Detection of infrared fluorescence of carbon dioxide in R Leonis with SOFIA/EXES.

We report on the detection of hot CO2 in the O-rich AGB star R Leo based on high spectral resolution observations in the range 12.8 - 14.3 µm carried out with the Echelon-cross-Echelle Spectrograph (EXES) mounted on the Stratospheric Observatory for Infrared Astronomy (SOFIA). We have found ≃ 240 CO2 emission lines in several vibrational bands. These detections were possible thanks to a favorable Doppler shift that allowed us to avoid contamination by telluric CO2 features. The highest excitation lines involve levels at an energy of ≃ 7000 K. The detected lines are narrow (average deconvolved width ≃ 2.5 km s-1) and weak (usually ≲ 10% the continuum). A ro-vibrational diagram shows that there are three different populations, warm, hot, and very hot, with rotational temperatures of ≃ 550, 1150, and 1600 K, respectively. From this diagram, we derive a lower limit for the column density of ≃ 2.2 × 1016 cm-2. Further calculations based on a model of the R Leo envelope suggest that the total column density can be as large as 7 × 1017 cm -2 and the abundance with respect to H2 - 2.5 × 10-5. The detected lines are probably formed due to de-excitation of CO2 molecules from high energy vibrational states, which are essentially populated by the strong R Leo continuum at 2.7 and 4.2 µm.

Treatment with low-dose tacrolimus inhibits bleeding complications in a patient with hereditary hemorrhagic telangiectasia and pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) can be found in patients suffering from a loss-of-function mutation of the gene encoding for the activin receptor-like kinase 1 (ALK-1), a bone morphogenetic protein (BMP) type 1 receptor. Interestingly, ALK-1 mutations also lead to hereditary hemorrhagic telangiectasia (HHT), an autosomal dominant disease characterized by arteriovenous malformations (AVMs) leading to potentially life-threatening bleeding complications such as epistaxis. Current therapeutic options for both diseases are limited and often only temporary or accompanied by severe side effects. Here, we report of a patient with a mutation of the ALK-1 gene suffering from both HHT and PAH. Recently, it was shown that tacrolimus increased ALK-1 signaling and had beneficial effects in selected end-stage PAH patients. We thus hypothesized that treatment with tacrolimus may prevent disease progression in this patient. Surprisingly, treatment with low-dose tacrolimus dramatically improved his HHT-associated epistaxis but did not attenuate progression of PAH.

[Hospital-acquired pneumonia]. / Nosokomial erworbene Pneumonie.

Hospital-acquired pneumonia (HAP) is a frequent complication of hospitalisation. Due to rising multidrug resistant bacteria an appropriate, empiric and targeted therapy is essential and requires an accurate assessment of risk for multidrug resistant bacteria. A targeted, temporal therapy is indispensable and should begin after a focussed diagnosis. Re-evaluation of therapy is important, as clinical course, microbiological and laboratory results might lead to de-escalation of therapy. In this review article the current German guidelines on the diagnosis and therapy of hospital-acquired pneumonia are summarized. Special focus is put on targeted, risk-adapted therapy.

Carbon Chemistry in IRC+10216: Infrared Detection of Diacetylene.

We present the detection of C4H2 for first time in the envelope of the C-rich AGB star IRC+10216 based on high spectral resolution mid-IR observations carried out with the Texas Echelon-cross-Echelle Spectrograph (TEXES) mounted on the Infrared Telescope Facility (IRTF). The obtained spectrum contains 24 narrow absorption features above the detection limit identified as lines of the ro-vibrational C4H2 band ν6+ν8(σu+). The analysis of these lines through a ro-vibrational diagram indicates that the column density of C4H2 is (2.4 ± 1.5) × 1016 cm-2. Diacetylene is distributed in two excitation populations accounting for 20 and 80% of the total column density and with rotational temperatures of 47 ± 7 and 420 ± 120 K, respectively. This two-folded rotational temperature suggests that the absorbing gas is located beyond ≃0·"4≃20R⋆ from the star with a noticeable cold contribution outwards from ≃ 10″ ≃ 500R⋆. This outer shell matches up with the place where cyanoacetylenes and carbon chains are known to form due to the action of the Galactic dissociating radiation field on the neutral gas coming from the inner layers of the envelope.

[Update pulmonary arterial hypertension : Definitions, diagnosis, therapy]. / Update pulmonalarterielle Hypertonie : Definitionen, Diagnose, Therapie.

The term pulmonary arterial hypertension comprises a group of pulmonary vascular diseases of different etiologies that are characterized by similar precapillary vascular remodeling processes and result in exertional dyspnea and right heart insufficiency. The specific pharmacological treatment approach considers the risk of mortality and phenotypical properties and includes treatment with phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and prostanoids, as well as with more novel substances, such as a soluble guanylyl cyclase stimulator and an oral prostacyclin receptor agonist. The prognosis of the disease is mainly determined by the right heart insufficiency for which there is currently no specific pharmacological treatment. Lung transplantation may be offered as a last option. This review provides an overview of the current European guidelines from 2015 and the recommendations of the Cologne Consensus Conference for pulmonary hypertension from 2016.

The Abundance of C2H4 in the Circumstellar Envelope of IRC+10216.

High spectral resolution mid-IR observations of ethylene (C2H4) towards the AGB star IRC+10216 were obtained using the Texas Echelon Cross Echelle Spectrograph (TEXES) at the NASA Infrared Telescope Facility (IRTF). Eighty ro-vibrational lines from the 10.5 µm vibrational mode ν7 with J ≲ 30 were detected in absorption. The observed lines are divided into two groups with rotational temperatures of 105 and 400 K (warm and hot lines). The warm lines peak at ≃ -14 km s-1 with respect to the systemic velocity, suggesting that they are mostly formed outwards from ≃ 20R⋆. The hot lines are centered at -10 km s-1 indicating that they come from a shell between 10 and 20R⋆. 35% of the observed lines are unblended and can be fitted with a code developed to model the emission of a spherically symmetric circumstellar envelope. The analysis of several scenarios reveal that the C2H4 abundance relative to H2 in the range 5 - 20R⋆ is 6.9 × 10-8 in average and it could be as high as 1.1 × 10-7. Beyond 20R⋆, it is 8.2 × 10-8. The total column density is (6.5 ± 3.0) × 1015 cm-2. C2H4 is found to be rotationally under local thermodynamical equilibrium (LTE) and vibrationally out of LTE. One of the scenarios that best reproduce the observations suggests that up to 25% of the C2H4 molecules at 20R⋆ could condense onto dust grains. This possible depletion would not influence significantly the gas acceleration although it could play a role in the surface chemistry on the dust grains.

[Medical treatment of pulmonary hypertension: what's new?]. / Medikamentöse Therapie der pulmonalen Hypertonie: Was ist neu?

Pulmonary hypertension (PH) is a chronic progressive disease of the pulmonary circulation of multifactorial causes. The current diagnostic classification of PH distinguishes five main groups, which have as a common feature an increased pulmonary arterial pressure and pulmonary resistance. The classification differentiates pulmonary arterial hypertension (PAH), PH due to left heart disease, PH in lung diseases and/or hypoxia, chronic thromboembolic pulmonary hypertension (CTEPH), and PH with unclear/multifactorial mechanisms. Recent advances in basic research with the approval of new drugs and the establishment of therapeutic strategies, mainly in PAH and CTEPH, require a differentiated view of the disease, a careful diagnosis and initiation of therapy, and regular follow-ups. In this article, we provide an overview of the complex drug therapy currently available for PAH patients.

The abundance of 28Si32S, 29Si32S, 28Si34S, and 30Si32S in the inner layers of the envelope of IRC+10216.

We present high spectral resolution mid-IR observations of SiS towards the C-rich AGB star IRC+10216 carried out with the Texas Echelon-cross-Echelle Spectrograph mounted on the NASA Infrared Telescope Facility. We have identified 204 ro-vibrational lines of 28Si32S, 26 of 29Si32S, 20 of 28Si34S, and 15 of 30Si32S in the frequency range 720 - 790 cm-1. These lines belong to bands v = 1 - 0, 2 - 1, 3 - 2, 4-3, and 5-4, and involve rotational levels with Jlow ≲ 90. About 30 per cent of these lines are unblended or weakly blended and can be partially or entirely fitted with a code developed to model the mid-IR emission of a spherically symmetric circumstellar envelope composed of expanding gas and dust. The observed lines trace the envelope at distances to the star ≲ 35R⋆(≃ 0″.7). The fits are compatible with an expansion velocity of 1+2.5(r/R⋆ -1) km s-1 between 1 and 5R⋆, 11 km s-1 between 5 and 20R⋆, and 14.5 km s-1 outwards. The derived abundance profile of 28Si32S with respect to H2 is 4.9 × 10-6 between the stellar photosphere and 5R⋆, decreasing linearly down to 1.6 × 10-6 at 20R⋆ and to 1.3 × 10-6 at 50R⋆. 28Si32S seems to be rotationally under LTE in the region of the envelope probed with our observations and vibrationally out of LTE in most of it. There is a red-shifted emission excess in the 28Si32S lines of band v = 1 - 0 that cannot be found in the lines of bands v = 2 - 1, 3 - 2, 4 - 3, and 5 - 4. This excess could be explained by an enhancement of the vibrational temperature around 20R⋆ behind the star. The derived isotopic ratios 28Si/29Si, and 32S/34S are 17 and 14, compatible with previous estimates.

[Dynamic hyperinflation in pulmonary arterial hypertension: "hyperinflator" and "non-hyperinflator"]. / Dynamische Hyperinflation bei der pulmonal arteriellen Hypertonie: "Hyperinflator" und "Non-Hyperinflator".

BACKGROUND: The dynamic decrease in inspiratory capacity (IC) during exercise with restriction of tidal volume (VT) is known as dynamic hyperinflation (DH) and is described mostly in patients with COPD differentiating between a "hyperinflator" and a "non-hyperinflator". Recent studies have revealed DH in patients with idiopathic pulmonary arterial hypertension (iPAH), but the influence of the DH on the reduced exercise capacity with exertional dyspnoae is still being debated. METHODS: We analysed flow-volume curves during cardiopulmonary exercise testing (CPET) in idiopathic PAH (n = 19), in COPD (n = 17), in idiopathic pulmonary fibrosis (IPF) (n = 19) and a control group (n = 30). We measured IC at rest and during maximal exercise and furthermore ventilation, VT and oxygen uptake (VO2 peak). In iPAH a right heart catheter test and a 6-minute walk test (6MWT) were performed, also the B-type naturetic peptide (BNP) and the NYHA/WHO functional class were determined. RESULTS: The IC decreased significantly in 11 PAH "hyperinflators" (PAH-H) (Δ IC: - 0.34 ± 0.14 L, p < 0.001) compared to 8 PAH "non-hyperinflators" (PAH-NH) (Δ IC: 0.08 ± 0.2 L). COPD patients exhibited a characteristic hyperinflation pattern with a decrease in IC throughout exercise (Δ IC: - 0.61 ± 0.3 L, p < 0.001), while patients with IPF (Δ IC: 0.03 ± 0.15 L) and the control group responsed to exercise with a non-hyperinflator pattern (Δ IC: 0.1 ± 0.2 L). Both PAH collectives showed a reduced IC/TLC, while VT/IC was elevated with a decreased peak VO2 and max. performance compared to the control group. Correlations of the IC rest/max (L) were shown in PAH-H and PAH-NH with the VO2 peak, max. performance and VT. CONCLUSION: The analysis of flow-volume curves during CPET can indentify DH in a subgroup of patients with iPAH. The DH contributes significantly but slightly to the development of exertional limitations and dyspnoe in a subgroup of iPAH. Further studies with a larger sample size will be required to definitively measure the impact of the DH seen in these patients.

[Chylothorax in an 87-year-old patient]. / Chylothorax bei einer 87-jährigen Patientin.

An 87-year-old woman presented with a left-sided pleural effusion. The milky aspirate fulfilled the criteria of a chylothorax. Thorax computed tomography (CT) showed characteristic multiple cysts and consequently the rare diagnosis of post-menopausal pulmonary lymphangioleiomyomatosis was made. In the diagnostic work-up of pleural effusion the determination of triglycerides should be considered to confirm the diagnosis of chylothorax. In the presence of a chylothorax the differential diagnosis of lymphangioleiomyomatosis should be included even in advanced age.

Similarity measure for quality control of dental CAD/CAM-applications.

There is no measure for morphometric quality control of dental CAD/CAM-restorations as well as for evaluation of newly developed CAD/CAM-applications. The aim of this study was to (a) establish a 3D-measure for morphological comparisons, (b) to proof its metrical and subjective-visual validity and (c) to explore morphological features which have relevant impact on visual perception. 125 maxillary anterior teeth were chosen from a digital library of 3D data sets and compared by automatic superimposition with a best-fit method. The superimposition was analyzed by a newly defined 3-dimensional similarity measure, called shape similarity value (SSV). With this measure, similarity between symmetrical and non-symmetrical teeth was evaluated and the metrical validity was tested. Additionally, visual evaluation of tooth similarities were performed and analyzed by means of multivariate statistical procedures, to test the correspondence between metrical similarity measure and visual similarity perception. The measure clearly reproduced the similarity of contralateral teeth and the dissimilarity of teeth between different individuals. The coincidence between quantitative similarity measure and visual perception was moderate. In conclusion, the presented 3D-measure can be considered as a first substantial step towards a morphometric quality control of CAD/CAM-restorations of anterior teeth.

Nutritional value of diets of blacks in Ciskei.

This dietary study was part of a nutritional status survey carried out at the request of the Ciskeian Government to provide a baseline from which to formulate a nutrition policy. Nutrient intake was assessed by means of a 24-hour recall of food intake and a diet history, recorded for 750 subjects including children aged 6-23 months, 2-3 years and 7-8 years and lactating women. Nutrient intake was evaluated according to WHO standards. The prevalence of inadequate energy intake was high, especially among the 7-8-year-old children. For all age groups protein represented 11% of total energy intake, but was mainly of low quality. Calcium and iron intakes were low in all age groups, especially in lactating women. For all groups the most deficient vitamin was nicotinic acid, followed by riboflavin and ascorbic acid. This deficiency pattern was the result of a diet consisting predominantly of maize.