Exhaust gas recirculation can be achieved by means of two different routes: the high-pressure route (high-pressure exhaust gas recirculation), where exhaust gas is conducted from upstream of the turbine to downstream of the compressor, and the low-pressure one (low-pressure exhaust gas recirculation), where exhaust gas is recirculated from downstream of the turbine and of the aftertreatment system to upstream of the compressor. In this study, the effectiveness of both exhaust gas recirculation systems on the improvement of the NOx-particulate matter emission trade-off has been compared on a Euro 6 turbocharged diesel engine equipped with a diesel oxidation catalyst, a lean-NOx trap, and a diesel particulate filter. Emissions were measured both upstream and downstream of the aftertreatment system, at different combinations of engine speed and torque (corresponding to different vehicle speeds), at transient and steady conditions, and at different coolant temperatures as switch points to change from high-pressure exhaust gas recirculation to low-pressure exhaust gas recirculation. It was shown that low-pressure exhaust gas recirculation was more efficient than high-pressure exhaust gas recirculation to reduce NOx emissions, mainly due to the higher recirculation potential and the lower temperature of the recirculated gas. However, such a differential benefit decreased as the coolant temperature decreased, which suggests the use of high-pressure exhaust gas recirculation during the engine warm-up. It was also shown that the lean-NOx trap storage efficiency decreased more rapidly at high engine load than at medium load and that such reduction in efficiency was much faster when high-pressure exhaust gas recirculation was used than when low-pressure exhaust gas recirculation was used.

ObjectivesTo compare the effectiveness of oral versus intramuscular (IM) vitamin B12 (VB12) in patients aged ≥65 years with VB12 deficiency.DesignPragmatic, randomised, non-inferiority, multicentre trial in 22 primary healthcare centres in Madrid (Spain).Participants283 patients ≥65 years with VB12 deficiency were randomly assigned to oral (n=140) or IM (n=143) treatment arm.InterventionsThe IM arm received 1 mg VB12 on alternate days in weeks 1–2, 1 mg/week in weeks 3–8 and 1 mg/month in weeks 9–52. The oral arm received 1 mg/day in weeks 1–8 and 1 mg/week in weeks 9–52.Main outcomesSerum VB12 concentration normalisation (≥211 pg/mL) at 8, 26 and 52 weeks. Non-inferiority would be declared if the difference between arms is 10% or less. Secondary outcomes included symptoms, adverse events, adherence to treatment, quality of life, patient preferences and satisfaction.ResultsThe follow-up period (52 weeks) was completed by 229 patients (80.9%). At week 8, the percentage of patients in each arm who achieved normal B12 levels was well above 90%; the differences in this percentage between the oral and IM arm were −0.7% (133 out of 135 vs 129 out of 130; 95% CI: −3.2 to 1.8; p>0.999) by per-protocol (PPT) analysis and 4.8% (133 out of 140 vs 129 out of 143; 95% CI: −1.3 to 10.9; p=0.124) by intention-to-treat (ITT) analysis. At week 52, the percentage of patients who achieved normal B12 levels was 73.6% in the oral arm and 80.4% in the IM arm; these differences were −6.3% (103 out of 112 vs 115 out of 117; 95% CI: −11.9 to −0.1; p=0.025) and −6.8% (103 out of 140 vs 115 out of 143; 95% CI: −16.6 to 2.9; p=0.171), respectively. Factors affecting the success rate at week 52 were age, OR=0.95 (95% CI: 0.91 to 0.99) and having reached VB12 levels ≥281 pg/mL at week 8, OR=8.1 (95% CI: 2.4 to 27.3). Under a Bayesian framework, non-inferiority probabilities (Δ>−10%) at week 52 were 0.036 (PPT) and 0.060 (ITT). Quality of life and adverse effects were comparable across groups. 83.4% of patients preferred the oral route.ConclusionsOral administration was no less effective than IM administration at 8 weeks. Although differences were found between administration routes at week 52, the probability that the differences were below the non-inferiority threshold was very low.Trial registration numbersNCT 01476007; EUDRACT (2010-024129-20).

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Este documento analiza el impacto del Brexit en las relaciones de España y Reino Unido con respecto a Gibraltar, así como en el nuevo sistema de cooperación necesario para garantizar el derecho de los ciudadanos y trabajadores de uno y otro lado de la Verja.