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The early evolution of a supernova (SN) can reveal information about the environment and the progenitor star. When a star explodes in vacuum, the first photons to escape from its surface appear as a brief, hours-long shock-breakout flare 1 , 2 , followed by a cooling phase of emission. However, for stars exploding within a distribution of dense, optically thick circumstellar material (CSM), the first photons escape from the material beyond the stellar edge and the duration of the initial flare can extend to several days, during which the escaping emission indicates photospheric heating 3 . Early serendipitous observations 2 , 4 that lacked ultraviolet (UV) data were unable to determine whether the early emission is heating or cooling and hence the nature of the early explosion event. Here we report UV spectra of the nearby SN 2023ixf in the galaxy Messier 101 (M101). Using the UV data as well as a comprehensive set of further multiwavelength observations, we temporally resolve the emergence of the explosion shock from a thick medium heated by the SN emission. We derive a reliable bolometric light curve that indicates that the shock breaks out from a dense layer with a radius substantially larger than typical supergiants. Using ultraviolet data as well as a comprehensive set of further multiwavelength observations of the supernova 2023ixf, a reliable bolometric light curve is derived that indicates the heating nature of the early emission.

Background/Objectives: Previous studies support the glucose-lowering effect of vinegar. However, the effect of vinegar on muscle glucose metabolism and endothelial function has not been studied in humans. This open, randomized, crossover, placebo-controlled study aims to investigate the effects of vinegar on muscle glucose metabolism, endothelial function and circulating lipid levels in subjects with impaired glucose tolerance (IGT) using the arteriovenous difference technique. Subjects/Methods: Eight subjects with IGT (4 males, age 46±10 years, body mass index 30±5) were randomised to consume 0.50 mmol vinegar (6% acetic acid) or placebo before a mixed meal. Plasma samples were taken for 300 min from the radial artery and the forearm vein for measurements of glucose, insulin, triglycerides, non-esterified fatty acids (NEFAs) and glycerol. Muscle blood flow was measured with strain gauge plethysmography. Glucose flux was calculated as the arteriovenous difference of glucose multiplied by the blood flow rates. Results: Vinegar compared with placebo: (1) decreased arterial plasma insulin ( P overall <0.001; P 75 min =0.014, β =−42), (2) increased forearm blood flow ( P overall <0.001; P 240 min =0.011, β =1.53; P 300 min =0.023, β =1.37), (3) increased muscle glucose uptake ( P overall <0.001; P 60 min =0.029, β =2.78) and (4) decreased arterial plasma triglycerides ( P overall =0.005; P 240 min <0.001, β =−344; P 300 min <0.001, β =−373), without changing NEFA and glycerol. Conclusions: In individuals with IGT, vinegar ingestion before a mixed meal results in an enhancement of muscle blood flow, an improvement of glucose uptake by the forearm muscle and a reduction of postprandial hyperinsulinaemia and hypertriglyceridaemia. From this point of view, vinegar may be considered beneficial for improving insulin resistance and metabolic abnormalities in the atherogenic prediabetic state.

Background/Objectives: The aim of the study was to compare the effect of two-meal patterns (three vs six meals per day) on glucose and insulin levels in women with polycystic ovary syndrome (PCOS). Subjects/Methods: In a randomised, crossover, 24-week study, 40 women with PCOS, aged 27±6 years, body mass index 27±6 kg/m 2 , followed a weight maintenance diet (% carbohydrates:protein:fat, 40:25:35), consumed either as a three- or a six-meal pattern, with each intervention lasting for 12 weeks. Anthropometric measurements, diet compliance and subjective hunger, satiety and desire to eat were assessed biweekly. All women underwent an oral glucose tolerance test (OGTT) with 75 g glucose for measurement of plasma glucose and insulin at the beginning and end of each intervention. HaemoglobinA1c (HbA1c), blood lipids and hepatic enzymes were measured at the beginning and end of each intervention. Results: Body weight remained stable throughout the study. Six meals decreased significantly fasting insulin ( P =0.014) and post-OGTT insulin sensitivity (Matsuda index, P =0.039) vs three meals. After incorporation of individual changes over time, with adjustment for potential confounders, the only variable that remained significant was the Matsuda index, which was then used in multivariate analysis and general linear models. Six meals improved post-OGTT insulin sensitivity independently of age and body weight vs three meals ( P =0.012). No significant differences were found between six and three meals for glucose, HbA1c, blood lipids, hepatic enzymes, subjective desire to eat and satiety. Conclusions: Six meals had a more favourable effect on post-OGTT insulin sensitivity in women with PCOS compared with isocaloric three meals.

Massive black holes (BHs) at the centres of massive galaxies are ubiquitous. The population of BHs within dwarf galaxies, on the other hand, is not yet known. Dwarf galaxies are thought to harbour BHs with proportionally small masses, including intermediate-mass BHs, with masses 10 2  <  M BH  < 10 6  solar masses ( M ⊙ ). Identification of these systems has historically relied on the detection of light emitted from accreting gaseous disks close to the BHs. Without this light, they are difficult to detect. Tidal disruption events, the luminous flares produced when a star strays close to a BH and is shredded, are a direct way to probe massive BHs. The rise times of these flares theoretically correlate with the BH mass. Here we present AT 2020neh, a fast-rising tidal disruption event candidate, hosted by a dwarf galaxy. AT 2020neh can be described by the tidal disruption of a main sequence star by a 10 4.7 –10 5.9   M ⊙ BH. We find the observable rate of fast-rising nuclear transients like AT 2020neh to be low, at ≲2 × 10 −8 events Mpc −3  yr −1 . Finding non-accreting BHs in dwarf galaxies is important to determine how prevalent BHs are within these galaxies, and to constrain models of BH formation. AT 2020neh-like events may provide a galaxy-independent method of measuring the masses of intermediate-mass BHs. The rapid rise in brightness of a tidal disruption event is attributed to the destruction of a main sequence star by a black hole of intermediate mass in a dwarf galaxy. Such events are rare, and non-accreting intermediate-mass black holes are challenging to find.

The purpose of this study is to assess lipid metabolism at the tissue level in critically ill subjects. We studied 182 patients with systemic inflammatory response syndrome/severe sepsis or shock during the acute (day 1) and subacute phase of critical illness (day 6). All subjects had a tissue microdialysis (MD) catheter placed in femoral adipose tissue upon admission to the intensive care unit (ICU). Plasma cholesterol, high-density lipoprotein, low-density lipoprotein, free fatty acids (FFAs), triglyceride, and MD glycerol (GLYC) were measured on days 1 and 6 in the ICU. On admission, 56% of the patients had increased levels (>200 μmol/L) of MD GLYC. Patients with shock displayed more pronounced subcutaneous tissue lipolysis and more profound derangements of circulating lipids vs patients without shock (but no appreciable differences in FFA levels). Furthermore, in patients with shock during the acute period, there were positive, albeit weak, correlations of subcutaneous tissue lipolysis (MD GLYC), plasma FFAs (r = 0.260; P = .01), and norepinephrine's dose (r = 0.230; P = .01), whereas during the subacute phase, MD GLY levels were higher in patients receiving glucocorticoids (344.7 ± 276.0 μmol/L vs 252.2 ± 158.4 μmol/L; P = .03). Subcutaneous tissue lipolysis is only one of the many determinants of plasma FFAs. Routinely applied therapeutic modalities in the ICU interfere with adipose tissue metabolism.

Type II supernovae are the final stage of massive stars (above 8  M ⊙ ) which retain part of their hydrogen-rich envelope at the moment of explosion. They typically eject up to 15 M ⊙ of material, with peak magnitudes of −17.5 mag and energies in the order of 10 51 erg, which can be explained by neutrino-driven explosions and neutron star formation. Here, we present our study of OGLE-2014-SN-073, one of the brightest type II supernovae ever discovered, with an unusually broad lightcurve combined with high ejecta velocities. From our hydrodynamical modelling, we infer a remarkable ejecta mass of 60 - 16 + 42 M ⊙ and a relatively high explosion energy of 12 .4 - 5 .9 + 13 .0 × 1 0 51 erg. We show that this object belongs, along with a very small number of other hydrogen-rich supernovae, to an energy regime that is not explained by standard core-collapse neutrino-driven explosions. We compare the quantities inferred by the hydrodynamical modelling with the expectations of various exploding scenarios and attempt to explain the high energy and luminosity released. We find some qualitative similarities with pair-instability supernovae, although the prompt injection of energy by a magnetar seems to be a viable alternative explanation for such an extreme event. The authors present a spectrophotometric and hydrodynamical study of supernova OGLE-2014-SN-073, which had remarkably high inferred ejecta mass and energy, potentially higher than can be explained with canonical core-collapse neutrino-driven explosions.

Purpose To assess the impact of hexaminolevulinate (HAL) on the long-term recurrence rate of NMIBC. Methods A total of 130 patients with bladder tumour were randomized into two groups. The patients in one group had a HAL instillation before surgery, and they first had a white-light and after that a blue-light cystoscopy (BL group) and resection. The second group had only white-light cystoscopy (WL group) and resection. They have been followed up with cystoscopy every 3 months for a period of up to 40 months. Results The recurrence-free period was not significantly different between the two groups (BL and WL groups) (long-rank test p  = 0.202). The use of HAL helped detect four flat lesions and 28 papillary lesions with cancer that would have been missed under WL only, on 16 out of the 54 patients (29.6 % CI 95 % 11.1–33.3). The use of HAL changed the proposed postoperative treatment and follow-up for one out of the five patients. Conclusions Although the use of HAL cystoscopy identified at least one cancer lesion more than WL cystoscopy on one out of the three patients, the recurrence-free period was not significantly different.

Abstract Objective To describe the development and demonstrate the use of a statistical framework based on statistical quality control (SQC) in order to monitor the performance of operating rooms (ORs). Design Data related to scheduled surgical operations have been collected from the information system of an existing Greek hospital. The data that contain the anesthesia and operation start and completion times of the operations carried out in the 14 ORs of the hospital are analyzed using control p-charts and hypotheses testing. The results obtained provide crucial information to health-care managers. Setting A large Greek public hospital. Participants Real-world data captured on daily basis from January 2015 to November 2017. Intervention The proportion of the idle time of an OR over its total available time is proposed as an OR key performance index. We present two directions of data monitoring and analysis: one that uses control p-charts and a second based on hypotheses testing. The improved Laney’s p΄-chart and the Laney’s approach for cross-sectional data are employed in order to overcome overdispersion that affects OR idle time data. Results The proposed methodology allows hospital management (i) to monitor the percentage of the idle time of an operating room through time and (ii) to identify the ORs that demonstrate exceptionally high or low percentage of idle time at a given period of time. Conclusion SQC charts are simple, yet powerful tools that may support the hospital management in monitoring OR performance and decision-making. The development of a dedicated management information system that automatically captures the required data and constructs the corresponding control charts would support effectively managerial decision-making.

Objectives To study the analgesic effect of electroacupuncture (EA) as perioperative adjunctive therapy added to a systemic analgesic strategy (including tramadol and ketamine) for postoperative pain, opioid-related side effects and patient satisfaction. Methods In a sham-controlled participant- and observer-blinded trial, 75 patients undergoing radical prostatectomy were randomly assigned to two groups: (1) EA (n=37; tramadol+ketamine+EA) and (2) control (n=38; tramadol+ketamine). EA (100 Hz frequency) was applied at LI4 bilaterally during the closure of the abdominal walls and EA (4 Hz) was applied at ST36 and LI4 bilaterally immediately after extubation. The control group had sham acupuncture without penetration or stimulation. The following outcomes were evaluated: postoperative pain using the Numerical Rating Scale (NRS) and McGill Scale (SF_MPQ), mechanical pain thresholds using algometer application close to the wound, cortisol measurements, rescue analgesia, Spielberger State Trait Anxiety Inventory (STAI Y-6 item), patient satisfaction and opioid side effects. Results Pain scores on the NRS and SF_MPQ were significantly lower and electronic pressure algometer measurements were significantly higher in the EA group than in the control group (p<0.001) at all assessments. In the EA group a significant decrease in rescue analgesia was observed at 45 min (p<0.001) and a significant decrease in cortisol levels was also observed (p<0.05). Patients expressed satisfaction with the analgesia, especially in the EA group (p<0.01). Significant delays in the start of bowel movements were observed in the control group at 45 min (p<0.001) and 2 h (p<0.05). Conclusions Adding EA perioperatively should be considered an option as part of a multimodal analgesic strategy.