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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The study of respiratory infections in patients with cystic fibrosis &#40;CF&#41; is complex due to the multitude of microorganisms involved&#46; In addition to chronic bacterial bronchial infection&#44; patients with CF are predisposed to fungal colonization due to the ability of some fungi to multiply in the lower respiratory tract and the frequent antibiotic cycles they receive for the control of their disease&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> While the clinical relevance of bacteria such as <span class="elsevierStyleItalic">Pseudomonas aeruginosa &#40;P&#46; aeruginosa&#41;</span> and <span class="elsevierStyleItalic">Staphylococcus aureus &#40;S&#46; aureus&#41;</span> in pulmonary decline is clearly established&#44; the role of some fungi is yet to be determined&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the fact that <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; is a very rare human pathogen&#44; it is the second most common filamentous fungus in CF patients after <span class="elsevierStyleItalic">Aspergillus</span> spp&#46; Unlike <span class="elsevierStyleItalic">Aspergillus</span> spp&#46;&#44; its spores are rarely found in the environment and the mechanisms of transmission and chronic colonization are unclear&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> The inhalation of spores has little effect in healthy subjects whose immune system is functioning properly&#46; In contrast&#44; in patients with chronic respiratory diseases&#44; such as bronchiectasis&#44; the fungi are more persistent&#44; due to impaired mucociliary clearance&#44; thick secretions&#44; and their ability to evade the host&#39;s immune system&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although a widely ranging prevalence of colonization by <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; has been described in patients with CF&#44; one reason for the increased detection rate in recent years is improved screening procedures&#46; Few studies have been published on the real prevalence of co-infection by fungi and bacteria in CF&#46; In most cases&#44; fungi are isolated together with bacteria&#44; such as <span class="elsevierStyleItalic">Haemophilus influenzae &#40;H&#46; influenzae&#41;</span> or <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#44; which makes it difficult to determine its real pathogenic impact&#44; although they are known to be associated with a persistent inflammatory airway response&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> To date&#44; few studies have analyzed the clinical impact and possible predisposing factors for colonization by <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in patients with CF&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Due to recent changes in taxonomy&#44; Scedosporium apiospermum complex is now considered a complex formed by 5 different species&#58; <span class="elsevierStyleItalic">Scedosporium apiospermum</span> &#40;<span class="elsevierStyleItalic">S&#46; apiospermum</span>&#41;&#44; <span class="elsevierStyleItalic">Scedosporium boydii</span>&#44; <span class="elsevierStyleItalic">Scedosporium aurantiacum</span>&#44; <span class="elsevierStyleItalic">Scedosporium minutispora</span> and <span class="elsevierStyleItalic">Scedosporium dehoogii</span>&#46; <span class="elsevierStyleItalic">Scedosporium prolificans</span>&#44; however&#44; is genetically different from other species of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;&#44; as recently demonstrated by Lackner et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> For this reason&#44; it is considered a distinct genus and has been reassigned to the genus Lomentospora&#44; and is now called Lomentospora prolificans&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The objective of this study was to analyze the frequency of isolates of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; and their predisposing factors in a cohort of patients with a diagnosis of CF monitored in an adult unit&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We collected all <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; isolated from respiratory secretions of patients treated in the Adult CF Unit of the Hospital Universitario de La Princesa&#44; Madrid &#40;Spain&#41; over the 5-year period between January 2012 and July 2017&#46; This department provides healthcare to a total of 87 patients&#44; and detailed charts are available for each case&#46; Check-ups were monthly or quarterly&#44; depending on severity&#44; and patients also attended in case of clinical exacerbation&#46; Their general status&#44; lung function&#44; antibiotic therapeutic control&#44; and microbiological findings obtained in respiratory samples were evaluated at each visit&#46; Patients were classified according to whether <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; had been previously isolated or not&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Sputum samples were collected at each patient visit&#46; Given the viscosity of the samples&#44; the usual microbiological processing involved prior homogenization with acetylcysteine&#46; Quantitative inoculation was performed to obtain a count of the different pathogens and facilitate the recognition of the different bacterial morphotypes&#46; Selective media used were Mannitol Salt&#44; MacConkey&#44; and Burkholderia cepacia Selective Agar&#46; In addition&#44; chocolate agar with bacitracin&#44; Saboureaud agar&#44; and blood agar were inoculated as a general medium for the total count of the respiratory microflora&#46; The incubation period was 5 days&#46; Filamentous fungi isolated were identified by macroscopic&#47;microscopic structural analysis and confirmed with MALDI-TOF &#40;Bruker-Daltonics&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We analyzed the first isolate of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; from each patient&#44; and presence or absence in successive cultures&#46; Two groups were defined according to the microbiological results&#58; patients who had at least one positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in respiratory secretions during the entire study period&#44; and those in whom <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was never isolated&#46; The definition of bronchial fungal infection is not clearly established&#46; However&#44; although there is no consensus definition&#44; a bronchial infection was defined as isolation from at least 3 separate cultures at intervals of at least 1 month over a period of 6 months&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">To assess pulmonary function&#44; we studied forced expiratory volume in 1 second &#40;FEV1&#41; and FEV1&#37;&#44; coinciding with the first isolation of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; We also evaluated respiratory exacerbations &#40;RE&#41;&#44; defined as increased baseline symptoms requiring additional antibiotics&#59; REs were considered mild-moderate when oral &#40;vo&#41; antibiotic treatment was required&#44; and severe if intravenous &#40;iv&#41; antibiotics were needed&#46; Data on cycles of oral or intravenous antibiotic therapy in the year before &#40;retrospectively&#41; and after the first isolation of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; were collected&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The following clinical variables were collected simultaneously&#58; gender of participants&#44; age&#44; body mass index &#40;BMI&#41;&#59; genotype&#44; according to information from the genetic study&#44; classified into three groups&#58; homozygous F508del&#44; heterozygous F508del&#44; and other mutations&#59; existence of pancreatic insufficiency&#44; defined as need for pancreatic enzymes with lower levels of fecal elastase &#40;&#60;200<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g&#41;&#59; CF-related diabetes &#40;CFRD&#41; with fasting hyperglycemia&#58; fasting blood glucose levels greater than 126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and above 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl at 2<span class="elsevierStyleHsp" style=""></span>h&#59; allergic bronchopulmonary aspergillosis &#40;ABPA&#41;&#59; and chronic bacterial infection&#44; defined according to the Leeds criteria&#58; isolation of bacteria in more than 50&#37; of samples cultured in the previous 12 months&#44; classifying patients as single isolation or chronic infection&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> The modified Bhalla score was calculated from the high resolution axial computed tomography &#40;HRCT&#41; performed closest to the last isolation&#46; This system is used to assess the degree of pulmonary involvement and the course of the lung damage caused by the disease&#44; depending on various radiological findings&#46; The overall score is obtained by subtracting points from a maximum score of 25&#44; which would be the best possible radiological situation&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">7</span></a> The presence of severe hemoptysis was recorded&#44; defined as greater than 400<span class="elsevierStyleHsp" style=""></span>ml&#47;day or 150<span class="elsevierStyleHsp" style=""></span>ml&#47;h&#44; regardless of whether it was treated conservatively or if bronchoscopy or embolization was required&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Chronic treatment was also evaluated&#44; defined as treatment administered to the patient for a period &#8805;3 months&#44; including&#58; macrolides&#44; aerosol antibiotics &#40;colistin&#44; tobramycin&#44; aztreonam&#44; or other&#41;&#44; oral corticosteroids&#44; inhaled corticosteroids&#44; ibuprofen&#44; oral antibiotic&#44; aerosol with DNase&#44; 0&#46;9&#37; hypertonic and physiological saline solution&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The results were analyzed using the IBM SPSS Statistics package version 22&#46;0&#46; Quantitative variables were analyzed descriptively by calculating means and standard deviations&#44; and qualitative variables were described by frequencies and percentages&#46; Student&#39;s t and Mann&#8211;Whitney-<span class="elsevierStyleItalic">U</span> tests were used to compare continuous variables&#44; according to normality&#46; The Chi-squared test was used to compare categorical variables&#46; The effect of the dependent variable was evaluated using the odds ratio &#40;OR&#41; and its confidence interval&#44; adjusting for the different covariates with a conditional logistic regression model&#46; A <span class="elsevierStyleItalic">p</span>-value of &#8804;0&#46;05 was considered statistically significant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">During the 5-year study period&#44; at least 1 positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was obtained from 22 of the 87 patients seen in the CF unit&#46; <span class="elsevierStyleItalic">Lomentospora prolificans</span> was isolated in 5 patients&#44; <span class="elsevierStyleItalic">Scedosporium apiospermum complex</span> in 12&#44; and both were isolated in 5 patients&#46; With regard to isolates per patient&#44; the mean number of positive cultures in each patient was 10&#46;7&#177;16&#46;3&#46; <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was isolated only once in 4 patients&#44; while in the remaining 18 it was isolated on more than 2 occasions&#46; Specifically&#44; 7 patients presented chronic bronchial infection due to <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;&#44; which was subsequently isolated during a period of between 6 months and the present&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">With regard to the clinical characteristics of patients included in the study&#44; the average age was 26&#46;14 years&#44; ranging between 18&#46;5 and 34 years of age &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The genotype of the most prevalent mutation was heterozygous F508&#46; There were no statistically significant differences according to sex or lung function in the 2 groups of patients with and without <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;&#44; although patients with positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; showed a slight decrease in lung diffusing capacity &#40;DLCO&#41; &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;043&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Most patients in our series were receiving chronic treatment &#40;93&#46;1&#37;&#41;&#44; and statistically significant differences were observed only in the use of inhaled antibiotics &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;033&#41;&#46; The inhaled antibiotic most frequently prescribed in patients with <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was inhaled colistin &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">With regard to prognostic factors&#44; the overall Bhalla score was worse in patients in whom <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was isolated&#44; with statistically significant results &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;047&#41;&#46; In the bivariate analysis&#44; the Bhalla items were significant for&#58; extension of bronchiectasis&#44; extension of bronchial mucous plugs and generations affected by bronchiectasis &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">All patients with positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; presented concomitant colonization by other microorganisms&#44; while 56 &#40;86&#46;15&#37;&#41; patients in whom <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was not isolated were co-infected by another pathogen&#46; Our results showed a significantly higher rate of chronic P&#46; aeruginosa colonization in patients with a positive culture compared to those without &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;006&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">With regard to treatment&#44; only 3 of 22 patients were treated for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;&#44; with an average treatment duration of 16&#46;5 months&#44; ranging between 3 and 30 months&#46; The prescribed treatment in the 3 cases was voriconazole&#44; voriconazole&#43;terbinafine&#44; or itraconazole&#43;terbinafine&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Risk factors that were statistically significant &#40;<span class="elsevierStyleItalic">p</span>&#8804;0&#46;05&#41; after the bivariate analysis were included in the multivariate analysis&#44; as follows&#58; <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#44; DLCO&#37;&#44; overall Bhalla score&#44; bronchial generations affected by bronchiectasis&#44; extension of bronchiectasis&#44; and extension of mucous plugs&#46; After the multivariate analysis&#44; only bronchial generations affected by bronchiectasis showed statistical significance &#40;OR&#58; 3&#46;315&#59; 95&#37; CI&#58; 1&#46;317&#8211;8&#46;344&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;011&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">This is one of the few studies to assess the prevalence of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in a series of CF patients and analyze the possible risk factors&#46; It highlights the high prevalence of this fungus&#44; and its association with <span class="elsevierStyleItalic">P&#46; aeruginosa</span> and greater structural and functional gas exchange damage&#46; We cannot conclude whether these findings are a result of the fungus or if they are a consequence of the disease course&#44; which makes this fungus appear more frequently in this type of patient&#46; Notwithstanding&#44; we observed that the prevalence of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; may increase in patients with involvement of a greater number of bronchial generations&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">CF patients have a high predisposition for colonization-chronic bronchopulmonary infection&#44; the main cause of high morbidity and early mortality of these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> While the clinical relevance of bacteria&#44; such as <span class="elsevierStyleItalic">P&#46; aeruginosa</span> and <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; in pulmonary impairment is clearly established&#44; the role of some filamentous fungi &#40;with the exception of <span class="elsevierStyleItalic">A&#46; fumigatus</span>&#41; is yet to be determined&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> In our study&#44; patients in whom <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was isolated had a worse Bhalla score&#44; especially with regard to mucous plugs&#44; which might explain why DLCO decline was greater than FEV1 decline&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Recently&#44; Schwarz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> conducted a review of the epidemiology of fungi in CF patients in different European countries&#46; They detected significant geographical differences and emphasized the need for more local studies&#46; In the Netherlands&#44; Engel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a> reported that <span class="elsevierStyleItalic">Aspergillus</span> spp&#46; is the most common filamentous fungus&#46; These data are consistent with ours&#44; which showed a rate of <span class="elsevierStyleItalic">Aspergillus</span> spp&#46; isolation of 45&#46;9&#37; &#40;data not shown&#41;&#46; The overall prevalence of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; has been estimated at over 14&#37;&#44; but prevalence in our study was 25&#46;3&#37;&#44; making it the second most common filamentous fungi in the airways of CF patients&#44; after <span class="elsevierStyleItalic">A&#46; fumigatus</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> In German cohorts&#44; the estimated prevalence was between 3&#46;1&#37; is<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> and 5&#46;3&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> In France&#44; it was 8&#46;6&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> and in Australia it ranged from 17&#46;4&#37; to 25&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">14&#44;15</span></a> This fungus is generally ubiquitous in contaminated water and soil&#44; which is why young patients have an increased risk of colonization as they tend to spend more time outdoors&#44; making it easier for them to become infected&#46; While the mechanisms of transmission and colonization are unclear&#44; a greater geographic and climatic predisposition is emerging&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleItalic">Lomentospora prolificans</span>&#44; specifically predominates in Australia&#44; the United States&#44; and Spain&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Another factor that may influence their heterogeneous prevalence is the lack of standardized testing procedures and the fact that other filamentous fungi like <span class="elsevierStyleItalic">A&#46; fumigatus</span> grow more rapidly than <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in non-selective media&#46; The recent introduction of semiselective culture media that inhibit the rapid growth of <span class="elsevierStyleItalic">A&#46; fumigatus</span> has allowed colonies that grow more slowly to be detected&#46; Molecular techniques such as loop-mediated isothermal amplification &#40;LAMP&#41; reverse hybridization can be powerful alternatives to culture media&#44; increasing the rate of detection in sputum samples&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> Both fungi can be grown in this manner&#44; and <span class="elsevierStyleItalic">Aspergillus</span> spp&#46; was also isolated in 9 of the 22 patients with <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In our series&#44; P&#46; aeruginosa colonization is more frequent in patients with positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; These results are consistent with the data of Schwarz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> who considered <span class="elsevierStyleItalic">P&#46; aeruginosa</span> colonization as a probable risk factor for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; isolation&#46; According to Schwarz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleItalic">H&#46; influenzae</span> rates were lower in our cohort in patients with a positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In this series&#44; we found a statistically significant relationship between exacerbations and <span class="elsevierStyleItalic">H&#46; influenzae</span> colonization&#46; This pathogen has the capacity to produce a biofilm that helps it persist in the respiratory system&#46; It is suggested that the lower rates of <span class="elsevierStyleItalic">H&#46; influenzae</span> in patients with CF and positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; are associated with repeated antibiotic treatment&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Treating <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; is a challenge because <span class="elsevierStyleItalic">in vitro</span> studies show high resistance or low sensitivity to most available antifungal treatments&#46; The first cases of colonization by <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; were detected after <span class="elsevierStyleItalic">A&#46; fumigatus</span> was eradicated with itraconazole&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> At the start of treatment&#44; it is vital to recognize the species of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;&#44; as different strains have shown different susceptibilities <span class="elsevierStyleItalic">in vitro</span>&#46; Therefore&#44; the logical approach is to start treatment with 2 or even 3 anti-fungal agents&#44; to achieve better therapeutic response and also to prevent the development of resistance&#46; Voriconazole has shown the best sensitivity <span class="elsevierStyleItalic">in vitro</span> in the treatment of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;&#44; and this is the drug we used to treat most of our patients&#46; However&#44; recent treatment guidelines from the Royal Brompton Hospital &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> discourage the use of voriconazole due to its side effects&#44; high photosensitivity despite the use of sunscreen&#44; and risk of liver toxicity&#46; For this reason&#44; the better tolerated posaconazole is currently recommended in <span class="elsevierStyleItalic">Scedosporium apiospermum complex</span> infection&#46; As <span class="elsevierStyleItalic">Lomentospora prolificans</span> is highly resistant to all anti-fungal agents&#44; the combination of posaconazole and terbinafine is recommended&#46; With regard to aerosol therapy&#44; Sole et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a> have recently reported 3 cases of transplanted patients with invasive disease due to <span class="elsevierStyleItalic">S&#46; apiospermum</span> who received nebulized posaconazole in compassionate use&#46; In their experience&#44; nebulized posaconazole was effective and showed a similar tolerance to other nebulized antifungals&#46; The authors also consider it an alternative therapeutic option if progress with conventional treatment is inadequate&#44; or if the infection is caused by highly resistant fungi&#46; Treatment duration after starting has not been established&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The question of whether colonization of the respiratory tract by <span class="elsevierStyleItalic">Lomentospora prolificans</span> in CF patients is a contraindication for lung transplantation is still under discussion&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> It has been shown that colonized patients have a worse prognosis after transplantation&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> It has also been reported to cause invasive disease in immunocompromised lung transplant recipients&#46; The time for determining invasive fungal infection is 12 months after transplantation&#46; A 3&#46;5&#37; rate of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; infection after lung transplantation has been described in 1 study&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The main limitations of our study were that all patients were recruited from a single center and the number of patients included was low&#44; so multicenter studies would be required to determine the real prevalence of this fungus&#44; and to clarify some issues&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">We conclude that <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; is an emergent fungus in CF patients&#44; raising many questions regarding its clinical implications&#44; risk factors&#44; and need for treatment&#44; which will have to be answered by more studies&#46; For now&#44; we recommend that these patients are closely monitored&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of Interests</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests&#46;</p></span></span>"
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          "identificador" => "xpalclavsec1168179"
          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and Methods"
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          "titulo" => "Conflict of Interests"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2018-09-24"
    "fechaAceptado" => "2019-02-14"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1168180"
          "palabras" => array:4 [
            0 => "<span class="elsevierStyleItalic">Scedosporium</span> spp&#46;"
            1 => "<span class="elsevierStyleItalic">Lomentospora</span> spp&#46;"
            2 => "Infection"
            3 => "Cystic fibrosis"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1168179"
          "palabras" => array:4 [
            0 => "<span class="elsevierStyleItalic">Scedosporium</span> spp&#46;"
            1 => "<span class="elsevierStyleItalic">Lomentospora</span> spp&#46;"
            2 => "Infecci&#243;n"
            3 => "Fibrosis qu&#237;stica"
          ]
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      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In recent years an increase in the prevalence of colonization and infection by <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in patients with cystic fibrosis &#40;CF&#41; has been observed&#46; In this article&#44; we study the frequency of isolation of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in an adult CF Unit&#44; analyzing characteristics of the patients and predisposing factors&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective observational study was conducted in 87 adult CF patients in whom the presence of positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was tested for a 5-year period &#40;January 2012&#8211;July 2017&#41;&#46; We recorded the following clinical variables&#58; age&#44; sex&#44; body mass index&#44; genotype&#44; presence of pancreatic insufficiency&#44; bacterial colonization&#44; lung function&#44; other complications&#44; exacerbations and treatment&#44; and the modified Bhalla score from the last high-resolution computed tomography&#46; Results were analyzed with IBM SPSS Statistics Version 22&#46;0 software&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was isolated in 25&#46;3&#37; of patients&#46; In the bivariate analysis&#44; these patients showed a higher rate of <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> infection&#44; worse score in the Bhalla classification &#40;highlighting the following items&#58; bronchiectasis&#44; mucus plugs and bronchial generations&#41;&#44; a slight decrease in the lung diffusion capacity and more frequently received inhaled antibiotics&#46; In the logistic regression multivariate analysis&#44; only the bronchial generations item was significant&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Scedosporium</span> spp&#46; must be considered an emerging opportunistic pathogen in patients with CF whose clinical involvement&#44; risk factors or need for treatment is unknown&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En los &#250;ltimos a&#241;os se observa un aumento de la prevalencia de colonizaci&#243;n e infecci&#243;n por <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; en pacientes con fibrosis qu&#237;stica &#40;FQ&#41;&#46; En el presente estudio se registra la frecuencia de aislamiento de <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; en una Unidad de FQ de adultos&#44; analiz&#225;ndose las caracter&#237;sticas de los pacientes y los factores predisponentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio observacional retrospectivo en 87 pacientes adultos con FQ en los que se valor&#243; la presencia de cultivo positivo para <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; durante 5 a&#241;os &#40;enero de 2012-julio de 2017&#41;&#46; Se recogieron las siguientes variables cl&#237;nicas&#58; edad&#44; sexo&#44; &#237;ndice de masa corporal&#44; genotipo&#44; presencia de insuficiencia pancre&#225;tica&#44; colonizaciones bacterianas&#44; funci&#243;n pulmonar&#44; complicaciones&#44; exacerbaciones y tratamiento&#44; as&#237; como puntuaci&#243;n Bhalla modificada de la &#250;ltima tomograf&#237;a computarizada axial de alta resoluci&#243;n&#46; Los resultados se analizaron con el paquete estad&#237;stico IBM SPSS Statistics Version 22&#46;0&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En un 25&#44;3&#37; de los pacientes se aisl&#243; <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; En el an&#225;lisis bivariante se observ&#243; en estos enfermos m&#225;s frecuencia de <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; peor puntuaci&#243;n en la clasificaci&#243;n de Bhalla &#40;destacando los &#237;tems presencia de bronquiectasias&#44; tapones mucosos y generaciones bronquiales&#41;&#44; un descenso leve en la capacidad de difusi&#243;n pulmonar &#40;DLCO&#41; y que recib&#237;an con m&#225;s frecuencia antibioterapia inhalada&#46; En el an&#225;lisis multivariante de regresi&#243;n log&#237;stica &#250;nicamente el &#237;tem generaciones bronquiales fue significativo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Scedosporium</span> spp&#46; debe considerarse un pat&#243;geno oportunista emergente en pacientes con FQ del que se desconoce su implicaci&#243;n cl&#237;nica&#44; factores de riesgo o necesidad de tratamiento&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Erro Iribarren M&#44; Gir&#243;n Moreno RM&#44; Diab C&#225;ceres L&#44; Pastor Sanz MT&#44; Buend&#237;a Moreno B&#44; Alarc&#243;n Cavero T&#44; et al&#46; Estudio de una cohorte de paciente con fibrosis qu&#237;stica y Scedosporium spp&#46; Arch Bronconeumol&#46; 2019&#59;55&#58;559&#8211;564&#46;</p>"
      ]
    ]
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Co-infection with other pathogens in patients with and without <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; isolates&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ABPA&#58; Allergic bronchopulmonary aspergillosis&#59; BMI&#44; body mass index&#59; CFRD&#58; CF-related diabetes&#59; DLCO&#58; diffusing capacity of the lung&#59; FEV1&#58; forced expiratory volume in 1 second&#59; FVC&#58; forced vital capacity&#59; iv&#58; intravenous&#59; <span class="elsevierStyleItalic">n</span>&#58; number&#59; RE&#58; respiratory exacerbations&#59; SD&#58; standard deviation&#59; vo&#58; oral&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Mean&#177;SD&#47;<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;<span class="elsevierStyleItalic">n</span>&#61;87&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;<span class="elsevierStyleItalic">n</span>&#61;65&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Yes &#40;<span class="elsevierStyleItalic">n</span>&#61;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">46 &#40;52&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;56&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9 &#40;40&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;193&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Women&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">41 &#40;47&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;43&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">13 &#40;59&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">26&#46;14&#177;7&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">25&#46;5&#177;7&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">27&#46;86&#177;7&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">22&#46;10&#177;2&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">22&#46;14&#177;3&#46;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">21&#46;98&#177;2&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;825&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mutation</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Homozygous F508&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23 &#40;26&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">17 &#40;26&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aztreonam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;6&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;7&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; <span class="elsevierStyleItalic">n</span>&#58; number&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Mean&#177;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in Culture</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;<span class="elsevierStyleItalic">n</span>&#61;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Yes &#40;<span class="elsevierStyleItalic">n</span>&#61;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Overall Bhalla score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;48&#177;4&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;37&#177;2&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severity bronchiectasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;02&#177;1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;89&#177;0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;450&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peribronchial thickening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;18&#177;0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;16&#177;0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;947&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extension bronchiectasis &#40;n&#46; segments&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;45&#177;1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;00&#177;0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extension mucous plugs &#40;n&#46; segments&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;86&#177;0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;32&#177;0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sacculations or abscesses &#40;n&#46; segments&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&#177;0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;16&#177;0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;694&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Generations of bronchial divisions involved &#40;bronchiectasis&#47;plugs&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;77&#177;0&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;42&#177;0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of bullae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;20&#177;0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;16&#177;0&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;952&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emphysema &#40;n&#46; segments&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&#177;0&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;11&#177;0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atelectasias&#47;consolidations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;32&#177;0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47&#177;0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Independent Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI for OR</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lower&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">P&#46; aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Generations of bronchial divisions involved&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Consenso espa&#241;ol para la prevenci&#243;n y el tratamiento de la infecci&#243;n bronquial por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> en el paciente con fibrosis qu&#237;stica"
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                  "referenciaCompleta" => "Engel TGP&#44; Slabbers L&#44; de Jong C&#44; Melchers WJG&#44; Hagen F&#44; Verweij PE&#44; et al&#46; Prevalence and diversity of filamentous fungi in the airways of cystic fibrosis patients A Dutch&#44; multicentre study&#46; J Cystic Fibrosis&#46; <a target="_blank" href="doi:10.1016/j.jcf.2018.11.012">doi&#58;10&#46;1016&#47;j&#46;jcf&#46;2018&#46;11&#46;012</a>&#46;"
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Original Article
Study of a Cohort of Patients With Cystic Fibrosis and Isolation of Scedosporium spp.
Estudio de una cohorte de paciente con fibrosis quística y Scedosporium spp.
Marta Erro Iribarrena,b,
Corresponding author
martaerro@gmail.com

Corresponding author.
, Rosa María Girón Morenoa,b, Layla Diab Cáceresa,b, María Teresa Pastor Sanza,b, Buenaventura Buendía Morenob,c, Teresa Alarcón Caverob,c, Silvia Granja Torrecillasb,c, Nelly Daniela Zurita Cruzb,c, Julio Ancochea Bermúdeza,b
a Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, Spain
b Instituto de Investigación Sanitaria de la Princesa, Madrid, Spain
c Servicio de Microbiología y Parasitología, Hospital Universitario de la Princesa, Madrid, Spain
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was never isolated&#46; The definition of bronchial fungal infection is not clearly established&#46; However&#44; although there is no consensus definition&#44; a bronchial infection was defined as isolation from at least 3 separate cultures at intervals of at least 1 month over a period of 6 months&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">To assess pulmonary function&#44; we studied forced expiratory volume in 1 second &#40;FEV1&#41; and FEV1&#37;&#44; coinciding with the first isolation of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; We also evaluated respiratory exacerbations &#40;RE&#41;&#44; defined as increased baseline symptoms requiring additional antibiotics&#59; REs were considered mild-moderate when oral &#40;vo&#41; antibiotic treatment was required&#44; and severe if intravenous &#40;iv&#41; antibiotics were needed&#46; Data on cycles of oral or intravenous antibiotic therapy in the year before &#40;retrospectively&#41; and after the first isolation of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; were collected&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The following clinical variables were collected simultaneously&#58; gender of participants&#44; age&#44; body mass index &#40;BMI&#41;&#59; genotype&#44; according to information from the genetic study&#44; classified into three groups&#58; homozygous F508del&#44; heterozygous F508del&#44; and other mutations&#59; existence of pancreatic insufficiency&#44; defined as need for pancreatic enzymes with lower levels of fecal elastase &#40;&#60;200<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g&#41;&#59; CF-related diabetes &#40;CFRD&#41; with fasting hyperglycemia&#58; fasting blood glucose levels greater than 126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and above 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl at 2<span class="elsevierStyleHsp" style=""></span>h&#59; allergic bronchopulmonary aspergillosis &#40;ABPA&#41;&#59; and chronic bacterial infection&#44; defined according to the Leeds criteria&#58; isolation of bacteria in more than 50&#37; of samples cultured in the previous 12 months&#44; classifying patients as single isolation or chronic infection&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> The modified Bhalla score was calculated from the high resolution axial computed tomography &#40;HRCT&#41; performed closest to the last isolation&#46; This system is used to assess the degree of pulmonary involvement and the course of the lung damage caused by the disease&#44; depending on various radiological findings&#46; The overall score is obtained by subtracting points from a maximum score of 25&#44; which would be the best possible radiological situation&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">7</span></a> The presence of severe hemoptysis was recorded&#44; defined as greater than 400<span class="elsevierStyleHsp" style=""></span>ml&#47;day or 150<span class="elsevierStyleHsp" style=""></span>ml&#47;h&#44; regardless of whether it was treated conservatively or if bronchoscopy or embolization was required&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Chronic treatment was also evaluated&#44; defined as treatment administered to the patient for a period &#8805;3 months&#44; including&#58; macrolides&#44; aerosol antibiotics &#40;colistin&#44; tobramycin&#44; aztreonam&#44; or other&#41;&#44; oral corticosteroids&#44; inhaled corticosteroids&#44; ibuprofen&#44; oral antibiotic&#44; aerosol with DNase&#44; 0&#46;9&#37; hypertonic and physiological saline solution&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The results were analyzed using the IBM SPSS Statistics package version 22&#46;0&#46; Quantitative variables were analyzed descriptively by calculating means and standard deviations&#44; and qualitative variables were described by frequencies and percentages&#46; Student&#39;s t and Mann&#8211;Whitney-<span class="elsevierStyleItalic">U</span> tests were used to compare continuous variables&#44; according to normality&#46; The Chi-squared test was used to compare categorical variables&#46; The effect of the dependent variable was evaluated using the odds ratio &#40;OR&#41; and its confidence interval&#44; adjusting for the different covariates with a conditional logistic regression model&#46; A <span class="elsevierStyleItalic">p</span>-value of &#8804;0&#46;05 was considered statistically significant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">During the 5-year study period&#44; at least 1 positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was obtained from 22 of the 87 patients seen in the CF unit&#46; <span class="elsevierStyleItalic">Lomentospora prolificans</span> was isolated in 5 patients&#44; <span class="elsevierStyleItalic">Scedosporium apiospermum complex</span> in 12&#44; and both were isolated in 5 patients&#46; With regard to isolates per patient&#44; the mean number of positive cultures in each patient was 10&#46;7&#177;16&#46;3&#46; <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was isolated only once in 4 patients&#44; while in the remaining 18 it was isolated on more than 2 occasions&#46; Specifically&#44; 7 patients presented chronic bronchial infection due to <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;&#44; which was subsequently isolated during a period of between 6 months and the present&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">With regard to the clinical characteristics of patients included in the study&#44; the average age was 26&#46;14 years&#44; ranging between 18&#46;5 and 34 years of age &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The genotype of the most prevalent mutation was heterozygous F508&#46; There were no statistically significant differences according to sex or lung function in the 2 groups of patients with and without <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;&#44; although patients with positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; showed a slight decrease in lung diffusing capacity &#40;DLCO&#41; &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;043&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Most patients in our series were receiving chronic treatment &#40;93&#46;1&#37;&#41;&#44; and statistically significant differences were observed only in the use of inhaled antibiotics &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;033&#41;&#46; The inhaled antibiotic most frequently prescribed in patients with <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was inhaled colistin &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">With regard to prognostic factors&#44; the overall Bhalla score was worse in patients in whom <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was isolated&#44; with statistically significant results &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;047&#41;&#46; In the bivariate analysis&#44; the Bhalla items were significant for&#58; extension of bronchiectasis&#44; extension of bronchial mucous plugs and generations affected by bronchiectasis &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">All patients with positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; presented concomitant colonization by other microorganisms&#44; while 56 &#40;86&#46;15&#37;&#41; patients in whom <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was not isolated were co-infected by another pathogen&#46; Our results showed a significantly higher rate of chronic P&#46; aeruginosa colonization in patients with a positive culture compared to those without &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;006&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">With regard to treatment&#44; only 3 of 22 patients were treated for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;&#44; with an average treatment duration of 16&#46;5 months&#44; ranging between 3 and 30 months&#46; The prescribed treatment in the 3 cases was voriconazole&#44; voriconazole&#43;terbinafine&#44; or itraconazole&#43;terbinafine&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Risk factors that were statistically significant &#40;<span class="elsevierStyleItalic">p</span>&#8804;0&#46;05&#41; after the bivariate analysis were included in the multivariate analysis&#44; as follows&#58; <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#44; DLCO&#37;&#44; overall Bhalla score&#44; bronchial generations affected by bronchiectasis&#44; extension of bronchiectasis&#44; and extension of mucous plugs&#46; After the multivariate analysis&#44; only bronchial generations affected by bronchiectasis showed statistical significance &#40;OR&#58; 3&#46;315&#59; 95&#37; CI&#58; 1&#46;317&#8211;8&#46;344&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;011&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">This is one of the few studies to assess the prevalence of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in a series of CF patients and analyze the possible risk factors&#46; It highlights the high prevalence of this fungus&#44; and its association with <span class="elsevierStyleItalic">P&#46; aeruginosa</span> and greater structural and functional gas exchange damage&#46; We cannot conclude whether these findings are a result of the fungus or if they are a consequence of the disease course&#44; which makes this fungus appear more frequently in this type of patient&#46; Notwithstanding&#44; we observed that the prevalence of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; may increase in patients with involvement of a greater number of bronchial generations&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">CF patients have a high predisposition for colonization-chronic bronchopulmonary infection&#44; the main cause of high morbidity and early mortality of these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> While the clinical relevance of bacteria&#44; such as <span class="elsevierStyleItalic">P&#46; aeruginosa</span> and <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; in pulmonary impairment is clearly established&#44; the role of some filamentous fungi &#40;with the exception of <span class="elsevierStyleItalic">A&#46; fumigatus</span>&#41; is yet to be determined&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> In our study&#44; patients in whom <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was isolated had a worse Bhalla score&#44; especially with regard to mucous plugs&#44; which might explain why DLCO decline was greater than FEV1 decline&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Recently&#44; Schwarz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> conducted a review of the epidemiology of fungi in CF patients in different European countries&#46; They detected significant geographical differences and emphasized the need for more local studies&#46; In the Netherlands&#44; Engel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a> reported that <span class="elsevierStyleItalic">Aspergillus</span> spp&#46; is the most common filamentous fungus&#46; These data are consistent with ours&#44; which showed a rate of <span class="elsevierStyleItalic">Aspergillus</span> spp&#46; isolation of 45&#46;9&#37; &#40;data not shown&#41;&#46; The overall prevalence of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; has been estimated at over 14&#37;&#44; but prevalence in our study was 25&#46;3&#37;&#44; making it the second most common filamentous fungi in the airways of CF patients&#44; after <span class="elsevierStyleItalic">A&#46; fumigatus</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> In German cohorts&#44; the estimated prevalence was between 3&#46;1&#37; is<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> and 5&#46;3&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> In France&#44; it was 8&#46;6&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> and in Australia it ranged from 17&#46;4&#37; to 25&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">14&#44;15</span></a> This fungus is generally ubiquitous in contaminated water and soil&#44; which is why young patients have an increased risk of colonization as they tend to spend more time outdoors&#44; making it easier for them to become infected&#46; While the mechanisms of transmission and colonization are unclear&#44; a greater geographic and climatic predisposition is emerging&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleItalic">Lomentospora prolificans</span>&#44; specifically predominates in Australia&#44; the United States&#44; and Spain&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Another factor that may influence their heterogeneous prevalence is the lack of standardized testing procedures and the fact that other filamentous fungi like <span class="elsevierStyleItalic">A&#46; fumigatus</span> grow more rapidly than <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in non-selective media&#46; The recent introduction of semiselective culture media that inhibit the rapid growth of <span class="elsevierStyleItalic">A&#46; fumigatus</span> has allowed colonies that grow more slowly to be detected&#46; Molecular techniques such as loop-mediated isothermal amplification &#40;LAMP&#41; reverse hybridization can be powerful alternatives to culture media&#44; increasing the rate of detection in sputum samples&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> Both fungi can be grown in this manner&#44; and <span class="elsevierStyleItalic">Aspergillus</span> spp&#46; was also isolated in 9 of the 22 patients with <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In our series&#44; P&#46; aeruginosa colonization is more frequent in patients with positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; These results are consistent with the data of Schwarz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> who considered <span class="elsevierStyleItalic">P&#46; aeruginosa</span> colonization as a probable risk factor for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; isolation&#46; According to Schwarz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleItalic">H&#46; influenzae</span> rates were lower in our cohort in patients with a positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In this series&#44; we found a statistically significant relationship between exacerbations and <span class="elsevierStyleItalic">H&#46; influenzae</span> colonization&#46; This pathogen has the capacity to produce a biofilm that helps it persist in the respiratory system&#46; It is suggested that the lower rates of <span class="elsevierStyleItalic">H&#46; influenzae</span> in patients with CF and positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; are associated with repeated antibiotic treatment&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Treating <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; is a challenge because <span class="elsevierStyleItalic">in vitro</span> studies show high resistance or low sensitivity to most available antifungal treatments&#46; The first cases of colonization by <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; were detected after <span class="elsevierStyleItalic">A&#46; fumigatus</span> was eradicated with itraconazole&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> At the start of treatment&#44; it is vital to recognize the species of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;&#44; as different strains have shown different susceptibilities <span class="elsevierStyleItalic">in vitro</span>&#46; Therefore&#44; the logical approach is to start treatment with 2 or even 3 anti-fungal agents&#44; to achieve better therapeutic response and also to prevent the development of resistance&#46; Voriconazole has shown the best sensitivity <span class="elsevierStyleItalic">in vitro</span> in the treatment of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46;&#44; and this is the drug we used to treat most of our patients&#46; However&#44; recent treatment guidelines from the Royal Brompton Hospital &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> discourage the use of voriconazole due to its side effects&#44; high photosensitivity despite the use of sunscreen&#44; and risk of liver toxicity&#46; For this reason&#44; the better tolerated posaconazole is currently recommended in <span class="elsevierStyleItalic">Scedosporium apiospermum complex</span> infection&#46; As <span class="elsevierStyleItalic">Lomentospora prolificans</span> is highly resistant to all anti-fungal agents&#44; the combination of posaconazole and terbinafine is recommended&#46; With regard to aerosol therapy&#44; Sole et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a> have recently reported 3 cases of transplanted patients with invasive disease due to <span class="elsevierStyleItalic">S&#46; apiospermum</span> who received nebulized posaconazole in compassionate use&#46; In their experience&#44; nebulized posaconazole was effective and showed a similar tolerance to other nebulized antifungals&#46; The authors also consider it an alternative therapeutic option if progress with conventional treatment is inadequate&#44; or if the infection is caused by highly resistant fungi&#46; Treatment duration after starting has not been established&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The question of whether colonization of the respiratory tract by <span class="elsevierStyleItalic">Lomentospora prolificans</span> in CF patients is a contraindication for lung transplantation is still under discussion&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> It has been shown that colonized patients have a worse prognosis after transplantation&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> It has also been reported to cause invasive disease in immunocompromised lung transplant recipients&#46; The time for determining invasive fungal infection is 12 months after transplantation&#46; A 3&#46;5&#37; rate of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; infection after lung transplantation has been described in 1 study&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The main limitations of our study were that all patients were recruited from a single center and the number of patients included was low&#44; so multicenter studies would be required to determine the real prevalence of this fungus&#44; and to clarify some issues&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">We conclude that <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; is an emergent fungus in CF patients&#44; raising many questions regarding its clinical implications&#44; risk factors&#44; and need for treatment&#44; which will have to be answered by more studies&#46; For now&#44; we recommend that these patients are closely monitored&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of Interests</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In recent years an increase in the prevalence of colonization and infection by <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in patients with cystic fibrosis &#40;CF&#41; has been observed&#46; In this article&#44; we study the frequency of isolation of <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in an adult CF Unit&#44; analyzing characteristics of the patients and predisposing factors&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective observational study was conducted in 87 adult CF patients in whom the presence of positive culture for <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was tested for a 5-year period &#40;January 2012&#8211;July 2017&#41;&#46; We recorded the following clinical variables&#58; age&#44; sex&#44; body mass index&#44; genotype&#44; presence of pancreatic insufficiency&#44; bacterial colonization&#44; lung function&#44; other complications&#44; exacerbations and treatment&#44; and the modified Bhalla score from the last high-resolution computed tomography&#46; Results were analyzed with IBM SPSS Statistics Version 22&#46;0 software&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Scedosporium</span> spp&#46; was isolated in 25&#46;3&#37; of patients&#46; In the bivariate analysis&#44; these patients showed a higher rate of <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> infection&#44; worse score in the Bhalla classification &#40;highlighting the following items&#58; bronchiectasis&#44; mucus plugs and bronchial generations&#41;&#44; a slight decrease in the lung diffusion capacity and more frequently received inhaled antibiotics&#46; In the logistic regression multivariate analysis&#44; only the bronchial generations item was significant&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Scedosporium</span> spp&#46; must be considered an emerging opportunistic pathogen in patients with CF whose clinical involvement&#44; risk factors or need for treatment is unknown&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En los &#250;ltimos a&#241;os se observa un aumento de la prevalencia de colonizaci&#243;n e infecci&#243;n por <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; en pacientes con fibrosis qu&#237;stica &#40;FQ&#41;&#46; En el presente estudio se registra la frecuencia de aislamiento de <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; en una Unidad de FQ de adultos&#44; analiz&#225;ndose las caracter&#237;sticas de los pacientes y los factores predisponentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio observacional retrospectivo en 87 pacientes adultos con FQ en los que se valor&#243; la presencia de cultivo positivo para <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; durante 5 a&#241;os &#40;enero de 2012-julio de 2017&#41;&#46; Se recogieron las siguientes variables cl&#237;nicas&#58; edad&#44; sexo&#44; &#237;ndice de masa corporal&#44; genotipo&#44; presencia de insuficiencia pancre&#225;tica&#44; colonizaciones bacterianas&#44; funci&#243;n pulmonar&#44; complicaciones&#44; exacerbaciones y tratamiento&#44; as&#237; como puntuaci&#243;n Bhalla modificada de la &#250;ltima tomograf&#237;a computarizada axial de alta resoluci&#243;n&#46; Los resultados se analizaron con el paquete estad&#237;stico IBM SPSS Statistics Version 22&#46;0&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En un 25&#44;3&#37; de los pacientes se aisl&#243; <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; En el an&#225;lisis bivariante se observ&#243; en estos enfermos m&#225;s frecuencia de <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; peor puntuaci&#243;n en la clasificaci&#243;n de Bhalla &#40;destacando los &#237;tems presencia de bronquiectasias&#44; tapones mucosos y generaciones bronquiales&#41;&#44; un descenso leve en la capacidad de difusi&#243;n pulmonar &#40;DLCO&#41; y que recib&#237;an con m&#225;s frecuencia antibioterapia inhalada&#46; En el an&#225;lisis multivariante de regresi&#243;n log&#237;stica &#250;nicamente el &#237;tem generaciones bronquiales fue significativo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Scedosporium</span> spp&#46; debe considerarse un pat&#243;geno oportunista emergente en pacientes con FQ del que se desconoce su implicaci&#243;n cl&#237;nica&#44; factores de riesgo o necesidad de tratamiento&#46;</p></span>"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Erro Iribarren M&#44; Gir&#243;n Moreno RM&#44; Diab C&#225;ceres L&#44; Pastor Sanz MT&#44; Buend&#237;a Moreno B&#44; Alarc&#243;n Cavero T&#44; et al&#46; Estudio de una cohorte de paciente con fibrosis qu&#237;stica y Scedosporium spp&#46; Arch Bronconeumol&#46; 2019&#59;55&#58;559&#8211;564&#46;</p>"
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        "etiqueta" => "Fig&#46; 1"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Co-infection with other pathogens in patients with and without <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; isolates&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ABPA&#58; Allergic bronchopulmonary aspergillosis&#59; BMI&#44; body mass index&#59; CFRD&#58; CF-related diabetes&#59; DLCO&#58; diffusing capacity of the lung&#59; FEV1&#58; forced expiratory volume in 1 second&#59; FVC&#58; forced vital capacity&#59; iv&#58; intravenous&#59; <span class="elsevierStyleItalic">n</span>&#58; number&#59; RE&#58; respiratory exacerbations&#59; SD&#58; standard deviation&#59; vo&#58; oral&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Mean&#177;SD&#47;<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Scedosporium</span> spp&#46; in Culture</th><th class="td" title="\n
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                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;<span class="elsevierStyleItalic">n</span>&#61;87&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;<span class="elsevierStyleItalic">n</span>&#61;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Yes &#40;<span class="elsevierStyleItalic">n</span>&#61;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">46 &#40;52&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;56&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9 &#40;40&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;193&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Women&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">41 &#40;47&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;43&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">13 &#40;59&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">26&#46;14&#177;7&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;5&#177;7&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;86&#177;7&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;10&#177;2&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;14&#177;3&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;98&#177;2&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;825&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mutation</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Homozygous F508&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23 &#40;26&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;26&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heterozygous F508&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;50&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other mutations&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;26&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;23&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;38&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">FEV1 ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;<span class="elsevierStyleItalic">n</span>&#61;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Yes &#40;<span class="elsevierStyleItalic">n</span>&#61;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Overall Bhalla score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;48&#177;4&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;37&#177;2&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severity bronchiectasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;02&#177;1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;89&#177;0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;450&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peribronchial thickening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;18&#177;0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;16&#177;0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;947&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extension bronchiectasis &#40;n&#46; segments&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;45&#177;1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;00&#177;0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extension mucous plugs &#40;n&#46; segments&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;86&#177;0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;32&#177;0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sacculations or abscesses &#40;n&#46; segments&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&#177;0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;16&#177;0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;694&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Generations of bronchial divisions involved &#40;bronchiectasis&#47;plugs&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;77&#177;0&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;42&#177;0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of bullae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;20&#177;0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;16&#177;0&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;952&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emphysema &#40;n&#46; segments&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&#177;0&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;11&#177;0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atelectasias&#47;consolidations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;32&#177;0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47&#177;0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2157787.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Modified Bhalla Score&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; OR&#58; odds ratio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Independent Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI for OR</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lower&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Upper&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P&#46; aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;224&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;990&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;498&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Generations of bronchial divisions involved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;315&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;317&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;344&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DLCO&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;342&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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Article information
ISSN: 15792129
Original language: English
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