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Various ceramic supports besides standard soda-lime glass have been utilized as substrates for deposition of molybdenum and copper indium diselenide layers (substrate/Mo/CuInSe2 heterostructures) for application in thin film photovoltaic solar cells. Molybdenum layers have been prepared simultaneously onto the different substrates by electron gun assisted evaporation. Subsequently, CuInSe2 thin films have been obtained by direct electrodeposition onto the Mo-coated substrates. The influence of the substrate characteristics onto the optical and structural properties of the developed materials has been determined to evaluate the possibility of substituting the commonly utilized glass by ceramics that can wide the applications of these photovoltaic systems. The obtained results indicate that the scattering factor and the structural stress in the layers are minimized when the morphological characteristics of the ceramic are close to those of the standard glass substrates.Se han probado distintos tipos de soportes cerámicos y vidrio sodocálcico convencional como sustratos sobre los que se han depositado películas de molibdeno y seleniuro de cobre e indio (heteroestructuras de la forma sustrato/Mo/CuInSe2) para su aplicación en células solares fotovoltaicas de lámina delgada. Las películas de Mo se han preparado simultáneamente sobre los distintos sustratos mediante evaporación asistida por cañón de electrones. A continuación, las láminas delgadas de CuInSe2 se han obtenido mediante electrodepósito directo sobre los sustratos cubiertos con Mo. Se ha determinado la influencia del tipo de sustrato empleado sobre las propiedades ópticas y estructurales de los materiales preparados, con objeto de evaluar las posibilidades de sustitución del soporte de vidrio usualmente utilizado por materiales cerámicos que permitan diversificar las aplicaciones fotovoltaicas de este tipo de sistemas. Los resultados obtenidos indican que el factor de dispersión y la tensión estructural de las láminas desarrolladas se minimizan cuando la morfología superficial del soporte cerámico se aproxima a la del vidrio convencional.

Some results are presented about the preparation of CuInS2 / buffer interfaces by chemical bath deposition. This type of interface has an interest for solar energy conversion by thin- film solar cells. It is shown that the deposition of buffer films with ZnSe composition onto CuInS2 is due to a combined electroless and chemical reaction process. Characterization of the CuInS2 / ZnSe structure is carried out with X-ray diffraction and microscope techniques (AFM, SEM). Solar cells of CuInS2 / ZnSe / ZnO type are characterized as a function of buffer layer deposition process.Se presentan resultados sobre la preparación mediante depósito químico de interfases CuInS2 / buffer. Estas interfases son de interés en la fabricación de células solares de lámina delgada. Se lleva a cabo el crecimiento de películas buffer de ZnSe en un baño químico, mediante a partir de reaccionesón electroless y química. La interfase CuInS2 / ZnSe resultante se caracteriza por medio de técnicas microscópicas (AFM, SEM). Se presentan resultados de células solares del tipo CuInS2 / ZnSe / ZnO, en función del tipo de depósito de la lámina buffer.

The optimization of the structural and morphological characteristics of the system constituted by molibdenum and copper indium diselenide layers deposited onto glass substrates (glass/Mo/CuInSe2) is essential for its application in efficient thin film solar cells. For developing such kind of systems, soda-lime glass substrates have been used to prepare Mo thin films by evaporation at deposition rates between 4 and 13 Å/s, and subsequently CuInSe2 layers by direct electrodeposition at 12 Å/s constant rate. The structural and morphological analysis of the samples indicated that the surface roughness of the CuInSe2 layer is minimized, and its grain size is maximized, when electrodeposition process takes place onto Mo thin films evaporated at rates higher than 8 Å/s.La optimización de las características estructurales y morfológicas del sistema formado por películas de molibdeno y seleniuro de cobre e indio depositadas sobre sustratos de vidrio (vidrio/Mo/CuInSe2) resulta esencial para su aplicación en la formación de células solares de lámina delgada eficientes. Para el desarrollo de este tipo de sistemas se han utilizado sustratos de vidrio sodocálcico, sobre los que se han preparado láminas delgadas de Mo mediante evaporación a ritmos de crecimiento de entre 4 y 13 Å/s, y a continuación películas de CuInSe2 mediante electrodepósito directo a una velocidad constante de 12 Å/s. El análisis estructural y morfológico de las muestras preparadas indica que la rugosidad superficial de la película de CuInSe2 se minimiza, y su tamaño de grano se maximiza, cuando el electrodepósito se realiza sobre láminas delgadas de Mo evaporadas a velocidades superiores a 8 Å/s.

The ongoing combination of global warming and increased anthropogenic pressure is causing latitudinal shifts in marine species, potentially impacting community composition, local richness, and marine trophic webs. This study investigates the factors influencing the distribution and diversity of intertidal seaweed and associated peracarid communities, including their functional traits, and explores various facets of beta diversity (taxonomic and functional). We hypothesize that: 1) abiotic factors such as temperature and anthropogenic pressure significantly influence seaweed distribution and diversity shifts, and 2) changes in seaweed functional diversity have an impact on the diversity and functioning of its associated peracarid communities. The sampling was conducted along a wide latitudinal gradient in the NE Atlantic (27°N - 65°N), encompassing three distinct ecoregions: Northern European coasts, the Iberian Peninsula, and Macaronesia. The identified seaweed and peracarid species were classified functionally, and taxonomic and functional diversity were analysed on a large geographic scale. The northern region exhibited large brown canopy seaweeds and epibiotic isopods, while Macaronesia featured small red, highly branched, and calcareous crust seaweeds with burrower and tube-building tanaids. The Iberian Peninsula acted as a transitional zone, showcasing a mix of green, red, and brown seaweeds, along with Amphipoda peracarids found across all ecoregions. Our findings underscore the impact of geographic distance on total beta diversity, revealing distinct seaweed and peracarid communities across spatial gradients. Environmental variables, particularly pH and maximum sea surface temperature, emerged as significant factors influencing beta diversity patterns of seaweeds, indicating the potential impact of acidification and heat waves on community composition. In addition, seaweed functional traits were shown to be significant in shaping the diversity and abundance of associated peracarid assemblages, impacting both taxonomic and functional beta diversity. These findings provide crucial insights into the factors influencing the biogeography and biodiversity dynamics of intertidal seaweeds and associated peracarids, offering essential implications for conservation and management strategies amid ongoing environmental changes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Optimal strategies to manage embolization of transcatheter aortic valve implantation (TAVI) devices are unclear; valve-in-valve (ViV) is often used. We aimed to describe through one-single center experience its rate, causes, consequences, and management as well as the rate and relevance of commissural alignment (CA) in this context., Methods: We identified across 1038 TAVI cases, those cases requiring ViV for the management of first device embolization. CA (absence or mild misalignment) after first and second device was assessed by CT or fluoroscopy., Results: A total of 23 cases (2.2%) were identified, 52.3% embolized towards the aorta and 47.7% towards the ventricle. Suboptimal implant height (38%) and embolization at the time of post-dilation (23%) were the most frequent mechanisms together with greater rate of bicuspid valve (p < 0.001) and a trend to greater annular eccentricity. Procedural and 1-year death occurred in 13% and 34%, respectively (vs. 1.1% and 7.8% in the global cohort, p < 0.001). CA was present in 76.9% of the prostheses initially implanted but was only spontaneously achieved in 30.8% of the second ViV device. Adequate CA of both prostheses was identified in only two cases (8.7%). There were no cases of coronary obstruction., Conclusions: TAVI device embolization mechanisms can often be predicted and prevented. Mortality following bail-out ViV is higher than in regular TAVI procedures but 2/3 of these patients survived beyond 1-year follow-up. In them, valve degeneration or coronary re-access might be particularly challenging since CA was rarely achieved with both devices suggesting that greater efforts should be made in this regard., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Abstract: T-ALL relapse usually occurs early but can occur much later, which has been suggested to represent a de novo leukemia. However, we conclusively demonstrate late relapse can evolve from a pre-leukemic subclone harbouring a non-coding mutation that evades initial chemotherapy., (© 2024 American Society of Hematology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

High-altitude mountain areas are sentinel ecosystems for global environmental changes such as anthropogenic pollution. In this study, we report a source apportionment of particulate material with an aerodynamic diameter smaller than 10 μm (PM 10 ) in a high-altitude site in southern Europe (Sierra Nevada Station; SNS (2500 m a.s.l.)) during summer 2021. The emission sources and atmospheric secondary processes that determine the composition of aerosol particles in Sierra Nevada National Park (Spain) are identified from the concentrations of organic carbon (OC), elemental carbon (EC), 12 major inorganic compounds, 18 trace elements and 44 organic molecular tracer compounds in PM 10 filter samples collected during day- and nighttime. The multivariate analysis of the joint dataset resolved five main PM 10 sources: 1) Saharan dust, 2) advection from the urbanized valley, 3) local combustion, 4) smoke from a fire-event, and 5) aerosol from regional recirculation with high contribution of particles from secondary inorganic and organic aerosol formation processes. PM sources were clearly associated with synoptic meteorological conditions, and day- and nighttime circulation patterns typical of mountainous areas. Although a local pollution source was identified, the contribution of this source to PM 10 , OC and EC was small. Our results evidence the strong influence of middle- and long-range transport of aerosols, mainly from anthropogenic origin, on the aerosol chemical composition at this remote site., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

The potential toxic and carcinogenic effects of chlorinated solvents in groundwater on human health and aquatic ecosystems require very effective remediation strategies of contaminated groundwater to achieve the low legal cleanup targets required. The transition zones between aquifers and bottom aquitards occur mainly in prograding alluvial fan geological contexts. Hence, they are very frequent from a hydrogeological point of view. The transition zone consists of numerous thin layers of fine to coarse-grained clastic fragments (e.g., medium sands and gravels), which alternate with fine-grained materials (clays and silts). When the transition zones are affected by DNAPL spills, free-phase pools accumulate on the less conductive layers. Owing to the low overall conductivity of this zone, the pools are very recalcitrant. Little field research has been done on transition zone remediation techniques. Injection of iron microparticles has the disadvantage of the limited accessibility of this reagent to reach the entire source of contamination. Biostimulation of indigenous microorganisms in the medium has the disadvantage that few of the microorganisms are capable of complete biodegradation to total mineralization of the parent contaminant and metabolites. A field pilot test was conducted at a site where a transition zone existed in which DNAPL pools of PCE had accumulated. In particular, the interface with the bottom aquitard was where PCE concentrations were the highest. In this pilot test, a combined strategy using ZVI in microparticles and biostimulation with lactate in the form of lactic acid was conducted. Throughout the test it was found that the interdependence of the coupled biotic and abiotic processes generated synergies between these processes. This resulted in a greater degradation of the PCE and its transformation products. With the combination of the two techniques, the mobilization of the contaminant source of PCE was extremely effective., Competing Interests: Declaration of competing interest The authors of this research paper (Diana Puigserver, Jofre Herrero and José M. Carmona) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The clinical burden of influenza is increasing worldwide. Aging, immunosuppression, and underlying respiratory illness are determinants of poor clinical outcomes, including greater mortality. Bacterial infections seem to be the main reason. Updated information on the role of bacterial infection as the cause of complications would be of value in improving the prognosis of patients with influenza., Methods: A systematic review and meta-analysis were performed by using the PubMed repository using keywords like: Influenza, H1N1, Streptococcus pneumoniae, bacterial coinfection, secondary coinfection, bacterial complications in pneumonia, and seasonal influenza. Only articles written in English were included in publications from 2010 to 2020. The analyses were conducted following the preferred reporting items for systematic review and meta-analyses guidelines. The results were independently validated using a TrinetX database cohort of roughly 4 million patients., Results: We included 135 studies that contained data from 48,259 patients hospitalized with influenza of any age. Bacterial infections were diagnosed in 5391 (11.2%). Streptococcus pneumoniae (30.7%) and Staphylococcus aureus (30.4%) were the most frequent microorganisms, followed by Haemophilus influenzae (7.1%) and Pseudomonas aeruginosa (5.9%). The random-effects model of the meta-analysis indicated that bacterial infections posed a 3.4-fold increased risk of death compared with influenza infection alone. Unexpectedly, asthma was protective (odds ratio 0.8)., Conclusion: Bacterial infections diagnosed in 11.2% of patients with influenza increase 3.4-fold the mortality risk. S. pneumoniae, S. aureus, H. influenzae, and P. aeruginosa account for nearly 75% of the cases. Earlier diagnosis and use of antibiotics should improve outcomes in this population., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The occurrence of nitrate is the most significant type of pollution affecting groundwater globally, being a major contributor to the poor condition of water bodies. This pollution is related to livestock-agricultural and urban activities, and the nitrate presence in drinking water has a clear impact on human health. For example, it causes the blue child syndrome. Moreover, the high nitrate content in aquifers and surface waters significantly affects aquatic ecosystems since it is responsible for the eutrophication of surface water bodies. A treatability test was performed in the laboratory to study the decrease of nitrate in the capture zone of water supply wells. For this purpose, two boreholes were drilled from which groundwater and sediments were collected to conduct the test. The goal was to demonstrate that nitrate in groundwater can be decreased much more efficiently using combined abiotic and biotic methods with micro-zero valent iron and biostimulation with lactic acid, respectively, than when both strategies are used separately. The broader implications of this goal derive from the fact that the separate use of these reagents decreases the efficiency of nitrate removal. Thus, while nitrate is removed using micro-valent iron, high concentrations of harmful ammonium are also generated. Furthermore, biostimulation alone leads to overgrowth of other microorganisms that do not result in denitrification, therefore complete denitrification requires more time to occur. In contrast, the combined strategy couples abiotic denitrification of nitrate with biostimulation of microorganisms capable of biotically transforming the abiotically generated harmful ammonium. The treatability test shows that the remediation strategy combining in situ chemical reduction using micro-zero valent iron and biostimulation with lactic acid could be a viable strategy for the creation of a reactive zone around supply wells located in regions where groundwater and porewater in low permeability layers are affected by diffuse nitrate contamination., Competing Interests: Declaration of competing interest The authors of this research paper (Diana Puigserver, Jofre Herrero and José M. Carmona) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Aim: Ketogenic dietary therapies (KDT) produce anticonvulsant and neuroprotective effects, reduce seizures and improve the cognitive state in patients with epilepsy. Our purpose was to evaluate the effects of KDT in children with refractory epilepsy (effectiveness, side effects, impact on nutritional status and growth)., Methods: A retrospective and prospective observational descriptive study was conducted in a Spanish tertiary hospital (January 2000 to December 2018). One hundred sixty pediatric patients with epilepsy were treated with KDT (82 males; mean age 5 years 9 months). Seizures, anti-epileptic drugs, anthropometric measures, side effects, and laboratory assessment were monitored baseline and at 3, 6, 12 and 24 months after the onset of KDT., Results: In these time intervals, the seizure-free patients were: 13.7, 12.5, 14.4 and 10.6%, respectively, and a reduction of seizures ≥ 50% was achieved in 41.9, 37.5, 28.7 and 16.2%. Side effects were frequent, especially digestive disorders, hypercalciuria, hypoglycemia, hepatic dysfunction and dyslipidemia. Prealbumin, retinol binding protein, vitamin A and magnesium decreased significantly. Height was affected, especially in children below 2 years., Conclusions: KDT are effective for refractory epilepsy in children. However, adverse effects are frequent, and it may affect nutritional status and growth., (Copyright © 2021 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Chlorinated solvents occur as dense nonaqueous phase liquid (DNAPL) or as solutes when dissolved in water. They are present in many pollution sites in urban and industrial areas. They are toxic, carcinogenic, and highly recalcitrant in aquifers and aquitards. In the latter case, they migrate by molecular diffusion into the matrix. When aquitards are fractured, chlorinated solvents also penetrate as a free phase through the fractures. The main objective of this study was to analyze the biogeochemical processes occurring inside the matrix surrounding fractures and in the joint-points zones. The broader implications of this objective derive from the fact that, incomplete natural degradation of contaminants in aquitards generates accumulation of daughter products. This causes steep concentration gradients and back-diffusion fluxes between aquitards and high hydraulic conductivity layers. This offers opportunities to develop remediation strategies based, for example, on the coupling of biotic and reactive abiotic processes. The main results showed: 1) Degradation occurred especially in the matrix adjacent to the orthogonal network of fractures and textural heterogeneities, where texture contrasts favored microbial development because these zones constituted ecotones. 2) A dechlorinating bacterium not belonging to the Dehalococcoides genus, namely Propionibacterium acnes, survived under the high concentrations of dissolved perchloroethene (PCE) in contact with the PCE-DNAPL and was able to degrade it to trichloroethene (TCE). Dehalococcoides genus was able to conduct PCE reductive dechlorination at least up to cis-1,2-dichloroethene (cDCE), which shows again the potential of the medium to degrade chloroethenes in aquitards. 3) Degradation of PCE in the matrix resulted from the coupling of reactive abiotic and biotic processes-in the first case, promoted by Fe 2+ sorbed to iron oxides, and in the latter case, related to dechlorinating microorganisms. The dechlorination resulting from these coupling processes is slow and limited by the need for an adequate supply of electron donors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Ketogenic dietary therapies (KDT) are high-fat and low-carbohydrate diets that may achieve seizure control and improve cognitive state. We describe our KDT experience in infants (children less than two years of age)., Research Methods & Procedures: We conducted a retrospective, descriptive and observational study of 42 infants treated with KDT between 2000-2018., Results: The types of KDT started were: classic ketogenic diet ratio 3:1 (40), ratio 4:1 (1) and modified ketogenic diet with medium-chain triglycerides (1). Four patients switched to a modified Atkins diet. During follow-up, 79%, 57%, 38% and 17% of infants remained on KDT at 3, 6, 12 and 24 months, respectively. Seizure reduction ≥50% compared to baseline was achieved in 50%, 45%, 38% and 17% at 3, 6, 12 and 24 months, respectively. Seizure control was excellent (reduction >90%) in 33%, 31%, 26% and 12%, and seizure-free infants were 9, 9, 10 and 4, at different follow-up intervals, respectively. Sixty-three percent of infants with West syndrome were responders to KDT. Mean length of KDT was 390 days (16 days-4.9 years). Ineffectiveness was the reason for withdrawal in 50% of patients. Early adverse effects (during first month) occurred in 40% of infants. The most frequent early side effects were asymptomatic hypoglycemia and gastrointestinal disturbances. Late-onset side effects occurred in 55-14% of infants during therapy, and most frequent were hypercalciuria and dyslipidaemia., Conclusion: KDT are useful and effective treatments in infancy. Side effects are frequent but mild and easy to manage., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aim: Ketogenic dietary therapies (KDT) produce anticonvulsant and neuroprotective effects, reduce seizures and improve the cognitive state in patients with epilepsy. Our purpose was to evaluate the effects of KDT in children with refractory epilepsy (effectiveness, side effects, impact on nutritional status and growth)., Methods: A retrospective and prospective observational descriptive study was conducted in a Spanish tertiary hospital (January 2000 to December 2018). One hundred sixty pediatric patients with epilepsy were treated with KDT (82 males; mean age 5 years 9 months). Seizures, anti-epileptic drugs, anthropometric measures, side effects, and laboratory assessment were monitored baseline and at 3, 6, 12 and 24 months after the onset of KDT., Results: In these time intervals, the seizure-free patients were: 13.7, 12.5, 14.4 and 10.6%, respectively, and a reduction of seizures≥50% was achieved in 41.9, 37.5, 28.7 and 16.2%. Side effects were frequent, especially digestive disorders, hypercalciuria, hypoglycemia, hepatic dysfunction and dyslipidemia. Prealbumin, retinol binding protein, vitamin A and magnesium decreased significantly. Height was affected, especially in children below 2 years., Conclusions: KDT are effective for refractory epilepsy in children. However, adverse effects are frequent, and it may affect nutritional status and growth., (Copyright © 2021 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: This study aimed to evaluate the safety and mid-term efficacy of transcatheter aortic valve replacement (TAVR) in the setting of aortic valve (AV) infective endocarditis (IE) with residual lesion despite successful antibiotic treatment., Background: Patients with AV-IE presenting residual lesion despite successful antibiotic treatment are often rejected for cardiac surgery due to high-risk. The use of TAVR following IE is not recommended., Methods: This was a multicenter retrospective study across 10 centers, gathering baseline, in-hospital, and 1-year follow-up characteristics of patients with healed AV-IE treated with TAVR. Matched comparison according to sex, EuroSCORE, chronic kidney disease, left ventricular function, prosthesis type, and valve-in-valve procedure was performed with a cohort of patients free of prior IE treated with TAVR (46 pairs)., Results: Among 2,920 patients treated with TAVR, 54 (1.8%) presented with prior AV-IE with residual valvular lesion and healed infection. They had a higher rate of multivalvular disease and greater surgical risk scores. A previous valvular prosthesis was more frequent than a native valve (50% vs. 7.5%; p < 0.001). The in-hospital and 1-year mortality rates were 5.6% and 11.1%, respectively, comparable to the control cohort. After matching, the 1-year III to IV aortic regurgitation rate was 27.9% (vs. 10%; p = 0.08) and was independently associated with higher mortality. There was only 1 case of IE relapse (1.8%); however, 18% of patients were complicated with sepsis, and 43% were readmitted due to heart failure., Conclusions: TAVR is a safe therapeutic alternative for residual valvular lesion after successfully healed AV-IE. At 1-year follow-up, the risk of IE relapse was low and mortality rate did not differ from TAVR patients free of prior IE, but one-fourth presented with significant aortic regurgitation and >50% required re-admission., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

In the transition zone between aquifers and aquitards, DNAPL pools of carbon tetrachloride and chloroform accumulate because of heterogeneity in this zone. Natural attenuation occurs at pools and plumes, indicating that remediation might be possible. The aims of the study were: i) to assess the role of heterogeneity in the natural attenuation of these compounds, ii) determine degradation processes within this zone, and iii) identify dechlorinating microorganisms. For this, groundwater concentrations, redox-sensitive parameters, CSIA isotopic and DGGE molecular techniques were used. The main findings at depth of the transition zone were: (1) the important key control played by heterogeneity on natural attenuation of contaminants. (2) Heterogeneity caused the highly anoxic environment and dominant sulfate-reducing conditions, which accounts for more efficient natural attenuation. (3) Heterogeneity also explains that the transition zone constitutes an ecotone. (4) The bacteria size exclusion is governed by the pore throat threshold and determines the penetration of dechlorinating microorganisms into the finest sediments, which is relevant, since it implies the need to verify whether microorganisms proposed for bioremediation can penetrate these materials. (5) Reductive dechlorination caused the natural attenuation of contaminants in groundwater and porewater of fine sediments. In the case of carbon tetrachloride, it was an abiotic process biogenically mediated by A. suillum, a bacterium capable of penetrating the finest sediments. In the case of chloroform, it was a biotic process performed by a Clostridiales bacterium, which is unable to penetrate the finest materials. (6) Both microorganisms have potential to be biostimulated to dechlorinate contaminants in the source and the plume in the transition zone. These outcomes are particularly relevant given the longevity of DNAPL sources and have considerable environmental implications as many supply wells in industrial areas exploit aquifers contaminated by chlorinated solvents emerging from DNAPL pools accumulated on the low-conductivity layers in transition zones., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Soil microbial communities (both Bacteria and Archaea) were studied after 16S rRNA genes massive sequencing in two hypersaline and gypsum-rich contrasted sites located in NE Spain. Soil microbial communities were also locally analysed according to environmental variables, including geological, physico-chemical, biogeochemically, and climatic data. Typical soil characteristics, climate data, and plant composition clearly split the two sites and major differences among the microbial communities for the areas were initially expected. Overall, high values of microbial species richness (up to 2300 taxa) and ecological diversity was detected in both sites. High genetic novelty levels were found mostly to environmental sequences, highlighting the high potential for microbiological studies. In contrast to the initial expectations, a substantial overlapping between Monegros and Gallocanta microbes was observed, indicating a high similarity despite of the geographical, botanical and environmental distances between sites, in agreement with both high dispersal and local selection inherent to the microbial world. The potential biogeochemical cycling showed small differences between sites, with presence of photosynthetic green and purple sulfur bacteria, cyanobacteria and aerobic and anaerobic chemolitotrophs. Potential for aerobic methane oxidation and anaerobic methanogenesis was observed in both sites, with predominance of potential nitrification mostly by ammonia-oxidizing archaea, nitrite oxidation and denitrification, and minor contribution for nitrate reduction and nitrate ammonification. The predicted functions based on the taxonomic composition showed high overlapping between the two studied regions, despite their difference in gypsum richness., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This paper explores the dynamics of temporal evolution of the high mountain Mediterranean grasslands, (Sierra Nevada, Spain SE). The indicator used is the emission of pollen (Pollen Index, PI) with respect to two important aspects: the incidence of the snow dynamic together with other hydro-meteorological parameters, and the changes in land use, which can Influence the evolution of the grasslands throughout time. The results reveal that pollen emissions in the last 25 years have shown a slight downward trend, with large interannual fluctuations, which are a consequence of diverse environmental factors, both general and specific to the area. One of the most influential parameters on pollen concentrations is snow cover, which reinforces the importance of the presence of snow-packs as water resource outside the winter season in the High Mediterranean Mountain environments. The changes in land use experienced in the area are a driver of change, especially due to the losses experienced in the last decades in the preferred habitats for many species of grasses. It can be concluded that the vulnerability of these ecosystems will be affected by an increase in winter temperatures and/or a decrease in rainfall (climate change) and an increase in the intensity of anthropogenic activities on land use. In this context, the PI is shown as a useful indicator of global change given its sensitivity to both anthropic and hydro-meteorological changes. In addition, it has a wide range of spatial detection and discrimination capacity by altitudinal dimensions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Langerhans cell histiocytosis (LCH) is a multisystemic dendritic cell proliferation that is relatively uncommon in adults. Central nervous system LCH outside the pituitary gland is even more uncommon., Case Description: We report the case of a 42-year-old man who had complained of right-side hemicranial pain and left arm minor paresis. The symptoms were due to a right insular lobe heterogeneous-enhancing lesion associated with extensive vasogenic edema. The first diagnostic impression suggested glioblastoma multiforme or localized metastasis. The thoracic, abdominal, pelvic computed tomography scan only detected small upper lung inactive nodules suggesting silent focal LCH. A very hard lesion was almost completely removed through a pterional craniotomy approach, with no fluorescence after aminolevulinic acid infusion. The intraoperative biopsy findings ruled out glioma but could not confirm lymphoma. The definitive cerebral biopsy findings showed lymphocytes and histiocytes (CD1a + , S-1001 + ), with a diagnosis of intracerebral parenchymal LCH. Fractioned radiotherapy resulted in clinical and radiological remission., Conclusions: The present case is so rare it should not be used as a guide. We probably will never see a single intraparenchymal supratentorial central nervous system LCH lesion. However, we hope our report will help colleagues in the future with the thought process., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Improving outcomes in multiple myeloma will involve not only development of new therapies but also better use of existing treatments. We performed RNA sequencing on samples from newly diagnosed patients enrolled in the phase 2 PADIMAC (Bortezomib, Adriamycin, and Dexamethasone Therapy for Previously Untreated Patients with Multiple Myeloma: Impact of Minimal Residual Disease in Patients with Deferred ASCT) study. Using synthetic annealing and the large margin nearest neighbor algorithm, we developed and trained a 7-gene signature to predict treatment outcome. We tested the signature in independent cohorts treated with bortezomib- and lenalidomide-based therapies. The signature was capable of distinguishing which patients would respond better to which regimen. In the CoMMpass data set, patients who were treated correctly according to the signature had a better progression-free survival (median, 20.1 months vs not reached; hazard ratio [HR], 0.40; confidence interval [CI], 0.23-0.72; P = .0012) and overall survival (median, 30.7 months vs not reached; HR, 0.41; CI, 0.21-0.80; P = .0049) than those who were not. Indeed, the outcome for these correctly treated patients was noninferior to that for those treated with combined bortezomib, lenalidomide, and dexamethasone, arguably the standard of care in the United States but not widely available elsewhere. The small size of the signature will facilitate clinical translation, thus enabling more targeted drug regimens to be delivered in myeloma., (© 2018 by The American Society of Hematology.)

Direct-acting antivirals have proved to be highly efficacious and safe in monoinfected liver transplant (LT) recipients who experience recurrence of hepatitis C virus (HCV) infection. However, there is a lack of data on effectiveness and tolerability of these regimens in HCV/HIV-coinfected patients who experience recurrence of HCV infection after LT. In this prospective, multicenter cohort study, the outcomes of 47 HCV/HIV-coinfected LT patients who received DAA therapy (with or without ribavirin [RBV]) were compared with those of a matched cohort of 148 HCV-monoinfected LT recipients who received similar treatment. Baseline characteristics were similar in both groups. HCV/HIV-coinfected patients had a median (IQR) CD4 T-cell count of 366 (256-467) cells/µL. HIV-RNA was <50 copies/mL in 96% of patients. The DAA regimens administered were SOF + LDV ± RBV (34%), SOF + SMV ± RBV (31%), SOF + DCV ± RBV (27%), SMV + DCV ± RBV (5%), and 3D (3%), with no differences between the groups. Treatment was well tolerated in both groups. Rates of SVR (negative serum HCV-RNA at 12 weeks after the end of treatment) were high and similar for coinfected and monoinfected patients (95% and 94%, respectively; P = .239). Albeit not significant, a trend toward lower SVR rates among patients with advanced fibrosis (P = .093) and genotype 4 (P = .088) was observed. In conclusion, interferon-free regimens with DAAs for post-LT recurrence of HCV infection in HIV-infected individuals were highly effective and well tolerated, with results comparable to those of HCV-monoinfected patients., (© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Objectives: The existing predictive models of laryngeal cancer recurrence present limitations for clinical practice. Therefore, we constructed, internally validated and implemented in a mobile application (Android) a new model based on a points system taking into account the internationally recommended statistical methodology., Materials and Methods: This longitudinal prospective study included 189 patients with glottic cancer in 2004-2016 in a Spanish region. The main variable was time-to-recurrence, and its potential predictors were: age, gender, TNM classification, stage, smoking, alcohol consumption, and histology. A points system was developed to predict five-year risk of recurrence based on a Cox model. This was validated internally by bootstrapping, determining discrimination (C-statistics) and calibration (smooth curves)., Results: A total of 77 patients presented recurrence (40.7%) in a mean follow-up period of 3.4 ± 3.0 years. The factors in the model were: age, lymph node stage, alcohol consumption and stage. Discrimination and calibration were satisfactory., Conclusion: A points system was developed to obtain the probability of recurrence of laryngeal glottic cancer in five years, using five clinical variables. Our system should be validated externally in other geographical areas., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Intratumoural heterogeneity (ITH) is well recognised in prostate cancer (PC), but its role in high-risk disease is uncertain. A prospective, single-arm, translational study using targeted multiregion prostate biopsies was carried out to study genomic and T-cell ITH in clinically high-risk PC aiming to identify drivers and potential therapeutic strategies., Patients and Methods: Forty-nine men with elevated prostate-specific antigen and multiparametric-magnetic resonance imaging detected PC underwent image-guided multiregion transperineal biopsy. Seventy-nine tumour regions from 25 patients with PC underwent sequencing, analysis of mutations, copy number and neoepitopes combined with tumour infiltrating T-cell subset quantification., Results: We demonstrated extensive somatic nucleotide variation and somatic copy number alteration heterogeneity in high-risk PC. Overall, the mutational burden was low (0.93/Megabase), but two patients had hypermutation, with loss of mismatch repair (MMR) proteins, MSH2 and MSH6. Somatic copy number alteration burden was higher in patients with metastatic hormone-naive PC (mHNPC) than in those with high-risk localised PC (hrlPC), independent of Gleason grade. Mutations were rarely ubiquitous and mutational frequencies were similar for mHNPC and hrlPC patients. Enrichment of focal 3q26.2 and 3q21.3, regions containing putative metastasis drivers, was seen in mHNPC patients. We found evidence of parallel evolution with three separate clones containing activating mutations of β-catenin in a single patient. We demonstrated extensive intratumoural and intertumoural T-cell heterogeneity and high inflammatory infiltrate in the MMR-deficient (MMRD) patients and the patient with parallel evolution of β-catenin. Analysis of all patients with activating Wnt/β-catenin mutations demonstrated a low CD8+/FOXP3+ ratio, a potential surrogate marker of immune evasion., Conclusions: The PROGENY (PROstate cancer GENomic heterogeneitY) study provides a diagnostic platform suitable for studying tumour ITH. Genetic aberrations in clinically high-risk PC are associated with altered patterns of immune infiltrate in tumours. Activating mutations of Wnt/β-catenin signalling pathway or MMRD could be considered as potential biomarkers for immunomodulation therapies., Clinical Trials.gov Identifier: NCT02022371., (© The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology.)

Unlabelled: Several studies have shown that some liver transplant recipients may tolerate immunosuppression withdrawal. Mechanisms and biomarkers of tolerance are not well known., Methods: Twenty-four LT patients with immunosuppression side-effects underwent progressive immunosuppression withdrawal. Peripheral lymphocyte populations and secretion of cytokines were analyzed at baseline and during withdrawal until tolerance (n = 15) or rejection (n = 9), as well as 3 months after tolerance achievement or rejection resolution (as follow-up). Immunological markers were compared among groups., Results: The percentages of CD3+CD4+ cells progressively decreased in both groups. CD3+CD8+ cells gradually increased in tolerant patients. B lymphocytes gradually decreased in tolerant and initially in non-tolerant patients, reverting at rejection. Regulatory T cells progressively increased until rejection in non-tolerants, decreasing to basal levels after renewing immunosuppression; no significant changes were found in tolerant patients. The percentages and absolute counts of natural killer cells significantly increased in both groups, being more evident in tolerant patients. The secretion of several cytokines was higher in non-tolerant patients when rejection was diagnosed., Conclusions: The greater increase of natural killer cells in tolerant patients suggests their potential role in the tolerance phenomenon., (Copyright © 2015 Elsevier B.V. All rights reserved.)

A retrospective cohort multicenter study was conducted to analyze the risk factors for tumor recurrence after liver transplantation (LT) in cirrhotic patients found to have an intrahepatic cholangiocarcinoma (iCCA) on pathology examination. We also aimed to ascertain whether there existed a subgroup of patients with single tumors ≤2 cm ("very early") in which results after LT can be acceptable. Twenty-nine patients comprised the study group, eight of whom had a "very early" iCCA (four of them incidentals). The risk of tumor recurrence was significantly associated with larger tumor size as well as larger tumor volume, microscopic vascular invasion and poor degree of differentiation. None of the patients in the "very early" iCCA subgroup presented tumor recurrence compared to 36.4% of those with single tumors >2 cm or multinodular tumors, p = 0.02. The 1-, 3- and 5-year actuarial survival of those in the "very early" iCCA subgroup was 100%, 73% and 73%, respectively. The present is the first multicenter attempt to ascertain the risk factors for tumor recurrence in cirrhotic patients found to have an iCCA on pathology examination. Cirrhotic patients with iCCA ≤2 cm achieved excellent 5-year survival, and validation of these findings by other groups may change the current exclusion of such patients from transplant programs., (© Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Noninvasive markers of embryo quality are being sought to improve IVF success. The present study aimed to discover possible associations between embryo division kinetics in the cleavage stage, the subsequent ability of human embryos to reach the blastocyst stage and the resulting blastocyst morphology. A retrospective cohort study analysed 834 embryos from 165 oocyte donation couples using a time-lapse monitoring system that allowed the recording of the exact timings for key events related to embryo development. Timing parameters were categorized into four quartiles. The probability of an embryo developing to a blastocyst was linked to a strict chronology of development. To further evaluate the relationships between these morphokinetic parameters and subsequent blastocyst formation, the ensuing blastocyst morphology was compared with a viability score based on a hierarchical classification of the cleavage-stage morphokinetic parameters. It is concluded that the kinetics of early embryo development and the potential for human embryos to develop to the blastocyst stage on day 5 are closely related and that time-lapse-based evaluation of the exact timing of early events in embryo development is a promising tool for the prediction of blastocyst formation and quality according to the proposed model., (Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Occasionally, patients with hepatocellular carcinoma (HCC) who receive radioembolization with palliative intent are downstaged for radical treatments. The aim of this study was to describe and analyze the overall survival (OS) in these patients compared with patients of the same baseline stage (UNOS T3), who were not eligible for radical treatment after radioembolization., Methods: Between September 2003 and August 2010, 118 patients with HCC received radioembolization with yttrium-90 ((90)Y) resin microspheres. Of these, 21 patients with UNOS T3 stage were retrospectively identified and included in this analysis., Results: In total, 6 of 21 patients were downstaged and treated radically between 2 and 35 months post-radioembolization. Three patients were resected, 2 received liver transplantation and 1 was ablated and then resected. Patients treated radically were significantly younger (62 vs. 73 years, p = 0.006) and had higher tumor volume (583 mL vs. 137 mL, p = 0.001) than patients who did not achieve radical treatment. There were no differences between the groups in number of lesions, BCLC stage, previous cirrhosis, activity administered per tumor volume, or median levels of alpha-fetoprotein or total bilirubin. Across the whole series, the median OS was 27.0 months (95% CI 5.0-48.9), varying significantly between those treated radically (OS not reached after a median follow-up of 41.5 months since radical therapy) and those who received palliative treatment only (22.0 months; 95% CI 15.0-30.9)., Conclusions: Radical therapy following tumor downstaging with radioembolization provides the possibility of long-term survival in a select subgroup (UNOS T3 stage) with otherwise limited options., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Control and minimization of tip-sample interaction forces are imperative tasks to maximize the performance of atomic force microscopy. In particular, when imaging soft biological matter in liquids, the cantilever dragging force prevents identification of the tip-sample mechanical contact, resulting in deleterious interaction with the specimen. In this work we present an improved jumping mode procedure that allows detecting the tip-sample contact with high accuracy, thus minimizing the scanning forces (-100 pN) during the approach cycles. To illustrate this method we report images of human adenovirus and T7 bacteriophage particles which are prone to uncontrolled modifications when using conventional jumping mode., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Introduction: Decreased levels of 25 hydroxyvitamin D (25[OH]D) have been reported in patients with chronic kidney disease (CKD). The pleiotropic effects of vitamin D are known to go beyond mineral metabolism., Objectives: The aims of this study were to: 1) Determine the 25(OH)D levels in predialysis outpatients. 2) Find out the clinical and biochemical characteristics of patients with 25(OH)D deficiency, and predictive factors for the deficiency., Patients and Methods: An observational study in 79 predialysis outpatients was performed. Clinical and biochemical parameters were analysed in terms of nutrition, inflammation and mineral metabolism in relation to serum levels of 25(OH)D. Levels of 25(OH)D lower than 15ng/ml were considered to be deficient., Results: Serum levels of 25(OH)D were deficient in 41 patients (52%). The comparative study regarding levels of vitamin 25(OH)D showed the group of patients with a deficiency, i.e. those with less than 15ng/ml, were older (70 ± 11.97 vs. 61 ± 14.5; p = 0.005), had a greater body mass index, BMI, (30±4.06 vs. 27.1 ± 5.08; p = 0.003) and increased proteinuria (1.42g/24h (0.53-2.96) vs. 0.51 (0.20-1.48), p = 0.009). This group included a greater number of diabetic patients: 20 (76.9%) vs. 6 (23%), p = 0.002. They had a higher level of parathyroid hormone (PTH): 359 (239-658) vs. 233 (129-323), p = 0.000; and more patients were under treatment with Calcitriol: 28 (62.2%) vs. 17 (37.8%), p = 0.024. In the multivariate analysis, high levels of PTH (OR 13.38; CI 95% [2.94-60.89]; p=0.001), increased proteinuria (OR 4.41; CI 95% [1.12-17.25]; p = 0.033); and being diabetic (OR 5.713; CI 95% [1.43-22.77]; p = 0.014) were independent predictor factors for patients with 25(OH)D deficiency., Conclusions: In our study, we observed a high prevalence of 25(OH)D deficiency among patients with CKD. The increased levels of PTH, the increase of proteinuria and the presence of diabetes were independent predictors for 25(OH)D deficiency.

Advance care planning (ACP) and the subsequent advance directive document (ADD), previously known as "living wills", have not been widely used in Spain. The Ethics Group from the Spanish Society of Nephrology has developed a survey in order to investigate the opinion of dialysis patients regarding the ADD and end-of-life care. Patients received documentation explaining ACP and filled out a survey about their familiarity with and approval of the ADD. Seven hospital dialysis centres participated in the study for a total of 416 active dialysis patients. Questionnaires were distributed to 263 patients, 154 of which answered (69.2% completed them without assistance). The rates for ADD implementation (7.9%) and designation of a representative person (6.6%) were very low. Most of the patients clearly expressed their wishes about irreversible coma, vegetative state, dementia and untreatable disease. More than 65% did not want mechanical ventilation, chronic dialysis, tube feeding or resuscitation if cardiorespiratory arrest occurred. They reported that an ADD could be done before starting dialysis but most thought that it should be offered only to those who requested it (65% vs 34%). In conclusion, patients have clear wishes about end-of-life care, although these desires had not been documented due to the very low implementation of the ADD.

Aims: To describe PD outcomes over 25 years in a single centre, comparing hospitalisation rate, technique withdrawal, and survival between diabetic (DM) and non-diabetic (NonDM) patients. Differences between type 1 (DM1) and type 2 (DM2) diabetics were also analysed., Patients and Methods: One hundred and eighteen DM patients (52 year old average, 74 men, 44 female) and 117 Non-DM (53 year old average, 64 men, 53 female), with at least 2 months on PD, 25±20 (2-109) and 29.4±27 (2-159) months respectively, were included. Diabetics were divided in 66 DM1 and 52 DM2. The survival and hospitalisation study was also analysed in two different time periods: before 1992 (1981-1992) and after 1992 (1993-2005)., Results: 93% Non-DM and 75% DM were self-sufficient to manage the PD technique (P<.001) as well as 65% of 44 blind patients. 28% of Non-DM and 15% of DM received a renal allograft (P<.001). There was no difference in transfer to haemodialysis. 18.6% of DM and 4.3% of Non-DM patients presented ≥4 comorbid factors on starting PD (P<.001). Hospitalisation (admissions/year) was higher in DM than in Non-DM (3.4 vs 1.8, P<.01) and also hospitalisation length (46 vs 22 days/year, P=.01), without differences between DM1 and DM2. Admissions due to cardiovascular events, infections, technical problems and peritonitis were more frequent in DM2 than in Non-DM and DM1 patients (P<.05). Mortality was 48% in DM and 22% in Non-DM (P<.001). Survival adjusted for comorbidity was higher in Non-DM (P<.001). Cerebrovascular disease was the highest risk factor for mortality in DM. Mortality was higher in DM2 than in DM1 and Non-DM (P<.001). Age (HR 1.052, P=.001), DM2 (HR 1.96, P<.01) and cerebrovascular disease (HR 4.01, P<.001) were the most important risk factors. In the post-1992 period, the hospitalisation rate and survival improved in DM1 and Non-DM patients., Conclusions: DM patients more often require outside assistance to perform PD and have more comorbidity, lower survival, and higher admissions than Non-DM, but there is no difference in HD discontinuation. Age and cardiovascular comorbidity are the factors involved in mortality. Technological advances and cumulative center experience may achieve dialysis outcome improvements in diabetic patients. 

A new variable external field magnetic force microscope is introduced here. The most outstanding feature of the system is its capability to perform stable images under a variable external magnetic field that can be applied both in in-plane and out-of-plane directions. The performances of the microscope are illustrated for four different suitable selected samples: highly oriented pyrolytic graphite, longitudinal magnetic storage media, FePt thin films with in-plane anisotropy and Ni nanowires with axial easy axis embedded on a ceramic matrix. The use of this variable-field magnetic force microscope as a magnetic writing-reading technique is also shown in this contribution.

A 1-year retrospective multicentre study was performed to identify factors influencing hospital length of stay (LOS) and mortality of patients (n = 3233) admitted to hospital because of community-acquired pneumonia (CAP). Pneumonia severity index (PSI) high-risk classes (IV and V), positive blood culture, admission to an intensive care unit (ICU), multi-lobar involvement and alcohol consumption were associated independently with prolonged LOS. Tobacco smoking was associated with a reduced LOS. The LOS varied markedly among centres. Only PSI high-risk class, admission to ICU and multi-lobar involvement were associated with early, late and global mortality. Positive blood cultures, antimicrobial therapy according to treatment guidelines and the establishment of an aetiological diagnosis were linked to reduced late and global mortality. These data suggest that early mortality associated with CAP is highly dependent on the clinical status of the patient at presentation. Conversely, late mortality seems to be associated more closely with clinical management factors; hence, an aetiological diagnosis and compliance with appropriate therapeutic guidelines have a significant influence on outcome.