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Noninvasive methods for prediction of esophageal varices in pediatric patients with portal hypertension

World Journal of Gastroenterology 2013年第13期19卷 2053-2059页

作者： Marina Rossato Adami Cristina Targa Ferreira carlos oscar kieling Vania Hirakata Sandra Maria Gonalves Vieira Universidade Federal do Rio Grande do Sul Post-Graduation in Gastroenterology and HepatologyHospital de Clínicas de Porto Alegre

AIM: To evaluate clinical and laboratory parameters for prediction of bleeding from esophageal varices (EV) in children with portal hypertension. METHODS: Retrospective study of 103 children (mean age: 10.1 ± 7.7 years), 95.1% with intrahepatic portal hypertension. All patients had no history of bleeding and underwent esophagogastroduodenoscopy for EV screening. We recorded variceal size (F1, F2 and F3), red-color signs and portal gastropathy, according to the Japanese Research Society for Portal Hypertension classification. Patients were classified into two groups: with and without EV. Seven noninvasive markers were evaluated as potential predictors of EV: (1) platelet count; (2) spleen size z score, expressed as a standard deviation score relative to normal values for age; (3)platelet count to spleen size z score ratio; (4) platelets count to spleen size (cm) ratio; (5) the clinical prediction rule (CPR); (6) the aspartate aminotransferase to platelet ratio index (APRI); and (7) the risk score. RESULTS: Seventy-one children had EV on first endoscopy. On univariate analysis, spleen size, platelets, CPR, risk score, APRI, and platelet count to spleen size z score ratio showed significant associations. The best noninvasive predictors of EV were platelet count [area under the receiver operating characteristic curve (AUROC) 0.82; 95%CI: 0.73-0.91], platelet: spleen size z score (AUROC 0.78; 95%CI: 0.67-0.88), CPR (AUROC 0.77; 95%CI: 0.64-0.89), and risk score (AUROC 0.77; 95%CI: 0.66-0.88). A logistic regression model was applied with EV as the dependent variable and corrected by albumin, bilirubin and spleen size z score. Children with a CPR 114. A risk score > -1.2 increased the likelihood of EV (odds ratio 7.47; 95%CI: 2.06-26.99). CONCLUSION: Children with portal hypertension with a CPR below 114 and a risk score greater than -1.2 are more likely to have present EV. Therefore, these two tes

关键词： Portal hypertension Clinical predictors Pediatric patients Esophageal varices

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Serum proinflammatory cytokines and nutritional status in pediatric chronic liver disease

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World Journal of Gastroenterology 2015年第29期21卷 8927-8934页

作者： Daniele Santetti Maria Inês de Albuquerque Wilasco Cristina Toscani Leal Dornelles Isabel Cristina Ribas Werlang Fernanda Urruth Fontella carlos oscar kieling Jorge Luiz dos Santos Sandra Maria Goncalves Vieira Helena Ayako Sueno Goldani Post-Graduate Program of Child and Adolescent Health Faculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto Alegre Nutrition Service Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto Alegre Laboratory of Translational Pediatrics-NESCA Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto Alegre Pediatric Hepatology Unit Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto Alegre Pediatric Gastroenterology Unit Hospital de Clínicas de Porto Alegre and Post-Graduate Program of Child and Adolescent HealthFaculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto Alegre

AIM: To evaluate the nutritional status and its association with proinflammatory cytokines in children with chronic liver ***: We performed a cross-sectional study with 43 children and adolescents, aged 0 to 17 years, diagnosed with chronic liver disease. All patients regularly attended the Pediatric Hepatology Unit and were under nutritional follow up. The exclusion criteria were fever from any etiology at the time of enrollment, inborn errors of the metabolism and any chronic illness. The severity of liver disease was assessed by Child-Pugh, Model for End-stage Liver Disease(MELD) and Pediatric End Stage Liver Disease(PELD) scores. Anthropometric parameters were height/age, body mass index/age and triceps skinfold/age according to World Health Organization standards. The cutoff points for nutritional status were risk of malnutrition(Z-score <-1.00) and malnutrition(Z-score <-2.00). Interleukin-1β(IL-1β), IL-6 and tumor necrosis factor-α levels were assessed by commercial ELISA kits. For multivariate analysis, linear regression was applied to assess the association between cytokine levels, disease severity and nutritional status. RESULTS: The median(25th-75 th centile) age of the study population was 60(17-116)-mo-old, and 53.5% were female. Biliary atresia was the main cause of chronic liver disease(72%). With respect to Child-Pugh score, cirrhotic patients were distributed as follows: 57.1% Child-Pugh A, a mild presentation of the disease, 34.3% Child-Pugh B, a moderate stage of cirrhosis and 8.6% Child-Pugh C, were considered severe cases. PELD and MELD scores were only above the cutoff point in 5 cases. IL-6 values were increased in patients at nutritional risk(34.9%) compared with those who were well-nourished [7.12(0.58-34.23) pg/m L vs 1.63(0.53-3.43) pg/m L; P = 0.02], correlating inversely with triceps skinfold-for-age z-score(rs =-0.61; P < 0.001). IL-6 levels were associated with liver disease severity assessed by Child-Pugh score(P = 0.001).

关键词： Cytokines Interleukin-6 Malnutrition Cirrhosis Child

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Changing pattern of indications of endoscopic retrograde cholangiopancreatography in children and adolescents:a twelve-year experience

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World Journal of Pediatrics 2015年第2期11卷 154-159页

作者： carlos O kieling Cristiane Hallal Camila O Spessato Luciana M Ribeiro Helenice Breyer Helena AS Goldani Ismael Maguilnik Post-Graduate Program of Sciences in Gastroenterology and Hepatology Universidade Federal do Rio Grande do Sul Pediatric Gastroenterology Unit Hospital de Clínicas de Porto AlegreFaculdade de MedicinaUniversidade Federal do Rio Grande do SulBrazil Endoscopy Service Hospital de Clínicas de Porto AlegreFaculdade de MedicinaUniversidade Federal do Rio Grande do SulBrazil

Background:There are few data regarding endoscopic retrograde cholangiopancreatography(ERCP)usefulness in children and *** reviewed the long-term experience with diagnostic and therapeutic ERCP in a tertiary single center in Southern ***:A retrospective chart review of patients aged 0-18 years who had undergone ERCPs from January 2000 to June 2012 was *** on demographics,indications,diagnosis,treatments,and complications were ***:Seventy-five ERCPs were performed in 60 *** median age of the patients at the procedure was 13.9 years(range:1.2-17.9).Of the 60 patients,47(78.3%)were *** all ERCPs,48(64.0%)were performed in patients above 10 years and 35(72.9%)of them were in *** was indicated for patients with bile duct obstruction(49.3%),sclerosing cholangitis(18.7%),post-surgery complication(12%),biliary stent(10.7%),choledochal cyst(5.3%),and pancreatitis(4%).The complication rate of ERCP was 9.7%involving mild bleeding,pancreatitis and *** who had therapeutic procedures were older(13.7±3.9 vs.9.9±4.9 years;P=0.001)and had more extrahepatic biliary abnormalities(82%vs.50%;P=0.015)than those who had diagnostic ERCPs.A marked change in the indications of ERCPs was found,i.e.,from 2001 to 2004,indications were more diagnostic and from 2005 therapeutic procedures were ***:Diagnostic ERCPs are being replaced by magnetic resonance cholangiopancreatography and also by endoscopic *** these procedures are complementary and ERCP still has a role for therapeutic purposes.

关键词： adolescents cholangiopancreatography endoscopic retrograde

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Review and update on the molecular basis of Leber congenital amaurosis

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World Journal of Clinical Cases 2015年第2期3卷 112-124页

作者： oscar Francisco Chacon-Camacho Juan carlos Zenteno Genetics Department-Research Unit Institute of Ophthalmology"Conde de Valenciana" Biochemistry Department Faculty of MedicineNational Autonomous University of Mexico

Inherited retinal diseases are uncommon pathologies and one of the most harmful causes of childhood and adult blindness. Leber congenital amaurosis(LCA) is the most severe kind of these diseases accounting for approximately 5% of the whole retinal dystrophies and 20% of the children that study on blind schools. Clinical ophthalmologic findings including severe vision loss, nystagmus and ERG abnormalities should be suspected through the first year of life in this group of patients. Phenotypic variability is found when LCA patients have a full ophthalmologic examination. However, a correct diagnosis may be carried out; the determination of ophthalmologic clues as light sensibility, night blindness, fundus pigmentation, among other, join with electroretinographics findings, optical coherence tomography, and new technologies as molecular gene testing may help to reach to a precise diagnosis. Several retinal clinical features in LCA may suggest a genetic or gene particular defect; thus genetic-molecular tools could directly corroborate the clinical diagnosis. Currently, approximately 20 genes have been associated to LCA. In this review, historical perspective, clinical ophthalmological findings, new molecular-genetics technologies, possible phenotype-genotypes correlations, and gene therapy for some LCA genes are described.

关键词： Gene therapy Leber congenital amaurosis Retinal dystrophies Childhood blindness

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Octogenarian liver grafts:Is their use for transplant currently justified?

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World Journal of Gastroenterology 2017年第17期23卷 3099-3110页

作者： carlos Jiménez-Romero Felix Cambra oscar Caso Alejandro Manrique Jorge Calvo Alejandro Marcacuzco Paula Rioja David Lora Iago Justo HPB Surgery and Abdominal Organ Transplantation Unit University Hospital“Doce de Octubre” Department of Surgery Facultad de Medicina

AIMTo analyse the impact of octogenarian donors in liver *** present a retrospective single-center study, performed between November 1996 and March 2015, that comprises a sample of 153 liver transplants. Recipients were divided into two groups according to liver donor age: recipients of donors ≤ 65 years (group A; n = 102), and recipients of donors ≥ 80 years (group B; n = 51). A comparative analysis between the groups was performed. Quantitative variables were expressed as mean values and SD, and qualitative variables as percentages. Differences in properties between qualitative variables were assessed by χ2 test. Comparison of quantitative variables was made by t-test. Graft and patient survivals were estimated using the Kaplan-Meier ***, 3 and 5-year overall patient survival was 87.3%, 84% and 75.2%, respectively, in recipients of younger grafts vs 88.2%, 84.1% and 66.4%, respectively, in recipients of octogenarian grafts (P = 0.748). One, 3 and 5-year overall graft survival was 84.3%, 83.1% and 74.2%, respectively, in recipients of younger grafts vs 84.3%, 79.4% and 64.2%, respectively, in recipients of octogenarian grafts (P = 0.524). After excluding the patients with hepatitis C virus cirrhosis (16 in group A and 10 in group B), the 1, 3 and 5-year patient (P = 0.657) and graft (P = 0.419) survivals were practically the same in both groups. Multivariate Cox regression analysis demonstrated that overall patient survival was adversely affected by cerebrovascular donor death, hepatocarcinoma, and recipient preoperative bilirubin, and overall graft survival was adversely influenced by cerebrovascular donor death, and recipient preoperative *** standard criteria for utilization of octogenarian liver grafts are: normal gross appearance and consistency, normal or almost normal liver tests, hemodynamic stability with use of < 10 μg/kg per minute of vasopressors before procurement, intensive care unit s

关键词： Older liver Donor age Marginal liver Liver transplant Aging liver

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Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over

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World Journal of Gastroenterology 2018年第47期24卷 5391-5402页

作者： oscar Caso-Maestro carlos Jiménez-Romero Iago Justo-Alonso Jorge Calvo-Pulido David Lora-Pablos Alberto Marcacuzco-Quinto Félix Cambra-Molero Alvaro García-Sesma Marina Pérez-Flecha carlos Munoz- Arce Carmelo Loinaz-Segurola Alejandro Manrique-Municio Unit of HBP Surgery and Abdominal Organs Transplantation Department of General Surgery“12 de octubre” University HospitalMadrid 28041Spain Clinical Research Department Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)“12 de octubre” University HospitalMadrid 28041Spain

AIM To increase the number of available *** This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation(LT) were performed with donors ≥ 70 years old(study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old(control group).RESULTS Graft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus(HCV)-positivity [hazard ratio(HR) = 2.35; 95% confidence interval(CI): 1.55-3.56; P = 0.00]; recipient age(HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease(D-MELD)(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium(HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD(donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients(77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00). CONCLUSION A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.

关键词： Liver transplantation Aged donors Old donors Marginal donors Donor age

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The Statistical Experimental Design for Chemical Reactors Modeling

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Applied Mathematics 2016年第14期7卷 1534-1546页

作者： Graciela Prieto oscar Prieto Teresa Unzaga carlos Gay Kazunori Takashima Akira Mizuno The Universidad Nacional de Tucumán San Miguel de Tucumán Argentina The Toyohashi University of Technology Toyohashi Japan

The Statistical Experimental Design techniques are the most powerful tools for the chemical reactors experimental modeling. Empirical models can be formulated for representing the chemical behavior of reactors with the minimal effort in the necessary number of experimental runs, hence, minimizing the consumption of chemicals and the consumption of time due to the reduction in the number of experimental runs and increasing the certainty of the results. Four types of nonthermal plasma reactors were assayed seeking for the highest efficiency in obtaining hydrogen and ethylene. Three different geometries for AC high voltage driven reactors, and only a single geometry for a DC high voltage pulse driven reactor were studied. According to the fundamental principles of chemical kinetics and considering an analogy among the reaction rate and the applied power to the plasma reactor, the four reactors are modeled following the classical chemical reactors design to understand if the behavior of the nonthermal plasma reactors can be regarded as the chemical reactors following the flow patterns of PFR (Plug Flow Reactor) or CSTR (Continuous Stirred Tank Reactor). Dehydrogenation is a common elimination reaction that takes place in nonthermal plasmas. Owing to this characteristic, a paraffinic heavy oil with an average molecular weight corresponding to C15 was used to study the production of light olefins and hydrogen.

关键词： Chemical Reactors Modeling Statistical Experimental Designs Nonthermal Plasma Chemical Reactors

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Posterior quadrant epilepsy surgery: case series of a South American hospital

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Acta Epileptologica 2022年第4期5卷 227-232页

作者： Mario Velasco Andrés Felipe Cárdenas-Cruz María Paula Aguilera-Pena Alejandro Vargas-Moreno Daniel Nariño Juan carlos Pérez oscar Zorro Pontificia Universidad Javeriana Cr16#75-32 apt 203BogotaColombia110221 Neuroscience Department Hospital Universitario San IgnacioCr16#75-32 apt 203BogotaColombia110221

Background Posterior quadrant epilepsy(PCE)is a type of focal epilepsy that originates in the parietal lobe,occipital lobe,and the parietal-occipital border of the temporal lobe,or in any combination of these *** has a low incidence,but it can cause a great burden in disability-adjusted life *** this retrospective cohort,patients of all ages with a diagnosis of PCE between 2006 and 2019 were evaluated in a referral center in Bogotá,Colombia.A descriptive analysis of demographic data,clinical history,imaging findings,type of surgery,histopathological diagnosis,outcome,and follow-up was performed using the Engel *** This study included refractory PCE patients of all ages who were evaluated by the epilepsy surgery group of the Hospital Universitario San Ignacio from 2006 to ***,imaging and surgical variables were obtained from the medical records and *** Thirteen patients were included in the study,including 8 males and 5 *** mean age of diagnosis was 8.8 years,while the mean age of surgery was 25 *** most frequent clinical finding was intellectual *** most common findings on magnetic resonance imaging were encephalomalacia and *** 61.5%of the patients,the lateralization of video-EEG matched with brain magnetic resonance imaging *** most frequent types of surgery performed were lobectomies,lesionectomies and cortical ***-freedom was achieved in approximately one third of the patients;however,more than half of the patients were free of disabling seizures or had significant improvement after *** PCE surgery is scarcely performed worldwide,therefore the effectiveness and outcomes are quite variable in the reported *** this study,we show that patients with PCE can obtain great benefits in terms of reduction of seizures with a low risk of surgical complications,encouraging the use of this type of procedure in carefully selected patients.

关键词： Posterior cortex Epilepsy surgery Posterior quadrant epilepsy

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Rolling Bearing Condition Monitoring Technique Based on Cage Rotation Analysis and Acoustic Emission

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Journal of Dynamics, Monitoring and Diagnostics 2022年第2期1卷 57-65页

作者： Matías Marticorena oscar García Peyrano Vibrations Laboratory Vibrations DivisionNational Atomic Energy CommissionSan Carlos de BarilocheArgentina Balseiro Institute Cuyo National UniversitySan Carlos de BarilocheArgentina

In this paper,we present an alternative technique for detecting changes in the operating conditions of rolling element bearings(REBs)that can lead to premature *** developed technique is based on measuring the kinematics of the bearing *** rotational motion of the cage is driven by traction forces generated in the contacts of the rolling elements with the *** is known that the cage angular frequency relative to shaft angular frequency depends on the bearing load,the bearing speed,and the lubrication condition since these factors determine the lubricant film thickness and the associated traction *** a large percentage of REB failures are due to misalignment or lubrication problems,any evidence of these conditions should be interpreted as an incipient *** this paper,a novel method for the measurement of the instantaneous angular speed(IAS)of the cage is *** method is evaluated in a deep groove ball bearing test rig equipped with a cage IAS sensor,as well as a custom acoustic emission(AE)transducer and a piezoelectric *** IAS of the cage is analyzed under different bearing loads and shaft speeds,showing the dependence of the cage angular speed with the calculated lubricant film *** bearing faulty operating conditions(mixed lubrication regime,lubricant depletion,and misalignment)are *** is shown that the cage IAS is dependent on the lubrication regime and is sensitive to *** AE signal is also used to evaluate the lubrication *** results suggest that the proposed technique can be used as a condition monitoring tool in industrial environments to detect abnormal REB conditions that may lead to premature failure.

关键词： acoustic emission cage instantaneous angular speed condition monitoring cyclostationary analysis rolling element bearing

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Using old liver grafts for liver transplantation: Where are the limits?

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World Journal of Gastroenterology 2014年第31期20卷 10691-10702页

作者： carlos Jiménez-Romero oscar Caso Maestro Félix Cambra Molero Iago Justo Alonso Cristina Alegre Torrado Alejandro Manrique Municio Jorge Calvo Pulido Carmelo Loinaz Segurola Enrique Moreno González Service of General and Digestive Surgery and Abdominal Organ Transplantation "Doce de Octubre" University Hospital

The scarcity of ideal liver grafts for orthotopic liver transplantation (OLT) has led transplant teams to investigate other sources of grafts in order to augment the donor liver pool. One way to get more liver grafts is to use marginal donors, a not well-defined group which includes mainly donors > 60 years, donors with hypernatremia or macrosteatosis > 30%, donors with hepatitis C virus or hepatitis B virus positive serologies, cold ischemia time > 12 h, non-heart-beating donors, and grafts from split-livers or living-related donations. Perhaps the most practical and frequent measure to increase the liver pool, and thus to reduce waiting list mortality, is to use older livers. In the past years the results of OLT with old livers have improved, mainly due to better selection and maintenance of donors, improvements in surgical techniques in donors and recipients, and intra- and post-OLT management. At the present time, sexagenarian livers are generally accepted, but there still exists some controversy regarding the use of septuagenarian and octogenarian liver grafts. The aim of this paper is to briefly review the aging process of the liver and reported experiences using old livers for OLT. Fundamentally, the series of septuagenarian and octogenarian livers will be addressed to see if there is a limit to using these aged grafts.

关键词： Old liver donors Liver transplantation Aging liver Liver graft Liver disease Aging Donor management Septuagenarian donors Octogenarian donors

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