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Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

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World Journal of Clinical Cases 2025年第3期13卷 35-41页

作者： Andres Fontalba-Navas francisco Pozo Muñoz Rogelio garcia Cisneros Maria jose garcia Larrosa Maria del Mar Callejon Gil Ignacio garcia Delgado Maria Belen Jimenez Martinez Antequera Hospital Northern Málaga Integrated Healthcare AreaAntequera 29200AndalusiaSpain Department of Public Health and Psychiatry University of MálagaMálaga 29010Spain Antequera Hospital Northern Málaga Antequera Integrated Healthcare AreaAntequera 29200MálagaSpain

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot *** diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient *** proven effective,this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid *** To evaluate the effectiveness of the high complexity unit(HCU)in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital *** The study employed a descriptive longitudinal approach,analyzing data from the Basic Minimum Data Set(BMDS)to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout *** HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity *** The study employed a descriptive longitudinal approach,analyzing data from the BMDS to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout *** HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity *** This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary *** coordinated care provided by the HCU results in improved patient outcomes,reduced unnecessary hospitalizations,and better management of patient *** superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction,reinforcing its value as a model of ca

关键词： High complexity unit Chronic multimorbidity Patient-centered care Integrated care Healthcare management

A SHORT NOTE ABOUT EXPOSED POINTS IN REAL BANACH SPACES

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Acta Mathematica Scientia 2008年第4期28卷 797-800页

作者： Antonio Aizpuru francisco J garcia-Pacheco Departamento de Matemá ticas Universidad de Cá diz Department of Mathematical Sciences Kent State University

We express the set of exposed points in terms of rotund points and non-smooth *** long as we have Banach spaces each time＂bigger＂,we consider sets of non-smooth points each time＂smaller＂.

关键词： Exposed point exposed face rotund point smooth point

Real-time cell analysis and heat shock protein gene expression in the TcA Tribofium castaneum cell line in response to environmental stress conditions

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Insect Science 2017年第3期24卷 358-370页

作者： Andres garcia-Reina Maria Juliana Rodriguez-garcia Guillermo Ramis jose Galian Department of Zoology and Physical Anthropology University of MurciaCampus Mare Nostrum E-30100 Murcia Spain Department of Animal Production Faculty of Veterinary University of MurciaCampus Mare Nostrum E-30100 Murcia Spain

The rust red flour beetle, Tribolium castaneum （Herbst, 1797）（Coleoptera： Tenebrionidae）, is a pest of stored grain and one of the most studied insect model species. Some of the previous studies involved heat response studies in terms of survival and heat shock protein expression, which are regulated to protect other proteins against environ- mental stress conditions. In the present study, we characterize the impedance profile with the xCELLigence Real-Time Cell Analyzer and study the effect of increased temperature in cell growth and viability in the cell line BCIRL-TcA-CLG 1 （TcA） of T castaneum. This novel system measures cells behavior in real time and is applied for the first time to insect cells. Additionally, cells are exposed to heat shock, increased salinity, acidic pH and UV-A light with the aim of measuring the expression levels of lisp27, Hsp68a, and Hsp83 genes. Results show a high thermotolerance of TeA in terms of cell growth and viability. This result is likely related to gene expression results in which a significant up-regulation of all studied Hsp genes is observed after 1 h of exposure to 40 ~C and UV light. All 3 genes show similar expression patterns, but Hsp27 seems to be the most affected. The results of this study validate the RTCA method and reveal the utility of insect cell lines, real-time analysis and gene expression studies to better understand the physiological response of insect cells, with potential applications in different fields of biology such as conservation biology and pest management.

关键词： environmental stress gene expression heat shock proteins insect cells,real-time cell analysis (RTCA) red flour beetle

COVID-19 pandemic,as experienced in the surgical service of a district hospital in Spain

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World Journal of Clinical Cases 2021年第23期9卷 6582-6590页

作者： francisco Javier Pérez Lara Maria Belen Jimenez Martinez francisco Pozo Muñoz Andres Fontalba Navas Rogelio garcia Cisneros Maria jose garcia Larrosa Ignacio garcia Delgado Maria del Mar Callejon Gil Department of Surgery Hopital de AntequeraAntequera 29200MálagaSpain North Malaga Healthcare District Hopital de AntequeraAntequera 29200MálagaSpain

The coronavirus disease 2019,which is caused by severe acute respiratory syndrome coronavirus 2,was first identified in December 2019 in Wuhan,China,and has since spread rapidly,evolving into a full-blown *** would like to report our experience after 1 year of this pandemic in the surgical service of a district hospital in *** have been many changes(including new protocols)that our service and the hospital have undergone,to adapt to the new *** believe that this experience can be useful for other professionals who have lived and are living a similar situation.

关键词： COVID-19 Hospital Experience Surgery Service Treatment

Some Comments on Zonal Polynomials and Their Expected Values with respect to ***

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Acta Mathematicae Applicatae Sinica 2017年第3期33卷 567-574页

作者： jose A.Diaz-garcia Ramon Gutierrez-Jaimez Department of Statistics and Computation Universidad Autonoma Agraria Antonio Narro25350 BuenavistaSaltilloCoahuilaMexico Department of Statistics and O.R University of GranadaGranada 18071Spain

In this paper, we give alternative proofs of some results in [15] （Li R.,1997） about the expected value of zonal polynomials.

关键词： elliptical matrix distributions random matrices zonal polynomials generalised Wishart distribution

Milk Yield of Holstein Cows Induced into Lactation Twice Consecutively and Lactation Curve Models Fitted to Artificial Lactations

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Journal of Integrative Agriculture 2014年第6期13卷 1349-1354页

作者： Jesus Mellado Edgar Sepulveda jose E garcia Alvaro Rodriguez Maria A De Santiago francisco G Veliz Miguel Mellado Department of Animal Nutrition Autonomous Agrarian University Antonio Narro Department of Veterinary Science Autonomous Agrarian University Antonio Narro

Nineteen multiparous barren Holstein cows were subjected to an induction of lactation protocol for 21 d administering estradiol cypionate （2 mg kg-1 of body weight （BW） d-1, on day 1 to 14）, progesterone （0.10 mg kg-1 of BW, on day 1 to 7）, lfumethasone （0.03 mg kg-1 of BW, on day 18 to 20） and recombinant bovine somatotropin （rbST;500 mg per cow, on day 1, 6, 16 and 21）. At the end of lactation and with a minimum of a 2-mon dry period, the same cows were again hormonally induced into lactation. Cows in both lactations were not artiifcially inseminated, they were milked 3 times daily and received rbST throughout lactation. Mean accumulated milk yield at 305 d in milk （DIM） did not differ between the ifrst and second induced lactations （（9 710 ＆#177;1 728） vs. （9 309＆#177;2 150） kg;mean＆#177;SD）. Total milk yield （（12 707＆#177;3 406） vs. （12 306＆#177;4 218） kg;mean＆#177;SD） and lactation length （（405＆#177;100） vs. （410＆#177;91） d;mean＆#177;SD） were not different between the ifrst and second induced lactations. In a second study, 15 empirical models including exponential, power law, yield-density, sigmoidal and miscellaneous models were compared for their suitability by modeling 12-mon （n=334）, 18-mon （n=164） and 29-mon （n=22） lactation cycles of Holsteins cows induced into lactation and treated with rbST throughout the lactation. Hoerl （Y=ab1/xxc）, Wood （Y=axb exp（cx）） and Dhanoa （Y=ax（bc）exp（cx）） models were equally suitable to describe 12-mon lactations. An exponential model with ifve parameters （Y=exp（a＋bx＋cd2＋e/x）） showed the best ift for milk yield for 18-mon lactations. The rational model （Y=a＋bx/1＋cx＋dx2） was found to produce the closest ift for 29-mon lactations. It was concluded that, with the protocol used in the present study, multiparous cows respond favorably to a second cycle of induced lactation, with milk yield similar to that experienced during the ifrst cycle. Thus, dairy producers might be able to lengthen the productive life of infertile high prod

关键词： lactation curve modeling extended lactations peak milk yield somatotropin Holstein cows

Importance of sperm morphology during sperm transport and fertilization in mammals

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Asian Journal of Andrology 2016年第6期18卷 844-850页

作者： francisco A garcia-Vazquez Joaquin Gadea Carmen Matas William V Holt Department of Physiology Faculty of Veterinary Science International Excellence Campus for Higher Education and Research 'Campus Mare Nostrum' University of Murcia Murcia 30100 Spain Institute for Biomedical Research of Murcia (IMIB-Arrixaca) Murcia Spain Department of Human Metabolism Academic Unit of Reproductive and Developmental Medicine Sheffield S10 2SF UK

After natural or artificial insemination, the spermatozoon starts a journey from the site of deposition to the place of fertilization. However, only a small subset of the spermatozoa deposited achieves their goal： to reach and fertilize the egg. Factors involved in controlling sperm transport and fertilization include the female reproductive tract environment, cell-cell interactions, gene expression, and phenotypic sperm traits. Some of the significant determinants of fertilization are known （i.e., motility or DNA status）, but many sperm traits are still indecipherable. One example is the influence of sperm dimensions and shape upon transport within the female genital tract towards the oocyte. Biophysical associations between sperm size and motility may influence the progression of spermatozoa through the female reproductive tract, but uncertainties remain concerning how sperm morphology influences the fertilization process, and whether only the sperm dimensions per se are involved. Moreover, such explanations do not allow the possibility that the female tract is capable of distinguishing fertile spermatozoa on the basis of their morphology, as seems to be the case with biochemical, molecular, and genetic properties. This review focuses on the influence of sperm size and shape in evolution and their putative role in sperm transport and selection within the uterus and the ability to fertilize the oocyte.

关键词： CASA-Morph female reproductive tract flagellum morphometry sperm competition sperm head sperm selectionsperm size

Oviductal epithelial cells selected boar sperm according to their functional characteristics

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Asian Journal of Andrology 2017年第4期19卷 396-403页

作者： Rebeca Lepez-Ubeda francisco A garcia-Vazquez Joaquin Gadea Carmen Matas Department of Physiology Veterinary Faculty University of Murcia International Excellence Campus for Higher Education and Research (Campus Mare Nostrum) Murcia 30100 Spain IMIB-Arrixaca (Institute for Biomedical Research of Murcia) Murcia Spain

The interaction of oviductal epithelial cells （OECs） with the spermatozoa has beneficial effects on the sperm functions. The aim of this study is to evaluate the in vitro fertilizing capacity of incubating spermatozoa previously selected by density gradient in OEC and determinate some sperm characteristics that could explain the results obtained. In this study, we assessed in vitro fertilization （IVF）, tyrosine phosphorylation, phosphatidylserine translocation, nuclear DNA fragmentation, and chromatin decondensation. Three experimental sperm groups, previously selected by Percoll gradient, were established according to the origin of the sperm used for IVF：（i） W30 group： spermatozoa were incubated with oocytes in the absence of OEC; （ii） NB group： after sperm incubation in OEC, the unbound spermatozoa were incubated with oocytes, in the absence of OEC; and （iii） B group： after sperm incubation with OEC, the bound spermatozoa were incubated with oocytes in the OEC plates. The results showed that sperm from the NB group led to a lower IVF yield, accompanied by low penetration rates （NB： 19.6%, B： 94.9%, and W30： 62.9%; P 〈 0.001） and problems of nuclear decondensation. Moreover, higher levels of tyrosine phosphorylation were observed in the NB group compared with the W30 and B groups （NB： 58.7%, B： 2.5%, and W30： 4.5%; P 〈 0.01）. A similar trend was observed in phosphatidylserine translocation （NB： 93.7%, B. 5.7%, and W30： 44.2%; P 〈 0.01）. These results demonstrate that the OEC exerts a rigorous degree of sperm selection, even within an already highly selected population of spermatozoa, and can capture the best functional spermatozoa for fertilization.

关键词： DNA status in vitro fertilization oviductal epithelial cells phosphatidylserine translocation sperm selection tyrosinephosphorylation

Secondary male hypogonadism： a prevalent but overlooked comorbidity of obesity

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Asian Journal of Andrology 2018年第6期20卷 531-538页

作者： Maria Molina-Vega Araceli Mufioz-Garach Miguel Damas-Fuentes JosO Carlos Fernfindez-garcia francisco J inahones Department of Endocrinology and Nutrition Virgen de la Victoria Universitary HospitalMalaga 29010Spain Institute of Biomedical Research in Malaga（IBIMA） Virgen de la Victoria Universitary HospitalMalaga 29010Spain CIBER Pathophysiology of Obesity and Nutrition（CB06/003） Institute of Health Carlos III（ISClII）Madrid 28029Spain.

Male hypogonadism associated with obesity is a very prevalent condition and is increasing in parallel with the epidemic prevalence of obesity. Low testosterone levels promote higher fat mass with reduced lean mass. Male hypogonadism is related to an increase in associated cardiometabolic complications, such as hypertension, type 2 diabetes mellitus, the metabolic syndrome, and cardiovascular disease. Its influence as a comorbidity of obesity is becoming more evident and should be evaluated and treated in at-risk patients. Mechanisms involved in this relationship include body composition changes, the presence of adipokines, insulin resistance, and other factors, some of which are still unknown. Weight loss and treatment to replace testosterone levels improve the metabolic profile and quality of life in patients with obesity and hypogonadism; these beneficial effects depend on treatment modality and duration of therapy. The use of testosterone replacement therapy may be indicated, as it has not been shown to increase cardiovascular risk, and retrospective studies suggest a reduction in events in men with metabolic syndrome and type 2 diabetes.

关键词： adipose tissue male hypogonadism obesity testosterone