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Review on the management of cardiovascular risk factors in the elderly

Journal of geriatric Cardiology 2022年第11期19卷 894-927页

作者： Magali gonzález-Colaço Harmand María del Mar garcía-Sanz Antònia Agustí pablo César Prada-Arrondo Alberto Domínguez-Rodríguez Beatriz grandal-leirós David Peña-Otero Natalia Negrín-Mena Jesús Javier lópez-Hernández pablo Díez-Villanueva Department of Internal Medicine-geriatric Medicine Hospital Universitario Nuestra Señora de CandelariaSanta Cruz de TenerifeSpain Universidad Europea de Canarias Faculty of Health SciencesLa OrotavaSpain Clinical Pharmacology Department Hospital Universitario Marqués de ValdecillaSantanderSpain Clinical Pharmacology Department.Hospital Vall d'Hebron BarcelonaSpain Cardiac Surgery Department Hospital Universitario de CanariasLa LagunaTenerifeSpain Cardiology Department Hospital Universitario de CanariasLa LagunaTenerifeSpain Ortogeriatric Department.Hospital Universitario de Canarias La LagunaTenerifeSpain Subdepartment of Health Care Hospital Universitario Marqués de ValdecillaServicio Cántabro de SaludSantanderSpain Instituto de Investigación Sanitaria gregorio Marañón(liSgM)y Valdecilla(IDIVAl) Spain Hospital Universitario de Canarias Sistema Canario de SaludTenerifeSpain Primary Care Management Servicio Cántabro de SaludSpain Cardiology Department Hospital de la PrincesaMadridSpain

Cardiovascular risk factors(CVRF)are very prevalent in the elderly population and in addition to predisposing to cardiovascular disease they are related to functional decline,which limits the quality of life in this population.The objective of this work is to offer a review of the current evidence in the management of CVRF in the elderly population.The search strategy was executed in PubMed,*** and Embase,to search for clinical trials,observational cohort or cross-sectional studies,reviews,and clinical practice guidelines focused or including elderly population.The results provided were refined after reading the title and abstract,as well as elimination of duplicates,and were finally identified and assessed following the gRADE methodology.A total of 136 studies were obtained for all predefined risk factors,such as sedentary lifestyle,smoking,obesity and metabolic syndrome,hypertension,diabetes mellitus,dyslipidemia and alcohol.We described the results of the studies identified and assessed according to their methodological quality in different recommendation sections:diagnostic and prevention,intervention,or treatment in the elderly population.As the main limitation to the results of this review,there is the lack of quality studies whose target population is elderly patients.This issue limits the recommendations that can be made in this population.Due to this reason,comprehensive geriatric assessment seems the best tool currently available to implement the most appropriate treatment plans based on the baseline situation and comorbidity of each elderly patient.

关键词： prevention elderly finally

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Hypothalamic-pituitary-adrenal axis function during perinatal depression

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Neuroscience Bulletin 2015年第3期31卷 338-350页

作者： Phillipe leff gelman Mónica Flores-Ramos Margarita lópez-Martínez Carlos Cruz Fuentes Juan pablo Reyes grajeda National Institute of Perinatology Mexico City National Council of Sciences and Technology (CONACy T) Mexico City National Institute of Psychiatry Mexico City National Institute of genomic Medicine Mexico City

Abnormal function of the hypothalamic-pituitary-adrenal （HPA） axis is an important pathological finding in pregnant women exhibiting major depressive disorder. They show high levels of cortisol pro- inflammatory cytokines, hypothalamic-pituitary peptide hormones and catecholamines, along with low dehydroepiandrosterone levels in plasma. During pregnancy, the TH2 balance together with the immune system and placental factors play crucial roles in the development of the fetal allograft to full term. These factors, when altered, may generate a persistent dysfunction of the HPA axis that may lead to an overt transfer of cortisol and toxicity to the fetus at the expense of reduced activity of placental 1113-hydroxysteroid dehydrogenase type 2. Epigenetic modifications also may contribute to the dysregulation of the HPA axis. Affective disorders in pregnant women should be taken seriously, and therapies focused on preventing the deleterious effects of stressors should be implemented to promote the welfare of both mother and baby.

关键词： brain depression neuroendocrine pregnancy stress glucocorticoids

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Optimal and synchronized germination of Robinia pseudoacacia,Acacia dealbata and other woody Fabaceae using a handheld rotary tool:concomitant reduction of physical and physiological seed dormancy

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Journal of Forestry Research 2018年第2期29卷 283-290页

作者： Nuria Pedrol Carolina g.Puig Antonio lo′pez-Nogueira Maria Pardo-Muras luis gonzalez pablo Souza-Alonso Department of Plant Biology and Soil Science Faculty of BiologyUniversity of VigoUniversity Campus36310 VigoSpain

The Fabaceae(legume family) is one of the largest families of plants with a worldwide distribution and a major role in agriculture and in agroforestry.A hard seed coat impermeable to water is a typical feature of several species.Physical dormancy delays and reduces germination so that mechanical,physical and chemical scarification methods have been classically used to break seed dormancy of many species.We evaluate the effectiveness of a methodology to scarify seeds of several woody Fabaceae of ecological and economical importance,including Robinia pseudoacacia and Acacia dealbata and the shrubs Cytisus scoparius,C.multiflorus and Ulex europaeus.We describe the optimized use of a handheld rotary tool(HRT),and compare its effectiveness with other scarification methods reported to break dormancy such as boiling or dry heating.Total germination and/or speed of germination were enhanced after the application of the HRT,with germination percentages significantly higher than those achieved by other methods of scarification.Based on a thorough literature review,a mode of action for the HRT is suggested which could operate by breaking the physical and physiological dormancy of treated seeds through thecombined action of coat abrasion and moderate temperatures.Considering these results,we recommend the application of this rapid,effective,low-cost and highly reproducible HRT method to break seed dormancy and enhance germination of these species and others with similar dormancy constraints.

关键词： Combinational dormancy Hardcoat Rotary tool Scarification Temperature

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From conventional two-stage hepatectomy to AlPPS:Fifteen years of experience in a hepatobiliary surgery unit

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Hepatobiliary & Pancreatic Diseases International 2021年第6期20卷 542-550页

作者： Javier Maupoey Ibáñez Eva María MontalváOrón Andrea BoscàRobledo Alonso Camacho Ramírez Ana Hernando Sanz pablo granero Castro Alberto Alegre Delgado Rafael lópez-Andújar Hepatobiliary Surgery and Transplant Unit La Fe University and Polytechnic HospitalValenciaSpain Department of Radiology La Fe University and Polytechnic HospitalValenciaSpain

Background:Hepatectomy in patients with large tumor load may result in postoperative liver failure and associated complications due to excessive liver parenchyma removal.Conventional two-stage hepatectomy(TSH)and associating liver partition and portal vein ligation for staged hepatectomy(AlPPS)technique are possible solutions to this problem.Colorectal liver metastases(CRlM)is the most frequent indication,and there is a need to assess outcomes for both techniques to improve surgical and long-term oncological outcomes in these patients.Methods:A single-center retrospective study was designed to compare TSH with AlPPS in patients with initially unresectable bilateral liver tumors between January 2005 and January 2020.AlPPS was performed from January 2012 onwards as the technique of choice.long-term overall survival(OS)and disease-free survival(DFS)were evaluated as primary outcome in CRlM patients.Postoperative morbidity,mortality and liver growth in all patients were also evaluated.Results:A total of 38 staged hepatectomies were performed:17 TSH and 21 AlPPS.Complete resection rate was 76.5%(n=13)in the TSH group and 85.7%(n=18)in the AlPPS group(P=0.426).Overall major morbidity(Clavien-Dindo≥3 a)(stage 1+stage 2)was 41.2%(n=7)in TSH and 33.3%(n=7)in AlPPS patients(P=0.389),and perioperative 90-day mortalities were 11.8%(n=2)vs.19.0%(n=4)in each group,respectively(P=0.654).Intention-to-treat OS rates at 1 and 5 years in CRlM patients for TSH(n=15)were 80%and 33%,and for AlPPS(n=17)76%and 35%,respectively.DFS rates at 1 and 5 years were 36%and 27%in the TSH group vs.33%and 27%in the AlPPS group,respectively.Conclusions:AlPPS is an effective alternative to TSH in bilateral affecting liver tumors,allowing higher resection rate,but patients must be carefully selected.In CRlM patients similar long-term OS and DFS can be achieved with both techniques.

关键词： AlPPS Two-stage hepatectomy Colorectal liver metastases Posthepatectomy liver failure

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Psychiatrists' approach to vascular risk assessment in latin America

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World Journal of Psychiatry 2014年第3期4卷 56-61页

作者： pablo Richly pablo lópez Ezequiel gleichgerrcht Daniel Flichtentrei María Prats Ricardo Mastandueno Julián Bustin Marcelo Cetkovich-Bakmas INECO (Institute of Cognitive Neurology) Buenos Aires C1126AAB Argentina Institute of Neurosciences Favaloro University Buenos Aires C1093AAS Argentina UDP-INECO Foundation Diego Portales University Santiago de Chile 8370076 Chile Intramed Buenos Aires B1636AJK Argentina

AIM: To explore the way in which latin American psychiatrists approach the screening of vascular risk factors in patients receiving antipsychotic medication.METHODS: This was a descriptive, cross sectional study that surveyed latin-American physicians to evaluate differences between groups divided in three main sections. The first section included demographic and professional data. The second section asked about the available medical resources: weighing scales, sphygmomanometer and measuring tape. Finally, the third section aimed at looking into the attitudes towards car-diovascular prevention. The latter was also divided into two subsections. In the first one, the questions were about weight, blood pressure and waist perimeter. In the second subsection the questions asked about the proportion of patients:(1) that suffered from overweight and/or obesity;(2) whose lipids and glycemia were controlled by the physician;(3) that were questioned by, and received information from the physician about smoking; and(4) that received recommendations from the physician to engage in regular physical activity. The participants were physicians, users of the medical website Intramed. The visitors were recruited by a banner that invited them to voluntarily access an online self-reported structured questionnaire with multiple options. RESUlTS: We surveyed 1185 general physicians and 792 psychiatrists. Regarding basic medical resources, a significantly higher proportion of general physicians claimed to have weighing scales(χ2 = 404.9; P gmomanometers(χ2 = 419.3; P g tapes(χ2 = 336.5; P le general physicians measured overweight and metabolic indexes in the general population in a higher proportion than in patients treated with antipsychotics(Z =-11.91; P laimed to measure them in patients medicated with antipsychotics in a higher proportion than in the general population(Z =-3.26; P lso general physicians tended to evaluate smoking habits in the gene

关键词： Antipsychotics Metabolic syndrome Psychiatric patients Schizophrenia Vascular risk factors

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Quasi non-Markovian Approach to the Study of Decoherence of a Controlled-Not Quantum gate in a Chain of Few Nuclear Spins Quantum Computer

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Journal of Modern Physics 2012年第9期3卷 902-917页

作者： pablo Carlos lópez Vázquez gustavo lópez Vázquez Departamento de Física Universidad de Guadalajara Guadalajara Mexico

We develop in the weak coupling approximation a quasi-non-Markovian master equation and study the phenomenon of decoherence during the operation of a controlled-not (CNOT) quantum gate in a quantum computer model formed by a linear chain of three nuclear spins system with second neighbor Ising interaction between them. We compare with the behavior of the Markovian counterpart for temperature different from zero (thermalization) and at zero temperature for low and high dissipation rates. At low dissipation there is a very small difference between Markovian and quasi no-Markovian at any temperature which is unlikely to be measured, and at high dissipation there is a difference which is likely to be measured at any temperature.

关键词： Decoherence Chain of Nuclear Spins Controlled-Not

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Hepatic flow is an intraoperative predictor of early allograft dysfunction in whole-graft deceased donor liver transplantation: An observational cohort study

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World Journal of Hepatology 2019年第9期11卷 689-700页

作者： pablo lozano lominchar Maitane Igone Orue-Echebarria lorena Martín Cristina Julia lisbona María Magdalena Salcedo luis Olmedilla Hemant Sharma Jose Manuel Asencio JoséAngel lópez-Baena general Surgery Department Liver Transplant UnitHospital General Universitario Gregorio MaranonMadrid 28007Spain Anesthesiology Department Liver Transplant UnitHospital General Universitario Gregorio MaranonMadrid 28007Spain Hepatology Department Liver Transplant UnitHospital General Universitario Gregorio MaranonMadrid 28007Spain Department of Transplant Surgery Oschner Medical CenterNew OrleansLA 70816United States

BACKgROUND Early allograft dysfunction(EAD)after liver transplantation(lT)is an important cause of morbidity and mortality.To ensure adequate graft function,a critical hepatocellular mass is required in addition to an appropriate blood supply.We hypothesized that intraoperative measurement of portal venous and hepatic arterial flow may serve as a predictor in the diagnosis of EAD.AIM To study whether hepatic flow is an independent predictor of EAD following lT.METHODS This is an observational cohort study in a single institution.Hepatic arterial blood flow and portal venous blood flow were measured intraoperatively by transit flow.EAD was defined using the Olthoff criteria.Univariate and multivariate analyses were used to determine the intraoperative predictors of EAD.Survival analysis and prognostic factor analysis were performed using the Kaplan-Meier and Cox regression models.RESUlTS A total of 195 liver transplant procedures were performed between January 2008 and December 2014 in 188 patients.A total of 54(27.7%)patients developed EAD.The median follow-up was 39 mo.Portal venous flow,hepatic arterial flow(HAF)and total hepatic arterial flow were associated with EAD in both the univariate and multivariate analyses.HAF is an independent prognostic factor for 30-d patient mortality.CONClUSION Intraoperative measurement of blood flow after reperfusion appears to be a predictor of EAD;Moreover,HAF should be considered a predictor of 30-d patient mortality.

关键词： Hepatic flow Early allograft dysfunction liver transplant

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Safety of digoxin in nonagenarian patients with atrial fibrillation:lessons from the Spanish Multicenter Registry

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Journal of geriatric Cardiology 2021年第10期18卷 809-815页

作者： pablo Domínguez-Erquicia Sergio Raposeiras-Roubín Emad Abu-Assi María Cespón-Fernández David Alonso-Rodríguez Santiago Jesús Camacho-Freire Naiara Cubelos-Fernández Álvaro lópez-Masjuán Ríos María Melendo-Viu AndrésÍñiguez-Romo Department of Cardiology University HospitalÁlvaro CunqueiroVigoSpain Health Research Institute galicia Sur VigoSpain Department of Cardiology University Hospital of LeónLeónSpain Department of Cardiology University Hospital Juan Ramón JiménezHuelvaSpain

BACKgROUND The association between digoxin and mortality is an unclear issue.In older patients with atrial fibrillation(AF),where use of digoxin is frequent,the evidence of its safety is scarce.Our aim is to assess the safety of digoxin in nonagenarian patients with AF.METHODS We evaluated data from 795 nonagenarian patients with non-valvular AF from the Spanish Multicenter Registry.We analyzed the relationship between digoxin and all-cause mortality with the Cox proportional-hazards model.RESUlTS Follow-up was 27.7±18.3 months.Mean age was 92.5±3.8 years,and 71%of nonagenarian patients were female.Digoxin was not associated with increased risk of mortality[adjusted hazard ratio(aHR)=1.16,95%CI:0.96−1.41,P=0.130].However,we found a significant increase in mortality in the subgroup with estimated glomerular filtration rate(egFR)l/min per 1.73 m^(2)(aHR=2.01,95%CI:1.13−3.57,P=0.018),but not in the other subgroups of egFR(30−59 ml/min per 1.73 m^(2) and≥60 ml/min per 1.73 m^(2)).When exploring the risk of mortality according to sex,male subgroup was associated with an in-crease in mortality(aHR=1.48,95%CI:1.02−2.14,P=0.041).This was not observed in females subgroup(aHR=1.03,95%CI:0.81−1.29,P=0.829).Based on the presence or absence of heart failure,we did not find significant differences(aHR=1.20,95%CI:0.87−1.65,P=0.268 vs.aHR=1.15,95%CI:0.90−1.47,P=0.273,respectively).CONClUSIONS In our large registry of nonagenarian patients with AF,we did not find an association between digoxin and mortality in the total sample.However,in the subgroup analyses,we found an increase in mortality with the use of digoxin in men and in patients with an egFRl/min per 1.73 m^(2).

关键词： patients digoxin fibrillation

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lévy Flights, 1/<i>f </i>Noise and Self Organized Criticality

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Journal of Modern Physics 2013年第3期4卷 337-343页

作者： Oliver lópez Corona pablo Padilla Oscar Escolero Alejandro Frank Ruben Fossion IIMAS Universidad Nacional Autónoma de México Ciudad de México México Instituto de Ciencias Nucleares Universidad Nacional Autónoma de México Ciudad de México México Instituto de geología Universidad Nacional Autónoma de México Ciudad de México México Instituto Nacional de geratria México Posgrado en Ciencias de la Tierra Instituto de Geología Universidad Nacional Autónoma de México Ciudad de México México

A new analysis of a previously studied traveling agent model, showed that there is a relation between the degree of homogeneity of the medium where the agents move, agent motion patterns, and the noise generated from their displacements. We proved that for a particular value of homogeneity, the system self organizes in a state where the agents carry out lévy walks and the displacement signal corresponds to 1/f noise. Using probabilistic arguments, we conjectured that 1/f noise is a fingerprint of a statistical phase transition, from randomness (disorder) to predictability (order), and that it emerges from the contextuality nature of the system which generates it.

关键词： lévy Flights 1/f Noise Self Organized Criticality Agents Modelling Complexity

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Transcatheter aortic valve implantation in very elderly patients： immediate results and medium term follow-up

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Journal of geriatric Cardiology 2015年第4期12卷 340-345页

作者： Isaac Pascual Antonio J Mu oz-garcía Diego lópez-Otero pablo Avanzas Manuel F Jimenez-Navarro Belén Cid-Alvarez Raquel del Valle Juan H Alonso-Briales Raimundo Ocaranza-Sanchez José M Hemández Ramiro Trillo-Nouche César Morís Area del Corazón Hospital Universitario Central de Asturias Av. Roma Oviedo Asturias Spain Department of Cardiology Hospital Universitario Virgen de la Victoria Campus de Teatinos Málaga Spain Department of Cardiology Complejo Hospitalario Universitario de Santiago de Compostela Travesla da Choupana A Coru a Spain

ObjectiveTo 评估立即的 transcatheter 在有严重、征兆的大动脉的狭窄的很老的病人的大动脉的阀门培植(TAVI ) 结果和中期的后续(作为).MethodsThis multicenter，观察、未来的学习在三所医院里被执行。我们包括了连续很老(>；... 详细信息

ObjectiveTo 评估立即的 transcatheter 在有严重、征兆的大动脉的狭窄的很老的病人的大动脉的阀门培植(TAVI ) 结果和中期的后续(作为).MethodsThis multicenter，观察、未来的学习在三所医院里被执行。我们包括了连续很老(>；85 年) 病人与作为严重由 TAVI 对待。主要端点是在包括的二 years.ResultsThe 研究从任何原因评估死亡率有一个平均数的 160 个连续病人 87 ± 变老；2.1 年(从 85 ～ 94 年的范围) 和 18.8%± 的吝啬的逻辑 EuroSCORE；11.2% 与 57 (35.6%) 病人得分 ≥；20% 。程序的成功率是 97.5% ，与 25 (15.6%) 与主要流血经历尖锐复杂并发症的病人(最经常) 。全球死亡率在住院期间是 8.8%(n = 14 ) 并且 30 天的死亡率是 10%(n = 16 ) 。中部在时期上面列在后面是 252.24 ±；232.17 天。在后续时期期间， 28 (17.5%) 病人们死了(他们中的 17 个由于心脏的原因) 。估计的二年全面、心脏的幸存率使用 Kaplan-Meier 方法分别地是 71% 和 86.4% 。比例的危险回归给看了的考克斯可变 EuroSCORE ≥；20 是与全面 mortality.ConclusionsTAVI 联系的唯一的变量在很老的病人的一张选择人口安全、有效。我们的调查结果支持在病人的这个复杂的组的这个新过程的采纳。

关键词：主动脉中老年患者随访植入导管中长死亡率

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