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Value of routine stool testing for pathogenic bacteria in the evaluation of symptomatic patients with ileal pouches

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Gastroenterology Report 2018年第2期6卷 93-100,I0001页

作者： Amandeep Singh Jean Ashburn Gursimran Kochhar rocio Lopez Tracy L.Hull Bo Shen Department of Gastroenterology&Hepatology Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA Department of Colorectal Surgery Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA Department of Quantitative Health Sciences Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA

Background:In symptomatic patients with an ileal pouch,stool studies are often sent to diagnose enteric *** of this study is to find the value of routine stool studies in the evaluation of symptomatic patients and the clinical implications of such pathogens in patients with ileal ***:Consecutive ileal pouch-anal anastomosis(IPAA)patients who had stool tests out of a 2283-case registry from 2002 to 2015 were included in the *** with positive stool cultures were compared with controls(symptomatic without positive stool culture)in a 1:4 *** to antibiotic therapy,recurrence rate and rate of hospitalization at 1 and 3 months were ***:A total of 643(28%)had stool cultures done and only 1.7%(11/643)were found to be positive for stool *** spp.(45%)was the most common pathogen followed by Aeromonas spp.(36%).Non-smokers and patients without any antibiotic use in the last 3 months were found to have higher prevalence of positive stool cultures than controls(p<0.001 and p¼0.023).Patients with pathogenic bacteria were found to have a higher risk of acute kidney injury(27.3%vs 4.5%,p¼0.049),hospitalization within 3 months of initial stool testing(36.4%vs 6.8%,p¼0.009)and mortality(18.2%vs 0%,p¼0.040).However,there were no statistically significant differences in the clinical outcomes in patients with positive stool cultures who received pathogen-directed ***:We found that the yield of stool tests for bacterial pathogens in symptomatic pouch patients was extremely low and the treatment of detected pathogens had a minimum impact on the disease course of *** clinical utility of routine stool culture in those patients warrants further study.

关键词： pouchitis ileal pouch enteric pathogens stool culture

Simultaneous expression analysis of deleted in azoospermia-family genes and CDC25A. their potential as a predictor for successful testicular sperm extraction

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Asian Journal of Andrology 2017年第6期19卷 715-716页

作者： Candela rocio Gonzailez Cristian Alvarez Sedo Florencia Nodar Sergio Papier Alfredo Daniel Vitullo Research Center of Biomedical Biotechnology Environmental and Diagnostic Studies Maim6nides University Hidalgo 775 1405 Buenos Aires Argentina National Scientific and Technical Research Council (CONICET) Argentina Laboratory of Reproductive Biology and Genetics (CEGyR) Viamonte 1432 1055 Buenos Aires Argentina.

Dear Editor, Infertility is a major health problem affecting 10%-15% of couples seeking to have children, and a male factor can be identified in about half of these cases.1 Nonobstructive azoospermia is one of the causes of male infertility （10%）, resulting from testicular failure？ The most common histological patterns in these patients are hypospermatogenesis （HS）, maturation arrest （MA）, and Sertoli cell-only syndrome （SCO）.3

关键词： Simultaneous azoospermia-family testicular

Healthcare utilization and costs associated with gastroparesis

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World Journal of Gastroenterology 2017年第24期23卷 4428-4436页

作者： Vaibhav Wadhwa Dhruv Mehta Yash Jobanputra rocio Lopez Prashanthi N Thota Madhusudhan R Sanaka Department of Internal Medicine Fairview HospitalCleveland Clinic Department of Internal Medicine Westchester Medical Center Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland Clinic Center for Advanced Endoscopy Digestive Disease InstituteCleveland Clinic

To use a national database of United States hospitals to evaluate the incidence and costs of hospital admissions associated with gastroparesis. METHODSWe analyzed the National Inpatient Sample Database (NIS) for all patients in whom gastroparesis (ICD-9 code: 536.3) was the principal discharge diagnosis during the period, 1997-2013. The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by regression analysis. RESULTSIn 1997, there were 3978 admissions with a principal discharge diagnosis of gastroparesis as compared to 16460 in 2013 (P < 0.01). The mean length of stay for gastroparesis decreased by 20 % between 1997 and 2013 from 6.4 d to 5.1 d (P < 0.001). However, during this period the mean hospital charges increased significantly by 159 % from $13350 (after inflation adjustment) per patient in 1997 to $34585 per patient in 2013 (P < 0.001). The aggregate charges (i.e., “national bill”) for gastroparesis increased exponentially by 1026 % from $50456642 ± 4662620 in 1997 to $568417666 ± 22374060 in 2013 (P < 0.001). The percentage of national bill for gastroparesis discharges (national bill for gastroparesis/total national bill) has also increased over the last 16 years (0.0013% in 1997 vs 0.004% in 2013). During the study period, women had a higher frequency of gastroparesis discharges when compared to men (1.39/10000 vs 0.9/10000 in 1997 and 5.8/10000 vs 3/10000 in 2013). There was a 6-fold increase in the discharge diagnosis of gastroparesis amongst type 1 DM and 3.7-fold increase amongst type 2 DM patients over the study period (P < 0.001). CONCLUSIONThe number of inpatient admissions for gastroparesis and associated costs have increased significantly over the last 16 years. Inpatient cost

关键词： Inpatient admission rates Gastroparesis Cancer epidemiology National inpatient database

Statins for primary cardiovascular prevention in the elderly

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Journal of Geriatric Cardiology 2015年第4期12卷 431-438页

作者： Juan Pedro-Botet Elisenda Climent Juan J Chillarón rocio Toro David Benaiges Juana A Flores-Le Roux Lipid and Vascular Risk Unit Endocrinology department Hospital del Mar. Spain Department of Medicine School of Medicine. Cáldiz University Cádiz Spain

The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older 〉 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for theft primary cardiovascular disease, with the associated risks and benefits of treatment.

关键词： Cardiovascular disease Dyslipidaemia Elderly Primary prevention Statins

Relationship between lipoprotein （a） and micro/macro complications in type 2 diabetes mellitus： a forgotten target

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Journal of Geriatric Cardiology 2015年第2期12卷 93-99页

作者： rocio Toro Eduardo Segura Jesfis Millan Nunez-Cortes Juan Carlos Pedro-Botet Maribel Quezada-Feijoo Alipio Mangas Department of Medicine Cfdiz University School of Medicine Cdtdiz 11002 C/ Dr Marahon S/N Cadiz Spain Department of Internal Medicine University Hospital Puerta del Mar Cadiz 11002 Ana de Viya S/N Cadiz Spain Department of Internal Medicine University Hospital Gregorio Maranon Madrid28007 C/Doctor Esquerdo 46 Madrid Spain Department of Internal Medicine University Hospital del Mar Barcelona 08003 Passeig Marltim 25-29 Barcelona Spain Department of Cardiology Cruz Roja Hospital Madrid 28003 Av. de la Reina Victoria 22-26 Madrid Spain

Objectives Increased lipoprotein （a） serum concentration seems to be a cardiovascular risk factor; this has not been confirmed in extracoronary atherosclerosis complications. We therefore wished to gain a deeper insight into relationship between the plasma concentrations of lipoprotein （a） and the micro- and macro-vascular complications of type 2 diabetes mellitus and to identify possible differences in this association. Methods This is a descriptive observational cross-sectional study. Two-hundred and seventeen elderly patients with type 2 diabetes mellitus were included from the internal medicine outclinic. Anthropometric data, analytical data （insulin reserve, basal and postprandial peptide C, glycosylated hemoglobin, renal parameters, lipid profile and clinical data as hypertension, obesity, micro and macrovascular complications were collected. Results Patients were grouped according to the type 2 diabetes mellitus time of evolution. The mean plasma concentration of lipoprotein （a） was 22.2± 17.3 mg/dL （22.1± 15.9 mg/dL for males, and 22.1 ± 18.4 mg/dL for females）. Patients with hypertension, coronary heart disease, cerebrovascular accident, microalbuminuria and proteinuria presented a statistically significant increased level of lipoprotein （a）. Similarly, the patients with hyperlipoprotein （a）（≥30 mg/dL） presented significantly increased levels of urea and total cholesterol. In the multivariate regression model, the level of lipoprotein （a） is positively correlated with coronary heart disease and diabetic nephropathy （P 〈 0.01 and P 〈 0.005, respectively）. Conclusions The elevation of plasma levels of lipoprotein （a） are associ- ated with the development of coronary heart disease and diabe tic nephropathy. Therefore, we consider that the determination of lipoprotein （a） may be a prognostic marker of vascular complications in patients with type 2 diabetes mellitus.

关键词： Lipoprotein (a) Macrovascular complications Type 2 diabetes Risk factors

Recurrence and survival rates of inflammatory bowel disease-associated colorectal cancer following postoperative chemotherapy:a comparative study

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Gastroenterology Report 2017年第1期5卷 57-61,I0002,I0003页

作者： Mohannad Dugum Jingmei Lin rocio Lopez Bassam Estfan Elena Manilich Luca Stocchi Bo Shen Xiuli Liu Division of Gastroenterology Hepatology and NutritionDepartment of MedicineUniversity of PittsburghPittsburghPAUSA Department of Pathology and Laboratory Medicine Indiana University School of MedicineIndianapolisINUSA Quantitative Health Sciences Cleveland ClinicClevelandOHUSA Department of Hematology and Oncology Taussig Cancer InstituteCleveland ClinicClevelandOHUSA Department of Colorectal Surgery Digestive Disease InstituteCleveland ClinicClevelandOHUSA Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicClevelandOHUSA Department of Anatomic Pathology Pathology&Laboratory Medicine InstituteCleveland ClinicClevelandOHUSA

Background and Aim:Inflammatory bowel disease(IBD)is associated with an increased risk of colorectal cancer(CRC).Studies have shown tumorigenetic and histomorphological differences between IBD-associated CRC and non-IBD CRC,suggesting differences in tumor behavior and response to *** aimed to compare tumor recurrence and survival rates following postoperative chemotherapy in CRC patients with and without ***:Search of the Cleveland Clinic’s CRC database revealed 65 patients who had IBD-associated CRC and received postoperative adjuvant chemotherapy between 1994 and ***-one patients were excluded due to incomplete clinical *** score-matching based on age,surgery intent,CRC site,tumor grade,American Joint Committee on Cancer(AJCC)stage and T stage was used to match IBD and non-IBD patients(1:4).Competing risk and Cox regression models were used to analyze differences in disease-free survival and overall survival,***:Forty-four patients with IBD-associated CRC were matched to 176 patients with non-IBD *** IBD patients,29(66%)had ulcerative colitis,14(32%)had Crohn’s disease,and one(2%)had indeterminate *** IBD diagnosis age was 28.1±14.5 years,and mean IBD duration at time of CRC treatment was 21.5±12.6 ***(23%)IBD patients had tumor recurrence compared with 34(19%)non-IBD patients(P=.074).There was no significant difference in disease-free survival(hazard ratio[HR]=0.60;95%CI:0.35–1.05;P=0.074)or overall survival(HR=0.87;95%CI:0.54–1.4;P=0.58)between IBD and non-IBD ***:Patients with IBD-associated CRC have comparable rates of tumor recurrence and survival following postoperative chemotherapy as CRC patients without *** studies are needed to confirm these findings and guide therapeutic decisions.

关键词： inflammatory bowel disease colorectal cancer adjuvant chemotherapy prognosis

What is the most effective exercise protocol to improve cardiovascular fitness in overweight and obese subjects？

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Journal of Sport and Health Science 2017年第4期6卷 454-461页

作者： Eliane Aparecida Castro Ana Belen Peinado Pedro Jose Benito MercedeS Galindo Marcela Gonzalez-Gross rocio Cupeiro Department of Health and Human Performance Faculty of Physical Activity and Sport Sciences Universidad Polit~cnica de Madrid Madrid 28040 Spain LFE Research Group Universidad PolitOcnica de Madrid Madrid 28040 Spain Faculty of Physical Activity and Sport Sciences Universidad Politecnica de Madrid Madrid 28040 Spain ImFINE Research Group Universidad PolitOcnica de Madrid Madrid 28040 Spain

Background: Increased peak oxygen consumption(VO2 peak) can reduce cardiovascular risks associated with obesity. Our aim was to analyze the effect of a weight loss program on cardiovascular fitness in overweight(W) and obese(O) ***: One hundred and sixty-seven subjects(77 males and 90 females), aged 18–50 years, performed a modified Bruce protocol before(pre)and after(post) a weight loss program of 24 weeks. This program combined physical training(strength, S; endurance, E; combined strength + endurance, SE; or physical activity recommendation, PA) 3 times per week, with a 25%–30% caloric restriction ***: VO2 peak improved in overweight and obese males(pre and post values in L/min, respectively; W = 3.2 ± 0.6 vs. 3.7 ± 0.5, p < 0.001;O = 3.6 ± 0.6 vs. 3.8 ± 0.6, p = 0.013) as well as in overweight females(2.0 ± 0.3 vs. 2.3 ± 0.4, p < 0.001). VO2 peak in the first ventilatory threshold(VT1) increased for all 4 interventions in males(p < 0.05), except for S in the obese group(1.6 ± 0.2 vs. 1.7 ± 0.3, p = 0.141). In females, it increased in E(0.9 ± 0.2 vs. 1.4 ± 0.3, p < 0.001), SE(0.9 ± 0.2 vs. 1.2 ± 0.4, p = 0.003), and PA(0.9 ± 0.1 vs. 1.2 ± 0.2, p = 0.006) in overweight groups. Time-to-exhaustion improved in all subjects except for females in PA group(15.7 ± 0.3 min vs. 15.9 ± 0.3 min, p = 0.495).Conclusion: Our results suggest that all methods, including the recommendation of physical activity, can improve cardiovascular fitness in overweight subjects and obese males.

关键词： Combined training Endurance training Obesity Oxygen consumption Physical activity Strength training Ventilatory threshold

An Unforgettable Ping Pong Trip

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Voice of Friendship 2009年第Z1期 44-45页

作者： Melba rocio

In our memory the famous Ping Pong Diplomacy took place in 1971. At that time the People’s Republic of China and the United States had not yet es- tablished diplomatic relations. In April that year, nine table

关键词： diplomatic Republic invitation visit match friends

Medications in type-2 diabetics and their association with liver fibrosis

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World Journal of Gastroenterology 2020年第23期26卷 3249-3259页

作者： Mohamed Tausif Siddiqui Hina Amin Rajat Garg Pravallika Chadalavada Wael Al-Yaman rocio Lopez Amandeep Singh Department of Gastroenterology Hepatology and NutritionDigestive Diseases and Surgery InstituteCleveland ClinicClevelandOH 44195United States Department of Hospital Medicine Cleveland ClinicOH 44195United States Department of Quantitative Health Sciences Cleveland ClinicOH 44195United States

BACKGROUND The prevalence of nonalcoholic fatty liver disease(NAFLD) is significantly rising worldwide. Type-2 diabetes(T2D) is a major risk factor for NAFLD *** To assess the association of commonly used medications to advanced fibrosis(AF) in patients with biopsy-proven NAFLD and *** We used the International Classification of Disease 9 th Revision Clinical Modification coding system to identify patients with T2D and included patients who underwent liver biopsy for suspected NAFLD between January 1, 2000 to December 31, 2015. We compared demographics, clinical characteristics, and differences in pattern of medication use in patients who had biopsy-proven AF to those without it. A univariate and multivariate analysis was performed to assess the association of different classes of medication with the presence of *** A total of 1183 patients were included in the final analysis, out of which 32%(n =381) had AF on liver biopsy. Mean age of entire cohort was 52 years and majority were females(65%) and Caucasians(85%). Among patients with AF, 51% were on oral hypoglycemics, 30% were on insulin, 66% were on antihypertensives and 27% were on lipid lowering agents for the median duration of 19 mo, 10 mo, 26 mo, and 24 mo respectively. Medications associated with decreased risk of AF included metformin, liraglutide, lisinopril, hydrochlorothiazide, atorvastatin and simvastatin while the use of furosemide and spironolactone were associated with higher prevalence of *** In our cohort of T2D with biopsy proven NAFLD, the patients who were receiving metformin, liraglutide, lisinopril, hydrochlorothiazide, atorvastatin and simvastatin were less likely to have AF on biopsy, while patients who were receiving furosemide and spironolactone had a higher likelihood of having AF when they underwent liver biopsy. Future studies are needed to confirm these findings and to establish measures for prevention of NAFLD progression in patients with T2D.

关键词： Diabetes medications Anti-lipid medications Antihypertensive medication Fatty liver Advanced fibrosis