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Prediction of sudden death in elderly patients with heart failure

Journal of Geriatric Cardiology 2018年第2期15卷 185-192页

作者： Ana Ayesta Helena Martinez-Sellest antonio bayes de luna Manuel Martinez-Selles Cardiology department Hospital Universitario del Sureste Arganda del Rey Madrid Spain Universidad Complutense Madrid Spain Fundacio lnvestigacio Cardiovascular ICCC Hospital de Sant Pau Barcelona Spain Cardiology department Hospital General Universitario Gregorio Maranon CIVERCK Universidad Europea Madrid Spain

Most heart failure （HF） related mortality is due to sudden cardiac death （SCD） and worsening HF, particularly in the case of reduced ejection fraction. Predicting and preventing SCD is an important goal but most works include no or few patients with advanced age, and the prevention of SCD in elderly patients with HF is still controversial. A recent reduction in the annual rate of SCD has been recently described but it is not clear if this is also true in advanced age patients. Age is associated with SCD, although physicians frequently have the perception that elderly patients with HF die mainly of pump failure, underestimating the importance of SCD. Other clinical variables that have been associated to SCD are symptoms, New York Heart Association functional class, ischemic cause, and comorbidities （chronic obstructive pulmonary disease, renal dysfunction and diabetes）. Some test results that should also be considered are left ventricular ejection fraction and diameters, natriuretic peptides, non-sustained ventricular tachycardias and autonomic abnormalities. The combination of all these markers is probably the best option to predict SCD. Different risk scores have been described and, although there are no specific ones for elderly populations, most include age as a risk predictor and some were developed in populations with mean age 〉 65 years. Finally, it is important to stress that these scores should be able to predict any type of SCD as, although most are due to tachyarrhythmias, bradyarrhythmias also play a role, particularly in the case of the elderly.

关键词： Heart failure Prediction Risk Sudden death The elderly

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Metastatic pancreatic and lung cancer patient in complete remission following immunotherapy: A case report and review of literature

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 2233-2240页

作者： Joaquina Martínez-Galán Cristina Jiménez-luna Isabel Rodriguez Elisabeth Maza Carlos García-Collado antonio Rodríguez-Fernández Javier Luis López-Hidalgo Octavio Caba department of Medical Oncology Virgen de las Nieves University HospitalGranada 18014Spain Instituto de Investigación Biosanitaria Ibs.GranadaGranada 18012Spain Institute of Biopathology and Regenerative Medicine(IBIMER) University of GranadaGranada 18016Spain Pharmacogenetics Unit Virgen de las Nieves University HospitalGranada 18014Spain department of Medicina Nuclear Virgen de las Nieves University HospitalGranada 18014Spain department of Anatomía Patológica Virgen de las Nieves University HospitalGranada 18014Spain

BACKGROUND Metastatic pancreatic ductal adenocarcinoma(PDAC)is a lethal malignancy with dispiriting survival *** is a promising approach to many cancer types,but achieves poor outcomes in advanced PDAC due to its immunosuppressive tumor *** describe a case of metastatic PDAC effectively treated with *** SUMMARY We report the case of a 67-year-old woman with unresectable locally advanced PDAC,treated with gemcitabine plus nab-paclitaxel followed by radiotherapy plus *** nine months,pancreatic tumor progression was observed at the level of the hepatic hilum with the appearance of a new pulmonary nodule suggestive of a second primary,confirmed by left lung *** immunotherapy was then initiated with pembrolizumab,an immune checkpoint inhibitor targeting programmed cell death protein-1 that covers the two tumor *** patient showed a complete metabolic response that was maintained throughout the *** patient continues to be disease-free at 5.6 years since the start of *** These results suggest that the administration of pembrolizumab after chemoradiotherapy has a beneficial effect in patients with metastatic *** our knowledge,this is the first reported case of a patient with metastatic PDAC and metastatic lung cancer showing such a long-lasting complete response after pembrolizumab treatment without curative *** studies are required to determine biomarkers that identify PDAC patients most likely to benefit from this immunotherapy.

关键词： Pancreatic ductal adenocarcinoma Lung cancer Immunotherapy Pembrolizumab Programmed cell death protein-1 Case report

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Atrial fibrillation in the elderly

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Journal of Geriatric Cardiology 2017年第3期14卷 155-157页

作者： Manuel Martinez-Selles antonio bayes de Lun Hospital General Universitario Gregorio Maranon CIBER C V Universidad Europea Universidad Complutense Madrid Spain Fundacio Investigacio Cardiovascular ICCC Hospital de Sant Pau Barcelona Spain

Atrial fibrillation （AF） is the most frequent arrhythmia. Due to population aging, AF is a growing epidemic and its importance will continue to increase in the next decades. Although the prevalence of AF is high in advanced age, the number of subjects with predisposing factors for AF is even higher. Most of these factors increase the risk of atrial fibro- sis, an important component of atrial arrhythmia mecha- nisms. In fact, the new techniques to detect atrial fibrosis are showing the strong association between atrial fibrosis and AF risk. Regarding predisposing factors for AF, interatrial block （LAB） seems to be a key factor.

关键词： Age Atrial fibrillation Interatrial block Predisposing factors

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Pancreatic cancer,autoimmune or chronic pancreatitis,beyond tissue diagnosis:Collateral imaging and clinical characteristics may differentiate them

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World Journal of Gastrointestinal Oncology 2023年第6期15卷 925-942页

作者： Ana I Tornel-Avelar Jose antonio Velarde Ruiz-Velasco Mario Pelaez-luna department of Gastroenterology Hospital Civil of Guadalajara“Fray Antonio Alcalde”Guadalajara 44340JaliscoMexico Research Division School of Medicine/department of Gastroenterology Universidad Nacional Autonoma de México/National Institute of Medical Sciences and Nutrition“Salvador Zubiran”Tlalpan 14000Mexico CityMexico

Pancreatic ductal adenocarcinoma(PDAC)is one of the most lethal malignancies and is developing into the 2nd leading cause of cancer-related ***,the clinical and radiological presentation of PDAC may be mirrored by other inflammatory pancreatic masses,such as autoimmune pancreatitis(AIP)and massforming chronic pancreatitis(MFCP),making its diagnosis *** AIP and MFCP from PDAC is vital due to significant therapeutic and prognostic *** diagnostic criteria and tools allow the precise differentiation of benign from malignant masses;however,the diagnostic accuracy is *** pancreatic resections have been performed in AIP cases under initial suspicion of PDAC after a diagnostic approach failed to provide an accurate *** is not unusual that after a thorough diagnostic evaluation,the clinician is confronted with a pancreatic mass with uncertain *** those cases,a re-evaluation must be entertained,preferably by an experienced multispecialty team including radiologists,pathologists,gastroenterologists,and surgeons,looking for disease-specific clinical,imaging,and histological hallmarks or collateral evidence that could favor a specific *** aim is to describe current diagnostic limitations that hinder our ability to reach an accurate diagnosis among AIP,PDAC,and MFCP and to highlight those disease-specific clinical,radiological,serological,and histological characteristics that could support the presence of any of these three disorders when facing a pancreatic mass with uncertain diagnosis after an initial diagnostic approach has been unsuccessful.

关键词： Pancreas cancer Chronic pancreatitis Autoimmune pancreatitis Pancreas mass Endoscopic ultrasound Diagnosis

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Clinical impact of artificial intelligence-based solutions on imaging of the pancreas and liver

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World Journal of Gastroenterology 2023年第9期29卷 1427-1445页

作者： M Alvaro Berbís Felix Paulano Godino Javier Royuela del Val Lidia AlcaláMata antonio luna department of Radiology HT MédicaSan Juan de Dios HospitalCórdoba 14960Spain Faculty of Medicine Autonomous University of MadridMadrid 28049Spain department of Radiology HT MédicaClínica las NievesJaén 23007Spain

Artificial intelligence(AI)has experienced substantial progress over the last ten years in many fields of application,including *** hepatology and pancreatology,major attention to date has been paid to its application to the assisted or even automated interpretation of radiological images,where AI can generate accurate and reproducible imaging diagnosis,reducing the physicians’*** can provide automatic or semi-automatic segmentation and registration of the liver and pancreatic glands and ***,using radiomics,AI can introduce new quantitative information which is not visible to the human eye to radiological *** has been applied in the detection and characterization of focal lesions and diffuse diseases of the liver and pancreas,such as neoplasms,chronic hepatic disease,or acute or chronic pancreatitis,among *** solutions have been applied to different imaging techniques commonly used to diagnose liver and pancreatic diseases,such as ultrasound,endoscopic ultrasonography,computerized tomography(CT),magnetic resonance imaging,and positron emission tomography/***,AI is also applied in this context to many other relevant steps involved in a comprehensive clinical scenario to manage a gastroenterological *** can also be applied to choose the most convenient test prescription,to improve image quality or accelerate its acquisition,and to predict patient prognosis and treatment *** this review,we summarize the current evidence on the application of AI to hepatic and pancreatic radiology,not only in regard to the interpretation of images,but also to all the steps involved in the radiological workflow in a broader ***,we discuss the challenges and future directions of the clinical application of AI methods.

关键词： Artificial intelligence Machine learning deep learning Imaging Liver Pancreas

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Role of artificial intelligence in multidisciplinary imaging diagnosis of gastrointestinal diseases

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World Journal of Gastroenterology 2021年第27期27卷 4395-4412页

作者： M Alvaro Berbís José Aneiros-Fernández F Javier Mendoza Olivares Enrique Nava antonio luna department of R&D HT MédicaMadrid 28046MadridSpain department of Pathology Hospital Universitario Clínico San CecilioGranada 18012Spain department of Gastroenterology Fatima ClinicSevilla 41012Spain department of Communications Engineering University of MálagaMalaga 29016Spain MRI Unit Department of RadiologyHT MédicaJaén 23007Spain

The use of artificial intelligence-based tools is regarded as a promising approach to increase clinical efficiency in diagnostic imaging,improve the interpretability of results,and support decision-making for the detection and prevention of ***,endoscopy and pathology images are suitable for deep-learning analysis,potentially changing the way care is delivered in *** aim of this review is to examine the key aspects of different neural network architectures used for the evaluation of gastrointestinal conditions,by discussing how different models behave in critical tasks,such as lesion detection or characterization(*** distinction between benign and malignant lesions of the esophagus,the stomach and the colon).To this end,we provide an overview on recent achievements and future prospects in deep learning methods applied to the analysis of radiology,endoscopy and histologic whole-slide images of the gastrointestinal tract.

关键词： Artificial intelligence Machine learning Radiology Endoscopy Pathology Gastroenterology

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Clinical applications of advanced magnetic resonance imaging techniques for arthritis evaluation

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World Journal of Orthopedics 2017年第9期8卷 660-673页

作者： Teodoro Martín Noguerol antonio luna Marta Gómez Cabrera Alexie D Riofrio MRI Unit Clínica Las Nieves SERCOSA Health Time department of Radiology University Hospitals of Cleveland Case Western Reserve University MRI Unit DADISA Health Time department of Radiology Duke Regional Hospital

Magnetic resonance imaging(MRI) has allowed a comprehensive evaluation of articular disease, increasing the detection of early cartilage involvement, bone erosions, and edema in soft tissue and bone marrow compared to other imaging techniques. In the era of functional imaging, new advanced MRI sequences are being successfully applied for articular evaluation in cases of inflammatory, infectious, and degenerative arthropathies. Diffusion weighted imaging, new fat suppression techniques such as DIXON, dynamic contrast enhanced-MRI, and specific T2 mapping cartilage sequences allow a better understanding of the physiopathological processes that underlie these different arthropathies. They provide valuable quantitative information that aids in their differentiation and can be used as potential biomarkers of articular disease course and treatment response.

关键词： Magnetic resonance imaging Joint Diffusion weighted imaging Dynamic contrast enhanced Musculoskeletal system Cartilage DIXON Arthritis

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Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial

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World Journal of Gastroenterology 2022年第33期28卷 4875-4889页

作者： Eduardo Turiani Hourneaux de Moura Jose Jukemura Igor Braga Ribeiro Galileu Ferreira Ayala Farias Aureo Augusto de Almeida delgado Lara Meireles Azeredo Coutinho Diogo Turiani Hourneaux de Moura Rubens antonio Aissar Sallum Ary Nasi Sergio A Sanchez-luna Paulo Sakai Eduardo Guimaraes Hourneaux de Moura departamento de Gastroenterologia Faculdade de MedicinaUniversidade de Sao PauloServico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSPSao Paulo 05403-010Brazil Division of Esophageal Surgery Hospital das ClinicasUniversity of Sao Paulo School of MedicineSao Paulo 05403-010Brazil departamento de Gastroenterologia Faculdade de MedicinaUniversidade de Sao PauloHospital das ClinicasUniversity of Sao Paulo School of MedicineSao Paulo 05403-010Brazil department of Internal Medicine The University of Alabama at Birmingham Heersink School of MedicineBasil I.Hirschowitz Endoscopic Center of ExcellenceDivision of Gastroenterology and HepatologyBirminghamAL 35233United States

BACKGROUND Achalasia is a rare benign esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter(LES). The treatment of achalasia is not curative, but rather is aimed at reducing LES pressure. In patients who have failed noninvasive therapy, surgery should be considered. Myotomy with partial fundoplication has been considered the first-line treatment for non-advanced achalasia. Recently, peroral endoscopic myotomy(POEM), a technique that employs the principles of submucosal endoscopy to perform the equivalent of a surgical myotomy,has emerged as a promising minimally invasive technique for the management of this *** To compare POEM and laparoscopic myotomy and partial fundoplication(LM-PF) regarding their efficacy and outcomes for the treatment of *** Forty treatment-naive adult patients who had been diagnosed with achalasia based on clinical and manometric criteria(dysphagia score ≥ II and Eckardt score > 3) were randomized to undergo either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, symptom improvement, reflux esophagitis(as determined with the Gastroesophageal Reflux Disease Questionnaire), barium column height at 1 and 5 min(on a barium esophagogram), pressure at the LES, the occurrence of adverse events(AEs), length of stay(LOS), and quality of life(QoL).RESULTS There were no statistically significant differences between the LM-PF and POEM groups regarding symptom improvement at 1, 6, and 12 mo of follow-up(P = 0.192, P = 0.242, and P = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 mo of follow-up were significantly higher in the POEM group(P = 0.014, P < 0.001, and P = 0.002, respectively). There were also no statistical differences regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time and procedure time were significantly shorter in the POEM group than in the LM-PF group(185.00 ± 56.89 and 95.70 ± 30.47 min v

关键词： Esophageal achalasia Gastroesophageal reflux deglutition disorders Heller myotomy Fundoplication Randomized controlled trial

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Perceptions of fishers to sea turtle bycatch,illegal capture and consumption in the San Ignacio-Navachiste-Macapule lagoon complex,Gulf of California,Mexico

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Integrative Zoology 2014年第1期9卷 70-84页

作者： Myrna E.AGUILAR-GONZÁLEZ antonio luna-GONZÁLEZ Alonso AGUIRRE Alan A.ZAVALA-NORZAGARAY Manuel MUNDO-OCAMPO Héctor A.GONZÁLEZ-OCAMPO National Polytechnic Institute(IPN) CIIDIR-IPNUNIDAD SINALOAJuan de Dios Batiz ParedesGuasaveSinaloaMexico department of Environmental Science and Policy George Mason UniversityFront RoyalVAUSA

In this study, 10% of all registered fishermen in the coastal towns of Navachiste in Sinaloa, in northwestern Mexico, answered a survey designed to collect data on their perceptions of the following topics: the impact of turtle meat consumption;human health;bycatch;illegal turtle fishing;the illegal sea turtle market;the lo-cal economy;pollution;environmental education;the success of protective legislation;and sea turtle-based ec-otourism. Perceptions were analyzed using the fuzzy logic method through classification into 5 fuzzy member-ship sets: VL, very low;L, low;M, moderate;H, high;VH, very high. The 9 topics generated decision areas upon applying fuzzy inference that revealed the membership level of the answers in each fuzzy set. The eco-nomic potential of sea turtle-based ecotourism and the economic profitability of the illegal turtle meat market were perceived as VL. Conservation legislation was perceived as H, although inefficiently applied due to cor-ruption. Ecotourism and impacts on sea turtles were perceived as VL, because they were deemed unprofitable activities at the individual and community levels. Environmental education was perceived as L, because it cen-ters on nesting, hatching and releasing turtles and is directed at elementary and middle-school students. While fishers perceive a serious negative impact of fishing activities on sea turtles in the San Ignacio-Navachiste- Macapule area, they do not see themselves individually as part of the problem. Achieving sea turtle conserva-tion in this region requires: suitable ecotourism infrastructure, government investments in promotion, and stud-ies to estimate the minimum number of tourists needed to assure profitability.

关键词： environmental impact assessment fishers’perceptions of impact impact on coastal fisheries sea turtle conservation

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Drought effects on the plasticity in vessel traits of two endemic Magnolia species in the tropical montane cloud forests of eastern Mexico

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Journal of Plant Ecology 2020年第3期13卷 331-340页

作者： Ernesto Chanes Rodríguez-Ramírez José antonio Vázquez-García Ignacio García-González Othón Alcántara-Ayala Isolda luna-Vega Laboratorio de Biogeografía y Sistemática Departamento de Biología EvolutivaFacultad de CienciasUniversidad Nacional Autónoma de MéxicoMexico CityMexico Laboratorio de Ecosistemática Instituto de BotánicaDepartamento de Botánica y ZoologíaCentro Universitario de Ciencias Biológicas y AgropecuariasUniversidad de GuadalajaraJaliscoMexico departamento de Botánica Escola Politécnica Superior de EnxeñaríaUniversidad de Santiago de CompostelaLugoSpain

Aims We aimed to evaluate how climatic fluctuations influence the plasticity of anatomical vessel traits and the width of annual tree-rings of two relict-endemic Mexican Magnolia ***,few studies have assessed the drought effect on vessel traits in tropical montane cloud trees of eastern *** Through digital images of growth rings,we assessed the tree radial growth rate,age of the trees and plasticity in vessel traits regarding climatic fluctuations of the Mexican Magnolia species *** compared vessel density,hydraulic diameter and percentage of conductive area in drought years(DY)and non-drought years(NDY)in two Mexican Magnolia *** Findings For the first time,the plasticity that occurs in porous wood vessel traits to long-term climatic fluctuations was analysed for two endangered Magnolia species(Magnolia vovidesii and ***)from two tropical montane cloud forests in *** found that temperature and precipitation were strongly associated with differences in tree-ring width when DY and NDY were *** analyses revealed that a high plasticity in vessel anatomy of diffuse-porous wood was related to temperature and/or water availability for both Magnolia species *** concluded that anatomical adaptations to DY resulted in a substantial reduction in vessel traits when compared with NDY,and that the plastic adaptations played an essential role in water transport and safety for the survival of the studied species during stressful long periods.

关键词： adaptability climate variability drought–growth relationship Magnolia schiedeana Magnolia vovidesii quantitative wood anatomy

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