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Hepatogenous diabetes: Is it a neglected condition in chronic liver disease?

World Journal of Gastroenterology 2016年第10期22卷 2869-2874页

作者： Diego García-Compeán josé Alberto gonzález-gonzález Fernando Javier Lavalle-gonzález Emmanuel Irineo gonzález-Moreno Jesús Zacarías Villarreal-Pérez Héctor Jesús Maldonado-Garza Gastroenterology Service and Department of Internal Medicine University Hospital "Dr. José E. González" and Medical SchoolUniversidad Autónoma de Nuevo León Endocrinology Service and Department of Internal Medicine University Hospital "Dr. José E. González" and Medical SchoolUniversidad Autónoma de Nuevo León

Diabetes mellitus(DM) that occurs because of chronic liver disease(CLD) is known as hepatogenous diabetes(HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely studied for long time. Patients suffering from this condition have low frequency of risk factors of type 2 DM. Its incidence is higher in CLD of viral, alcoholic and cryptogenic etiology. Its pathophysiology relates to liver damage, pancreatic dysfunction, interactions between hepatitis C virus(HCV) and glucose metabolism mechanisms and genetic susceptibility. It associates with increased rate of liver complications and hepatocellular carcinoma, and decreased 5-year survival rate. It reduces sustained virological response in HCV infected patients. In spite of these evidences, the American Diabetes Association does not recognize HD. In addition, the impact of glucose control on clinical outcomes of patients has not been evaluated. Treatment of diabetes may be difficult due to liver insufficiency and hepatotoxicity of antidiabetic drugs. Notwithstanding, no therapeutic guidelines have been implemented up to date. In this editorial, authors discuss the reasons why they think that HD may be a neglected pathological condition and call attention to the necessity for more clinical research on different fields of this disease.

关键词： Hepatogenous diabetes Diabetes mellitus Outcomes Therapy Hepatitis C virus Chronic liver disease

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Neutral protamine hagedorn/regular insulin in the treatment of inpatient hyperglycemia: Comparison of 3 basal-bolus regimens

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World Journal of Diabetes 2017年第10期8卷 455-463页

作者： Dania Lizet Quintanilla-Flores joséGerardo gonzález-gonzález Guillermo García-De la Cruz Héctor Eloy Tamez-Pérez Department of Internal Medicine 'Dr. José Eleuterio González' University HospitalUniversidad Autónoma de Nuevo León Endocrinology Service 'Dr. José Eleuterio González' University HospitalUniversidad Autónoma de Nuevo León School of Medicine Universidad Autónoma de Nuevo León Research Division School of MedicineUniversidad Autónoma de Nuevo León

AIM To compare the safety and efficacy or 3 basal-bolus regimens of neutral protamine hagedorn(NPH)/regular insulin in the management of inpatient *** We randomized 105 patients with blood glucose levelsbetween 140 and 400 mg/dL to a basal-bolus regimen of NPH insulin given once(n = 30), twice(n = 40) or three times(n = 35) daily, in addition to pre-meal regular insulin. Major outcomes included were differences in glycemic control, frequency of hypoglycemia and total insulin *** NPH insulin given in a once-daily regimen was associated with better glycemic control(58.3%) compared to twice daily(42.4%) and three times daily(48.9) regimens(P = 0.031). The frequency of hypoglycemia was similar between the three groups(2.0%, 0.7% and 1.2%, P = 0.21). The mean insulin dose at discharge was 0.48 ± 0.14 U/kg in the once-daily group compared to 0.69 ± 0.28 in the twice-daily, and 0.65 ± 0.20 in the three times daily regimens(P < 0.001).CONCLUSION NPH insulin administered in a once-daily regimen resulted in improvement in glycemic control with similar rates of hypoglycemia compared to a twice-daily and a three times-daily regimen. Further studies are needed to evaluate whether this regimen could be implemented in all hospitalized patients with hyperglycemia.

关键词： Neutral protamine hagedorn insulin Hospital hyperglycemia Basal-bolus regimen Type 2 diabetes mellitus Inpatient care units

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Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: A critical review and view points

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World Journal of Gastroenterology 2019年第21期25卷 2549-2564页

作者： Diego García-Compeán ángel N Del Cueto-Aguilera Alan R Jiménez-Rodríguez josé a gonzález-gonzález Héctor J Maldonado-Garza Gastroenterology Service and Department of Internal Medicine Faculty of Medicine University Hospital "Dr. José E. González"Universidad Autónoma de Nuevo León

Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes;nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient’s quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.

关键词： Angiodysplasias Angioectasias Vascular malformations Epidemiology Pathogenesis Endoscopic treatment Somatostatin analogues

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Meckel's diverticulum diagnosis by video capsule endoscopy: A case report and review of literature

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World Journal of Clinical Cases 2018年第14期6卷 791-799页

作者： Diego García-Compeán Alan R Jiménez-Rodríguez Angel N Del Cueto-Aguilera Gilberto Herrera-Quinones josé a gonzález-gonzález Héctor J Maldonado-Garza Gastroenterology Service and Department of Internal Medicine Faculty of Medicine University Hospital "Dr. José E. González" Universidad Autónoma de Nuevo León Monterrey 64700 Nuevo León México

BACKGROUND Meckel’s diverticulum （MD） occurs predominantly in chil-dren and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is diffcult due to low sensitivity of the radiological imaging studies. The role of video capsule endoscopy （VCE） in the diagnosis of MD is unknown, and the endoscopic patterns are not defned. We will describe four of our cases of MD evaluated with VCE and make a review of the literature focusing on the endoscopic *** SUMMARYWe present four cases of MD confirmed by surgery. They were all adult males with ages going from 18 to 50 years, referred to our service from 2004 to 2018, due to obscure gastrointestinal bleeding （OGIB）. TheyGarcía-Compeán D et al . Merckel’s diverticulum diagnosis by VCEhad a history of 1 mo to 10 years of overt and occult bleeding episodes. Laboratory blood test showed an iron-deficiency anemia from 4 to 9 g/dL of hemoglo-bin that required multiple hospitalizations and blood transfusions in all cases. Repeated upper digestive endoscopies and colonoscopies were negative. Small bowel was examined with VCE, which revealed double lumen images in all cases, one with polyps and three with circumferential ulcers in the diverticulum. However, based on VCE findings, preoperative diagnosis of MD was suggested only in two patients. Capsule was retain-ed in one patient, which was recovered with surgery. The anatomopathological report revealed ulcerated ectopic gastric mucosa in all *** is useful for the diagnosis of MD. However, endo-scopic characteristics must be recognized in order to establish preoperative diagnosis.

关键词： Meckel’s diverticulum Endoscopic features Video capsule endoscopy Wireless capsule endoscopy Review Case report

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Subclinical abnormal glucose tolerance is a predictor of death in liver cirrhosis

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World Journal of Gastroenterology 2014年第22期20卷 7011-7018页

作者： Diego García-Compeán Joel Omar Jáquez-Quintana Fernando Javier Lavalle-gonzález josé Alberto gonzález-gonzález Linda Elsa Mu?oz-Espinosa Jesús Zacarías Villarreal-PérezEndocrinology Service and Department of Internal Medicine University Hospital "Dr. josé E. gonzález" and Medical School Universidad Autónoma de Nuevo León Monterrey 64320 México Héctor J Maldonado-Garza Gastroenterology Service and Department of Internal Medicine University Hospital "Dr. José E. Gonzalez" and Medical SchoolUniversidad Autónoma de Nuevo LeónMonterrey 64320México Endocrinology Service and Department of Internal Medicine University Hospital "Dr. José E. González" and Medical SchoolUniversidad Autónoma de Nuevo LeónMonterrey 64320México Liver Unit University Hospital "Dr. José E. González" and Medical SchoolUniversidad Autónoma de Nuevo LeónMonterrey 64320México

AIM: To determine if subclinical abnormal glucose tolerance (SAGT) has influence on survival of non-diabetic patients with liver cirrhosis.

关键词： Diabetes mellitus Liver cirrhosis Oral glucose tolerance test Survival Glucose metabolism disorders

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Clinical implications of diabetes in chronic liver disease:Diagnosis,outcomes and management,current and future perspectives

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World Journal of Gastroenterology 2022年第8期28卷 775-793页

作者： Diego García-Compeán Emanuela Orsi Ramesh Kumar Felix Gundling Tsutomu Nishida Jesús Zacarías Villarreal-Pérez Ángel N Del Cueto-Aguilera joséA gonzález-gonzález Giuseppe Pugliese Gastroenterology Service and Department of Internal Medicine Faculty of MedicineUniversity Hospital“Dr.JoséE.González”Universidad Autónoma de Nuevo LeónMonterrey 64700Nuevo LeónMexico Diabetes Service Endocrinology and Metabolic Diseases UnitFdn IRCCS Ca GrandaEndocrine UnitPadigl GranelliMilan 20121Italy Department of Gastroenterology All India Institute of Medical SciencesPatna 801507India Department of Gastroenterology Gastrointestinal OncologyHepatologyDiabeticsMetabolism and Infectious DiseasesSozialstiftung BambergBamberg 96049Germany Department of Gastroenterology Toyonaka Municipal HospitalOsaka 560-8565Japan Department of Endocrinology University HospitalAutonomous University of Nuevo LeónMonterrey 64700Mexico Department of Gastroenterology and Internal Medicine Faculty of MedicineUniversity HospitalAutonomous University of Nuevo LeónMonterrey 64700Nuevo LeónMexico Gastroenterology Service and Department of Internal Medicine University Hospital Dr.JoséE González and Medical SchoolMonterrey 64460Nuevo LeónMexico Department of Clinical and Molecular Medicine La Sapienza UniversityRoma 00161Italy

Diabetes mellitus(DM)is common in liver cirrhosis(LC).The pathophysiological association is *** is a risk factor of LC and LC is a diabetogenic *** the recent years,research on different aspects of the association DM and LC has been ***,it has been insufficient and still exist many *** aims of this review are:(1)To discuss the latest understandings of the association of DM and LC in order to identify the strategies of early diagnosis;(2)To evaluate the impact of DM on outcomes of LC patients;and(3)To select the most adequate management benefiting the two *** searches were conducted using Pub Med,Ovid and Scopus engines for DM and LC,diagnosis,outcomes and *** authors also provided insight from their own published *** on the published studies,two types of DM associated with LC have emerged:Type 2 DM(T2 DM)and hepatogenous diabetes(HD).High-quality evidences have determined that T2 DM or HD significantly increase complications and death pre and post-liver *** has been poorly studied and has not been recognized as a complication of *** management of DM in LC patients continues to be difficult and should be based on drug pharmacokinetics and the degree of liver *** conclusion,the clinical impact of DM in outcomes of LC patients has been the most studied item *** many gaps still exist particularly in the *** most important gaps were highlighted in order to propose future lines for research.

关键词： Diabetes mellitus Liver cirrhosis Hepatogenous diabetes Clinical implications Therapy

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Post-acute pancreatitis diabetes:A complication waiting for more recognition and understanding

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World Journal of Gastroenterology 2023年第28期29卷 4405-4415页

作者： Diego García-Compeán Alan R Jiménez-Rodríguez Juan M Muñoz-Ayala josé a gonzález-gonzález Héctor J Maldonado-Garza Jesús Z Villarreal-Pérez Department of Gastroenterology Autonomous University of Nuevo LeónMonterrey 64700Nuevo LeónMexico Department of Endocrinology Autonomous University of Nuevo LeónMonterrey 64700Nuevo LeónMexico

Post-acute pancreatitis diabetes(PAPD)is the second most common type of diabetes below type 2 diabetes *** to the boom in research on this entity carried out during the last decade,its recognition has ***,much of the medical community still does not recognize it as a medium and long-term complication of acute pancreatitis(AP).Recent prospective cohort studies show that its incidence is about 23%globally and 34.5%in patients with severe *** the overall increase in the incidence of AP this complication will be certainly seen more *** to its high morbidity,mortality and difficult control,early detection and treatment are ***,its risk factors and pathophysiological mechanisms are not clearly *** diagnosis should be made excluding pre-existing diabetes and applying the criteria of the American Diabetes Association after 90 d of resolution of one or more AP *** review will show the evidence published so far on the incidence and prevalence,risk factors,possible pathophysiological mechanisms,clinical outcomes,clinical characteristics and preventive and corrective management of *** important gaps needing to be clarified in forthcoming studies will also be discussed.

关键词： Acute pancreatitis Diabetes mellitus Chronic pancreatitis Post-pancreatitis diabetes Pancreatogenic diabetes

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Simultaneous optimization of even flow and land and timber value in forest planning:a continuous approach

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Forest Ecosystems 2021年第4期8卷 645-658页

作者： jose M.gonzalez-gonzalez Miguel E.Vazquez-Mendez Ulises Dieguez-Aranda Departamento de Enxenaria Agroforestal Universidade de Santiago de Compostela.Escola Politecnica Superior de EnxenariaR/Benigno Ledo27002 LugoSpain Departamento de Matematica Aplicada Instituto de MatematicasUniversidade de Santiago de Compostela.Escola Politecnica Superior de EnxenariaR/Benigno Ledo27002 LugoSpain

Background:Forest management planning involves deciding which silvicultural treatment should be applied to each stand and at what time to best meet the objectives established for the *** this,many mathematical formulations have been proposed,both within the linear and non-linear programming frameworks,in the latter case generally considering integer variables in a combinatorial *** present a novel approach for planning the management of forests comprising single-species,even-aged stands,using a continuous,multi-objective formulation(considering economic and even flow)which can be solved with gradient-type ***:The continuous formulation has proved robust in forest with different structures and different number of *** results obtained show a clear advantage of the gradient-type methods over heuristics to solve the problems,both in terms of computational time(efficiency)and in the solution obtained(effectiveness).Their improvement increases drastically with the dimension of the problem(number of stands).Conclusions:It is advisable to rigorously analyze the mathematical properties of the objective functions involved in forest management planning *** continuous bi-objective model proposed in this paper works with smooth enough functions and can be efficiently solved by using gradient-type *** advantages of the new methodology are summarized as:it does not require to set management prescriptions in advance,it avoids the division of the planning horizon into periods,and it provides better solutions than the traditional combinatorial ***,the graphical display of trade-off information allows an a posteriori articulation of preferences in an intuitive way,therefore being a very interesting tool for the decision-making process in forest planning.

关键词： Even-aged forest management Forest-level optimization Continuous optimization Gradient-type algorithms

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Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review

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World Journal of Diabetes 2015年第8期6卷 1073-1081页

作者： Héctor Eloy Tamez-Pérez Dania Lizet Quintanilla-Flores René Rodríguez-Gutiérrez josé Gerardo gonzález-gonzález Alejandra Lorena Tamez-Pena Internal Medicine Service “Dr.José Eleuterio González”University Hospital and School of MedicineUniversidad Autónoma de Nuevo León Research Division School of MedicineUniversidad Autónoma de Nuevo León Endocrinology Service “Dr.José Eleuterio González”University Hospital and School of MedicineUniversidad Autónoma de Nuevo León

Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. In the present review, we discuss the main epidemiologic characteristics associated with steroid use, with emphasis on the identification of high risk populations. Additionally we present the pathophysiology of corticosteroid induced hyperglycemia as well as the pharmacokinetics and pharmacodynamics associated with steroid use. We propose a treatment strategy based on previous reports and the understanding of the mechanism of action of both, the different types of glucocorticoids and the treatment options, in both the ambulatory and the hospital setting. Finally, we present some of the recent scientific advances as well as some options for future use of glucocorticoids.

关键词： Steroid Hyperglycemia Diabetes mellitus Treatment Insulin

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Tracking the change in Spanish greenhouse gas emissions through an LMDI decomposition model:A global and sectoral approach

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Journal of Environmental Sciences 2024年第5期139卷 114-122页

作者： Paula Fernández gonzález María josé Presno Manuel Landajo Department of Applied Economics University of OviedoAuda del Cristos/n 33011 OviedoSpain

The reduction of GHG emissions to reverse the greenhouse effect is one of the main challenges in this *** this paper we pursue two ***,we analyze the evolution of GHG emissions in Spain in 2008–2018,at both the global and sectoral levels,with the variation in emissions decomposed into a set of determining ***,we propose several actions specifically oriented to more tightly controlling the level of *** results showed a remarkable reduction(18.44%)in GHG emissions,mainly due to the intensity effect,but also to the production-per-capita *** detected somewhat different patterns among the various sectors *** the intensity effect was the most influential one in the agricultural,transport,and others sectors,the production-per-capita effect was predominant in the case of *** carbonization effect was revealed as crucial in the commerce *** above findings highlight the importance of the energy efficiency measures taken in recent years in the Spanish economy,also pointing to the need to deepen those strategies and to propose new measures that entail greater efficiency in *** efforts in areas like innovation,R&D,diffusion of more eco-friendly technologies,and a greater use of greener energies all prove to be essential reduction actions to fight the greenhouse effect.

关键词： LMDI Decomposition Spain GHG emissions

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