Digital ulcers predict a worse disease course in patients with systemic sclerosis

Objective: Systemic sclerosis (SSc) is a systemic autoimmune disease with high morbidity and significant mortality. There is a great need of predictors that would allow risk stratification of patients with SSc and ultimately initiation of treatment early enough to ensure optimal clinical results. In this study, we evaluated whether a history of digital ulcers (HDU) at presentation may be a predictor of vascular outcomes and of overall clinical worsening and death in patients with SSc. Methods: Patients from the EULAR Scleroderma Trials and Research (EUSTAR) database, satisfying at inclusion the 1980 American College of Rheumatology classification criteria for SSc, who had a follow-up of at least 3 years since baseline or who have died, were included in the analysis. HDU at presentation as a predictor of disease worsening or death was evaluated by Cox proportional hazards regression analysis. Results :3196 patients matched the inclusion criteria (male sex 13.2%, 33.4% diffuse subset). At presentation, 1092/3196 patients had an HDU (34.1%). In multivariable analysis adjusting for age, gender and all parameters considered potentially significant, HDU was predictive for the presence of active digital ulcers (DUs) at prospective visits (HR (95% CI)): 2.41(1.91 to 3.03), p<0.001, for an elevated systolic pulmonary arterial pressure on heart ultrasound (US-PAPs):1.36 (1.03 to 1.80), p=0.032, for any cardiovascular event (new DUs, elevated US-PAPs or LV failure):3.56 (2.26 to 5.62), p<0.001, and for death (1.53 (1.16 to 2.02), p=0.003). Conclusions :In patients with SSc, HDU at presentation predicts the occurrence of DUs at follow-up and is associated with cardiovascular worsening and decreased survival

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Space Technology for Reduction of Desert Areas on Earth and Weather Control

In precedent papers the authors presented the idea of a space system composed of two opposite parabolic mirrors (large and small) having the same focal point. This system is able to concentrate solar power in a strong light beam having irradiance of hundreds or thousands of times stronger than the solar irradiance on Earth's orbit. The system can be placed on a Sun synchronous orbit around the Earth or on the Earth’s orbit around the Sun at a distance of several hundred km from ground. When the concentrated light beam is directed toward the Earth surface it can locally melt, vaporize or decomposes tones of ground in its elements. This is happening because when the ground is hit by the light beam, ground temperature can reach thousands of degrees Celsius. At such temperatures the matter is decomposed into constitutive elements. For example, the silicate oxides which are frequently found in the composition of desert ground are decomposed into oxygen and silicon. Similarly, other oxides release oxygen and other type of oxides or constitutive elements. A network of deep and large channels can be dug in this way in hot deserts as Sahara. When these channels are connected with the seas & oceans, a network of water channels is created in those deserts. In this way, the local climate of deserts will change because channel water is vaporized during daytime when air temperature reaches 50ºC and condenses during nighttime when air temperature is around 0ºC. Presence of clouds over the hot deserts can lead to a reduction of ground temperature and rain follows. The channel water can be desalinized for producing drinking water and for irrigation using simple equipment. In addition to these advantages, channel deserts can be a solution for melting of polar ice calottes and flooding of seaside areas that are inhabited areas. On the other hand, the system composed of two opposite mirrors can be used for strength decreasing or deviation of hurricanes and tornados. The power of these meteorological phenomena increased in the last time due to global warming producing disasters of tens of billions of dollars. The hurricane is a thermal engine working in Carnot cycle. Due to this fact, although the difference between the cold source temperature (temperature of high atmosphere) and hot source temperature (temperature of ocean surface) is of only 100 °C, the thermal efficiency is ηt=0.333 leading to increasing of hurricane's total energy at extremely high levels. The cold source can be heated through vaporizing the system of clouds of hurricane formed in the high atmosphere by the concentrated light beam directed from space. In this way the energy of hurricane or tornado no longer increases and damages produced at ground level are limited. Another possibility is to vaporize locally the hurricane's eye-wall for its deviation far away of dense populated areas

Passenger Spaceplanes and Airplanes that Have Variable Configuration for Sonic Boom Reduction

In the last time, the interest for passenger space plane, supersonic passenger aircraft and supersonic business jets is increasing. For reducing sonic boom effects at ground level, some companies proposed airplanes having fuselage with small traversal section or having curved fuselage. This paper presents a new practical method for exciting vibrations in the leading edge of wing, tail and airplane's nose surfaces in order to scatter the shock wave and to reduce the sonic boom impact at ground level. The leading edges of wing, tail and airplane nose are covered with thin elastic fairings made of carbon fiber composite material which are separated through small gaps by the adjacent surfaces of wing, tail and nose. When the aircraft flies over populated areas, compressed air bleed from the engine compressors excites the vibration of carbon fiber fairings. The air is released through calibrated nozzles and directly impinges on the fairing surface generating their vibration. Thus, the shock waves are scattered and the impact of sonic boom on ground is much reduced

A Thermal-Solar System for De-Orbiting of Space Debris

This paper presents a system for removal of space debris, which can be placed on geocentric, heliocentric or Sun-synchronous orbit. The system is composed of two parabolic mirrors, a large one and a small one. The concave face of the large parabolic mirror is oriented toward the concave face of the small parabolic mirror. Sunlight is focused by the large parabolic mirror in its focal point. Then, the light rays are reflected by the small parabolic mirror (which has the same focal point as the large parabolic mirror) and form parallel rays directed along the axis. A guide-tube having a honeycomb structure plated with gold is attached to the convex side of the large parabolic mirror within a spherical articulation. Elastic lens filled with liquid are placed at the end of this guide tube. The guide-tube is normally closed by a gold platted shutter. When the shutter is opened, the light coming from Sun is focused by lens in one focal point onto target debris. The high power of focused light locally vaporizes/ionizes the debris material. The thrust created in this way de-orbits the space debris pushing it toward the Earth surface

ACCIDENT VASCULAR CEREBRAL ISCHEMIC LA UN COPIL CU CARDIOPATIE CONGENITALĂ CIANOGENĂ COMPLEXĂ

Accidentul vascular cerebral (AVC) este rar la copil comparativ cu adultul. Cauzele cele mai comune de AVC la copil sunt cardiopatiile emboligene pentru infarctul cerebral şi malformaţiile arteriovenoase pentru hemoragiile cerebrale, dar un număr de cazuri rămân idiopatice, fără a li se putea afi rma etiologia precisă. Autorii prezintă cazul unui copil diagnosticat în perioada de sugar cu malformaţie congenitală de cord cianogenă complexă, dar neoperată, internat cu semne clinice şi radiologice de pneumonie, care a evoluat favorabil sub tratament antibiotic şi simptomatic. În timpul perioadei rezolutive a pneumoniei, copilul devine brusc somnolent, prezentând hemiplegie dreaptă cu absenţa refl exelor de aceeaşi parte. Examenul clinic corelat cu CT cranio-cerebral au stabilit diagnosticul de AVC ischemic sylvian bilateral. Evoluţia a fost favorabilă sub tratament conservator (antiagregante plachetare, fi zioterapie), persistând însă hemiplegia dreaptă

Characterization of X3 Silicon Detectors for the ELISSA Array at ELI-NP

Position-sensitive silicon strip detectors represent one of the best solutions for the detection of charged particles as they provide good energy and position resolution over a large range of energies. A silicon array coupled with the gamma beams at the ELI-NP facility would allow measuring photodissociation reactions of interest for Big Bang Nucleosynthesis and on heavy nuclei intervening in the p-process. Forty X3 detectors for our ELISSA (ELI-NP Silicon Strip Detectors Array) project have been recently purchased and tested. We investigated several specifications, such as leakage currents, depletion voltage, and detector stability under vacuum. The energy and position resolution, and ballistic deficit were measured and analyzed. This paper presents the main results of our extensive testing. The measured energy resolution for the X3 detectors is better than results published for similar arrays (ANASEN or ORRUBA)