Obstructive sleep apnoea (OSA) is a risk factor for stroke, but little is known about the effect of OSA and continuous positive airway pressure (CPAP) on the incidence of long-term, nonfatal ...cardiovascular events (CVE) in stroke patients. A prospective observational study was made in 223 patients consecutively admitted for stroke. A sleep study was performed on 166 of them. 31 had an apnoea/hypopnoea index (AHI) <10 events · h(-1); 39 had an AHI between 10 and 19 events · h(-1) and 96 had an AHI ≥ 20 events · h(-1). CPAP treatment was offered when AHI was ≥ 20 events · h(-1). Patients were followed up for 7 yrs and incident CVE data were recorded. The mean ± SD age of the subjects was 73.3 ± 11 yrs; mean AHI was 26 ± 16.7 events · h(-1). Patients with moderate-to-severe OSA who could not tolerate CPAP (AHI ≥ 20 events · h(-1); n = 68) showed an increased adjusted incidence of nonfatal CVE, especially new ischaemic strokes (hazard ratio 2.87, 95% CI 1.11-7.71; p = 0.03), compared with patients with moderate-to-severe OSA who tolerated CPAP (n = 28), patients with mild disease (AHI 10-19 events · h(-1); n = 36) and patients without OSA (AHI <10 events · h(-1); n = 31). Our results suggest that the presence of moderate-to-severe OSA is associated with an increased long-term incidence of nonfatal CVE in stroke patients and that CPAP reduces the excess of incidence seen in these patients.
Introduction
Haemophilia is one of the most common inherited bleeding disorders in the Emergency Department (ED). The most dangerous site of bleeding is the central nervous system.
Aims
To describe ...the characteristics of haemophiliacs arrived to our ED following a head trauma and to analyse the incidence of intracranial haemorrhage (ICH).
Materials and Methods
Retrospective, analytical, observational study, conducted in a Paediatric ED. We included haemophilic patients aged from birth to 16 years who consulted after a head trauma over a 6‐year period. Data collected included age, type of haemophilia and head trauma, symptoms, prophylaxis status, CT imaging, treatment and number of visits to the ED.
Results
About 46 males and 85 episodes were analysed. The median age was 2.38 years. Severe haemophilia A was the most frequent type of disease (50%). All head injuries were mild, and the most frequent mechanism was a collision with an object (38.8%). In 62 episodes (72.9%) the patients were asymptomatic. The rest 23 events had symptomatology, being the most common headache (26%), emesis (21.7%) and drowsiness (17.4%). Head CT was obtained in 31 episodes, founding altered results in 10 (6 of them corresponding to ICH). All the patients with ICH had symptomatology. About 37 episodes required admission.
Conclusion
Intracranial haemorrhage is one of the most dangerous events in haemophiliacs and it may occur after a head trauma. Our study suggests that, in case of head trauma, CT must be obtained in symptomatic patients and in those with additional risk factors. Asymptomatic patients must have prolonged observation.
Mediterranean grasslands provide different ecosystems and social and economic services to the Mediterranean basin. Specifically, in Spain, pastures occupy more than 55% of the Spanish surface. ...Farmers and policymakers need to estimate the Gross Primary Production (GPP) to make sustainable management of these ecosystems and to study the role of grasslands acting as sinks or sources of Carbon in the context of climate change. High-frequency satellites, such as Sentinel-2, have opened the door to study GPP with a higher spatial and lower revisit time (10 m and 5 days). Therefore, the overall objective of this research is to estimate an ecosystem light use efficiency (eLUE) GPP model for a Mediterranean grassland in central Spain using Sentinel-2 NDVI Normalized Difference Vegetation Index (NDVI), complemented with meteorological information at the field scale for a relatively long period (from January 2018 to July 2020). The GPP models studied in this research were the MODIS GPP product, as well as the four eLUE models built with MODIS or Sentinel-2 NDVI and complemented by the inclusion of minimum temperature (Tmin) and soil water content (SWC). The models were validated through the GPP obtained from an eddy-covariance flux tower located in the study site (GPP_T). Results showed that the MODIS GPP product underestimated the GPP_T of the grassland ecosystem. Besides this, the approach of the eLUE concept was valid for estimating GPP in this Mediterranean grassland ecosystem. In addition, the models showed an improvement using Sentinel-2 NDVI compared to MODIS GPP product and compared to the models that used MODIS NDVI due to its higher spatial and temporal resolution. The inclusion of Tmin and SWC was also a determinant in improving GPP models during winter and summer periods. This work also illustrates how the main wind directions of the study area must be considered to appropriately estimate the footprint of the eddy covariance flux tower. In conclusion, this study is the first step to efficiently estimating the GPP of Mediterranean grasslands using the Sentinel-2 NDVI with complementary meteorological field information to make the management of these ecosystems sustainable.
Background: Patients with chronic obstructive pulmonary disease (COPD) often present with severe acute exacerbations requiring hospital treatment. However, little is known about the prognostic ...consequences of these exacerbations. A study was undertaken to investigate whether severe acute exacerbations of COPD exert a direct effect on mortality. Methods: Multivariate techniques were used to analyse the prognostic influence of acute exacerbations of COPD treated in hospital (visits to the emergency service and admissions), patient age, smoking, body mass index, co-morbidity, long term oxygen therapy, forced spirometric parameters, and arterial blood gas tensions in a prospective cohort of 304 men with COPD followed up for 5 years. The mean (SD) age of the patients was 71 (9) years and forced expiratory volume in 1 second was 46 (17)%. Results: Only older age (hazard ratio (HR) 5.28, 95% CI 1.75 to 15.93), arterial carbon dioxide tension (HR 1.07, 95% CI 1.02 to 1.12), and acute exacerbations of COPD were found to be independent indicators of a poor prognosis. The patients with the greatest mortality risk were those with three or more acute COPD exacerbations (HR 4.13, 95% CI 1.80 to 9.41). Conclusions: This study shows for the first time that severe acute exacerbations of COPD have an independent negative impact on patient prognosis. Mortality increases with the frequency of severe exacerbations, particularly if these require admission to hospital.
The aim of the present study was to analyse the role of continuous positive airway pressure (CPAP) treatment in patients with difficult-to-control hypertension (DC-HT) and sleep apnoea. An Autoset ...(ResMed, Sydney, Australia) study was performed in 60 patients diagnosed with DC-HT based on two 24-h ambulatory blood pressure monitorisation (ABPM) studies. CPAP was offered to patients with an apnoea/hypopnoea index (AHI) > or =15 events.h(-1). After 3 months of treatment, repeat ABPM was performed to evaluate the effect of CPAP upon the blood pressure values. A total of 39 (65%) patients received CPAP treatment, but only 33 completed the study. The mean+/-sd systolic and diastolic blood pressures (SBP and DBP, respectively) were 154.8+/-14 and 90+/-8.8 mmHg. Patients had a mean+/-sd AHI of 37.7+/-18.2 events.h(-1). Only three patients presented a dipper nocturnal pressure pattern. CPAP treatment significantly reduced SBP (-5.2 mmHg), and particularly the nocturnal values (-6.1 mmHg), but not DBP. Considering only those patients who tolerated CPAP, the decrease in SBP was greater (-7.3 mmHg). Furthermore, CPAP treatment significantly increased the percentage of patients who recovered the dipper pattern (three (9.1%) out of 33 versus 12 (36.4%) out of 33). Continuous positive airway pressure treatment significantly reduces systolic blood pressure, particularly at night, and normalises the nocturnal pressure pattern in patients with difficult-to-control hypertension and sleep apnoea.
We present a technique that permits the analysis of stellar population gradients in a relatively low-cost way compared to integral field unit (IFU) surveys. We developed a technique to analyze ...unresolved stellar populations of spatially resolved galaxies based on photometric multi-filter surveys. This technique allows the analysis of vastly larger samples and out to larger galactic radii. We derived spatially resolved stellar population properties and radial gradients by applying a centroidal Voronoi tessellation and performing a multicolor photometry spectral energy distribution fitting. This technique has been successfully applied to a sample of 29 massive (M⋆ > 1010.5M⊙) early-type galaxies at z < 0.3 from the ALHAMBRA survey. We produced detailed 2D maps of stellar population properties (age, metallicity, and extinction), which allow us to identify galactic features. Radial structures were studied, and luminosity-weighted and mass-weighted gradients were derived out to 2–3.5 Reff. We find that the spatially resolved stellar population mass, age, and metallicity are well represented by their integrated values. We find the gradients of early-type galaxies to be on average flat in age (∇log AgeL = 0.02 ± 0.06 dex/Reff) and negative in metallicity (∇Fe/HL = −0.09 ± 0.06 dex/Reff). Overall,the extinction gradients are flat (∇Av = −0.03 ± 0.09 mag/Reff ) with a wide spread. These results are in agreement with previous studies that used standard long-slit spectroscopy, and with the most recent IFU studies. According to recent simulations, these results are consistent with a scenario where early-type galaxies were formed through major mergers and where their final gradients are driven by the older ages and higher metallicity of the accreted systems. We demonstrate the scientific potential of multi-filter photometry to explore the spatially resolved stellar populations of local galaxies and confirm previous spectroscopic trends from a complementary technique.
Abstract Study objective To analyze the impact of the number of respiratory sleep disorders or clinically related conditions (especially excessive daytime sleepiness EDS), on health related quality ...of life (HRQoL) in subjects over 65 years of age, as compared to younger subjects and the general population. Methods Two hundred and twelve adult patients with obstructive sleep apnea (OSA, AHI ⩾ 10) divided into two age groups, over 65 ( n = 109, mean age 74.6 6, 8 years, and 65 or under ( n = 103, mean age 51.7, 6, 5 years). General, anthropometric and clinical data related to OSA (epworth sleepiness score ESS), comorbidities (Charlson comorbidity index CCI), HRQoL (SF-36 questionnaire), use of psychotropic medications and habitual polygraphic/polysomnographic parameters were recorded and compared between the two age groups. The HRQoL values in each age group were compared with the values in the general population, adjusted for age and gender. Results In patients 65 and under, both the presence of OSA as well as the presence of EDS (ESS > 11) were associated with an important deterioration in HRQoL as compared to normal reference values. The principal determinants of HRQoL were the presence of EDS ( p < 0.04), body mass index ( p < 0.03) and the apnea–hypopnea index (AHI) ( p < 0.04). Nevertheless, in subjects over 65 years of age, the presence of OSA or EDS had only a slight impact on HRQoL, relative to normal values. In this age group, the principal determinants of HRQoL were the presence of comorbidities (CCI, p < 0.01), age ( p < 0.01), oxygen desaturation parameters ( p < 0.04) and the use of psychotropic medications ( p < 0.04). Conclusion In elders, the presence of OSA with or without EDS has little impact on HRQoL measures.
Proteins are macromolecules essential for living organisms. However, to perform their function, proteins need to achieve their Native Structure (NS). The NS is reached fast in nature. By contrast, in ...silico, it is obtained by solving the Protein Folding problem (PFP) which currently has a long execution time. PFP is computationally an NP-hard problem and is considered one of the biggest current challenges. There are several methods following different strategies for solving PFP. The most successful combine computational methods and biological information: I-TASSER, Rosetta (Robetta server), AlphaFold2 (CASP14 Champion), QUARK, PEP-FOLD3, TopModel, and GRSA2-SSP. The first three named methods obtained the highest quality at CASP events, and all apply the Simulated Annealing or Monte Carlo method, Neural Network, and fragments assembly methodologies. In the present work, we propose the GRSA2-FCNN methodology, which assembles fragments applied to peptides and is based on the GRSA2 and Convolutional Neural Networks (CNN). We compare GRSA2-FCNN with the best state-of-the-art algorithms for PFP, such as I-TASSER, Rosetta, AlphaFold2, QUARK, PEP-FOLD3, TopModel, and GRSA2-SSP. Our methodology is applied to a dataset of 60 peptides and achieves the best performance of all methods tested based on the common metrics TM-score, RMSD, and GDT-TS of the area.
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