Cassini spacecraft reveals global energy imbalance of saturn.

The global energy budget is pivotal to understanding planetary evolution and climate behaviors. Assessing the energy budget of giant planets, particularly those with large seasonal cycles, however, remains a challenge without long-term observations. Evolution models of Saturn cannot explain its estimated Bond albedo and internal heat flux, mainly because previous estimates were based on limited observations. Here, we analyze the long-term observations recorded by the Cassini spacecraft and find notably higher Bond albedo (0.41 ± 0.02) and internal heat flux (2.84 ± 0.20 Wm-2) values than previous estimates. Furthermore, Saturn's global energy budget is not in a steady state and exhibits significant dynamical imbalances. The global radiant energy deficit at the top of the atmosphere, indicative of the planetary cooling of Saturn, reveals remarkable seasonal fluctuations with a magnitude of 16.0 ± 4.2%. Further analysis of the energy budget of the upper atmosphere including the internal heat suggests seasonal energy imbalances at both global and hemispheric scales, contributing to the development of giant convective storms on Saturn. Similar seasonal variabilities of planetary cooling and energy imbalance exist in other giant planets within and beyond the Solar System, a prospect currently overlooked in existing evolutional and atmospheric models.

Cancer is not a risk factor for severe COVID-19 in children, except in patients with recent allogeneic hematopoietic stem cell transplantation or comorbidities.

The EPICO (Spanish general registry of COVID-19 in children)-SEHOP (Spanish Society of Pediatric Hematology and Oncology) platform gathers data from children with SARS-CoV-2 in Spain, allowing comparison between children with cancer or allogeneic hematopoietic stem cell transplantation (alloHSCT) and those without. The infection is milder in the cancer/alloHSCT group than in children without comorbidities (7.1% vs. 14.7%), except in children with recent alloHSCT (less than 300 days), of which 35.7% experienced severe COVID-19. These data have been shared with the SEHOP members to support treatment and isolation policies akin to those for children without cancer, except for those with recent alloHSCT or additional comorbidities. This highlights the collaborative registries potential in managing pandemic emergencies.

Effects of Achieving Rapid, Intensive, and Sustained Blood Pressure Reduction in Intracerebral Hemorrhage Expansion and Functional Outcome.

BACKGROUND AND OBJECTIVES: The time taken to achieve blood pressure (BP) control could be pivotal in the benefits of reducing BP in acute intracerebral hemorrhage (ICH). We aimed to assess the relationship between the rapid achievement and sustained maintenance of an intensive systolic BP (SBP) target with radiologic, clinical, and functional outcomes. METHODS: Rapid, Intensive, and Sustained BP lowering in Acute ICH (RAINS) was a multicenter, prospective, observational cohort study of adult patients with ICH <6 hours and SBP ≥150 mm Hg at 4 Comprehensive Stroke Centers during a 4.5-year period. Patients underwent baseline and 24-hour CT scans and 24-hour noninvasive BP monitoring. BP was managed under a rapid (target achievement ≤60 minutes), intensive (target SBP <140 mm Hg), and sustained (target stability for 24 hours) BP protocol. SBP target achievement ≤60 minutes and 24-hour SBP variability were recorded. Outcomes included hematoma expansion (>6 mL or >33%) at 24 hours (primary outcome), early neurologic deterioration (END, 24-hour increase in NIH Stroke Scale score ≥4), and 90-day ordinal modified Rankin scale (mRS) score. Analyses were adjusted by age, sex, anticoagulation, onset-to-imaging time, ICH volume, and intraventricular extension. RESULTS: We included 312 patients (mean age 70.2 ± 13.3 years, 202 [64.7%] male). Hematoma expansion occurred in 70/274 (25.6%) patients, END in 58/291 (19.9%), and the median 90-day mRS score was 4 (interquartile range, 2-5). SBP target achievement ≤60 minutes (178/312 [57.1%]) associated with a lower risk of hematoma expansion (adjusted odds ratio [aOR] 0.43, 95% confidence interval [CI] 0.23-0.77), lower END rate (aOR 0.43, 95% CI 0.23-0.80), and lower 90-day mRS scores (aOR 0.48, 95% CI 0.32-0.74). The mean 24-hour SBP variability was 21.0 ± 7.6 mm Hg. Higher 24-hour SBP variability was not related to expansion (aOR 0.99, 95% CI 0.95-1.04) but associated with higher END rate (aOR 1.15, 95% CI 1.09-1.21) and 90-day mRS scores (aOR 1.06, 95% CI 1.04-1.10). DISCUSSION: Among patients with acute ICH, achieving an intensive SBP target within 60 minutes was associated with lower hematoma expansion risk. Rapid SBP reduction and stable sustention within 24 hours were related to improved clinical and functional outcomes. These findings warrant the design of randomized clinical trials examining the impact of effectively achieving rapid, intensive, and sustained BP control on hematoma expansion. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that in adults with spontaneous ICH and initial SBP ≥150 mm Hg, lowering SBP to <140 mm Hg within the first hour and maintaining this for 24 hours is associated with decreased hematoma expansion.

Valvuloplastia aórtica pediátrica: estudio de variables con influencia en los resultados a largo plazo / Pediatric balloon aortic valvuloplasty. Long-term prognostic factors

Fundamentos y objetivo: En la edad pediátrica, la valvuloplastia aórtica es considerada como una opción para el tratamiento paliativo de la estenosis aórtica congénita. Se revisaron las valvuloplastias aórticas sobre válvula nativa realizadas consecutivamente en nuestro centro desde marzo de 1994 hasta junio de 2013, con el objetivo de identificar variables asociadas a necesidad de reintervención en el seguimiento. Métodos: Análisis de pacientes sometidos a valvuloplastia aórtica, en relación a sus características clínicas, ecocardiográficas y evolutivas, de una serie de 51 individuos, dividida en dos grupos -neonatal y pediátrico- según si la valvuloplastia se hubiere realizado antes o después del mes de vida. El tiempo mediano de seguimiento fue de 5,8 años (0,5-12,3) por paciente. Resultados: De los 51 pacientes, 20 presentaban alguna malformación cardiaca asociada. Tras el procedimiento la media de los gradientes pico-pico descendió de 60 ± 18 a 25 ± 13 mmHg. Evolutivamente, la valvuloplastia inicial fue suficiente en 24 (47%) enfermos, en 12 (23,5%) pacientes se requirió revalvuloplastia por reestenosis a un tiempo mediano de 0,61 años (0,3-3,2), y en 13 (25%) se indicó cirugía a un tiempo medio de 1,62 años (0,4-10,9); en dos casos (4%) se perdió el seguimiento. Las variables: grupo neonatal, patrón diastólico restrictivo, z-score del diámetro telediastólico ventricular izquierdo < -2,5, gradiente hemodinámico pico-pico > 60 mmHg, se asociaron a necesidad de cirugía (p < 0,05) en el seguimiento. No se encontraron factores asociados a revalvuloplastia. Conclusiones:La valvuloplastia aórtica pediátrica es una opción terapéutica paliativa eficaz. En este estudio las variables descritas anteriormente se asociaron a necesidad de cirugía.

Introduction and objective: Balloon aortic valvuloplasty is regarded as a good palliative option for congenital aortic stenosis in children. Our main objective was to review the results of all consecutives balloon aortic valvuloplasties performed in children over a native valve from march 1994 until June 2013, trying to identify those variables associated with need of reintervention during follow-up. Methods: We studied the echocardiographic, clinical and evolutionary features of 51 pediatric patients who underwent a balloon aortic valvuloplasty. Two groups were recognized: neonatal (n = 11) and pediatric (n = 40) patients depending on whether valvuloplasty was performed before or after the first month of life. Median follow-up was 5.8 years (0.5-12,3). Results: There were 37 boys and 14 girls, and 20 patients had some additional cardiac malformation. The average peak to peak hemodynamic gradient fell from 60 ± 18 a 25 ± 13 mmHg. During follow-up, 12 patients needed a second valvuloplasty for reestenosis (23.5%) at 0.61 years (0.3-3.2) and 13 others needed surgery (25%) at 1.62 years (0.4-10.9); 2 cases (4%) had no follow-up. The variables neonatal group, echocardiographic restrictive diastolic pattern, z-score of end-diastolic left ventricle diameter < -2.5, and peak to peak hemodynamic gradient > 60 mmHg were associated with need of surgery during follow-up (p < 0.05). However, we did not find factors associated with repeated valvuloplasty. Conclusions: Balloon aortic valvuloplasty in children is an effective option for palliative treatment of congenital aortic stenosis. In this study the variables previously described were predictors of the need of surgery.