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En las normas dirigidas a la creación de un mercado interior del gas natural en la UniónEuropea se habían dejado fuera del ámbito de aplicación los gasoductos de importación procedentes de terceros países. Las controversias políticas generadas por la construcción del gasoducto directo entre Rusia y Alemania, por el Mar Báltico (Nord Stream 2) condujeron en 2019 a la modificación de la Directiva relativa al mercado interior del gas natural de 2009, de manera que, sin resultados extraterritoriales en la eficacia de la norma, las normas se aplican a los gasoductos procedentes de terceros países. Esta modificación afecta en España a dos gasoductos procedentes de Argelia, para los cuales, de acuerdo con la reforma europea, se han establecido excepciones.

Further improvement on irrigation management requires continuous plant water status monitoring. The non-invasive ZIM-probe measures the pressure (Pp) transfer function through a patch of an intact leaf, which is inversely correlated with the turgor pressure. Data are sent wireless in real-time by telemetry to an internet server via a mobile phone network where it is available to be analyzed. In this work, the detection of water stress by measuring relative changes in turgor pressure with the ZIM-probe was evaluated in clementine and persimmon trees. Ten trees of both species were equipped with two ZIM-probes each located at the east side of the canopy. The ZIM-probes were used over several months during which half of the trees were subjected to two drought cycles. Concomitant measurements of stem water potential (ψs) were taken at midday in both orchards during the drought periods. Additionally, determinations of ψs and stomatal conductance (gs) were also performed during 1-2 days at hourly intervals in the clementine and persimmon orchards, respectively, to study the existing relationship of these classical indicators with the leaf turgor pressure. Results showed that diurnal Pp values increased in non-irrigated clementine trees when water restrictions were imposed. Persimmon drought-stressed trees, on the other hand, showed different Pp curve shapes (half and complete inverse curve) depending on the level of stress reached by the trees. There was a tight correlation between the hourly spot measurements of ψs and gs with the probe data. Overall, results show that the ZIM-probe enables the detection of drought stress in clementine and persimmon trees. Nevertheless, different approaches for calculating the water stress level must be used in each of these species due to the higher tendency of persimmon leaves to the inversed Pp curve phenomena.

Varón de 78 años con miocardiopatía dilatada de origen isquémico que ingresa por insuficiencia cardíaca. Durante su ingreso sufre una caída con fractura de cadera de la que es intervenido. En el posoperatorio presenta cuadro de delirium. Tras la instauración de medidas ambientales y preventivas, y neurolépticos evoluciona favorablemente. La identificación de las causas precipitantes del delirium, así como el tratamiento médico precoz y la actuación sobre los factores de riesgo del mismo, son esenciales para lograr el éxito terapéutico.

Locomotor system disorders in equine species, such as tendon lesions, osteoarthritis, or ligament injuries, are some of the most frequent causes of dramatic reduction in horse performance. Traditional therapies are aimed at the inflammatory process and pain, but they do not regenerate normal tendon or ligament matrix and do not reduce re-injured rates. Mesenchymal stem cells have started to use as therapeutic option to repair these injured tissues. Most studies have focused on their isolation, in vitro culture and pheno-typing. However, mesenchymal stem cell ultrastructure has been disregarded in the last years. We investigate the ultrastructural characteristics of these cells once differentiated into chondrocytes. Ultrastructural analysis was conducted on suspension cultures of differentiated chondrocytes from bone marrow mesenchymal stem cells by means of transmission electron microscopy. The morphologic characteristics of these cells, their ability to produce the extracellular matrix, and the presence of a single cilium could be indicative of the mesenchymal cells differentiation into chondrocyte phenotype. This study provides essential data to evaluate the degree of suitable phenotypic stability, for these cells can be used with repair purposes. (C) 2016 Elsevier Inc. All rights reserved.

La esteatosis hepática cuando alcanza un determinado nivel, puede alterar el funcionamiento del hígado, ante situaciones fisiopatológicas límite como el proceso de trasplante hepático, las grandes resecciones hepáticas y la esteatohepatitis .La biopsia hepática es el standard actual en el diagnóstico de la infiltración grasa hepática.El objetivo de nuestro trabajo es el de cuantificar la esteatosis hepática por medio de la medición de la bioimpedancia (BI) de la víscera, a través de un electrodo implantable mejorado y determinar las características de la corriente más útiles para realizar la medición de la BI.MATERIAL Y MÉTODOS:Utilizamos un electrodo de diseño propio, tetrapolar, a lo largo de una aguja de punción de 1,5 mm de grosor, conectado a un medidor de impedancia multifrecuencia de uso humano.Utilizamos un modelo de esteatosis hepática en grandes animales, cerdos de la raza White x Landrace.Utilizamos una muestra de 18 animales, dividida en:- 15 animales en el grupo estudio, que fueron alimentados con una dieta diseñada para la generación de esteatosis.-3 animales en el grupo control, alimentados con la dieta convencional.Tras 4 meses de dieta se realizaron las medidas de bioimpedancia. Las mediciones fueron realizadas en los segmentos 3 y 4 del hígado porcino, con el electrodo insertado y con el electrodo apoyado. A su vez se tomó una biopsia hepática a cielo abierto.RESULTADOS:Los animales sometidos a dieta esteatósica presentaron cifras de esteatosis entre el 20 y el 90%, ningún animal del grupo control presentó esteatosis (Media 64,16 y desviación típica de 36,14). Los animales del grupo esteatósico tuvieron una menor ganancia ponderal.Se obtuvo una correlación lineal entre la BI del hígado y la esteatosis hepática en las 2 formas de medición (apoyado e insertado), siendo más altas las correlaciones obtenidas con las mediciones realizadas con el electrodo apoyado.Las mediciones más significativas con el electrodo apoyado:-en el segmento 4 se realizaron en las frecuencias de 101,1 kHz y de 204,2 kHz. -en el segmento 3 las mejores frecuencias para realizar la medición fueron las de 142,1 y 204,2 kHz (obteniendo la máxima correlación: 0,837).CONCLUSIONES:-Utilizando la sonda tetrapolar, de nuevo diseño, y un sistema de medida podemos obtener cifras de BI que se correlacionan con el grado de esteatosis en un modelo de esteatosis porcina inducido mediante dietas especiales. -Hemos obtenido correlaciones entre la BI y el porcentaje de esteatosis tanto mediante la medición con la sonda insertada en el seno del parénquima hepático como con la sonda apoyada en su superficie.-Las mejores cifras de correlación se han obtenido mediante las mediciones con la sonda apoyada en la superficie del hígado.-Las frecuencias óptimas de la corriente con las cuales se han realizado las mediciones con el electrodo apoyado, han sido entre 101,1 kHz y 204,2 kHz-Como conclusión final creemos que somos capaces de medir la esteatosis hepática con nuestro método de medición de la BI.

Introducción: Los trastornos mentales en edad infanto-juvenil presentan una prevalencia de 15-25%. La infancia y la adolescencia suponen etapas de gran vulnerabilidad en el desarrollo neurológico, tanto a nivel anatómico como funcional. Se ha evidenciado la influencia de una serie de factores neuroquímicos y ambientales sobre el desarrollo cerebral, entre los que la nutrición ocupa un lugar primordial. Así mismo, en la última década, diversos autores han observado una asociación entre la nutrición durante la infancia y el desarrollo de algunos trastornos relacionados con la salud mental. Objetivos: El objetivo principal del presente estudio es valorar la presencia de asociación entre los hábitos dietéticos y la salud mental en población infanto-juvenil. Material y métodos: Se ha desarrollado un estudio de corte transversal a partir de los datos recogidos en la Encuesta Nacional de Salud de España (ENSE) 2017. Resultados y conclusiones: Se observan mejores puntuaciones en el Cuestionario de Calidad de Vida abreviado KIDSCREEN-10 y en las diferentes subescalas del Cuestionario de Cualidades y Dificultades SDQ conforme aumenta el consumo de fruta y en el consumo habitual de pescado frente al consumo infrecuente (< de una vez por semana), si bien no se obtienen asociaciones estadísticamente significativas en todas las categorías. No se han obtenido resultados concluyentes entorno a la relación entre la ingesta de verdura y la salud mental de los menores.

Osteoporosis is a highly prevalent disease with important consequences. The most widely used drugs to control this disease are bisphosphonates but their prolonged use is associated with the risk of atypical fractures. We report the cases of two patients under bisphosphonate treatment with bilateral atypical femoral fractures. In one patient the fractures occurred simultaneously, unprovoked by trauma, and in the other, they occurred as delayed fractures after mild trauma. In both cases, the fractures were preceded by pain. The fractures were treated with intramedullary nailing and bisphosphonate withdrawal with good outcomes. Although bisphosphonates have demonstrated effectiveness in preventing frailty-related fractures, their prolonged use has paradoxically been associated with atypical fractures. These fractures are usually preceded by pain. Consequently, when faced with this clinical picture, physicians should request imaging studies that could show incomplete fractures that could benefit from prophylactic nailing before becoming complete fractures.

Early in the EU liberalization process, renewable energies needed governmental support in a market dominated by traditional sources. Support was considered an exception to prohibition of governmental promotion of indigenous national energy sources. The Climate and Energy Package changed this perspective, leading to the 2009 Directive, allowing member states to enforce support schemes promoting renewable energies. Conflicts emerged between some schemes and the rules on state aids of the Treaty on the Functioning of the European Union. Deficient stability of support schemes must yield to a more predictable legal framework. The proposed substitute renewable energies Directive must be read in light of reinforcements of EU sustainable energies policies and 2015 Paris Agreement commitments. Renewable energies technology innovation has reduced costs and governmental support is somehow redundant. The future Directive provides rules that are compatible with competition and on the need to support generation from renewable energies in other member states.

Frailty is an important prognostic factor in older adults with cardiovascular diseases. We aim to describe the characteristics of elderly hospitalised frail patients with non-valvular atrial fibrillation (NVAF) and to assess the influence of frailty, along with other functional and health status variables on anticoagulation prescription, 1-year all-cause mortality, and the incidence of ischemic and bleeding complications. An observational, prospective multicentre study was carried out on patients with NVAF over the age of 75, who were admitted to the Internal Medicine departments in Spain. A total of 615 patients were evaluated (mean age 85.23 ± 5.16 years, 54.3% females, 48.3% frail). Frail patients had higher CHA2DS2-VASc and HAS-BLED scores, more comorbidities and worse functional status and cognitive impairment compared to non-frail. During hospitalisation, 58 (9.4%) patients died (12.5% frail, 6.6% non-frail, p = 0.01). Among the participants discharged, 69.8% received anticoagulants, 13% anti-platelets only and 16.9% no anti-thrombotics, with no difference by frailty status. Frailty is not a predictor of anticoagulant prescription at discharge (OR 0.93, 95% CI 0.55-1.57), while functional dependency remains significantly associated (OR for severe dependency 0.44, 95% CI 0.23-0.82). After the 1-year follow-up, frail patients have a higher risk of death (HR 1.99, 95% CI 1.43-2.76). Among patients taking anticoagulants, the incidence of stroke and major bleeding is similar between frailty groups. In our study, frailty is related to worse global health status. It has no impact on antithrombotic prescription, nor is a predictor of AF complications, even though frail subjects have a higher mortality during hospitalisation and after 1-year follow-up.

Dedifferentiation is a loss of phenotypic specialization that converts differentiated cells into adult stem cells in order to proliferate and differentiate into replacement tissue. This occurs in several tissues from various organs, such as smooth muscle cells (SMCs) of the mammalian gastrointestinal tract. The aim of this study was to describe ultrastructural and immunohistochemical changes in SMCs which could be compatible with a dedifferentiation process in human and rabbit intestinal muscles. Ultrastructural study and immunohistochemical staining (SMemb and MyoD) on human and rabbit duodenum tissue sections were performed. In both species, this dedifferentiation process is characterized by a loss of intercellular junctions, increased intercellular spaces, cytoskeletal disorganization, perinuclear accumulation of large vacuoles that tend to fuse, rupture of the vacuole membrane and release of cytoplasmic fragments. Dedifferentiated cells show the characteristic phenotype of a mesenchymal cell with scarce perinuclear cytoplasm, long cytoplasmic prolongations and finely distributed granular chromatin in the nucleus. These morphological changes are accompanied by a modulation to a less mature phenotype showing immunoreactivity for the embryonic form of the myosin heavy chain and for the myogenic regulatory factor MyoD. We suggest that SMC dedifferentiation includes the elimination of the contractile apparatus, the activation of the nucleus and the re-expression of embryonic markers. We described an ultrastructural dedifferentiation process possible in intestinal SMCs. This dedifferentiation process seems to play a key role in the homeostasis of the intestinal muscle.

To describe the care provided at the end of life for patients who die in internal medicine departments.An observational, cross-sectional, retrospective multicentre, clinical audit study was conducted where each hospital included the first 10 patients who died in the internal medicine department starting on December 1, 2015. We collected demographic and clinical data and information regarding the circumstances and care at the time of death.The study included 1,447 patients with a median age of 84 years. Of these, 1,065 (74.3%) were polypathological, 751 (51.9%) were terminal and 248 (17.1%) had cancer. For the terminal patients, do-not-resuscitate orders were established for 539 (73.3%), and palliative sedation was performed for 422 (57.4%). There was no record as to whether psychological, religious or grief care was provided in 32%, 64.8% and 44.1% of the terminal patients, respectively. The patients with cancer were more often competent to make decisions (54.4% vs. 15.5%; P.001), knew their prognosis (42.6% vs. 8.6%; P.001), received psychological care (24.9% vs. 8.6%; P.001), died in an individual room (64.6% vs. 44.4%; P.001) and were accompanied (81.9% vs. 71.9%; P=.003). Their relatives also more frequently received grief care (15.6% vs. 8.2%; P=.002).There is insufficient recording in the medical history as to the end-of-life care. There are differences in the care provided to patients with cancer and to those without cancer.

Background and Aims. There are limited data on clinical and phenotypic characteristics of outpatients referred for hyperferritinemia (HF). To determine the causes of HF in outpatients referred to a secondary hospital.Material and methods. A prospective study of 132 consecutive patients with HF (> 200 μg/L, women; > 300 μg/L, men) was conducted from January-December 2010.Results. Mean age, 54.42 years (SD: 13.47, range: 23-83); body mass index (BMI), 28.80 (SD: 3.96, 17-39); ferritin (SF), 579.54 ng/mL (SD: 296.575, 206-1668); transferrin saturation (TSI), 43.87% (SD: 14.09, 12-95); iron (Fe), 134 μg/dL (SD: 49.68, 55-322); overweight: 48.31%, and obese: 40.44% (89%), and most patients were men (108/132). Regarding HFE mutations, H63D/H63D genotype and H63D allele frequencies were 17.5% (vs. 7.76% in controls); and 36% (31% in controls) respectively. While 63.6% consumed no alcohol, 18.1% consumed ≥ 60 g/day, the mean being 20.83 (SD: 33.95, 0-140). Overall, 6/132 (4.5%) patients were positive for B or C hepatitis. Mean LIC by MRI was 36.04 (SD: 32.78, 5-210), 53 patients having normal concentrations (< 36 µmol/g), 22 (33%) iron overload (37-80), and 4 (5%) high iron overload (> 80). Metabolic syndrome (MS) was detected in 44/80 men (55%) and 10/17 women (59%). In this group, the genotype frequency of the H63D/H63D mutation was significantly higher than in controls-21.56% vs. 7.76%- (p = 0.011); the H63D allelic frequency was 42.15% in MS group and 31% in controls (p = 0.027).Conclusion. The H63D/H63D genotype and H63D allele predispose individuals to HF and MS. MRI revealed iron overload in 33% of patients.

Background & Aims The current definition of the pattern of liver injury in hepatotoxicity (DILI) is given by the R (ratio) value, dividing alanine aminotransferase (ALT) and alkaline phosphatase (ALP) in upper limits of normal at DILI onset. We aimed to explore the validity of using aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) as biomarkers of hepatocelullar and cholestatic damage, respectively, when calculating the R value. Methods Clinical, laboratory and histological data from 588 DILI episodes included in the Spanish DILI Registry were analyzed. Linear regression analysis was performed to establish the most appropriate cut-off points for hepatocellular and cholestatic patterns when calculating R with AST and GGT. Results The overall agreement between ALT/ALP and AST/ALP was 76%, with 96%, 61% and 41% agreement in the hepatocellular (R ≥ 5), cholestatic (R ≤ 2) and mixed groups respectively (P