Histopathologic parameters as predictors of response to endoscopic sinus surgery in nonallergic patients with chronic rhinosinusitis

OBJECTIVE: To estimate the predictable value of histopathologic parameters in chronic rhinosinusitis (CRS) for response to endoscopic sinus surgery (ESS). - - - - - STUDY DESIGN: Symptomatology was rated in 100 patients prior to as well as 12 and 24 months after surgery. Specimens taken during the procedure were examined and scored for goblet cells, subepithelial thickening, mast cells, and eosinophils. Multiple regression analysis was performed to predict the total score of subjective symptoms before treatment by histopathologic parameters. The correlation between histopathologic parameters and postoperative symptoms was then evaluated. - - - - - RESULTS: Goblet cells were the best predictor correlating with 5 symptoms. Subepithelial thickening correlated with 4 symptoms. Mast cell infiltration correlated with 3 symptoms. Eosinophilic infiltration correlated with only one symptom (P<0.05). - - - - - CONCLUSION: Certain histopathologic parameters in CRS are predictive of favorable response to ESS. - - - - - SIGNIFICANCE: Pathologic evaluation may help the ENT surgeon to predict the persistence of certain CRS symptoms after ESS, even in patients at low risk for surgical failure. - - - - - EBM rating: C-4

Using binary statistics in Taurus-Auriga to distinguish between brown dwarf formation processes

Whether BDs form as stars through gravitational collapse ("star-like") or BDs and some very low-mass stars constitute a separate population which form alongside stars comparable to the population of planets, e.g. through circumstellar disk ("peripheral") fragmentation, is one of the key questions of the star-formation problem. For young stars in Taurus-Auriga the binary fraction is large with little dependence on primary mass above ~0.2Msun, while for BDs it is <10%. We investigate a case in which BDs in Taurus formed dominantly through peripheral fragmentation. The decline of the binary frequency in the transition region between star-like and peripheral formation is modelled. A dynamical population synthesis model is employed in which stellar binary formation is universal. Peripheral objects form separately in circumstellar disks with a distinctive initial mass function (IMF), own orbital parameter distributions for binaries and a low binary fraction. A small amount of dynamical processing of the stellar component is accounted for as appropriate for the low-density Taurus-Auriga embedded clusters. The binary fraction declines strongly between the mass-limits for star-like and peripheral formation. The location of characteristic features and the steepness depend on these mass-limits. Such a trend might be unique to low density regions hosting dynamically unprocessed binary populations. The existence of a strong decline in the binary fraction -- primary mass diagram will become verifiable in future surveys on BD and VLMS binarity in the Taurus-Auriga star forming region. It is a test of the (non-)continuity of star formation along the mass-scale, the separateness of the stellar and BD populations and the dominant formation channel for BDs and BD binaries in regions of low stellar density hosting dynamically unprocessed populations.Comment: accepted for publication in A&A, 11 pages, 4 figures, 1 tabl

Atomic-scale structure of the SrTiO3(001)-c(6x2) reconstruction: Experiments and first-principles calculations

The c(6x2) is a reconstruction of the SrTiO3(001) surface that is formed between 1050-1100oC in oxidizing annealing conditions. This work proposes a model for the atomic structure for the c(6x2) obtained through a combination of results from transmission electron diffraction, surface x-ray diffraction, direct methods analysis, computational combinational screening, and density functional theory. As it is formed at high temperatures, the surface is complex and can be described as a short-range ordered phase featuring microscopic domains composed of four main structural motifs. Additionally, non-periodic TiO2 units are present on the surface. Simulated scanning tunneling microscopy images based on the electronic structure calculations are consistent with experimental images

Applications of M.G. Krein's Theory of Regular Symmetric Operators to Sampling Theory

The classical Kramer sampling theorem establishes general conditions that allow the reconstruction of functions by mean of orthogonal sampling formulae. One major task in sampling theory is to find concrete, non trivial realizations of this theorem. In this paper we provide a new approach to this subject on the basis of the M. G. Krein's theory of representation of simple regular symmetric operators having deficiency indices (1,1). We show that the resulting sampling formulae have the form of Lagrange interpolation series. We also characterize the space of functions reconstructible by our sampling formulae. Our construction allows a rigorous treatment of certain ideas proposed recently in quantum gravity.Comment: 15 pages; v2: minor changes in abstract, addition of PACS numbers, changes in some keywords, some few changes in the introduction, correction of the proof of the last theorem, and addition of some comments at the end of the fourth sectio

Derivation and validation of a novel risk score to predict need for haemostatic intervention in acute upper gastrointestinal bleeding (London Haemostat Score)

Background: Acute Upper Gastrointestinal Bleeding (AUGIB) is a common medical emergency which takes up considerable healthcare resources. However, only approximately 20-30% of bleeds require urgent haemostatic intervention. Current standard of care is for all patients admitted to hospital to undergo endoscopy within 24 hours for risk stratification, but this is difficult to achieve in practice, invasive and costly. Aim To develop a novel non-endoscopic risk stratification tool for AUGIB to predict the need for haemostatic intervention by endoscopic, radiological or surgical treatments. We compared this with the Glasgow-Blatchford Score (GBS). Design: Model development was carried out using a derivation (n=466) and prospectively collected validation cohort (n=404) of patients who were admitted with AUGIB to three large hospitals in London, UK (2015-2020). Univariable and multivariable logistic regression analysis was used to identify variables that were associated with increased or decreased chances of requiring haemostatic intervention. This model was converted into a risk scoring system, the London Haemostat Score (LHS). Results: The LHS was more accurate at predicting need for haemostatic intervention than the GBS, in the derivation cohort (Area Under the Receiver Operating Curve [AUROC] 0.82; 95% Confidence Interval (CI), 0.78-0.86 vs 0.72; 95% CI, 0.67-0.77; p<0.001) and validation cohort (AUROC 0.80; 95% CI, 0.75-0.85 vs 0.72; 95% CI, 0.67-0.78; p<0.001). At cut-off scores at which LHS and GBS identified patients who required haemostatic intervention with 98% sensitivity, the specificity of the LHS was 41% vs 18% with the GBS (p<0.001). This could translate to 32% of inpatient endoscopies for AUGIB being avoided at a cost of only a 0.5% false negative rate. Conclusions: The London Haemostat score is accurate at predicting the need for haemostatic intervention in AUGIB and could be used identify a proportion of low-risk patients who can undergo delayed or outpatient endoscopy. Validation in other geographical settings is required before routine clinical use

Aluminum-, Calcium- And Titanium-Rich Oxide Stardust In Ordinary Chondrite Meteorites

We report isotopic data for a total of 96 presolar oxide grains found in residues of several unequilibrated ordinary chondrite meteorites. Identified grain types include Al2O3, MgAl2O4, hibonite (CaAl12O19) and Ti oxide. This work greatly increases the presolar hibonite database, and is the first report of presolar Ti oxide. O-isotopic compositions of the grains span previously observed ranges and indicate an origin in red giant and asymptotic giant branch (AGB) stars of low mass (<2.5 MSun) for most grains. Cool bottom processing in the parent AGB stars is required to explain isotopic compositions of many grains. Potassium-41 enrichments in hibonite grains are attributable to in situ decay of now-extinct 41Ca. Inferred initial 41Ca/40Ca ratios are in good agreement with model predictions for low-mass AGB star envelopes, provided that ionization suppresses 41Ca decay. Stable Mg and Ca isotopic ratios of most of the hibonite grains reflect primarily the initial compositions of the parent stars and are generally consistent with expectations for Galactic chemical evolution, but require some local interstellar chemical inhomogeneity. Very high 17O/16O or 25Mg/24Mg ratios suggest an origin for some grains in binary star systems where mass transfer from an evolved companion has altered the parent star compositions. A supernova origin for the hitherto enigmatic 18O-rich Group 4 grains is strongly supported by multi-element isotopic data for two grains. The Group 4 data are consistent with an origin in a single supernova in which variable amounts of material from the deep 16O-rich interior mixed with a unique end-member mixture of the outer layers. The Ti oxide grains primarily formed in low-mass AGB stars. They are smaller and rarer than presolar Al2O3, reflecting the lower abundance of Ti than Al in AGB envelopes.Comment: Accepted for publication in ApJ; 47 pages, 13 figure

Self-aligned fabrication process for silicon quantum computer devices

We describe a fabrication process for devices with few quantum bits (qubits), which are suitable for proof-of-principle demonstrations of silicon-based quantum computation. The devices follow the Kane proposal to use the nuclear spins of 31P donors in 28Si as qubits, controlled by metal surface gates and measured using single electron transistors (SETs). The accurate registration of 31P donors to control gates and read-out SETs is achieved through the use of a self-aligned process which incorporates electron beam patterning, ion implantation and triple-angle shadow-mask metal evaporation

How primary care can contribute to good mental health in adults.

The need for support for good mental health is enormous. General support for good mental health is needed for 100% of the population, and at all stages of life, from early childhood to end of life. Focused support is needed for the 17.6% of adults who have a mental disorder at any time, including those who also have a mental health problem amongst the 30% who report having a long-term condition of some kind. All sectors of society and all parts of the NHS need to play their part. Primary care cannot do this on its own. This paper describes how primary care practitioners can help stimulate such a grand alliance for health, by operating at four different levels - as individual practitioners, as organisations, as geographic clusters of organisations and as policy-makers

A Three Monoclonal Antibody Combination Potently Neutralizes Multiple Botulinum Neurotoxin Serotype E Subtypes.

Human botulism is most commonly caused by botulinum neurotoxin (BoNT) serotypes A, B, and E. For this work, we sought to develop a human monoclonal antibody (mAb)-based antitoxin capable of binding and neutralizing multiple subtypes of BoNT/E. Libraries of yeast-displayed single chain Fv (scFv) antibodies were created from the heavy and light chain variable region genes of humans immunized with pentavalent-toxoid- and BoNT/E-binding scFv isolated by Fluorescence-Activated Cell Sorting (FACS). A total of 10 scFv were isolated that bound one or more BoNT/E subtypes with nanomolar-level equilibrium dissociation constants (KD). By diversifying the V-regions of the lead mAbs and selecting for cross-reactivity, we generated three scFv that bound all four BoNT/E subtypes tested at three non-overlapping epitopes. The scFvs were converted to IgG that had KD values for the different BoNT/E subtypes ranging from 9.7 nM to 2.28 pM. An equimolar combination of the three mAbs was able to potently neutralize BoNT/E1, BoNT/E3, and BoNT/E4 in a mouse neutralization assay. The mAbs have potential utility as therapeutics and as diagnostics capable of recognizing multiple BoNT/E subtypes. A derivative of the three-antibody combination (NTM-1633) is in pre-clinical development with an investigational new drug (IND) application filing expected in 2018