Under Stress: Searching for Genes Involved in the Response of Abies pinsapo Boiss to Climate Change.

Currently, Mediterranean forests are experiencing the deleterious effects of global warming, which mainly include increased temperatures and decreased precipitation in the region. Relict Abies pinsapo fir forests, endemic in the southern Iberian Peninsula, are especially sensitive to these recent environmental disturbances, and identifying the genes involved in the response of this endangered tree species to climate-driven stresses is of paramount importance for mitigating their effects. Genomic resources for A. pinsapo allow for the analysis of candidate genes reacting to warming and aridity in their natural habitats. Several members of the complex gene families encoding late embryogenesis abundant proteins (LEAs) and heat shock proteins (HSPs) have been found to exhibit differential expression patterns between wet and dry seasons when samples from distinct geographical locations and dissimilar exposures to the effects of climate change were analyzed. The observed changes were more perceptible in the roots of trees, particularly in declining forests distributed at lower altitudes in the more vulnerable mountains. These findings align with previous studies and lay the groundwork for further research on the molecular level. Molecular and genomic approaches offer valuable insights for mitigating climate stress and safeguarding this endangered conifer.

Prognostic Usefulness of Basic Analytical Data in Chronic Obstructive Pulmonary Disease Exacerbation.

Introduction: COPD causes high morbidity and mortality and high health costs. Thus, identifying and analyzing the distinctive and treatable traits seems useful to optimize the management of AEPOC patients. While various biomarkers have been researched, no solid data for systematic use have been made available. Aim: Assessing the short-term prognostic usefulness of clinical and analytical parameters available in routine clinical practice in COPD exacerbations. Material and methods: Multicenter prospective observational study conducted between 2016 and 2018. Patients admitted for COPD exacerbation who agreed to participate and signed an informed consent form were included. Prolonged stay, in-hospital mortality or early readmission was considered an unfavorable progression. 30-Day mortality was also analyzed. Results: 615 patients were included. Mean age was 73.9 years (SD 10.6); 86.2% were male. Progression of 357 patients (58%) was considered unfavorable. Mortality at 1 month from discharge was 6.7%. The multivariate analysis shows a relationship between the CRP/Albumin ratio and unfavorable progression (OR 1.008, 95% CI 1.00; 1.01), as well as increased risk of death at 1 month from discharge with elevated urea (OR 1.01, 95% CI 1.005; 1.02) and troponin T (OR 2.21, 95% CI 1.06; 4.62). Conclusion: Elevated CRP/Albumin, urea and TnT are prognostic indicators of poor short-term outcome in patients admitted for COPD exacerbation. Cardiovascular comorbidity and systemic inflammation could explain these findings.

Introducción: : La EPOC provoca una elevada morbimortalidad y elevados costes sanitarios. Identificar y analizar los rasgos distintivos y tratables parece útil para optimizar el tratamiento de los pacientes con AEPOC. Se han investigado varios biomarcadores sin que de momento se disponga de datos sólidos para su uso sistemático. Objetivo: Evaluar la utilidad pronóstica a corto plazo de los parámetros clínicos y analíticos disponibles en la práctica clínica habitual en las exacerbaciones de la EPOC. Material y métodos: Estudio observacional prospectivo multicéntrico realizado entre 2016 y 2018. Se incluyeron pacientes ingresados por exacerbación de EPOC que aceptaron participar y que firmaron consentimiento informado. Se consideró evolución desfavorable la estancia prolongada, la mortalidad hospitalaria o el reingreso precoz. También se analizó la mortalidad a 30 días. Resultados: Se incluyeron 615 pacientes. La edad media fue 73,9 años (DE 10,6); El 86,2% eran varones. Se consideró desfavorable la evolución de 357 pacientes (58%). La mortalidad al mes del alta fue del 6,7%. El análisis multivariante muestra una relación entre el ratio PCR/Albúmina y la progresión desfavorable (OR 1,008, IC 95% 1,00; 1,01), así como un mayor riesgo de muerte al mes del alta con urea elevada (OR 1,01, IC 95% 1,005; 1,02) y troponina T (OR 2,21; IC del 95%: 1,06; 4,62). Conclusión: La elevación de PCR/albúmina, la urea y la TnT son indicadores de mal pronóstico a corto plazo en pacientes ingresados por exacerbación de la EPOC. La comorbilidad cardiovascular y la inflamación sistémica podrían explicar estos hallazgos.

Faecal nutrient deposition of domestic and wild herbivores in an alpine grassland.

The contribution of herbivores to ecosystem nutrient fluxes through dung deposition has the potential to, directly and indirectly, influence ecosystem functioning. This process can be particularly important in nutrient-limited ecosystems such as alpine systems. However, herbivore dung content (carbon, C; nitrogen, N; phosphorus, P; potassium, K) and stoichiometry (C/N) may differ among species due to differences in diet, seasonality, body type, feeding strategy, and/or digestive system with consequences for soil biogeochemistry. Here we explore how species, body size, and seasonality may result in differences in dung stoichiometry for four alpine herbivores (chamois, sheep, horse, and cattle). We found that herbivore dung nutrient content often varies among species as well as with body size, with the dung of small herbivores having larger C, N, and P faecal content. Seasonality also showed marked effects on faecal nutrient content, with a general pattern of decreasing levels of faecal P, N and an increase of C/N as the summer progresses following the loss of nutrient value of the vegetation. Moreover, we showed how herbivores play an important role as natural fertilizers of C, N, and P in our study area, especially cattle. Our study highlights the importance of considering the relative contribution of different herbivores to ecosystem nutrient fluxes in management practices, especially with ongoing changes in wild and domestic herbivore populations in alpine ecosystems.

Transcriptome Analysis and Intraspecific Variation in Spanish Fir (Abies pinsapo Boiss.).

Spanish fir (Abies pinsapo Boiss.) is an endemic, endangered tree that has been scarcely investigated at the molecular level. In this work, the transcriptome of Spanish fir was assembled, providing a large catalog of expressed genes (22,769), within which a high proportion were full-length transcripts (12,545). This resource is valuable for functional genomics studies and genome annotation in this relict conifer species. Two intraspecific variations of A. pinsapo can be found within its largest population at the Sierra de las Nieves National Park: one with standard green needles and another with bluish-green needles. To elucidate the causes of both phenotypes, we studied different physiological and molecular markers and transcriptome profiles in the needles. "Green" trees showed higher electron transport efficiency and enhanced levels of chlorophyll, protein, and total nitrogen in the needles. In contrast, needles from "bluish" trees exhibited higher contents of carotenoids and cellulose. These results agreed with the differential transcriptomic profiles, suggesting an imbalance in the nitrogen status of "bluish" trees. Additionally, gene expression analyses suggested that these differences could be associated with different epigenomic profiles. Taken together, the reported data provide new transcriptome resources and a better understanding of the natural variation in this tree species, which can help improve guidelines for its conservation and the implementation of adaptive management strategies under climatic change.

Evaluation of Celiac Disease by Minimally Invasive Biomarkers in a Spanish Pediatric Population.

BACKGROUND: The diagnosis of celiac disease (CD) has been substantially improved with the availability of highly sensitive CD-specific IgA-TG2, Ig-GDP, and IgA-EMA. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published (2012) and updated (2020) diagnostic criteria for CD in order to simplify CD diagnosis and to avoid biopsies in selected patients. METHODS: A prospective study including 5641 pediatric patients (0-16 years old) from January 2012 to January 2019 was performed. CD diagnosis was made according to the ESPGHAN algorithm. The objective of this study was to evaluate the utility of biomarkers and the relationship between TGA-IgA and EMA titers. RESULTS: CD diagnoses were confirmed in 113 patients, 110 were IgA-TG2-positive and 3 (2.7%) had IgA deficiency. The diagnosis was made by serologic tests in 95 (84.1%) patients. Only 18 (15.9%) patients underwent intestinal biopsy. We obtained 100% concordance between IgA-EMA and positive results for IgA-TG2 ≥ 10 ULN with IgA-EMA antibody titer ≥ 1:80. CONCLUSIONS: This study provides evidence of a positive correlation between IgA-TG2 antibody serum levels and IgA-EMA. The diagnosis could be guaranteed with strict application of IgA-TG2 values ≥ 10 ULN (confirmed by subsequent testing) plus the serological response to the gluten-free diet (GFD).

Impact of anxiety and depression on the prognosis of copd exacerbations.

BACKGROUND: Frequent and highly prevalent as comorbidities in Chronic Obstructive Pulmonary Disease (COPD) patients, both depression and anxiety seem to have an impact on COPD prognosis. However, they are underdiagnosed and rarely treated properly. AIM: To establish the prevalence of depression and anxiety in patients admitted for Acute Exacerbation of COPD (AECOPD) and determine their influence on COPD prognosis. METHODS: Prospective observational study conducted from October 1, 2016 to October 1, 2018 at the following centers in Galicia, Spain: Salnés County Hospital, Arquitecto Marcide, and Clinic Hospital Complex of Santiago de Compostela. Patients admitted for AECOPD who agreed to participate and completed the anxiety and depression scale (HADS) were included in the study. RESULTS: 288 patients (46.8%) were included, mean age was 73.7 years (SD 10.9), 84.7% were male. 67.7% patients were diagnosed with probable depression, and depression was established in 41.7%; anxiety was probable in 68.2% and established in 35.4%. 60.4% of all patients showed symptoms of both anxiety and depression. Multivariate analysis relates established depression with a higher risk of late readmission (OR 2.06, 95% CI 1.28; 3.31) and a lower risk of mortality at 18 months (OR 0.57, 95% CI 0.37; 0.90). CONCLUSION: The prevalence of anxiety and depression in COPD patients is high. Depression seems to be an independent factor for AECOPD, so early detection and a multidisciplinary approach could improve the prognosis of both entities. The study was approved by the Ethical Committee of Galicia (code 2016/460).

Risk Factors of Mortality in Hospitalized Patients With COVID-19 Applying a Machine Learning Algorithm.

Introduction: Risk stratification of patients with COVID-19 can be fundamental to support clinical decision-making and optimize resources. The objective of our study is to identify among the routinely tested clinical and analytical parameters those that would allow us to determine patients with the highest risk of dying from COVID-19. Material and methods: We carried out a retrospective cohort multicentric study by consecutively, including hospitalized patients with COVID-19 admitted in any of the 11 hospitals in the healthcare network of HM Hospitals-Spain. We collected the clinical, demographic, analytical, and radiological data from the patient's medical records.To assess each of the biomarkers' predictive impact and measure the statistical significance of the variables involved in the analysis, we applied a random forest with a permutation method. We used the similarity measure induced by a previously classification model and adjusted the k-groups clustering algorithm based on the energy distance to stratify patients into a high and low-risk group. Finally, we adjusted two optimal classification trees to have a schematic representation of the cut-off points. Results: We included 1246 patients (average age of 65.36 years, 62% males). During the study one hundred sixty-eight patients (13%) died. High values of age, D-Dimer, White Blood Cell, Na, CRP, and creatinine represent the factors that identify high-risk patients who would die. Conclusions: Age seems to be the primary predictor of mortality in patients with SARS-CoV-2 infection, while the impact of acute phase reactants and blood cellularity is also highly relevant.

Introducción: La estratificación del riesgo de los pacientes con COVID-19 puede ser fundamental para apoyar la toma de decisiones clínicas y optimizar los recursos. El objetivo de nuestro estudio es identificar, entre los parámetros clínicos y analíticos probados de forma rutinaria, aquellos que nos permitirían determinar a los pacientes con mayor riesgo de morir por COVID-19. Material y métodos: Se realizó un estudio multicéntrico de cohorte retrospectiva de forma consecutiva, incluyendo pacientes hospitalizados con COVID-19 ingresados en cualquiera de los 11 hospitales de la red sanitaria de HM Hospitales-España.Los datos clínicos, demográficos, analíticos y radiológicos se recopilaron de las historias clínicas de los pacientes.Para evaluar el impacto predictivo de cada uno de los biomarcadores y medir la significación estadística de las variables involucradas en el análisis, se aplicó un bosque aleatorio con un método de permutación. Utilizamos la medida de similitud inducida por un modelo de clasificación previo, y ajustamos el algoritmo de agrupación de grupos k en función de la distancia de energía para estratificar a los pacientes en un grupo de alto y bajo riesgo. Finalmente, ajustamos 2 árboles de clasificación óptimos para tener una representación esquemática de los puntos de corte. Resultados: Se incluyeron 1.246 pacientes (edad promedio de 65,36 años, 62% varones). Durante el estudio murieron 168 pacientes (13%). Los factores que identifican a los pacientes de alto riesgo de mortalidad son los valores elevados de edad, dímero D, glóbulos blancos, Na, PCR y creatinina. Conclusiones: La edad parece ser el principal predictor de mortalidad en pacientes con infección por SARS-CoV-2, mientras que el impacto de los reactantes de fase aguda y la celularidad sanguínea también es muy relevante.

Red Cell Distribution Width as a Predictive Factor of Celiac Disease in Middle and Late Adulthood and Its Potential Utility as Celiac Disease Screening Criterion.

Red cell distribution width (RDW) could be of interest by its potential use in the assessment of celiac disorder (CD). The main objective of this study was to evaluate the case positive rate of CD and the utility of red cell distribution width (RDW) in the CD diagnosis. This prospective study included 9.066 middle adult (≥45 years old) and elderly patients (≥60 years old) from 2012 to 2021. CD diagnosis was performed by CD antibody tests (serology and Human Leucocyte Antigen genotype (HLA)) and biopsy. Gastrointestinal and extra-intestinal manifestations as well as hematological and biochemical parameters were analyzed. CD diagnoses were confirmed in 101 patients (median (IQR) age = 62 (52.3−73); 68.32% women) by serologic tests (100%) and intestinal biopsy (88.12%), showing mainly marked or complete atrophy (76.24%, MARSH 3a−c). Anemia was the most commonly presenting extra-intestinal manifestation (28.57%). Among 8975 individuals without CD, 168 age and sex matched were included. By comparison of CD and no CD individuals, we observed that high >14.3% RDW was exhibited by 58.40% and 35.2% individuals with CD and without CD, respectively. Furthermore, high RDW is associated with CD and grade III atrophy. We suggest that RDW could be used as a CD screening criterion.

Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation.

INTRODUCTION: In complex and deformed knees, soft tissue release (STR) is required to obtain symmetry in the femorotibial gap. The objective of this study was to attempt to predict the need for soft tissue release using surgical navigation in total knee replacement (TKR). METHODS: Prospective and non-randomized study. One hundred thirty knees. At the start of navigation, an attempt was made to correct the femorotibial mechanical axis by applying force to the medial or lateral side of the knee (varus-valgus stress angle test). A gap balanced technique with computer-assisted surgery (CAS) was performed in all cases. The ligaments were tensioned, and using CAS visualization and control, progressive STR was performed in the medial or lateral side until a symmetry of the femorotibial gap was achieved. RESULTS: Eighty-two patients had a varus axis ≥ 3° and 38 had a valgus axis (P < 0.001). STR was performed under navigation control in 38.5% of cases, lateral release (LR) in 12 cases, and medial release (MR) in 38 cases. After performing the varus-valgus stress angle test (VVSAT), the axis of 0° could be restored at some point during the manoeuvre in 28 cases. STR was required in 44.6% of varus cases and 27% of valgus cases (P = 0.05). A significant relationship was found between the previous deformity and the need for MR (P < 0.001) or LR (P = 0.001). STR was more common in male patients (P = 0.002) and as obesity increased. CONCLUSION: This study shows that pre-operative factors favouring the need to perform STR in a TKR implant can be defined.

Unexpected resilience in relict Abies pinsapo Boiss forests to dieback and mortality induced by climate change.

Acute and early symptoms of forest dieback linked to climate warming and drought episodes have been reported for relict Abies pinsapo Boiss. fir forests from Southern Spain, particularly at their lower ecotone. Satellite, orthoimages, and field data were used to assess forest decline, tree mortality, and gap formation and recolonization in the lower half of the altitudinal range of A. pinsapo forests (850-1550 m) for the last 36 years (1985-2020). Field surveys were carried out in 2003 and in 2020 to characterize changes in stand canopy structure and mortality rates across the altitudinal range. Time series of the Normalized Difference Vegetation Index (NDVI) at the end of the dry season (derived from Landsat 5 and 7 imagery) were used for a Dynamic Factor Analysis to detect common trends across altitudinal bands and topographic solar incidence gradients (SI). Historical canopy cover changes were analyzed through aerial orthoimages classification. Here we show that extensive decline and mortality contrast to the almost steady alive basal area for 17 years, as well as the rising photosynthetic activity derived from NDVI since the mid-2000s and an increase in the forest canopy cover in the late years at mid and high altitudes. We hypothesized that these results suggest an unexpected resilience in A. pinsapo forests to climate change-induced dieback, that might be promoted by compensation mechanisms such as (i) recruitment of new A. pinsapo individuals; (ii) facilitative effects on such recruitment mediated by revegetation with other species; and (iii) a 'release effect' in which surviving trees can thrive with fewer resource competition. Future research is needed to understand these compensation mechanisms and their scope in future climate change scenarios.

Deep learning method for aortic root detection.

BACKGROUND: Computed tomography angiography (CTA) is a preferred imaging technique for a wide range of vascular diseases. However, extensive manual analysis is required to detect and identify several anatomical landmarks for clinical application. This study demonstrates the feasibility of a fully automatic method for detecting the aortic root, which is a key anatomical landmark in this type of procedure. The approach is based on the use of deep learning techniques that attempt to mimic expert behavior. METHODS: A total of 69 CTA scans (39 for training and 30 for validation) with different pathology types were selected to train the network. Furthermore, a total of 71 CTA scans were selected independently and applied as the test set to assess their performance. RESULTS: The accuracy was evaluated by comparing the locations marked by the method with benchmark locations (which were manually marked by two experts). The interobserver error was 4.6 ± 2.3 mm. On an average, the differences between the locations marked by the two experts and those detected by the computer were 6.6 ± 3.0 mm and 6.8 ± 3.3 mm, respectively, when calculated using the test set. CONCLUSIONS: From an analysis of these results, we can conclude that the proposed method based on pre-trained CNN models can accurately detect the aortic root in CTA images without prior segmentation.

Drought, axe and goats. More variable and synchronized growth forecasts worsening dieback in Moroccan Atlas cedar forests.

Understanding how climate warming and land-use changes determine the vulnerability of forests to drought is critical. However, we still lack: (i) robust quantifications of long-term growth changes during aridification processes, (ii) links between growth decline, changes in forest cover, stand structure and soil conditions, and (iii) forecasts of growth variability to projected climate warming. We investigated tree-ring records over the past 400-700 years, quantified changes in grazing area and forest cover during the 20th century, sampled current stand structure, and analyzed soil organic carbon δ13C and total nitrogen δ15N of Atlas cedar (Cedrus atlantica (Endl.) Manetti ex Carrière) Moroccan forests to characterize their dieback. Atlas cedar forests experienced massive dieback after the 1970s, particularly in the xeric High Atlas region. Forest cover increased in the less xeric regions (Middle Atlas and Rif) by almost 20%, while it decreased about 18% in the High Atlas, where soil δ13C and δ15N showed evidences of grazing. Growth declined and became more variable in response to recent droughts. The relative growth reduction (54%) was higher in the Middle Atlas than elsewhere (Rif, 32%; High Atlas, 36%). Growth synchrony between forests located within the Middle and High Atlas regions increased after the 1970s. Simulations based on a worst-case emission scenario and rapid warming forecast a stronger limitation of growth by low soil moisture in all regions, but particularly in the Middle Atlas and after the mid-21st century. Climate warming is expected to strengthen growth synchronization preceding dieback of conifer forests in xeric regions. The likelihood of similar dieback episodes is further exacerbated by historical degradation of these forests.

Morphostatic Speciation within the Dagger Nematode Xiphinema hispanum-Complex Species (Nematoda: Longidoridae).

Dagger nematodes of the genus Xiphinema include a remarkable group of invertebrates of the phylum Nematoda comprising ectoparasitic animals of many wild and cultivated plants. Damage is caused by direct feeding on root cells and by vectoring nepoviruses that cause diseases on several crops. Precise identification of Xiphinema species is critical for launching appropriate control measures. We deciphered the cryptic diversity of the Xiphinema hispanum-species complex applying integrative taxonomical approaches that allowed us to verify a paradigmatic example of the morphostatic speciation and the description of a new species, Xiphinema malaka sp. nov. Detailed morphological, morphometrical, multivariate and genetic studies were carried out, and mitochondrial and nuclear haploweb analyses were used for species delimitation of this group. The new species belongs to morphospecies Group 5 from the Xiphinema nonamericanum-group species. D2-D3, ITS1, partial 18S, and partial coxI regions were used for inferring the phylogenetic relationships of X. malaka sp. nov. with other species within the genus Xiphinema. Molecular analyses showed a clear species differentiation not paralleled in morphology and morphometry, reflecting a clear morphostatic speciation. These results support the hypothesis that the biodiversity of dagger nematodes in southern Europe is greater than previously assumed.

Using ForeStereo and LIDAR data to assess fire and canopy structure-related risks in relict Abies pinsapo Boiss. forests.

In this study we combine information from aerial LIDAR and hemispherical images taken in the field with ForeStereo-a forest inventory device-to assess the vulnerability and to design conservation strategies for endangered Mediterranean fir forests based on the mapping of fire risk and canopy structure spatial variability. We focused on the largest continuous remnant population of the endangered tree species Abies pinsapo Boiss. spanning 252 ha in Sierra de las Nieves National Park (South Andalusia, Spain). We established 49 sampling plots over the study area. Stand structure variables were derived from ForeStereo device, a proximal sensing technology for tree diameter, height and crown dimensions and stand crown cover and basal area retrieval from stereoscopic hemispherical images photogrammetry. With this information, we developed regression models with airborne LIDAR data (spatial resolution of 0.5 points∙m-2). Thereafter, six fuel models were fitted to the plots according to the UCO40 classification criteria, and then the entire area was classified using the Nearest Neighbor algorithm on Sentinel imagery (overall accuracy of 0.56 and a KIA-Kappa Coefficient of 0.46). FlamMap software was used for fire simulation scenarios based on fuel models, stand structure, and terrain data. Besides the fire simulation, we analyzed canopy structure to assess the status and vulnerability of this fir population. The assessment shows a secondary growth forest that has an increasing presence of fuel models with the potential for high fire spread rate fire and burn probability. Our methodological approach has the potential to be integrated as a support tool for the adaptive management and conservation of A. pinsapo across its whole distribution area (<4,000 ha), as well as for other endangered circum-Mediterranean fir forests, as A. numidica de Lannoy and A. pinsapo marocana Trab. in North Africa.

Automatic detection of anatomical landmarks of the aorta in CTA images.

Computed tomography angiography (CTA) is one of the most common vascular imaging modalities. However, for clinical use, it still requires laborious manual analysis. This study demonstrates the feasibility of a fully automated technology for the accurate detection and identification of several anatomical reference points (landmarks), commonly used in intravascular imaging. This technology uses two different approaches, specially designed for the detection of aortic root and supra-aortic and visceral branches. In order to adjust the parameters of the developed algorithms, a total of 33 computed tomography scans with different types of pathologies were selected. Furthermore, a total of 30 independently selected computed tomography scans were used to assess their performance. Accuracy was evaluated by comparing the locations of reference points manually marked by human experts with those that were automatically detected. For supra-aortic and visceral branches detection, average values of 91.8 % for recall and 98.8 % for precision were obtained. For aortic root detection, the average difference between the positions marked by the experts and those detected by the computer was 5.7 ± 7.3 mm. Finally, diameters and lengths of the aorta were measured at different locations related to the extracted landmarks. Those measurements agreed with the values reported by the literature. Graphical abstract Schematic description of the proposed algorithm. The input includes an already segmented aorta (left), there are two main sub-processes related to the detection of branches and roots (center), and the output includes the segmented original aorta with the branches and the detected landmarks superimposed (right).

Obesity Does Not Increase the Risk of Asthma Readmissions.

The relationship between obesity and asthma exacerbations is still under debate. The aim of our work is to analyse the relationship between obesity and hospital re-admissions in asthmatics. A review was retrospectively performed on all hospital admissions of adult patients due to asthma exacerbation occurring in our hospital for 11 years. All those cases with asthma as the first diagnosis in the discharge report were included, or those with asthma as the second diagnosis provided when the first diagnosis was respiratory infection or respiratory failure. Only the first hospital admission of each patient was included in this study. The Odds Ratios of a higher incidence of early/late readmissions due to asthma exacerbation were calculated using a binary logistic regression, using the body mass index (BMI) as independent variable, adjusted for all the variables included in the study. The study included 809 patients with a mean age of 55.6 years, and 65.2% were female. The majority (71.4%) were obese or overweight. No significant relationship was observed in the univariate or multivariate analyses between overweight or obesity and the early or late hospital readmissions due to asthma. Therefore, obesity does not seem to be a determining factor in the risk of asthma exacerbations.

Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations.

Introduction The aim of analysing the usefulness of the blood eosinophil count (BEC) as a prognostic marker in exacerbations of patients with Chronic Obstructive Pulmonary Disease (COPD), evaluating its relationship with hospital mortality, the length of stay and the early and late re-admissions. Materials and Methods We have carried out a retrospective study including all patients who required hospital admission from 1 January 2008 to 31 December 2009, with a diagnosis on hospital discharge of COPD exacerbation. These patients were classified using three cut-off points of BEC: less than 200 vs ≥ 200/µL, less than 300 vs ≥ 300/µL and less than 400 vs ≥ 400/µL. Results There were a total of 1626 hospital admissions during the study period with the diagnosis of exacerbation of COPD. In this study we have included 358 patients. The probability of any late re-admission increased with a BEC ≥ 300/µL (odds ratio: 1.684) and for those with a BEC ≥ 400/µL (odds ratio: 2.068). The BEC does not appear to be related to hospital mortality or the probability of early re-admission after an exacerbation of COPD. Conclusions In our study an elevated BEC is associated with a higher incidence of late hospital readmissions in COPD exacerbations.

Spinal fusion achieves similar two-year improvement in HRQoL as total hip and total knee replacement. A prospective, multicentric and observational study.

INTRODUCTION: Total hip and knee arthroplasty (THA/TKA) are surgical procedures with proven benefits. Although the literature reports outcomes of fusion of the lumbar spine comparable to those of THA/TKA in general health-related quality-of-life (HRQoL) questionnaires, functional assessment is nevertheless needed for these results to be of use in clinical practice and management. Aim of our study was to prove that lumbar spinal fusion has similar if not better outcomes than THA/TKA using intervention-specific HRQoL questionnaires and functional assessment questionnaires. MATERIALS AND METHODS: Observational, ambispective, multicentre study of three cohorts undergoing lumbar spinal fusion (n = 115), THA (n = 119) and TKA (n = 253). Patients were evaluated using the Short-Form-12 (SF-12), Harris-Hip-Score, Hospital for Special Surgery Scale (HSS) and Oswestry Low Back Pain Disability questionnaires. A minimum follow-up of two years was conducted. RESULTS: The SF-12 showed significant improvement in all groups. The SF-12 physical component summary score indicated a more severe pre-operative status (p = 0.031) in the THA cohort. The mental component summary score indicated a less severe pre-operative status in the TKA cohort (p = 0.008) and greater post-operative improvement in the TKA and THA cohorts across follow-up (six months p = 0.021; one year p = 0.012; two years p = 0.042). Functional assessment indicated greater pre-operative disability in the THA group. At two years of follow-up, functional improvement according to the Harris, HSS and Oswestry questionnaires were 152.01%, 50.07% and 41.14% respectively. CONCLUSIONS: This study demonstrates that lumbar spinal fusion and total knee and hip arthroplasty are comparable in terms of functional improvement when thoroughly studied with health, quality-of-life and functional assessment questionnaires.

Automatic estimation of the aortic lumen geometry by ellipse tracking.

PURPOSE: The shape and size of the aortic lumen can be associated with several aortic diseases. Automated computer segmentation can provide a mechanism for extracting the main features of the aorta that may be used as a diagnostic aid for physicians. This article presents a new fully automated algorithm to extract the aorta geometry for either normal (with and without contrast) or abnormal computed tomography (CT) cases. METHODS: The algorithm we propose is a fast incremental technique that computes the 3D geometry of the aortic lumen from an initial contour located inside it. Our approach is based on the optimization of the 3D orientation of the cross sections of the aorta. The method uses a robust ellipse estimation algorithm and an energy-based optimization technique to automatically track the centerline and the cross sections. The optimization involves the size and eccentricity of the ellipse which best fits the aorta contour on each cross-sectional plane. The method works directly on the original CT and does not require a prior segmentation of the aortic lumen. We present experimental results to show the accuracy of the method and its ability to cope with challenging CT cases where the aortic lumen may have low contrast, different kinds of pathologies, artifacts, and even significant angulations due to severe elongations. RESULTS: The algorithm correctly tracked the aorta geometry in 380 of 385 CT cases. The mean of the dice similarity coefficient was 0.951 for aorta cross sections that were randomly selected from the whole database. The mean distance to a manually delineated segmentation of the aortic lumen was 0.9 mm for sixteen selected cases. CONCLUSIONS: The results achieved after the evaluation demonstrate that the proposed algorithm is robust and accurate for the automatic extraction of the aorta geometry for both normal (with and without contrast) and abnormal CT volumes.