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Aims. Through the ATOMIUM project, based on an ALMA large program, we aim to present a consistent view of a sample of 17 nearby cool evolved stars (Aymptotic Giant Branch and red supergiant stars). Methods. Here we present VLT/SPHERE-ZIMPOL polarimetric maps obtained in the visible of 14 out of the 17 ATOMIUM sources. They were obtained contemporaneously with the ALMA high spatial resolution data. To help interpret the polarized signal, we produced synthetic maps of light scattering by dust, through 3D radiative transfer simulations with the RADMC3D code. Results. The degree of linear polarization (DoLP) observed by ZIMPOL spreads across several optical filters. We infer that it primarily probes dust located just outside of the point spread function, and in or near the plane of the sky, with a total optical depth close to unity in the line of sight, representing only a fraction of the total circumstellar dust. The maximum DoLP ranges from 0.03-0.38 depending on the source, fractions that can be reproduced by our 3D pilot models for grains composed of common dust species. The spatial structure of the DoLP shows a diverse set of shapes. Only for three sources do we note a correlation between the ALMA CO and SiO lines, which trace the gas density, and the DoLP, which traces the dust. Conclusion. The clumpiness of the DoLP and the lack of a consistent correlation between the gas and the dust location show that, in the inner circumstellar environment (CSE), dust formation occurs at very specific sites. This has potential consequences for the derived mass-loss rates and dust-to-gas ratio in the inner region of the CSE. Except for $\pi^1$~Gru and perhaps GY Aql, we do not detect interactions between the circumstellar wind and the hypothesized companions that shape the wind at larger scales. This suggests that the orbits of any other companions are tilted out of the plane of the sky., Comment: Accepted for publication in Astronomy & Astrophysics. 22 pages, 15 figures, 5 tables

Nasopharyngeal carcinoma is frequently an undifferentiated squamous cell carcinoma, which is primarily treated with radiotherapy with or without chemotherapy; however, for residual or recurrent cancer, salvage surgery is the treatment of choice for resectable disease because it reduces the significant morbidity associated with re-irradiation. This review highlights the current surgical approach, mapping the extent of disease with an emphasis on magnetic resonance imaging (MRI) and integrated positron-emission tomography (PET)/computed tomography (CT), imaging features that determine operability for nasopharyngectomy and neck dissection, and need for a succinct radiological report and multidisciplinary team discussion, which are of paramount importance for successful surgical planning.

Binary interactions dominate the evolution of massive stars, but their role is less clear for low- and intermediate-mass stars. The evolution of a spherical wind from an asymptotic giant branch (AGB) star into a nonspherical planetary nebula (PN) could be due to binary interactions. We observed a sample of AGB stars with the Atacama Large Millimeter/submillimeter Array (ALMA) and found that their winds exhibit distinct nonspherical geometries with morphological similarities to planetary nebulae (PNe). We infer that the same physics shapes both AGB winds and PNe; additionally, the morphology and AGB mass-loss rate are correlated. These characteristics can be explained by binary interaction. We propose an evolutionary scenario for AGB morphologies that is consistent with observed phenomena in AGB stars and PNe., 19 pages main journal, 97 pages Supplementary Information

This article uncovers how the distribution of yaoi anime in the United States, in the specific context of streaming services, could be affected by and is reflective of shifting market conditions. S...

This overview paper presentsATOMIUM, a Large Programme in Cycle 6 with the Atacama Large Millimeter/submillimeter Array (ALMA). The goal ofATOMIUMis to understand the dynamics and the gas phase and dust formation chemistry in the winds of evolved asymptotic giant branch (AGB) and red supergiant (RSG) stars. A more general aim is to identify chemical processes applicable to other astrophysical environments. Seventeen oxygen-rich AGB and RSG stars spanning a range in (circum)stellar parameters and evolutionary phases were observed in a homogeneous observing strategy allowing for an unambiguous comparison. Data were obtained between 213.83 and 269.71 GHz at high (∼0″​​.025–0″​​.050), medium (∼0″​​.13–0″​​.24), and low (∼1″) angular resolution. The sensitivity per ∼1.3 km s−1channel was 1.5–5 mJy beam−1, and the line-free channels were used to image the millimetre wave continuum. Our primary molecules for studying the gas dynamics and dust formation are CO, SiO, AlO, AlOH, TiO, TiO2, and HCN; secondary molecules include SO, SO2, SiS, CS, H2O, and NaCl. The scientific motivation, survey design, sample properties, data reduction, and an overview of the data products are described. In addition, we highlight one scientific result – the wind kinematics of theATOMIUMsources. Our analysis suggests that theATOMIUMsources often have a slow wind acceleration, and a fraction of the gas reaches a velocity which can be up to a factor of two times larger than previously reported terminal velocities assuming isotropic expansion. Moreover, the wind kinematic profiles establish that the radial velocity described by the momentum equation for a spherical wind structure cannot capture the complexity of the velocity field. In fifteen sources, some molecular transitions other than12COv = 0J = 2 − 1 reach a higher outflow velocity, with a spatial emission zone that is often greater than 30 stellar radii, but much less than the extent of CO. We propose that a binary interaction with a (sub)stellar companion may (partly) explain the non-monotonic behaviour of the projected velocity field. TheATOMIUMdata hence provide a crucial benchmark for the wind dynamics of evolved stars in single and binary star models.

S-type asymptotic giant branch (AGB) stars are thought to be intermediates in the evolution of oxygen- to carbon-rich AGB stars. The chemical compositions of their circumstellar envelopes are also intermediate, but have not been studied in as much detail as their carbon- and oxygen-rich counterparts. We aim to determine the abundances of AlCl and AlF from rotational lines, which have been observed for the first time towards an S-type AGB star, W Aql. In combination with models based on PACS observations, we aim to update our chemical kinetics network based on these results. We analyse ALMA observations towards W Aql of AlCl in the ground and first two vibrationally excited states and AlF in the ground vibrational state. Using radiative transfer models, we determine the abundances and spatial abundance distributions of Al$^{35}$Cl, Al$^{37}$Cl, and AlF. We also model HCl and HF emission and compare these models to PACS spectra to constrain the abundances of these species. AlCl is found in clumps very close to the star, with emission confined within 0.1$^{\prime\prime}$ of the star. AlF emission is more extended, with faint emission extending 0.2$^{\prime\prime}$ to 0.6$^{\prime\prime}$ from the continuum peak. We find peak abundances, relative to H$_2$, of $1.7\times 10^{-7}$ for Al$^{35}$Cl, $7\times 10^{-8}$ for Al$^{37}$Cl and $1\times 10^{-7}$ for AlF. From the PACS spectra, we find abundances of $9.7\times 10^{-8}$ and $\leq 10^{-8}$, relative to H$_2$, for HCl and HF, respectively. The AlF abundance exceeds the solar F abundance, indicating that fluorine synthesised in the AGB star has already been dredged up to the surface of the star and ejected into the circumstellar envelope. From our analysis of chemical reactions in the wind, we conclude that AlF may participate in the dust formation process, but we cannot fully explain the rapid depletion of AlCl seen in the wind., Accepted for publication in Astronomy & Astrophysics

Besides the well-known positive impacts of public sector-led urban redevelopment projects on housing prices in their vicinity, we found that there were less noticeable negative impacts on the price...

Evolved low- to intermediate-mass stars are known to shed their gaseous envelope into a large, dusty, molecule-rich circumstellar nebula which typically develops a high degree of structural complexity. Most of the large-scale, spatially correlated structures in the nebula are thought to originate from the interaction of the stellar wind with a companion. As part of the Atomium large programme, we observed the M-type asymptotic giant branch (AGB) star R Hydrae with ALMA. The morphology of the inner wind of R Hya, which has a known companion at ~3500 au, was determined from maps of CO and SiO obtained at high angular resolution. A map of the CO emission reveals a multi-layered structure consisting of a large elliptical feature at an angular scale of ~10'' that is oriented along the north-south axis. The wind morphology within the elliptical feature is dominated by two hollow bubbles. The bubbles are on opposite sides of the AGB star and lie along an axis with a position angle of ~115 deg. Both bubbles are offset from the central star, and their appearance in the SiO channel maps indicates that they might be shock waves travelling through the AGB wind. An estimate of the dynamical age of the bubbles yields an age of the order of 100 yr, which is in agreement with the previously proposed elapsed time since the star last underwent a thermal pulse. When the CO and SiO emission is examined on subarcsecond angular scales, there is evidence for an inclined, differentially rotating equatorial density enhancement, strongly suggesting the presence of a second nearby companion. The position angle of the major axis of this disc is ~70 deg in the plane of the sky. We tentatively estimate that a lower limit on the mass of the nearby companion is ~0.65 Msol on the basis of the highest measured speeds in the disc and the location of its inner rim at ~6 au from the AGB star., 21 pages, 23 figures

Left ventricular hypertrophy (LVH) caused by cardiac variant Fabry disease (FD) is typically late-onset and may mimic LVH caused by abnormal loading conditions. We aimed to determine the prevalence of FD in a non-selective patient population of everyday practice presenting with LVH, including those with hypertension and valve disease. We measured plasma alpha-galactosidase A activity using dried blood spot tests in 499 (age = 66 ± 13 years, 336 men) Hong Kong Chinese patients with LVH defined as maximal LV septal/posterior wall thickness ≥13 mm on echocardiography. Patients with low enzyme activity underwent mutation analysis of the GLA gene. Eight (age = 53−74 years, all men) unrelated patients (1.6%) had low plasma alpha-galactosidase A activity (0.57 ± 0.27 μmol/L wb/hr) and all were confirmed to have the GLA IVS4 + 919G &gt, A mutation. FD patients presented with heart failure (n = 5), heart block (n = 2), ventricular tachycardia (n = 1), chest pain (n = 3), and/or murmur (n = 1). Uncontrolled hypertension (n = 4) and/or severe mitral/aortic valve pathology (n = 2) were frequent. Ethnic subgroups included Teochew (n = 5), Canton (n = 2), and Wenzhou (n = 1). Endomyocardial biopsy (n = 6) revealed hypertrophic myocytes with vacuolization and dense lamellar bodies. Late-onset IVS4 + 919G &gt, A FD is prevalent among Chinese LVH patients, and should be considered as a cause of LVH in adult patients even when hypertension and/or valve pathology are present.

Co-infection with multiple different parasites is a common phenomenon in both human and animals. Among parasites that frequently co-infect the same hosts, are the filarial worms and malaria parasites. Despite this, the mechanisms underlying the interactions between these parasites is still relatively unexplored with very few studies available on the resulting pathologies due to co-infection by filarial nematodes and malaria parasites. Hence, this study investigated the histopathological effect of Brugia pahangi and Plasmodium berghei ANKA (PbA) infections in gerbil host. Gerbils grouped into B. pahangi-infected, PbA-infected, B. pahangi and PbA-coinfected, and uninfected control, were necropsied at different time points of post PbA infections. Brugia pahangi infections in the gerbils were first initiated by subcutaneous inoculation of 50 infective larvae, while PbA infections were done by intraperitoneal injection of 10

The nebular circumstellar environments of cool evolved stars are known to harbour a rich morphological complexity of gaseous structures on different length scales. A large part of these density structures are thought to be brought about by the interaction of the stellar wind with a close companion. The S-type asymptotic giant branch star Pi1 Gruis, which has a known companion at ~440 au and is thought to harbour a second, closer-by (, 19 pages, 20 figures

This nationwide study assessed the impact of Lynch syndrome-related risk management guidelines on clinicians’ recommendations of risk management strategies to carriers of pathogenic variants in mismatch repair genes and the extent to which carriers took up strategies in concordance with guidelines. Clinic files of 464 carriers (with and without colorectal cancer) were audited for carriers who received their genetic testing results in July 2008–July 2009 (i.e. before guideline release), July 2010–July 2011 and July 2012–July 2013 (both after guideline release) at 12 familial cancer clinics (FCCs) to ascertain the extent to which carriers were informed about risk management in accordance with guidelines. All carriers captured by the audit were invited to participate in interviews; 215 were interviewed to assess adherence to recommended risk management guidelines. The rates of documentation in clinic files increased significantly from pre- to post-guideline for only two out of eight risk management strategies. The strategies with the highest compliance of carriers post-guidelines were: uptake of one or two-yearly colonoscopy (87%), followed by hysterectomy to prevent endometrial cancer (68%), aspirin as risk-reducing medication (67%) and risk-reducing salpingo-oophorectomy (63%). Interrater reliability check for all guidelines showed excellent agreement (k statistics = 0.89). These results indicate that there is scope to further increase provision of advice at FCCs to ensure that all carriers receive recommendations about evidence-based risk management. A multi-pronged behaviour change and implementation science approach tailored to specific barriers is likely to be needed to achieve optimal clinician behaviours and outcomes for carriers.

The latest evolutionary phases of low- and intermediate mass stars are characterized by complex physical processes like turbulence, convection, stellar pulsations, magnetic fields, condensation of solid particles, and the formation of massive outflows that inject freshly produced heavy elements and dust particles into the interstellar medium. We use the Northern Extended Millimeter Array (NOEMA) to obtain spatially and spectrally resolved observations of the semi-regular Asymptotic Giant Branch star RS Cancri to shed light on the morpho-kinematic structure of its inner, wind forming environment by applying detailed 3-D reconstruction modeling and LTE radiative transfer calculations. We detect 32 lines of 13 molecules and isotopologs (CO, SiO, SO, SO$_2$, H$_2$O, HCN, PN), including several transitions from vibrationally excited states. HCN, H$^{13}$CN, millimeter vibrationally excited H$_2$O, SO, $^{34}$SO, SO$_2$, and PN are detected for the first time in RS Cnc. Evidence for rotation is seen in HCN, SO, SO$_2$, and SiO(v=1). From CO and SiO channel maps, we find an inner, equatorial density enhancement, and a bipolar outflow structure with a mass loss rate of $1 \times 10^{-7}M_\odot{\rm yr}^{-1}$ for the equatorial region and of $2 \times 10^{-7}M_\odot{\rm yr}^{-1}$ for the polar outflows. The $^{12}$CO/$^{13}$CO ratio is measured to be $\sim20$ on average, $24\pm2$ in the polar outflows and $19\pm3$ in the equatorial region. We do not find direct evidence of a companion that might explain this kind of kinematic structure, and explore the possibility that a magnetic field might be the cause of it. The innermost molecular gas is influenced by stellar pulsation and possibly by convective cells that leave their imprint on broad wings of certain molecular lines, such as SiO and SO., Comment: 28 pages, 40 figures, accepted for publication in Astronomy & Astrophysics

CK Vul erupted in 1670 and is considered a stellar-merger candidate. Its remnant contains a molecular component of surprisingly rich composition. We present interferometric line surveys with subarcsec resolution with ALMA and SMA. The observations provide interferometric maps of molecular line emission at frequencies between 88 and 243 GHz that allow imaging spectroscopy of more than 180 transitions of 26 species. We present, classify, and analyze the different morphologies of the emission regions displayed by the molecules. We also perform a non-LTE radiative-transfer analysis of emission of most of the observed species, deriving temperatures and column densities in five parts of the nebula. Non-LTE effects are clearly seen in complex species including methanol absorption against the CMB. The temperatures are 17 K in the inner remnant and 14 K in the extended lobes. We find total (hydrogen plus helium) densities in the range of $10^4-10^6$ cm$^{-3}$. The column densities provide relative abundance patterns in the remnant which currently are not understood. Attempts to derive elemental abundances within the assumption of a chemical equilibrium give only loose constraints on the CNO elements. That the formation of many of the observed molecules requires a major involvement of circumstellar shocks remains the preferred possibility. The molecular gas could have formed 350 yr ago or more recently. The molecules are well shielded from the interstellar radiation field by the circumstellar dust. Their presence alone indicates that the unobservable central star cannot be a hot object such as a white dwarf. This excludes some of the proposed scenarios on the nature of CK Vul. The general characteristics of the molecular environment of CK Vul derived in this study resemble quite well those of some pre-planetary nebulae and AGB stars, most notably that of OH231.8., Comment: submitted to A&A; comments welcome

Background:While carotid ultrasound (US) has been advocated for cardiovascular (CV) risk screening in patients with rheumatoid arthritis as various traditional scores underestimate CV risk, whether subclinical carotid atherosclerosis (SCA) is associated with coronary atherosclerosis on coronary computed tomography angiography (CCTA) in patients with psoriatic arthritis (PsA) remains uncertain.Objectives:This study aimed to identify carotid US parameters which can discriminate PsA patients with coronary artery disease (CAD) and obstructive CAD (O-CAD), and determine the utility in combination with Framingham Risk Score (FRS).Methods:Ninety-one PsA patients (56 males; age: 50±11years, disease duration: 9.4±9.2years) without overt CV diseases were recruited. Carotid intima-media thickness (cIMT), presence of plaque and total plaque area (TPA) were determined by high-resolution US. CAD was defined as the presence of any coronary plaque on CCTA. O-CAD was defined as >50% stenosis of the lumen. FRS Results:Thirty-five (38%) patient had carotid plaque. Fifty-five (60%) patients had CAD and 9 (10%) patients had O-CAD. 53 (58%), 25 (17%) and 13 (14%) were classified as low, moderate and high CV risk according to the FRS respectively. FRS underestimated the CV risk as only 11/55 (20%) of subjects with CAD were correctly identified as having high CV risk by FRS (Figure 1). Fifteen patients out of 53 (28%) with low CV risk based on FRS were reclassified as high CV risk by the presence of carotid plaque. Nine out of these 15 (60%) had CAD and 1/15 (6.7%) had O-CAD. Concerning the carotid ultrasound parameters, cIMT (mean and maximum) and TPA were increased in both the CAD+ and O-CAD+ group compared to those without CAD or O-CAD (Table 1). Multivariate logistic regression analysis revealed that mean cIMT (OR=1.06, 95% CI:1.01-1.11,p=0.013) was an independent explanatory variables associated with CAD. Meanwhile, mean cIMT (OR=1.06, 95%CI: 1.01-1.11,p=0.013) maximum cIMT (OR=1.06, 95%CI: 1.00-1.13,p=0.043), and TPA (OR=1.55, 95%CI: 1.01-2.36,p=0.043) were independent explanatory variables associated with O-CAD after adjusting for covariates. Based on Receiver Operating Curve (ROC) analysis, an optimal cut off for FRS at 5% and mean cIMT at 0.62mm yield 63% sensitivity and 73% specificity for the presence of CAD (AUC: 0.71,p=0.001).Table 1.Relationship between carotid ultrasound parameters and the presence and extent of coronary artery disease on coronary computed tomography angiography.Coronary artery diseaseNo (n=37)Yes (n=54)pMean carotid IMT, mm0.63±0.120.69±0.10.017Maximum carotid IMT, mm0.77±0.170.84±0.140.040Carotid Plaque, n, %Absence2646.4%3053.6%0.156Presence1131.4%2468.6%Total plaque area, mm20.0[0,6]0.0[0, 10.8]0.059Obstructive coronary artery diseaseNo (n=82)Yes (n=9)pMean carotid IMT, mm0.65±0.120.76±0.070.011Maximum carotid IMT, mm0.80±0.160.93±0.140.020Carotid Plaque, n, %Absence5393.0%47.0%0.235Presence2985.3%514.7%Total plaque area, mm20.0[0, 7.0]6.0[0, 15.3]0.103IMT-intima media thickness; coronary computed tomography angiography.Conclusion:Increased cIMT and TPA were associated with CAD and O-CAD in PsA patients while the presence of carotid plaque alone was insufficient to discriminate patient with or without CAD. A combination of US parameters should be considered for CV risk stratification in patients with PsA.References:[1]Ford ES et al.,J Am Coll Cardiol. 2004;43(10):1791-6.Disclosure of Interests:Isaac T. Cheng: None declared, Ka Tat Wong: None declared, Edmund Li: None declared, Priscilla C Wong: None declared, Billy Tin Lok Lai: None declared, Cheuk Wan Yim: None declared, Shirley King Yee Ying: None declared, Kitty Yan Kwok: None declared, Martin Li: None declared, Tena K. Li: None declared, Jack Jock Wai Lee: None declared, Alex Pui Wai Lee: None declared, Lai-Shan Tam Grant/research support from: Janssen, Pfizer, Novartis, Speakers bureau: Abbvie, Lilly, Sanofi

Purpose Prospective randomized controlled trials and long-term studies are essential future directions for building evidence-based practices in developmental dysplasia of the hip (DDH), however, sufficient attrition in data (> 20%) can introduce bias deteriorating research quality. Pelvic radiography is synonymous with DDH assessment and so are Gonadal Shield (GS) recommendations with pelvic radiography. Nonetheless, losses to diagnostic information and inadequate protection have been increasingly implicated to GS usage, with significantly worse implications in female patients. Understandably for DDH, a disease with 80% female prevalence, the impact of GS usage on quality of radiographs and readability of radiological data may be drastic. This study aims to objectively define the implications of GS recommendations in DDH patients. Methods Pelvis radiographs of all DDH patients under the hip surveillance programme at a tertiary care hospital with a written protocol for GS usage were evaluated. Images were reviewed for gender, GS presence, adequate gonadal protection and obstruction of essential anatomical landmarks for pelvic indices. Results In all, 131 pelvis radiographs with DDH diagnoses (age: 1.25 to 6 years; 107 female, 24 male pelvises) were reviewed. Only 42.67% (56) of pelvis radiographs used GS despite the presence of a clear protocol. Useful anatomical landmarks were obstructed in 58.9% of radiographs with GS present. Lost diagnostic information was more common in female patients than male patients (68.1% versus 11.1%, p < 0.01). GS was ineffective at gonadal protection in 73.2% (41) of the pelvises with worse protection in female patients (78.7% vs 44.4%; p = 0.03). Conclusions Ironically, essential anatomy was obstructed in all the adequately protected female pelvises. Routine GS usage results in substantial attrition of radiographic data in DDH patients. Level of Evidence III

Decades ago, $\gamma$-ray observatories identified diffuse Galactic emission at 1.809 MeV originating from $\beta^+$ decays of an isotope of aluminium, $^{26}$Al, that has a mean-life time of 1.04 Myr. Objects responsible for the production of this radioactive isotope have never been directly identified, owing to insufficient angular resolutions and sensitivities of the $\gamma$-ray observatories. Here, we report observations of millimetre-wave rotational lines of the isotopologue of aluminium monofluoride that contains the radioactive isotope ($^{26}$AlF). The emission is observed toward CK Vul which is thought to be a remnant of a stellar merger. Our constraints on the production of $^{26}$Al combined with the estimates on the merger rate make it unlikely that objects similar to CK Vul are major producers of Galactic $^{26}$Al. However, the observation may be a stepping stone for unambiguous identification of other Galactic sources of $^{26}$Al. Moreover, a high content of $^{26}$Al in the remnant indicates that prior to the merger, the CK Vul system contained at least one solar-mass star that evolved to the red giant branch., Comment: 18 pages, accepted to Nature Astronomy

Introduction/Purpose This article aims to review of the common diffuse thyroid disease. Methods Thorough literature search and review was performed for each diffuse thyroid disease. The most recent and updated ultrasound images were obtained. Results Diffuse thyroid diseases discussed include multinodular goitre, Graves’ disease, Hashimoto thyroiditis, de Quervain thyroiditis, acute suppurative thyroiditis, anaplastic carcinoma, thyroid metastases, chronic lymphocytic leukaemia/small lymphocytic lymphoma, Langerhans cell histiocytosis, tuberculosis, plasmacytoma, IgG4-related disease and thyrolipoma Discussion The major clinical features and the sonographic features of each diffuse thyroid disease are reviewed. Conclusion This article serves as a synopsis of diffuse thyroid disease.

International audience; AbstractBackgroundSelective estrogen receptor modulators, such as tamoxifen, reduce breast cancer risk by up to 50% in women at increased risk for breast cancer. Despite tamoxifen’s well-established efficacy, many studies show that most women are not taking up tamoxifen. This systematic literature review aimed to identify the motivators and barriers to tamoxifen use ‘s amongst high-risk women.MethodsUsing MEDLINE, PsycINFO, and Embase plus reviewing reference lists of relevant articles published between 1995 and 2016, 31 studies (published in 35 articles) were identified, which addressed high-risk women’s decisions about risk-reducing medication to prevent breast cancer and were peer-reviewed primary clinical studies.ResultsA range of factors were identified as motivators of, and barriers to, tamoxifen uptake including: perceived risk, breast-cancer-related anxiety, health professional recommendation, perceived drug effectiveness, concerns about side-effects, knowledge and access to information about side-effects, beliefs about the role of risk-reducing medication, provision of a biomarker, preference for other forms of breast cancer risk reduction, previous treatment experience, concerns about randomization in clinical trial protocols and finally altruism.ConclusionsResults indicate that the decision for high-risk women regarding tamoxifen use or non-use as a risk-reducing medication is not straightforward. Support of women making this decision is essential and needs to encompass the full range of factors, both informational and psychological.

Von Willebrand's disease (VWD) is the most common inherited bleeding disorder caused by either quantitative or qualitative defects of von Willebrand factor (VWF). Current tests for VWD require relatively large blood volumes, have low throughput, are time-consuming, and do not incorporate the physiologically relevant effects of haemodynamic forces. We developed a microfluidic device incorporating micro-contractions that harnesses well-defined haemodynamic strain gradients to initiate platelet aggregation in citrated whole blood. The microchannel architecture has been specifically designed to allow for continuous real-time imaging of platelet aggregation dynamics. Subjects aged ≥18 years with previously diagnosed VWD or who presented for evaluation of a bleeding disorder, where the possible diagnosis included VWD, were tested. Samples were obtained for device characterization as well as for pathology-based testing. Platelet aggregation in the microfluidic device is independent of platelet amplification loops but dependent on low-level platelet activation, GPIb/IX/V and integrin αIIbβ3 engagement. Microfluidic output directly correlates with VWF antigen levels and is able to sensitively detect aggregation defects associated with VWD subtypes. Testing demonstrated a strong correlation with standard clinical laboratory-based tests. Head-to-head comparison with PFA100® demonstrated equivalent, if not improved, sensitivity for screening aggregation defects associated with VWD. This strain rate gradient microfluidic prototype has the potential to be a clinically useful, rapid and high throughput-screening tool for VWD as well as other strain-dependent platelet disorders. In addition, the microfluidic device represents a novel approach to examine the effects of high magnitude/short duration (ms) strain rate gradients on platelet function.

The purposes of this study were to evaluate the chest radiographic features of adult patients hospitalized for respiratory syncytial virus respiratory tract infections and to assess whether initial chest radiographic findings help predict clinical outcome.All adult patients hospitalized from January 2009 to December 2011 with laboratory-confirmed respiratory syncytial virus infection were included in the study. Patient clinical data and admission chest radiographs were retrospectively reviewed. Adverse outcomes included need for supplemental oxygen, need for assisted ventilation, and death.Of 285 patients (mean age, 74 ± 16 years) included, 199 (69.8%) had abnormal chest radiographic findings: 49.5% (141/285) had acute changes, and 47.7% (136/285) had chronic changes. Consolidation (68/141 [48.2%]) and ground-glass opacity (57/141 [40.4%]) were the predominant types of acute changes and were most common in unilateral single-lower-zone involvement. Consolidation, ground-glass opacity, and chronic changes occurred with significantly higher frequency in patients with adverse outcomes. The presence of acute (odds ratio, 3.6) and chronic (odds ratio, 2.2) changes were independent risk factors for mortality.A large proportion of adult patients hospitalized with respiratory syncytial virus respiratory tract infection had changes on initial chest radiographs. Consolidation or ground-glass opacity in a unilateral single-lower-zone distribution were the most common findings. The presence of acute and chronic radiographic lung changes was associated with adverse outcomes.

Background. Better understanding of complications and outcomes of adults hospitalized with respiratory syn-cytial virus (RSV) infection is necessary.Methods. A retrospective cohort study was conducted on all adults (≥18 years) admitted to 3 acute care generalhospitals in Hong Kong with virologically confirmed RSV infection during 2009–2011 (N=607). Adults hospital-ized forseasonal influenza during the period wereused forcomparison (n=547). Both infections were prospectivelydiagnosed following a standard protocol. Independent reviews of chest radiographs were performed by radiologists.Main outcome measures were all-cause death, respiratory failure requiring ventilatory support, and hospitalizationduration. Cox proportional hazards models were used foranalyses.Results. Themeanage ofRSV patients was75 (SD,16) years; 87% hadunderlyingconditions. Lower respiratoryand cardiovascularcomplications were diagnosed in 71.9% (pneumonia, 42.3%; acute bronchitis, 21.9%; chronic ob-structive pulmonary disease/asthma exacerbation, 27.3%) and 14.3% of patients, respectively; 12.5% had bacterialsuperinfections. Supplemental oxygen and ventilatory support were required in 67.9% and 11.1%, respectively.Crude all-cause mortality was 9.1% and 11.9% within 30days and 60 days, respectively; mean length ofstayof survi-vors was 12 (SD, 13) days. Advanced age, radiographic pneumonia, requirement for ventilation, bacterial superin-fection, and elevated urea level and white blood cell count were independently associated with poorer survival.Systemic corticosteroid use was associated with longer hospitalization and secondary infections. The overall out-comes of survival and length of stay were not significantly different from those in influenza.Conclusions. RSV can cause severe lower respiratory complications in older adults, resulting in respiratoryfailure, prolonged hospitalization, and high mortality similar to seasonal influenza. Corticosteroids did not seem toimprove outcomes. The unmet need forantiviral therapy and vaccination against RSV in adults should be promptlyaddressed.Keywords. RSV; hospitalization; respiratory failure; lower respiratory tract infection; adults.Respiratory syncytial virus (RSV) is known to be animportant cause of lower respiratory tract infection ininfants and young children, leading to hospitalizationsand deaths [1]. Its impact in adults, however, has onlybeen appreciated in recent years. It has been estimatedthat RSV infects 3%–10% of adults annually; althoughmost infections are mild, increasing evidence suggeststhat severe lower respiratory tract infections can occur,especially among older adults and those with underlyingconditions [2–4].RSV may have accounted for 5%–15%of community-acquired pneumonia, 9%–10% of hospi-tal admissions for acute cardiorespiratory diseases, andexcessive deaths duringseasonalpeaks [3,4].Thedisease

This is a pictorial essay of unusual parotid gland lesions that may be encountered in routine clinical practice.

The formation of silicate dust in oxygen-rich envelopes of evolved stars is thought to be initiated by formation of seed particles that can withstand the high temperatures close to the stellar photosphere and act as condensation cores farther away from the star. Candidate species considered as first condensates are TiO and TiO$_2$. We aim to identify and characterize the circumstellar gas-phase chemistry of titanium that leads to the formation of solid titanium compounds in the envelope of $o$ Cet, the prototypical Mira, and seek an observational verification of whether titanium oxides play a major role in the onset of dust formation in M-type AGB stars. We present high angular-resolution ALMA observations at submillimeter (submm) wavelengths supplemented by APEX and Herschel spectra of the rotational features of TiO and TiO$_2$. In addition, circumstellar features of TiO and TiI are identified in optical spectra which cover multiple pulsation cycles of $o$ Cet. The submm ALMA data reveal TiO and TiO$_2$ bearing gas within the extended atmosphere of Mira. While TiO is traceable up to a radius (FWHM/2) of 4.0 R$_{\star}$, TiO$_2$ extends as far as 5.5 R$_{\star}$ and unlike TiO appears to be anisotropically distributed. Optical spectra display variable emission of TiI and TiO from inner parts of the extended atmosphere (, 19 pages plus spectral atlas of the TiO gamma' band in 1998-2014 submitted to A&A