42 research outputs found

    Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

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    Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

    The Science Performance of JWST as Characterized in Commissioning

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    This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

    Data sharing reveals complexity in the westward spread of domestic animals across Neolithic Turkey

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    This study presents the results of a major data integration project bringing together primary archaeozoological data for over 200,000 faunal specimens excavated from seventeen sites in Turkey spanning the Epipaleolithic through Chalcolithic periods, c. 18,000-4,000 cal BC, in order to document the initial westward spread of domestic livestock across Neolithic central and western Turkey. From these shared datasets we demonstrate that the westward expansion of Neolithic subsistence technologies combined multiple routes and pulses but did not involve a set 'package' comprising all four livestock species including sheep, goat, cattle and pig. Instead, Neolithic animal economies in the study regions are shown to be more diverse than deduced previously using quantitatively more limited datasets. Moreover, during the transition to agro-pastoral economies interactions between domestic stock and local wild fauna continued. Through publication of datasets with Open Context (opencontext.org), this project emphasizes the benefits of data sharing and web-based dissemination of large primary data sets for exploring major questions in archaeology (Alternative Language Abstract S1)

    Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

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    BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

    Hunting and herding in Central Anatolian prehistory: the 9th and 7th Millenium sites at Pinarbaşi

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    This dissertation examines the faunal remains from a series of Neolithic archaeological sites located in Central Anatolia dated from the 9th to the 6th millennium cal BC. The purpose of this research is to reinterpret previously published faunal datasets and present new faunal data from Central Anatolia in order to elucidate subsistence patterns for this region The research is divided into two sections. The first section will review published palaeoenvironmental, archaeological and zooarchaeological data which have been used to established subsistence behaviour for the region. Critical to this review is the addition of new zooarchaeological data sets from Asikli Hoytuk and the renewed excavations at Catalhoyiik (East). The second section presents the results of the zooarchaoelogical analysis of faunal remains from the newly excavated sites at Pinarbasi A and B located on the Konya Plain in Central Anatolia. Pinirbasi , Site A is the earliest excavated site in Central Anatolia, dated at 8500 cal BC; Site B is contemporaneous with the latter part of the Catalhoyuk (East) sequence and is dated at 6400 cal BC. The re-examination of faunal data published from Central Anatolian sites appear to contradict commonly accepted patterns which characterise the Region as the centre of cattle domestication for the Near East. Based on the faunal data analysed, there is not enough data to currently state that cattle were locally domesticated within Central Anatolia and then distributed outwards to other centres. The examination of Pinarbasi A faunal data indicates hunting and broad spectrum subsistence was practiced at 8500 cal BC in Central Anatolia. However, due to the small morphological size of sheep bones recovered, herding is speculated. In addition, there is also evidence of longer, semi-sedentary occupation of the site due to the presence of cultural material that includes indigenous microlith tools and stone and mud brick foundations. Pinarbasi B' s faunal assemblage revealed subsistence practices characteristic of a herd based economy. Sheep and goat remains dominate the assemblage in addition to the continuation of seasonal hunting of larger wild taxa. Based on the new data from Pinarbasi Site A and B, and the reanalysis of new and existing faunal data, it is argued that Central Anatolian settlement and subsistence patterns did not display a pattern of gradual change in subsistence from hunting and gathering to plant and subsequently animal domestication that appear in the rest of the Levant but rather the domestication of animals appears to be quite early based on Central Anatolia's present chronological composition. Central Anatolian sites appear to be settled with domestic caprines. It is only speculated that in later levels of Catalhoyuk (East), Erbaba and Catalhoyuk (West) that domestic cattle will be found

    Ritual in the landscape: Evidence from Pinarbasi in the seventh-millennium cal BC Konya Plain

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    Excavations in the rockshelter at Pinarbasi, 24.5km south-east of Çatalhöyük, have brought to light a sequence of structures and a rich assemblage of animal bones, with some of the bones embedded in plaster objects. The authors argue for a strong link with Çatalhöyük, and propose a hunter-herder site operated by a close-knit group from that settlement, supplying meat to it, but practising their own up-country rituals - so providing a glimpse of the 'lived landscape'

    Performance criteria for the benchmarking of air quality model regulatory applications: the 'target' approach

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    The definition of appropriate performance criteria is one of the key issues for the benchmarking of air quality models in regulatory applications. As part of the FAIRMODE benchmarking activities (Thunis et al., 2010), suitable criteria for air quality modelling in the frame of the EU air quality directive (AQD) 2008 are proposed and tested. The suggested approach builds on the target indicator (Jolliff et al., 2009) as support to the relative directive error, the current official statistical parameter as defined in the AQD (EEA, 2011), for quantitatively estimating model performances in air quality modelling applications. This study describes the advantages of using the target compared to the actual limitations of RDE and addresses the main links between the target and some 'traditional' statistical indicators (MFB, R, FAC2, σ). It also describes the application of this methodology to NO2, O3 and PM10 concentrations on three different model-observations datasets. Among these datasets two focus on the urban areas of Madrid and London and include modelled results provided by the air quality models CMAQ and ADMS-Urban for years 2007 and 2008 respectively. One other dataset (POMI) covering the Po valley and including multiple model results has also been tested for year 200
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