Manifestações neuropsiquiátricas do hiperparatiroidismo primário no idoso: relato de casos e revisão da literatura

Osteoporosis and neuropsychiatric disorders occur more frequently in elderly than in young people. When they appear together there is a possibility of a common etiology. We report two cases of elderly women at the ages of 75 and 80y with established osteoporosis and neuropsychiatric manifestations (apathy, weakness, depression and loss of memory) caused by hypercalcemia (ionic calcium of 1.43mmol/L and 1.65mmol/L, respectively) due to primary hyperparathyroidism (PHPT). Other laboratory results showed normal levels of the intact fraction of parathormone (iPTH), i.e. 64 and 63pg/ml, respectively. They were submitted to parathyroidectomy and only one tumoral mass was removed from each woman. Pathologic examination showed parathyroid adenoma. Shortly after the surgery they got better of the neuropsychiatric signs and symptoms. Six months later the bone mineral density (BMD) of the second patient increased whereas the other one was unable to have her BMD evaluated due to thoracic deformities. The possibility of PHPT must be always considered, especially in patients with normal but not suppresible parathormone levels. The reason is that some parathyroid adenomas present an abnormal set point to calcium and no significantly increase in parathormone production. It should be emphasized that there is no satisfactory medical treatment for parathyroid adenoma except for surgical excision, which is effective in the majority of cases. We conclude that ionic calcium must be measured in all elderly patients who present neuropsychiatric disorders and/ or osteoporosis.A osteoporose e os distúrbios neuropsiquiátricos surgem com maior freqüência entre os pacientes idosos, quando comparados com as demais faixas etárias. Manifestações concomitantes destas síndromes podem apresentar causas comuns. Neste artigo, nós descrevemos os casos de duas mulheres com osteoporose estabelecida e idades de 75 e 80 anos, que desenvolveram sinais e sintomas neuropsiquiátricos (apatia, fraqueza, depressão e perda de memória) associados a hipercalcemia [cálcio iônico de 1,43mmol/L e 1,65mmol/L (1,14 - 1,30mmol/L), respectivamente]. Na investigação laboratorial foi observado que os níveis da fração intacta do paratormônio (PTHi) estavam dentro dos limites da normalidade (64 e 63pg/ml, respectivamente) ou não suprimidos. Após exploração cirúrgica cervical foram removidas, de cada paciente, massas tumorais únicas, cujo anátomo-patológico revelou adenoma de paratireóide. As duas pacientes apresentaram melhora dos sintomas e sinais neuropsiquiátricos após a cirurgia e a segunda paciente obteve ganho de massa óssea significativo, sem uso de qualquer droga anti-reabsortiva. A outra paciente não pode ser avaliada através da densitometria óssea, devido às deformidades na coluna torácica. A possibilidade de HPTP deve ser sempre considerada, principalmente em pacientes com níveis de paratormônio dentro da faixa de normalidade, ou não suprimidos apesar de cálcio ionizado elevado. Isso ocorre devido a alguns tumores de paratireóide apresentarem set point alterado em relação aos níveis de cálcio mas sem aumento significativo da produção de paratormônio. Outra correlação observada é que quanto menor forem os adenomas, maior a chance de serem hipersecretores e autônomos. Em conclusão, a aferição do cálcio iônico em pacientes idosos com osteoporose e ou sintomas e sinais neuropsiquiátricos deve ser feita de rotina com o objetivo de se excluir doenças que possam ser tratadas prontamente e com bons resultados.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL

Optical Line Emission from z∼\sim6.8 Sources with Deep Constraints on Lyα\alpha Visibility

We analyze a sample of $z$-dropout galaxies in the CANDELS GOODS South and UDS fields that have been targeted by a dedicated spectroscopic campaign aimed at detecting their Ly$\alpha$ line. Deep IRAC observations at 3.6 and 4.5 $\mu$m are used to determine the strength of optical emission lines affecting these bands at z$\sim$6.5-6.9 in order to i) investigate possible physical differences between Ly$\alpha$ emitting and non-emitting sources; ii) constrain the escape fraction of ionizing photons; iii) provide an estimate of the specific star-formation rate at high redshifts. We find evidence of strong [OIII]+H$\beta$ emission in the average (stacked) SEDs of galaxies both with and without Ly$\alpha$ emission. The blue IRAC [3.6]-[4.5] color of the stack with detected Ly$\alpha$ line can be converted into a rest-frame equivalent width EW([OIII]+H$\beta$)=1500$^{+530}_{-440}\AA$ assuming a flat intrinsic stellar continuum. This strong optical line emission enables a first estimate of f$_{esc}\lesssim$20% on the escape fraction of ionizing photons from Ly$\alpha$ detected objects. The objects with no Ly$\alpha$ line show less extreme EW([OIII]+H$\beta$)=520$^{+170}_{-150}\AA$ suggesting different physical conditions of the HII regions with respect to Ly$\alpha$-emitting ones, or a larger f$_{esc}$. The latter case is consistent with a combined evolution of f$_{esc}$ and the neutral hydrogen fraction as an explanation of the lack of bright Ly$\alpha$ emission at z$>$6. A lower limit on the specific star formation rate, SSFR$>$9.1$Gyr^{-1}$ for $M_{star}=2 \times 10^9 M_{\odot}$ galaxies at these redshifts can be derived from the spectroscopically confirmed sample.Comment: 10 pages, 7 figures; The Astrophysical Journal in press; matched to the published versio

Scalar and vector decomposition of the nucleon self-energy in the relativistic Brueckner approach

We investigate the momentum dependence of the nucleon self-energy in nuclear matter. We apply the relativistic Brueckner-Hartree-Fock approach and adopt the Bonn A potential. A strong momentum dependence of the scalar and vector self-energy components can be observed when a commonly used pseudo-vector choice for the covariant representation of the T-matrix is applied. This momentum dependence is dominated by the pion exchange. We discuss the problems of this choice and its relations to on-shell ambiguities of the T-matrix representation. Starting from a complete pseudo-vector representation of the T-matrix, which reproduces correctly the pseudo-vector pion-exchange contributions at the Hartree-Fock level, we observe a much weaker momentum dependence of the self-energy. This fixes the range of the inherent uncertainty in the determination of the scalar and vector self-energy components. Comparing to other work, we find that extracting the self-energy components by a fit to the single particle potential leads to even more ambiguous results.Comment: 35 pages RevTex, 7 PS figures, replaced by a revised and extended versio

Hubble imaging of the ionizing radiation from a star-forming galaxy at z=3.2 with fesc>50%

Star-forming galaxies are considered to be the leading candidate sources that dominate the cosmic reionization at z>7, and the search for analogs at moderate redshift showing Lyman continuum (LyC) leakage is currently a active line of research. We have observed a star-forming galaxy at z=3.2 with Hubble/WFC3 in the F336W filter, corresponding to the 730-890A rest-frame, and detect LyC emission. This galaxy is very compact and also has large Oxygen ratio [OIII]5007/[OII]3727 (>=10). No nuclear activity is revealed from optical/near-infrared spectroscopy and deep multi-band photometry (including the 6Ms X-ray, Chandra). The measured escape fraction of ionizing radiation spans the range 50-100\%, depending on the IGM attenuation. The LyC emission is detected at S/N=10 with m(F336W)=27.57+/-0.11 and it is spatially unresolved, with effective radius R_e<200pc. Predictions from photoionization and radiative transfer models are in line with the properties reported here, indicating that stellar winds and supernova explosions in a nucleated star-forming region can blow cavities generating density-bounded conditions compatible with optically thin media. Irrespective to the nature of the ionizing radiation, spectral signatures of these sources over the entire electromagnetic spectrum are of central importance for their identification during the epoch of reionization, when the LyC is unobservable. Intriguingly, the Spitzer/IRAC photometric signature of intense rest-frame optical emissions ([OIII]+Hbeta) observed recently at z~7.5-8.5 is similar to what is observed in this galaxy. Only the James Webb Space Telescope will measure optical line ratios at z>7 allowing a direct comparison with lower redshift LyC emitters, as reported here.Comment: 6 pages, 5 figures, ApJ submitted (comments welcome

Constraints on the star-formation rate of z~3 LBGs with measured metallicity in the CANDELS GOODS-South field

We analyse 14 LBGs at z~2.8-3.8 constituting the only sample where both a spectroscopic measurement of their metallicity and deep IR observations (CANDELS+HUGS survey) are available. Fixing the metallicity of population synthesis models to the observed values, we determine best-fit physical parameters under different assumptions about the star-formation history and also consider the effect of nebular emission. For comparison we determine the UV slope of the objects, and use it to estimate their SFR_UV99 by correcting the UV luminosity following Meurer et al. (1999). A comparison between SFR obtained through SED-fitting (SFR_fit) and the SFR_UV99 shows that the latter are underestimated by a factor 2-10, regardless of the assumed SFH. Other SFR indicators (radio, far-IR, X-ray, recombination lines) coherently indicate SFRs a factor of 2-4 larger than SFR_UV99 and in closer agreement with SFR_fit. This discrepancy is due to the solar metallicity implied by the usual beta-A1600 conversion factor. We propose a refined relation, appropriate for sub-solar metallicity LBGs: A1600 = 5.32+1.99beta. This relation reconciles the dust-corrected UV with the SED-fitting and the other SFR indicators. We show that the fact that z~3 galaxies have sub-solar metallicity implies an upward revision by a factor of ~1.5-2 of the global SFRD, depending on the assumptions about the age of the stellar populations. We find very young best-fit ages (10-500 Myrs) for all our objects. From a careful examination of the uncertainties in the fit and the amplitude of the Balmer break we conclude that there is little evidence of the presence of old stellar population in at least half of the LBGs in our sample, suggesting that these objects are probably caught during a huge star-formation burst, rather than being the result of a smooth evolution.Comment: 16 pages, 13 figures, A&A in press. Matched to the published versio

T-PHOT: A new code for PSF-matched, prior-based, multiwavelength extragalactic deconfusion photometry

We present T-PHOT, a publicly available software aimed at extracting accurate photometry from low-resolution images of deep extragalactic fields, where the blending of sources can be a serious problem for the accurate and unbiased measurement of fluxes and colours. T-PHOT has been developed within the ASTRODEEP project and it can be considered as the next generation to TFIT, providing significant improvements above it and other similar codes. T-PHOT gathers data from a high-resolution image of a region of the sky, and uses it to obtain priors for the photometric analysis of a lower resolution image of the same field. It can handle different types of datasets as input priors: i) a list of objects that will be used to obtain cutouts from the real high-resolution image; ii) a set of analytical models; iii) a list of unresolved, point-like sources, useful e.g. for far-infrared wavelength domains. We show that T-PHOT yields accurate estimations of fluxes within the intrinsic uncertainties of the method, when systematic errors are taken into account (which can be done thanks to a flagging code given in the output). T-PHOT is many times faster than similar codes like TFIT and CONVPHOT (up to hundreds, depending on the problem and the method adopted), whilst at the same time being more robust and more versatile. This makes it an optimal choice for the analysis of large datasets. In addition we show how the use of different settings and methods significantly enhances the performance. Given its versatility and robustness, T-PHOT can be considered the preferred choice for combined photometric analysis of current and forthcoming extragalactic optical to far-infrared imaging surveys. [abridged]Comment: 23 pages, 20 figures, 2 table

Identification of z~>2 Herschel 500 micron sources using color-deconfusion

We present a new method to search for candidate z~>2 Herschel 500{\mu}m sources in the GOODS-North field, using a S500{\mu}m/S24{\mu}m "color deconfusion" technique. Potential high-z sources are selected against low-redshift ones from their large 500{\mu}m to 24{\mu}m flux density ratios. By effectively reducing the contribution from low-redshift populations to the observed 500{\mu}m emission, we are able to identify counterparts to high-z 500{\mu}m sources whose 24{\mu}m fluxes are relatively faint. The recovery of known z~4 starbursts confirms the efficiency of this approach in selecting high-z Herschel sources. The resulting sample consists of 34 dusty star-forming galaxies at z~>2. The inferred infrared luminosities are in the range 1.5x10^12-1.8x10^13 Lsun, corresponding to dust-obscured star formation rates (SFRs) of ~260-3100 Msun/yr for a Salpeter IMF. Comparison with previous SCUBA 850{\mu}m-selected galaxy samples shows that our method is more efficient at selecting high-z dusty galaxies with a median redshift of z=3.07+/-0.83 and 10 of the sources at z~>4. We find that at a fixed luminosity, the dust temperature is ~5K cooler than that expected from the Td-LIR relation at z<1, though different temperature selection effects should be taken into account. The radio-detected subsample (excluding three strong AGN) follows the far-infrared/radio correlation at lower redshifts, and no evolution with redshift is observed out to z~5, suggesting that the far-infrared emission is star formation dominated. The contribution of the high-z Herschel 500{\mu}m sources to the cosmic SFR density is comparable to that of SMG populations at z~2.5 and at least 40% of the extinction-corrected UV samples at z~4 (abridged).Comment: 33 pages in emulateapj format, 24 figures, 2 tables, accepted for publication in the ApJ

Nuclear Saturation with in-Medium Meson Exchange Interactions

We show that the assumption of dropping meson masses together with conventional many-body effects, implemented in the relativistic Dirac-Brueckner formalism, explains nuclear saturation. We use a microscopic model for correlated $2\pi$ exchange and include the standard many-body effects on the in-medium pion propagation, which initially increase the attractive nucleon-nucleon ($NN$) potential with density. For the vector meson exchanges in both the $\pi\pi$ and $NN$ sector, we assume Brown-Rho scaling which---in concert with `chiral' $\pi\pi$ contact interactions---reduces the attraction at higher densities.Comment: 5 pages REVTeX, 2 eps-figures included, submitted to Phys. Rev. Let

The Exogravity Project: Using Single Mode Interferometry to Characterize Exoplanets

Combining adaptive optics and interferometric observations results in a considerable contrast gain compared to single-telescope, extreme AO systems. Taking advantage of this, the ExoGRAVITY project is a survey of known young giant exoplanets located in the range of 0.1 to 2 from their stars. The observations provide astrometric data of unprecedented accuracy, being crucial for refining the orbital parameters of planets and illuminating their dynamical histories. Furthermore, GRAVITY will measure non-Keplerian perturbations due to planet-planet interactions in multi-planet systems and measure dynamical masses. Over time, repetitive observations of the exoplanets at medium resolution (R = 500) will provide a catalogue of K-band spectra of unprecedented quality, for a number of exoplanets. The K-band has the unique properties that it contains many molecular signatures (CO, H2O, CH4, CO2). This allows constraining precisely surface gravity, metallicity, and temperature, if used in conjunction with self-consistent models like Exo-REM. Further, we will use the parameter-retrieval algorithm petitRADTRANS to constrain the C/O ratio of the planets. Ultimately, we plan to produce the first C/O survey of exoplanets, kick-starting the difficult process of linking planetary formation with measured atomic abundances

The ALPINE-ALMA [C ii] Survey: Size of Individual Star-forming Galaxies at z = 4-6 and Their Extended Halo Structure

We present the physical extent of [CII] 158um line-emitting gas from 46 star-forming galaxies at z=4-6 from the ALMA Large Program to INvestigate CII at Early Times (ALPINE). Using exponential profile fits, we measure the effective radius of the [CII] line (r_e,[CII]) for individual galaxies and compare them with the rest-frame ultra-violet (UV) continuum (r_e,UV) from Hubble Space Telescope images. The effective radius r_e,[CII] exceeds r_e,UV by factors of ~2-3 and the ratio of r_e,[CII]/r_e,UV increases as a function of M_star. We do not find strong evidence that [CII] line, the rest-frame UV, and FIR continuum are always displaced over ~ 1-kpc scale from each other. We identify 30% of isolated ALPINE sources as having an extended [CII] component over 10-kpc scales detected at 4.1$\sigma$-10.9$\sigma$ beyond the size of rest-frame UV and far-infrared (FIR) continuum. One object has tentative rotating features up to ~10-kpc, where the 3D model fit shows the rotating [CII]-gas disk spread over 4 times larger than the rest-frame UV-emitting region. Galaxies with the extended [CII] line structure have high star-formation rate (SFR), stellar mass (M_star), low Lya equivalent-width, and more blue-shifted (red-shifted) rest-frame UV metal absorption (Lya line), as compared to galaxies without such extended [CII] structures. Although we cannot rule out the possibility that a selection bias towards luminous objects may be responsible for such trends, the star-formation driven outflow also explains all these trends. Deeper observations are essential to test whether the extended [CII] line structures are ubiquitous to high-z star-forming galaxies.ERC STF