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Objective methods are needed to quantify digital artery disease in systemic sclerosis (SSc) for clinical trials of vascular therapies. Our primary aim was to examine feasibility of a novel tomographic three-dimensional-(3-D) ultrasound (tUS) with high-frequency ultrasound (HFUS) or ultra-high-frequency ultrasound (UHFUS) to assess the digital arteries in patients with SSc compared to healthy controls. A secondary objective was to compare the total wall volume (TWV) as a measure of intimal/medial thickness. Eighteen patients with a confirmed diagnosis of SSc were studied by tUS HFUS (17.5 MHz, n = 10) or tUS UHFUS (48 and 70 MHz, n = 8) with equal numbers of healthy controls of similar age and gender. The majority of patients had limited cutaneous SSc and were representative of a spectrum of digital vasculopathy, with over half (n = 6 HFUS and n = 5 UHFUS) having previous digital ulceration. Over half were receiving oral vasodilatory therapy. TWV was measured in both digital arteries of the middle finger bilaterally. At least, two digital arteries could be identified at 17.5 MHz in all patients and healthy controls. Whereas, at least two digital arteries could be identified in relatively fewer patients compared to healthy controls using 48 MHz (n = 6 and 10) and especially 70 MHz (n = 4 and 10) UHFUS. The median difference in TWV between patients and healthy controls was -6.49 mm3 using 17.5 MHz, 1.9 mm3 at 48 MHz, and -0.4 mm3 at 70 MHz. tUS using UHFUS is a feasible method to measure TWV of digital arteries in SSc. Transducer frequency plays an important factor in successful digital artery measurement, with 48 MHz being the optimal frequency. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study is to analyse hospital readmissions due to asthma, as well as the factors associated with their increase.Study design: We carried out a retrospective study including all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010.Methods: The data were gathered by two members of the research team, by reviewing the clinical records. The first hospital admission of each patient was included for this study. An early readmission (ER) was defined as that which occurred in the following 15 days after hospital discharge and late readmission (LR) to that occurring from 16 days after discharge.Results: This study included 2166 hospital admissions and 1316 patients, with a mean age of 62.6 years. Of the 1316 patients analysed, 36 (2.7%) had one ER and 313 (23.8%) one LR. The only factor independently associated with a higher probability of an ER was poor lung function. A higher probability of LR was associated with a greater severity of the asthma (OR: 17.8, for severe asthma versus intermittent asthma), to have had any hospital admission in the previous year (OR: 3.5) and the use of a combination of ICS-LABA as maintenance treatment.Conclusions: About 25% of the patients in our area admitted to hospital due to asthma exacerbation had repeat episodes of hospitalisation. [ABSTRACT FROM AUTHOR]

Background: Timeliness of care is an important dimension of health care quality. The determining factors of less timely care and their influence on the survival of patients with lung cancer (LC) remain uncertain. Aims: To analyse the delays in the diagnosis and treatment of LC in our health area, the factors associated with the timeliness of care and their possible relationship with the survival of these patients. Methods: A retrospective study was conducted on all patients with a cytohistologically confirmed diagnosis of LC between 1 June 2005 and 31 May 2008. The time delays for consultation (specialist delay), diagnosis (diagnosis delay), and treatment (treatment delay), were analysed, as well as the factors associated with these delays and the influence of the timeliness of care on survival. Results: A total of 307 cases were included (87 % males). The mean specialist delay was 53.6 days (median 35 days), diagnosis delay 31.5 days (median 18 days), treatment delay 23.5 days (median 14 days). The greater age of the patient and a more advanced stage were associated with a shorter specialist delay. Male sex, a more advanced stage, and poor general status were associated with a shorter treatment delay. The survival is longer in patients with a longer treatment delay. Conclusions: The delay in the diagnosis in our population seems to be excessively long. The greater the age, a more advanced tumour stage, male sex, and poor general health status are associated with shorter delays. A longer treatment delay is associated with a longer survival. [ABSTRACT FROM AUTHOR]

Background and aims: Interacting effects of atmospheric N deposition on the degree to which tree demand for other nutrients is met by soil supply has seldom been explored in Mediterranean-type ecosystems. We hypothesized that patterns for the relative availability of N and P in soils will be matched by variations in process rates related to soil organic P cycling and by shifts from N to P limitation of tree growth. Methods: We examined N/P relationships in Mediterranean-fir ( Abies pinsapo) forests from two nearby regions differing in N deposition levels. Results: N pools and transformation rates and the contribution of organic fractions to the labile P pool in soils showed increasing trends toward the pollution source. Phosphomonoesterase activity (PME) in bulk soils, root PME per unit biomass (but not per unit soil volume) and biomass accumulation in P-fertilized root-in-growth cores incubated in situ were also the highest at the sites receiving elevated N deposition, indicating P limitation. In contrast, forest stands in the region farther from the pollutant source were N-limited (preferential root growth in N-rich soil microsites) and showed lower PME activities and higher total fine root biomass. Conclusions: In the forests under elevated N deposition, higher values for an overall indicator of soil N status matched with indications of an accelerated soil organic P subcycle and P-limitation of tree growth. [ABSTRACT FROM AUTHOR]

Environmental factors and land-use are likely interacting to drive forest structure and species diversity, making it difficult to disentangle their separate impacts. Both components influence the resilience and stability of mountain forests in the Mediterranean Basin, since secular land-use has shaped stands structure and forests dynamics are constrained to the environment. Approaches covering environmental factors and contrasting land-uses are still needed to understand their implications on forest dynamics. We investigated patterns of environmental variables, stand structure and biodiversity in forest dominated by Abies pinsapo for 61 stands over their whole range. In addition, since land-use by local inhabitant could be a key factor, logging intensity was quantified by stumps basal area and recent land-use history was investigated. Partial redundancy analysis (pRDA) was conducted to assess to which degree the structural attributes are related to environmental characteristics and/or the land-use in the main A. pinsapo forests. Environmental characteristics accounted for 13% of the total variance, while the contrasting land-use (Spain vs. Morocco) and the stumps basal area, as indicator of human logging, accounted for 23% of the total variance. Trees species diversity was near 5 times higher in Moroccan stands than in stands from south Spain. According to recent human logging, Spanish stands have been strictly protected, but Moroccan stands showed widespread axe-logging by local inhabitant over the smaller tree sizes. Our results suggest that the preservation of a minor perturbation regimen by local populations enhance and help to preserve the whole biodiversity of this relict habitat. [ABSTRACT FROM AUTHOR]

Giant cell arteritis most often affects the superficial temporal artery. Arterial territories such as the facial, carotid, myometrial and upper and lower limb arteries may be affected. In this paper we describe the case of a 52-year-old patient with upper and lower limb ischaemia who presented with grade III ischaemia in the left lower limb. Giant cell arteritis was diagnosed as responsible for the symptoms. After treatment with corticoids, an angiographic improvement was evidence after 2-year period. The low number of reported cases, the diverse symptoms and varied course make diagnosis of GCA difficult. Therefore, GCA must be taken into consideration in the ischaemia of inferior and superior limbs whether isolated or simultaneous. [ABSTRACT FROM AUTHOR]

Purpose: To present our experience in the treatment of nasolacrimal occlusion by means of polyurethane stents.Methods: Forty polyurethane stents were placed under fluoroscopic guidance in 35 consecutive patients with epiphora due to total or partial obstruction of the nasolacrimal system. The set designed by Song was used in all patients. The procedure was performed by introducing a guidewire through the superior punctum into the canaliculus and advancing it across the obstruction into the inferior meatus of the nasal cavity. After pulling out the guidewire, the stent was advanced in retrograde fashion and released into the sac and the nasolacrimal duct.Results: The technical success rate was 100%. The average time for the procedure was 25 min (range 10-60 min). Immediate complications were: mild pain (n = 5), severe pain (n = 1), minimal epistaxis (n = 7), and moderate epistaxis (n = 1). No major complications occurred. The last clinical control revealed complete resolution of epiphora in 35 eyes and partial resolution in four; one patient did not improve.Conclusion: This technique for treatment of obstruction of the nasolacrimal system is simple and safe, and may obviate the use of more invasive procedures. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate our results in treatment and management of symptomatic hepatic venous malformations using transcatheter embolization therapy. From 1991 to 1997 five venous malformations were embolized in one man and four women ranging in age from 31 to 50 years. All patients presented nonspecific abdominal pain and were assessed in the general surgery unit. Percutaneous embolization was recommended. In all cases polyvinyl alcohol was used to embolize the afferent arterioles. Clinical and echographic control follow-up was carried out on an outpatient basis in our Vascular and Interventional Radiology Unit. Embolization was possible in all cases. No complications developed during the procedure, except in one case where the subject suffered a spasm of the hepatic artery. Mean follow-up time was 42 months (6-73 months). Four patients remained asymptomatic during the entire follow-up period, whereas one patient required reembolization. In our experience, transcatheter embolization of hepatic venous malformations is a noninvasive technique which requires few admissions and presents few complications. With further use, it could become the treatment of choice in symptomatic hepatic venous malformations as an alternative to surgery. [ABSTRACT FROM AUTHOR]

Models of P transformations during pedogenesis and with succession have developed from studies in temperate humid regions with neutral toacidic soils. Little is known about P biogeochemistry and P availability in semi-arid Mediterranean-type shrublands with alkaline soils. We studied P transformations in a series of semi-arid, dolomitic shrublands in southeastern Spain, ranging from a frequently-burned, open gorse-scrubland on eroded Typic Xerorthents to a long-unburned, mature garrigue on Entic Haploxerolls. In contrast to the common pattern of decreasing total P concentrations in the soil profile with soil development due to leaching, total P increased markedly in this system. This is due to concentration increases of relatively insoluble elements (P, Al, Fe, Ti) as karstification of parent material (dolomitic marbles with up to 94% Ca-Mg carbonate) during pedogenesis released bicarbonate and, subsequently, Ca and Mg leached from the profile at a higher rate. The total element to Ti ratios indicated that the relative ion weathering loss sequence, from easily weathered to resistant ions, was Ca>Mg > > > Fe>=Al>Ti, showing that P is lost from these shrublands at an intermediate rate. In one extreme of the series (the open gorse-scrubland), most soil P was Ca bound and organic P concentrations, organic matter content and phosphatase activity were very low, as predicted by the model of Walker and Syers for the initial stages of soil development. However, this site showed the highest inorganic soil solution P concentration, low soil P fixation capacity and the lowest foliar N:P ratios. Soils from the intermediate stages of the series showed the highest labile inorganic and labile organic P concentrations. At the other extreme of the series (the mature garrigue), a high proportion of soil P was in occluded inorganic and organic formsas predicted by the Walker and Syers' model. However, Ca bound P still accounted for the largest single P fraction. Soils showed very high [ABSTRACT FROM AUTHOR]