The role of desalination in water management in Southeast Spain

The aim of this paper is to evaluate the importance of seawater desalination to the supply of fresh water to SE Spain, in order to tackle the problem of the shortage of water resources. The Mancomunidad de los Canales del Taibilla (MCT) supplies water to a population of more than 2,400,000 inhabitants in SE Spain. Resources managed by the MCT include the Taibilla river basin, water from the Tajo-Segura transfer, other unusual occasional groundwater contributions and from 2003, sea water desalination. Four desalination plants: Alicante I and II and San Pedro del Pinatar I and II together with resources from other desalination plants provide a significant amount of resources. For a decade (2004-2013) the resources coming from sea water desalination averaged 20.2% of all the resources used by MCT, with 432 Mm3 of total production in the period studied. However, the yearly contribution of desalination has changed depending on the availability of other resources. Moreover, seawater desalination has been essential to ensure water supply in the Alicante and Murcia areas. This resource has been important in periods of shortage, but also in unusual exploitation situations, such as that of the post-transfer tunnel detachment, which was classified as the most important breakdown of this infrastructure within its long lifetime. Moreover, scenarios of future climate changes could increase demands for water supply.Ministerio de Economía y Competitividad (Spanish government), for the financial aid with Project CTM2013-46669-R

Multi-body-site colonization screening cultures for predicting multi-drug resistant Gram-negative and Gram-positive bacteremia in hematological patients

Background To investigate the multi-drug resistant bacteria (MDRB) colonization rate in hematological patients hospitalized for any cause using a multi-body-site surveillance approach, and determine the extent to which this screening strategy helped anticipate MDRB bloodstream infections (BSI). Methods Single-center retrospective observational study including 361 admissions documented in 250 adult patients. Surveillance cultures of nasal, pharyngeal, axillary and rectal specimens (the latter two combined) were performed at admission and subsequently on a weekly basis. Blood culture samples were incubated in an automated continuous monitoring blood culturing instrument (BACTEC FX). Results In total, 3463 surveillance cultures were performed (pharyngeal, n = 1201; axillary-rectal, n = 1200; nasal, n = 1062). MDRB colonization was documented in 122 out of 361 (33.7%) admissions corresponding to 86 patients (34.4%). A total of 149 MDRB were isolated from one or more body sites, of which most were Gram-negative bacteria, most frequently non-fermenting (n = 83) followed by Enterobacterales (n = 51). BSI were documented in 102 admissions (28%) involving 87 patients. Overall, the rate of BSI caused by MDRB was significantly higher (p = 0.04) in the presence of colonizing MDRB (16 out of 47 admissions in 14 patients) than in its absence (9 out of 55 admissions in 9 patients). Colonization by any MDRB was independently associated with increased risk of MDRB-BSI (HR, 3.70; 95% CI, 1.38-9.90; p = 0.009). Conclusion MDRB colonization is a frequent event in hematological patients hospitalized for any reason and is associated with an increased risk of MDRB BSI. The data lend support to the use of MDRB colonization surveillance cultures for predicting the occurrence of MDRB BSI in this cohort

An Assessment of the Effect of Human Herpesvirus-6 Replication on Active Cytomegalovirus Infection after Allogeneic Stem Cell Transplantation

Human herpesvirus-6 (HHV-6) may enhance cytomegalovirus (CMV) replication in allogeneic stem cell transplant (allo-SCT) recipients either through direct or indirect mechanisms. Definitive evidence supporting this hypothesis are lacking. We investigated the effect of HHV-6 replication on active CMV infection in 68 allo-SCT recipients. Analysis of plasma HHV-6 and CMV DNAemia was performed by real-time PCR. Enumeration of pp65 and IE-1 CMV-specific IFNγ CD8+ and CD4+T cells was performed by intracellular cytokine staining. HHV-6 DNAemia occurred in 39.8% of patients, and was significantly associated with subsequent CMV DNAemia in univariate (P=.01), but not in multivariate analysis (P=.65). The peak of HHV-6 DNAemia was not predictive of the development of CMV DNAemia. Timing and kinetics of active CMV infection were comparable in patients either with or without a preceding episode of HHV-6 DNAemia. The occurrence of HHV-6 DNAemia had no impact on CMV-specific T cell immunity reconstitution early after transplant. The receipt of a graft from an HLA-mismatched donor was independently associated with HHV-6 (P=.009) and CMV reactivation (P=.04). The data favor the hypothesis that a state of severe immunosuppression leads to HHV-6 and CMV coactivation, but argue against a role of HHV-6 in predisposing to the development of CMV DNAemia or influencing the course of active CMV infection

Eficàcia i seguretat d’un tractament oral a base de mucopolisacàrids, col·lagen tipus I i vitamina C en pacients amb tendinopaties

Introducció i objectius La tendinopatia és una lesió freqüent durant la pràctica esportiva que es manifesta amb una alteració estructural del tendó. L’objectiu d’aquest estudi fou avaluar l’eficàcia i la seguretat d’un complement alimentari a base de mucopolisacàrids, col·lagen tipus i i vitamina C (Tendoactive®) sobre l’evolució clínica i estructural de les tendinopaties del tendó d’Aquil·les, del rotular i de l’epicòndil lateral del colze. Material i mètodes Es realitzà un estudi multicèntric prospectiu, de tipus exploratori en fase iv, obert i no comparatiu. S’inclogueren un total de 98 pacients amb tendinopaties (32 d’Aquil·les, 32 de rotular i 34 de l’epicòndil lateral) que reberen una dosi diària de 435 mg de mucopolisacàrids, 75 mg de col·lagen tipus i i 60 mg de vitamina C (equivalent a 3 càpsules al dia de Tendoactive®) durant 90 dies consecutius. Mensualment s’avaluà el dolor en repòs i en activitat mitjançant una escala visual analògica (EVA), la funció articular mitjançant els qüestionaris VISA-A, VISA-P i PRTEE, i el tendó afectat es caracteritzà ecogràficament. Resultats En els 3 tipus de tendinopatia es registrà una reducció significativa del dolor, tant en repòs com en activitat, des de la primera visita de control (dia 30) fins al final de l’estudi (dia 90). Així mateix, el dia 90 es detectà una millora del 38% en VISA-A, del 46% en VISA-P i del 77% en PRTEE (p < 0,001). Simultàniament es registrà una reducció del 12% en el gruix del tendó d’Aquil·les, del 10% en el rotular i del 20% en el tendó de l’epicòndil lateral (p < 0,05). Conclusions Els resultats de l’estudi indiquen que l’administració de Tendoactive® és segura i eficaç per millorar els símptomes clínics i l’evolució estructural de les tendinopaties del tendó d’Aquil·les, del tendó rotular i del tendó de l’epicòndil lateral

The efficacy and safety of oral mucopolysaccharide, type I collagen and vitamin C treatment in tendinopathy patients

Introduction and objectives Tendinopathy, which is accompanied by structural changes to the tendon, is a common sporting injury. The aim of this study was to evaluate the efficacy and safety of a nutritional supplement containing mucopolysaccharides, type I collagen and vitamin C (TendoactiveTM) on the clinical and structural evolution of tendinopathies of the Achilles tendon, patellar tendon and lateral epicondyle tendon in the elbow. Materials and methods A multicenter, open-label, non-comparative, prospective, exploratory phase iv study was performed. A total of 98 tendinopathy patients (32 Achilles, 32 patellar and 34 lateral epicondylar), who received a daily dose of 435 mg mucopolysaccharides, 75 mg type i collagen and 60 mg vitamin C (equivalent to three capsules of TendoactiveTM per day) for 90 consecutive days, were included. Every month, pain at rest and when active was assessed using a visual analogue scale (VAS), joint function was assessed using the VISA-A, VISA-P and PRTEE questionnaires, and the tendon affected was characterized by ultrasound. Results A significant reduction in pain both at rest and when active was observed between the first control visit (day 30) and the end of the study (day 90) for all three types of tendinopathy. Thus, a 38% improvement in VISA-A, 46% in VISA-P and 77% in PRTEE was observed on day 90 (P < .001). Similarly, a 12% decrease in the thickness of the Achilles tendon, a 10% decrease in the patellar tendon and a 20% decrease in the lateral epicondyle tendon was observed (P < .05). Conclusions The results of this study show that the administration of TendoactiveTM is safe and effective for improving the clinical symptoms and structural evolution of tendinopathies of the Achilles, patella and lateral epicondyle tendons

Eficacia y seguridad de un tratamiento oral a base de mucopolisacáridos, colágeno tipo i y vitamina C en pacientes con tendinopatías

Introducción y objetivos La tendinopatía es una lesión frecuente durante la práctica deportiva que cursa con una alteración estructural del tendón. El objetivo de este estudio fue evaluar la eficacia y la seguridad de un complemento alimentario a base de mucopolisacáridos, colágeno tipo i y vitamina C (Tendoactive®) sobre la evolución clínica y estructural de las tendinopatías del tendón de Aquiles, rotuliano y del epicóndilo lateral del codo. Material y métodos Se realizó un estudio multicéntrico prospectivo, de tipo exploratorio en fase iv , abierto y no comparativo. Se incluyeron un total de 98 pacientes con tendinopatías (32 de Aquiles, 32 de rotuliano y 34 del epicóndilo lateral) que recibieron una dosis diaria de 435 mg de mucopolisacáridos, 75 mg de colágeno tipo i y 60 mg de vitamina C (equivalente a 3 cápsulas al día de Tendoactive®) durante 90 días consecutivos. Mensualmente se evaluó el dolor en reposo y en actividad mediante una escala visual analógica (EVA), la función articular mediante los cuestionarios VISA-A, VISA-P y PRTEE, y se caracterizó ecográficamente el tendón afectado. Resultados En los 3 tipos de tendinopatía se registró una reducción significativa del dolor tanto en reposo como en actividad desde la primera visita de control (día 30) hasta el final del estudio (día 90). Asimismo el día 90 se detectó una mejora del 38% en VISA-A, del 46% en VISA-P y del 77% en PRTEE (p < 0,001). Simultáneamente se registró una reducción del 12% en el grosor del tendón de Aquiles, del 10% en el rotuliano y del 20% en el tendón del epicóndilo lateral (p < 0,05). Conclusiones Los resultados del estudio indican que la administración de Tendoactive® es segura y eficaz para mejorar los síntomas clínicos y la evolución estructural de las tendinopatías del tendón de Aquiles, tendón rotuliano y tendón del epicóndilo lateral

E14a2 Transcript Favors Treatment-Free Remission in Chronic Myeloid Leukemia When Associated with Longer Treatment with Tyrosine Kinase Inhibitors and Sustained Deep Molecular Response

e13a2 and e14a2 are the most frequent transcript types of the BCR::ABL1 fusion gene in chronic myeloid leukemia (CML). The current goal with tyrosine kinase inhibitors (TKI) is to achieve sustained deep molecular response (DMR) in order to discontinue TKI treatment and remain in the so-called treatment-free remission (TFR) phase, but biological factors associated with these goals are not well established. This study aimed to determine the effect of transcript type on TFR in patients receiving frontline treatment with imatinib (IM) or second-generation TKI (2G-TKI). Patients treated at least 119 months with IM presented less post-discontinuation relapse than those that discontinued IM before 119 months (p = 0.005). In addition, cases with the e14a2 transcript type treated at least 119 months with IM presented a better TFR (p = 0.024). On the other hand, the type of transcript did not affect the cytogenetic or molecular response in 2G-TKI treated patients; however, the use of 2G-TKI may be associated with higher and earlier DMR in patients with the e14a2 transcript

Acute leukemia arising from myeloproliferative or myelodysplastic/myeloproliferative neoplasms: A series of 372 patients from the PETHEMA AML registry

PETHEMA group.Treatment of acute myeloid leukemia (AML) evolving from myeloproliferative (MPN) or myelodysplastic/myeloproliferative neoplasms (MDS/MPN) is challenging. We evaluated disease characteristics, treatment patterns and outcomes in 372 patients diagnosed with AML after MPN or MDS/MPN over a 27-year period. Frontline treatment was intensive chemotherapy (38%), hypomethylating agents [HMAs] (17%), non-intensive chemotherapy (14%), and supportive care (31%). Median overall survival was 4.8 months, with a 5-year survival rate of 4%. Median survival was 2.8, 3.9 and 8.3 months for the 1992-2010, 2011-2015 and 2016-2019 periods, respectively (test for trend p < 0.001). Complete response (CR) rate was higher with intensive chemotherapy (43%) than with non-intensive chemotherapy (12%) or HMAs (8.5%) [p < 0.001], but responses were short-lived without allogeneic hematopoietic cell transplantation. Patients treated with intensive chemotherapy or HMAs had superior survival than those receiving non-intensive chemotherapy (median: 8.5 vs. 8.6 vs. 4.2 months, respectively). No differences in treatment response or survival were observed according to prior disease subtypes. Patients undergoing transplantation in CR had better survival than those transplanted in other response categories (3-year survival rate of 64% vs. 22%, p = 0.002). Our results support the use of intensive chemotherapy followed by transplant whenever possible, and the preferential use of HMAs over attenuated chemotherapy regimens in unfit patients. In spite of the survival improvement in recent years, this subset of AML constitutes an unmet medical need and deserves systematic incorporation in clinical trials.Peer reviewe

Machine Learning Improves Risk Stratification in Myelofibrosis: An Analysis of the Spanish Registry of Myelofibrosis

Myelofibrosis (MF) is a myeloproliferative neoplasm (MPN) with heterogeneous clinical course. Allogeneic hematopoietic cell transplantation remains the only curative therapy, but its morbidity and mortality require careful candidate selection. Therefore, accurate disease risk prognostication is critical for treatment decision-making. We obtained registry data from patients diagnosed with MF in 60 Spanish institutions (N = 1386). These were randomly divided into a training set (80%) and a test set (20%). A machine learning (ML) technique (random forest) was used to model overall survival (OS) and leukemia-free survival (LFS) in the training set, and the results were validated in the test set. We derived the AIPSS-MF (Artificial Intelligence Prognostic Scoring System for Myelofibrosis) model, which was based on 8 clinical variables at diagnosis and achieved high accuracy in predicting OS (training set c-index, 0.750; test set c-index, 0.744) and LFS (training set c-index, 0.697; test set c-index, 0.703). No improvement was obtained with the inclusion of MPN driver mutations in the model. We were unable to adequately assess the potential benefit of including adverse cytogenetics or high-risk mutations due to the lack of these data in many patients. AIPSS-MF was superior to the IPSS regardless of MF subtype and age range and outperformed the MYSEC-PM in patients with secondary MF. In conclusion, we have developed a prediction model based exclusively on clinical variables that provides individualized prognostic estimates in patients with primary and secondary MF. The use of AIPSS-MF in combination with predictive models that incorporate genetic information may improve disease risk stratification