Results of a LMXB survey: variation in the height of the neutron star blackbody emission region

We present results of a survey of the spectra of Low Mass X-ray Binaries using ASCA. It is shown that all sources in the survey are well-fitted by the same two-component emission model that we have previously shown is able to describe both the non-dip and dip spectra of the dipping class of LMXB. This model consists of point-like blackbody emission from the neutron star plus Comptonized emission from a disk-like accretion disk corona of radius typically 50,000 km. Additional data from results published elsewhere by us from BeppoSAX and ASCA are added to the survey. The large variation in blackbody luminosity of survey sources is shown to be due primarily to major changes in blackbody emitting area. Fitting a multi-temperature disk blackbody plus Comptonization model to the survey spectra requires values of inner disk radius substantially less than the neutron star radius in many cases, making disk origin of the blackbody highly unlikely. Assuming that the emission is from an equatorial strip on the neutron star, it is shown that the half-height of the strip h agrees well with the half-height H of the radiatively-supported inner accretion disk, this agreement spanning three orders of magnitude in each parameter. Possible mechanisms for the agreement are discussed, including radial accretion flow between inner disk and star, and accretion flow ``creep' on the surface of the neutron star.Comment: 10 pages, 7 ps figures; accepted for publication in A&A Main Journa

Acute type A aortic dissection and pregnancy: a population-based study

Objective: Pregnancy has been reported to be an independent risk factor for 50% of acute aortic dissections recorded in women younger than 45 years of age. The present epidemiologic study aimed to identify whether this putative association of pregnancy and acute type A dissection could be an artifact of selective reporting. Methods: This population-based study was conducted in the City of Vienna, Austria, Europe, in an average female population of 341381 women in the age range of 15-45 years who were followed up between 1994 and 2004 (total of 3755.195 person-years of observation). During this study, the incidence, management, and outcome of acute type A dissection were determined. Results: Fifteen patients (mean age: 38.8 years, SD: 4.8) with acute aortic dissection were identified, and an overall incidence of 0.4 case per 100000 person-years was estimated. The prehospital mortality rate was recorded to be 53%. Six patients, including two women in late pregnancy (incidence: 0.05 cases per 100000 person-years), were treated successfully by surgical repair during deep hypothermic circulatory arrest (in-hospital mortality rate: 6.6%). Pregnancy and aortic dissection were identified as events that were not related (RR: 3.27; 95% confidence interval (CI): 0.82-12.95; P=0.14). Observation during long-term follow-up was uneventful. Conclusions: Acute aortic dissection represents a rare pathology in women younger than 45 years of age; however, it is associated with a high rate of sudden death. Pregnancy may not be a risk factor for this life-threatening vascular emergency. Immediate referral to surgery, even during pregnancy, will result in a prognosis of favorable outcom

Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery†

Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most devastating complication. The aim of this position paper is to provide physicians with broad information regarding spinal cord blood supply, to share strategies for shortening intraprocedural spinal cord ischaemia and to increase spinal cord tolerance to transitory ischaemia through detection of ischaemia and augmentation of spinal cord blood perfusion. This study is meant to support physicians caring for patients in need of any kind of thoracic or thoracoabdominal aortic repair in decision-making algorithms in order to understand, prevent or reverse ischaemic SCI. Information has been extracted from focused publications available in the PubMed database, which are cohort studies, experimental research reports, case reports, reviews, short series and meta-analyses. Individual chapters of this position paper were assigned and after delivery harmonized by Christian D. Etz, Ernst Weigang and Martin Czerny. Consequently, further writing assignments were distributed within the group and delivered in August 2014. The final version was submitted to the EJCTS for review in September 201

Acceleration and collimation of relativistic MHD disk winds

We perform axisymmetric relativistic magnetohydrodynamic (MHD) simulations to investigate the acceleration and collimation of jets and outflows from disks around compact objects. The fiducial disk surface (respectively a slow disk wind) is prescribed as boundary condition for the outflow. We apply this technique for the first time in the context of relativistic jets. The strength of this approach is that it allows us to run a parameter study in order to investigate how the accretion disk conditions govern the outflow formation. Our simulations using the PLUTO code run for 500 inner disk rotations and on a physical grid size of 100x200 inner disk radii. In general, we obtain collimated beams of mildly relativistic speed and mass-weighted half-opening angles of 3-7 degrees. When we increase the outflow Poynting flux by injecting an additional disk toroidal field into the inlet, Lorentz factors up to 6 are reached. These flows gain super-magnetosonic speed and remain Poynting flux dominated. The light surface of the outflow magnetosphere tends to align vertically - implying three relativistically distinct regimes in the flow - an inner sub-relativistic domain close to the jet axis, a (rather narrow) relativistic jet and a surrounding subrelativistic outflow launched from the outer disk surface - similar to the spine-sheath structure currently discussed for asymptotic jet propagation and stability. The outer subrelativistic disk wind is a promising candidate for the X-ray absorption winds that are observed in many radio-quiet AGN.Comment: 22 pages, 15 figures; accepted for publication in ApJ; incorporates changes according to refere

Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?

Thoracic endovascular aortic repair (TEVAR) has emerged as a promising therapeutic alternative to conventional open aortic replacement but it requires suitable proximal and distal landing zones for stent-graft anchoring. Many aortic pathologies affect in the immediate proximity of the left subclavian artery (LSA) limiting the proximal landing zone site without proximal vessel coverage. In patients in whom the distance between the LSA and aortic lesion is too short, extension of the landing zone can be obtained by covering the LSA's origin with the endovascular stent graft (ESG). This manoeuvre has the potential for immediate and delayed neurological and vascular symptoms. Some authors, therefore, propose prophylactic revascularisation of the LSA by transposition or bypass, while others suggest prophylactic revascularisation only under certain conditions, and still others see no requirement for prophylactic revascularisation in anticipation of LSA ostium coverage. In this review about LSA revascularisation in TEVAR patients with coverage of the LSA, we searched the electronic databases MEDLINE and EMBASE historically until the end date of May 2010 with the search terms left subclavian artery, covering, endovascular, revascularisation and thoracic aorta. We have gathered the most complete scientific evidence available used to support the various concepts to deal with this issue. After a review of the current available literature, 23 relevant articles were found, where we have identified and analysed three basic treatment concepts for LSA revascularisation in TEVAR patients (prophylactic, conditional prophylactic and no prophylactic LSA revascularisation). The available evidence supports prophylactic revascularisation of the LSA before ESG LSA coverage when preoperative imaging reveals abnormal supra-aortic vascular anatomy or pathology. We further conclude that elective patients undergoing planned coverage of the LSA during TEVAR should receive prophylactic LSA transposition or LSA-to-left-common-carotid-artery (LCCA) bypass surgery to prevent severe neurological complications, such as paraplegia or brain stem infarctio

Transit timing variation and activity in the WASP-10 planetary system

Transit timing analysis may be an effective method of discovering additional bodies in extrasolar systems which harbour transiting exoplanets. The deviations from the Keplerian motion, caused by mutual gravitational interactions between planets, are expected to generate transit timing variations of transiting exoplanets. In 2009 we collected 9 light curves of 8 transits of the exoplanet WASP-10b. Combining these data with published ones, we found that transit timing cannot be explained by a constant period but by a periodic variation. Simplified three-body models which reproduce the observed variations of timing residuals were identified by numerical simulations. We found that the configuration with an additional planet of mass of $\sim$0.1 $M_{\rm{J}}$ and orbital period of $\sim$5.23 d, located close to the outer 5:3 mean motion resonance, is the most likely scenario. If the second planet is a transiter, the estimated flux drop will be $\sim$0.3 per cent and can be observable with a ground-based telescope. Moreover, we present evidence that the spots on the stellar surface and rotation of the star affect the radial velocity curve giving rise to spurious eccentricity of the orbit of the first planet. We argue that the orbit of WASP-10b is essentially circular. Using the gyrochronology method, the host star was found to be $270 \pm 80$ Myr old. This young age can explain the large radius reported for WASP-10b.Comment: MNRAS accepte

Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS†

The implementation of new surgical techniques offers chances but carries risks. Usually, several years pass before a critical appraisal and a balanced opinion of a new treatment method are available and rely on the evidence from the literature and expert's opinion. The frozen elephant trunk (FET) technique has been increasingly used to treat complex pathologies of the aortic arch and the descending aorta, but there still is an ongoing discussion within the surgical community about the optimal indications. This paper represents a common effort of the Vascular Domain of EACTS together with several surgeons with particular expertise in aortic surgery, and summarizes the current knowledge and the state of the art about the FET technique. The majority of the information about the FET technique has been extracted from 97 focused publications already available in the PubMed database (cohort studies, case reports, reviews, small series, meta-analyses and best evidence topics) published in Englis

Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications

OBJECTIVES To learn upon incidence, underlying mechanisms and effectiveness of treatment strategies in patients with central airway and pulmonary parenchymal aorto-bronchial fistulation after thoracic endovascular aortic repair (TEVAR). METHODS Analysis of an international multicentre registry (European Registry of Endovascular Aortic Repair Complications) between 2001 and 2012 with a total caseload of 4680 TEVAR procedures (14 centres). RESULTS Twenty-six patients with a median age of 70 years (interquartile range: 60-77) (35% female) were identified. The incidence of either central airway (aorto-bronchial) or pulmonary parenchymal (aorto-pulmonary) fistulation (ABPF) in the entire cohort after TEVAR in the study period was 0.56% (central airway 58%, peripheral parenchymal 42%). Atherosclerotic aneurysm formation was the leading indication for TEVAR in 15 patients (58%). The incidence of primary endoleaks after initial TEVAR was n = 10 (38%), of these 80% were either type I or type III endoleaks. Fourteen patients (54%) developed central left bronchial tree lesions, 11 patients (42%) pulmonary parenchymal lesions and 1 patient (4%) developed a tracheal lesion. The recognized mechanism of ABPF was external compression of the bronchial tree in 13 patients (50%), the majority being due to endoleak formation, further ischaemia due to extensive coverage of bronchial feeding arteries in 3 patients (12%). Inflammation and graft erosion accounted for 4 patients (30%) each. Cumulative survival during the entire study period was 39%. Among deaths, 71% were attributed to ABPF. There was no difference in survival in patients having either central airway or pulmonary parenchymal ABPF (33 vs 45%, log-rank P = 0.55). Survival with a radical surgical approach was significantly better when compared with any other treatment strategy in terms of overall survival (63 vs 32% and 63 vs 21% at 1 and 2 years, respectively), as well as in terms of fistula-related survival (63 vs 43% and 63 vs 43% at 1 and 2 years, respectively). CONCLUSIONS ABPF is a rare but highly lethal complication after TEVAR. The leading mechanism behind ABPF seems to be a continuing external compression of either the bronchial tree or left upper lobe parenchyma. In this setting, persisting or newly developing endoleak formation seems to play a crucial role. Prognosis does not differ in patients with central airway or pulmonary parenchymal fistulation. Radical bronchial or pulmonary parenchymal repair in combination with stent graft removal and aortic reconstruction seems to be the most durable treatment strateg