908 resultados para Refractory septic shock
Resumo:
The propagation of ion acoustic shocks in nonthermal plasmas is investigated, both analytically and numerically. An unmagnetized collisionless electron-ion plasma is considered, featuring a superthermal (non-Maxwellian) electron distribution, which is modeled by a ?-(kappa) distribution function. Adopting a multiscale approach, it is shown that the dynamics of low-amplitude shocks is modeled by a hybrid Korteweg-de Vries-Burgers (KdVB) equation, in which the nonlinear and dispersion coefficients are functions of the ? parameter, while the dissipative coefficient is a linear function of the ion viscosity. All relevant shock parameters are shown to depend on ?: higher deviations from a pure Maxwellian behavior induce shocks which are narrower, faster, and of larger amplitude. The stability profile of the kink-shaped solutions of the KdVB equation against external perturbations is investigated. The spatial profile of the shocks is found to depend upon the dispersion and the dissipation term, and the role of the interplay between dispersion and dissipation is elucidated.
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The well-known shock solutions of the Korteweg-de Vries-Burgers equation are revisited, together with their limitations in the context of plasma (astro)physical applications. Although available in the literature for a long time, it seems to have been forgotten in recent papers that such shocks are monotonic and unique, for a given plasma configuration, and cannot show oscillatory or bell-shaped features. This uniqueness is contrasted to solitary wave solutions of the two parent equations (Korteweg-de Vries and Burgers), which form a family of curves parameterized by the excess velocity over the linear phase speed.
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Refractory asthma represents a significant unmet clinical need. Data from a national online registry audited clinical outcome in 349 adults with refractory asthma from four UK specialist centres in the British Thoracic Society Difficult Asthma Network. At follow-up, lung function improved, with a reduction in important healthcare outcomes, specifically hospital admission, unscheduled healthcare visits and rescue courses of oral steroids. The most frequent therapeutic intervention was maintenance oral corticosteroids and most steroid sparing agents (apart from omalizumab) demonstrated minimal steroid sparing benefit. A significant unmet clinical need remains in this group, specifically a requirement for therapies which reduce systemic steroid exposure.
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Some patients with coeliac disease, despite strict adherence to a gluten-free diet, continue to have significant symptoms and/or a severe small intestinal histological lesion. The term "refractory coeliac disease" (rCD) is used to describe this condition. The purpose of this study was to investigate the value of tissue molecular markers reported to help in the diagnosis of rCD.
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The purpose of this paper is to examine the consequences that medical practitioners’ decisions about whether or not to be candid about terminal prognosis have for those suffering from refractory cachexia and their families. It presents the findings of a qualitative study which used focus groups and semi-structured interviews of a volunteer sample of doctors, nurses and dieticians in a cancer centre of a large teaching hospital in Northern Ireland. Respondents reported that some physicians tended to avoid discussing terminal prognosis in a direct manner with their patients. Nurses and dieticians tended to be reluctant to engage in conversations about weight loss with patients with cachexia. One of the reasons they reported for their lack of acknowledgement of weight loss concerned the close association between refractory cachexia and terminal prognosis. Because they viewed the telling of bad news as an exclusive prerogative of medical practitioners, they did not feel in a position to discuss cachexia because they were concerned that this had the potential to raise end-of-life issues that lay outside the boundaries of their professional role. This meant patients and their families were provided with little information about how to cope with the distressing consequences of cachexia.
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Cells respond to different types of stress by inhibition of protein synthesis and subsequent assembly of stress granules (SGs), cytoplasmic aggregates that contain stalled translation preinitiation complexes. Global translation is regulated through the translation initiation factor eukaryotic initiation factor 2a (eIF2a) and the mTOR pathway. Here we identify cold shock as a novel trigger of SG assembly in yeast and mammals. Whereas cold shock-induced SGs take hours to form, they dissolve within minutes when cells are returned to optimal growth temperatures. Cold shock causes eIF2a phosphorylation through the kinase PERK in mammalian cells, yet this pathway is not alone responsible for translation arrest and SG formation. In addition, cold shock leads to reduced mitochondrial function, energy depletion, concomitant activation of AMP-activated protein kinase (AMPK), and inhibition of mTOR signaling. Compound C, a pharmacological inhibitor of AMPK, prevents the formation of SGs and strongly reduces cellular survival in a translation-dependent manner. Our results demonstrate that cells actively suppress protein synthesis by parallel pathways, which induce SG formation and ensure cellular survival during hypothermia.
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Chronic myelomonocytic leukemia is similar to but a separate entity from both myeloproliferative neoplasms and myelodysplastic syndromes, and shows either myeloproliferative or myelodysplastic features. We ask whether this distinction may have a molecular basis. We established the gene expression profiles of 39 samples of chronic myelomonocytic leukemia (including 12 CD34-positive) and 32 CD34-positive samples of myelodysplastic syndromes by using Affymetrix microarrays, and studied the status of 18 genes by Sanger sequencing and array-comparative genomic hybridization in 53 samples. Analysis of 12 mRNAS from chronic myelomonocytic leukemia established a gene expression signature of 122 probe sets differentially expressed between proliferative and dysplastic cases of chronic myelomonocytic leukemia. As compared to proliferative cases, dysplastic cases over-expressed genes involved in red blood cell biology. When applied to 32 myelodysplastic syndromes, this gene expression signature was able to discriminate refractory anemias with ring sideroblasts from refractory anemias with excess of blasts. By comparing mRNAS from these two forms of myelodysplastic syndromes we derived a second gene expression signature. This signature separated the myelodysplastic and myeloproliferative forms of chronic myelomonocytic leukemias. These results were validated using two independent gene expression data sets. We found that myelodysplastic chronic myelomonocytic leukemias are characterized by mutations in transcription/epigenetic regulators (ASXL1, RUNX1, TET2) and splicing genes (SRSF2) and the absence of mutations in signaling genes. Myelodysplastic chronic myelomonocytic leukemias and refractory anemias with ring sideroblasts share a common expression program suggesting they are part of a continuum, which is not totally explained by their similar but not, however, identical mutation spectrum. © 2013 Ferrata Storti Foundation.
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Nociception allows for immediate reflex withdrawal whereas pain allows for longer-term protection via rapid learning. We examine here whether shore crabs placed within a brightly lit chamber learn to avoid one of two dark shelters when that shelter consistently results in shock. Crabs were randomly selected to receive shock or not prior to making their first choice and were tested again over 10 trials. Those that received shock in trial 2, irrespective of shock in trial 1, were more likely to switch shelter choice in the next trial and thus showed rapid discrimination. During trial 1, many crabs emerged from the shock shelter and an increasing proportion emerged in later trials, thus avoiding shock by entering a normally avoided light area. In a final test we switched distinctive visual stimuli positioned above each shelter and/or changed the orientation of the crab when placed in the chamber for the test. The visual stimuli had no effect on choice, but crabs with altered orientation now selected the shock shelter, indicating that they had discriminated between the two shelters on the basis of movement direction. These data, and those of other recent experiments, are consistent with key criteria for pain experience and are broadly similar to those from vertebrate studies. © 2013. Published by The Company of Biologists Ltd.
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The standard model for the origin of galactic magnetic fields is through the amplification of seed fields via dynamo or turbulent processes to the level consistent with present observations. Although other mechanisms may also operate, currents from misaligned pressure and temperature gradients (the Biermann battery process) inevitably accompany the formation of galaxies in the absence of a primordial field. Driven by geometrical asymmetries in shocks associated with the collapse of protogalactic structures, the Biermann battery is believed to generate tiny seed fields to a level of about 10 gauss (refs 7, 8). With the advent of high-power laser systems in the past two decades, a new area of research has opened in which, using simple scaling relations, astrophysical environments can effectively be reproduced in the laboratory. Here we report the results of an experiment that produced seed magnetic fields by the Biermann battery effect. We show that these results can be scaled to the intergalactic medium, where turbulence, acting on timescales of around 700 million years, can amplify the seed fields sufficiently to affect galaxy evolution.
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We report on the temporally and spatially resolved detection of the precursory stages that lead to the formation of an unmagnetized, supercritical collisionless shock in a laser-driven laboratory experiment. The measured evolution of the electrostatic potential associated with the shock unveils the transition from a current free double layer into a symmetric shock structure, stabilized by ion reflection at the shock front. Supported by a matching particle-in-cell simulation and theoretical considerations, we suggest that this process is analogous to ion reflection at supercritical collisionless shocks in supernova remnants.
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The self-consistent interaction between energetic particles and self-generated hydromagnetic waves in a cosmic ray pressure dominated plasma is considered. Using a three-dimensional hybrid magnetohydrodynamics (MHD)-kinetic code, which utilizes a spherical harmonic expansion of the Vlasov-Fokker-Planck equation, high-resolution simulations of the magnetic field growth including feedback on the cosmic rays are carried out. It is found that for shocks with high cosmic ray acceleration efficiency, the magnetic fields become highly disorganized, resulting in near isotropic diffusion, independent of the initial orientation of the ambient magnetic field. The possibility of sub-Bohm diffusion is demonstrated for parallel shocks, while the diffusion coefficient approaches the Bohm limit from below for oblique shocks. This universal behaviour suggests that Bohm diffusion in the root-mean-squared field inferred from observation may provide a realistic estimate for the maximum energy acceleration time-scale in young supernova remnants. Although disordered, the magnetic field is not self-similar suggesting a non-uniform energy-dependent behaviour of the energetic particle transport in the precursor. Possible indirect radiative signatures of cosmic ray driven magnetic field amplification are discussed.
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The non-thermal particle spectra responsible for the emission from many astrophysical systems are thought to originate from shocks via a first order Fermi process otherwise known as diffusive shock acceleration. The same mechanism is also widely believed to be responsible for the production of high energy cosmic rays. With the growing interest in collisionless shock physics in laser produced plasmas, the possibility of reproducing and detecting shock acceleration in controlled laboratory experiments should be considered. The various experimental constraints that must be satisfied are reviewed. It is demonstrated that several currently operating laser facilities may fulfil the necessary criteria to confirm the occurrence of diffusive shock acceleration of electrons at laser produced shocks. Successful reproduction of Fermi acceleration in the laboratory could open a range of possibilities, providing insight into the complex plasma processes that occur near astrophysical sources of cosmic rays.