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Sphincter lesions observed on ultrasound after transanal endoscopic surgery

World Journal of Gastroenterology 2015年第46期21卷 13160-13165页

作者： laura mora lópez Xavier Serra-Aracil Salvador Navarro Soto General and Digestive Surgery Service Parc Tauli University HospitalUniversidad Autonoma Barcelona

AIM: To assess the morphological impact of transanal endoscopic surgery on the sphincter apparatus using the modified Starck classification. METHODS: A prospective,observational study of 118 consecutive patients undergoing Transanal Endoscopic Operation/Transanal Endoscopic Microsurgery(TEO/TEM) from March 2013 to May 2014 was performed. All the patients underwent an endoanal ultrasound prior to surgery and one and four months postoperatively in order to measure sphincter width,identify sphincter defects and to quantify them in terms of the level,depth and size of the affected anal canal. To assess the lesions,we used the "modified" Starck classifi-cation,which incorporates the variable "sphincter fragmentation". The results were correlated with the Wexner incontinence ***: Of the 118 patients,twelve(sphincter lesions) were excluded. The results of the 106 patients were as follows after one month: 31(29.2%) lesions found on ultrasound after one month,median overall Starck score of 4(range 3-6); 10(9.4%) defects in the internal anal sphincter(IAS) and 3(2.8%) in the external anal sphincter(EAS); 17 patients(16%) had fragmentation of the sphincter apparatus with both sphincters affected in one case. At four months: 7(6.6%) defects,all in the IAS,overall median Starck score of 4(range 3-6). Mean IAS widths were 3.5 mm(SD 1.14) preoperatively,4.38 mm(SD 2.1) one month postoperatively and 4.03 mm(SD 1.46) four months postoperatively. The only statistically significant difference in sphincter width in the IAS measurements was between preoperatively and one month postoperatively. No incontinence was reported,even in cases of ultrasound ***: TEO/TEM may produce ultrasounda b n o r m a l i t i e s b u t t h i s i s n o t a c c o m p a n i e d b y clinical changes in continence. The modified Starck classification is useful for describing and managing these disorders.

关键词： Transanal endoscopic surgery Endoscopic ultrasound

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Determinants of invasive strategy in elderly patients with non-ST elevation myocardial infarction

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Journal of Geriatric Cardiology 2017年第7期14卷 465-472页

作者： Antonin Negers Jacques Boddaert lucie mora Jean-louis Golmard laura Moisi Ariel Cohen Jean-Philippe Collet Alice Breining Acute Geriatric Care Unit Saint-Antoine University Hospital Paris France Department of Geriatrics Pitie-Salpetriere University Hospital Paris France Department of Biostatistics Pitie-Salpetriere University Hospital Paris France Department of Cardiology Saint-Antoine University Hospital Paris France Department of Cardiology Pitie-Salpetrere University Hospital Paris France Department of Geriatrics Charles Foix University Hospital Paris France

Background Knowledge gaps across literature prevent current guidelines from providing the profile of elderly patients most likely to derive benefit fi^om invasive strategy （IS） in non ST-elevation myocardial infarction （NSTEMI）. Furthermore, the benefit of IS in a real-world elderly population with NSTEMI remains unclear. The aims of this study were to determine factors that lead the cardiologist to opt for an IS in elderly patients with NSTEMI, and to assess the impact of IS on the 6-month all-cause mortality. Methods This multicenter prospective study enrolled all consecutive patients aged 〉 75 years old who presented a NSTEMI and were hospitalized in cardiology intensive care unit between February 2014 and February 2015. Patients were compared on the basis of reperfusion strategy （invasive or conservative） and living status at six months, in order to determine multivariate predictors of the realization of an IS and multivariate predictors of 6-month mor- tality. Results A total of 141 patients were included; 87 （62%） underwent an IS. The strongest independent determinants of IS were younger age [odds ratio （OR）： 0.85, 95%-confidence interval （CI）： 0.78-0.92; P 〈 0.001） and lower ＂Cumulative Illness Rating Scale-Geriatric＂ number of categories score （OR： 0.83, 95%CI： 0.73-0.95; P = 0.002）. IS was not significantly associated with 6-month survival （OR： 0.80, 95%CI： 0.27-2.38; P = 0.69）. Conclusions In real-world elderly patients with NSTEMI, younger patients with fewer comorbidities profited more often from an IS. However, IS did not modify 6-month all-cause mortality.

关键词： Comorbidity Coronary angiography Decision making Mortality Myocardial infarction

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Effectiveness of statins *** on reducing postprandial hypertriglyceridemia in dyslipidemic population:A systematic review and network meta-analysis

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Journal of Sport and Health Science 2022年第5期11卷 567-577页

作者： laura Alvarez-Jimenez Alfonso Moreno-Cabanas Miguel Ramirez-Jimenez Felix morales-Palomo Juan FOrtega Ricardo mora-Rodriguez Exercise Physiology lab at Toledo Sports Science DepartmentUniversity of Castilla-La ManchaToledo 45004Spain

Background:Individuals at risk of suffering cardiovascular disease(CVD) present with larger increases in blood trigyceride(TG) concentration after a high-fat meal than do healthy *** postprandial hypertriglyceride levels are an independent risk factor for *** of statins and a bout of prolonged exercise are both effective in lowering postprandial hypertriglyceride *** aimed to evaluate the comparative effectiveness of statins vs.a bout of aerobic exercise in reducing fasting and postprandial TG(PPTG) concentrations in indiv、duals at high nsk of developing ***:Thirty-seven sltudies from a systematic literature search of the PubMed,EMBASE,and Cochrane databases were included in this *** selected studies conducted trials involving statin therapy(n=20) or a bout of aerobic exercise(n=19) and measured their impact on PPTG levels as the *** studies analyzed both treatments and were included in *** meta-analysis was constructed using a random-effects model to calculate the mean difference(MD).The Student t test was used to compare the data sets for statins ***:Overall,statin and exercise interventions showed similar reductions in PPTG levels,with an MD of-0.65 mmol/l for statins(95% confidence interval(95%CI):-0.54 to-0.77;p l/l for exercise(95%CI:-0.21 to-0.71;p lowered fasting TG levels more than exercise(MD=-1.54 mmol/l,95%CI:-2.25 to-0.83;p=0.009).Conclusion:Although aerobic exercise is effective in lowering blood TG levels,statins seem to be more efficient,especially in the fasted state.A combination of exercise and statins might reveal a valuable approach to the treatment and prevention of *** studies are required to determine the underlying mechanisms and the possible additive effects of these interventions.

关键词： Aerobic exercise Cardiovascular disease Hydroxymethylglutaryl-CoA reductase inhibitor Meta-analysis Metabolic syndrome

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Transanal endoscopic surgery in rectal cancer

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World Journal of Gastroenterology 2014年第33期20卷 11538-11545页

作者： Xavier Serra-Aracil laura mora-lopez Manel Alcantara-moral Aleidis Caro-Tarrago Carlos Javier Gomez-Diaz Salvador Navarro-Soto Coloproctology Unit General and Digestive Surgery Service Parc Tauli University Hospital Universitat Autònoma de Barcelona 08208 Sabadell (Barcelona) Spain

Total mesorectal excision(TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery(TEM) allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond(T1). Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentageof infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors. The standard treatment for rectal adenocarcinoma T2N0M0 is TME without adjuvant therapy. In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present.

关键词： Rectal cancer Rectal adenocarcinoma Transanal endoscopic microsurgery Transanal endo-scopic surgery Colorectal cancer

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Emerging Water Quality Issues along Rio de la Sabana, Mexico

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Journal of Water Resource and Protection 2018年第7期10卷 621-636页

作者： Daniel Pineda-mora Jeiry Toribio-Jiménez Teresa leal-Ascencio Ma Ana laura Juárez-lópez Justiniano González-González Jesús Carlos Ruvalcaba-ledezma Ramón Alberto Batista-García Paul Alexander Arp local Development Science Center Autonomous University of Guerrero Acapulco Mexico Faculty of Chemistry and Biological Science Autonomous University of Guerrero Chilpancingo Mexico Faculty of Chemistry Science University of Veracruz Xalapa Mexico Health Science Institute Autonomous University of Hidalgo Pachuca Mexico Cell Dynamics Research Center Autonomous University of Morelos Cuernavaca Mexico Faculty of Forestry and Environmental Management University of New Brunswick Fredericton Canada

The basin of Rio de la Sabana is the largest tributary of the Tres Palos coastal lagoon in Southwest Mexico, east of Acapulco. This lagoon and its upstream basin areas have become a high priority area for the preservation of coastal and marine environments. To obtain information about water quality as affected by urban expansion since 2002, fourteen physicochemical parameters (temperature, pH, electrical conductivity, dissolved oxygen, ammonium, nitrate, nitrite, sulphate, phosphate), biochemical (biological and chemical oxygen demand, methylene blue active substances) and bacteriological parameters (total and fecal coliforms) were determined. This sampling was done for dry and rainy season conditions at seven locations (S1, S2, S3, …, S7) along the river, spaced 3 to 6 km apart to a total of 30.4 km. The results were grouped into four zones: (Z1) reference, (Z2) transition, (Z3) polluted, (Z4) recovery. The Alborada (S5) and Tunzingo (S6) sites, adjacent to dense high-class residential areas (Z3), had the greatest pollution charges in both seasons, while the la Poza (S7) site near the Tres Palos lagoon (Z4) showed a decrease in pollution. All parameters correlated with increasing head- to down-river sampling distance by following linear (pH, DO) or curvilinear patterns (all other parameters). Using sampling location and dry versus rainy sampling season as multivariate regression (predictor) variables led to least-squares capturing: 1) 66% to 95% of the T(°C), pH, DO, and PO3-4 variations, and 2) 57% to 96% of the log-linear variations of the other parameters. Among the parameters, T(°C), DO, and PO3-4 were not significantly affected by sampling season, while pH became so after deleting two higher than usual pH values at the S5 and S6 locations during the dry season.

关键词： Rio de la Sabana Urban Developments Water Pollution Sampling locations Dry/Rainy Season Multivariate Analyses

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Neuropsychological Profile of a Patient with Acquired Brain Damage Following Vascular lesion of the left Anterior Cingulate Cortex

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Neuroscience & Medicine 2024年第1期15卷 66-75页

作者： Jimmy Zúñiga-Márquez lina Borda-Camargo Diego Buitrago-mora lorely Guerra-Valdés laura González Patricia Quintero-Cusgüen Nataly Gutierrez-Ávila Hospital Universitario de la Samaritana Bogotá Colombia Neuropsychological Assessment and Diagnosis Graduate Program School of Psychology Universidad San Buenaventura Bogotá Bogotá Colombia

Stroke is a physiological alteration associated with changes in blood flow that can result in sudden-onset cognitive impairment. It has a heterogenous clinical presentation with varying degrees of severity correlated with specific central nervous system zones or areas, and its prognosis is uncertain. This case study describes a 62-year-old male patient with acquired brain damage of the anterior cingulate cortex as a result of an ischemic event in the territory of the left anterior cerebral artery. Cognitive function was assessed using the neuropsychological executive function and frontal lobe test battery (BANFE-2) as well as other neuropsychological tests. The results show a profile of higher mental functions characterized by the presence of dysexecutive syndrome with marked behavioral alteration and diencephalic amnesia. .

关键词： Ischemic Stroke Anterior Cingulate Cortex Neuropsychology Acquired Brain Damage

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Effect of Gamma Irradiation and Selection with Fungus Filtrate(Rhizoctonia solani Kuhn)on the in Vitro Culture of Common Bean(Phaseolus vulgaris)

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American Journal of Plant Sciences 2015年第16期6卷 2672-2685页

作者： laura Y.Solís-Ramos Marta Valdez-Melara Ricardo Alvarado-Barrantes Floribeth mora-Umana Eduardo Hernández-Jiménez Natalia Barboza-Vargas Pilar Ramírez-Fonseca Plant Biotechnology & Genetic Transformation School of Biology University of Costa Rica San Pedro Costa Rica School of Statistic University of Costa Rica San Pedro Costa Rica Interagency Cooperation Agreement between the Research Center for Cellular and Molecular Biology (CIBCM) University of Costa Rica and the Phytosanitary Agency of the Ministry of Agriculture and Livestock (MAG) San José Costa Rica Research Center for Cellular and Molecular Biology (CIBCM) University of Costa Rica San Pedro Costa Rica

The present investigation was undertaken to study the effect of gamma irradiation (dose from 10 to 100 Gy) and in vitro selection with fungus filtrate as selecting agent (concentration from 20% to 100%) on the susceptibility of the common bean to Rhizoctonia solani. The best results were found with a dose of 20 Gy or a concentration of 20% of fungus filtrate applied separately. These conditions were used to evaluate the combined effect of both approaches in a second experiment. The combined effect of irradiation and then selection adversely affected growth (height and roots) and survival of the in vitro plants. It may not be necessary to combine the variation generated by irradiation with the selection technique. For future assays we propose the application of: 1) gamma radiation, thereby inducing not only mutants with pathogen resistance, but also with other agronomic traits of interest. later in the subculture MV4 potential fungus-resistant mutants will be evaluated in the field;or 2) selection pressure using fungus filtrate during three subcultures, which may be sufficient to induce the variation necessary to obtain in vitro plants resistant to fungus.

关键词： Mutagenesis Radiosensitivity In Vitro Selection Rhizoctonia Common Bean

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Genetic Diversity Analysis of Jatropha Species from Costa Rica Using AFlP Markers

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American Journal of Plant Sciences 2015年第14期6卷 2426-2438页

作者： Roberto Avendano Elmer García Díaz Marta Valdez-Melara Nefertiti Chaves Solano Aníbal mora Villalobos Francisco Aguilar Cascante Bruce Williamson Benavides laura Y.Solís-Ramos Center for Biotechnological Innovations(CENIBiot) CeNAT-CONARESan JoséCosta Rica School of Biology University of Costa RicaSan JoséCosta Rica

The genetic diversity from species of the genus Jatropha collected from Costa Rica was analyzed by AFlP (amplified fragments length polymorphism). The study consisted of 114 accessions from 15 populations of 4 different species: J. curcas, J. costaricensis, J. gossypifolia and J. stevensii. These were collected from different locations in Costa Rica. Three different primers were used, resulting in 428 loci, and they were classified in three categories: unique and double bands (UBD), rare bands (RB) and shared bands (SB). The UBD were excluded for a total of 339 polymorphic loci used for the UPGMA dendrogram and principal component analysis (PCA). The species that obtained the highest average of polymorphic loci was J. curcas, which obtained the highest percentage of polymorphic loci (80.24%), followed by J. gossypifolia (79.35%), J. costaricensis (78.76%), and finally J. stevensii (40.71%). The average for the polymorphic loci was of 69.76%. Thus, the phylogeny of the Jatropha species in Costa Rica was elucidated, showing J. curcas more related to J. stevensii and this one with J. costaricensis, and J. gossypifolia as the most distant member of the genus. For the best of our knowledge this is the first report of a genetic analysis of J. costaricensis and J. stevensii. The obtained molecular evidence showed high levels of polymorphisms in the present study compared with reports from Africa, India, and China. The molecular diversity estimated in our analysis, together with agronomical or morphological data, can be very useful for plant breeding programs, given the importance of Jatropha species in oil production. Interestingly, Central American Jatropha material can be used to increase the genetic base of J. curcas populations localized in Asia and Africa, where reduced genetic diversity has been reported.

关键词： Jatropha spp. AFlP Molecular Markers Polymorphism Genetic Diversity

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Soil Carbon Storage in Experimental Forest Plantations with Tropical Species

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Open Journal of Forestry 2022年第1期12卷 1-18页

作者： Celia De la mora-Orozco José Germán Flores Garnica Irma Julieta González Acuña Juan De Dios Benavides Solorio César S. Magaña Martínez laura Izascum Pérez Valencia Instituto Nacional de Investigaciones Forestales Agrícolas y Pecuarias Tepatitlán México Instituto Nacional de Investigaciones Forestales Agrícolas y Pecuarias Guadalajara México Instituto Nacional de Investigaciones Forestales Agrícolas y Pecuarias Santiago Ixcuintla México Instituto Tecnológico José Mario Molina Pasquel y Henríquez Unidad Académica Arandas Arandas México

Forest ecosystems represent a third of the total organic carbon (TOC) stored in the soil. However, studies still need to be carried out to generate reliable information on its soil carbon storage potential in an experimental plantation. Therefore, the objective of this research was to determine the storage of total organic carbon (TOC) in the soil in two experimental forest plantations with tropical species, located in the state of Nayarit, México. The research was carried out in two experimental plantations with tropical species, located at the Santiago Ixcuintla Experimental Field (CESIX) and at the El Verdine?o Experimental Site (SEEV). The established species are Swietenia macrophylla King (mahogany), Cedrela odorata l. (cedar) and Tabebuia rosea Bertoil (pink trumpet-tree). In addition, data from dasometric variables were used in order to define if any of these variables had a similar variation to the soil TOC stock by species. The sampling was done under a randomized block experimental design in each experimental forest plantation (CESIX and SEEV). Nine composite samples were collected in the soil under the tree species at a depth of 0 - 30 cm, and 1.5 m distance from the tree. To determine the soil TOC, an elemental analyzer with a thermal conductivity detector Thermo Scientific (Flash 2000) was used. The results showed that TOC presented mean values of 103.60 and 219.98 t·ha-1 at a depth of 0 - 30 cm in CESIX and SEEV respectively. The highest TOC wasle="font-family:;" "=""> obtained in soil under mahogany;142.95 t·ha-1 in CESIX and 284.41 t·ha-1 in SEEV. The analysis of the differences in TOC between the two plantations was highly significant. In the analysis of the species, it showed a statistically significant difference (p l unde

关键词： Carbon Sequestration Dasometric Variables Tropical Trees

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Post-Hospital Syndrome and Hyponatremia

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Health 2021年第8期13卷 846-856页

作者： José Bellod-Tonda Julio Blázquez-Encinar María Dolores Jover-Ríos Carmen Seguí-Pérez Juan Méndez-mora Francisco Caparrós-Hernández Álex Méndez-Jover Marc Seguí-Pérez David Baláž leticia Espinosa del Barrio Jesús Corbacho-Redondo Carles García-Cervera Juan Manuel Núñez-Cruz Isidro Hernández-Isasi Javier Guzmán-Martínez Angie Gómez-Uranga Pedro Esteve-Atiénzar Jorge Peris-García Veronica Martínez-Sempere Eliana Damonte-White Óscar Hernando Ruiz-Ariza Juan Carlos lópez-Corbalán lourdes lajara-Villar Andrea Riaño-Pérez Paloma Chazarra-Pérez María Escamilla-Espínola Maria luisa Asensio-Tomás Miguel Ángel Auladell-Alemany laura Serna-Torres Asunción Pérez-Fullana Amparo Gómez-Siurana Sergio Menargues-Irles José Miguel Seguí-Ripoll Internal Medicine Department University Hospital of San Juan Alicante Spain Internal Medicine Department Torrevieja University Hospital Alicante Spain Internal Medicine Department Hospital La Vega Baja of Orihuela Alicante Spain CEU Cardinal Herrera University Veterinary Hospital Valencia Spain Secondary School Marist Brothers High School Alicante Spain Department of Clinical Medicine Miguel Hernández University Elche Spain Primary Care Medicine Benilloba Spain Sub-Delegation of the Government Alicante Spain Chemical Engineering Department University of Alicante Alicante Spain

Introduction: Post-hospital syndrome (PHS) is defined as a period of vulnerability during the first 30 days after a patient is discharged from hospital, in which multiple factors come into play. Hyponatremia is the most frequent hydroelectrolytic disorder in hospitalized patients and may be related to the appearance of PHS. Objective: The objective is to estimate the prevalence of PHS that is assessed as the rate of readmissions in the first 30 days after discharge, in patients with hyponatremia. Material and Methods: It is a descriptive observational study of patients with hyponatremia who were discharged from 1 September 2010 to 2 February 2020 at the Internal Medicine Service of the Hospital University of San Juan (Alicante, Spain). Results: Of the 25 included patients, 5 (20%) were readmitted within a month of discharge, after a mean of 11.4 days (standard deviation [SD] 5.1). The overall mortality of the study was 20% (n = 5), with one case of death in the first 30 days post-hospitalization (4%). In 12 patients (48%) the origin of the hyponatremia was undetermined. The most frequently recorded etiology for the condition was pharmacological (n = 7, 28%), and there was pronounced variability in its clinical and laboratory study. The most widely used corrective measure was drug withdrawal, in 16 patients (64%). Water intake restriction was the most common treatment after discharge (5 patients, 20%), followed by urea (2 patients, 8%), while tolvaptan was not used. Conclusion: Hyponatremia may be the cause of PHS, which could increase the rate of early readmission. Hyponatremia is an underdiagnosed and undertreated entity, so it is necessary to apply an appropriate system to optimize its management and, in future studies, to assess its impact on PHS.

关键词： Hospitalization Hyponatremia Patient Readmission Inappropriate ADH Syndrome

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