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Recurrent anal fistulae:Limited surgery supported by stem cells

World Journal of Gastroenterology 2015年第11期21卷 3330-3336页

作者： Damian Garcia-Olmo Hector Guadalajara ines rubio-perez Maria Dolores Herreros Paloma de-la-Quintana Mariano Garcia-Arranz Hospital Fundación Jimenez Díaz Colorectal Surgery Unit University Hospital Fundación Jiménez Díaz Colorectal Surgery Unit La Paz University Hospital Cell Therapy Laboratory University Hospital Fundación Jiménez Díaz

AIM:To study the results of stem-cell therapy under a Compassionate-use Program for patients with recurrent anal fistulae.METHODS:Under controlled circumstances,and approved by European and Spanish laws,a Compassionate-use Program allows the use of stem-cell therapy for patients with very complex anal fistulae.Candidates had previously undergone multiple surgical interventions that had failed to resolve the fistulae,and presented symptomatic recurrence.The intervention consisted of limited surgery(with closure of the internal opening),followed by local implant of stem cells in the fistula-tract wall.Autologous expanded adipose-derived stem cells were the main cell type selected for implant.The first evaluation was performed on the 8th postoperative week;outcome was classified as response or partial response.Evaluation one year after the intervention confirmed if complete healing of the fistula was achieved.RESULTS:Ten patients(8 male)with highly recurrent and complex fistulae were treated(mean age:49years,range:28-76 years).Seven cases were nonCrohn’s fistulae,and three were Crohn’s-associated fistulae.Previous surgical attempts ranged from 3to 12.Two patients presented with preoperative incontinence(Wexner scores of 12 and 13 points).After the intervention,six patients showed clinical response on the 8th postoperative week,with a complete cessation of suppuration from the fistula.Three patients presented a partial response,with an evident decrease in suppuration.A year later,six patients(60%)remained healed,with complete reepithelization of the external opening.Postoperative Wexner Scores were 0 in six cases.The two patients with previous incontinence improved their scores from12 to 8 points and from 13 to 5 points.No adverse reactions or complications related to stem-cell therapy were reported during the study period.CONCLUSION:Stem cells are safe and useful for treating anal fistulae.Healing can be achieved in severe cases,sparing fecal incontinence risk,and improving previous scoring.

关键词： Adipose-derived stem cells Cell therapy Compassion

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Increased postoperative complications after protective ileostomy closure delay: An institutional study

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World Journal of Gastrointestinal Surgery 2014年第9期6卷 169-174页

作者： ines rubio-perez Miguel Leon Daniel Pastor Joaquin Diaz Dominguez Ramon Cantero General and Digestive Surgery Department La Paz University Hospital

AIM: To study the morbidity and complications as-sociated to ileostomy reversal in colorectal surgery pa-tients, and if these are related to the time of closure. METHODS: A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance.RESULTS: The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy cre-ation was rectal cancer(56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the pa-tients, with 1% mortality. The most frequent were ileus(13%) and wound infection(13%). Pseudomembra-nous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomyclosure(P = 0.041). Male patients had more complica-tions(P = 0.042), mainly wound infections(P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure(P = 0.003). End-to-end in-testinal anastomosis without resection was significantly associated with postoperative ileus(P = 0.037). CONCLUSION: Although closure of a protective il-eostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.

关键词： closure protective postoperative ileus colorectal stoma anastomosis indication univariate multivariate

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Generalized Multiscale RBF Networks and the DCT for Breast Cancer Detection

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International Journal of Automation and computing 2020年第1期17卷 55-70页

作者： Carlos Beltran-perez Hua-Liang Wei Adrian rubio-Solis Department of Automatic Control and Systems Engineering University of SheffieldSheffield S13JDUK Tecnologico de Monterrey Campus TolucaEduardo Monroy Cardenas 2000San Antonio BuenavistaToluca 50110Mexico

The use of the multiscale generalized radial basis function(MSRBF)neural networks for image feature extraction and medical image analysis and classification is proposed for the first time in this work.The MSRBF networks hold a simple and flexible architecture that has been successfully used in forecasting and model structure detection of input-output nonlinear systems.In this work instead,MSRBF networks are part of an integrated computer-aided diagnosis(CAD)framework for breast cancer detection,which holds three stages:an input-output model is obtained from the image,followed by a high-level image feature extraction from the model and a classification module aimed at predicting breast cancer.In the first stage,the image data is rendered into a multiple-input-single-output(MISO)system.In order to improve the characterisation,the nonlinear autoregressive with exogenous inputs(NARX)model is introduced to rearrange the available input-output data in a nonlinear way.The forward regression orthogonal least squares(FROLS)algorithm is then used to take advantage of the previous arrangement by solving the system as a model structure detection problem and finding the output layer weights of the NARX-MSRBF network.In the second stage,once the network model is available,the feature extraction takes place by stimulating the input to produce output signals to be compressed by the discrete cosine transform(DCT).In the third stage,we leverage the extracted features by using a clustering algorithm for classification to integrate a CAD system for breast cancer detection.To test the method performance,three different and well-known public image repositories were used:the mini-MIAS and the MMSD for mammography,and the BreaKHis for histopathology images.A comparison exercise was also made between different database partitions to understand the mammogram breast density effect in the performance since there are few remarks in the literature on this factor.Classification results show that the new CAD method reached an accuracy of 93.5%i

关键词： Nonlinear system identification image processing discrete cosine transform radial basis functions computer-aided diagnosis neural networks

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Global longitudinal strain is superior to ejection fraction for detecting myocardial dysfunction in end-stage renal disease with hyperparathyroidism

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World Journal of Cardiology 2022年第4期14卷 239-249页

作者： Maria Fernanda Carrasco-Ruiz Antonio Ruiz-Rivera Marvin A Soriano-Ursúa Carlos Martinez-Hernandez Leticia Manuel-Apolinar Carmen Castillo-Hernandez Gustavo Guevara-Balcazar Eunice D Farfán-García Ana Mejia-Ruiz Ivan rubio-Gayosso Teresa perez-Capistran Department of Physiology Escuela Superior de MedicinaInstituto Politécnico NacionalCiudad de México 11340Mexico Department of Cardiology Instituto Mexicano del Seguro SocialCiudad de México 06720Mexico Endocrine Research Unit Instituto Mexicano del Seguro SocialCiudad de México 06720Mexico Department of Cardiovascular Pharmacology Instituto Politécnico NacionalCiudad de México 11340Mexico Department of Biochemistry Escuela Superior de MedicinaInstituto Politécnico NacionalCiudad de México 11340Mexico Education Research Comisión Nacional Para la Mejora Continua de la EducaciónCiudad de México 03900Mexico Postgraduate Studies and Research Section Escuela Superior de MedicinaInstituto Politécnico NacionalCiudad de México 11340Mexico Department of Physiology Instituto Politécnico NacionalMexico City 11340Ciudad de MéxicoMexico

BACKGROUND The estimation of left ventricular ejection fraction(LVEF)by 2D echocardiography(2D-ECHO)is the most used tool to assess LV systolic function(LVSF).Global longitudinal strain(GLS)has recently been suggested as a superior method for several evaluations.This study explored the association and prevalence of LV systolic dysfunction(LVSD)by using these methods in patients with end-stage renal disease(ESRD)and severe hyperparathyroidism(SHPTH);both associated with cardiovascular events(CEs).AIM To evaluate the myocardial function in patients with ESRD and SHPTH by using the GLS and LVEF measured through conventional 2D-ECHO.METHODS In 62 patients with ESRD and SHPTH,asymptomatic,and without a history of CEs,LVSF was evaluated by 2D-ECHO,obtaining the EF,by the Simpson biplane method,and GLS by speckle tracking.RESULTS The total patients with ESRD had a preserved LVEF(>50%)but abnormal GLS(<13.55%).Additionally,multivariate analysis showed an independent association of GLS and serum parathyroid hormone(PTH),LV mass index,and hemoglobin.Also,PTH was independently associated with lateral e'wave and tricuspid regurgitation velocity.CONCLUSION In patients with SHPTH linked to ESRD,the use of GLS by 2D-ECHO is a more sensitive tool than LVEF for detecting LVSD.

关键词： Left ventricular hypertrophy Systolic dysfunction Global longitudinal strain End-stage renal disease Parathormone

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Evaluation of an educational telephone intervention strategy to improve non-screening colonoscopy attendance:A randomized controlled trial

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World Journal of Gastroenterology 2020年第47期26卷 7568-7583页

作者： Agustin Seoane Xenia Font Juan C perez Rocio perez Carlos F Enriquez Miriam Parrilla Faust Riu Josep M Dedeu Luis E Barranco Xavier Duran ines A Ibanez Marco A Alvarez Digestive Department Endoscopy UnitHospital del MarParc de Salut MarBarcelona 08003Spain Colorectal Cancer Research Group IMIM(Hospital del Mar Medical Research Institute)Barcelona 08003Spain Department of Medicine Autonomous University of BarcelonaBarcelona 08003Spain Consulting Service on Methodology for Biomedical Research IMIM(Hospital del Mar Medical Research Institute)Barcelona 08003Spain

BACKGROUND Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes.Within these programmes,educative interventions with bidirectional contact carried out by trained personnel have been proved to be an important tool for colonoscopy attendance improvement,and because of its huge clinical and economic impact,they have been widely implemented.However,outside of this population programmes,educative measures to improve colonoscopy attendance have been poorly studied and no navigation interventions are usually performed.AIM To investigate the clinical and economic impacts of an educational telephone intervention on colonoscopy attendance outside colorectal cancer screening programmes.METHODS This randomized controlled trial included consecutive patients referred to colonoscopy from primary care centres from November 2017 to May 2018.The intervention group(IG)received a telephone intervention,while the control group(CG)did not.Patients assigned to the IG received an educational telephone call 7 d before the colonoscopy appointment.The intervention was carried out by two nurses with deep endoscopic knowledge who were previously trained for a telephone educational intervention for colonoscopy.The impact on patient compliance with preparedness protocols related to bowel cleansing,antithrombotic management,and sedation scheduling was also evaluated.A second call was conducted to assess patient satisfaction.Intention-to-treat(ITT)and perprotocol(PP)analyses were performed.RESULTS A total of 738 and 746 patients were finally included in the IG and CG respectively.Six hundred thirteen(83%)patients were contacted in the IG.The non-attendance rate was lower in the IG,both in the ITT analysis(IG 8.4%vs CG 14.3%,P<0.001)and in the PP analysis(4.4%vs 14.3%,P<0.001).In a multivariable analysis,belonging to the control group increased the risk of nonattendance in both,the ITT analysis(OR 1.81,95%CI:1.27 to 2.58,P=0.001)and the PP analysis(OR 3.56,95%CI:2.25 to 5.64,P<0.001).There was als

关键词： Colonoscopy Quality improvement No-show patients Nursing education Patient compliance Telephone intervention

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LJItrasensitive H2S gas sensors based on p-type WS2 hybrid materials

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Nano Research 2018年第8期11卷 4215-4224页

作者： Georgies Alene Asrest Jose J. Baldovi Aron Dombovari Topias Jarvinen Gabriela Simone Lorite Melinda Mohl Andrey Shchukarev Alejandro perez Paz Lede Xian Jyri-Pekka Mikkola Anita Lloyd Spetz Heli Jantunen Angel rubio Krisztian Kordas Microelectronics Research Unit Faculty of Information Technology and Electrical Engineering University of Oulu P.O. Box 4S00FI-90014 Oulu Finland Max Planck Institute for the Structure and Dynamics of Matter Luruper Chaussee 149 22761 Hamburg Germany Nano-Bio Spectroscopy Group European Theoretical Spectroscopy Facifity (ETSF) Universidad del Pals Vasco CFM SCIC-UPV/EHU-MPC DIPC A venida Tolosa 72 20018 San Sebastian Spain Technical Chemistry Department of Chemistry Chemical-Biological Centre Umea University SE-90187 Umea Sweden School of Chemical Sciences and Engineering School of Physics and Nanotechnology Yachay Tech University Urcuquf Ecuador Industrial Chemistry & Reaction Engineering Department of Chemical Engineering Johan Gadolin Process Chemistry Centre AboAkademi University FI-20500 Abo-Turku Finland Sensor and Actuator Systems Department of Physics Chemistry and Biology Link~ping University SE-58183 LinkOping Sweden

Owing to their higher intrinsic electrical conductivity and chemical stability with respect to their oxide counterparts, nanostructured metal sulfides are expected to revive materials for resistive chemical sensor applications. Herein, we explore the gas sensing behavior of WS2 nanowire-nanoflake hybrid materials and demonstrate their excellent sensitivity （0.043 ppm-1） as well as high selectivity towards H2S relative to CO, NH~, H2, and NO （with corresponding sensitivities of 0.002, 0.0074, 0.0002, and 0.0046 pprn-1, respectively）. Gas response measurements, complemented with the results of X-ray photoelectron spectroscopy analysis and first-principles calculations based on density functional theory, suggest that the intrinsic electronic properties of pristine WS2 alone are not sufficient to explain the observed high sensitivity towards H2S. A major role in this behavior is also played by O doping in the S sites of the WS2 lattice. The results of the present study open up new avenues for the use of transition metal disulfide nanomaterials as effective alternatives to metal oxides in future applications for industrial process control, security, and health and environmental safety.

关键词： ws nanowire nanoflake gas sensor H2S,O doping

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Literature Review of the Outcome after One-Stage Transanal Endorectal Pull-Through Procedure for Hirschsprung’s Disease in Children

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Surgical Science 2013年第5期4卷 258-262页

作者： Irene Ortiz-rubio Maria perez-Aguilera Christina Graneli Pernilla Stenstrom Einar Arnbjornsson Autonomous University of Barcelona BarcelonaSpain University of Seville SevilleSpain Department of Paediatric Surgery Skane University HospitalLundSweden Lund University LundSweden

Background: Transanal endorectal one-stage pull-through (TERPT) procedure in children with Hirschsprung’s disease (HD) is frequently used worldwide. In order to give the families realistic expectations and to plan the medical care for the years after TERPT, the long term outcome is of great importance. Aim: To collect information on the long term outcome reported after one stage TERPT procedure for HD in children 0 - 15 years. Method: A literature review on the outcome of planned TERPT from 2005 through 2012 was carried out. Information was collected on the number of daily stools a few months postoperatively, incontinence and constipation and the measures taken to deal with these. Results: The reports are few and prospective studies were missing. The results show an initial high frequency of daily stools, 12% had later abnormal stool patterns, 21% had fecal incontinence and 10% had problems with constipation. Conclusion: In order to compare the long term outcome, it would be desirable to have uniform regular reports on the daily frequency of passed stools, incontinence and constipation during the first years after TERPT. Such knowledge would be of importance for the information given to the guardians of children with HD preoperatively to TERPT and in the planning of the future care. The findings can, furthermore, provide a benchmark for the outcome from a single centre.

关键词： Transendorectal Pull-Through(TERPT) Hirschsprung’s Disease(HD) Outcome Incontinence Constipation

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Low prevalence of germline hMSH6 mutations in colorectal cancer families from Spain

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World Journal of Gastroenterology 2005年第37期11卷 5770-5776页

作者： Ana Sánchez de Abajo Miguel de la Hoya Alicia Tosar Javier Godino Juan Manuel Fernández Jose Lopez Asenjo Beatriz perez Villamil Pedro perez Segura Eduardo Diaz-rubio Trinidad Caldes Laboratorio de Oncología Molecular Hospital Clinico San Carlos Madrid Spain Servicio de Anatomía Patológica Hospital Clinico San Carlos Madrid Spain Servicio de Oncología Médica Hospital Clinico San Carlos Madrid Spain

AIM: To investigate the prevalence and penetrance of hMSH6 mutations in Spanish HNPCC families that was negative for mutation in hMLH1 or hMSH2.METHODS: We used PCR-based DGGE assay and direct Sequencing to screen for hMSH6 gene in 91 HNPCC families.RESULTS: we have identified 10 families with germ-line mutations in the DNA sequence. These mutations included two intronic variation, three missense mutation, one nonsense mutation, and four silent mutations. Among the 10 germ-line mutations identified in the Spanish cohort,8 were novel, perhaps, suggesting different mutational spectra in the Spanish population. Detailed pedigrees were constructed for the three families with a possible pathogenic hMSH6 mutation. The two silent mutations H388H and L758L, detected in a person affected of colorectal cancer at age 29, produce loss of the wild-type allele in the tumor sample. Immunohistochemical analysis showed that expression of MSH6 protein was lost only in the tumors from the carriers of V878A and Q263X mutations.CONCLUSION: Altogether, our results indicate that disease-causing germ-line mutations of hMSH6 are very less frequent in Spanish HNPCC families.

关键词：基因突变 hMSH6 结肠癌直肠癌西班牙遗传因素

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Circulation-Type Classification over Mexico by the Era-Interim Database and Cost733

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Atmospheric and Climate Sciences 2018年第2期8卷 286-305页

作者： Sergio Natan Gonzalez-Rocha Juan Cervantes-perez Fredy Juarez-perez Z.Arturo Gonzalez-Cerezo Lizeth Rios Velasco ines Palomino-Mendez Jose Maria Baldasano Recio Universidad Veracruzana VeracruzMexico Barcelona Supercomputing Center BarcelonaSpain Instituto Tecnologico Superior de Alama Temapache XoyotitlaMexico Universitat Politecnica de Catalunya BarcelonaSpain

In this paper an approach of a synoptic classification by cluster k-means (CKM) and the European Großwettertypes (GWT) was performed and executed in COST733 package. The methodology used a CKM with nine clusters and GWT with 16. The COST733 evaluated a dataset of 30-years since 1986 to 2015. The variables selected were mean sea level pressure (mslp), geopotential height (z500 and z850), wind speed and direction (u10, v10 and u, v at 850 hPa) and relative vorticity (vo) with a 0.75° × 0.75° resolution of the data grid at 00:00, 06:00, 12:00 and 18:00 UTC and 0 steps. These results were evaluated using COST733 to find the quality of measurements by the explained variance (EV) or reduction ratio in error and pseudo F value (PF) to determine the certainty of the results. GWT-16 showed better yearly values in the evaluation with 32.7 (EV) and 354.3 (PF) against the CKM-9 of 54.2 (EV) and 1621.8 (PF). Finally, it was concluded that GWT-16 could be used for classification of synoptic systems over Mexico and the analysis of meteorological phenomena triggers on increases or decreases of atmospheric pollution in areas over Mexico.

关键词： Cluster k-Mean Synoptic Patterns European Groβwettertypes

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A High-Resolution Modeling Strategy to Assess Impacts of Climate Change for Mesoamerica and the Caribbean

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American Journal of Climate Change 2016年第2期5卷 202-228页

作者： Robert Oglesby Clinton Rowe Alfred Grunwaldt ines Ferreira Franklyn Ruiz Jayaka Campbell Luis Alvarado Francisco Argenal Berta Olmedo Alejandro del Castillo Pilar Lopez Edwards Matos Yosef Nava Carlos perez Joel perez Department of Earth and Atmospheric Sciences University of Nebraska Lincoln NE USA Climate Change and Sustainability Division Inter-American Development Bank Washington DC USA Instituto de Hidrología Meteorología y Estudios Ambientales de Colombia Bogota Colombia University of the West Indies Kingston Jamaica Instituto Meteorológico Nacional Costa Rica San Jose Costa Rica Servicio Meteorológico Nacional de Honduras Dirección General de Aeronáutica Civil Tegucigalpa Honduras Empresa de Transmisión Eléctrica Paname?a Ciudad de Panamá Panamá Water Center for the Humid Tropics of Latin America and the Caribbean (CATHALAC) Ciudad de Panamá Panamá Unidad de Análisis Meteorológico Empresa de Transmisión Eléctrica Paname?a Ciudad de Panamá Panamá Instituto Nacional de Ecología y Cambio Climático Mexico City Mexico National Weather Service MARN San Salvador El Salvador

Mesoamerica and the Caribbean are low-latitude regions at risk for the effects of climate change. Global climate models provide large-scale assessment of climate drivers, but, at a horizontal resolution of 100 km, cannot resolve the effects of topography and land use as they impact the local temperature and precipitation that are keys to climate impacts. We developed a robust dynamical downscaling strategy that used the WRF regional climate model to downscale at 4 - 12 km resolution GCM results. Model verification demonstrates the need for such resolution of topography in order to properly simulate temperatures. Precipitation is more difficult to evaluate, being highly variable in time and space. Overall, a 36 km resolution is inadequate;12 km appears reasonable, especially in regions of low topography, but the 4 km resolution provides the best match with observations. This represents a tradeoff between model resolution and the computational effort needed to make simulations. A key goal is to provide climate change specialists in each country with the information they need to evaluate possible future climate change impacts.

关键词： Regional Climate Models Dynamical Downscaling Strategy Mesoamerica and Caribbean Climate Change

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