Quality of life as a prognostic marker in pulmonary arterial hypertension

Background: Improvement in quality of life together with better survival are the ultimate goals in the treatment of pulmonary arterial hypertension (PAH) patients. the objective of this study was to evaluate the health-related quality of life (HRQL) of pulmonary arterial hypertension (PAH) patients with the SF-36 generic questionnaire and to identify the prognostic implication of this assessment.Methods: Fifty-four consecutive newly diagnosed PAH patients (WHO classification group I) in a single PAH reference center were included. Patients were evaluated at baseline for clinical and hemodynamic parameters, and they subsequently received first-line therapy with either an endothelin receptor antagonist or a phosphodiesterase-5 inhibitor. After 16 weeks of specific PAH therapy, all patients were re-evaluated using a 6MWT and a SF 36 questionnaire, and then they were followed up for at least 36 months.Results: After treatment, the patients demonstrated an improved 6MWT (414 +/- 124 m vs. 440 +/- 113 m, p = 0.001). Specific PAH therapy also improved the HRQL scores.Patients with a baseline Physical Component Score (PCS) higher than 32 had a better survival rate than those who had a score under 32 (p = 0.04). Similarly, patients with a PCS of at least a 38 after the 16 week therapy period had a better survival rate when compared with those who did not achieve this value (p = 0.016). Unlike the absolute PCS values, the post-treatment PCS variability was unable to predict better survival rates (p = 0.58).Conclusions: Our findings suggest that HRQL is associated with prognosis in PAH. Furthermore, achieving pre-determined PCS scores might represent a specific goal to be reached in treatment-to-target strategies.Univ São Paulo, Sch Med, Pulm Dept, Inst Heart, BR-05403000 São Paulo, BrazilUniversidade Federal de São Paulo, Rheumatol Dept, São Paulo, BrazilUniversidade Federal de São Paulo, Rheumatol Dept, São Paulo, BrazilWeb of Scienc

New Young Star Candidates in CG4 and Sa101

The CG4 and Sa101 regions together cover a region of ~0.5 square degree in the vicinity of a "cometary globule" that is part of the Gum Nebula. There are seven previously identified young stars in this region; we have searched for new young stars using mid- and far-infrared data (3.6 to 70 microns) from the Spitzer Space Telescope, combined with ground-based optical data and near-infrared data from the Two-Micron All-Sky Survey (2MASS). We find infrared excesses in all 6 of the previously identified young stars in our maps, and we identify 16 more candidate young stars based on apparent infrared excesses. Most (73%) of the new young stars are Class II objects. There is a tighter grouping of young stars and young star candidates in the Sa101 region, in contrast to the CG4 region, where there are fewer young stars and young star candidates, and they are more dispersed. Few likely young objects are found in the "fingers" of the dust being disturbed by the ionization front from the heart of the Gum Nebula.Comment: Accepted for publication in A

The central engine of GRB 130831A and the energy breakdown of a relativistic explosion

Gamma-ray bursts (GRBs) are the most luminous explosions in the universe, yet the nature and physical properties of their energy sources are far from understood. Very important clues, however, can be inferred by studying the afterglows of these events. We present optical and X-ray observations of GRB 130831A obtained by Swift, Chandra, Skynet, RATIR, Maidanak, ISON, NOT, LT and GTC. This burst shows a steep drop in the X-ray light-curve at $\simeq 10^5$ s after the trigger, with a power-law decay index of $\alpha \sim 6$. Such a rare behaviour cannot be explained by the standard forward shock (FS) model and indicates that the emission, up to the fast decay at $10^5$ s, must be of "internal origin", produced by a dissipation process within an ultrarelativistic outflow. We propose that the source of such an outflow, which must produce the X-ray flux for $\simeq 1$ day in the cosmological rest frame, is a newly born magnetar or black hole. After the drop, the faint X-ray afterglow continues with a much shallower decay. The optical emission, on the other hand, shows no break across the X-ray steep decrease, and the late-time decays of both the X-ray and optical are consistent. Using both the X-ray and optical data, we show that the emission after $\simeq 10^5$ s can be explained well by the FS model. We model our data to derive the kinetic energy of the ejecta and thus measure the efficiency of the central engine of a GRB with emission of internal origin visible for a long time. Furthermore, we break down the energy budget of this GRB into the prompt emission, the late internal dissipation, the kinetic energy of the relativistic ejecta, and compare it with the energy of the associated supernova, SN 2013fu.Comment: Accepted for publication by MNRAS. 21 pages, 3 figures, 8 tables. Extra table with magnitudes in the sourc

Polarization and spectral energy distribution in OJ 287 during the 2016/17 outbursts

We report optical photometric and polarimetric observations of the blazar OJ 287 gathered during 2016/17. The high level of activity, noticed after the General Relativity Centenary flare, is argued to be part of the follow-up flares that exhibited high levels of polarization and originated in the primary black hole jet. We propose that the follow-up flares were induced as a result of accretion disk perturbations, travelling from the site of impact towards the primary SMBH. The timings inferred from our observations allowed us to estimate the propagation speed of these perturbations. Additionally, we make predictions for the future brightness of OJ 287. © 2017 by the authors

Polarization and spectral energy distribution in OJ 287 during the 2016/17 outbursts

© 2017 by the authors. We report optical photometric and polarimetric observations of the blazar OJ 287 gathered during 2016/17. The high level of activity, noticed after the General Relativity Centenary flare, is argued to be part of the follow-up flares that exhibited high levels of polarization and originated in the primary black hole jet. We propose that the follow-up flares were induced as a result of accretion disk perturbations, travelling from the site of impact towards the primary SMBH. The timings inferred from our observations allowed us to estimate the propagation speed of these perturbations. Additionally, we make predictions for the future brightness of OJ 287

GRB 130831a: Rise and demise of a magnetar at z = 0.5

Gamma-ray bursts (GRBs) are the brightest explosions in the universe, yet the properties of their energy sources are far from understood. Very important clues, however, can be deduced by studying the afterglows of these events. We present observations of GRB 130831A and its afterglow obtained with Swift, Chandra, and multiple ground-based observatories. This burst shows an uncommon drop in the X-ray light curve at about 100 ks after the trigger, with a decay slope of α 7. The standard Forward Shock (FS) model offers no explanation for such a behaviour. Instead, a model in which a newly born magnetar outflow powers the early X-ray emission is found to be viable. After the drop, the X-ray afterglow resumes its decay with a slope typical of FS emission. The optical emission, on the other hand, displays no clear break across the X-ray drop and its decay is consistent with that of the late X-rays. Using both the X-ray and optical data, we show that the FS model can explain the emission after 100 ks. We model our data to infer the kinetic energy of the ejecta and thus estimate the efficiency of a magnetar “central engine” of a GRB. Furthermore, we break down the energy budget of this GRB into prompt emission, late internal dissipation, kinetic energy of the relativistic ejecta, and compare it with the energy of the accompanying supernova, SN 2013fu

Polarization and Spectral Energy Distribution in OJ 287 during the 2016/17 Outbursts

We report optical photometric and polarimetric observations of the blazar OJ 287 gathered during 2016/17. The high level of activity, noticed after the General Relativity Centenary flare, is argued to be part of the follow-up flares that exhibited high levels of polarization and originated in the primary black hole jet. We propose that the follow-up flares were induced as a result of accretion disk perturbations, traveling from the site of impact towards the primary SMBH. The timings inferred from our observations allowed us to estimate the propagation speed of these perturbations. Additionally, we make predictions for the future brightness of OJ 287.</p

RTML – a standard for use of remote telescopes

The scientific need for a homogenous remote telescope image request system is rapidly escalating as more remote or robotic telescopes are brought to function and scientific programs are created or adapted to use such powerful telescopes. To respond to this need, we have drafted a protocol – “Remote Telescope Markup Language" (Version 2.1) – which has enabled us to implement a non-homogeneous network of imaging telescopes capable of processing requests for the acquisition and retrieval of simple astronomical images. This protocol is designed to be independent of the specific instrumentation and software that control the remote and/or robotic telescopes. It embeds traditional astronomical features such as coordinates and exposure times, and allows for prioritized queue scheduling of telescopes while protecting the telescope operating system. The prioritization supports high-stakes interruption of other observations – “Targets of Opportunity" like optical detection of gamma-ray bursts or other transient events. Some generality in this definition and flexibility is desirable, so that a broad variety of objects and observations can be accommodated within this standard. A number of professional observatories, telescope hardware/software companies, and amateur astronomers are already working with this version of RTML and a large body of additional professional and amateur users willing to share observing time and/or provide observations for scientific or educational use could easily adopt this protocol. The next generation mark-up language (RTML 3) will include elements necessary to schedule more complex observations, enabling its use in practically all ground-based and satellite observatories

Electrical impedance tomography in pulmonary arterial hypertension.

The characterization of pulmonary arterial hypertension (PAH) relies mainly on right heart catheterization (RHC). Electrical impedance tomography (EIT) provides a non-invasive estimation of lung perfusion that could complement the hemodynamic information from RHC. To assess the association between impedance variation of lung perfusion (ΔZQ) and hemodynamic profile, severity, and prognosis, suspected of PAH or worsening PAH patients were submitted simultaneously to RHC and EIT. Measurements of ΔZQ were obtained. Based on the results of the RHC, 35 patients composed the PAH group, and eight patients, the normopressoric (NP) group. PAH patients showed a significantly reduced ΔZQ compared to the NP group. There was a significant correlation between ΔZQ and hemodynamic parameters, particularly with stroke volume (SV) (r = 0.76; P < 0.001). At 60 months, 15 patients died (43%) and 1 received lung transplantation; at baseline they had worse hemodynamics, and reduced ΔZQ when compared to survivors. Patients with low ΔZQ (≤154.6%.Kg) presented significantly worse survival (P = 0.033). ΔZQ is associated with hemodynamic status of PAH patients, with disease severity and survival, demonstrating EIT as a promising tool for monitoring patients with pulmonary vascular disease