We present Chandra and Very Large Array observations of GW170817 at ∼521-743 days post-merger, and a homogeneous analysis of the entire Chandra data set. We find that the late-time nonthermal ...emission follows the expected evolution of an off-axis relativistic jet, with a steep temporal decay F ∝ t − 1.95 0.15 and power-law spectrum F ∝ − 0.575 0.007 . We present a new method to constrain the merger environment density based on diffuse X-ray emission from hot plasma in the host galaxy and find n ≤ 9.6 × 10 − 3 cm − 3 . This measurement is independent from inferences based on jet afterglow modeling and allows us to partially solve for model degeneracies. The updated best-fitting model parameters with this density constraint are a fireball kinetic energy E 0 = 1.5 − 1.1 + 3.6 × 10 49 erg ( E iso = 2.1 − 1.5 + 6.4 × 10 52 erg ) and jet opening angle θ 0 = 5.9 − 0.7 + 1.0 deg with characteristic Lorentz factor Γ j = 163 − 43 + 23 , expanding in a low-density medium with n 0 = 2.5 − 1.9 + 4.1 × 10 − 3 cm − 3 and viewed θ obs = 30.4 − 3.4 + 4.0 deg off-axis. The synchrotron emission originates from a power-law distribution of electrons with index p = 2.15 − 0.02 + 0.01 . The shock microphysics parameters are constrained to ϵ e = 0.18 − 0.13 + 0.30 and ϵ B = 2.3 − 2.2 + 16.0 × 10 − 3 . Furthermore, we investigate the presence of X-ray flares and find no statistically significant evidence of ≥2.5 of temporal variability at any time. Finally, we use our observations to constrain the properties of synchrotron emission from the deceleration of the fastest kilonova ejecta with energy E k KN ∝ ( Γ β ) − into the environment, finding that shallow stratification indexes ≤ 6 are disfavored. Future radio and X-ray observations will refine our inferences on the fastest kilonova ejecta properties.
We present a revised and complete optical afterglow light curve of the binary neutron star merger GW170817, enabled by deep Hubble Space Telescope (HST) F606W observations at 584 days post-merger, ...which provide a robust optical template. The light curve spans 110-362 days, and is fully consistent with emission from a relativistic structured jet viewed off-axis, as previously indicated by radio and X-ray data. Combined with contemporaneous radio and X-ray observations, we find no spectral evolution, with a weighted average spectral index of 〈 β 〉 = − 0.583 0.013 , demonstrating that no synchrotron break frequencies evolve between the radio and X-ray bands over these timescales. We find that an extrapolation of the post-peak temporal slope of GW170817 to the luminosities of cosmological short gamma-ray bursts matches their observed jet break times, suggesting that their explosion properties are similar, and that the primary difference in GW170817 is viewing angle. Additionally, we place a deep limit on the luminosity and mass of an underlying globular cluster (GC) of L 6.7 × 103 L , or M 1.3 × 104 M , at least 4 standard deviations below the peak of the GC mass function of the host galaxy, NGC 4993. This limit provides a direct and strong constraint that GW170817 did not form and merge in a GC. As highlighted here, HST (and soon the James Webb Space Telescope) enables critical observations of the optical emission from neutron star merger jets and outflows.
Summary
Background Some probiotics can ameliorate childhood atopic dermatitis (AD). Prebiotics have also shown some efficacy, although when combined with probiotics as synbiotics, their efficacy may ...improve.
Objective We compared the effects of Lactobacillus salivarius and fructo‐oligosaccharide (synbiotic) with fructo‐oligosaccharide alone (prebiotic) on children with moderate to severe AD.
Methods We randomly assigned 60 children aged 2–14 years with moderate to severe AD SCORing AD (SCORAD) > 25 to a treatment (synbiotic) or a control (prebiotic) group (30 per group). They received one capsule twice daily for 8 weeks containing either L. salivarius plus fructo‐oligosaccharide (treatment) or fructo‐oligosaccharide only (control). SCORAD indices were monitored at weeks 0, 4, 8 and 10 (post‐treatment). Laboratory results and AD medication use were also monitored.
Results Baseline demographic and clinical characteristics and SCORAD scores were similar between the two groups. At 8 weeks, the treatment group SCORAD scores (27·4 ± 12·7) were significantly lower than for the controls (36·3 ± 14·9) (P = 0·022); this difference remained at 10 weeks. At 8 weeks, treatment group AD intensity was significantly lower (P = 0·013); more children had mild AD in the treatment group (52%; 14/27) than the control group (30%; 8/27) (P = 0·024). Medication use frequency and eosinophil cationic protein levels were significantly reduced in the treatment group at 8 weeks compared with 4 weeks.
Conclusion A synbiotic combination of L. salivarius plus fructo‐oligosaccharide is superior to the prebiotic alone for treating moderate to severe childhood AD. However, continued follow‐up will be necessary to ascertain long‐term benefits.
Summary Objective To determine whether autophagy contributes to the pathogenesis of degenerative disc disease (DDD) or retards the intervertebral disc (IVD) degeneration, and investigate the possible ...relationship between compression-induced autophagy and intracellular reactive oxygen species (ROS) in nucleus pulposus (NP) cells in vitro. Methods The autophagosome and autophagy-related markers were used to explore the role of autophagy in rat NP cells under compressive stress, which were measured directly by electronic microscopy, monodansylcadaverine (MDC) staining, immunofluorescence, western blot, and indirectly by analyzing the impact of pharmacological inhibitors of autophagy such as 3-methyladenine (3-MA) and chloroquine (CQ). And the relationship between autophagy and apoptosis was investigated by Annexin-V/propidium iodide (PI)-fluorescein staining. In addition, ROS were measured to determine whether these factors are responsible for the development of compression-induced autophagy. Results Our results indicated that rat NP cells activated autophagy in response to the same strong apoptotic stimuli that triggered apoptosis by compression. Autophagy and apoptosis were interconnected and coordinated in rat NP cells exposed to compression stimuli. Compression-induced autophagy was closely related to intracellular ROS production. Conclusions Enhanced degradation of damaged components of NP cells by autophagy may be a crucial survival response against mechanical overload, and extensive autophagy may trigger autophagic cell death. Regulating autophagy and reducing the generation of intracellular ROS may retard IVD degeneration.
A preliminary investigation was carried out into the application of angularly exerted ultrasonic vibrations in friction stir welding for the joining of AA 6061-T4 alloy to AZ31B at different tool ...rotation speeds. The variations in the welding process and weld properties due to the applied acoustic field were investigated. The process temperature was increased, the material flow path was widened and mechanical interlocking features at weld interfaces were improved in the presence of ultrasonics. Morphology and distribution of intermetallic compounds were influenced by the added vibrations at all rotation speeds. Formation of intermetallic layers at the weld interfaces was driven by heat input. Composition of the intermetallic compound was roughly unaffected but the layer thickness was reduced by the additional acoustic field. The ultrasonic enhanced improvement in weld mechanical properties was significant at very low rotation speeds but less substantial at higher rotation speeds.
Colorectal cancer (CRC) is rapidly increasing in Asia, but screening guidelines are lacking. Through reviewing the literature and regional data, and using the modified Delphi process, the Asia ...Pacific Working Group on Colorectal Cancer and international experts launch consensus recommendations aiming to improve the awareness of healthcare providers of the changing epidemiology and screening tests available. The incidence, anatomical distribution and mortality of CRC among Asian populations are not different compared with Western countries. There is a trend of proximal migration of colonic polyps. Flat or depressed lesions are not uncommon. Screening for CRC should be started at the age of 50 years. Male gender, smoking, obesity and family history are risk factors for colorectal neoplasia. Faecal occult blood test (FOBT, guaiac-based and immunochemical tests), flexible sigmoidoscopy and colonoscopy are recommended for CRC screening. Double-contrast barium enema and CT colonography are not preferred. In resource-limited countries, FOBT is the first choice for CRC screening. Polyps 5-9 mm in diameter should be removed endoscopically and, following a negative colonoscopy, a repeat examination should be performed in 10 years. Screening for CRC should be a national health priority in most Asian countries. Studies on barriers to CRC screening, education for the public and engagement of primary care physicians should be undertaken. There is no consensus on whether nurses should be trained to perform endoscopic procedures for screening of colorectal neoplasia.
Aliment Pharmacol Ther 2010; 32: 1228–1239
Summary
Background Adalimumab induces and maintains remission in adults with Crohn’s disease.
Aim To evaluate safety, fistula healing, quality of life and ...work productivity in adalimumab‐treated patients who failed infliximab, including primary nonresponders.
Methods After a ≥8‐week infliximab washout, patients with moderate‐to‐severe Crohn’s disease received open‐label adalimumab as induction (160/80 mg at weeks 0/2) and maintenance (40 mg every other week) therapies. At/after 8 weeks, patients with flare/nonresponse could receive weekly therapy. Minimum study duration was 8 weeks, continuing until the commercial availability of adalimumab for Crohn’s disease.
Results Of 673 patients enrolled, 17% were infliximab primary nonresponders and 83% were initial responders. Three percent of patients had serious infections (mainly abscesses). Complete fistula healing was achieved by 34/88 (39%) patients with baseline fistulas. Improvements in quality of life and work productivity were sustained from week 4 to week 24 for all patients, as well as the subgroup of primary nonresponders.
Conclusions Blinded clinical trials have shown adalimumab to be both an effective first‐line therapy for anti‐TNF‐naïve patients and an important treatment option for infliximab‐refractory or ‐intolerant patients. This trial presents open‐label experience to support further the safety and effectiveness of adalimumab in patients who failed infliximab therapy, including primary nonresponders (NCT00338650).
Please cite this paper as: Moss J, Cooper K, Khaund A, Murray L, Murray G, Wu O, Craig L, Lumsden M. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients ...with symptomatic uterine fibroids (REST trial): 5‐year results. BJOG 2011;118:936–944.
Objective To compare the long‐term results of uterine artery embolisation (UAE) with surgery for women with symptomatic uterine fibroids.
Design Pragmatic, open, multicentre, randomised trial.
Setting Twenty‐seven participating UK secondary care centres.
Sample Women aged ≥18 years with symptomatic fibroids who were considered to justify surgical treatment.
Methods In total, 157 women were randomised (in a 2:1 ratio): 106 to UAE and 51 to surgery (hysterectomy 42; myomectomy nine).
Main outcome measures Quality of life at 5 years, as assessed by the Short Form General Health Survey (SF‐36). Secondary measures included complications, adverse events and the need for further intervention.
Results There were no significant differences between groups in any of the eight components of the SF‐36 scores at 5 years (minimum P = 0.45). Symptom score reduction and patient satisfaction with either treatment was very high, with no group difference. Rates of adverse events were similar in both groups (19% embolization and 25% surgery; P = 0.40). The 5‐year intervention rate for treatment failure or complications was 32% (UAE arm) and 4% (surgery arm), respectively. The initial cost benefit of UAE over surgery at 12 months was substantially reduced because of subsequent interventions, with treatments being cost neutral at 5 years.
Conclusions We have found that UAE is a satisfactory alternative to surgery for fibroids. The less invasive nature of UAE needs to be balanced against the need for re‐intervention in almost a third of patients. The choice should lie with the informed patient.
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