Mortality prediction in chronic obstructive pulmonary disease comparing the GOLD 2015 and GOLD 2019 staging: a pooled analysis of individual patient data

In 2019, The Global Initiative for Chronic Obstructive Lung Disease (GOLD) modified the grading system for patients with COPD, creating 16 subgroups (1A-4D). As part of the COPD Cohorts Collaborative International Assessment (3CIA) initiative, we aim to compare the mortality prediction of the 2015 and 2019 COPD GOLD staging systems. We studied 17 139 COPD patients from the 3CIA study, selecting those with complete data. Patients were classified by the 2015 and 2019 GOLD ABCD systems, and we compared the predictive ability for 5-year mortality of both classifications. In total, 17139 patients with COPD were enrolled in 22 cohorts from 11 countries between 2003 and 2017; 8823 of them had complete data and were analysed. Mean +/- SD age was 63.9 +/- 9.8 years and 62.9% were male. GOLD 2019 classified the patients in milder degrees of COPD. For both classifications, group D had higher mortality. 5-year mortality did not differ between groups B and C in GOLD 2015; in GOLD 2019, mortality was greater for group B than C. Patients classified as group A and B had better sensitivity and positive predictive value with the GOLD 2019 classification than GOLD 2015. GOLD 2015 had better sensitivity for group C and D than GOLD 2019. The area under the curve values for 5-year mortality were only 0.67 (95% CI 0.66-0.68) for GOLD 2015 and 0.65 (95% CI 0.63-0.66) for GOLD 2019. The new GOLD 2019 classification does not predict mortality better than the previous GOLD 2015 system

Sex differences between women and men with COPD: A new analysis of the 3CIA study

Background: There is partial evidence that COPD is expressed differently in women than in men, namely on symptoms, pulmonary function, exacerbations, comorbidities or prognosis. There is a need to improve the characterization of COPD in females. Methods: We obtained and pooled data of 17 139 patients from 22 COPD cohorts and analysed the clinical differences by sex, establishing the relationship between these characteristics in women and the prognosis and severity of the disease. Comparisons were established with standard statistics and survival analysis, including crude and multivariate Cox-regression analysis. Results: Overall, 5355 (31.2%) women were compared with men with COPD. Women were younger, had lower pack-years, greater FEV1%, lower BMI and a greater number of exacerbations (all p < 0.05). On symptoms, women reported more dyspnea, equal cough but less expectoration (p < 0.001). There were no differences in the BODE index score in women (2.4) versus men (2.4) (p = 0.5), but the distribution of all BODE components was highly variable by sex within different thresholds of BODE. On prognosis, 5-year survival was higher in COPD females (86.9%) than in males (76.3%), p < 0.001, in all patients and within each of the specific comorbidities that we assessed. The crude and adjusted RR and 95% C.I. for death in males was 1.82 (1.69–1.96) and 1.73 (1.50–2.00), respectively. Conclusions: COPD in women has some characteristic traits expressed differently than compared to men, mainly with more dyspnea and COPD exacerbations and less phlegm, among others, although long-term survival appears better in female COPD patients

Al-behandling mot Gyrodactylus salaris i Batnfjordelva

Med kun ett doseringspunkt for aluminiumsulfat (AlS), har vi lykkes med å eliminere lakseparasitten Gyrodactylus salaris (Malmberg) over en strekning på 4.5 - 5.0 km i Batnfjordelva, Møre og Romsdal. Elvas lakseførende strekning er ca 11 km. Ved Stasjon 1 som lå 2.2 km nedstrøms doseringspunktet, var alle undersøkte laks G. salaris-frie etter 4 dager. At vi ikke klarte å fjerne G. salaris enda lengre ned i vassdraget, skyldes det faktum at store sidevassdrag kommer inn i hovedelva. De aktive formene av aluminium (Al) blir da fortynnet. I tillegg bidrar sidevassdragene til økt pH som reduserer mengden aktive Al-former som kan være tilstede løst i vannet. I en framtidig fullskala-behandling vil selvsagt sidevassdragene også behandles med sur aluminiumløsning. Da vil aluminium virke i hele den lakseførende strekningen. Under forsøkene i Batnfjorden ble Al-dosene doblet i forhold til den dosen som fjernet parasitten etter 4 dager. Dette doseringsregimet varte i en uke. Ingen fiskedød ble registrert, men en svak fysiologisk påvirkning ble påvist hos den eksponerte fisken. Effektene var imidlertid så marginale at fisken ikke vil ha problemer med å restitueres når behandlingen opphører og fisken igjen får normal vannkvalitet. Under behandlingen var all aktivitet i og rundt vassdraget som normalt. Husdyr på beite brukte elva som drikkevannskilde og fiskere fanget fisk mens behandlingen pågikk

An SEM study of the haptoral sclerites of the genus Gyrodactylus Nordmann, 1832 (Monogenea) following extraction by digestion and sonication techniques

Techniques for the preparation of haptoral sclerites of Gyrodactylus species for scanning electron microscopy are described. Enzymatic digestion using pepsin allows fresh, frozen and alcohol-fixed material to be examined, but some sclerites, such as the dorsal and ventral bars, are lost. Sonication of fresh and frozen material retained these accessory bars, including the ventral bar membrane, the guard or sickle filament loop on the marginal hooks and even on some occasions ligaments associated with the sclerites. The sclerites of Gyrodactylus spp. from Gasterosteus aculeatus (L.) (three-spined stickleback), Oncorhynchus mykiss (Walbaum) (rainbow trout) and Salvelinus alpinus (L.) (charr) are described from SEM observations following the use of these preparation techniques, and the articulation between the hamuli and bars is commented upon