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Efficacy of the vaccination in inflammatory bowel disease

World Journal of Gastroenterology 2013年第9期19卷 1349-1353页

作者： elisa carrera Rebeca Manzano Elena Garrido Department of Gastroenterology University Hospital of Guadalajara 19002 Guadalajara Spain Department of Gastroenterology Sureste Hospital Arganda 28500 Madrid Spain Inflammatory Bowel Disease Clinic Department of Gastroenterology University Hospital Ramón y Cajal 28034 Madrid Spain

Inflammatory bowel disease (IBD) is associated with conditions that may predispose to infections, such as the lack of an appropriate innate immune response to infectious agents, malnutrition, surgery, and immunosuppressive and biological drugs. Some of these infections may be preventable by vaccination. Therefore, for this particular patient population, the benefits of implementing a well-established immunization protocol in daily clinical practice are potentially even greater than for the general population. In recent years international consensus guidelines have been published, but in spite of theses recommendations, studies have shown that a significant number of patients with IBD remain inadequately immunized. Another important issue regarding immunization in this population is that vaccine efficacy among patients receiving immunosuppressive therapies has been variable. In a healthy population, a humoral immune response to hepatitis B vaccination (HBV) is expected in > 90%, whereas a much lower rate is achieved in the IBD patients. Immunosuppressive, anti-tumor necrosis factor therapy and disease activity have been implicated in the impaired efficacy of the vaccination. The serological response to HBV should be confirmed and patients with an inadequate response should receive a second full series of vaccine. Modified dosing regimens, including doubling the standard antigen dose, might increase the effectiveness. Response to influenza, pneumococcal and tetanus immunization is still not clear, as there are studies that show a normal response to the vaccination while others demonstrate a lack of efficacy. We pose a series of questions on the efficacy of the different vaccinations recommended for IBD patients and attempt to answer them using scientific evidence.

关键词： Vaccination Efficacy Infections Immunization Inflammatory bowel disease Immunosuppressive medications Hepatitis B vaccines Influenza vaccines Pneumococcal vaccines Tetanus vaccines

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Clinical significance of cytomegalovirus infection in patients with inflammatory bowel disease

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World Journal of Gastroenterology 2013年第1期19卷 17-25页

作者： Elena Garrido elisa carrera Rebeca Manzano Antonio Lopez-Sanroman Inflammatory Bowel Disease Clinic Department of GastroenterologyUniversity Hospital Ramón y Cajal28034 MadridSpain Department of Gastroenterology University Hospital of Guadalajara19002 GuadalajaraSpain Department of Gastroenterology Hospital Sureste28500 MadridSpain

Cytomegalovirus(CMV) infection is common in *** virus then enters a "latency phase" and can reactivate to different stimuli such as *** clinical significance of CMV infection in inflammatory bowel disease is different in Crohn's disease(CD) and ulcerative colitis(UC).CMV does not interfere in the clinical course of ***,CMV reactivation is frequent in severe or steroid-resistant *** is not known whether the virus exacerbates the disease or simply appears as a bystander of a severe *** methods are used to diagnose CMV *** is classically based on histopathological identification of viral-infected cells or CMV antigens in biopsied tissues using haematoxylin-eosin or immunohistochemistry,other tests on blood or tissue samples are currently being *** chain reaction performed in colonic mucosa has a high sensitivity and a positive result could be associated with a worse prognosis disease;further studies are needed to determine the most appropriate strategy with positive CMV-DNA in colonic *** endoscopic features have not been described in active UC and CMV *** colitis is usually treated with ganciclovir for several weeks,there are different opinions about whether or not to stop immunosuppressive *** antiviral drugs may be *** controlled studies would needed to determine which subgroup of UC patients would benefit from early antiviral treatment.

关键词： Cytomegalovirus Inflammatory bowel disease Crohn’s disease Ulcerative colitis Hematoxylin and eosin Immunohistochemical Polymerase chain reaction Ganciclovir Infectious colitis

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Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy

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World Journal of Hepatology 2015年第3期7卷 539-547页

作者： Pilar López-Serrano Elsa de la Fuente Briongos elisa carrera Alonso Jose Lázaro Pérez-Calle Conrado Fernández Department of Gastroenterology University Hospital Fundación Alcorcón Department of Gastroenterology University Hospital of Guadalajara

Currently immunosuppressive and biological agentsare used in a more extensive and earlier way in patients with inflammatory bowel disease, rheumatic or dermatologic diseases. Although these drugs have shown a significant clinical benefit, the safety of these treatments is a challenge. Hepatitis B virus(HBV) reactivations have been reported widely, even including liver failure and death, and it represents a deep concern in these patients. Current guidelines recommend to preemptive therapy in patients with immunosuppressants in general, but preventive measures focused in patients with corticosteroids and inflammatory diseases are scarce. Screening for HBV infection should be done at diagnosis. The patients who test positive for hepatitis B surface antigen, but do not meet criteria for antiviral treatment must receive prophylaxis before undergoing immunosuppression, including corticosteroids at higher doses than prednisone 20 mg/d during more than two weeks. Tenofovir and entecavir are preferred than lamivudine because of their better resistance profile in long-term immunosuppressant treatments. There is not a strong evidence, to make a general recommendation on the necessity of prophylaxis therapy in patients with inflammatory diseases that are taking low doses of corticosteroids in short term basis or low systemic bioavailability corticosteroids such as budesonide or beclomethasone dipropionate. In these cases regularly HBV DNA monitoring is recommended, starting early antiviral therapy if DNA levels begin to rise. In patients with occult or resolved hepatitis the risk of reactivation is much lower, and excepting for Rituximab treatment, the prophylaxis is not necessary.

关键词： Hepatitis B virus Inflammatory boweldisease Rheumatic disease. Dermatologic diseases Corticosteroids Anti-tumor necrosis factor Prophylaxis Immunosuppressants

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Wilson's disease in two siblings from Ecuador:Two case reports

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World Journal of Clinical Cases 2025年第3期13卷 50-60页

作者： Enrique carrera Jonathan Alvarado Martina Astudillo Galo Pillajo Department of Gastroenterology and Hepatology Hospital de Especialidades Eugenio EspejoQuito 170136PichinchaEcuador Faculty of Medicine Pontificia Universidad Catolica del EcuadorQuito 170143PichinchaEcuador Department of Radiology Hospital de Especialidades Eugenio EspejoQuito 170136PichinchaEcuador

BACKGROUND Wilson's disease(WD)is a rare metabolic disorder of copper accumulation in organs such as liver,brain,and *** and treatments are challenging in settings,where advanced diagnostic tests are unavailable,copper chelating agents are frequently scarce,healthcare professionals lack disease awareness,and medical follow-ups are *** diagnoses and treatments help prevent complications,improve patients’quality of life,and ensure a normal life *** clinical presentations and outcomes of WD can vary within a single *** SUMMARY We present the cases of two siblings(19 and 27 years)from a consanguineous family in rural Ecuador,diagnosed as having WD during a family *** male patient,diagnosed at age 19 after his brother’s death from acute liver failure,presented with compensated cirrhosis,neurological symptoms,and bilateral Kayser-Fleischer *** developed progressive neurological deterioration during an irregular treatment with D-penicillamine due to medication *** condition improved upon switching to trientine tetrahydrochloride,and his neurological symptoms improved over an 8-year period of *** female patient,diagnosed at age 10,exhibited only biochemical *** treatment history was similar;however,she remained asymptomatic without disease progression over the same follow-up *** discuss the potential influence of epigenetic mechanisms and modifier genes on the various phenotypes,emphasizing the need for research in these areas to optimize therapeutic *** Our patients’medical histories show how early diagnosis and treatment can prevent disease progression;and,how suboptimal treatments impact disease outcomes.

关键词： Wilson disease Kayser-Fleischer rings Copper chelator D-penicillamine Trientine tetrahydrochloride Case report

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Hierarchical models for failure analysis of plates bent by distributed and localized transverse loadings

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Journal of Zhejiang University-Science A(Applied Physics & Engineering) 2008年第5期9卷 600-613页

作者： Erasmo carrera Gaetano GIUNTA Aeronautic and Space Engineering Department Politecnico di Torino Torino Italy

The failure analysis of simply supported, isotropic, square plates is addressed. Attention focuses on minimum failure load amplitudes and failure locations, von Mises＇ equivalent stress along the plate thickness is also addressed. Several distributed and localized loading conditions are considered. Loads act on the top of the plate. Bi-sinusoidal and uniform loads are taken into account for distributed loadings, while stepwise constant centric and off-centric loadings are addressed in the case of localized loadings. Analysis is performed considering plates whose length-to-thickness ratio a/h can be as high as 100 （thin plates） and as low as 2 （very thick plates）. Results are obtained via several 2D plate models. Classical theories （CTs） and higher order models are applied. Those theories are based on polynomial approximation of the displacement field. Among the higher order theories （HOTs） HOTsa models account for the transverse shear deformations, while HOTs models account for both transverse shear and transverse normal deformations. LHOTs represent a local application of the higher order theories. A layerwise approach is thus assumed： by means of mathematical interfaces, the plate is considered to be made of several fictitious layers. The exact 3D solution is presented in order to determine the accuracy of the results obtained via the 2D models. In this way a hierarchy among the 2D theories is established. CTs provide highly accurate results for a/h greater than 10 in the case of distributed loadings and greater than 20 for localized loadings. Results obtained via HOTs are highly accurate in the case of very thick plates for bi-sinusoidal and centric loadings. In the case of uniform and off-centric loadings a high gradient is present in the neighborhood of the plate top. In those cases, LHOTs yield results that match the exact solution.

关键词： Failure load von Mises' equivalent stress lsotropic plates Higher order theories (HOTs) Exact 3D solution

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Advanced modeling of embedded piezo-electric transducers for the health-monitoring of layered structures

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International Journal of Smart and Nano Materials 2020年第4期11卷 325-342页

作者： Enrico Zappino Erasmo carrera Department of Mechanical and Aerospace Engineering Politecnico di TorinoMul2 Research GroupTorinoItaly

The present paper presents an innovative approach for the numerical modeling of piezo-electric transducers for the health-monitoring of layered *** numerical approach has been developed in the frameworks of the carrera Unified *** computa-tional tool allows refined numerical models to be derived in a unified and efficient *** use of higher-order models and the cap-ability to connect different kinematic models using the node-depen-dent kinematic approach has led to an efficient modeling technique for global-local *** approach can refine the model only in those regions where it is required,e.g.,the areas where piezo-electric transducers are *** model has been used to study embedded and surface-mounted *** accuracy of the pre-sent model has been verified by comparing the current results with numerical and experimental data from the *** mod-eling solutions have been developed,mixing one-,two-and threedimensional finite *** results show that the use of the present modeling technique allows the computational cost to be reduced with respect to the classical approaches preserving the ccuracy of the results in the critical areas.

关键词： carrera Unified Formulation Embedded Sensor Health Monitoring Layered Structures Refined models

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Hierarchical closed form solutions for plates bent by localized transverse loadings

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Journal of Zhejiang University-Science A(Applied Physics & Engineering) 2007年第7期8卷 1026-1037页

作者： carrera E. GIUNTA G. BRISCHETTO S. Aeronautical and Space Department Politecnico di Torino c.so Duca degli Abruzzi 24 10129 Torino Italy

3D and 2D closed form plate models are here applied to static analysis of simply supported square isotropic plates. 2D theories are hierarchically classified on the basis of the accuracy of the displacements and stresses obtained by comparison to the 3D exact results that could be assumed by the reader as benchmark for further analyses. Attention is mainly paid on localized loading conditions, that is, piecewise constant load. Also bi-sinusoidal and uniformly distributed loadings are taken into account. All of those configurations are considered in order to investigate the behavior of the 2D models in the case of continu- ous/uncontinuous, centric or off-centric loading conditions. The ratio between the side length a and the plate thickness h has been assumed as analysis parameter. Higher order 2D models yield accurate results for any considered load condition in the case of moderately thick plates, a/h=10. In the case of thick plates, a/h=5, and continuous/uncontinuous centric loading conditions high accuracy is also obtained. For the considered off-centric load condition and thick plates good results are provided for some output quantities. A better solution could be achieved by simply increasing the polynomial approximation order of the axiomatic 2D displacement field.

关键词： Exact 3D model Hierarchical 2D models Principle of Virtual Displacements (PVD) Localized loading Simply supported square isotropic plate

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Current scenario of the genetic testing for rare neurological disorders exploiting next generation sequencing

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Neural Regeneration Research 2021年第3期16卷 475-481页

作者： Chiara Di Resta Giovanni Battista Pipitone Paola carrera Maurizio Ferrari Vita-Salute San Raffaele University MilanItaly Unit of Genomics for Human Disease Diagnosis Division of Genetics and Cell BiologyIRCCS San Raffaele Scientific InstituteMilanItaly Clinical Molecular Biology Laboratory IRCCS San Raffaele HospitalMilanItaly

Next generation sequencing is currently a cornerstone of genetic testing in routine diagnostics,allowing for the detection of sequence variants with so far unprecedented large scale,mainly in genetically heterogenous diseases,such as neurological *** is a fast-moving field,where new wet enrichment protocols and bioinformatics tools are constantly being developed to overcome initial *** the as yet undiscussed advantages,however,there are still some challenges in data analysis and the interpretation of *** this review,we address the current state of next generation sequencing diagnostic testing for inherited human disorders,particularly giving an overview of the available high-throughput sequencing approaches;including targeted,whole-exome and whole-genome sequencing;and discussing the main critical aspects of the bioinformatic process,from raw data analysis to molecular diagnosis.

关键词： clinical practice genetic testing neurogenesis next generation sequencing sequencing approaches variant interpretation

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Multi-layered plate finite element models with node-dependent kinematics for smart structures with piezoelectric components

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Chinese Journal of Aeronautics 2021年第8期34卷 164-175页

作者： Guohong LI Erasmo carrera Yuliang HOU Gennady M.KULIKOV MUL2 Group Department of Mechanical and Aerospace EngineeringPolitecnico di TorinoTorino 10129Italy Laboratory of Intelligent Materials and Structures Tambov State Technical UniversityTambov 392000Russia School of Mechanical and Power Engineering Zhengzhou UniversityZhangzhou 450001China

This article presents a type of plate Finite Element(FE)models with adaptive mathematical refinement capabilities for modeling laminated smart structures with piezoelectric layers or distributed *** p-version shape functions are used in combination with the higher-order Layer-Wise(LW)kinematics adopting hierarchical Legendre ***-Dependent Kinematics(NDK)is employed to implement local LW models in the regions with piezoelectric components and simulate the global substrate structure with the Equivalent Single-Layer(ESL)*** the proposed NDK FE models,the electro-mechanical behavior of smart structures can be predicted with high fidelity and numerical efficiency,and various patch configurations can be conveniently modeled through one set of mesh ***,the effectiveness and efficiency of the NDK FE approach are assessed through numerical examples and its application is demonstrated.

关键词： Finite element Laminated composites Piezoelectric Refined plate theory Smart structures

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A layer-wise MITC9 finite element for the freevibration analysis of plates with piezo-patches

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International Journal of Smart and Nano Materials 2015年第2期6卷 85-104页

作者： Maria Cinefra Stefano Valvano Erasmo carrera Department of Mechanical and Aerospace Engineering Politecnico di TorinoTorinoItaly School of Aerospace Mechanical and Manufacturing Engineering CollegeRMIT UniversityMelbourneAustralia Department of Mathematics Faculty of ScienceKing Abdulaziz UniversityP.O.Box 80203Jeddah 21589Saudi Arabia

The present article considers the free-vibration analysis of plate structures with piezoelectric patches by means of a plate finite element with variable through-the-thickness layer-wise *** refined models used are derived from carrera’s Unified Formulation(CUF)and they permit the vibration modes along the thickness to be accurately *** finite-element method is employed and the plate element implemented has nine nodes,and the mixed interpolation of tensorial component(MITC)method is used to contrast the membrane and shear locking *** related governing equations are derived from the principle of virtual displacement,extended to the analysis of electromechanical *** isotropic plate with piezoelectric patches is analyzed,with clamped-free boundary conditions and subjected to open-and short-circuit *** results,obtained with different theories,are compared with the higher-order type solutions given in the *** conclusion is reached that the plate element based on the CUF is more suitable and efficient compared to the classical models in the study of multilayered structures embedding piezo-patches.

关键词： plate patches finite-element method piezoelectric materials mixed interpolated tensorial components carrera’s Unified Formulation layer-wise

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