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Hepatobiliary manifestations in inflammatory bowel disease: The gut,the drugs and the liver

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World Journal of Gastroenterology 2013年第42期19卷 7327-7340页

作者： María Rojas-Feria manuel castro Emilio Suárez Javier Ampuero manuel Romero-Gómez Unit for Medical and Surgical Management of Digestive Diseases and CIBERehd Valme University HospitalUniversity of SevilleE-41014 SevillaSpain

Abnormal liver biochemical tests are present in up to30%of patients with inflammatory bowel disease(IBD),and therefore become a diagnostic challenge.Liver and biliary tract diseases are common extraintestinal manifestations for both Crohn’s disease and ulcerative colitis(UC),and typically do not correlate with intestinal activity.Primary sclerosing cholangitis(PSC)is the most common hepatobiliary manifestation of IBD,and is more prevalent in UC.Approximately 5%of patients with UC develop PSC,with the prevalence reaching up to 90%.Cholangiocarcinoma and colon cancer risks are increased in these patients.Less common disorders include autoimmune hepatitis/PSC overlap syndrome,IgG4-associated cholangiopathy,primary biliary cirrhosis,hepatic amyloidosis,granulomatous hepatitis,cholelithiasis,portal vein thrombosis,liver abscess,and non-alcoholic fatty liver disease.Hepatitis B reactivation during immunosuppressive therapy is a major concern,with screening and vaccination being recommended in serologically negative cases for patients with IBD.Reactivation prophylaxis with entecavir or tenofovir for 6to 12 mo after the end of immunosuppressive therapy is mandatory in patients showing as hepatitis B surface antigen(HBsAg)positive,independently from viral load.HBsAg negative and anti-HBc positive patients,with or without anti-HBs,should be closely monitored,measuring alanine aminotransferase and hepatitis B virus DNA within 12 mo after the end of therapy,and should be treated if the viral load increases.On the other hand,immunosuppressive therapy does not seem to promote reactivation of hepatitis C,and hepatitis C antiviral treatment does not influence IBD natural history either.Most of the drugs used for IBD treatment may induce hepatotoxicity,although the incidence of serious adverse events is low.Abnormalities in liver biochemical tests associated with aminosalicylates are uncommon and are usually not clinically relevant.Methotrexaterelated hepatotoxicity has been described in 14%of patients with IBD,in a dose-dependen

关键词： Inflammatory bowel disease Hepatobiliary disorders Extraintestinal manifestations Primary sclerosing cholangitis Drug-induced liver injury Hepatotoxicity Hepatitis B Hepatitis C

克罗恩病患者回结肠切除一期吻合手术的围手术期处理和术后近期并发症:对PRACTICROHN研究的数据分析

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Gastroenterology Report 2019年第3期7卷 168-175,I0001,I0002页

作者： Ana Gutierrez Montserrat Rivero Maria Dolores Martin-Arranz Valle Garcia Sanchez manuel castro Jesus Barrio Ruth de Francisco manuel Barreiro-de Acosta Berta Julia Luis Cea-Calvo Cristina Romero Natalia Borruel Sainz Eugeni Domenech Gastroenterology Department General University Hospital of Alicante and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas(CIBERehd)CarlosⅢHealth InstituteMadridSpain Gastroenterology Department Marques de Valdecilla General University HospitalSantanderSpain Gastroenterology Department La Paz General University HospitalInstituto de Investigacion Biomedica La Paz(IdiPaz)MadridSpain Clinical Management of Gastrointestinal Tract Diseases Unit Reina Sofia University HospitalMaimonides Institute of Biomedical Research of Cordoba(IMIBIC)Cordoba UniversityCordobaSpain Gastroenterology Department Valme University HospitalSevillaSpain Gastroenterology Department University HospitalRio HortegaValladolidSpain Gastroenterology Department University Hospital Central de AsturiasOviedoSpain Gastroenterology Department Inflammatory Bowel Disease UnitUniversity Hospital Complex of Santiago de CompostelaSantiago de CompostelaSpain Medical Department Merck Sharp and DohmeMadridSpain Crohn-Colitis Care Unit(UACC) Digestive Tract ServiceHospital Universitari Vall d’HebronBarcelonaSpain Gastroenterology Department Germans Trias i Pujol University Hospital and CIBERehdBadalonaSpain

背景:本研究旨在分析克罗恩病患者回结肠切除术后近期并发症的发生率及危险因素。方法:对PRACTICROHN研究队列进行回顾性分析,纳入2007年1月至2010年12月间行回结肠切除一期吻合的成人克罗恩病患者。术后近期并发症定义为术后30天内出... 详细信息

背景:本研究旨在分析克罗恩病患者回结肠切除术后近期并发症的发生率及危险因素。方法:对PRACTICROHN研究队列进行回顾性分析,纳入2007年1月至2010年12月间行回结肠切除一期吻合的成人克罗恩病患者。术后近期并发症定义为术后30天内出现的并发症,包括死亡、肠梗阻、吻合口漏、消化道出血、腹腔脓肿、切口感染、导管相关感染及其他腹腔外感染。结果:364例患者纳入分析,手术时患者的中位年龄38岁,男性占50%。手术适应证:狭窄型占46.4%,穿透型占31.3%,狭窄+穿透型占14.0%,药物难治性占5.8%。100例(27.5%)出现术后近期并发症,其中切口感染、腹腔脓肿和吻合口漏最为常见。出现并发症的患者其中位住院时间较未出现并发症者显著延长(16 vs 9天,P<0.001)。术后并发症更多发生于穿透型病变(36/114,31.6%)和药物难治性(9/21,42.9%)患者,而狭窄型(45/169,26.6%)和狭窄+穿透型(6/51,11.8%)患者并发症发生率相对较低(P=0.040)。术中才作出诊断的患者,术后并发症发生率较术前已明确诊断者显著升高[48.4%(15/31)vs.25.7%(85/331),P=0.013)。手术期间接受药物治疗并不会影响并发症发生率。结论:约四分之一的克罗恩病患者行回结肠切除术后会出现近期并发症,其中穿透型病变和急诊手术患者术后并发症风险增高。

关键词： Ileocolonic resection Crohn’s disease post-operative complications risk factors

Hepatic“pregnancy”:hepatocellular carcinoma with extensive extrahepatic growth

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Hepatobiliary Surgery and Nutrition 2023年第4期12卷 641-642页

作者： Ana Rita Ferreira Bárbara castro Jose Daniel Martins João Varanda Alexandre Costa Bela Pereira manuel Oliveira General Surgery Centro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal

A female in her 50s,no previous personal history,presented to the Emergency Department with a 7 months history of progressively worsening abdominal diffuse pain associated with increasing abdominal volume.On physical ... 详细信息

关键词： pregnancy Hepatic Figure

Faecal immunochemical test outside colorectal cancer screening?

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World Journal of Gastroenterology 2021年第38期27卷 6415-6429页

作者： Noel Pin-Vieito manuel Puga Daniel Fernández-de-castro Joaquín Cubiella Department of Gastroenterology Complexo Hospitalario Universitario de OurenseInstituto de Investigación Sanitaria Galicia SurCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas(CIBERehd)Ourense 32005Spain

Faecal immunochemical tests(FITs)are the most widely colorectal cancer(CRC)diagnostic biomarker available.Many population screening programmes are based on this biomarker,with the goal of reducing CRC mortality.Moreover,in recent years,a large amount of evidence has been produced on the use of FIT to detect CRC in patients with abdominal symptoms in primary healthcare as well as in surveillance after adenoma resection.The aim of this review is to highlight the available evidence on these two topics.We will summarize the evidence on diagnostic yield in symptomatic patients with CRC and significant colonic lesion and the different options to use this(thresholds,brands,number of determinations,prediction models and combinations).We will include recommendations on FIT strategies in primary healthcare proposed by regulatory bodies and scientific societies and their potential effects on healthcare resources and CRC prognosis.Finally,we will show information regarding FIT-based surveillance as an alternative to endoscopic surveillance after high-risk polyp resection.To conclude,due to the coronavirus disease 2019 pandemic,FIT-based strategies have become extremely relevant since they enable a reduction of colonoscopy demand and access to the healthcare system by selecting individuals with the highest risk of CRC.

关键词： Adenoma Colorectal cancer Diagnostic performance Faecal biomarkers Faecal haemoglobin Faecal immunochemical test Primary healthcare

Solving Two-Mode Shallow Water Equations Using Finite Volume Methods

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Communications in Computational Physics 2014年第10期16卷 1323-1354页

作者： manuel Jesus castro Dıaz Yuanzhen Cheng Alina Chertock Alexander Kurganov Dpto.de Analisis Matematico Facultad de CienciasUniversidad de MalagaCampus de Teatinos29071 M´alagaSpain. Mathematics Department Tulane UniversityNew OrleansLA 70118USA. Department of Mathematics North Carolina State UniversityRaleighNC 27695USA.

In this paper,we develop and study numerical methods for the two-mode shallow water equations recently proposed in[S.STECHMANN,A.MAJDA,and B.KHOUIDER,Theor.Comput.Fluid Dynamics,22(2008),pp.407–432].Designing a reliable numerical method for this system is a challenging task due to its conditional hyperbolicity and the presence of nonconservative terms.We present several numerical approaches—two operator splitting methods(based on either Roe-type upwind or central-upwind scheme),a central-upwind scheme and a path-conservative centralupwind scheme—and test their performance in a number of numerical experiments.The obtained results demonstrate that a careful numerical treatment of nonconservative terms is crucial for designing a robust and highly accurate numerical method。

关键词： Two-mode shallow water equations nonconservative products conditional hyperbolicity finite volume methods central-upwind schemes splitting methods upwind schemes.

Cardiovascular prevention in elderly patients

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Journal of Geriatric Cardiology 2022年第5期19卷 377-392页

作者： Clara Bonanad Rosa Fernández-Olmo Sergio García-Blas Jose Antonio Alarcon Pablo Díez-Villanueva Carmen Rus Mansilla Héctor García-Pardo Pablo Toledo Ana Ayesta Eva Pereira Antoni Carol Almudena castro-Conde Carmen de Pablo-Zarzoso manuel Martínez-Sellés Vicente Arrarte Raquel Campuzano Albert Ariza-Solé Servicio de Cardiología Hospital Clínico Universitario de ValenciaValenciaSpain Instituto de Investigación Sanitaria INCLIVA ValenciaSpain Servicio Cardiología Hospital Universitario de Jaén Spain Servicio Cardiología Hospital de Donosti Spain Servicio de Cardiología Hospital Universitario La Princesa de MadridSpain Servicio de Cardiología Hospital Alto Gudalquivir de AndújarJaénSpain Servicio de Cardiología Hospital Rio Hortega de ValladolidSpain Servicio Cardiología Hospital Clínico San Cecilio de Granada Spain Servicio de Cardiología Hospital Universitario Central de AsturiasSpain Servicio de Cardiologia Hospital de LugoSpain Servicio de Cardiología Hospital Moisés Broggi de BarcelonaSpain Servicio de Cardiología Hospital Universitario de la Paz de Madrid Spain Servicio de Cardiología Hospital Ramón y Cajal de MadridSpain Department of Cardiology.Hospital Universitario Gregorio Marañón CIBERCV.Universidad EuropeaUniversidad Compluten Servicio de Cardiología del Hospital General de Alicante Spain Servicio de Cardiología Hospital Universitario Fundación de Alcorcón de MadridSpain Servicio de Cardiología Hospital Bellvitge de BarcelonaBioheartGrup de Malalties CardiovascularsInstitut d’InvestigacióBiomèdica de BellvitgeIDIBELLL’Hospitalet de LlobregatBarcelonaSpain

In recent decades,life expectancy has been increasing significantly.In this scenario,health interventions are ne-cessary to improve prognosis and quality of life of elderly with cardiovascular risk factors and cardiovascular disease.However,the number of elderly patients included in clinical trials is low,thus current clinical practice guidelines do not include specific re-commendations.This document aims to review prevention recommendations focused in patients≥75 years with high or very high cardiovascular risk,regarding objectives,medical treatment options and also including physical exercise and their inclusion in cardiac rehabilitation programs.Also,we will show why geriatric syndromes such as frailty,dependence,cognitive impair-ment,and nutritional status,as well as comorbidities,ought to be considered in this population regarding their important pro-gnostic impact.

关键词： prevention patients cardiovascular

Mantle derived crystal-poor rhyolitic ignimbrites:Eruptive mechanism from geochemical and geochronological data of the Piedra Parada caldera,Southern Argentina

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Geoscience Frontiers 2018年第5期9卷 1529-1553页

作者： Eugenio Aragon Antonio castro Juan Diaz-Alvarado Lucio Pinotti Fernando D'eramo manuel Demartis Jorge Coniglio Irene Hernando Carmen Rodriguez Centro de Investigaciones Geológicas(UNLP-CONICET) 1 N^o 644(1900)La PlataBuenos AiresArgentina Departamento de Geología Universidad de Huelva21071 HuelvaSpain Departamento de Geología Universidad de AtacamaCopayapu 485CopiapóChile Departamento de Geología Universidad Nacional de Río Cuarto(UNRC-CONICET)Ruta 36 km 601Río CuartoCórdobaArgentina

Trace elements, isotopic modeling and U-Th-Pb SHRIMP zircon age constraints are used to reconstruct the eruption history and magmatic processes of the Piedra Parada Caldera. In the early Eocene, the crystal-poor Barda Colorada ignimbrite(BCI), having >>15% micro-porphyritic crystals with respect to magmatic components, erupted a volume estimated in more than 300 km^3. The Piedra Parada caldera is located in the Patagonian Andes foreland, at the southern end of the calderas field of the Pilcaniyeu Volcanic Belt(PVB). This belt is related to an extensional tectonic setting as a result of the collision of the Farallon-Aluk ridge with South America, which enabled the development of a transform ocean/continental plate margin followed by the detachment of the Aluk plate and the opening of a slab window. The BCI extra-caldera Plateau is a >100 m thick deposit, having a lower unit with high silica(Si O_2> 76 wt.%),potassium poor rhyolitic composition(trondhjemitic like magma), and an upper unit with normal to high potassium rhyolitic composition(granitic like magma). A trace elements modeling of the BCI units shows that the BCI lower and upper units did not evolve from fractionation or immiscibility in the shallow magma reservoir. The BCI also have a primitive isotopic signature(initial87 Sr/86 Sr =0.7031-0.7049 and ε_(Nd)= +3.4 to +3.65). Thus, tectonic, compositional and isotopic constraints suggest the fast ascent of high silica magmas to a shallow reservoir, and point to an upper mantle origin for these rhyolitic magmas in a transitional(Orogenic-Anorogenic) tectono-magmatic setting. U-Th-Pb SHRIMP zircon crystallization ages of the Syn-caldera stage BCI units(56 -51.5 Ma) show a protracted life of 5 Ma for this caldera reservoir. The age of 52.9 ± 0.3 Ma is considered the best fit for the possible maximum age for the caldera collapse. The Late-caldera magmatism has trachyandesitic and rhyolitic compositions.The trace element modeling suggests that these rhyolites evolve from the trachyandesites and do not evolve fro

关键词： Mantle derived rhyolite Crystal-poor ignimbrite Bimodal volcanism Slab window volcanism K poor-rhyolite

Conducting clinical research in community mental health settings: Opportunities and challenges

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世界精神病学杂志 2014年第3期4卷 49-55页

作者： Oleg V Tcheremissine Whitney E Rossman manuel A castro Dineen R Gardner Department of Psychiatry Carolinas Health Care System-Behavioral Health Center Charlotte NC 28203 United States

Tremendous progress has been made in the past decade surrounding the underlying mechanisms and treatment of neuropsychiatric disease. Technological advancements and a broadened research paradigm have contributed to the understanding of the neurochemistry, brain function and brain circuitry involved in neuropsychiatric disorders. The predominant area of unmet medical need in the United States is major psychiatric disorders, and major depressive disorder is the leading cause of disability for ages 15-44. Total spending on research and development by the pharmaceutical industry has grown exponentially during the past decade, but fewer new molecular entities(NME) for the treatment of major psychiatric disorders have received regulatory approvals compared to other therapeutic areas. Though significant expansion has occurred during the "decade of the brain", the translation of clinical trials outcomes into the community mental health setting is deficient. Randomized controlled trials(RCTs) have been the standard approach to clinical evaluation of the safety and efficacy of NMEs for the past 60 years; however, there are significant barriers and skepticism in the implementation of evidence-based outcomes into clinical practice. Recruitment of patients, shortages of experiencedclinical researchers, regulatory requirements and later translation of outcomes into clinical practice are ever growing problems faced by investigators. The community mental health setting presents particular barriers in the replication of therapeutic outcomes from RCTs. The diagnostic complexity of major psychiatric diseases and the highly selective patient populations involved in clinical trials lend to the gap in translation from the "bench to the bedside". The community mental health setting lends to a diverse patient population with numerous co-morbidities and environmental factors that are unaccounted in the average RCT. While we acknowledge the enormous complexity in developing novel and innovative treatments for major psychiatric disorders,

关键词： Community mental health Clinical trials in psychiatry Study population

Modulation of faecal metagenome in Crohn's disease:Role of microRNAs as biomarkers

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World Journal of Gastroenterology 2018年第46期24卷 5223-5233页

作者： María Rojas-Feria Teresa Romero-García Jose Angel Fernández Caballero-Rico Helena Pastor Ramírez Marta Avilés-Recio manuel castro-Fernandez Natalia Chueca Porcuna manuel Romero-Gomez Federico García Lourdes Grande JoséA Del Campo Department of Digestive Diseases Valme University HospitalUGC Digestive Disease and CIBERehdServicio Andaluz de SaludSeville E-41014Spain Complejo Hospitalario Universitario de Granada MicrobiologyGranada E-18016Spain Institute of Biomedicine of Seville Digestive DiseasesHospital Universitario Virgen del Rocío and CIBERehdSeville E-41013Spain Facultad de ciencias de la salud.Universidad Europea Miguel de Cervantes Madrid E-28280Spain

BACKGROUND The gut microbiota plays a key role in the maintenance of intestinal homeostasis and the development and activation of the host immune system. It has been shown that commensal bacterial species can regulate the expression of host genes. 16 S rRNA gene sequencing has shown that the microbiota in inflammatory bowel disease(IBD) is abnormal and characterized by reduced diversity. Micro RNAs(miRNAs) have been explored as biomarkers and therapeutic targets, since they are able to regulate specific genes associated with Crohn's disease(CD). In this work, we aim to investigate the composition of gut microbiota of active treatment-na?ve adult CD patients, with miRNA profile from gut microbiota.AIM To investigate the composition of gut microbiota of active treatment-na?ve adult CD patients, with miRNA profile from gut microbiota.METHODS Patients attending the outpatient clinics at Valme University Hospital without relevant co-morbidities were matched according to age and gender. Faecal samples of newonset CD patients, free of treatment, and healthy controls were collected. Faecal samples were homogenized, and DNA was amplified by PCR using primers directed to the 16 S bacterial rRNA gene. Pyrosequencing was performed using GS-Junior platform. For sequence analysis, MGRAST server with the database Ribosomal Project was used. MiRNA profile and their relative abundance were analyzed by quantitative PCR.RESULTS Microbial community was characterized using 16 S rRNA gene sequencing in 29 samples(n = 13 CD patients, and n = 16 healthy controls). The mean Shannon diversity was higher in the healthy control population compared to CD group(5.5 vs 3.7). A reduction in Firmicutes and an increase in Bacteroidetes were found. Clostridia class was also significantly reduced in CD. Principal components analysis showed a grouping pattern, identified in most of the subjects in both groups, showing a marked difference between control and CD groups. A functional metabolic study showed that a lower metabolism of carbohydrates(P = 0

关键词： Crohn’s disease Dysbiosis microRNAs Firmicutes Bacteroidetes