Multi-epoch VLBI of a double maser super burst

In a rare and spectacular display, two well-known massive star forming regions, W49N and G25.65+1.05, recently underwent maser 'super burst' - their fluxes suddenly increasing above 30,000 and 18,000 Jy, respectively, reaching several orders of magnitude above their usual values. In quick-response, ToO observations with the EVN, VLBA and KaVA were obtained constituting a 4 week campaign - producing a high-cadence multi-epoch VLBI investigation of the maser emission. The combination of high-resolution, polarisation and flux monitoring during the burst provides one of the best accounts, to date, of the maser super burst phenomenon, aiding their use as astrophysical tools. These proceedings contain the preliminary results of our campaign

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P &lt;.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Recent updates on the Maser Monitoring Organisation

The Maser Monitoring Organisation (M2O) is a research community of telescope operators, astronomy researchers and maser theoreticians pursuing a joint goal of reaching a deeper understanding of maser emission and exploring its variety of uses as tracers of astrophysical events. These proceedings detail the origin, motivations and current status of the M2O, as was introduced at the 2021 EVN symposium

Russell - Silver syndrome associated with low conus medullaris

WOS: 000395657900019PubMed ID: 28217167Russell - Silver syndrome is a rare heterogeneous disorder mainly characterized by intrauterine and postnatal growth retardation, craniofacial disproportion, clinodactyly, variation in urogenital development, and skeletal asymmetry. It is rare to come across tethered cord-associated Russell - Silver syndrome. We report a rare case of Russell-Silver syndrome associated with low conus medullaris in a 2-year-old patient with demonstrative phenotype. Magnetic resonance imaging indicated a low conus medullaris at the inferior border of the L3 vertebral body. Urodynamic study revealed detrusor-sphincter dyssynergia and detrusor overactivity. A decision to follow-up the patient was made because of the suspicion of tethered cord syndrome. Even though tethered cord syndrome is not a common finding in Russell-Silver syndrome, it is important to consider tethered cord syndrome to avoid scoliosis and other long-term complications

Millimeter methanol emission in the high-mass young stellar object G24.33+0.14

&lt;jats:title&gt;Abstract&lt;/jats:title&gt; &lt;jats:p&gt;In 2019 September, a sudden flare of the 6.7???GHz methanol maser was observed toward the high-mass young stellar object (HMYSO) G24.33+0.14. This may represent the fourth detection of a transient mass accretion event in an HMYSO after S255IR??NIRS3, NGC??6334I-MM1, and G358.93???0.03-MM1. G24.33+0.14 is unique among these sources as it clearly shows a repeating flare with an 8???yr interval. Using the Atacama Large Millimeter/submillimeter Array (ALMA), we observed the millimeter continuum and molecular lines toward G24.33+0.14 in the pre-flare phase in 2016 August (ALMA Cycle??3) and the mid-flare phase in 2019 September (ALMA Cycle??6). We identified three continuum sources in G24.33+0.14, and the brightest source, C1, which is closely associated with the 6.7???GHz maser emission, shows only a marginal increase in flux density with a flux ratio (Cycle??6$/$Cycle??3) of 1.16 ?? 0.01, considering an additional absolute flux calibration uncertainty of $10\%$. We identified 26 transitions from 13 molecular species other than methanol, and they exhibit similar levels of flux differences with an average flux ratio of 1.12 ?? 0.15. In contrast, eight methanol lines observed in Cycle??6 are brighter than those in Cycle??3 with an average flux ratio of 1.23 ?? 0.13, and the higher excitation lines tend to show a larger flux increase. If this systematic increasing trend is real, it would suggest radiative heating close to the central HMYSO due to an accretion event which could expand the size of the emission region and/or change the excitation conditions. Given the low brightness temperatures and small flux changes, most of the methanol emission is likely to be predominantly thermal, except for the 229.759???GHz (8???1???70??E) line known as a class??I methanol maser. The flux change in the millimeter continuum of G24.33+0.14 is smaller than in S255IR??NIRS3 and NGC??6334I-MM1 but is comparable with that in G358.93???0.03-MM1, suggesting different amounts of accreted mass in these events.&lt;/jats:p&gt

Millimeter methanol emission in the high-mass young stellar object G24.33+0.14

In 2019 September, a sudden flare of the 6.7 GHz methanol maser was observed toward the high-mass young stellar object (HMYSO) G24.33+0.14. This may represent the fourth detection of a transient mass accretion event in an HMYSO after S255IR NIRS3, NGC 6334I-MM1, and G358.93−0.03-MM1. G24.33+0.14 is unique among these sources as it clearly shows a repeating flare with an 8 yr interval. Using the Atacama Large Millimeter/submillimeter Array (ALMA), we observed the millimeter continuum and molecular lines toward G24.33+0.14 in the pre-flare phase in 2016 August (ALMA Cycle 3) and the mid-flare phase in 2019 September (ALMA Cycle 6). We identified three continuum sources in G24.33+0.14, and the brightest source, C1, which is closely associated with the 6.7 GHz maser emission, shows only a marginal increase in flux density with a flux ratio (Cycle 6$/$Cycle 3) of 1.16 ± 0.01, considering an additional absolute flux calibration uncertainty of $10\%$. We identified 26 transitions from 13 molecular species other than methanol, and they exhibit similar levels of flux differences with an average flux ratio of 1.12 ± 0.15. In contrast, eight methanol lines observed in Cycle 6 are brighter than those in Cycle 3 with an average flux ratio of 1.23 ± 0.13, and the higher excitation lines tend to show a larger flux increase. If this systematic increasing trend is real, it would suggest radiative heating close to the central HMYSO due to an accretion event which could expand the size of the emission region and/or change the excitation conditions. Given the low brightness temperatures and small flux changes, most of the methanol emission is likely to be predominantly thermal, except for the 229.759 GHz (8−1–70 E) line known as a class I methanol maser. The flux change in the millimeter continuum of G24.33+0.14 is smaller than in S255IR NIRS3 and NGC 6334I-MM1 but is comparable with that in G358.93−0.03-MM1, suggesting different amounts of accreted mass in these events