Strong Evidence for

The boundaries of the chart of nuclides contain exotic isotopes that possess extreme proton-to-neutron asymmetries. Here we report on strong evidence of ^{9}N, one of the most exotic proton-rich isotopes where more than one half of its constitute nucleons are unbound. With seven protons and two neutrons, this extremely proton-rich system would represent the first-known example of a ground-state five-proton emitter. The invariant-mass spectrum of its decay products can be fit with two peaks whose energies are consistent with the theoretical predictions of an open-quantum-system approach; however, we cannot rule out the possibility that only a single resonancelike peak is present in the spectrum.

National report on healthcare utilization and mortality in patients with hepatitis A infection in the United States.

OBJECTIVES: Predictors of negative outcomes related to hepatitis A virus (HAV) need to be studied at a national level. STUDY DESIGN AND METHODS: A retrospective analysis using the Nationwide Inpatient Sample (2002-2013) and Nationwide Readmission Database (2010-2014) was performed to evaluate the outcomes of hospitalized patients with HAV. The Nationwide Inpatient Sample and the Nationwide Readmission Database included a varying number of states during the studied time and reflect the range of implementation dates of the HAV vaccines. Multivariable analyses were fit to determine predictors of outcomes. RESULTS: A total of 13,514 patients were admitted with HAV during the studied time. Thirty-day and 90-day readmission rates were 11.4% and 15%, respectively. Predictors of readmission, longer length of stay, and mortality included patients aged >60 years ([odds ratio [OR]: 1.02; 95% confidence interval [CI]: 1.001-1.03], [OR: 1.15; CI: 1.07-1.24], [OR: 4.06; 95% CI: 1.47-11.16], respectively), Medicare insurance ([OR:3.63; 95% CI: 2.18-6.03], [OR: 1.26; 95% CI: 1.17-1.37], [OR: 2.67; 95% CI: 1.18-6.04], respectively), and cirrhosis ([OR: 1.83; 95% CI: 1.05-3.21], [OR: 1.33; 95% CI: 1.20-1.47], [OR: 2.83; 95% CI: 1.14-7.05], respectively). Predictors of higher cost of admission included patients aged >60 years (OR: 1.32, 95% CI: 1.19-1.46), Hispanic (OR: 1.14; 95% CI: 1.05-1.24), Medicare insurance (OR: 1.22; 95% CI: 1.10-1.35), Medicaid insurance (OR: 1.10; 95% CI: 1.02-1.20), and cirrhosis (OR: 1.28; 95% CI: 1.11-1.46). CONCLUSIONS: Patients at increased healthcare utilization and mortality should be prioritized for HAV vaccination.

Observation of the Exotic Isotope

A ^{13}F resonance was observed following a charge-exchange reaction between a fast ^{13}O beam and a ^{9}Be target. The resonance was found in the invariant-mass distribution of 3p+^{10}C events and probably corresponds to a 5/2^{+} excited state. The ground state was also expected to be populated, but was not resolved from the background. The observed level decays via initial proton emissions to both the ground and first 2^{+} state of ^{12}O, which subsequently undergo 2p decay. In addition, there may also be a significant proton decay branch to the second 2^{+} level in ^{12}O. The wave function associated with the observed level may be collectivized due to coupling to the continuum as is it located just above the threshold for proton decay to the 2_{2}^{+} state of ^{12}O.

First Observation of the Four-Proton Unbound Nucleus

^{18}Mg was observed, for the first time, by the invariant-mass reconstruction of ^{14}O+4p events. The ground-state decay energy and width are E_{T}=4.865(34) MeV and Γ=115(100) keV, respectively. The observed momentum correlations between the five particles are consistent with two sequential steps of prompt 2p decay passing through the ground state of ^{16}Ne. The invariant-mass spectrum also provides evidence for an excited state at an excitation energy of 1.84(14) MeV, which is likely the first excited 2^{+} state. As this energy exceeds that for the 2^{+} state in ^{20}Mg, this observation provides an argument for the demise of the N=8 shell closure in nuclei far from stability. However, in open systems this classical argument for shell strength is compromised by Thomas-Ehrman shifts.

Systematic Matter and Binding-Energy Distributions from a Dispersive Optical Model Analysis.

We present the first systematic nonlocal dispersive optical model analysis using both bound-state and scattering data of ^{16,18}O, ^{40,48}Ca, ^{58,64}Ni, ^{112,124}Sn, and ^{208}Pb. In all systems, roughly half the total nuclear binding energy is associated with the most-bound 10% of the total nucleon density. The extracted neutron skins reveal the interplay of asymmetry, Coulomb, and shell effects on the skin thickness. Our results indicate that simultaneous optical model fits of inelastic scattering and structural data on isotopic pairs are effective for constraining asymmetry-dependent nuclear structural quantities otherwise difficult to observe experimentally.

First Observation of Unbound

The structure of the extremely proton-rich nucleus _{8}^{11}O_{3}, the mirror of the two-neutron halo nucleus _{3}^{11}Li_{8}, has been studied experimentally for the first time. Following two-neutron knockout reactions with a ^{13}O beam, the ^{11}O decay products were detected after two-proton emission and used to construct an invariant-mass spectrum. A broad peak of width ∼3.4 MeV was observed. Within the Gamow coupled-channel approach, it was concluded that this peak is a multiplet with contributions from the four lowest ^{11}O resonant states: J^{π}=3/2_{1}^{-}, 3/2_{2}^{-}, 5/2_{1}^{+}, and 5/2_{2}^{+}. The widths and configurations of these states show strong, nonmonotonic dependencies on the depth of the p-^{9}C potential. This unusual behavior is due to the presence of a broad threshold resonant state in ^{10}N, which is an analog of the virtual state in ^{10}Li in the presence of the Coulomb potential. After optimizing the model to the data, only a moderate isospin asymmetry between ground states of ^{11}O and ^{11}Li was found.

Large Longitudinal Spin Alignment of Excited Projectiles in Intermediate Energy Inelastic Scattering.

We study the sequential breakup of E/A=24.0 MeV ^{7}Li projectiles excited through inelastic interactions with C, Be, and Al target nuclei. For peripheral events that do not excite the target, we find very large spin alignment of the excited ^{7}Li projectiles longitudinal to the beam axis. This spin alignment is independent of the target used, and we propose a simple alignment mechanism that arises from an angular-momentum-excitation-energy mismatch. This mechanism is independent of the potential used for scattering and should be present in many scattering experiments.

[Survival Analysis Three-year Follow-up of Pacients with Head and Neck Cancer]. / Analýza prezití tríletého sledování nemocných s rakovinou hlavy a krku.

BACKGROUND: Patients with head and neck cancer are predominantnly at the risk for malnutrition. Monitoring of nutritional status and pre-treatment variables can favorably observe many prognostic indicators for overall survival in head and neck cancer before and during oncological treatment up to three years in head and neck cancer pacients. MATERIALS AND METHODS: In 726 patients diagnosed head and neck cancer patients with curative intent, were collected data according to the monitoring scheme of observation. As a clinical important of uninteded weight loss was defined weight loss 10% in input (T0). Differences in groups were analysed by Coxs regression with adjustments for important demografic and tumor-related data. RESULTS: The acceptance of the percutaneous endoscopic gastrostomy was a key factor for less complications and to improve tolerance of anticancer treatment. Men-smokers have the highest risk of cardiovascular mortality. Men-stop-smokers have the most significant life extension of 11 to 22 months; p < 0.007. Men-non-smokers have a life extension of 15 to 23 months (p < 0.005) and having its lowest cardiovascular mortality (11%). Women tolerate cancer better, have minor subjective complaints and a lower number of complications but significantly higher consumption of antidepressants (p < 0.003). While men have higher analgesic consumption (p < 0.001). Weight loss > 10% significantly correlates with the clinical manifestations of malnutrition and is associated with an increase in complications and mortality dependent cancer (p < 0.008). CONCLUSION: Consistent assessment of nutritional status with early intervention is considered as an essential part of comprehensive anticancer treatment. An independent risk factor for cancer-dependent mortality is considered weight loss of > 5% with a BMI < 21 at time T0 or weight loss > 10% weight T0 in BMI 21- 29 and continuing weight loss to T12 and also BMI 30. The highest-risk profile has a male sex-smoker, age > 63, hypopharyngeal carcinoma, stage III- IV, weight loss of > 10% and non-acceptance of percutaneous endoscopic gastrostomy. Another long-term observation of monitored nutritional status with intervention, clinical status and quality of life are needed.

[Long Term Monitoring of Nutritional, Clinical Status and Quality of Life in Head and Neck Cancer Patients]. / Dlouhodobé sledování nutricního, klinického stavu a kvality zivota u nemocných s rakovinou hlavy a krku.

BACKGROUND: Malnutrition in head and neck cancer (HNC) patients decreases survival, quality of life (QOL) and oncological outcomes. The aim of the prospective three-year study was to compare QOL, clinical symptoms and variables (complications, survival and mortality rates in HNC patients). PATIENTS AND METHODS: A total of 726 patients aged 55 to 72 years with treatable HNC were included from January 2004 to December 2009; these patients were randomized to either group with PEG and enteral nutrition and nonPEG group with nutritional counselling according to nutritional care. We used EORTC questionnaires QOL C-30 and Head and neck module (HN-35) for measuring of QOL. The following variables due to expectable influence on QOL (demographic data, oncological data, nutritional screening, Clinical symptom score, Karnofsky performance status score, Charlson comorbidity index) were included. Monitoring was done five times in three years. RESULTS: In the first six months, we found decrease of weight and body mass index (BMI). After this critical time point and finish of oncological treatment, a marked difference in the development of patients treated with PEG. Negative factors influencing patients survival, QOL, clinical status were males aged > 63 years, hypopharyngeal cancer (stage III- IV), smoking, weight loss > 10%, BMI < 21 and disallowance of PEG. CONCLUSIONS: QOL is an essential factor for cancer patients. Our study showed that nutritional intervention with early enteral nutrition may improve QOL and survival in HNC patients. The PEG group better tolerated oncological treatment, had lower incidence of complications, shorter time to re-entry of permanent increase in weight, lower rate of rehospitalization and its shorter length. We found QOL questionnaires to be very important for better understanding and communication and a key instrument for improving solution of patients difficulties during their therapy in multidisciplinary approach.

Observation of long-range three-body coulomb effects in the decay of (16)Ne.

The interaction of an E/A=57.6-MeV ^{17}Ne beam with a Be target is used to populate levels in ^{16}Ne following neutron knockout reactions. The decay of ^{16}Ne states into the three-body ^{14}O+p+p continuum is observed in the High Resolution Array (HiRA). For the first time for a 2p emitter, correlations between the momenta of the three decay products are measured with sufficient resolution and statistics to allow for an unambiguous demonstration of their dependence on the long-range nature of the Coulomb interaction. Contrary to previous measurements, our measured limit Γ<80 keV for the intrinsic decay width of the ground state is not in contradiction to the small values (of the order of keV) predicted theoretically.

Democratic decay of 6Be exposed by correlations.

The interaction of an E/A=70-MeV (7)Be beam with a Be target was used to populate levels in (6)Be following neutron knockout reactions. The three-body decay of the ground and first excited states into the α+p+p exit channel were detected in the High Resolution Array. Precise three-body correlations extracted from the experimental data allowed us to obtain insight into the mechanism of the three-body democratic decay. The correlation data are in good agreement with a three-cluster-model calculation and thus validate this theoretical approach over a broad energy range.

[Current guidelines on the care of tunelized vascular catheters in patients on home parenteral nutrition]. / Péce o tunelizované zilní katétry u nemocných na domácí parenterální výzive podle soucasných doporucení

Home parenteral nutrition is the only option to provide nutrition in a number of patients. Care of venous entry, its management and treatment of complications resulting from its use importantly affect patient survival. Appropriate care of the catheter and the use of current knowledge may prolong the lifespan of the catheter, reduce patient morbidity and mortality and thus increase quality of life of patients who are dependent on home parenteral nutrition. The present paper summarizes recommendations for the care of long-term venous catheters.

Neutron-upscattering enhancement of the triple-alpha process.

The neutron inelastic scattering of carbon-12, populating the Hoyle state, is a reaction of interest for the triple-alpha process. The inverse process (neutron upscattering) can enhance the Hoyle state's decay rate to the bound states of 12C, effectively increasing the overall triple-alpha reaction rate. The cross section of this reaction is impossible to measure experimentally but has been determined here at astrophysically-relevant energies using detailed balance. Using a highly-collimated monoenergetic beam, here we measure neutrons incident on the Texas Active Target Time Projection Chamber (TexAT TPC) filled with CO2 gas, we measure the 3α-particles (arising from the decay of the Hoyle state following inelastic scattering) and a cross section is extracted. Here we show the neutron-upscattering enhancement is observed to be much smaller than previously expected. The importance of the neutron-upscattering enhancement may therefore not be significant aside from in very particular astrophysical sites (e.g. neutron star mergers).

Ground-state proton decay of 69Br and implications for the 68Se astrophysical rapid proton-capture process waiting point.

We report on the first direct measurement of the proton separation energy for the proton-unbound nucleus (69)Br. Bypassing the (68)Se waiting point in the rp process is directly related to the 2p-capture rate through (69)Br, which depends exponentially on the proton separation energy. We find a proton separation energy for (69)Br of Sp((69)Br )= -785(-40)(+34) keV; this is less bound compared to previous predictions which have relied on uncertain theoretical calculations. The influence of the extracted proton separation energy on the rp process occurring in type I x-ray bursts is examined within the context of a one-zone burst model.

[Acute pancreatitis in diabetics]. / Akutní pankreatitida u diabetika.

All diabetic patients with acute pancreatitis should be intensively treated and monitored in spite of the fact that 75-80% have mild-to-moderate disease. This is due to difficult diagnosis and problems with standard monitoring due to diabetes and its complications. Especially intensive rehydration and subsequent fluid mobilisation can be difficult. Also glucose control and impaired gut motility can cause difficulties in diabetic patients with acute pancreatitis. Nutrition support should be implemented according to severity of disease and insulin infused to control glycaemia.

Neutron-proton asymmetry dependence of spectroscopic factors in ar isotopes.

Spectroscopic factors have been extracted for proton-rich 34Ar and neutron-rich 46Ar using the (p, d) neutron transfer reaction. The experimental results show little reduction of the ground state neutron spectroscopic factor of the proton-rich nucleus 34Ar compared to that of 46Ar. The results suggest that correlations, which generally reduce such spectroscopic factors, do not depend strongly on the neutron-proton asymmetry of the nucleus in this isotopic region as was reported in knockout reactions. The present results are consistent with results from systematic studies of transfer reactions but inconsistent with the trends observed in knockout reaction measurements.

Effects of hyaluronan and iodine on wound contraction and granulation tissue formation in rat skin wounds.

BACKGROUND: Hyaluronan (HA) plays an important role in the repair of damaged skin and has been used for the treatment of wounds. Iodine is a mild topical antiseptic. AIM: A mixture of high molecular weight HA with the iodine complex KI(3) (hyiodine) was reported to accelerate wound healing in patients with diabetes and patients after surgery. We investigated how this mixture affects wound contraction, granulation tissue (GT) and wound edges in excision skin wounds in rats. METHODS: Hyiodine was applied to full-thickness wounds made on the back of rats. The areas of the contracting wounds were calculated from digital photographs. The moving edges of the wound were studied by histological methods. The properties of GT were studied in wounds in which contraction was prevented by the insertion of plastic rings. The effects of hyiodine were compared with those of high molecular weight (1200 kDa) HA, low molecular weight (11 kDa) HA and KI(3) solution. RESULTS: Hyiodine accelerated wound contraction significantly in the first 5 days of healing. On day 3, hyiodine-treated wounds had reduced to 63% of the original area, whereas the wound area in saline-treated animals was 75% of the original size. The proliferating epidermis was thicker in hyiodine-treated animals on day 7. In the wounds with inserted rings, hyiodine caused little change in GT, but the weight of the crust/exudate formed on the top of the wound was increased by 351% compared with only minor changes caused by the hyiodine components alone. CONCLUSIONS: Hyiodine supports wound healing by stimulating wound contraction and epidermal proliferation and by keeping the wound moist through increased exudation.

[Local treatment of wounds and vascular perfusion]. / Lokální lécba ran a cévní zásobení.

Skin defects and wounds are rather frequent in diabetic population. They most frequently occur on lower limbs and their origins are often multifaceted. If vascular perfusion is not damaged, it is important to secure perfect drainage with sufficient incision and to use local treatment modalities such as hyaluronan-iodine complex, now well-established at our clinic. It is always essential to save the vascular system if this is damaged. Careful examination by an angiologist is normally followed by angioplasty or vascular bypass. Amputation is an extreme solution that, nevertheless, may save the limb functionality if done in a patient with ischemic damage that cannot be resolved.

[Abdominal catastrophe--abdominal wall defect associated with gastrointestinal fistula--strategy of therapy]. / Abdominální katastrofa--defekt steny brisní komplikovaný strevní pístelí--strategie lécby.

BACKGROUND: Wound dehiscence complicated by gastrointestinal (GI) fistula to belong ,,abdominal catastrophe". Therapy is prolonged and connected with high morbidity and mortality rate. METHODS: In the period from October 2006 to July 2009 we performed 12 reconstructive surgical procedures on gastrointestinal tract in patients with abdominal catastrophe. Treatment of 12 consecutive patients (9 men, 3 women) was managed according to a standardize protocol. The protocol consists of treatment of septic complications, optimisation of nutritional state, special wound procedures, diagnosis of gastrointestinal fistulas and GI tract, timing of surgical procedures, reconstruction of GI tract and postoperative care. RESULTS: Reconstructive surgery of GI tract was successful on 11 patients. One patient developed recurrence of early GI fistula. In four patients we let open abdomen to heal per secundam. We observed no deaths after operation. CONCLUSION: With regard to complex character of therapy of abdominal catastrophe there is a need of multidisciplinary approach. Considering long-lasting and expensive therapy there is logical step to concentrate these patients into special centres which are experienced, equipped and their staff is trained in treatment of such a seriously impaired patients.

[Enteral and parenteral nutrition with diabetes]. / Enterální a parenterální výziva u diabetu.

In type I diabetes insulin must be administered during nutritional support. The method of insulin administration is dependent on the clinical situation, presence of inflammation, method of nutrition delivery (enteral or parenteral) and other conditions. In type II diabetic patients oral drug treatment should be stopped in stress conditions. Obese type II diabetic patients often profit from hypocaloric nutrition but only when they are stable and any acute inflammatory illness has passed. This may improve their condition before elective procedures. However, strict monitoring of these patients is necessary in both types of diabetes mellitus.