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Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

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

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2004-2015年西班牙原发性肺高血压特征及其转归：基于医院出院数据库的回顾性分析

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中华高血压杂志 2019年第11期27卷 1069-1069页

作者：陈嘉睿(译) 叶鹏(审校) de-Miguel-Diez J Lopez-de-Andres A Hernandez-Barrera V jimenez-Trujillo I Mendez-Bailon M de Miguel-Yanes JM Mu oz-rivas N romero-Maroto M jimenez-garcia r 不详

为了检查2004-2015年西班牙原发性肺高血压(primary pulmonary hypertension,PPH)的发病率、临床特征和转归的趋势,及确定影响西班牙住院患者住院死亡率(in-hospital mortality,IHM)的因素,研究患者纳入西班牙国家医院出院数据库的所有... 详细信息

为了检查2004-2015年西班牙原发性肺高血压(primary pulmonary hypertension,PPH)的发病率、临床特征和转归的趋势,及确定影响西班牙住院患者住院死亡率(in-hospital mortality,IHM)的因素,研究患者纳入西班牙国家医院出院数据库的所有PPH住院患者,共分析了46883例出院患者(7.14%以PPH为主要诊断)。

关键词：住院死亡率肺高血压 PPH hypertension 出院患者 pulmonary 临床特征转归

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Assessment of skeletal muscle alterations and circulating myokines in metabolic dysfunction-associated steatotic liver disease:A crosssectional study

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World Journal of Gastroenterology 2025年第7期31卷 63-73页

作者： Yolanda real Martinez Carlos Ernesto Fernandez-garcia Esther Fuertes-Yebra Mario Calvo Soto Angela Berlana Vicente Barrios Maria Caldas Leticia Gonzalez Moreno Luisa garcia-Buey Begoña Molina Baena Miguel Sampedro-Nuñez Maria J Beceiro C García-Monzón Águeda González-rodríguez Servicio Aparato Digestivo Hospital Universitario La PrincesaInstituto de Investigación Sanitaria La PrincesaUniversidad Autónoma de MadridMadrid 28006Spain Unidad de Investigación Hospital Universitario Santa CristinaInstituto de Investigación Sanitaria La PrincesaMadrid 28009Spain Department of Endocrinology Department of PediatricsHospital Infantil Universitario Niño JesúsInstituto de Investigación La PrincesaMadrid 28009Spain Centro de Investigación Biomédica en red de Fisiopatología de la Obesidad y Nutrición Instituto de Salud Carlos IIIMadrid 28029Spain Servicio de Endocrinología y Nutrición Hospital Universitario La PrincesaInstituto de Investigación Sanitaria La PrincesaUniversidad Autónoma de MadridMadrid 28006Spain Instituto de Investigaciones Biomédicas Sols-Morreale(IIBM) CSIC-UAMMadrid 28029Spain Centro de Investigación Biomédica en red de Diabetes y Enfermedades Metabólicas Asociadas Madrid 28029Spain

BACKGrOUND Skeletal muscle alterations(SMAs)are being increasingly recognized in patients with metabolic dysfunctionassociated steatotic liver disease(MASLD)and appear to be associated with deleterious outcomes in these ***,their actual prevalence and pathophysiology remain to be *** To determine the prevalence of SMAs and to assess the significance of circulating myokines as biomarkers in patients with *** Skeletal muscle strength and muscle mass were measured in a cross-sectional study in a cohort of 62 patients fulfilling MASLD criteria,recruited from the outpatient clinics of a tertiary level *** degree of fibrosis and liver steatosis was studied using abdominal ultrasound and transitional *** and metabolic characteristics as well as serum levels of different myokines were also determined in the MASLD *** analysis was performed comparing results according to liver fibrosis and *** No significant differences were found in both skeletal muscle strength and skeletal muscle mass in patients with MASLD between different stages of liver ***,serum levels of fibroblast growth factor-21(FGF21)were significantly higher in patients with MASLD with advanced hepatic fibrosis(F3-F4)than in those with lower fibrosis stages(F0-F2)(197.49±198.27 pg/mL vs 95.62±83.67 pg/mL;P=0.049).In addition,patients with MASLD with severe hepatosteatosis(S3)exhibited significantly higher serum levels of irisin(1116.87±1161.86 pg/mL)than those with lower grades(S1-S2)(385.21±375.98 pg/mL;P=0.001).CONCLUSION SMAs were uncommon in the patients with MASLD *** serum levels of irisin and FGF21 were detected in patients with advanced liver steatosis and fibrosis,respectively,with potential implications as biomarkers.

关键词： Skeletal muscle alterations Myokines Metabolic dysfunction-associated steatotic liver disease Liver fibrosis Hepatosteatosis

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Navigating medial patellotibial ligament reconstruction:Clinical perspectives and surgical strategies

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World Journal of Clinical Cases 2025年第1期13卷 6-10页

作者： Juan Pablo Zicaro Ignacio garcia-Mansilla Division of Knee Hospital Italiano de Buenos AiresBuenos Aires 1109Argentina

The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when *** medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the *** this,both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°.The medial patellotibial ligament plays a particularly important role in the final stages of stretching in extension and between 40 degrees to 90 degrees of *** clinical relevance and surgical indications for medial patellotibial ligament reconstruction associated with medial patellofemoral ligament reconstruction are still *** editorial explores the surgical indications and clinical results for medial patellotibial ligament reconstruction to improve readers’understanding of this technique,especially because reported clinical outcomes have remained sparse.

关键词： Medial patellotibial ligament Patellar instability reconstruction Surgical

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Environmental Factors that Affect Primary Plant Succession Trajectories on Lahars(Popocatépetl Volcano,Mexico)

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Journal of Mountain Science 2015年第5期12卷 1254-1266页

作者： garcia-rOMErO Arturo ALANIS-ANAYA rocío Marisol MUNOZ-jimenez Julio Departamento de Geografía Física Instituto de GeografíaUniversidad Nacional Autónoma de México.Circuitoexterior s/nCiudad Universitaria04510 MexicoDistrito FederalMexico Laboratorio de Análisis Geoespacial Instituto de GeografíaUniversidad Nacional Autónoma de México.Circuitoexterior s/nCiudad Universitaria04510 MexicoDistrito FederalMexico Departamento de A.G.r.y Geografía Física Facultad de Geografía e HistoriaUniversidad Complutense de Madrid.Calle Profesor Aranguren s/nCiudad Universitaria28040MadridSpain

The earliest stages of plant succession on severely disturbed sites usually follow highly unpredictable trajectories. However, in the Popocatépetl volcano area(50 km SE of Mexico City),the development of physiognomically distinct primary plant communities suggests the occurrence of various successional trajectories only 10 years after the onset of colonization of a temperate forest on lahars. To characterize plant communities and determine the environmental factors that drive the differences observed between plant communities and their successional trajectories, we monitored 64 circular sample plots(3.14 m2) from 2002 to 2011. We examined the plant communities' composition and structure in terms of their species richness and abundance, plant cover, and maximum stem height,and recorded 13 environmental factors related to the volcanic deposit characteristics, microclimate, soil,flow dynamics and gravitational processes. A cluster analysis of the species abundance data showed that,by 2011, six plant community types(CT's) had established, including grasslands, and open, dense and very dense shrub lands. As these communities developed over the same period of time and within the same overall ecosystem, then these plant community types were interpreted as different stages of the same successional trajectory. Two sequential main stages that drive regeneration were identified from this successional trajectory: a) the first four years are characterized by a steady increase in species richness and physiognomic development(plant size and coverage), mostly dominated by Baccharis conferta, Eupatorium glabratum and Senecio barbajohannis; b) from the sixth year onwards, a continued increase in the abundance of those same species led to the development of the dense shrubland *** in the availability of soil resources and disturbances linked to recent lahar flows were the main factors accounting for such differences.

关键词： Ecosystem regeneration Plantcolonization Primary succession Temperate forest Light exposure Elevation Soil Slope aspect

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How GLOBALIZATION INFLUENCES COrPOrATE GOVErNANCE AND COrPOrATE SOCIAL rESPONSIBILITY IN THE WOrLD -- THE SECOND GENEVA-HArVArD-rENMIN-SYDNEY CONFErENCE ON COrPOrATE GOVErNANCE AND COrPOrATE SOCIAL rESPONSIBILITY （JULY 11--12, 2014）

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Frontiers of Law in China-Selected Publications from Chinese Universities 2015年第1期10卷 202-208页

作者： GUO rui Alejandro garcia jimenez ZUO Zhenbin Harvard Law School and Assistant Professor at School of Law Renmin University of China Beijing 100872 China. School of Law Renmin University of China Beijing 100872 China. Undergraduate student in law at School of Law Renmin University of China Beijing 100872 China

In the age of globalization, national legislations on corporate governance and corporate social responsibility inevitably influence other parts of the world. This has been the dominant reason for many countries to adopt a comparative approach in legislations and judicial practices. In order to better understand globalization and develop a better approach to it from a comparative perspective, renmin Law School held a conference that gathered scholars from four prominent law schools, namely Geneva University Law Faculty, Harvard Law School, renmin Law School, and Sydney University Law School, to exchange ideas on corporate governance and corporate social responsibility. As Vice President of renmin University has said during the opening ceremony, this conference aims to provide the Chinese government and corporations with new ideas and inspirations by sharing the comparative studies of prominent scholars on corporate governance and corporate social responsibility.

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Emerging concepts in the care of patients with cirrhosis and septic shock

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World Journal of Hepatology 2023年第4期15卷 497-514页

作者： Jose Victor jimenez Guadalupe garcia-Tsao Saad Saffo Section of Digestive Diseases Yale School of MedicineNew HavenCT 06520United States

Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review,we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.

关键词： Cirrhosis Septic shock Intravenous fluids Vasopressors Antibiotics Steroids

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基于期刊耦合识别“无形学院”成员的新方法（英文）

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Journal of Data and Information Science 2025年第1期 101-131+236-237页

作者： Jose A.garcia rosa rodriguez-Sanchez J.Fdez-Valdivia Department of Computer Science and Artificial Intelligence CITIC-UGRUniversidad de Granada

研究目的：本文通过基于期刊耦合（即共享学术期刊）的作者聚类分析，识别具有相似科学兴趣与概念框架的研究者群体。其核心假设是：相较于从未在相同期刊发表论文的学者，共同发文于同一期刊的作者更可能共享相似的研究范式与学术关注... 详细信息

研究目的：本文通过基于期刊耦合（即共享学术期刊）的作者聚类分析，识别具有相似科学兴趣与概念框架的研究者群体。其核心假设是：相较于从未在相同期刊发表论文的学者，共同发文于同一期刊的作者更可能共享相似的研究范式与学术关注点，从而更可能隶属于同一“无形学院”（即在某一研究领域内具有重要贡献，并倾向于在相似期刊发表成果的作者群体）。研究设计/方法：以Web of Science核心合集中“信息科学与图书馆学（IS&LS）”领域的302位作者为案例，测试基于期刊耦合的作者分组方法，以识别该领域的“无形学院”。对于每位作者，我们检索其发表论文的所有学术期刊，并利用余弦相似度（包括一阶和二阶相似度）计算作者之间的相似性。研究发现：通过分析IS&LS领域作者的期刊耦合关系，我们识别出四个主要的“无形学院”：“信息系统”、“商业与信息管理”、“计量信息科学”和“图书馆学”；定义“无形学院”的期刊包括《Inform Syst res》《Inform Syst J》《J Bus res》《J Knowl Manage》《J Informetr》《Pro Int Conf Sci Inf》《Int J Geogr Inf Sci》《J Am Med Inform Assn》和《Learn Publ》；支撑IS&LS领域整体性的核心期刊包括《J Am Soc Inf Sci Tec/J Assoc Inf Sci Tech》《Scientometrics》《Inform Process Manag》《J Inf Sci》。研究局限性：实验设计为控制性验证，分析仅使用了学术期刊，未纳入专著、图书章节及会议论文。因此，研究结果可能无法全面代表整个学术交流生态。实践意义：本研究的结果对于IS&LS领域的学者具有重要参考价值。通过期刊发表概况和期刊耦合，我们提供了一种新的作者归类视角。此外，该方法可进一步扩展至其他学科领域的结构研究，对科学史学者和科学计量学研究者亦具有潜在价值。原创性/价值：本研究提出了一种基于期刊耦合的新方法，以识别最有可能属于同一“无形学院”的研究者，为科学合作网络研究提供了新的理论和实践工具。

关键词：作者期刊耦合聚类分析无形学院信息科学与图书馆学 Web of Science核心合集

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Corrosion behavior of hypoeutectic Al-Cu alloys in H_2SO_4 and NaCl solutions

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Acta Metallurgica Sinica(English Letters) 2009年第4期22卷 241-246页

作者： Wislei r.Osório Leandro C.Peixoto Leonardo r.garcia Amauri garcia Department of Materials Engineering University of Campinas-UNICAMP

The aim of this work was to evaluate the electrochemical behaviour of hypoeutectic Al-Cu alloys immersed in two different solutions containing sulphate and chloride ions, respectively. The influence of Al2Cu associated to the dendritic arm spacing on the general corrosion resistance of such alloys is analysed. The typical microstructural pattern was examined by using scanning electron microscope. The corrosion tests were performed in both 0.5 M sulphuric acid and 0.5 M NaCl solutions at 25℃ by using an electrochemical impedance spectroscopy （EIS） technique and potentiodynamic polarization curves. Equivalent circuits by using the ZView software, were also used to provide quantitative support for the discussions. It was found that as the Cu content increased （i.e., increasing the Al2Cu fraction）, a higher susceptibility to the corrosion action in the NaCl solution is detected. In contrast, the tests carried out in the H2SO4 solution resulted in similar corrosion,rates for the three different hypoeutectic alloys.

关键词： Al-Cu alloys Al2Cu Corrosion Microstructure Castings

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In-hand manipulation of a circular dynamic object by soft fingertips without angle measurement

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Science China(Information Sciences) 2021年第5期64卷 193-208页

作者： r.garcia-rODrIGUEZ V.PArrA-VEGA Aeronautical Engineering Program and Postgraduate Program in Aerospacial Engineering Universidad Politecnica Metropolitana de Hidalgo robotics and Advanced Manufacturing Department Research Center for Advanced Studies (CINVESTAV)

A multi-fingered robotic hand with curved fingertips enables contact re-positioning without reattaching at the expense of fingertip rolling. This rolling stands for a characteristic that facilitates dexterous manipulation but results in an algebraically complex dynamic model subject to such constraints. The hemispherical shape of fingertips allows a dexterous manipulation when controlling the tangent forces, which are essential to rotate object. However, the measurement of the object angle in practice requires tactile-optical sensing. In this paper, considering robotic fingers with curved soft tips, we propose a feedback control that ensures optimal dynamical grasping of a circular rigid object. It is shown that the collaboration of the contact forces, to get a minimum pose of internal forces, and the tangential forces, to induce the conditions for assuring the grasp closure, is necessary to get a skillful manipulation. In this case, the orientation control of a circular object to the desired angle while avoiding direct measurement of the object angle is presented. Stability conditions of the system are presented in the sense of stability-in-the-manifold. Finally, representative simulations are shown and discussed.

关键词： optimal grasping manipulation soft-fingertips circular object stability-in-the-manifold

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