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Abstract The natural history of compensated cirrhosis due to nonalcoholic fatty liver disease (NAFLD) has not been completely characterized. The aim of the present study was to assess the incidence and risk factors of acute decompensation of cirrhosis, hepatocellular carcinoma, and extrahepatic cancers. This was a multicenter, retrospective, cohort study including 449 patients with compensated cirrhosis due to NAFLD. We calculated cumulative incidences and used competitive risk analysis to determine the risk factors associated with decompensation and cancer development. Over a median of 39 months of follow‐up, 124 patients (28%) presented acute decompensation. The most frequent decompensation was ascites (21%) followed by hepatic encephalopathy (15%), variceal bleeding (9%), and spontaneous bacterial peritonitis (3%). Acute‐on‐chronic liver failure was diagnosed in 6% of patients during follow‐up. Liver function parameters and specifically an albumin level below 40 g/L were independently associated with an increased risk of decompensation. The presence of ischemic heart disease was independently associated with acute decompensation. Seventy‐eight patients (18%) developed hepatocellular carcinoma or extrahepatic cancers during follow‐up (51 and 27, respectively). Conclusion: Patients with compensated cirrhosis due to NAFLD are at high risk of severe liver complications, such as the development of acute decompensation, in a relative short follow‐up time. This population is at high risk of hepatic and extrahepatic cancers.

Background & Aims: The COVID-19 pandemic has had a major negative impact on health systems and many chronic diseases globally. We aimed to evaluate the impact of the first year of the pandemic on the outcomes of people with NAFLD cirrhosis. Methods: We conducted a before-after study in four University hospitals in Catalonia, Spain. Study subperiods were divided into Pre-pandemic (March/2019–February/2020) vs. Pandemic (March/2020–February/2021). The primary outcome was the rate of first liver-related event (LRE). Overall clinical outcomes (LREs plus cardiovascular plus all-cause mortality) were also assessed. Results: A total of 354 patients were included, all of whom were compensated at the beginning of the study period; 83 individuals (23.5%) had a history of prior hepatic decompensation. Mean age was 67.3 years and 48.3% were female. Median BMI was 31.2 kg/m2 and type 2 diabetes was present in 72.8% of patients. The rates of first LRE in the Pre-pandemic and Pandemic periods were 7.4% and 11.3% (p = 0.12), respectively. Whilst the rate of overall events was significantly higher in the Pandemic period (9.9% vs. 17.8%; p = 0.009), this was strongly associated with COVID-19-related deaths. The rate of worsened metabolic status was significantly higher in the Pandemic period (38.4% vs. 46.1%; p = 0.041), yet this was not associated with the risk of first LRE during the Pandemic period, whereas type 2 diabetes (odds ratio [OR] 3.77; 95% CI 1.15–12.32; p = 0.028), albumin 2.67 (OR 15.74; 95% CI 2.01–123.22; p = 0.009) were identified as risk factors in the multivariable analysis. Conclusion: Overall, people with NAFLD cirrhosis did not present poorer liver-related outcomes during the first year of the pandemic. Health system preparedness seems key to ensure that people with NAFLD cirrhosis receive appropriate care during health crises. Lay summary: Mobility restrictions and social stress induced by the COVID-19 pandemic have led to increased alcohol drinking and worsened metabolic control (e.g., weight gain, poor control of diabetes) in a large proportion of the population in many countries. We aimed to analyze whether people with cirrhosis due to non-alcoholic fatty liver disease, who are particularly vulnerable to such lifestyle modifications, were significantly impacted during the first year of the pandemic. We compared the clinical situation of 354 patients one year before the pandemic and one year after. We found that although metabolic control was indeed worse after the first year of the pandemic and patients presented worse clinical outcomes, the latter was mostly due to non-liver causes, namely COVID-19 itself. Moreover, the care provided to these patients did not worsen during the first year of the pandemic.

Duodenal tumours are uncommon, but they can cause significant morbidity and mortality. As stomach and colon are a more common site of gastrointestinal malignancies, radiologists sometimes neglect the duodenum. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) can accurately locate and characterize mass-forming duodenal lesions, making them invaluable for the differential diagnosis and determining management strategies such as biopsy or surgery. Although conventional endoscopy continues to play an important role in the diagnosis of duodenal tumors, MDCT and MRI are very useful for evaluating the duodenal wall, extraduodenal space, and surrounding viscera, as well as the intraluminal content seen on endoscopy. This pictorial review aims to illustrate the most common benign and malignant mass-forming duodenal lesions and to focus on the imaging features that are most helpful in reaching the correct diagnosis.

Background: Chronic hepatic inflammation leads to liver fibrosis, which may progress to cirrhosis, a condition with high morbidity. Our aim was to assess the as yet unknown role of innate immunity protein CD5L in liver fibrosis. Methods: CD5L was measured by ELISA in plasma samples from cirrhotic (n = 63) and hepatitis (n = 39) patients, and healthy controls (n = 7), by immunohistochemistry in cirrhotic tissue (n = 12), and by quantitative RT-PCR in mouse liver cell subsets isolated by cell sorting. Recombinant CD5L (rCD5L) was administered into a murine model of CCl4-induced fibrosis, and damage, fibrosis and hepatic immune cell infiltration, including the LyC6hi (pro-fibrotic)-LyC6low (pro-resolutive) monocyte ratio were determined. Moreover, rCD5L was added into primary human hepatic stellate cells to study transforming growth factor β (TGFβ) activation responses. Findings: Cirrhotic patients showed elevated plasma CD5L concentrations as compared to patients with hepatitis and healthy controls (Mann-Whitney test p

O presente artigo visa dar a conhecer o projeto em curso sobre aquisição de competências dos estudantes da Pós-Licenciatura e do Mestrado em Saúde Materna e Obstétrica e assim contribuir para a melhoria das práticas pedagógicas da unidade curricular Estágio com Relatório. Compreender o fenómeno do desenvolvimento de competências específicas do futuro Enfermeiro Especialista de Saúde Materna e Obstétrica. Estudo exploratório, qualitativo, utilizando o método Photovoice para a colheita e análise de dados (colheita de fotos e entrevistas) e posterior análise de conteúdo segundo Bardin com recurso ao WebQDA. Foram obtidas até ao momento, 29 fotos de 9 participantes, ainda em fase de análise. O método Photovoice permite aceder à perspetiva de desenvolvimento de competências dos estudantes, apreendendo a sua experiência do fenómeno através da captura de fotos significativas para o processo e da sua narrativa.

Abstract A wide spectrum of abnormalities can affect the duodenum, ranging from congenital anomalies to traumatic and inflammatory entities. The location of the duodenum and its close relationship with other organs make it easy to miss or misinterpret duodenal abnormalities on cross-sectional imaging. Endoscopy has largely supplanted fluoroscopy for the assessment of the duodenal lumen. Cross-sectional imaging modalities, especially multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), enable comprehensive assessment of the duodenum and surrounding viscera. Although overlapping imaging findings can make it difficult to differentiate between some lesions, characteristic features may suggest a specific diagnosis in some cases. Familiarity with pathologic conditions that can affect the duodenum and with the optimal MDCT and MRI techniques for studying them can help ensure diagnostic accuracy in duodenal diseases. The goal of this pictorial review is to illustrate the most common non-malignant duodenal processes. Special emphasis is placed on MDCT features and their endoscopic correlation as well as on avoiding the most common pitfalls in the evaluation of the duodenum. Teaching points • Cross-sectional imaging modalities enable comprehensive assessment of duodenum diseases. • Causes of duodenal obstruction include intraluminal masses, inflammation and hematomas. • Distinguishing between tumour and groove pancreatitis can be challenging by cross-sectional imaging. • Infectious diseases of the duodenum are difficult to diagnose, as the findings are not specific. • The most common cause of nonvariceal upper gastrointestinal bleeding is peptic ulcer disease.

Isabel Serra Pfennig, Universidad Complutense de Madrid

El objetivo de este artículo es analizar los cambios sociopolíticos y culturales que ha tenido la ciudad de Berlín a lo largo de la historia reciente. Se ha enfocado el análisis como fenómeno histórico en sus múltiples facetas, analizando la situación sociohistórica a través de algunas obras literarias que han sido fundamentales para entender la evolución cultural de Berlín desde principios del siglo XX hasta la caída del muro.

En la obra Berlin.... Endstation, Edgar Hilsenrath (1926) recrea con ironía la situación de Berlín de los años setenta. En ella retrata como telón de fondo el trauma de la guerra y el omnipresente recuerdo del Holocausto, reflejados por un escritor judío, Joseph Leschinsky, quien regresa a Berlín después de su largo exilio en los Estados Unidos movido por dos motivos fundamentales. El primero, vengarse de quien lo maltrató en la escuela por ser judío, pero se encuentra con un panorama distinto: la persona en cuestión se ha “reconvertido” viviendo ahora como un hombre ejemplar. El segundo motivo que impulsa su regreso a Berlín es la nostalgia y su amor incondicional por la lengua alemana. Paralelamente Leschinsky revivirá también otras experiencias traumáticas: el odio y las constantes amenazadas de un grupo de neonazis.

La riqueza tanto estilística como de contenido que encontramos en loscuentos de los hermanos Grimm ha dado lugar a la recuperación de unsin fin de viejas historias, queridas y fascinantes a la vez, las cuales hanalcanzado una enorme repercusión literaria a lo largo de la culturaoccidental. Estos maestros de la fantasía, que también destacaron comofilólogos, gramáticos y folcloristas, se sirvieron de la tradición oral yescrita para, con su enorme erudición, llegar a crear un mundo mágicocargado de un atractivo singular que atrapa a los niños, pero también alos adultos. Como un caso especial de traducción, el presente trabajo pretendeanalizar algunas de estas bellas y singulares narraciones desde el puntode vista del psicoanálisis, dada la importancia que puede tener esta visiónen el proceso de desarrollo del ser humano.

En el presente artículo se analiza la obra El joven Moncada del autor austriaco Alexander Lernet-Holenia (1897-1976) uno de los escritores más destacados del siglo XX en lengua alemana. Se trata de una novela corta en la que el autor nos cuenta con delicada sutileza una historia cuyo desarrollo se sitúa a caballo entre dos países, Argentina y España. La obra original que se publicó en alemán en 1954, fue traducida al español en el año 2006. Es una novela impregnada de elegancia y fina ironía y en la que Lernet­-Holenia narra aspectos culturales de gran relevancia, pero también profundiza en temas universales como el amor, las clases sociales o el dinero.

It is well accepted that, at the global scale, the Gutenberg-Richter (GR) law describing the distribution of earthquake magnitude or seismic moment has to be modified at the tail to properly account for the most extreme events. It is debated, though, how much additional time of earthquake recording will be necessary to properly constrain this tail. Using the global CMT catalog, we study how three modifications of the GR law that incorporate a corner-value parameter are compatible with the size of the largest observed earthquake in a given time window. Current data lead to a rather large range of parameter values (e.g., corner magnitude from 8.6 to 10.2 for the so-called tapered GR distribution). Updating this estimation in the future will strongly depend on the maximum magnitude observed, but, under reasonable assumptions, the range will be substantially reduced by the end of this century, contrary to claims in previous literature.

Introduction: Inflammatory bowel disease may cause both intestinal and extraintestinal manifestations. Respiratory symptoms in ulcerative colitis are rare and tracheal involvement is exceedingly rare in children. Case 1: Sixteen year-old female with a 4-week-complaint of abdominal pain, bloody diarrhea, fever and cough. The investigation was consistent with the diagnosis of concomitant ulcerative colitis/coinfection to Escherichia coli. On day 4 respiratory signs persisted so azithromycin and inhaled corticosteroids were added. By day 6 she progressed to respiratory failure and was diagnosed with necrotic tracheitis so started on intravenous steroids with fast clinical improvement. Case 2: Twelve-year-old male adolescent with ulcerative colitis and sclerosing cholangitis started dry cough and throat pain 10 days after diagnosis. Laboratory investigations showed increased inflammatory signs and normal chest X-ray. He started treatment with azithromycin without clinical improvement and on day five he presented dyspnea and fever. Laryngeal fibroscopy suggested tracheitis and so systemic steroids where added with fast clinical and analytic improvement. Discussion: Tracheitis should be suspected if there are persistent respiratory symptoms even when exams are normal. Early recognition and early treatment are essential for a good prognosis preventing progression to respiratory failure.

Across the world, countries have engaged in different iterations of curriculum change, and one of the common denominators of reform is the proposal of more agency for teachers around curriculum making. This is not an easy task for teachers. The purpose of this paper is to contribute to the discussion about the effects that international ERASMUS+ mobilities have had on the power of curricular agency of teachers from two European countries. This work is based on an empirical investigation of a qualitative nature which collected the testimonies of four school headmasters, a deputy principal and eleven teachers from Ireland and Portugal, teaching different curriculum matters, who were involved in the ERASMUS+ programme. Our findings evidence a very positive impact on secondary teachers' capacity to self-organize and achieve agency in relation to curriculum making by adapting their knowledge and skills, learnt through the mobility, to their own culture and context through collaborative communities of practice.

An important body of quantitative linguistics is constituted by a series of statistical laws about language usage. Despite the importance of these linguistic laws, some of them are poorly formulated, and, more importantly, there is no unified framework that encompasses all them. This paper presents a new perspective to establish a connection between different statistical linguistic laws. Characterizing each word type by two random variables—length (in number of characters) and absolute frequency—we show that the corresponding bivariate joint probability distribution shows a rich and precise phenomenology, with the type-length and the type-frequency distributions as its two marginals, and the conditional distribution of frequency at fixed length providing a clear formulation for the brevity-frequency phenomenon. The type-length distribution turns out to be well fitted by a gamma distribution (much better than with the previously proposed lognormal), and the conditional frequency distributions at fixed length display power-law-decay behavior with a fixed exponent α ≃ 1.4 and a characteristic-frequency crossover that scales as an inverse power δ ≃ 2.8 of length, which implies the fulfillment of a scaling law analogous to those found in the thermodynamics of critical phenomena. As a by-product, we find a possible model-free explanation for the origin of Zipf’s law, which should arise as a mixture of conditional frequency distributions governed by the crossover length-dependent frequency.

El P. Buenaventura de Carrocera (1905-1999), cuyo nombre era Antonio Rabanal de la Hoz nació en el pueblo de Carrocera provincia de León. Fue un prolífico historiador y bibliógrafo, se especializó en la Historia franciscano-capuchina y en la Historia de las misiones. Además de un importante legado histórico, entre otras obras, escribió Los Primeros Historiadores de las Misiones Capuchinas en Venezuela (1964), Misión de los Capuchinos en Cunamá (1968), Misión de los Capuchinos en Guayana (1979) y colaboró con la Academia Nacional de la Historia de Venezuela, siendo nombrado en 1972 académico de dicha Institución. Cuando en 1946 se creó el Instituto de Misionología Española, se incorporó al cuerpo de redactores de la revista Missionalia Hispanica ejerciendo de director de 1946 a 1975. Esta revista está enfocada a la historia de las misiones que existieron en todo el mundo y es, por lo tanto, una fuente documental fundamental para la investigación y la divulgación de la historia de la traducción misionera.

Freight transportation is becoming an increasingly critical activity for enterprises in a global world. Moreover, the distribution activities have a non-negligible impact on the environment, as well as on the citizens’ welfare. The classical vehicle routing problem (VRP) aims at designing routes that minimize the cost of serving customers using a given set of capacitated vehicles. Some VRP variants consider traveling times, either in the objective function (e.g., including the goal of minimizing total traveling time or designing balanced routes) or as constraints (e.g., the setting of time windows or a maximum time per route). Typically, the traveling time between two customers or between one customer and the depot is assumed to be both known in advance and static. However, in real life, there are plenty of factors (predictable or not) that may affect these traveling times, e.g., traffic jams, accidents, road works, or even the weather. In this work, we analyze the VRP with dynamic traveling times. Our work assumes not only that these inputs are dynamic in nature, but also that they are a function of the structure of the emerging routing plan. In other words, these traveling times need to be dynamically re-evaluated as the solution is being constructed. In order to solve this dynamic optimization problem, a learnheuristic-based approach is proposed. Our approach integrates statistical learning techniques within a metaheuristic framework. A number of computational experiments are carried out in order to illustrate our approach and discuss its effectiveness.

Severe alcoholic hepatitis is associated with high early mortality. This study aimed at identifying prognostic factors associated with in-hospital, medium- and long-term mortality of severe alcoholic hepatitis and to evaluate the different prognostic scoring systems on a cohort of patients in our hospital. To this end, we conducted a retrospective analysis of 66 episodes admitted between 2000 and 2008. Clinical and laboratory data on admission, at 7 days, 1 month, 6 months, and after one year were collected and analyzed, as were the details on the treatment and complications that occurred during hospitalization; the different prognostic indices used in the literature were calculated. Death event associated with an episode of severe alcoholic hepatitis occurs primarily during the first month, with an average mortality rate of 16.9. Infectious complications were associated with lower in-hospital survival. MELD score, urea and bilirubin values one week after admission were independently associated with both in-hospital survival (OR = 1.14, 1.012 and 1.1, respectively), and survival at 6 months (OR = 1, 15; 1.014 and 1.016, respectively). Only MELD score and urea values at 7 days were independent predictors of survival twelve months after the acute hepatitis episode. MELD score, urea, and bilirubin 7 days after admission were the only independent in-hospital survival and also long-term survival factors 6 months and one year after the episode. In our cohort, the MELD score was the best prognostic index to predict mortality associated with an episode of severe alcoholic hepatitis.

Ischia fue a partir de los años 50 un espacio de encuentro de escritores, artistas y bohemios. Fue escenario del comienzo de una gran amistad que duró más de dos décadas entre Ingeborg Bachmann y Hans Werner Henze. Gran parte de sus creaciones artísticas, tanto poéticas como musicales tuvieron lugar en Italia. El país meridional no supuso para ambos un espacio de evasión, la idílica huida hacia el sur supuso la confrontación con las consecuencias del pasado histórico reciente. Henze descubre en Bachmann el sentido exacto de la palabra, mientras que él, este mismo sentido lo expresa con la música. Dos almas gemelas y errantes, pertenecientes a una generación de artistas que viven el malestar de la experiencia de la Segunda Guerra Mundial y la afrontan con una feroz crítica ante una sociedad conformista y a la vez, conscientes de una necesaria toma de postura que se desarrollará a través de una amplia actividad artística.