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Impact of minimally invasive surgery on the treatment of benign esophageal disorders

World Journal of Gastroenterology 2012年第46期18卷 6764-6770页

作者： Brian Bello fernando A Herbella Marco E Allaix Marco G Patti Department of Surgery University of Chicago Pritzker School of Medicine

Thanks to the development of minimally invasive surgery, the last 20 years have witnessed a change in the treatment algorithm of benign esophageal disorders. Today a laparoscopic operation is the treatment of choice for esophageal achalasia and for most patients with gastroesophageal reflux disease. Because the pathogenesis of achalasia is unknown, treatment is palliative and aims to improve esophageal emptying by decreasing the functional obstruction at the level of the gastro-esophageal junction. The refinement of minimally invasive techniques accompanied by large, multiple randomized control trials with long-term outcome has allowed the laparoscopic Heller myotomy and partial fundoplication to become the treatment of choice for achalasia compared to endoscopic procedures, including endoscopic botulinum toxin injection and pneumatic dilatation. Patients with suspected gastroesophageal reflux need to undergo a thorough preoperative workup. After establishing diagnosis, treatment for gastroesophageal reflux should be individualized to patient characteristics and a decision about an operation made jointly between surgeon and patient. The indications for surgery have changed in the last twenty years. In the past, surgery was often considered for patients who did not respond well to acid reducing medications. Today, the best candidate for surgery is the patient who has excellent control of symptoms with proton pump inhibitors. The minimally invasive approach to antireflux surgery has allowed surgeons to control reflux in a safe manner, with excellent long term outcomes. Like achalasia and gastroesophageal reflux, the treatment of patients with paraesophageal hernias has also seen a major evolution. The laparoscopic approach has been shown to be safe, and durable, with good relief of symptoms over the long-term. The most significant controversy with laparoscopic paraesophageal hernia repair is the optimal crural repair. This manuscript reviews the evolution of these tec

关键词： Gastroesophageal reflux disease Esophageal achalasia Hiatal hernia Laparoscopic fundoplication Laparoscopic Heller myotomy

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Maintaining flexibility in smart grid consumption through deep learning and deep reinforcement learning

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Energy and AI 2023年第3期13卷 137-148页

作者： fernando Gallego Cristian Martin Manuel Diaz Daniel Garrido ITIS Software Institute University of MalagaMalagaSpain

The smart grid concept is key to the energy revolution that has been taking place in recent *** Grids have been present in energy research since their ***,the scarcity of data from different energy sources,hardware power,or co-simulation environments has hindered their *** advances in multi-agent-based systems,the possibility of simulating the behavior of different energy sources,combining real building consumption,and simulated data,storage batteries and vehicle charging points,has opened *** development has resulted in much research published using both simulated and physical *** these investigations show that the main problem is that the machine learning algorithms do not fully match the real behavior,it is complex to use them to replicate the different actions to be *** paper aims to combine the approach of behavior prediction with state-of-the-art techniques,such as deep learning and deep reinforcement learning,to simulate unknown or critical system scenarios.A very important element in smart grids is the possibility of maintaining consumption within specific ranges(flexibility).For this purpose,we have made use of Tensorflow libraries that predict energy consumption and deep reinforcement learning to select the optimal actions to be performed in our *** developed platform is flexible enough to include new technologies such as smart batteries,electric vehicles,etc.,and it is oriented to real-time operation,being applied in an on-going real project such as the European ebalance-plus project.

关键词： Multi-agent based system Smart grid Distributed energy resources

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Blood transfusion for the treatment of acute anaemia in inflammatory bowel disease and other digestive diseases

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World Journal of Gastroenterology 2009年第37期15卷 4686-4694页

作者： José Antonio García-Erce fernando Gomollón Manuel Muoz Transfusion Medicine and Apheresis Unit Haematology and Haemotherapy Regional Service "Miguel Servet" University Hospital Zaragoza 50009 Spain Gastroenterology Unit University Clinical Hospital and Biomedical Investigation Center at Digestive and Hepatic Disease Network c/San Juan Bosco 15 Zaragoza 50009 Spain Transfusion Medicine School of Medicine University of Málaga Málaga 29071 Spain

Allogeneic blood transfusion (ABT) is frequently used as the first therapeutic option for the treatment of acute anaemia in patients with inflammatory bowel disease (IBD), especially when it developed due to gastrointestinal or perioperative blood loss, but is not risk-free. Adverse effects of ABT include, but are not limited to, acute hemolytic reaction (wrong blood or wrong patient), febrile non-hemolytic transfusional reaction, bacterial contamination, transfusion-related acute lung injury, transfusion associated circulatory overload, transfusion-related immuno-modulation, and transmission of almost all infectious diseases (bacteria, virus, protozoa and prion), which might result in increased risk of morbidity and mortality. Unfortunately, the main physiological goal of ABT, i.e. to increase oxygen consumption by the hypoxic tissues, has not been well documented. In contrast, the ABT is usually misused only to increase the haemoglobin level within a f ixed protocol [mostly two by two packed red blood cell (PRC) units] independently of the patient' s tolerance to normovolemic anaemia or his clinical response to the transfusion of PRC units according to a "one-by-one" administration schedule. Evidencebased clinical guidelines may promote best transfusion practices by implementing restrictive transfusion protocols, thus reducing variability and minimizing the avoidable risks of transfusion, and the use of autologous blood and pharmacologic alternatives. In this regard, preoperative autologous blood donation (PABD) consistently diminished the frequency of ABT, although its contribution to ABT avoidance is reduced when performed under a transfusion protocol. In addition, interpretation of utility of PABD in surgical IBD patients is hampered by scarcity of published data. However, the role of autologous red blood cells as drug carriers is promising. Finally, it must be stressed that a combination of methods used within wellconstructed protocols will offer better prospe

关键词： Anaemia Blood transfusion Autologous blood transfusion Inflammatory bowel diseases Risk assessment

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An approach to viscoelastic c haracterization of dispersive media by inversion of a general wave propagation model

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Journal of Innovative Optical Health Sciences 2017年第6期10卷 73-88页

作者： fernando Zvietcovich Jannick P.Rolland Kevin J.Parker Department of Electrical and Computer Engineering University of Rochester Rochester New York 14627USA The Institute of Optics University of Rochester Rochester New York 14627USA

In the characterization of elastic properties of tissue using dynarmic optical coherence elasto-graphy,shear/surface waves are propagated and tracked in order to estimate speed and Y oung's ***,for dispersive tssues,the displacement pulse is highly damped and distorted during propagation,diminishing the ffectiveness of peak tracking approaches,and leading to biased cstimates of wave ***,plane wave propagation is sometimes assumed,which contributes to estimation ***,we invert a wave propagation model that incorpo-rates propagation,decay,and distortion of pulses in a dispersive media in order to accurately estimate its elastic and viscous *** model uses a general first-order approximation of dispersion,avoiding the use of any particular rheological model of *** are conducted in elastic and viscoelastic tissue mimicking phantoms by producing a Gaussian push using acoustic radiation force excitation and measuring the wave propagation using a Fourier domain optical coherence tomography *** confirmed the ffectiveness of the inversion method in est imat ing viscoelastic parameters in both the viscoelastic and elastic phantoms when compared to mechanical ***,the viscoelastic characterization of a fresh porcine comea was *** results validate this approach when compared to other methods.

关键词： Elastography viscoelasticity cylindrical waves optical coherence tomography shear waves surface acoustic waves viscoelastic pha ntoms

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A Clearinghouse for Genome-Edited Crops and Field Testing

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Molecular Plant 2021年第1期14卷 3-5页

作者： Angela fernando Michael Selvaraj Paul Chavarriaga Sandra Valdes Joe Tohme The Alliance of Bioversity International and International Center for Tropical Agriculture(CIAT) Km 17 Recta Cali-PalmiraApartado Aereo 6713763537 CaliColombia

Latin America was commonly called"sleeping giant"for its humid tropics and land base relative to its population *** International Center for Tropical Agriculture(ClAT,*** Spanish acronym)was initiated in 1967 to serve three important zones-coastal plains,savannahs,and“hot,humid jungles.”In line,the research areas were organized to be fitted as appropriate into these important ecological *** the 50 years,CIAT has been a forerunner in developing and disseminating improved crop varieties and agricultural technologies,including its pioneering approaches in the tropics.

关键词： initiated fitted plain

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The power of phenomics:Improving genebank value and utility

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Molecular Plant 2023年第7期16卷 1099-1101页

作者： Ezhilmathi Angela Joseph fernando Michael Selvaraj Kioumars Ghamkhar The Aliance of Bioversity International and International Center for Tropical Agriculture(CIAT) Km 17 Recta Cali-PalmiraApartado Aereo 6713Cali 763537Colombia AgResearch Grasslands Research CentrePalmerston NorthNew Zealand

Genebanks are considered the"crown jewels"of research organizations,as they safeguard valuable plant genetic resources and address the emerging challenges posed by climate-related constraints(Anglin et al.,2018).Currently,7.4 million accessions have been conserved in 1750 gene banks *** these,only 10%are being used for crop improvement(Commission on Genetic Resources for Food and Agriculture,2010).The limited availability of passport data and the challenge of characterizing trait attributes of accessions at large scale are some of the challenges to relate their true value(Tadesse et al.,2019).Obtaining traits such as agronomic or nutritional characteristics requires extensive field phenotyping and multiple site testing over several *** will create value with accurate evaluation of genotype-by-environmental variation in a given *** use of low-cost high-throughput phenotyping(HTP)methods to characterize the genotypic and phenotypic representations of genebank genetic resources,otherwise known as genebank phenomics,will help in understanding crops'potential for use in breeding programs with desirable traits.

关键词： breeding crops value

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The ecological scale mediates whether trees experience drought legacies in radial growth

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Forest Ecosystems 2023年第3期10卷 298-306页

作者： Héctor Hernández-Alonso Jaime Madrigal-González fernando Silla Area of Ecology Faculty of BiologyUniversidad de SalamancaE-37007SalamancaSpain iuFOR-EiFAB Campus de SoriaUniversidad de ValladolidE-42004SoriaSpain

The impact of lag effects produced by disturbances on primary production has been a major concern among ecologists during the last *** and extreme climatic events are imposing drastic reductions in radial growth of trees as evidenced in tree-rings series Dendrochronological samples are obtained at tree level but analyzed at an aggregated scale(i.e.,mean chronologies),although aggregating tree-ring chronology on a regional scale may reduce the possibility of studying the variability of individual tree response to drought,by amplifying the average population ***,we conducted experimental research in which 370 trees of 5 species were analyzed to assess the potential statistical and scaling issues that may occur when using regressionbased methods to analyze ecosystem responses to *** legacy effects were quantified using individual and aggregated ***,lag effects were validated using confidence and prediction intervals to identify values falling outside the certainty of the climate-growth model Individual scale legacy effects contrasted with confidence intervals were commonly distributed across species but were scarce when compared with prediction *** analysis of aggregated scale legacies detected significant growth reductions when validated using prediction intervals;however,individual scale legacy lag effects were not *** finding directly contrasts the results obtained when using an aggregated *** results provide empirical evidence on how aggregating ecological data to infer processes that emerge from an individual scale can lead to distorted *** therefore encourage the use of individual based statistical and ecological procedures to analyze tree rings as a means of further understanding the ecosystem responses to disturbances.

关键词： Legacy effects Drought disturbances Tree growth Tree-ring width Dendrochronology Individual scale Mountainous forests

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Scalar and Dirac quasinormal modes of scalar-tensor-Gauss-Bonnet black holes

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Chinese Physics C 2022年第4期46卷 156-163页

作者： Tong-Zheng Wang Wei-Liang Qian Juan fernando Zapata Zapata Kai Lin Hubei Subsurface Multi-scale Imaging Key Laboratory Institute of Geophysics and GeomaticsChina University of GeosciencesWuhan 430074China Escola de Engenharia de Lorena Universidade de São Paulo12602-810LorenaSPBrazil Faculdade de Engenharia de Guaratinguetá Universidade Estadual Paulista12516-410GuaratinguetáSPBrazil Center for Gravitation and Cosmology College of Physical Science and TechnologyYangzhou UniversityYangzhou 225009China

This study explores the scalar and Dirac quasinormal modes pertaining to a class of black hole solutions in the scalar-tensor-Gauss-Bonnet *** black hole metrics in question are novel analytic solutions recently derived in the extended version of the theory,which effectively follows at the level of the action of string *** to the existence of a nonlinear electromagnetic field,the black hole solution possesses a nonvanishing magnetic *** particular,the metric is capable of describing black holes with distinct characteristics by assuming different values of the ADM mass and the magnetic *** study investigates the scalar and Dirac perturbations in these black hole spacetimes;in particular,we focus on two different types of solutions,based on distinct horizon *** properties of the complex frequencies of the obtained dissipative oscillations are investigated,and the stability of the metric is subsequently *** also elaborate on the possible implications of this study.

关键词： quasinormal modes scalar-tensor-Gauss-Bonnet theory modified gravity

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Checkpoint inhibitor-induced hepatotoxicity:Role of liver biopsy and management approach

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World Journal of Hepatology 2022年第7期14卷 1269-1276页

作者： fernando Bessone Einar Stefan Bjornsson Department of Gastroenterology and Hepatology Facultad de Ciencias MédicasHospital Provincial del CentenarioUniversity of Rosario School of MedicineRosario 2000Santa FeArgentina Department of Gastroenterology Natl Univ Hosp IcelandSect Gastroenterol&HepatolDept Internal MedHringbraut 11DIS-101 ReykjavikIceland Landspitali University Hospital and Faculty of Medicine University of IcelandReykjavik Postal code 101State of ReykjavikIceland

Immunological checkpoint inhibitors(ICIs)have revolutionized therapy of many different *** immune-mediated adverse effects are common and can affect many organs such as the skin,lungs,gastrointestinal and endocrine organs as well as the *** injury has been reported in 3%-8%of patients with grade III-IV hepatitis in retrospective *** liver injury is characterized by hepatocellular injury resembling autoimmune hepatitis biochemically but not immunologically as patients with ICI induced hepatoxicity rarely have auto-antibodies or IgG *** role for liver biopsy(LB)in patients with suspected liver injury due to ICIs is controversial and it is not clear whether results of a LB will change clinical *** can be helpful when there is diagnostic uncertainty and pre-existing liver disease is *** there are no distinctive histological features,the finding of granulomas and endothelitis may suggest a specific type of hepatitis induced by *** natural history of hepatotoxicity of ICI therapy is not well *** studies have demonstrated that 33%-50%of patients improve spontaneously with discontinuation of *** patients with jaundice and/or coagulopathy corticosteroids are *** high doses of corticosteroids with 1-2 mg/kg/d of methylprednisolone recommended by the oncological societies are *** it has shown that initial treatment with 1 mg/kg/d provided similar liver tests improvement which was also associated with a reduced risk of steroid-induced adverse effects in comparison with higher-dose *** immunosuppression mostly with mycophenolate mofetil has been reported to be helpful.

关键词： Hepatotoxicity Checkpoint inhibitors Biologics hepatitis Drug-induced liver injury Liver biopsy

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TopSTO:a 115-line code for topology optimization of structures under stationary stochastic dynamic loading

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Earthquake Engineering and Engineering Vibration 2023年第4期22卷 1081-1100页

作者： Sebastian Pozo fernando Gomez Thomas Golecki Juan Carrion Billie F.Spencer Jr. Civil and Environmental Engineering University of Illinois at Urbana-ChampaignUrbana 61801ILUSA College of Science and Engineering Universidad San Francisco de QuitoDiego de Robles y Vía InteroceanicaQuitoEcuador Skidmore Owings&MerrillLLPChicago 60604ILUSA Department of Civil Engineering University of CuencaCuencaEcuador

The use of topology optimization in structural design under dynamic excitation is becoming more prevalent in the *** many such applications utilize frequency or time domain formulations,relatively few consider stochastic dynamic *** paper presents an efficient and compact code called TopSTO for structural topology optimization considering stationary stochastic dynamic loading using a method derived from random vibration *** theory,described in conjunction with the implementation in the provided code,is illustrated for a seismically excited *** work demonstrates the efficiency of the approach in terms of both the computational resources and minimal amount of code *** code is intended to serve as a baseline for understanding the theory and implementation of this topology optimization approach and as a foundation for additional applications and developments.

关键词： topology optimization stochastic dynamics matlab python

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