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The evolution of massive stars is influenced by the mass lost to stellar winds over their lifetimes. These winds limit the masses of the stellar remnants (such as black holes) that the stars ultimately produce. We used radio astrometry to refine the distance to the black hole x-ray binary Cygnus X-1, which we found to be [Formula: see text] kiloparsecs. When combined with archival optical data, this implies a black hole mass of 21.2 ± 2.2 solar masses, which is higher than previous measurements. The formation of such a high-mass black hole in a high-metallicity system (within the Milky Way) constrains wind mass loss from massive stars., (Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

The 2017 Event Horizon Telescope (EHT) observations of the central source in M87 have led to the first measurement of the size of a black-hole shadow. This observation offers a new and clean gravitational test of the black-hole metric in the strong-field regime. We show analytically that spacetimes that deviate from the Kerr metric but satisfy weak-field tests can lead to large deviations in the predicted black-hole shadows that are inconsistent with even the current EHT measurements. We use numerical calculations of regular, parametric, non-Kerr metrics to identify the common characteristic among these different parametrizations that control the predicted shadow size. We show that the shadow-size measurements place significant constraints on deviation parameters that control the second post-Newtonian and higher orders of each metric and are, therefore, inaccessible to weak-field tests. The new constraints are complementary to those imposed by observations of gravitational waves from stellar-mass sources.

Phytobezoars are rare causes for intestinal obstruction. Therapy options include surgical removal, enzyme treatment, endoscopic removal and lyis with Coca-Cola ® . While there is ample literature about successful Coca-Cola ® -lysis, little is to be found concerning intestinal beozars. In our case, neither surgical nor endoscopic treatment of the intestinal obstruction was possible, which is why we opted for a Coca-Cola ® -lysis., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

This article reports the course of a complicated malaria in a 41-year-old male patient. After spending several months in Mali, the patient decompensated shortly after onset of the first symptoms. Under the signs of a multi-organ failure and with an initial parasitic load of 25%, the patient developed a microcirculation disturbance in the acra. In addition to sepsis-induced disseminated microthrombosis, high-dose catecholamine treatment contributes to the genesis of this disease with a high clinical probability. To improve the peripheral blood circulation, intravenous treatment with the synthetic prostaglandin E1 (PGE1) alprostadil with 20 μg (1-0-1) was carried out over a period of 21 days. Relevant circulatory depression as a side effect did not occur. The microcirculatory disturbances were no longer evident and the necrosis healed. Furthermore, the clearance course of the plasmodia was delayed under artemisinin-based combination therapy. Prolonged hemolysis required multiple transfusions.

Powerful relativistic jets are one of the main ways in which accreting black holes provide kinetic feedback to their surroundings. Jets launched from or redirected by the accretion flow that powers them are expected to be affected by the dynamics of the flow, which for accreting stellar-mass black holes has shown evidence for precession 1 due to frame-dragging effects that occur when the black-hole spin axis is misaligned with the orbital plane of its companion star 2 . Recently, theoretical simulations have suggested that the jets can exert an additional torque on the accretion flow 3 , although the interplay between the dynamics of the accretion flow and the launching of the jets is not yet understood. Here we report a rapidly changing jet orientation-on a time scale of minutes to hours-in the black-hole X-ray binary V404 Cygni, detected with very-long-baseline interferometry during the peak of its 2015 outburst. We show that this changing jet orientation can be modelled as the Lense-Thirring precession of a vertically extended slim disk that arises from the super-Eddington accretion rate 4 . Our findings suggest that the dynamics of the precessing inner accretion disk could play a role in either directly launching or redirecting the jets within the inner few hundred gravitational radii. Similar dynamics should be expected in any strongly accreting black hole whose spin is misaligned with the inflowing gas, both affecting the observational characteristics of the jets and distributing the black-hole feedback more uniformly over the surrounding environment 5,6 .

Emission from Saggitarius A* is highly variable at both X-ray and infrared (IR) wavelengths. Observations over the last ~20 yr have revealed X-ray flares that rise above a quiescent thermal background about once per day, while faint X-ray flares from Sgr A* are undetectable below the constant thermal emission. In contrast, the IR emission of Sgr A* is observed to be continuously variable. Recently, simultaneous observations have indicated a rise in IR flux density around the same time as every distinct X-ray flare, while the opposite is not always true (peaks in the IR emission may not be coincident with an X-ray flare). Characterizing the behavior of these simultaneous X-ray/IR events and measuring any time lag between them can constrain models of Sgr A*'s accretion flow and the flare emission mechanism. Using 100+ hours of data from a coordinated campaign between the Spitzer Space Telescope and the Chandra X-ray Observatory , we present results of the longest simultaneous IR and X-ray observations of Sgr A* taken to date. The cross-correlation between the IR and X-ray light curves in this unprecedented data set, which includes four modest X-ray/IR flares, indicates that flaring in the X-ray may lead the IR by approximately 10-20 min with 68% confidence. However, the 99.7% confidence interval on the time-lag also includes zero, i.e., the flaring remains statistically consistent with simultaneity. Long-duration and simultaneous multi-wavelength observations of additional bright flares will improve our ability to constrain the flare timing characteristics and emission mechanisms, and must be a priority for Galactic Center observing campaigns.

We model the accretion of gas onto a population of massive primordial black holes in the Milky Way and compare the predicted radio and x-ray emission with observational data. We show that, under conservative assumptions on the accretion process, the possibility that O(10)M_{⊙} primordial black holes can account for all of the dark matter in the Milky Way is excluded at 5σ by a comparison with a Very Large Array radio catalog at 1.4 GHz and at ≃40σ by a comparison with a Chandra x-ray catalog (0.5-8 keV). We argue that this method can be used to identify such a population of primordial black holes with more sensitive future radio and x-ray surveys.

The eclipses of certain types of binary millisecond pulsars (i.e. 'black widows' and 'redbacks') are often studied using high-time-resolution, 'beamformed' radio observations. However, they may also be detected in images generated from interferometric data. As part of a larger imaging project to characterize the variable and transient sky at radio frequencies <200 MHz, we have blindly detected the redback system PSR J2215+5135 as a variable source of interest with the Low-Frequency Array (LOFAR). Using observations with cadences of two weeks - six months, we find preliminary evidence that the eclipse duration is frequency dependent (∝ν -0.4 ), such that the pulsar is eclipsed for longer at lower frequencies, in broad agreement with beamformed studies of other similar sources. Furthermore, the detection of the eclipses in imaging data suggests an eclipsing medium that absorbs the pulsed emission, rather than scattering it. Our study is also a demonstration of the prospects of finding pulsars in wide-field imaging surveys with the current generation of low-frequency radio telescopes.

Cosmic rays are the highest-energy particles found in nature. Measurements of the mass composition of cosmic rays with energies of 10(17)-10(18) electronvolts are essential to understanding whether they have galactic or extragalactic sources. It has also been proposed that the astrophysical neutrino signal comes from accelerators capable of producing cosmic rays of these energies. Cosmic rays initiate air showers--cascades of secondary particles in the atmosphere-and their masses can be inferred from measurements of the atmospheric depth of the shower maximum (Xmax; the depth of the air shower when it contains the most particles) or of the composition of shower particles reaching the ground. Current measurements have either high uncertainty, or a low duty cycle and a high energy threshold. Radio detection of cosmic rays is a rapidly developing technique for determining Xmax (refs 10, 11) with a duty cycle of, in principle, nearly 100 per cent. The radiation is generated by the separation of relativistic electrons and positrons in the geomagnetic field and a negative charge excess in the shower front. Here we report radio measurements of Xmax with a mean uncertainty of 16 grams per square centimetre for air showers initiated by cosmic rays with energies of 10(17)-10(17.5) electronvolts. This high resolution in Xmax enables us to determine the mass spectrum of the cosmic rays: we find a mixed composition, with a light-mass fraction (protons and helium nuclei) of about 80 per cent. Unless, contrary to current expectations, the extragalactic component of cosmic rays contributes substantially to the total flux below 10(17.5) electronvolts, our measurements indicate the existence of an additional galactic component, to account for the light composition that we measured in the 10(17)-10(17.5) electronvolt range.

Most supermassive black holes (SMBHs) are accreting at very low levels and are difficult to distinguish from the galaxy centers where they reside. Our own Galaxy's SMBH provides an instructive exception, and we present a close-up view of its quiescent x-ray emission based on 3 megaseconds of Chandra observations. Although the x-ray emission is elongated and aligns well with a surrounding disk of massive stars, we can rule out a concentration of low-mass coronally active stars as the origin of the emission on the basis of the lack of predicted iron (Fe) Kα emission. The extremely weak hydrogen (H)-like Fe Kα line further suggests the presence of an outflow from the accretion flow onto the SMBH. These results provide important constraints for models of the prevalent radiatively inefficient accretion state.

Background: Celiac disease (CD) is under-diagnosed in the United States, and factors related to the performance of endoscopy may be contributory., Aim: To identify newly diagnosed patients with CD who had undergone a prior esophagogastroduodenoscopy (EGD) and examine factors contributing to the missed diagnosis., Methods: We identified all patients age ≥ 18 years whose diagnosis of CD was made by endoscopy with biopsy at our institution (n = 316), and searched the medical record for a prior EGD. We compared those patients with a prior EGD to those with without a prior EGD with regard to age at diagnosis and gender, and enumerated the indications for EGD., Results: Of the 316 patients diagnosed by EGD with biopsy at our center, 17 (5 %) had previously undergone EGD. During the prior non-diagnostic EGD, a duodenal biopsy was not performed in 59 % of the patients, and ≥ 4 specimens (the recommended number) were submitted in only 29 % of the patients. On the diagnostic EGD, ≥ 4 specimens were submitted in 94 %. The mean age of diagnosis of those with missed/incident CD was 53.1 years, slightly older than those diagnosed with CD on their first EGD (46.8 years, p = 0.11). Both groups were predominantly female (missed/incident CD: 65 vs. 66 %, p = 0.94)., Conclusions: Among 17 CD patients who had previously undergone a non-diagnostic EGD, non-performance of duodenal biopsy during the prior EGD was the dominant feature. Routine performance of duodenal biopsy during EGD for the indications of dyspepsia and reflux may improve CD diagnosis rates.

Pulsars emit from low-frequency radio waves up to high-energy gamma-rays, generated anywhere from the stellar surface out to the edge of the magnetosphere. Detecting correlated mode changes across the electromagnetic spectrum is therefore key to understanding the physical relationship among the emission sites. Through simultaneous observations, we detected synchronous switching in the radio and x-ray emission properties of PSR B0943+10. When the pulsar is in a sustained radio-"bright" mode, the x-rays show only an unpulsed, nonthermal component. Conversely, when the pulsar is in a radio-"quiet" mode, the x-ray luminosity more than doubles and a 100% pulsed thermal component is observed along with the nonthermal component. This indicates rapid, global changes to the conditions in the magnetosphere, which challenge all proposed pulsar emission theories.

A subset of ultraluminous X-ray sources (those with luminosities of less than 10(40) erg s(-1); ref. 1) are thought to be powered by the accretion of gas onto black holes with masses of ∼5-20M cicled dot, probably by means of an accretion disk. The X-ray and radio emission are coupled in such Galactic sources; the radio emission originates in a relativistic jet thought to be launched from the innermost regions near the black hole, with the most powerful emission occurring when the rate of infalling matter approaches a theoretical maximum (the Eddington limit). Only four such maximal sources are known in the Milky Way, and the absorption of soft X-rays in the interstellar medium hinders the determination of the causal sequence of events that leads to the ejection of the jet. Here we report radio and X-ray observations of a bright new X-ray source in the nearby galaxy M 31, whose peak luminosity exceeded 10(39) erg s(-1). The radio luminosity is extremely high and shows variability on a timescale of tens of minutes, arguing that the source is highly compact and powered by accretion close to the Eddington limit onto a black hole of stellar mass. Continued radio and X-ray monitoring of such sources should reveal the causal relationship between the accretion flow and the powerful jet emission.

Before the launch of Chandra, our Galactic Center supermassive black hole, Sgr A*, had never been positively identified outside the radio bands. A great deal has changed in the past decade, starting with the discovery that our own backyard harbors a very weak, yet clearly active, galactic nucleus. I will review how this revelation has been a boon for accretion studies around black holes in general and has helped us place our own Galaxy in context within the active galactic nuclei (AGN) zoology. Chandra's exquisite resolution has also unveiled entirely new populations of faint sources and transients, as well as regions of extreme gas dynamics and hints of prior, more typical AGN-like activity in our Galactic Center.

Magnetars are young neutron stars with very strong magnetic fields of the order of 10(14)-10(15) G. They are detected in our Galaxy either as soft gamma-ray repeaters or anomalous X-ray pulsars. Soft gamma-ray repeaters are a rare type of gamma-ray transient sources that are occasionally detected as bursters in the high-energy sky. No optical counterpart to the gamma-ray flares or the quiescent source has yet been identified. Here we report multi-wavelength observations of a puzzling source, SWIFT J195509+261406. We detected more than 40 flaring episodes in the optical band over a time span of three days, and a faint infrared flare 11 days later, after which the source returned to quiescence. Our radio observations confirm a Galactic nature and establish a lower distance limit of approximately 3.7 kpc. We suggest that SWIFT J195509+261406 could be an isolated magnetar whose bursting activity has been detected at optical wavelengths, and for which the long-term X-ray emission is short-lived. In this case, a new manifestation of magnetar activity has been recorded and we can consider SWIFT J195509+261406 to be a link between the 'persistent' soft gamma-ray repeaters/anomalous X-ray pulsars and dim isolated neutron stars.