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Gastrointestinal disorders associated with migraine: A comprehensive review

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World Journal of Gastroenterology 2016年第36期22卷 8149-8160页

作者： Carlos R Cámara-Lemarroy rene.Rodriguez-gutierrez Roberto Monreal-Robles Alejandro Marfil-Rivera Servicio de Neurología Hospital Universitario "Dr. José E. González" Universidad Autónoma de Nuevo León Servicio de Endocrinología Hospital Universitario "Dr. José E. González" Universidad Autónoma de Nuevo León Servicio de Gastroenterología Hospital Universitario "Dr. José E. González" Universidad Autónoma de Nuevo León

Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all playing an important role. The physiopathology of migraine is complex and still not fully understood. Many different neuropeptides, neurotransmitters and brain pathways have been implicated. In connection with the myriad mechanisms and pathways implicated in migraine, a variety of multisystemic comorbidities(e.g., cardiovascular, psychiatric and other neurological conditions) have been found to be closely associated with migraine. Recent reports demonstrate an increased frequency of gastrointestinal(GI) disorders in patients with migraine compared with the general population. Helicobacter pylori infection, irritable bowel syndrome, gastroparesis, hepatobiliary disorders, celiac disease and alterations in the microbiota have been linked to the occurrence of migraine. Several mechanisms involving the gut-brain axis, such as a chronic inflammatory response with inflammatory and vasoactive mediators passing to the circulatory system, intestinal microbiota modulation of the enteric immunological milieu and dysfunction of the autonomic and enteric nervous system, have been postulated to explain these associations. However, the precise mechanisms and pathways related to the gut-brain axis in migraine need to be fully elucidated. In this review, we survey the available literature linking migraine with GI disorders. We discuss the possible physiopathological mechanisms, and clinical implications as well as several future areas of interest for research.

关键词： Migraine Headache Microbiota Review Gastrointestinal diseases

A Feature Selection Strategy to Optimize Retinal Vasculature Segmentation

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Computers, Materials & Continua 2022年第2期70卷 2971-2989页

作者： Jose Escorcia-gutierrez Jordina Torrents-Barrena Margarita Gamarra Natasha Madera Pedro Romero-Aroca Aida Valls Domenec Puig Electronic and Telecommunications Engineering Program Universidad Autónoma del CaribeBarranquilla080001Colombia Department of Computational Science and Electronic Universidad de la CostaCUCBarranquilla080001Colombia Ophthalmology Service Universitari Hospital Sant JoanInstitut de Investigacio Sanitaria Pere VirgiliReus43201Spain Departament d’Enginyeria Informàtica i Matemàtiques Escola Tècnica Superior d’EnginyeriaUniversitat Rovira i VirgiliTarragona43007Spain

Diabetic retinopathy (DR) is a complication of diabetesmellitus thatappears in the retina. Clinitians use retina images to detect DR pathologicalsigns related to the occlusion of tiny blood vessels. Such occlusion brings adegenerative cycle between the breaking off and the new generation of thinnerand weaker blood vessels. This research aims to develop a suitable retinalvasculature segmentation method for improving retinal screening proceduresby means of computer-aided diagnosis systems. The blood vessel segmentationmethodology relies on an effective feature selection based on SequentialForward Selection, using the error rate of a decision tree classifier in theevaluation function. Subsequently, the classification process is performed bythree alternative approaches: artificial neural networks, decision trees andsupport vector machines. The proposed methodology is validated on threepublicly accessible datasets and a private one provided by Hospital Sant Joanof Reus. In all cases we obtain an average accuracy above 96% with a sensitivityof 72% in the blood vessel segmentation process. Compared with the state-ofthe-art, our approach achieves the same performance as other methods thatneed more computational *** method significantly reduces the numberof features used in the segmentation process from 20 to 5 dimensions. Theimplementation of the three classifiers confirmed that the five selected featureshave a good effectiveness, independently of the classification algorithm.

关键词： Diabetic retinopathy artificial neural networks decision trees support vector machines feature selection retinal vasculature segmentation

筛查和治疗糖尿病前期的价值由于筛检的准确性低和对患者重要结果影响的间接证据而降低

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英国医学杂志中文版 2018年第2期21卷 109-110页

作者： Neri A Alvarez-Villalobos rene.Rodriguez-gutierrez Victor M Montoril 郑湃 Knowledge and Evaluation Research Unit Mayo ClinicRochesterMinnesota USA Department ofResearch Unit University Hospital 'Dr Jose E Gonzalez'AutonomousUniversity of Nuevo Leon RochesterMinnesota USA Division ofEndocrinology University Hospital' Dr Jose E Gonzalez' Autonomous University of Nuevo Leon MonterreyNuevo Leon Mexico Division of Endocrinology Diabetes Metabolism and Nutrition Mayo Clinic RochesterMinnesota USA 中华预防医学杂志编辑部

糖尿病是导致高发病率和病死率的主要原因。为了减轻糖尿病对人和社会的负担，指南建议在健康人群中进行高血糖的筛查。这些建议假设，早发现和早干预措施可以预防与2型糖尿病及其并发症相关的病死率。在这项系统性综述中，Barry等试图... 详细信息

糖尿病是导致高发病率和病死率的主要原因。为了减轻糖尿病对人和社会的负担，指南建议在健康人群中进行高血糖的筛查。这些建议假设，早发现和早干预措施可以预防与2型糖尿病及其并发症相关的病死率。在这项系统性综述中，Barry等试图评估筛查的准确性和早期干预（如生活方式干预或二甲双胍治疗）对预防2型糖尿病的疗效。

关键词：糖尿病病死率患者筛检方法

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2型糖尿病患者强化血糖控制的利与弊

英国医学杂志中文版 2020年第9期23卷 505-521页

作者： rene.Rodriguez-gutierrez Jose Gerardo Gonzalez-Gonzalez Jorge A Zuniga-Hernandez- Rozalina G McCoy 吴量(译) 潘洁敏(校) Plataforma INVEST Medicina UANL-KER Unit(KER Unit México) Subdireccion de InvestigacionUniversidad Autónoma de Nuevo LeónMonterrey64460Mexico Knowledge and Evaluation Research Unit in Endocrinology Mayo ClinicRochesterMN 55905USA Endocrinology Division Department of Internal MedicineUniversity Hospital"Dr JoséE González"Universidad Autonoma de Nuevo LeonMonterrey64460MexicoPlataforma INVEST Medicina UANL-KER Unit(KER Unit México)Subdireccion de InvestigacionUniversidad Autónoma de Nuevo LeónMonterrey64460Mexico Endocrinology Division Department of Internal MedicineUniversity Hospital"Dr JoséE González"Universidad Autonoma de Nuevo LeonMonterrey64460MexicoDivision of Community Internal MedicineDepartment of MedicineMayo ClinicRochesterMN 55905USA Division of Health Care Policy and Research Department of Health Sciences ResearchMayo ClinicRochesterMN 55905USA 上海交通大学附属第六人民医院内分泌代谢科

糖尿病是全球主要的健康问题,治疗花费高,有较高的发病率、致残率和死亡率,显著影响患者生活质量。绝大多数糖尿病患者属于2型糖尿病。从既往研究看,减少2型糖尿病并发症的主要策略是加强血糖控制。然而大量证据表明,除了降低非致死性... 详细信息

糖尿病是全球主要的健康问题,治疗花费高,有较高的发病率、致残率和死亡率,显著影响患者生活质量。绝大多数糖尿病患者属于2型糖尿病。从既往研究看,减少2型糖尿病并发症的主要策略是加强血糖控制。然而大量证据表明,除了降低非致死性心肌梗死的发生率外,强化(相对于适度)血糖控制对重要的微血管和大血管并发症预后没有显著获益。但是,严格的血糖控制却会增加严重低血糖的风险,并会增加药物种类、副作用和成本等额外负担。此外,来自心血管结局研究的数据表明,使用特定类别的降糖药可大大改善心血管、肾脏和死亡的结果,而这些效应在很大程度上不是由降糖作用带来的。因此,为2型糖尿病患者提供基于循证医学的、以患者为中心的诊疗,需要转变范式并脱离以血糖为中心的糖尿病管理观点。与其优先考虑加强血糖控制,不如将重点放在确保患者获得足够的糖尿病照护,使血糖目标和患者的目标与情况保持一致,最大程度地减少短期和长期并发症,减轻治疗负担以及改善生活质量上。

关键词：严重低血糖循证医学糖尿病管理血糖控制大血管并发症以患者为中心 2型糖尿病降糖作用

Growth of PbS Nanocrystals Thin Films by Chemical Bath

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材料科学与工程（中英文A版） 2013年第1期3卷 1-13页

作者： rene.gutierrez perez Guadalupe Hemandez T611ezI Ulises Pefia Rosas A. Moran Torres Juan Hernandez Laboratory Materials Sciences Facultad de Ciencias Qulmicas Benemdrita Universidad Aut6noma de Puebla (BUAP) PueblaMdxico

Nanocrystalline PbS films were grown onto glass substrates by chemical bath deposition (CBD). The temperature of the bath (Td) was selected in the interval: 0-80 °C. Scanning electron microscopy (SEM), atomic force microscopy (AFM), Transmission microscopy electronic (TEM), X-ray diffraction (XRD), optical absorption (OA), Raman spectroscopy (RS), measurements were carried out to characterize the films. Using the SEM, TEM and AFM, we analyzed the morphological changes. Spectra of DRX show peaks the angular positions: 2θ = (26.00, 30.07, 43.10, 51.00, 53.48), growth on zinc blende face. Average grain size (GS)is calculated by employing Scherer"s decrease monotonically ~32-15 nm. Optical properties have been studied from transmittance spectra by UV-V. From the transmittance spectra we have also calculated the optical Eg shift 0.25-0.41 eV and 1.92-2.35 eV range, the Raman shift confirming formation of nanocrystals, strong band in ~138-148 cm-1 is attributed to a combination of longitudinal and transversal acoustic modes. The results observed here can be better explained if the interprets of the ~444 cm-1 could then be attributed to resonant 2LO overtone induced by a Frohlich interaction, where the LO phonons are very close to the center of the Brioull in zone. Furthermore Gibbs free energy calculation for the growth PbS process also included.

关键词：化学浴沉积薄膜生长纳米晶硫化铅扫描电子显微镜原子力显微镜透射电子显微镜 X-射线衍射

钠-葡萄糖共转运蛋白-2抑制剂或胰高血糖素样肽-1受体激动剂治疗成人2型糖尿病:临床实践指南

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英国医学杂志中文版 2021年第9期24卷 523-531页

作者： Sheyu Li Per Olav Vandvik Lyubov Lytvyn Gordon H Guyatt Suetonia C Palmer rene.Rodriguez-gutierrez Farid Foroutan Thomas Agoritsas Reed A C Siemieniuk Michael Walsh Lawrie Frere David J Tunnicliffe Evi V Nagler Veena Manja Bjφrn Olav Asvold Vivekanand Jha Mieke Vermandere Karim Gariani Qian Zhao Yan Ren Emma Jane Cartwright Patrick Gee Alan Wickes Linda Fems Robin Wright Ling Li Qiukui Hao Reem A Mustafa 无郭鹤鸣(译) Chengdu China Chinese Evidencebased Medicine Center Cochrane China Center and MAGIC China CenterWest China HospitalSichuan UniversityChengduChina University of Oslo OsloNorway MAGIC Evidence Ecosystem Foundation Department of Health Research Methods Evidence and ImpactMcMaster UniversityHamiltonONCanada Department of Medicine McMaster UniversityHamiltonONCanada Department of Medicine University of OtagoChristchurchNew Zealand Plataforma INVEST Medicina UANL-KER Unit(KER Unit Mexico) Subdireccion de InvestigacionUniversidad Autonoma de Nuevo LeonMonterrey64460Mexico Knowledge and Evaluation Research Endocrinology Mayo ClinicRochesterMN55905USA Endocrinology Division Department of Internal MedicineUniversity Hospital"Dr.Jose E.Gonzalez"Universidad Autonoma de Nuevo LeonMonterrey64460Mexico Ted Rogers Center for Heart Research Canada Service of Endocrinology DiabetesNutrition and Patient Therapeutic EducationGeneva University HospitalsGenevaSwitzerland Newbridge Surgery BathUK Sydney School of Public Health The University of SydneySydneyAustralia Centre for Kidney Research The Children's Hospital at WestmeadSydneyAustralia Renal Division Ghent University HospitalBelgium University of California Davis USA Department of Endocrinology Clinic of MedicineSt Olavs HospitalTrondheim University HospitalTrondheimNorway K.G.Jebsen Center for Genetic Epidemiology Department of Public Health and NursingNTNUNorwegian University of Science and TechnologyTrondheimNorway The George Institute for Global Health UNSWIndia School of Public Health Imperial CollegeLondonUK Prasanna School of Public Health Manipal Academy of Higher EducationManipalIndia Department of Public Health and Primary Care KU LeuvenLeuvenBelgium International Medical Center/Ward of General Practice West China HospitalSichuan UniversityChengduChina London UK Founder&CEHD iAdvorateInc.VirginiaPatient partner Patient partner The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatr

临床问题对于存在不同心血管风险及肾脏结局的2型糖尿病患者,在原有生活方式干预和/或其他降糖药物的基础上加用钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂的获益及风险是什么?现行做法几十年来,2型糖尿病... 详细信息

临床问题对于存在不同心血管风险及肾脏结局的2型糖尿病患者,在原有生活方式干预和/或其他降糖药物的基础上加用钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂的获益及风险是什么?现行做法几十年来,2型糖尿病的治疗决策都以控制血糖为主导。SGLT-2抑制剂和GLP-1受体激动剂在传统观念中常被用于二甲双胍治疗后血糖仍控制不佳的患者。目前这一现状已经发生了改变,这得益于多项临床研究结果。研究显示SGLT-2抑制剂和GLP-1受体激动剂拥有独立于药物降糖作用之外的对于动脉粥样硬化性心血管病(CVD)和慢性肾脏病(CKD)的获益。建议本指南阐述了针对不同风险分层的成人2型糖尿病患者使用SGLT-2抑制剂或GLP-1受体激动剂的建议。•伴有3种或更少的心血管风险因素且不存在CVD或CKD:不建议启动SGLT-2抑制剂或GLP-1受体激动剂治疗。(推荐等级:弱)•伴有3种以上心血管风险因素且不存在CVD或CKD:建议启动SGLT-2抑制剂治疗,不建议启动GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD或CKD:建议启动SGLT-2抑制剂治疗和GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD和CKD:建议启动SGLT-2抑制剂治疗(推荐等级:强)和GLP-1受体激动剂治疗。(推荐等级:弱)•对于那些想要进一步降低CVD和CKD结局风险的患者:推荐优先启用SGLT-2抑制剂治疗而非GLP-1受体激动剂治疗。(推荐等级:弱)这项指南是如何制订的一个由患者、临床医生和方法学家共同组成的国际小组提出了这些推荐意见。这些推荐意见基于可信度较高的指南的标准,并使用GRADE分级方法进行评估。该小组采用了息者个体化的观点。证据一项关于获益与风险的系统综述和网络meta分析(764项随机对照研究,包括421346例参与者)发现SGLT-2抑制剂和GLP-1受体激动剂可以降低总体死亡率、心肌梗死发生率、终末期肾病或肾衰竭的发生率(中等至高等质量的证据)。在不同的亚组中这些药物对卒中、因心力衰竭所致住院和其他主要不良事件有不同的影响。药物绝对获益的程度因患者个体风险的不同有很大的差异。(例如,对于接受了超过5年药物治疗的1000例患者,在最低风险人群中死亡人数减少了5人,在最高风险人群中死亡人数减少了48人)。一项关于预后的综述确认了14种风险预测模型,其中一种(RECODe)在证据总结中报告了大部分基线风险评估数据,小组利用该模型以支持风险分层的建议。考虑到患者的价值观及个体差异,指南推荐的支撑证据包括一项对已发表论文的系统综述、一项患者焦点小组研究、一项临床问题总结,以及一项指南调查。指南解读我们依据不同的CVD和CKD风险水平,综合考虑获益、风险和其他因素的平衡,以及每一个风险组别的实际问题,来对推荐意见进行分层。本指南强烈建议CVD和CKD患者使用SGLT-2抑制剂治疗,这说明专家组认为其具有显著的获益。而对于其他成人2型糖尿病患者,推荐等级较弱,这说明专家组想要在获益、风险及治疗花费上取得一个更好的平衡。临床医生通过该指南可以使用可靠的风险计算模型,如RECODe,来明确其患者的个体心血管和肾脏疾病风险。医患交互式总结临床证据和制订决策有助于患者知晓治疗选择,包括进行共同决策。2型糖尿病人群(全球患病率不断增长1-2)正面临着不断增加的心血管疾病、肾脏病和其他并发症的风险3。数十年来,2型糖尿病的管理始终以控制血糖及糖化血红蛋白(HbA1c)为治疗目标4-5,但是,最近的高质量随机对照研究已经对这种以血糖为中心的治疗模式发起了挑战。研究结果显示,强化血糖控制未必会降低大血管不良事件,它还可能带来不利影响监管机构现在要求新型糖尿病药物必须证明其具有心血管和肾脏获益才能获得批准。对两类新药--钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂(见框图1)的临床试验结果显示,在现有治疗方案(常规治疗)之上加用这些药物,对死亡、心肌梗死、卒中、心力衰竭和肾脏的结局(如进展为终末期肾病)都有获益8-12。

关键词：胰高血糖素样肽1 终末期肾病临床研究结果心血管风险 meta分析临床试验结果临床证据控制血糖

Optical and Structural Properties PbS：Bi3＊ Nanocrystals

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材料科学与工程（中英文A版） 2013年第9期3卷 621-627页

作者： Sandra Cruz Cruz Guadalupe Herneindez Tellez Ulises Pefia Rosas rene.gutierrez perez Rodolfo PalominoMerino Leslie Chaltel Lima Oscar Portillo Moreno Chemical Engineering Department Technical University of Tlaxcala. San Pedro Xalcaltzingo Tepeyanco C. P. 90180 Tlax.Mdxico Complex Synthesis Lab School of Chemical Sciences Autonomous University of Puebla Puebla Pue. 72001 Mexico Faculty of Science Fisicomatem~ticasopto Electronics Graduate of Autonomous University of Puebla. Pue. 72001 Mexico