Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

Constraints on the spin-parity and anomalous HVV couplings of the Higgs boson in proton collisions at 7 and 8 TeV

The study of the spin-parity and tensor structure of the interactions of the recently discovered Higgs boson is performed using the $\mathrm{H} \rightarrow \mathrm{Z} \mathrm{Z}$, $\mathrm{Z}\gamma^*$, $\gamma^*\gamma^* \rightarrow 4\ell$, $\mathrm{H} \rightarrow \mathrm{W} \mathrm{W} \rightarrow \ell\nu\ell\nu$, and $\mathrm{H} \rightarrow \gamma\gamma$ decay modes. The full dataset recorded by the CMS experiment during the LHC Run 1 is used, corresponding to an integrated luminosity of up to $5.1~\mathrm{fb}^{-1}$ at a center-of-mass energy of 7 TeV and up to $19.7~\mathrm{fb}^{-1}$ at 8 TeV. A wide range of spin-two models is excluded at a 99% confidence level or higher, or at a 99.87% confidence level for the minimal gravity-like couplings, regardless of whether assumptions are made on the production mechanism. Any mixed-parity spin-one state is excluded in the $\mathrm{ZZ}$ and $\mathrm{WW }$ modes at a greater than 99.999% confidence level. Under the hypothesis that the resonance is a spin-zero boson, the tensor structure of the interactions of the Higgs boson with two vector bosons $\mathrm{Z} \mathrm{Z}$, $\mathrm{Z}\gamma$, $\gamma\gamma$, and $\mathrm{W} \mathrm{W}$ is investigated and limits on eleven anomalous contributions are set. Tighter constraints on anomalous $\mathrm{HVV}$ interactions are obtained by combining the $\mathrm{HZZ}$ and $\mathrm{HWW}$ measurements. All observations are consistent with the expectations for the standard model Higgs boson with the quantum numbers $J^{\mathrm{PC}}=0^{++}$

Constraints on the spin-parity and anomalous HVV couplings of the Higgs boson in proton collisions at 7 and 8 TeV

The study of the spin-parity and tensor structure of the interactions of the recently discovered Higgs boson is performed using the $\mathrm{H} \rightarrow \mathrm{Z} \mathrm{Z}$, $\mathrm{Z}\gamma^*$, $\gamma^*\gamma^* \rightarrow 4\ell$, $\mathrm{H} \rightarrow \mathrm{W} \mathrm{W} \rightarrow \ell\nu\ell\nu$, and $\mathrm{H} \rightarrow \gamma\gamma$ decay modes. The full dataset recorded by the CMS experiment during the LHC Run 1 is used, corresponding to an integrated luminosity of up to $5.1~\mathrm{fb}^{-1}$ at a center-of-mass energy of 7 TeV and up to $19.7~\mathrm{fb}^{-1}$ at 8 TeV. A wide range of spin-two models is excluded at a 99% confidence level or higher, or at a 99.87% confidence level for the minimal gravity-like couplings, regardless of whether assumptions are made on the production mechanism. Any mixed-parity spin-one state is excluded in the $\mathrm{ZZ}$ and $\mathrm{WW }$ modes at a greater than 99.999% confidence level. Under the hypothesis that the resonance is a spin-zero boson, the tensor structure of the interactions of the Higgs boson with two vector bosons $\mathrm{Z} \mathrm{Z}$, $\mathrm{Z}\gamma$, $\gamma\gamma$, and $\mathrm{W} \mathrm{W}$ is investigated and limits on eleven anomalous contributions are set. Tighter constraints on anomalous $\mathrm{HVV}$ interactions are obtained by combining the $\mathrm{HZZ}$ and $\mathrm{HWW}$ measurements. All observations are consistent with the expectations for the standard model Higgs boson with the quantum numbers $J^{\mathrm{PC}}=0^{++}$