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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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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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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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Role of advanced magnetic resonance imaging in the assessment of malignancies of the mediastinum

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World Journal of Radiology 2019年第3期11卷 27-45页

作者： Jordi Broncano Ana María Alvarado-Benavides Sanjeev Bhalla antonio álvarez-Kindelan Constantine A Raptis antonio luna Cardiothoracic Imaging Unit Hospital San Juan de Dios Cardiothoracic Department Mallinckrodt Institute of Radiology Washington University in Saint Louis Thoracic Surgery Department Hospital Reina Sofía MR imaging Unit Clínica Las Nieves

In the new era of functional magnetic resonance imaging(MRI), the utility of chest MRI is increasing exponentially due to several advances, including absence of ionizing radiation, excellent tissue contrast and high capability for lesion characterization and treatment monitoring. The application of several of these diagnostic weapons in a multiparametric fashion enables to better characterize thymic epithelial tumors and other mediastinal tumoral lesions, accurate assessment of the invasion of adjacent structures and detection of pathologic lymph nodes and metastasis. Also, "do not touch lesions" could be identified with the associated impact in the management of those patients. One of the hotspots of the multiparametric chest MR is its ability to detect with acuity early response to treatment in patients with mediastinal malignant neoplasms. This has been related with higher rates of overall survival and progression free ***, in this review we will analyze the current functional imaging techniques available(18 F-Fluorodeoxiglucose positron emission tomography/computed tomography, diffusion-weighted imaging, dynamic contrast-enhanced MRI, diffusion tensor imaging and MR spectroscopy) for the evaluation of mediastinal lesions, with a focus in their correct acquisition and post-processing. Also, to review the clinical applications of these techniques in the diagnostic approach of benign and malignant conditions of the mediastinum.

关键词： Mediastinum Magnetic resonance Diffusion Perfusion ^18FFluorodeoxiglucose positron emission tomography/computed tomography Advanced imaging

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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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Congenitally Corrected Transposition of the Great Arteries: Conduction Anomalies: A Case Report

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World Journal of Cardiovascular Diseases 2021年第9期11卷 439-444页

作者： Jose antonio luna-Alvarez-Amezquita Javier Ivan Armenta-Moreno Joaquin Berarducci Jorge Luis Bermudez-Gonzalez Jose Luis Siller-Nava Edson Alberto Escandón-Villalobos Nilda Espinola-Zavaleta Roberto Cano-Zarate Juan Ignacio Straface Department of Nuclear Cardiology National Institute of Cardiology Ignacio Chavez Mexico City Mexico Department of Echocardiography ABC Medical Center I.A.P. Mexico City Mexico Department of Magnetic Resonance National Institute of Cardiology Ignacio Chavez Mexico City Mexico

Introduction: Congenitally corrected transposition of the great arteries (CCTGA) is a rare heart disease that encompasses an atrioventricular and ventriculoarterial discordance and accounts for less than 1 percent of congenital heart diseases. Objective: To present an atypical case of a man with complex congenital heart disease and conduction anomalies. Case Presentation: This is a case of a 34-year-old patient who came to the hospital with 1 week of dyspnea on exertion and episodes of lipothymia. The patient was referred to our hospital after an electrocardiogram from his primary care with evidence of blocked atrial fibrillation. During the initial evaluation blocked atrial fibrillation was confirmed with a rescue ventricular rate of 38 bpm. A magnetic resonance confirmed the presence of the atrioventricular and ventriculoarterial discordance, the aorta had a left anterior position, perimembranous ventricular septal defect with a right to left shunt, biventricular systolic dysfunction, moderate tricuspid, and mitral regurgitation, interventricular septal intramyocardial and biatrial fibrosis, left atrial dilation, and dilation of the pulmonary artery. After pacemaker placement, the patient has an improvement in his clinical symptoms and quality of life. Conclusions: Cardiac arrhythmias are CCTGA’s leading cause of death, mostly ventricular tachycardia, and atrial fibrillation. Right bundle branch block is a previously unreported and potentially very rare presentati

关键词： Congenital Heart Disease Congenitally Corrected Transposition of the Great Arteries Cardiac Magnetic Resonance Echocardiography Arrhythmia

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Interferon Regulatory Factor 5 and Renin-Angiotensin-Aldosterone System Polymorphisms in Coronary Artery Disease: An Overview of Experimental and Clinical Studies

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World Journal of Cardiovascular Diseases 2021年第7期11卷 332-341页

作者： Jorge Luis Bermudez-Gonzalez Rodrigo Dagio-Cuellar Cristina Villarreal-Guerrero Ana Gilabert-Garcia Luis Angel Ferral-Barbabosa Joaquin Berarducci Jose Luis Siller-Nava Jose antonio luna-Alvarez-Amezquita Javier Iván Armenta-Moreno Nilda Espínola-Zavaleta Erick Alexanderson-Rosas Juan Ignacio Straface National Institute of Cardiology Ignacio Chavez Mexico City Mexico Medicine Faculty of National Autonomous University of Mexico Mexico City Mexico

Heart diseases are the main cause of mortality in Mexico, being coronary heart disease the most frequent in the country. Its high prevalence makes important the study of the pathophysiology and the search for prognostic factors. Different genes and polymorphisms promote atherogenesis and coronary artery disease, they affect inflammatory and vascular pathological processes. Interferon regulatory factor 5 (IRF5) is associated with coronary heart disease, it promotes chronic inflammation and cytokines release;it could trigger immune reactions and its activating receptors express in the vascular endothelium. Besides, polymorphisms in the renin-angiotensin-aldosterone system (RAAS) are implied with coronary disease, they are found in angiotensinogen (AGT), angiotensin II type 1 receptor (AT1R), angiotensin II type 2 receptor (AT2R), and angiotensin-converting enzyme (ACE) genes. These genetic polymorphisms are associated with a prothrombotic state, endothelial dysfunction, and immune activation. Multiple experimental studies showed that chronic activation of RAAS and chronic expression of IRF5 generates an environment prone to the development of atherosclerosis, and autoimmune and cardiovascular diseases. Studying these specific genes and their relationship with coronary heart disease will allow a better understanding of the pathological process and possibly the quest for new treatments.

关键词： Interferon Regulatory Factor 5 (IRF5) Angiotensin-Converting Enzyme (ACE) Angiotensinogen (AGT) Angiotensin II Type 1 Receptor (AT1R) Angiotensin II Type 2 Receptor (AT2R) Polymorphisms

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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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