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Outcomes of abdominal surgery in patients with liver cirrhosis

World Journal of Gastroenterology 2016年第9期22卷 2657-2667页

作者： Juan C Lopez-Delgado Josep Ballus francisco esteve Nelson L Betancur-Zambrano Vicente Corral-Velez Rafael Manez Antoni J Betbese Joan A Roncal Casimiro Javierre Hospital Universitari de Bellvitge Intensive Care Department L'Hospitalet de Llobregat 08907 Barcelona Spain IDIBELL (Institut d'Investigacio Biomedica Bellvitge Biomedical Investigation Institute of Bellvitge) Research Team of Area of Innate Immunity and Pathology of the Critical Patient L'Hospitalet de Llobregat 08908 Barcelona Spain Hospital de la Santa Creu i Sant Pau Intensive Care Department 08041 Barcelona Spain Physiological Sciences II Department Universitat de Barcelona Campus Bellvitge 08907 Barcelona Spain

Patients suffering from liver cirrhosis(LC) frequently require non-hepatic abdominal surgery,even before liver *** is an important risk factor itself for surgery,due to the higher than average associated morbidity and *** high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors,such as coagulopathy,poor nutritional status,adaptive immune dysfunction,cirrhotic cardiomyopathy,and renal and pulmonary dysfunction,which all lead to poor *** evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal *** the emergency setting,with the presence of decompensated LC,alcoholic hepatitis,severe/advanced LC,and significant extrahepatic organ dysfunction conservative management is preferred.A multidisciplinary,individualized,and specialized approach can improve outcomes;preoperative optimization after risk stratification and careful management are mandatory before *** techniques can also improve *** review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before,during,and after surgery.

关键词： Liver cirrhosis Outcomes Coagulopathy Nutritional status Abdominal surgery Adaptive immune dysfunction Cirrhotic cardiomyopathy

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Influence of cirrhosis in cardiac surgery outcomes

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World Journal of Hepatology 2015年第5期7卷 753-760页

作者： Juan C Lopez-Delgado francisco esteve Casimiro Javierre Josep L Ventura Rafael Maez Elisabet Farrero Herminia Torrado David Rodríguez-Castro Maria L Carrio Intensive Care Department Hospital Universitari de BellvitgeIDIBELL (Institut d’Investigació Biomèdica BellvitgeBiomedical Investigation Institute of Bellvitge) Physiological Sciences Ⅱ Department Universitat de BarcelonaIDIBELL (Institut d’Investigació Biomèdica BellvitgeBiomedical Investigation Institute of Bellvitge)

Liver cirrhosis has evolved an important risk factor for cardiac surgery due to the higher morbidity and mortality that these patients may suffer compared with general cardiac surgery *** presence of contributing factors for a poor outcome,such as coagulopathy,a poor nutritional status,an adaptive immune dysfunction,a degree of cirrhotic cardiomyopathy,and a degree of renal and pulmonary dysfunction,have to be taken into account for surgical evaluation when cardiac surgery is needed,together with the degree of liver disease and its primary *** associated pathophysiological characteristics that liver cirrhosis represents have a great influence in the development of complications during cardiac surgery and the postoperative *** the population of cirrhotic patients who are referred for cardiac surgery is small and recommendations come from small series,since liver cirrhotic patients have increased their chance of survival in the last 20 years due to the advances in their medical care,which includes liver transplantation,they have been increasingly considered for cardiac ***,there is an expected rise of cirrhotic patients within the cardiac surgical population due to the increasing rates of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis,especially in western *** consequence,a more specific approach is needed in the assessment of care of these patients if we want to improve their *** this article,we review the pathophysiology and outcome prediction of cirrhotic patients who underwent cardiac surgery.

关键词： Liver cirrhosis Cardiac surgery Outcomes Coagulopathy Nutritional status Adaptive immunedysfunction Cirrhotic cardiomyopathy

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Genetic and experimental evidence for the involvement of the CD6 lymphocyte receptor in psoriasis

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Cellular & Molecular Immunology 2018年第10期15卷 898-906页

作者： Marta Consuegra-Fernández Marc Julià Mario Martínez-Florensa Fernando Aranda Cristina Català Noelia Armiger-Borràs María-Teresa Arias Francisca Santiago Antonio Guilabert Anna esteve Carlos Muñoz Carlos Ferrándiz José-Manuel Carrascosa Edurne Pedrosa Jorge Romaní MercèAlsina José-Manuel Mascaró-Galy francisco Lozano Immunoreceptores del Sistema Innat i Adaptatiu Institut d'Investigacions Biomèdiques August Pi i Sunyer(IDIBAPS)Barcelona 08036Spain Servicio de Dermatologia Hospital Universitario de BasurtoBilbao 48013Spain Servei d’Immunologia Centre de Diagnòstic BiomèdicHospital Clínic de BarcelonaBarcelona 08036Spain Servei de Dermatologia Hospital General de GranollersBarcelona 08402Spain Centre d’Estudis Epidemiològics sobre les ITS i Sida de Catalunya(CEEISCAT) ASPCCIBER Epidemiologia y Salud PúblicaBadalona 08916Spain Servei de Dermatologia Hospital Universitari Germans Trias i PujolBadalona 08916Spain Laboratori d’Immunobiologia per Investigaciói Aplicacions al Diagnòstic Banc de Sang i Teixits(BST)Institut d’Investigacióen Ciències de la Salut Germans Trias i PujolDepartament de Biologia Cel·lularFisiologia i ImmunologiaUniversitat Autònoma de BarcelonaBellaterra 08193Spain Servei de Dermatologia Consorci Sanitari Parc Taulí08208 Sabadell.Universitat Autónoma de BarcelonaBellaterra 08193Spain Servei de Dermatologia Hospital Clínic de BarcelonaBarcelona 08036Spain Departament de Biomedicina Universitat de BarcelonaBarcelona 08036Spain

Psoriasis is a chronic inflammatory skin disease with a strong genetic background and is triggered by environmental *** evidence supports CD6,a lymphocyte surface receptor mostly expressed by T cells,as a putative target in ***,a humanized anti-CD6 antibody has been assayed for the treatment of certain autoimmune disorders,including ***,we present novel evidence in mice and humans for a direct involvement of CD6 in psoriasis ***,an attenuated form of imiquimod-induced psoriasis-like skin inflammation was demonstrated in CD6-deficient mice,as deduced from lower epidermal thickness and local reduced production of pro-inflammatory cytokines,namely,***,isolated CD4+CD62L+T cells from CD6-deficient mice displayed decreased in vitro T-helper type 17 ***,a statistically significant association between CD6 single-nucleotide polymorphisms(rs17824933,rs11230563 and rs12360861)and more severe forms of psoriasis was demonstrated in a cohort of 304 patients at three public hospitals from the metropolitan area of *** together,these results provide new supportive evidence of the contribution of the CD6 lymphocyte receptor in psoriasis at both experimental and clinical levels.

关键词： ALCAM CD5 CD6 lymphocyte psoriasis

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Sudden Death in Sports: Case Report and Review of an Ongoing Problem

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Health 2019年第1期11卷 67-80页

作者： María Elena Caparrós-Hernández Mónica García-Fernández Carla Miró-Vicedo María del Mar Ponce-Abellán Andrea Ruso-Ruso María Dolores Jover-Ríos Juan Méndez-Mora francisco Caparrós-Hernández Carmen Seguí-Pérez Marc Seguí-Pérez Pedro esteve-Atiénzar Jorge Peris-García David Bonet-Tur Pablo Roig-Rico Asunción Pérez-Fullana José Miguel Seguí-Ripoll School of Medicine Miguel Hernández University Elche (Alicante) Spain Department of Internal Medicine Hospital La Vega Baja of Orihuela (Alicante) Spain Secondary School Marist Brothers High School Alicante Spain Department of Internal Medicine University Hospital of San Juan Alicante Spain Department of Clinical Medicine Miguel Hernández University Elche (Alicante) Spain

Background: Both competitive and recreational sports are considered a positive practice that is good for human health and quality of life, so it is difficult to understand how young, energetic and apparently healthy people can die while playing their usual sports. When these events occur in elite athletes during monitored events, they normally receive considerable media attention. Objective: To describe the case of sudden death in a young professional athlete who was successfully aided and resuscitated outside our hospital, and to review the literature about sudden death in sports. Materials and Method: We searched for Sudden Death (according to the International Classification of Diseases (ICD-9 and ICD-10)) in our hospital but found no other relevant cases. We performed a literature search on the state of the art in sudden death (Google Scholar, PubMed, LILACS, Scielo and the Revista Española de Cardiología). Results: Although we observed that the prevalence of sudden death is not very high, it still represents a potentially avoidable event. An adequate medical examination prior to regular sporting practice can decrease the incidence of sudden death in athletes under the age of 35. Data available in the literature support medical check-ups that include history-taking, physical examination and electrocardiogram. The findings of this evaluation may also prompt further assessment (electrocardiograph, ergometry). Conclusions: We could not identify standard, obligatory guidelines for screening possible heart diseases causing cardiorespiratory failure and sudden death. As a measure for primary prevention, we propose a protocol for reducing the risk of sudden death in athletes.

关键词： Sudden Death Sports Athletes Cardiopulmonary Resuscitation Implantable Automatic Defibrillator

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Post-Hospital Syndrome and Hyponatremia

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Health 2021年第8期13卷 846-856页

作者： José Bellod-Tonda Julio Blázquez-Encinar María Dolores Jover-Ríos Carmen Seguí-Pérez Juan Méndez-Mora francisco Caparrós-Hernández Álex Méndez-Jover Marc Seguí-Pérez David Baláž Leticia Espinosa del Barrio Jesús Corbacho-Redondo Carles García-Cervera Juan Manuel Núñez-Cruz Isidro Hernández-Isasi Javier Guzmán-Martínez Angie Gómez-Uranga Pedro esteve-Atiénzar Jorge Peris-García Veronica Martínez-Sempere Eliana Damonte-White Óscar Hernando Ruiz-Ariza Juan Carlos López-Corbalán Lourdes Lajara-Villar Andrea Riaño-Pérez Paloma Chazarra-Pérez María Escamilla-Espínola Maria Luisa Asensio-Tomás Miguel Ángel Auladell-Alemany Laura Serna-Torres Asunción Pérez-Fullana Amparo Gómez-Siurana Sergio Menargues-Irles José Miguel Seguí-Ripoll Internal Medicine Department University Hospital of San Juan Alicante Spain Internal Medicine Department Torrevieja University Hospital Alicante Spain Internal Medicine Department Hospital La Vega Baja of Orihuela Alicante Spain CEU Cardinal Herrera University Veterinary Hospital Valencia Spain Secondary School Marist Brothers High School Alicante Spain Department of Clinical Medicine Miguel Hernández University Elche Spain Primary Care Medicine Benilloba Spain Sub-Delegation of the Government Alicante Spain Chemical Engineering Department University of Alicante Alicante Spain

Introduction: Post-hospital syndrome (PHS) is defined as a period of vulnerability during the first 30 days after a patient is discharged from hospital, in which multiple factors come into play. Hyponatremia is the most frequent hydroelectrolytic disorder in hospitalized patients and may be related to the appearance of PHS. Objective: The objective is to estimate the prevalence of PHS that is assessed as the rate of readmissions in the first 30 days after discharge, in patients with hyponatremia. Material and Methods: It is a descriptive observational study of patients with hyponatremia who were discharged from 1 September 2010 to 2 February 2020 at the Internal Medicine Service of the Hospital University of San Juan (Alicante, Spain). Results: Of the 25 included patients, 5 (20%) were readmitted within a month of discharge, after a mean of 11.4 days (standard deviation [SD] 5.1). The overall mortality of the study was 20% (n = 5), with one case of death in the first 30 days post-hospitalization (4%). In 12 patients (48%) the origin of the hyponatremia was undetermined. The most frequently recorded etiology for the condition was pharmacological (n = 7, 28%), and there was pronounced variability in its clinical and laboratory study. The most widely used corrective measure was drug withdrawal, in 16 patients (64%). Water intake restriction was the most common treatment after discharge (5 patients, 20%), followed by urea (2 patients, 8%), while tolvaptan was not used. Conclusion: Hyponatremia may be the cause of PHS, which could increase the rate of early readmission. Hyponatremia is an underdiagnosed and undertreated entity, so it is necessary to apply an appropriate system to optimize its management and, in future studies, to assess its impact on PHS.

关键词： Hospitalization Hyponatremia Patient Readmission Inappropriate ADH Syndrome

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