77 research outputs found
A new life for sterile neutrino dark matter after the pandemic
We propose a novel mechanism to generate sterile neutrinos in theearly Universe, by converting ordinary neutrinos in scatteringprocesses . After initial production byoscillations, this leads to an exponential growth in the abundance. Weshow that such a production regime naturally occurs for self-interacting, and that this opens up significant new parameter space where make up all of the observed dark matter. Our results provide strong motivationto further push the sensitivity of X-ray line searches, and to improve onconstraints from structure formation.<br
A new life for sterile neutrino dark matter after the pandemic
We propose a novel mechanism to generate sterile neutrinos in the early Universe, by converting ordinary neutrinos in scattering processes . After initial production by oscillations, this leads to an exponential growth in the abundance. We show that such a production regime naturally occurs for self-interacting , and that this opens up significant new parameter space where make up all of the observed dark matter. Our results provide strong motivation to further push the sensitivity of X-ray line searches, and to improve on constraints from structure formation
A new life for sterile neutrino dark matter after the pandemic
We propose a novel mechanism to generate sterile neutrinos in theearly Universe, by converting ordinary neutrinos in scatteringprocesses . After initial production byoscillations, this leads to an exponential growth in the abundance. Weshow that such a production regime naturally occurs for self-interacting, and that this opens up significant new parameter space where make up all of the observed dark matter. Our results provide strong motivationto further push the sensitivity of X-ray line searches, and to improve onconstraints from structure formation.<br
ΠΠ±ΡΠ΅ΠΌΠ½Π°Ρ ΠΊΠ°ΠΏΠ½ΠΎΠ³ΡΠ°ΡΠΈΡ ΠΊΠ°ΠΊ ΡΠΏΠΎΡΠΎΠ± ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π°Π»ΡΠ²Π΅ΠΎΠ»ΡΡΠ½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅
The purpose of the study was to compare the relationship between the dead space volume and tidal volume (VD/VT) using volumetric capnography (VCap) during pressure controlled (PCV) and pressure supported (PSV) ventilation mode in the postoperative period.Materials and methods. 30 randomly assigned cardiac surgical patients undergoing CABG (coronary artery bypass grafting) using ECC (extracorporeal circuit) were included in an observational, prospective study. Patients were connected to the ventilator immediately after ICU admission. After that, monitoring VD/VT, CO2 production (VECO2) as well as ventilation parameters was carried out. The parameters during PCV and PSV mode were statistically evaluated using t-test.Results. Expiratory CO2 (ETCO2) concentration were not significantly different in both PCV or PSV (p=NS), although both VECO2 and minute ventilation (MV) increased during PSV mode (p<0.01). VD/VT in PSV mode was lower than in PCV. Gas exchange represented by alveolar ventilation (VA) was better during PSV (p<0.01). VA was also higher during PSV (p<0.05). The calculated VD/VT ratio differed between PCV and PSV mode (p<0.01).Conclusion. VCap represents a tool for monitoring of CO2 exchange effectivness. We registered a decrease in VD/VT with improved alveolar ventilation (VA) in PSV mode. VCap seems to be a suitable instrument for adjustment of protective lung ventilation.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΡΡΠ°Π²Π½ΠΈΡΡ Π²Π·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·Ρ ΠΌΠ΅ΠΆΠ΄Ρ ΠΎΠ±ΡΠ΅ΠΌΠΎΠΌ ΠΌΠ΅ΡΡΠ²ΠΎΠ³ΠΎ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π° ΠΈ Π΄ΡΡ
Π°ΡΠ΅Π»ΡΠ½ΡΠΌ ΠΎΠ±ΡΠ΅ΠΌΠΎΠΌ (VD/VT) ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΎΠ±ΡΠ΅ΠΌΠ½ΠΎΠΉ ΠΊΠ°ΠΏΠ½ΠΎΠ³ΡΠ°ΡΠΈΠΈ (VCap) Π² ΡΠ΅ΠΆΠΈΠΌΠ°Ρ
ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ
Ρ ΡΠΏΡΠ°Π²Π»ΡΠ΅ΠΌΡΠΌ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅ΠΌ (PCV) ΠΈ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΎΠΉ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅ΠΌ (PSV) Π² ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΎΠ±ΡΠ΅ΡΠ²Π°ΡΠΈΠΎΠ½Π½ΠΎΠ΅, ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΡΠ»ΡΡΠ°ΠΉΠ½ΠΎΠ³ΠΎ Π²ΡΠ±ΠΎΡΠ° Π²ΠΊΠ»ΡΡΠΈΠ»ΠΈ 30 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠ· ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ, ΠΏΠ΅ΡΠ΅Π½Π΅ΡΡΠΈΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡ Π°ΠΎΡΡΠΎΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ (ΠΠΠ¨) Ρ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΡΠΌ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΠ΅ΠΌ. ΠΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΠΎΠ΄ΠΊΠ»ΡΡΠ°Π»ΠΈ ΠΊ ΡΠΈΡΡΠ΅ΠΌΠ΅ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ
ΡΡΠ°Π·Ρ ΠΏΡΠΈ ΠΏΠΎΡΡΡΠΏΠ»Π΅Π½ΠΈΠΈ Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ. ΠΠ°ΡΠ΅ΠΌ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³ VD/VT, ΠΏΡΠΎΠ΄ΡΠΊΡΠΈΠΈ CO2 (VECO2), Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ. ΠΠ°ΡΠ°ΠΌΠ΅ΡΡΡ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π² ΡΠ΅ΠΆΠΈΠΌΠ°Ρ
Ρ ΡΠΏΡΠ°Π²Π»ΡΠ΅ΠΌΡΠΌ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅ΠΌ (PCV) ΠΈ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΎΠΉ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅ΠΌ (PSV) ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈΠ Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ΅ Π²ΡΡΠ²ΠΈΠ»ΠΈ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΡΡ
ΡΠ°Π·Π»ΠΈΡΠΈΠΉ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ CO2 Π²ΠΎ Π²ΡΠ΄ΡΡ
Π°Π΅ΠΌΠΎΠΌ Π²ΠΎΠ·Π΄ΡΡ
Π΅ (ETCO2) ΠΌΠ΅ΠΆΠ΄Ρ ΡΠ΅ΠΆΠΈΠΌΠ°ΠΌΠΈ PCV ΠΈ PSV (p=NS), Ρ
ΠΎΡΡ ΠΊΠ°ΠΊ VECO2, ΡΠ°ΠΊ ΠΈ ΠΌΠΈΠ½ΡΡΠ½Π°Ρ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΡ (MV) Π²ΠΎΠ·ΡΠ°ΡΡΠ°Π»ΠΈ Π² ΡΠ΅ΠΆΠΈΠΌΠ΅ PSV (p<0,01). ΠΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ VD/VT Π² ΡΠ΅ΠΆΠΈΠΌΠ΅ PSV Π±ΡΠ»ΠΎ Π½ΠΈΠΆΠ΅, ΡΠ΅ΠΌ Π² ΡΠ΅ΠΆΠΈΠΌΠ΅ PCV. ΠΠ°Π·ΠΎΠΎΠ±ΠΌΠ΅Π½, ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Π½ΡΠΉ Π°Π»ΡΠ²Π΅ΠΎΠ»ΡΡΠ½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠ΅ΠΉ (VA), Π±ΡΠ» Π»ΡΡΡΠ΅ Π² ΡΠ΅ΠΆΠΈΠΌΠ΅ PSV (p<0,01). ΠΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ VA Π±ΡΠ» ΡΠ°ΠΊΠΆΠ΅ Π²ΡΡΠ΅ Π² ΡΠ΅ΠΆΠΈΠΌΠ΅ PSV (p<0,05). Π Π°ΡΡΠ΅ΡΠ½ΠΎΠ΅ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ VD/VT ΡΠ°Π·Π»ΠΈΡΠ°Π»ΠΎΡΡ ΠΌΠ΅ΠΆΠ΄Ρ ΡΠ΅ΠΆΠΈΠΌΠ°ΠΌΠΈ PCV ΠΈ PSV (p<0,01).ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ±ΡΠ΅ΠΌΠ½Π°Ρ ΠΊΠ°ΠΏΠ½ΠΎΠ³ΡΠ°ΡΠΈΡ (VCap) ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΠ΅Π΄ΡΡΠ²ΠΎΠΌ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³Π° ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΎΠ±ΠΌΠ΅Π½Π° CO2. ΠΡΠΌΠ΅ΡΠ°Π»ΠΈ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ VD/VT Ρ ΡΠ»ΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π°Π»ΡΠ²Π΅ΠΎΠ»ΡΡΠ½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ (VA) Π² ΡΠ΅ΠΆΠΈΠΌΠ΅ PSV. VCap ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅ΡΡΡ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ΡΡΠΈΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΡΠ΅Π³ΡΠ»ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠΎΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ
T cell-mediated hypersensitivity to quinolones: mechanisms and cross-reactivity
BACKGROUND: Quinolones are widely used, broad spectrum antibiotics that can induce immediate- and delayed-type hypersensitivity reactions, presumably either IgE or T cell mediated, in about 2-3% of treated patients. OBJECTIVE: To better understand how T cells interact with quinolones, we analysed six patients with delayed hypersensitivity reactions to ciprofloxacin (CPFX), norfloxacin (NRFX) or moxifloxacin (MXFX). METHODS: We confirmed the involvement of T cells in vivo by patch test and in vitro by means of the lymphocyte proliferation test (LTT). The nature of the drug-T cell interaction as well as the cross-reactivity with other quinolones were investigated through the generation and analysis (flow cytometry and proliferation assays) of quinolone-specific T cell clones (TCC). RESULTS: The LTT confirmed the involvement of T cells because peripheral blood mononuclear cells (PBMC) mounted an enhanced in vitro proliferative response to CPFX and/or NRFX or MXFX in all patients. Patch tests were positive after 24 and 48 h in three out of the six patients. From two patients, CPFX- and MXFX-specific CD4(+)/CD8(+) T cell receptor (TCR) alphabeta(+) TCC were generated to investigate the nature of the drug-T cell interaction as well as the cross-reactivity with other quinolones. The use of eight different quinolones as antigens (Ag) revealed three patterns of cross-reactivity: clones exclusively reacting with the eliciting drug, clones with a limited cross-reactivity and clones showing a broad cross-reactivity. The TCC recognized quinolones directly without need of processing and without covalent association with the major histocompatability complex (MHC)-peptide complex, as glutaraldehyde-fixed Ag-presenting cells (APC) could present the drug and washing quinolone-pulsed APC removed the drug, abrogating the reactivity of quinolone-specific TCC. CONCLUSION: Our data show that T cells are involved in delayed immune reactions to quinolones and that cross-reactivity among the different quinolones is frequent
Transcaval Versus Transaxillary TAVR in Contemporary Practice: A Propensity-Weighted Analysis
Objectives: The aim of this study was to compare transcaval and transaxillary artery access for transcatheter aortic valve replacement (TAVR) at experienced medical centers in contemporary practice.
Background: There are no systematic comparisons of transcaval and transaxillary TAVR access routes.
Methods: Eight experienced centers contributed local data collected for the STS/ACC TVT Registry (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry) between 2017 and 2020. Outcomes after transcaval and axillary/subclavian (transaxillary) access were adjusted for baseline imbalances using doubly robust (inverse propensity weighting plus regression) estimation and compared.
Results: Transcaval access was used in 238 procedures and transaxillary access in 106; for comparison, transfemoral access was used in 7,132 procedures. Risk profiles were higher among patients selected for nonfemoral access but similar among patients requiring transcaval and transaxillary access. Stroke and transient ischemic attack were 5-fold less common after transcaval than transaxillary access (2.5% vs 13.2%; OR: 0.20; 95% CI: 0.06-0.72; P = 0.014) compared with transfemoral access (1.7%). Major and life-threatening bleeding (Valve Academic Research Consortium 3 β₯ type 2) were comparable (10.0% vs 13.2%; OR: 0.66; 95% CI: 0.26-1.66; P = 0.38) compared with transfemoral access (3.5%), as was blood transfusion (19.3% vs 21.7%; OR: 1.07; 95% CI: 0.49-2.33; P = 0.87) compared with transfemoral access (7.1%). Vascular complications, intensive care unit and hospital length of stay, and survival were similar between transcaval and transaxillary access. More patients were discharged directly home and without stroke or transient ischemic attack after transcaval than transaxillary access (87.8% vs 62.3%; OR: 5.19; 95% CI: 2.45-11.0; P \u3c 0.001) compared with transfemoral access (90.3%).
Conclusions: Patients undergoing transcaval TAVR had lower rates of stroke and similar bleeding compared with transaxillary access in a contemporary experience from 8 US centers. Both approaches had more complications than transfemoral access. Transcaval TAVR access may offer an attractive option
Clinical outcomes associated with proton pump inhibitor use among clopidogrel-treated patients within CYP2C19 genotype groups following acute myocardial infarction
We examined clinical outcomes with proton pump inhibitors (PPI) use within CYP2C19 genotype groups during clopidogrel treatment following acute myocardial infarction (AMI). 2062 patients were genotyped for CYP2C19*2 and *17 variants in TRIUMPH. 12 month clinical outcomes were analyzed among patients discharged on clopidogrel within CYP2C19*2 carrier, CYP2C19*17 carrier, and CYP2C19*1 homozygote genotype groups. PPI use was not associated with a difference in mortality. Among clopidogrel-treated Caucasians following AMI, PPI use was associated with a significantly higher rate of cardiac rehospitalization (HR 1.62, 95% CI 1.19-2.19; P=0.002) compared with no PPI use. PPI users who were carriers of the CYP2C19*17 variant experienced significantly higher rates of cardiac rehospitalization (HR 2.05, 95% CI 1.26-3.33; P=0.003), carriers of the CYP2C19*2 variant had a trend toward increased 1-year cardiac rehospitalization (HR 1.69, 95% CI 0.95-2.99; P=0.07), while no significant differences were observed among CYP2C19*1 homozygotes. These results indicate that the risks associated with PPI use among clopidogrel-treated Caucasian post-MI patients are impacted by CYP2C19 genotype, and suggest knowledge of genotype may be useful for personalizing PPI use among patients following AMI to reduce rehospitalization
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