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

Virtual Reality and Anxiety Disorders Treatment: Evolution and Future Perspectives

Virtual reality (VR) is a technology that allows the simulation of different real-life situations on a tridimensional computer-generated environment where the user can interact with the environment as if he/she were the real world. VR has potential as an exposure technique for treating anxiety disorders because VR and real objects have similar characteristics, which creates the illusion that the user is immersed and engaged with objects in the real world. Regarding the efficacy of using virtual reality exposure-based therapy (VR-EBT), for more than two decades, there has been sufficient empirical evidence regarding VR-EBT for treating anxiety disorders. Finally, this chapter ends with some directions and perspectives for future VR-EBT developments and treatments protocols

A Dynamic Economic Model with Discrete Time and Consumer Sentiment

The paper describes a dynamical economic model with discrete time and consumer sentiment in the deterministic and stochastic cases. We seek to demonstrate that consumer sentiment may create fluctuations in the economical activities. The model possesses a flip bifurcation and a Neimark-Sacker bifurcation, after which the stable state is replaced by a (quasi) periodic motion. We associate the difference stochastic equation to the model by randomizing the control parameter d and by adding one stochastic control. Numerical simulations are made for the deterministic and stochastic models, for different values of the control parameter d

Chemical features, cholesterol and energy content of table hen eggs from conventional and alternative farming systems

This study was carried out to investigate the effect of conventional farming systems for laying hens (standard cage batteries) and new alternative systems (improved cages and free range), approved by European Union (EU) poultry welfare legislation, on the chemical and nutritional quality of table eggs. The biological material consisted of eggs laid by 1200 Lohmann Brown hens, aged 27 weeks, fed similarly (a corn-wheat-soymeal diet). Conventional AOAC methods were used to analyse the eggs, and gross energy was calculated based on organic matter energy. All data were subjected to ANOVA statistical computation. The eggs produced in conventional cages compared with those laid in free-range farming conditions, presented significantly higher concentrations of total lipids (11.40 ± 0.65 g/100 g vs. 10.78 ± 0.87 g/100 g), cholesterol (211 ± 6.31 μg/egg vs. 202 ± 7.79 μg/60 g egg) and gross energy (0.36 ± 0.007 MJ/egg vs. 0.35 ± 0.012 MJ/egg). Consequently, it could be stated that under similar dietary conditions, the cage-free system influenced hens to produce eggs with a higher nutritive value than in the other systems.Keywords: Battery cages, chemical composition, dietetic value, improved cages, free-range, laying hen