Caesarean section in Eisenmenger’s syndrome: anaesthetic management with titrated epidural and nebulised alprostadil

Pregnancy in patients with Eisenmenger’s syndrome is associated with a high mortality. This article reports two cases of women with Eisenmenger’s syndrome (secondary to two different primary cardiac defects) who presented with near-term pregnancies. Both the patients underwent successful elective Caesarean section with slowly titrated epidural anaesthesia. Nebulised prostaglandin E1(PGE1) analogue, alprostadil, administered immediately post-delivery resulted in a significant drop in systolic pulmonary artery pressures as measured from tricuspid regurgitant jet by transthoracic echocardiography. The postoperative period was uneventful in both patients. A slow induction of epidural anaesthesia can be a safe mode of anaesthesia for Caesarean section in pregnant patients with Eisenmenger’s syndrome. Nebulised alprostadil intraoperatively or postoperatively in the intensive care unit (ICU) is readily available and a relatively cheap option as a selective pulmonary vasodilator in developing countries.Keywords: alprostadil, Caesarean section, Eisenmenger’s syndrome, epidura

Melting in the Fe–C system to 70 GPa

We determined high-pressure melting curves for Fe₃C, Fe₇C₃ and the Fe-Fe₃C eutectic using laser-heated diamond anvil cell techniques. The principal criterion for melting is the observation of plateaus in the temperature vs. laser power function, which is an expected behavior at isobaric invariant points (e.g. congruent, eutectic, or peritectic melting) as increased power provides the latent heat of melting. We verified this technique by reproducing the melting curves of well-studied congruently melting compounds at high pressure (Fe, Pt, FeS, Pb), and by comparison with melting determinations made using thermocouple-based large-volume press techniques. The incongruent melting curve of Fe₃C measured to 70 GPa has an apparent change in slope at ~ 8 GPa, which we attribute to stabilization of FeC₃ at the solidus and the creation of a P-T invariant point. We observe that Fe₇C₃ melts at higher temperatures than Fe₃C between 14 and 52 GPa and has a steep P-T slope, and on this basis predicts an expanding field of Fe₇C₃ + liquid with pressure. The Fe-Fe₃C eutectic melting curve measured to 70 GPa agrees closely with multi-anvil data and thermodynamic calculations. We also measured the eutectic composition as a function of pressure using an in situ X-radiographic imaging technique, and find a rapid drop in carbon in the eutectic composition above about 20 GPa, generally consistent with previous thermodynamic calculations, and predict that the eutectic lies close to pure iron by ~ 50 GPa. We use these observations to extrapolate phase relations to core-relevant pressures. Convergence of the Fe₃C and Fe-Fe₃C eutectic melting curves indicate that Fe₃C is replaced at the solidus by Fe₇C₃ at ~ 120 GPa, forming another P-T invariant point and a new eutectic between Fe and Fe₇C₃. Thus, Fe₃C is unlikely to be an important crystallizing phase at core conditions, whereas Fe₇C₃ could become an important crystallizing phase.11 page(s

Strategically Equivalent Contests

Using a two-player Tullock-type contest, we show that intuitively and structurally different contests can be strategically equivalent. Strategically equivalent contests generate the same best response functions and, as a result, the same equilibrium efforts. However, strategically equivalent contests may yield different equilibrium payoffs. We propose a simple two-step procedure to identify strategically equivalent contests. Using this procedure, we identify contests that are strategically equivalent to the original Tullock contest, and provide new examples of strategically equivalent contests. Finally, we discuss possible contest design applications and avenues for future theoretical and empirical research

On the breaking of collinear factorization in QCD

We investigate the breakdown of collinear factorization for non-inclusive observables in hadron-hadron collisions. For pure QCD processes, factorization is violated at the three-loop level and it has a structure identical to that encountered previously in the case of super-leading logarithms. In particular, it is driven by the non-commutation of Coulomb/Glauber gluon exchanges with other soft exchanges. Beyond QCD, factorization may be violated at the two-loop level provided that the hard subprocess contains matrix element contributions with phase differences between different colour topologies.Comment: Version 2: minor improvements for journal publicatio

Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA)

Background Giant cell arteritis (GCA) is a common large vessel vasculitis of the elderly, often associated with sight loss. Glucocorticoids (GC remain the mainstay of treatment, although biologic treatments have been approved. Biomarkers predicting disease severity, relapse rates and damage are lacking in GCA. EULAR recommends ultrasound (US) as the first investigation for suspected GCA. The cardinal US finding, a non-compressible halo, is currently categorised as either negative or positive. However, the extent and severity of this finding may vary. In this study, we hypothesise whether the extent and severity of the halo sign [calculated as a single composite Halo score (HS)] of temporal and axillary arteries may be of diagnostic, prognostic and monitoring importance; whether baseline HS is linked to disease outcomes, relapses and damage; whether HS can stratify GCA patients for individual treatment needs; whether HS can function as an objective monitoring tool during follow up. Methods This is a prospective, observational study. Suspected GCA Participants will be selected from the GCA FTC at the participating centres in the UK. Informed consent will be obtained, and patients managed as part of standard care. Patients with GCA will have HS (temporal and axillary arteries) measured at baseline and months 1,3,6 and 12 long with routine clinical assessments, blood sampling and patient-reported outcomes (EQ5D). Non-GCA patients will be discharged back to the referral team and will have a telephone interview in 6 months. We aim to recruit 272 suspected GCA referrals which should yield 68 patients (25% of referrals) with confirmed GCA. The recruitment will be completed in 1 year with an estimated total study period of 24 months. Discussion The identification of prognostic factors in GCA is both timely and needed. A prognostic marker, such as the HS, could help to stratify GCA patients for an appropriate treatment regimen. Tocilizumab, an IL-6R blocking agent, switches off the acute phase response (C-Reactive Protein), making it difficult to measure the disease activity. Therefore, an independent HS, and changes in that score during treatment and follow-up, maybe a more objective measure of response compare to patient-reported symptoms and clinical assessment alone

Angles in Fuzzy Disc and Angular Noncommutative Solitons

The fuzzy disc, introduced by the authors of Ref.[1], is a disc-shaped region in a noncommutative plane, and is a fuzzy approximation of a commutative disc. In this paper we show that one can introduce a concept of angles to the fuzzy disc, by using the phase operator and phase states known in quantum optics. We gave a description of a fuzzy disc in terms of operators and their commutation relations, and studied properties of angular projection operators. A similar construction for a fuzzy annulus is also given. As an application, we constructed fan-shaped soliton solutions of a scalar field theory on a fuzzy disc, which corresponds to a fan-shaped D-brane. We also applied this concept to the theory of noncommutative gravity that we proposed in Ref.[2]. In addition, possible connections to black hole microstates, holography and an experimental test of noncommutativity by laser physics are suggested.Comment: 24 pages, 12 figures; v2: minor mistake corrected in Eq.(3.21), and discussion adapted accordingly; v3: a further discussion on the algebra of the fuzzy disc added in subsection 3.2; v4: discussions improved and typos correcte

Aidnogenesis via Leptogenesis and Dark Sphalerons

We discuss aidnogenesis, the generation of a dark matter asymmetry via new sphaleron processes associated to an extra non-abelian gauge symmetry common to both the visible and the dark sectors. Such a theory can naturally produce an abundance of asymmetric dark matter which is of the same size as the lepton and baryon asymmetries, as suggested by the similar sizes of the observed baryonic and dark matter energy content, and provide a definite prediction for the mass of the dark matter particle. We discuss in detail a minimal realization in which the Standard Model is only extended by dark matter fermions which form "dark baryons" through an SU(3) interaction, and a (broken) horizontal symmetry that induces the new sphalerons. The dark matter mass is predicted to be approximately 6 GeV, close to the region favored by DAMA and CoGeNT. Furthermore, a remnant of the horizontal symmetry should be broken at a lower scale and can also explain the Tevatron dimuon anomaly.Comment: Minor changes, discussion of present constraints expanded. 16 pages, 2 eps figures, REVTeX

Role of the halo sign in the assessment of giant cell arteritis: a systematic review and meta-analysis

Objectives This systematic review and meta-analysis aimed to evaluate the diagnostic value of the halo sign in the assessment of GCA. Methods A systematic literature review was performed using MEDLINE, EMBASE and Cochrane central register databases up to August 2020. Studies informing on the sensitivity and specificity of the US halo sign for GCA (index test) were selected. Studies with a minimum of five participants were included. Study articles using clinical criteria, imaging such as PET-CT and/or temporal artery biopsy (TAB) as the reference standards were selected. Meta-analysis was conducted with a bivariate model. Results The initial search yielded 4023 studies. Twenty-three studies (patients n = 2711) met the inclusion criteria. Prospective (11 studies) and retrospective (12 studies) studies in academic and non-academic centres were included. Using clinical diagnosis as the standard (18 studies) yielded a pooled sensitivity of 67% (95% CI: 51, 80) and a specificity of 95% (95% CI: 89, 98%). This gave a positive and negative likelihood ratio for the diagnosis of GCA of 14.2 (95% CI: 5.7, 35.5) and 0.375 (95% CI: 0.22, 0.54), respectively. Using TAB as the standard (15 studies) yielded a pooled sensitivity of 63% (95% CI: 50, 75) and a specificity of 90% (95% CI: 81, 95). Conclusion The US halo sign is a sensitive and specific approach for GCA assessment and plays a pivotal role in diagnosis of GCA in routine clinical practice