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To scan or not to scan:Use of transient elastography in an integrated health system

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World journal of Hepatology 2023年第3期15卷 419-430页

作者： Libby stein Rasham Mittal hubert Song joanie Chung Amandeep Sahota Department of Internal Medicine Kaiser Permanente Los Angeles Medical CenterLos AngelesCA 90027United States Department of Transplant Hepatology Kaiser Permanente Los Angeles Medical CenterLos AngelesCA 90027United States Research and Evaluation Kaiser Permanente Southern CaliforniaLos AngelesCA 91101United States

BACKGROUND Non-invasive tests,such as Fibrosis-4 index and transient elastography(com-monly FibroScan),are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease(NAFLD).In 2018,a clinical decision support tool(CDST)was implemented to guide primary care providers(PCPs)on use of FibroScan for *** To analyze how this CDST impacted health care utilization and patient *** We performed a retrospective review of adults who had FibroScan for NAFLD indication from january 2015 to December 2017(pre-CDST)or january 2018 to December 2020(post-CDST).Outcomes included FibroScan result,laboratory tests,imaging studies,specialty referral,patient morbidity and *** We identified 958 patients who had FibroScan,115 before and 843 after the CDST was *** percentage of FibroScans ordered by PCPs increased from 33%to 67.1%.The percentage of patients diagnosed with early F1 fibrosis,on a scale from F0 to F4,increased from 7.8%to 14.2%.Those diagnosed with ad-vanced F4 fibrosis decreased from 28.7%to 16.5%.There were fewer laboratory tests,imaging studies and biopsy after the CDST was *** there were more specialty referrals placed after the CDST was implemented,multivariate analysis revealed that healthcare utilization aligned with fibrosis score,whereby patients with more advanced disease had more *** few patients were hospitalized or *** This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.

关键词： Non-alcoholic fatty liver disease Transient elastography FibroScan Clinical decision support tool Health care utilization Primary care

Global sensitivity analysis for choosing the main soil parameters of a crop model to be determined

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Agricultural Sciences 2012年第7期3卷 949-961页

作者： hubert Varella Samuel Buis Marie Launay Martine Guérif INRA UMR 1114 INRA-UAPV EMMAH Avignon France INRA Unite Agroclim Avignon France Syngenta Crop Protection Münchwilen AG Stein/AG Switzerland

The use of a crop model like STICS for appropriate management decision support requires a good knowledge of all the parameters of the model. Among them, the soil parameters are difficult to know at each point of interest and costly techniques may be used to measure them. It is therefore important to know which soil parameters need to be determined. It can be stated that those which affect significantly the output variable deserve an accurate determination while those which slightly affect the model output variable do not. This paper demonstrates how a global sensitivity analysis method based on variance decomposition can be applied on soil parameters in order to divide them in the two categories. The Extended FAST method applied to the crop model STICS and a set of 13 soil parameters first allows to calculate the part of variance explained by each soil parameter (giving global sensitivity indices of the soil parameters) and the coefficient of variation of the output variables (measuring the effect of the parameter uncertainty on each variable). These metrics are therefore used for deciding on the importance of the parameter value measurement. Different output variables (Leaf Area Index and chlorophyll content) are evaluated at different stages of interest while others (crop yield, grain protein content, soil mineral nitrogen) are evaluated at harvest. The analysis is applied on two different annual crops (wheat and sugar beet), two contrasted weather and two types of soil depth. When the uncertainty of the output generated by the soil parameters is large (coefficient of variation > 1/3), only the parameters having a significant global sensitivity indices (higher than 10%) are retained. The results show that the number of soil parameters which deserve an accurate determination can be significantly reduced by the use of this relevant method for appropriate management decision support.

关键词： Global Sensitivity Analysis Uncertainty Analysis Soil Parameters Crop Model STICS Management Decision Support Agro-Environmental Variables

Serotonin type 3 receptor subunit gene polymorphisms associated with psychosomatic symptoms in irritable bowel syndrome:A multicenter retrospective study

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World journal of Gastroenterology 2022年第21期28卷 2334-2349页

作者： Sabrina Berens Yuanjun Dong Nikola Fritz jutta Walstab Mauro D'Amato Tenghao Zheng Verena Wahl Felix Boekstegers justo Lorenzo Bermejo Cristina Martinez Stefanie Schmitteckert Egbert Clevers Felicitas Engel Annika Gauss Wolfgang Herzog Robin Spiller Miriam Goebel-Stengel hubert Mönnikes Viola Andresen Frieling Thomas jutta Keller Christian Pehl Christoph stein-Thöringer Gerard Clarke Timothy G Dinan Eamonn M Quigley Gregory Sayuk Magnus Simrén jonas Tesarz Gudrun Rappold Lukas van Oudenhove Rainer Schaefert Beate Niesler Department of General Internal Medicine and Psychosomatics University Hospital HeidelbergHeidelberg 69120Germany Department of Human Molecular Genetics Institute of Human GeneticsUniversity of HeidelbergHeidelberg 69120Germany Department of General Internal Medicine and Psychosomatics Internal Medicine IIUniversity Hospital HeidelbergHeidelberg 69120Germany Department of Human Molecular Genetics University of HeidelbergHeidelberg 69120Germany Gastrointestinal Genetics Lab CIC bioGUNE-BRTADerio 48160Spain IKERBASQUE Basque Foundation for ScienceBilbao 48001Spain Unit of Clinical Epidemiology Department of Medicine SolnaKarolinska InstitutetStockholm 17177Sweden Institute of Medical Biometry and Informatics Heidelberg UniversityHeidelberg 69120Germany Lleida Institute for Biomedical Research Dr.PifarréFoundation(IRBLleida) Av.Alcalde Rovira RoureLleida 25198Spain Department of Clinical and Experimental Medicine Translational Research Center for Gastrointestinal DisordersKU LeuvenLeuven 3000Belgium Department of Gastroenterology Infectious Diseases and IntoxicationsUniversity of HeidelbergHeidelberg 69120Germany Department of General Internal Medicine and Psychosomatics Heidelberg UniversityHeidelberg 69120Germany Nottingham Digestive Diseases Centre University of NottinghamNottingham NG72QLUnited Kingdom Helios Klinikum Rottweil Rottweil 78628Germany Department of Medicine Institute of Neurogastroenterology(H.M.)Martin-Luther-HospitalBelin 14193Germany Israelitisches Krankenhaus in Hamburg Hamburg 22297Germany Internal Medicine II Helios Klinikum KrefeldKrefeld 47805Germany Israelitisches Krankenhaus Hamburg Hamburg 22297Ghana Krankenhaus Vilsbiburg Vilsbiburg 84137Germany Division of Microbiome and Cancer German Cancer Research Center(DKFZ)Heidelberg 69120Germany Department of Psychiatry and Neurobehavioral Science University College CorkCork T23Ireland Medicine in Digestive Disorders Department of MedicineLynda K.and David M.Underwood Center for Digestive DisordersHou

BACKGROUND Single-nucleotide polymorphisms(SNPs)of the serotonin type 3 receptor subunit(HTR3)genes have been associated with psychosomatic symptoms,but it is not clear whether these associations exist in irritable bowel syndrome(IBS).AIM To assess the association of HTR3 polymorphisms with depressive,anxiety,and somatization symptoms in individuals with *** In this retrospective study,623 participants with IBS were recruited from five specialty centers in Germany,Sweden,the United States,the United Kingdom,and ***,anxiety,and somatization symptoms and sociodemographic characteristics were *** functional SNPs—HTR3A c.-42C>T,HTR3B c.386A>C,HTR3C c.489C>A,and HTR3E c.*76G>A—were genotyped and analyzed using the dominant and recessive *** also performed separate analyses for sex and IBS *** scores were calculated as the number of minor alleles of the SNPs *** impact of HTR3C c.489C>A was tested by radioligand-binding and calcium influx *** Depressive and anxiety symptoms significantly worsened with increasing numbers of minor HTR3C c.489C>A alleles in the dominant model(F_(depressive)=7.475,P_(depressive)=0.006;F_(anxiety)=6.535,P_(anxiety)=0.011).A higher SNP score(range 0-6)was linked to a worsened depressive symptoms score(F=7.710,P-linear trend=0.006)in *** potential relevance of the HTR3C SNP was corroborated,showing changes in the expression level of 5-HT3AC variant *** We have provided the first evidence that HTR3C c.489C>A is involved in depressive and anxiety symptoms in individuals with *** SNP score indicated that an increasing number of minor alleles is linked to the worsening of depressive symptoms in IBS.

关键词： Irritable bowel syndrome 5-HT3 receptor subunit gene polymorphisms Single-nucleotide polymorphism score Depression Anxiety Somatization

Epidemiological Aspects and Results of the Management of Polycystic Ovary Syndrome at the CNHU-HKM of Cotonou

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Open journal of Endocrine and Metabolic Diseases 2022年第12期12卷 266-282页

作者： Annelie Kerekou Hode justin Lewis Denakpo Dedjan A. hubert Mohamed Dakin Esther Techeme Department of Endocrinology Metabolism and Nutrition-CNHU-HKM Cotonou Benin Department of Gynecology and Obstetric-CNHU-HKM Cotonou Benin

Introduction: Polycystic Ovarian Syndrome (PCOS), also known as stein Leventhal Syndrome, is one of the common endocrine diseases affecting women of childbearing age and the leading cause of anovulatory infertility worldwide. The aim of this study was to describe the clinical, paraclinical and therapeutic aspects of PCOS at the University Clinic of Obstetrics and Gynaecology of the National Hospital and University Centre hubert Koutoukou MAGA of Cotonou (CNHU). Patients and Method: The study was doing in the University Clinic of Gynecology and Obstetrics of the CNHU-HKM. This was a descriptive and analytical longitudinal study with retrospective and prospective data collection over a period of 7 years from january 2015 to December 2021. It focused on women of childbearing age seen in gynecological consultation. Results: The frequency of PCOS was 2.53%. The mean age of the patients was 27.28 ± 6.55 years. They were educated for the most part with a university level in 43.8% of cases. Obstetrically they were nulligest (45.63%) and nulliparous in 60% of cases. The history of spontaneous miscarriages was found in 61.11%. The main reasons for consultation were menstrual disorders (51%) followed by the desire for pregnancy (40.6%). Clinically, obesity (30%), overweight (33.1%), high blood pressure (20.63%), hirsutism (24%) and acne (27%) were noted. All the women had micropolycystic ovaries in ultrasound. Testosterone was elevated in 61% of cases. Phenotype D was found in 45.63% of patients. All these patients were put under lifestyle and dietary measures, Metformin (13.80%) and estrogen-progestogen (18.80%). The outcome of the treatment was assessed by cycle regularity, regression of hirsutism, weight loss, fertility and fertility. The cycle was normalised in most cases with notable regression of physical signs of hyperandrogenism. The cycle was normalized in most cases with the notable regression of physical signs of hyperandrogenism. We had recorded 25 pregnancies incl

关键词： Hirsutism Spaniomenorrhea Hyperandrogenism Insulin Resistance Metformin

1999年8月17日伊兹米特地震之后马尔马拉海地区的地震危险性

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世界地震译丛 2001年第3期32卷 17-23页

作者： A. hubert-Ferrari A. Barka E. jacques S. S. Nalbant B. Meyer R. Armijo P. Tapponnier G. C. P. King 万永革中国地震局防灾技术高等专科学校

1999年8月17日,在北安纳托利亚断层上伊斯坦布尔以东100 km的伊兹米特市附近发生了7.4级的破坏性大地震。这个1600 km长的板块边界(Barka,1992,1999)以平均为2～3cm/a的速率滑动(Reilinger,et al,1997;hubert,1998;hrmijo,et al,1999),历史上为多次破坏性地震的发生地点(Ambraseys,1970;Ambraseys and Finkel,1991)。仅20世纪沿此断层就破裂了900 km的长度(Ambraseys,1970)。利用地震产生的应力变化的模型(King,et al,1994),结合活动断层分布图分析,预测的1999年伊兹米特地震的震中区确实是大地震发生的可能位置(Nalbant,et al,1998;stein,et al,1997)。本文展示证据说明,1999年的地震本身显著改变了先前地震断层相互作用产生的应力分布(Nalbant,et al,1998;stein,et al,1997)。我们的新应力模型考虑了此地区自1700年后发生的震级大于6的所有地震(Ambraseys,et al,1991),以及由GPS数据约束的地震之间的长期应力变化(straub,et al,1997)。这些模型提供了北安纳托利亚断层长期时空行为的一致图象,并指出在今后数十年内,伊斯坦布尔以南的马尔马拉海之下将可能发生震级等于或大于伊兹米特地震的两个地震。

关键词：北安纳托利亚断层马尔马拉海分支地震危险性伊兹米特地震