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SS 433 is a binary system containing a supergiant star that is overflowing its Roche lobe with matter accreting onto a compact object (either a black hole or neutron star)1-3. Two jets of ionized matter with a bulk velocity of approximately 0.26c (where c is the speed of light in vacuum) extend from the binary, perpendicular to the line of sight, and terminate inside W50, a supernova remnant that is being distorted by the jets2,4-8. SS 433 differs from other microquasars (small-scale versions of quasars that are present within our own Galaxy) in that the accretion is believed to be super-Eddington9-11, and the luminosity of the system is about 1040 ergs per second2,9,12,13. The lobes of W50 in which the jets terminate, about 40 parsecs from the central source, are expected to accelerate charged particles, and indeed radio and X-ray emission consistent with electron synchrotron emission in a magnetic field have been observed14-16. At higher energies (greater than 100 gigaelectronvolts), the particle fluxes of γ-rays from X-ray hotspots around SS 433 have been reported as flux upper limits6,17-20. In this energy regime, it has been unclear whether the emission is dominated by electrons that are interacting with photons from the cosmic microwave background through inverse-Compton scattering or by protons that are interacting with the ambient gas. Here we report teraelectronvolt γ-ray observations of the SS 433/W50 system that spatially resolve the lobes. The teraelectronvolt emission is localized to structures in the lobes, far from the centre of the system where the jets are formed. We have measured photon energies of at least 25 teraelectronvolts, and these are certainly not Doppler-boosted, because of the viewing geometry. We conclude that the emission-from radio to teraelectronvolt energies-is consistent with a single population of electrons with energies extending to at least hundreds of teraelectronvolts in a magnetic field of about 16 microgauss.
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In this Letter, owing to a production error, the penultimate version of the PDF was published. The HTML version was always correct. The PDF has been corrected online.
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The rotational relaxation of CO2 by inelastic collisions has been studied in three supersonic jets. The jets were probed by means of Raman spectroscopy with high spectral and spatial resolutions, measuring the rotational populations and the total number density. The time evolution of the rotational populations was analyzed by means of a kinetic master equation, with the help of the energy-corrected sudden power law to relate the numerous state-to-state rate (STS rates) coefficients. In the thermal range investigated, 60-260 K, the STS rates decrease with increasing temperature and with increasing change in the rotational quantum number. Other quantities of interest for fluid dynamics, such as the rotational collision number, the relaxation cross section, and the bulk viscosity, have been derived from the STS rates.
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DIGEST is a validated, open-source method to grade the severity of pharyngeal dysphagia from the modified barium swallow (MBS) study. Dissemination and implementation of DIGEST is rising, making it critical to understand reliability and facilitators of accurate implementation among users. The aim was to assess reliability of the tool among speech-language pathology (SLP) raters practicing at multiple sites before and after review of a DIGEST training manual and evaluate confidence of DIGEST use pre-and post-training. Thirty-two SLPs from 5 sites participated in a blinded longitudinal DIGEST rating study. Raters were provided a standardized training set of MBS (n = 19). Initial SLP ratings (round 1, R1) were followed by a 2-4 week break before raters rated a re-keyed MBS set (round 2, R2). A minimum 4-8 week wash-out period then preceded self-study of the DIGEST training manual which was followed by a final rating (round 3, R3) and a post-manual survey afterwards. Baseline reliability (R1) of overall DIGEST was on average k = 0.70, reflecting agreement in the substantial range. Seventy-five percent of raters (24/32) demonstrated reliability ≥ 0.61 in the substantial to almost perfect range prior to training. Inter-rater reliability significantly improved from R1 to R3 after review of the DIGEST manual, with the largest change in DIGEST-Efficiency (mean change: DIGEST k = .04, p = .009, DIGEST-Safety k = .07, p = 0.03, and DIGEST-Efficiency k = .14, p = 0.009). Although DIGEST reliability at baseline was adequate in the majority of raters, self-study of the DIGEST training manual significantly improved inter-rater reliability and rater confidence using the DIGEST method, particularly when assigning DIGEST-Efficiency grade. These early data show promise that provider training may be useful to aid in fidelity of DIGEST implementation among SLP clinical users with varying DIGEST experience.
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We report the first detection of a TeV γ-ray flux from the solar disk (6.3σ), based on 6.1 years of data from the High Altitude Water Cherenkov (HAWC) observatory. The 0.5-2.6 TeV spectrum is well fit by a power law, dN/dE=A(E/1 TeV)^{-γ}, with A=(1.6±0.3)×10^{-12} TeV^{-1} cm^{-2} s^{-1} and γ=3.62±0.14. The flux shows a strong indication of anticorrelation with solar activity. These results extend the bright, hard GeV emission from the disk observed with Fermi-LAT, seemingly due to hadronic Galactic cosmic rays showering on nuclei in the solar atmosphere. However, current theoretical models are unable to explain the details of how solar magnetic fields shape these interactions. HAWC's TeV detection thus deepens the mysteries of the solar-disk emission.
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In this study, we tested a response function comprising responses in milk to changes in organic matter digestibility of silages and concentrate supply. We studied the effect of changes in silage digestibility and concentrate supply on milk yield, feed intake, body weight, and methane production using 60 Norwegian Red cows. The experiment was a complete randomized block design comprising 3 periods. The pre-experimental period lasted 20 d and all the cows were fed a common silage for ad libitum intake and concentrate according to yield. Next, response period 1 lasted 17 d and the cows were divided into 2 treatments, where a low-digestible silage (LDS) was fed to half of the cows, and the other half were fed a high-digestible silage (HDS). Both groups were fed silage for ad libitum silage intake. Concentrate was optimized according to the yield and type of silage offered. In this period, the effect of silage was evaluated using a mixed model, including the results from pre-experimental period, with parity as a covariate and animal as a random effect. In response period 2, which lasted 20 d, the concentrate level was evaluated by dividing the silage digestibility treatments further into 3 subgroups. Concentrate was increased by 2 kg of dry matter (DM) per day, decreased by 2 kg of DM/d, or remained unchanged. In response period 1, silage treatments were optimized to obtain similar yields and resulted in a lower concentrate offer to HDS treatment. However, the HDS treatment showed a 3.0 kg of DM/d higher total feed intake due to a higher than expected silage intake. This resulted in 3.5 kg higher energy-corrected milk (ECM). Methane emissions were similar between silage treatments, but HDS showed lower methane per kilogram of DM due to its higher intake. The effect of concentrate supply level and interaction with silage digestibility was evaluated using mixed models, including the results for response period 1, with parity as a covariate and animal as a random effect. The reduction in concentrate offer by 2 kg/d in response period 2 was compensated for by increased 1.3 kg of DM/d of silage intake for HDS, resulting in similar intake (22.1 kg of DM/d and 21.7 kg of DM/d without and with concentrate reduction, respectively) and ECM yields (29.4 and 29 kg of ECM without and with concentrate reduction, respectively). However, concentrate offer reduction could not be compensated for by increased silage intake for LDS and resulted in lower milk yields (27.5 kg of ECM). Increased concentrate showed a higher marginal ECM response (kg of ECM per kg of additional concentrate intake) for LDS (1.8 vs. 3.3 kg of ECM for HDS and LDS, respectively). Thus, the drop in milk yields could be compensated for by increased concentrate offers if LDS are fed. Total methane production increased with increased concentrate intake, regardless of silage digestibility. Methane emissions per unit of milk were affected by total DM intake rather than by changes in silage digestibility and concentrate level. The results of this study are based on short-term periods and could show differences if study periods were longer; the results should be interpreted accordingly.
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Metano , Ensilaje , Animales , Bovinos , Dieta/veterinaria , Digestión , Femenino , Lactancia/fisiología , Leche , Embarazo , Rumen , Ensilaje/análisis , Zea maysRESUMEN
The objective of the study was to develop a static empirical model for the estimation of net energy content of compound feeds in a dynamic feeding system using net energy for lactation at 20 kg of dry matter intake/d (NEL20) values calculated by the Nordic Feed Evaluation System (NorFor) model. In the NorFor system, NEL20 is a standardized value used to describe net energy content of feeds. The static model would allow prediction of the net energy value of compound feeds without access to the input data needed for the dynamic models. Our hypothesis was that NEL20 values of compound feeds can be predicted using organic matter digestibility (in vitro) and chemical components of the compound feeds as input variables. For this, 75 compound feeds and their 108 associated ingredients were collected across Scandinavia for model development. The proposed best model for prediction of compound feed NEL20 included crude fat, neutral detergent fiber, digestible organic matter measured in vitro, and crude protein (urea corrected) as independent variables. Lack of additivity of chemical components between values analyzed directly in the compound feed and values calculated by the weighted sum of ingredients was detected as the main source of error in the model, emphasizing the importance of accurate chemical analysis and sampling practices. Results from practical use of the model show that it may be a valuable tool that could be used by several actors in the feeding sector using the NorFor system. Feed manufacturers could use it to monitor the net energy content in their final product, and farmers could use it to check the net energy content of the purchased compound feed. However, validation of this model against an independent set of samples is lacking in this study and its prediction performance should be further evaluated. The model will need recalibration if the feed parameters used in the dynamic model for the estimation of reference values change, as this would not be reflected in the predicted values of the created model.
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Alimentación Animal , Digestión , Alimentación Animal/análisis , Animales , Dieta , Fibras de la Dieta , Femenino , Lactancia , Países Escandinavos y NórdicosRESUMEN
OBJECTIVE: To investigate the impact of hip osteoarthritis (OA) and/or hip symptoms on excess mortality. DESIGN: We analyzed data from 3,919 individuals in a community-based prospective cohort of African Americans and Caucasians age ≥45 years. Women ≥50 years of age and all men underwent supine anteroposterior pelvic radiography at baseline, with the participant's feet in 15 degrees of internal rotation. Hip radiographic (rOA) was defined as a Kellgren-Lawrence grade of ≥2 in at least one hip. Participants completed questionnaires at baseline to determine presence of hip symptoms and covariate status. Participants with symptomatic hip rOA (SxOA) are a subset of individuals with hip rOA and symptoms in the same hip. Multiple imputation was used to impute missing values of covariates. Mortality was determined through 2015 and follow-up time was calculated from baseline assessment until death or censoring which took place when a participant was lost to follow-up or reached the end of study period. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). We carried out additional analyses stratified by sex, race, age and obesity. RESULTS: Mean follow-up time was 14.2 years during which 1762 deaths occurred. There were 29.9% participants in our population with hip rOA at baseline. Compared to those with neither hip rOA nor hip symptoms, we observed an increased risk of all-cause mortality in participants with hip symptoms alone (HR = 1.28, 95% CI = 1.13-1.46), but no association for hip rOA either with or without symptoms. In stratified analyses we observed increased associations for hip symptoms alone and hip sxOA in those <65 years (43% and 39% increase, respectively) and in Caucasians (34% and 21% increase, respectively). CONCLUSIONS: Individuals who had hip symptoms without hip rOA had an increased risk of mortality. These effects were particularly strong for those who were <65 years of age and Caucasians. Effective interventions to identify those with hip pain in order to lessen it could reduce premature mortality.
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Artralgia/epidemiología , Mortalidad Prematura , Osteoartritis de la Cadera/epidemiología , Anciano , Anciano de 80 o más Años , Artralgia/fisiopatología , Estudios de Cohortes , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/fisiopatología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To describe the incidence and progression of radiographic and symptomatic hand osteoarthritis (rHOA and sxHOA) in a large community-based cohort. DESIGN: Data were from the Johnston County OA Project (1999-2015, 12 ± 1.2 years follow-up, age 45+). Participants had bilateral hand radiographs each visit, read for Kellgren-Lawrence grade (KLG) at 30 joints. We defined rHOA as KLG ≥2 in ≥1 joint. SxHOA was defined in a hand/joint with rHOA and self-reported symptoms or tenderness on exam. Incidence was assessed in those without, while progression was assessed in those with, baseline rHOA. Proportions or medians are reported; differences by sex and race were assessed using models appropriate for dichotomous or continuous definitions, additionally adjusted for age, education, body mass index (BMI), and weight change. RESULTS: Of 800 participants (68% women, 32% African American, mean age 60 years), 327 had baseline rHOA and were older, more often white and female, than those without rHOA (n = 473). The incidence of HOA was high, for rHOA (60%) and for sxHOA (13%). Women were more likely than men to have incident HOA, particularly for distal interphalangeal joint radiographic osteoarthritis (DIP rOA) (adjusted odds ratios (aOR) 1.60 95% confidence intervals (95% CI) [1.03, 2.49]) and sxHOA (aOR 2.98 [1.50, 5.91]). Progressive HOA was more similar by sex, although thumb base rOA progressed more frequently in women than in men (aOR 2.56 [1.44, 4.55]). Particularly HOA incidence, but also progression, was more frequent among whites compared with African Americans. CONCLUSION: This study provides much needed information about the natural history of HOA, a common and frequently debilitating condition, in the general population.
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Articulaciones de la Mano/diagnóstico por imagen , Osteoartritis/epidemiología , Negro o Afroamericano , Anciano , Articulaciones Carpometacarpianas/diagnóstico por imagen , Articulaciones Carpometacarpianas/fisiopatología , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/fisiopatología , Articulaciones de la Mano/fisiopatología , Humanos , Incidencia , Masculino , Articulación Metacarpofalángica/diagnóstico por imagen , Articulación Metacarpofalángica/fisiopatología , Persona de Mediana Edad , North Carolina/epidemiología , Osteoartritis/diagnóstico por imagen , Osteoartritis/etnología , Osteoartritis/fisiopatología , Radiografía , Población BlancaRESUMEN
Because of the high energies and long distances to the sources, astrophysical observations provide a unique opportunity to test possible signatures of Lorentz invariance violation (LIV). Superluminal LIV enables the decay of photons at high energy. The high altitude water Cherenkov (HAWC) observatory is among the most sensitive gamma-ray instruments currently operating above 10 TeV. HAWC finds evidence of 100 TeV photon emission from at least four astrophysical sources. These observations exclude, for the strongest of the limits set, the LIV energy scale to 2.2×10^{31} eV, over 1800 times the Planck energy and an improvement of 1 to 2 orders of magnitude over previous limits.
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The enzymatic digestibility of organic matter (EDOM) method is an in vitro multi-enzymatic method for estimating the organic matter (OM) digestibility of feeds. The EDOM method previously showed high accuracy with in vivo values for compound feeds. The aim of this study was to evaluate the precision of the EDOM method and determine its additivity, compared with the long-assumed additive property of the chemical components of compound feeds. 149 feed samples, 70 commercial compound feeds and 79 associated ingredients, were analyzed in a laboratory (lab1) for OM digestibility measured by EDOM (OMDEDOM) with 2 repetitions separated in time to estimate repeatability. Of the total samples, 49 compound feeds were further analyzed in a commercial laboratory (lab2) for OMDEDOM to determine reproducibility. The 49 compounds and their 69 associated ingredients were also analyzed by lab2 for dry matter (DM), ash, crude protein (CP), neutral detergent fiber (NDF), and starch. The EDOM method resulted in an intralaboratory correlation of 98.9% and an interlaboratory correlation of 92.6%, with no significant mean bias between the 2 laboratories tested. The formulation of compound feeds, total mixed rations, and mixtures in general assumes that their nutrient content can be calculated by adding together the nutrient supply of individual ingredients. This is of great importance in the feed industry for the creation of compound feeds. Additivity of OMDEDOM for the compound feed samples was evaluated by comparing the sum of the digestible OM (DOMEDOM) of the ingredients (predicted) with DOMEDOM estimated directly in the compound feed (observed). The regression of predicted versus observed showed a coefficient of determination (R2) of 0.93 and root mean square error (RMSE) of 1.07% of total DM, with no linear bias but with a mean bias (0.83% of DM). Additivity of CP, starch, crude fat, and NDF showed an R2 of 0.95, 0.98, 0.95, and 0.93, and RMSE of 1.56, 1.90, 0.39, and 1.46% of DM, respectively, all presenting linear bias. Crude fat also presented mean bias. Although significant, all linear and mean bias for DOMEDOM and chemical components were within the acceptable error limits for declaration of feeds. The results demonstrate the high precision of the EDOM method and its additive property, which is an advantage for the estimation of OM digestibility in compound feeds. Moreover, results of the tests of chemical components confirm their additive property.
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Alimentación Animal , Digestión , Técnicas In Vitro , Fibras de la Dieta/metabolismo , Compuestos Orgánicos , Reproducibilidad de los ResultadosRESUMEN
Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HLH) is a highly lethal hyper-inflammatory disorder that leads to a storm of cytokines, hemophagocytosis and multiple organ failure. It can be primary, which is inherited, or secondary. In the latter, virus infections are a frequent trigger, predominantly the family of herpes viruses, such as Epstein-Barr virus. An early treatment is recommended. Until recently there was no consensus about the management of secondary cases. The protocols for the treatment of primary HLH were used, which include cytotoxic agents and corticosteroids. We herein review the current diagnostic and therapeutic approach of HLH, based on a case associated with a reactivation of the Epstein-Barr virus in an immunocompetent adolescent. We highlight the importance of suspecting this disease in patients with a persistent inflammatory response state or with a fever of unknown origin, in order to carry out a timely treatment, with the least toxicity, and appropriate to the characteristics of each individual, which is the current therapeutic trend.
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Linfohistiocitosis Hemofagocítica , Corticoesteroides , Citocinas , Infecciones por Virus de Epstein-Barr , HumanosRESUMEN
BACKGROUND: Mannose-binding lectin (MBL) is a key component of innate immunity. Low serum MBL levels, related to promoter polymorphism and structural variants, have been associated with an increased risk of infection. The aim of this work was to analyse the incidence and severity of infections and mortality in relation to the MBL2 genotype and MBL levels in patients underwent allogeneic haematopoietic stem cell transplantation (Allo-HSCT). RESULTS: This was a prospective cohort study of 72 consecutive patients underwent Allo-HSCT between January 2007 and June 2009 in a tertiary referral centre. Three periods were considered in the patients' follow-up: the early period (0-30 days after Allo-HSCT), the intermediate period (30-100 days after Allo-HSCT) and the late period (> 100 days after Allo-HSCT). A commercial line probe assay for MBL2 genotyping and an ELISA Kit were used to measure MBL levels. A total of 220 episodes of infection were collected in the 72 patients. No association between donor or recipient MBL2 genotype and infection was found. The first episode of infection presented earlier in patients with pre-transplant MBL levels of < 1000 ng/ml (median 6d vs 8d, p = 0.036). MBL levels < 1000 ng/ml in the pre-transplant period (risk ratio (RR) 2.48, 95% CI 1.00-6.13), neutropenic period (0-30 days, RR 3.28, 95% CI 1.53-7.06) and intermediate period (30-100 days, RR 2.37, 95% CI 1.15-4.90) were associated with increased risk of virus infection. No association with bacterial or fungal disease was found. Mortality was associated with pre-transplant MBL levels < 1000 ng/ml (hazard ratio 5.55, 95% CI 1.17-26.30, p = 0.03) but not with MBL2 genotype. CONCLUSIONS: Patients who underwent Allo-HSCT with low pre-transplant MBL levels presented the first episode of infection earlier and had an increased risk of viral infections and mortality in the first 6 months post-transplant. Thus, pre-transplant MBL levels would be important in predicting susceptibility to viral infections and mortality and might be considered a biomarker to be included in the pre-transplantation risk assessment.
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Susceptibilidad a Enfermedades , Expresión Génica , Trasplante de Células Madre Hematopoyéticas , Lectina de Unión a Manosa/genética , Virosis/etiología , Virosis/mortalidad , Adolescente , Adulto , Biomarcadores , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/terapia , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Masculino , Lectina de Unión a Manosa/sangre , Persona de Mediana Edad , Polimorfismo Genético , Periodo Preoperatorio , Pronóstico , Trasplante Homólogo , Virosis/diagnóstico , Adulto JovenRESUMEN
OBJECTIVE: To investigate the impact of knee osteoarthritis (OA) and/or knee pain on excess mortality. METHOD: We analyzed data from 4,182 participants in a community-based prospective cohort study of African American and Caucasian men and women aged ≥45 years. Participants completed knee radiographs and questionnaires at baseline and at up to three follow-ups to determine knee OA (rOA), knee pain and covariate status. Mortality was determined through 2015. We used Cox proportional hazards regression with time-varying covariates (TVC) to estimate hazard ratios (HR) and 95% confidence intervals (CI). Additional analyses stratified by sex, race and age were carried out. RESULTS: Median follow-up time was 14.6 years during which 1822 deaths occurred. Baseline knee radiographic osteoarthritis (rOA) was 27.7%, 38.8% at first follow-up, 52.6% at second follow-up and 61.9% at the third follow-up. Knee rOA with pain and knee pain alone were both associated with a >15% increase in premature all-cause mortality. In analyses stratified by sex, race and age, associations between knee pain, with or without knee rOA, and all-cause death were found among women, Caucasians, those ≤65 years of age, and those with a body mass index (BMI)≥30, with observed increased risks of death between 21% and 65%. We observed similar, somewhat attenuated, results for cardiovascular disease (CVD) deaths. CONCLUSION: In models taking into account variables that change over time, individuals who had knee pain, alone or with knee rOA, had increased mortality. These effects were particularly strong among those obese. Effective interventions to reduce knee pain, particularly those including weight management and prevention of comorbidities, could reduce mortality.
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Artralgia/etiología , Predicción , Articulación de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/mortalidad , Dimensión del Dolor/métodos , Medición de Riesgo/métodos , Anciano , Anciano de 80 o más Años , Artralgia/epidemiología , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/fisiopatología , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/diagnóstico , Estudios Prospectivos , Tasa de Supervivencia/tendencias , Estados Unidos/epidemiologíaRESUMEN
AIMS: Determine the antimicrobial effects of 5 µmol ml-1 sodium chlorate, 9 µmol ml-1 nitroethane or 2-nitropropanol as well as lauric acid, myristic acid and the glycerol ester of lauric acid Lauricidin® , each at 5 mg ml-1 , against representative methicillin-resistant staphylococci, important mastitis- and opportunistic dermal-pathogens of humans and livestock. METHODS AND RESULTS: Three methicillin-resistant Staphylococcus aureus and two methicillin-resistant coagulase-negative staphylococci were cultured at 39°C in 5 µmol ml-1 nitrate-supplemented half-strength Brain Heart Infusion broth treated without or with the potential inhibitors. Results revealed that 2-nitropropanol was the most potent and persistent of all compounds tested, achieving 58-99% decreases in mean specific growth rates and maximum optical densities when compared with untreated controls. Growth inhibition did not persist by cultures treated solely with chlorate or nitroethane, with adaptation occurring by different mechanisms after 7 h. Adaptation did not occur in cultures co-treated with nitroethane and chlorate. The medium chain fatty acid compounds had modest effects on all the staphylococci tested except the coagulase-negative Staphylococcus epidermidis strain NKR1. CONCLUSIONS: The antimicrobial activity of nitrocompounds, chlorate and medium chain fatty acid compounds against different methicillin-resistant staphylococci varied in potency. SIGNIFICANCE AND IMPACT OF THE STUDY: Results suggest that differential antimicrobial activities exhibited by mechanistically dissimilar inhibitors against methicillin-resistant staphylococci may yield potential opportunities to combine the treatments to overcome their individual limitations and broaden their activity against other mastitis and dermal pathogens.
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Antibacterianos/farmacología , Cloratos/farmacología , Ácidos Grasos/farmacología , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacosRESUMEN
OBJECTIVE: To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. METHODS: Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. RESULTS: 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. CONCLUSIONS: Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.
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Corticoesteroides/uso terapéutico , Asma/epidemiología , Costo de Enfermedad , Asma/tratamiento farmacológico , Asma/economía , Niño , Chile/epidemiología , Estudios de Cohortes , Progresión de la Enfermedad , Servicios Médicos de Urgencia , Femenino , Estudios de Seguimiento , Hospitalización , Humanos , Masculino , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Shrimp of Farfantepenaeus californiensis (78 groups) and Litopenaeus stylirostris (14 groups) were caught in the northwestern fishing zones in Mexico during the 2014-2015 fishing season (September-February); both shrimp species have high commercial value. Muscle, hepatopancreas and exoskeleton were analyzed to determine their metal contents. For F. californiensis, the highest Cd, Pb and Zn contents were determined in specimens caught off the State of Baja California Sur (BCS) with 22.4 ± 8.9 (hepatopancreas), 2.83 ± 4.63 (muscle), and 748.5 ± 1567 (muscle) µg/g, in the regions off Mulegé, Los Cabos and Los Cabos, respectively. For L. stylirostris, the fishing zone of Comundú (BCS) showed higher Cd (12.3 ± 11.5 µg/g), Cu (569.1 ± 646.5 µg/g) and Zn (549.7 ± 400.7 µg/g) contents; all values were determined in the hepatopancreas. Regarding the hazard quotient and total hazard quotient calculated in this study, the consumption of marine shrimp caught off NW Mexico does not represent a risk to human health (both < 1).
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Contaminación de Alimentos , Metales/análisis , Penaeidae/química , Alimentos Marinos , Animales , Monitoreo del Ambiente , Hepatopáncreas/química , Humanos , México , Músculos/química , Medición de RiesgoRESUMEN
Background: Papillary thyroid cancer (PTC) is the most common thyroid carcinoma and exhibits an almost uniformly good prognosis, while anaplastic thyroid cancer (ATC) is less frequent and is one of the most aggressive cancers usually resistant to conventional treatment. Current hypothesis posits that ATC derives from PTC through the progressive acquisition of a discrete number of genomic alterations and implies that the mutational landscape of ATC resembles that of PTC. However, the clinical behaviour of ATC and PTC is radically different. We decided to address the disconnection between the clinical behaviour of ATC and PTC and the proposed model of the progressive development of ATC from PTC. Patients and methods: We carried out exome sequencing of DNA from 14 ATC specimens including three cases of concomitant ATC and PTC as well as their corresponding normal DNA from 14 patients. The sequencing results were validated using droplet digital PCR. We carried out immunohistochemistry and immunofluorescence studies of the concomitant ATC and PTC cases. In addition, we integrated our sequencing results with the existing TCGA data. Results: Most of the somatic mutations identified in the ATC component differed from the ones in PTC in the cases of concomitant ATC and PTC. The trunks of the phylogenetic trees representing the somatic mutations were short with long branches. In one case of concomitant PTC and ATC specimens, we observed an infiltration of PTC cells within the ATC component. Moreover, we integrated our results with data obtained from TCGA and observed that the most frequent mutations found in ATC presented high cancer cell fraction values and were significantly different from the PTC ones. Conclusion: ATC diverge from PTC early in tumour development and both tumour types evolve independently. Our work allows the understanding of the relationship between ATC and PTC facilitating the clinical management of these malignancies.
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Biomarcadores de Tumor/genética , Evolución Clonal , Cáncer Papilar Tiroideo/patología , Carcinoma Anaplásico de Tiroides/patología , Neoplasias de la Tiroides/patología , Humanos , Mutación , Filogenia , Pronóstico , Cáncer Papilar Tiroideo/genética , Carcinoma Anaplásico de Tiroides/genética , Neoplasias de la Tiroides/genética , Secuenciación del ExomaRESUMEN
BACKGROUND: Little evidence exists on which variables of body composition or muscular strength mediates more glucose control improvements taking into account inter-individual metabolic variability to different modes of exercise training. OBJECTIVE: We examined 'mediators' to the effects of 6-weeks of resistance training (RT) or high-intensity interval training (HIT) on glucose control parameters in physically inactive schoolchildren with insulin resistance (IR). Second, we also determined both training-induce changes and the prevalence of responders (R) and non-responders (NR) to decrease the IR level. METHODS: Fifty-six physically inactive children diagnosed with IR followed a RT or supervised HIT program for 6 weeks. Participants were classified based on ΔHOMA-IR into glycemic control R (decrease in homeostasis model assessment-IR (HOMA-IR) <3.0 after intervention) and NRs (no changes or values HOMA-IR⩾3.0 after intervention). The primary outcome was HOMA-IR associated with their mediators; second, the training-induced changes to glucose control parameters; and third the report of R and NR to improve body composition, cardiovascular, metabolic and performance variables. RESULTS: Mediation analysis revealed that improvements (decreases) in abdominal fat by the waist circumference can explain more the effects (decreases) of HOMA-IR in physically inactive schoolchildren under RT or HIT regimes. The same analysis showed that increased one-maximum repetition leg-extension was correlated with the change in HOMA-IR (ß=-0.058; P=0.049). Furthermore, a change in the waist circumference fully mediated the dose-response relationship between changes in the leg-extension strength and HOMA-IR (ß'=-0.004; P=0.178). RT or HIT were associated with significant improvements in body composition, muscular strength, blood pressure and cardiometabolic parameters irrespective of improvement in glycemic control response. Both glucose control RT-R and HIT-R (respectively), had significant improvements in mean HOMA-IR, mean muscular strength leg-extension and mean measures of adiposity. CONCLUSIONS: The improvements in the lower body strength and the decreases in waist circumference can explain more the effects of the improvements in glucose control of IR schoolchildren in R group after 6 weeks of RT or HIT, showing both regimes similar effects on body composition or muscular strength independent of interindividual metabolic response variability.
Asunto(s)
Glucemia/metabolismo , Ejercicio Físico/fisiología , Entrenamiento de Intervalos de Alta Intensidad , Resistencia a la Insulina/fisiología , Entrenamiento de Fuerza , Glucemia/análisis , Niño , Femenino , Entrenamiento de Intervalos de Alta Intensidad/métodos , Entrenamiento de Intervalos de Alta Intensidad/estadística & datos numéricos , Humanos , Masculino , Fuerza Muscular/fisiología , Entrenamiento de Fuerza/métodos , Entrenamiento de Fuerza/estadística & datos numéricosRESUMEN
OBJECTIVE: To provide the first prevalence estimates of different radiographic hip morphologies relevant to dysplasia and femoroacetabular impingement in a well-characterized USA population-based cohort. METHODS: Cross-sectional data were from the baseline examination (1991-1997) of a large population-based prospective longitudinal cohort study (The Johnston County Osteoarthritis Project). HipMorf software (Oxford, UK) was used to assess hip morphology on anteroposterior (AP) pelvis radiographs. Weighted, sex-stratified prevalence estimates and 95% confidence intervals for four key hip morphologies (AP alpha angle, triangular index sign, lateral center edge angle (LCEA), and protrusio acetabula) were derived and further stratified by age, race and body mass index (BMI). RESULTS: A total of 5192 hips from 2596 individuals were included (31% African American, 43% male, mean age 63 years, mean BMI 29 kg/m2). Cam morphology was seen in more than 25% of men and 10% of women. Mild dysplasia was present in about 1/3 of men and women, while pincer morphology was identified in 7% of men and 10% of women. Femoral side (cam) morphologies were more common and more frequently bilateral among men, while pincer morphologies were more common in women; mixed morphologies were infrequent. African-Americans were more likely to have protrusio acetabula than whites. CONCLUSION: We report the first population-based prevalence estimates of radiographic hip morphologies relevant to femoroacetabular impingement (FAI) and dysplasia in the USA. These morphologies are very common, with » men and 1/10 women having cam morphology, 1/3 of all adults having mild dysplasia, and 1/15 men and 1/10 women having pincer morphology in at least one hip.