The utility of airborne hyperspectral and satellite multispectral images in identifying Natura 2000 non-forest habitats for conservation purposes.

Aerial hyperspectral and multispectral satellite data are the two most commonly used datasets to identify natural and semi-natural vegetation. However, there is no documented analysis based on data from several areas concerning the difference in the classification accuracy of non-forest Natura 2000 habitat with the use of aerial hyperspectral and satellite multispectral data. Also, there is no recommendation, on which habitat can be classified with sufficient accuracy using free multispectral images. This study aimed to analyse the difference in classification accuracy of Natura 2000 habitats representing: meadows, grasslands, heaths and mires between data with different spectral resolutions and the results utility for nature conservation compared to conventional maps. The analysis was conducted in five study areas in Poland. The classification was performed on multispectral Sentinel-2 (S2) and hyperspectral HySpex (HS) images using the Random Forest algorithm. Based on the results, it can be stated that the use of HS data resulted in higher classification accuracy, on average 0.14, than using S2 images, regardless of the area of the habitat. However, the difference in accuracy was not constant, varying by area and habitat characterisation. Greater differences in accuracy were observed for areas where habitats were characterised by high α-diversity or ß-diversity. The HS and S2 data make it possible to create maps that provide a great deal of new knowledge about the distribution of Natura 2000 habitats, which is necessary for the management of protected areas. The obtained results indicate that by using S2 images it is possible to identify, at a satisfactory level, alluvial meadows and grassland. For heaths and mires, using HS data improved the results, but it is also possible to acquire general distribution of these classes, whereas HS images are obligatory for mapping salt, Molinia and lowland hay meadows.

Vegetation of temperate inland salt-marshes reflects local environmental conditions.

Inland salt marshes are recognized as habitats of unique and valuable vegetation at the European scale. There is still a lack of generalization regarding its vegetation syntaxonomy and environmental requirements, which is needed for its effective protection. To falsify our hypothesis about vegetation dependence on environmental requirements we aimed at description of the syntaxonomical units present in temperate European inland salt marshes and identification of their main environmental drivers. In our work we focused on the vegetation from the northern part of temperate salt marshes to limit confusion related to the geographical ranges of species. We collected the database of 968 vegetation plots from different European countries and applied the Cocktail method to analyze the data. Based on results, expert knowledge, existing syntaxonomical classifications and information from the literature, we identified diagnostic, constant and dominant species for individual syntaxonomical units. Then, we compiled maps of the vegetation unit distribution, and identified the most important environmental factors for the analyzed vegetation using statistical and multivariate methods, including canonical variate analysis. We classified the analyzed vegetation into nine classes, including two typical for salt-marsh vegetation - the Therosalicornietea and Festuco-Puccinellietea. Within these two classes, we distinguished two alliances and a total of five associations. The classes differ the most in terms of species preferences to salinity, soil moisture, light availability and soil nitrogen content. In addition salt marsh associations differ also by soil reaction and soil organic matter content. This provides direct implications for salt marsh sustainable management.

Invasive Plant Species Distribution Is Structured by Soil and Habitat Type in the City Landscape.

Invasive alien species (IAS) is a global problem that largely relates to human activities and human settlements. To prevent the further spread of IAS, we first need to know their pattern of distribution, to determine which constitutes the greatest threat, and understand which habitats and migration pathways they prefer. Our research aimed to identify the main vectors and distribution pattern of IAS of plants in the city environment. We checked the relations between species distribution and such environmental factors as urban soil type and habitat type. We applied data on IAS occurrence (collected in the period 1973-2015) in 515 permanent plots with dimensions of 0.5 × 0.5 km and analyzed by direct ordination methods. In total, we recorded 66 IAS. We found a 27% variance in the IAS distribution pattern, which can be explained by statistically significant soil and habitat types. The most important for species distribution were: river and alluvial soils, forests and related rusty soils, and places of intensive human activities, including areas of urbisols and industriosols. Our results provide details that can inform local efforts for the management and control of invasive species, and they provide evidence of the different associations between natural patterns and human land use.

The influence of comorbidities on mortality in sarcoidosis: a observational prospective cohort study.

AIM: The aim of this study was to identify the frequency and prevalence of comorbidities in sarcoid patients and to assess their influence on overall mortality in the cohort of patients with sarcoidosis. MATERIALS AND METHODS: A cohort of 557 patients with histologically confirmed sarcoidosis diagnosed between 2007 and 2011 and a group of non-sarcoid controls were observed. All patients were carefully observed for comorbidities and mortality. RESULTS: 291 males (52.2%) and 266 females (47.8%) with mean age 48.4 ± 12.0 years in sarcoidosis group and a group of 100 controls with mean age (49.25 ± 10.3) were observed. The mean number of comorbidities in both groups was similar (0.9 ± 0.99 vs 0.81 ± 0.84 NS). The frequency of thyroid disease was significantly higher in sarcoidosis group comparing to controls at the time of diagnosis (OR = 3.62 P = 0.0144). During the observation period (median 58.0 months), 16 patients died (2.9%). The mean number of comorbidities was significantly higher in the groups of non-survivors as compared to survivors (2.8 ± 1.0, vs 0.8 ± 0.9), P < 0.0001. CONCLUSION: The comorbidity burden has strong impact on mortality in sarcoidosis. Thyroid diseases are more frequent in sarcoidosis than in non-sarcoid controls.

Methotrexate as a single agent for treating pulmonary sarcoidosis: a single centre real-life prospective study.

INTRODUCTION: The first-line therapy in chronic sarcoidosis, according to WASOG/ATS/ERS recommendations, is GCS. This therapy is associated with significant adverse effects and finally does not alter the natural history of the disease. The objective of our study was to evaluate the efficacy and safety of monotherapy with MTX, as an alternative to GCS, in progressive pulmonary sarcoidosis. MATERIAL AND METHODS: An open prospective real-life, single-centre trial was performed on 50 patients with biopsy proven sarcoidosis, 28M and 22F, mean age 45.55 ± 8.9 years. The average duration of disease before MTX therapy was 12.34 ± 20.49 years, GCS therapy in the past was applied in 41 patients. All patients received MTX (10 mg or 15 mg weekly) between 2004 and 2013 because of chronic progressive pulmonary sarcoidosis. Therapy was planned for 24 months. Patients underwent regular clinical evaluation, pulmonary function assessment, exercise ability testing (6MWT), and chest radiography for therapy effectiveness every six months and side effects monitoring every 4-6 weeks. Forty-nine patients were included for statistical analysis of treatment efficacy. They were retrospectively allocated to "MTX responder" group if an improvement of 10% of FEV1, FVC, TLC, or 15% of DLCO from the initial value was documented for at least one parameter or "non-responders" if the patient did not meet the above-mentioned criteria. RESULTS: Duration of treatment ranged from 6 to 24 months, mean time 60.75 ± 34.1 weeks. For the whole cohort significant improvement after MTX therapy was observed for minimal SaO2 (%) (p = 0.043) and for decrease of DSaO2 (%) (p = 0.048) in six-minute walk test. The results were significantly better for patients treated with 15 mg than for those treated with 10 mg weekly and for those who obtained a greater total amount of MTX during therapy. Significant difference of DLCO%pred was observed after six months of MTX therapy between groups treated 15 mg vs 10 mg weekly (73.27 ± 12.7% vs. 63.15 ± 16.4%, p = 0.03). Twenty-five patients (55%) met the criteria of "MTX responders" group. Patients who responded well to treatment had significantly lower TLC and FVC initial values comparing to "MTX non-responders". After treatment the only significant difference in PFT between groups was noted for DLCO%pred. Eleven patients (22%) stopped the treatment due to adverse events of MTX, mild hepatic abnormalities were observed in ten patients (20%), and concomitant infection was found in four patients. There were no patients with a fatal outcome. CONCLUSIONS: MTX as a single agent in the treatment of sarcoidosis has proved to be a safe and effective steroid alternative. Selected patients with chronic pulmonary sarcoidosis experience definite PFT improvements after MTX treatment. There is need to search for predictors of MTX treatment effectiveness.

Fatal clinical outcome in a patient with sarcoidosis-lymphoma syndrome.

A 62-year-old female suspected of malignant disease underwent a splenectomy that revealed noncaseating granulomas in the histological specimen. Chest X-ray (CXR) and lung CT scans suggested sarcoidosis stage II. TBLB showed noncaseating granulomas. A diagnosis of sarcoidosis was made. Initially no treatment was needed as partial remission on CXR and normal lung function were observed. During the follow up she underwent open lung biopsy and axillary lymph node biopsy because of radiological progression with presence of CXR opacities imitating metastases and recurrent lymphadenopathy. No malignant cells were found. Spontaneous partial resolution of disseminated changes on the CXR was observed. Because of progressive deterioration in lung function and the clinical course of the disease strongly suggesting the progression of systemic sarcoidosis, the patient was given steroid treatment, which initially resulted in partial remission of pulmonary disseminated changes, peripheral lymphadenopathy and improvement in lung function test. Eight months later severe deterioration in general condition, anaemia, leukocytosis, hypoxemia, massive hepatomegaly and recurrence of general lymphadenopathy along with progression of disseminated changes were found. She died before the final diagnosis was established. Post-mortem examination showed a nodal marginal zone B-cell lymphoma with monocytoid B-cells, according to WHO classification. The malignant cells were found in the jugular, mediastinal, paratracheal, paragastric, paraintestinal and retroperitoneal lymph nodes and they infiltrated the lungs, pleura, liver, thyroid gland and pancreas. No sarcoid granulomas were found in the autopsy.

Impact of mild anaemia on dyspnoea during exertion and exercise tolerance in patients with acute exacerbation of chronic obstructive pulmonary disease.

INTRODUCTION: Dyspnoea and decreased exercise tolerance are symptoms of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Anaemia is a risk factor for reduced functional capacity and dyspnoea in stable COPD. There is limited information about the impact of anaemia on functional capacity and dyspnoea of patients during AECOPD. The aim of this study was to evaluate the impact of decreased blood haemoglobin concentration on the results of six-minute walking test (6MWT) in patients during AECOPD. MATERIAL AND METHODS: A post hoc analysis of data collected from prospective long-term studies on AECOPD. Haemoglobin concentration from the first obtainable hospital measurement were included in the assessment. 6MWT was performed after clinical improvement of the patient. Dyspnoea at baseline and after exercise and oxygen saturation (SpO(2)) during exercise was measured. RESULTS: (presented as means ± SD): 402 patients with exacerbation of COPD (COPD stage 3.5 ± 0.6) were examined. Patients with anaemia (26% of those studied, age 74.5 ± 8.2 years) achieved 258.1 ± 125.1 m during 6MWT, with exertional desaturation of 2.9 ± 2.6%. Patients without anaemia (74% of those studied, age 70.2 ± 8.7 years) achieved 271 ± 136.0 m during 6MWT with exertional desaturation of 3.8 ± 3.7%. The haemoglobin concentration did not correlate with 6MWT, dyspnoea during 6MWT, or exercise oxygenation and blood desaturation during exercise. CONCLUSION: Mildly decreased blood haemoglobin concentration did not influence the results of 6MWT in patients with AECOPD.

[Autoimmunological pulmonary alveolar proteinosis--case report]. / Autoimmunologiczna proteinoza pecherzyków plucnych--opis przypadku.

Autoimmunological pulmonary alveolar proteinosis (APAP) is a rare interstitial lung disease with abnormal surfactant homeostasis. Autoimmunological pulmonary alveolar proteinosis is diagnosed most often in the third or fourth decade of life. Predominant symptoms are dyspnea and cough. In most cases, disease is mild but in more severe cases when dyspnea limits patient physical activity a treatment is required. The most common treatment procedure is a whole-lung lavage. We present a case study of 37 years old woman with the patchy consolidations in the chest radiograph. High resolution computed tomography (HRCT) image suggested hipersensivity pneumonitis. At the beginning due to limited disease symptoms no specific proceedings was implemented. After two year follow-up of non-resolving pulmonary changes the decision about open lung biopsy was made. On the basis of histological examination of samples and presence of anty GM-CSF antibodies the diagnosis of autoimmunological pulmonary alveolar proteinosis was established.

[The impact of comorbidities on the length of hospital treatment in patients with chronic obstructive pulmonary disease]. / Wplyw chorób wspólistniejacych na dlugosc leczenia szpitalnegou chorych z zaostrzeniem przewleklej obturacyjnej choroby pluc.

INTRODUCTION: The aim of this study was to assess relationships of chronic obstructive pulmonary disease (COPD) comorbidities number, with the duration of hospital stay due to acute AE COPD in longitudinal prospective study. MATERIAL AND METHODS: We evaluated the number of re-hospitalizations, length of stay and number of comorbidities in 464 consecutive COPD patients admitted to the tertiary respiratory hospital due to AE COPD enrolled in longitudinal prospective study from 2005 to 2009 year. RESULTS: GOLD II stage COPD patients had 4.1 ± 1.2 comorbidities (p = 0.002), stage III 3.4 ± 1.3 and stage IV had 3.6 ± 1.2 comorbidities. Duration of hospital stay (medians) was longer in more severe patients. Duration of hospitalization correlated with urea level (r = 0.19 p 〈 0.001), pCO(2) (r = 0.193, p = 0.0003), HCO(3) (r = 0.25, p 〈 0.0001), haemoglobin (r = -0.18, p 〈 0.001), and hematocrit (r = -0.13, p = 0.008). The patients with the risk of readmission had more severe GOLD stage and were hypercapnic (pCO(2) = 47.6 mmHg v. 43.9 mmHg in those without hospitalization). CONCLUSIONS: The haemoglobin level, hypercapnia and renal function are predictors of prolonged hospitalization. Patients with more severe airflow limitation and higher pCO(2) have increased risk for readmission to the hospital. More severe disease stage, clinical diagnosis of cor pulmonale or bronchiectasis was related to longer hospital stay.

[Restless legs syndrome and periodic limb movements during sleep in a patient with obstructive sleep apnea]. / Zespól niespokojnych nóg i okresowe ruchy konczyn w czasie snu u chorego na obturacyjny bezdech senny.

A case of moderate obstructive sleep apnea in which effective treatment with continuous positive airway pressure did not reduce excessive daytime sleepiness was described. Polysomnography with tibial muscles activity recording revealed frequent periodic limb movements in sleep (PLMS) with sleep fragmentation. PLMS index was 13.6/h of sleep. Clonazepam combined with iron and magnesium supplementation reduced limb movements, excessive daytime sleepiness and improved the patient's mood. Causes of PLMS and treatment options are discussed. PLMS and restless legs syndrome (RLS) should be considered in the differential diagnosis of excessive daytime sleepiness.

[The variability of clinical presentation of chronic obstructive pulmonary disease in patients with hereditary alpha-1 antitrypsin deficiency]. / Zmiennosc obrazu klinicznego przewleklej obturacyjnej choroby pluc u chorych z wrodzonym niedoborem alfa-1 antytrypsyny.

Four patients with alpha-1 antitrypsin (alpha-1 AT) deficiency are presented: one woman with severe (phenotype PiZ) and 3 men with moderate (phenotype PiMZ) deficiency of alpha-1 AT. The variability of clinical presentation of hereditary emphysema is described. In all patients tobacco smoking history, spirometric and 6-minutes walking tests as well as HRCT of the lung were performed and compared. The influence of smoking on the functional status is underlined.

Cost-effectiveness analysis of enoxaparin versus unfractionated heparin in patients with acute coronary syndrome in Poland: modelling study from the hospital perspective.

UNLABELLED: AIM AND PERSPECTIVE: To estimate the cost effectiveness of enoxaparin versus unfractionated heparin (UFH) in patients with acute coronary syndrome (ACS) from a Polish hospital perspective. This was intended to facilitate the decisionmaking process in selecting the most cost-effective treatment for ACS. METHOD: A decision model was used to quantify costs and effectiveness of alternative treatments. Published results from the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) study were used to estimate the probability for clinical endpoints (death, myocardial infarction or recurrent angina) at 30 days. Probabilities of patients undergoing revascularisation procedures were obtained from the Global Registry of Acute Coronary Events (GRACE) which included data from 961 patients at six centres in Poland. The analysis assessed only direct medical costs, determined from actual resource consumption on a patient-specific basis (6-month observational study) and estimated using Polish data on unit costs. One- and two-way sensitivity analyses and threshold analysis were performed. RESULTS: At 30 days, 19.8% of patients receiving enoxaparin compared with 23.3% of those receiving UFH reached a composite endpoint consisting of death, myocardial infarction and recurrent angina (p = 0.02). The average costs (in zloty ; 1 US dollar = 4 zloty [2000 values]) were 1,085 per patient receiving enoxaparin compared with 1,097 per patient receiving UFH. Therefore, for every 29 patients treated, not only would enoxaparin therapy avoid one event of the composite endpoint, it would also save 348 zloty. The threshold analysis suggests that enoxaparin would lose dominance when the cost of enoxaparin increased by 10%, the cost of monitoring UFH therapy decreased by 12%, the probability of reaching the composite endpoint in the enoxaparin arm increased to 0.22 or decreased to 0.21 in the UFH arm. CONCLUSION: According to our model enoxaparin was more effective at a lower cost than UFH, therefore this treatment was shown to be dominant for patients with ACS in Poland.