Distribution and outcomes of a phenotype-based approach to guide COPD management: Results from the CHAIN cohort

Rationale: The Spanish guideline for COPD (GesEPOC) recommends COPD treatment according to four clinical phenotypes: non-exacerbator phenotype with either chronic bronchitis or emphysema (NE), asthma-COPD overlap syndrome (ACOS), frequent exacerbator phenotype with emphysema (FEE) or frequent exacerbator phenotype with chronic bronchitis (FECB). However, little is known on the distribution and outcomes of the four suggested phenotypes. Objective: We aimed to determine the distribution of these COPD phenotypes, and their relation with one-year clinical outcomes. Methods: We followed a cohort of well-characterized patients with COPD up to one-year. Baseline characteristics, health status (CAT), BODE index, rate of exacerbations and mortality up to one year of follow-up were compared between the four phenotypes. Results: Overall, 831 stable COPD patients were evaluated. They were distributed as NE, 550 (66.2%); ACOS, 125 (15.0%); FEE, 38 (4.6%); and FECB, 99 (11.9%); additionally 19 (2.3%) COPD patients with frequent exacerbations did not fulfill the criteria for neither FEE nor FECB. At baseline, there were significant differences in symptoms, FEV1 and BODE index (all p<0.05). The FECB phenotype had the highest CAT score (17.1±8.2, p<0.05 compared to the other phenotypes). Frequent exacerbator groups (FEE and FECB) were receiving more pharmacological treatment at baseline, and also experienced more exacerbations the year after (all p<0.05) with no differences in one-year mortality. Most of NE (93%) and half of exacerbators were stable after one year. Conclusions: There is an uneven distribution of COPD phenotypes in stable COPD patients, with significant differences in demographics, patient-centered outcomes and health care resources use

Evolution of the use of corticosteroids for the treatment of hospitalised COVID-19 patients in Spain between March and November 2020: SEMI-COVID national registry

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID- 19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7-160) vs. 49.3 (16-109) mg/dL; p < 0.001), ferritin (791 (393-1534) vs. 470 (236- 996) µg/dL; p < 0.001), D dimer (750 (430-1400) vs. 617 (345-1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Evaluación de la diversidad genética y fenotípica retenida en colecciones nucleares de manzano formadas a partir de caracterizaciones agro-morfológicas o moleculares

Various types of data have been used for sampling plant core collections, including morphological, agronomic and ecogeographical traits, and molecular and biochemical markers. However, little is known about the ability of woody perennial core collections to retain the diversity and structure of the whole collection for characters that were not considered in the selection, especially when molecular markers are used. In this study, three core subsets were established for the apple germplasm bank curated at the Public University of Navarre (UPNa, Spain): based upon the diversity found with 10 SSR markers, another based upon the diversity assessed with 12 isozyme loci; and a third based upon morpho-agronomic diversity evaluated by 23 morpho-agronomic traits. Comparisons between these three subsets and to the whole collection were assessed to determine the impact of the data used in the selection on phenotypic and genetic diversity and on their population structure. The three subsets had a similar diversity and they did not differ from the original collection, according to Nei and Shannon-Weaver indices. The allelic/class frequencies were also always maintained in the three subsets. Overall, the kind of data used to constitute a core collection had little influence on the phenotypic and genetic diversity retained, so in the case of apple collections the use of molecular markers is preferable for this task because they allow a rapid and reliable characterization.Las colecciones nucleares de plantas pueden formarse a partir de la información obtenida en caracterizaciones morfológicas, agronómicas o eco-geográficas, así como a partir de caracterizaciones bioquímicas o moleculares. Un aspecto poco estudiado de la formación y validación de colecciones nucleares es la capacidad de éstas para conservar la estructura y diversidad de la colección global en aquellos caracteres que no han sido empleados para formar la colección nuclear. En el presente estudio se determinaron tres colecciones nucleares para el Banco de Germoplasma de Manzano de la Universidad Pública de Navarra: para el primero se emplearon los datos de caracterización de 10 marcadores SSR, la segunda fue formada a partir de la caracterización hecha con 12 loci de isoenzimas, y la tercera se construyó a partir de la información proporcionada por 23 caracteres morfo-agronómicos. Se comparó la estructura y diversidad genotípica y fenotípica de las tres colecciones, entre sí y respecto de la colección original, para determinar el impacto que sobre dicha estructura y diversidad tenía el tipo de dato con que se formó la colección nuclear. Las tres colecciones conservaron una diversidad similar y no difirieron de la original en sus índices de Nei y Shannon-Weaver, y siempre se mantuvieron las frecuencias de las clases alélicas o fenotípicas. En conjunto, el tipo de caracterización empleada en la formación de la colección nuclear tuvo escasa influencia sobre la diversidad retenida, de lo que se concluye que en el manzano los microsatélites son especialmente adecuados para formar dichas colecciones

Regulated deficit irrigation effects on growth, yield, grape quality and individual anthocyanin composition in Vitis vinifera L. cv. 'Tempranillo'

Regulated Deficit Irrigation (RDI) is an irrigation scheduling technique, originally developed for fruit orchards, that has been successfully adapted for winegrape production. The aim of this work is to evaluate the effect of RDI in vegetative growth, yield and harvest quality in 'Tempranillo' vineyards grown under semiarid conditions typical in Mediterranean areas. Two RDI strategies were compared with conventional irrigation practices (CI). CI that consisted in a progressive increase in water deficit as summer progressed, whereas RDI strategies (RDI1 and RDI2) had in common a deficit period just after fruit set and, in RDI2, vines were subjected to an additional stress period shortly after veraison. The experiment was carried out in four consecutive seasons in a commercial vineyard. Water stress at the beginning of berry development resulted in an important reduction of both vegetative growth and berry weight in RDI strategies. No differences in sugar concentration were found between treatments, and RDI berries tended to have lower acidity. The most relevant effect of RDI strategies on grape quality was an increase in anthocyanin and phenolics concentration. In RDI1 berries, this increase was mainly an indirect consequence of smaller berry size. However, in the RDI2 treatment the higher berry anthocyanin concentration reported was not exclusively due to a reduction in berry size. Since harvest quality has been clearly improved by any of the RDI strategies in both years, it can be concluded that RDI constitutes an interesting technique to be applied in 'Tempranillo' vineyards grown in semiarid areas aiming to obtain high quality grape.Irrigation scheduling Leaf water potential Carbon isotopic ratio Berry size

Are precision agriculture tools and methods relevant at the whole vineyard scale ?

International audiencePrecision viticulture (PV) has been mainly applied at the field level, for which the ability of high resolution data to match within-field variability has been already shown. However, the interest of PV for grape growers would be greater if its principles could also apply at a larger scale, as most growers still focus their management on a multi-field scale, not considering each field as an isolated unit. The aim of this study was to analyse whether it is possible and relevant to use PV tools to define meaningful management zones at the whole-vineyard scale. The study was carried out on a 90-ha vineyard made of 27 contiguous fields. The spatial variability of vine vigour, estimated with the Normalized Difference Vegetation Index (NDVI), was analysed at within-field and whole-vineyard scales. The spatial variability of the vigour was significant and spatially organized whatever the considered scale. Besides, vineyard spatial variability was characterised using information on environmental factors (soil apparent conductivity and elevation) and vine response (yield, vigour and grape composition). At both scales, NDVI and measured environmental factors were used to establish a three-level classification, whose agronomic significance was tested comparing the vine response observed for each class. The analysis of high resolution information allowed the definition of classes with agronomic and oenological implications, although there was not a straightforward correspondence between the classes defined and quality. Analysing the variability at the whole-vineyard scale highlighted a trend of spatial variation associated to elevation that was hardly visible at the within-field level

Est-il pertinent d'envisager la télédétection pour orienter le positionnement de capteurs de suivi des plantes ?

International audienceAn experiment was carried out to test the relevance of using satellite images (NDVI) to define locations of plant monitoring systems. The experiment took place over a 200 ha commercial vineyard located in Navarra (Spain). Airborne images of 30 cm. resolution were processed to compute a biomass index (NDVI). Images were segmented in four classes according to the NDVI pixel values. Each of the zones was assigned a linguistic label: low, medium, high, very high. For each of these zones, punctual information related to plant vigour and plant water deficit were collected during the vine growing period. Plant monitoring systems (dendrometer) and soil monitoring systems (C-probe) were positioned according to NDVI zones. Parameters like Daily growth (DG) and maximum daily shrinkage (MDS) were derived from dendrometers for each NDVI zone. Similarly, soil moisture provided by soil sensors were associated to NDVI zones. Finally, harvest quality was measured. Data were analysed on a NDVI zone basis. Results confirmed the relevance of NDVI information to highlight zones of different vigour and yield which corresponded, in our conditions, to zones with different water restriction. Results highlighted the difficulty to use NDVI information as a surrogate for harvest quality. This experiment also pointed out the lack of coherence between NDVI zones and information provided by plant and soil monitoring systems. This weak relation may be explained by problems of high variability due to the choice of the plant or the soil location and difficulty to compare values provided by different sensors at the same time

Oenological significance of vineyard management zones delineated using early grape sampling

International audienceEarly definition of oenologically significant zones within a vineyard is one of the main goals of precision viticulture, as it would allow an increase in profitability through the adaptation of agronomic practices to the specific requirements of each zone, and/or segregation of the harvest into different batches to produce wines with different qualities. The aim of this work was to evaluate whether early grape sampling is a relevant tool for within-vineyard zone definition. The study was carried out in 2010 and 2011 in a 4.2 ha vineyard, where a grid of 60 sampling points was defined. 300-berry samples were picked from each sampling point after veraison and at harvest, post-veraison information being used to define zones within the vineyard after fuzzy k-means analysis and subsequent application of a zoning procedure that took into account membership degree and neighbourhood criteria. Two variations of the zoning procedure were used, standard (StdZ) and top (TopZ) zoning. Each was designed to meet different requirements of wineries; StdZ gave the same oenological relevance to all the zones, and TopZ differentiated the zones producing "top class" grapes, minimizing the within-zone variability in the top-class zone. Grape composition obtained at harvest from the zones delineated post-veraison was compared. Zone delineation using post-veraison data was proved to be oenologically relevant, provided sampling is performed once veraison is completed. The two zoning algorithms designed were shown to be suitable for objective zone delineation according to the goals intended for each

Pertinence de l'estimation du puits pour le zonage intra-parcellaire de la vigne

International audienceSource to sink size ratio, i.e.: the relative abundance of photosynthetically active organs (leaves) with regards to photosynthate demanding organs (mainly bunches), is widely known to be one of the main drivers of grape oenological quality. However, due to the difficulty of remote sink size estimation, Precision Viticulture (PV) has been mainly based on within-field zone delineation using vegetation indices. This approach has given only moderately satisfactory results for discriminating zones with differential quality. The aim of this work was to investigate an approach to delineate within-vineyard quality zones that includes an estimator of sink size in the data-set. The study was carried out during two consecutive seasons on a 4.2 ha gobelet-trained cv. ‘Tempranillo’ vineyard. Zone delineation was performed using Normalized Difference Vegetation Index (NDVI), soil apparent electrical conductivity (ECa) and bunch number (BN) data. These variables were considered separately, in pairs, or the three altogether, using fuzzy k-means cluster analysis for combinations. The zones delineated based on single variables did not allow a sufficient discrimination for grape composition at harvest, NDVI being the only variable that by itself resulted in zones that to some extent differed in grape composition. On the contrary, when two variables were combined, discrimination in terms of grape composition improved remarkably, provided the sink size estimation variable (BN) was included in the combination. Lastly, the combination of the three variables yielded the best discriminating zoning, improving slightly on those provided by NDVI+BN and ECa+BN combinations. Thus, the relevance of including a variable related to sink size (in this case the number of bunches per plant) has been confirmed, which makes its consideration highly advisable for any PV work aiming at zone delineation for grape quality purposes