Laser-Assisted Removal of Aspirated Thumbtacks by Flexible Bronchoscopy

Background. Aspirated thumbtacks are difficult to extract as the sharp edge of the thumbtack often is well imbedded within bronchial wall and its removal is technically demanding and may cause complications such as bronchial mucosal tear and bronchial wall perforation. These sharp metal objects are commonly removed using rigid bronchoscopy since their removal through flexible bronchoscopy is considered to be dangerous. Objectives. To describe a technique for removal of sharp aspirated metal objects employing laser through flexible bronchoscopy. Methods. We report two patients in whom a new technique for removal of sharp aspirated metal objects utilizing Nd-Yag laser flexible bronchoscopy was used. Results. Successful and uncomplicated removal of the aspirated thumbpack by flexible bronchoscopy under conscious sedation was accomplished in the two patients described. Both patients were discharged within 24 hours. Conclusions. In patients with aspirated thumbtack laser-assisted breakage of the object through flexible bronchoscopy may obviate the need for rigid bronchoscopy or thoracotomy

Long-Term Follow-Up of Flexible Bronchoscopic Treatment for Bronchial Carcinoids with Curative Intent

Background. Typical pulmonary carcinoids represent less than 5% of primary lung tumors. In patients with typical bronchial carcinoid, formal surgical resection still remains the gold-standard treatment. Data regarding long-term outcome in using flexible bronchoscope-based modalities under conscious sedation is very limited. Objectives. We sought to investigate, over extended follow-up period, the effectiveness of endobronchial resection for carcinoid tumors with curative intent using flexible bronchoscopy. Methods. Nd:YAG laser photoresection using flexible bronchoscope under conscious sedation. Follow-up included repeat bronchoscopy every 6 months and chest CT every year. Results. Ten patients aged 24 to 70 years with endobronchial carcinoid were treated. The tumor location was variable: 2 left Main bronchus, 1 left upper lobe bronchus, 2 right main bronchus, 2 right middle lobe bronchus and 3 right lower lobe bronchus. No major complications were observed. The patients required between 2 and 4 procedures. Patients were followed for a median period of 29 months with no evidence of tumor recurrence. Conclusions. Endobronchial laser photoresection of typical bronchial carcinoids using flexible bronchsocopy under conscious sedation is an effective treatment modality for a subgroup of patients that provides excellent long-term results that are similar to outcome obtained by more invasive procedures

The diversity of kilonova emission in short gamma-ray bursts

The historic first joint detection of both gravitational-wave and electromagnetic emission from a binary neutron star merger cemented the association between short gamma-ray bursts (SGRBs) and compact object mergers, as well as providing a well-sampled multi-wavelength light curve of a radioactive kilonova (KN) for the first time. Here, we compare the optical and near-infrared light curves of this KN, AT 2017gfo, to the counterparts of a sample of nearby (z < 0.5) SGRBs to characterize their diversity in terms of their brightness distribution. Although at similar epochs AT 2017gfo appears fainter than every SGRB-associated KN claimed so far, we find three bursts (GRBs 050509B, 061201, and 080905A) where, if the reported redshifts are correct, deep upper limits rule out the presence of a KN similar to AT 2017gfo by several magnitudes. Combined with the properties of previously claimed KNe in SGRBs this suggests considerable diversity in the properties of KN drawn from compact object mergers, despite the similar physical conditions that are expected in many NS–NS mergers. We find that observer angle alone is not able to explain this diversity, which is likely a product of the merger type (NS–NS versus NS–BH) and the detailed properties of the binary (mass ratio, spins etc.). Ultimately disentangling these properties should be possible through observations of SGRBs and gravitational-wave sources, providing direct measurements of heavy element enrichment throughout the universe

Flexible bronchoscopic management of benign tracheal stenosis: long term follow-up of 115 patients

<p>Abstract</p> <p>Background</p> <p>Management of benign tracheal stenosis (BTS) varies with the type and extent of the disease and influenced by the patient's age and general health status, hence we sought to investigate the long-term outcome of patients with BTS that underwent minimally invasive bronchoscopic treatment.</p> <p>Methods</p> <p>Patients with symptomatic BTS were treated with flexible bronchoscopy therapeutic modalities that included the following: balloon dilatation, laser photo-resection, self-expanding metal stent placement, and High-dose rate endobronchial brachytherapy used in cases of refractory stent-related granulation tissue formation.</p> <p>Results</p> <p>A total of 115 patients with BTS and various cardiac and respiratory co-morbidities with a mean age of 61 (range 40-88) were treated between January 2001 and January 2009. The underlining etiologies for BTS were post - endotracheal intubation (N = 76) post-tracheostomy (N = 30), Wegener's granulomatosis (N = 2), sarcoidosis (N = 2), amyloidosis (N = 2) and idiopathic BTS (N = 3). The modalities used were: balloon dilatation and laser treatment (N = 98). Stent was placed in 33 patients of whom 28 also underwent brachytherapy. Complications were minor and mostly included granulation tissue formation. The overall success rate was 87%. Over a median follow-up of 51 months (range 10-100 months), 30 patients (26%) died, mostly due to exacerbation of their underlying conditions.</p> <p>Conclusions</p> <p>BTS in elderly patients with co-morbidities can be safely and effectively treated by flexible bronchoscopic treatment modalities. The use of HDR brachytherapy to treat granulation tissue formation following successful airway restoration is promising.</p

JEAN-JACQUES ROUSSEAU – FRÈRE ENNEMI OF POLITICAL LIBERALISM

Je li Rousseau samorazumljivi neprijatelj političkog liberalizma, kao što glasi čuveni besprizivni pravorijek I. Berlina? Drukčije rečeno, je li on zastupnik radikalne (čak “totalitarne”) demokracije, apologet pučke suverenosti i opaki plebejski “prijatelj naroda” (tzv. “pozitivne slobode”), koji previđa važnost negativne slobode individua i podjele vlasti? Zagovara li Rousseau, kao republikanski politički teoretičar, s jedne strane i politički liberalizam, a s druge strane ne samo različito nego i oprečno shvaćanje političke slobode? U prvom se dijelu izlaganja podsjeća na to da se Rousseauova politička teorija oblikuje u osviještenoj i potpunoj opreci spram fiziokratskog ekonomskog liberalizma, koji slobodu svodi na ekonomsku i pravnu, a modernog čovjeka na bourgeois. U tome je Rousseau veoma blizak Tocquevilleu koji fiziokratsku doktrinu dovodi u pitanje sa stajališta političkog liberalizma. U drugom dijelu sažeto se prikazuje i vrednuje kritika Rousseauova političkog nauka (političke slobode i pučke suverenosti) sa stajališta klasičnoga političkog liberalizma B. Constanta. U trećem se završnom i najvažnijem dijelu pokazuje da primjerena usporedba Rousseauova i liberalnoga političkog nauka mora pažljivo razlikovati pojmovne sklopove u kojima se očituje srodnost (poimanje naroda i podjele vlasti) od onih u kojima se očituje suprotnost (poimanje naroda, zakona, općenite volje i citoyena). Otuda je Rousseau i frere i ennemi, dakle, frere ennemi političkoga liberalizma, premda ne i ekonomskog liberizma.Is Rousseau unquestionably an enemy of political liberalism, as per the famous irrevocable judgment of I. Berlin? In other words, is he a representative of radical (even “totalitarian”) democracy, an apologist of popular sovereignty and a vicious plebeian “friend of the people” (of so-called “positive freedom”), who overlooks the importance of negative freedom of individuums and the separation of powers? Are Rousseau as republican political theorist on the one hand and political liberalism on the other advocates not only of different, but opposite perceptions of political freedom? The first part of the paper recalls the fact that Rousseau’s political theory is shaped in a deliberate and complete opposition with regard to the physiocratic economic liberalism, which reduces freedom to its economic and legal aspects, and the modern man to a bourgeois. In this Rousseau is very close to Tocqueville, who questions the physiocratic doctrine from the standpoint of political liberalism. The second part provides a concise presentation and evaluation of the critique of Rousseau’s political doctrine (of political freedom and popular sovereignty) from the standpoint of B. Constant’s classic political liberalism. In the third, final and most important part, the author shows that an adequate comparison of Rousseau’s doctrine with the liberal political doctrine must carefully distinguish between the conceptual clusters reflecting affinity (the people and the separation of powers) and the ones reflecting opposition (the people, the law, the general will and the citoyen). On the basis of this distinction, Rousseau turns out to be both frere and ennemi – i.e. frere ennemi – of political liberalism, but not of economic liberism as well

A detached stellar-mass black hole candidate in the globular cluster NGC 3201

Large scale structure and cosmolog

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Heavy element production in a compact object merger observed by JWST

The mergers of binary compact objects such as neutron stars and black holes are of central interest to several areas of astrophysics, including as the progenitors of gamma-ray bursts (GRBs) 1, sources of high-frequency gravitational waves (GWs) 2 and likely production sites for heavy-element nucleosynthesis by means of rapid neutron capture (the r-process) 3. Here we present observations of the exceptionally bright GRB 230307A. We show that GRB 230307A belongs to the class of long-duration GRBs associated with compact object mergers 4–6 and contains a kilonova similar to AT2017gfo, associated with the GW merger GW170817 (refs. 7–12). We obtained James Webb Space Telescope (JWST) mid-infrared imaging and spectroscopy 29 and 61 days after the burst. The spectroscopy shows an emission line at 2.15 microns, which we interpret as tellurium (atomic mass A = 130) and a very red source, emitting most of its light in the mid-infrared owing to the production of lanthanides. These observations demonstrate that nucleosynthesis in GRBs can create r-process elements across a broad atomic mass range and play a central role in heavy-element nucleosynthesis across the Universe