Antibacterial Therapy for Purulent-Septic Complications in Patientswith Combat Related Penetrating Craniocerebral Gunshot Wounds

Aim - to evaluate pathogens and their susceptibility to antibiotic therapy (ABT) in combat-related penetrating craniocerebral gunshot wound (PCGW) patients and develop recommendations for treatment of post-traumatic meningoencephalitis. We conducted a prospective analysis of examination and treatment results of 121 patients who were admitted to the Public Institution, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine, from 25 May 2014, to 31 December 2017, and were successively enrolled in the study. Intracranial purulent-septic complications were diagnosed in 14 (11.6%) patients including eight cases of isolated meningoencephalitis, three cases of meningoencephalitis combined with ventriculitis, two cases of meningoencephalitis combined with ventriculitis and subdural empyema and one case of multiple brain abscesses. In most cases of combat-related craniocerebral wounds, infections are considered nosocomial and typically related to medical procedures and devices. In most cases, the effectiveness of first-line antibiotics was low, and it was often necessary to prescribe broad-spectrum ABT, including those related to secondline antibiotics and reserve drugs, according to the World Health Organisation classification. The use of initial de-escalation of empiric ABT with the broadest-spectrum drugs, mainly as a part of combination therapy for expected gram-positive and gramnegative aerobic and anaerobic infection pathogens, is recommended

Prognostic factors of intracranial purulent-septic complications of combat-related gunshot penetrating skull and brain wounds.

Purpose – to ana­lyze the structure of intracranial purulent-septic complications (IPSC), determine the factors influencing development of purulent-septic complications in patients with combat-related gunshot penetrating skull and brain wounds (CRPSBW), determine the effect of intracranial PSC on patients’ outcomes. A prospective analysis of results of exa­mination and treatment of 121 patients was performed. All patients had gunshot penetrating skull and brain wounds sustained in combat conditions during a local armed conflict in the Eastern Ukraine. Evaluation of treatment outcome included analysis of mortality in 1 month (survived/died) and dichotomous Glasgow Outcome Scale (GOS) score in 12 months (favorable/unfavorable outcome). 121 wounded men aged 18 to 56 (average, 34.1±9.1) were included in the study. Intracranial purulent-septic complications (IPSC) were diagnosed in 14 (11.6%) gunshot CRPSBW patients. The following prognostic factors had statistically significantly correlation with the risk of intracranial purulent-septic complications development: wound liquorrhea on admission (p = 0.043), intraventricular hemorrhage (p = 0.007), bone fragments left in the wound (p = 0.0152), and  duration of inflow-outflow wound drainage for more than 3 days (p= 0.0123). Intracranial PSC patients had mortality rate of 50%, and only 14.3% of those patients had a favorable outcome according to GOS score in one year. Presence of intracranial PSC had statistically significant association with mortality rate (p=0.0091) and GOS score in one year (p=0.0001)

SURGICAL TREATMENT OF COMBAT CRANIOCEREBRAL GUNSHOT WOUNDS COMBINED WITH PARANASAL SINUSES INJURY

Results of surgical treatment of 30 patients with combat-related gunshot traumatic brain injuries (GTBI) combined with paranasal sinuses injury (PNS) were analyzed. The injuries resulted from local armed conflict in the Eastern Ukraine. Object and methods. The patients were consistently enrolled in the prospective study in the period from May 25, 2014 to December 31, 2017. This group of patients made up 16.3% of all GTBI patients treated during that period. All patients underwent high-resolution cranial CT at admission. Frontal sinus injuries were observed in 25 (83%) cases; ethmoid bone injuries, in 13 (43) cases; sphenoidal sinus injuries, in 1 (3%) case. 26 (87%) patients had penetrating wounds; 4 (13%) patients, non-penetrating cerebral wounds. Fragment mine blast wounds were observed in 26 (87%) cases; 4 (13.3%) wounds were caused by bullets. Blunt wounds were diagnosed in 17 (57%) patients; bound shot wounds, in 7 (23%) patients; penetrating wounds, in 6 (20%) patients. GCS score after initial resuscitation ranged from 5 to 15 (average 10.6±3.5). Four non-penetrating brain wound patients were treated conservatively. Initially, 26 (87%) patients underwent surgery. Emergency intervention was performed to remove intracranial hematoma, close dura mater defects and restore skull base while simultaneously sealing ethmoid and frontal air sinuses. Well-vascularized frontal and lateral pericranial flaps on pedicle in various modifications were used to close frontal sinus and anterior cranial fossa defects. Outcomes. Nasal liquorrhea was observed in 12 (40%) patients at admission and in 2 (7%) patients after treatment. Purulent and septic complications were only detected in 1 (3%) patient. The complications had the form of combined meningoencephalitis, ventriculitis, and subdural empyema. Favourable treatment outcomes (good recovery or moderate disability) in 6 months after treatment were detected in 24 (80%) patients; unfavourable outcomes (severe disability or death), in 6 (20%) patients. Vegetative state was not observed in treated patients. Two lethal cases were not associated with paranasal sinus injury. In one case, there was a severe primary brain injury; in the other case, severe combined internal organ injuries with multiple organ failure

HAT-P-15b: A 10.9-day Extrasolar Planet Transiting a Solar-type Star

We report the discovery of HAT-P-15b, a transiting extrasolar planet in the `period valley', a relatively sparsely-populated period regime of the known extrasolar planets. The host star, GSC 2883-01687, is a G5 dwarf with V=12.16. It has a mass of 1.01+/-0.04 M(Sun), radius of 1.08+/-0.04 R(Sun), effective temperature 5568+/-90 K, and metallicity [Fe/H] = +0.22+/-0.08. The planetary companion orbits the star with a period 10.863502+/-0.000027 days, transit epoch Tc = 2454638.56019+/-0.00048 (BJD), and transit duration 0.2285+/-0.0015 days. It has a mass of 1.946+/-0.066 M(Jup), and radius of 1.072+/-0.043 R(Jup) yielding a mean density of 1.96+/-0.22 g/cm3. At an age of 6.8+/-2.1 Gyr, the planet is H/He-dominated and theoretical models require about 2% (10 M(Earth)) worth of heavy elements to reproduce its measured radius. With an estimated equilibrium temperature of 820 K during transit, and 1000 K at occultation, HAT-P-15b is a potential candidate to study moderately cool planetary atmospheres by transmission and occultation spectroscopy.Comment: 12 pages with 10 figures and 6 tables in emulateapj format. Submitted to The Astrophysical Journa

The Century Survey Galactic Halo Project III: A Complete 4300 deg^2 Survey of Blue Horizontal Branch Stars in the Metal-Weak Thick Disk and Inner Halo

We present a complete spectroscopic survey of 2414 2MASS-selected blue horizontal branch (BHB) candidates selected over 4300 deg^2 of the sky. We identify 655 BHB stars in this non-kinematically selected sample. We calculate the luminosity function of field BHB stars and find evidence for very few hot BHB stars in the field. The BHB stars located at a distance from the Galactic plane |Z|<4 kpc trace what is clearly a metal-weak thick disk population, with a mean metallicity of [Fe/H]= -1.7, a rotation velocity gradient of dv_{rot}/d|Z|= -28+-3.4 km/s in the region |Z|<6 kpc, and a density scale height of h_Z= 1.26+-0.1 kpc. The BHB stars located at 5<|Z|<9 kpc are a predominantly inner-halo population, with a mean metallicity of [Fe/H]= -2.0 and a mean Galactic rotation of -4+-31 km/s. We infer the density of halo and thick disk BHB stars is 104+-37 kpc^-3 near the Sun, and the relative normalization of halo to thick-disk BHB stars is 4+-1% near the Sun.Comment: 12 pages in emulateapj format, accepted for publication in February A

The Case for the Dual Halo of the Milky Way

Carollo et al. have recently resolved the stellar population of the Milky Way halo into at least two distinct components, an inner halo and an outer halo. This result has been criticized by Schoenrich et al., who claim that the retrograde signature associated with the outer halo is due to the adoption of faulty distances. We refute this claim, and demonstrate that the Schoenrich et al. photometric distances are themselves flawed because they adopted an incorrect main-sequence absolute magnitude relationship from the work of Ivezi\'c et al. When compared to the recommended relation from Ivezi\'c et al., which is tied to a Milky Way globular cluster distance scale and accounts for age and metallicity effects, the relation adopted by Schoenrich et al. yields up to 18% shorter distances for stars near the main-sequence turnoff (TO). Use of the correct relationship yields agreement between the distances assigned by Carollo et al. and Ivezi\'{c} et al. for low-metallicity dwarfs to within 6-10%. Schoenrich et al. also point out that intermediate-gravity stars (3.5 <= log g <= 4.0) with colors redder than the TO region are likely misclassified, with which we concur. We implement a new procedure to reassign luminosity classifications for the TO stars that require it. New derivations of the rotational behavior demonstrate that the retrograde signature and high velocity dispersion of the outer-halo population remains. We summarize additional lines of evidence for a dual halo, including a test of the retrograde signature based on proper motions alone, and conclude that the preponderance of evidence strongly rejects the single-halo interpretation.Comment: 46 pages, 2 tables, 15 figures, Accepted for publication in the Astrophysical Journa

Constraining stellar assembly and AGN feedback at the peak epoch of star formation

We study stellar assembly and feedback from active galactic nuclei (AGN) around the epoch of peak star formation (1<z<2), by comparing hydrodynamic simulations to rest-frame UV-optical galaxy colours from the Wide Field Camera 3 (WFC3) Early-Release Science (ERS) Programme. Our Adaptive Mesh Refinement simulations include metal-dependent radiative cooling, star formation, kinetic outflows due to supernova explosions, and feedback from supermassive black holes. Our model assumes that when gas accretes onto black holes, a fraction of the energy is used to form either thermal winds or sub-relativistic momentum-imparting collimated jets, depending on the accretion rate. We find that the predicted rest-frame UV-optical colours of galaxies in the model that includes AGN feedback is in broad agreement with the observed colours of the WFC3 ERS sample at 1<z<2. The predicted number of massive galaxies also matches well with observations in this redshift range. However, the massive galaxies are predicted to show higher levels of residual star formation activity than the observational estimates, suggesting the need for further suppression of star formation without significantly altering the stellar mass function. We discuss possible improvements, involving faster stellar assembly through enhanced star formation during galaxy mergers while star formation at the peak epoch is still modulated by the AGN feedback.Comment: 6 pages, 4 figures, accepted for publication in MNRAS Letter

Spectra of regular quantum graphs

We consider a class of simple quasi one-dimensional classically non-integrable systems which capture the essence of the periodic orbit structure of general hyperbolic nonintegrable dynamical systems. Their behavior is simple enough to allow a detailed investigation of both classical and quantum regimes. Despite their classical chaoticity, these systems exhibit a ``nonintegrable analog'' of the Einstein-Brillouin-Keller quantization formula which provides their spectra explicitly, state by state, by means of convergent periodic orbit expansions.Comment: 32 pages, 10 figure

Ionization via Chaos Assisted Tunneling

A simple example of quantum transport in a classically chaotic system is studied. It consists in a single state lying on a regular island (a stable primary resonance island) which may tunnel into a chaotic sea and further escape to infinity via chaotic diffusion. The specific system is realistic : it is the hydrogen atom exposed to either linearly or circularly polarized microwaves. We show that the combination of tunneling followed by chaotic diffusion leads to peculiar statistical fluctuation properties of the energy and the ionization rate, especially to enhanced fluctuations compared to the purely chaotic case. An appropriate random matrix model, whose predictions are analytically derived, describes accurately these statistical properties.Comment: 30 pages, 11 figures, RevTeX and postscript, Physical Review E in pres

Field Blue Stragglers and Related Mass Transfer Issues

This chapter contains my impressions and perspectives about the current state of knowledge about field blue stragglers (FBS) stars, drawn from an extensive literature that I searched. I conclude my review of issues that attend FBS and mass transfer, by a brief enumeration of a few mildly disquieting observational facts.Comment: Chapter 4, in Ecology of Blue Straggler Stars, H.M.J. Boffin, G. Carraro & G. Beccari (Eds), Astrophysics and Space Science Library, Springe