Revealing the mid-infrared emission structure of IRAS 16594-4656 and IRAS 07027-7934

TIMMI2 diffraction-limited mid-infrared images of a multipolar proto-planetary nebula IRAS 16594-4656 and a young [WC] elliptical planetary nebula IRAS 07027-7934 are presented. Their dust shells are for the first time resolved (only marginally in the case of IRAS 07027-7934) by applying the Lucy-Richardson deconvolution algorithm to the data, taken under exceptionally good seeing conditions (<0.5"). IRAS 16594-4656 exhibits a two-peaked morphology at 8.6, 11.5 and 11.7 microns which is mainly attributed to emission from PAHs. Our observations suggest that the central star is surrounded by a toroidal structure observed edge-on with a radius of 0.4" (~640 AU at an assumed distance of 1.6 kpc) with its polar axis at P.A.~80 degrees, coincident with the orientation defined by only one of the bipolar outflows identified in the HST optical images. We suggest that the material expelled from the central source is currently being collimated in this direction and that the multiple outflow formation has not been coeval. IRAS 07027-7934 shows a bright, marginally extended emission (FWHM=0.3") in the mid-infrared with a slightly elongated shape along the N-S direction, consistent with the morphology detected by HST in the near-infrared. The mid-infrared emission is interpreted as the result of the combined contribution of small, highly ionized PAHs and relatively hot dust continuum. We propose that IRAS 07027-7934 may have recently experienced a thermal pulse (likely at the end of the AGB) which has produced a radical change in the chemistry of its central star.Comment: 35 pages, 8 figures (figures 1, 2, 4 and 6 are in low resolution) accepted for publication in Ap

Efficacy and safety of tacrolimus in Crohn's disease: a nationwide, multi-centric study from GETECCU

Background: Crohn's disease (CD) is chronic inflammatory disease of the gastrointestinal tract. Tacrolimus (TCR) is a calcineurin inhibitor drug commonly used for prophylaxis of rejection in renal and liver transplantation. There is some evidence on the short- and medium-term efficacy and safety of TCR in CD, but data are still scarce. The primary aim of our study was to evaluate the efficacy and safety of TCR in CD in clinical practice in Spain. Methods: We performed a retrospective, multi-centric study in 22 inflammatory bowel disease Units in Spain. We included all adult patients with an established diagnosis of CD in whom oral TCR was prescribed for this condition. Clinical response was assessed by Harvey?Bradshaw index (H-B) and physician global assessment after 3 months. Perianal disease was evaluated by fistula drainage assessment (FDA) at the same time point. Follow-up period was considered until the last visit during therapy or 12 months after stopping the drug. Descriptive statistics and non-parametric tests were used in the statistical analysis. Results: Between January 2000 and November 2017 a total of 85 patients received TCR (mean age 36 years; 55% female; 69% perianal disease; mean CRP 14 mg/l). The most common indications for TCR were refractory luminal disease (57%) and perianal disease (32%). Most patients (81%) had previously received at least one anti-TNF agent and 61% ?2. Blood drug levels were 5?10 ng/ml during induction (34%) and maintenance (47%). In 25% of cases, TCR was started concomitantly with systemic steroids, in 11% with an anti-TNF agent and in 6% with vedolizumab. The drug was maintained for a median time of 6 months (2.7?18) and the median follow?up was 28 months (15?56). We found statistically significant differences in H-B after 3 months (median 7.4 (SD 4.4), p = 0.014). FDA showed a complete response in 8%, while 34% had partial response. In the univariate analysis, concomitant thiopurines were significantly associated with short-term clinical response (OR 5.53 95% CI 1.36?22.5, p = 0.017). We observed statistically significant differences in CRP levels 1, 3, 6, and 12 months when compared with baseline (p < 0.03). The drug was stopped in 86% of patients after a median time of 6 months (2?17): 62% requiring a new immunomodulator, 44% hospitalisation and 42% surgery. A total of 34% patients suffered adverse events related to the drug (45% tremor, 28% acute kidney injury), and in 37% they led to the discontinuation of the drug. Conclusions: Tacrolimus shows a clinical benefit in CD in the short-term, but its lower long-term effectiveness and frequent adverse events remain relevant issues in clinical practice

Incidence and trends of childhood Type 1 diabetes worldwide 1990-1999.

Aims. To examine incidence and trends of Type 1 diabetes worldwide for the period 1990–1999. Methods. The incidence of Type 1 diabetes (per 100000/year) was analysed in children aged ≤ 14 years from 114 populations in 112 centres in 57 countries. Trends in the incidence of Type 1 diabetes were analysed by fitting Poisson regression models to the dataset. Results. A total of 43013 cases were diagnosed in the study populations of 84 million children. The age-adjusted incidence of Type 1 diabetes among 112 centres (114 populations) varied from 0.1 per 100000/year in China and Venezuela to 40.9 per 100000/year in Finland. The average annual increase in incidence calculated from 103 centres was 2.8% (95% CI 2.4–3.2%). During the years 1990–1994, this increase was 2.4% (95% CI 1.3–3.4%) and during the second study period of 1995–1999 it was slightly higher at 3.4% (95% CI 2.7– 4.3%). The trends estimated for continents showed statistically significant increases all over the world (4.0% in Asia, 3.2% in Europe and 5.3% in North America), except in Central America and the West Indies where the trend was a decrease of 3.6%. Only among the European populations did the trend in incidence diminish with age. Conclusions. The rising incidence of Type 1 diabetes globally suggests the need for continuous monitoring of incidence by using standardized methods in order to plan or assess prevention strategies

A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

Background: Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.\ud \ud Methods: We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison.\ud \ud Results: A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P = 0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P = 0.49).\ud \ud Conclusion: In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery