National trends in utilization, mortality, and survival after repair of type B aortic dissection in the Medicare population

ObjectiveThe application of thoracic endovascular aortic repair (TEVAR) has changed treatment paradigms for thoracic aortic disease. We sought to better define specific treatment patterns and outcomes for type B aortic dissection treated with TEVAR or open surgical repair (OSR).MethodsMedicare patients undergoing type B thoracic aortic dissection repair (2000-2010) were identified by use of a validated International Classification of Diseases, Ninth Revision diagnostic and procedural code–based algorithm. Trends in utilization were analyzed by procedure type (OSR vs TEVAR), and patterns in patient characteristics and outcomes were examined.ResultsTotal thoracic aortic dissection repairs increased by 21% between 2000 and 2010 (2.5 to 3 per 100,000 Medicare patients; P = .001). A concomitant increase in TEVAR was seen during the same interval (0.03 to 0.8 per 100,000; P < .001). By 2010, TEVAR represented 27% of all repairs. TEVAR patients had higher rates of comorbid congestive heart failure (12% vs 9%; P < .001), chronic obstructive pulmonary disease (17% vs 10%; P < .001), diabetes (8% vs 5%; P < .001), and chronic renal failure (8% vs 3%; P < .001) compared with OSR patients. For all repairs, patient comorbidity burden increased over time (mean Charlson comorbidity score of 0.79 in 2000, 1.10 in 2010; P = .04). During this same interval, in-hospital mortality rates declined from 47% to 23% (P < .001), a trend seen in both TEVAR and OSR patients. Whereas in-hospital mortality rates and 3-year survival were similar between patients selected for TEVAR and OSR, there was a trend toward women having slightly lower 3-year survival after TEVAR (60% women vs 63% men; P = .07).ConclusionsSurgical treatment of type B aortic dissection has increased over time, reflecting an increase in the utilization of TEVAR. Overall, type B dissection repairs are currently performed at lower mortality risk in patients with more comorbidities

Shape model and spin-state analysis of PHA contact binary (85990) 1999 JV6 from combined radar and optical observations

Context. The potentially hazardous asteroid (85990)1999 JV6 has been a target of previously published thermal-infrared observations and optical photometry. It has been identified as a promising candidate for possible Yarkovsky-O’Keefe-Radzievskii-Paddack (YORP) effect detection. Aims. The YORP effect is a small thermal-radiation torque considered to be a key factor in spin-state evolution of small Solar System bodies. In order to detect YORP on 1999 JV6 we developed a detailed shape model and analysed the spin-state using both optical and radar observations. Methods. For 1999 JV6, we collected optical photometry between 2007 and 2016. Additionally, we obtained radar echo-power spectra and imaging observations with Arecibo and Goldstone planetary radar facilities in 2015, 2016, and 2017. We combined our data with published optical photometry to develop a robust physical model. Results. We determine that the rotation pole resides at negative latitudes in an area with a 5◦ radius close to the south ecliptic pole. The refined sidereal rotation period is 6.536787±0.000007 h. The radar images are best reproduced with a bilobed shape model. Both lobes of 1999 JV6 can be represented as oblate ellipsoids with a smaller, more spherical component resting at the end of a larger, more elongated component. While contact binaries appear to be abundant in the near-Earth population, there are only a few published shape models for asteroids in this particular configuration. By combining the radar-derived shape model with optical light curves we determine a constant-period solution that fits all available data well. Using light-curve data alone we determine an upper limit for YORP of 8.5×10−8 rad day−2. Conclusions. The bifurcated shape of 1999 JV6 might be a result of two ellipsoidal components gently merging with each other, or a deformation of a rubble pile with a weak-tensile-strength core due to spin-up. The physical model of 1999 JV6 presented here will enable future studies of contact binary asteroid formation and evolution

Prevalence of 2009 Pandemic Influenza A (H1N1) Virus Antibodies, Tampa Bay Florida — November–December, 2009

BACKGROUND: In 2009, a novel influenza virus (2009 pandemic influenza A (H1N1) virus (pH1N1)) caused significant disease in the United States. Most states, including Florida, experienced a large fall wave of disease from September through November, after which disease activity decreased substantially. We determined the prevalence of antibodies due to the pH1N1 virus in Florida after influenza activity had peaked and estimated the proportion of the population infected with pH1N1 virus during the pandemic. METHODS: During November-December 2009, we collected leftover serum from a blood bank, a pediatric children's hospital and a pediatric outpatient clinic in Tampa Bay Florida. Serum was tested for pH1N1 virus antibodies using the hemagglutination-inhibition (HI) assay. HI titers ≥40 were considered seropositive. We adjusted seroprevalence results to account for previously established HI assay specificity and sensitivity and employed a simple statistical model to estimate the proportion of seropositivity due to pH1N1 virus infection and vaccination. RESULTS: During the study time period, the overall seroprevalence in Tampa Bay, Florida was 25%, increasing to 30% after adjusting for HI assay sensitivity and specificity. We estimated that 5.9% of the population had vaccine-induced seropositivity while 25% had seropositivity secondary to pH1N1 virus infection. The highest cumulative incidence of pH1N1 virus infection was among children aged 5-17 years (53%) and young adults aged 18-24 years (47%), while adults aged ≥50 years had the lowest cumulative incidence (11-13%) of pH1N1 virus infection. CONCLUSIONS: After the peak of the fall wave of the pandemic, an estimated one quarter of the Tampa Bay population had been infected with the pH1N1 virus. Consistent with epidemiologic trends observed during the pandemic, the highest burdens of disease were among school-aged children and young adults

Hyperpolarization-activated and cyclic nucleotide-gated channels are differentially expressed in juxtaglomerular cells in the olfactory bulb of mice

In the olfactory bulb, input from olfactory receptor neurons is processed by neuronal networks before it is relayed to higher brain regions. In many neurons, hyperpolarization-activated and cyclic nucleotide-gated (HCN) channels generate and control oscillations of the membrane potential. Oscillations also appear crucial for information processing in the olfactory bulb. Four channel isoforms exist (HCN1–HCN4) that can form homo- or heteromers. Here, we describe the expression pattern of HCN isoforms in the olfactory bulb of mice by using a novel and comprehensive set of antibodies against all four isoforms. HCN isoforms are abundantly expressed in the olfactory bulb. HCN channels can be detected in most cell populations identified by commonly used marker antibodies. The combination of staining with marker and HCN antibodies has revealed at least 17 different staining patterns in juxtaglomerular cells. Furthermore, HCN isoforms give rise to an unexpected wealth of co-expression patterns but are rarely expressed in the same combination and at the same level in two given cell populations. Therefore, heteromeric HCN channels may exist in several cell populations in vivo. Our results suggest that HCN channels play an important role in olfactory information processing. The staining patterns are consistent with the possibility that both homomeric and heteromeric HCN channels are involved in oscillations of the membrane potential of juxtaglomerular cells

The anti-bacterial iron-restriction defence mechanisms of egg white; the potential role of three lipocalin-like proteins in resistance against Salmonella

Salmonella enterica serovar Enteritidis (SE) is the most frequently-detected Salmonella in foodborne outbreaks in the European Union. Among such outbreaks, egg and egg products were identified as the most common vehicles of infection. Possibly, the major antibacterial property of egg white is iron restriction, which results from the presence of the iron-binding protein, ovotransferrin. To circumvent iron restriction, SE synthesise catecholate siderophores (i.e. enterobactin and salmochelin) that can chelate iron from host iron-binding proteins. Here, we highlight the role of lipocalin-like proteins found in egg white that could enhance egg-white iron restriction through sequestration of certain siderophores, including enterobactin. Indeed, it is now apparent that the egg-white lipocalin, Ex-FABP, can inhibit bacterial growth via its siderophore-binding capacity in vitro. However, it remains unclear whether ex-FABP performs such a function in egg white or during bird infection. Regarding the two other lipocalins of egg white (Cal-γ and α-1-glycoprotein), there is currently no evidence to indicate that they sequester siderophores

Discovery of very-high-energy gamma-ray emission from the vicinity of PSR J1913+1011 with H.E.S.S

The H.E.S.S. experiment, an array of four Imaging Atmospheric Cherenkov Telescopes with high sensitivity and large field-of-view, has been used to search for emitters of very-high-energy (VHE, >100 GeV) gamma-rays along the Galactic plane, covering the region 30 deg < l < 60 deg, 280 deg < l < 330 deg, and -3 deg < b < 3 deg. In this continuation of the H.E.S.S. Galactic Plane Scan, a new extended VHE gamma-ray source was discovered at alpha(2000)=19h12m49s, delta(2000)=+10d09'06'' (HESS J1912+101). Its integral flux between 1-10 TeV is ~10% of the Crab Nebula flux in the same energy range. The measured energy spectrum can be described by a power law with a photon index Gamma = 2.7+-0.2(stat)+-0.3(sys). HESS J1912+101 is plausibly associated with the high spin-down luminosity pulsar PSR J1913+1011. We also discuss associations with an as yet unconfirmed SNR candidate proposed from low frequency radio observation and/or with molecular clouds found in 13CO data.Comment: 6 pages, 2 figures; Accepted for publication in A&A on February 20, 200