Proof of principle X-ray reflection mass measurement of the black hole in H1743-322

\ua9 2024 The Author(s). The black hole X-ray binary H1743-322 lies in a region of the Galaxy with high extinction, and therefore it has not been possible to make a dynamical mass measurement. In this paper, we make use of a recent model which uses the X-ray reflection spectrum to constrain the ratio of the black hole mass to the source distance. By folding in a reported distance measurement, we are able to estimate the mass of the black hole to be 12 \ub1 2 M☉ (1σ credible interval). We are then able to revise a previous disc continuum fitting estimate of black hole spin a∗ (previously relying on a population mass distribution) using our new mass constraint, finding a∗ = 0.47 \ub1 0.10. This work is a proof of principle demonstration of the method, showing it can be used to find the mass of black holes in X-ray binaries

Mapping Human Immunity and the Education of Waldeyer\u27s Ring

The development and deployment of single-cell genomic technologies have driven a resolution revolution in our understanding of the immune system, providing unprecedented insight into the diversity of immune cells present throughout the body and their function in health and disease. Waldeyer\u27s ring is the collective name for the lymphoid tissue aggregations of the upper aerodigestive tract, comprising the palatine, pharyngeal (adenoids), lingual, and tubal tonsils. These tonsils are the first immune sentinels encountered by ingested and inhaled antigens and are responsible for mounting the first wave of adaptive immune response. An effective mucosal immune response is critical to neutralizing infection in the upper airway and preventing systemic spread, and dysfunctional immune responses can result in ear, nose, and throat pathologies. This review uses Waldeyer\u27s ring to demonstrate how single-cell technologies are being applied to advance our understanding of the immune system and highlight directions for future research

One-Month Versus Three-Month Dual-Antiplatelet Therapy in High Bleeding Risk Patients With Chronic Kidney Disease

\ua9 2024 Elsevier Inc.Shortening the duration of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) was shown to be effective and safe in patients at high bleeding risk (HBR). We aimed to investigate the effect of 1 versus 3-month DAPT on outcomes after drug-eluting stent in HBR patients with or without chronic kidney disease (CKD). Data from 3 prospective single-arm studies (XIENCE Short DAPT Program) enrolling HBR patients after successful coronary implantation of cobalt-chromium everolimus-eluting stent (XIENCE, Abbott) were analyzed. Subjects were eligible for DAPT discontinuation at 1 or 3 months if free from ischemic events. The primary end point was all-cause death or any myocardial infarction. The key secondary end point was Bleeding Academic Research Consortium Type 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after PCI. CKD was defined as baseline creatinine clearance <60 ml/min. Of 3,286 patients, 1,432 (43.6%) had CKD. One-month versus 3-month DAPT was associated with a similar 12-month risk of the primary outcome irrespective of CKD status (CKD: 9.5% vs 10.9%, adjusted hazard ratio 0.86, 95% confidence interval 0.60 to 1.22; no-CKD: 6.6% vs 5.6%, adjusted hazard ratio 1.15, 95% confidence interval 0.77 to 1.73; p interaction 0.299). Bleeding Academic Research Consortium 2 to 5 bleeding rates were numerically but not significantly lower with 1-month versus 3-month DAPT in both CKD (9.9% vs 12%) and no-CKD (6.4% vs 9.0%) patients. In conclusion, in HBR patients, 1-month versus 3-month DAPT was associated with a similar risk of ischemic complications and a trend toward fewer bleeding events at 12 months after PCI, irrespective of CKD status

Anterior cruciate ligament reconstruction: Effect of graft tunnel position on early to mid-term clinical outcomes

\ua9 The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.BACKGROUND Patient reported outcome measures (PROMs) can be used to assess knee function following anterior cruciate ligament (ACL) reconstruction. Intra-operatively, femoral and tibial tunnels are created to accommodate the new ACL graft. It is postulated that there is an optimum position and orientation of these tunnels and that outcomes from this procedure are affected by their position. AIM To evaluate the influence of graft tunnel position on early to mid-term clinical outcomes following ACL reconstruction. METHODS Six PROMs were collected following ACL reconstruction which included the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee, Lysholm, Tegner, EuroQol-5 Dimension-5 level, and Short Form 12-item Health Survey. A total of 8 radiological parameters were measured from post-operative X-rays relating to graft tunnel positions. This data was analysed to assess for any correlations between graft tunnel position and postoperative PROMs. RESULTS A total of 87 patients were included in the study with a mean post-operative follow-up of 2.3 years (range 1 to 7 years). Posterior position of tibial tunnel was associated with improved KOOS quality of life (rho = 0.43, P = 0.002) and EQ-5D VAS (rho = 0.36, P = 0.010). Anterior position of EndoButton femoral tunnel was associated with an improved EQ-5D index (rho = -0.38, P = 0.028). There were no other significant correlations between any of the other radiological parameters and PROM scores. CONCLUSION Overall, graft tunnel position had very little correlation with clinical outcomes following ACL reconstruction. A few (posterior) tibial tunnel and (anterior) EndoButton femoral tunnel measurements were associated with better PROMs

Clinical Outcomes and Quality of Life of Patients Receiving Multi-Solid-Organ Transplants in Childhood Are Excellent: Results From a 20-Year Cohort Study

Copyright \ua9 2024 Paessler, Maple, Cortes, Simmonds, Tse, Raja, Muorah, Kessaris and Stojanovic.Advances in medicine allow children with previously fatal conditions to survive longer and present as transplant candidates; some requiring multiple solid-organ transplants (MSOT). There is limited data on clinical outcomes and no data on quality of life (QoL). In this mixed methods cohort study clinical outcomes from the NHSBT registry were analysed for all patients who received a kidney and one other solid-organ transplant as a child between 2000 and 2021 in the UK. QoL was measured using the PedsQL 3.0 Transplant Module questionnaire. 92 children met the inclusion criteria: heart/heart-lung and kidney (n = 15), liver and kidney (n = 72), pancreas and kidney (n = 4) and multivisceral (n = 1). Results showed excellent patient and graft survival, comparable to single-organ transplants. Allograft survival and rejection were significantly better in patients with combined liver and kidney transplants compared to patients with sequential liver and kidney transplants. QoL was excellent with a mean score of 74%. Key findings included a significant improvement in QoL post-transplant. This is the first study to look at clinical and QoL outcomes in MSOT recipients. The results indicate excellent long-term outcomes. All children born with conditions leading to end-stage disease in multiple solid-organs should be assessed as transplant candidates

Barriers and enablers to engagement with a type 2 diabetes remission project in the North East of England: Qualitative perspectives of patients

\ua9 The Author(s), 2024.This qualitative research sought to identify factors influencing patient choice of, and patient-related internal and external enablers and barriers to engagement with, type 2 diabetes (T2D) remission strategies offered by the Remission in diabetes (REMI.D) project. Patients had a choice of three diets: Total Diet Replacement (TDR)-Formula Food Products, TDR-Food, and Healthy lifestyle approach; and three activity pathways: Everyday life, General Practitioner referral, and Social hub. Semi-structured interviews were recorded and transcribed. Thematic analysis used the Framework Method and NVivo 12 to assist with generation and organisation of codes, inductive and deductive (Theoretical Domains Framework). The REMI.D project was a place-based approach (place in this case being defined as two local authorities with significant rates of deprivation) situated in the North East of England. Twenty patients out of a possible 65 patients took part. Areas of interest included: patient choice, patient intention, patient adherence, patient non-Adherence, and patient stigma. Addition of a more moderate dietary strategy (not dissimilar to the diet in the Healthier You NHS Diabetes Prevention Programme) to the existing NHS England T2D Path to Remission programme may enable more patients to achieve remission or delayed progression with deprescribing of diabetes medications. Embedding a tailored physical activity path within or as a bolt-on to the NHS programme requires consideration. Limited resources should be targeted towards patients who identify with more barriers or fewer opportunities for health behaviour modification. Further research on use of virtual programmes in deprived areas is warranted

Animal welfare with Chinese characteristics: Chinese poultry producers’ perceptions of, and attitudes towards, animal welfare

Copyright: \ua9 2024 Yang et al.China’s poultry industry faces challenges in adopting and sustaining cage-free systems for poultry production. Effective interventions are crucial to support producers transitioning from cages to alternative systems or maintaining cage-free systems to improve animal welfare. However, little is known about how Chinese poultry producers perceive animal welfare in relation to cage-free systems and the importance of animal welfare in poultry production. Through a qualitative interview study with 30 Chinese farm owners, managers and senior managers from large-scale egg and broiler farms using cages and non-cage systems (collectively referred to as “producers”), this paper explores Chinese poultry producers’ attitudes and perceptions regarding animal welfare and welfare in different poultry housing systems. Template analysis was used to analyse the data from semi-structured interviews, which generated themes related to the participants’ awareness and understanding of the concept of animal welfare, the factors that impacted their choices of different housing systems, and the perceived priorities in poultry production. The responses revealed that the participating producers had a strong awareness and knowledge of animal welfare. However, the participants’ understanding of the term is heterogeneous: generally, egg producers emphasised natural behaviours, whereas broiler producers prioritised health and productivity. Nevertheless, profitability, leadership, and organisational policies primarily influenced housing system choices rather than animal welfare values. Economic motives drove egg producers towards cage-free systems, prompted by consumers’ and companies’ demand for cage-free eggs committed to transitioning away from cages by 2025. In conclusion, tailored interventions for different poultry sectors within China are necessary. While animal welfare values matter, economic incentives seem more promising for steering the shift towards and maintaining cage-free poultry production

Complex Percutaneous Coronary Intervention in Patients Unable to Undergo Coronary Artery Bypass Grafting During the COVID-19 Pandemic: Insights From the UK-ReVasc Registry

\ua9 2024 HMP Global. All Rights Reserved.Objectives. Cardiac surgery for coronary artery disease was dramatically reduced during the first wave of the COVID-19 pandemic. Many patients with disease ordinarily treated with coronary artery bypass grafting (CABG) instead underwent percutaneous coronary intervention (PCI). We sought to describe 12-month outcomes following PCI in patients who would typically have undergone CABG. Methods. Between March 1, 2020 and July 31, 2020, patients who received revascularization with PCI when CABG would have been the primary choice of revascularization were enrolled in the prospective, multicenter UK-ReVasc Registry. We evaluated the following major adverse cardiovascular events at 12 months: all-cause mortality, myocardial infarction (MI), repeat revascularization, stroke, major bleeding, and stent thrombosis. Results. A total of 215 patients were enrolled across 45 PCI centers in the United Kingdom. Twelve-month follow-up data were obtained for 97% of the cases. There were 9 deaths (4.3%), 5 MIs (2.4%), 12 repeat revascularizations (5.7%), 1 stroke (0.5%), 3 major bleeds (1.4%), and no cases of stent thrombosis. No difference in the primary endpoint was observed between patients who received complete vs incomplete revascularization (residual SYNTAX score <=8 vs > 8) (P = .22). Conclusions. In patients with patterns of coronary disease in whom CABG would have been the primary therapeutic choice outside of the pandemic, PCI was associated with acceptable outcomes at 12 months of follow-up. Contemporary randomized trials that compare PCI to CABG in such patient cohorts may be warranted

Presentation, care, coronary intervention and outcomes of patients with NSTEMI according to age: Insights from the international prospective ACVC-EAPCI EORP NSTEMI registry

\ua9 2024 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. Background: Older people less frequently receive invasive coronary angiography (ICA) for NSTEMI than younger patients. We describe care, ICA data, and in-hospital and 30-day outcomes of NSTEMI by age in a contemporary and geographically diverse cohort. Methods: Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by age (≥75 years, n = 761). Quality of care was evaluated based on 12 guideline-recommended care interventions, and data collected on ICA. Outcomes included in hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack, BARC Type ≥3 bleeding and death, as well as 30-day mortality. Results: Patients aged ≥75 years, compared with younger patients, at presentation had a higher prevalence of comorbidities and oral anticoagulation prescription (22.4% vs 7.6%, p < 0.001). Older patients less frequently received ICA than younger patients (78.6% vs 90.6%, p < 0.001) with the recorded reason more often being advanced age, comorbidities or frailty. Of those who underwent ICA, older patients more frequently demonstrated 3-vessel, 4-vessel and/or left main stem coronary artery disease compared to younger patients (49.7% vs 34.1%, p < 0.001) but less frequently received revascularisation (63.6% vs 76.9%, p < 0.001). Older patients experienced higher rates of in-hospital acute heart failure (15.0% vs 8.4%, p < 0.001) and bleeding (2.8% vs 1.3%, p = 0.006), as well as in-hospital and 30-day mortality (3.4% vs 1.3%, p < 0.001; 4.8% vs 1.7%, p < 0.001; respectively), than younger patients. Conclusions: Patients aged ≥75 years with NSTEMI, compared with younger patients, less frequently received ICA and guideline-recommended care, and had worse short-term outcomes

Cygnus X-3 revealed as a Galactic ultraluminous X-ray source by IXPE

\ua9 The Author(s), under exclusive licence to Springer Nature Limited 2024.The accretion of matter by compact objects can be inhibited by radiation pressure if the luminosity exceeds a critical value known as the Eddington limit. The discovery of ultraluminous X-ray sources has shown that accretion can proceed even when the apparent luminosity considerably exceeds this limit. A high apparent luminosity might be produced due to the geometric beaming of radiation by an outflow. The outflow half-opening angle, which determines the amplification due to beaming, has never been robustly constrained. Using the Imaging X-ray Polarimetry Explorer, we measured the X-ray polarization in the Galactic X-ray binary Cygnus X-3 (Cyg X-3). We found high, >20%, nearly energy-independent linear polarization orthogonal to the direction of the radio ejections. These properties unambiguously indicate the presence of a collimating outflow from the X-ray binary Cyg X-3 and constrain its half-opening angle to ≲15\ub0. Thus, the source can be used as a laboratory for studying the supercritical accretion regime. This finding underscores the importance of X-ray polarimetry in advancing our understanding of accreting sources