Systemic lupus erythematosus in Spanish males: a study of the Spanish Rheumatology Society Lupus Registry (RELESSER) cohort.

Objective The objective of this study was to describe the demographic, clinical, and immunological manifestations of systemic lupus erythematosus (SLE) in male patients. Methods A cross-sectional, multicenter study was carried out of 3651 patients (353 men, 9.7%, and 3298 women, 90.2%) diagnosed with SLE, included in the Spanish Rheumatology Society SLE Registry (RELESSER). Results Mean ages (18-92 years) of symptom onset were 37 (SD 17) years (men) and 32 (SD 14) years (women). Male/female ratio was 1/9. Age of onset of symptoms and age at diagnosis were higher in men than in women ( p < 0.001). Males were diagnosed earlier than females (p = 0.04) and had more cardiovascular comorbidities ( p < 0.001). Two hundred and thirty-six males (68%) with SLE required hospitalization in comparison with 1713 females (53%) ( p < 0.001). During follow-up, 208 patients died: 30 men (9.3%) and 178 women (5.9%) ( p = 0.02). As regards clinical manifestations, loss of weight ( p = 0.01), lymphadenopathies ( p = 0.02), and splenomegaly ( p = 0.02) were more common in male patients. Female patients were more likely to have inflammatory rash, alopecia, and arthritis ( p < 0.05). As for lung involvement, men with SLE had more pleural fibrosis ( p < 0.001) and pulmonary embolism ( p = 0.01). However, Raynaud's phenomenon was more common in women (35%) than in men (23.7%) ( p < 0.001); lupus nephritis was more common in men, being present in 155 (44.8%) of males versus 933 (29%) of females ( p < 0.001). Multivariate analysis showed that SLE patients with a high Charlson index (more than 3 points) and age > 50 years had a higher mortality (odds ratios 3.6 and 2.1, respectively). Furthermore, SLE patients who developed pulmonary hemorrhage, pulmonary hypertension, psychiatric involvement, complement deficiency, and hemophagocytic syndrome also had higher mortality, regardless of gender. Conclusion Patients with SLE over the age of 50 years have an increased risk of mortality. In Caucasians, age at diagnosis and symptom onset is higher in men than in women. The diagnostic delay is shorter in men. Male SLE patients present more cardiovascular comorbidities, and also more serositis, adenopathies, splenomegaly, renal involvement, convulsion, thrombosis, and lupus anticoagulant positivity than women.

The use of the acute Pd/Pa drop after intracoronary nitroglycerin infusion to rule out significant FFR: CANICA (Can intracoronary nitroglycerin predict fractional flow reserve without adenosine?) multicenter study.

OBJECTIVE: Functional assessment of coronary artery stenosis is performed by measuring the fractional flow reserve (FFR) under hyperemic conditions (Adenosine). However, the use of adenosine portends limitations. OBJECTIVE: We sought to investigate the relationship and correlation between FFR and the Pd/Pa value obtained just after the intracoronary infusion (acute drop) of nitroglycerin (Pd/Pa-NTG) and if this parameter enhances diagnostic accuracy for FFR prediction compared to the resting baseline Pd/Pa. METHODS: We conducted a multicenter study including prospectively patients presenting intermediate coronary artery stenosis (30-70%) evaluated with pressure wire. Resting baseline Pd/Pa, Pd/Pa-NTG and FFR were measured. RESULTS: 283 patients (335 lesions) were included. Resting baseline Pd/Pa value was 0.72 to 1.0 (0.93 ± 0.04), Pd/Pa-NTG was 0.60 to 1.0 (0.87 ± 0.07) and FFR 0.55 to 1.0 (0.83 ± 0.08). The ROC curves for resting baseline Pd/Pa and for Pd/Pa-NTG, using a FFR ≤ 0.80 showed an AUC of 0.88 (95% CI: 0.84-0.92, P < 0.001) and 0.94 (95% CI: 0.92-0.96, P < 0.001) respectively. The optimal cutoff values of resting baseline Pd/Pa and Pd/Pa-NTG for an FFR > 0.80, were >0.96 and >0.88, respectively. These values were present in a 29.8% (n = 100) and a 47.1% (n = 158), of the total lesions. Scatter plots showed a better correlation and agreement points with Pd/Pa-NTG than resting baseline Pd/Pa. The cutoff value of Pd/Pa-NTG > 0.88 showed an excellent NPV (96.2% for FFR > 0.8 and 100% for FFR > 0.75) and sensitivity (95% for FFR > 0.8 and 100% for FFR > 0.75) which were consistently high across all the subgroups analysis. CONCLUSION: The cutoff value of acute Pd/Pa-NTG > 0.88 has a high NPV meaning adenosine-FFR can be avoided in almost half of lesions.

Do surgical expectations change depending on first time surgery or reoperation? A prospective cohort study in lumbar spine surgery.

PURPOSE: To assess whether patients undergoing lumbar spine surgery for the first time (Group 1) had different expectations from those undergoing lumbar spine surgery for a failed previous procedure (Group 2). METHODS: A prospective study that included 77 patients. A set of self-reported questionnaires was pre-operatively administered including VAS, Oswestry Disability Index (ODI), Zung Depression Scale and the NASS lumbar spine questionnaire (expectations scale). RESULTS: Fifty-six patients in Group 1 and 21 patients in Group 2. Both groups had high expectations with regard to the surgical procedure (n.s.). Depressed patients, despite being more disabled than non-depressed according to ODI (p 0.001), had similar expectations than non-depressed patients (n.s.). CONCLUSION: Patients' expectations remained very high despite having had a failed previous surgery for the same procedure.

Absorption Ångström exponents of aerosols and light absorbing carbon (LAC) obtained from in situ data in Covilhã, central Portugal.

A field campaign was conducted from October 2009 to July 2010 at Covilhã, a small town located in the region of Beira Interior (Portugal) in the interior of the Iberian Peninsula. The ambient light-absorption coefficient, σ(a) (522 nm), obtained from a Particle Soot Absorption Photometer (PSAP), presented a daily mean value of 12.1 Mm⁻¹ (StD = 7.3 Mm⁻¹). The wavelength dependence of aerosol light absorption is investigated through the Ångström parameter, α(a). The α(a) values for the pair of wavelengths 470-660 nm ranged from 0.86 to 1.47 during the period of measurements. The PSAP data were used to infer the mass of light absorbing carbon (LAC) and the daily mean varied from 0.1 to 6.8 µg m⁻³. A detailed study of special events with different aerosol characteristics is carried out and, to support data interpretation, air masses trajectory analysis is performed.

In situ UV-VIS-NIR absorbing properties of atmospheric aerosol particles: estimates of the imaginary refractive index and comparison with columnar values.

In this work, a novel technique is used to estimate the aerosol complex index of refraction of in situ collected samples. Samples of atmospheric particulate matter were collected in El Arenosillo, southern Spain, on polycarbonate filters during summer 2004 as part of an aerosol characterization campaign. These samples were analyzed for the volumetric absorption coefficient in the 320-800 nm spectral region and an estimation of the effective imaginary refractive index was made. The values of the imaginary part of the complex refractive index ranged between 0.0009-0.0215 at 800 nm and 0.0015-0.0114 at 320 nm. Little dependence on the wavelength was observed. Several intense and long lasting desert outbreaks were registered during the campaign and the complex refractive index almost doubles its value during these dust events. Finally, we present a comparison of data obtained in situ with columnar data obtained from the AERONET network. A correlation factor of 0.64 was obtained between both data, which gives an idea of how accurately the in situ ground data represent the total column.

Comparison between the optical properties of aerosols in the fine and coarse fractions over Valladolid, Spain.

Continuous measurements of the optical properties of aerosol particles have been made at Valladolid, Spain, covering the period from June 2011 to July 2012. The measurements were made at two size cuts: sub-10 µm and sub-1 µm (PM10 and PM1). The data measured were the scattering and backscattering coefficients, σs and σbs, obtained from an integrating nephelometer, and the absorption coefficient, σa, obtained from a particle soot absorption photometer. Spectrally resolved data were obtained from both instruments at 3 wavelengths (blue/green/red) at low relative humidity (RH < 40%). The statistical data for the instruments were calculated based on the hourly averages. For the PM10 fraction, the hourly mean values of σs and σa at 550 nm were 33 Mm-1 (StD = 30 Mm-1) and 4 Mm-1 (StD = 3 Mm-1), respectively. For the PM1 fraction, σs and σa mean values were 16 Mm-1 (StD = 14 Mm-1) and 4 Mm-1 (StD = 3 Mm-1), also at 550 nm. The derived parameters analyzed were the single scattering albedo, ω0, the backscatter fraction, σbs/σs, and the Ångström exponents of scattering, absorption and single scattering albedo, αs, αa and αω0. The contribution of the PM10 and the PM1 fractions for all these parameters plays a central role throughout the paper, allowing an improved classification of aerosol types. Our data are dominated by elemental carbon (EC) and elemental carbon/organic carbon mixed (EC/OC). For the PM10 data, dust dominated aerosol is also observed. Although we found that fine particles contribute more than coarse particles for decreasing the ω0 values, results suggest that it is also necessary to quantify the effect of coarse particles. Fine particles were found to produce ω0 spectra that decrease with the wavelength, αω0 > 0, while PM10 fractions were found to produce spectra that can decrease or increase with the wavelength, 0 < αω0 < 0. Both daily cycle and monthly variations are analyzed and related to local features as well as the transport of particles from elsewhere. A diurnal pattern characteristic of urban areas is observed, but it is less evident on weekends. The main long range transport influences are Atlantic advection, anthropogenic events from Central Europe and dust events.

Thoracolumbar fractures without neurological impairment: A review of diagnosis and treatment.

An appropriate protocol and unified management of thoracolumbar fractures without neurological impairment has not been well defined.This review attempts to elucidate some controversies regarding diagnostic tools, the ability to define the most appropriate treatment of classification systems and the evidence for conservative and surgical methods based on the recent literature. Cite this article: Vilà-Canet G, García de Frutos A, Covaro A, Ubierna MT, Caceres E. Thoracolumbar fractures without neurological impairment: a review of diagnosis and treatment. EFORT Open Rev 2016;1:332-338. DOI: 10.1302/2058-5241.1.000029.

Aerosol properties of mineral dust and its mixtures in a regional background of north-central Iberian Peninsula.

To broaden the knowledge about desert dust (DD) aerosols in western Mediterranean Basin, their fingerprints on optical and microphysical properties are analyzed during DD episodes in the north-central plateau of the Iberian Peninsula between 2003 and 2014. Aerosol columnar properties obtained from the AErosol RObotic NETwork (AERONET), such as aerosol optical depth (AOD), Ångström exponent (AE), volume particle size distribution, volume concentration (VC), sphericity, single scattering albedo, among others, are analyzed in order to provide a general characterization, being some of them compared to particle mass surface concentrations PM10, PM2.5, and their ratio, data obtained from EMEP network. The mean intensity of DD episodes exhibits: AOD440nm=0.27±0.12, PM10=24±18µg/m3, AE=0.94±0.40 and PM2.5/PM10=0.54±0.16. The AOD and PM10 annual cycles show maximum intensity in March and summer and minima in winter. A customized threshold of AE=1 distinguishes two types of dusty days, those with a prevailing desert character and those of mixed type, which is corroborated by sphericity values. Three well established intervals are obtained with the fine mode volume fraction (VCF/VCT). Coarse-mode-dominated cases (VCF/VCT≤0.2) present a mineral dust character: e.g., particle maximum concentration about 2µm, non-sphericity, stronger absorption power at shorter wavelengths, among others. The relevance of the fine mode is noticeable in mixtures with a predominance of particles about 0.2-0.3µm radii. Conditions characterized by 0.2

Comparison of total water vapor column from GOME-2 on MetOp-A against ground-based GPS measurements at the Iberian Peninsula.

Water vapor column (WVC) obtained by GOME-2 instrument (GDP-4.6 version) onboard MetOp-A satellite platform is compared against reference WVC values derived from GPS (Global Positioning System) instruments from 2007 to 2012 at 21 places located at Iberian Peninsula. The accuracy and precision of GOME-2 to estimate the WVC is studied for different Iberian Peninsula zones using the mean (MBE) and the standard deviation (SD) of the GOME-2 and GPS differences. A direct comparison of all available data shows an overestimation of GOME-2 compared to GPS with a MBE of 0.7 mm (10%) and a precision quantified by a SD equals to 4.4mm (31%). South-Western zone presents the highest overestimation with a MBE of 1.9 mm (17%), while Continental zone shows the lowest SD absolute value (3.3mm) due mainly to the low WVC values reached at this zone. The influence of solar zenith angle (SZA), cloud fraction (CF), and the type of surface and its albedo on the differences between GOME-2 and GPS is analyzed in detail. MBE and SD increase when SZA increases, but MBE decreases (taking negative values) when CF increases and SD shows no significant dependence on CF. Under cloud-free conditions, the differences between WVC from GOME-2 and GPS are within the WVC error given by GOME-2. The changes of MBE and SD on Surface Albedo are not so evident, but MBE slightly decreases when the Surface Albedo increases. WVC from GOME-2 is, in general, more precise for land than for sea pixels.

Columnar and surface aerosol load over the Iberian Peninsula establishing annual cycles, trends, and relationships in five geographical sectors.

The study of atmospheric aerosol load over the Iberian Peninsula (IP) under a climatological perspective is accomplished by means of PM10 and AOD440 nm measurements from EMEP and AERONET networks, respectively, in the period 2000-2013. The PM10 annual cycles in five Iberian sectors show a main maximum in summer and a secondary maximum in spring, which is only observed in the southern area for the AOD climatology. The characteristics of PM10-AOD annual cycles of each geographical sector are explained by the different climatology of the air mass origins and their apportioning. The two magnitudes are correlated with a factor ranging between 20 and 90 depending on the sector. The temporal evolution of the aerosol load has shown a notable decrease in the IP since the 1980s. Statistically significant trends are obtained in the Northeastern sector with a reduction of 26% (period 1985-2000) for the total suspended particles, which continues for the PM10 data with a value of 35% per decade (2001-2013), and also in the whole column, 61% per decade in the AOD440 nm (2004-2013).

DNA computing on surfaces: encoding information at the single base level.

The feasibility of encoding a bit (0 or 1) of information for DNA-based computations at the single nucleotide level is evaluated, particularly with regard to the efficiency and specificity of hybridization discrimination. Hybridization experiments are performed on addressed arrays of 32 (2(5)) distinct oligonucleotides immobilized on chemically modified glass and gold surfaces with information encoded in a binary (base 2) format. Similar results are obtained on both glass and gold surfaces and the results are generally consistent with thermodynamic calculations of matched and mismatched duplex stabilities. It is found that under the conditions required to obtain single nucleotide specificity in the hybridization process, hybridization efficiency is low, compromising the utility of single nucleotide encoding for DNA computing applications in the absence of some additional mechanism for increasing specificity. Several methods are suggested to provide such increased discrimination.

A surface-based approach to DNA computation.

A scalable approach to DNA-based computations is described. Complex combinatorial mixtures of DNA molecules encoding all possible answers to a computational problem are synthesized and attached to the surface of a solid support. This set of molecules is queried in successive MARK (hybridization) and DESTROY (enzymatic digestion) operations. Determination of the sequence of the DNA molecules remaining on the surface after completion of these operations yields the answer to the computational problem. Experimental demonstrations of aspects of the strategy are presented.

A comparison of two neurologic scoring instruments for multiple sclerosis.

We examined the degree of association between two neurologic impairment scales, the Extended Disability Status Scale (EDSS) and the Scripps Neurologic Rating Scale (SNRS), with data from a randomized, double-blind, placebo-controlled clinical trial assessing the safety and efficacy of cladribine as treatment for chronic progressive multiple sclerosis (MS). We found that the EDSS and SNRS were not strongly correlated within individual patients, contrary to expectation; moreover, in 9 of the 48 evaluable patients, the directions of their changes from baseline values were not mutually consistent. The scales were differentially sensitive to clinical changes over time, with the EDSS indicating a more abrupt, and the SNRS a more gradual, change in the clinical course of disease. The validity of different impairment scales, and their sensitivity to detect clinical changes, should be formally assessed in future clinical trials using these scales as outcome measures.

Progress toward demonstration of a surface based DNA computation: a one word approach to solve a model satisfiability problem.

A multi-base encoding strategy is used in a one word approach to surface-based DNA computation. In this designed DNA model system, a set of 16 oligonucleotides, each a 16mer, is used with the format 5'-FFFFvvvvvvvvFFFF-3' in which 4-8 bits of data are stored in eight central variable ('v') base locations, and the remaining fixed ('F') base locations are used as a word label. The detailed implementations are reported here. In order to achieve perfect discrimination between each oligonucleotide, the efficiency and specificity of hybridization discrimination of the set of 16 oligonucleotides were examined by carrying out the hybridization of each individual fluorescently tagged complement to an array of 16 addressed immobilized oligonucleotides. A series of preliminary hybridization experiments are presented and further studies about hybridization, enzymatic destruction, read out and demonstrations of a SAT problem are forthcoming.

Surface-based DNA computing operations: DESTROY and READOUT.

DNA computing on surfaces is where complex combinatorial mixtures of DNA molecules are immobilized on a substrate and subsets are tagged and enzymatically modified (DESTROY) in repeated cycles of the DNA computation. A restriction enzyme has been chosen for the surface DESTROY operation. For the READOUT operation, both cycle sequencing and PCR amplification followed by addressed array hybridization were studied to determine the DNA sequences after the computations.

Benign intracardiac teratoma detected prenatally. Case report and review of the literature.

Primary cardiac tumors are rare and, until recently, were mostly incidental postmortem findings. Nowadays, due to the widespread use of prenatal ultrasound scans, we are able to diagnose them in utero. We present a case of an intracardiac teratoma diagnosed at 38 weeks, menstrual age. Previous scans had been normal. Labor was induced, and a female infant with an Apgar score of 9 and 4, at 1 and 5 min, was delivered. Her condition worsened rapidly. She died 16 h after birth. Necropsy was performed, and a cystic, mature teratoma of 4 cm was found in the interventricular septum, growing into the right ventricle. No other anomalies were found. This probably represents the first case of an intracardiac, benign teratoma diagnosed prenatally.

Situs inversus and myocardial revascularization. Case report.

This report describes an internal mammary artery by-pass grafting to the anterior descending coronary artery in a man with an unstable postinfarction angor pectoris and a "situs inversus totalis" condition. The association of "situs inversus totalis" and atherosclerotic coronary artery disease has the same incidence as in normal people. To the authors' knowledge, this is the second case in medical literature of coronary artery by-pass surgery with internal mammary artery graft in a patient with "situs inversus totalis".

[Palliative interatrial septostomy in severe pulmonary hypertension]. / Septostomía interatrial paliativa en la hipertensión pulmonar severa.

Three patients with severe pulmonary hypertension underwent palliative atrial septostomy by dilating the interatrial septum with valvuloplasty catheter-balloons. In two cases successful dilation improved cardiac index and symptoms of cardiac failure (13 and 11 months follow-up). One patient died immediately post-septotomy due to severe hypoxemia. Severe pulmonary hypertension with low cardiac output and high right ventricular filling pressures has a very poor short-term prognosis. Atrial septostomy is a useful palliative procedure and can serve as a bridge to heart and/or lung transplantation. It is not free of risk and the resultant systemic hypoxemia can lead to dead; that is why we recommend progressive balloon diameters, stopping the procedure when improvement of cardiac index is achieved with the minimal systemic oxygen desaturation.

[Rupture of the mitral posteromedial papillary muscle associated with myxomatous mitral valve]. / Rotura del músculo papilar posteromedial mitral asociada a válvula mitral mixomatosa.

We report a 52 year old man, who without previous thoracic trauma, cardiac diseases or cardiovascular risk factors presented after mild epigastric discomfort acute pulmonary oedema. He did not present clinical, electrocardiographic and biochemical manifestation of acute myocardial infarction. He was hospitalized and 15 days later he was sent to our hospital intubated and with assisted respiration. Haemodynamic studies showed severe acute mitral regurgitation and absence of significant obstructing lesions in the coronaries arteries. He was operated few hours after admission. The surgeon found a dysplasic mitral valve and rupture of a head of the posteromedial papillary muscle. The anatomopathological studies discovered mitral myxoid degeneration and ischemic lesion of the papillary muscle. We review the literature of the exclusive infarction of the papillary muscles and their possible relationships with the mitral prolapse syndrome.

[A case of Carney syndrome]. / Un caso de síndrome de Carney.

The Carney complex is an autosomal dominant syndrome characterised by multiple neoplasies, including myxomas at various sites (cardiac, cutaneous, mammary), spotty pigmentation, endocrine overactivity (Cushing's syndrome, acromegalia), testicular tumours and schwannomas. This report describes the case of a 43-year-old woman with an acute inferior myocardial infarction, probably due to coronary embolization from a large left atrial myxoma and who presented this association. A brief review of the Carney complex is provided after discussion of this rare case that required an screening of family members.