Factors associated with positive blood cultures in outpatients with suspected bacteremia

Blood cultures are routinely taken in outpatients with fever and suspected bacterial infections. However, in the majority of cases, they are not informative and of limited value for clinical decision making. The aim of this study was therefore to investigate factors associated with positive blood cultures in outpatients presenting to an outpatient clinic and emergency room. This was a case-control study of all outpatients with positive blood cultures from January 1, 2006 to October 31, 2007 and matched control patients with negative blood cultures in the same time period. Microbiology results and medical charts were reviewed to determine factors associated with positive blood cultures. The presence of a systemic inflammation response syndrome (SIRS) (OR 2.7, 95% Cl 1.0-7.2) and increased C-reactive protein (CRP) (OR 1.1 per 10mg/l, 95% Cl 1.0-1.2) were the most powerful predictive values for the development of positive blood cultures. In positive cases serum albumin was lower (35mg/l versus 39mg/l) than in controls. SIRS, increasing CRP and low albumin were associated with positive blood cultures in outpatients. With simple clinical assessment and few laboratory tests indicative of infection, it is possible to define a group at higher risk for bacteremia in outpatient

Reconstruction of the gastric passage by a side-to-side gastrogastrostomy after failed vertical-banded gastroplasty: a case report

INTRODUCTION: Vertical-banded gastroplasty, a technique that is commonly performed in the treatment of morbid obesity, represents a nonadjustable restrictive procedure which reduces the volume of the upper stomach by a vertical stapler line. In addition, a textile or silicone band restricts food passage through the stomach. CASE PRESENTATION: A 71-year-old woman presented with a severe gastric stenosis 11 years after vertical gastroplasty. We describe a side-to-side gastrogastrostomy as a safe surgical procedure to restore the physiological gastric passage after failed vertical-banded gastroplasty. CONCLUSION: Occasionally, restrictive procedures for morbid obesity cannot be converted into an alternative bariatric procedure to maintain weight control. This report demonstrates that a side-to-side gastrogastrostomy is a feasible and safe procedure

Astrophysical false positives in direct imaging for exoplanets: a white dwarf close to a rejuvenated star

As is the case for all techniques involved in the research for exoplanets, direct imaging has to take into account the probability of so-called astrophysical false positives, which are phenomena that mimic the signature of objects we are seeking. In this work we aim to present a case of a false positive found during a direct imaging survey conducted with VLT/NACO. A promising exoplanet candidate was detected around the K2-type star HD\,8049 in July 2010.Its contrast of $\Delta H$=7.05 at 1.57 arcsec allowed us to guess the presence of a 35 \MJup companion at 50 projected AU, for the nominal system age and heliocentric distance.To check whether it was gravitationally bound to the host star, as opposed to an unrelated background object, we re-observed the system one year later and concluded a high probability of a bound system. We also used radial velocity measurements of the host star, spanning a time range of $\sim$ 30 yr, to constrain the companion's mass and orbital properties, as well as to probe the host star's spectral age indicators and general spectral energy distribution. We also obtained for the companion $U$-band imaging with EFOSC and $NIR$ spectroscopy. Combining all these information we conclude that the companion of HD\,8049 is a white dwarf (WD), with temperature $T_{eff}=18800 \pm 2100$ K and mass $M_{WD}=0.56 \pm 0.08 M_{\odot}$. The significant radial velocity trend coupled with the imaging data indicate that the most probable orbit has a semimajor axis of about 50 AU.The discrepancy between the age indicators suggested against a bona-fide young star. The moderately large level of chromospheric activity and fast rotation, mimicking the properties of a young star, might be induced by the exchange of mass with the progenitor of the WD. This example demonstrates some of the challenges in determining accurate age estimates and identifications of faint companions.Comment: 12 pages, 10 figures, 4 tables. Accepted for publication in Astronomy&Astrophysic

Shadows cast on the transition disk of HD 135344B. Multiwavelength VLT/SPHERE polarimetric differential imaging

The protoplanetary disk around the F-type star HD 135344B (SAO 206462) is in a transition stage and shows many intriguing structures both in scattered light and thermal (sub-)millimeter emission which are possibly related to planet formation processes. We study the morphology and surface brightness of the disk in scattered light to gain insight into the innermost disk regions, the formation of protoplanets, planet-disk interactions traced in the surface and midplane layers, and the dust grain properties of the disk surface. We have carried out high-contrast polarimetric differential imaging (PDI) observations with VLT/SPHERE and obtained polarized scattered light images with ZIMPOL in R- and I-band and with IRDIS in Y- and J-band. The scattered light images reveal with unprecedented angular resolution and sensitivity the spiral arms as well as the 25 au cavity of the disk. Multiple shadow features are discovered on the outer disk with one shadow only being present during the second observation epoch. A positive surface brightness gradient is observed in the stellar irradiation corrected images in southwest direction possibly due to an azimuthally asymmetric perturbation of the temperature and/or surface density by the passing spiral arms. The disk integrated polarized flux, normalized to the stellar flux, shows a positive trend towards longer wavelengths which we attribute to large aggregate dust grains in the disk surface. Part of the the non-azimuthal polarization signal in the Uphi image of the J-band observation could be the result of multiple scattering in the disk. The detected shadow features and their possible variability have the potential to provide insight into the structure of and processes occurring in the innermost disk regions.Comment: Accepted for publication in A&A, 20 pages, 15 figure

Shadows and spirals in the protoplanetary disk HD 100453

Understanding the diversity of planets requires to study the morphology and the physical conditions in the protoplanetary disks in which they form. We observed and spatially resolved the disk around the ~10 Myr old protoplanetary disk HD 100453 in polarized scattered light with SPHERE/VLT at optical and near-infrared wavelengths, reaching an angular resolution of ~0.02", and an inner working angle of ~0.09". We detect polarized scattered light up to ~0.42" (~48 au) and detect a cavity, a rim with azimuthal brightness variations at an inclination of 38 degrees, two shadows and two symmetric spiral arms. The spiral arms originate near the location of the shadows, close to the semi major axis. We detect a faint spiral-like feature in the SW that can be interpreted as the scattering surface of the bottom side of the disk, if the disk is tidally truncated by the M-dwarf companion currently seen at a projected distance of ~119 au. We construct a radiative transfer model that accounts for the main characteristics of the features with an inner and outer disk misaligned by ~72 degrees. The azimuthal brightness variations along the rim are well reproduced with the scattering phase function of the model. While spirals can be triggered by the tidal interaction with the companion, the close proximity of the spirals to the shadows suggests that the shadows could also play a role. The change in stellar illumination along the rim, induces an azimuthal variation of the scale height that can contribute to the brightness variations. Dark regions in polarized images of transition disks are now detected in a handful of disks and often interpreted as shadows due to a misaligned inner disk. The origin of such a misalignment in HD 100453, and of the spirals, is unclear, and might be due to a yet-undetected massive companion inside the cavity, and on an inclined orbit.Comment: A&A, accepte

First light of the VLT planet finder SPHERE. II. The physical properties and the architecture of the young systems PZ Tel and HD 1160 revisited

[Abridged] Context. The young systems PZ Tel and HD 1160, hosting known low-mass companions, were observed during the commissioning of the new planet finder SPHERE with several imaging and spectroscopic modes. Aims. We aim to refine the physical properties and architecture of both systems. Methods. We use SPHERE commissioning data and REM observations, as well as literature and unpublished data from VLT/SINFONI, VLT/NaCo, Gemini/NICI, and Keck/NIRC2. Results. We derive new photometry and confirm the nearly daily photometric variability of PZ Tel A. Using literature data spanning 38 yr, we show that the star also exhibits a long-term variability trend. The 0.63-3.8 mic SED of PZ Tel B allows us to revise its properties: spectral type M7+/-1, Teff=2700+/-100 K, log(g)<4.5 dex, log(L/L_Sun)=-2.51+/-0.10 dex, and mass 38-72 MJ. The 1-3.8 mic SED of HD 1160 B suggests a massive brown dwarf or a low-mass star with spectral type M5.5-7.0, Teff=3000+/-100 K, [M/H]=-0.5-0.0 dex, log(L/L_Sun)=-2.81+/-0.10 dex, and mass 39-168 MJ. We confirm the deceleration and high eccentricity (e>0.66) of PZ Tel B. For e<0.9, the inclination, longitude of the ascending node, and time of periastron passage are well constrained. The system is seen close to an edge-on geometry. We reject other brown dwarf candidates outside 0.25" for both systems, and massive giant planets (>4 MJ) outside 0.5" for the PZ Tel system. We also show that K1-K2 color can be used with YJH low-resolution spectra to identify young L-type companions, provided high photometric accuracy (<0.05 mag) is achieved. Conclusions. SPHERE opens new horizons in the study of young brown dwarfs and giant exoplanets thanks to high-contrast imaging capabilities at optical and near-infrared wavelengths, as well as high signal-to-noise spectroscopy in the near-infrared from low (R~30-50) to medium resolutions (R~350).Comment: 25 pages, 23 figures, accepted for publication in A&A on Oct. 13th, 2015; version including language editing. Typo on co-author name on astroph page corrected, manuscript unchange

First light of the VLT planet finder SPHERE. I. Detection and characterization of the sub-stellar companion GJ 758 B

GJ758 B is a brown dwarf companion to a nearby (15.76 pc) solar-type, metal-rich (M/H = +0.2 dex) main-sequence star (G9V) that was discovered with Subaru/HiCIAO in 2009. From previous studies, it has drawn attention as being the coldest (~600K) companion ever directly imaged around a neighboring star. We present new high-contrast data obtained during the commissioning of the SPHERE instrument at the VLT. The data was obtained in Y-, J-, H-, and Ks-bands with the dual-band imaging (DBI) mode of IRDIS, providing a broad coverage of the full near-infrared (near-IR) range at higher contrast and better spectral sampling than previously reported. In this new set of high-quality data, we report the re-detection of the companion, as well as the first detection of a new candidate closer-in to the star. We use the new 8 photometric points for an extended comparison of GJ758 B with empirical objects and 4 families of atmospheric models. From comparison to empirical object, we estimate a T8 spectral type, but none of the comparison object can accurately represent the observed near-IR fluxes of GJ758 B. From comparison to atmospheric models, we attribute a Teff = 600K $\pm$ 100K, but we find that no atmospheric model can adequately fit all the fluxes of GJ758 B. The photometry of the new candidate companion is broadly consistent with L-type objects, but a second epoch with improved photometry is necessary to clarify its status. The new astrometry of GJ758 B shows a significant proper motion since the last epoch. We use this result to improve the determination of the orbital characteristics using two fitting approaches, Least-Square Monte Carlo and Markov Chain Monte Carlo. Finally, we analyze the sensitivity of our data to additional closer-in companions and reject the possibility of other massive brown dwarf companions down to 4-5 AU. [abridged]Comment: 20 pages, 15 figures. Accepted for publication in A&

Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection: A Collaborative Meta-analysis.

Background: High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI). Purpose: To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults presenting to the emergency department (ED) with chest pain. Data Sources: EMBASE and MEDLINE without language restrictions (1 January 2008 to 14 December 2016). Study Selection: Cohort studies involving adults presenting to the ED with possible acute coronary syndrome in whom an ECG and hs-cTnT measurements were obtained and AMI outcomes adjudicated during initial hospitalization. Data Extraction: Investigators of studies provided data on the number of low-risk patients (no new ischemia on ECG and hs-cTnT measurements <0.005 µg/L) and the number who had AMI during hospitalization (primary outcome) or a major adverse cardiac event (MACE) or death within 30 days (secondary outcomes), by risk classification (low or not low risk). Two independent epidemiologists rated risk of bias of studies. Data Synthesis: Of 9241 patients in 11 cohort studies, 2825 (30.6%) were classified as low risk. Fourteen (0.5%) low-risk patients had AMI. Sensitivity of the risk classification for AMI ranged from 87.5% to 100% in individual studies. Pooled estimated sensitivity was 98.7% (95% CI, 96.6% to 99.5%). Sensitivity for 30-day MACEs ranged from 87.9% to 100%; pooled sensitivity was 98.0% (CI, 94.7% to 99.3%). No low-risk patients died. Limitation: Few studies, variation in timing and methods of reference standard troponin tests, and heterogeneity of risk and prevalence of AMI across studies. Conclusion: A single hs-cTnT concentration below the limit of detection in combination with a nonischemic ECG may successfully rule out AMI in patients presenting to EDs with possible emergency acute coronary syndrome. Primary Funding Source: Emergency Care Foundation