Management in non-traumatic arm, neck and shoulder complaints: differences between diagnostic groups

Arm, neck and/or shoulder complaints are common in western societies. In the Netherlands, general practice guidelines are issued on shoulder pain and epicondylitis only. Little is known about actual management of the total range of diagnoses. The objectives of the study are: to determine management in patients consulting the GP with a new episode of non-traumatic arm neck and shoulder complaints up to 6 months after the first consultation. To evaluate differences in management between patients with specific diagnoses versus non-specific diagnoses and between specific diagnostic groups. In a prospective cohort study in general practice. We recruited 682 eligible patients. Data on diagnosis, management, patient- and complaint-characteristics were collected. Co-occurrence of treatment options was presented in scaled rectangles. After 6 months, additional diagnostic tests had been performed in 18% of the patients, mainly radiographic examination (14%). Further, 49% had been referred for physiotherapy and 12% to the medical specialist. Patients with specific diagnoses were more frequently referred for specialist treatment, and patients with non-specific diagnoses for physiotherapy. Corticosteroid injections (17%) were mainly applied specific diagnoses (e.g. impingement syndrome, frozen shoulder, carpal tunnel and M. Quervain). Frequencies of prescribed medication (51%) did not differ between specific and non-specific

Core fragmentation and Toomre stability analysis of W3(H2O): A case study of the IRAM NOEMA large program CORE

The fragmentation mode of high-mass molecular clumps and the properties of the central rotating structures surrounding the most luminous objects have yet to be comprehensively characterised. Using the IRAM NOrthern Extended Millimeter Array (NOEMA) and the IRAM 30-m telescope, the CORE survey has obtained high-resolution observations of 20 well-known highly luminous star-forming regions in the 1.37 mm wavelength regime in both line and dust continuum emission. We present the spectral line setup of the CORE survey and a case study for W3(H2O). At ~0.35" (700 AU at 2 kpc) resolution, the W3(H2O) clump fragments into two cores (West and East), separated by ~2300 AU. Velocity shifts of a few km/s are observed in the dense-gas tracer, CH3CN, across both cores, consistent with rotation and perpendicular to the directions of two bipolar outflows, one emanating from each core. The kinematics of the rotating structure about W3(H2O) W shows signs of differential rotation of material, possibly in a disk-like object. The observed rotational signature around W3(H2O) E may be due to a disk-like object, an unresolved binary (or multiple) system, or a combination of both. We fit the emission of CH3CN (12-11) K = 4-6 and derive a gas temperature map with a median temperature of ~165 K across W3(H2O). We create a Toomre Q map to study the stability of the rotating structures against gravitational instability. The rotating structures appear to be Toomre unstable close to their outer boundaries, with a possibility of further fragmentation in the differentially-rotating core W3(H2O) W. Rapid cooling in the Toomre-unstable regions supports the fragmentation scenario. Combining millimeter dust continuum and spectral line data toward the famous high-mass star-forming region W3(H2O), we identify core fragmentation on large scales, and indications for possible disk fragmentation on smaller spatial scales

Fragmentation and disk formation during high-mass star formation: The IRAM NOEMA (Northern Extended Millimeter Array) large program CORE

Aims: We aim to understand the fragmentation as well as the disk formation, outflow generation and chemical processes during high-mass star formation on spatial scales of individual cores. Methods: Using the IRAM Northern Extended Millimeter Array (NOEMA) in combination with the 30m telescope, we have observed in the IRAM large program CORE the 1.37mm continuum and spectral line emission at high angular resolution (~0.4'') for a sample of 20 well-known high-mass star-forming regions with distances below 5.5kpc and luminosities larger than 10^4Lsun. Results: We present the overall survey scope, the selected sample, the observational setup and the main goals of CORE. Scientifically, we concentrate on the mm continuum emission on scales on the order of 1000AU. We detect strong mm continuum emission from all regions, mostly due to the emission from cold dust. The fragmentation properties of the sample are diverse. We see extremes where some regions are dominated by a single high-mass core whereas others fragment into as many as 20 cores. A minimum-spanning-tree analysis finds fragmentation at scales on the order of the thermal Jeans length or smaller suggesting that turbulent fragmentation is less important than thermal gravitational fragmentation. The diversity of highly fragmented versus singular regions can be explained by varying initial density structures and/or different initial magnetic field strengths. Conclusions: The smallest observed separations between cores are found around the angular resolution limit which indicates that further fragmentation likely takes place on even smaller spatial scales. The CORE project with its numerous spectral line detections will address a diverse set of important physical and chemical questions in the field of high-mass star formation

Theory of disk accretion onto supermassive black holes

Accretion onto supermassive black holes produces both the dramatic phenomena associated with active galactic nuclei and the underwhelming displays seen in the Galactic Center and most other nearby galaxies. I review selected aspects of the current theoretical understanding of black hole accretion, emphasizing the role of magnetohydrodynamic turbulence and gravitational instabilities in driving the actual accretion and the importance of the efficacy of cooling in determining the structure and observational appearance of the accretion flow. Ongoing investigations into the dynamics of the plunging region, the origin of variability in the accretion process, and the evolution of warped, twisted, or eccentric disks are summarized.Comment: Mostly introductory review, to appear in "Supermassive black holes in the distant Universe", ed. A.J. Barger, Kluwer Academic Publishers, in pres

Withaferin a-induced apoptosis in human breast cancer cells is mediated by reactive oxygen species

Withaferin A (WA), a promising anticancer constituent of Ayurvedic medicinal plant Withania somnifera, inhibits growth of MDA-MB-231 and MCF-7 human breast cancer cells in culture and MDA-MB-231 xenografts in vivo in association with apoptosis induction, but the mechanism of cell death is not fully understood. We now demonstrate, for the first time, that WA-induced apoptosis is mediated by reactive oxygen species (ROS) production due to inhibition of mitochondrial respiration. WA treatment caused ROS production in MDA-MB-231 and MCF-7 cells, but not in a normal human mammary epithelial cell line (HMEC). The HMEC was also resistant to WA-induced apoptosis. WA-mediated ROS production as well as apoptotic histone-associated DNA fragment release into the cytosol was significantly attenuated by ectopic expression of Cu,Zn-superoxide dismutase in both MDA-MB-231 and MCF-7 cells. ROS production resulting from WA exposure was accompanied by inhibition of oxidative phosphorylation and inhibition of complex III activity. Mitochondrial DNA-deficient Rho-0 variants of MDA-MB-231 and MCF-7 cells were resistant to WA-induced ROS production, collapse of mitochondrial membrane potential, and apoptosis compared with respective wild-type cells. WA treatment resulted in activation of Bax and Bak in MDA-MB-231 and MCF-7 cells, and SV40 immortalized embryonic fibroblasts derived from Bax and Bak double knockout mouse were significantly more resistant to WA-induced apoptosis compared with fibroblasts derived from wild-type mouse. In conclusion, the present study provides novel insight into the molecular circuitry of WA-induced apoptosis involving ROS production and activation of Bax/Bak. © 2011 Hahm et al