Procalcitonin concentration in the emergency department predicts 30-day mortality in COVID-19 better than the lymphocyte count, the neutrophil-tolymphocyte ratio, or the C-reactive protein level. / Procalcitonina es superior a recuento linfocitario, índice neutrófilo/linfocito y proteína C reactiva para la predicción de mortalidad a 30 días de pacientes con COVID-19 en el servicio de urgencias.

OBJECTIVES: Although many demographic and clinical predictors of mortality have been studied in relation to COVID-19, little has been reported about the prognostic utility of inflammatory biomarkers. MATERIAL AND METHODS: Retrospective cohort study. All patients with laboratory-confirmed COVID-19 treated in a hospital emergency department were included consecutively if baseline measurements of the following biomarkers were on record: lymphocyte counts, neutrophil-to-lymphocyte ratio NRL, and C-reactive protein (CRP) and procalcitonin (PCT) levels. We analyzed associations between the biomarkers and all-cause 30-day mortality using Cox regression models and dose-response curves. RESULTS: We included 896 patients, 151 (17%) of whom died within 30 days. The median (interquartile range) age was 63 (51-78) years, and 494 (55%) were men. NLR, CRP and PCT levels at ED presentation were higher, while lymphocyte counts were lower, in patients who died compared to those who survived (P .001). The areas under the receiver operating characteristic curves revealed the PCT concentration (0.79; 95% CI, 0.75-0.83) to be a better predictor of 30-day mortality than the lymphocyte count (0.70; 95% CI, 0.65-0.74; P .001), the NLR (0.74; 95% CI, 0.69-0.78; P = .03), or the CRP level (0.72; 95% CI, 0.68-0.76; P .001). The proposed PCT concentration decision points for use in emergency department case management were 0.06 ng/L (negative) and 0.72 ng/L (positive). These cutoffs helped classify risk in 357 patients (40%). Multivariable analysis demonstrated that the PCT concentration had the strongest association with mortality. CONCLUSION: PCT concentration in the emergency department predicts all-cause 30-day mortality in patients with COVID-19 better than other inflammatory biomarkers.

OBJETIVO: Existen múltiples variables demográficas y clínicas predictivas de mortalidad en pacientes con COVID-19. Sin embargo, hay menos información sobre el valor pronóstico de los biomarcadores inflamatorios. METODO: Estudio de cohorte retrospectivo. Se incluyeron de forma consecutiva todos los pacientes con COVID-19, confirmado por laboratorio, atendidos en un servicio de urgencias hospitalario (SUH) y con valor basal de los siguientes biomarcadores: recuento linfocitario, índice neutrófilo/linfocito (INL), proteína C reactiva (PCR) y procalcitonina (PCT). La relación entre los biomarcadores y la mortalidad total a 30 días se analizó mediante una regresión de Cox y gráficos de dosis-respuesta. RESULTADOS: Se incluyeron 896 pacientes, 151 (17%) fallecieron en los primeros 30 días. La mediana de edad fue de 63 años (51-78) y 494 (55%) eran hombres. El valor de INL, PCR y PCT fue mayor, mientras que el recuento linfocitario fue menor, en los pacientes que fallecieron respecto a los que sobrevivieron (p 0,001). La PCT fue superior al recuento linfocitario, INL y PCR en la predicción de mortalidad a 30 días (ABC 0,79 [IC 95%: 0,75-0,83] vs 0,70 [IC 95%: 0,65-0,74], p 0,001; 0,74 [IC 95%: 0,69-0,78], p = 0,03; y 0,72 [IC 95%: 0,68-0,76], p 0,001). Los puntos de decisión de PCT propuestos, 0,06 ng/l para exclusión y 0,72 ng/l para inclusión de muerte a 30 días, podrían facilitar la toma de decisiones en urgencias. Hubo 357 pacientes (40%) con valores de PCT en estas categorías. El análisis multivariable mostró una mayor asociación con la mortalidad para PCT que en los otros biomarcadores estudiados. CONCLUSIONES: PCT es el biomarcador con mejor capacidad para predecir mortalidad a 30 días por cualquier causa en pacientes con COVID-19 valorados en un SUH.

Error Propagation in Microwave Soil Moisture and Vegetation Optical Depth Retrievals.

Satellite soil moisture and vegetation optical depth [(VOD); related to the total vegetation water mass per unit area] are increasingly being used to study water relations in the soil-plant continuum across the globe. However, soil moisture and VOD are typically jointly estimated, where errors in the optimization approach can cause compensation between both variables and confound such studies. It is thus critical to quantify how satellite microwave measurement errors propagate into soil moisture and VOD. Such a study is especially important for VOD given limited investigations of whether VOD reflects in situ plant physiology. Furthermore, despite new approaches that constrain (or regularize) VOD dynamics to reduce soil moisture errors, there is limited study of whether regularization reduces VOD errors without obscuring true vegetation temporal dynamics. Here, we find that, across the globe, VOD is less robust to measurement error (more difficult for optimization methods to find the true solution) than soil moisture in their joint estimation. However, a moderate degree of regularization (via time-constrained VOD) reduces errors in VOD to a greater degree than soil moisture and reduces spurious soil moisture-VOD coupling. Furthermore, despite constraining VOD time dynamics, regularized VOD variations on subweekly scales are both closer to simulated true VOD time series and have global VOD post-rainfall responses with reduced error signatures compared to VOD retrievals without regularization. Ultimately, we recommend moderately regularized VOD for use in large scale studies of soil-plant water relations because it suppresses noise and spurious soil moisture-VOD coupling without removing the physical signal.

Función endotelial y lipemia postprandial en adultos con presencia de criterios asociados a síndrome metabólico: efecto del estado nutricional / Endothelial function and postprandial lipemia in adults presenting criteria associated to metabolic syndrome: effect of nutritional state

Resumen Introducción : La lipemia postprandial se caracteriza por un aumento de las lipoproteínas ricas en triglicéridos y varios trabajos lo describen como un factor que determina la salud metabólica de un individuo. El objetivo del estudio fue cuantificar la contribución del sobrepeso en la magnitud de la lipemia postprandial en 33 sujetos con criterios asociados al síndrome metabólico (n = 20, sobrepeso y n = 13 eutróficos, 66% hombres, edad media 31,2 ± 7,6 años). Métodos: Estudio descriptivo y transversal. Se midió la vasodilatación mediada por el flujo, la velocidad de onda del pulso, el perfil lipídico, el cociente Log triglicéridos/lipoproteínas de alta densidad, la glucosa y la presión arterial tras una ingesta estándar alta en lípidos (79% Kcal/grasa). Se calculó el Z-score de riesgo cardiovascular a partir de la suma de los residuos tipificados (Z) de las variables bioquímicas. El estado de lipemia se midió en ayuno (0 min.) y a los (60, 120, 180, y 240 minutos) postprandiales. Resultados: El valor basal de la vasodilatación mediada por el flujo y la velocidad de onda del pulso fue de 6,9 ± 5,9% y 7,0 ± 0,8 m/s, respectivamente. Se identificó que la lipemia postprandial reducía la vasodilatación mediada por el flujo en 19,2% a los 60 minutos (5,9 ± 1,5%) y a los 240 minutos (3,7 ± 1,2%) (p = 0,04), respectivamente. Este hallazgo se acompañó con un aumento en la velocidad de onda del pulso (p < 0,05). Al dividir los sujetos en dos grupos según el índice de masa corporal, los participantes en sobrepeso muestran cifras más elevadas en el Zscore de riesgo cardiovascular, la velocidad de onda del pulso, el Log triglicéridos/lipoproteínas de alta densidad y el Δ-velocidad de onda del pulso, (p < 0,001). Conclusión: Este estudio demuestra que los sujetos clasificados en sobrepeso y que presentan criterios asociados al síndrome metabólico, muestran un perfil cardiometabólico asociado con un mayor riesgo cardiovascular, tras una ingesta alta en grasas.

Abstract Introduction: Postprandial lipemia is characterised by an increase in triglyceride-rich lipoproteins and several studies describe it as a factor that determines metabolic health of an individual. The motivation of the study was to quantify the contribution to overweight in the magnitude of the postprandial lipemia in 33 persons with criteria associated to metabolic syndrome (n = 20 being overweight and n = 13 eutrophic, 66% male, average age 31.2 ± 7.6 years). Methods: Cross-sectional descriptive study. Flow-mediated vasodilation, pulse wave velocity, lipid profile, log of the triglyceride/protein ratio, glucose and blood pressure were measured after high standard intake of lipids (79% Kcal/fat). Z-score for cardiovascular risk was calculated using the sum of typified residues (Z) of biochemical variables. Lipemia state was measured at fasting (0 min) and after 60, 120, 180 and 240 postprandial minutes. Results: Baseline flow-mediated vasodilation and pulse wave velocity values were 6.9 ± 5.9% and 7.0 ± 0.8 m/s, respectively. It was identified that postprandial lipemia reduced flowmediated vasodilation by 19.2% after 60 minutes (5.9 ± 1.5%) and after 240 minutes (3.7 ± 1.2%) (p = 0.04), respectively. This finding was paired with an increase in pulse wave velocity (p < 0.05). When dividing subjects into two groups according to their body mass index, overweight participants show higher Z-score cardiovascular risk values, pulse wave velocity, log of the triglyceride/protein ratio and the Δ pulse wave velocity (p > 0.001). Conclusion: This study reveals that overweight individuals showing criteria associated to metabolic syndrome have a cardiometabolic profile linked to a higher cardiovascular risk, after high intake of lipids.

In vivo tricalcium phosphate, bone morphogenetic protein and autologous bone marrow biomechanical enhancement in vertebral fractures in a porcine model.

PURPOSE: Minimally invasive techniques that introduce cement and bone substitutes inside the fractured vertebral body are a new treatment line with clinically proven efficacy. However, mechanical behaviours between different fillers throughout fracture evolution is yet to be clarified, as many substances are available for introduction into the vertebral body fracture. METHODS: We comparatively studied biomechanical properties of tricalcium phosphate, tricalcium phosphate with bone morphogenetic protein (rhBMP-7) and autologous bone marrow aspirate with rhBMP-7 in vivo to determine what substance is optimal for repairing vertebral lesions in a porcine model. This biomechanical study was carried out with an Instron-type testing machine. Data registered were necessary strength to reach vertebral fracture [Newtons (N)], shortening (millimeters) of the vertebra, energy absorption until vertebral fracture (Joules) and vertebral unit stiffness. RESULTS: For statistical study, we used the SPSS 16 package at a significance level of α = 0.05. In the presentation of the results, mean, standard deviation of mean, median and interquartile range (IQR) were analysed. Mean and standard deviation (SD) of strength in newtons (N) for the vertebral fracture are 756 N (SD = 253) in group 1, 1,500 N (SD = 1598) in group 2 and 1,230 N (SD = 1,598) in group 3. Stiffness after fracture was 229 N (SD = 123) in group 1, 277 N (SD = 135) in group 2 and 404 N (SD = 325) in group 3. CONCLUSIONS: The association of tricalcium phosphate and BMP-7 generates major vertebral resistance to external energy, the cause of such fractures. In such fractures, minor shortening occurs as soon as the vertebral body is fractured. Autologous bone marrow and BMP-7 provides increased biomechanical behavior, and the vertebral body is thus significantly strengthened.