Evidence of direct detection of interstellar deuterium in the local interstellar medium by IBEX

We report the first in situ measurements of neutral deuterium originating in the local interstellar medium (LISM) in Earth’s orbit. These measurements were performed with the IBEX-Lo camera on NASA’s interstellar boundary explorer (IBEX) satellite. All data from the spring observation periods of 2009 through 2011 have been analysed. In the three years of the IBEX mission time, the observation geometry and orbit allowed for a total observation time of 115.3 days for the LISM. However, the effects of the spinning spacecraft and the stepping through 8 energy channels mean that we are only observing the interstellar wind for a total time of 1.44 days, in which 2 counts for interstellar deuterium were collected. We report here a conservative number, because a possibility of systematic error or additional noise, though eliminated in our analysis to the best of our knowledge, only supports detection at a 1-sigma level. From these observations, we derive a ratio D/H = (5.8 ± 4.4) × 10-4 at 1 AU. After modelling the transport and loss of D and H from the termination shock to Earth’s orbit, we find that our result of D/HLISM = (1.6 ± 1.2) × 10-5 agrees with D/HLIC = (1.6 ± 0.4) × 10-5 for the local interstellar cloud. This weak interstellar signal is extracted from a strong terrestrial background signal consisting of sputter products from the sensor’s conversion surface. As reference, we accurately measure the terrestrial D/H ratio in these sputtered products and then discriminate this terrestrial background source. Because of the diminishing D and H signal at Earth’s orbit during the rising solar activity due to photoionisation losses and increased photon pressure, our result demonstrates that in situ measurements of interstellar deuterium in the inner heliosphere are only possible during solar minimum conditions.

THE SOLAR WIND AS A POSSIBLE SOURCE OF FAST TEMPORAL VARIATIONS OF THE HELIOSPHERIC RIBBON

We present a possible source of pickup ions (PUIs) the ribbon observed by the Interstellar Boundary EXplorer (IBEX). We suggest that a gyrating solar wind and PUIs in the ramp and in the near downstream region of the termination shock (TS) could provide a significant source of energetic neutral atoms (ENAs) in the ribbon. A fraction of the solar wind and PUIs are reflected and energized during the first contact with the TS. Some of the solar wind may be reflected propagating toward the Sun but most of the solar wind ions form a gyrating beam-like distribution that persists until it is fully thermalized further downstream. Depending on the strength of the shock, these gyrating distributions can exist for many gyration periods until they are scattered/thermalized due to wave-particle interactions at the TS and downstream in the heliosheath. During this time, ENAs can be produced by charge exchange of interstellar neutral atoms with the gyrating ions. In order to determine the flux of energetic ions, we estimate the solar wind flux at the TS using pressure estimates inferred from in situ measurements. Assuming an average path length in the radial direction of the order of a few AU before the distribution of gyrating ions is thermalized, one can explain a significant fraction of the intensity of ENAs in the ribbon observed by IBEX. With a localized source and such a short integration path, this model would also allow fast time variations of the ENA flux.

Low Energy Neutral Atoms from the Heliosheath

In the heliosheath beyond the termination shock, low energy (<0.5 keV) neutral atoms are created by charge exchange with interstellar neutrals. Detecting these neutrals from Earth's orbit is difficult because their flux is reduced substantially by ionization losses as they propagate from about 100 to 1 AU and because there are a variety of other signals and backgrounds that compete with this weak signal. Observations from IBEX-Lo and -Hi from two opposing vantage points in Earth's orbit established a lower energy limit of about 0.1 keV on measurements of energetic neutral atoms (ENAs) from the heliosphere and the form of the energy spectrum from about 0.1 to 6 keV in two directions in the sky. Below 0.1 keV, the detailed ENA spectrum is not known, and IBEX provides only upper limits on the fluxes. However, using some assumptions and taking constraints on the spectrum into account, we find indications that the spectrum turns over at an energy between 0.1 and 0.2 keV.

Termination of Ventricular Tachycardia with Antitachycardia Pacing after Ineffective Shock Therapy in an ICD Recipient with Hypertrophic Cardiomyopathy

Implantable Cardioverter Defibrillator (ICD) implantation is the only established therapy for primary or secondary prevention of sudden cardiac death in patients with Hypertrophic Cardiomyopathy (HCM). Ineffectiveness of shock therapy for the termination of potentially fatal ventricular arrhythmias in ICD recipients is rare in the presence of appropriate arrhythmia detection by the device. We report the case of a 48-year-old woman with HCM and a single chamber ICD, who received five inefficient high-energy (35 Joules) shocks for the termination of an appropriately detected episode of Ventricular Tachycardia (VT). The episode was safely terminated with a subsequent application of Antitachycardia Pacing (ATP) by the device. At the following ICD control, an acceptable defibrillation threshold was detected.

The effect of high-energy extracorporeal shock waves on hyaline cartilage of adult rats in vivo

The aim of this study was to determine if extracorporeal shock wave therapy (ESWT) in vivo affects the structural integrity of articular cartilage. A single bout of ESWT (1500 shock waves of 0.5 mJ/mm(2)) was applied to femoral heads of 18 adult Sprague-Dawley rats. Two sham-treated animals served as controls. Cartilage of each femoral head was harvested at 1, 4, or 10 weeks after ESWT (n = 6 per treatment group) and scored on safranin-O-stained sections. Expression of tenascin-C and chitinase 3-like protein 1 (Chi3L1) was analyzed by immunohistochemistry. Quantitative real-time polymerase chain reaction (PCR) was used to examine collagen (II)alpha(1) (COL2A1) expression and chondrocyte morphology was investigated by transmission electron microscopy no changes in Mankin scores were observed after ESWT. Positive immunostaining for tenascin-C and Chi3L1 was found up to 10 weeks after ESWT in experimental but not in control cartilage. COL2A1 mRNA was increased in samples 1 and 4 weeks after ESWT. Alterations found on the ultrastructural level showed expansion of the rough-surfaced endoplasmatic reticulum, detachment of the cell membrane and necrotic chondrocytes. Extracorporeal shock waves caused alterations of hyaline cartilage on a molecular and ultrastructural level that were distinctly different from control. Similar changes were described before in the very early phase of osteoarthritis (OA). High-energy ESWT might therefore cause degenerative changes in hyaline cartilage as they are found in initial OA.

Plasma copeptin levels before and during exogenous arginine vasopressin infusion in patients with advanced vasodilatory shock

Plasma copeptin levels before and during exogenous arginine vasopressin infusion (AVP) were evaluated, and the value of copeptin levels before AVP therapy to predict complications during AVP therapy and outcome in vasodilatory shock patients was determined.

Current approach to the haemodynamic management of septic shock patients in European intensive care units: a cross-sectional, self-reported questionnaire-based survey

The aim of this survey was to investigate clinicians' current approach to the haemodynamic management and resuscitation endpoints in septic shock.

Role of selective V2-receptor-antagonism in septic shock: a randomized, controlled, experimental study

ABSTRACT : INTRODUCTION : V2-receptor (V2R) stimulation potentially aggravates sepsis-induced vasodilation, fluid accumulation and microvascular thrombosis. Therefore, the present study was performed to determine the effects of a first-line therapy with the selective V2R-antagonist (Propionyl1-D-Tyr(Et)2-Val4-Abu6-Arg8,9)-Vasopressin on cardiopulmonary hemodynamics and organ function vs. the mixed V1aR/V2R-agonist arginine vasopressin (AVP) or placebo in an established ovine model of septic shock. METHODS : After the onset of septic shock, chronically instrumented sheep were randomly assigned to receive first-line treatment with the selective V2R-antagonist (1 g/kg per hour), AVP (0.05 g/kg per hour), or normal saline (placebo, each n = 7). In all groups, open-label norepinephrine was additionally titrated up to 1 g/kg per minute to maintain mean arterial pressure at 70 ± 5 mmHg, if necessary. RESULTS : Compared to AVP- and placebo-treated animals, the selective V2R-antagonist stabilized cardiopulmonary hemodynamics (mean arterial and pulmonary artery pressure, cardiac index) as effectively and increased intravascular volume as suggested by higher cardiac filling pressures. Furthermore, left ventricular stroke work index was higher in the V2R-antagonist group than in the AVP group. Notably, metabolic (pH, base excess, lactate concentrations), liver (transaminases, bilirubin) and renal (creatinine and blood urea nitrogen plasma levels, urinary output, creatinine clearance) dysfunctions were attenuated by the V2R-antagonist when compared with AVP and placebo. The onset of septic shock was associated with an increase in AVP plasma levels as compared to baseline in all groups. Whereas AVP plasma levels remained constant in the placebo group, infusion of AVP increased AVP plasma levels up to 149 ± 21 pg/mL. Notably, treatment with the selective V2R-antagonist led to a significant decrease of AVP plasma levels as compared to shock time (P < 0.001) and to both other groups (P < 0.05 vs. placebo; P < 0.001 vs. AVP). Immunohistochemical analyses of lung tissue revealed higher hemeoxygenase-1 (vs. placebo) and lower 3-nitrotyrosine concentrations (vs. AVP) in the V2R-antagonist group. In addition, the selective V2R-antagonist slightly prolonged survival (14 ± 1 hour) when compared to AVP (11 ± 1 hour, P = 0.007) and placebo (11 ± 1 hour, P = 0.025). CONCLUSIONS : Selective V2R-antagonism may represent an innovative therapeutic approach to attenuate multiple organ dysfunction in early septic shock.

Early fish oil supplementation and organ failure in patients with septic shock from abdominal infections: a propensity-matched cohort study

Fish oil (FO) has immunomodulating effects and may improve organ function and outcome in critically ill patients. This retrospective, propensity-matched cohort study investigates the effects of early intravenous FO supplementation on organ failure in patients with septic shock from abdominal infection.

The association between body-mass index and patient outcome in septic shock: a retrospective cohort study

It is unknown whether body-mass index (BMI) and commonly defined BMI categories are associated with mortality in patients with septic shock.

The shock index and the simplified PESI for identification of low-risk patients with acute pulmonary embolism

We compared the test characteristics of the shock index (SI) and the simplified pulmonary embolism severity index (sPESI) for predicting 30-day outcomes in a cohort of 1,206 patients with objectively confirmed pulmonary embolism (PE). The primary outcome of the study was all-cause mortality. The secondary outcome was nonfatal symptomatic recurrent venous thromboembolism (VTE) or nonfatal major bleeding. Overall, 119 (9.9%) out of 1,206 patients died (95% CI 8.2-11.5%) during the first month of follow-up. The sPESI classified fewer patients as low-risk (369 (31%) out of 1,206 patients, 95% CI 28-33%) compared to the SI (1,024 (85%) out of 1,206 patients, 95% CI 83-87%) (p<0.001). Low-risk patients based on the sPESI had a lower 30-day mortality than those based on the SI (1.6% (95% CI 0.3-2.9%) versus 8.3% (95% CI 6.6-10.0%)), while the 30-day rate of nonfatal recurrent VTE or major bleeding was similar (2.2% (95%CI 0.7-3.6%) versus 3.3% (95%CI 2.2-4.4%)). The net reclassification improvement with the sPESI was 13.4% (p = 0.07). The integrated discrimination improvement was estimated as 1.8% (p<0.001). The sPESI quantified the prognosis of patients with PE better than the SI.

Concomitant arginine-vasopressin and hydrocortisone therapy in severe septic shock: association with mortality

To evaluate the association between concomitant arginine-vasopressin (AVP)/hydrocortisone therapy and mortality in severe septic shock patients.