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Role of high definition colonoscopy in colorectal adenomatous polyp detection

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World Journal of Gastroenterology 2011年第35期17卷 4001-4006页

作者： Tolga Erim John M Rivas Evelio Velis fernando castro Department of Gastroenterology Cleveland Clinic FloridaWestonFL 33331United States Department of Internal Medicine Cleveland Clinic FloridaWestonFL 33331United States Health Services Administration Master Program Barry UniversityMiami ShoresFlorida 33161United States

AIM:To investigate the rates of polyp detection in a mixed risk population using standard definition (SDC) vs high definition colonoscopes (HDC).METHODS:This was a retrospective cohort comparative study of 3 colonoscopists who each consecutively performed 150 SDC (307,200 pixel) and 150 HDC (792,576 pixels) in a community teaching ***:A total of 900 colonoscopies were evaluated (mean age 56,46.8% men),450 with each *** of any type were detected in 46.0% of patients using SDC and 43.3% with HDC (P=0.42).There was no significant difference between the overall number of polyps,HDC (397) and SDC (410),detected among all patients examined,(P=0.73).One or more adenomatous polyps were detected in 24.2% of patients with HDC and 24.9% of patients with SDC colonoscopy (P=0.82).There was no significant difference between HDC (M=0.41) and SDC (M=0.42) regarding adenomatous polyp (P=0.88) or advanced adenoma (P=0.56) detection rate among all patients ***:HDC did not improve yield of adenomatous polyp,advanced adenoma or overall polyp detection in a population of individuals with mixed risk for colorectal cancer.

关键词： High definition colonoscopy Colon cancer screening Adenomatous polyps

Lupus enteritis as the only active manifestation of systemic lupus erythematosus: A case report

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World Journal of Clinical Cases 2019年第11期7卷 1315-1322页

作者： Adalberto Gonzalez Vaibhav Wadhwa Fayssa Salomon Jeevna Kaur fernando J castro Department of Internal Medicine Cleveland Clinic Florida Weston FL 33331 United States Department of Gastroenterology and Hepatology Cleveland Clinic Florida Weston FL 33331 United States

BACKGROUND Lupus enteritis is a rare manifestation of systemic lupus erythematosus (SLE). Diagnosis of this condition is difficult, especially in the absence of other symptoms related to active SLE. We present the case of a 25-year-old female with lupus enteritis as the sole initial manifestation of active SLE. CASE SUMMARY A 25-year-old African American female presented to the Emergency Department complaining of diffuse abdominal pain, diarrhea, nausea, and vomiting for 2 days. Her past medical history was significant for seasonal allergies and family history was pertinent for discoid lupus in her father and SLE in a cousin. The patient’s vital signs on presentation were normal. Her physical exam was remarkable for significant lower abdominal tenderness without guarding or rigidity. A computed tomography of the abdomen and pelvis revealed marked circumferential wall thickening and edema of the proximal and mid small bowel predominantly involving the submucosa. Our main differential diagnoses were intestinal angioedema and mesenteric vein thrombosis. However, mesenteric vessels were patent, and laboratory testing for hereditary angioedema showed a normal C1 Esterase Inhibitor level and low C3 and C4 levels. Infectious work-up was negative. Autoimmune tests showed elevated anti-nuclear antibodies (ANA)(13.6), anti-Smith antibody, and anti-ribonucleoprotein (anti-RNP) antibody. The patient was diagnosed with SLE enteritis. She was maintained on bowel rest, given intravenous hydration, and started on methylprednisolone 60 mg IV daily. She had significant improvement in her abdominal pain, diarrhea, and emesis after 2 days of treatment. Steroids were tapered and maintained on Hydroxychloroquine with no relapses one year after *** This case of lupus enteritis represents a rare manifestation of SLE. Diagnosis requires clinical suspicion, characteristic imaging and laboratory tests. Endoscopic appearance and biopsies usually yield non-specific findings.

关键词： Lupus enteritis Systemic lupus erythematous Abdominal pain Hereditary angioedema Case report

Damage-associated molecular patterns in inflammatory bowel disease:From biomarkers to therapeutic targets

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World Journal of Gastroenterology 2018年第41期24卷 4622-4634页

作者： Hayandra Ferreira Nanini Claudio Bernardazzi fernando castro Heitor Siffert Pereira de Souza Servico de Gastroenterologia e Laboratorio Multidisciplinar de Pesquisa Departamento de Clinica MedicaHospital Universitario Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroRJ 21941-913Brazil D’Or Institute for Research and Education(IDOR) Rua Diniz Cordeiro 30BotafogoRio de JaneiroRJ 22281-100Brazil

The chronic inflammatory process underlying inflammatory bowel disease (IBD), comprising Crohn's disease and ulcerative colitis, derives from the interplay of several components in a genetically susceptible host. These components include environmental elements and gut microbiota a dysbiosis. For decades, immune abnormalities have been investigated as critically important in IBD pathogenesis, and attempts to develop effective therapies have predominantly targeted the immune system. Nevertheless, immune events represent only one of the constituents contributing to IBD pathogenesis within the context of the complex cellular and molecular network underlying chronic intestinal inflammation. These factors need to be appreciated within the milieu of nonimmune components. Damage-associated molecular patterns (DAMPs), which are essentially endogenous stress proteins expressed or released as a result of cell or tissue damage, have been shown to act as direct proinflammatory mediators. Excessive or persistent signalling mediated by such molecules can underlie several chronic inflammatory disorders, including IBD. The release of endogenous DAMPs amplifies the inflammatory response driven by immune and non-immune cells and promotes epigenetic reprogramming in *** effects determine pathologic changes,which may sustain chronic intestinal inflammation and also underlie specific disease *** addition to highlighting the potential use of DAMPs such as calprotectin as biomarkers,research on DAMPs may reveal novel mechanistic associations in IBD pathogenesis and is expected to uncover putative therapeutic targets.

关键词： Damage-associated molecular patterns Environmental factors Epigenetics Inflammatory bowel disease Therapeutic targets

The first meteorological observations at a tropical high elevation site:Antisana,1846

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Journal of Mountain Science 2016年第6期13卷 1047-1055页

作者： Aria Ma M.FARRONA fernando DOMINGUEZ-castro Ma Cruz GALLEGO Jose M.VAQUERO Departamento de Fisica Facultad de CienciasUniversidad de ExtremaduraBadajoz 06071Spain Instituto de Fisica de Cantabria(UC-CSIC) Santander 39005Spain Departamento de Ingenieria Civily Ambiental Escuela Politecnica NacionalQuito 170112Ecuador Instituto Nacional de Meteorologiae Hidrologia Quito 170135Ecuador instituto universitario de investigación del agua cambio climático y sostenibilidad (iacys) universidad de extremaduraBadajoz 06071，Spain departamento de física centro universitario de mérida universidad de extremaduraMerida 06800Spain

Antisana is a stratovolcano with an associated glacier located in the Ecuadorian Andes. Dr Aguirre made meteorological readings every day, at every hour from sunrise to sunset, from December 1845 to December 1846, at Antisana using a meteorological station at 4060 mamsl （meters above mean sea level）. Unfortunately, only the monthly average data have been preserved. These meteorological data are here studied and compared with the closest modern stations for monthly values of temperature, rainfall, and pressure. According to these comparisons, the year 1846 was rainy and cold in comparison with the current climate. Moreover, these observations have been useful to help resolve a debate about a possible E1Nifio event in 1846 with the high precipitation in Antisana and Quito in 1846 discarding the occurrence of an E1 Nifio event. The probable occurrence of a La Nifia event is discussed. These data are the earliest known systematic instrumental meteorological observations taken at above 4000 mamsl.

关键词： Early instrumental records Glacier Pastclimate conditions

Development of a warning score for early detection of colorectal anastomotic leakage:Hype or hope?

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World Journal of Gastrointestinal Surgery 2022年第11期14卷 1297-1309页

作者： Nuno J G Rama Óscar Lourenço Patrícia C Motta Lima Maria Pedro S Guarino Diana Parente Ricardo castro Ana Bento Anabela Rocha fernando castro-Poças João Pimentel Division of Colorectal Surgical Leiria Hospital CentreLeiria 2410-021Portugal Abel Salazar Biomedical Institute University of OportoOporto 4099-002Portugal Center for Innovative Care and Health Technology(ciTechCare) Polytechnic of LeiriaLeiria 2410-541Portugal Faculty of Economics CeBERUniversity of CoimbraCoimbra 3000-137Portugal Division of Clinical Pathology Leiria Hospital CentreLeiria 2410-541Portugal Division of Surgical Oporto Hospital CentreOporto 4099-001Portugal Department of Gastroenterology Santo António HospitalPorto Hospital CenterOporto 4099-001Portugal Institute of Biomedical Sciences Abel Salazar University of OPortoOporto 4099-001Portugal Faculty of Medicine University of CoimbraCoimbra 3004-531Portugal Division of Surgical Montes Claros HospitalCoimbra 3030-320Portugal

BACKGROUND Colorectal anastomotic leakage(CAL),a severe postoperative complication,is associated with high morbidity,hospital readmission,and overall healthcare *** detection of CAL remains a challenge in clinical ***,some decision models have been developed to increase the diagnostic accuracy of this *** To develop a score based on easily accessible variables to detect CAL *** Based on the least absolute shrinkage and selection operator method,a predictive classification system was developed[Early ColoRectAL Leakage(E-CRALL)score]from a prospective observational,single center cohort,carried out in a colorectal division from a non-academic *** score performance and CAL threshold from postoperative day(POD)3 to POD5 were *** on a precise analytical decision model,the standard clinical practice was compared with the E-CRALL adoption on POD3,POD4,or POD5.A cost-minimization analysis was conducted,on the assumption that all alternatives delivered similar health-related *** In this study,396 patients who underwent colorectal resection surgery with anastomosis,and 6.3%(n=25)developed *** of the patients who developed CAL(n=23;92%)were diagnosed during the first hospital admission,with a median time of diagnosis of 9.0±6.8 *** POD3 to POD5,the area under the receiver operating characteristic curve of the E-CRALL score was 0.82,0.84,and 0.95,*** POD5,if a threshold of 8.29 was chosen,87.4%of anastomotic failures were identified with E-CRALL ***,score usage could anticipate CAL diagnosis in an average of 5.2 d and 4.1 d,if used on POD3 and POD5,*** of score adoption,episode comprehensive costs were markedly greater(up to four times)in patients who developed CAL in comparison with patients who did not develop ***,the use of the E-CRALL warning score was associated with cost savings of€421442.20,with most(92.9%)of the savings from patients

关键词： Anastomotic leakage Colorectal Surgery Biomarkers Score Costs

Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage:A prospective observational study

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World Journal of Gastroenterology 2022年第24期28卷 2758-2774页

作者： Nuno J G Rama Marlene C C Lages Maria Pedro S Guarino Óscar Lourenço Patrícia C Motta Lima Diana Parente Cândida S G Silva Ricardo castro Ana Bento Anabela Rocha fernando castro-Pocas João Pimente Colorectal Surgical Division Leiria Hospital CentreLeiria 2410-021Portugal Abel Salazar Biomedical Institute(ICBAS) University of OportoOporto 4099-002Portugal Center for Innovative Care and Health Technology(ciTechCare) Polytechnic of LeiriaLeiria 2410-541Portugal Faculty of Economics CeBERUniversity of CoimbraCoimbra 3000-137Portugal Clinical Pathology Division Leiria Hospital CentreLeiria 2410-541Portugal Surgical Division Oporto Hospital CentreOporto 4099-001Portugal Department of Gastroenterology Santo António HospitalPorto Hospital CenterPorto 4099-001Portugal Institute of Biomedical Sciences Abel Salazar University of PortoPorto 4099-001Portugal Faculty of Medicine University of CoimbraCoimbra 3004-531Portugal Surgical Division Montes Claros HospitalCoimbra 3030-320Portugal

BACKGROUND Colorectal anastomotic leakage(CAL)is one of the most dreaded complications after colorectal surgery,with an incidence that can be as high as 27%.This event is associated with increased morbidity and mortality;therefore,its early diagnosis is crucial to reduce clinical consequences and *** biomarkers have been suggested as laboratory tools for the diagnosis of *** To assess the usefulness of plasma C-reactive protein(CRP)and calprotectin(CLP)as early predictors of *** A prospective monocentric observational study was conducted including patients who underwent colorectal resection with anastomosis,from March 2017 to August *** were divided into three groups:G1–no complications;G2–complications not related to CAL;and G3–*** biomarkers were measured and analyzed in the first 5 postoperative days(PODs),namely white blood cell(WBC)count,eosinophil cell count(ECC),CRP,CLP,and procalcitonin(PCT).Clinical criteria,such as abdominal pain and clinical condition,were also *** correlation between biomarkers and CAL was *** operating characteristic(ROC)curve analysis was used to compare the accuracy of these biomarkers as predictors of CAL,and the area under the ROC curve(AUROC),specificity,sensitivity,positive predictive value,and negative predictive value(NPV)during this period were *** In total,25 of 396 patients developed CAL(6.3%),and the mean time for this diagnosis was 9.0±6.8 *** operative characteristics,such as surgical approach,blood loss,intraoperative complications,and duration of the procedure,were notably related to the development of *** length of hospital stay was markedly higher in the group that developed CAL compared with the group with complications other than CAL and the group with no complications(median of 21 d vs 13 d and 7 d respectively;P<0.001).For abdominal pain,the best predictive performance was on POD4 and POD5,with the largest AUROC of 0.84 on ***

关键词： Anastomotic leakage Colorectal Surgery Biomarkers C-reactive protein Calprotectin

Comparison between metabolic-associated fatty liver disease and nonalcoholic fatty liver disease:From nomenclature to clinical outcomes

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World Journal of Hepatology 2023年第4期15卷 477-496页

作者： Mohammad Alomari Mamoon Ur Rashid Pravallika Chadalavada Jonathan Ragheb Hammad Zafar Zoilo Karim Suarez Shrouq Khazaaleh Adalberto Jose Gonzalez fernando J castro Department of Gastroenterology and Hepatology Cleveland Clinic FloridaWestonFL 33331United States Department of Internal Medicine Florida Atlantic University Charles E Schmidt College of MedicineBoca RatonFL 33431United States Department of Internal Medicine Cleveland Clinic Fairview HospitalClevelandOH 44126United States

As a result of the obesity epidemic,Nonalcoholic fatty liver disease(NAFLD)and its complications have increased among millions of ***,a group of experts recommended changing the term NAFLD to an inclusive terminology more reflective of the underlying pathogenesis;metabolic-associated fatty liver disease(MAFLD).This new term of MAFLD has its own disease epidemiology and clinical outcomes prompting efforts in studying its differences from *** article discusses the rationale behind the nomenclature change,the main differences,and its clinical implications.

关键词： Metabolic associated fatty liver disease Non alcoholic fatty liver disease Fatty liver disease Obesity Diabetes mellitus

Benthic Diversity of Sessile Organisms in Rocky Reef Habitats of Coastal Brazil: An Insight into the Implementation of Marine Protected Areas

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Natural Resources 2018年第12期9卷 404-412页

作者： Ralf Riedel fernando castro-Cardoso Gabriel Correal Mauricio Mata Jr. Project Grouper ATEVI Ilhabela Brazil

Marine Protected Areas are increasingly becoming a tool of choice for conservation and management of marine resources and ecosystems. Data on biodiversity are necessary to assist in establishing protected areas for conservation objectives to be met. Toward that effect, we investigated reef biodiversity patterns in three large-scale coastal regions of Brazil. The study areas comprised of an upwelling region, an adjacent high impacted region, and a more distant marine park. We surveyed four reef sites in each study region. Species counts of sessile benthic organisms, substrate relief, and average monthly water temperatures were recorded during the surveys. Benthic organisms were identified to the lowest taxa possible using still photos. Biodiversity was estimated using Shannon’s index on richness of organism taxa. Diversity was highest at the upwelling and high-impacted areas. No substrate relief patterns were found. Temperature readings showed lower average values at the upwelling and high impacted regions. Our results favor the upwelling region for establishment of a Marine Protected Area. Moreover, the similar diversity between the upwelling and the high impacted regions showed evidence of spillover effects from the former into the latter region, further demonstrating the importance of the former region for conservation.

关键词： Conservation Marine Protected Areas Biodiversity Reefs Benthic Brazil Coastal Habitat

Body mass index and colon cancer screening:The road ahead

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World Journal of Gastroenterology 2015年第5期21卷 1372-1376页

作者： Kanwarpreet Tandon Mohamad Imam Bahaa Eldeen Senousy Ismail fernando castro Department of Gastroenterology Cleveland Clinic FloridaWestonFL 33331United States Department of Internal Medicine University of North DakotaFargoND 58202United States

Screening for colorectal cancer(CRC) has been associated with a decreased incidence and mortality from ***,patient adherence to screening is less than desirable and resources are limited even indeveloped *** identification of individuals at a higher risk could result in improved screening *** the past few years,formulas have been developed to predict the likelihood of developing advanced colonic neoplasia in susceptible individuals but have yet to be utilized in mass screening *** models use a number of clinical factors that have been associated with colonic neoplasia including the body mass index(BMI).Advances in our understanding of the mechanisms by which obesity contributes to colonic neoplasia as well as clinical studies on this subject have proven the association between BMI and colonic ***,there are still controversies on this subject as some studies have arrived at different conclusions on the influence of BMI by *** studies should aim at resolving these discrepancies in order to improve the efficiency of screening strategies.

关键词： Body mass index Colorectal cancer Colon cancer scr