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Whilst aortopexy is an accepted and established procedure, there remains considerable heterogeneity within the literature, with inconsistencies in both the approach taken and the technique employed. Furthermore, limited data exist on both patient selection and long-term outcomes. This study aimed to report the experience of managing severe tracheomalacia by way of aortopexy in a large UK paediatric centre.
A retrospective case note review was conducted. Mean follow up was five years.
Twenty-five patients underwent aortopexy for severe tracheomalacia caused by external vascular compression. Acute life-threatening events precipitated investigation in 72 per cent of cases. Twenty-one patients initially presented to ENT services for investigation, which comprised upper airway endoscopy and imaging with computed tomography angiography. Post-operatively, the majority of patients demonstrated complete resolution of symptoms and were discharged from all associated services. Only four patients required a tracheostomy.
Aortopexy offers an effective method of treating severe tracheomalacia due to vascular compression.
The brain functional correlates of autobiographical recall are well established, but have been little studied in schizophrenia. Additionally, autobiographical memory is one of a small number of cognitive tasks that activates rather than de-activates the default mode network, which has been found to be dysfunctional in this disorder.
Twenty-seven schizophrenic patients and 30 healthy controls underwent functional magnetic resonance imaging while viewing cue words that evoked autobiographical memories. Control conditions included both non-memory-evoking cues and a low level baseline (cross fixation).
Compared to both non-memory evoking cues and low level baseline, autobiographical recall was associated with activation in default mode network regions in the controls including the medial frontal cortex, the posterior cingulate cortex and the hippocampus, as well as other areas. Clusters of de-activation were seen outside the default mode network. There were no activation differences between the schizophrenic patients and the controls, but the patients showed clusters of failure of de-activation in non-default mode network regions.
According to this study, patients with schizophrenia show intact activation of the default mode network and other regions associated with recall of autobiographical memories. The finding of failure of de-activation outside the network suggests that schizophrenia may be associated with a general difficulty in de-activation rather than dysfunction of the default mode network per se.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
With the aim to elucidate gonococcal antimicrobial resistance (AMR)–risk factors, we undertook a retrospective analysis of the molecular epidemiology and AMR of 104 Neisseria gonorrhoeae isolates from clinical samples (urethra, rectum, pharynx and cervix) of 94 individuals attending a sexually transmitted infection clinic in Madrid (Spain) from July to October 2016, and explored potential links with socio-demographic, behavioural and clinical factors of patients. Antimicrobial susceptibility was determined by E-tests, and isolates were characterised by N. gonorrhoeae multi-antigen sequence typing. Penicillin resistance was recorded for 15.4% of isolates, and most were susceptible to tetracycline, cefixime and azithromycin; a high incidence of ciprofloxacin resistance (~40%) was found. Isolates were grouped into 51 different sequence types (STs) and 10 genogroups (G), with G2400, ST5441, ST2318, ST12547 and G2992 being the most prevalent. A significant association (P = 0.015) was evident between HIV-positive MSM individuals and having a ciprofloxacin-resistant strain. Likewise, a strong association (P = 0.047) was found between patient age of MSM and carriage of isolates expressing decreased susceptibility to azithromycin. A decrease in the incidence of AMR gonococcal strains and a change in the strain populations previously reported from other parts of Spain were observed. Of note, the prevalent multi-drug resistant genogroup G1407 was represented by only three strains in our study, while the pan-susceptible clones such as ST5441, and ST2318, associated with extragenital body sites were the most prevalent.
Background: Biallelic variants in POLR1C are associated with POLR3-related leukodystrophy (POLR3-HLD), or 4H leukodystrophy (Hypomyelination, Hypodontia, Hypogonadotropic Hypogonadism), and Treacher Collins syndrome (TCS). The clinical spectrum of POLR3-HLD caused by variants in this gene has not been described. Methods: A cross-sectional observational study involving 25 centers worldwide was conducted between 2016 and 2018. The clinical, radiologic and molecular features of 23 unreported and previously reported cases of POLR3-HLD caused by POLR1C variants were reviewed. Results: Most participants presented between birth and age 6 years with motor difficulties. Neurological deterioration was seen during childhood, suggesting a more severe phenotype than previously described. The dental, ocular and endocrine features often seen in POLR3-HLD were not invariably present. Five patients (22%) had a combination of hypomyelinating leukodystrophy and abnormal craniofacial development, including one individual with clear TCS features. Several cases did not exhibit all the typical radiologic characteristics of POLR3-HLD. A total of 29 different pathogenic variants in POLR1C were identified, including 13 new disease-causing variants. Conclusions: Based on the largest cohort of patients to date, these results suggest novel characteristics of POLR1C-related disorder, with a spectrum of clinical involvement characterized by hypomyelinating leukodystrophy with or without abnormal craniofacial development reminiscent of TCS.
We prove that if
-triple and not a Cartan factor of rank two, then
satisfies the Mazur–Ulam property, that is, every surjective isometry from the unit sphere of
onto the unit sphere of another real Banach space
extends to a surjective real linear isometry from
The purpose of this study is to understand different roles that interpreters play in a pediatric, limited English proficient (LEP) health care encounter and to describe what factors within each role inform physicians’ assessment of the overall quality of interpretation.
Language barriers contribute to lower quality of care in LEP pediatric patients compared to their English-speaking counterparts. Use of professional medical interpreters has been shown to improve communication and decrease medical errors in pediatric LEP patients. In addition, in many pediatric encounters, interpreters take on roles beyond that of a pure language conduit.
We conducted 11 semi-structured interviews with pediatricians and family medicine physicians in one health system. Transcripts were audio-recorded and transcribed verbatim. We analyzed our data using directed content analysis. Two study team members coded all transcripts, reviewed agreement, and resolved discrepancies.
Physicians described four different interpreter roles: language conduit, flow manager, relationship builder, and cultural insider. Within each role, physicians described components of quality that informed their assessment of the overall quality of interpretation during a pediatric encounter. We found that for many physicians, a high-quality interpreted encounter involves multiple roles beyond language transmission. It is important for health care systems to understand how health care staff conceptualize these relationships so that they can develop appropriate expectations and trainings for medical interpreters in order to improve health outcomes in pediatric LEP patients.
Clostridium difficile infection (CDI) and asymptomatic carriage of toxigenic C. difficile are common in long-term care facilities (LTCFs). However, whether C. difficile is frequently acquired in the LTCF versus during acute-care admissions remains unknown.
To test the hypothesis that LTCF residents often acquire C. difficile colonization and infection in the LTCF
This 5-month cohort study was conducted to determine the incidence of acquisition of C. difficile colonization and infection in asymptomatic patients transferred from a Veterans Affairs hospital to an affiliated LTCF.
Rectal swabs were cultured for toxigenic C. difficile at the time of transfer to the LTCF and weekly for up to 6 weeks. We calculated the proportion of LTCF-onset CDI cases within 1 month of transfer that occurred in residents colonized on admission versus those with new acquisition in the LTCF.
Of 110 patients transferred to the LTCF, 12 (11%) were asymptomatically colonized with toxigenic C. difficile upon admission, and 4 of these 12 patients (33%) developed CDI within 1 month, including 3 recurrent and 1 initial CDI episode. Of 82 patients with negative cultures on transfer and at least 1 follow-up culture, 22 (27%) acquired toxigenic C. difficile colonization, and 4 developed CDI within 1 month, including 1 recurrent and 3 initial CDI episodes.
LTCF residents frequently acquired colonization with toxigenic C. difficile after transfer from the hospital, and 3 of 4 initial CDI cases with onset within 1 month of transfer occurred in residents who acquired colonization in the LTCF.
A pilot study by 6 Clinical and Translational Science Awards (CTSAs) explored how bibliometrics can be used to assess research influence.
Evaluators from 6 institutions shared data on publications (4202 total) they supported, and conducted a combined analysis with state-of-the-art tools. This paper presents selected results based on the tools from 2 widely used vendors for bibliometrics: Thomson Reuters and Elsevier.
Both vendors located a high percentage of publications within their proprietary databases (>90%) and provided similar but not equivalent bibliometrics for estimating productivity (number of publications) and influence (citation rates, percentage of papers in the top 10% of citations, observed citations relative to expected citations). A recently available bibliometric from the National Institutes of Health Office of Portfolio Analysis, examined after the initial analysis, showed tremendous potential for use in the CTSA context.
Despite challenges in making cross-CTSA comparisons, bibliometrics can enhance our understanding of the value of CTSA-supported clinical and translational research.
Making a morphological pre-selection of Pura Raza Español horses (PRE) for dressage is a challenging task within its current breeding program. The aim of our research was to design an early genetic selection morphological linear traits index to improve dressage performance, using 26 morphological linear traits and six dressage traits (walk, trot, canter, submission, general impression – partial scores – and total score) as selection criteria. The data set included morphological linear traits of 10 127 PRE (4159 males and 5968 females) collected between 2008 and 2013 (one record per horse) and 19 095 dressage traits of 1545 PRE (1476 males and 69 females; 12.4 records of average) collected between 2004 and 2014. A univariate animal model was applied to predict the breeding values (PBV). A partial least squares regression analysis was used to select the most predictive morphological linear traits PBV on the dressage traits PBV. According to the Wold Criterion, the 13 morphological linear traits (width of head, head–neck junction, upper neck line, neck–body junction, width of chest, angle of shoulder, lateral angle of knee, frontal angle of knee, cannon bone perimeter, length of croup, angle of croup, ischium–stifle distance and lateral hock angle) most closely related to total score PBV, partial scores PBV and gait scores PBV (walk, trot and canter) were selected. A multivariate genetic analysis was performed among the 13 morphological linear traits selected and the six dressage traits to estimate the genetic parameters. After it, the selection index theory was used to compute the expected genetic response using different strategies. The expected genetic response of total score PBV (0.76), partial scores PBV (0.04) and gait scores PBV (0.03) as selection objectives using morphological linear traits PBV as criteria selection were positive, but lower than that obtained using dressage traits PBV (1.80, 0.16 and 0.14 for total score PBV, partial scores PBV and gait scores PBV) or dressage traits PBV and morphological linear traits PBV (2.97, 0.16 and 0.15 for total score PBV, partial scores PBV and gait scores PBV), as selection criteria. This suggests that it is possible to preselect the PRE without dressage traits PBV using as selection criteria the morphological linear traits PBV, but the expected genetic response will be lower.
The fast stellar winds can blow bubbles in the circumstellar material ejected from previous phases of stellar evolution. These are found at different scales, from planetary nebulae (PNe) around stars evolving to the white dwarf stage, to Wolf-Rayet (WR) bubbles and up to large-scale bubbles around massive star clusters. In all cases, the fast stellar wind is shock-heated and a hot bubble is produced. Processes of mass evaporation and mixing of nebular material and heat conduction occurring at the mixing layer between the hot bubble and the optical nebula are key to determine the thermal structure of these bubbles and their evolution. In this contribution we review our current understanding of the X-ray observations of hot bubbles in PNe and present the first spatially-resolved study of a mixing layer in a PN.
Magnetic instability is a key consideration for filament eruptions and subsequent CMEs. In this contribution we are considering different magnetic conditions for active and non-active regions, such as coronal hole regions and quiet sun, and also active regions of a simple magnetic configuration. The aim is to assess magnetic instability through potential and non-potential field modelling and 3D evaluation of the magnetic decay index. Some eruptive examples from solar cycle 24 using HMI/SDO data are presented, complemented with observations of AIA/SDO.
We present Spitzer Space Telescope archival mid-infrared (mid-IR) spectroscopy of a sample of eleven planetary nebulae (PNe). The observations, acquired with the Spitzer Infrared Spectrograph (IRS), cover the spectral range 5.2-14.5 μm that includes the H2 0-0 S(2) to S(7) rotational emission lines. This wavelength coverage has allowed us to derive the Boltzmann distribution and calculate the H2 rotational excitation temperature (Tex). The derived excitation temperatures have consistent values ≃ 900 ±70 K for different sources despite their different structural components. We also report the detection of mid-IR ionic lines of [Ar iii], [S iv], and [Ne ii] in most objects, and polycyclic aromatic hydrocarbon (PAH) features in a few cases.
The mechanism by which sunspots are generated at the surface of the sun remains unclear. In the current literature two types of explanations can be found. The first one is related to the buoyant emergence of toroidal magnetic fields generated at the tachocline. The second one states that active regions are formed, from initially diffused magnetic flux, by MHD instabilities that develop in the near-surface layers of the Sun. Using the anelastic MHD code EULAG we address the problem of sunspot formation by performing implicit large-eddy simulations of stratified magneto-convection in a domain that resembles the near-surface layers of the Sun. The development of magnetic structures is explored as well as their effect on the convection dynamics. By applying a homogeneous magnetic field over an initially stationary hydrodynamic convective state, we investigate the formation of self-organized magnetic structures in the range of the initial magnetic field strength, 0.01 < B0/Beq < 0.5, where Beq is the characteristic equipartition field strength.
While most of the low-mass stars stay hydrogen-rich on their surface throughout their evolution, a considerable fraction of white dwarfs as well as central stars of planetary nebulae have a hydrogen-deficient surface composition. The majority of these H-deficient central stars exhibit spectra very similar to massive Wolf-Rayet stars of the carbon sequence, i.e. with broad emission lines of carbon, helium, and oxygen. In analogy to the massive Wolf-Rayet stars, they are classified as [WC] stars. Their formation, which is relatively well understood, is thought to be the result of a (very) late thermal pulse of the helium burning shell. It is therefore surprising that some H-deficient central stars which have been found recently, e.g. IC 4663 and Abell 48, exhibit spectra that resemble those of the massive Wolf-Rayet stars of the nitrogen sequence, i.e. with strong emission lines of nitrogen instead of carbon. This new type of central stars is therefore labelled [WN]. We present spectral analyses of these objects and discuss the status of further candidates as well as the evolutionary status and origin of the [WN] stars.
We have investigated the case of a coronal mass ejection that was eroded by the fast wind of a coronal hole in the interplanetary medium. When a solar ejection takes place close to a coronal hole, the flux rope magnetic topology of the coronal mass ejection (CME) may become misshapen at 1 AU as a result of the interaction. Detailed analysis of this event reveals erosion of the interplanetary coronal mass ejection (ICME) magnetic field. In this communication, we study the photospheric magnetic roots of the coronal hole and the coronal mass ejection area with HMI/SDO magnetograms to define their magnetic characteristics.
Cottonseed hulls are co-product of agribusiness that can be used in beef cattle rations, decreasing the cost of feed. The aim of this study was to evaluate the effects of different cottonseed hull levels, display and ageing times on visual and sensorial meat acceptability. Longissimus thoracis muscle from 30 crossbred young bulls finished on three high-grain diets (210, 270 or 330 g/kg of cottonseed hulls on dry matter, respectively) were visually evaluated during 10 days of display by 37 appraisers. Tenderness, flavour and overall acceptability from the three diets and three ageing times (1, 7 and 14 days) were evaluated by 120 consumers. On the visual study, time of display (P⩽0.001) was a more significant factor than diet. Cottonseed hull level had no effect on sensorial analyses, with tenderness acceptability improving with ageing time (P⩽0.001). Results indicate the possibility of using the three studied levels of cottonseed without damaging consumer meat acceptability.
Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment.
This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes.
Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan–Meier method.
The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx.
Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes.