Management of the COPD patient with comorbidities: an experts recommendation document

Background: Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose: To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods: A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results: A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion: This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials. Keywords: chronic obstructive pulmonary disease, COPD, comorbidities, modified RANDUCLA, Delphi techniqu

Covariant Momentum Map Thermodynamics for Parametrized Field Theories

Inspired by Souriau's symplectic generalization of the Maxwell-Boltzmann-Gibbs equilibrium in Lie group thermodynamics, we investigate a spacetime-covariant formalism for statistical mechanics and thermodynamics in the multi-symplectic framework for relativistic field theories. A general-covariant Gibbs state is derived, via a maximal entropy principle approach, in terms of the covariant momentum map associated with the lifted action of the diffeomorphisms group on the extended phase space of the fields. Such an equilibrium distribution induces a canonical spacetime foliation, with a Lie algebra-valued generalized notion of temperature associated to the covariant choice of a reference frame, and it describes a system of fields allowed to have non-vanishing probabilities of occupying states different from the diffeomorphism invariant configuration. We focus on the case of parametrized first-order field theories, as a concrete simplified model for fully constrained field theories sharing fundamental general covariant features with canonical general relativity. In this setting, we investigate how physical equilibrium, hence time evolution, emerge from such a state via a gauge-fixing of the diffeomorphism symmetry

Produzione, mercato e consumi della cerasicoltura spagnola

La crisi di sovrapproduzione di alcune specie tradizionali sta favorendo la crescita del ciliegio, che mostra un costante incremento delle superfici, favorito dal rinnovamento varietale, dall’aumento dei consumi, dal miglioramento delle tecnologie di produzione e dalla precocità di maturazione. Tutti fattori che garantiscono alla Spagna elevata competitività nelle esportazioni verso i Paesi dell’Ue.Colaboración en el blog: Rivista di frutticoltura e di ortofloricoltura. Disponible: http://www.rivistafrutticoltura.it

Non-gray rotating stellar models and the evolutionary history of the Orion Nebular Cluster

Rotational evolution in the pre-main sequence (PMS) is described with new sets of PMS evolutionary tracks including rotation, non-gray boundary conditions (BCs) and either low (LCE) or high convection efficiency (HCE). Using observational data and our theoretical predictions, we aim at constraining 1) the differences obtained for the rotational evolution of stars within the ONC by means of these different sets of models; 2) the initial angular momentum of low mass stars, by means of their templates in the ONC. We discuss the reliability of current stellar models for the PMS. While the 2D radiation hydrodynamic simulations predict HCE in PMS, semi-empirical calibrations either seem to require that convection is less efficient in PMS than in the following MS phase or are still contradictory. We derive stellar masses and ages for the ONC by using both LCE and HCE. The resulting mass distribution for the bulk of the ONC population is in the range 0.2$-$0.3 {\msun} for our non-gray models and in the range 0.1$-$0.3{\msun} for models having gray BCs. In agreement with Herbst et al. (2002) we find that a large percentage ($\sim$70%) of low-mass stars (M\simlt 0.5{\msun} for LCE; M\simlt0.35{\msun} for HCE) in the ONC appears to be fast rotators (P$<$4days). Three possibilities are open: 1) $\sim$70% of the ONC low mass stars lose their disk at early evolutionary phases; 2)their locking period is shorter; 3) the period evolution is linked to a different morphology of the magnetic fields of the two groups of stars. We also estimate the range of initial angular momentum consistent with the observed periods. The comparisons made indicate that a second parameter is needed to describe convection in the PMS, possibly related to the structural effect of a dynamo magnetic field.Comment: 17 pages, 11 figure

Ionized gas kinematics of galaxies in the CALIFA survey I: Velocity fields, kinematic parameters of the dominant component, and presence of kinematically distinct gaseous systems

This work provides an overall characterization of the kinematic behavior of the ionized gas of the galaxies included in the Calar Alto Legacy Integral field Area (CALIFA), offering kinematic clues to potential users of this survey for including kinematical criteria for specific studies. From the first 200 galaxies observed by CALIFA, we present the 2D kinematic view of the 177 galaxies satisfying a gas detection threshold. After removing the stellar contribution, we used the cross-correlation technique to obtain the radial velocity of the dominant gaseous component. The main kinematic parameters were directly derived from the radial velocities with no assumptions on the internal motions. Evidence of the presence of several gaseous components with different kinematics were detected by using [OIII] profiles. Most objects in the sample show regular velocity fields, although the ionized-gas kinematics are rarely consistent with simple coplanar circular motions. 35% of the objects present evidence of a displacement between the photometric and kinematic centers larger than the original spaxel radii. Only 17% of the objects in the sample exhibit kinematic lopsidedness when comparing receding and approaching sides of the velocity fields, but most of them are interacting galaxies exhibiting nuclear activity. Early-type galaxies in the sample present clear photometric-kinematic misaligments. There is evidence of asymmetries in the emission line profiles suggesting the presence of kinematically distinct gaseous components at different distances from the nucleus. This work constitutes the first determination of the ionized gas kinematics of the galaxies observed in the CALIFA survey. The derived velocity fields, the reported kinematic peculiarities and the identification of the presence of several gaseous components might be used as additional criteria for selecting galaxies for specific studies.Comment: 38 pages, 16 figures, 4 tables. Paper accepted for publication in A&

Biomimetic Magnetic Nanocarriers Drive Choline Kinase Alpha Inhibitor inside Cancer Cells for Combined Chemo-Hyperthermia Therapy

Choline kinase a1 (ChoKa1) has become an excellent antitumor target. Among all the inhibitors synthetized, the new compound Ff35 shows an excellent capacity to inhibit ChoKa1 activity. However, soluble Ff35 is also capable of inhibiting choline uptake, making the inhibitor not selective for ChoKa1. In this study, we designed a new protocol with the aim of disentangling whether the Ff35 biological action is due to the inhibition of the enzyme and/or to the choline uptake. Moreover, we offer an alternative to avoid the inhibition of choline uptake caused by Ff35, since the coupling of Ff35 to novel biomimetic magnetic nanoparticles (BMNPs) allows it to enter the cell through endocytosis without interacting with the choline transporter. This opens the possibility of a clinical use of Ff35. Our results indicate that Ff35-BMNPs nanoassemblies increase the selectivity of Ff35 and have an antiproliferative effect. Also, we demonstrate the effectiveness of the tandem Ff35-BMNPs and hyperthermia.This research was funded by the Ministerio de Economía y Competitividad (CGL2013-46612 and CGL2016-76723 projects), Ramón y Cajal programme (RYC-2014-16901) and the Fondo Europeo de Desarrollo Regional (FEDER). Also, this research was aided by the Andalusian regional government (CTS-236)

Imprints of galaxy evolution on H ii regions Memory of the past uncovered by the CALIFA survey

H ii regions in galaxies are the sites of star formation and thus particular places to understand the build-up of stellar mass in the universe. The line ratios of this ionized gas are frequently used to characterize the ionization conditions. We use the Hii regions catalogue from the CALIFA survey (~5000 H ii regions), to explore their distribution across the classical [OIII]/Hbeta vs. [NII]/Halpha diagnostic diagram, and how it depends on the oxygen abundance, ionization parameter, electron density, and dust attenuation. We compared the line ratios with predictions from photoionization models. Finally, we explore the dependences on the properties of the host galaxies, the location within those galaxies and the properties of the underlying stellar population. We found that the location within the BPT diagrams is not totally predicted by photoionization models. Indeed, it depends on the properties of the host galaxies, their galactocentric distances and the properties of the underlying stellar population. These results indicate that although H ii regions are short lived events, they are affected by the total underlying stellar population. One may say that H ii regions keep a memory of the stellar evolution and chemical enrichment that have left an imprint on the both the ionizing stellar population and the ionized gasComment: 18 pages, 8 figures, accepted for publishing in A&

The effects of spatial resolution on Integral Field Spectrograph surveys at different redshifts. The CALIFA perspective

Over the past decade, 3D optical spectroscopy has become the preferred tool for understanding the properties of galaxies and is now increasingly used to carry out galaxy surveys. Low redshift surveys include SAURON, DiskMass, ATLAS3D, PINGS and VENGA. At redshifts above 0.7, surveys such as MASSIV, SINS, GLACE, and IMAGES have targeted the most luminous galaxies to study mainly their kinematic properties. The on-going CALIFA survey ($z\sim0.02$) is the first of a series of upcoming Integral Field Spectroscopy (IFS) surveys with large samples representative of the entire population of galaxies. Others include SAMI and MaNGA at lower redshift and the upcoming KMOS surveys at higher redshift. Given the importance of spatial scales in IFS surveys, the study of the effects of spatial resolution on the recovered parameters becomes important. We explore the capability of the CALIFA survey and a hypothetical higher redshift survey to reproduce the properties of a sample of objects observed with better spatial resolution at lower redshift. Using a sample of PINGS galaxies, we simulate observations at different redshifts. We then study the behaviour of different parameters as the spatial resolution degrades with increasing redshift.Comment: 20 pages, 16 figures. Accepted for publication in A&

The Mass-Metallicity relation explored with CALIFA: I. Is there a dependence on the star formation rate?

We present the results on the study of the global and local M-Z relation based on the first data available from the CALIFA survey (150 galaxies). This survey provides integral field spectroscopy of the complete optical extent of each galaxy (up to 2-3 effective radii), with enough resolution to separate individual HII regions and/or aggregations. Nearly $\sim$3000 individual HII regions have been detected. The spectra cover the wavelength range between [OII]3727 and [SII]6731, with a sufficient signal-to-noise to derive the oxygen abundance and star-formation rate associated with each region. In addition, we have computed the integrated and spatially resolved stellar masses (and surface densities), based on SDSS photometric data. We explore the relations between the stellar mass, oxygen abundance and star-formation rate using this dataset. We derive a tight relation between the integrated stellar mass and the gas-phase abundance, with a dispersion smaller than the one already reported in the literature ($\sigma_{\Delta{\rm log(O/H)}}=$0.07 dex). Indeed, this dispersion is only slightly larger than the typical error derived for our oxygen abundances. However, we do not find any secondary relation with the star-formation rate, other than the one induced due to the primary relation of this quantity with the stellar mass. We confirm the result using the $\sim$3000 individual HII regions, for the corresponding local relations. Our results agree with the scenario in which gas recycling in galaxies, both locally and globally, is much faster than other typical timescales, like that of gas accretion by inflow and/or metal loss due to outflows. In essence, late-type/disk dominated galaxies seem to be in a quasi-steady situation, with a behavior similar to the one expected from an instantaneous recycling/closed-box model.Comment: 19 Pages, 8 figures, Accepted for Publishing in Astronomy and Astrophysics (A&A

NG2 antigen is involved in leukemia invasiveness and central nervous system infiltration in MLL-rearranged infant B-ALL

Mixed-lineage leukemia (MLL)-rearranged (MLLr) infant B-cell acute lymphoblastic leukemia (iMLLr-B-ALL) has a dismal prognosis and is associated with a pro-B/mixed phenotype, therapy refractoriness and frequent central nervous system (CNS) disease/relapse. Neuron-glial antigen 2 (NG2) is specifically expressed in MLLr leukemias and is used in leukemia immunophenotyping because of its predictive value for MLLr acute leukemias. NG2 is involved in melanoma metastasis and brain development; however, its role in MLL-mediated leukemogenesis remains elusive. Here we evaluated whether NG2 distinguishes leukemia-initiating/propagating cells (L-ICs) and/or CNS-infiltrating cells (CNS-ICs) in iMLLr-B-ALL. Clinical data from the Interfant cohort of iMLLr-B-ALL demonstrated that high NG2 expression associates with lower event-free survival, higher number of circulating blasts and more frequent CNS disease/relapse. Serial xenotransplantation of primary MLL-AF4 + leukemias indicated that NG2 is a malleable marker that does not enrich for L-IC or CNS-IC in iMLLr-B-All. However, NG2 expression was highly upregulated in blasts infiltrating extramedullar hematopoietic sites and CNS, and specific blockage of NG2 resulted in almost complete loss of engraftment. Indeed, gene expression profiling of primary blasts and primografts revealed a migratory signature of NG2 + blasts. This study provides new insights on the biology of NG2 in iMLLr-B-ALL and suggests NG2 as a potential therapeutic target to reduce the risk of CNS disease/relapse and to provide safer CNS-directed therapies for iMLLr-B-ALL