Heart Rate-Corrected QT Interval Helps Predict Mortality after Intentional Organophosphate Poisoning

INTRODUCTION: In this study, we investigated the outcomes for patients with intentional organophosphate poisoning. Previous reports indicate that in contrast to normal heart rate-corrected QT intervals (QTc), QTc prolongation might be indicative of a poor prognosis for patients exposed to organophosphates. METHODS: We analyzed the records of 118 patients who were referred to Chang Gung Memorial Hospital for management of organophosphate poisoning between 2000 and 2011. Patients were grouped according to their initial QTc interval, i.e., normal (<0.44 s) or prolonged (>0.44 s). Demographic, clinical, laboratory, and mortality data were obtained for analysis. RESULTS: The incidence of hypotension in patients with prolonged QTc intervals was higher than that in the patients with normal QTc intervals (P = 0.019). By the end of the study, 18 of 118 (15.2%) patients had died, including 3 of 75 (4.0%) patients with normal QTc intervals and 15 of 43 (34.9%) patients with prolonged QTc intervals. Using multivariate-Cox-regression analysis, we found that hypotension (OR = 10.930, 95% CI = 2.961-40.345, P = 0.000), respiratory failure (OR = 4.867, 95% CI = 1.062-22.301, P = 0.042), coma (OR = 3.482, 95% CI = 1.184-10.238, P = 0.023), and QTc prolongation (OR = 7.459, 95% CI = 2.053-27.099, P = 0.002) were significant risk factors for mortality. Furthermore, it was revealed that non-survivors not only had longer QTc interval (503.00±41.56 versus 432.71±51.21 ms, P = 0.002), but also suffered higher incidences of hypotension (83.3 versus 12.0%, P = 0.000), shortness of breath (64 versus 94.4%, P = 0.010), bronchorrhea (55 versus 94.4%, P = 0.002), bronchospasm (50.0 versus 94.4%, P = 0.000), respiratory failure (94.4 versus 43.0%, P = 0.000) and coma (66.7 versus 11.0%, P = 0.000) than survivors. Finally, Kaplan-Meier analysis demonstrated that cumulative mortality was higher among patients with prolonged QTc intervals than among those with normal QTc intervals (Log-rank test, Chi-square test = 20.36, P<0.001). CONCLUSIONS: QTc interval helps predict mortality after intentional organophosphate poisoning

A long-duration gamma-ray burst of dynamical origin from the nucleus of an ancient galaxy

The majority of long-duration (>2 s) gamma-ray bursts (GRBs) arise from the collapse of massive stars, with a small proportion created from the merger of compact objects. Most of these systems form via standard stellar evolution pathways. However, a fraction of GRBs may result from dynamical interactions in dense environments. These channels could also contribute substantially to the samples of compact object mergers detected as gravitational wave sources. Here we report the case of GRB 191019A, a long GRB (a duration of T 90 = 64.4 ± 4.5 s), which we pinpoint close (⪅100 pc projected) to the nucleus of an ancient (>1 Gyr old) host galaxy at z = 0.248. The lack of evidence for star formation and deep limits on any supernova emission disfavour a massive star origin. The most likely route for progenitor formation is via dynamical interactions in the dense nucleus of the host. The progenitor, in this case, could be a compact object merger. These may form in dense nuclear clusters or originate in a gaseous disc around the supermassive black hole. Identifying, to the best of our knowledge, a first example of a dynamically produced GRB demonstrates the role that such bursts may have in probing dense environments and constraining dynamical fractions in gravitational wave populations

Alignment of the ALICE Inner Tracking System with cosmic-ray tracks

37 pages, 15 figures, revised version, accepted by JINSTALICE (A Large Ion Collider Experiment) is the LHC (Large Hadron Collider) experiment devoted to investigating the strongly interacting matter created in nucleus-nucleus collisions at the LHC energies. The ALICE ITS, Inner Tracking System, consists of six cylindrical layers of silicon detectors with three different technologies; in the outward direction: two layers of pixel detectors, two layers each of drift, and strip detectors. The number of parameters to be determined in the spatial alignment of the 2198 sensor modules of the ITS is about 13,000. The target alignment precision is well below 10 micron in some cases (pixels). The sources of alignment information include survey measurements, and the reconstructed tracks from cosmic rays and from proton-proton collisions. The main track-based alignment method uses the Millepede global approach. An iterative local method was developed and used as well. We present the results obtained for the ITS alignment using about 10^5 charged tracks from cosmic rays that have been collected during summer 2008, with the ALICE solenoidal magnet switched off.Peer reviewe

The First JWST Spectrum of a GRB Afterglow: No Bright Supernova in Observations of the Brightest GRB of all Time, GRB 221009A

We present James Webb Space Telescope (JWST) and Hubble Space Telescope (HST) observations of the afterglow of GRB 221009A, the brightest gamma-ray burst (GRB) ever observed. This includes the first mid-IR spectra of any GRB, obtained with JWST/Near Infrared Spectrograph (0.6-5.5 micron) and Mid-Infrared Instrument (5-12 micron), 12 days after the burst. Assuming that the intrinsic spectral slope is a single power law, with F ν ∝ ν −β , we obtain β ≈ 0.35, modified by substantial dust extinction with A V = 4.9. This suggests extinction above the notional Galactic value, possibly due to patchy extinction within the Milky Way or dust in the GRB host galaxy. It further implies that the X-ray and optical/IR regimes are not on the same segment of the synchrotron spectrum of the afterglow. If the cooling break lies between the X-ray and optical/IR, then the temporal decay rates would only match a post-jet-break model, with electron index p < 2, and with the jet expanding into a uniform ISM medium. The shape of the JWST spectrum is near-identical in the optical/near-IR to X-SHOOTER spectroscopy obtained at 0.5 days and to later time observations with HST. The lack of spectral evolution suggests that any accompanying supernova (SN) is either substantially fainter or bluer than SN 1998bw, the proto-type GRB-SN. Our HST observations also reveal a disk-like host galaxy, viewed close to edge-on, that further complicates the isolation of any SN component. The host galaxy appears rather typical among long-GRB hosts and suggests that the extreme properties of GRB 221009A are not directly tied to its galaxy-scale environment

Radiofrequency versus conventional diathermy Milligan-Morgan hemorrhoidectomy: A prospective, randomized study

In the past decade, several new surgical tools have revived the hope for an improved technique to treat radically hemorrhoids with less postoperative pain. Among these radiofrequency (RF), excisional surgery seems to be safe, fast, and accompanied by less postoperative pain. The aim of this study was to evaluate and compare RF (ligasure TM) to conventional diathermy Milligan-Morgan hemorrhoidectomy (MMH)