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We aim to describe the incidence and source of contagion of COVID-19 in patients with IBD, as well as the risk factors for a severe course and long-term sequelae. This is a prospective observational study of IBD and COVID-19 included in the ENEIDA registry (53,682 from 73 centres) between March-July 2020 followed-up for 12 months. Results were compared with data of the general population (National Centre of Epidemiology and Catalonia). A total of 482 patients with COVID-19 were identified. Twenty-eight percent were infected in the work environment, and 48% were infected by intrafamilial transmission, despite having good adherence to lockdown. Thirty-five percent required hospitalization, 7.9% had severe COVID-19 and 3.7% died. Similar data were reported in the general population (hospitalisation 19.5%, ICU 2.1% and mortality 4.6%). Factors related to death and severe COVID-19 were being aged >= 60 years (OR 7.1, 95% CI: 1.8-27 and 4.5, 95% CI: 1.3-15.9), while having >= 2 comorbidities increased mortality (OR 3.9, 95% CI: 1.3-11.6). None of the drugs for IBD were related to severe COVID-19. Immunosuppression was definitively stopped in 1% of patients at 12 months. The prognosis of COVID-19 in IBD, even in immunosuppressed patients, is similar to that in the general population. Thus, there is no need for more strict protection measures in IBD. This study is funded by the Carlos III Health Institute (COV20/00227: Co-IP Dra. Maria Esteve and Dra. Yamile Zabana), FEDER (Fondo Europeo de Desarrollo Regional) and supported by GETECCU. The ENEIDA Registry of GETECCU is supported by Takeda, Pfizer, Galapagos, AbbVie and Biogen.

BACKGROUND: Studies to evaluate the use of mycophenolate mofetil (MMF) in inflammatory bowel disease (IBD) are limited after the appearance of biological treatments. AIMS: Our primary objective was to evaluate the effectiveness and safety of MMF in IBD. METHODS: IBD patients who had received MMF were retrieved from the ENEIDA registry. Clinical activity as per the Harvey-Bradshaw Index (HBI), partial Mayo score (pMS), physician global assessment (PGA) and C-reactive protein (CRP) were reviewed at baseline, at 3 and 6 months, and at final follow-up. Adverse events and causes of treatment discontinuation were documented. RESULTS: A total of 83 patients were included (66 Crohn's disease, 17 ulcerative colitis), 90% of whom had previously received other immunosuppressants. In 61% of patients systemic steroids were used at initiation of MMF, and in 27.3% biological agents were co-administered with MMF. Overall clinical effectiveness was observed in 64.7% of the population. At the end of treatment, 45.6% and 19.1% of subjects showed remission and clinical response, respectively. MMF treatment was maintained for a median of 28.9 months (IQR: 20.4-37.5). CONCLUSION: Our study suggests, in the largest cohort to date, that MMF may be an effective alternative to thiopurines and methotrexate in IBD.

Background and aims Crohn's disease [CD] can develop penetrating complications at any time during the disease course. Enterocutaneous fistulae [ECF] are disease-related complications with an important impact on quality of life. Our aim was to describe the outcomes of this complication, including its medical and/or surgical management and their temporal trends. The primary endpoint was fistula closure, defined as the absence of drainage, with no new abscess or surgery, over the preceding 6 months. Methods Clinical information from all adult patients with CD and at least one ECF-excluding perianal fistulae-were identified from the prospectively-maintained ENEIDA registry. All additional information regarding treatment for this complication was retrospectively reviewed. Results A total of 301 ECF in 286 patients [January 1970-September 2020] were analysed out of 30 088 records. These lesions were mostly located in the ileum [67%] and they had a median of one external opening [range 1-10]. After a median follow-up of 146 months (interquartile range [IQR], 69-233), 69% of patients underwent surgery. Fistula closure was achieved in 84%, mostly after surgery, and fistula recurrence was uncommon [13%]. Spontaneous and low-output fistulae were associated with higher closure rates (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.17-1.93, p = 0.001, and HR 1.49, 95% CI 1.07-2.06, p = 0.03, respectively); this was obtained more frequently with medical therapy since biologics have been available. Conclusions ECF complicating CD are rare but entail a high burden of medical and surgical resources. Closure rates are high, usually after surgery, and fistula recurrence is uncommon. A significant proportion of patients receiving medical therapy can achieve fistula closure.

BACKGROUND AND AIMS: Immunomediated adverse events [IAEs] are the most frequently reported infliximab [IFX]-related adverse events. Combination therapy may reduce their incidence, although this strategy is not recommended in elderly patients. We aimed to compare the rates of IFX-related IAEs and loss of response [LOR] in elderly and younger patients. METHODS: Adult patients in the ENEIDA registry who had received a first course of IFX therapy were identified and grouped into two cohorts regarding age at the beginning of treatment [over 60 years and between 18 and 50 years]. The rates of IAEs and LOR were compared. RESULTS: In total, 939 patients [12%] who started IFX over 60 years of age and 6844 [88%] below 50 years of age were included. Elderly patients presented a higher proportion of AEs related to IFX [23.2% vs 19%; p = 0.002], infections [7.1% vs 4.3%; p < 0.001] and neoplasms [2.2% vs 0.5%; p < 0.001]. In contrast, the rates of IAEs [14.8% vs 14.8%; p = 0.999], infusion reactions [8.1% vs 8.1%; p = 0.989], late hypersensitivity [1.3% vs 1.2%; p = 0.895], paradoxical psoriasis [1% vs 1.5%; p = 0.187] and drug-induced lupus erythematosus [0.6% vs 0.7%; p = 0.947] were similar in elderly and younger patients. LOR rates were also similar between the two groups [20.5% vs 19.3%; p = 0.438]. In the logistic regression analysis, IFX monotherapy, extraintestinal manifestations and female gender were the only risk factors for IAEs, whereas IFX monotherapy, extraintestinal manifestations and Crohn's disease were risk factors for LOR. CONCLUSIONS: Elderly patients with inflammatory bowel disease have a similar risk of developing IFX-related IAEs and LOR to that of younger patients.

BACKGROUND: Endoscopic balloon dilation (EBD) is the established endoscopic treatment for short strictures in Crohn's disease. Fully covered self-expandable metal stents (FCSEMS) have been used for endoscopic treatment of patients for whom EBD was unsuccessful. We aimed to determine the efficacy and safety of the two endoscopic treatments in patients with Crohn's disease with stenosis and compare the mean cost of both treatments.; METHODS: This multicentre, open-label, randomised trial was done in 19 tertiary and secondary hospitals in Spain. Patients with Crohn's disease with obstructive symptoms and predominantly fibrotic strictures of less than 10 cm in length were eligible for inclusion. We excluded patients with stenosis treated with SEMS or EBD in the previous year and stenosis not accessible to a colonoscope. Patients were randomly assigned (1:1) to receive either EBD (EBD group) or FCSEMS (FCSEMS group) using a digital en-block randomisation system (block size of four). In the EBD group, dilation was done with a CRE Boston Scientific (Marlborough, MA, USA) pneumatic balloon with the diameter set at the discretion of the endoscopist; a maximum of two sessions of dilation were allowed with a minimum interval of 15-30 days between them. In the FCSEMS group, a 20 mm diameter Taewoong (Gimpo-si, South Korea) fully covered metal stent was placed; stent length was set at the discretion of the endoscopist. The primary outcome was to assess the efficacy of the endoscopic treatment, defined by the proportion of patients free of a new therapeutic intervention (EBD, FCSEMS, or surgery) due to symptomatic recurrence at 1 year of follow-up. Patients were analysed according to the intention-to-treat principle. Adverse events were recorded for all the patients; events were considered associated to be with the procedure when a causal association was possible, probable, or definite. This trial is registered with ClinicalTrials.gov, NCT02395354.; FINDINGS: From Aug 28, 2013, to Oct 9, 2017, we assessed the eligibility of 99 patients, of whom 19 (19%) patients were excluded. Thus, 80 (81%) patients were randomly assigned to treatment: 39 (49%) patients to the FCSEMS group and 41 (51%) patients to the EBD group. 33 (80%) of 41 patients in the EBD group and 20 (51%) of 39 patients in the FCSEMS group were free of a new therapeutic intervention at 1 year (odds ratio [OR] 3·9 [95% CI 1·4-10·6]; p=0·0061). Two (3%) of 80 patients had severe adverse events (one [2%] patient in the EBD group and one [3%] patient in the FCSEMS group); both patients had perforations.; INTERPRETATION: EBD is more effective than FCSEMS for Crohn's disease strictures, with a good safety profile for both treatments.; FUNDING: Spanish National Institute of Health, Foundation of Spanish Society of Digestive Endoscopy, Catalan Society of Gastroenterology, and Taweoong. Copyright © 2022 Elsevier Ltd. All rights reserved.

Background Methotrexate can be used to maintain remission in Crohn's disease patients who are intolerant to thiopurines. Data on its use as monotherapy in other scenarios are limited. Aim To assess the effectiveness of methotrexate monotherapy in Crohn's disease patients after previous failure to anti-tumour necrosis factor (anti-TNF alpha) drugs. Methods A retrospective, observational multicentre study of data from the Spanish ENEIDA registry. Participants were patients with active Crohn's disease and previous failure to anti-TNF alpha started on methotrexate monotherapy. Short-term effectiveness was assessed at 12-16 weeks based on Harvey-Bradshaw index (HBI): clinical remission as HBI = 3 points over baseline. Long-term effectiveness was defined as steroid-free methotrexate persistence from 12 to 16 weeks until maximum follow up. Adverse events were recorded. Results Data were compiled for 110 patients treated with methotrexate after a failed response to one (39%) or two (55.6%) anti-TNF alpha agents. Short-term clinical response and remission rates were 60% and 30.9% respectively. Of 74 patients who continued after week 16, long-term effectiveness was achieved in 82% and 74% at 12 and 24 months respectively. In the multivariate analysis, non-remission at short term (vs remission) was associated with long-term failure (HR 2.58, 95%CI 1.95-3.68, P = 0.028). Adverse events (evaluated in 100 patients) were recorded in 44%, and in 30.4% of these patients, they led to methotrexate discontinuation. Conclusions The benefits observed suggest methotrexate monotherapy could be a valid option in Crohn's disease patients with previous failure to anti-TNF alpha.

OBJECTIVE: No studies evaluating the rapidity of response to biological therapies are available for Crohn's disease (CD). The aim of this study was to evaluate rapidity of onset of clinical response and impact on quality of life (QoL) of adalimumab therapy in adult anti-TNF-naïve patients with moderately-to-severely active CD. PATIENTS AND METHODS: RAPIDA was an open-label, single-arm, prospective, multicenter clinical trial. Adult patients with moderately-to-severely active luminal CD, anti-TNF-naïve, and unresponsive to conventional therapy were treated with adalimumab. Clinical disease activity, QoL and inflammatory biomarkers were measured at day 4, and weeks 1, 2, 4, and 12 after treatment initiation. RESULTS: Eighty-six patients were included in the intention-to-treat (ITT) analyses. Clinical disease activity was reduced from a median of 9.0 points to 6.0 points at day 4. Clinical response (= 3-point reduction in the Harvey-Bradshaw Index, HBI) was achieved by 61.6% (d4) and 75.6% (w1) of patients in the ITT population (median 2.5 days) and with non-responder imputation (NRI), by 55.8% and 53.4%, respectively. The proportion of patients in clinical remission (HBI

Background and Aims Immunomediated adverse events [IAEs] are the most frequently reported infliximab [IFX]-related adverse events. Combination therapy may reduce their incidence, although this strategy is not recommended in elderly patients. We aimed to compare the rates of IFX-related IAEs and loss of response [LOR] in elderly and younger patients. Methods Adult patients in the ENEIDA registry who had received a first course of IFX therapy were identified and grouped into two cohorts regarding age at the beginning of treatment [over 60 years and between 18 and 50 years]. The rates of IAEs and LOR were compared. Results In total, 939 patients [12%] who started IFX over 60 years of age and 6844 [88%] below 50 years of age were included. Elderly patients presented a higher proportion of AEs related to IFX [23.2% vs 19%; p = 0.002], infections [7.1% vs 4.3%; p < 0.001] and neoplasms [2.2% vs 0.5%; p < 0.001]. In contrast, the rates of IAEs [14.8% vs 14.8%; p = 0.999], infusion reactions [8.1% vs 8.1%; p = 0.989], late hypersensitivity [1.3% vs 1.2%; p = 0.895], paradoxical psoriasis [1% vs 1.5%; p = 0.187] and drug-induced lupus erythematosus [0.6% vs 0.7%; p = 0.947] were similar in elderly and younger patients. LOR rates were also similar between the two groups [20.5% vs 19.3%; p = 0.438]. In the logistic regression analysis, IFX monotherapy, extraintestinal manifestations and female gender were the only risk factors for IAEs, whereas IFX monotherapy, extraintestinal manifestations and Crohn’s disease were risk factors for LOR. Conclusions Elderly patients with inflammatory bowel disease have a similar risk of developing IFX-related IAEs and LOR to that of younger patients.

Background Thiopurines are the most widely used immunosuppressants in IBD although drug-related adverse events (AE) occur in 20%-30% of cases. Aim To evaluate the safety of thiopurines in elderly IBD patients Methods Cohort study including all adult patients in the ENEIDA registry who received thiopurines. Patients were grouped in terms of age at the beginning of thiopurine treatment, specifically in those who started thiopurines over 60 years or between 18 and 50 years of age. Thiopurine-related AEs registered in the ENEIDA database were compared. Results Out of 48 752 patients, 1888 thiopurines when over 60 years of age and 15 477 under 50 years of age. Median treatment duration was significantly shorter for those who started thiopurines >60 years (13 [IQR 2-55] vs 32 [IQR 5-82] months; P < .001). Patients starting >60 years had higher rates of all types of myelotoxicity, digestive intolerance and hepatotoxicity. Thiopurines were discontinued due to AEs (excluding malignancies and infections) in more patients starting >60 years (67.2% vs 63.1%; P < .001). Elderly age and female sex were independent risk factors for most AEs. Conclusion In elderly IBD patients, thiopurines are associated with an increased risk of non-infectious, non-neoplastic, AEs.

Background There are limited data of ustekinumab administered according to the doses recommended in the UNITI studies. Aim To assess the real-world, short-term effectiveness of ustekinumab in refractory Crohn's disease (CD) Methods Multicentre study of CD patients starting ustekinumab after June 2017 at the recommend dose (260, 390 or 520 mg based on weight ~6 mg/kg IV week 0 and 90 mg subcutaneously week 8). Values for Harvey-Bradshaw Index (HBI), C-reactive protein (CRP) and faecal calprotectin (FC) were recorded at baseline and at weeks 8 and 14. Demographic and clinical data, previous treatments, AEs and hospitalisations were documented. Possible predictors of clinical remission were examined. Results Three hundred and five patients were analysed (>= 2 previous anti-TNF alpha therapies 64% and vedolizumab 29%). At baseline, 217 (72%) had an HBI >4 points. Of these, 101 (47%) and 126 (58%) achieved clinical remission at weeks 8 and 14, respectively. FC levels returned to normal (

OBJECTIVES: The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed. METHODS: This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included. RESULTS: A total of 1,055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn's disease and ulcerative colitis patients, respectively. In both Crohn's disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confi dence interval (CI)= 1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI= 1.07-3.37) or discontinuation because of adverse events (HR= 2.33; 95% CI= 1.27-2.02) vs. a top-down strategy, colonic localization (HR= 1.51; 95% CI= 1.13-2.02) vs. ileal, and stricturing behavior (HR= 1.5; 95% CI= 1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn's disease patients, whereas treatment with immunomodulators after discontinuation (HR= 0.67; 95% CI= 0.51-0.87) and age (HR= 0.98; 95% CI= 0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe. CONCLUSIONS: The incidence rate of infl ammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identifi ed. Retreatment with the same anti-TNF drug was effective and safe.

The aim of the present work is to establish the relationship between laser cladding process parameters (Power, Process Speed and Powder feed rate) and AISI D2 tool steel metallurgical transformations, with the objective of optimizing the processing conditions during real reparation. It has been deposited H13 tool steel powder on some steel substrates with different initial metallurgical status (annealed or tempered) using a coaxial laser cladding system. The microstructure of the laser clad layer and substrate heat affected zone (HAZ) was characterized by Optical microscopy, Scanning Electron Microscopy (SEM) and Electron Backscattered Diffraction (EBSD). Results show that the process parameters (power, process speed, feed rate…) determine the dimensions of the clad layer and are related to the microstructure formation. Although it is simple to obtain geometrically acceptable clads (with the right shape and dimensions) in many cases occur some harmful effects as carbide dilution and non-equilibrium phases formation which modify the mechanical properties of the coating. Specifically, the presence of retained austenite in the substrate-coating interface is directly related to the cooling rate and implies a hardness diminution that must be avoided. It has been checked that initial metallurgical state of the substrate has a big influence in the final result of the deposition. Tempered substrates imply higher laser absorption and heat accumulation than the ones in annealed condition. This produces a bigger HAZ. For this reason, it is necessary to optimize process conditions for each reparation in order to improve the working behaviour of the component.Se ha depositado polvo de acero de herramienta (H13) sobre diferentes sustratos de acero que se encuentran en estado metalúrgico diferente (recocido o de temple y revenido) para comparar los resultados y se ha analizado la microestructura del recubrimiento y de la zona afectada por el calor (ZAC) mediante microscopia óptica, microscopía electrónica de barrido (MEB) y difracción de electrones retrodispersados (EBSD). El objetivo del trabajo es relacionar los parámetros del proceso de recubrimiento por láser (potencia, velocidad, caudal de polvo) con las transformaciones metalúrgicas producidas en el acero de herramienta AISI D2, con el fin de optimizar las condiciones de operación durante la reparación. Los resultados muestran que los parámetros influyen en gran medida en la geometría del cordón y en la formación de la microestructura. Aunque es sencillo obtener deposiciones geométricamente aceptables (forma y tamaño adecuado, ausencia de porosidad), en muchos casos aparecen fenómenos perjudiciales como la dilución de carburos y la aparición de fases metaestables que modifican las propiedades mecánicas del recubrimiento. En concreto, la presencia de austenita retenida en el recubrimiento, relacionada con la temperatura máxima alcanzada y la velocidad de enfriamiento, produce una fuerte disminución en la dureza, que debe evitarse. Además, para una misma composición y acabado superficial, el estado metalúrgico inicial del sustrato tiene una gran influencia sobre el resultado. Sustratos en estado de temple implican una mayor absorción del láser y la acumulación de calor que produce mayores zonas afectadas por el calor (ZAC). Por ese motivo, deben optimizarse los parámetros del proceso para cada operación de manera que se mejore el comportamiento en servicio del componente.

In this work the sintering behaviour of fine, ultrafine and nanocrystalline WC-12Co mixtures obtained by high energy milling, as well as commercial nanopowders, have been studied, in order to evaluate the effect of the particle size and the powder processing, in the densification, microstructural development and mechanical properties of the final product. The consolidation of the mixtures has been made by uniaxial pressing and sintering in vacuum, and by hot isostatic pressing. The sintered materials have been evaluated by measures of density, hardness and indentation fracture toughness, and microstructurally characterized by optical microscopy and scanning and transmission electronic microscopy (SEM and TEM). The results show the improvements in resistant behaviour of the materials obtained from nanocrystalline powders, in spite of the grain growth experienced during the sintering. The best results were obtained for the milling nanocrystalline material, which presents values of hardness higher than 1800 HV.En este trabajo se ha estudiado el comportamiento, durante la sinterización, de mezclas WC-12Co finas, ultrafinas y nanométricas obtenidas por molienda de alta energía y de material nanométrico comercial, a fin de evaluar el efecto del tamaño de partícula y del proceso de obtención del polvo en la densificación, desarrollo microestructural y propiedades mecánicas del producto final. La consolidación de las mezclas se ha realizado mediante compactación uniaxial y sinterización en vacío y por compactación isostática en caliente. Los materiales sinterizados se han evaluado mediante medidas de densidad, dureza y tenacidad a fractura por indentación y se han caracterizado microestructuralmente mediante microscopía óptica y microscopía electrónica de barrido y de transmisión. Los resultados obtenidos ponen de manifiesto las mejoras en comportamiento resistente de los materiales obtenidos a partir polvos nanométricos, a pesar del engrosamiento de grano experimentado durante la sinterización, destacando el material nanométrico de molienda, que presenta valores de dureza superiores a los 1.800 HV.

The high reactivity of titanium and the facility of the same one to form intermetallics makes difficult obtaining composites with this material and brings the need in any case of covering the principal fibres used as reinforcement. To obtain composites of titanium reinforced with ceramic particles is proposed in this paper, and for this reason it turns out to be fundamental to evaluate the reactivity between the matrix and reinforcement. Both titanium nitride and carbide (TiN and TiC) are investigated as materials of low reactivity whereas titanium silicide (TiSi2) is also studied as materials of major reactivity, already stated by the scientific community. This reactivity will be analyzed by means of scanning electron microscopy (SEM) there being obtained distribution maps of the elements that allow to establish the possible influence of the sintering temperature and time. Hereby the matrix-reinforcement interactions are optimized to obtain suitable mechanical properties.La elevada reactividad del titanio y la facilidad del mismo en formar intermetálicos dificulta la obtención de compuestos con este material y la necesidad, en todo caso, de recurrir al recubrimiento de las principales fibras utilizadas como refuerzo. Se propone obtener compuestos de titanio reforzados con partículas cerámicas y, por ello, resulta fundamental evaluar la reactividad entre los diferentes materiales. Se investiga como materiales de baja reactividad el nitruro y carburo de titanio y como materiales de mayor reactividad, ya constatada por la comunidad científica, el TiSi2. Esta reactividad se analizará mediante microscopía electrónica de barrido obteniéndose mapas de distribución de los elementos, que permiten establecer la posible influencia de la temperatura de sinterización y el tiempo de permanencia a éstas. De esta manera, se optimiza en lo posible las interacciones matriz-refuerzo para obtener unas propiedades mecánicas adecuadas.

"Consciente de su responsabilidad como doctor y como pastor", Lutero se apoya en su experiencia interior y en el estudio intensivo de la Sagrada Escritura, y es "conducido a redescubrir la misericordia de Dios, en medio de la angustia e incertidumbre de su tiempo". Se trata del "descubrimiento reformador", que consiste en "reconocer la justicia de Dios, como justicia que da y no como justicia que exige y que condena al pecador". El justo vive por la fe, es decir "vive de la misericordia que Dios nos da por Jesucristo" (55). Este descubrimiento, liberador para él, encuentra confirmación en la doctrina de su maestro, san Agustín. Es innegable la presencia de la teología agustiniana en el tema de la justificación. Sin embargo, por ser la adhesión a la doctrina de Agustín posterior al "descubrimiento" de Lutero, este recibe más influencia del agustinismo posterior que de la doctrina estricta del santo obispo de Hipona. Lo más exacto es constatar en Martín Lutero un agustinismo desviado. En su combate contra la Escolástica, Lutero se sirve de Agustín. Este enfrentamiento, dominado por el subjetivismo y la desazón, le conduce a radicalizar su postura y a adaptar la teología agustiniana a su Reforma. Así interpreta abusivamente a Agustín como teólogo antiescolástico, antiaristotélico y, en definitiva, el anti-Tomás. La Orden de san Agustín mantuvo la tradición de su escuela teológica y levantó la bandera del pensamiento agustiniano, antes y después del reformador alemán. La hipótesis de la historiografía actual, sobre una vinculación entre el pensamiento de san Agustín, la teología de su orden y la del ex fraile agustino Lutero me parece sostenible (56). Este agustinismo teológico también encontró eco y alianzas en las corrientes "devotas", evangelistas y erasmistas de la prerreforma y la reforma católica. No debe olvidarse el ambiente devocionalista y reformista de los conventos que pertenecían a congregaciones de observancia (como el de Erfurt), que estaban influidos por la Mística renana, con su teología "negativa", y más por la Devotio moderna, con su espiritualidad subjetiva y experiencial, biblista y cristocéntrica (Tauler, Kempis, Teología Deutsch), a la vez que con cierto distanciamiento de la Iglesia jerárquica. En vísperas del concilio de Trento, el agustinismo tuvo un peso notable, especialmente a través del "partido" más proclive a establecer puentes con los reformadores (integrado por teólogos y reformistas católicos: Pflug, Gropper, los cardenales Pole, Contarini y Cervini). En el concilio "la batalla" sobre la justificación se llevó en nombre de Agustín. Con la doctrina de la doble justicia propugnada por Seripando, se pretendía mantener a la vez el punto de vista luterano complementado con el católico. El intento fue rechazado por Lutero y por el Concilio (que, sin embargo, no lo condenó). El decreto del Tridentino sobre la justificación conserva el estilo paulino y agustiniano y debe considerarse "la interpretación más exacta del pensamiento de Agustín" (57). Finalmente, Lutero se lanzó apasionada y angustiadamente a la búsqueda de lo que debía ser nuclear en la fe. Lo más central de la teología cristiana es la justificación del pecador exclusivamente por la acción de Dios. Es la misericordia del Padre que la realiza aplicando al hombre la gracia de su Hijo. Este "feliz intercambio" constituye su descubrimiento, su novedad, su evangelio, la única verdad. La comprensión oportuna de este estudio tiene su marco en el diálogo ecuménico entre las Iglesias. En efecto, iniciado en los albores del siglo XX, el ecumenismo va dando sus frutos, después de largos años de trabajo conjunto, muchas veces silencioso y siempre superando escollos. Los resultados en el campo más estrictamente teológico constituyen "un motivo de esperanza" y deben atribuirse, primero al movimiento ecuménico en toda su amplitud, pero también al espíritu y a los principios emanados por el Vaticano II (especialmente en el decreto Unitatis redintegratio). Por lo que toca a nuestro tema, este es el resultado todavía muy reciente: "Un amplio consenso se dibuja sobre la doctrina de la justificación que ha revestido una importancia decisiva para la Reforma. En efecto, solo por la gracia y por la fe en la acción salvadora de Cristo, y no sobre el fundamento de nuestros méritos, somos aceptados por Dios…" (58). Por fin, el 31 de agosto de 1999, se firmó en Augsburg el acuerdo oficial "sobre la doctrina de la justificación". Existe un consenso sobre las verdades básicas de la fe: "Juntos confesamos que es únicamente por la gracia por medio de la fe en la acción salvadora de Cristo y no sobre la base de nuestros méritos, que somos aceptados por Dios y que recibimos el Espíritu Santo que renueva nuestros corazones, nos capacita y nos llama a realizar obras buenas" (59). Las diferencias que subsisten de lenguaje, elaboración teológica y énfasis, son aceptables. Por tanto las diversas explicaciones luterana y católica de la justificación están abiertas las unas a las otras y no son obstáculo para el consenso mutuo relativo a los postulados fundamentales (60)"Aware of his responsibility as doctor and pastor" Luther finds support on his spiritual experience and on a deep study of the sacred Scripture, so as to "rediscover God's mercy, within the anguish and uncertainty of his times". Such is a reformist discovery, which consists on "discovering God's justice as giving, rather than demanding from and condemning the sinner". The just lives by faith, that is "lives from the mercy God gives us through Christ". This discovery, liberating for himself finds confirmation on his master's doctrine Saint Augustine. The presence of Augustinian theology on the issue of justification is evident. However, because his adherence to such theory came after his "discovery", he receives more influence from the late Augustinism than from the strict doctrine of the holy Bishop of Hipona There is a clear deviated augustinism in Luther. In his strruggle against the scholastics, Luther makes use of Augustine. Such confrontation, dominated by subjectivism and uneasiness, makes his position more radical and adapts Augustine's doctrine to his Reformation. So, he exploits Augustine as an anti-scholastic, anti-Aristotelian and even as an anti-Thomist theologian. The Augustinian order kept his theological tradition, and raised the flag of the Augustinian thought before and after the German reformer. Today's hypothesis of the link between Saint Augustine's and his order's thought, and Luther's theology, seems unsustainable. Such Augustinian Theology also found echo in other "devoted" currents, such as the evangelists and erasmists, in times of the pre-reformation and the Catholic Reformation. Those were times of a devotional and reformist atmosphere in observant convents (such as the Erfrut), which were influenced by the Renana Mystic with a "negative" theology, and inclined to the Modern Devotio with a subjective and experiential spirituality, biblical and Christ-centered, together with certain distance form the hierarchical Church. In times of the Council of Trent, the Augustinism had a notable weight, especially through those who were more prone to establishing links with the Reformers (such as the catholic theologians and reformists: Pflug, Gropper, the cardinals Pole, Contarini and Cerveni). At the council, the struggle about the justification took Augustine's name. With Seripando's double justice doctrine, they attempted to match both the Lutheran with the Catholic view. Such an attempt was rejected by Luther and the council. The Tridentinian decree about justification keeps the purest Paul's and Augustine's style, and so is considered as "the most accurate interpretation of Augustine's thought". Finally, Luther plunged passionately on what was to be his faith nucleous. The core of the Christian theology is the justification of the sinner just by the action of God. It is the Father's mercy accomplished on Man, by applying His son's grace. This "fortunate exchange" is bis discovery, his novelty, his only truth. The true understanding of this work, is framed in ecumenical dialogue between churches. Ecumenism, started early in the XX century, is beginning to bear fruit, after long years of shared silent work, overcoming hurdles. The results in the theological field, set a "reason for hope". They need to be attributed to the whole of the ecumenical movement, but also to the spirit and principles generated from the Council Vatican II (especially the decree Unitatis redintegratio). On August 31st, 1999, the final agreement about the doctrine of justification was signed in Ausburg, consenting the existence of a common consensus on the basic truths of the faith. The still remaining language differences, theological elaboration and emphasis, are acceptable. Therefore, the various Lutheran and Catholic explanations about the Justification are open to each other and are not an obstacle for the mutual consensus regarding the essential postulates

Objetivo: comparar la eficacia de la instauración precoz de nutrición enteral total (NET) frente a nutrición parenteral total (NPT) en pacientes con pancreatitis aguda grave (PAG). Métodos: estudio prospectivo aleatorio. Se incluyeron consecutivamente 22 pacientes con PAG aplicando los criterios APACHE II, valores de PCR y graduación de Balthazar en la TC. El grupo I (n = 11) recibió NPT y el grupo II (n = 12) NET. Se valoró la respuesta inflamatoria (PCR, TNF-alfa, IL-6), las proteínas viscerales (pre-albúmina, albúmina), la tasa de complicaciones (síndrome de respuesta inflamatoria sistémica, fallo multiorgánico, infecciones), las intervenciones quirúrgicas, la estancia hospitalaria y la mortalidad. Resultados: no hubo diferencias significativas en los primeros 10 días entre los dos grupos en la evolución de los criterios APACHE II, en las concentraciones de PCR, TNF-alfa e IL-6 ni tampoco en los valores de pre-albúmina y albúmina. Siete pacientes del grupo I presentaron complicaciones graves frente a 4 del grupo II. Requirieron intervención quirúrgica 3 pacientes del grupo I. La estancia hospitalaria fue similar en los dos grupos. Dos pacientes del grupo I fallecieron. Conclusiones: se ha observado una tendencia a una mejor evolución de los pacientes con PAG que utilizaron NET frente a los que utilizaron NPT. Objective: to compare the efficacy of early total enteral nutrition (TEN) vs. total parenteral nutrition (TPN) in patients with severe acute pancreatitis (SAP). Methods: a total of 22 consecutive patients with SAP were randomized to receive TPN (group I) or TEN (group II). SAP was defined applying APACHE II score, C-reactive protein (CRP) measurements and/or Balthazar CT scan score. Acute inflammatory response (CRP, TNF-alpha, IL-6), visceral proteins (pre-albumin, albumin), complications (systemic inflammatory response syndrome, multiorgan failure, infections), surgical interventions, length of hospital stay and mortality were evaluated. Results: no significant differences were found between the two groups in the APACHE II score, in CRP, TNF-alpha and IL-6 concentrations or in pre-albumin and albumin levels over the first 10 days. Seven patients in group I and 4 in group II suffered severe complications. Three patients in group I required surgical intervention. Length of hospital stay was alike in the two groups. Two patients from group I died in the course of the hospitalization. Conclusions: SAP patients with TEN feeding showed a tendency towards a better outcome than patients receiving TPN.

Navigation in unknown unstructured environments is still a difficult open problem in the field of robotics. In this PhD thesis we present a novel approach for robot navigation based on the combination of landmark-based navigation, fuzzy distances and angles representation and multiagent coordination based on a bidding mechanism. The objective has been to have a robust navigation system with orientation sense for unstructured environments using visual information. To achieve such objective we have focused our efforts on two main threads: navigation and mapping methods, and control architectures for autonomous robots. Regarding the navigation and mapping task, we have extended the work presented by Prescott, so that it can be used with fuzzy information about the locations of landmarks in the environment. Together with this extension, we have also developed methods to compute diverting targets, needed by the robot when it gets blocked. Regarding the control architecture, we have proposed a general architecture that uses a bidding mechanism to coordinate a group of systems that control the robot. This mechanism can be used at different levels of the control architecture. In our case, we have used it to coordinate the three systems of the robot (Navigation, Pilot and Vision systems) and also to coordinate the agents that compose the Navigation system itself. Using this bidding mechanism the action actually being executed by the robot is the most valued one at each point in time, so, given that the agents bid rationally, the dynamics of the biddings would lead the robot to execute the necessary actions in order to reach a given target. The advantage of using such mechanism is that there is no need to create a hierarchy, such in the subsumption architecture, but it is dynamically changing depending on the specific situation of the robot and the characteristics of the environment. We have obtained successful results, both on simulation and on real experimentation, showing that the mapping system is capable of building a map of an unknown environment and use this information to move the robot from a starting point to a given target. The experimentation also showed that the bidding mechanism we designed for controlling the robot produces the overall behavior of executing the proper action at each moment in order to reach the target.

This work explores the use of bidding mechanisms to coordinate the actions requested by a group of agents in charge of achieving the task of guiding a root towards a specified target in an unknown environment. This approach is based on a fuzzy approach to landmark-based navigation.

The aim of the present study is to evaluate the changes through the HAZ, analyzed under two different but complementary techniques. These are Transmission Electronic Microscopy (TEM) and Differential Scanning Calorimetry (DSC). The results shown that there are remarkable changes in size and morphology of the precipitates, being in accordance with the results obtained by DSC. El presente estudio evalúa los cambios acaecidos a lo largo de la zona afectada por el calor, ZAC, bajo dos ópticas diferentes pero complementarias: la microscopía electrónica de transmisión (TEM) y la calorimetría diferencial de barrido (DSC). Se han obtenido cambios claros y definidos en cuanto a la morfología y tamaño de los precipitados observados por TEM a lo largo de la ZAC, los cuales se correlacionan con los diferentes barridos de DSC. Palabras clave Aleación de aluminio.

In this work we present an application of Intelligent Agents Technology to mediate in the exchange of Human Tissues for transplantation.The impact of this activity is considered to be of first importance for health and also very important in economic terms. The creation of an Institution, called Carrel, will aid in finding intelligent means for a better assignation of organs, tissues and bones banked for transplantation in human beings. Carrel follows the approach of other well-known Agent Mediated Institutions such as Fishmarket and AuctionBot, in order to assure a fair distribution of resources. Carrel is an Intelligent Resources Management Service.

The improvement of the mechanical properties of aluminium MMCs reinforced with Ni3Al particles is based on the continuity of the matrix-particle interface as well as on the strength of these particles. This work deals with the influence of different heat treatments on the evolution of new phases in that interface. Samples were prepared following a powder metallurgy route with a final stage of extrusion. Several heat treatments encompassing a broad group of temperatures and times were applied, producing different phases around the primary particles. Samples were analysed via optical and scanning electron microscopy with energy dispersive X ray analysis. Microhardness tests were also conducted on the different phases generated. La mejora de las propiedades mecánicas de los composites de aluminio reforzados con partículas de Ni3Al se debe a la continuidad de la unión entre las partículas de refuerzo y la matriz, así como a la resistencia de las primeras. En este trabajo, se analiza la influencia que diferentes tratamientos térmicos tienen en la evolución de nuevas fases en la intercara matriz-partícula. Las muestras se prepararon por vía pulvimetalúrgica con una etapa de extrusión final. Se realizaron diferentes tratamientos térmicos abarcando un amplio espectro de temperaturas y tiempos, que dieron lugar al desarrollo de distintas fases alrededor de las partículas iniciales. Las muestras se analizaron mediante técnicas de microscopía óptica y electrónica de barrido con análisis de elementos por rayos X. Así mismo, se realizaron ensayos de microdureza en las distintas fases generadas.