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Tuberous sclerosis complex is a rare genetic disorder leading to the growth of hamartomas in multiple organs, including cardiac rhabdomyomas. Children with symptomatic cardiac rhabdomyoma require frequent admissions to intensive care units, have major complications, namely, arrhythmias, cardiac outflow tract obstruction and heart failure, affecting the quality of life and taking on high healthcare cost. Currently, there is no standard pharmacological treatment for this condition, and the management includes a conservative approach and supportive care. Everolimus has shown positive effects on subependymal giant cell astrocytomas, renal angiomyolipoma and refractory seizures associated with tuberous sclerosis complex. However, evidence supporting efficacy in symptomatic cardiac rhabdomyoma is limited to case reports. The ORACLE trial is the first randomised clinical trial assessing the efficacy of everolimus as a specific therapy for symptomatic cardiac rhabdomyoma.
ORACLE is a phase II, prospective, randomised, placebo-controlled, double-blind, multicentre protocol trial. A total of 40 children with symptomatic cardiac rhabdomyoma secondary to tuberous sclerosis complex will be randomised to receive oral everolimus or placebo for 3 months. The primary outcome is 50% or more reduction in the tumour size related to baseline. As secondary outcomes we include the presence of arrhythmias, pericardial effusion, intracardiac obstruction, adverse events, progression of tumour reduction and effect on heart failure.
ORACLE protocol addresses a relevant unmet need in children with tuberous sclerosis complex and cardiac rhabdomyoma. The results of the trial will potentially support the first evidence-based therapy for this condition.
Recently, a new 2D carbon allotrope structure, named phagraphene (PG), was proposed. PG has a densely array of penta-hexa-hepta-graphene carbon rings. PG was shown to present low and anisotropic thermal conductivity and it is believed that this anisotropy should be also reflected in its mechanical properties. Although PG mechanical properties have been investigated, a detailed and comprehensive study is still lacking. In the present work we have carried out fully atomistic reactive molecular dynamics simulations using the ReaxFF force field, to investigate the mechanical properties and fracture patterns of PG membranes. The Young’s modulus values of the PG membranes were estimated from the stress-strain curves. Our results show that these curves present three distinct regimes: one regime where ripples dominate the structure and mechanical properties of the PG membranes; an elastic regime where the membranes exhibit fully planar configurations; and finally am inelastic regime where permanent deformations happened to the PG membrane up to the mechanical failure or fracture.
The study of the mechanical properties of nanostructured systems has gained importance in theoretical and experimental research in recent years. Carbon nanotubes (CNTs) are one of the strongest nanomaterials found in nature, with Young’s Modulus (EY) in the order 1.25 TPa. One interesting question is about the possibility of generating new nanostructures with 1D symmetry and with similar and/or superior CNT properties. In this work, we present a study on the dynamical, structural, mechanical properties, fracture patterns and EY values for one class of these structures, the so-called pentagraphene nanotubes (PGNTs). These tubes are formed rolling up pentagraphene membranes (which are quasi-bidimensional structures formed by densely compacted pentagons of carbon atoms in sp3 and sp2 hybridized states) in the same form that CNTs are formed from rolling up graphene membranes. We carried out fully atomistic molecular dynamics simulations using the ReaxFF force field. We have considered zigzag-like and armchair-like PGNTs of different diameters. Our results show that PGNTs present EY ∼ 800 GPa with distinct elastic behavior in relation to CNTs, mainly associated with mechanical failure, chirality dependent fracture patterns and extensive structural reconstructions.
Current Galactic surveys, including the Gaia mission, rely on the efficiency of the spectral analysis techniques to provide precise and accurate spectral information (i.e. effective temperature, surface gravity, metallicity, and chemical abundances) in the shortest computational time. In this work, we present a new package to preform complete spectral analyses based on the spectral synthesis technique (Tsantaki et al. 2017, submitted). We focus on deriving atmospheric parameters for FGK-type stars using both high and medium resolution (GIRAFFE) spectra. This method is implemented on the Gaia-ESO benchmark stars to confirm its validity, achieving similar accuracy for the two resolution setups.
Some studies suggested that the chemical abundance trend with the condensation temperature, Tc, is a signature of rocky planet formation. Very recently, a strong Tc trend was reported in ζ2 Ret relative to its companion (ζ1 Ret) and was explained by the presence of a debris disk around ζ2 Ret. We re-evaluated the presence and variability of the Tc trend in this system with a goal to understand the impact of the presence of the debris disk on a star. Our results confirm the reported abundance difference between ζ2 Ret and ζ1 Ret and its dependence on the Tc. However, we also found that the Tc trends depend on the individual spectrum used. We conclude that for the ζ Reticuli system, for example, nonphysical factors can be at the root of the Tc trends for the case of individual spectra. For more details see Adibekyan et al. (2016b).
In this work we present chemical abundances of heavy elements (Z>28) for a homogeneous sample of 1059 stars from HARPS planet search program. We also derive ages using parallaxes from Hipparcos and Gaia DR1 to compare the results. We study the [X/Fe] ratios for different populations and compare them with models of Galactic chemical evolution. We find that thick disk stars are chemically disjunt for Zn adn Eu. Moreover, the high-alpha metal-rich population presents an interesting behaviour, with clear overabundances of Cu and Zn and lower abundances of Y and Ba with respect to thin disk stars. Several abundance ratios present a significant correlation with age for chemically separated thin disk stars (regardless of their metallicity) but thick disk stars do not present that behaviour. Moreover, at supersolar metallicities the trends with age tend to be weaker for several elements.
The experiment, conducted at Bahia, Brazil, from May to August 2010, aimed to evaluate the nitrogen (N) balance, urea excretion and microbial protein synthesis in lactating goats fed pelleted concentrates with the addition of crude protein (CP), obtained by replacing alfalfa hay with soybean meal. The diets consisted of different levels of CP and 200 g of roughage (Tifton 85 hay)/kg. Maize and mesquite bran were used as the energy source, with maize replaced by mesquite bran in the ratio of 1·7:1. Eight female Saanen goats were used, confined in individual pens and allocated to a 4 × 4 Latin square design. The N balance in the body was positive, and loss of body weight (–0·03 g/day) was observed for the diet with 190 g CP/kg. The concentration (mg/dl) of urea in urine, milk and blood plasma was positively influenced in a linear form, and the highest rate of increase was found in urine, with 2 mg/dl for every 10 g CP/kg added to the diet. The microbial protein synthesis was not affected, but the diets reduced the microbial protein (44 g/day) and its ruminal production efficiency (30 g/kg total digestible nutrients). The levels above 190 g of CP are not recommended because of the energy expenditure required to excrete the urea.
The Spanish Influenza Pandemic of 1918-1919 sheds new light on what the World Health Organization described as "the single most devastating infectious disease outbreak ever recorded" by situating the Iberian Peninsula as the key point of connection, both epidemiologically and discursively, between Europe and the Americas. The essays in this volume elucidate specific aspects of the pandemic that have received minimal attention until now, including social control, gender, class, religion, national identity, and military medicine's reactions to the pandemic and its relationship with civilian medicine, all in the context of World War I. As the authors point out, however, the experiences of 1918-19 remain persistently relevant to contemporary life, particularly in view of events such as the 2009 H1N1 swine flu pandemic. Contributors: Mercedes Pascual Artiaga, Catherine Belling, Josep Bernabeu-Mestre, Ryan A, Davis, Esteban Domingo, Magda Fahrni, Hernán Feldman, Pilar León-Sanz, Maria Luísa Lima, Maria deFátima Nunes, María-Isabel Porras-Gallo, Anny Jackeline Torres Silveira, José Manuel Sobral, Paulo Silveira e Sousa, Christiane Maria Cruz de Souza. María-Isabel Porras-Gallo is Professor of History of Science in the Medical Faculty of Ciudad Real at the University of Castile-La Mancha (Spain). She is the author of Un reto para la sociedad madrileña: la epidemia de gripe de 1918-1919 and co-editor of El drama de la polio. Un problema social y familiar en la España franquista. Ryan A. Davis is Assistant Professor in the Department of Languages, Literatures, and Cultures at Illinois State University. He is the author of The Spanish Flu: Narrative and Cultural Identity in Spain, 1918.
Introduction: Smoking is associated with the development of coronary artery disease and influences negatively the prognosis of patients undergoing myocardial revascularization procedures. However, the rate of smoking cessation after these procedures is not well established in the literature. We aimed to evaluate the rate of smoking cessation in patients undergoing revascularization procedures, immediately and after 12 months of follow-up.
Methods: We examined smoking patients from a unique cardiology center who underwent myocardial revascularization procedures between January 2010 and December 2011. These patients were allocated to two groups according to the revascularization procedure performed: Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Interventions (PCI). Data related to cessation or maintenance of smoking were obtained at subsequent clinical appointments or telephone calls.
Results: Among 173 patients selected, 118 (68.2%) underwent PCI and 55 (31.8%) underwent CABG. After revascularization procedures, the total rate of smoking cessation was 79.3%. Furthermore, there was no significant difference between the two groups (83.6% – CI 95%: 71.2–92.2% for CABG, and 79.3% – CI 95%: 70.8–86.3% for PCI). The maintenance of smoking cessation after one year was 53.2%, similar between groups (52.7% for CABG and 53.4% for PCI). Nevertheless, the average time of smoking cessation was significantly higher in the CABG group (6.9 months versus 4.5 months for PCI).
Conclusions: Coronary interventions add important value to smoking cessation, and the smoking cessation rates were similar, independent of the procedure executed.
Hantavirus pulmonary syndrome (HPS) is a zoonosis and a public health concern in the Americas due to its high fatality rate. Since the first cases were identified in USA in 1993, HPS has been observed over a wide area of the American continents. Over 1600 HPS cases have been confirmed in Brazil since 1993, and different genotypes of hantavirus have been identified in several biomes in this country of continental dimensions. We performed a retrospective study of data from 2001 to 2011 that encompassed all notified cases of HPS in the National Disease Notification System (SINAN) of Brazil to determine the regional differences and temporal trends of the disease. During the study period, 1486 cases were reported, and analyses of the temporal trends of the disease revealed that the number of cases in Brazil increased over this period (P < 0·01). The frequency distributions of the cases stratified by region revealed different patterns of seasonality; however, these patterns were not statistically significant with the exception of the South region (P < 0·05). We found regional differences in the occurrence of the disease throughout the year and a trend towards an increasing number of cases. These findings reinforce the necessity of adjusting surveillance tools and control policies to respond effectively to this public health problem.
Morphometric characteristics of the periotic–timpanic bone complex in the middle ear of cetaceans, are effective characteristics in evaluating systematics. However, they have not been used for studies of geographic variation regarding dolphins of the genus Sotalia. This study aimed to compare the periotic–timpanic of Sotalia guianensis from four distinct locations, considered here as different operational taxonomic units, Amapá/Pará (AM/PA), Maranhão/Piauí (MA/PI), Ceará (CE), and Rio de Janeiro (RJ), using 21 morphometric measurements. Multivariate analysis showed significant distinction mainly between the units of northern (AM/PA and MA/PI) and south-eastern (RJ) Brazilian coast. The timpanic bone showed variation, reaching larger sizes in the Brazilian south coast unit, corroborating current molecular data on the geographic variation of S. guianensis.