Suspected Blood Indicator to Identify Active Gastrointestinal Bleeding: A Prospective Validation

Background: The suspected blood indicator (SBI) function in the RAPID Reader v8.3 program was designed to quickly identify the presence of blood in video capsule endoscopy. While previous retrospective studies have shown that the SBI function was accurate in detecting the presence of active bleeding in the small bowel, its specificity and sensitivity were poor. Methods: An initial retrospective review (phase 1) compared 115 patients with active gastrointestinal bleeding seen on video capsule endoscopy (VCE) to 115 patients with no active bleeding seen on VCE to produce a highly accurate algorithm. A prospective study (phase 2) was then performed by applying the algorithm to 100 consecutive patients who received VCE for the following indications: obscure bleeding, iron deficiency anemia, melena, and hematochezia. Results: The initial retrospective review found that eight contiguous SBI markers had a specificity of 100% in identifying active gastrointestinal bleeding regardless of the total number of SBI markers, while two or more contiguous SBI markers had a sensitivity of 96.5%. Using a cutoff of eight contiguous SBI markers, the prospective arm found that there was a 100% sensitivity and specificity in detecting active gastrointestinal bleeding (P \u3c 0.001). Conclusions: The SBI function can greatly facilitate the identification of active gastrointestinal bleeding on VCE by using eight contiguous SBI markers as a cutoff for active bleeding

Clostridium difficile in Inflammatory Bowel Disease: A Retrospective Study

Aim: To investigate the epidemiology and risk factors of Clostridium difficile infections (CDI) in patients with inflammatory bowel disease (IBD). Methods: This is a retrospective study of patients diagnosed with IBD. 1006 charts were screened and 654 patients met the inclusion criteria. Patients were divided into 2 cohorts based on the presence of prior diagnosis of CDI. Statistical analysis with Pearson\u27s chi-squared and two-sample t-test was performed. Results: The incidence of CDI among IBD patients was 6.7%. There was equal prevalence of CDI among Crohn\u27s disease (CD) (n = 21, 49%) and ulcerative colitis (UC) (n = 22, 51%). IBD patients acquired CDI at a mean age of 42.7 years, with 56% of infections acquired in the community and only 28% associated with healthcare. Only 30% of IBD patients with CDI had prior antibiotic use, and 16% had prior steroid use. IBD patients were significantly more likely to require biologic therapy (57% versus 37%, p \u3c 0.01) and have extraintestinal manifestations of IBD (43% versus 28%, p \u3c 0.02). Conclusions: IBD patients are more susceptible to CDI at a younger age and often lack traditional risk factors. IBD patients with at least one CDI were more likely to require biologic therapy and had greater rates of extraintestinal manifestations

WR 110: A Single Wolf-Rayet Star With Corotating Interaction Regions In Its Wind?

A 30-day contiguous photometric run with the MOST satellite on the WN5-6b star WR 110 (HD 165688) reveals a fundamental periodicity of P = 4.08 +/- 0.55 days along with a number of harmonics at periods P/n, with n ~ 2,3,4,5 and 6, and a few other possible stray periodicities and/or stochastic variability on timescales longer than about a day. Spectroscopic RV studies fail to reveal any plausible companion with a period in this range. Therefore, we conjecture that the observed light-curve cusps of amplitude ~ 0.01 mag that recur at a 4.08 day timescale may arise in the inner parts, or at the base of, a corotating interaction region (CIR) seen in emission as it rotates around with the star at constant angular velocity. The hard X-ray component seen in WR 110 could then be a result of a high velocity component of the CIR shock interacting with the ambient wind at several stellar radii. Given that most hot, luminous stars showing CIRs have two CIR arms, it is possible that either the fundamental period is 8.2 days or, more likely in the case of WR 110, there is indeed a second weaker CIR arm for P = 4.08 days, that occurs ~ two thirds of a rotation period after the main CIR. If this interpretation is correct, WR 110 therefore joins the ranks with three other single WR stars, all WN, with confirmed CIR rotation periods (WR 1, WR 6, and WR 134), albeit with WR 110 having by far the lowest amplitude photometric modulation. This illustrates the power of being able to secure intense, continuous high-precision photometry from space-based platforms such as MOST. It also opens the door to revealing low-amplitude photometric variations in other WN stars, where previous attempts have failed. If all WN stars have CIRs at some level, this could be important for revealing sources of magnetism or pulsation in addition to rotation periods.Comment: 25 pages, 8 figures, 2 tables, accepted in Ap

Spectroscopic variability of two Oe stars

The Oe stars HD45314 and HD60848 have recently been found to exhibit very different X-ray properties: whilst HD60848 has an X-ray spectrum and emission level typical of most OB stars, HD45314 features a much harder and brighter X-ray emission, making it a so-called gamma Cas analogue. Monitoring the optical spectra could provide hints towards the origin of these very different behaviours. We analyse a large set of spectroscopic observations of HD45314 and HD60848, extending over 20 years. We further attempt to fit the H-alpha line profiles of both stars with a simple model of emission line formation in a Keplerian disk. Strong variations in the strengths of the H-alpha, H-beta, and He I 5876 emission lines are observed for both stars. In the case of HD60848, we find a time lag between the variations in the equivalent widths of these lines. The emission lines are double peaked with nearly identical strengths of the violet and red peaks. The H-alpha profile of this star can be successfully reproduced by our model of a disk seen under an inclination of 30 degrees. In the case of HD45314, the emission lines are highly asymmetric and display strong line profile variations. We find a major change in behaviour between the 2002 outburst and the one observed in 2013. This concerns both the relationship between the equivalent widths of the various lines and their morphologies at maximum strength (double-peaked in 2002 versus single-peaked in 2013). Our simple disk model fails to reproduce the observed H-alpha line profiles of HD45314. Our results further support the interpretation that Oe stars do have decretion disks similar to those of Be stars. Whilst the emission lines of HD60848 are explained by a disk with a Keplerian velocity field, the disk of HD45314 seems to have a significantly more complex velocity field that could be related to the phenomenon that produces its peculiar X-ray emission.Comment: Accepted for Publication in A&

WR 110: a single wolf-rayet star with corotating interaction regions in its wind?

A 30 day contiguous photometric run with the Microvariability and Oscillations of STars (MOST) satellite on the WN5-6b star WR110 (HD 165688) reveals a fundamental periodicity of P= 4.08 0.55days along with a number of harmonics at periods P/n, with n 2, 3, 4, 5, and 6, and a few other possible stray periodicities and/or stochastic variability on timescales longer than about a day. Spectroscopic radial velocity studies fail to reveal any plausible companion with a period in this range. Therefore, we conjecture that the observed light-curve cusps of amplitude 0.01mag that recur at a 4.08 day timescale may arise in the inner parts, or at the base, of a corotating interaction region (CIR) seen in emission as it rotates around with the star at constant angular velocity. The hard X-ray component seen in WR110 could then be a result of a high velocity component of the CIR shock interacting with the ambient wind at several stellar radii. Given that most hot, luminous stars showing CIRs have two CIR arms, it is possible that either the fundamental period is 8.2 days or, more likely in the case of WR110, there is indeed a second weaker CIR arm for P= 4.08 days, that occurs two-thirds of a rotation period after the main CIR. If this interpretation is correct, WR110 therefore joins the ranks with three other single WR stars, all WN, with confirmed CIR rotation periods (WR1, WR6, and WR134), albeit with WR110 having by far the lowest amplitude photometric modulation. This illustrates the power of being able to secure intense, continuous high-precision photometry from space-based platforms such as MOST. It also opens the door to revealing low-amplitude photometric variations in other WN stars, where previous attempts have failed. If all WN stars have CIRs at some level, this could be important for revealing sources of magnetism or pulsation in addition to rotation periods.Instituto de Astrofísica de La Plat

Prediction of Thrombectomy Functional Outcomes using Multimodal Data

Recent randomised clinical trials have shown that patients with ischaemic stroke {due to occlusion of a large intracranial blood vessel} benefit from endovascular thrombectomy. However, predicting outcome of treatment in an individual patient remains a challenge. We propose a novel deep learning approach to directly exploit multimodal data (clinical metadata information, imaging data, and imaging biomarkers extracted from images) to estimate the success of endovascular treatment. We incorporate an attention mechanism in our architecture to model global feature inter-dependencies, both channel-wise and spatially. We perform comparative experiments using unimodal and multimodal data, to predict functional outcome (modified Rankin Scale score, mRS) and achieve 0.75 AUC for dichotomised mRS scores and 0.35 classification accuracy for individual mRS scores.Comment: Accepted at Medical Image Understanding and Analysis (MIUA) 202

Variability monitoring of OB stars during the Mons campaign

We present preliminary results of a 3-month campaign carried out in the framework of the Mons project, where time-resolved Halpha observations are used to study the wind and circumstellar properties of a number of OB stars.Comment: 2 pages, 1 figure. To appear in proceedings of IAUS272 'Active OB Stars: Structure, Evolution, Mass Loss and Critical Limits

WR 110: a single wolf-rayet star with corotating interaction regions in its wind?

A 30 day contiguous photometric run with the Microvariability and Oscillations of STars (MOST) satellite on the WN5-6b star WR110 (HD 165688) reveals a fundamental periodicity of P= 4.08 0.55days along with a number of harmonics at periods P/n, with n 2, 3, 4, 5, and 6, and a few other possible stray periodicities and/or stochastic variability on timescales longer than about a day. Spectroscopic radial velocity studies fail to reveal any plausible companion with a period in this range. Therefore, we conjecture that the observed light-curve cusps of amplitude 0.01mag that recur at a 4.08 day timescale may arise in the inner parts, or at the base, of a corotating interaction region (CIR) seen in emission as it rotates around with the star at constant angular velocity. The hard X-ray component seen in WR110 could then be a result of a high velocity component of the CIR shock interacting with the ambient wind at several stellar radii. Given that most hot, luminous stars showing CIRs have two CIR arms, it is possible that either the fundamental period is 8.2 days or, more likely in the case of WR110, there is indeed a second weaker CIR arm for P= 4.08 days, that occurs two-thirds of a rotation period after the main CIR. If this interpretation is correct, WR110 therefore joins the ranks with three other single WR stars, all WN, with confirmed CIR rotation periods (WR1, WR6, and WR134), albeit with WR110 having by far the lowest amplitude photometric modulation. This illustrates the power of being able to secure intense, continuous high-precision photometry from space-based platforms such as MOST. It also opens the door to revealing low-amplitude photometric variations in other WN stars, where previous attempts have failed. If all WN stars have CIRs at some level, this could be important for revealing sources of magnetism or pulsation in addition to rotation periods.Instituto de Astrofísica de La Plat

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study\u27s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p\u3c0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p\u3c0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction