Predictors of respiratory failure in Guillain−Barré syndrome: a 22 year cohort study from a single Italian centre

Background and purpose: The study aimed to identify predictors of respiratory failure leading to mechanical ventilation (MV) and tracheostomy in Guillain−Barré syndrome (GBS). Methods: Two hundred and thirty adult cases admitted to the Neurology Unit of Modena, Italy, between January 2000 and December 2021 were studied. A cut-off of MV starting within 8 weeks from onset of weakness was used. Univariable, multivariable logistic and Cox regression analyses were used to determine which pre-specified clinical and diagnostic characteristics were capable of predicting MV and tracheostomy, due to weaning failure. The model was internally validated within the full cohort. The Erasmus GBS Respiratory Insufficiency Score was retrospectively applied. Results: One hundred and seventy-six cases (76.5%) were classified as classical sensorimotor GBS and 54 (23.4%) as variants. Thirty-two patients (13.9%) needed MV: 84.3% required respiratory support within 7 days. Independent predictors of respiratory failure and MV were older age, facial, bulbar, neck flexor weakness, dysautonomia, axonal electrophysiological subtype, cardiovascular comorbidities and higher disability score at entry. There was no association with abnormal spinal fluid parameters nor with positive serology for recent infections. Twenty-two patients (68.7%) were ventilated for more than 7 days; 4.7% died within 8 weeks. The patients who required MV were treated more often with plasma exchange. Independent predictors of tracheostomy due to weaning trial failure were facial, bulbar, neck flexor weakness, autonomic dysfunction, associated cardiovascular morbidities and axonal electrophysiological subtype on nerve conduction study. Conclusions: Our study indicates distinct predictors of MV and tracheostomy in GBS patients

Evidence of Asymmetry in SN 2007rt, a Type IIn Supernova

An optical photometric and spectroscopic analysis of the slowly-evolving Type IIn SN2007rt is presented, covering a duration of 481 days after discovery. Its earliest spectrum, taken approximately 100 days after the explosion epoch, indicates the presence of a dense circumstellar medium, with which the supernova ejecta is interacting. This is supported by the slowly-evolving light curve. A notable feature in the spectrum of SN 2007rt is the presence of a broad He I 5875 line, not usually detected in Type IIn supernovae. This may imply that the progenitor star has a high He/H ratio, having shed a significant portion of its hydrogen shell via mass-loss. An intermediate resolution spectrum reveals a narrow Halpha P-Cygni profile, the absorption component of which has a width of 128 km/s. This slow velocity suggests that the progenitor of SN 2007rt recently underwent mass-loss with wind speeds comparable to the lower limits of those detected in luminous blue variables. Asymmetries in the line profiles of H and He at early phases bears some resemblance to double-peaked features observed in a number of Ib/c spectra. These asymmetries may be indicative of an asymmetric or bipolar outflow or alternatively dust formation in the fast expanding ejecta. In addition, the late time spectrum, at over 240 days post-explosion, shows clear evidence for the presence of newly formed dust.Comment: Submitted to A&A on 4/2/2009. Accepted by A&A on 17/5/2009.15 pages plus 3 pages of online materia

Spectral Evolution of the Extraordinary Type IIn Supernova 2006gy

We present a detailed analysis of the extremely luminous Type IIn supernova SN2006gy using spectra obtained between days 36 and 237 after explosion. We derive the temporal evolution of the effective temperature, radius, expansion speeds, and bolometric luminosity, as well as the progenitor wind density and total swept-up mass overtaken by the shock. SN2006gy can be interpreted in the context of shock interaction with a dense CSM, but with quite extreme values for the CSM mass of 20 Msun and an explosion kinetic energy of at least 5e51 erg. A key difference between SN2006gy and other SNeIIn is that, owing to its large CSM mass, the interaction region remained opaque much longer. At early times, H-alpha widths suggest that the photosphere is ahead of the shock, and photons diffuse out through the opaque CSM. The pivotal transition to optically thin emission begins around day 110, when we start to see a decrease in the blackbody radius and strengthening tracers of the post-shock shell. From the evolution of pre-shock velocities, we deduce that the CSM was ejected by the progenitor in a 1e49 erg precursor event 8yr before explosion. The large CSM mass rules out models involving stars with initial masses around 10Msun. With the full mass budget, even massive M_ZAMS=30-40 Msun progenitor stars are inadequate. At roughly solar metallicity, substantial mass loss probably occurred during the star's life, so SN 2006gy's progenitor is more consistent with LBV eruptions or pulsational pair-instability ejections in stars with initial masses above 100 Msun. This requires significant revision to current paradigms of massive-star evolution. (abridged)Comment: Really long. 30 pages, 26 figs, appendix. Submitted to ApJ - v2 corrected one referenc

Supernova 2007bi as a pair-instability explosion

Stars with initial masses 10 M_{solar} < M_{initial} < 100 M_{solar} fuse progressively heavier elements in their centres, up to inert iron. The core then gravitationally collapses to a neutron star or a black hole, leading to an explosion -- an iron-core-collapse supernova (SN). In contrast, extremely massive stars (M_{initial} > 140 M_{solar}), if such exist, have oxygen cores which exceed M_{core} = 50 M_{solar}. There, high temperatures are reached at relatively low densities. Conversion of energetic, pressure-supporting photons into electron-positron pairs occurs prior to oxygen ignition, and leads to a violent contraction that triggers a catastrophic nuclear explosion. Tremendous energies (>~ 10^{52} erg) are released, completely unbinding the star in a pair-instability SN (PISN), with no compact remnant. Transitional objects with 100 M_{solar} < M_{initial} < 140 M_{solar}, which end up as iron-core-collapse supernovae following violent mass ejections, perhaps due to short instances of the pair instability, may have been identified. However, genuine PISNe, perhaps common in the early Universe, have not been observed to date. Here, we present our discovery of SN 2007bi, a luminous, slowly evolving supernova located within a dwarf galaxy (~1% the size of the Milky Way). We measure the exploding core mass to be likely ~100 M_{solar}, in which case theory unambiguously predicts a PISN outcome. We show that >3 M_{solar} of radioactive 56Ni were synthesized, and that our observations are well fit by PISN models. A PISN explosion in the local Universe indicates that nearby dwarf galaxies probably host extremely massive stars, above the apparent Galactic limit, perhaps resulting from star formation processes similar to those that created the first stars in the Universe.Comment: Accepted version of the paper appearing in Nature, 462, 624 (2009), including all supplementary informatio

SN 2008iy: An Unusual Type IIn Supernova with an Enduring 400 Day Rise Time

We present spectroscopic and photometric observations of the Type IIn supernova (SN) 2008iy. SN 2008iy showed an unprecedentedly long rise time of ~400 days, making it the first SN to take significantly longer than 100 days to reach peak optical luminosity. The peak absolute magnitude of SN 2008iy was M_r ~ -19.1 mag, and the total radiated energy over the first ~700 days was ~2 x 10^50 erg. Spectroscopically, SN 2008iy is very similar to the Type IIn SN 1988Z at late times, and, like SN 1988Z, it is a luminous X-ray source (both supernovae had an X-ray luminosity L_ X > 10^41 erg/s). The Halpha emission profile of SN 2008iy shows a narrow P Cygni absorption component, implying a pre-SN wind speed of ~100 km/s. We argue that the luminosity of SN 2008iy is powered via the interaction of the SN ejecta with a dense, clumpy circumstellar medium. The ~400 day rise time can be understood if the number density of clumps increases with distance over a radius ~1.7 x 10^16 cm from the progenitor. This scenario is possible if the progenitor experienced an episodic phase of enhanced mass-loss < 1 century prior to explosion or the progenitor wind speed increased during the decades before core collapse. We favour the former scenario, which is reminiscent of the eruptive mass-loss episodes observed for luminous blue variable (LBV) stars. The progenitor wind speed and increased mass-loss rates serve as further evidence that at least some, and perhaps all, Type IIn supernovae experience LBV-like eruptions shortly before core collapse. We also discuss the host galaxy of SN 2008iy, a subluminous dwarf galaxy, and offer a few reasons why the recent suggestion that unusual, luminous supernovae preferentially occur in dwarf galaxies may be the result of observational biases.Comment: 15 pages, 5 figures, MNRAS accepte

UC.183, UC.110, and UC.84 Ultra-Conserved RNAs Are Mutually Exclusive with miR-221 and Are Engaged in the Cell Cycle Circuitry in Breast Cancer Cell Lines.

In the human genome, there are about 600 ultra-conserved regions (UCRs), long DNA sequences extremely conserved in vertebrates. We performed a large-scale study to quantify transcribed UCR (T-UCR) and miRNA levels in over 6000 cancer and normal tissue samples to find possible correlation between these kinds of regulatory molecules. Our analysis evidenced several non-coding RNAs showing negative co-regulation with miRNAs; among them, we focused on miR-221 to investigate any relationship with its pivotal role in the cell cycle. We have chosen breast cancer as model, using two cell lines with different phenotypes to carry out in vitro treatments with siRNAs against T-UCRs. Our results demonstrate that the expression of uc.183, uc.110, and uc.84 T-UCRs is mutually exclusive with miR-221 and is engaged in the regulation of CDKN1B expression. In addition, tests with a set of anticancer drugs, including BYL719, AZD5363, AZD8055, AZD7762, and XL765, revealed the modulation of specific T-UCRs without alteration of miR-221 levels

SN 2008S: an electron capture SN from a super-AGB progenitor?

We present comprehensive photometric and spectroscopic observations of the faint transient SN 2008S discovered in NGC 6946. SN 2008S exhibited slow photometric evolution and almost no spectral variability during the first nine months, implying a high density CS medium. The light curve is similar in shape to that of SN 1998S and SN 1979C, although significantly fainter at maximum light. Our quasi-bolometric lightcurve extends to 300 days and shows a tail phase decay rate consistent with that of ^{56}Co. We propose that this is evidence for an explosion and formation of ^{56}Ni (0.0015 +/- 0.0004 M_Sun). The large MIR flux detected shortly after explosion can be explained by a light echo from pre-exisiting dust. The late NIR flux excess is plausibly due to a combination of warm newly-formed ejecta dust together with shock-heated dust in the CS environment. We reassess the progenitor object detected previously in Spitzer archive images, supplementing this discussion with a model of the MIR spectral energy distribution. This supports the idea of a dusty, optically thick shell around SN 2008S with an inner radius of nearly 90AU and outer radius of 450AU, and an inferred heating source of 3000 K and luminosity of L ~ 10^{4.6} L_Sun. The combination of our monitoring data and the evidence from the progenitor analysis leads us to support the scenario of a weak electron capture supernova explosion in a super-AGB progenitor star (of initial mass 6-8 M_sun) embedded within a thick CS gaseous envelope. We suggest that all of main properties of the electron capture SN phenomenon are observed in SN 2008S and future observations may allow a definitive answer.Comment: accepted for publication in MNRAS (2009 May 7

Prevalence and factors associated with traditional herbal medicine use among patients on highly active antiretroviral therapy in Uganda

<p>Abstract</p> <p>Background</p> <p>In Africa, herbal medicines are often used as primary treatment for Human immunodeficiency virus (HIV) related problems. Concurrent use of traditional herbal medicines (THM) with antiretroviral drugs (ARVs) is widespread among HIV infected patients. However, the extent of THM use is not known in most settings in Sub-Saharan Africa. This study aimed at determining the prevalence and factors associated with THM use among HIV infected patients on highly active antiretroviral therapy (HAART) attending The AIDS Support Organization (TASO) in Uganda. TASO is a non-governmental organization devoted to offering HIV/AIDS care and treatment services in the population.</p> <p>Methods</p> <p>This was a cross-sectional study carried out in two TASO treatment centres in Uganda among 401 randomly selected eligible participants. We included participants who were 18 years and above, were enrolled on HAART, and consented to participate in the study. Data was collected using an interviewer-administered semi-structured questionnaire. THM use referred to someone who had ever used or was currently using herbal medicine while on highly active antiretroviral therapy (HAART) by the time of the study. Data was captured in Epi-data version 3.1 and exported to STATA version 9.0 for analysis.</p> <p>Results</p> <p>The prevalence of THM use was 33.7%. Patients on HAART for < 4 years were more likely to use THM (OR = 5.98, 95% CI 1.13 - 31.73) as well as those who experienced HAART side effects (OR = 3.66, 95% CI: 1.15 - 11.68). Older patients (≥39 years) were less likely to use THM (OR = 0.26 95% CI: 0.08 - 0.83). Participants with HAART adherence levels > 95% were less likely to use THM (OR = 0.09, 95% CI 0.01 - 0.65).</p> <p>Conclusion</p> <p>The prevalence of THM use among participants on HAART was high. This raises clinical and pharmacological concerns that need attention by the health care service providers.</p

SN 2008S: an electron-capture SN from a super-AGB progenitor?

We present comprehensive photometric and spectroscopic observations of the faint transient SN 2008S discovered in the nearby galaxy NGC 6946. SN 2008S exhibited slow photometric evolution and almost no spectral variability during the first nine months, implying a long photon diffusion time and a high-density circumstellar medium. Its bolometric luminosity (≃1041 erg s−1 at peak) is low with respect to most core-collapse supernovae but is comparable to the faintest Type II-P events. Our quasi-bolometric light curve extends to 300 d and shows a tail phase decay rate consistent with that of 56Co. We propose that this is evidence for an explosion and formation of 56Ni (0.0014 ± 0.0003 M⊙). Spectra of SN 2008S show intense emission lines of Hα, [Ca ii] doublet and Ca ii near-infrared (NIR) triplet, all without obvious P-Cygni absorption troughs. The large mid-infrared (MIR) flux detected shortly after explosion can be explained by a light echo from pre-existing dust. The late NIR flux excess is plausibly due to a combination of warm newly formed ejecta dust together with shock-heated dust in the circumstellar environment. We reassess the progenitor object detected previously in Spitzer archive images, supplementing this discussion with a model of the MIR spectral energy distribution. This supports the idea of a dusty, optically thick shell around SN 2008S with an inner radius of nearly 90 au and outer radius of 450 au, and an inferred heating source of 3000 K. The luminosity of the central star is L≃ 104.6 L⊙. All the nearby progenitor dust was likely evaporated in the explosion leaving only the much older dust lying further out in the circumstellar environment. The combination of our long-term multiwavelength monitoring data and the evidence from the progenitor analysis leads us to support the scenario of a weak electron-capture supernova explosion in a super-asymptotic giant branch progenitor star (of initial mass 6-8 M⊙) embedded within a thick circumstellar gaseous envelope. We suggest that all of main properties of the electron-capture SN phenomenon are observed in SN 2008S and future observations may allow a definitive answe

The bright Type IIP SN 2009bw, showing signs of interaction

We present photometry and spectroscopy of the type IIP supernova 2009bw in UGC 2890 from few days after the outburst to 241 days. The light curve of SN 2009bw during the photospheric phase is similar to that of normal SNe IIP but with brighter peak and plateau (Mmax R = -17.82 mag, Mplateau R = -17.37 mag). The luminosity drop from the photospheric to the nebular phase is one of the fastest ever observed, ~2.2 mag in about 13 days. The radioactive tail of the bolometric light curve indicates that the amount of ejected 56 Ni is \approx 0.022 M\odot. The photospheric spectra reveal high velocity lines of H{\alpha} and H{\beta} until about 105 days after the shock breakout, suggesting a possible early interaction between the SN ejecta and pre-existent circumstellar material, and the presence of CNO elements. By modeling the bolometric light curve, ejecta expansion velocity and photospheric temperature, we estimate a total ejected mass of 8-12M\odot, a kinetic energy of ~0.3 foe and an initial radius of ~ 3.6 - 7 \times 10^13 cm.Comment: Accepted for publication in MNRAS, 19 pages, 13 figures, 9 table