Persistent Respiratory Failure and Re-Admission in Patients with Chronic Obstructive Pulmonary Disease Following Hospitalization for COVID-19.

Background: Chronic obstructive pulmonary disease (COPD) has been associated with worse clinical evolution/survival during a hospitalization for SARS-CoV2 (COVID-19). The objective of this study was to learn the situation of these patients at discharge as well as the risk of re-admission/mortality in the following 12 months. Methods: We carried out a subanalysis of the RECOVID registry. A multicenter, observational study that retrospectively collected data on severe acute COVID-19 episodes and follow-up visits for up to a year in survivors. The data collection protocol includes general demographic data, smoking, comorbidities, pharmacological treatment, infection severity, complications during hospitalization and required treatment. At discharge, resting oxygen saturation (SpO2), dyspnea according to the mMRC (modified Medical Research Council) scale and long-term oxygen therapy prescription were recorded. The follow-up database included the clinical management visits at 6 and 12 months, where re-admission and mortality were recorded. Results: A total of 2047 patients were included (5.6% had a COPD diagnosis). At discharge, patients with COPD had greater dyspnea and a greater need for prescription home oxygen. After adjusting for age, sex and Charlson comorbidity index, patients with COPD had a greater risk of hospital re-admission due to respiratory causes (HR 2.57 [1.35-4.89], p = 0.004), with no significant differences in survival. Conclusion: Patients with COPD who overcome a serious SARS-CoV2 infection show a worse clinical situation at discharge and a greater risk of re-admission for respiratory causes.

Histological and MRI brain atlas of the common shrew, Sorex araneus, with brain region-specific gene expression profiles.

The common shrew, Sorex araneus, is a small mammal of growing interest in neuroscience research, as it exhibits dramatic and reversible seasonal changes in individual brain size and organization (a process known as Dehnel's phenomenon). Despite decades of studies on this system, the mechanisms behind the structural changes during Dehnel's phenomenon are not yet understood. To resolve these questions and foster research on this unique species, we present the first combined histological, magnetic resonance imaging (MRI), and transcriptomic atlas of the common shrew brain. Our integrated morphometric brain atlas provides easily obtainable and comparable anatomic structures, while transcriptomic mapping identified distinct expression profiles across most brain regions. These results suggest that high-resolution morphological and genetic research is pivotal for elucidating the mechanisms underlying Dehnel's phenomenon while providing a communal resource for continued research on a model of natural mammalian regeneration. Morphometric and NCBI Sequencing Read Archive are available at https://doi.org/10.17617/3.HVW8ZN.

Residual pulmonary infiltrates, symptoms and diffusion impairment at 1-year after severe COVID-19 infection have different associated factors.

INTRODUCTION: After severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, patients may show lung sequelae on radiology and functional impairment at the 1-year follow-up. We aimed to describe the persistence of symptoms, radiological alterations, or reduced diffusing capacity of the lung for carbon monoxide (DLCO ) at 1-year follow-up in patients from the Spanish Registry RECOVID. METHODS: RECOVID collected symptom and radiological and functional lung tests data on hospitalized patients with coronavirus disease 2019 during the acute phase and at the 6- and 12-month follow-up visits. RESULTS: Of the 2500 enrolled survivors (90% admitted to the ward), 1874 had follow-up visits for up to a year. Of these, 42% continued to present with symptoms, 27% had radiological sequelae and 31% had reduced DLCO . Independently associated factors included female sex, asthma and the requirement for invasive or non-invasive mechanical ventilation. Complete radiological resolution was 72.2% at 12 months; associated factors with incomplete recovery were age, male sex, oxygen or respiratory support, corticosteroids and an initial SpO2 /FiO2 <450 or CURB-65 ≥2. Reduced DLCO was observed in 31% of patients at 12 months; associated factors were older age, female sex, smoking habit, SpO2 /FiO2 <450 and CURB-65 ≥2 and the requirement of respiratory support.At 12 months, a proportion of the asymptomatic patients showed reduced DLCO (9.5%), radiological findings (25%) or both (11%). CONCLUSIONS: The factors associated with symptom persistence, incomplete radiological resolution and DLCO <80% differed according to age, sex, comorbidities and respiratory support. The burden of symptoms, reduced DLCO and incomplete radiological resolution were considerable in patients with SARS-CoV-2 pneumonia at the 1-year follow-up after hospitalisation.

Height and standard of living in Puerto Rico from the Spanish enlightenment to annexation by the United States, 1770-1924.

This preliminary work presents a first series of heights of male adults in Puerto Rico. The sample, made up of 6000 prisoner records. the estimates were systematically assessed for selectivity, and we find that selectivity is quite negligible for the main results. The text studies the extreme dependence of the standard of living on the evolution of the price of sugar, a dependence which caused the progressive deterioration of material well-being in the country. Only between 1860 and 1880 did Puerto Ricans enjoy some improvement and a higher level of height. We measures the negative short-term effects of the 1898 annexation Puerto Rico by the United States.

Biometría histórica de los jóvenes varones castellanos. La incidencia en su estatura de los salarios y la nutrición, 1858-1959 / Historical biometrics of young Castilian males: the impact of income and Nutrition on their height, 1858-1959

Antecedentes: los estudios antropométricos han permitido medir la evolución del bienestar en España y en perspectiva histórica, pero aún no se ha calculado el efecto preciso de los ingresos económicos en la talla. Objetivo: el propósito del este trabajo es identificar los periodos en la trayectoria vital de los jóvenes en los que las disponibilidades alimentación fueron más determinantes en su crecimiento físico. Resultados: el modelo estimado mediante mínimos cuadrados ordinarios demostraría que los ingresos salariales percibidos por sus progenitores por el joven varón en los tres primeros años de vida y los tres inmediatamente anteriores al comienzo de la adolescencia explican hasta un 60 % de su talla al cumplir los 18 años. Todos los coeficientes de los regresores de los modelos planteados son significativos al 0,99 %. Conforme a estos cálculos, el tipo de alimentación del joven en el periodo comprendido entre los 11 y los 14 años fue determinante en su proceso evolutivo. Adicionalmente, los cálculos presentan a las carencias alimentarias como el culpable de los recurrentes periodos de pérdida del bienestar, especialmente en la segunda mitad del siglo XIX. Conclusión: las carencias nutricionales causadas por los bajos salarios y la nutrición deficiente han obstaculizado secularmente el crecimiento físico de los jóvenes castellanos. (AU)

Background: anthropometric studies have made it possible to measure the evolution of well-being in Spain and under a historical perspective, but the precise effect of income on height has not yet been calculated. Objective: the purpose of this paper is to identify the periods in the life trajectory of young people in which food availability was the most important determinant of their physical growth. Results: the model estimated using ordinary least squares shows that the wage income received by the parents of the young male in the first three years of life and the three years immediately prior to the onset of adolescence explain up to 60 % of his height at the age of 18. All the coefficients of the regressors of the models presented are significant at 0.99 %. According to these calculations, the type of Nutrition received by the young person in the period between 11 to 14 years of age was a determining factor in his or her evolutionary process. In addition, the calculations show that food deficiencies were to blame for recurrent periods of loss of well-being, especially in the second half of the 19th century. Conclusion: Nutritional deficiencies caused by low wages and poor Nutrition have for centuries hampered the physical growth of Castilian youth. (AU)

Fifty years of data show the effects of climate on overall skull size and the extent of seasonal reversible skull size changes (Dehnel's phenomenon) in the common shrew.

Global climate change affects many aspects of biology and has been shown to cause body size changes in animals. However, suitable datasets allowing the analysis of long-term relationships between body size, climate, and its effects are rare. The size of the skull is often used as a proxy for overall body size. Skull size does not change much in fully grown vertebrates; however, some high-metabolic small mammals shrink in winter and regrow in spring, including their skull and brain. This is thought to be a winter adaptation, as a smaller brain size reduces energy requirements. Climate could thus affect not only the overall size but also the pattern of the size change, that is, Dehnel's phenomenon, in these animals. We assessed the impact of the changes in climate on the overall skull size and the different stages of Dehnel's phenomenon in skulls of the common shrew, Sorex araneus, collected over 50 years in the Bialowieza Forest, E Poland. Overall skull size decreased, along with increasing temperatures and decreasing soil moisture, which affected the availability of the shrews' main food source, earthworms. The skulls of males were larger than those of females, but the degree of the decrease in size did not differ between sexes. The magnitude of Dehnel's phenomenon increased over time, indicating an increasing selection pressure on animals in winter. Overall, climate clearly affected the common shrew's overall size as well as its seasonal size changes. With the current acceleration in climate change, the effects on the populations of this cold-adapted species may be quite severe in a large part of its distribution range.

[Historical biometrics of young Castilian males: the impact of income and nutrition on their height, 1858-1959]. / Biometría histórica de los jóvenes varones castellanos. La incidencia en su estatura de los salarios la nutrición, 1858-1959.

Introduction: Background: anthropometric studies have made it possible to measure the evolution of well-being in Spain and under a historical perspective, but the precise effect of income on height has not yet been calculated. Objective: the purpose of this paper is to identify the periods in the life trajectory of young people in which food availability was the most important determinant of their physical growth. Results: the model estimated using ordinary least squares shows that the wage income received by the parents of the young male in the first three years of life and the three years immediately prior to the onset of adolescence explain up to 60 % of his height at the age of 18. All the coefficients of the regressors of the models presented are significant at 0.99 %. According to these calculations, the type of nutrition received by the young person in the period between 11 to 14 years of age was a determining factor in his or her evolutionary process. In addition, the calculations show that food deficiencies were to blame for recurrent periods of loss of well-being, especially in the second half of the 19th century. Conclusion: nutritional deficiencies caused by low wages and poor nutrition have for centuries hampered the physical growth of Castilian youth.

Introducción: Antecedentes: los estudios antropométricos han permitido medir la evolución del bienestar en España y en perspectiva histórica, pero aún no se ha calculado el efecto preciso de los ingresos económicos en la talla. Objetivo: el propósito del este trabajo es identificar los periodos en la trayectoria vital de los jóvenes en los que las disponibilidades alimentación fueron más determinantes en su crecimiento físico. Resultados: el modelo estimado mediante mínimos cuadrados ordinarios demostraría que los ingresos salariales percibidos por sus progenitores por el joven varón en los tres primeros años de vida y los tres inmediatamente anteriores al comienzo de la adolescencia explican hasta un 60 % de su talla al cumplir los 18 años. Todos los coeficientes de los regresores de los modelos planteados son significativos al 0,99 %. Conforme a estos cálculos, el tipo de alimentación del joven en el periodo comprendido entre los 11 y los 14 años fue determinante en su proceso evolutivo. Adicionalmente, los cálculos presentan a las carencias alimentarias como el culpable de los recurrentes periodos de pérdida del bienestar, especialmente en la segunda mitad del siglo XIX. Conclusión: las carencias nutricionales causadas por los bajos salarios y la nutrición deficiente han obstaculizado secularmente el crecimiento físico de los jóvenes castellanos.

Winter conditions, not resource availability alone, may drive reversible seasonal skull size changes in moles.

Seasonal changes in the environment can lead to astonishing adaptations. A few small mammals with exceptionally high metabolisms have evolved a particularly extreme strategy: they shrink before winter and regrow in spring, including changes of greater than 20% in skull and brain size. Whether this process is an adaptation to seasonal climates, resource availability or both remains unclear. We show that European moles (Talpa europaea) also decrease skull size in winter. As resources for closely related Iberian moles (Talpa occidentalis) are lowest in summer, we predicted they should shift the timing of size changes. Instead, they do not change size at all. We conclude that in moles, seasonal decrease and regrowth of skull size is an adaptation to winter climate and not to a changing resource landscape alone. We not only describe this phenomenon in yet another taxon, but take an important step towards a better understanding of this enigmatic cycle.

Recomendaciones de la sociedad Española de cirugía torácica para el manejo del derrame pleural maligno [Pré-print] / Recommendations of the Spanish Society of Thoracic Surgery for the management of malignant pleural effusion

This article summarizes the clinical guidelines for the diagnosis and treatment of malignant pleural effusion (MPE) sponsored by the Spanish Society of Thoracic Surgery (SECT). Ten clinical controversies were elaborated under the methodology of PICO (Patient, Intervention, Comparison, Outcome) questions and the quality of the evidence and grading of the strength of the recommendations was based on the GRADE system. Immunocytochemical and molecular analyses of pleural fluid may avoid further invasive diagnostic procedures. Currently, the definitive control of MPE can be achieved either by pleurodesis (talc poudrage or slurry) or the insertion of a tunneled pleural catheter (TPC). It is likely that the combination of both techniques (i.e., thoracoscopy with talc poudrage and insertion of a TPC, or instillation of talc slurry through a TPC) will have a predominant role in the future therapeutic management.

Este artículo resume la guía clínica de diagnóstico y tratamiento del derrame pleural maligno (DPM) auspiciada por la Sociedad Española de Cirugía Torácica (SECT). Se elaboraron 10 controversias clínicas bajo la metodología de preguntas PICO (Patient, Intervention, Comparison, Outcome) y la calidad de la evidencia y graduación de la fuerza de las recomendaciones se basó en el sistema Grading of Recommendations, Assessment, Development and Evaluations (GRADE). El análisis inmunocitoquímico y molecular del líquido pleural puede evitar procedimientos invasivos ulteriores con finalidad diagnóstica. Actualmente, el control definitivo del DPM se puede realizar indistintamente a través de una pleurodesis (talco poudrage o slurry) o de la inserción de un catéter pleural tunelizado (CPT). Es probable que la combinación de ambas técnicas (p.ej. toracoscopia con talco poudrage e inserción de un CPT, o instilación de talco slurry a través de un CPT) ocupe un lugar predominante en el manejo terapéutico futuro.

Dehnel's phenomenon.

Lázaro and Dechmann explain how some mammals that live through harsh winters exhibit seasonal shrinkage of the brain and skull, a process called Dehnel's phenomenon, which helps to spare energy during times of food shortage and high energetic demands.

Geographic patterns in seasonal changes of body mass, skull, and brain size of common shrews.

Some small mammals exhibit Dehnel's Phenomenon, a drastic decrease in body mass, braincase, and brain size from summer to winter, followed by a regrowth in spring. This is accompanied by a re-organization of the brain and changes in other organs. The evolutionary link between these changes and seasonality remains unclear, although the intensity of change varies between locations as the phenomenon is thought to lead to energy savings during winter.Here we explored geographic variation of the intensity of Dehnel's Phenomenon in Sorex araneus. We compiled literature on seasonal changes in braincase size, brain, and body mass, supplemented by our own data from Poland, Germany, and Czech Republic.We analyzed the effect of geographic and climate variables on the intensity of change and patterns of brain re-organization.From summer to winter, the braincase height decreased by 13%, followed by 10% regrowth in spring. For body mass, the changes were -21%/+82%, respectively. Changes increased toward northeast. Several climate variables were correlated with these transformations, confirming a link of the intensity of the changes with environmental conditions. This relationship differed for the decrease versus regrowth, suggesting that they may have evolved under different selective pressures.We found no geographic trends explaining variability in the brain mass changes although they were similar (-21%/+10%) to those of the braincase size. Underlying patterns of change in brain organization in northeastern Poland were almost identical to the pattern observed in southern Germany. This indicates that local habitat characteristics may play a more important role in determining brain structure than broad scale geographic conditions.We discuss the techniques and criteria used for studying this phenomenon, as well as its potential presence in other taxa and the importance of distinguishing it from other kinds of seasonal variation.

Muskuloskeletal injuries in mountain running races: A 5 seasons study.

INTRODUCTION: Mountain running races have grown in popularity in the recent years. Nonetheless, there are few studies on injuries and injury rates. Moreover, these studies have focused on long-distance events such as ultramarathons (>42 km). Therefore, the aim of the present study was to examine the severity, type, and body location of musculoskeletal injuries during 20-42 km mountain running races. In addition, the injury rates in this type of races were examined. METHODS: Data on injuries were collected during 36 mountain running races over 5 consecutive seasons from 2015 to 2019. The participants reported all musculoskeletal injuries on a standardized injury report form. The results were presented as the number of injuries per 1000 h exposure and per 1000 participants. RESULTS: Twenty eight injuries were reported. Most injuries occurred in the ankle (32%) followed by the knee (14%) and foot/toe (11%). The number of injuries represented an overall injury rate of 1.6 injuries per 1000 h running and 5.9 injuries per 1000 runners. The case fatality rate was 0. CONCLUSIONS: The incidence of musculoskeletal injuries during 20-42 km mountain running races is low. In addition, the majority of injuries experienced by runners are minor in nature and located in lower extremities, mainly the ankles.

Sensibilidad de un modelo secuencial basado en cuestionario (STOP-Bang vs. Dixon) y pulsioximetría nocturna para el screening de apnea obstructiva del sueño en pacientes obesos mórbidos candidatos a cirugía bariátrica / Sensitivity of a sequential model based on a questionnaire (STOP-Bang vs Dixon) and nocturnal pulse oximetry for screening obstructive sleep apnea in patients with morbid obesity candidates for bariatric surgery

INTRODUCCIÓN: La apnea obstructiva del sueño (AOS) tiene una elevada incidencia en obesos mórbidos candidatos a cirugía bariátrica (CB). Un screening adecuado reduciría el número de poligrafías (PR). OBJETIVO: Analizar la utilidad de un modelo secuencial con un cuestionario (Dixon modificado [DXM] vs. STOP-Bang) y pulsioximetría nocturna en pacientes candidatos a CB. MÉTODOS: Estudio prospectivo, desde el 1 de julio de 2014 hasta el 1 de julio de 2015. Se incluyeron candidatos a CB, excluyéndose aquellos que ya se habían sometido a una PR. VARIABLES: cuestionarios (Epworth, STOP-Bang y DXM), medidas antropométricas, PR y analítica de sangre y gases. Se dividió la muestra entre los que no tenían AOS o era leve (No AOS) y los que tuvieron una AOS moderada-grave (IAH>15). RESULTADOS: Se analizaron 70 pacientes, de los cuales 46 (65,7%) eran mujeres. Se diagnosticaron 26 (37,1%) de AOS moderada-grave. Comparamos STOP-Bang y DXM mediante curvas ROC con una mayor área bajo la curva (AUC) para este último (0,873 [0,74-0,930] vs. 0,781 [0,673-0,888]). La sensibilidad fue superior para el STOP-Bang con un 100% vs. 73,1% de DXM. El IDO3% presentó mayor rentabilidad diagnóstica AUC=0,982 (0,970-1). La aplicación del modelo secuencial con STOP-Bang>3, DXM>5 y DXM>3 hubiese evitado 41 (58,5%), 50 (71,4%) y 41 (58,5%) PR y 0, 7 (10%) y 0 falsos negativos, respectivamente. CONCLUSIÓN: La aplicación de un modelo secuencial basado en el STOP-Bang y pulsioximetría nocturna es una herramienta útil para el screening de AOS en obesos mórbidos candidatos a CB, reduciendo el número de PR

INTRODUCTION: Obstructive sleep apnea (OSA) has a high incidence in patients with morbid obesity who are candidates for bariatric surgery (BS). Adequate screening would decrease the number of respiratory polygraphies (RPs). OBJECTIVE: To analyze the value of a sequential model consisting of a questionnaire (modified Dixon [DXM] vs STOP-Bang) and nocturnal pulse oximetry in patients who were candidates for BS. METHODS: A prospective study was conducted from July 1, 2014 to July 1, 2015 on candidates for BS, excluding those who have already undergone RP. VARIABLES: questionnaires (Epworth, STOP-Bang, and DXM), anthropometric measurements, RP, and blood and gas tests. The sample was divided into patients with no or mild OSA (no OSA) and those with moderate to severe OSA (AHI>15). RESULTS: A total of 70 patients were analyzed, 46 (65.7%) of them females. Moderate to severe OSA was diagnosed in 26 (37.1%) patients. STOP-Bang and DXM were compared using ROC curves, and greater area under the curve (AUC) was found for the latter (0.873 [0.74 -0.930] vs 0.781 [0.673-0.888]). STOP-Bang had greater sensitivity, 100%, as compared to 73.1% for DXM. ODI3% showed greater diagnostic yield (AUC=0.982 [0.970-1]). Use of the sequential model with STOP-Bang>3, DXM>5, and DXM>3 would have avoided 41 (58.5%), 50 (71.4%), and 41 (58.5%) RPs and 0, 7 (10%), and 0 false negatives, respectively. CONCLUSION: Use of a sequential model based on the STOP-Bang and nocturnal pulse oximetry is a useful tool for screening OSA in patients with morbid obesity candidates for BS, decreasing the number of RPs

Sensitivity of a sequential model based on a questionnaire (STOP-Bang vs Dixon) and nocturnal pulse oximetry for screening obstructive sleep apnea in patients with morbid obesity candidates for bariatric surgery. / Sensibilidad de un modelo secuencial basado en cuestionario (STOP-Bang vs. Dixon) y pulsioximetría nocturna para el screening de apnea obstructiva del sueño en pacientes obesos mórbidos candidatos a cirugía bariátrica.

INTRODUCTION: Obstructive sleep apnea (OSA) has a high incidence in patients with morbid obesity who are candidates for bariatric surgery (BS). Adequate screening would decrease the number of respiratory polygraphies (RPs). OBJECTIVE: To analyze the value of a sequential model consisting of a questionnaire (modified Dixon [DXM] vs STOP-Bang) and nocturnal pulse oximetry in patients who were candidates for BS. METHODS: A prospective study was conducted from July 1, 2014 to July 1, 2015 on candidates for BS, excluding those who have already undergone RP. VARIABLES: questionnaires (Epworth, STOP-Bang, and DXM), anthropometric measurements, RP, and blood and gas tests. The sample was divided into patients with no or mild OSA (no OSA) and those with moderate to severe OSA (AHI>15). RESULTS: A total of 70 patients were analyzed, 46 (65.7%) of them females. Moderate to severe OSA was diagnosed in 26 (37.1%) patients. STOP-Bang and DXM were compared using ROC curves, and greater area under the curve (AUC) was found for the latter (0.873 [0.74 -0.930] vs 0.781 [0.673-0.888]). STOP-Bang had greater sensitivity, 100%, as compared to 73.1% for DXM. ODI3% showed greater diagnostic yield (AUC=0.982 [0.970-1]). Use of the sequential model with STOP-Bang>3, DXM>5, and DXM>3 would have avoided 41 (58.5%), 50 (71.4%), and 41 (58.5%) RPs and 0, 7 (10%), and 0 false negatives, respectively. CONCLUSION: Use of a sequential model based on the STOP-Bang and nocturnal pulse oximetry is a useful tool for screening OSA in patients with morbid obesity candidates for BS, decreasing the number of RPs.

Metabolic rate in common shrews is unaffected by temperature, leading to lower energetic costs through seasonal size reduction.

Small endothermic mammals have high metabolisms, particularly at cold temperatures. In the light of this, some species have evolved a seemingly illogical strategy: they reduce the size of the brain and several organs to become even smaller in winter. To test how this morphological strategy affects energy consumption across seasonally shifting ambient temperatures, we measured oxygen consumption and behaviour in the three seasonal phenotypes of the common shrew (Sorex araneus), which differ in size by about 20%. Body mass was the main driver of oxygen consumption, not the reduction of metabolically expensive brain mass. Against our expectations, we found no change in relative oxygen consumption with low ambient temperature. Thus, smaller body size in winter resulted in significant absolute energy savings. This finding could only partly be explained by an increase of lower cost behaviours in the activity budgets. Our findings highlight that these shrews manage to avoid one of the most fundamental and intuitive rules of ecology, allowing them to subsist with lower resource availability and successfully survive the harsh conditions of winter.

Epigenetics dysfunction in morbid obesity with or without obstructive sleep apnoea: the EPIMOOSA study.

BACKGROUND: Obstructive sleep apnoea (OSA) and morbid obesity (MO), defined by a body mass index ≥35 kg/m2, are two closely related conditions. Recent studies suggest that circulating microRNA (miRNA) plays a potential role in the physiopathology of both conditions. To date, circulating miRNA expression has been studied separately in both conditions, but never jointly. The primary treatment of OSA is continuous positive airway pressure (CPAP), whereas bariatric surgery (BS) is the treatment of choice for MO. We have thus initiated the Epigenetics modification in Morbid Obesity and Obstructive Sleep Apnoea (EPIMOOSA) study (ClinicalTrials.gov identifier: NCT03995836). METHODS/DESIGN: EPIMOOSA is a prospective non-interventional cohort study aiming to recruit 45 MO patients who are candidates for BS. Three groups will be formed: MO without OSA, MO with OSA without CPAP and MO with OSA and CPAP. All of them will be followed up in 4 visits: baseline, 6 months prior to BS and 3, 6 and 12 months post-BS. At baseline, OSA status will be assessed by home sleep polygraphy (HSP), and CPAP will be adopted according to national guidelines. A specific standardized questionnaire (including medical conditions and AOS-related symptoms) and anthropometrical examination will be performed at each visit. Blood samples will be obtained at each visit for immediate standard biochemistry, haematology and inflammatory cytokines. For bio-banking, serum, plasma, and circulating exosomes will also be obtained. Twenty-four hours of blood pressure and electrocardiogram (ECG) Holter monitoring will be performed at all visits. A new HSP will be performed at the last visit. Finally, the three groups will be sex- and age- matched with participants in the EPIOSA study, an ongoing study aimed at understanding epigenetic changes in non-obese OSA patients. DISCUSSION: EPIMOOSA will evaluate changes in circulating miRNA in MO with or without OSA for the first time. In addition, EPIMOOSA will be able to elucidate the influence of OSA in MO patients and how specific and combined treatments alter miRNA expression.

Seasonal reversible size changes in the braincase and mass of common shrews are flexibly modified by environmental conditions.

The growth of the vertebrate skull and brain is usually unidirectional and more or less stops when animals are adult. Red-toothed shrews break this rule. They seasonally shrink and regrow brain and skull size by 20% or more, presumably to save energy when conditions are harsh. The size change is anticipatory of environmental change and occurs in all individuals, but it is unknown whether its extent can be modulated by environmental conditions. We kept shrews under different conditions, monitored seasonal changes in skull size with series of X-rays, and compared them with free ranging animals. We found extensive differences in the pattern of skull size change between experimental groups. Skull size of shrews kept at constant temperature showed a steady decline, while the skull size changes of free ranging shrews and captive individuals exposed to natural temperature regimes were identical. In contrast, body mass never reached the spring values of free ranging shrews in either captive regime. The extent of this adaptive seasonal pattern can thus be flexibly adapted to current environmental conditions. Combining reversible size changes with such strong phenotypic plasticity may allow these small, non-hibernating predators with high metabolic rates to continue being successful in today's changing environments.

Profound seasonal changes in brain size and architecture in the common shrew.

The seasonal changes in brain size of some shrews represent the most drastic reversible transformation in the mammalian central nervous system known to date. Brain mass decreases 10-26% from summer to winter and regrows 9-16% in spring, but the underlying structural changes at the cellular level are not yet understood. Here, we describe the volumetric differences in brain structures between seasons and sexes of the common shrew (Sorex araneus) in detail, confirming that changes in different brain regions vary in the magnitude of change. Notably, shrews show a decrease in hypothalamus, thalamus, and hippocampal volume and later regrowth in spring, whereas neocortex and striatum volumes decrease in winter and do not recover in size. For some regions, males and females showed different patterns of seasonal change from each other. We also analyzed the underlying changes in neuron morphology. We observed a general decrease in soma size and total dendrite volume in the caudoputamen and anterior cingulate cortex. This neuronal retraction may partially explain the overall tissue shrinkage in winter. While not sufficient to explain the entire seasonal process, it represents a first step toward understanding the mechanisms beneath this remarkable phenomenon.