We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Duchenne muscular dystrophy is a devastating neuromuscular disorder characterized by the loss of dystrophin, inevitably leading to cardiomyopathy. Despite publications on prophylaxis and treatment with cardiac medications to mitigate cardiomyopathy progression, gaps remain in the specifics of medication initiation and optimization.
Method:
This document is an expert opinion statement, addressing a critical gap in cardiac care for Duchenne muscular dystrophy. It provides thorough recommendations for the initiation and titration of cardiac medications based on disease progression and patient response. Recommendations are derived from the expertise of the Advance Cardiac Therapies Improving Outcomes Network and are informed by established guidelines from the American Heart Association, American College of Cardiology, and Duchenne Muscular Dystrophy Care Considerations. These expert-derived recommendations aim to navigate the complexities of Duchenne muscular dystrophy-related cardiac care.
Results:
Comprehensive recommendations for initiation, titration, and optimization of critical cardiac medications are provided to address Duchenne muscular dystrophy-associated cardiomyopathy.
Discussion:
The management of Duchenne muscular dystrophy requires a multidisciplinary approach. However, the diversity of healthcare providers involved in Duchenne muscular dystrophy can result in variations in cardiac care, complicating treatment standardization and patient outcomes. The aim of this report is to provide a roadmap for managing Duchenne muscular dystrophy-associated cardiomyopathy, by elucidating timing and dosage nuances crucial for optimal therapeutic efficacy, ultimately improving cardiac outcomes, and improving the quality of life for individuals with Duchenne muscular dystrophy.
Conclusion:
This document seeks to establish a standardized framework for cardiac care in Duchenne muscular dystrophy, aiming to improve cardiac prognosis.
We performed a literature review to describe the risk of surgical-site infection (SSI) in minimally invasive surgery (MIS) compared to standard open surgery. Most studies reported decreased SSI rates among patients undergoing MIS compared to open procedures. However, many were observational studies and may have been affected by selection bias. MIS is associated with reduced risk of surgical-site infection compared to standard open surgery and should be considered when feasible.
Spatially resolved transcriptomics (SRT) is a growing field that links gene expression to anatomical context. SRT approaches that use next-generation sequencing (NGS) combine RNA sequencing with histological or fluorescent imaging to generate spatial maps of gene expression in intact tissue sections. These technologies directly couple gene expression measurements with high-resolution histological or immunofluorescent images that contain rich morphological information about the tissue under study. While broad access to NGS-based spatial transcriptomic technology is now commercially available through the Visium platform from the vendor 10× Genomics, computational tools for extracting image-derived metrics for integration with gene expression data remain limited. We developed VistoSeg as a MATLAB pipeline to process, analyze and interactively visualize the high-resolution images generated in the Visium platform. VistoSeg outputs can be easily integrated with accompanying transcriptomic data to facilitate downstream analyses in common programing languages including R and Python. VistoSeg provides user-friendly tools for integrating image-derived metrics from histological and immunofluorescent images with spatially resolved gene expression data. Integration of this data enhances the ability to understand the transcriptional landscape within tissue architecture. VistoSeg is freely available at http://research.libd.org/VistoSeg/.
Diagnosing the evolution of laser-generated high energy density (HED) systems is fundamental to develop a correct understanding of the behavior of matter under extreme conditions. Talbot–Lau interferometry constitutes a promising tool, since it permits simultaneous single-shot X-ray radiography and phase-contrast imaging of dense plasmas. We present the results of an experiment at OMEGA EP that aims to probe the ablation front of a laser-irradiated foil using a Talbot–Lau X-ray interferometer. A polystyrene (CH) foil was irradiated by a laser of 133 J, 1 ns and probed with 8 keV laser-produced backlighter radiation from Cu foils driven by a short-pulse laser (153 J, 11 ps). The ablation front interferograms were processed in combination with a set of reference images obtained ex situ using phase-stepping. We managed to obtain attenuation and phase-shift images of a laser-irradiated foil for electron densities above ${10}^{22}\;{\mathrm{cm}}^{-3}$. These results showcase the capabilities of Talbot–Lau X-ray diagnostic methods to diagnose HED laser-generated plasmas through high-resolution imaging.
Recurrent laryngeal nerve injury leading to vocal cord paralysis is a known complication of cardiothoracic surgery. Its occurrence during interventional catheterisation procedures has been documented in case reports, but there have been no studies to determine an incidence.
Objective:
To establish the incidence of left recurrent laryngeal nerve injury leading to vocal cord paralysis after left pulmonary artery stenting, patent ductus arteriosus device closure and the combination of the procedures either consecutively or simultaneously.
Methods:
Members of the Congenital Cardiovascular Interventional Study Consortium were asked to perform a retrospective analysis to identify cases of recurrent laryngeal nerve injury after the aforementioned procedures. Twelve institutions participated in the analysis. They also contributed the total number of each procedure performed at their respective institutions for statistical purposes.
Results:
Of the 1337 patients who underwent left pulmonary artery stent placement, six patients (0.45%) had confirmed vocal cord paralysis. 4001 patients underwent patent ductus arteriosus device closure, and two patients (0.05%) developed left vocal cord paralysis. Patients who underwent both left pulmonary artery stent placement and patent ductus arteriosus device closure had the highest incidence of vocal cord paralysis which occurred in 4 of the 26 patients (15.4%). Overall, 92% of affected patients in our study population had resolution of symptoms.
Conclusion:
Recurrent laryngeal nerve injury is a rare complication of left pulmonary artery stent placement or patent ductus arteriosus device closure. However, the incidence is highest in patients undergoing both procedures either consecutively or simultaneously. Additional research is necessary to determine contributing factors that might reduce the risk of recurrent laryngeal nerve injury.
In recent years, evidence has started piling up that some high-energy cosmic neutrinos can be associated with blazars in flaring states. On 2022 February 26, a new blazar-neutrino coincidence was reported: the track-like neutrino event IC220225A detected by IceCube is spatially coincident with the flat-spectrum radio quasar PKS 0215+015. Like previous associations, this source was found to be in a high optical and γ-ray state. Moreover, the source showed a bright radio outburst, which substantially increases the probability of a true physical association. We have performed six observations with the VLBA shortly after the neutrino event with a monthly cadence and are monitoring the source with the Effelsberg 100m-Telescope, and with the Australia Compact Telescope Array. Here, we present first results on the contemporary parsec-scale jet structure of PKS 0215+015 in total intensity and polarization to constrain possible physical processes leading to neutrino emission in blazars.
This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
Postoperative cognitive impairment is among the most common medical complications associated with surgical interventions – particularly in elderly patients. In our aging society, it is an urgent medical need to determine preoperative individual risk prediction to allow more accurate cost–benefit decisions prior to elective surgeries. So far, risk prediction is mainly based on clinical parameters. However, these parameters only give a rough estimate of the individual risk. At present, there are no molecular or neuroimaging biomarkers available to improve risk prediction and little is known about the etiology and pathophysiology of this clinical condition. In this short review, we summarize the current state of knowledge and briefly present the recently started BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), which is funded by the European Union. It is the goal of this research and development (R&D) project, which involves academic and industry partners throughout Europe, to deliver a multivariate algorithm based on clinical assessments as well as molecular and neuroimaging biomarkers to overcome the currently unsatisfying situation.
Laser–plasma interaction (LPI) at intensities $10^{15}{-}10^{16}~\text{W}\cdot \text{cm}^{-2}$ is dominated by parametric instabilities which can be responsible for a significant amount of non-collisional absorption and generate large fluxes of high-energy nonthermal electrons. Such a regime is of paramount importance for inertial confinement fusion (ICF) and in particular for the shock ignition scheme. In this paper we report on an experiment carried out at the Prague Asterix Laser System (PALS) facility to investigate the extent and time history of stimulated Raman scattering (SRS) and two-plasmon decay (TPD) instabilities, driven by the interaction of an infrared laser pulse at an intensity ${\sim}1.2\times 10^{16}~\text{W}\cdot \text{cm}^{-2}$ with a ${\sim}100~\unicode[STIX]{x03BC}\text{m}$ scalelength plasma produced from irradiation of a flat plastic target. The laser pulse duration (300 ps) and the high value of plasma temperature (${\sim}4~\text{keV}$) expected from hydrodynamic simulations make these results interesting for a deeper understanding of LPI in shock ignition conditions. Experimental results show that absolute TPD/SRS, driven at a quarter of the critical density, and convective SRS, driven at lower plasma densities, are well separated in time, with absolute instabilities driven at early times of interaction and convective backward SRS emerging at the laser peak and persisting all over the tail of the pulse. Side-scattering SRS, driven at low plasma densities, is also clearly observed. Experimental results are compared to fully kinetic large-scale, two-dimensional simulations. Particle-in-cell results, beyond reproducing the framework delineated by the experimental measurements, reveal the importance of filamentation instability in ruling the onset of SRS and stimulated Brillouin scattering instabilities and confirm the crucial role of collisionless absorption in the LPI energy balance.
Introduction: NSAIDS offer more effective analgesia than opioids, require less rescue medication, and decrease the incidence of nausea and vomiting in renal colic patients. Alpha blockers and Opioids are also prescribed frequently, but doses used and treatment durations are not well described. Our objective was to investigate ED prescribing decisions and medication compliance by patients with acute renal colic. Methods: In this prospective two-city cohort study, we invited patients with a first ED visit for image-confirmed 2-10 mm ureteric stones to consent to a telephone survey 10 days after their ED visit. During follow-up interviews, patients were asked what drugs they were prescribed and how many doses they required. This study was REB approved. Results: A convenience sample of 224 patients, including 152 males (67.9%) and 72 females (median age= 52.4 years) completed 10-day surveys. NSAIDS were prescribed for 48.7%, tamsulosin for 65.2% and opioids for 81.7%. One-third received a tamsulosin-NSAID combination, 40% an opioid-NSAID combination and 28% a tamsulosin-NSAID-opioid combination. Of 109 patients prescribed an NSAID, only 70 (64.2%) took 1 dose/day; however an additional 28 who were not prescribed NSAIDs took 1 NSAID dose/day. Mean (sd) NSAID intake in the overall study group was 1.1 (1.5) doses/day from day 1-5 and 0.6 (1.1) doses/day on days 6-10, with 90%ile values of 3.0 and 2.0 doses/day. NSAID compliance was more common in patients who stated they received high quality discharge instructions (63.8% vs. 32.6%; RR=1.95; 95% CI 1.47-2.60). Mean opioid intake in the overall study group was 1.2 (1.7) doses/day from day 1-5 and 0.5 (1.3) doses/day on days 6-10, with 90%ile values of 4.0 and 2.0 doses/day. Among patients prescribed tamsulosin, the average was 4.0 days of compliance (sd=4.3), with a 90%ile value of 10 days. Conclusion: This study provides estimates for the amount of drug actually used by renal colic patients during the 10-days after their ED visit. Patients used fewer opioid doses than expected, and NSAID and tamsulosin compliance appears relatively poor. NSAID compliance was better in patients who perceived high quality discharge instructions. This study suggests there is room for improvement in medication prescribing and discharge instructions for ED patients with an acute episode of ureteral colic.
This study aimed to compare the view into the maxillary sinus using the posterior translacrimal approach compared with grade 3 antrostomy.
Methods:
Grade 3 antrostomy followed by a posterior translacrimal approach was performed on four cadavers. The maximum intramaxillary view was documented endoscopically guided by electromagnetic navigation. Representative screenshots were evaluated in a blinded manner by three independent sinus surgeons. In addition, a prospective investigation of specific complications in the post-operative course of consecutive patients was performed.
Results:
In the cadaver study, the posterior translacrimal approach provided a significantly better view into the maxillary sinus compared with grade 3 antrostomy. In the clinical study, only 1 out of 20 patients reported on a minor problem with lacrimal drainage at 6 months.
Conclusion:
The posterior translacrimal approach to visualising the maxillary sinus should be considered a strong alternative to more radical techniques.
The paleoclimatic record of Juréia Paleolagoon, coastal southeastern Brazil, includes cyclic and gradual changes with different intensities and frequencies through geological time, and it is controlled by astronomical, geophysical, and geological phenomena. These variations are not due to one single cause, but they result from the interaction of several factors, which act at different temporal and spatial scales. Here, we describe paleoenvironmental evidence regarding climatic and sea level changes from the last 9400 cal yr BP at the Juréia Paleolagoon – one of the main groups of protected South Atlantic ecosystems. Geochemical evidences were used to identify anomalies from multi-proxy analyses of a paleolagoon sediment core. The anomalies of centennial scale were correlated to climate and transgression–regression cycles from the Holocene period. Decadal scale anomalous oscillations in the Quaternary paleolagoon sediments occur between 9400 and 7500 cal yr BP, correlated with long- and short-term natural events, which generated high sedimentation rates, mainly between 8385 and 8375 cal yr BP (10 cm/yr). Our results suggest that a modern-day short-duration North Atlantic climatic event, such as the 8.2 ka event, could affect the environmental equilibrium in South America and intensify the South American Summer Monsoon.
Herbicide soil/solution distribution coefficients (Kd) are used in mathematical models to predict the movement of herbicides in soil and groundwater. Herbicides bind to various soil constituents to differing degrees. The universal soil colloid that binds most herbicides is organic matter (OM), however clay minerals (CM) and metallic hydrous oxides are more retentive for cationic, phosphoric, and arsenic acid compounds. Weakly basic herbicides bind to both organic and inorganic soil colloids. The soil organic carbon (OC) affinity coefficient (Koc) has become a common parameter for comparing herbicide binding in soil; however, because OM and OC determinations vary greatly between methods and laboratories, Koc values may vary greatly. This proposal discusses this issue and offers suggestions for obtaining the most accurate Kd, Freundlich constant (Kf), and Koc values for herbicides listed in the WSSA Herbicide Handbook and Supplement.
In humans, maximum brain development occurs between the third trimester of gestation and 2 years of life. Nutrition during these critical windows of rapid brain development might be essential for later cognitive functioning and behaviour. In the last few years, trends on protein recommendations during infancy and childhood have tended to be lower than that in the past. It remains to be demonstrated that lower protein intakes among healthy infants, a part of being able to reduce obesity risk, is safe in terms of mental performance achievement. Secondary analyses of the EU CHOP, a clinical trial in which infants from five European countries were randomised to be fed a higher or a lower protein content formula during the 1st year of life. Children were assessed at the age of 8 years with a neuropsychological battery of tests that included assessments of memory (visual and verbal), attention (visual, selective, focused and sustained), visual-perceptual integration, processing speed, visual-motor coordination, verbal fluency and comprehension, impulsivity/inhibition, flexibility/shifting, working memory, reasoning, visual-spatial skills and decision making. Internalising, externalising and total behaviour problems were assessed using the Child Behaviour Checklist 4–18. Adjusted analyses considering factors that could influence neurodevelopment, such as parental education level, maternal smoking, child’s gestational age at birth and head circumference, showed no differences between feeding groups in any of the assessed neuropsychological domains and behaviour. In summary, herewith we report on the safety of lower protein content in infant formulae (closer to the content of human milk) according to long-term mental performance.
Influenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013–2014 influenza season. Little is known about the epidemiology of severe influenza during this season.
METHODS
A retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals from September 1, 2013, through April 1, 2014, was conducted to determine risk factors for mortality present on intensive care unit admission and to describe patient characteristics, spectrum of disease, management, and outcomes.
RESULTS
A total of 444 adults and 63 children were admitted to an intensive care unit in a study hospital; 93 adults (20.9%) and 4 children (6.3%) died. By logistic regression analysis, the following factors were significantly associated with mortality among adult patients: older age (>65 years, odds ratio, 3.1 [95% CI, 1.4–6.9], P=.006 and 50–64 years, 2.5 [1.3–4.9], P=.007; reference age 18–49 years), male sex (1.9 [1.1–3.3], P=.031), history of malignant tumor with chemotherapy administered within the prior 6 months (12.1 [3.9–37.0], P<.001), and a higher Sequential Organ Failure Assessment score (for each increase by 1 in score, 1.3 [1.2–1.4], P<.001).
CONCLUSION
Risk factors for death among US patients with severe influenza during the 2013–2014 season, when influenza A (H1N1) pdm09 was the predominant circulating strain type, shifted in the first postpandemic season in which it predominated toward those of a more typical epidemic influenza season.
Infect. Control Hosp. Epidemiol. 2015;36(11):1251–1260
We present VLA 21-cm observations of the spiral galaxy ESO 481-G017 to determine the nature of remote star formation traced by an Hii region found 43 kpc and ∼800 km s−1 from the galaxy center (in projection). ESO 481-G017 is found to have a 120 kpc Hi disk with a mass of 1.2 × 1010M⊙ and UV GALEX images reveal spiral arms extending into the gaseous disk. Two dwarf galaxies with Hi masses close to 108M⊙ are detected at distances of ∼200 kpc from ESO 481-G017 and a Hi cloud with a mass of 6 × 107M⊙ is found near the position and velocity of the remote Hii region. The Hii region is somewhat offset from the Hi cloud spatially and there is no link to ESO 481-G017 or the dwarf galaxies. We consider several scenarios for the origin of the cloud and Hii region and find the most likely is a dwarf galaxy that is undergoing ram pressure stripping. The Hi mass of the cloud and Hi luminosity of the Hii region (1038.1 erg s−1) are consistent with dwarf galaxy properties, and the stripping can trigger the star formation as well as push the gas away from the stars.