, falta de manejo, éxito del manejo y porcentaje de reducción de amenazas) pueden agregarse para examinar las tendencias de un taxón individual o las tendencias de las amenazas para múltiples taxones. Probamos la utilidad de estas medidas por medio de su aplicación en aves australianas amenazadas, que parece ser la primera vez que se evalúa el progreso en la investigación y en el manejo de amenazas para el caso de varios taxones amenazados dentro de un grupo faunístico a escala continental. Se ha realizado algún tipo de investigación sobre casi tres cuartas partes de las amenazas conocidas para los taxones, y hay un claro entendimiento de cómo aliviar casi la mitad de las amenazas con el impacto más alto. Se ha intentado algún tipo de manejo con casi la mitad de las amenazas. Los resultados del manejo variaron desde ensayos exitosos hasta la mitigación completa de la amenaza, incluso para un tercio de las amenazas de alto impacto. Tanto el progreso en la investigación como en el manejo tendió a ser mayor para los taxones que estaban siendo monitoreados, o que ocurrían en islas oceánicas. La depredación por gatos tuvo el puntaje más como amenaza potencial. Sin embargo, ha habido poco de éxito en la reducción del impacto de la depredación por gatos, así que ahora el cambio climático (particularmente la sequía) es la mayor amenaza para las aves amenazadas en Australia. Nuestros resultados demuestran el potencial que tienen las medidas propuestas de encapsular las tendencias más importantes en la investigación y en el manejo tanto de las amenazas como de los taxones amenazados y de proporcionar una base para comparaciones internacionales de la ciencia de la conservación basada en evidencias.
摘要
虽然受威胁物种的管理中常常用到基于证据的方法来确定保护措施的成效, 但还没有统一的标准来评估受胁物种研究或管理的进展。我们为受威胁物种制定了五个指标, 并量化分析了深入行动和有效减缓威胁的需求。这些指标 (研究需求、研究成果、管理需求、管理成果和威胁减少的百分比) 可以共同用于分析单个类群的趋势或跨类群的威胁。我们通过在澳大利亚受胁迫鸟类上的应用检验了这些指标的效用, 这是首次在大陆尺度上评估一个动物区系中所有受胁迫类群面临威胁的研究和管理进展。该类群已知的威胁中有四分之三已有一些研究, 且影响最大的威胁中有一半已被清楚地指出应如何减缓这种威胁。针对近一半的威胁因素已有相应管理措施。管理成果包括成功的尝试到完全减缓威胁, 这涉及了三分之一影响较大的威胁。那些受到监测、或分布在海岛上, 或的类群的研究和管理往往有更多进展。被猫捕食的鸟类受到的潜在威胁最大。不过, 在减轻被猫捕食的影响方面已取得一些成功, 而气候变化 (特别是干旱) 才是目前澳大利亚鸟类面临的最大威胁。我们的结果表明, 我们制定的指标可以概括受威胁类群及其面临威胁的研究和管理的主要趋势, 并为全球范围内基于证据的保护科学的比较分析提供了基础。【翻译: 胡怡思; 审校: 聂永刚】
Article impact statement: Quantification of needs and achievements in research and management will help conservation funders and practitioners prioritize investment and action.
The alkylation of amines by alcohols has been achieved using 0.5 mol % Ru(p-cymene)Cl(2)(2) with the bidentate phosphines dppf or DPEphos as the catalyst. Primary amines have been converted into ...secondary amines, and secondary amines into tertiary amines, including the syntheses of Piribedil, Tripelennamine, and Chlorpheniramine. N-Heterocyclization reactions of primary amines are reported, as well as alkylation reactions of primary sulfonamides. Secondary alcohols require more forcing conditions than primary alcohols but are still effective alkylating agents in the presence of this catalyst.
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