Chemical characteristics of wildfire ash across the globe and their environmental and socio-economic implications.

The mobilisation of potentially harmful chemical constituents in wildfire ash can be a major consequence of wildfires, posing widespread societal risks. Knowledge of wildfire ash chemical composition is crucial to anticipate and mitigate these risks. Here we present a comprehensive dataset on the chemical characteristics of a wide range of wildfire ashes (42 types and a total of 148 samples) from wildfires across the globe and examine their potential societal and environmental implications. An extensive review of studies analysing chemical composition in ash was also performed to complement and compare our ash dataset. Most ashes in our dataset had an alkaline reaction (mean pH 8.8, ranging between 6 and 11.2). Important constituents of wildfire ash were organic carbon (mean: 204 g kg-1), calcium, aluminium, and iron (mean: 47.9, 17.9 and 17.1 g kg-1). Mean nitrogen and phosphorus ranged between 1 and 25 g kg-1, and between 0.2 and 9.9 g kg-1, respectively. The largest concentrations of metals of concern for human and ecosystem health were observed for manganese (mean: 1488 mg kg-1; three ecosystems > 1000 mg kg-1), zinc (mean: 181 mg kg-1; two ecosystems > 500 mg kg-1) and lead (mean: 66.9 mg kg-1; two ecosystems > 200 mg kg-1). Burn severity and sampling timing were key factors influencing ash chemical characteristics like pH, carbon and nitrogen concentrations. The highest readily dissolvable fractions (as a % of ash dry weight) in water were observed for sodium (18 %) and magnesium (11.4 %). Although concentrations of elements of concern were very close to, or exceeded international contamination standards in some ashes, the actual effect of ash will depend on factors like ash loads and the dilution into environmental matrices such as water, soil and sediment. Our approach can serve as an initial methodological standardisation of wildfire ash sampling and chemical analysis protocols.

Primary central nervous system vasculitis: A diagnostic and therapeutic challenge. A series of 7 patients.

INTRODUCTION: Primary central nervous system vasculitis (PCNSV) is a rare disease affecting medium- and small-calibre blood vessels of the central nervous system. OBJECTIVE: The aim of this study was to analyse clinical findings and diagnostic aspects, with special attention to histopathological findings, as well as the treatments used and treatment response in patients diagnosed with PCNSV at our hospital. PATIENTS AND METHODS: We conducted a retrospective descriptive analysis of patients with a diagnosis of PCNSV at discharge from our centre and meeting the 1988 Calabrese criteria. To this end, we analysed the hospital discharge records of Hospital General Universitario de Castellón between January 2000 and May 2020. RESULTS: We analysed a series of 7 patients who were admitted with transient focal alterations and other less specific symptoms such as headache or dizziness; diagnosis was based on histological findings in 5 cases and on suggestive arteriographic findings in the remaining 2. Neuroimaging results were pathological in all cases, and CSF analysis detected alterations in 3 of the 5 patients who underwent lumbar puncture. All patients received initial treatment with megadoses of corticosteroids followed by immunosuppressive treatment. Progression was unfavourable in 6 cases, with fatal outcomes in 4. CONCLUSIONS: Despite the diagnostic challenge of PCNSV, it is essential to attempt to reach a definitive diagnosis using such tools as histopathology and/or arteriography studies, in order to promptly establish appropriate treatment and thus reduce the morbidity and mortality of this condition.

Disfunción endotelial. Mecanismos e implicancias en Covid-19 / Endothelial dysfunction. Mechanisms and implications on Covid-19

Endothelium is the inner layer of vessels that separates circulating blood from the rest of the body tissues. Since its discovery, it has been involved in various functions, both systemic and organ specific. Currently, endothelial damage and failure in its functions is considered a key element in pathophysiology of various clinical scenarios, among which we may find COVID-19.Hence, it has been a target in development of strategies that seek to maintain, enhance or repair its function. The purpose of the following review is to describe what an endothelial function is about, its relation with current medical practice, and its implications in the SARS- CoV-2 pandemic. (AU)

Soil erosion on mountain trails as a consequence of recreational activities. A comprehensive review of the scientific literature.

This article reviews the scientific literature on trail erosion and the magnitude of the erosive processes that occur on mountain trails due to recreational activities, mainly due to hiking. This work is necessary as a result of the increase in hiking and biking in forest, scrubland and grasslands, and the soil and vegetation degradation induced by these activities. We analysed results that have been compiled in the scientific literature, as well as other issues such as the geographical and temporal distribution of the research, the methods applied, the journals where the research was published, the types and quantity of uses of the pathways and the measures undertaken for damage mitigation. This paper highlights that there is a need for harmonization of methods. The results show that soil erosion rates are highly variable, high, and non-sustainable. Trail erosion research is growing at a rate of 3 papers per year and is published in a small group of scientific journals. Six journals published 47% of the papers on trail erosion, which show a high concentration in environmental journals. There are few papers published in the soil science and geomorphology disciplines, although the research topic and the science background are in these two disciplines. Reported world soil losses from trails ranged from 6.1 Mg ha-1 y-1 to 2090 Mg ha-1 y-1, all of which are not sustainable. Trail erosion has mainly been investigated in the USA and is a new topic in other regions of the world. There is a need to implement mitigation measures to avoid land degradation, and this should be researched in the near future as right now most of the research describes and quantifies the problem but does not provide solutions: mitigation, rehabilitation or restoration. From a pure scientific approach, we claim that there is a need to research the connectivity of flows and the role of the trails on runoff generation and then sediment yield at pedon, slope and watershed scales. There is a need to research the mechanisms of the soil erosion process in trails: trampling effect, wheel impact, factors and seasonal and temporal changes.

Three topographical approaches to survey soil erosion on a mountain trail affected by a forest fire. Barranc de la Manesa, Llutxent, Eastern Iberian Peninsula.

Soil erosion on mountain trails threaten the sustainability of soils and vegetation. There is a wide theoretical knowledge about the effects produced by mountain recreational activities, but particularly for soil erosion there is a shortage of field data. This is why it is necessary to properly survey the soil losses on mountain trails. The most widely applied method in scientific literature is the Cross-Section field survey as is easy-to-apply and low-cost. However, there is a doubt about its accuracy and the development of the new technologies may improve the quality and accuracy of the measurements. Aerial and terrestrial photogrammetric methods are difficult to apply when vegetation is present but, an opportunity arises to apply this method when fire takes place. This paper analyses the soil losses in a recently fire-affected land to check the accuracy of the three methodologies to assess soil loss on mountain trails. The results obtained show an average soil loss between 1287 and 1404 Mg ha-1 of trail erosion for the three methodologies applied, which implies that the Cross-Sectional-Area method, aerial photography and terrestrial photography provide very similar values. Therefore, the conventional Cross-Section field surveys method is useful and adequate to evaluate the impacts generated on mountain trails as it provides accurate measurement and can be repeated any time and below different vegetation covers. The terrestrial photogrammetric methods are accurate too, but they can only be used when there is very little vegetation cover such as in semiarid and arid landscapes or after forest fires. Moreover, they are more expensive and time consuming.

Valorisation of biowaste digestate through solid state fermentation to produce biopesticides from Bacillus thuringiensis.

The main goal of this work is the production of a biopesticide through solid-state fermentation of biowaste digestate inoculated with Bacillus thuringiensis (Bt) at pilot scale using different configurations of reactors. Fermentations were carried out using insulated and non-insulated, stirred and non-stirred reactors at different scales (10, 22 and 100 L) in order to assess the influence of the reactor configuration on the biopesticide production process. A maximum temperature of 60 °C was reached in 10-L insulated non-stirred reactors where increments of Bt viable cells and spores with respect to initial values of 1.9 and 171.6 respectively, were attained. In contrast, when temperature was regulated by using 22-L non-insulated stirred reactors the increment of viable cells and spores were 0.8 and 1.9, respectively, at a stable temperature of 27 °C. When the non-insulated stirred reactor was scaled up to 100-L, the increase of viable cells and spore counts were 1.2 and 3.8 respectively, with an average temperature of 28 °C. These results demonstrated that the election of a proper reactor configuration is important when considering the development of a new SSF process, especially when dealing with non-conventional substrates as digestate.

Soil erosion on the "El Portalet" mountain trails in the Eastern Iberian Peninsula.

Leisure activities in natural areas have experienced a large increase in popularity. In Mediterranean ecosystems, research on soil erosion in agriculture and forest fire affected land has been well developed but trail erosion has not been widely studied. In this work we evaluated two trails in the eastern Iberian Peninsula to assess soil erosion rates and provide new data. The study area is located in a semi-arid Mediterranean climate (around 400 mm y-1) and in limestone terrain with scarce soil development. The average erosion rates were 24.39 Mg ha-1 y-1 and 40.40 Mg ha-1 y-1 for the "Barranc de la Cova de la Hedra" and "Casa del Racó" study trails, respectively. These are non-sustainable rates due to the shallow soils and slow soil development in Mediterranean ecosystems. We found that the depth at the centre of the trail and the maximum depth measured could quickly and easily assess soil erosion rates in the mountain trails. Measuring the width and depth in the centre of the trail can assess 91% of the total erosion and reduces the time of the survey by 80%.

The impact of straw mulching and salvage logging on post-fire runoff and soil erosion generation under Mediterranean climate conditions.

Forest fires-affected landscapes enhance sudden runoff discharges, high sediment loads and extreme soil erosion rates. Different soil stabilisation treatments, such as mulching, can be applied to avoid runoff and soil erosion after wildfires. To characterise the post-fire soil erosion rates and runoff generation, we selected a Mediterranean forest affected by a wildfire in Lietor (Spain) to determine the sediment yield (dry sediment (DS), total suspended sediment (TSS), total dissolved sediment (TDS)) and runoff discharge in twelve 200 m2 (10 × 20 m) plots. Immediately after the wildfire, six plots were covered by straw and six other plots were set up as controls. Three months after the wildfire, logging activities were performed and the experimental designs were as follows: mulching + logging (three replicates), non-mulching + logging (three replicates), non-mulching + non-logging (three replicates) and mulching + non-logging (three replicates). During the period after wildfire and before salvage logging, the straw mulch controlled the soil erosion rates (DS, TSS and TDS) versus the non-mulched plots, but straw had no real impact on runoff discharge. For the period after salvage logging, once again runoff did not differ when comparing all the treatments. DS was higher in the non-mulched and non-logging plots, whereas the highest TSS was found in the non-mulched plots (in logged or non-logged plots). TDS was higher in the mulched and non-logged plots. We conclude that straw mulch is efficient management in recent fire-affected mountainous terrains to control soil loss immediately after wildfire. Moreover, logging operations done 3 months after wildfire did not necessary generate higher DS, TSS, TDS rates, mainly because of the type of machinery used for forest operations.

The effect of soil on human health: an overview.

Soil has a considerable effect on human health, whether those effects are positive or negative, direct or indirect. Soil is an important source of nutrients in our food supply and medicines such as antibiotics. However, nutrient imbalances and the presence of human pathogens in the soil biological community can cause negative effects on health. There are also many locations where various elements or chemical compounds are found in soil at toxic levels, because of either natural conditions or anthropogenic activities. The soil of urban environments has received increased attention in the last few years, and they too pose a number of human health questions and challenges. Concepts such as soil security may provide a framework within which issues on soil and human health can be investigated using interdisciplinary and transdisciplinary approaches. It will take the contributions of experts in several different scientific, medical and social science fields to address fully soil and human health issues. Although much progress was made in understanding links between soil and human health over the last century, there is still much that we do not know about the complex interactions between them. Therefore, there is still a considerable need for research in this important area.

Caracterización del perfil clínico y funcional de pacientes con lesión medular en rehabilitación intrahospitalaria / Characterization of the clinical profile and function of patients with spinal cord injury in in-hospital rehabilitation

Spinal cord injury (SCI) is a pathology that generates great personal, family, economic and social impact. There are two main etiologies that are traumatic (T-SCI) and non-traumatic (NTSCI). These patients receive their rehabilitation in specialized hospital services in the acute and sub-acute phase. A retrospective, descriptive, observational study was designed, reviewing the clinical records of patients diagnosed with SCI at discharge, hospitalized in the Physical Medicine and Rehabilitation Service of the Clinical Hospital of the University of Chile. The general profile of admission of patients with SCI was a young men with NT- SCI, with higher education, paid work and incomplete injury (ASIA B, C, D). An improvement was observed for all patients for the severity of the injury, neurological level, motor level, sensory level and functionality. This is the first study conducted nationwide that provides epidemiological data and functional evolution of patients with SCI and are comparable to those found in the international literature. (AU)

Manejo de cicatrices patológicas excesivas en el Servicio de Rehabilitación / Management of excessive pathological scars in the Rehabilitation Service

The excessive pathological scars are subdivided into hypertrophic, keloid and contracted. They have a complex pathophysiology, not entirely known that only exists in humans. Although the frequency of presentation is not high, excessive pathological scars can affect several areas of human functioning, in the first level of functions and body structures and in the second level of activities of daily life and participation. The evaluation of patients must be complete, including the scar, and any other affected body system, together with psychological, functional and socioeconomic factors. In the treatment of excessive scars there are multiple options that must be combined for a better result. The non-surgical treatments of the most used scars are the pressotherapy, silicone plates, intralesional injections and laser. There are other rehabilitation treatments that although without solid evidence could have a role in patients. The referral to the rehabilitation service is recommended for patients with excessive pathological scars located in areas of folds or special areas and / or, which are accompanied by pain, alterations in the function of the body segment or limitations in activities of daily life, for comprehensive assessment and multidisciplinary management. (AU)

Runoff initiation, soil detachment and connectivity are enhanced as a consequence of vineyards plantations.

Rainfall-induced soil erosion is a major threat, especially in agricultural soils. In the Mediterranean belt, vineyards are affected by high soil loss rates, leading to land degradation. Plantation of new vines is carried out after deep ploughing, use of heavy machinery, wheel traffic, and trampling. Those works result in soil physical properties changes and contribute to enhanced runoff rates and increased soil erosion rates. The objective of this paper is to assess the impact of the plantation of vineyards on soil hydrological and erosional response under low frequency - high magnitude rainfall events, the ones that under the Mediterranean climatic conditions trigger extreme soil erosion rates. We determined time to ponding, Tp; time to runoff, Tr; time to runoff outlet, Tro; runoff rate, and soil loss under simulated rainfall (55 mm h-1, 1 h) at plot scale (0.25 m2) to characterize the runoff initiation and sediment detachment. In recent vine plantations (<1 year since plantation; R) compared to old ones (>50 years; O). Slope gradient, rock fragment cover, soil surface roughness, bulk density, soil organic matter content, soil water content and plant cover were determined. Plantation of new vineyards largely impacted runoff rates and soil erosion risk at plot scale in the short term. Tp, Tr and Tro were much shorter in R plots. Tr-Tp and Tro-Tr periods were used as connectivity indexes of water flow, and decreased to 77.5 and 33.2% in R plots compared to O plots. Runoff coefficients increased significantly from O (42.94%) to R plots (71.92%) and soil losses were approximately one order of magnitude lower (1.8 and 12.6 Mg ha-1 h-1 for O and R plots respectively). Soil surface roughness and bulk density are two key factors that determine the increase in connectivity of flows and sediments in recently planted vineyards. Our results confirm that plantation of new vineyards strongly contributes to runoff initiation and sediment detachment, and those findings confirms that soil erosion control strategies should be applied immediately after or during the plantation of vines.

The impact of agricultural management on selected soil properties in citrus orchards in Eastern Spain: A comparison between conventional and organic citrus orchards with drip and flood irrigation.

The agricultural management of citrus orchards is changing from flood irrigated managed orchards to drip irrigated organic managed orchards. Eastern Spain is the oldest and largest European producer of citrus, and is representative of the environmental changes triggered by innovations in orchard management. In order to determine the impact of land management on different soil quality parameters, twelve citrus orchards sites were selected with different land and irrigation management techniques. Soil samples were taken at two depths, 0-2cm and 5-10cm for studying soil quality parameters under the different treatments. Half of the studied orchards were organically managed and the other six were conventionally managed, and for each of these six study sites three fields were flood irrigated plots and the other three drip irrigated systems. The outcome of the studied parameters was that soil organic matter (SOM) and aggregate stability were higher for organic farms. Bulk density and pH were only significantly different for organic farms when drip irrigation was applied in comparison with flooded plots. C/N ratio did not vary significantly for the four treatments. Although there are some points of discussion, this research shows that a combination of different management decisions leads to improvement of a couple of soil quality parameters. Organic management practices were found to be beneficial for soil quality, compared to conventional management for soils with comparable textures and applied irrigation water.

Islands of biogeodiversity in arid lands on a polygons map study: Detecting scale invariance patterns from natural resources maps.

Many maps (geology, hydrology, soil, vegetation, etc.) are created to inventory natural resources. Each of these resources is mapped using a unique set of criteria, including scales and taxonomies. Past research indicates that comparing results of related maps (e.g., soil and geology maps) may aid in identifying mapping deficiencies. Therefore, this study was undertaken in Almeria Province, Spain to (i) compare the underlying map structures of soil and vegetation maps and (ii) investigate if a vegetation map can provide useful soil information that was not shown on a soil map. Soil and vegetation maps were imported into ArcGIS 10.1 for spatial analysis, and results then exported to Microsoft Excel worksheets for statistical analyses to evaluate fits to linear and power law regression models. Vegetative units were grouped according to the driving forces that determined their presence or absence: (i) climatophilous (ii) lithologic-climate; and (iii) edaphophylous. The rank abundance plots for both the soil and vegetation maps conformed to Willis or Hollow Curves, meaning the underlying structures of both maps were the same. Edaphophylous map units, which represent 58.5% of the vegetation units in the study area, did not show a good correlation with the soil map. Further investigation revealed that 87% of the edaphohygrophilous units were found in ramblas, ephemeral riverbeds that are not typically classified and mapped as soils in modern systems, even though they meet the definition of soil given by the most commonly used and most modern soil taxonomic systems. Furthermore, these edaphophylous map units tend to be islands of biodiversity that are threatened by anthropogenic activity in the region. Therefore, this study revealed areas that need to be revisited and studied pedologically. The vegetation mapped in these areas and the soils that support it are key components of the earth's critical zone that must be studied, understood, and preserved.

Quantitative comparison of initial soil erosion processes and runoff generation in Spanish and German vineyards.

The aim of this study was to enable a quantitative comparison of initial soil erosion processes in European vineyards using the same methodology and equipment. The study was conducted in four viticultural areas with different characteristics (Valencia and Málaga in Spain, Ruwer-Mosel valley and Saar-Mosel valley in Germany). Old and young vineyards, with conventional and ecological planting and management systems were compared. The same portable rainfall simulator with identical rainfall intensity (40mmh(-1)) and sampling intervals (30min of test duration, collecting the samples at 5-min-intervals) was used over a circular test plot with 0.28m(2). The results of 83 simulations have been analysed and correlation coefficients were calculated for each study area to identify the relationship between environmental plot characteristics, soil texture, soil erosion, runoff and infiltration. The results allow for identification of the main factors related to soil properties, topography and management, which control soil erosion processes in vineyards. The most important factors influencing soil erosion and runoff were the vegetation cover for the ecological German vineyards (with 97.6±8% infiltration coefficients) and stone cover, soil moisture and slope steepness for the conventional land uses.

[Identification and in vitro antifungal susceptibility of vaginal Candida spp. isolates to fluconazole, clotrimazole and nystatin]. / Identificación y sensibilidad antifúngica in vitro de Candida spp. de origen vaginal a fluconazol, clotrimazol y nistatina.

OBJECTIVE: The aim of this study was to identify and determine the in vitro antifungal susceptibility testing to clotrimazole, fluconazole, and nystatin of 145 clinical isolates of Candida spp. METHODS: M27-A3 microdilution method was used to determine minimal inhibitory concentrations (MIC) and partial MICs (MIC50 and MIC90) of drugs. A total of 145 isolates were studied, 126 were C. albicans, 16 C. glabrata, 2 C. parapsilosis y 1 C. tropicalis. RESULTS: MIC50 and MIC90 for FLZ against C. albicans were 0.25 mg/L and 1 mg/L respectively and for C. glabrata was achieved at 8 mg/L and 16 mg/L for fluconazole. Five isolates of C. albicans and one isolate of C. tropicalis were in vitro resistant to fluconazole (M27-S4). In C. albicans MIC50 and MIC90 for clotrimazole were of 0.03 mg/L and 0.06 mg/L, respectively. These values for C. glabrata were 0.25 mg/L and 1 mg/L, respectively. Five C. glabrata and 1 C. tropicalis were in vitro resistant to clotrimazole. MIC50 and MIC90 of nystatin were of 1 mg/L and 2 mg/L, respectively for C. albicans and C. glabrata. CONCLUSIONS: In this study, C. albicans is the most frequently isolated yeast, followed by C. glabrata. The antifungals tested were found to be in vitro active for the isolates, except for 6 isolates for fluconazole and 6 to clotrimazole.

Unravelling the importance of forest age stand and forest structure driving microbiological soil properties, enzymatic activities and soil nutrients content in Mediterranean Spanish black pine(Pinus nigra Ar. ssp. salzmannii) Forest.

This study aimed to investigate the effects that stand age and forest structure have on microbiological soil properties, enzymatic activities and nutrient content. Thirty forest compartments were randomly selected at the Palancares y Agregados managed forest area (Spain), supporting forest stands of five ages; from 100 to 80years old to compartments with trees that were 19-1years old. Forest area ranging from 80 to 120years old and without forest intervention was selected as the control. We measured different soil enzymatic activities, soil respiration and nutrient content (P, K, Na, Mg, Cr, Mn, Fe, Co, Ni, Cu, Zn, Pb and Ca) in the top cm of 10 mineral soils in each compartment. Results showed that the lowest forest stand age and the forest structure created by management presented lower values of organic matter, soil moisture, water holding capacity and litterfall and higher values of C/N ratio in comparison with the highest forest stand age and the related forest structure, which generated differences in soil respiration and soil enzyme activities. The forest structure created by no forest management (control plot) presented the highest enzymatic activities, soil respiration, NH4(+) and NO3(-). Results did not show a clear trend in nutrient content comparing all the experimental areas. Finally, the multivariate PCA analysis clearly clustered three differentiated groups: Control plot; from 100 to 40years old and from 39 to 1year old. Our results suggest that the control plot has better soil quality and that extreme forest stand ages (100-80 and 19-1years old) and the associated forest structure generates differences in soil parameters but not in soil nutrient content.

Increased Nicotiana tabacum fitness through positive regulation of carotenoid, gibberellin and chlorophyll pathways promoted by Daucus carota lycopene ß-cyclase (Dclcyb1) expression.

Carotenoids, chlorophylls and gibberellins are derived from the common precursor geranylgeranyl diphosphate (GGPP). One of the enzymes in carotenoid biosynthesis is lycopene ß-cyclase (LCYB) that catalyzes the conversion of lycopene into ß-carotene. In carrot, Dclcyb1 is essential for carotenoid synthesis in the whole plant. Here we show that when expressed in tobacco, increments in total carotenoids, ß-carotene and chlorophyll levels occur. Furthermore, photosynthetic efficiency is enhanced in transgenic lines. Interestingly, and contrary to previous observations where overexpression of a carotenogenic gene resulted in the inhibition of the synthesis of gibberellins, we found raised levels of active GA4 and the concommitant increases in plant height, leaf size and whole plant biomass, as well as an early flowering phenotype. Moreover, a significant increase in the expression of the key carotenogenic genes, Ntpsy1, Ntpsy2 and Ntlcyb, as well as those involved in the synthesis of chlorophyll (Ntchl), gibberellin (Ntga20ox, Ntcps and Ntks) and isoprenoid precursors (Ntdxs2 and Ntggpps) was observed. These results indicate that the expression of Dclcyb1 induces a positive feedback affecting the expression of isoprenoid gene precursors and genes involved in carotenoid, gibberellin and chlorophyll pathways leading to an enhancement in fitness measured as biomass, photosynthetic efficiency and carotenoid/chlorophyll composition.

Levels of Regulatory Proteins Associated With Cell Proliferation in Endometria From Untreated Patients Having Polycystic Ovarian Syndrome With and Without Endometrial Hyperplasia.

Polycystic ovarian syndrome (PCOS) has been associated with endometrial hyperplasia and cancer. The aim of this study was to establish whether the expression of proliferation regulatory proteins in the endometria of patients having PCOS, with or without hyperplasia, differs from control women. Control endometria (CE), patients having PCOS without and with endometrial hyperplasia (PCOSE and HPCOSE, respectively), and that of women with endometrial hyperplasia (HE) were used. The phosphorylated estrogen receptor form (pERα), similar to mother against decapentaplegic (SMAD) 2, SMAD3, and SMAD4, vascular epithelial growth factor (VEGF), and phosphorylated SMAD (pSMAD) 2 and pSMAD3 were detected by immunohistochemistry or Western blot. The results show higher levels of pERα in HE versus CE (P < .05), while higher VEGF levels were found in PCOSE and HE (P < .05) compared to CE; SMAD2 diminished in HE (P < .05) versus CE. Consequently, the higher levels of VEGF and pERα in PCOSE could represent early changes in the progression of PCOSE toward hyperplasia and cancer, whereas changes observed in SMAD proteins support the differential origin of the pathologies of HPCOSE and HE.