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Many Mediterranean rivers are characterized by an inter-annual climatic variability, additionally intensified by climate change. Moreover, these rivers have limited extensions and a reduced dilution capacity which make them vulnerable to human pressures, especially to water pollution. During the 1970s, the Besos river basin had historically suffered the continuous discharge of untreated residual water, leading to be considered as the most polluted river in Europe. During the 1990s and 2000s, environmental laws such as the Catalan Treatment Plan and the Water Framework Directive (2000/60/EC) were implemented to resolve the problem. Consequently, the number of wastewater treatment plants (WWTPs) and long-term monitoring programs to assess the ecological status increased in the territory. In order to evaluate these changes, this study assesses the biological quality status (IBMWP, QBR and IPS) in the Besos river water at three spatial scales (headwater, middle and lower sections). Our results clearly show that water quality across the basin has been improved. This improvement has become more significant after the implementation of new treatment systems. The trends in ammonia concentrations (NH4+, in mg/L) and conductivity (EC, in μS/cm) discharged from 13 selected WWTPs during the period 2000–2018 displays a clear decreasing tendency. Finally, we have applied a thorough statistical analysis to the IBMWP dataset to demonstrate the positive influence of the treatment systems on the ecological quality status across the river basin. We conclude that the implementation and enforcement of environmental laws are valid and effective tools to improve water quality in Mediterranean rivers. • Wastewater treatment plant upgrading has positive effects on biological quality status. • High NH4+ and conductivity levels provoke alterations on biological quality status. • Correct quality status (IBMWP) is reached when NH4+

Resumen Antecedentes y objetivo Previamente se habia iniciado el proceso metodologico para la validacion transcultural al idioma espanol de la escala Hair Specific Skindex-29 (HSS-29), que mide el impacto de la alopecia androgenica femenina sobre la calidad de vida relacionada con la salud (CVRS). Para finalizar el proceso, el objetivo del estudio fue completar la validacion a traves de la determinacion de su sensibilidad al cambio y su correlacion con una escala generalista de CVRS (SF-12). Material y metodo Se establecieron dos visitas, una basal y otra tras 6 meses de tratamiento con suplemento alimenticio con actividad inhibidora de la enzima 5-alfa reductasa. En cada visita, investigadores y pacientes valoraron la gravedad de la alopecia mediante la escala Sinclair, el estado de la apariencia del cabello, y se administraron las escalas HSS-29 y SF-12. Resultados Participaron 983 mujeres con alopecia androgenica. La media de puntuacion en la escala HSS-29 cambio de 27,5 ± 18,7 en la visita basal a 19,3 ± 15,7 en la de seguimiento, y sus dimensiones funcional, emocional y sintomatica tambien cambiaron significativamente. Tanto las diferencias entre basal y seguimiento en el indice HSS-29 global como en cada una de sus dimensiones se correlacionaron significativamente con las diferencias encontradas en las dimensiones de SF-12. Los coeficientes de correlacion de Pearson oscilaron entre −0,1 y −0,4, y en todos los casos el grado de significacion fue p Conclusiones La version en espanol de la escala HSS-29 posee sensibilidad, es decir, detecta cambios relacionados con la calidad de vida cuando las condiciones objetivas varian. Igualmente, se observo una correlacion entre las escalas HSS-29 y SF-12.

This paper aims to present the initial results of an ongoing research on the study of fishing in the island of Majorca in the Middle Ages, which includes the fishing activity, its production organization, as well as the commercialization and consumption of fish catches, and geography and sociology of population dedicated to fishing activities. The present study pays special attention to the most significant features of this activity in Majorca. That is the use of slave labour as part of the crew, the growing importance of coral extraction, and the development of fish-sale areas at almost all the villages of the island, as a way to tax fishing activities.

Aquest treball ofereix l’edició d’un tractat de falconeria, anònim, escrit en català i que, segurament, el podem datar en el segle XV. El manuscrit 102 que es conserva a la Biblioteca de la Universitat de Barcelona conté dos textos; en primer lloc, una traducció feta per Antoni Canals d’una obra de Petrarca i, en segon lloc, un recull de receptes mèdiques destinades a les aus de caça. Aquest article consta de tres parts. Primerament, presentem una succinta introducció per a conéixer les característiques d’elaboració i el contingut del manuscrit. A continuació, fem una aprofundida anàlisi lèxica de la terminologia tècnica referida a la falconeria que té dues parts: una proposta de classificació del lèxic específic en els diferents camps semàntics i un glossari dels vocables més destacats. Finalment, oferim l’edició crítica d’aquest tractat de falconeria. This is a edition of an anonymous treatise on falconry, written in Catalan, and which can be, most probably, dated back to the 15th century. Manuscript 102, kept in the Library of the University of Barcelona, contains two texts: the first is Antoni Canals’ translation of a text by Petrarch, and the second a text which contains a set of medical prescriptions for game birds. This article consists of three parts: firstly, a short introduction on the writing and contents of the manuscript; secondly, an in-depth lexical analysis of the technical terminology on falconry divided into two parts: a proposal for the classification of the specific lexicon in the different semantic fields, and a glossary of the more relevant terms; and finally, a critical edition of this treatise on falconry. Aquest treball s’inscriu en el marc del Projecte d’investigació subvencionat per la Generalitat Valenciana «La falconeria a la Corona d’Aragó durant la baixa edat mitjana: edició crítica de textos i estudi de documentació arxivística» (AICO/2019/255).

Presentació del monogràfic.

Background & Aims The combination of hepatitis B immunoglobulin and a nucleos(t)ide analogues has markedly reduced the rate of hepatitis B virus recurrence after liver transplantation; however, the optimal duration of hepatitis B immunoglobulin has not been clarified. This lack of consensus perpetuates the use of different strategies. The aim of this study was to evaluate the risk factors associated to hepatitis B virus recurrence after liver transplantation in a large cohort of patients under different hepatitis B immunoglobulin regimens. MethodsResultsRetrospective multicentre analysis of hepatitis B virus-related liver transplantation recipients receiving combined prophylaxis (hepatitis B immunoglobulin + nucleos(t)ide analogues). The strategy of short-term hepatitis B immunoglobulin was compared to lifelong administration. Hepatitis B virus recurrence was defined as positive HBsAg after liver transplantation. Three hundred and thirty-eight patients were analysed. After a median follow-up period of 72months, 37 patients (11%) developed hepatitis B virus recurrence. Hepatocellular carcinoma recurrence and lamivudine resistance after liver transplantation were the only factors independently associated to hepatitis B virus recurrence (HR 5.4 [2.3-12] and 9.3 [4.2-20] respectively P

Durant l’edat mitjana, els tractats de falconeria es dedicaven, entre altres assumptes, a descriure els símptomes i malalties que patien les aus, i oferien com a cures pal·liatives diferents remeis terapèutics a partir de les plantes medicinals. Aquest treball presenta un inventari de termes botànics que registrem en una obra del segle xv, el Llibre de Caça, a més dels vocables corresponents que hem trobat en quatre obres de falconeria medieval de tantes altres llengües romàniques: portuguès, castellà, francès i italià. De cada terme exposem quines propietats curatives tenien, el nom científic de la planta de què procedeix, l’etimologia del mot, juntament amb l’ètim estàndard actual. Finalment presentem una possible classificació dels vocables segons l’etimologia i les llengües. In the Middle Ages, the falconry treaties focused on, among other topics, describing the symptoms and diseases of the birds, and offered as pallative care different therapeutic remedies from medicinal plants. This article presents a list of botanical terms used in five Medieval falconry works in five Romance languages: Portuguese, Spanish, Catalan, French and Italian. From the Latin scientific term, consisting of the genus and species, we propose its etymology together with the current term. Finally, we present a posible classification and distribution by words and languages.

Grey Zone (GZ) is an ill-defined situation including patients falling between inactive carrier (IC) state and HBeAg-negative chronic hepatitis B (HBeAg-negative CHB).To assess the long-term outcomes of GZ patients compared to IC in the absence of treatment.Retrospective analysis of 287 IC and GZ HBeAg-negative patients. Patients were classified into 4 groups at baseline: HBV-DNA2000 IU/mL and ALT40 U/L (IC), HBV-DNA2000 IU/mL and ALT 40-80 U/L (GZ-1), HBV-DNA 2000-20 000 IU/mL and ALT40 U/L (GZ-2) or ALT 40-80 U/L (GZ-3). Data were also analysed using AASLD ALT criteria.After a median follow-up of 8.2 (5-19) years, HBsAg loss occurred in about 15% ICs or GZ patients. Transition into IC state occurred in 40% of GZ patients. DNA fluctuations2000 IU/mL correlated inversely with transition into IC and HBsAg loss. HBsAg levels were significantly lower in ICs than in GZ patients (338 IU/mL [20-3269] vs 5763 IU/mL [2172-17 754]; P 0.05). Among the latter group, there was an increasing gradient of HBsAg levels from GZ-1 to GZ-3 patients (P 0.05). HBeAg-negative CHB occurred in only 18 (6.3%) GZ patients. No patient developed cirrhosis nor advanced fibrosis. ALT/HBV-DNA fluctuations and HBeAg-negative CHB development were more frequent in genotype B/C patients, whereas HBsAg loss occurred only in genotype A/D patients.Most Caucasian GZ patients present excellent long-term outcomes in the absence of treatment, with a high rate of HBsAg loss and low rate of progression to HBeAg-negative CHB. HBV-genotyping and HBsAg levels could help to predict outcomes and better classify GZ patients.

The permanence of slave labour until the 16th century was a lasting legacy of the late feudal colonization of the Mallorca Island. Through a large set of probate inventories and accounting books, we have documented the use of a great deal of slaves in farming large noble estates during the 14th and 15th centuries. The defeat of the peasant revolt of 1450&ndash, 1454 offered to nobles and patricians the opportunity to seize much of the land previously colonized by Mallorcan peasants. This creation of a dispossessed peasantry, combined with new trade demands, led to a transition from slave-powered manorial farms to capitalist olive oil-exporting estates that took advantage of the low-wage workforce reserve. A peculiar feature was the massive use of women&rsquo, s gangs as olive pickers when olive oil became the main cash-crop exported from the 16th century onwards. By linking changes in work and land uses, this study brings to Southern Europe the debate over the driving forces of the emergence of agrarian capitalism.

To assess the impact of chronic liver disease (CLD) on ICU-acquired pneumonia. This was a prospective, observational study of the characteristics, microbiology, and outcomes of 343 consecutive patients with ICU-acquired pneumonia clustered according to the presence of CLD. Sixty-seven (20 %) patients had CLD (67 % had liver cirrhosis, LC), MELD score 26 ± 9, 20 % Child–Pugh class C). They presented higher severity scores than patients without CLD both on admission to the ICU (APACHE II, LC 19 ± 6 vs. other CLD 18 ± 6 vs. no CLD 16 ± 6; p

Aim: The present study was aimed at the early identification of the prognostic factors for 30-day mortality in acutely decompensated cirrhotic patients. Methods: Logistic regression models were used to study the predictors of mortality. Variables significant on univariate testing were included for the multivariate analysis. ROC curves were constructed. The model used retrospective data from 228 patients; and was prospectively validated among 64 patients from the Hospital Clinic: internal validation and 90 patients from Hospital Gregorio Maranon: external validation. Results: The model identified age at admission, serum concentrations of bilirubin, creatinine and sodium, and INR obtained 2 to 8 days after admission as predictors of death in this population. The resulting risk score was highly accurate: AUROC: 0.9150, 95%CI: 0.8509-0.9790 also in the internal and external validation series, but not better that the most widely used scores in hepatology: MELD: 0.8335, 95%CI: 0.7486-0.9184, MELD-Na: 0.8565, 95%CI: 0.7774-0.9356, iMELD: 0.8972, 95%CI: 0.8297-0.9648 and MESO Index: 0.8464, 95%CI: 0.7656-0.9272. The cutoff levels: LR+, LR- of the new score, MELD and MELD-Na that best predicted 30 days mortality were -0.09: 38.6, 0.51, 28: 16.7, 0.42 and 47: 12, 0.7, respectively. Conclusions: MELD, as well as new, more complicated and scanty used scores, obtained 2 to 8 days after admission allows the early and easy identification of patients with an acute decompensation of cirrhosis at high-risk of death on short-term follow-up. These scores may represent a useful tool to select the population suitable for studies to evaluate the efficacy of new therapies and stratify patients in randomized trials.

A study of the reactivity of [Pd({(η5-C5H3)–CH=N–(CH2)n–(C4H3S)}Fe{η5-C5H5})Cl], n = 2 (1e) or 1 (1f), with symmetric alkynes R1–C≡C–R1 (R1 = CO2Me, Et or Ph) has allowed us to achieve the di-μ-chloro-bridged complexes [Pd({(MeO2C–C=C–CO2Me)(η5-C5H3)–CH=N–(CH2)n–(C4H3S)}Fe{η5-C5H5})μ-Cl]2, n = 2 (3e) or 1 (3f), and the mononuclear derivatives [Pd({(MeO2C–C=C–CO2Me)(η5-C5H3)–CH=N–(CH2)n–(C4H3S)}Fe{η5-C5H5})Cl(PPh3)], n = 2 (4e) or 1 (4f), [Pd({(R1–C=C–R1)2(η5-C5H3)–CH=N–(CH2)n–(C4H3S)}Fe{η5-C5H5})Cl],R1 = CO2Me, n = 2 (5e) or 1 (5f), R1 = Et, n = 2 (6e) or 1 (6f), or R1 = Ph, n = 2 (7e), and [Pd({(Ph–C=C–Ph)2(η5-C5H3)–CH=N–(CH2)–(C4H3S)}Fe{η5-C5H5})Cl(PPh3)] (7f·1/2Ph–C≡C–Ph). With MeO2C–C≡C–CO2Me, mono- (3e, 3f, 4e and 4f) and bis-insertion complexes (5e and 5f) were obtained, whereas for R1–C≡C–R1 with R1 = Et or Ph, only bis-insertion products (6e, 6f, 7e and 7f) were isolated. These studies also proved that 1e and 1f, which have a labile Pd–S(thienyl) bond, are more prone to undergo the insertion of R1–C≡C–R1 (R1 = CO2Me, Et or Ph) than their analogues with [C(sp2, ferrocene), N, X]– [X = O, N(amine) or S(thioether)] pincer ligands.

Terlipressin is frequently used in acute variceal bleeding due to its powerful effect on vasopressin V1 receptors. Although terlipressin is also a partial agonist of renal vasopressin V2 receptors, its effects on serum sodium concentration have not been specifically investigated. To examine the effects of terlipressin on serum sodium concentration in patients with acute portal-hypertensive bleeding, 58 consecutive patients with severe portal-hypertensive bleeding treated with terlipressin were investigated. In the whole population, serum sodium decreased from 134.9 ± 6.6 mEq/L to 130.5 ± 7.7 mEq/L (P = 0.002). Thirty-nine patients (67%) had a decrease in serum sodium ≥ 5 mEq/L during treatment: in 18 patients (31%), between 5 and 10 mEq/L and in 21 patients (36%), greater than 10 mEq/L. In this latter group, serum sodium decreased from 137.2 ± 5 to 120.5 ± 5 mEq/L (P < 0.001). In multivariate analysis, the reduction in serum sodium was related to baseline serum sodium and Model for End-Stage Liver Disease (MELD) score; patients with low MELD and normal or near-normal baseline serum sodium had the highest risk of hyponatremia. Serum sodium returned to baseline values in most patients shortly after cessation of therapy. Three of the 21 patients with marked reduction in serum sodium developed neurological manifestations, including osmotic demyelination syndrome in one patient due to a rapid recovery of serum sodium (serum sodium in these three patients decreased from 135, 130, and 136 to 117, 114, and 109 mEq/L, respectively). Conclusion: An acute reduction in serum sodium concentration is common during treatment with terlipressin for severe portal-hypertensive bleeding. It develops rapidly after start of therapy, may be severe in some patients and is associated with neurological complications, and is usually reversible after terlipressin withdrawal. (HEPATOLOGY 2010

Acute-on-Chronic Liver Failure (ACLF) is a recently introduced term defined as severe acute deterioration of an established liver disease. This entity usually develops after an acute insult. The main clinical manifestations are hepatorenal syndrome, hepatic encephalopathy and organ failure, with a high risk of death in the short term. The true incidence of ACLF remains difficult to determine due to confusions surrounding the definition of this entity, but seems to be 40% at 5 years in patients with advanced cirrhosis, which translates into 4,000 cases in Europe within this time span. The treatment of choice is liver transplantation. However, due to the shortage of suitable organs and morbidity and mortality in these patients, other options must be used.

Summary Background Acute liver injury of uncertain aetiology is often drug related and quantitative information about the associated risk is scarce. Aim To estimate the risk of acute liver injury associated with the use of drugs. Methods In a population survey study, 126 cases of acute liver injury were prospectively assembled from January 1993 to December 1999, in patients over 15 years of age, in 12 hospitals in Barcelona (Spain). We estimated the relative risk for each drug as the ratio between the incidence of acute liver injury among the exposed population to the drug and the incidence of acute liver injury among those not exposed to it. Drug consumption data were used to estimate the exposed population. Results Isoniazid, pyrazinamide, rifampicin, amoxicillin with clavulanic acid, erythromicin, chlorpromazine, nimesulide, and ticlopidine presented the highest risk (point relative risk > 25). Amoxicillin, metoclopramide, captopril and enalapril, furosemide, hydrochlorothiazide, fluoxetine, paroxetine, diazepam, alprazolam, lorazepam, metamizole, low-dose acetylsalicylic acid and salbutamol showed the lowest risk (point relative risk

The cause of acute liver failure (ALF) is a major determinant of its outcome. Acetaminophen (paracetamol) overdose is a leading cause of ALF in some developed countries, whereas in others, such as Spain, it is extremely rare. To analyze the etiology, characteristics, and outcome of ALF in Spain, we performed a retrospective analysis of 267 patients whom we observed from 1992 to 2000. Seventeen tertiary-care hospitals with active liver transplantation (LT) programs contributed data. Causes of ALF were viral hepatitis in 98 (37%; hepatitis B virus in 75 patients), unknown in 86 (32%), drug or toxic reactions in 52 (19.5%; acetaminophen overdose in 6), and miscellaneous in 31 (11.6%). Overall survival was 58%. LT was performed in 150 patients, with a survival of 69%. Despite fulfilling criteria, 51 patients were not transplanted because of contraindications; their survival was only 7.8%. Forty-seven (85.5%) of 55 patients without transplant criteria survived. Hepatitis B virus is the most common cause of ALF in Spain, although the origin of 30% of cases remains undetermined. Acetaminophen overdose represents a very rare cause of ALF. LT was performed in >50% of cases. Patients without transplant criteria had a very good prognosis; those who fulfilled these criteria but who had contraindications for transplantation had a high mortality rate.

Objectives The aim of this study was to evaluate the efficacy and safety of entecavir monotherapy in nucleos(t) ide-naive chronic hepatitis B patients and to analyse the influence of the comorbidity burden on therapy outcome. Methods We retrospectively analysed data from 237 nucleos(t) ide-naive chronic hepatitis B white patients treated with entecavir (0.5 mg/day) at 23 Spanish centres. For the efficacy and safety analyses, patients were grouped according to their baseline comorbidities. Results The mean age of the cohort was 43 years (range: 19-82 years); 73% were male, 83% were white, and 33% were hepatitis B e antigen (HBeAg) positive. At baseline, the median hepatitis B virus DNA level was 6.20 log10 IU/ml. Of the patients, 18% had cirrhosis, 9.7% had diabetes, 16.3% had hypertension, and 15.7% had obesity; 13.4% of patients had more than one comorbid condition. Virological and biochemical responses at month 36 were obtained independently of the patients' baseline comorbid condition. Of 10 HBeAg-positive patients who discontinued treatment after HBeAg seroconversion, those who had not also cleared HBsAg (six) experienced virological recurrence in a median 5.6 months. There were no treatment discontinuations due to adverse events. Three patients were diagnosed with hepatocellular carcinoma at months 12, 30 and 54, and six experienced hepatic decompensation during follow-up. The median serum creatinine levels did not increase after 36 months of treatment, even in patients with comorbidities. Conclusion Entecavir is safe, well tolerated, and highly effective, even in patients with comorbid condition(s). Discontinuation of treatment in patients who have not been cleared of HBsAg may lead to virological recurrence. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

The feudal colonisation of the Island of Majorca, traditionally considered part of the Spanish ‘Reconquista’, must be included in the greater process of European feudal expansion. The island was inhabited by people living in a Muslim society, not a feudal one. The conquest by Catalan lords meant the imposition of a new feudal class structure and a new use of natural resources on the conquered land. We summarise the composition and evolution of the three main components of this top-down imposed feudalism: the Muslim populations conquered and enslaved, the Catalan settlers and the entirely new agricultural landscape they created.

Relative adrenal insufficiency is frequent in patients with severe sepsis and is associated with hemodynamic instability, renal failure, and increased mortality. This study prospectively evaluated the effects of steroids on shock resolution and hospital survival in a series of 25 consecutive patients with cirrhosis and septic shock (group 1). Adrenal function was evaluated by the short corticotropin test within the first 24 hours of admission. Patients with adrenal insufficiency were treated with stress doses of intravenous hydrocortisone (50 mg/6 h). Data were compared to those obtained from the last 50 consecutive patients with cirrhosis and septic shock admitted to the same intensive care unit in whom adrenal function was not investigated and who did not receive treatment with steroids (group 2). Incidence of adrenal insufficiency in group 1 was 68% (17 patients). Adrenal dysfunction was frequent in patients with advanced cirrhosis (Child C: 76% vs. Child B: 25%, P = .08). Resolution of septic shock (96% vs. 58%, P = .001), survival in the intensive care unit (68% vs. 38%, P = .03), and hospital survival (64% vs. 32%, P = .003) were significantly higher in group 1. The main causes of death in group 1 were hepatorenal syndrome or liver failure (7 of 9 patients). In contrast, refractory shock caused most of the deaths in group 2 (20 of 34 patients). In conclusion, relative adrenal insufficiency is very frequent in patients with advanced cirrhosis and septic shock. Hydrocortisone administration in these patients is associated with a high frequency of shock resolution and high survival rate.

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome due to hepatic dysfunction and porto-systemic shunting of the intestinal blood. Cirrhosis is the most frequent liver disease causing HE. On most occasions, HE appears due to a superimposed precipitating factor (gastrointestinal bleeding, infections, renal and electrolyte disturbances, etc.). Ammonia produced in colon by intestinal bacteria is the main toxic substance implicated in the pathogenesis of HE. Other mechanisms, such as changes in the GABA-benzodiazepine system, accumulation of manganese into the basal ganglia of the brain, changes in blood-brain barrier and neurotransmission disturbances are also present. Clinical manifestations of HE may vary widely, from minimal neurologic changes, only detected with specific tests, to deep coma. Treatment of HE should be directed to controlling the precipitating factors, as well as therapies aimed at correcting the above-mentioned pathophysiological changes, mainly reduction of blood ammonia levels. Artificial liver support systems may play a role in the future. Liver transplantation should be evaluated as a definitive therapy in all cases of HE.