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Anemia in inflammatory bowel disease: A neglected issue with relevant effects

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World journal of Gastroenterology 2014年第13期20卷 3542-3551页

作者： Danila Guagnozzi alfredo j.lucendo Department of Gastroenterology Hospital General de Tomelloso 13700 TomellosoCiudad RealSpain

Anemia, a common complication associated with inflammatory bowel disease (IBD), is frequently overlooked in the management of IBD patients. Unfortunately, it represents one of the major causes of both decreased quality of life and increased hospital admissions among this population. Anemia in IBD is pathogenically complex, with several factors contributing to its development. While iron deficiency is the most common cause, vitamin B12 and folic acid deficiencies, along with the effects of pro-inflammatory cytokines, hemolysis, drug therapies, and myelosuppression, have also been identified as the underlying etiology in a number of patients. Each of these etiological factors thus needs to be identified and corrected in order to effectively manage anemia in IBD. Because the diagnosis of anemia in IBD often presents a challenge, combinations of several hematimetric and biochemical parameters should be used. Recent studies underscore the importance of determining the ferritin index and hepcidin levels in order to distinguish between iron deficiency anemia, anemia due to chronic disease, or mixed anemia in IBD patients. With regard to treatment, the newly introduced intravenous iron formulations have several advantages over orally-administered iron compounds in treating iron deficiency in IBD. In special situations, erythropoietin supplementation and biological therapies should be considered. In conclusion, the management of anemia is a complex aspect of treating IBD patients, one that significantly influences the prognosis of the disease. As a consequence, its correction should be considered a specific, first-line therapeutic goal in the management of these patients.

关键词： Anemia Inflammatory bowel disease Iron deficiency Anemia of chronic disease Erythropoietin

Importance of nutrition in inflammatory bowel disease

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World journal of Gastroenterology 2009年第17期15卷 2081-2088页

作者： alfredo josé lucendo Livia Cristina De Rezende Department of Gastroenterology Hospital General de Tomelloso Vereda de Socuéllamos s/n. 13700 Tomelloso (Ciudad Real) Spain

Inflammatory bowel disease （IBD） results from the interaction between an individual＇s immune response and precipitant environmental factors, which generatean anomalous chronic inflammatory response in thosewho are genetically predisposed. Various feeding practices have been implicated in the origin of IBD based on epidemiological observations in developed countries, but we do not have solid evidence for the etiological role played by specific food types. IBD is associated with frequent nutritional deficiencies, thepattern and severity of which depends on the extent,duration and activity of the inflammation. Nutritional support allows these deficiencies in calories, macro and micronutrients to be rectified. Enteral nutrition is also aprimary therapy for IBD, especially for Crohn＇s disease,as it allows the inflammatory activity to be controlled,kept in remission, and Drevents or delays the need forsurgery. Nutritional support is especially important in childhood IBD as an alternative to pharmacological treatment. This report discusses the complex relationship between diet and IBD.

关键词： Nutritional support Inflammatory boweldisease Enteral diet Crohn's disease Ulcerative colitis

Colorectal cancer surveillance in patients with inflammatory bowel disease: What's new?

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World journal of Gastrointestinal Endoscopy 2012年第4期4卷 108-116页

作者： Danila Guagnozzi alfredo j.lucendo Department of Gastroenterology Hospital General de Tomelloso 13700 Tomelloso Ciudad Real Spain

Several studies assessing the incidence of colorectal cancer (CRC) in inflammatory bowel disease (IBD) patients have found an increased risk globally estimated to be 2 to 5 times higher than for the general population of the same age group. The real magnitude of this risk, however, is still open to debate. Research is currently being carried out on several risk and protective factors for CRC that have recently been identified in IBD patients. A deeper understanding of these factors could help stratify patient risk and aid specialists in choosing which surveillance program is most efficient. There are several guidelines for choosing the correct surveillance program for IBD patients; many present common characteristics with various distinctions. Current recommendations are far from perfect and have important limitations such as the fact that their efficiency has not been demonstrated through randomized controlled trials, the limited number of biopsies performed in daily endoscopic practice, and the difficulty in establishing the correct time to begin a given surveillance program and maintain a schedule of surveillance. That being said, new endoscopic technologies should help by replacing random biopsy protocols with targeted biopsies in IBD patients, thereby improving the efficiency of surveillance ***, further studies are needed to evaluate the cost-effectiveness of introducing these techniques into daily endoscopic practice.

关键词： Colonoscopy Colorectal cancer Crohn’s disease Dysplasia Inflammatory bowel disease Ulcerative colitis

Small bowel video capsule endoscopy in Crohn’s disease: What have we learned in the last ten years?

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World journal of Gastrointestinal Endoscopy 2011年第2期3卷 23-29页

作者： alfredo j.lucendo Danila Guagnozzi Department of Gastroenterology Hospital General de Tomelloso Tomelloso 13700 Ciudad Real Spain

Since its introduction in 2001, capsule endoscopy (CE) has become the most important advance in the study of small bowel disease, including Crohn's disease (CD). This technique has been demonstrated to be superior to all other current forms of radiological investigation in detecting mucosal abnormalities of small bowel nonstricturing CD. CE has proven to be extremely useful in diagnosing CD in patients with inconclusive findings from ileocolonoscopy and x-ray-based studies. Almost half of all patients with CD involving the ileum also present lesions in proximal intestinal segments, with the small bowel being exclusively involved in up to 30% of all CD cases. Despite the widespread use of CE, several questions concerning the utility of this technique remain unanswered. The lack of commonly agreed diagnostic criteria for defining CD lesions with the aid of CE may have had an influence on the variation in diagnostic re sults for CE reported in the literature. The utility of CE in monitoring CD and in guiding therapy has also been proposed. Furthermore, CE could be a useful second-line technique for patients with an established diagn osis of CD and unexplained symptoms. Finally, as no thres hold for CD diagnosis has been agreed upon, a se verity scale of mucosal disease activity has notbeen universally followed. None of the available activity indexes based on CE findings has been independently validated. This article discusses several cutting-edge aspects of the usefulness of CE in CD 10 years after its introduction as a sensible method to study the small intestine.

关键词： Capsule endoscopy Crohn’s disease Inflammatory bowel disease

Hepatic osteodystrophy: An important matter for consideration in chronic liver disease

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World journal of Hepatology 2011年第12期3卷 300-307页

作者： Germán López-Larramona alfredo j.lucendo Sonia González-Castillo josé M Tenias Department of Internal Medicine Hospital General de Tomelloso 13700 Ciudad Real Spain Department of Gastroenterology Hospital General de Tomelloso 13700 Ciudad Real Spain Research Support Unit Complejo Hospitalario Mancha Centro Alcázar de San Juan 13700 Ciudad Real Spain

Hepatic osteodystrophy (HO) is the generic term defining the group of alterations in bone mineral metabolism found in patients with chronic liver disease. This paper is a global review of HO and its main pathophysiological, epidemiological and therapeutic aspects. Studies examining the most relevant information concerning the prevalence, etiological factors, diagnostic and therapeutic aspects involved in HO were identified by a systematic literature search of the PubMed database. HO generically defines overall alterations in bone mineral density (BMD) (osteoporosis or osteopenia) which appear as a possible complication of chronic liver disease. The origin of HO is multifactorial and its etiology and severity vary in accordance with the underlying liver disease. Its exact prevalence is unknown, but different studies estimate that it could affect from 20% to 50% of patients. The reported mean prevalence of osteoporosis ranges from 13%-60% in chronic cholestasis to 20% in chronic viral hepatitis and 55% in viral cirrhosis. Alcoholic liver disease is not always related to osteo-penia. HO has been commonly studied in chronic cholestatic disease (primary biliary cirrhosis and primary sclerosing cholangitis). Several risk factors and pathogenic mechanisms have been associated with the loss of BMD in patients with chronic liver disease. However, little information has been discovered in relationship to most of these mechanisms. Screening for osteopenia and osteoporosis is recommended in advanced chronic liver disease. There is a lack of randomized studies assessing specific management for HO.

关键词： Hepatic osteodystrophy Liver disease Osteoporosis Osteopenia

Ligand effects on the structure and vibrational properties of the thiolated Au18 cluster

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Progress in Natural Science:Materials International 2016年第5期26卷 510-515页

作者： alfredo Tlahuice-Flores CICFIM-Facultad de Ciencias Físico-Matemáticas Universidad Autónoma de Nuevo León

Most of the studies devoted to thiolated gold clusters suppose that their core and Au-S framework do not suffer from distortion independently of the protecting ligands（-SR） and it is assumed as correct to simplify the ligand as SCH3. In this work is delivered a systematic study of the structure and vibrational properties（IR and Raman）of the Au18（SR）14cluster. The pursued goal is to understand the dependency of the displayed vibrational properties of the thiolated Au18cluster with the ligands type. A set of six ligands was considered during calculations of the vibrational properties based on density functional theory（DFT） and in its dispersioncorrected approach（DFT-D）.

关键词： Gold cluster Ligand effects Structure Vibration Au18(SR)14 Density functional theory

Resolution of metabolic syndrome after following a gluten free diet in an adult woman diagnosed with celiac disease

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World journal of Gastrointestinal Pathophysiology 2011年第3期2卷 49-52页

作者： lvaro García-Manzanares alfredo j.lucendo Sonia González-Castillo jesús Moreno-Fernández Department of Endocrinology Hospital General de Tomellosorea de Atención especializada La Mancha Centro13700 Tomelloso(Ciudad Real)Spain Department of Gastroenterology Hospital General de Tomelloso

Adult celiac disease(CD) presents with very diverse symptoms that are clearly different from those typically seen in pediatric patients,including ferropenic anemia,dyspepsia,endocrine alterations and elevated transaminase concentration. We present the case of a 51-year-old overweight woman with altered basal blood glucose,hypercholesterolemia,hypertriglyceridemia and persisting elevated transaminase levels,who showed all the symptoms for a diagnosis of metabolic syndrome. Because she presented iron deficiency anemia,she was referred to the gastroenterology department and subsequently diagnosed with celiac disease after duodenal biopsies and detection of a compatible HLA haplotype. Gluten-free diet(GFD) was prescribed and after 6 mo the patient showed resolution of laboratory abnormalities(including recovering anemia and iron reserves,normalization of altered lipid and liver function parameters and decrease of glucose blood levels) . No changes in weight or waist circumference were observedand no significant changes in diet were documented apart from the GFD. The present case study is the first reported description of an association between CD and metabolic syndrome,and invites investigation of the metabolic changes induced by gluten in celiac patients.

关键词： Celiac disease Metabolic syndrome Glutenfree diet

Complementarity of electric vehicles and pumped-hydro as energy storage in small isolated energy systems:case of La Palma,Canary Islands

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journal of Modern Power Systems and Clean Energy 2016年第4期4卷 604-614页

作者： alfredo RAMIREZ-DIAZ Francisco j.RAMOS-REAL Gustavo A.MARRERO Departamento de Economı´a Contabilidad y FinanzasFacultad de Economı´aEmpresa y TurismoUniversidad de La Laguna38071 La LagunaSpain Instituto Universitario de Ciencias Polı´ticas y Sociales Universidad de La Laguna38071 La LagunaSpain Instituto Universitario de Desarrollo Regional Universidad de La Laguna38071 La LagunaSpain

Isolated energy systems in archipelagos are characterized for having a great dependence on fossil sources due to isolation and territorial *** island of La Palma is situated on the northwest of the Canary Islands,and its electric system is very *** policies planned by local authorities are aimed to increase the share of renewable energies and the reduction of fossil ***,intermittence and the concentration of unmanageable renewable energies in few locations may hinder the operation of the *** order to solve these problems,energy storage plays an essential *** aim of this paper is to analyse the effects of the introduction of two possible alternatives as a way of energy storage:pumped hydro storage and electric *** this,we use a simulation model adapted to the features of La Palma,considering different *** show that,in the most favourable scenario,the installation of an additional 25 MW from renewables(more than double the current power),supported by 20 MW of pumped hydro storage and a fleet of 3361 electric vehicles,would allow the current share of renewables to increase from11%(in 2015)to 49%.Furthermore,this would mean a 26%reduction in CO2 emissions,10%in costs of generated k Wh and 19%in energy dependence.

关键词： Energy storage Electric vehicles Vehicle-to-grid Grid-for-vehicles Pumped-hydro energy storage Isolated systems

Threat recognition and response in an avian brood-parasite host from New Caledonia

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Current Zoology 2021年第3期67卷 255-262页

作者： alfredo Attisaino Kasper Hlebowicz Roman Gula jorn Theuerkauf Museum and Institute of Zoology Polish Academy of SciencesWarsawPoland Conservation Research New Caledonia La FoaNew Caledonia

Nest predation and avian brood parasitism are the main sources of nest failure in many passerine *** predators threaten both brood and parents,whereas brood parasites pose only a danger to eggs or *** fan-tailed gerygone Gerygone flavolateralis from New Caledonia is subjected to high rates of nest predation by the New Caledonian crow Corvus moneduloides(responsible for about 20-40%of predation)and moderate rates of brood parasitism by the shining bronze-cuckoo Chalcites lucidus(parasitizing about 18%of nests),which also depredates nests that are too advanced for parasitism(13%of nests).To test if fan-tailed gerygones are able to discriminate predators from brood parasites,we presented 3 bird models at active gerygone nests:a brood parasite/small nest predator(shining bronze-cuckoo),a large nest predator(crow),and a small non-native bird(common chaffinch Fringilla coelebs),which is unknown to the gerygone,as a *** assessed the response of adult gerygones to the presentation of each model by measuring the minimum approach distance,number of alarm calls,number of attacks,and time to first nest visit after the presentation(latency).Adult gerygones often attacked the cuckoo,approached but never attacked the chaffinch and always avoided the *** was shorter after an attack response and during brooding,but similar among *** did not find any link between the cuckoo model presentation and later ejection of cuckoo *** conclude that adult fan-tailed gerygones discriminate between different models and respond accordingly to the level of threat but do not show awareness of parasitism risk and increase of nestling ejection rates following exposure to the cuckoo model.

关键词： brood parasitism enemy recognition frontline defense mobbing nest defense nest predation