Laparoscopic Versus Open Nissen Fundoplication in Infants After Neonatal Laparotomy

BACKGROUND: Nissen fundoplication is an effective treatment of gastroesophageal reflux in infants. Laparoscopic procedures after previous laparotomy are technically more challenging. The role of laparoscopic Nissen fundoplication after neonatal laparotomy for diseases unrelated to reflux is poorly described. METHODS: This was a retrospective review of open vs laparoscopic Nissen fundoplication in infants after neonatal laparotomy. Of 32 infants who underwent neonatal laparotomy, 26 required a surgical antireflux operation within the first year of life. Twelve infants underwent laparoscopic Nissen fundoplication versus 14 infants who underwent open Nissen fundoplication. Parameters like age, weight, operative time, number of previous operations, length of stay following fundoplication, time to feedings, and complications were compared between the 2 groups. RESULTS: No statistically significant differences existed between most of the parameters compared following laparoscopic vs open Nissen fundoplication. No conversions to open procedures were necessary in infants undergoing laparoscopic fundoplication, and these infants resumed enteral feeds earlier than those who underwent the open procedure. CONCLUSION: Laparoscopic compared with open Nissen fundoplication performed in infants after a neonatal laparotomy were comparable procedures across most data points studied. However, a laparoscopic fundoplication did allow for earlier return to enteral feeds compared with the open approach. Laparoscopic Nissen fundoplication is technically feasible, safe, and effective in the treatment of gastroesophageal reflux in infants with a previous neonatal laparotomy

Contaminación ambiental acústica y percepción de salud de los comerciantes y transeúntes de la Avenida César Vallejo en Villa El Salvador, Lima

La contaminación ambiental acústica es ocasionada por distintas actividades del hombre, afectando el entorno que lo rodea. Por ello, el objetivo de la investigación fue determinar la contaminación ambiental acústica y percepción de salud de los comerciantes y transeúntes en la avenida César Vallejo de Villa El Salvador en Lima, Perú. Para la medición de los niveles sonoros se establecieron 7 puntos en el lugar utilizando un sonómetro Criffer durante 7 días, teniendo en cuenta los turnos mañana (7:00 a 9:00 am), tarde (12:00 a 2:00 pm) y noche (6:00 a 8:00 pm). Además, se realizó una encuesta a comerciantes y transeúntes del lugar para saber la noción que tienen sobre las consecuencias del ruido a la salud. Los resultados evidenciaron que, los niveles de presión sonora en los puntos seleccionados sobrepasan lo establecido por los estándares de calidad ambiental (ECA) de ruido, obteniendo valores de 86.88 a 58.12 dB. Por otra parte, se determinó que la mayoría de comerciantes y transeúntes tienen ideas claras referentes al tema de contaminación ambiental acústica y sus efectos. Finalmente, se concluye que los niveles de ruido en la avenida César Vallejo son altos y perjudiciales a la salud de acuerdo a cada tipo de zonificación establecida, influyendo de forma negativa en los comerciantes y transeúntes

Dense stellar clump formation driven by strong quasar winds in the FIRE cosmological hydrodynamic simulations

We investigate the formation of dense stellar clumps in a suite of high-resolution cosmological zoom-in simulations of a massive, star forming galaxy at $z \sim 2$ under the presence of strong quasar winds. Our simulations include multi-phase ISM physics from the Feedback In Realistic Environments (FIRE) project and a novel implementation of hyper-refined accretion disk winds. We show that powerful quasar winds can have a global negative impact on galaxy growth while in the strongest cases triggering the formation of an off-center clump with stellar mass ${\rm M}_{\star}\sim 10^{7}\,{\rm M}_{\odot}$, effective radius ${\rm R}_{\rm 1/2\,\rm Clump}\sim 20\,{\rm pc}$, and surface density $\Sigma_{\star} \sim 10^{4}\,{\rm M}_{\odot}\,{\rm pc}^{-2}$. The clump progenitor gas cloud is originally not star-forming, but strong ram pressure gradients driven by the quasar winds (orders of magnitude stronger than experienced in the absence of winds) lead to rapid compression and subsequent conversion of gas into stars at densities much higher than the average density of star-forming gas. The AGN-triggered star-forming clump reaches ${\rm SFR} \sim 50\,{\rm M}_{\odot}\,{\rm yr}^{-1}$ and $\Sigma_{\rm SFR} \sim 10^{4}\,{\rm M}_{\odot}\,{\rm yr}^{-1}\,{\rm kpc}^{-2}$, converting most of the progenitor gas cloud into stars in $\sim$2\,Myr, significantly faster than its initial free-fall time and with stellar feedback unable to stop star formation. In contrast, the same gas cloud in the absence of quasar winds forms stars over a much longer period of time ($\sim$35\,Myr), at lower densities, and losing spatial coherency. The presence of young, ultra-dense, gravitationally bound stellar clumps in recently quenched galaxies could thus indicate local positive feedback acting alongside the strong negative impact of powerful quasar winds, providing a plausible formation scenario for globular clusters.Comment: 14 pages, 12 figure

Dense stellar clump formation driven by strong quasar winds in the FIRE cosmological hydrodynamic simulations

We investigate the formation of dense stellar clumps in a suite of high-resolution cosmological zoom-in simulations of a massive, star-forming galaxy at z ∼ 2 under the presence of strong quasar winds. Our simulations include multiphase ISM physics from the Feedback In Realistic Environments (FIRE) project and a no v el implementation of hyper-refined accretion disc winds. We show that powerful quasar winds can have a global negative impact on galaxy growth while in the strongest cases triggering the formation of an off-centre clump with stellar mass M ∼ 10 7 M , effective radius R 1 / 2 Clump ∼ 20 pc , and surface density ∼10 4 M pc −2 . The clump progenitor gas cloud is originally not star -forming, b ut strong ram pressure gradients driven by the quasar winds (orders of magnitude stronger than experienced in the absence of winds) lead to rapid compression and subsequent conversion of gas into stars at densities much higher than the average density of star-forming gas. The AGN-triggered star-forming clump reaches SFR ∼ 50 M yr −1 and SFR ∼ 10 4 M yr −1 kpc −2 , converting most of the progenitor gas cloud into stars in ∼2 Myr, significantly faster than its initial free-fall time and with stellar feedback unable to stop star formation. In contrast, the same gas cloud in the absence of quasar winds forms stars over a much longer period of time ( ∼35 Myr), at lower densities, and losing spatial coherency. The presence of young, ultra-dense, gravitationally bound stellar clumps in recently quenched galaxies could thus indicate local positive feedback acting alongside the strong negative impact of powerful quasar winds, providing a plausible formation scenario for globular clusters

Local positive feedback in the overall negative: the impact of quasar winds on star formation in the FIRE cosmological simulations

Negative feedback from accreting supermassive black holes is regarded as a key ingredient in suppressing star formation and quenching massive galaxies. However, several models and observations suggest that black hole feedback may have a positive effect, triggering star formation by compressing interstellar medium gas to higher densities. We investigate the dual role of black hole feedback using cosmological hydrodynamic simulations from the Feedback In Realistic Environments (FIRE) project, including a novel implementation of hyper-refined accretion-disc winds. Focusing on a massive, star-forming galaxy at $z \sim 2$ ($M_{\rm halo} \sim 10^{12.5} \, {\rm M}_{\odot}$), we show that strong quasar winds with kinetic power $\sim$10$^{46}$ erg/s acting for $>$20$\,$Myr drive the formation of a central gas cavity and can dramatically reduce the star formation rate surface density across the galaxy disc. The suppression of star formation is primarily driven by reducing the amount of gas that can become star-forming, compared to directly evacuating the pre-existing star-forming gas reservoir (preventive feedback dominates over ejective feedback). Despite the global negative impact of quasar winds, we identify several plausible signatures of local positive feedback, including: (1) spatial anti-correlation of wind-dominated regions and star-forming clumps, (2) higher local star formation efficiency in compressed gas near the edge of the cavity, and (3) increased local contribution of outflowing material to star formation. Stars forming under the presence of quasar winds tend to do so at larger radial distances. Our results suggest that positive and negative AGN feedback can coexist in galaxies, but local positive triggering of star formation plays a minor role in global galaxy growth.Comment: 17 pages, 12 figure

Heterogeneity in the M. tuberculosis β-Lactamase Inhibition by Sulbactam

15 pags., 7 figs., 1 tab.For decades, researchers have been determined to elucidate essential enzymatic functions on the atomic lengths scale by tracing atomic positions in real time. Our work builds on new possibilities unleashed by mix-and-inject serial crystallography (MISC) 1-5 at X-ray free electron laser facilities. In this approach, enzymatic reactions are triggered by mixing substrate or ligand solutions with enzyme microcrystals 6 . Here, we report in atomic detail and with millisecond time-resolution how the Mycobacterium tuberculosis enzyme BlaC is inhibited by sulbactam (SUB). Our results reveal ligand binding heterogeneity, ligand gating 7-9 , cooperativity, induced fit 10,11 and conformational selection 11-13 all from the same set of MISC data, detailing how SUB approaches the catalytic clefts and binds to the enzyme non-covalently before reacting to a trans- enamine. This was made possible in part by the application of the singular value decomposition 14 to the MISC data using a newly developed program that remains functional even if unit cell parameters change during the reaction.This work was supported by NSF-STC-1231306 (BioXFEL). P.F. was supported by NSF BioXFEL STC grant NSF-1231306 Biology with X-ray Lasers, the NIH grant R01GM095583, and the ASU Biodesign Center for Applied Structural Discovery. A.O. was supported by the US Department of Energy, Office of Science, Basic Energy Sciences under award DESC0002164 (underlying dynamical techniques) and by the US National Science Foundation under awards STC-1231306 (underlying data analytical techniques) and DBI-2029533 (underlying analytical models). K.A.Z. was supported by the Cornell Molecular Biophysics Training Program (NIH T32-GM008267). D.F, L.A., and E.A.S. were supported by NSF STC BioXFEL center award 6227. L.A. training was supported in part by the National Institute of General Medical Sciences (NIGMS) of the National Institutes of Health (NIH) Maximizing Access to Research Careers (MARC) -T34 GM105549 grant. We acknowledge funding from DESY (Hamburg, Germany), a member of the Helmholtz Association HGF; the Cluster of Excellence “Advanced Imaging of Matter” of the Deutsche Forschungsgemeinschaft (DFG) - EXC 2056 - project ID 390715994; the Helmholtz Association Impulse and Networking fund - project InternLabs-0011 “HIR3X”; and the German Federal Ministry of Education and Research (BMBF) - project 05K18CHA. Use of the LCLS, SLAC National Accelerator Laboratory, is supported by the U.S. DOE, Office of Science, BES, under contract no. DE-AC02-76SF00515. The HERA system for in-helium experiments at MFX was developed by Bruce Doak and funded by the Max Planck Institute for Medical Research. One or more of the authors of this paper received support from a program designed to increase minority representation in sciencePeer reviewe

Another Shipment of Six Short-Period Giant Planets from TESS

We present the discovery and characterization of six short-period, transiting giant planets from NASA's Transiting Exoplanet Survey Satellite (TESS) -- TOI-1811 (TIC 376524552), TOI-2025 (TIC 394050135), TOI-2145 (TIC 88992642), TOI-2152 (TIC 395393265), TOI-2154 (TIC 428787891), & TOI-2497 (TIC 97568467). All six planets orbit bright host stars (8.9 <G< 11.8, 7.7 <K< 10.1). Using a combination of time-series photometric and spectroscopic follow-up observations from the TESS Follow-up Observing Program (TFOP) Working Group, we have determined that the planets are Jovian-sized (R$_{P}$ = 1.00-1.45 R$_{J}$), have masses ranging from 0.92 to 5.35 M$_{J}$, and orbit F, G, and K stars (4753 $<$ T$_{eff}$ $<$ 7360 K). We detect a significant orbital eccentricity for the three longest-period systems in our sample: TOI-2025 b (P = 8.872 days, $e$ = $0.220\pm0.053$), TOI-2145 b (P = 10.261 days, $e$ = $0.182^{+0.039}_{-0.049}$), and TOI-2497 b (P = 10.656 days, $e$ = $0.196^{+0.059}_{-0.053}$). TOI-2145 b and TOI-2497 b both orbit subgiant host stars (3.8 $<$ $\log$ g $<$4.0), but these planets show no sign of inflation despite very high levels of irradiation. The lack of inflation may be explained by the high mass of the planets; $5.35^{+0.32}_{-0.35}$ M$_{\rm J}$ (TOI-2145 b) and $5.21\pm0.52$ M$_{\rm J}$ (TOI-2497 b). These six new discoveries contribute to the larger community effort to use {\it TESS} to create a magnitude-complete, self-consistent sample of giant planets with well-determined parameters for future detailed studies.Comment: 20 Pages, 6 Figures, 8 Tables, Accepted by MNRA

Identification of novel risk loci, causal insights, and heritable risk for Parkinson's disease: a meta-analysis of genome-wide association studies

Background Genome-wide association studies (GWAS) in Parkinson's disease have increased the scope of biological knowledge about the disease over the past decade. We aimed to use the largest aggregate of GWAS data to identify novel risk loci and gain further insight into the causes of Parkinson's disease. Methods We did a meta-analysis of 17 datasets from Parkinson's disease GWAS available from European ancestry samples to nominate novel loci for disease risk. These datasets incorporated all available data. We then used these data to estimate heritable risk and develop predictive models of this heritability. We also used large gene expression and methylation resources to examine possible functional consequences as well as tissue, cell type, and biological pathway enrichments for the identified risk factors. Additionally, we examined shared genetic risk between Parkinson's disease and other phenotypes of interest via genetic correlations followed by Mendelian randomisation. Findings Between Oct 1, 2017, and Aug 9, 2018, we analysed 7·8 million single nucleotide polymorphisms in 37 688 cases, 18 618 UK Biobank proxy-cases (ie, individuals who do not have Parkinson's disease but have a first degree relative that does), and 1·4 million controls. We identified 90 independent genome-wide significant risk signals across 78 genomic regions, including 38 novel independent risk signals in 37 loci. These 90 variants explained 16–36% of the heritable risk of Parkinson's disease depending on prevalence. Integrating methylation and expression data within a Mendelian randomisation framework identified putatively associated genes at 70 risk signals underlying GWAS loci for follow-up functional studies. Tissue-specific expression enrichment analyses suggested Parkinson's disease loci were heavily brain-enriched, with specific neuronal cell types being implicated from single cell data. We found significant genetic correlations with brain volumes (false discovery rate-adjusted p=0·0035 for intracranial volume, p=0·024 for putamen volume), smoking status (p=0·024), and educational attainment (p=0·038). Mendelian randomisation between cognitive performance and Parkinson's disease risk showed a robust association (p=8·00 × 10−7). Interpretation These data provide the most comprehensive survey of genetic risk within Parkinson's disease to date, to the best of our knowledge, by revealing many additional Parkinson's disease risk loci, providing a biological context for these risk factors, and showing that a considerable genetic component of this disease remains unidentified. These associations derived from European ancestry datasets will need to be followed-up with more diverse data. Funding The National Institute on Aging at the National Institutes of Health (USA), The Michael J Fox Foundation, and The Parkinson's Foundation (see appendix for full list of funding sources)

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

NEID Rossiter–McLaughlin Measurement of TOI-1268b: A Young Warm Saturn Aligned with Its Cool Host Star

Close-in gas giants present a surprising range of stellar obliquity, the angle between a planet's orbital axis and its host star's spin axis. It is unclear whether the obliquities reflect the planets' dynamical history (e.g., aligned for in situ formation or disk migration versus misaligned for high-eccentricity tidal migration) or whether other mechanisms (e.g., primordial misalignment or planet-star interactions) are more important in sculpting the obliquity distribution. Here we present the stellar obliquity measurement of TOI-1268 (TIC-142394656, V mag ∼10.9), a young K-type dwarf hosting an 8.2 day period, Saturn-sized planet. TOI-1268's lithium abundance and rotation period suggest the system age between the ages of the Pleiades cluster (∼120 Myr) and the Prasepe cluster (∼670 Myr). Using the newly commissioned NEID spectrograph, we constrain the stellar obliquity of TOI-1268 via the Rossiter-McLaughlin effect from both radial velocity and Doppler tomography signals. The 3σ upper bounds of the projected stellar obliquity λ from both models are below 60°. The large host star separation (a/R ∗ ∼17), combined with the system's young age, makes it unlikely that the planet has realigned its host star. The stellar obliquity measurement of TOI-1268 probes the architecture of a young gas giant beyond the reach of tidal realignment (a/R ∗ ≲10) and reveals an aligned or slightly misaligned system