Post-drought conditions and hydraulic dysfunction determine tree resilience and mortality across Mediterranean Aleppo pine (Pinus halepensis) populations after an extreme drought event.

Drought-related tree mortality is a global phenomenon that currently affects a wide range of forests. Key functional variables on plant hydraulics, carbon economy, growth and allocation have been identified and play a role in tree drought responses. However, tree mortality thresholds based on such variables are difficult to identify, especially under field conditions. We studied several Aleppo pine populations differently affected by an extreme drought event in 2014, with mortality rates ranging from no mortality to 90% in the most severely affected population. We hypothesized that mortality is linked with high levels of xylem embolism, i.e., hydraulic dysfunction, which would also lead to lower tree resistance to drought in subsequent years. Despite not finding any differences among populations in the vulnerability curves to xylem embolism, there were large differences in the hydraulic safety margin (HSM) and the hydraulic dysfunction level. High mortality rates were associated with a negative HSM when xylem embolism reached values over 60%. We also found forest weakening and post-drought mortality related to a low hydraulic water transport capacity, reduced plant growth, low carbohydrate contents and high pest infestation rates. Our results highlight the importance of drought severity and the hydraulic dysfunction level on pine mortality, as well as post-drought conditions during recovery processes.

Neutrophil extracellular traps are a source of extracellular HMGB1 in lupus nephritis: associations with clinical and histopathological features.

OBJECTIVE: This study aimed to analyze the expression of the high mobility group box-1 (HMGB1) protein in neutrophil extracellular traps (NETs) of patients with lupus nephritis (LN) and its association with clinical and histopathological features of the disease. METHODS: Twenty-three patients with biopsy-confirmed LN and 14 systemic lupus erythematosus (SLE) patients with active disease (SLE Disease Activity Index (SLEDAI) score ≥ 6) and no evidence of LN were included. Clinical and laboratory features were recorded. NETs and the expression of HMGB1 were assessed by confocal microscopy, and serum HMGB1 levels were measured by ELISA. RESULTS: In comparison to patients without kidney disease, patients with LN had a higher expression of HMGB1 in spontaneous (57 vs. 30.4; p = 0.027) and lipopolysaccharide (LPS)-induced (55.8 vs. 24.9; p = 0.005) NETs. We found a positive correlation between serum HMGB1 and the expression of HMGB1 in LPS-induced NETs (r = 0.447, p = 0.017). The expression of HMGB1 in spontaneous NETs correlated with SLEDAI score (r = 0.514, p = 0.001), anti-dsDNA antibodies (r = 0.467, p = 0.004), the rate of glomerular filtration descent (r = 0.543, p = 0.001), and diverse histopathological components of active nephritis in the kidney biopsy, such as the activity index (r = 0.581, p = 0.004), fibrinoid necrosis (r = 0.603, p = 0.002), and cellular crescents (r = 0.486, p = 0.019). CONCLUSIONS: In patients with SLE, NETs are a source of extracellular HMGB1. The expression of HMGB1 in NETs is higher among patients with LN, which correlates with clinical and histopathological features of active nephritis and suggest a possible role of this alarmin in the pathophysiology of kidney damage in SLE.

Quantifying in situ phenotypic variability in the hydraulic properties of four tree species across their distribution range in Europe.

Many studies have reported that hydraulic properties vary considerably between tree species, but little is known about their intraspecific variation and, therefore, their capacity to adapt to a warmer and drier climate. Here, we quantify phenotypic divergence and clinal variation for embolism resistance, hydraulic conductivity and branch growth, in four tree species, two angiosperms (Betula pendula, Populus tremula) and two conifers (Picea abies, Pinus sylvestris), across their latitudinal distribution in Europe. Growth and hydraulic efficiency varied widely within species and between populations. The variability of embolism resistance was in general weaker than that of growth and hydraulic efficiency, and very low for all species but Populus tremula. In addition, no and weak support for a safety vs. efficiency trade-off was observed for the angiosperm and conifer species, respectively. The limited variability of embolism resistance observed here for all species except Populus tremula, suggests that forest populations will unlikely be able to adapt hydraulically to drier conditions through the evolution of embolism resistance.

Variation in xylem vulnerability to embolism in European beech from geographically marginal populations.

Climate change is expected to increase the frequency and intensity of droughts and heatwaves in Europe, leading to effects on forest growth and major forest dieback events due to hydraulic failure caused by xylem embolism. Inter-specific variability in embolism resistance has been studied in detail, but little is known about intra-specific variability, particularly in marginal populations. We evaluated 15 European beech populations, mostly from geographically marginal sites of the species distribution range, focusing particularly on populations from the dry southern margin. We found small, but significant differences in resistance to embolism between populations, with xylem pressures causing 50% loss of hydraulic conductivity ranging from -2.84 to -3.55 MPa. Significant phenotypic clines of increasing embolism resistance with increasing temperature and aridity were observed: the southernmost beech populations growing in a warmer drier climate and with lower habitat suitability have higher resistance to embolism than those from Northern Europe growing more favourable conditions. Previous studies have shown that there is little or no difference in embolism resistance between core populations, but our findings show that marginal populations have developed ways of protecting their xylem based on either evolution or plasticity.

Microbiological and immunological profile of patients with severe lupus flares related to bloodstream infections: a retrospective cohort study.

Background This study aimed to address whether bloodstream infections are a risk factor for the development of severe lupus flares, as well as clinical, immunological and microbiological features of patients with bloodstream infections that develop severe lupus flares. Methods We performed a retrospective cohort study comparing 87 systemic lupus erythematosus (SLE) patients with bloodstream infections and 87 hospitalized SLE patients without bloodstream infections as a comparison group. All patients were followed up for at least 3 months or until one of the primary outcomes was developed (severe SLE flare according to SELENA/SLEDAI score or death). Microbiological features of all bloodstream infections were recorded. The disease status at the end of follow up was registered. Results A total of 23 patients (13.2%) developed a severe flare during follow up; among them, 20 (87%) had an associated episode of bloodstream infection ( p < 0.001). The most frequent flares were renal (43.4%) and severe thrombocytopenia (26%). After multivariate analysis, baseline-independent factors associated with severe SLE flare were bloodstream infection [hazard ratio (HR) 7.3, 95% confidence interval (CI) 2.13-24.95; p = 0.002]. Among patients with bloodstream infections, low C4 levels (HR 2.43, 95% CI 1.04-5.69: p = 0.04) and Streptococcus pneumoniae were associated with severe SLE flare (HR 3.41, 95% CI 1.68-6.91; p = 0.012). Conclusions SLE patients with bloodstream infections, especially due to S. pneumoniae, and low C4 levels, are at higher risk for development of severe SLE flares.

Air Travel, Circadian Rhythms/Hormones, and Autoimmunity.

Biological rhythms are fundamental for homeostasis and have recently been involved in the regulatory processes of various organs and systems. Circadian cycle proteins and hormones have a direct effect on the inflammatory response and have shown pro- or anti-inflammatory effects in animal models of autoimmune diseases. The cells of the immune system have their own circadian rhythm, and the light-dark cycle directly influences the inflammatory response. On the other hand, patients with autoimmune diseases characteristically have sleep disorders and fatigue, and in certain disease, such as rheumatoid arthritis (RA), a frank periodicity in the signs and symptoms is recognized. The joint symptoms predominate in the morning, and apparently, subjects with RA have relative adrenal insufficiency, with a cortisol peak unable to control the late night load of pro-inflammatory cytokines. Transatlantic flights represent a challenge in the adjustment of biological rhythms, since they imply sleep deprivation, time zone changes, and potential difficulties for drug administration. In patients with autoimmune diseases, the use of DMARDs and prednisone at night is probably best suited to lessen morning symptoms. It is also essential to sleep during the trip to improve adaptation to the new time zone and to avoid, as far as possible, works involving flexible or nocturnal shifts. The study of proteins and hormones related to biological rhythms will demonstrate new pathophysiological pathways of autoimmune diseases, which will emphasize the use of general measures for sleep respect and methods for drug administration at key daily times to optimize their anti-inflammatory and immune modulatory effects.

Autoimmune reaction after anti-tetanus vaccination-description of four cases and review of the literature.

Autoimmune reaction after vaccination is sporadically reported in the medical literature. Vaccinations are generally safe and have an important role in eradicating endemic diseases worldwide. Nevertheless, the question arises as to whether there is a possibility of post-vaccination autoimmune phenomena. The anti-tetanus vaccine is being used since 1924, and it is part of the recommended immunization schedules for children. There are few reports of autoimmune diseases, such as rheumatoid arthritis and anti-phospholipid syndrome after anti-tetanus vaccination. Herein, we describe four cases, of which we believe, show a clear temporal relation between anti-tetanus vaccination and the appearance of dermatomyositis, systemic lupus erythematosus, type 1 diabetes mellitus and anti-phospholipid syndrome. We also suggest some of the pathogenic mechanisms that promote a pathogenic autoimmune response.

Ro52/TRIM21-deficient expression and function in different subsets of peripheral blood mononuclear cells is associated with a proinflammatory cytokine response in patients with idiopathic inflammatory myopathies.

The presence of anti-Ro52/tripartite motif 21 (Trim21) autoantibodies has been associated with a distinctive clinical profile and has gained value as a prognostic marker in idiopathic inflammatory myopathies (IIM). The aim of the present work was to analyse Ro52/Trim21 expression in different subsets of peripheral blood mononuclear cells (PBMCs) of patients with IIM, as well as the ubiquitination profile and its association with proinflammatory cytokine production. We included 18 patients with recent-onset IIM and 18 age- and gender-matched healthy donors. PBMCs were isolated and different subsets (CD4+ , CD8+ , CD14+ ) were purified by magnetic selection. The expression of Ro52/Trim21 in different PBMC subsets of patients with IIM and healthy donors was analysed by Western blot. We assessed the presence of myositis-specific and associated autoantibodies by enzyme-linked immunosorbent assay (ELISA). Cytokine levels were measured by cytometric bead array. Patients with IIM showed decreased protein expression of Ro52/Trim21 in comparison to healthy controls in PBMC (0·97 ± 0·60 versus 1·84 ± 0·92, P = 0·016), CD4+ lymphocytes (0·79 ± 0·54 versus 2·41 ± 0·78, P = 0·017), and monocytes (0·87 ± 0·35 versus 1·89 ± 0·20, P < 0·001). There were no significant differences among IIM groups. Also, a lower K48-mediated ubiquitination profile was found, predominantly in CD4+ lymphocytes. Furthermore, after mitogenic stimulation, there was a higher synthesis of proinflammatory cytokines by T cells [interleukin (IL)-17A and tumour necrosis factor (TNF)-α] and monocytes [IL-6 and interferon (IFN)-α] from IIM patients compared with healthy controls. Our data suggest that patients with IIM, mainly DM, are characterized by a deficient expression of Ro52/TRIM21 in different PBMC subsets (CD4+ lymphocytes and monocytes), along with lower K48-mediated ubiquitination, which is associated with a proinflammatory cytokine response.

Actuación de los pacientes ante un síndrome coronario agudo: diferencias desde una perspectiva de género / Patient responses to symptoms of acute coronary syndrome: a gender-perspective study

Objetivos: Conocer las características del entorno, pensamientos, actuaciones y tipo de transporte utilizado en hombres y mujeres con síndrome coronario agudo –SCA– (infarto agudo de miocardio y angina inestable) al inicio de los síntomas. Método: Estudio observacional descriptivo de una muestra representativa de pacientes ingresados en las unidades de cuidados intensivos de 33 hospitales públicos de las 8provincias andaluzas, entre 2007 y 2010, con diagnóstico al alta de SCA. Resultados: Se obtuvieron 1.416 encuestas: 948 hombres y 468 mujeres, con una edad media de 63,0 años y 70,5, respectivamente. Los síntomas se inician mayormente en la vivienda habitual y por la mañana. Menos de una tercera parte de las personas encuestadas supo desde el principio que se trataba de un infarto (hombres 29,9%, mujeres 24,2% p < 0,001). El 26,0% lo primero que hace es telefonear o desplazarse en busca de familiares, amistades o gente vecina, además las personas realizan más de (..) (AU)

Objective: To determine the environmental characteristics and the opinions, behaviors, and types of transfer to hospital of men and women who experience symptoms of acute coronary syndrome (acute myocardial infarct and unstable angina).Methods: Descriptive observational study of a representative sample of patients with a diagnosis of acute coronary syndrome who were admitted to the intensive care units of 33 public health service hospitals in 8 provinces in Andalusia, Spain, between 2007 and 2010.Results: A total of 1416 surveys were completed; 948 were for men and 468 were for women (mean [SD] ages, 63.0and 70.5 years, respectively). Symptoms usually began in the patient’s home. Fewer than a third of the patients surveyed knew they were experiencing a coronary event from the beginning of symptoms (29.9% of men and 24.2% of women;P<.001). The first reaction of 26.0% was to call or try to find a family member, friend, or neighbor. Many (..) (AU)

Thrombolysis with recombinant tissue plasminogen activator during cardiopulmonary resuscitation in fulminant pulmonary embolism. A case series.

OBJECTIVE: To describe our outcomes using thrombolysis during the cardiopulmonary resuscitation (CPR) of patients in cardiorespiratory arrest (CA) caused by fulminant pulmonary embolism (FPE). DESIGN: A case series. SETTING: Intensive care units of a district hospital and a referral centre. PATIENTS: Six patients that suffered CA secondary to an FPE. INTERVENTIONS: Administration of recombinant tissue plasminogen activator during usual CPR manoeuvres when there was a strong suspicion of FPE. Permission for the thrombolytic therapy was sought from family members in all cases. RESULTS: Four out of the six patients survived and remain symptom-free. The thrombolysis was not associated with any fatal complications. CONCLUSIONS: Early thrombolysis during CPR manoeuvres for CA apparently caused by an FPE may reduce the mortality rate among these patients.

Presence of Chromatium vinosum chaperonins 10 and 60 in mitochondria and peroxisomes of rat hepatocytes.

In the present study we report the occurrence of chaperonins, cpn10 and cpn60, in Chromatium vinosum and rat hepatocytes, using specific polyclonal antibodies in conjunction with the protein A-gold immunocytochemical technique. As demonstrated by quantitative evaluations, the immunolabeling for cpn10 and cpn60 in C vinosum cells was associated primarily with the bacterial cell envelope. In rat liver homogenates, Western immunoblotting analysis has shown that antibodies to cpn10 from C vinosum recognize an unique 25-kDa protein that remains to be further characterized. On the other hand, the antibody to cpn60 from C vinosum revealed the presence of a 60-kDa protein in the rat liver homogenates. Immunofluorescence on rat liver tissue revealed an intracellular granular labeling for both chaperonins. On the other hand, using the post-embedding immunoelectron microscopy technique cpn10 and cpn60 were localized specifically in liver mitochondria and peroxisomes. Interestingly, further analysis of the labeling distribution confirmed the association of both proteins with the mitochondrial inner membrane whereas in the peroxisomes the chaperonins appeared to be located in the matrix, away from the limiting peroxisomal membrane. The colocalization of both chaperonins suggests that, as in other bacteria as well as eukaryotic cells, they may act in tandem for the proper folding of particular proteins.

Involvement of molecular chaperones in the aberrant aggregation of secretory proteins in pancreatic acinar cells.

Molecular chaperones have recently been shown to be accurately located along distinct cellular compartments of the secretory pathway of pancreatic acinar cells. Since the aberrant aggregation of secretory proteins leading to the formation of RER intracisternal crystals induced by DL-p-chlorophenylalanine methyl ester (CPME) comprises major changes in the sorting, selective transport, and/or posttranslational modifications of secretory proteins, we decided to investigate the possible involvement of chaperones in this phenomenon by applying the protein A-gold immunocytochemical approach. In addition to their presence in the cellular compartments of the secretory pathway, the chaperonins cpn10 and cpn60 were found to also be concentrated in the RER intracisternal crystals. In contrast, the hsp70 protein remained confined to the trans-Golgi network and was absent from the crystals. In both control and experimental conditions the three chaperones were present in mitochondria. Quantitative evaluations confirmed these observations and revealed an overall decrease in the labeling, particularly for hsp70 after CPME treatment. These labeling patterns suggest a participation of the chaperonins cpn10 and cpn60 but not of the hsp70 in the aberrant aggregation of secretory proteins leading to RER crystal formation. The role played by chaperones in this process, however, remains to be elucidated.

Molecular chaperones in pancreatic tissue: the presence of cpn10, cpn60 and hsp70 in distinct compartments along the secretory pathway of the acinar cells.

Three chaperones, the chaperonins cpn10 and cpn60, and the hsp70 protein, were revealed by immunochemistry and cytochemistry in pancreatic rat acinar cells. Western immunoblotting analysis of rat pancreas homogenates has shown that antibodies against cpn10, cpn60 and hsp70 protein recognize single protein bands of 25 kDa, 60 kDa and 70 kDa, respectively. Single bands for the cpn10 and cpn60 were also detected in pancreatic juice. Immunofluorescence studies on rat pancreatic tissue revealed a strong positive signal in the apical region of the acinar cells for cpn10 and cpn60, while an immunoreaction was detected at the juxtanuclear Golgi region with the anti-hsp70 antibody. Immunocytochemical gold labeling confirmed the presence of these three chaperones in distinct cell compartments of pancreatic acinar cells. Chaperonin 10 and cpn60 were located in the endoplasmic reticulum, Golgi apparatus, condensing vacuoles and secretory granules. Interestingly, the labeling for both cpn10 and cpn60 followed the increasing concentration gradient of secretory proteins along the RER-Golgi-granule secretory pathway. On the contrary, the labeling for hsp70 was mainly concentrated in the endoplasmic reticulum and the Golgi apparatus. In the latter, the hsp70 was found to be primary located in the trans-most cisternae and to colocalize with acid phosphatase in the trans-Golgi network. The three chaperones were also present in mitochondria. In view of the role played by the chaperones in the proper folding, sorting and aggregation of proteins, we postulate that hsp70 assists the adequate sorting and packaging of proteins from the ER to the trans-Golgi network while cpn10 and cpn60 play key roles in the proper packaging and aggregation of secretory proteins as well as, most probably, in the prevention of early enzyme activation in secretory granules.

Factors related to quality of life 12 months after discharge from an intensive care unit.

OBJECTIVE: To perform an analysis of the quality of life of survivors after ICU discharge. DESIGN: Prospective study. SETTING: Medical-surgical ICU of a Spanish reference hospital. PATIENTS: Patients (n = 606) admitted in a 6-month period. METHOD: A questionnaire regarding quality of life issues was completed at the time of admission by patients or surrogates (n = 606). The questionnaire was given again 12 months after ICU discharge to 444 surviving patients. Both questionnaires evaluated the patient's ability to function and communicate for the previous 3 months. A Quality of Life score of 0 corresponded to no limitations. An increasing score indicated a reduction in function. A score of greater than 10 points implied a severe physical handicap. Information was also collected on the severity of illness and the diagnosis that prompted ICU admission. RESULTS: The mean Quality of Life score of all survivors worsened from a mean of 4.62 at the time of ICU admission to a mean of 6.11 at 12 months after ICU discharge (p less than .01) and was most evident for patients greater than 75 yrs of age (from a mean of 6.33 to a mean of 9.54). However, patients with the highest initial Quality of Life scores had a significant improvement at 12 months (14.61 +/- 0.50 to 12.48 +/- 0.78 points [p less than .05]). A higher severity of illness score corresponded to a higher Quality of Life score, but a multivariate analysis indicated that the factors with the greatest influence on the post-discharge Quality of Life score were the initial Quality of Life score and age. CONCLUSIONS: Twelve months after discharge from the ICU, a patient's functional status, as measured by the Quality of Life score, is influenced most by age and their Quality of Life score at the time of ICU admission. While there is an overall decrease in the Quality of Life score for survivors, admission and treatment in an ICU do not always result in deterioration of the Quality of Life score. This study indicates that Quality of Life scores could become a routine part of patient evaluation.

Purification and characterization of chaperonin 10 from Chromatium vinosum.

Chromatium vinosum contains a polypeptide that is functionally and structurally similar to the Escherichia coli chaperonin 10. The protein has been purified to homogeneity by sucrose density gradient centrifugation followed by gel filtration using a Bio-Gel A-1.5 m column. The molecular mass of chaperonin 10, as determined by gel filtration or nondenaturing polyacrylamide gel electrophoresis, is 95 kDa. The oligomer is composed of seven or eight subunits. Comparisons of the overall amino acid composition and N-terminal sequences among chaperonin 10 species from C. vinosum and E. coli reflect a high degree of similarity. A physical association between chaperonins 60 and 10 from C. vinosum, in vitro, is supported by three experimental approaches. First, the proteins form a stable binary complex in sucrose density gradients, gel filtration chromatography, and nondenaturing polyacrylamide gel electrophoresis, solely in the presence of ATP and Mg2+. Second, chaperonin 10 from C. vinosum binds, selectively, to a chaperonin 60-coupled Affi-Gel 10 matrix column. Third, a slight molar excess of chaperonin 10 is able to abolish, almost completely, the ATPase in chaperonin 60. The rate for ATPase activity of chaperonin 60 from C. vinosum is enhanced when supplemented with monovalent cations.

Increase in lung volume originated by extrinsic PEEP in patients with auto-PEEP. The role of static lung compliance.

The use of extrinsic positive end expiratory pressure (PEEPe) in patients with auto-PEEP (AP) can reduce the respiratory work during weaning from mechanical ventilation. However, the application of PEEPe can produce a certain level of hyperinflation, an undesirable effect which can limit the efficacy of the reduction of respiratory work. The objective of the present study has been to determine if the increase in end expiratory lung volume (EELV) originated by the PEEPe is related to static lung compliance (SLC). We have studied 14 patients on mechanical ventilation in whom an AP of between 4 and 12 cmH2O was detected. On applying PEEPe equal to half the AP, the EELV increased slightly (77 +/- 64 ml) and was not related to pulmonary compliance. When PEEPe equal to the AP was applied, the EELV increased by 178 +/- 110 ml (range 45-375 ml, p less than 0.05), and there was a significant correlation with SLC (r = 0.659, p less than 0.05). In conclusion, the application of PEEPe equal to the AP causes a moderate increase in EELV. However, in patients with high pulmonary compliance this increase can be more important and must be taken into account when considering the use of PEEPe during weaning.

[The level of knowledge about different aspects of health of the population served in the Pedro Borras health area in the city of Pinar del Río]. / Nivel de conocimientos sobre diferentes aspectos de salud de la poblacíon atendida en el área de salud "Pedro Borras", municipio Pinar del Río.

A prospective study in order to determine level knowledge of the population about health, before and after the implantation of the Integral Medical Attention Programme to the Family, was carried out at the outpatient services in the "Pedro Borrás" Teaching Community Polyclinic Health Area. Of the population attending to this outpatient area, 917 individuals older than 15 years, were selected at random. These individuals were surveyed at the beginning of the study (November 1986), in order to collect data of main necessary aspects that the population must be acquainted with on health condition and health promotion, and were surveyed again after six months of the performance of the system (May 1987), and results of both surveys were compared and shown in tables with statistical data. The main programmes for health promotion before the implantation of the new system were, known, effectively, by the population in ratios ranging 0.26-0.49. After the performance of the new programme it was observed how the level of knowledge raises to 0.31-0.70, and knowledges on obesity and sedentary habits (0.69) and on prevention of accidents (0.70) becomes significative. We consider all these changes depending on a greater educational work by the physician and nurse in charge of the plan.