Blunt traumatic thoracic aortic injuries: early or delayed repair-results of an American Association for the Surgery of Trauma prospective study

BACKGROUND: The traditional approach to stable blunt thoracic aortic injuries (TAI) is immediate repair, with delayed repair reserved for patients with major associated injuries. In recent years, there has been a trend toward delayed repair, even in low-risk patients. This study evaluates the current practices in the surgical community regarding the timing of aortic repair and its effects on outcomes. METHODS: This was a prospective, observational multicenter study sponsored by the American Association for the Surgery of Trauma. The study included patients with blunt TAI scheduled for aortic repair by open or endovascular procedure. Patients in extremis and those managed without aortic repair were excluded. The data collection included demographics, initial clinical presentation, Injury Severity Scores, type and site of aortic injury, type of aortic repair (open or endovascular repair), and time from injury to aortic repair. The study patients were divided into an early repair (< or = 24 hours) and delayed repair groups (> 24 hours). The outcome variables included survival, ventilator days, intensive care unit (ICU) and hospital lengths of stay, blood transfusions, and complications. The outcomes in the two groups were compared with multivariate analysis after adjusting for age, Glasgow Coma Scale, hypotension, major associated injuries, and type of aortic repair. A second multivariate analysis compared outcomes between early and delayed repair, in patients with and patients without major associated injuries. RESULTS: There were 178 patients with TAI eligible for inclusion and analysis, 109 (61.2%) of which underwent early repair and 69 (38.8%) delayed repair. The two groups had similar epidemiologic, injury severity, and type of repair characteristics. The adjusted mortality was significantly higher in the early repair group (adjusted OR [95% CI] 7.78 [1.69-35.70], adjusted p value = 0.008). The adjusted complication rate was similar in the two groups. However, delayed repair was associated with significantly longer ICU and hospital lengths of stay. Analysis of the 108 patients without major associated injuries, adjusting for age, Glasgow Coma Scale, hypotension, and type of aortic repair, showed that in early repair there was a trend toward higher mortality rate (adjusted OR 9.08 [0.88-93.78], adjusted p value = 0.064) but a significantly lower complication rate (adjusted OR 0.4 [0.18-0.96], adjusted p value 0.040) and shorter ICU stay (adjusted p value = 0.021) than the delayed repair group. A similar analysis of the 68 patients with major associated injuries, showed a strong trend toward higher mortality in the early repair group (adjusted OR 9.39 [0.93-95.18], adjusted p value = 0.058). The complication rate was similar in both groups (adjusted p value = 0.239). CONCLUSIONS: Delayed repair of stable blunt TAI is associated with improved survival, irrespective of the presence or not of major associated injuries. However, delayed repair is associated with a longer length of ICU stay and in the group of patients with no major associated injuries a significantly higher complication rate.

The HARPS search for southern extra-solar planets

The meter-per-second precision achieved by today’s velocimeters enables us to search for 1−10 M⊕ planets in the habitable zone of cool stars. This paper reports on the detection of three planets orbiting GJ 163 (HIP 19394), a M3 dwarf monitored by our ESO/HARPS search for planets. We made use of the HARPS spectrograph to collect 150 radial velocities of GJ 163 over a period of eight years. We searched the radial-velocity time series for coherent signals and found five distinct periodic variabilities. We investigated the stellar activity and called into question the planetary interpretation for two signals. Before more data can be acquired we concluded that at least three planets are orbiting GJ 163. They have orbital periods of Pb = 8.632 ± 0.002, Pc = 25.63 ± 0.03, and Pd = 604 ± 8 days and minimum masses msini = 10.6 ± 0.6, 6.8 ± 0.9, and 29 ± 3 M⊕, respectively. We hold our interpretations for the two additional signals with periods P(e) = 19.4 and P(f) = 108 days. The inner pair presents an orbital period ratio of 2.97, but a dynamical analysis of the system shows that it lays outside the 3:1 mean motion resonance. The planet GJ 163c, in particular, is a super-Earth with an equilibrium temperature of Teq = (302 ± 10)(1 − A)1/4 K and may lie in the so-called habitable zone for albedo values (A = 0.34 − 0.89) moderately higher than that of Earth (A⊕ = 0.2−0.3).

Debris discs around M stars: non-existence versus non-detection

Motivated by the reported dearth of debris discs around M stars, we use survival models to study the occurrence of planetesimal discs around them. These survival models describe a planetesimal disc with a small number of parameters, determine if it may survive a series of dynamical processes and compute the associated infrared excess. For the Wide-field Infrared Survey Explorer (WISE) satellite, we demonstrate that the dearth of debris discs around M stars may be attributed to the small semimajor axes generally probed if either: (1) the dust grains behave like blackbodies emitting at a peak wavelength coincident with the observed one; (2) or the grains are hotter than predicted by their blackbody temperatures and emit at peak wavelengths that are shorter than the observed one. At these small distances from the M star, planetesimals are unlikely to survive or persist for time-scales of 300 Myr or longer if the disc is too massive. Conversely, our survival models allow for the existence of a large population of low-mass debris discs that are too faint to be detected with current instruments. We gain further confidence in our interpretation by demonstrating the ability to compute infrared excesses for Sun-like stars that are broadly consistent with reported values in the literature. However, our interpretation becomes less clear and large infrared excesses are allowed if only one of these scenarios holds: (3) the dust grains are hotter than blackbody and predominantly emit at the observed wavelength; (4) or are blackbody in nature and emit at peak wavelengths longer than the observed one. Both scenarios imply that the parent planetesimals reside at larger distances from the star than inferred if the dust grains behaved like blackbodies. In all scenarios, we show that the infrared excesses detected at 22 μm (via WISE) and 70 μm (via Spitzer) from AU Mic are easily reconciled with its young age (12 Myr). Conversely, the existence of the old debris disc (2–8 Gyr) from GJ 581 is due to the large semimajor axes probed by the Herschel PACS instrument. We elucidate the conditions under which stellar wind drag may be neglected when considering dust populations around M stars. The WISE satellite should be capable of detecting debris discs around young M stars with ages ∼10 Myr.

ON THE STABILITY OF SUPER-EARTH ATMOSPHERES

We investigate the stability of super-Earth atmospheres around M stars using a seven-parameter, analytical framework. We construct stability diagrams in the parameter space of exoplanetary radius versus semimajor axis and elucidate the regions in which the atmospheres are stable against the condensation of their major constituents, out of the gas phase, on their permanent nightside hemispheres. We find that super-Earth atmospheres that are nitrogen-dominated (Earth-like) occupy a smaller region of allowed parameter space, compared to hydrogen-dominated atmospheres, because of the dual effects of diminished advection and enhanced radiative cooling. Furthermore, some super-Earths which reside within the habitable zones of M stars may not possess stable atmospheres, depending on the mean molecular weight and infrared photospheric pressure of their atmospheres. We apply our stability diagrams to GJ 436b and GJ 1214b, and demonstrate that atmospheric compositions with high mean molecular weights are disfavored if these exoplanets possess solid surfaces and shallow atmospheres. Finally, we construct stability diagrams tailored to the Kepler data set, for G and K stars, and predict that about half of the exoplanet candidates are expected to harbor stable atmospheres if Earth-like conditions are assumed. We include 55 Cancri e and CoRoT-7b in our stability diagram for G stars

Differentiation of Diabetic Macular Edema From Pseudophakic Cystoid Macular Edema by Spectral-Domain Optical Coherence Tomography.

PURPOSE: To differentiate diabetic macular edema (DME) from pseudophakic cystoid macular edema (PCME) based solely on spectral-domain optical coherence tomography (SD-OCT). METHODS: This cross-sectional study included 134 participants: 49 with PCME, 60 with DME, and 25 with diabetic retinopathy (DR) and ME after cataract surgery. First, two unmasked experts classified the 25 DR patients after cataract surgery as either DME, PCME, or mixed-pattern based on SD-OCT and color-fundus photography. Then all 134 patients were divided into two datasets and graded by two masked readers according to a standardized reading-protocol. Accuracy of the masked readers to differentiate the diseases based on SD-OCT parameters was tested. Parallel to the masked readers, a computer-based algorithm was established using support vector machine (SVM) classifiers to automatically differentiate disease entities. RESULTS: The masked readers assigned 92.5% SD-OCT images to the correct clinical diagnose. The classifier-accuracy trained and tested on dataset 1 was 95.8%. The classifier-accuracy trained on dataset 1 and tested on dataset 2 to differentiate PCME from DME was 90.2%. The classifier-accuracy trained and tested on dataset 2 to differentiate all three diseases was 85.5%. In particular, higher central-retinal thickness/retinal-volume ratio, absence of an epiretinal-membrane, and solely inner nuclear layer (INL)-cysts indicated PCME, whereas higher outer nuclear layer (ONL)/INL ratio, the absence of subretinal fluid, presence of hard exudates, microaneurysms, and ganglion cell layer and/or retinal nerve fiber layer cysts strongly favored DME in this model. CONCLUSIONS: Based on the evaluation of SD-OCT, PCME can be differentiated from DME by masked reader evaluation, and by automated analysis, even in DR patients with ME after cataract surgery. The automated classifier may help to independently differentiate these two disease entities and is made publicly available.