Lung Fluid Clearance in Chronic Heart Failure Patients

© 2017 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (May 2017) in accordance with the publisher’s archiving policyChronic elevation of pulmonary microvascular pressure (Pmv) consistently leads to alveolocapillary barrier thickening and reduction in the filtration coefficient. In animal models of chronic heart failure (CHF) the lung remains dry despite hydrostatic forces. As fluid flux is bi-directional, it has been postulated that an increase in alveolar fluid clearance may facilitate the dry lung when Pmv is chronically elevated. In this study we aimed to examine alveolar fluid clearance in ambulatory patients with CHF secondary to left ventricular (LV) systolic dysfunction compared against non-CHF controls. Lung clearance following aerosol delivery of 99mtechnetium (Tc)-diethyl triaminepentaacetic acid (DTPA) was measured non-invasively by scintigraphy and half time of 99mTc-DTPA clearance (T (1/2)) was calculated by mono-exponential curve fit. Alveolar fluid clearance measured as half time DTPA clearance was significantly faster in CHF patients than controls (P = 0.001). This was further defined by NYHA classification. No correlation was found between DTPA clearance and plasma epinephrine, norepinephrine or aldosterone hormone (P > 0.05). Our results support an association between increasing alveolar fluid clearance and disease severity in CHF, and the concept of controlled bi-directional fluid flux in CHF associated with increasing Pmv, and represents another defence mechanism of the lung against pulmonary oedema

The electron-capture origin of supernova 2018zd

In the transitional mass range ($\sim$ 8-10 solar masses) between white dwarf formation and iron core-collapse supernovae, stars are expected to produce an electron-capture supernova. Theoretically, these progenitors are thought to be super-asymptotic giant branch stars with a degenerate O+Ne+Mg core, and electron capture onto Ne and Mg nuclei should initiate core collapse. However, no supernovae have unequivocally been identified from an electron-capture origin, partly because of uncertainty in theoretical predictions. Here we present six indicators of electron-capture supernovae and show that supernova 2018zd is the only known supernova having strong evidence for or consistent with all six: progenitor identification, circumstellar material, chemical composition, explosion energy, light curve, and nucleosynthesis. For supernova 2018zd, we infer a super-asymptotic giant branch progenitor based on the faint candidate in the pre-explosion images and the chemically-enriched circumstellar material revealed by the early ultraviolet colours and flash spectroscopy. The light-curve morphology and nebular emission lines can be explained with the low explosion energy and neutron-rich nucleosynthesis produced in an electron-capture supernova. This identification provides insights into the complex stellar evolution, supernova physics, cosmic nucleosynthesis, and remnant populations in the transitional mass range.Comment: Author version of the published letter in Nature Astronomy, 28 June 202

Prediction Scores Do Not Correlate with Clinically Adjudicated Categories of Pulmonary Embolism in Critically Ill Patients

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.BACKGROUND: Prediction scores for pretest probability of pulmonary embolism (PE) validated in outpatient settings are occasionally used in the intensive care unit (ICU).OBJECTIVE: To evaluate the correlation of Geneva and Wells scores with adjudicated categories of PE in ICU patients.METHODS: In a randomized trial of thromboprophylaxis, patients with suspected PE were adjudicated as possible, probable or definite PE. Data were then retrospectively abstracted for the Geneva Diagnostic PE score, Wells, Modified Wells and Simplified Wells Diagnostic scores. The chance-corrected agreement between adjudicated categories and each score was calculated. ANOVA was used to compare values across the three adjudicated PE categories.RESULTS: Among 70 patients with suspected PE, agreement was poor between adjudicated categories and Geneva pretest probabilities (kappa 0.01 [95% CI −0.0643 to 0.0941]) or Wells pretest probabilities (kappa −0.03 [95% CI −0.1462 to 0.0914]). Among four possible, 16 probable and 50 definite PEs, there were no significant differences in Geneva scores (possible = 4.0, probable = 4.7, definite = 4.5; P=0.90), Wells scores (possible = 2.8, probable = 4.9, definite = 4.1; P=0.37), Modified Wells (possible = 2.0, probable = 3.4, definite = 2.9; P=0.34) or Simplified Wells (possible = 1.8, probable = 2.8, definite = 2.4; P=0.30).CONCLUSIONS: Pretest probability scores developed outside the ICU do not correlate with adjudicated PE categories in critically ill patients. Research is needed to develop prediction scores for this population

The electron-capture origin of supernova 2018zd

In the transitional mass range (~8–10 solar masses) between white dwarf formation and iron core-collapse supernovae, stars are expected to produce an electron-capture supernova. Theoretically, these progenitors are thought to be super-asymptotic giant branch stars with a degenerate O + Ne + Mg core, and electron capture onto Ne and Mg nuclei should initiate core collapse1–4. However, no supernovae have unequivocally been identified from an electron-capture origin, partly because of uncertainty in theoretical predictions. Here we present six indicators of electron-capture supernovae and show that supernova 2018zd is the only known supernova with strong evidence for or consistent with all six: progenitor identification, circumstellar material, chemical composition5–7, explosion energy, light curve and nucleosynthesis8–12. For supernova 2018zd, we infer a super-asymptotic giant branch progenitor based on the faint candidate in the pre-explosion images and the chemically enriched circumstellar material revealed by the early ultraviolet colours and flash spectroscopy. The light-curve morphology and nebular emission lines can be explained by the low explosion energy and neutron-rich nucleosynthesis produced in an electron-capture supernova. This identification provides insights into the complex stellar evolution, supernova physics, cosmic nucleosynthesis and remnant populations in the transitional mass range. Electron-capture supernovae are thought to come from progenitors with a narrow range of masses, and thus they are rare. Here the authors present six indicators of an electron-capture supernova origin, and find that supernova 2018zd fulfils all six criteria.Instituto de Astrofísica de La PlataFacultad de Ciencias Astronómicas y Geofísica

Energetic eruptions leading to a peculiar hydrogen-rich explosion of a massive star

Every supernova so far observed has been considered to be the terminal explosion of a star. Moreover, all supernovae with absorption lines in their spectra show those lines decreasing in velocity over time, as the ejecta expand and thin, revealing slower-moving material that was previously hidden. In addition, every supernova that exhibits the absorption lines of hydrogen has one main light-curve peak, or a plateau in luminosity, lasting approximately 100 days before declining1. Here we report observations of iPTF14hls, an event that has spectra identical to a hydrogen-rich core-collapse supernova, but characteristics that differ extensively from those of known supernovae. The light curve has at least five peaks and remains bright for more than 600 days; the absorption lines show little to no decrease in velocity; and the radius of the line-forming region is more than an order of magnitude bigger than the radius of the photosphere derived from the continuum emission. These characteristics are consistent with a shell of several tens of solar masses ejected by the progenitor star at supernova-level energies a few hundred days before a terminal explosion. Another possible eruption was recorded at the same position in 1954. Multiple energetic pre-supernova eruptions are expected to occur in stars of 95 to 130 solar masses, which experience the pulsational pair instability2,3,4,5. That model, however, does not account for the continued presence of hydrogen, or the energetics observed here. Another mechanism for the violent ejection of mass in massive stars may be required

Fluid management in the ventilated patient

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