Reflex syncope in the setting of deglutition: A case report

Background: Deglutition syncope was first identified by Thomas Spens in 1793 as a rare form of neurally-mediated transient loss of consciousness secondary to an atypical vasovagal reflex during swallow-induced esophageal dilation. Due to the lack of validated diagnosing criteria, detailed history is imperative to guide timely evaluation and management.Case: A 58-year-old male with a past medical history of bipolar disorder, PTSD, anxiety, cocaine and methamphetamine use presented after a syncopal episode. He reported multiple syncopal episodes over the past five years associated with swallowing. During the most recent incident, the patient reported consuming food when he started feeling fullness in his throat, associated with lightheadedness and diaphoresis prior to a syncope episode. Patient's ED course was unremarkable with stable vitals without orthostasis, negative troponin, chest radiography and ECG. Patient was admitted for further syncope work up.Decision-making: Modified barium swallow study and CT chest were performed to evaluate dysphagia and anatomical abnormality, which revealed mild esophageal reflux and normal anatomy respectively. The patient was allowed to eat. He was placed on continuous telemetry. Patient had several witnessed syncopal events while eating. Corresponding telemetry strips demonstrated bradycardia with a low of 10 bpm along with a 3 second pause.Echocardiogram revealed EF of 35-40% with no significant structural abnormalities. Left heart catheterization revealed normal coronaries. Given his symptomatic bradycardia associated with swallowing, a permanent pacemaker device was suggested as the definitive treatment. Patient requested time to consider the decision, but ultimately decided to leave the hospital against medical advice.Conclusion: This case demonstrates the broad differential for syncope and lack of validated diagnostic criteria for situational syncope. We have excluded esophageal and structural pathology. Patient's symptoms were corresponding to telemetry findings. His psychiatric illness and substance dependence made management challenging, but detailed history and high clinical suspicion guided our diagnosis

BioAmbients: an abstraction for biological compartments

AbstractBiomolecular systems, composed of networks of proteins, underlie the major functions of living cells. Compartments are key to the organization of such systems. We have previously developed an abstraction for biomolecular systems using the π-calculus process algebra, which successfully handled their molecular and biochemical aspects, but provided only a limited solution for representing compartments. In this work, we extend this abstraction to handle compartments. We are motivated by the ambient calculus, a process algebra for the specification of process location and movement through computational domains. We present the BioAmbients calculus, which is suitable for representing various aspects of molecular localization and compartmentalization, including the movement of molecules between compartments, the dynamic rearrangement of cellular compartments, and the interaction between molecules in a compartmentalized setting. Guided by the calculus, we adapt the BioSpi simulation system, to provide an extended modular framework for molecular and cellular compartmentalization, and we use it to model and study a complex multi-cellular system

The feeder system of the Toba supervolcano from the slab to the shallow reservoir

The Toba Caldera has been the site of several large explosive eruptions in the recent geological past, including the world’s largest Pleistocene eruption 74,000 years ago. The major cause of this particular behaviour may be the subduction of the fluid-rich Investigator Fracture Zone directly beneath the continental crust of Sumatra and possible tear of the slab. Here we show a new seismic tomography model, which clearly reveals a complex multilevel plumbing system beneath Toba. Large amounts of volatiles originate in the subducting slab at a depth of ∼150 km, migrate upward and cause active melting in the mantle wedge. The volatile-rich basic magmas accumulate at the base of the crust in a ∼50,000 km3 reservoir. The overheated volatiles continue ascending through the crust and cause melting of the upper crust rocks. This leads to the formation of a shallow crustal reservoir that is directly responsible for the supereruptions

Theory of a spherical quantum rotors model: low--temperature regime and finite-size scaling

The quantum rotors model can be regarded as an effective model for the low-temperature behavior of the quantum Heisenberg antiferromagnets. Here, we consider a $d$-dimensional model in the spherical approximation confined to a general geometry of the form $L^{d-d'}\times\infty^{d'}\times L_{\tau}^{z}$ ( $L$-linear space size and $L_{\tau}$-temporal size) and subjected to periodic boundary conditions. Due to the remarkable opportunity it offers for rigorous study of finite-size effects at arbitrary dimensionality this model may play the same role in quantum critical phenomena as the popular Berlin-Kac spherical model in classical critical phenomena. Close to the zero-temperature quantum critical point, the ideas of finite-size scaling are utilized to the fullest extent for studying the critical behavior of the model. For different dimensions $1<d<3$ and $0\leq d'\leq d$ a detailed analysis, in terms of the special functions of classical mathematics, for the susceptibility and the equation of state is given. Particular attention is paid to the two-dimensional case.Comment: 33pages, revtex+epsf, 3ps figures included submitted to PR

Foodborne Botulism in the Republic of Georgia

In the Republic of Georgia, high rates of foodborne botulism are largely caused by home-preserved vegetables

COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries

Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.Publisher PDFPeer reviewe

The origins and spread of domestic horses from the Western Eurasian steppes

This is the final version. Available on open access from Nature Research via the DOI in this recordData availability: All collapsed and paired-end sequence data for samples sequenced in this study are available in compressed fastq format through the European Nucleotide Archive under accession number PRJEB44430, together with rescaled and trimmed bam sequence alignments against both the nuclear and mitochondrial horse reference genomes. Previously published ancient data used in this study are available under accession numbers PRJEB7537, PRJEB10098, PRJEB10854, PRJEB22390 and PRJEB31613, and detailed in Supplementary Table 1. The genomes of ten modern horses, publicly available, were also accessed as indicated in their corresponding original publications57,61,85-87.NOTE: see the published version available via the DOI in this record for the full list of authorsDomestication of horses fundamentally transformed long-range mobility and warfare. However, modern domesticated breeds do not descend from the earliest domestic horse lineage associated with archaeological evidence of bridling, milking and corralling at Botai, Central Asia around 3500 BC. Other longstanding candidate regions for horse domestication, such as Iberia and Anatolia, have also recently been challenged. Thus, the genetic, geographic and temporal origins of modern domestic horses have remained unknown. Here we pinpoint the Western Eurasian steppes, especially the lower Volga-Don region, as the homeland of modern domestic horses. Furthermore, we map the population changes accompanying domestication from 273 ancient horse genomes. This reveals that modern domestic horses ultimately replaced almost all other local populations as they expanded rapidly across Eurasia from about 2000 BC, synchronously with equestrian material culture, including Sintashta spoke-wheeled chariots. We find that equestrianism involved strong selection for critical locomotor and behavioural adaptations at the GSDMC and ZFPM1 genes. Our results reject the commonly held association between horseback riding and the massive expansion of Yamnaya steppe pastoralists into Europe around 3000 BC driving the spread of Indo-European languages. This contrasts with the scenario in Asia where Indo-Iranian languages, chariots and horses spread together, following the early second millennium BC Sintashta culture

On the age of the hominid fossils at the Sima de los Huesos, Sierra de Atapuerca, Spain: paleomagnetic evidence

We report new paleomagnetic data for the Middle Pleistocene hominid-bearing strata in the Sima de los Huesos, North Spain. Sediments (brown muds with human and bear fossils and the underlying sterile clayey and sandy unit) preserve both normal and reversed magnetic components. The sterile unit has exclusively reversed magnetization, dating back to the Matuyama Chron, and thus is Lower Pleistocene in age. The overlying fossiliferous muds have a dominant normal magnetization that overprints a partially resolved reversed magnetization. These data are compatible with one of the reversal events that occurred during the Brunhes Chron. Combined with the existing U-series dates and evidence from the macro- and microfauna, these paleomagnetic results suggest an age of the hominid fossils between 325 to 205 ka, whereas the underlying sand and silts are older than 780 ka. Am J Phys Anthropol 111:451–461, 2000. © 2000 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34269/1/2_ftp.pd

3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background: Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods: In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings: The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p&lt;0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13–0·34). Liraglutide induced greater weight loss than placebo at week 160 (–6·1 [SD 7·3] vs −1·9% [6·3]; estimated treatment difference −4·3%, 95% CI −4·9 to −3·7, p&lt;0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation: In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding: Novo Nordisk, Denmark

Dire wolves were the last of an ancient New World canid lineage

Dire wolves are considered to be one of the most common and widespread large carnivores in Pleistocene America1, yet relatively little is known about their evolution or extinction. Here, to reconstruct the evolutionary history of dire wolves, we sequenced five genomes from sub-fossil remains dating from 13,000 to more than 50,000 years ago. Our results indicate that although they were similar morphologically to the extant grey wolf, dire wolves were a highly divergent lineage that split from living canids around 5.7 million years ago. In contrast to numerous examples of hybridization across Canidae2,3, there is no evidence for gene flow between dire wolves and either North American grey wolves or coyotes. This suggests that dire wolves evolved in isolation from the Pleistocene ancestors of these species. Our results also support an early New World origin of dire wolves, while the ancestors of grey wolves, coyotes and dholes evolved in Eurasia and colonized North America only relatively recently