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Pinus halepensis Mill. covers most lowland forests on limestone soils and semiarid to sub-humid climates in the Mediterranean basin. It is considered a key species in climate change due to its pioneer nature, versatility, and flexibility. Moreover, its industrial potential is an additional incentive to promote forest management to increase its quality and productivity while contributing to other environmental and social objectives. However, there is a considerable gap in science-based knowledge on the effects of different silvicultural treatments on Pinus halepensis stands. Thus, this research compares the impact of four different treatments (light thinnings, strong thinnings, transformation to uneven-aged, and diameter-driven uneven-aged) on even-aged mid-rotation stands of Pinus halepensis in terms of growth, vulnerability, and resilience to extreme weather events, regeneration, and shrub cover. The effects of four treatments are evaluated in 12 research plots of 0.49 ha each (three per treatment) and contrasted with the other three non-managed control plots. Light and strong thinning treatments show better growth—at least in the short term—and stock results than those reported in the reference yield tables. Transformation to uneven-aged treatment shows advantages in maintaining periodic growth, regeneration, and stability. In addition, it offers an alternative for steep slope stands, smallholders, and extended narrow-aged estates to speed up the desirable balanced age class distribution. Diameter-driven uneven-aged treatment implies greater vulnerability to extreme weather events during the first years and considerable stock reduction while offering faster and taller tree regeneration. A dual regeneration pattern of Ulex parviflorus Pourr is observed in addition to post-fire regeneration in the case of sudden and well-distributed tree cover reduction around 40% of the canopy due to the transformation into the uneven-aged stand. An observation period longer than a decade of the research plots will confirm these first conclusions.

13 Pág. Centro de Investigación Forestal (CIFOR), In this contribution, we assessed the biomass and carbon stock of a post-fire area covered by a young oak coppice of Quercus pyrenaica Willd. associated with shrubs, mainly of Cistus laurifolius L. This area was burned during the fire event of Chequilla (Guadalajara, Spain) in 2012. Sentinel-2 imagery was used together with our own forest inventories in 2020 and machine learning methods to assess the total biomass of the area. The inventory includes plots of total dry weight ranging between 6 and 14 Mg·ha−1 with individuals up to 8 years old. Nonlinear, nonparametric Gaussian process regression methods were applied to link reflectance values from Sentinel-2 imagery with total shrub biomass. With a reduced inventory of only 32 plots covering 136 ha, the total biomass could be assessed with a root-mean-square error of 1.36 Mg·ha−1 and a bias of −0.04 Mg·ha−1, getting a relative error between 9.8% and 20.4% for the gathered biomass. This is a rather good estimation considering the little effort and time invested; thus, the suggested methodology is very suitable for forest monitoring and management., This research was funded by the Interreg SUDOE Program through the European Regional Development Fund (ERDF): Interreg SUDOE REMAS project (SOE3/P4/E0954) “Greenhouse gas emissions risk management in forest fires” (2019–2022)

1 Pág. Centro de Investigación Forestal (CIFOR), The REMAS project SOE3/P4/E0954 is co-financed by the Interreg Sudoe Program through the European Regional Development Fund (ERDF).

We report a case of a patient with Cushing's disease with oseltamivir-induced toxic epidermal necrolysis, who was treated with cyclosporine with favorable evolution. There is only one case reported of Cushing's disease and toxic epidermal necrolysis and very few oseltamivir-induced toxic epidermal necrolysis cases in literature. This report also discusses the role that the preexisting hypercortisolism condition may have played in the development and favorable resolution of the toxic epidermal necrolysis.

Forest fires are increasing their recurrence, intensity and scale in Portugal, increasing also the vulnerability of this region of Southwestern Europe to the impacts of the climate change. In Portugal, several studies have been focusing the dynamic of cork oak forest after fires from tree level to landscape level. However few information is available about the impact of wildfires in the soil quality, namely C stock, and its evolution. This component of the ecosystem and the evolution of its characteristics can be related with the dynamics of the landscape in the post-fire period and its knowledge can help in the management and rehabilitation of plant-soil system.Serra do Caldeirão is located in Algarve region (S of Portugal). The soils are classified as Leptosols with low fertility. The landscape is characterized by cork oak forests with shrub cover which is dominated by Cistus species. To assess the distribution of total organic C in the study area, several soil sampling were intersected, on two sampling dates (2012 and 2013), with the vector information of the burned area in 2004. This information was intended to assess the temporal evolution of C concentration, depending on its location in a burnt or non-burnt area.In general, the burnt areas showed greater variability of C concentrations in soils collected in both the years, with maximum values ​​of 33.0 g/kg for 2012 and 36.5 g/kg for 2013. These maximum values ​​exceed those obtained for soils in non-burnt areas. Despite of this scenario, and independently of the year, no statistically significant differences were found in the C concentrations of the burnt plots and the control plots. For other chemical characteristics (e.g. nutrients), the variations depended on the area. Implementation of post-fire recovery measures and forest management of the areas can justify this variation.Acknowledgment: This work is co-financed by project REMAS (SOE3/P4/E0954) from Interreg SUDOE 2014-2020 program and is also financed by the FEDER Funds through the Operational Competitiveness Factors Program - COMPETE and by National Funds through FCT - Foundation for Science and Technology within the scope of the project UID/AGR/04129/2020 (LEAF) and the project UID/BIA/50027/2019 (CEABN/InBIO).

[EN] The Agenda for Sustainable Development 2030 of United Nations is made up of the 17 Sustainable Development Goals (SDGs) that humanity will have to meet by 2030. In achieving the SDGs, green urban areas (GUA) play a fundamental role at the local level as they provide recreational and bioclimatic regulatory functions and act as a carbon sink, as well. Specifically, the GUAs contribute directly to three SDGs: SDG 11 Sustainable cities and communities, SDG 13 Climate Action and SDG 15 Life on land. This paper evaluates direct contribution of GUA to this SDGs with high spatial resolution in the case study of the city of Valencia (Spain). The evaluation carried out has made it possible to make a diagnosis of the quantity and accessibility of GUA at sub-neighbourhood level. The results for SDG 11 show that only 9.23% of the population do not have desirable access to GUA and 2.73% live in areas without easy walking distance access to GUA. On the other hand, the evaluation of SDG 15 shows that each inhabitant has at their disposal 10 m2 of GUA, below the average of cities of more than 250,000 inhabitants in Spain. The high spatial resolution of the evaluation has also made it possible to identify the city areas with the worst access to GUA and the least amount of GUA per inhabitant. In consequence, the results allow determining zones with high potential to improve. Additionally, the quantification of the CO2 fixed by the GUA carried out for the evaluation of SDG 13, shows that the fixed carbon is equivalent to 0.04% of total gross GHG emissions of the city and is 36% higher than the total GHG emissions of the annual fuel consumption of the total fleet in the city. Finally, the monitoring of the indicators applied allows evaluating the evolution of the GUA to improve the sustainable development of the city., We are grateful to the Valencia City Council, specifically the Department of Open Government and Transparency directed by Elisa Valia, through the DataGovernance VLC university chair, for being able to make available much of the data necessary for this research. We are also thankful to the company GreenUrbanData, which provided tech-nical expertise that greatly assisted the research. Finally, we also thank the scientific support of Dr Carolina Perpina and Dr Carlo Lavalle of the Joint Research Centre (JRC) of the European Commission (Directorate B-Growth and Innovation, Territorial Development Unit B3) for their scientific support within the framework of collaboration agreement (No. 35930) to contribute to analyse field of urban sustainability indicators, where Valencia acts a City Lab under the framework of the EU Com-munity of Practice on CITIES. Funding sources This work was supported by the Regional Agency of Innovation of Valencia/Spain (AVI) in the project TRUST "Sustainable urban transition through metrics for public decision based on big data" (INNEST00/18/005) .

[EN] Forest management is an untapped tool, yet to realize its full potential to fight against climate change. The capability of forests to act as carbon sinks makes them a key resource to reduce CO2 concentration in the atmosphere. However, carbon which has been fixed can be suddenly emitted again as a consequence of disturbances such as pests or wildfires. Mediterranean plant phenology, climatic conditions, and the accumulation of fuel biomass due to abandonment of traditional forest uses generate a scenario prone to large wildfires and consequently large greenhouse gases (GHG) emissions. The abandonment could be offset by considering the economic value of forest ecosystem services, principally carbon fixation. Nevertheless, currently existing forest carbon markets consider only anthropogenic fixation based on a business as usual scenario without disturbances that cannot be applied to Mediterranean forest reality. Thus, a methodology to monetize carbon fixed has been developed and applied. A range between 55.5 and 250 million euro produced by the monetization of 16.5 million potential carbon credits has been obtained based on anthropogenic avoided emissions produced over a 10 year-period. Thereby, the potential for offsetting emissions of the pilot region was between 1.2% and 5.6% of total diffuse GHG emissions. Consequently, sustainable forest management represents an important opportunity to combat climate change, taking advantage of the margin of improvement that the Mediterranean forests currently have to avoid GHG emissions through forest fire prevention silviculture., This research was funded by EIT Climate KIC in the frame of the ValVolCar project and by Interreg SUDOE REMAS project (SOE3/P4/E0954), project co-financed by the Interreg Sudoe Program through the European Regional Development Fund (ERDF).

During the period of the COVID-19 pandemic, the air quality reached the best levels to be recorded in large cities in Spain. To analyze and demonstrate this improvement in air quality levels, the evolution of the average nitrogen dioxide (NO2) levels in 78 Spanish cities with more than 50,000 inhabitants during the pre-COVID-19 years (2017–2019), the period of the COVID-19 lockdown, and the post-COVID-19 year (2021) was analyzed. The results show an improvement in the air quality in most of the cities analyzed for 2020 due to the COVID-19 restrictions. In addition, in 2021, without the COVID-19 restrictions, the air quality levels of the largest cities in Spain showed important improvements in terms of NO2 concentration compared to the levels in the pre-COVID-19 years (2017–2019). Nevertheless, in 2021, only 11 cities were below the average annual limit of 10 µg/m3 NO2 established by the World Health Organization (WHO). In addition, no cities with more than 500,000 inhabitants achieved NO2 levels below the WHO limit. Finally, a detailed monthly analysis indicated that the pre-COVID-19 levels were reached again during the last months of the monitored period.

[EN] Buildings have become a key source of greenhouse gas (GHG) emissions due to the consumption of primary energy, especially when used to achieve thermal comfort conditions. In addition, buildings play a key role for adapting societies to climate change by achieving more energy efficiency. Therefore, buildings have become a key sector to tackle climate change at the local level. However, public decision-makers do not have tools with enough spatial resolution to prioritise and focus the available resources and efforts in an efficient manner. The objective of the research is to develop an innovative methodology based on a geographic information system (GIS) for mapping primary energy consumption and GHG emissions in buildings in cities according to energy efficiency certificates. The developed methodology has been tested in a representative medium-sized city in Spain, obtaining an accurate analysis that shows 32,000 t of CO2 emissions due to primary energy consumption of 140 GWh in residential buildings with high spatial resolution at single building level. The obtained results demonstrate that the majority of residential buildings have low levels of energy efficiency and emit an average of 45 kg CO2/m(2). Compared to the national average in Spain, this obtained value is on the average, while it is slightly better at the regional level. Furthermore, the results obtained demonstrate that the developed methodology is able to directly identify city districts with highest potential for improving energy efficiency and reducing GHG emissions. Additionally, a data model adapted to the INSPIRE regulation has been developed in order to ensure interoperability and European-wide application. All these results have allowed the local authorities to better define local strategies towards a low-carbon economy and energy transition. In conclusion, public decision-makers will be supported with an innovative and user-friendly GIS-based methodology to better define local strategies towards a low-carbon economy and energy transition in a more efficient and transparent way based on metrics of high spatial resolution and accuracy., This work was supported by the City Council of Quart de Poblet (Valencia, Spain).

[Background] Concerns have been raised about the possibility that inhibitors of the renin–angiotensin–aldosterone system (RAAS) could predispose individuals to severe COVID-19; however, epidemiological evidence is lacking. We report the results of a case-population study done in Madrid, Spain, since the outbreak of COVID-19., [Methods] In this case-population study, we consecutively selected patients aged 18 years or older with a PCR-confirmed diagnosis of COVID-19 requiring admission to hospital from seven hospitals in Madrid, who had been admitted between March 1 and March 24, 2020. As a reference group, we randomly sampled ten patients per case, individually matched for age, sex, region (ie, Madrid), and date of admission to hospital (month and day; index date), from Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), a Spanish primary health-care database, in its last available year (2018). We extracted information on comorbidities and prescriptions up to the month before index date (ie, current use) from electronic clinical records of both cases and controls. The outcome of interest was admission to hospital of patients with COVID-19. To minimise confounding by indication, the main analysis focused on assessing the association between COVID-19 requiring admission to hospital and use of RAAS inhibitors compared with use of other antihypertensive drugs. We calculated odds ratios (ORs) and 95% CIs, adjusted for age, sex, and cardiovascular comorbidities and risk factors, using conditional logistic regression. The protocol of the study was registered in the EU electronic Register of Post-Authorisation Studies, EUPAS34437., [Findings] We collected data for 1139 cases and 11 390 population controls. Among cases, 444 (39·0%) were female and the mean age was 69·1 years (SD 15·4), and despite being matched on sex and age, a significantly higher proportion of cases had pre-existing cardiovascular disease (OR 1·98, 95% CI 1·62–2·41) and risk factors (1·46, 1·23–1·73) than did controls. Compared with users of other antihypertensive drugs, users of RAAS inhibitors had an adjusted OR for COVID-19 requiring admission to hospital of 0·94 (95% CI 0·77–1·15). No increased risk was observed with either angiotensin-converting enzyme inhibitors (adjusted OR 0·80, 0·64–1·00) or angiotensin-receptor blockers (1·10, 0·88–1·37). Sex, age, and background cardiovascular risk did not modify the adjusted OR between use of RAAS inhibitors and COVID-19 requiring admission to hospital, whereas a decreased risk of COVID-19 requiring admission to hospital was found among patients with diabetes who were users of RAAS inhibitors (adjusted OR 0·53, 95% CI 0·34–0·80). The adjusted ORs were similar across severity degrees of COVID-19., [Interpretation] RAAS inhibitors do not increase the risk of COVID-19 requiring admission to hospital, including fatal cases and those admitted to intensive care units, and should not be discontinued to prevent a severe case of COVID-19., This study was funded by a research grant from the Institute of Health Carlos III (COV20/00027).

To estimate the specific incidences of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) among new users of drugs frequently reported to be associated with this serious event. We performed a case-population approach, which combined data from a registry of SJS/TEN cases from the Madrid region (numerator) during the study period 2005–2015 and a primary healthcare database from the same catchment population. The proportion of new users of drugs estimated in the primary healthcare database was stratified by calendar year, sex and age (5-year bands), and then applied to the same strata of Madrid’s population census to compute the number of new users (denominator). Incidences were re-estimated using only cases in which the concerned drug had a probable or very probable causal relationship. A total of 44 SJS/TEN cases aged > 14 years were registered during the study period. The highest SJS/TEN incidence was found for phenytoin with 68.9 per 100,000 new users (95% CI 27.7–141.9), followed by dexamethasone (5.48; 1.49–14.03), allopurinol (3.29; 1.07–7.67) and cotrimoxazole (3.19; 0.87–8.16). Considering only probable and very probable cases, the incidences hardly changed, except for dexamethasone, which was left without cases. Pantoprazole, levofloxacin and lorazepam showed incidences between 1 per 100,000 and 1 per 1,000,000 new users. Ibuprofen, amoxicillin-clavulanic acid, metamizole, amoxicillin, paracetamol and omeprazole showed incidences around 1 per one million new users. Phenytoin was the drug with the highest incidence of SJS/TEN, followed by allopurinol and cotrimoxazole. For the rest of the drugs, the estimated incidences were below 1 in 100,000 new users.

[EN] The plantations of short rotation play a role importantly as source sustainable energetics that can increase the safety of the supply, the generation of income in rural communities and decrease energy dependence on fossil fuels. In this respect, short rotation plantations have been widely recognized, which makes it necessary to increase the available biomass sources alternatives for their energy use. The aim of this study was to quantify the woody biomass and the energetic potential of the forest species paulonia (Paulownia spp.) of a year of age in Mediterranean conditions. Test plots were selected in the Valencian Community (eastern Spain) to develop a predictive model of biomass quantification and his energetic potential in two types of plots according to density and existence of irrigation (P1 and P2), with the average effective biomass per hectare (the stem is hollow in its medullary section in 19,2%) in P1 and P2 between 27,3 t ha-1 and 47,6 t ha-1 respectively. As for the energy potential, the laboratory tests show that paulonia has a calorific value of 17,8 MJ kg-1, his potential energy in P1 is 207 MJ tree-1 and 247 GJ ha-1 and higher in P2 with 349 MJ tree-1 and 274 GJ ha-1. Taking into account the fast growing of the species and its high energy potential, it should be considered as a valid raw material for his use in heat energy in the short term in Mediterranean zones., [ES] Las plantaciones de rotación corta desempeñan un papel importante como fuente biomásica energética sostenible que puede aumentar la seguridad del suministro, la generación de ingresos en comunidades rurales locales y disminuir la dependencia energética de combustibles fósiles. En este sentido, las plantaciones de rotación corta han sido ampliamente reconocidas, lo que hace necesario aumentar las alternativas de fuentes biomásicas disponibles para su uso energético. Es así como este estudio trata sobre cuantificar la biomasa leñosa y el potencial energético de la especie arbórea paulonia (Paulownia spp.) de un año de edad en condiciones mediterráneas. Para ello, se seleccionaron parcelas de prueba en la Comunidad Valenciana (España oriental) para desarrollar un modelo predictivo de cuantificación de biomasa y su potencial energético, en dos tipos de parcelas según densidad y existencia de riego (P1 y P2), siendo el promedio efectivo de biomasa por hectárea (el fuste es hueco en su sección medular en un 19,2%) en P1 y P2 de 13,9 a 15,3 t ha-1 respectivamente. En cuanto al potencial energético, sabiendo que los ensayos de laboratorio muestran que paulonia posee un poder calorífico de 17,8 MJ kg-1, su energía potencial en P1 es de 207 MJ árbol-1 y 247 GJ ha-1 y mayor en P2 con 349 MJ árbol-1 y 274 GJ ha-1. Es por esto que teniendo en cuenta el rápido crecimiento de esta especie y su alto potencial energético, debería ser considerada como una materia prima válida para su uso en energía térmica a corto plazo en zonas mediterráneas.

Severe cutaneous adverse drug reactions (SCARs) can occur at any age and can be life threatening, although some drugs have been more frequently reported than others. The spectrum of SCARs includes acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, also known as drug-induced hypersensitivity syndrome (DiHS) or hypersensitivity syndrome (HSS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Immediate withdrawal of the offending drug is the mainstay treatment in SCARs, and rechallenge often leads to recurrent reactions. Cross reactivity and multiple sensitivities have also been reported. The identification of the offending medication at the onset of the disease is therefore essential to avoid future exposures to the same or chemically related compounds. Various algorithms can be useful to identify the culprit drug in the acute stage. Delayed onset from the initiation of treatment differs in the various clinical entities. Therefore, a prompt, accurate diagnosis is crucial for proper identification of the offending agent. After resolution of the disease, cutaneous tests and in vitro tests can be useful for confirmation of drug causality and investigation of possible cross-reactivity. SCARs are rare diseases, given the incidence is extremely low. Multidisciplinary and international teams are required to study these diseases. Further research is needed to fully understand etiopathogenesis and for the development of specific treatments.

The HLA-B*15:02 allele is a risk factor for carbamazepine (CBZ)-induced Stevens–Johnson syndrome/toxic epidermal necrolysis in populations where the allele is prevalent. Han Chinese and Thai patients are advised to take a genetic test before introducing CBZ. Such testing is not recommended for patients of European descent. We report the case of a Spanish Romani patient who developed Stevens–Johnson syndrome upon treatment with CBZ. In vitro assays confirmed CBZ as the culprit drug. HLA typing showed that the patient carried the HLA-B*15:02 allele. A public database search revealed that 2% of Spanish Romani people likely carry the risk variant HLA-B*15:02 and therefore may be included in the population to be tested prior to beginning treatment with CBZ.

Summary Vemurafenib is a newly licensed target-directed medication. It has been proven to improve the survival of patients with metastatic melanoma and the BRAFV600E mutation; however, adverse cutaneous reactions are frequent. Few cases of life-threatening severe cutaneous adverse reactions (SCARs) induced by vemurafenib have been reported. Dabrafenib, another selective BRAF inhibitor, has been licensed recently as an alternative drug with the same indications. From a molecular point of view, both vemurafenib and dabrafenib contain a sulfonamide group; cross-reactivity to sulfonamide compounds has been reported in allergic patients. We report on a patient with vemurafenib-induced toxic epidermal necrolysis (TEN). In vitro analysis of lymphocyte reactivity to vemurafenib showed positive results, confirming drug causality. In addition, lymphocytes from the patient reacted to dabrafenib and to the antibiotic sulfonamide drug sulfamethoxazole. Moreover, lymphocytes from two patients with cutaneous adverse reactions to sulfamethoxazole also reacted to vemurafenib and dabrafenib in vitro. These data strongly suggest that there might be clinical cross-reactivity between BRAF inhibitors and sulfonamides in some patients. Thus, precautions should be taken to avoid sulfonamide drugs as much as possible in patients showing serious hypersensitivity reactions to vemurafenib and vice versa.

Purpose The "case-population" design has been proposed for the surveillance of rare events like Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), wherein a registry of cases is combined with sales data from the source population in order to estimate crude odds ratios (ORs). A major drawback of this method is the inability to distinguish between new and non-new users of drugs, which for the study of hypersensitivity reactions is of utmost importance. Methods We have explored an approach in which the exposure to the drugs of interest in the source population is inferred from a primary health care database (BIFAP), which helped us to identify drug initiators among all users and additionally adjust for potential confounders. A total of 44 SJS/TEN cases from the Registry and 44 000 controls randomly sampled from BIFAP and matched with cases for index date were included. We estimated the adjusted ORs (AORs) and 95% confidence intervals (CI) of SJS/TEN associated with the new use of 13 drugs (for which we had at least two exposed cases) through a conditional logistic regression model. Results AORs (95% CI) were estimated for phenytoin, 4618 (434-49112); cotrimoxazole, 1142 (163-8015); allopurinol, 160 (36-709); dexamethasone, 38 (1.33-1077); ibuprofen, 33 (8.6-124); lorazepam, 27 (5.8-124); paracetamol, 13 (2.8-62); levofloxacine, 12 (1.24-120); amoxicillin, 6.9 (1.39-35); pantoprazole, 6.5 (0.10-420); metamizole, 6.3 (0.69-57); amoxicillin clavulanic acid, 4.2 (0.53-34); and omeprazole, 1.34 (0.06-31). The inclusion of non-new users dramatically decreased the AORs for all drugs. Conclusions The case-population approach using a registry of cases and a primary health care database proved feasible and efficient for the active surveillance of SJS/TEN.

Objective To describe how nursing care is delivered to patients with epidermal necrolysis in burn units/specialized units in Spain and a selection of countries. Method Descriptive cross-sectional study. Data were collected through a structured questionnaire which was sent to nurse managers in all burn units in Spain and a selection of countries. Descriptive statistics was used to summarize the results. Results All BU/SUs in Spain (n = 12) and seven BU/SUs from a selection of countries completed the questionnaire. A lack of specific nursing protocols on Epidermal Necrolysis was observed in most burn units in Spain. Skin cleansing techniques such as showering were only reported by participants from Spain. Use of antiseptics was less frequent in other countries. Conservative skin management was the most extended practice reported by all participants. The use of vaginal molds to prevent synechiae and coverage of the ocular surface with amniotic membrane to minimize sequelae were rarely reported. Pain assessment was not always documented in sedated patients and few participants reported the use of specific scales for this purpose. All nurses agreed in the need for consensus nursing care guidelines on the disease. Conclusions Nursing care in patients with epidermal necrolysis varied between burn units in Spain. Differences and similarities were observed when compared with burn units in other countries. Genital and ocular care were outdated in all BU/SUs. Pain assessment documentation was suboptimal. Evidence-based nursing care guidelines were generally demanded by all participants to help reduce mortality and morbidity of this rare and often devastating disease.

[EN] The lack of management and economic value of forest ecosystems in Mediterranean areas, mainly dominated by pines (Pinus halepensis Mill. and Pinus pinaster Ait.), together with a continuous growing of forests on marginal agricultural land have leaded to an increased forest fire risk and devaluation of natural resources in less favoured rural regions. The use of residual forest-based biomass as value added biofuels like pellets can reverse this situation. Nevertheless, there is an industrial need of knowledge of the influence of raw material composition on pellet manufacturing quality for the main Mediterranean softwood species. In this research influencing pellet quality variables such as contents of moisture, ash, fine particles, chlorine and sulphate, but also mechanical durability, bulk density and net calorific value have been analysed following EN standards. The obtained results demonstrate that it is possible to obtain high quality pellets from barked and debarked logs as well as from branches from P. halepensis and P. pinaster. This implies that the abundant forest biomass residues in the western Mediterranean region of Europe can be transformed into high added value solid biofuels, opening new opportunities for local industries., This work was supported by Moixent Forestal company, the Municipality of Enguera and AIDIMA Wood, Furniture and Packaging Technology Institute, which have allowed and facilitated raw materials, pelletization and analysis in the biomass pilot plant. This study has been partly funded by the Government of Valencia (IVACE) in the framework of the BIOPELLET project.

Several immunomodulatory agents are used in the treatment of epidermal necrolysis, but evidence of their efficacy is limited. The Autonomous Community of Madrid has two reference burn units to which all patients with epidermal necrolysis are referred. One burn unit has mostly used cyclosporine (CsA), and the other has used non-CsA therapies (mainly high-dose intravenous immunoglobulin). The allocation of patients to one or the other burn unit was mainly based on proximity, resembling a random assignment. Thus, we took advantage of this “natural experiment” to estimate the mortality risk ratio (MRR) of CsA (n = 26) compared with non-CsA (n = 16) treatment using hospital as an instrumental variable over the period from 2001 to 2015. We also computed the observed versus expected (O/E) MRR in a case series of 49 CsA-treated patients (including 23 patients from other regions treated in Madrid), and using the Score for Toxic Epidermal Necrolysis (i.e., SCORTEN) scale to estimate the expected values. The instrumental variable-based MRR of CsA versus non-CsA was 0.09 (95% confidence interval = 0.00–0.49). The O/E analysis also showed a reduction in mortality risk (MRROE = 0.42; 95% confidence interval = 0.14–0.99). We identified five other case series of CsA-treated patients providing MRROE and meta-analyzed their results. The pooled MRROE (including from this study) was 0.41 (95% confidence interval = 0.21–0.80). All three approaches consistently show that CsA reduces the mortality in epidermal necrolysis patients. Ministerio de Economía, Industria y Competitividad (#PI12/02267) 6.448 JCR (2017) Q1, 3/64 Dermatology 2.282 SJR (2017) Q1, 48/457 Biochemistry No data IDR 2017 UEM

Introduction Our aim was to evaluate the equivalence between analytic parameters from blood samples obtained from a saline solution lock device used for the infusion of drugs and those from venipuncture. In our emergency department, patients bearing a saline solution lock device have blood extracted by venipuncture to avoid possible contamination of the sample. Methods Adults from the emergency department with a saline solution lock device who required laboratory tests were selected as candidates for this cross-sectional observational study. Infusions were halted and flushed with 0.9% saline solution; 2 minutes later, 2 mL of blood was drawn and discarded, and the corresponding laboratory tubes were filled. Immediately after, another sample was withdrawn from the opposite extremity by venipuncture. Both samples were analyzed for hematology, biochemistry, venous blood gases, and coagulation parameters. Concordance was evaluated by use of the intraclass correlation coefficient with its 95% confidence intervals; Bland-Altman plots were used to illustrate the percentage of samples with differences exceeding 2 SDs. The mean differences were also checked to detect those exceeding the laboratory's systematic error. Results An intraclass correlation coefficient of over 0.9 was achieved for all parameters except for pH, partial pressure of carbon dioxide, and partial pressure of oxygen. Differences of over 2 SDs were found in fewer than 10% of all parameters. None of them exceeded 3 SDs, except for pH and venous blood gases. All parameters showed differences below the laboratory's accepted systematic error except for pH and venous blood gases. Discussion Blood samples extracted from a peripheral catheter with or without drug infusions are valid for the analysis of hematology, biochemistry, and coagulation parameters but not for venous blood gases. Nurses should know the benefits of using an existing peripheral catheter for drawing blood samples for laboratory analysis even when infusing commonly used drugs. Emergency nurses should consider collecting blood specimens from a venous access device regardless of the type of drug infusions administered, because it is a safe, simple, and fast technique, which is time efficient when treating patients with limited venous access sites. This procedure reduces patient discomfort and the risk of complications related to venipunctures.

Aromatic antiepileptic drugs (AEDs) are among the drugs most frequently involved in severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reactions with eosinophilia and systemic symptoms (DRESS). This study investigated the associations between the genetic polymorphisms of HLA class-I and AED-induced SCARs in the Spanish population. HLA class-I genotypes were determined in AED (phenytoin[PHT],lamotrigine[LTG],carbamazepine[CBZ],phenobarbital[PB])-induced SJS/TEN (n=15) or DRESS (n=12) cases included in the Spanish SCAR registry, PIELenRed. There were 3 control groups: (A)tolerant to a single AED, (B)tolerant to any AED, and (C)Spanish population controls. For SJS/TEN, concomitant HLA-A*02:01/Cw15:02 alleles were significantly associated with PHT-cases compared to control groups B and C [(B)odds ratio(OR):14.75, p=0.009;(C)OR:27.50, p

[EN] In the framework of a sustainable bio-based economy, this doctoral thesis aims to stimulate sustainable forest management by providing scientific information and guidelines tending to plan and mobilizate bioenergy resources from Mediterranean forests, protect forest ecosystems from forest fires, optimize the carbon balances of the entire bioenergy value chain and finally, contribute to the rural development through employment and richness creation in the renewable energy sector.To achieve these goals, the general objective of this research is to analyse and develop an integral management, planning, logistics and energy valuation model for the forest biomass residues available in the Valencian Province. For that purpose, forest and agricultural crops data in the Valencian Province have been analised by using Geographical Information Systems (GIS) and applying selection and sustainable harvesting criteria. Biomass quantity and real available biomass residues have been estimated. Based on a sustainable management, planning, logistics, transformation and biomass use model, eight bioenergy districts have been identified at a supramunicipal level. Representative forest plots have been selected and two harvesting systems, the integrated system (separated use of logs and forest residues) and the whole tree system, have been tested. Subsequently, productivity, costs, environmental impact, carbon emissions and energy balances have been compared and the quality of the obtained chips has been analysed according to European quality norms. In addition, a pilot pellet plant at a laboratory scale has been designed and started and pellets have been fabricated. Finally, pellet quality and influencing variables such as species, tree fraction of the chips and bark presence have been studied together with the maximum amount of bark that quality pellets can tolerate.It has been estimated 28t/ha of residual biomass for the Valencian Province. A total of eight bioenergy districts have been identified, which could provide a in which a sustained supply of high quality biomass.Representative forest plots are those with a pole stage of Pinus halepensis with a canopy cover estimated in between 40-69% at altitudes around 600 m above the sea level, east-southwest dominating aspects and 15% of average slope. The integrated system has proven to be the most suitable for harvesting Pinus halepensis in a pole stage in the Valencian Province due to a higher harvesting productivity, which in turn means lower fuel consumption, lower total costs, higher economic and financial profitability due to the higher value of log woodchips in the market, lower environmental impact due to the need of less manoeuvrability forwarder space with the integrated systems and a lower number of cycles, slightly lower emissions thanks to a lower fuel consumption and finally, a slightly higher energy balance, with an energy contained in biomass that is around ten times the energy necessary for the biomass mobilization and use.In conclusion, it is possible to obtain high quality woodchips from these two harvesting systems (integrated and whole tree system) when moisture and ash content are properly monitored. It is also possible to obtain high quality pellets from barked and debarked logs as well as from branches. This implies that the abundant forest biomass residues in the Valencian Province can be transformed into high added value solid biofuels., [ES] En el marco del desarrollo de una bioeconomía sostenible, esta tesis doctoral pretende estimular la gestión forestal sostenible orientada a la ordenación y movilización de los recursos bioenergéticos de los montes mediterráneos, proteger los ecosistemas forestales frente a los incendios forestales, optimizar los balances de carbono en la cadena de valor de la bioenergía forestal y, finalmente, contribuir al desarrollo rural mediante la generación de empleo y riqueza en el sector de las energías renovables. Para alcanzar estos retos, el objetivo general de la investigación es el análisis y el desarrollo de un modelo integral de gestión, planificación, aprovisionamiento y valorización energética de la biomasa forestal residual de la Provincia de Valencia. Para ello, se ha analizado el territorio de la Provincia de Valencia a partir de información forestal y agrícola recogida en distintas bases de datos mediante la aplicación de Sistemas de Información Geográfica (SIG) y de criterios de selección y aprovechamiento sostenible. Se ha estimado la cantidad de biomasa agroforestal residual existente y aprovechable. Se han definido e identificado distritos bioenergéticos en base a un modelo sostenible de gestión, aprovisionamiento, transformación y uso de la biomasa a escala supramunicipal. Se han seleccionado parcelas forestales representativas y en ellas se han llevado a cabo aprovechamientos experimentales de biomasa mediante el sistema de aprovechamiento integrado (aprovechamiento separado de fuste y residuos forestales) y el sistema de árbol completo. A continuación, se han comparado rendimientos, productividad, costes, rentabilidad, impacto ambiental, emisiones de carbono y balances energéticos de ambos sistemas. Posteriormente, a partir del material recogido se ha analizado la calidad de las astillas según la normativa de calidad europea. En paralelo, se ha diseñado y puesto en marcha una planta piloto a escala de laboratorio para la fabricación de pellets a partir de astillas obtenidas en campo. Por último, se ha analizado la calidad de los pellets y se ha estudiado la influencia de factores como la especie, la fracción del árbol y la presencia de corteza sobre las variables de calidad, estableciendo los límites máximos tolerables de corteza para la producción de pellets de calidad.Como resultados, se ha estimado que en la Provincia de Valencia la cantidad de biomasa residual aprovechable es de en torno a 28t/ha, identificándose ocho distritos bioenergéticos en que se podría dar un suministro sostenido en cantidad y calidad de biomasa en base a sus propios recursos agroforestales. Las parcelas representativas de las masas dominantes pertenecen al estrato Pinus halepensis en estado de latizal-fustal con una fracción de cabida cubierta de entre el 40-69%, situadas a altitudes medias de 600 m sobre el nivel del mar, con orientaciones dominantes este-suroeste y pendientes medias en torno al 15%. El sistema de aprovechamiento integrado ha resultado ser el más adecuado para el aprovechamiento de estas masas debido a un mayor rendimiento en el desembosque que se traduce en menores consumos de combustible, menores costes totales, mayor rentabilidad económica y financiera, un menor impacto ambiental, emisiones ligeramente menores en el sistema integrado frente al completo y un balance energético algo superior, siendo la energía contenida en la biomasa, en ambos casos, diez veces superior respecto a la que se necesita para su aprovechamiento.Se concluye que es posible obtener astillas de calidad procedente de estos sistemas de aprovechamiento biomásico (fustes y árbol completo) siempre que se controle la humedad y el contenido en cenizas y que es posible obtener pellets de alta calidad a partir de fustes descortezados y sin descortezar, así como de su fracción de ramas, lo que implica que los abundantes recursos biomásicos en la Provincia de Valencia pueden ser transformados en, [CAT] En el marc del desenvolupament d'una bioeconomia sostenible, aquesta tesis doctoral pretén estimular la gestió forestal sostenible orientada a l'ordenació i movilització dels recursos bioenergètics dels forets mediterranis, protegir els ecosistemes forestals front als incendis forestals, optimitzar els balanços de carboni en la cadena de valor de la bioenergia forestal i, finalment, contribuir al desenvolupament rural mitjançant la generació de treball i riquesa en el sector de les energies renovables.Per a assolir aquests reptes, l'objectiu general de la investigació és l'anàlisis i el desenvolupament d'un model integral de gestió, planificació, aprovisionament i valorització energètica de la biomasa forestal residual de la Provincia de València.Per a fer açò possible, s'ha analitzat el territori de la Provincia de València a partir d'informació forestal i agrícola recollida en distintes bases de dades mitjançant l'aplicació de Sistemes d'Informació Geogràfica (SIG) i de criteris de selecció i d'aprofitament sostenible. S'ha estimat la quantitat de biomasa agroforestal residual existent i aprofitable. S'han definit e identificat districtes bioenergètics en base a un model sostenible de gestió, aprovisionament, transformació i ús de la biomasa a escala supramunicipal. S'han seleccionat parcel·les forestals representatives i en elles s'han dut a terme aprofitaments experimentals de biomasa mitjançant el sistema integrat (aprofitament per separat de canó i de residus forestals) i el sistema d'arbre complet. A continuació, s'han comparat ambdós sistemes pel que fa a rendiments, productivitat, costs, impacte ambiental, emissions de carboni i balanços energètics. Posteriorment, a partir del material recollit s'ha estudiat la qualitat de les estelles generades amb els aprofitaments segons la normativa de qualitat europea. En paralel, s'ha disenyat i posat en marxa una planta pilot a escala de laboratori per a l'elaboració de pellets a partir de les estelles obtingudes de camp. Per últim, s'ha analitzat la qualitat dels pellets i s'ha estudiat la influència de factors com l'espècie, la fracció de l'arbre i la presencia d'escorça sobre les variables de qualitat establint els límits màxims tolerables d'escorça per a la producció de pellets de qualitat.Com resultats, s'ha estimat que en la Provincia de València la quantitat de biomasa residual aprofitable és d'al voltant de 28t/ha, identificant-se huit districtes bioenergètics en els que es podria donar un sumisitre sostingut en quantitat i en qualitat de biomasa en base als seus propis recursos agroforestals. Les parceles representatives de les mases dominants perteneixen al estrate Pinus halepensis en estat de perxada amb una desnitat de recobriment de entre el 40-69%, situades a altituds mitjanes de 600 m sobre el nivell del mar, amb orientacions dominants est-suroest i pendents mitjanes al voltant del 15%. El sistema d'aprofitament integrat ha resultat ser el més adequat per a l'aprofitament d'estes mases dominants debut a un major rendiment en el desembosc que se tradueix en menors consums de combustible, menors costs totals, major rentabilitat econòmica i financiera, un menor impacte ambiental, unes emissions lleugerament menors del sistema integrat front al complet per menor consum de combustibles i un balanç energètic lleugérament superior, siguent l'energia continguda en la biomasa per a amdós sistemes deu voltes superior respecte a la que es necessita per a la seua mobilització i aprofitament.Se conclou que és possible obtindre estelles de qualitat procedent d'aquests sistemes d'aprofitament biomàsic (canó i arbre complet) sempre que se controle la humitat i el contigut de cendres i que és possible obtindre pellets d'alta qualitat a partir de canons descorçats i amb escorça, així com de la seua fracció de rames, el que implica que els abundants recursos biomàsics de la Provincia de València poden ser, Lerma Arce, V. (2015). Planificación, logística y valorización de biomasa forestal residual en la provincia de Valencia [Tesis doctoral no publicada]. Universitat Politècnica de València. doi:10.4995/Thesis/10251/52391., TESIS

Background DRESS (drug rash with eosinophilia and systemic symptoms) syndrome is quite difficult to diagnose due to its mimic nature and an absence of a specific diagnostic confirmation technique. In fact, this entity used to be misdiagnosed. Different drug families have been described as causative agents, being the aromatic anticonvulsants the most frequent drugs involved, although other drugs as allopurinol or sulfonamides must be kept in mind too. Until now, piperacillin-tazobactam has been scarcely reported as the culprit drug.

The effects of stage of microspore development, cold pretreatment, and growth regulators on the embryogenic response of anthers from service tree (Sorbus domestica L.) are reported. Callus proliferation required the presence of growth regulators in the culture medium, best results being obtained with combinations of auxins and BA. Microspore embryogenesis was only induced when anthers containing tetrads or uninucleate pollen were cultured on BA-supplemented media containing IBA or IAA. A cold pretreatment before anther culture elicited a significant decrease in callus formation and inhibited embryogenesis. Chemical names used: benzyladenine (BA), indole-3-butyric acid (IBA), indole-3-acetic acid (IAA).

A protocol for in vitro propagation in flowering ash (Fraxinus ornus L.) has been developed. Shoot apices or nodal segments from aseptically grown seedings or shoot apices from adult trees were used as initial explants. Highest shoot multiplication rates were obtained when the explants were cultured for 30 days in liquid Rugini induction medium supplemented with BA followed by 30 days on solidified Rugini multiplication medium without growth regulators. Regenerated shoots were rooted on Heller medium containing auxins alone or in combination with BA. Rooting percentages up to 71% (juvenile material) or 50% (adult material) were obtained in the presence of NAA and BA, and were not improved by treating the basal end of the shoots with concentrated NAA solutions. Following conventional procedures, regenerated plants were transferred to soil with more than 80% success. Chemical names used: N-(phenylmethyl)-1H-purin-6-amine (BA); 1-naphthaleneacetic acid (NAA). Flowering ash is a deciduous, temperate ash indigenous to southern Europe and western Asia that has been introduced as an ornamental in North America. Due to its timber and orna- mental qualities, the species is used for a variety of wood prod- ucts and has also become popular for urban planting. Conventional vegetative or sexual methods for propagation of flowering ash are beset with numerous problems that hinder mass multiplication (Bonner, 1974; Hartmann et al., 1990). Thus, tissue culture techniques may constitute an alternative approach for efficient propagation of this species. Although these techniques have been successfully employed with several Frax- inus spp. (Browne and Hicks, 1983; Chalupa, 1983, 1990; Do- ley and Leyton, 1970; Leforestier et al., 1990; Navarrete et al., 1989; Preece et al., 1987, 1989; Wolter and Skoog, 1966), we found no studies reporting their application to flowering ash. Therefore, the objective of this research was to develop methods for in vitro propagation of flowering ash from juvenile and adult trees.