3,792 research outputs found

    Postoperative pulmonary complications and mortality after major abdominal surgery. An observational multicenter prospective study

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    Background: Postoperative pulmonary complications (PPCs) significantly contribute to postoperative morbidity and mortality. We conducted a study to determine the incidence of PPCs after major elective abdominal surgery and their association with early and 1-year mortality in patient without pre-existing respiratory disease. Methods: We conducted a multicenter observational prospective clinical study in 40 Italian centers. 1542 patients undergoing elective major abdominal surgery were recruited in a time period of 14 days and clinically managed according to local protocol. The primary outcome was to determine the incidence of PPCs. Further, we aimed to identify independent predictors for PPCs and examine the association between PPCs and mortality. Results: PPCs occurred in 12.6% (95% CI 11.1-14.4%) of patients with significant differences among general (18.3%, 95% CI 15.7-21.0%), gynecological (3.7%, 95% CI 2.1-6.0%) and urological surgery (9.0%, 95% CI 6.0-12.8%). PPCs development was associated with known pre- and intraoperative risk factors. Patients who developed PPCs had longer length of hospital stay, higher risk of 30-days hospital readmission, and increased in-hospital and one-year mortality (OR 3.078, 95% CI 1.825-5.191; P<0.001). Conclusions: The incidence of PPCs in patients without pre-existing respiratory disease undergoing elective abdominal surgery is high and associated with worse clinical outcome at one year after surgery. General surgery is associated with higher incidence of PPCs and mortality compared to gynecological and urological surgery

    Final Results of GERDA on the Two-Neutrino Double-β\beta Decay Half-Life of 76^{76}Ge

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    We present the measurement of the two-neutrino double-β\beta decay rate of 76^{76}Ge performed with the GERDA Phase II experiment. With a subset of the entire GERDA exposure, 11.8 kg\cdotyr, the half-life of the process has been determined: T1/22ν=(2.022±0.018stat±0.038sys)×1021T^{2\nu}_{1/2} = (2.022 \pm 0.018_{stat} \pm 0.038_{sys})\times10^{21} yr. This is the most precise determination of the 76^{76}Ge two-neutrino double-β\beta decay half-life and one of the most precise measurements of a double-β\beta decay process. The relevant nuclear matrix element can be extracted: Meff2ν=(0.101±0.001).M^{2\nu}_{\text{eff}} = (0.101\pm0.001).Comment: 7 pages, 4 figures, 2 table

    Structure of the complete human TSC:WIPI3 lysosomal recruitment complex

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    Tuberous sclerosis complex (TSC) turns off cell growth in response to energy stress by inhibiting the master kinase mechanistic target of rapamycin complex (mTORC1). TSC hydrolyzes RAS homolog-mTORC1 binding (RHEB) from its GTP-bound to GDP-bound state, preventing the allosteric activation of mTORC1. Loss-offunction TSC mutations hyperactivate mTORC1 resulting in the common genetic disorder TSC characterized by excess cell growth and tumor formation. Here we overcome a high degree of continuous conformational heterogeneity to determine the 2.9 Å cryo-electron microscopy (cryo-EM) structure of the complete human TSC in complex with the lysosomal recruitment factor WIPI3. TSC forms an elongated 40 nm wing-like structure with a core HEAT-repeat scaffold formed by a TSC2 dimer joined centrally by the juxtaposition of two catalytic domains. The TSC1 coil-coil dimer runs across the TSC2 surface, forming a previously undetected N-terminal TSC1 dimer that clamps onto the core scaffold on a single TSC wing. Structural and biochemical analysis reveals a novel phosphatidylinositol phosphate (PIP)-binding pocket in the TSC1 dimer interface that specifically binds singularly phosphorylated PIPs. WD repeat domain phosphoinositide-interacting-protein-3 (WIPI3) binds to the extreme tip of the complex through a conserved motif in TSC1, providing a second membrane anchor point for TSC lysosomal recruitment. The TSC:WIPI3 complex helps explain how TSC lysosomal recruitment proteins coordinate with endolysosomal phosphoinositide-signaling networks to regulate TSC localization, RHEB hydrolysis, and mTORC1 inhibition. More broadly, the high-resolution structure of the complete human TSC identifies novel mutational hotspots that unravel crucial new mechanisms of TSC dysregulation in disease.</p

    Search for events in XENON1T associated with Gravitational Waves

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    We perform a blind search for particle signals in the XENON1T dark matter detector that occur close in time to gravitational wave signals in the LIGO and Virgo observatories. No particle signal is observed in the nuclear recoil, electronic recoil, CEν\nuNS, and S2-only channels within ±\pm 500 seconds of observations of the gravitational wave signals GW170104, GW170729, GW170817, GW170818, and GW170823. We use this null result to constrain mono-energetic neutrinos and Beyond Standard Model particles emitted in the closest coalescence GW170817, a binary neutron star merger. We set new upper limits on the fluence (time-integrated flux) of coincident neutrinos down to 17 keV at 90% confidence level. Furthermore, we constrain the product of coincident fluence and cross section of Beyond Standard Model particles to be less than 102910^{-29} cm2^2/cm2^2 in the [5.5-210] keV energy range at 90% confidence level

    Understanding the Liquid Structure in Mixtures of Ionic Liquids with Semiperfluoroalkyl or Alkyl Chains

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    By mixing ionic liquids (ILs), it is possible to fine-tune their bulk and interfacial structure. This alters their physical properties and solvation behavior and is a simple way to prepare a collection of ILs whose properties can be tuned to optimize a specific application. In this study, mixtures of perfluorinated and alkylated ILs have been prepared, and links between composition, properties, and nanostructure have been investigated. These different classes of ILs vary substantially in the flexibility and polarizability of their chains. Thus, a range of useful structural and physical property variations are accessible through mixing that will expand the library of IL mixtures available in an area that to this point has received relatively little attention. In the experiments presented herein, the physical properties and bulk structure of mixtures of 1-methyl-3-octylimidazolium bis(trifluoromethylsulfonyl)imide [C8MIM][Tf2N] and 1-(1H,1H,2H,2H-perfluorooctyl)-3-methylimidazolium bis(trifluoromethylsulfonyl)imide [C8MIM-F13][Tf2N] have been prepared. The bulk liquid structure was investigated using a combination of small-angle X-ray and neutron scattering (SAXS and SANS, respectively) experiments in combination with atomistic molecular dynamics simulations and the measurement of density and viscosity. We observed that the addition of [C8MIM-F13][Tf2N] to [C8MIM][Tf2N] causes changes in the nanostructure of the IL mixtures that are dependent on composition so that variation in the characteristic short-range correlations is observed as a function of composition. Thus, while the length scales associated with the apolar regions (polar non-polar peak─PNPP) increase with the proportion of [C8MIM-F13][Tf2N] in the mixtures, perhaps surprisingly given the greater volume of the fluorocarbon chains, the length scale of the charge-ordering peak decreases. Interestingly, consideration of the contact peak shows that its origins are both in the direct anion···cation contact length scale and the nature (and hence volume) of the chains appended to the imidazolium cation

    Performance of a double-crystal setup for LHC fixed-target experiments

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    The Physics Beyond Colliders (PBC) studies at CERN address the possibility to utilise protons in the Large Hadron Collider (LHC) for a fixed-target program beyond the colliding-beam physics. As part of PBC, a double-crystal test stand is considered for installation in the LHC off-momentum collimation Insertion Region (IR) 3. In this PBC experiment, a first silicon crystal deflects beam-halo protons from the main beam onto a fixed-target. A second crystal, providing bending angles in the mrad range, is located immediately downstream of the target to deflect target-produced secondary particles onto a detector that will measure the electric and magnetic dipole moments of short-lived baryons. The LHC test stand will serve as a proof-of-principle machine experiment to assess the performance of new crystals at LHC energies and to address a number of critical machine aspects related to this complex setup. In this paper, simulations in MAD-X and SixTrack are used to predict the performance of the proposed double-crystal layout for the LHC Run 3 test stand and the LHC Run 4 final experiment

    Bypass vs endovascular treatment for occluded femoro-popliteal stents in patients with critical limb-threatening ischemia

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    Objective: The aim of the study was to compare the early and medium-term outcomes of bypass vs endovascular treatment of occluded femoro-popliteal stents in patients with chronic limb-threatening ischemia (the OUT-STEPP multicentric registry). Methods: Between January 2016 and December 2021, 317 patients in 14 centers underwent treatment for a symptomatic occlusion of femoro-popliteal stent/stents. One hundred sixty-one patients were included into the present study: 46 (28.6%) underwent open bypass surgery (Group OPEN), and 115 (71.4%) underwent endovascular revascularization (Group ENDO). Early (30 days) results were assessed and compared between the two groups. Estimated 5-year outcomes were evaluated and compared with the log rank test. Results: At 30 days, no differences were found in terms of major adverse cardiovascular events, acute kidney injury, reinterventions, major amputation, and all-cause mortality between the two groups. The need for blood transfusions was higher for patients in Group OPEN (17; 36.9% vs 13; 11.3%; P &lt;.001). The mean length of intensive care unit stay and the mean hospital stay were higher for patients in Group OPEN ([0.3 ± 0.9 vs 0 days; P &lt;.001] and [9.7 ± 5.8 vs 3.3 ± 1.4 days; P &lt;.001], respectively). The overall median duration of follow-up was 33.1 months (interquartile range, 14-49.5 months). At 5 years, there were no differences between the two groups in terms of survival (68.7% Group OPEN vs 68.8% Group ENDO; P =.27; log-rank, 1.21), primary patency (56.3% Group OPEN vs 67.8% Group ENDO; P =.39; log-rank, 0.75), secondary patency (59.1% Group OPEN vs 77.8% Group ENDO; P =.24; log-rank, 1.40), absence of target lesion restenosis (56.8% Group OPEN vs 62.7% Group ENDO; P =.42; log-rank, 0.65), and limb salvage (77.2% Group OPEN vs 90.4% Group ENDO; P =.17; log-rank, 1.87). Conclusions: Both bypass and endovascular treatment provided safe and effective restoration of patency for femoro-popliteal in-stent occlusion in patients with chronic limb-threatening ischemia. Open surgery was associated with longer stay in hospital and increased use of blood transfusions. At 5 years, no significant differences were found in the rates of overall patency or limb salvage between bypass and endovascular treatment
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