Gas inflows in the polar ring of NGC 4111 : the birth of an AGN

We have used Hubble Space Telescope (HST) images, SAURON Integral Field Spectroscopy (IFS), and adaptative optics assisted Gemini NIFS near-infrared K-band IFS to map the stellar and gas distribution, excitation and kinematics of the inner few kpc of the nearby edge-on S0 galaxy NGC 4111. The HST images map its ≈450 pc diameter dusty polar ring, with an estimated gas mass ≥107 M . The NIFS data cube maps the inner 110 pc radius at ≈7 pc spatial resolution, revealing a ≈220 pc diameter polar ring in hot (2267 ± 166 K) molecular H2 1–0 S(1) gas embedded in the polar ring. The stellar velocity field shows disc-dominated kinematics along the galaxy plane both in the SAURON large scale and in the NIFS nuclear-scale data. The large-scale [O III] λ5007 Å velocity field shows a superposition of two disc kinematics: one similar to that of the stars and another along the polar ring, showing non-circular motions that seem to connect with the velocity field of the nuclear H2 ring, whose kinematics indicate accelerated inflow to the nucleus. The estimated mass inflow rate is enough not only to feed an active galactic nucleus (AGN) but also to trigger circumnuclear star formation in the near future. We propose a scenario in which gas from the polar ring, which probably originated from the capture of a dwarf galaxy, is moving inwards and triggering an AGN, as supported by the local X-ray emission, which seems to be the source of the H2 1–0 S(1) excitation. The fact that we see neither near-UV nor Br γ emission suggests that the nascent AGN is still deeply buried under the optically thick dust of the polar ring

Lymphatic exosomes promote dendritic cell migration along guidance cues

Lymphatic endothelial cells (LECs) release extracellular chemokines to guide the migration of dendritic cells. In this study, we report that LECs also release basolateral exosome-rich endothelial vesicles (EEVs) that are secreted in greater numbers in the presence of inflammatory cytokines and accumulate in the perivascular stroma of small lymphatic vessels in human chronic inflammatory diseases. Proteomic analyses of EEV fractions identified >1,700 cargo proteins and revealed a dominant motility-promoting protein signature. In vitro and ex vivo EEV fractions augmented cellular protrusion formation in a CX3CL1/fractalkine-dependent fashion and enhanced the directional migratory response of human dendritic cells along guidance cues. We conclude that perilymphatic LEC exosomes enhance exploratory behavior and thus promote directional migration of CX3CR1-expressing cells in complex tissue environments.Peer reviewe

Gas inflows in the polar ring of NGC 4111: the birth of an AGN

We have used Hubble Space Telescope (HST) images, SAURON Integral Field Spectroscopy (IFS) and adaptative optics assisted Gemini NIFS near-infrared K-band IFS to map the stellar and gas distribution, excitation and kinematics of the inner few kpc of the nearby edge-on S0 galaxy NGC 4111. The HST images map its $\approx$ 450 pc diameter dusty polar ring, with an estimated gas mass $\ge10^7$ M$_\odot$. The NIFS datacube maps the inner 110 pc radius at $\approx$ 7 pc spatial resolution revealing a $\approx$ 220 pc diameter polar ring in hot ($2267\pm166$ K) molecular H$_2$ 1-0 S(1) gas embedded in the polar ring. The stellar velocity field shows disk-dominated kinematics along the galaxy plane both in the SAURON large-scale and in the NIFS nuclear-scale data. The large-scale [O III] $\lambda5007$ \AA velocity field shows a superposition of two disk kinematics: one similar to that of the stars and another along the polar ring, showing non-circular motions that seem to connect with the velocity field of the nuclear H$_2$ ring, whose kinematics indicate accelerated inflow to the nucleus. The estimated mass inflow rate is enough not only to feed an Active Galactic Nucleus (AGN) but also to trigger circumnuclear star formation in the near future. We propose a scenario in which gas from the polar ring, which probably originated from the capture of a dwarf galaxy, is moving inwards and triggering an AGN, as supported by the local X-ray emission, which seems to be the source of the H$_2$ 1-0 S(1) excitation. The fact that we see neither near-UV nor Br$\gamma$ emission suggests that the nascent AGN is still deeply buried under the optically thick dust of the polar ring.Comment: 18 pages, 21 figure

A European International Multicentre Survey on the Current Practice of Perioperative Antibiotic Prophylaxis for Paediatric Liver Transplantations

(1) Background: Postoperative infections are major contributors of morbidity and mortality after paediatric liver transplantation (pLTX). Evidence and recommendations regarding the most effective antimicrobial strategy are lacking. (2) Results: Of 39 pLTX centres, 20 responded. Aminopenicillins plus ß-lactamase inhibitors were used by six (30%) and third generation cephalosporins by three (15%), with the remaining centres reporting heterogenous regimens. Broad-spectrum regimens were the standard in 10 (50%) of centres and less frequent in the 16 (80%) centres with an infectious disease specialist. The duration ranged mainly between 24–48 h and 3–5 days in the absence and 3–5 days or 6–10 days in the presence of risk factors. Strategies regarding antifungal, antiviral, adjunctive antimicrobial, and surveillance strategies varied widely. (3) Methods: This international multicentre survey endorsed by the European Liver Transplant Registry queried all European pLTX centres from the registry on their current practice of perioperative antibiotic prophylaxis and antimicrobial strategies via an online questionnaire. (4) Conclusions: This survey found great heterogeneity regarding all aspects of postoperative antimicrobial treatment, surveillance, and prevention of infections in European pLTX centres. Evidence-based recommendations are urgently needed to optimise antimicrobial strategies and reduce the spectrum and duration of antimicrobial exposure

Changes in the pattern of suicides and suicide attempt admissions in relation to the COVID-19 pandemic

The consequences of the current COVID-19 pandemic for mental health remain unclear, especially regarding the effects on suicidal behaviors. To assess changes in the pattern of suicide attempt (SA) admissions and completed suicides (CS) in association with the COVID-19 pandemic. As part of a longitudinal study, SA admissions and CS are systematically documented and analyzed in all psychiatric hospitals in Frankfurt/Main (765.000 inhabitants). Number, sociodemographic factors, diagnoses and methods of SA and CS were compared between the periods of March–December 2019 and March–December 2020. The number of CS did not change, while the number of SA significantly decreased. Age, sex, occupational status, and psychiatric diagnoses did not change in SA, whereas the percentage of patients living alone while attempting suicide increased. The rate and number of intoxications as a SA method increased and more people attempted suicide in their own home, which was not observed in CS. Such a shift from public places to home is supported by the weekday of SA, as the rate of SA on weekends was significantly lower during the pandemic, likely because of lockdown measures. Only admissions to psychiatric hospitals were recorded, but not to other institutions. As it seems unlikely that the number of SA decreased while the number of CS remained unchanged, it is conceivable that the number of unreported SA cases increased during the pandemic. Our data suggest that a higher number of SA remained unnoticed during the pandemic because of their location and the use of methods associated with lower lethality

A Bayesian reanalysis of the Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial

Background Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. Methods We performed a secondary analysis of all 2927 patients randomized in multi-national STARRT-AKI trial, performed at 168 centers in 15 countries. The primary endpoint, 90-day all-cause mortality, was evaluated using hierarchical Bayesian logistic regression. A spectrum of priors includes optimistic, neutral, and pessimistic priors, along with priors informed from earlier clinical trials. Secondary endpoints (KRT-free days and hospital-free days) were assessed using zero–one inflated beta regression. Results The posterior probability of benefit comparing an accelerated versus a standard KRT initiation strategy for the primary endpoint suggested no important difference, regardless of the prior used (absolute difference of 0.13% [95% credible interval [CrI] − 3.30%; 3.40%], − 0.39% [95% CrI − 3.46%; 3.00%], and 0.64% [95% CrI − 2.53%; 3.88%] for neutral, optimistic, and pessimistic priors, respectively). There was a very low probability that the effect size was equal or larger than a consensus-defined minimal clinically important difference. Patients allocated to the accelerated strategy had a lower number of KRT-free days (median absolute difference of − 3.55 days [95% CrI − 6.38; − 0.48]), with a probability that the accelerated strategy was associated with more KRT-free days of 0.008. Hospital-free days were similar between strategies, with the accelerated strategy having a median absolute difference of 0.48 more hospital-free days (95% CrI − 1.87; 2.72) compared with the standard strategy and the probability that the accelerated strategy had more hospital-free days was 0.66. Conclusions In a Bayesian reanalysis of the STARRT-AKI trial, we found very low probability that an accelerated strategy has clinically important benefits compared with the standard strategy. Patients receiving the accelerated strategy probably have fewer days alive and KRT-free. These findings do not support the adoption of an accelerated strategy of KRT initiation

Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis.

ObjectivesAmong patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant.DesignSecondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722).SettingOne hundred-fifty-three ICUs in 13 countries.PatientsAltogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ).InterventionsNone.Measurements and main resultsTotal mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p p p p p p p p = 0.007).ConclusionsAmong STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions