Response surface modeling of the interaction between propofol and sevoflurane

BACKGROUND: Propofol and sevoflurane display additivity for gamma-aminobutyric acid receptor activation, loss of consciousness, and tolerance of skin incision. Information about their interaction regarding electroencephalographic suppression is unavailable. This study examined this interaction as well as the interaction on the probability of tolerance of shake and shout and three noxious stimulations by using a response surface methodology. METHODS: Sixty patients preoperatively received different combined concentrations of propofol (0-12 microg/ml) and sevoflurane (0-3.5 vol.%) according to a crisscross design (274 concentration pairs, 3 to 6 per patient). After having reached pseudo-steady state, the authors recorded bispectral index, state and response entropy and the response to shake and shout, tetanic stimulation, laryngeal mask airway insertion, and laryngoscopy. For the analysis of the probability of tolerance by logistic regression, a Greco interaction model was used. For the separate analysis of bispectral index, state and response entropy suppression, a fractional Emax Greco model was used. All calculations were performed with NONMEM V (GloboMax LLC, Hanover, MD). RESULTS: Additivity was found for all endpoints, the Ce(50, PROP)/Ce(50, SEVO) for bispectral index suppression was 3.68 microg. ml(-1)/ 1.53 vol.%, for tolerance of shake and shout 2.34 microg . ml(-1)/ 1.03 vol.%, tetanic stimulation 5.34 microg . ml(-1)/ 2.11 vol.%, laryngeal mask airway insertion 5.92 microg. ml(-1) / 2.55 vol.%, and laryngoscopy 6.55 microg. ml(-1)/2.83 vol.%. CONCLUSION: For both electroencephalographic suppression and tolerance to stimulation, the interaction of propofol and sevoflurane was identified as additive. The response surface data can be used for more rational dose finding in case of sequential and coadministration of propofol and sevoflurane.

Risk factors for treatment-limiting toxicities in patients starting nevirapine-containing antiretroviral therapy

BACKGROUND: This collaboration of seven observational clinical cohorts investigated risk factors for treatment-limiting toxicities in both antiretroviral-naive and experienced patients starting nevirapine-based combination antiretroviral therapy (NVPc). METHODS: Patients starting NVPc after 1 January 1998 were included. CD4 cell count at starting NVPc was classified as high (>400/microl/>250/microl for men/women, respectively) or low. Cox models were used to investigate risk factors for discontinuations due to hypersensitivity reactions (HSR, n = 6547) and discontinuation of NVPc due to treatment-limiting toxicities and/or patient/physician choice (TOXPC, n = 10,186). Patients were classified according to prior antiretroviral treatment experience and CD4 cell count/viral load at start NVPc. Models were stratified by cohort and adjusted for age, sex, nadir CD4 cell count, calendar year of starting NVPc and mode of transmission. RESULTS: Median time from starting NVPc to TOXPC and HSR were 162 days [interquartile range (IQR) 31-737] and 30 days (IQR 17-60), respectively. In adjusted Cox analyses, compared to naive patients with a low CD4 cell count, treatment-experienced patients with high CD4 cell count and viral load more than 400 had a significantly increased risk for HSR [hazard ratio 1.45, confidence interval (CI) 1.03-2.03] and TOXPC within 18 weeks (hazard ratio 1.34, CI 1.08-1.67). In contrast, treatment-experienced patients with high CD4 cell count and viral load less than 400 had no increased risk for HSR 1.10 (0.82-1.46) or TOXPC within 18 weeks (hazard ratio 0.94, CI 0.78-1.13). CONCLUSION: Our results suggest it may be relatively well tolerated to initiate NVPc in antiretroviral-experienced patients with high CD4 cell counts provided there is no detectable viremia.

Assessment of the Matrix Degenerative Effects of MMP-3, ADAMTS-4 and HTRA1 injected into a bovine Intervertebral Disc Organ Culture Model

Study Design. In vitro study to develop an intervertebral disc degeneration (IDD) organ culture model, using coccygeal bovine intervertebral discs (IVDs) and injection of proteolytic enzymes MMP-3, ADAMTS-4 and HTRA1.Objective. This study aimed to develop an in-vitro model of enzyme-mediated IDD to mimic the clinical outcome in humans for investigation of therapeutic treatment options.Summary of Background Data. Bovine IVDs are comparable to human IVDs in terms of cell composition and biomechanical behavior. Researchers injected papain and trypsin into them to create an IDD model with a degenerated nucleus pulposus (NP) area. They achieved macroscopic cavities as well as a loss of glycosaminoglycans (GAGs). However, none of these enzymes are clinically relevant.Methods. Bovine IVDs were harvested maintaining the endplates. Active forms of MMP-3, ADAMTS-4 and HTRA1 were injected at a dose of 10μg/ml each. Phosphate buffered saline (PBS) was injected as a control. Discs were cultured for 8 days and loaded diurnally (day 1 to day 4 with 0.4 MPa for 16 h) and left under free swelling condition from day 4 to day 8 to avoid expected artifacts due to dehydration of the NP. Outcome parameters included disc height, metabolic cell activity, DNA content, glycosaminoglycan (GAG) content, total collagen content, relative gene expression and histological investigation.Results. The mean metabolic cell activity was significantly lower in the NP area of discs injected with ADAMTS-4 compared to the day 0 control discs. Disc height was decreased following injection with HTRA1, and was significantly correlated with changes in GAG/DNA of the NP tissue. Total collagen content tended to be lower in groups injected with ADAMTS4 and MMP-3.Conclusion. MMP-3, ADAMTS-4 and HTRA1 neither provoked visible matrix degradation nor major shifts in gene expression. However, cell activity was significantly reduced and HTRA1 induced loss of disc height which positively correlated with changes in GAG/DNA content. The use of higher doses of these enzymes or a combination thereof may therefore be necessary to induce disc degeneration

Geochemical and isotopic characterization of the Bodélé Depression dust source and implications for transatlantic dust transport to the Amazon Basin

The Bodélé Depression (Chad) in the central Sahara/Sahel region of Northern Africa is the most important source of mineral dust to the atmosphere globally. The Bodélé Depression is purportedly the largest source of Saharan dust reaching the Amazon Basin by transatlantic transport. Here, we have undertaken a comprehensive study of surface sediments from the Bodélé Depression and dust deposits (Chad, Niger) in order to characterize geochemically and isotopically (Sr, Nd and Pb isotopes) this dust source, and evaluate its importance in present and past African dust records. We similarly analyzed sedimentary deposits from the Amazonian lowlands in order to assess postulated accumulation of African mineral dust in the Amazon Basin, as well as its possible impact in fertilizing the Amazon rainforest. Our results identify distinct sources of different ages and provenance in the Bodélé Depression versus the Amazon Basin, effectively ruling out an origin for the Amazonian deposits, such as the Belterra Clay Layer, by long-term deposition of Bodélé Depression material. Similarly, no evidence for contributions from other potential source areas is provided by existing isotope data (Sr, Nd) on Saharan dusts. Instead, the composition of these Amazonian deposits is entirely consistent with derivation from in-situ weathering and erosion of the Precambrian Amazonian craton, with little, if any, Andean contribution. In the Amazon Basin, the mass accumulation rate of eolian dust is only around one-third of the vertical erosion rate in shield areas, suggesting that Saharan dust is “consumed” by tropical weathering, contributing nutrients and stimulating plant growth, but never accumulates as such in the Amazon Basin. The chemical and isotope compositions found in the Bodélé Depression are varied at the local scale, and have contrasting signatures in the “silica-rich” dry lake-bed sediments and in the “calcium-rich” mixed diatomites and surrounding sand material. This unexpected finding implies that the Bodélé Depression material is not “pre-mixed” at the source to provide a homogeneous source of dust. Rather, different isotope signatures can be emitted depending on subtle vagaries of dust-producing events. Our characterization of the Bodélé Depression components indicate that the Bodélé “calcium-rich” component, identified here, is most likely released via eolian processes of sand grain saltation and abrasion and may be significant in the overall global budget of dusts carried out by the Harmattan low-level jet during the winter.

Search for dark matter candidates and large extra dimensions in events with a photon and missing transverse momentum in pp collision data at sqrts=7 TeV w the ATLAS detector

Results of a search for new phenomena in events with an energetic photon and large missing transverse momentum in proton-proton collisions at root s = 7 TeV are reported. Data collected by the ATLAS experiment at the LHC corresponding to an integrated luminosity of 4.6 fb(-1) are used. Good agreement is observed between the data and the standard model predictions. The results are translated into exclusion limits on models with large extra spatial dimensions and on pair production of weakly interacting dark matter candidates.

Search for new phenomena in the W W to ell u ell' u' final state in pp collisions at sqrts=7 TeV with the ATLAS detector

This Letter reports a search for a heavy particle that decays to WW using events produced in pp collisions at root s = 7 TeV. The data were recorded in 2011 by the ATLAS detector and correspond to an integrated luminosity of 4.7 fb(-1). WW -> lvl'v' (l,l' = e or mu) final states are considered and the distribution of the transverse mass of the W W candidates is found to be consistent with Standard Model expectations. Upper limits on the production cross section times branching ratio into W boson pairs are set for Randall-Sundrum and bulk Randall-Sundrum gravitons, which result in observed 95% CL lower limits on the masses of the two particles of 1.23 TeV and 0.84 TeV, respectively.

Measurement of the cross-section for W boson production in association with b-jets in pp collisions at sqrt(s) = 7 TeV with the ATLAS detector

This paper reports a measurement of the W+b-jets (W+b+X and W+b (b) over bar +X) production cross-section in proton-proton collisions at a centre-of-mass energy of 7 TeV at the LHC. These results are based on data corresponding to an integrated luminosity of 4.6 fb(-1), collected with the ATLAS detector. Cross-sections are presented as a function of jet multiplicity and of the transverse momentum of the leading b-jet for both the muon and electron decay modes of the W boson. The W+b-jets cross-section, corrected for all known detector effects, is quoted in a limited kinematic range. Combining the muon and electron channels, the fiducial cross-section for W+b-jets is measured to be 7.1 +/- 0.5 (stat) +/- 1.4 (syst) pb, consistent with the next-to-leading order QCD prediction, corrected for non-perturbative and double-parton interactions (DPI) contributions, of 4.70 +/- 0.09 (stat) (+0.60)(-0.49) (scale) +/- 0.06 (PDF) +/- 0.16 (non-pert) (+0.52)(-0.38) (DPI) pb.

Measurement of kT splitting scales in W���lv events at sqrt(s)=7 TeV with the ATLAS detector

A measurement of splitting scales, as defined by the kT clustering algorithm, is presented for final states containing a W boson produced in proton-proton collisions at a centre-of-mass energy of 7 TeV. The measurement is based on the full 2010 data sample corresponding to an integrated luminosity of 36 pb(-1) which was collected using the ATLAS detector at the CERN Large Hadron Collider. Cluster splitting scales are measured in events containing W bosons decaying to electrons or muons. The measurement comprises the four hardest splitting scales in a k(T) cluster sequence of the hadronic activity accompanying the W boson, and ratios of these splitting scales. Backgrounds such as multi-jet and top-quark-pair production are subtracted and the results are corrected for detector effects. Predictions from various Monte Carlo event generators at particle level are compared to the data. Overall, reasonable agreement is found with all generators, but larger deviations between the predictions and the data are evident in the soft regions of the splitting scales.

Measurement of hard double-parton interactions in W���lv+ 2 jet events at sqrt(s)=7 TeV with the ATLAS detector

The production of W bosons in association with two jets in proton-proton collisions at a centre-of-mass energy of root s = 7 TeV has been analysed for the presence of double-parton interactions using data corresponding to an integrated luminosity of 36 pb(-1), collected with the ATLAS detector at the Large Hadron Collider. The fraction of events arising from double-parton interactions, f(DP)((D)), has been measured through the p(T) balance between the two jets and amounts to f(DP)((D)) = 0.08 +/- 0.01 (stat.) +/- 0.02 (sys.) for jets with transverse momentum p(T) > 20 GeV and rapidity vertical bar y vertical bar < 2.8. This corresponds to a measurement of the effective area parameter for hard double-parton interactions of sigma(eff) = 15 +/- 3 (stat.)(-3)(+5) (sys.) mb.

Search for pair production of heavy top-like quarks decaying to a high-pT W boson and a b quark in the lepton plus jets final state at sqrts=7 TeV with the ATLAS detector

A search is presented for production of a heavy up-type quark (t') together with its antiparticle, assuming a significant branching ratio for subsequent decay into a W boson and a b quark. The search is based on 4.7 fb(-1) of pp collisions root s = 7 TeV recorded in 2011 with the ATLAS detector at the CERN Large Hadron Collider. Data are analyzed in the lepton + jets final state, characterized by a high-transverse-momentum isolated electron or muon, large missing transverse momentum and at least three jets. The analysis strategy relies on the substantial boost of the W bosons in the t'(t') over bar signal when m(t') greater than or similar to 400 GeV. No significant excess of events above the Standard Model expectation is observed and the result of the search is interpreted in the context of fourth-generation and vector-like quark models. Under the assumption of a branching ratio BR(t' -> W b) = I, a fourth-generation t' quark with mass lower than 656 GeV is excluded at 95% confidence level. In addition, in light of the recent discovery of a new boson of mass similar to 126 GeV at the LHC, upper limits are derived in the two-dimensional plane of BR(t' -> Wb) versus BR(t' -> Ht), where H is the Standard Model Higgs boson, for vector-like quarks of various masses.

Search for a multi-Higgs-boson cascade in W(+)W(-)b(b)over-bar events with the ATLAS detector in pp collisions at root s=8 TeV

A search is presented for new particles in an extension to the Standard Model that includes a heavy Higgs boson (H-0), an intermediate charged Higgs-boson pair (H-+/-), and a light Higgs boson (h(0)). The analysis searches for events involving the production of a single heavy neutral Higgs boson which decays to the charged Higgs boson and a W boson, where the charged Higgs boson subsequently decays into a W boson and the lightest neutral Higgs boson decaying to a bottom-antibottom-quark pair. Such a cascade results in a W-boson pair and a bottom-antibottom-quark pair in the final state. Events with exactly one lepton, missing transverse momentum, and at least four jets are selected from a data sample corresponding to an integrated luminosity of 20.3 fb(-1), collected by the ATLAS detector in proton-proton collisions at root s = 8 TeV at the LHC. The data are found to be consistent with Standard Model predictions, and 95% confidence-level upper limits are set on the product of cross section and branching ratio. These limits range from 0.065 to 43 pb as a function of H-0 and H-+/- masses, with m(h)o fixed at 125 GeV.

A measurement of the ratio of the production cross sections for W and ℤ bosons in association with jets with the ATLAS detector

The ratio of the production cross sections for W and Z bosons in association with jets has been measured in proton–proton collisions at √s = 7 TeV with the ATLAS experiment at the Large Hadron Collider. The measurement is based on the entire 2011 dataset, corresponding to an integrated luminosity of 4.6 fb−1. Inclusive and differential cross-section ratios for massive vector bosons decaying to electrons and muons aremeasured in association with jets with transverse momentum pT > 30 GeV and jet rapidity |y| < 4.4. The measurements are compared to next to-leading-order perturbative QCD calculations and to predictions from different Monte Carlo generators implementing leading-order matrix elements supplemented by parton showers.

Search for new resonances in W�� and ℤѵ final states in pp collisions at √s=8 TeV with the ATLAS detector

This Letter presents a search for new resonances decaying to final states with a vector boson produced in association with a high transverse momentum photon, Vγ, with V=W(→ℓν)or Z(→ℓ+ℓ−), where ℓ =e or μ. The measurements use 20.3fb−1 of proton–proton collision data at a center-of-mass energy of √s=8TeV recorded with the ATLAS detector. No deviations from the Standard Model expectations are found, and production cross section limits are set at 95% confidence level. Masses of the hypothetical aT and ωT states of a benchmark Low Scale Technicolor model are excluded in the ranges [275, 960] GeVand [200, 700] ∪[750, 890] GeV, respectively. Limits at 95% confidence level on the production cross section of a singlet scalar resonance decaying to Zγ final states have also been obtained for masses below 1180 GeV.