Development and validation of a nomogram predicting recurrence risk in women with symptomatic urinary tract infection

Objectives: To develop and externally validate a novel nomogram predicting recurrence risk probability at 12 months in women after an episode of urinary tract infection. Methods: The study included 768women from Santa Maria Annunziata Hospital, Florence, Italy, affected by urinary tract infections from January 2005 to December 2009. Another 373 women with the same criteria enrolled at Santa Chiara Hospital, Trento, Italy, from January 2010 to June 2012 were used to externally validate and calibrate the nomogram. Univariate and multivariate Cox regression models tested the relationship between urinary tract infection recurrence risk, and patient clinical and laboratory characteristics. The nomogram was evaluated by calculating concordance probabilities, as well as testing calibration of predicted urinary tract infection recurrence with observed urinary tract infections. Nomogram variables included: number of partners, bowel function, type of pathogens isolated (Grampositive/ negative), hormonal status, number of previous urinary tract infection recurrences and previous treatment of asymptomatic bacteriuria. Results: Of the original development data, 261 out of 768 women presented at least one episode of recurrence of urinary tract infection (33.9%). The nomogram had a concordance index of 0.85. The nomogram predictions were well calibrated. This model showed high discrimination accuracy and favorable calibration characteristics. In the validation group (373 women), the overall c-index was 0.83 (P = 0.003, 95% confidence interval 0.51–0.99), whereas the area under the receiver operating characteristic curve was 0.85 (95% confidence interval 0.79–0.91). Conclusions: The present nomogram accurately predicts the recurrence risk of urinary tract infection at 12 months, and can assist in identifying women at high risk of symptomatic recurrence that can be suitable candidates for a prophylactic strategy

The Gaia-ESO Survey: open clusters in Gaia-DR1 A way forward to stellar age calibration

Context. Determination and calibration of the ages of stars, which heavily rely on stellar evolutionary models, are very challenging, while representing a crucial aspect in many astrophysical areas. Aims. We describe the methodologies that, taking advantage of Gaia-DR1 and the Gaia-ESO Survey data, enable the comparison of observed open star cluster sequences with stellar evolutionary models. The final, long-term goal is the exploitation of open clusters as age calibrators. Methods. We perform a homogeneous analysis of eight open clusters using the Gaia-DR1 TGAS catalogue for bright members and information from the Gaia-ESO Survey for fainter stars. Cluster membership probabilities for the Gaia-ESO Survey targets are derived based on several spectroscopic tracers. The Gaia-ESO Survey also provides the cluster chemical composition. We obtain cluster parallaxes using two methods. The first one relies on the astrometric selection of a sample of bona fide members, while the other one fits the parallax distribution of a larger sample of TGAS sources. Ages and reddening values are recovered through a Bayesian analysis using the 2MASS magnitudes and three sets of standard models. Lithium depletion boundary (LDB) ages are also determined using literature observations and the same models employed for the Bayesian analysis. Results. For all but one cluster, parallaxes derived by us agree with those presented in Gaia Collaboration (2017, A&A, 601, A19), while a discrepancy is found for NGC 2516; we provide evidence supporting our own determination. Inferred cluster ages are robust against models and are generally consistent with literature values. Conclusions. The systematic parallax errors inherent in the Gaia DR1 data presently limit the precision of our results. Nevertheless, we have been able to place these eight clusters onto the same age scale for the first time, with good agreement between isochronal and LDB ages where there is overlap. Our approach appears promising and demonstrates the potential of combining Gaia and ground-based spectroscopic datasets.Based on data products from observations made with ESO Telescopes at the La Silla Paranal Observatory under programme IDs 188.B-3002, 193.B.0936, and 197.B-1074. These data products have been processed by the Cambridge Astronomy Survey Unit (CASU) at the Institute of Astronomy, University of Cambridge, and by the FLAMES/UVES reduction team at INAF/Osservatorio Astrofisico di Arcetri. These data have been obtained from the Gaia-ESO Survey Data Archive, prepared and hosted by the Wide Field Astronomy Unit, Institute for Astronomy, University of Edinburgh, which is funded by the UK Science and Technology Facilities Council. This work has made use of data from the European Space Agency (ESA) mission Gaia (http://www.cosmos.esa.int/gaia), processed by the Gaia Data Processing and Analysis Consortium (DPAC, http://www.cosmos.esa.int/web/gaia/dpac/consortium). Funding for the DPAC has been provided by national institutions, in particular the institutions participating in the Gaia Multilateral Agreement. This research was made possible through the use of the AAVSO Photometric All-Sky Survey (APASS), funded by the Robert Martin Ayers Sciences Fundation. This research has made use of the SIMBAD and VizieR databases, operated at CDS, Strasbourg, France. This research has made use of NASA’s Astrophysics Data System. This work was partly supported by the European Union FP7 programme through ERC grant number 320360 and by the Leverhulme Trust through grant RPG-2012-541. We acknowledge the support from INAF and Ministero dell’ Istruzione, dell’ Università’ e della Ricerca (MIUR) in the form of the grant “Premiale VLT 2012” and by PRIN-INAF 2014. The results presented here benefit from discussions held during the Gaia-ESO Survey workshops and conferences supported by the ESF (European Science Foundation) through the GREAT Research Network Programme. E.T., P.G.P.M. and S.D. acknowledge PRA Universitá di Pisa 2016 (Stelle di piccola massa: le pietre miliari dell’archeologia galattica, PI: S. Degl’Innocenti) and INFN (Iniziativa specifica TAsP). M.T.C. acknowledge the financial support from the Spanish Ministerio de Economía y Competitividad, through grant AYA2016-75931. U.H. acknowledges support from the Swedish National Space Board (SNSB/Rymdstyrelsen)

The Gaia-ESO Survey: Age spread in the star forming region NGC 6530 from the HR diagram and gravity indicators

Context. In very young clusters, stellar age distribution is empirical proof of the duration of star cluster formation and thus it gives indications of the physical mechanisms involved in the star formation process. Determining the amount of interstellar extinction and the correct reddening law are crucial steps to derive fundamental stellar parameters and in particular accurate ages from the Hertzsprung-Russell diagram. Aims. In this context, we seek to derive accurate stellar ages for NGC 6530, the young cluster associated with the Lagoon Nebula to infer the star formation history of this region. Methods. We used the Gaia-ESO survey observations of the Lagoon Nebula, together with photometric literature data and Gaia DR2 kinematics, to derive cluster membership and fundamental stellar parameters. Using spectroscopic effective temperatures, we analysed the reddening properties of all objects and derived accurate stellar ages for cluster members. Results. We identified 652 confirmed and 9 probable members. The reddening inferred for members and non-members allows us to distinguish foreground objects, mainly main-sequence stars, and background objects, mainly giants, and to trace the three-dimensional structure of the nebula. This classification is in agreement with the distances inferred from Gaia DR2 parallaxes for these objects. Finally, we derive stellar ages for 382 confirmed cluster members for which we obtained the individual reddening values. In addition, we find that the gravity-sensitive γ index distribution for the M-type stars is correlated with stellar age. Conclusions. For all members with Teff < 5500 K, the mean logarithmic age is 5.84 (units of years) with a dispersion of 0.36 dex. The age distribution of stars with accretion or discs, i.e. classical T Tauri stars with excess (CTTSe), is similar to that of stars without accretion and without discs, i.e. weak T Tauri stars with photospheric emission (WTTSp). We interpret this dispersion as evidence of a real age spread since the total uncertainties on age determinations, derived from Monte Carlo simulations, are significantly smaller than the observed spread. This conclusion is supported by evidence of the decrease of the gravity-sensitive γ index as a function of stellar ages. The presence of a small age spread is also supported by the spatial distribution and kinematics of old and young members. In particular, members with accretion or discs, formed in the last 1 Myr, show evidence of subclustering around the cluster centre, in the Hourglass Nebula and in the M8-E region, suggesting a possible triggering of star formation events by the O-type star ionization fronts.Includes STFC, FP7 and ERC

Expression and function of G-protein-coupled receptorsin the male reproductive tract

This review focuses on the expression and function of muscarinic acetylcholine receptors (mAChRs), α1-adrenoceptors and relaxin receptors in the male reproductive tract. The localization and differential expression of mAChR and α1-adrenoceptor subtypes in specific compartments of the efferent ductules, epididymis, vas deferens, seminal vesicle and prostate of various species indicate a role for these receptors in the modulation of luminal fluid composition and smooth muscle contraction, including effects on male fertility. Furthermore, the activation of mAChRs induces transactivation of the epidermal growth factor receptor (EGFR) and the Sertoli cell proliferation. The relaxin receptors are present in the testis, RXFP1 in elongated spermatids and Sertoli cells from rat, and RXFP2 in Leydig and germ cells from rat and human, suggesting a role for these receptors in the spermatogenic process. The localization of both receptors in the apical portion of epithelial cells and smooth muscle layers of the vas deferens suggests an involvement of these receptors in the contraction and regulation of secretion.Esta revisão enfatiza a expressão e a função dos receptores muscarínicos, adrenoceptores α1 e receptores para relaxina no sistema reprodutor masculino. A expressão dos receptores muscarínicos e adrenoceptores α1 em compartimentos específicos de dúctulos eferentes, epidídimo, ductos deferentes, vesícula seminal e próstata de várias espécies indica o envolvimento destes receptores na modulação da composição do fluido luminal e na contração do músculo liso, incluindo efeitos na fertilidade masculina. Além disso, a ativação dos receptores muscarínicos leva à transativação do receptor para o fator crescimento epidermal e proliferação das células de Sertoli. Os receptores para relaxina estão presentes no testículo, RXFP1 nas espermátides alongadas e células de Sertoli de rato e RXFP2 nas células de Leydig e germinativas de ratos e humano, sugerindo o envolvimento destes receptores no processo espermatogênico. A localização de ambos os receptores na porção apical das células epiteliais e no músculo liso dos ductos deferentes de rato sugere um papel na contração e na regulação da secreção.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de FarmacologiaUNIFESP, EPM, Depto. de FarmacologiaSciEL

The Gaia -ESO Survey: radial distribution of abundances in the Galactic disc from open clusters and young-field stars

The spatial distribution of elemental abundances in the disc of our Galaxy gives insights both on its assembly process and subsequent evolution, and on the stellar nucleogenesis of the different elements. Gradients can be traced using several types of objects as, for instance, (young and old) stars, open clusters, HII regions, planetary nebulae. We aim at tracing the radial distributions of abundances of elements produced through different nucleosynthetic channels -the alpha-elements O, Mg, Si, Ca and Ti, and the iron-peak elements Fe, Cr, Ni and Sc - by using the Gaia-ESO idr4 results of open clusters and young field stars. From the UVES spectra of member stars, we determine the average composition of clusters with ages >0.1 Gyr. We derive statistical ages and distances of field stars. We trace the abundance gradients using the cluster and field populations and we compare them with a chemo-dynamical Galactic evolutionary model. Results. The adopted chemo-dynamical model, with the new generation of metallicity-dependent stellar yields for massive stars, is able to reproduce the observed spatial distributions of abundance ratios, in particular the abundance ratios of [O/Fe] and [Mg/Fe] in the inner disc (5 kpc<RGC <7 kpc), with their differences, that were usually poorly explained by chemical evolution models. Often, oxygen and magnesium are considered as equivalent in tracing alpha-element abundances and in deducing, e.g., the formation time-scales of different Galactic stellar populations. In addition, often [alpha/Fe] is computed combining several alpha-elements. Our results indicate, as expected, a complex and diverse nucleosynthesis of the various alpha-elements, in particular in the high metallicity regimes, pointing towards a different origin of these elements and highlighting the risk of considering them as a single class with common features.This work was partially supported by the Gaia Research for European Astronomy Training (GREAT-ITN) Marie Curie network, funded through the European Union Seventh Framework Programme [FP7/2007-2013] under grant agreement n. 264895. This work was partly supported support through the European Research Council grant 320360: The Gaia-ESO Milky Way Survey G.T. and A.D. acknowledge support by the Research Council of Lithuania (MIP- 082 / 2015). This research has been partially supported by the National Institute for Astrophysics (INAF) through the grant PRIN-2014 ("Transient Universe, unveiling new types of stellar explosions with PESSTO"). F.J.E. acknowledges financial support from the Spacetec-CM project (S2013/ICE-2822). S.F. and T.B. are supported by the project grant "The New Milky Way" from the Knut and Alice Wallenberg Foundation. Support for SD was provided by the Chile’s Ministry of Economy, Development, and Tourism’s Millennium Science Initiative through grant IC120009, awarded to The Millennium Institute of Astrophysics, MAS

Adherence to european association of urology guidelines on prophylactic antibiotics: an important step in antimicrobial stewardship

The evolution of resistant pathogens is a worldwide health crisis and adherence to European Association of Urology (EAU) guidelines on antibiotic prophylaxis may be an important way to improve antibiotic stewardship and reduce patient harm and costs. OBJECTIVE: To evaluate the prevalence of antibiotic-resistant bacterial strains and health care costs during a period of adherence to EAU guidelines in a tertiary referral urologic institution. DESIGN, SETTING, AND PARTICIPANTS: A protocol for adherence to EAU guidelines for antibiotic prophylaxis for all urologic procedures was introduced in January 2011. Data for 3529 urologic procedures performed between January 2011 and December 2013 after protocol introduction were compared with data for 2619 procedures performed between January 2008 and December 2010 before protocol implementation. The prevalence of bacterial resistance and health care costs were compared between the two periods. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The outcome measures were the proportion of resistant uropathogens and costs related to antibiotic consumption and symptomatic postoperative infection. We used χ(2) and Fisher's exact tests to test the significance of differences. RESULTS AND LIMITATIONS: The proportion of patients with symptomatic postoperative infection did not differ (180/3529 [5.1%] vs 117/2619 [4.5%]; p=0.27). A total of 342 isolates from all patients with symptomatic postoperative infections were analysed. The rate of resistance of Escherichia coli to piperacillin/tazobactam (9.1% vs 5.4%; p=0.03), gentamicin (18.3% vs 11.2%; p=0.02), and ciprofloxacin (32.3% vs 19.1%; p=0.03) decreased significantly after protocol introduction. The defined daily dose (DDD) use of ciprofloxacin fell from 4.2 to 0.2 DDD per 100 patient-days after implementation (p<0.001). Antibiotic drug costs (€76 980 vs €36 700) and costs related to postoperative infections (€45 870 vs €29 560) decreased following introduction of the protocol (p<0.001). CONCLUSIONS: Adherence to EAU guidelines on antibiotic prophylaxis reduced antibiotic usage without increasing post-operative infection rate and lowered the prevalence of resistant uropathogens. PATIENT SUMMARY: We analysed the impact of adherence to European Association of Urology guidelines on antibiotic prophylaxis for all surgical urologic procedures on the prevalence of infections and resistant bacterial strains and on costs. We found that adherence to the guidelines reduced the rate of bacterial resistance, in particular against piperacillin/tazobactam, gentamicin, and ciprofloxacin, and reduced costs without increasing the risk of postoperative infection after urologic procedures. We recommend adherence to the guidelines as an important part of antibiotic stewardship programmes

The Gaia -ESO Survey: The N/O abundance ratio in the Milky Way?

The abundance ratio N/O is a useful tool to study the interplay of galactic processes, e.g. star formation efficiency, time-scale of infall and outflow loading factor We aim to trace log(N/O) versus [Fe/H] in the Milky Way and to compare it with a set of chemical evolution models to understand the role of infall, outflow and star formation efficiency in the building-up of the Galactic disc. We use the abundances from idr2-3, idr4, idr5 data releases of the Gaia-ESO Survey both for Galactic field and open cluster stars.We determine membership and average composition of open clusters and we separate thin and thick disc field stars.We consider the effect of mixing in the abundance of N in giant stars. We compute a grid of chemical evolution models, suited to reproduce the main features of our Galaxy, exploring the effects of the star formation efficiency, the infall time-scale and the differential outflow. With our samples, we map the metallicity range -0.6<[Fe/H]<0.3 with a corresponding -1.2<log(N/O)<-0.2, where the secondary production of N dominates. Thanks to the wide range of Galactocentric distances covered by our samples, we can distinguish the behaviour of log(N/O) in different parts of the Galaxy. Our spatially resolved results allow us to distinguish differences in the evolution of N/O with Galactocentric radius. Comparing the data with our models, we can characterise the radial regions of our Galaxy. A shorter infall time-scale is needed in the inner regions, while the outer regions need a longer infall time-scale, coupled with a higher star formation efficiency. We compare our results with nebular abundances obtained in MaNGA galaxies, finding in our Galaxy a much wider range of log(N/O) than in integrated observations of external galaxies of similar stellar mass, but similar to the ranges found in studies of individual H ii regions

Laser and Light-Based Therapies in the Treatment of Hair Loss

Laser and light-based therapies including low-level laser and light therapy, fractional, excimer, and other lasers are increasingly well-regarded treatment options for patients with hair loss. Lasers emit wavelengths of light specific to a chromophore in the tissue, causing a targeted thermal response with minimal damage to surrounding tissue. The cascade of events downstream of the initial injury is responsible for the clinical effects seen. Low-level laser or light therapy (LLLT) was accidentally discovered in the 1960s when Hungarian scientist Endre Mester attempted to repeat an experiment performed by American Paul McGuff, who had cured malignant tumors in rats using a ruby laser. Mester’s laser was much less powerful than McGuff’s, and while he did not successfully cure any tumors, he observed for the first time that a low-level laser induced hair growth and improved wound healing. The mechanism by which this occurs is described as photobiomodulation or the stimulation of biological processes in the target tissue. This accidental discovery is the basis for the huge variety of LLLT products available on the market today. In the last 2 years alone, the number of approved items classified as laser, comb, or hair products intended for the purpose of the growth of scalp hairs on the FDA’s 510(k) premarket notification list, meaning the device is demonstrated to be at least safe and effective, has nearly doubled to a total of 50. This chapter will summarize current knowledge regarding all laser and light devices for patients with various forms of alopecia and will outline treatment strategy, device parameters, and appropriate limitations of use to guide providers toward optimal patient management