Nitrogen chronology of massive main sequence stars

Rotational mixing in massive main sequence stars is predicted to monotonically increase their surface nitrogen abundance with time. We use this effect to design a method for constraining the age and the inclination angle of massive main sequence stars, given their observed luminosity, effective temperature, projected rotational velocity and surface nitrogen abundance. This method relies on stellar evolution models for different metallicities, masses and rotation rates. We use the population synthesis code STARMAKER to show the range of applicability of our method. We apply this method to 79 early B-type main sequence stars near the LMC clusters NGC 2004 and N 11 and the SMC clusters NGC 330 and NGC 346. From all stars within the sample, 17 were found to be suitable for an age analysis. For ten of them, which are rapidly rotating stars without a strong nitrogen enhancement, it has been previously concluded that they did not evolve as rotationally mixed single stars. This is confirmed by our analysis, which flags the age of these objects as highly discrepant with their isochrone ages. For the other seven stars, their nitrogen and isochrone ages are found to agree within error bars, what validates our method. Constraints on the inclination angle have been derived for the other 62 stars,with the implication that the nitrogen abundances of the SMC stars, for which mostly only upper limits are known, fall on average significantly below those limits. Nitrogen chronology is found to be a new useful tool for testing stellar evolution and to constrain fundamental properties of massive main sequence stars. A web version of this tool is provided.Comment: accepted by A&A, 15 pages, 16 figures, 6 table

Boron depletion in 9 to 15 M(circle dot) stars with rotation

The treatment of mixing is still one of the major uncertainties in stellar evolution models. One open question is how well the prescriptions for rotational mixing describe the real effects. We tested the mixing prescriptions included in the Geneva stellar evolution code (GENEC) by following the evolution of surface abundances of light isotopes in massive stars, such as boron and nitrogen. We followed 9, 12 and 15 M(O) models with rotation from the zero age main sequence up to the end of He burning. The calculations show the expected behaviour with faster depletion of boton for faster rotating stars and more massive stars. The mixing at the surface is more efficient, than predicted by prescriptions used in other codes and reproduces the majority of observations very well However two observed stars with strong boron depletion but, no nitrogen enhancement still can not be explained and let the question open whether additional mixing processes are acting in these massive star

A hydrodynamic study of the circumstellar envelope of alpha Scorpii

Context: Both the absolute mass-loss rates and the mechanisms that drive the mass loss of late-type supergiants are still not well known. Binaries such as alpha Sco provide the most detailed empirical information about the winds of these stars. Aims: The goal was to improve the binary technique for the determination of the mass-loss rate of alpha Sco A by including a realistic density distribution and velocity field from hydrodynamic and plasma simulations. Methods: We performed 3D hydrodynamic simulations of the circumstellar envelope of alpha Sco in combination with plasma simulations accounting for the heating, ionization, and excitation of the wind by the radiation of alpha Sco B. These simulations served as the basis for an examination of circumstellar absorption lines in the spectrum of alpha Sco B as well as of emission lines from the Antares nebula. Results: The present model of the extended envelope of alpha Sco reproduces some of the structures that were observed in the circumstellar absorption lines in the spectrum of alpha Sco B. Our theoretical density and velocity distributions of the outflow deviate considerably from a spherically expanding model, which was used in previous studies. This results in a higher mass-loss rate of (2 +/- 0.5) x 10^-6 M_sun/yr. The hot H II region around the secondary star induces an additional acceleration of the wind at large distances from the primary, which is seen in absorption lines of Ti II and Cr II at -30 km/s.Comment: 12 pages, 14 figures, accepted for publication in A&

Oral antiplatelet therapy in diabetes mellitus and the role of prasugrel: an overview

Diabetics have a prothrombotic state that includes increased platelet reactivity. This contributes to the less favorable clinical outcomes observed in diabetics experiencing acute coronary syndromes as well as stable coronary artery disease. Many diabetics are relatively resistant to or have insufficient response to several antithrombotic agents. In the setting of percutaneous coronary intervention, hyporesponsiveness to clopidogrel is particularly common among diabetics. Several strategies have been examined to further enhance the benefits of oral antiplatelet therapy in diabetics. These include increasing the dose of clopidogrel, triple antiplatelet therapy with cilostazol, and new agents such as prasugrel. The large TRITON TIMI 38 randomized trial compared clopidogrel to prasugrel in the setting of percutaneous coronary intervention for acute coronary syndromes. The diabetic subgroup (n = 3146) experienced considerable incremental benefit with a 4.8% reduction in cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke at 15-month follow-up with prasugrel treatment. Among diabetics on insulin this combined endpoint was reduced by 7.9% at 15 months. Major bleeding was not increased in the diabetic subgroup. This confirms the general hypothesis that more potent oral antiplatelet therapy can partially overcome the prothrombotic milieu and safely improve important clinical outcomes in diabetics

The effectiveness and safety of antifibrinolytics in patients with acute intracranial haemorrhage: statistical analysis plan for an individual patient data meta-analysis

Introduction: The Antifibrinolytic Trialists Collaboration aims to increase knowledge about the effectiveness and safety of antifibrinolytic treatment by conducting individual patient data (IPD) meta-analyses of randomised trials. This article presents the statistical analysis plan for an IPD meta-analysis of the effects of antifibrinolytics for acute intracranial haemorrhage. Methods: The protocol for the IPD meta-analysis has been registered with PROSPERO (CRD42016052155). We will conduct an individual patient data meta-analysis of randomised controlled trials with 1000 patients or more assessing the effects of antifibrinolytics in acute intracranial haemorrhage. We will assess the effect on two co-primary outcomes: 1) death in hospital at end of trial follow-up, and 2) death in hospital or dependency at end of trial follow-up. The co-primary outcomes will be limited to patients treated within three hours of injury or stroke onset. We will report treatment effects using odds ratios and 95% confidence intervals. We use logistic regression models to examine how the effect of antifibrinolytics vary by time to treatment, severity of intracranial bleeding, and age. We will also examine the effect of antifibrinolytics on secondary outcomes including death, dependency, vascular occlusive events, seizures, and neurological outcomes. Secondary outcomes will be assessed in all patients irrespective of time of treatment. All analyses will be conducted on an intention-to-treat basis. Conclusions: This IPD meta-analysis will examine important clinical questions about the effects of antifibrinolytic treatment in patients with intracranial haemorrhage that cannot be answered using aggregate data. With IPD we can examine how effects vary by time to treatment, bleeding severity, and age, to gain better understanding of the balance of benefit and harms on which to base recommendations for practice

The R136 star cluster dissected with Hubble Space Telescope/STIS. I. Far-ultraviolet spectroscopic census and the origin of HeII 1640 in young star clusters

We introduce a HST/STIS stellar census of R136a, the central ionizing star cluster of 30 Doradus. We present low resolution far-ultraviolet STIS/MAMA spectroscopy of R136 using 17 contiguous 52x0.2 arcsec slits which together provide complete coverage of the central 0.85 parsec (3.4 arcsec). We provide spectral types of 90% of the 57 sources brighter than m_F555W = 16.0 mag within a radius of 0.5 parsec of R136a1, plus 8 additional nearby sources including R136b (O4\,If/WN8). We measure wind velocities for 52 early-type stars from CIV 1548-51, including 16 O2-3 stars. For the first time we spectroscopically classify all Weigelt & Baier members of R136a, which comprise three WN5 stars (a1-a3), two O supergiants (a5-a6) and three early O dwarfs (a4, a7, a8). A complete Hertzsprung-Russell diagram for the most massive O stars in R136 is provided, from which we obtain a cluster age of 1.5+0.3_-0.7 Myr. In addition, we discuss the integrated ultraviolet spectrum of R136, and highlight the central role played by the most luminous stars in producing the prominent HeII 1640 emission line. This emission is totally dominated by very massive stars with initial masses above ~100 Msun. The presence of strong HeII 1640 emission in the integrated light of very young star clusters (e.g A1 in NGC 3125) favours an initial mass function extending well beyond a conventional upper limit of 100 Msun. We include montages of ultraviolet spectroscopy for LMC O stars in the Appendix. Future studies in this series will focus on optical STIS/CCD medium resolution observations.Comment: 20 pages plus four Appendices providing LMC UV O spectral templates, UV spectral atlas in R136, wind velocities of LMC O stars and photometry of additional R136 source

The stroke oxygen pilot study: a randomized control trial of the effects of routine oxygen supplementation early after acute stroke--effect on key outcomes at six months

Introduction: Post-stroke hypoxia is common, and may adversely affect outcome. We have recently shown that oxygen supplementation may improve early neurological recovery. Here, we report the six-month outcomes of this pilot study. Methods: Patients with a clinical diagnosis of acute stroke were randomized within 24 h of admission to oxygen supplementation at 2 or 3 L/min for 72 h or to control treatment (room air). Outcomes (see below) were assessed by postal questionnaire at 6 months. Analysis was by intention-to-treat, and statistical significance was set at p#0.05. Results: Out of 301 patients randomized two refused/withdrew consent and 289 (148 in the oxygen and 141 in the control group) were included in the analysis: males 44%, 51%; mean (SD) age 73 (12), 71 (12); median (IQR) National Institutes of Health Stroke Scale score 6 (3, 10), 5 (3, 10) for the two groups respectively. At six months 22 (15%) patients in the oxygen group and 20 (14%) in the control group had died; mean survival in both groups was 162 days (p= 0.99). Median (IQR) scores for the primary outcome, the modified Rankin Scale, were 3 (1, 5) and 3 (1, 4) for the oxygen and control groups respectively. The covariate-adjusted odds ratio was 1.04 (95% CI 0.67, 1.60), indicating that the odds of a lower (i.e. better) score were non-significantly higher in the oxygen group (p= 0.86). The mean differences in the ability to perform basic (Barthel Index) and extended activities of daily living (NEADL), and quality of life (EuroQol) were also non-significant. Conclusions: None of the key outcomes differed at 6 months between the groups. Although not statistically significant and generally of small magnitude, the effects were predominantly in favour of the oxygen group; a larger trial, powered to show differences in longer-term functional outcomes, is now on-going. Trial Registration: Controlled-Trials.com ISRCTN12362720; Eudract.ema.europa.eu 2004-001866-4

The VLT-FLAMES Tarantula Survey III: A very massive star in apparent isolation from the massive cluster R136

VFTS 682 is located in an active star-forming region, at a projected distance of 29 pc from the young massive cluster R136 in the Tarantula Nebula of the Large Magellanic Cloud. It was previously reported as a candidate young stellar object, and more recently spectroscopically revealed as a hydrogen-rich Wolf-Rayet (WN5h) star. Our aim is to obtain the stellar properties, such as its intrinsic luminosity, and to investigate the origin of VFTS 682. To this purpose, we model optical spectra from the VLT-FLAMES Tarantula Survey with the non-LTE stellar atmosphere code CMFGEN, as well as the spectral energy distribution from complementary optical and infrared photometry. We find the extinction properties to be highly peculiar (RV ~4.7), and obtain a surprisingly high luminosity log(L/Lsun) = 6.5 \pm 0.2, corresponding to a present-day mass of ~150Msun. The high effective temperature of 52.2 \pm 2.5kK might be explained by chemically homogeneous evolution - suggested to be the key process in the path towards long gamma-ray bursts. Lightcurves of the object show variability at the 10% level on a timescale of years. Such changes are unprecedented for classical Wolf-Rayet stars, and are more reminiscent of Luminous Blue Variables. Finally, we discuss two possibilities for the origin of VFTS 682: (i) the star either formed in situ, which would have profound implications for the formation mechanism of massive stars, or (ii) VFTS 682 is a slow runaway star that originated from the dense cluster R136, which would make it the most massive runaway known to date.Comment: 5 pages, 5 figures, accepted by A&A Letter

The SOS Pilot Study: a RCT of routine oxygen supplementation early after acute stroke—effect on recovery of neurological function at one week

Mild hypoxia is common after stroke and associated with poor long-term outcome. Oxygen supplementation could prevent hypoxia and improve recovery. A previous study of routine oxygen supplementation showed no significant benefit at 7 and 12 months. This pilot study reports the effects of routine oxygen supplementation for 72 hours on oxygen saturation and neurological outcomes at 1 week after a stroke

Safety and Clinical Outcome of Thrombolysis in Ischaemic Stroke Using a Perfusion CT Mismatch between 3 and 6 Hours

It may be possible to thrombolyse ischaemic stroke (IS) patients up to 6 h by using penumbral imaging. We investigated whether a perfusion CT (CTP) mismatch can help to select patients for thrombolysis up to 6 h.A cohort of 254 thrombolysed IS patients was studied. 174 (69%) were thrombolysed at 0-3 h by using non-contrast CT (NCCT), and 80 (31%) at 3-6 h (35 at 3-4.5 h and 45 at 4.5-6 h) by using CTP mismatch criteria. Symptomatic intracerebral haemorrhage (SICH), the mortality and the modified Rankin Score (mRS) were assessed at 3 months. Independent determinants of outcome in patients thrombolysed between 3 and 6 h were identified.The baseline characteristics were comparable in the two groups. There were no differences in SICH (3% v 4%, p = 0.71), any ICH (7% v 9%, p = 0.61), or mortality (16% v 9%, p = 0.15) or mRS 0-2 at 3 months (55% v 54%, p = 0.96) between patients thrombolysed at 0-3 h (NCCT only) or at 3-6 h (CTP mismatch). There were no significant differences in outcome between patients thrombolysed at 3-4.5 h or 4.5-6 h. The NIHSS score was the only independent determinant of a mRS of 0-2 at 3 months (OR 0.89, 95% CI 0.82-0.97, p = 0.007) in patients treated using CTP mismatch criteria beyond 3 h.The use of a CTP mismatch model may help to guide thrombolysis decisions up to 6 h after IS onset