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Asociación de la hemoglobina Groene Hart con la hemoglobina J-París-I: primer caso en España
Association between hemoglobin Groene Hart and hemoglobin J-Paris-I: First case in Spain
Félix de la Fuente-Gonzalo
Autor para correspondencia
felixfuenteg@hotmail.com

Autor para correspondencia.
, Paloma Ropero, Jorge Martínez-Nieto, Ana Villegas, Fernando A. González, Joaquín Díaz-Mediavilla
Servicio de Hematología, Hospital Clínico San Carlos, Madrid, España
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traducci&#243;n o en el procesamiento postraduccional<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Este &#250;ltimo mecanismo origina las denominadas Hb hiperinestables&#44; que no pueden ser detectadas por la mayor&#237;a de los m&#233;todos electrofor&#233;ticos o cromatogr&#225;ficos&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La Hb Groene Hart&#44; tambi&#233;n denominada Hb Bernalda&#44; es una variante hiperinestable que precipita en los precursores eritroides de manera precoz y est&#225; caracterizada por la mutaci&#243;n puntual CCT&#8594;TCT en el cod&#243;n 119 del gen <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span>&#44; originando el cambio de prolina &#40;Pro&#41; por serina &#40;Ser&#41; en la posici&#243;n H2 de la cadena pept&#237;dica<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La variante fue descrita por primera vez en 2 miembros de una misma familia de origen marroqu&#237;&#44; los cuales mostraron un fenotipo de &#945;-talasemia leve con microcitosis e hipocrom&#237;a<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Tambi&#233;n se ha encontrado en homocigosis en una mujer marroqu&#237; de 32 a&#241;os con un fenotipo de vtalasemia<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44; y asociada a la deleci&#243;n &#945;3&#44;7 en una ni&#241;a de origen tunecino que al nacimiento presentaba un 3&#37; de Hb Bart<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En este trabajo se presenta el estudio de 24 casos pertenecientes a 17 familias afectadas por Hb Groene Hart&#44; uno de ellos asociado a una Hb J-Par&#237;s-I<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;11</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Observaci&#243;n cl&#237;nica o m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Desde enero de 2009 hasta abril de 2013 fueron estudiados 998 pacientes con &#945;-talasemia que fueron remitidos a nuestro centro por presentar microcitosis sin ferropenia y en los que se hab&#237;a descartado previamente &#946;-talasemia y &#948;&#946;-talasemia&#46; Se recogi&#243; un consentimiento informado de todos los pacientes estudiados&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Los datos hematol&#243;gicos fueron obtenidos en un contador hematol&#243;gico &#40;Coulter<span class="elsevierStyleSup">&#174;</span> LH750 Analyzer&#59; Beckman Coulter&#44; Brea&#44; CA&#44; EE&#46; UU&#46;&#41;&#46; La cuantificaci&#243;n de las Hb A<span class="elsevierStyleInf">2</span> y F fue llevada a cabo por <span class="elsevierStyleItalic">high-performance liquid chromatography</span> &#40;HPLC&#44; &#171;cromatograf&#237;a l&#237;quida de alta presi&#243;n&#187;&#41; de intercambio i&#243;nico &#40;VARIANT&#8482;&#59; Hemel Hempstead&#44; Reino Unido&#41;&#46; Las Hb fueron estudiadas por electroforesis capilar &#40;Sebia<span class="elsevierStyleSup">&#174;</span> hispania S&#46;A&#46;&#44; Barcelona&#44; Espa&#241;a&#41; y HPLC de intercambio i&#243;nico &#40;VARIANT&#8482;&#44; Hemel Hempstead&#44; Reino Unido&#41;&#44; y las cadenas de globina&#44; mediante HPLC de fase reversa &#40;Shimadzu&#44; Kioto&#44; Jap&#243;n&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio molecular requiri&#243; la extracci&#243;n autom&#225;tica del ADN gen&#243;mico &#40;BioRobot<span class="elsevierStyleSup">&#174;</span> EZ1&#59; Qiagen&#44; Hilden&#44; Alemania&#41;&#46; Las mutaciones m&#225;s frecuentes fueron descartadas mediante &#945;-globin StripAssay<span class="elsevierStyleSup">&#174;</span> &#40;ViennaLab Diagnostic GmbH&#44; Viena&#44; Austria&#41;&#44; y la caracterizaci&#243;n molecular fue llevada a cabo mediante secuenciaci&#243;n autom&#225;tica espec&#237;fica en un secuenciador ABI PRISM<span class="elsevierStyleSup">&#174;</span> 3100 Genetic Analyzer &#40;Applied Biosystems&#44; Foster City&#44; CA&#44; EE&#46; UU&#46;&#41; y con el <span class="elsevierStyleItalic">kit</span> comercial ABI PRISM<span class="elsevierStyleSup">&#174;</span> BigDye<span class="elsevierStyleSup">&#174;</span> Terminador V1&#46;1 Cycle Sequencing Ready Reaction Kit &#40;PE Applied BioSystems&#44; Foster City&#44; CA&#44; EE&#46; UU&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0045" class="elsevierStylePara elsevierViewall">De los 998 pacientes estudiados&#44; 875 presentaron grandes deleciones en el cl&#250;ster &#945; de globinas y 126 mostraron mutaciones puntuales &#40;&#945;-talasemia no deleci&#243;n&#41;&#46; Dentro de este &#250;ltimo grupo con &#945;-talasemia no deleci&#243;n&#44; 24 pacientes &#40;pertenecientes a 17 familias no relacionadas entre s&#237;&#44; 6 de ellas de origen magreb&#237;&#41; presentaron la mutaci&#243;n CCT&#8594;TCT &#40;Pro&#8594;Ser&#41; en el cod&#243;n 119 &#40;Hb Groene Hart&#41;&#46; Por lo tanto&#44; en nuestra serie de pacientes&#44; la Hb Groene Hart supone un 19&#37; de la &#945;-talasemia no deleci&#243;n&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los par&#225;metros hematim&#233;tricos&#44; Hb A<span class="elsevierStyleInf">2</span>&#44; Hb F&#44; y el genotipo en el cl&#250;ster &#945; quedan recogidos en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">La Hb var&#237;a desde 8<span class="elsevierStyleHsp" style=""></span>g&#47;dl hasta valores de 16<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#46; El rango del volumen corpuscular medio &#40;VCM&#41; est&#225; entre 70&#44;2 y 85&#44;6<span class="elsevierStyleHsp" style=""></span>fl&#44; y la Hb corpuscular media &#40;HCM&#41; se encuentra entre 23 y 27&#44;6<span class="elsevierStyleHsp" style=""></span>pg&#46; Todos presentaron una Hb A<span class="elsevierStyleInf">2</span> en los l&#237;mites de la normalidad &#40;2&#44;2-3&#44;5&#37;&#41;&#44; con una Hb F y ferritina normales&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">No se separaron Hb an&#243;malas ni por electroforesis capilar ni por HPLC de intercambio i&#243;nico&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La secuenciaci&#243;n selectiva del gen <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span> mostr&#243; la Hb Groene Hart&#46; Adem&#225;s&#44; en un paciente se observ&#243; tambi&#233;n la mutaci&#243;n GCC&#8594;GAC &#40;Ala&#8594;Asp&#41; en el cod&#243;n 12 del gen <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span> &#40;Hb J-Par&#237;s-I&#41;&#46; Todas las mutaciones se encontraron en heterocigosis &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1 y 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">Los portadores de Hb hiperinestables cursan con un s&#237;ndrome talas&#233;mico que es debido a la precipitaci&#243;n postraduccional de las cadenas an&#243;malas&#46; Este tipo de variantes de Hb supone un 9&#44;5&#37; de las hemoglobinopat&#237;as estructurales&#44; y es necesario tenerlas en cuenta puesto que es complejo ponerlas de manifiesto por las t&#233;cnicas electrofor&#233;ticas y la HPLC de intercambio i&#243;nico<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En la Hb Groene Hart &#91;CD119&#40;H2&#41; Pro&#8594;Ser &#945;<span class="elsevierStyleInf">1</span>&#93; se ve afectado el residuo 119 de la cadena &#945;&#44; el cual tiene un papel fundamental a la hora de interaccionar con la <span class="elsevierStyleItalic">alpha hemoglobin stabilizing protein</span> &#40;AHSP&#44; &#171;prote&#237;na estabilizadora de la cadena &#945; de la Hb&#187;&#41; y as&#237; conservar la estabilidad de toda la cadena glob&#237;nica&#46; La AHSP es una chaperona que se une a las cadenas &#945; de globina para protegerlas de su precipitaci&#243;n&#44; ya que esta ocasionar&#237;a un da&#241;o en la membrana del eritrocito&#46; En el caso de la Hb Groene Hart&#44; su hiperinestabilidad es debida a la disminuci&#243;n de su afinidad por la AHSP<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Este mismo mecanismo ha sido postulado para otras variantes cuyo residuo alterado se encuentra en las h&#233;lices G y H&#44; ya que estas son las que interaccionan con la AHSP&#46; Las variantes que se comportar&#237;an de este modo son&#44; entre otras&#44; Hb Bronovo &#91;CD103&#40;G10&#41; His&#8594;Leu &#945;<span class="elsevierStyleInf">2</span>&#93;&#44; Hb Suan Dok &#91;CD109&#40;G16&#41; Leu&#8594;Arg&#93;&#44; Hb Foggia &#91;CD117&#40;GH5&#41; Phe&#8594;Ser&#93; y Hb Utrecht &#91;CD129&#40;H12&#41; Leu&#8594;Pro &#945;<span class="elsevierStyleInf">2</span>&#93;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Sin embargo&#44; en la Hb Diamant &#91;CD119&#40;H2&#41; Pro&#8594;Leu &#945;<span class="elsevierStyleInf">1</span>&#93;&#44; en la que el residuo afectado es el mismo que en la Hb Groene Hart&#44; los heterocigotos no muestran un fenotipo talas&#233;mico<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; La diferencia entre ambas reside en que mientras en la Hb Diamant la sustituci&#243;n de prolina por leucina no origina cambio de polaridad&#44; en la Hb Groene Hart el residuo prolina es desplazado por un amino&#225;cido polar &#40;Ser&#41;&#46; Probablemente esto hace que exista una menor distorsi&#243;n en las interacciones en la Hb Diamant&#46; De hecho&#44; <span class="elsevierStyleItalic">in vivo</span> la estabilidad del complejo formado por la AHSP y la cadena &#945;<span class="elsevierStyleSup">Hb Diamant</span> es superior a la que existe con la cadena normal&#44; debido a la mayor apolaridad que muestra la Leu sobre la Pro<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;17</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">No obstante&#44; otras muchas Hb cuyo residuo afectado se encuentra en las h&#233;lices G o H muestran una inestabilidad similar a la Hb Groene Hart&#44; lo que pone de manifiesto la importancia de dichas regiones en la interacci&#243;n con la chaperona AHSP<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Si exceptuamos al ni&#241;o de 2 a&#241;os que presentaba anemia ferrop&#233;nica&#44; el valor medio de la Hb fue de 13&#44;4<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#59; &#250;nicamente cabe destacar el valor de 16<span class="elsevierStyleHsp" style=""></span>g&#47;dl en 2 pacientes en relaci&#243;n con el h&#225;bito del tabaquismo&#46; Todos presentaron hipocrom&#237;a&#44; con una HCM media de 25&#44;8<span class="elsevierStyleHsp" style=""></span>pg&#44; excepto el caso asociado a la Hb J-Paris-I &#40;27&#44;6<span class="elsevierStyleHsp" style=""></span>pg&#41;&#44; lo cual demuestra que el par&#225;metro m&#225;s id&#243;neo para el diagn&#243;stico de una &#945;-talasemia no es el VCM&#44; sino el HCM&#44; siempre<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>27<span class="elsevierStyleHsp" style=""></span>pg&#46; El VCM oscil&#243; entre 71&#44;3 y 85&#44;6<span class="elsevierStyleHsp" style=""></span>fl&#44; coincidiendo los de menor valor con los ni&#241;os y&#44; en general&#44; siendo todos los valores ligeramente superiores a los que se encuentran en mutaciones cuyo resultado es una hemoglobinopat&#237;a hiperinestable&#44; pero en las cuales el gen afectado es <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span>&#44; como en el caso de la Hb Agrino &#91;CD29&#40;B10&#41; Leu&#8594;Pro&#59; &#945;<span class="elsevierStyleInf">2</span>&#93;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Este hecho&#44; sin embargo&#44; podr&#237;a ser explicado por la menor expresi&#243;n que tiene el gen <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span> &#40;en el cual se encuentra localizada la mutaci&#243;n responsable de la Hb Groene Hart&#41; con respecto al gen <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En nuestro estudio no hemos encontrado casos homocigotos o dobles heterocigotos con una deleci&#243;n en el otro alelo &#40;&#945;<span class="elsevierStyleSup">&#43;</span> talasemia deleci&#243;n&#41;&#44; aunque s&#237; se han descrito en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; En ning&#250;n paciente se manifest&#243; una enfermedad de la Hb H&#44; puesto que esto ocurrir&#237;a cuando la Hb Groene Hart se asociase a una deleci&#243;n causante de una &#945;<span class="elsevierStyleSup">0</span> talasemia deleci&#243;n en el otro alelo&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Dentro del estudio se ha encontrado el primer caso de Hb Groene Hart asociada a una Hb J-Par&#237;s-I &#91;CD12&#40;A10&#41; Ala&#8594;Asp&#59; &#945;<span class="elsevierStyleInf">2</span>&#93;&#46; No se observan diferencias con respecto al resto de los pacientes&#46; La Hb J-Par&#237;s-I es una variante denominada r&#225;pida&#44; descrita por primera vez en una mujer espa&#241;ola y que posteriormente se observ&#243; en Portugal&#44; Ir&#225;n&#44; Yugoslavia e Italia<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;11</span></a>&#46; Es cl&#237;nicamente silente&#44; no se observan alteraciones hematol&#243;gicas&#44; lo cual confirmar&#237;a que la asociaci&#243;n con otras variantes no agrava el cuadro cl&#237;nico&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En este estudio se ha encontrado la Hb Groene Hart tanto en poblaci&#243;n espa&#241;ola como en poblaci&#243;n inmigrante procedente del Magreb&#44; donde fue descrita por primera vez y donde es relativamente frecuente<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Dada la relaci&#243;n geogr&#225;fica e hist&#243;rica de las 2 poblaciones&#44; es probable que la mutaci&#243;n tuviera un origen com&#250;n&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Durante la Edad Media&#44; entre los a&#241;os 711 y 1492&#44; la pen&#237;nsula ib&#233;rica form&#243; parte del denominado al-&#193;ndalus bajo el poder musulm&#225;n del Califato Omeya del norte de &#193;frica&#46; En 1492&#44; los Reyes Cat&#243;licos pusieron fin al poder isl&#225;mico en la pen&#237;nsula&#44; aunque la mayor parte de la poblaci&#243;n musulmana prefiri&#243; adoptar las nuevas costumbres y permanecer en sus tierras&#46; Estos 8 siglos de dominio musulm&#225;n podr&#237;an haber sido tiempo suficiente para que tuviera lugar un proceso de mestizaje que ser&#237;a el responsable de que esta variante se encuentre hoy en d&#237;a en la poblaci&#243;n aut&#243;ctona&#46; Esta idea se ve reforzada por el hecho de que los pacientes espa&#241;oles proceden todos de la mitad sur peninsular &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; a excepci&#243;n de un caso procedente del Pa&#237;s Vasco&#44; pero de or&#237;genes extreme&#241;os&#46; De modo que las poblaciones que estuvieron durante m&#225;s tiempo en contacto con los musulmanes ser&#237;an aquellas en las que hoy en d&#237;a sigue persistiendo la Hb Groene Hart&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Ambas contribuciones &#40;aut&#243;ctona e inmigrante&#41; mantienen una frecuencia de la Hb Groene Hart cercana al 20&#37; dentro de los casos de &#945;-talasemia no deleci&#243;n en nuestro pa&#237;s&#44; siendo relativamente elevada en comparaci&#243;n con otras variantes menos usuales&#46; Por ello&#44; la identificaci&#243;n molecular de los portadores de la mutaci&#243;n responsable de la Hb Groene Hart deber&#237;a estar considerada en el estudio de los casos de &#945;-talasemia no deleci&#243;n&#44; en el contexto de programas de cribado de microcitosis&#44; al igual que se realiza en el norte de &#193;frica<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#44; para con ello tratar de evitar&#44; mediante el consejo gen&#233;tico&#44; la aparici&#243;n de las formas graves de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicto de intereses</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            0 => "Alfatalasemia no deleci&#243;n"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamento y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las talasemias son las enfermedades monog&#233;nicas m&#225;s frecuentes a nivel mundial&#46; Representan un grave problema sanitario en las regiones de mayor incidencia&#46; Las &#945;-talasemias se deben a un d&#233;ficit de s&#237;ntesis de las cadenas &#945; de la hemoglobina &#40;Hb&#41;&#46; La Hb Groene Hart es una variante hiperinestable&#46; En este trabajo se presentan 24 casos pertenecientes a 17 familias afectadas por la Hb Groene Hart&#44; uno de ellos asociado con Hb J-Par&#237;s-I&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Veinticuatro pacientes de 17 familias no relacionadas fueron incluidos en este estudio&#46; La caracterizaci&#243;n se realiz&#243; mediante secuenciaci&#243;n&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La secuenciaci&#243;n del gen <span class="elsevierStyleItalic">&#945;1</span> mostr&#243; la mutaci&#243;n CCT&#8594;TCT &#40;Pro&#8594;Ser&#41; en el cod&#243;n 119 &#40;Hb Groene Hart&#41;&#46; En un paciente se asoci&#243; con la Hb J-Par&#237;s-I&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En la Hb Groene Hart se encuentra afectado un residuo clave para preservar la estabilidad de las cadenas &#945; de globina&#46; La presencia de esta variante es elevada en poblaci&#243;n espa&#241;ola e inmigrante&#46; La aparici&#243;n de formas graves de la enfermedad podr&#237;a ser evitada incorporando esta mutaci&#243;n al cribado de las mutaciones &#945;-talasemia no deleci&#243;n&#46;</p></span>"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Thalassemias are the most frequent monogenic disorder around the world&#46; &#945;-thalassemias are due to a deficiency of synthesis in the alpha-globin chain of the hemoglobin &#40;Hb&#41;&#46; Hb Groene Hart is a hyperunstable variant&#46; In this work&#44; we have studied 24 cases affected by Hb Groene Hart&#44; one of them associated with Hb J-Paris-I&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Twenty-four patients from 17 unrelated families were included in this study&#46; The characterization was done by sequencing&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#945;1</span> gene sequencing showed the mutation CCT&#8594;TCT &#40;Pro&#8594;Ser&#41; at codon 119 &#40;Hb Groene Hart&#41; in all patients&#46; In one case&#44; there was an association with Hb J-Paris-I&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In the Hb Groene Hart&#44; the residue 119 of alpha-globin chain is affected&#46; This amino acid has a key role in preserving the stability of alpha-globin chain&#46; It is also remarkable the presence of this variant in both the immigrant and native population&#46; Thus&#44; the identification of Hb Groene Hart carriers should be considered in the screening of &#945;-thalassemia in Spain&#44; as it is done in Northern Africa&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1027
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        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Secuenciaci&#243;n directa&#58; hemoglobina Groene Hart o Bernalda &#40;&#945;<span class="elsevierStyleInf">1</span> 119&#40;H2&#41; Pro&#8594;Ser&#41;&#58; CCT&#8594;TCT&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1194
            "Ancho" => 2501
            "Tamanyo" => 154101
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Secuenciaci&#243;n directa&#58; hemoglobina J-Par&#237;s-I &#40;&#945;<span class="elsevierStyleInf">2</span> 12&#40;A10&#41; Ala&#8594;Asp&#41;&#58; GCC&#8594;GAC&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">H&#58; hombre&#59; Hb&#58; hemoglobina&#59; HCM&#58; hemoglobina corpuscular media&#59; M&#58; mujer&#59; VCM&#58; volumen corpuscular medio&#59; &#945;<span class="elsevierStyleSup">Gr</span>&#58; Groene Hart&#59; &#945;<span class="elsevierStyleSup">J-Pa</span>&#58; J-Par&#237;s-I&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Familia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Procedencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Individuo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hb &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VCM &#40;fl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HCM &#40;pg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hb A<span class="elsevierStyleInf">2</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hb F &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reticulocitos &#40;x100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Genotipo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;<span class="elsevierStyleSup">J-Pa</span>&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">II1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;1<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">II2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Guip&#250;zcoa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">II1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">E<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Navarra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#225;laga&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">G<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Navarra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">H<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lanzarote&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">J&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">K&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">M<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gran Canaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">N<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Guadalajara&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Guadalajara&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#209;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Toledo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#945;&#945;<span class="elsevierStyleSup">Gr</span>&#47;&#945;&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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