Pulmonary arterial hypertension: the burden of disease and impact on quality of life.

Pulmonary arterial hypertension (PAH) is a debilitating disease that pervades all aspects of a patients daily life. It is also increasingly acknowledged that the burden of PAH extends to older patients and carers. Until recently, the adverse effect of disease symptoms on the physical, emotional and social factors governing patient health-related quality of life (HRQoL) remained largely unrecognised. With a shift in therapeutic objectives to longer term improvements and HRQoL benefits, clinical trials now frequently include HRQoL measures as study end-points. Most HRQoL instruments used in patients with PAH are generic or non-disease-specific questionnaires and therefore may not accurately capture PAH disease burden. New PAH-specific HRQoL instruments currently undergoing validation include emPHasis-10 and Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT; Actelion Pharmaceuticals Ltd, Allschwil, Switzerland). Using various HRQoL measures, pharmacological therapies have been shown to improve HRQoL in patients with PAH. Patients also derive HRQoL benefits from nonpharmacological strategies, which include the emotional support provided by multidisciplinary care and support groups that is fundamental to patient wellbeing. Looking to the future, validated PAH-specific HRQoL instruments together with dedicated guidelines and procedures are essential to support the translation of HRQoL scores to the clinic, thus enabling a holistic treatment approach to the management of patients with PAH

The little finger ulnar palmar digital artery perforator flap: anatomical basis

PURPOSE: The aim of this study was to explore the cutaneous vascularization of the hypothenar region and investigate the anatomical basis for perforator propeller flaps for coverage of the flexor aspect of the little finger. METHODS: The area between the pisiform and the base of the little finger was studied in 14 hands of fresh cadavers injected with red latex. An oval flap 1.5 cm large was raised along the axis between these two points. Perforators going into the flap were dissected up to their origin from the ulnar palmar digital artery of the little finger, and their distance from the proximal edge of the A1 pulley was recorded. RESULTS: The mean number of perforator arteries entering the flap was 5.8 (range 4-8). A constant sizeable perforator was identified within 0.7 cm from the proximal margin of the A1 pulley in all 14 specimens. In the majority of cases (64 %), the most distal perforator was located at this level. Dissection of the flap was carried out suprafascially on the most distal perforator and 180° rotation allowed the flap to reach the flexor surface of the fifth finger. The donor site was closed primarily. CONCLUSION: Distal perforators of the ulnar palmar digital artery of the little finger are constantly found. Our anatomical findings support the possibility of raising a propeller perforator flap from the hypothenar region for coverage of the flexor aspect of the little finger. Its clinical application could provide a quick and straightforward single-stage option with a negligible donor-site morbidity for reconstruction of such defects

Dihydroxyacetone conversion into lactic acid in an aqueous medium in the presence of metal salts: influence of the ionic thermodynamic equilibrium on the reaction performance

International audienceThe catalytic conversion of dihydroxyacetone (DHA) to lactic acid (LA) via pyruvaldehyde (PA) in aqueous media was studied using different homogeneous metal salts. A kinetic model was developed and the parameters corresponding to each reaction steps were estimated. Agreement between experiments and simulated results was excellent and the performance of the different catalysts was consistent with previous studies described in the literature. Aluminium salts, which show the best performance, were tested in a whole range of concentrations and at different pH, in order to identify the catalytically active ionic species. It was confirmed that the DHA to pyruvaldehyde (PA) dehydration step is catalyzed by both Brønsted and Lewis acids whereas the consecutive reaction of PA to LA is solely catalyzed by Lewis acids. Moreover, comparing thermodynamic analysis of the reaction media and kinetic parameters demonstrated that cationic hydroxyl-aluminium complexes [Al(OH)h] (3-h)+ formed in situ by the hydrolysis of the aluminium aqua complexes like [Al(OH2)6] 3+ are the most active Lewis acids

Generalized Fourier Integral Operators on spaces of Colombeau type

Generalized Fourier integral operators (FIOs) acting on Colombeau algebras are defined. This is based on a theory of generalized oscillatory integrals (OIs) whose phase functions as well as amplitudes may be generalized functions of Colombeau type. The mapping properties of these FIOs are studied as the composition with a generalized pseudodifferential operator. Finally, the microlocal Colombeau regularity for OIs and the influence of the FIO action on generalized wave front sets are investigated. This theory of generalized FIOs is motivated by the need of a general framework for partial differential operators with non-smooth coefficients and distributional data

Isomorphisms of algebras of Colombeau generalized functions

We show that for smooth manifolds X and Y, any isomorphism between the special algebra of Colombeau generalized functions on X, resp. Y is given by composition with a unique Colombeau generalized function from Y to X. We also identify the multiplicative linear functionals from the special algebra of Colombeau generalized functions on X to the ring of Colombeau generalized numbers. Up to multiplication with an idempotent generalized number, they are given by an evaluation map at a compactly supported generalized point on X.Comment: 10 page

A complex storm system in Saturn’s north polar atmosphere in 2018

Producción CientíficaSaturn’s convective storms usually fall in two categories. One consists of mid-sized storms ∼2,000 km wide, appearing as irregular bright cloud systems that evolve rapidly, on scales of a few days. The other includes the Great White Spots, planetary-scale giant storms ten times larger than the mid-sized ones, which disturb a full latitude band, enduring several months, and have been observed only seven times since 1876. Here we report a new intermediate type, observed in 2018 in the north polar region. Four large storms with east–west lengths ∼4,000–8,000 km (the first one lasting longer than 200 days) formed sequentially in close latitudes, experiencing mutual encounters and leading to zonal disturbances affecting a full latitude band ∼8,000 km wide, during at least eight months. Dynamical simulations indicate that each storm required energies around ten times larger than mid-sized storms but ∼100 times smaller than those necessary for a Great White Spot. This event occurred at about the same latitude and season as the Great White Spot in 1960, in close correspondence with the cycle of approximately 60 years hypothesized for equatorial Great White Spots.Ministerio de Economía, Industria y Competitividad - Fondo Europeo de Desarrollo Regional (project AYA2015-65041-P)Gobierno Vasco (project IT-366-19