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Drylands are ecohydrologically-coupled ecosystems whose functioning depends on the interplay between hydrological connectivity between runoff source areas and the capacity of vegetation to retain water fluxes and associated resources. In this study we present a new easily applicable methodology for the ecohydrological characterization of dryland ecosystem functioning grounded in the balance between these two strongly interrelated processes using easily obtainable remote sensing data (e.g. UAV and SENTINEL-2 images), the BalanCR method (Balance between Connectivity and potential Water Retention Capacity). This methodology was first tested on synthetic hillslopes representing different configurations of the patchy and heterogenic distribution of vegetation in drylands. The analysis of these synthetic vegetation spatial patterns involving different vegetation patch densities, sizes, and fractional coverage values showed that BalanCR properly characterizes the expected ecohydrological interactions between potential conditions of runoff connectivity and water retention by plants operating in drylands. In a second step, we applied the BalanCR method on four semiarid hillslopes along an altitudinal aridity gradient covered by Mediterranean alpha steppes at very detailed spatial resolution (0.2 m) and at medium resolution (10 m). The obtained results were validated based on soil moisture data and vegetation greening and clearly recognized the four study sites as functional ecosystems, with very low water resource losses, and a pattern of increasing water redistribution processes as vegetation coverage declines. However, the sensitivity of methodology depends on the resolution of the input data (vegetation map and Digital Elevation Model; DEM), and the expected positive effect of small vegetation structures (vegetation patches smaller than the pixel size) on water redistribution is underestimated. Even in this case, the functionality and connectivity of the analyzed sites is correctly characterized as ecosystems showed similar values of both components for the methodology BalanC (hydrological connectivity component) and BalanR (potential water retention capacity component) than those obtained at very detailed scale, with a similar pattern of water allocation values in response to increased aridity. Thus, the proposed metric represents a promising tool for the proper evaluation of dryland conditions and to incorporate hillslope processes in climate change models, which is one of the main gaps to better understand the drylands response upon ongoing climate change.

Water availability controls the functioning of dryland ecosystems, driving a patchy vegetation distribution, unequal nutrient availability, soil respiration in pulses, and limited productivity. Groundwater-dependent ecosystems (GDEs) are acknowledged to be decoupled from precipitation, since their vegetation relies on groundwater sources. Despite their relevance to enhance productivity in drylands, our understanding of how different components of GDEs interconnect (i.e., soil, vegetation, water) remains limited. We studied the GDE dominated by the deep-rooted phreatophyte Ziziphus lotus, a winter-deciduous shrub adapted to arid conditions along the Mediterranean basin. We aimed to disentangle whether the groundwater connection established by Z. lotus will foster soil biological activity and therefore soil fertility in drylands. We assessed (1) soil and vegetation dynamics over seasons (soil CO 2 efflux and plant activity), (2) the effect of the patchy distribution on soil quality (properties and nutrient availability), and soil biological activity (microbial biomass and mineralization rates) as essential elements of biogeochemical cycles, and (3) the implications for preserving GDEs and their biogeochemical processes under climate change effects. We found that soil and vegetation dynamics respond to water availability. Whereas soil biological activity promptly responded to precipitation events, vegetation functioning relies on less superficial water and responded on different time scales. Soil quality was higher under the vegetation patches, as was soil biological activity. Our findings highlight the importance of groundwater connections and phreatophytic vegetation to increase litter inputs and organic matter into the soils, which in turn enhances soil quality and decomposition processes in drylands. However, biogeochemical processes are jeopardized in GDEs by climate change effects and land degradation due to the dependence of soil activity on: (1) precipitation for activation, and (2) phreatophytic vegetation for substrate accumulation. Therefore, desertification might modify biogeochemical cycles by disrupting key ecosystem processes such as soil microbial activity, organic matter mineralization, and plant productivity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Aim: The aim of this study was to evaluate the association between periodontal parameters related with the periodontal disease severity and the presence and levels of anti-citrullinated protein antibodies (ACPAs) in rheumatoid arthritis (RA) patients., Materials and Methods: This cross-sectional study included 164 RA patients. Socio-demographics and RA disease characteristics, including ELISA-detected ACPA (anti-CCP-2), were recorded. Exposure was assessed by periodontal parameters: plaque index (PI), bleeding on probing (BoP), probing pocket depth, and clinical attachment levels (CAL). Presence and levels of ACPAs (outcome) and exposure variables were compared by both parametric and non-parametric tests and associations were evaluated by adjusted odds ratio (OR)., Results: A significant association was observed between the presence of anti-CCP antibodies and severity of periodontal outcomes such as the mean CAL (OR 1.483, p = 0.036), mean PI (OR 1.029, p = 0.012), and the number of pockets ≥ 5 mm (OR 1.021, p = 0.08). High anti-CCP antibodies levels were associated with mean CAL, mean PI, and number of pockets ≥ 5 mm with an OR of 1.593 (p = 0.043), 1.060 (p <  0.001), and 1.031 (p = 0.031), respectively. Furthermore, a significant increase of 4.45 U/mL in anti-CCP antibodies levels (p = 0.002) in RA patients was found for each pocket ≥ 5 mm after adjusting for age, gender, smoking, time of disease evolution, and RA activity., Conclusions: In RA patients, the severity of periodontal conditions such as mean CAL, mean PI, and the number of pockets ≥ 5 mm were linearly associated with both the presence and levels of anti-CCP antibodies.

Background: A high prevalence of periodontitis has been reported in rheumatoid arthritis (RA) patients, although the strength of this association, its temporal link and the possible relationship between the severity of periodontitis and RA disease activity remain unclear. The objective of this work was to investigate whether periodontitis is associated with RA and whether periodontitis severity is linked to RA disease activity., Methods: This case-control study included 187 patients diagnosed with RA and 157 control patients without inflammatory joint disease. RA disease activity and severity were evaluated by the Disease Activity Score 28, the Simplified Disease Activity Index, the Clinical Disease Activity Index, rheumatoid factor, anti-citrullinated protein antibody titers, the erythrocyte sedimentation rate, C-reactive protein, presence of extra-articular manifestations and type of RA therapy. Exposure severity was assessed by the following periodontal parameters: plaque index, bleeding on probing, probing pocket depth and clinical attachment levels. Sociodemographic variables and comorbidities were evaluated as confounding variables. Outcome and exposure variables were compared by both parametric and nonparametric tests, and possible associations were assessed through regression analysis with a calculation for the adjusted odds ratio (OR)., Results: A significant association was demonstrated between periodontitis and RA with an adjusted OR of 20.57 (95% CI 6.02-70.27, p < 0.001). Compared with controls, all parameters related to periodontal status (plaque index, bleeding on probing, probing pocket depth and clinical attachment levels) were significantly worse in RA patients (p < 0.001). Periodontitis severity was significantly associated with RA disease activity (p < 0.001), showing in an ordinal logistic regression model an association between periodontal severity and disease activity with an adjusted OR of 2.66 (95% CI 1.24-5.74, p = 0.012)., Conclusion: A significant association was demonstrated between periodontitis and RA, independent of other confounders. This association was more evident in patients with pronounced periodontal disease and higher RA disease activity.

Objectives: The natural evolution of undifferentiated connective tissue diseases (UCTD) has not yet been established. The aim of our study was to analyse the clinical outcomes of a cohort of UCTD patients followed in a routine outpatient setting and to establish which clinical, serological or capillaroscopy features are associated with an increased risk of evolution to definite connective tissue disease (CTD)., Methods: Data for this study were collected by a retrospective review of 758 patients referred to our hospital, between 1999 and 2008, with suspected CTD. After selection criteria, 98 patients were considered eligible and their records, laboratory findings and nailfold-capillaroscopy pattern (NCP) were analysed until clinical outcome. Three groups of patient outcomes were established: remission, UCTD, and definite CTD. Logistic regression analysis was performed to study the association of baseline clinical features, including NCP progression during monitoring, with clinical outcomes., Results: After a mean follow-up of 11±3 years, 62% of the patients continued to suffer from UCTD, 24% regressed to a remission state and 14% developed definite CTD. Cytopenias (p=0.030), positivity for antibody specificities (ENA) (p=0.008), anti-Ro (p=0.036) and antiphospholipid antibodies (p=0.032), and the presence of an altered NCP (p=0.026) at baseline proved different between groups and were more frequently encountered in the group that evolved to definite CTD when compared with the others two groups. Specifically, cytopenias (odds ratio -OR- 4.20 [1.30-13.56] p=0.016), the presence of an antinuclear antibody (ANA) titre ≥1/640 (OR 7.00 [1.99-24.66], p=0.002) and anti-centromere positivity (OR 3.77 [1.03-13.79], p=0.045) at baseline and NCP progression (OR 6.63 [1.70-25.87], p=0.007) were associated with the future presence of definite CTD., Conclusions: Most patients with UCTD remain in an undifferentiated state after routine outpatient clinic follow-up. High ANA titres or the presence of cytopenias at baseline, as well as progression of NCP during follow-up, are the leading factors associated with evolution to definite CTD.

The term undifferentiated connective tissue disease (UCTD) is used to describe undiagnosed patients that do not fulfill classification criteria for definite connective tissue disease (Systemic Lupus, Systemic Sclerosis, Sjögren Syndrome, and Dermatomyositis/Polymyositis). It is important to find serological markers as predictors of the evolution or severity of these diseases. The objective of this retrospective study was to investigate if there was a milder subgroup of UCTD with a special clinical profile consisting only in the presence of anti-Ro52 autoantibodies. Immunological and clinical records of 62 patients attending the hospital during 30 months were studied. Results showed a target population formed by mostly women, aged between 40 and 80 years at the moment of the study, with a registered age of onset between 40 and 60 years. Speckled pattern was the most frequent pattern found by indirect immunofluorescence. Given the obtained results and keeping in mind possible limitations because of sample size, isolated positive anti-Ro52 autoantibodies seem to lead to a benign effect in terms of evolution of the disease. As a future objective, the follow-up of these patients should be necessary to investigate new clinical symptoms, serological markers, or development of a definite connective tissue disease over time., Competing Interests: The authors declare that there is no conflict of interests regarding the publication of this paper.

Objective: To compare the prevalence of the main comorbidities in 2 large cohorts of patients with primary Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE), with a focus on cardiovascular (CV) diseases., Methods: This was a cross-sectional multicenter study where the prevalence of more relevant comorbidities in 2 cohorts was compared. Patients under followup from SJOGRENSER (Spanish Rheumatology Society Registry of Primary SS) and RELESSER (Spanish Rheumatology Society Registry of SLE), and who fulfilled the 2002 American-European Consensus Group and 1997 American College of Rheumatology classification criteria, respectively, were included. A binomial logistic regression analysis was carried out to explore potential differences, making general adjustments for age, sex, and disease duration and specific adjustments for each variable, including CV risk factors and treatments, when appropriate., Results: A total of 437 primary SS patients (95% female) and 2,926 SLE patients (89% female) were included. The mean age was 58.6 years (interquartile range [IQR] 50.0-69.9 years) for primary SS patients and 45.1 years (IQR 36.4-56.3 years) for SLE patients (P < 0.001), and disease duration was 10.4 years (IQR 6.0-16.7 years) and 13.0 years (IQR 7.45-19.76 years), respectively (P < 0.001). Smoking, dyslipidemia, and arterial hypertension were associated less frequently with primary SS (odds ratio [OR] 0.36 [95% confidence interval (95% CI) 0.28-0.48], 0.74 [95% CI 0.58-0.94], and 0.50 [95% CI 0.38-0.66], respectively) as were life-threatening CV events (i.e., stroke or myocardial infarction; OR 0.57 [95% CI 0.35-0.92]). Conversely, lymphoma was associated more frequently with primary SS (OR 4.41 [95% CI 1.35-14.43]). The prevalence of severe infection was lower in primary SS than in SLE (10.1% versus 16.9%; OR 0.54 [95% CI 0.39-0.76]; P < 0.001)., Conclusion: Primary SS patients have a consistently less serious CV comorbidity burden and a lower prevalence of severe infection than those with SLE. In contrast, their risk of lymphoma is greater., (© 2016, American College of Rheumatology.)

Purpose: To report a case of central retinal artery occlusion (CRAO) in a patient with biopsy-verified Wegener's granulomatosis (WG) with positive C-ANCA., Methods: A 55-year-old woman presented with a 3-day history of acute painless bilateral loss of vision; she also complained of fever and weight loss. Examination showed a CRAO in the left eye and angiographically documented choroidal ischemia in both eyes., Results: The possibility of systemic vasculitis was not kept in mind until further studies were carried out; methylprednisolone pulse therapy was then started. Renal biopsy disclosed focal and segmental necrotizing vasculitis of the medium-sized arteries, supporting the diagnosis of WG, and cyclophosphamide pulse therapy was administered with gradual improvement, but there was no visual recovery., Conclusion: CRAO as presenting manifestation of WG, in the context of retinal vasculitis, is very uncommon, but we should be aware of WG in the etiology of CRAO. This report shows the difficulty of diagnosing Wegener's granulomatosis; it requires a high index of suspicion, and we should obtain an accurate medical history and repeat serological and histopathological examinations. It emphasizes that inflammation of arteries leads to irreversible retinal infarction, and visual loss may occur.

We report two cases of pseudogout after parathyroidectomy by primary hyperparathyroidism. The pseudogout in each instance developed within 48 hours after parathyroid adenoma resection. Calcium supplement therapy, nonsteroidal anti-inflammatory drugs and colchicine (1 mg/day) suppressed the acute attack. The chondrocalcinosis is often asymptomatic or undiagnosed, for that, preoperative radiological studies of the knees, wrists and pelvis are recommended to screen for chondrocalcinosis. We advocate also, therapy with colchicine (1 mg/day, oral) in the prophylaxis of postoperative pseudogout.

Background: To study the clinical activity of systemic lupus erythematosus (SLE) in recipients of renal transplants (rT) performed by terminal renal failure (TRF) secondary to lupus nephritis., Methods: The clinical evolution of 11 patients with SLE (ARA criteria) and TRF were evaluated with a descriptive character by the modified index of activity SLE-DAI during dialysis periods and post rT as well as in the course prior to disease. A comparative analysis was carried out in a control group of 25 patients with SLE without renal failure., Results: The indexes of activity of the group investigated were higher than those of the control group during the predialysis period, similar in the dialysis period and significantly decreased (p < 0.01) in the post rT. In the group with rT a significant decrease was reported in the indexes of activity in the periods of dialysis (p < 0.05) and post rT (p < 0.01) with respect to the previous period. A significant reduction was observed in the post rT therapeutic options., Conclusions: The clinical activity of systemic lupus erythematosus is reduced in the terminal renal failure in dialysis. The most significant reduction of clinical activity is found after renal transplantation.