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Throughout the COVID-19 Pandemic, an increase in self-harm behavior (SHB) among children and adolescents has been observed. The aim of this study is to examine the rise of SHB in children and adolescents during the COVID-19 Pandemic in a Pediatric Emergency Department, considering clinical and sociodemographic variables, and to analyze the potential impact of social restriction measures on the incidence of SHB compared to other known risk factors. Data for the study was obtained from 194 discharge reports of psychiatric pediatric emergency department visits between January 2019 and June 2021, inclusive, with subjects ranging in age from 7 to 17 years old. A logistic regression model was used for data analysis. Although not significant, higher rates of SHB were observed in adolescents during the first half of 2021 (73.5%; p = 0.06). A significantly higher risk of SHB was associated with the persistence of the Pandemic, but the variable 'Pandemic semester' explained only 8.0% of the variance, and the association lost significance when the variables 'female gender' and especially 'diagnosis of affective disorder' were introduced into the regression model, explaining 35% and 53% of the variance, respectively. The increased risk of SHB in minors during the COVID-19 Pandemic would not be generalizable to the entire child and adolescent population, but would occur especially in the group of adolescent girls with underlying affective psychopathology. Further clinical and functional impact must be assessed to provide effective measures to preserve psychosocial maturation of vulnerable young people. [ABSTRACT FROM AUTHOR]

Abstract: Mobilization patterns of energy reserves during starvation are highly variable among crustaceans, and understanding this process is useful to satisfy the nutritional requirements of cultured organisms. The aim of this study was to elucidate the mobilization patterns on early and advanced juveniles—first free stage and one‐gram juveniles—of redclaw crayfish (Cherax quadricarinatus). A biochemical approach was used to analyse the organic carbon, total proteins, lipids and glycogen levels of the entire animal, and a histochemical approach was adopted to identify location of metabolites in the hepatopancreas and abdominal muscle. While starvation did not affect early juvenile protein levels, it showed a significant decrease in advanced juveniles. Histochemical analysis showed that lipid storage of hepatopancreas R cells was depleted near point of no return (PNR) and recovered after feeding. Glycogen storage was localized in the F cells of the hepatopancreas, and among muscle fibres of the abdomen, where after feeding, a pronounced accumulation was observed. Early and advanced juveniles of redclaw crayfish showed different patterns of consumption mainly related to the protein level, which was the most abundant reserve in advanced juveniles and the most consumed during starvation. Hepatopancreas R cells were confirmed as the principal lipid storage, whereas the abdominal muscle was the main glycogen storage. In crustacean aquaculture, the understanding of resistance to temporary feed deprivation is relevant to achieve an adequate feeding management, thereby avoiding the overfeeding and diminishing operating costs. [ABSTRACT FROM AUTHOR]

Aichi Target 11 (AT11), adopted by 193 Parties to the Convention on Biological Diversity (CBD) in 2010, states that protected areas (PAs) must be equitably managed by 2020. However, significant challenges remain in terms of actual implementation of equitable management in PAs. These challenges include, among others, the lack of a standardized approach to assess and monitor social equity and the difficulty of reducing social equity to a series of metrics. This perspective addresses these challenges and it proposes a minimum set of ten indicators for assessing and monitoring the three dimensions of social equity in protected areas: recognition, procedure and distribution. The indicators target information on social equity regarding cultural identity, statutory and customary rights, knowledge diversity; free, prior and informed consent mechanisms, full participation and transparency in decision-making, access to justice, accountability over decisions, distribution of conservation burdens, and sharing of conservation benefits. The proposed indicator system is a first step in advancing an approach to facilitate our understanding of how the different dimensions of social equity are denied or recognized in PAs globally. The proposed system would be used by practitioners to mainstream social equity indicators in PAs assessments at the site level and to report to the CBD on the ‘equitably managed’ element of AT11. [ABSTRACT FROM AUTHOR]

The Northern Hemisphere (NH) stratospheric signals of eastern Pacific (EP) and central Pacific (CP) El Niño events are investigated in stratosphere-resolving historical simulations from phase 5 of the Coupled Model Intercomparison Project (CMIP5), together with the role of the stratosphere in driving tropospheric El Niño teleconnections in NH climate. The large number of events in each composite addresses some of the previously reported concerns related to the short observational record. The results shown here highlight the importance of the seasonal evolution of the NH stratospheric signals for understanding the EP and CP surface impacts. CMIP5 models show a significantly warmer and weaker polar vortex during EP El Niño. No significant polar stratospheric response is found during CP El Niño. This is a result of differences in the timing of the intensification of the climatological wavenumber 1 through constructive interference, which occurs earlier in EP than CP events, related to the anomalous enhancement and earlier development of the Pacific-North American pattern in EP events. The northward extension of the Aleutian low and the stronger and eastward location of the high over eastern Canada during EP events are key in explaining the differences in upward wave propagation between the two types of El Niño. The influence of the polar stratosphere in driving tropospheric anomalies in the North Atlantic European region is clearly shown during EP El Niño events, facilitated by the occurrence of stratospheric summer warmings, the frequency of which is significantly higher in this case. In contrast, CMIP5 results do not support a stratospheric pathway for a remote influence of CP events on NH teleconnections. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to determine the distribution of uridine diphosphate-glucuronosyltransferase 1A9 (UGT1A9) promoter region T-275A and C-2152T single-nucleotide polymorphisms (SNPs) in stable transplant patients and to investigate the impact of these SNPs on the evolution of this population after 10 years of follow-up. Methods White renal transplant recipients (n = 873) were studied. The median time of follow-up was 91.8 months (P25–75 46–146). Amplification with specific “primers” to delimit the study area was performed for each polymorphism. Amplification was performed with the use of real-time polymerase chain reaction. Results T-275A promoter mutation was detected in 13% of patients and C-2152T in 12% of patients. Survival analysis was performed on 873 renal transplants, carried out between 2004 and 2013. We found a higher frequency of death from cancer among polymorphism carriers ( P = .001). Conclusions It appears that carriers of T-275A and C-2152T SNPs of the UGT1A9 gene promoter region show a greater incidence of death from cancer, with a significantly higher cumulative incidence of death from gastrointestinal tumors. [ABSTRACT FROM AUTHOR]

A.I. Sánchez Fructuoso, N. Calvo, I. Perez-Flores, R. Valero, B. Rodríguez-Sánchez, D. García de Viedma, P. Muñoz, A. Barrientos. Mammalian target of rapamycin signal inhibitors could play a role in the treatment of BK polyomavirus nephritis in renal allograft recipients. Transpl Infect Dis 2011: 13: 584-591. All rights reserved Abstract: BK virus (BKV) nephropathy is a common viral infection in renal transplant patients, with a prevalence of 1-9% at approximately 12 months after surgery. While it is widely agreed that reduction of immunosuppression should be the first intervention after diagnosis of BKV infection, there is no consensus on whether calcineurin inhibitors or antiproliferative drugs should be reduced first. Furthermore, target levels of immunosuppressive drugs are poorly defined, as are criteria for replacing one immunosuppressive agent with another. Results. We report our series of 15 renal transplant patients who underwent surgery between September 2004 and March 2010 and who developed BKV infection. The first 8 patients were treated with reduction of immunosuppression; 7 of these patients received cidofovir and 6 received intravenous immunoglobulin. The remaining 7 renal transplant recipients received mammalian target of rapamycin inhibitors (imTOR). In this group, we observed faster and more efficacious BKV clearance in plasma and urine and a steady improvement in allograft function, with no episodes of acute allograft rejection during follow-up. The polymerase chain reaction assay for BKV in urine became positive in 2 patients in whom imTOR were stopped due to severe side effects. Conclusions. The use of imTOR should be considered a first step in the treatment of renal transplant recipients with BKV infection. In our experience, this change in treatment was safe and resulted in viral clearance. [ABSTRACT FROM AUTHOR]

Abstract: In this paper the numerical solution of a highly nonlinear model for the thermomechanical behavior of polythermal glaciers is presented. The modeling follows the shallow ice approximation (SIA) for glaciers introduced in Fowler (1997) . The model has been extended to incorporate additional moving boundaries and other nonlinear features. Moreover, a fixed domain formulation is proposed to avoid the computational drawbacks of a time-dependent domain in the numerical simulation with front tracking methods. In this setting, the coupled problem is decomposed into different nonlinear problems which allow one to obtain sequentially the profile evolution, the velocity field, the glacier surface and atmospheric temperatures, basal magnitudes and the temperature distribution inside the ice mass. A fixed point iteration algorithm converges to the solution of the nonlinear coupled problem. Among different numerical methods involved in the solution of the subproblems, characteristic schemes for time discretization, finite elements for spatial discretization, duality methods for the nonlinearities associated to maximal monotone operators and a Newton scheme for the nonlinear viscous term are proposed. Several numerical simulation examples illustrate the performance of the numerical methods and the behavior of the involved physical magnitudes. [Copyright &y& Elsevier]

Abstract: We compared the response to repeated social defeat in rats selected as high (HR) and low (LR) responders to novelty. In experiment 1, we investigated the behavioral and neuroendocrine effects of repeated social defeat in HR-LR rats. By the last defeat session, HR rats exhibited less passive-submissive behaviors than LR rats, and exhibited higher corticosterone secretion when recovering from defeat. Furthermore, in the forced swim test, while HR defeated rats spent more time immobile than their undefeated controls, LR rats'' immobility was unaffected by defeat. In experiment 2, we compared the effects of repeated social defeat on body, adrenal, thymus, and spleen weights in HR-LR rats; moreover, we compared the effects of repeated social defeat on stress related molecules gene expression in these two groups of rats. Our results show that HR rats exhibited a decrease in thymus weight after repeated social defeat that was not present in LRs. Analyses of in situ hybridization results found HR-LR differences in 5-HT2a mRNA levels in the parietal cortex and 5-HT1a mRNA levels in the dorsal raphe. Moreover, LR rats had higher glucocorticoid receptor (GR) mRNA expression than HR rats in the dentate gyrus, and repeated social defeat decreased this expression in LR rats to HR levels. Finally, hippocampal mineralcorticoid receptor (MR)/GR ratio was reduced in HR rats only. Taken together, our results show a differential response to social defeat in HR-LR rats, and support the HR-LR model as a useful tool to investigate inter-individual differences in response to social stressors. [Copyright &y& Elsevier]

Abstract: In this paper we develop a set of numerical techniques for the simulation of the profile evolution of a valley glacier in the framework of isothermal shallow ice approximation models. The different mathematical formulations are given in terms of a highly nonlinear parabolic equation. A first nonlinearity comes from the free boundary problem associated with the unknown basal extension of the glacier region. This feature is treated using a fixed domain complementarity formulation which is solved numerically by a duality method. The nonlinear diffusive term is explicitly treated in the time marching scheme. A convection dominated problem arises, so a characteristic scheme is proposed for the time discretization, while piecewise linear finite elements are used for the spatial discretization. The presence of infinite slopes in polar regimes motivates an alternative formulation based on a prescribed flux boundary condition at the head of the glacier instead a homogeneous Dirichlet one. Finally, several numerical examples illustrate the performance of the proposed methods. [ABSTRACT FROM AUTHOR]

The Brewer–Dobson circulation strengthens in the lowermost tropical stratosphere during warm El Niño–Southern Oscillation (ENSO) events. Dynamical analyses using the most recent version of the Whole Atmosphere Community Climate Model show that this is due mainly to anomalous forcing by orographic gravity waves, which maximizes in the Northern Hemisphere subtropics between 18 and 22 km, especially during the strongest warm ENSO episodes. Anomalies in the meridional gradient of temperature in the upper troposphere and lower stratosphere (UTLS) are produced during warm ENSO events, accompanied by anomalies in the location and intensity of the subtropical jets. This anomalous wind pattern alters the propagation and dissipation of the parameterized gravity waves, which ultimately force increases in tropical upwelling in the lowermost stratosphere. During cold ENSO events a similar signal, but of opposite sign, is present in the model simulations. The signals in ozone and water vapor produced by ENSO events in the UTLS are also investigated. [ABSTRACT FROM AUTHOR]

Abstract: A shallow ice thermocoupled model for the complex nonlinear polythermal ice sheet dynamics is proposed and solved by means of efficient numerical methods. A novelty is the obstacle problem formulation associated to a nonlinear integro-differential equation (with nonlocal temperature dependent coefficients) for the ice sheet profile. This formulation is motivated by the free boundary feature and the influence of the temperature on the profile (fully nonisothermal model). Concerning the temperature equation, a dynamically prescribed surface temperature, obtained from an Energy Balance model corrected by the altitude effect, is posed. As the profile and temperature equations are fully coupled, a nonlinear PDE system governing the upper ice sheet profile, the velocity field, the temperature and the basal stress is stated. In addition to the numerical difficulties associated to the new profile equation, several techniques have been considered for the numerical solution of the temperature, velocity and basal magnitudes. Discussions concerning the nonlinear dynamics of the different involved magnitudes and the improvement in their computed values with respect to previous works are also presented. [Copyright &y& Elsevier]

The here presented GLAciology NUmerical SImulation Toolbox (GLANUSIT) is a software application which provides a user friendly environment for the numerical simulation of large ice masses evolution. The graphical user interface has been developed in MATLAB while the core of GLANUSIT contains the original FORTRAN codes, which develop the specific numerical methods for the solution of the complex shallow ice model. This highly nonlinear model governs the coupled thermodynamical and hydrodynamical processes. The global algorithm mainly consists on a fixed point iteration between the different subproblems. The numerical solution of each subproblem requires specific techniques, which are not common in present software packages, as for example the part of moving boundaries solvers included in the code. Finally, a practical case study with real data is presented. [Copyright &y& Elsevier]

This work deals with the numerical solution of a complex mathematical model arising in theoretical glaciology. The global moving boundary problem governs thermomechanical processes jointly with ice sheet hydrodynamics. One major novelty is the inclusion of the ice velocity field computation in the framework of the shallow ice model so that it can be coupled with profile and temperature equations. Moreover, the proposed basal velocity and shear stress laws allow the integration of basal sliding effects in the global model. Both features were not taking into account in a previous paper (Math. Model. Methods Appl. Sci. 12 (2) (2002) 229) and provide more realistic convective terms and more complete Signorini boundary conditions for the thermal problem. In the proposed numerical algorithm, one- and two-dimensional piecewise linear Lagrange finite elements in space and a semi-implicit upwinding scheme in time are combined with duality and Newton''s methods for nonlinearities. A simulation example involving real data issued from Antarctic shows the temperature, profile and velocity qualitative behaviour as well as the free boundaries and basal effects. [Copyright &y& Elsevier]

This paper deals with the weak formulation of a free (moving) boundary problem arising in theoretical glaciology. Considering shallow ice sheet flow, we present the mathematical analysis and the numerical solution of the second order nonlinear degenerate parabolic equation modelling, in the isothermal case, the ice sheet non-Newtonian dynamics. An obstacle problem is then deduced and analyzed. The existence of a free boundary generated by the support of the solution is proved and its location and evolution are qualitatively described by using a comparison principle and an energy method. Then the solutions are numerically computed with a method of characteristics and a duality algorithm to deal with the resulting variational inequalities. The weak framework we introduce and its analysis (both qualitative and numerical) are not restricted to the simple physics of the ice sheet model we consider nor to the model dimension; they can be successfully applied to more realistic and sophisticated models related to other geophysical settings. [ABSTRACT FROM AUTHOR]

In this work we propose a new numerical method for solving a thermomechanical coupled problem which arises as a mathematical model for the evolution of ice sheets profiles and the corresponding temperatures. From the accumulation-ablation ratio, the atmospheric temperature and the geothermic flux, the ice sheet profile is the solution of a moving boundary problem governed by a nonlinear convection-diffusion equation. Moreover, the mathematical model which governs the temperature distribution involves three nonlinearities: a reaction term due to the viscous dissipation, a Signorini boundary condition associated to the geothermic flux and an enthalpy term issued from the two-phase Stefan formulation of the polythermal regime. The problems are discretized in time with upwind characteristics schemes and in space with finite elements. The nonlinearities are solved either by fixed point methods or by duality techniques. Several numerical simulation examples involving real data sets issued from the Antartic ice sheet are shown. [ABSTRACT FROM AUTHOR]

Background. Literature comparing different alternatives for pain control in the immediate postoperative period of pediatric acute appendicitis (PAA) is scarce. Materials and methods. We prospectively compared the analgesic and emetogenic profile of intravenous ibuprofen and metamizole in the immediate postoperative period of PAA. For this purpose, we used a sample of patients operated on in 2021 in our center. Participants were recruited on arrival at the Emergency Department and histopathological confirmation of the diagnosis was obtained in all of them. Pain was evaluated every 8 hours after the surgery with validated visual analog scales ranging from 0 to 10 points. Repeated measures ANOVA was used to compare the evolution of pain in the 48 hours after surgery between the two groups. Results. The sample included 95 patients (65% males) with a mean age of 9.7 years (sd: 3.14). 41 patients were treated with Ibuprofen (group 1) and 54 with metamizole (group 2). No significant differences were found in the level of pain either in the comparisons of point measurements or in its evolution in the 48 hours after surgery (p= 0.58). After adjusting for the received fluid therapy, children in the metamizole group had significantly more emetic episodes and needed significantly more doses of ondansetron. Conclusions. In our cohort, ibuprofen had a similar analgesic efficacy and a better emetogenic profile than metamizole in the immediate postoperative period of PAA. Future prospective, adequately controlled studies with larger sample sizes are needed to validate these findings. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The incidence of candiduria in renal transplant recipients is unknown. In clinical practice, the indications for antifungal therapy are not well established. Furthermore, there is the problem of the choice of the antifungal drug since some of them may select resistant Candida species, or interact with immunosuppressive agents or only be used intravenously. Aim: We sought to study the incidence, clinical repercussions and effectiveness of antifungal treatment to prevent recurrence of candiduria. Materials and methods: We examined all episodes of Candida-positive urine cultures (>50,000 cfu/mL) in 996 recipients over 2 years. We considered the Candida species, administered treatment, presence of fever, requirement for hospital admission versus outpatient case, occurrence of simultaneous bacterial urinary tract infection (UTI), antibiotic use during the week before candiduria, and presence of an indwelling urinary catheter. Results: Among 996 subjects, 34 displayed 83 episodes of candiduria, yielding an accumulated incidence of 3.4% after 2 years. The frequency was higher among women (6.3% vs 1.7%, P < .001). Of the 45 outpatient episodes (54.2%), 17 were treated and one required hospitalization (5.9%). Of the 28 nontreated outpatients, two were hospitalized (7.1%, P = .68 vs treated patients). All cases of hospital admission presented simultaneous bacterial UTI, none developed candidemia, and two patients did not receive any antifungal therapy. With respect to the first episodes of each patient (n = 34), 5/11 treated (45.5%) and 4/23 untreated (17.4%) patients developed recurrences (P = .095). Selection of more resistant Candida species was not observed. Fifty cases (60%) were associated with antibiotic therapy and 34 (41%) the presence of a urinary catheter. Conclusions: It does not seem necessary to treat candiduria in this setting. Antifungal therapy was not associated with either a reduction in recurrence or the appearance of more resistant species in this study. We observed no important clinical repercussions. [Copyright &y& Elsevier]

Abstract: Introduction: mTOR inhibitors (imTOR) are immunosuppressive drugs that have a concentration-related effects on hematopoiesis, potentially resulting in anemia. The reason is uncertain, but a pathogenic link between sirolimus-induced anemia and the appearance of an inflammatory state was recently suggested. Because inflammation-related anemia is characterized by a functional iron deficiency, we studied whether everolimus influenced iron homeostasis. Methods: We studied iron homeostasis in 43 patients after late introduction of everolimus into the immunosuppressive treatment. Thirty-seven patients (86%) were receiving mycophenolate. Hemoglobin concentration, red blood cell count, mean corpuscular volume, serum iron, ferritin, C-reactive protein levels, and transferrin saturation were evaluated 3 months before and 1, 3, and 6 months after the switch. Results: The percentage of anemic patients preconversion was 18.6% and it was 34.9% at 3 months and 18.6% at 6 months. We did not observe a significant reduction in hemoglobin, but there was increased red blood cell count after everolimus introduction, with a significant reduction in mean corpuscular volume. Serum iron and transferrin saturation levels were also markedly reduced after the switch, while ferritin serum concentrations remained stable. An improvement in renal function was observed. Conclusions: The anemia caused by everolimus—microcytosis, low serum iron, despite high ferritinemia, and elevated C-reactive protein levels—was consistent with the anemia of a chronic inflammatory state. This alteration occurred within the first months postconversion and disappeared at 6 months. The combination of mycophenolate and everolimus seemed to be useful without significant secondary effects. [Copyright &y& Elsevier]

Abstract: Introduction: Enteric-coated mycophenolate sodium (EC-MPS) is the enteric-coated salt form of mycophenolic acid (MPA), the active component of the prodrug mycophenolate mofetil. EC-MPS was developed to reduce the upper-gastrointestinal (GI) effects of mycophenolate mofetil. There are no studies available comparing trough plasma levels in patients with GI intolerance to MMF when they are converted to EC-MPS. Aim: To compare the GI tolerance and the MPA levels in patients previously treated with MMF in whom this drug was replaced by EC-MPS. Materials and methods: A prospective study was conducted in 133 renal transplant patients after conversion from MMF to EC-MPS (median time posttransplant 42 months, range 1 to 240 months). The causes for EC-MPS switching were GI intolerance to MMF (51.9%; group A), low trough plasma levels with MMF (29.3%; group B), and others (18.8%; group C). These patients were converted to equipotent doses of EC-MPS. Results: The trough plasma MPA levels increased from 1.5 ± 1.1 μg/mL at baseline to 2.5 ± 2.0 μg/mL at 1 month postconversion despite the equipotent EC-MPS doses not being increased. These higher plasma levels were maintained throughout the study. In group A, this increase was from 1.8 ± 1.0 to 2.7 ± 2.1 μg/mL (P = .01) and in group B from 0.8 ± 0.4 to 2.4 ± 1.4 μg/mL (P < .001). The doses and levels of calcineurin inhibitor decreased from baseline. Creatinine clearance improved from 56.5 ± 24.7 mg/dL at baseline to 61.9 ± 28.6 at 6 months postconversion (P = .02). There was a statistically significant increase in hemoglobin levels. In group A, the GI tolerance improved in 78% of the patients. Conclusions: At equipotent doses, patients converted to EC-MPS have higher and more adequate levels of MPA. At 6 months postconversion, we observed an improvement of the renal function, probably due to a reduction of calcineurin inhibitor drugs. However, the possibility that a better immunosuppressive efficacy as demonstrated by more suitable trough plasma levels may have been a contributing factor cannot be discarded. [Copyright &y& Elsevier]

Abstract: The introduction of mycophenolate mofetil (MMF) was an important advance in immunosuppressive therapy, although its use is limited by adverse gastrointestinal events. Enteric-coated mycophenolate sodium (EC-MPS; myfortic) has been developed to avoid these side effects. Recent clinical trials have demonstrated that EC-MPS is a safe drug in both de novo and maintenance renal transplant patients. In this prospective study, therapeutically equivalent doses of EC-MPS were administered to 39 stable kidney transplant patients receiving MMF. After 3 months of treatment with EC-MPS the incidence of adverse gastrointestinal events was lower (15.8% of the patients). There were higher levels of mycophenolic acid after conversion to EC-MPS, probably due to better absorption. These factors allowed decreased doses and levels of calcineurin inhibitors without increasing the risk of graft rejection. At 3 months postconversion, serum creatinine improved from the mean baseline value of 1.83 ± 0.12 mg/dL to 1.70 ± 0.10 mg/dL. In conclusion, EC-MPS was well tolerated in maintenance renal transplant patients with adverse gastrointestinal events secondary to MMF. [Copyright &y& Elsevier]

Whooping cough is a respiratory infection with a severity that varies with age, immune status, and probably with other factors such as the degree of exposure and the virulence of the organism. The most frequent microorganism responsible for whooping cough is Bordetella pertussis. We present the case of a 62-year-old renal transplant recipient presenting with typical and severe manifestations of whooping cough caused by B. pertussis. [ABSTRACT FROM AUTHOR]

This study provides a long-term (1891–2014) global assessment of precipitation trends using data from two station-based gridded datasets and climate model outputs evolved through the fifth and sixth phases of the Coupled Model Intercomparison Project (CMIP5 and CMIP6, respectively). Our analysis employs a variety of modeling groups that incorporate low- and high-top level members, with the aim of assessing the possible effects of including a well-resolved stratosphere on the model's ability to reproduce long-term observed annual precipitation trends. Results demonstrate that only a few regions show statistically significant differences in precipitation trends between observations and models. Nevertheless, this pattern is mostly caused by the strong interannual variability of precipitation in most of the world regions. Thus, statistically significant model-observation differences on trends (1891–2014) are found at the zonal mean scale. The different model groups clearly fail to reproduce the spatial patterns of annual precipitation trends and the regions where stronger increases or decreases are recorded. This study also stresses that there are no significant differences between low- and high-top models in capturing observed precipitation trends, indicating that having a well-resolved stratosphere has a low impact on the accuracy of precipitation projections. [ABSTRACT FROM AUTHOR]

Background Although acute vascular rejection (AVR) is associated with a high risk of graft loss, it remains unclear whether AVR with accompanied cellular or humoral rejection (AHR) has dissimilar outcomes. The aim of this study was to examine the association between subtypes of AVR and graft loss. Methods We assessed patients who provided biopsy samples for acute allograft rejection from 1998 to 2014. To investigate distinct rejection patterns, we retrospectively assessed rejection episodes with review of graft histology as well as donor-specific anti-HLA antibodies when available. Results A total of 1,004 patients were biopsied and included in the main analyses, of which 259 (32.87%) had acute biopsy-proven rejection. We identified three patterns of graft rejection defined according to the presence of peritubular capillaritis (ptc): a) T-cell–mediated acute vascular rejection if ptc free; b) humoral-mediated acute vascular rejection if ptc >0; and c) T-cell–mediated rejection if vasculitis = 0 and ptc = 0 (148 [57%], 70 [27%], and 41 [16%], respectively). At 5 years, graft survival was lower among patients with ptc-vascular rejection than those with T-cell vascular rejection (72.3% vs 83.2%; P = .010). T-cell–mediated rejection without vasculitis had similar survival compared with rejection absence (89.3% vs 8 9.2%; P = .698). Multivariate analysis adjusted by age and sex showed that risk of graft loss was higher in biopsies with high scores of glomerulitis (g2-g3); vasculitis (v2-v3), capillaritis (ptc2-ptc3), or interstitial inflammation (i2-i3). However, tubulitis and C4d were not statically significant. Conclusions We conclude that antibody-mediated AVR involves a poorer prognosis than T-cell–mediated AVR. The presence of tubulitis does not seem to determine a poor long-term renal graft prognosis. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Persistence of inappropriately high serum levels of fibroblast growth factor-23 (FGF23), a recently discovered phosphaturic hormone, has been reported to play an important role in the pathogenesis of posttransplant hypophosphatemia. The aim of the present study was to evaluate FGF23 in the early posttransplant period and study the complex associations between FGF23, parathyroid hormone (PTH), 1,25(OH)2 vitamin D, and phosphate in transplant patients. Materials and methods: We performed a cross-sectional observational study of 42 adult kidney recipients in the early posttransplant period (<6 months). Fasting serum samples and 24-hour urine samples were collected during a routine follow-up outpatient visit. Serum creatinine, calcium, phosphate, magnesium and urinary creatinine, calcium, magnesium, and phosphate were measured using standard assays. We also studied concentrations of 25 hydroxyvitamin D, 1,25(OH)2 vitamin D, intact PTH, and circulating FGF23. Results: Median values for the different parameters studied were as follows: 9.9 ± 0.6 mg/dL, phosphatemia 3.3 ± 0.7 mg/dL, estimated glomerular filtration rate (eGFR; 41.1 ± 14.0 mL/min, phosphate reabsorption rate 68.4% ± 10.7%, PTH 94.5 ng/L (53.8–199.5), calcitriol 33.0 pg/mL (24.0–44.1), calcidiol 27.3 ng/mL (17.0–38.0), FGF23 139 pg/mL (88–221), and calciuria 62.5 mg/d (40.3–101.3). The variables significantly associated with serum FGF23 levels were phosphate reabsorption rate (r = .493; P = .001), calcitriol (r = .399; P = .009), eGFR (r = .557; P < .001), PTH (0.349; P = .024). Conclusions: Elevated serum levels of FGF23 could explain the deficiency of calcitriol and elevated renal phosphorus wasting in the early posttransplant period. All treatments that can lead to increased serum phosphate levels (eg, oral medication or calcitriol) should be carefully evaluated, since increased phosphatemia could further stimulate secretion of FGF23 and prolong high phosphorus loss. [Copyright &y& Elsevier]

Purpose: Physicians and nurses often underestimate the incidence of chemotherapy-induced nausea and vomiting (CINV) after both highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). This study assesses physicians' and nurses' perceptions of CINV in their own practices after the introduction of aprepitant.Methods: A prospective observational study of patients receiving the first cycle of HEC regimens with CDDP and without CDDP or MEC was performed. Eligible patients completed a 6-day diary recording emetic episodes, nausea assessment, and antiemetic medication use. Physicians and nurses estimated the incidence of acute and delayed CINV after the first administration of HEC and MEC. The observed incidence rates of CINV were compared with the rates predicted by healthcare providers. Aprepitant was given to patients receiving HEC regimes with CDDP.Results: Twenty-nine physicians and nurses and 95 patients (87% receiving HEC and 14% MEC) were recruited. The global control of CINV was 66.67% for all patients and 73.33%, 47.06%, and 55.56% for patients receiving HEC regimens with CDDP, HEC regimens without CDDP and MEC, respectively. Physicians and nurses underestimated the control of acute CINV in patients receiving HEC regimens with CDDP, but they accurately predicted the control of delayed CINV. All physicians and nurses predicted the control of acute CINV after HEC regiments without CDDP and after MEC quite accurately, whereas they overestimated the control of delayed CINV after both regimens.Conclusions: Aprepitant allows for better control of CINV in HEC regimens with CDDP, and this control is accurately perceived by physicians and nurses. However, physicians and nurses overestimate the control of delayed CINV after HEC regimens without CDDP and after MEC. CINV is still an important target for improved therapeutic intervention and the healthcare providers must be aware of its actual incidence. [ABSTRACT FROM AUTHOR]

Antidepressant medications are effective only in a subpopulation of patients with depression, and some patients respond to certain drugs, but not others. The biological bases for these clinical observations remain unexplained. To investigate individual differences in response to antidepressants, we have examined the effects of the norepinephrine reuptake inhibitor desipramine (DMI) and the selective serotonin reutake inhibitor fluoxetine (FLU) in the forced swim test (FST) in rats that differ in their emotional behavior. As response to novelty correlates with numerous other measures of emotionality and substance abuse, we contrasted animals that are high responders (HR) in a novel environment with animals that are low responders (LR) and asked whether the two groups exhibit differential responses to DMI (10mg/kg) and FLU (20mg/kg). At the behavioral level, DMI caused a significant decrease in immobility in LR animals only, while FLU caused a significant reduction in immobility in both groups. Moreover, at the neural level, DMI treatment led to a decrease in FST-induced c-fos messenger RNA levels in medial prefrontal cortex (PFC) and paraventricular nucleus of the hypothalamus (PVN) in LR but not HR animals. Taken together, our results suggest that the HR-LR model is a useful tool to investigate individual differences in responses to norepinephrine reuptake inhibitors (NRIs) and that a differential activation of PFC and/or PVN could underlie some of the inter-individual differences in the efficacy of NRIs. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: We investigated the incidence and risk factors for the metabolic syndrome (MS) and posttransplant diabetes mellitus (PTDM) among renal transplant recipients on tacrolimus-based immunosuppressive regimens during the first year posttransplant. In addition, we studied the relationship between MS and PTDM with transplant renal function at 1 year. Methods: We included the 100 patients who received a renal transplant in our unit between January 2007 and June 2008, collecting demographic, clinical and biochemical characteristics at 1, 6, and 12 months posttransplantation. We excluded 15% of patients with pretransplantation diabetes. MS was defined according to the National Cholesterol Education Program criteria and PTDM according to World Health Organization criteria. Insulin resistance at one year posttransplant was measured using the homeostasis model assessment (HOMA) index. Results: Insulin therapy was required in 46% of patients during the first hospitalization and hyperglycemia was present in 65% of the cases. The incidence of PTDM decreased throughout the first year posttransplant, namely, 44%, 24%, and 13% at 1, 6, and 12 months, respectively. The incidence of MS increased to 33%, 48% and 50% at 1, 6, and 12 months, respectively. Age, body mass index, plasma fasting glucose levels at 1 month posttransplant, and pretransplant fasting triglyceridemia predicted PTDM. Rejection and in-patient hyperglycemia predicted MS. PTDM and MS were closely correlated (P = .004). The HOMA index was higher among patients with MS than other subjects at 1 year posttransplant: 3.2 (1.2) versus 2.3 (0.9; P = .035). Neither PTDM nor MS was associated with impaired plasma creatinine levels at 1 year after kidney transplantation. Conclusion: There was an high incidence of PTDM and MS among kidney transplant recipients treated with tacrolimus as the main immunosuppressive agent. The HOMA index was a good test of insulin resistance in this population. Screening and treatment of risk factors may avoid the development of these entities, which are related to poor cardiovascular outcomes. [Copyright &y& Elsevier]

Abstract: Everolimus has recently been introduced into clinical practice with promising perspectives due to its efficacy, lack of nephrotoxicity, and antitumor effects. Experience in clinical trials associated with low-dose cyclosporine showed good results, but there is almost no experience in calcineurin inhibitor (CNI) elimination learning it as the primary immunosuppressant. We describe our experience in a series of 78 stable renal transplant patients who were switched to Everolimus with complete and quick elimination of the CNI: the procedure of conversion, pharmacokinetic results after conversion, evolution of renal parameters (renal function, proteinuria, and others), and safety data (acute rejection and adverse events). An initial dose of 3 mg/d was adequate to obtain the recommended trough levels between 5 and 10 ng/mL. Our results demonstrated that conversion to Everolimus was a simple, safe procedure that must be considered in patients CNI toxicity, especially those with malignant neoplasms and progressive deterioration of renal function due to chronic allograft nephropathy. [Copyright &y& Elsevier]

Abstract: Disseminated varicella-zoster virus (VZV) infection in adult renal allograft recipients is a rare but potentially fatal illness. We retrospectively collected the cases of VZV infection that occurred in 812 adult renal transplant recipients, performed between 1995 and 2004 at our institution. Eight patients developed varicella (1%), seven men and one woman. The overall median age was 38 years (range = 31 to 64). The median time from transplantation to infection was 32 months (range = 2 to 92). Four cases were primary infections and four disseminated VZV reactivations. Immunosuppression consisted of prednisone (PDN) + cyclosporine (CSA) + mycophenolate (MF; n = 4); PDN + CSA + azathioprine (n = 1); PDN + tacrolimus (FK) + MF (n = 1); FK + MF (n = 1); PDN + rapamycin + MF (n = 1). Seven patients (87%) required hospital admission for a median duration of 11 days (range = 3 to 21). Four patients were previously diagnosed with chronic hepatitis virus infection: two type B (HBV) and two type C (HCV). The last cohort required longer admission than the negative patients (11.5 ± 3 vs 7.5 ± 9 days; P = .1). The only clinical manifestation in four patients was general malaise, fever, and a disseminated vesicular rash; the other four patients also showed visceral involvement: two pneumonitis, one hepatitis, and thrombotic microangiopathy, and one developed multiorgan failure and died due to a delayed diagnosis in a patient positive for HBVs. The diagnosis was established according to the symptoms, IgG-IgM seroconversion and VZV polymerase chain reaction quantification in vesicle contents. Treatment consisted of reduced immunosuppression, antiviral drugs (acyclovir or gancyclovir), and in six patients, a varicella-zoster immunoglobulin dose. We concluded that varicella infection in adult renal allograft recipients is unusual but highly morbid. A vaccination program in seronegative pretransplant candidates should be attempted. Early diagnosis and treatment may improve the prognosis. Although further studies are required, chronic HBV or HCV infection seemed to be a risk factor for the disease. [Copyright &y& Elsevier]

The European precipitation response to El Niño (EN) has been found to present interdecadal changes, with alternated periods of important or negligible EN impact in late winter. These periods are associated with opposite phases of multi-decadal sea surface temperature (SST) variability, which modifies the tropospheric background and EN teleconnections. In addition, other studies have shown how SST anomalies in the equatorial Pacific, and in particular, the location of the largest anomalous SST, modulate the stratospheric response to EN. Nevertheless, the role of the stratosphere on the stationarity of EN response has not been investigated in detail so far. Using reanalysis data, we present a comprehensive study of EN teleconnections to Europe including the role of the ocean background and the stratosphere in the stationarity of the signal. The results reveal multidecadal variability in the location of EN-related SST anomalies that determines different teleconnections. In periods with relevant precipitation signal over Europe, the EN SST pattern resembles Eastern Pacific EN and the stratospheric pathway plays a key role in transmitting the signal to Europe in February, together with two tropospheric wavetrains that transmit the signal in February and April. Conversely, the stratospheric pathway is not detected in periods with a weak EN impact on European precipitation, corresponding to EN-related SST anomalies primarily located over the central Pacific. SST mean state and its associated atmospheric background control the location of EN-related SST anomalies in different periods and modulate the establishment of the aforementioned stratospheric pathway of EN teleconnection to Europe too. [ABSTRACT FROM AUTHOR]

Background: Inflammation related molecules such as tumor necrosis factor‐α (TNF‐α), interleukin 6 (IL‐6), and cardiotrophin‐1 (CT‐1) are highly expressed in obese individuals and could partly explain some comorbidities associated to obesity. In obese children, lifestyle interventions are able to lower inflammation and reduce cardiovascular risk factors associated with obesity. The aim of the present work was to study changes in inflammation‐related molecules serum and peripheral blood mononuclear cells (PBMC) transcript levels after a 10‐week lifestyle intervention in obese children and asses their potential association with glucose metabolism. Methods: Twenty‐three obese children (mean age 11.5 years; 48% males) underwent a 10‐week lifestyle not controlled intervention trial. Anthropometric and biochemical measurements were analyzed. Transcript analysis for CT‐1, IL‐6, and TNF‐α in PBMC were performed by RT‐PCR. Serum cytokine levels were also measured at baseline and after 10‐weeks. Results: Participants achieved a significant reduction in body adiposity (0.34 decrease in body mass index‐standard deviation), total cholesterol, and glucose levels after 10‐weeks. A Significant decrease in serum TNF‐α and C reactive protein (CRP) were observed. CT‐1 transcript levels were significantly reduced (P = .005) after lifestyle intervention, and these changes were significantly correlated with changes in serum CT‐1 levels (r = 0.451; P = .031). In multiple regression analysis baseline CT‐1 transcript levels were positively associated with final insulin (R2 = 0.506; P = .035) and HOMA‐IR values (R2 = 0.473; P = .034). Conclusions: We reported that serum CRP, TNF‐α, as well as PBMC CT‐1 transcript levels were reduced after lifestyle intervention in obese children. More studies are needed to clarify the role of inflammation‐related molecules in glucose metabolism. [ABSTRACT FROM AUTHOR]

Both modern humans (MHs) and Neanderthals successfully settled across western Eurasian cold-climate landscapes. Among the many adaptations considered as essential to survival in such landscapes, changes in the nasal morphology and/or function aimed to humidify and warm the air before it reaches the lungs are of key importance. Unfortunately, the lack of soft-tissue evidence in the fossil record turns difficult any comparative study of respiratory performance. Here, we reconstruct the internal nasal cavity of a Neanderthal plus two representatives of climatically divergent MH populations (southwestern Europeans and northeastern Asians). The reconstruction includes mucosa distribution enabling a realistic simulation of the breathing cycle in different climatic conditions via computational fluid dynamics. Striking across-specimens differences in fluid residence times affecting humidification and warming performance at the anterior tract were found under cold/dry climate simulations. Specifically, the Asian model achieves a rapid air conditioning, followed by the Neanderthals, whereas the European model attains a proper conditioning only around the medium-posterior tract. In addition, quantitative-genetic evolutionary analyses of nasal morphology provided signals of stabilizing selection for MH populations, with the removal of Arctic populations turning covariation patterns compatible with evolution by genetic drift. Both results indicate that, departing from important craniofacial differences existing among Neanderthals and MHs, an advantageous speciesspecific respiratory performance in cold climates may have occurred in both species. Fluid dynamics and evolutionary biology independently provided evidence of nasal evolution, suggesting that adaptive explanations regarding complex functional phenotypes require interdisciplinary approaches aimed to quantify both performance and evolutionary signals on covariation patterns. [ABSTRACT FROM AUTHOR]

Abstract: Background: Preemptive living donor kidney transplantation is associated with better allograft and recipient survival. However, it remains unclear whether preemptive transplantation from deceased donors is beneficial too. An increased number of deceased donors has reduced the waiting list in our hospital in the last years allowing preemptive deceased donor kidney transplantation (PDDKT). Aim: We compared our experience with preemptive transplantation with patients who underwent dialysis before transplantation. Patients and Methods: Thirty-three PDDKT, including 77.5% male patients of overall mean age of 48 ± 14 years, were performed in our hospital between January 1999 and December 2004 (8% of transplantations). We compared the outcomes of these patients with those of renal transplants in subjects who had undergone dialysis. The donors for both groups had similar characteristic; they were paired donor kidneys in most cases. Results: The types of donors in both groups were: non–heart-beating (49%), heart-beating deceased (27%) or en bloc pediatric (24%). The serum creatinine of the recipients was 6.9 ± 1.8 mg/dL prior to transplantation, and the creatinine clearance was 14.6 ± 3.6 mL/min (estimated by the Cockroft-Gault formula). The Charlson comorbidity index adapted for patients with advanced chronic kidney disease (ACKD) was 0.8 ± 0.2 in the preemptive group versus 1.7 ± 0.4 in the dialysis group (P < .05). Delayed graft function rates were 0% versus 25% in preemptive vs dialysis groups, respectively. No differences in 1-month or 1-year renal function as determined by serum creatinine were observed between the groups. We did not observe differences in the incidence of acute rejection or 1- and 2-year graft and patient survivals. Conclusion: PDDKT is the treatment of choice for ACKD. It is associated with less delayed graft function and similar 2-year graft and patient survivals than kidney transplantation after dialysis. The Charlson index reflected less comorbidity among patients with PDDKT, a finding that must influence long-term outcomes. [Copyright &y& Elsevier]

Background Renal transplantation has been established as the treatment of choice for end-stage renal disease (ESRD) due to diabetic nephropathy. This study aimed to investigate the risk factors for recurrence of diabetic nephropathy (RDN) in renal allografts. Methods We studied 1,011 renal transplant patients from 1986 to 2003, of which 95 had ESRD due to diabetic nephropathy. We retrospectively analyzed the clinical characteristics and outcomes of RDN after renal transplantation. Results Of the 95 recipients with ESRD due to diabetic nephropathy, 41 developed RDN and 11 of those 41 underwent graft biopsy. The mean durations from transplantation to RDN and to renal replacement therapy was 81.58 months (range, 54–120 mo), and 109.66 months (range, 27–188.4 mo), respectively. At 5 years, treatment on statins and renin-angiotensin-aldosterone system (RAAS) blockers were associated with a higher survival free from RND (82.2% vs 63.2% [ P = .070] and 100% vs 80% vs 0.6% [ P = .013], respectively). Compared with cyclosporine, tacrolimus was associated with a higher risk for RND (odds ratio [OR], 4.27; 95% confidence interval [CI], 1.75–5.13; P = .047). High doses of prednisone (>0.06 mg/kg) were also associated with a higher risk of RDN (OR, 3.03; 95% CI, 1.19–8.30; P = .029). The combination of calcineurin inhibitor and mammalian target of rapamycin inhibitor (mTORi) demonstrated the highest risk of RDN (OR, 14.08; 95% CI, 3.72–53.29; P < .01). Conclusions Treatment with tacrolimus and mTORi is the most diabetogenic immunosuppressive regimen. Treatment with tacrolimus entails a greater risk of RDN than with cyclosporine. The administration of statins or RAAS blockers could delay the progression of RDN. [ABSTRACT FROM AUTHOR]

BACKGROUND: Catheter ablation (CA) and minimally invasive surgical ablation (SA) have become accepted therapy for antiarrhythmic drug-refractory atrial fibrillation. This study describes the first randomized clinical trial comparing their efficacy and safety during a 12-month follow-up. METHODS AND RESULTS: One hundred twenty-four patients with antiarrhythmic drug-refractory atrial fibrillation with left atrial dilatation and hypertension (42 patients, 33%) or failed prior CA (82 patients, 67%) were randomized to CA (63 patients) or SA (61 patients). CA consisted of linear antral pulmonary vein isolation and optional additional lines. SA consisted of bipolar radiofrequency isolation of the bilateral pulmonary vein, ganglionated plexi ablation, and left atrial appendage excision with optional additional lines. Follow-up at 6 and 12 months was performed by ECG and 7-day Holter recording. The primary end point, freedom from left atrial arrhythmia >30 seconds without antiarrhythmic drugs after 12 months, was 36.5% for CA and 65.6% for SA (P=0.0022). There was no difference in effect for subgroups, which was consistent at both sites. The primary safety end point of significant adverse events during the 12-month follow-up was significantly higher for SA than for CA (n=21 [34.4%] versus n=10 [15.9%]; P=0.027), driven mainly by procedural complications such as pneumothorax, major bleeding, and the need for pacemaker. In the CA group, 1 patient died at 1 month of subarachnoid hemorrhage. CONCLUSION: In atrial fibrillation patients with dilated left atrium and hypertension or failed prior atrial fibrillation CA, SA is superior to CA in achieving freedom from left atrial arrhythmias after 12 months of follow-up, although the procedural adverse event rate is significantly higher for SA than for CA. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov. Unique identifier: NCT00662701. [ABSTRACT FROM AUTHOR]

Background Despite inoculation into blood culture bottles, ascitic fluid culture is negative in 50% of cases of spontaneous bacterial peritonitis (SBP). Aim To determine whether 16S rDNA gene detection by real-time polymerase chain reaction (PCR) and sequencing increases the efficacy of culture in microbiological diagnosis of spontaneous bacterial peritonitis. Methods We prospectively included 55 consecutive spontaneous bacterial peritonitis episodes in cirrhotic patients, 20 cirrhotic patients with sterile ascites and 27 patients with neoplasic ascites. Ascitic fluid was inoculated into blood culture bottles at the bedside and tested for bacterial DNA by real-time PCR and sequencing of 16S rDNA gene. Results Bacterial DNA was detected in 23 / 25 (92%) culture-positive SBP, 16 / 30 (53%) culture-negative SBP (P = 0.002 with respect to culture-positive SBP), 12 / 20 (60%) sterile ascites (P = 0.01 with respect to culture-positive SBP) and 0 / 27 neoplasic ascites (P < 0.001 with respect to other groups). Sequencing identified to genus or species level 12 culture-positive SBP, six culture-negative SBP and six sterile ascites. In the remaining cases with positive PCR, sequencing did not yield a definitive bacterial identification. Conclusions Bacterial DNA was not detected in almost half the culture-negative spontaneous bacterial peritonitis episodes. Methodology used in the present study did not always allow identification of amplified bacterial DNA. [ABSTRACT FROM AUTHOR]

The quasibiennial oscillation (QBO) dominates the variability of the equatorial stratosphere and also affects the circulation and temperature of the extratropical region. In this paper we review previous work showing that the mid- to high-latitude circulation is weaker (stronger) when QBO easterlies (westerlies) dominate in the low equatorial stratosphere. The accepted explanation for the extratropical QBO signature is based on the QBO modulation of upward propagating planetary Rossby waves. This mechanism is consistent with the strong seasonality observed in the extratropical QBO. The largest QBO signature in the northern extratropical stratosphere occurs during winter when the dominating westerly wind allows the penetration of planetary waves in the northern stratosphere. However, during the southern winter, planetary waves do not disrupt the southern stratospheric vortex and the largest QBO signature is found during the late spring (November). To further illustrate these mechanisms, we analyze the QBO signature on the mid- to high-latitude circulation of the stratosphere using data from the ERA-40 reanalysis. The extratropical signature in both hemispheres is evaluated as a function of the latitude–height structure of the zonal wind in the tropical region in order to determine how the extratropical response depends on the vertical phase structure of the tropical QBO. We also analyze the QBO impact on planetary wave activity in order to determine how this modulation can explain the observed extratropical QBO signal. [ABSTRACT FROM AUTHOR]

Background: The use of non-heart-beating donors could help shorten the list of patients who are waiting for a kidney transplant. Several reports describe acceptable results of transplantations from non-heart-beating donors who had in-hospital cardiac arrest, but few reports describe results of transplantations from non-heart-beating donors who had cardiac arrest that occurred outside of the hospital (Maastricht type I and type II donors).Objective: To compare graft survival rates among patients receiving kidneys from heart-beating donors versus type I or type II non-heart-beating donors.Design: Retrospective cohort study of transplantations performed from January 1989 to December 2004.Setting: Kidney transplant program of a teaching hospital in Madrid, Spain.Patients: 320 patients who received a kidney transplant from non-heart-beating donors (273 type I donors and 47 type II donors) and 584 patients who received a kidney transplant from heart-beating donors divided into 2 groups according to donor age (age <60 years [n = 458] and age > or =60 years [n = 126]).Measurements: The primary outcome measure was graft survival. The median follow-up time was 68 months (range, 9 to 198 months).Results: One- and 5-year graft survival rates were 90.7% and 85.5%, respectively, for transplants from heart-beating donors younger than 60 years of age; 79.8% and 73.3%, respectively, for transplants from heart-beating donors 60 years of age or older (P < 0.001); and 87.4% and 82.1%, respectively, for transplants from non-heart-beating donors (P = 0.22 [vs. those from heart-beating donors < 60 years of age] and P = 0.014 [vs. those from heart-beating donors >or = 60 years of age]). Graft survival did not differ between patients who received kidneys from heart-beating donors younger than 60 years of age and patients who received kidneys from non-heart-beating donors.Limitations: This single-site, observational study was retrospective, and immunosuppressive therapy regimens given to transplant recipients varied over time.Conclusions: Outcomes of transplants from non-heart-beating donors and younger heart-beating donors are similar, and results for transplants from non-heart-beating donors improved compared with those from older heart-beating donors. On the basis of these results, the authors encourage other transplant units to adopt the use of type I and type II non-heart-beating donors. [ABSTRACT FROM AUTHOR]

Abstract: To date there is a substantial experience with rapamycin conversion in stable renal transplant recipients with respect to the procedure of conversion, initial doses, and target blood levels as well as adverse events, but in the case of Everolimus there is almost no experience with conversion and calcineurin inhibitor (CNI) withdrawal. We describe an initial experience among 32 renal transplant recipients who were converted to Everolimus with complete suspension of CNI in two Spanish transplant centers. Our results emphasised the procedure for conversion, the target levels, the adverse events, and the initial efficacy, over the first month after conversion. Our conclusions were that conversion from CNI to Everolimus was a simple, safe procedure with a predictable profile of adverse events, which were, in general, of mild intensity. There was a good correlation between initial dose and blood level. Initial doses of about 3 mg/d combined with rapid reduction in CNI exposure seemed to be adequate. The target range levels between 5 and 10 ng/mL seemed to be sufficient for complete CNI elimination, especially in patients also receiving antiproliferative drugs (such as mycophenolate mofetil or azathioprine) in whom levels near the lower end of the range might be adequate. [Copyright &y& Elsevier]

Southwestern Europe experienced extraordinary rainy and windy conditions in March 2018, leading to the end of the most severe drought since 1970 at continental scale. This anomalous weather was linked to a persistent negative North Atlantic Oscillation pattern. Two weeks earlier a sudden stratospheric warming (SSW) took place, preceded by the strongest planetary wave activity on record. In this study, we explore the connection between the SSW and the weather shift by employing a weather regime approach and flow analogues. The timing of the downward propagation of the stratospheric anomalies, the transition to and persistence of the negative North Atlantic Oscillation weather regime, and the sudden precipitation increase are all consistent with the typical tropospheric state after SSWs. Our results evidence a significant role of the 2018 SSW in the record‐breaking precipitation event. Plain Language Summary: March 2018 was characterized by extraordinary heavy rain and strong winds over the Iberian Peninsula that ended the most severe drought since 1970 at continental scale. Two weeks earlier the polar stratosphere experienced anomalous conditions with a sudden rise in temperature, so‐called sudden stratospheric warming (SSW). Although SSWs are not rare events, the 2018 case was remarkable in terms of its intensity and persistence. The coincidence in time of both extreme events and the known link between SSWs and anomalous weather in the North Atlantic led the media to claim that the SSW was the main culprit of the anomalous weather of March 2018. However, this assumption is not straightforward because of the large variability in the magnitude of tropospheric responses to SSWs. Here we explore the role of the SSW in the abrupt weather shift by analyzing the downward propagation of the SSW signal and its link to the tropospheric synoptic conditions. Our results indicate an actual connection between the 2018 SSW and the record‐breaking precipitation event. Key Points: Outstanding stratospheric and tropospheric conditions occurred in late winter 2018, with a persistent SSW and extreme Iberian precipitationThe rainy conditions were associated with an extremely persistent negative NAO patternThe 2018 SSW played a relevant role in the shift to and maintenance of the negative NAO event that ended the severe Iberian drought [ABSTRACT FROM AUTHOR]