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Clinical assessment and management of liver fibrosis in nonalcoholic fatty liver disease

World Journal of Gastroenterology 2020年第39期26卷 5919-5943页

作者： Alejandro Campos-murguía Astrid Ruiz-margáin JoséA gonzález-Regueiro ricardo U macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

Non-alcoholic fatty liver disease(NAFLD)is among the most frequent etiologies of cirrhosis worldwide,and it is associated with features of metabolic syndrome;the key factor influencing its prognosis is the progression of liver *** review aimed to propose a practical and stepwise approach to the evaluation and management of liver fibrosis in patients with NAFLD,analyzing the currently available *** the assessment of NAFLD patients,it is important to identify clinical,genetic,and environmental determinants of fibrosis development and its *** properly detect fibrosis,it is important to take into account the available methods and their supporting scientific evidence to guide the approach and the sequential selection of the best available biochemical scores,followed by a complementary imaging study(transient elastography,magnetic resonance elastography or acoustic radiation force impulse)and finally a liver biopsy,when *** help with the selection of the most appropriate method a Fagan′s nomogram analysis is provided in this review,describing the diagnostic yield of each method and their post-test probability of detecting liver ***,treatment should always include diet and exercise,as well as controlling the components of the metabolic syndrome,+/-vitamin E,considering the presence of sleep apnea,and when available,allocate those patients with advanced fibrosis or high risk of progression into clinical *** final end of this approach should be to establish an opportune diagnosis and treatment of liver fibrosis in patients with NAFLD,aiming to decrease/stop its progression and improve their prognosis.

关键词： Non-alcoholic fatty liver disease Liver fibrosis Clinical assessment Diagnosis Treatment Test accuracy

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Combining cytochrome P-450 3A4 modulators and cyclosporine or everolimus in transplantation is successful

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World Journal of Transplantation 2015年第4期5卷 338-347页

作者： Fernando gonzález ricardo Valjalo Department of Nephrology Faculty of MedicineUniversidad de ChileHospital del Salvador

AIm: To describe the long term follow-up of kidney allograft recipients receiving ketoconazole with calcineurin inhibitors(CNI) alone or combined with everolimus. mETHODS: This is an open-label, prospective observational clinical trial in low immunologic risk patients who, after signing an Institutional Review Board approved consent form, were included in one of two groups. The first one(n = 59) received everolimus(target blood level, 3-8 ng/m L) and the other(n = 114) azathioprine 2 mg/kg per day or mycophenolate mofetyl(mmF) 2 g/d. Both groups also received tapering steroids, the cytochrome P-450 3A4(CYP3A4) modulator, ketoconazole 50-100 mg/d, and cyclosporine with C0 targets in the everolimus group of 200-250 ng/mL in 1 mo, 100-125 ng/m L in 2 mo, and 50-65 ng/m L thereafter, and in the azathioprine or mmF group of 250-300 ng/mL in 1 mo, 200-250 ng/mL in 2 mo, 180-200 ng/m L until 3-6 mo, and 100-125 ng/mL thereafter. Clinical visits were performed monthly the first year and quarterly thereafter by treating physicians and all data was extracted by the ***: The clinical characteristics of these two cohorts were similar. During the follow up(66 + 31 mo), both groups showed comparable clinical courses, but the biopsy proven acute rejection rate during the full follow-up period seemed to be lower in the everolimus group(20% vs 36%; P = 0.04). The everolimus group did not show a higher surgical complication rate thanthe other group. By the end of the follow-up period, the everolimus group tended to show a higher glomerular filtration rate. Nevertheless, we found no evidence of a consistent negative slope of the temporal allograft function estimated by the modification of the diet in renal disease formula in any of both groups. At 6 years of follow-up, the uncensored and death-censored graft survivals were 91% and 93%, and 91% and 83% in the everolimus plus cyclosporine, and cyclosporine alone groups, respectively. The addition of ketoconazole saved

关键词： Kidney transplant Immunosuppressive Cyclosporine Ketoconazole Everolimus Cytochrome P-450 Cytochrome P-450 3A4 modulator

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morphometry and mineral Content in the Seeds and Soil of Two Species of Argemone L.(Papaveraceae)in the Central Part of the Chihuahuan Desert

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Phyton-International Journal of Experimental Botany 2024年第2期93卷 371-386页

作者： Perla Patricia Ochoa-García Jaime Sánchez-Salas ricardo Trejo-Calzada Jesús JosafathQuezada-Rivera Fabián García-gonzález Unidad Regional Universitaria de ZonasÁridas BermejilloUniversidad Autónoma ChapingoDurango35230México Facultad de Ciencias Biológicas Universidad Juárez del Estado de DurangoGómez PalacioDurango35010México

The genus Argemone L.(Papaveraceae)is found widely distributed in mexico’s Chihuahuan Desert(CD).Some species of this genus are of phytochemical or ethnobotanical *** are inedible plants considered as *** date they have not been broadly studied;thus,their ecology is,to our knowledge,*** present work was centered around carrying out a morphometric analysis and the determination of minerals in the soil and seeds of the wild populations of Argemone at sites belonging to two ecoregions of the CD in *** April 2021 and April 2022,seeds of Argemone spp.,and soil samples were collected at 10 sites of the *** seeds were selected under a randomized design,and weight,length,diameter,thickness,buoyancy,and mineral content were *** soil samples were obtained under the mexican regulation NOm-021-RECNAT-2000,and determinations of mineral content,electrical conductivity,apparent density,and soluble anions were *** information obtained was grouped by variable,species,and place of *** statistical tests consisted of an ANOVA,Tukey means tests considering p≤0.05,and a Principal Components *** pleiacantha exhibited differences in terms of weight(F=54.79,p=0.001),length(F=90.83,p=0.001),thickness(F=104.89,p=0.001),and diameter(F=155.82,p=0.001),and the differences in Argemone mexicana were in weight(F=46.71,p=0.001),thickness(F=187.49,p=0.001),length(F=191.56,p=0.001),and diameter(F=215.83,p=0.001).The evaluated seeds reached their maximal imbibition velocity at 24 h of *** content of the micro-and macro-nutrients analyzed in the seeds and soil suggest a tight relation with the morphometric characteristics of the seeds.

关键词： micronutrients agricultural area semiarid zone ecoregion buoyancy

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Adipokines,cytokines and body fat stores in hepatitis Cvirus liver steatosis

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World Journal of Hepatology 2016年第1期8卷 74-82页

作者： emilio gonzález-reimers javier lópez-prieto geraldine quintero-platt ricardo pelazas-gonzález m remedios alemán-valls onán pérez-hernández m joséde-la-vega-prieto m angeles gómez-rodríguez candelaria martín-gonzález francisco santolaria-fernández Servicio de medicina Interna Hospital Universitario de CanariasUniversidad de La Laguna38320 Canary IslandsSpain

AIm: To identify patients with or without liver steatosis and its severity in treatment-na?ve patients affected by hepatitis C virus(HCV) ***: We included 56 HCV infected patients, and assessed the amount of liver fat by histomorphometry, and its relationships with fat and lean mass at different parts of the body(by densitometry), hormones [insulin, homeostatic model assessment(HOmA)], adipokines(resistin, adiponectin, leptin), and cytokines(tumor necrosis factor α, interleukin-6).RESULTS: Although the intensity of liver steatosis is related to trunk fat mass and HOmA, 33% of patients showed no liver steatosis, and this finding was not related to body mass index or genotype. Besides trunkfat mass, no other factor was related to the presence or not of liver steatosis, or to the intensity of it, by multivariate analysis. Lean mass was not related to liver steatosis. Adiponectin levels were lower among patients. No differences were observed in leptin and ***: Steatosis in HCV infection is common(67.2%), and closely related to trunk fat, and insulin resistance, but not with leg fat mass or adipokines.

关键词： Resistin Adiponectin Insulin resistance Proinflammatory cytokines Leptin Hepatitis C virus Liver steatosis

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Nutritional therapy for hepatocellular carcinoma

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World Journal of Gastrointestinal Oncology 2021年第10期13卷 1440-1452页

作者： Astrid Ruiz-margáin Berenice m Román-Calleja Paulina moreno-Guillén JoséA gonzález-Regueiro DeyaniraKúsulas-Delint Alejandro Campos-murguía Nayelli C Flores-García ricardo Ulises macías-Rodríguez Liver Nutrition Clinic Department of GastroenterologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Liver Fibrosis and Nutrition Lab MICTLÁN-Network(Mechanisms of Liver InjuryCell Death and Translational Nutrition in Liver Diseases-Research Network)Mexico City 14080Mexico Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

Hepatocellular carcinoma(HCC)is the most frequent primary liver cancer and presents together with cirrhosis in most *** addition to commonly recognized risk factors for HCC development,such as hepatitis B virus/hepatitis C virus infection,age and alcohol/tobacco consumption,there are nutritional risk factors also related to HCC development including high intake of saturated fats derived from red meat,type of cooking(generation of heterocyclic amines)and contamination of foods with *** the contrary,protective nutritional factors include diets rich in fiber,fruits and vegetables,n-3 polyunsaturated fatty acids and *** the patient is being evaluated for staging and treatment of HCC,special attention should be paid to nutritional support,including proper nutritional assessment and therapy by a multidisciplinary *** must be considered that these patients usually develop HCC on top of long-lasting cirrhosis,and therefore they could present with severe *** complications should be properly addressed and considered for nutritional *** addition to traditional methods,functional testing,phase angle and computed tomography scan derived skeletal muscle index-L3 are among the most useful tools for nutritional *** therapy should be centered on providing enough energy and protein to manage the increased requirements of both cirrhosis and *** with branched-chain amino acids is also recommended as it improves response to treatment,nutritional status and survival,and finally physical exercise must be encouraged and adapted to individual needs.

关键词： Sarcopenia Liver Cancer Diet Branched-chain amino acids Nutrition

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Pathogenesis and diagnosis of contact dermatitis:Applications of reflectance confocal microscopy

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World Journal of Dermatology 2014年第3期3卷 45-49页

作者： Jorge A Suárez-Pérez ricardo Bosch Salvador gonzález Ernesto gonzález Department of Dermatology Virgen de la Victoria University Hospital Spain and University of Málaga 29010 Málaga Spain Dermatology Service Memorial Sloan-Kettering Cancer Center New York NY 10022 United States memorial Sloan-Kettering Cancer Center Dermatology Service New York NY 10022 United States Department of Dermatology Massachusetts General Hospital Harvard Medical School Boston MA 02114 United States

Contact dermatitis(CD) is the most common professional skin disease, with frequencies ranging from 24 to 170 every 100000 individuals. Approximately 20% of the United States population suffers from CD. CD can be classified according to its origin and severity. ICD stands for irritant CD, whereas ACD means allergic CD. Their clinical presentation includes acute, sub-acute and chronic eczema. Despite their different origin, ICD and ACD often present similar clinical and histologic findings. The current gold standard for diagnosis is patchtesting. However, patch-testing is being questioned in terms of validity and reproducibility, as it relies heavily on the skill of the observer. Real-time reflectance confocal microscopy is a non-invasive imaging technique that bears strong promise for the study of CD, and it enables the evaluation of cellular and subcellular changes over time with similar resolution compared to that of conventional histology.

关键词： Dermatitis Allergic contact Eczema Etiology Diagnosis

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Clinical characteristics and treatment outcomes in patients with liver cirrhosis and lymphoma

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World Journal of Hepatology 2020年第2期12卷 34-45页

作者： JoséA gonzález-Regueiro Astrid Ruiz-margáin mariana Cruz-Contreras Ana m montaña-Duclaud Andrea Cavazos-Gómez Roberta Demichelis-Gómez ricardo U macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición SalvadorGastroenterologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránVasco de Quiroga 15Belisario Domínguez Sección XVITlalpanMexico City 14080Mexico Department of Hematology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránVasco de Quiroga 15Belisario Domínguez Sección XVITlalpanMexico City 14080Mexico

BACKGROUND A significant number of patients with liver cirrhosis concomitantly develop some type of solid or hematological cancer,including *** of patients with lymphoma and cirrhosis is challenging for physicians due to the clinical characteristics related to cirrhosis,including biochemical and functional abnormalities,as well as portal hypertension and lack of scientific evidence,limiting the use of ***,experts recommend only offering oncological treatment to patients with compensated *** To evaluate the clinical characteristics and treatment outcomes in patients with cirrhosis and lymphoma treated with *** This was a case-control study conducted at a tertiary care center in *** was recorded from medical files and from 8658 possible candidates with cirrhosis and/or lymphoma(2000 to 2018).Only 23 cases had both diseases concomitantly;10 patients with cirrhosis and lymphoma(cases)met the selection criteria and were included,and 20 patients with lymphoma(controls)were included and matched according to age,sex,and date of diagnosis,type and clinical stage of *** patients received treatment with *** statistical analysis,descriptive statistics,Shapiro-Wilk test,mann-Whitney U test,chisquare test and Fisher's exact test were *** was evaluated using Kaplan-meier curves and Log-rank *** There were differences in biochemical variables inherent to liver disease and portal hypertension in patients with *** most frequent etiology of cirrhosis was hepatitis C virus(50%);80%were decompensated,the median Child-Turcotte-Pugh score was 7.5(6.75-9.25),and mean model for End-stage Liver Disease was 11.5±*** lymphomas,non-Hodgkin's were the most common(90%),and diffuse large B cell subtype was the most frequent,with a higher International Prognostic Index in the cases(3 vs 2,P=0.049).The chemotherapy regimens had to be adjusted more frequently in the case

关键词： Cirrhosis Cancer Lymphoma Chemotherapy Treatment Survival Toxicity Adverse events

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Hematological abnormalities in liver cirrhosis

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World Journal of Hepatology 2024年第9期16卷 1229-1244页

作者： Oscar manuel Fierro-Angulo JoséAlberto gonzález-Regueiro Ariana Pereira-García Astrid Ruiz-margáin Fernando Solis-Huerta ricardo Ulises macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico 14080Mexico Department of Hematology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico 14080Mexico

Hematological abnormalities are common in cirrhosis and are associated with various pathophysiological *** have documented a prevalence of thrombocytopenia,leukopenia,and anemia in patients with compensated cirrhosis of 77.9%,23.5%,and 21.1%,*** abnormalities carry significant clinical implications,including considerations for invasive procedures,infection risk,bleeding risk,and ***,cirrhosis was believed to predispose patients to bleeding due to alterations observed in classical coagula-tion tests such as prothrombin time,partial thromboplastin time,international normalized ratio,and ***,this understanding has evol-ved,and cirrhosis patients are now also acknowledged as being at a high risk for thrombotic *** in cirrhosis patients presents a complex pheno-type,with procoagulant and anticoagulant abnormalities offsetting each *** multifactorial phenomenon is inadequately reflected by routine laboratory *** complications are more prevalent in decompensated cirrhosis and may correlate with disease *** is primarily associated with portal hypertension,endothelial dysfunction,mechanical vessel injury,dissem-inated intravascular coagulation,endotoxemia,and renal *** review comprehensively outlines hematologic index abnormalities,mechanisms of hemostasis,coagulation,and fibrinolysis abnormalities,limitations of laboratory testing,and clinical manifestations of bleeding and thrombosis in patients with liver cirrhosis.

关键词： Cirrhosis Anemia Leukopenia Thrombocytopenia Coagulopathy Bleeding Thrombosis

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macrophages and the maintenance of homeostasis

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Cellular & molecular Immunology 2021年第3期18卷 579-587页

作者： David m.mosser Kajal Hamidzadeh ricardo Goncalves The Department of Cell Biology and molecular Genetics The University of MarylandCollege ParkMD 20742USA The Department of General Pathology Federal University of Minas GeraisBelo HorizonteMGBrazil

There have been many chapters written about macrophage *** chapters generally focus on the role of macrophages in orchestrating immune responses by highlighting the T-cell-derived cytokines that shape these polarizing *** bias toward immunity is understandable,given the importance of macrophages to host ***,macrophages are ubiquitous and are involved in many different cellular processes,and describing them as immune cells is undoubtedly an *** disregards their important roles in development,tissue remodeling,wound healing,angiogenesis,and metabolism,to name just a few *** this chapter,we propose that macrophages function as transducers in the *** to Wikipedia,WA transducer is a device that converts energy from one form to another.^The word transducer is a term used to describe both the"sensor,which can interpret a wide range of energy forms,and the"actuator,which can switch voltages or currents to affect the *** are able to sense a seemingly endless variety of inputs from their environment and transduce these inputs into a variety of different response ***,rather than functioning as immune cells,they should be considered more broadly as cellular transducers that interpret microenvironmental changes and actuate vital tissue *** this chapter,we will describe some of the sensory stimuli that macrophages perceive and the responses they make to these stimuli to achieve their prime directive,which is the maintenance of homeostasis.

关键词： macrophages polarization cytokines development inflammation

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Prognostic performance of an index based on lactic dehydrogenase and transaminases for patients with liver steatosis and COVID-19

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World Journal of Gastroenterology 2022年第37期28卷 5444-5456页

作者： ricardo Ulises macías-Rodríguez Alberto Adrián Solís-Ortega Victoria J Ornelas-Arroyo Astrid Ruiz-margáin maria Sarai gonzález-Huezo Nestor A Urdiales-morán Berenice m Román-Calleja Juan m mayorquín-Aguilar JoséA gonzález-Regueiro Alejandro Campos-murguía Israel Vicente Toledo-Coronado mónica Chapa-Ibargüengoitia Bernardo Valencia-Peña Carlos Fernando martínez-Cabrera Nayelli C Flores-García Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Department of Gastroenterology Centro Médico ISSEMYMToluca 52140Mexico Department of Radiology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

BACKGROUND metabolic associated fatty liver disease(mAFLD)is associated with complications and mortality in patients with coronavirus disease 2019(COVID-19).However,there are no prognostic scores aimed to evaluate the risk of severe disease specifically in patients with mAFLD,despite its high *** dehydrogenase,aspartate aminotransferase and alanine aminotransferase have been used as markers of liver ***,we propose an index based on lactate dehydrogenase,aspartate aminotransferase and alanine aminotransferase for the prediction of complications and mortality in patients with mAFLD and *** To evaluate the prognostic performance of an index based on lactate dehydrogenase and transaminases(aspartate aminotransferase/alanine aminotransferase)in patients with COVID-19 and mAFLD[liver fibrosis and nutrition(LNF)-COVID-19 index].mETHODS In this retrospective cohort study,two cohorts from two different tertiary centers were *** first was the derivation cohort to obtain the score cutoffs,and the second was the validation *** included hospitalized patients with severe COVID-19 and *** steatosis was evaluated by computed tomography *** under the receiver operating characteristic(ROC)curve analysis and survival analysis were *** In the derivation cohort,44.6%had mAFLD;ROC curve analysis yielded a LFN-COVID-19 index>1.67 as the best cutoff,with a sensitivity of 78%,specificity of 63%,negative predictive value of 91%and an area under the ROC curve of *** the multivariate analysis,the LFN-COVID-19 index>1.67 was independently associated with the development of acute kidney injury(odds ratio:1.8,95%confidence interval:1.3-2.5,Pmance to predict prognosis in patients with mAFLD and COVID-19,which

关键词： COVID-19 metabolic associated fatty liver disease Lactate dehydrogenase Transaminases Prognosis Nonalcoholic fatty liver disease

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