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A Disruptive Treatment to Prevent Amputation and Enhance Limb Salvage in an Elderly Patient

Journal of Cosmetics, Dermatological Sciences and Applications 2019年第2期9卷 129-154页

作者： Sarah Cristina Castillo Benitez Rosa Alduey Duran pilar matos-ruiz Madalene C. Y. Heng Thomas L. Vander Laan Department of Medicine/Dermatology UCLA School of Medicine Los Angeles USA

Background: Chronic wounds are a growing problem internationally, termed a silent epidemic. To combat this epidemic, it is not sufficient to rely on traditional wound care treatments alone, but to look to innovative and alternative therapies. The indispensable role of oxygen in wound healing is well-discussed in the literature, and in the past two decades the topical application of oxygen has shown promising results in the healing of chronic wounds. However, the toxic effects of oxygen are usually not appreciated and can often lead to wound necrosis and gangrene in wounds with compromised blood supply. While wounds with adequate blood supply contain free radical quenchers (catalase, superoxide dismutase and reduced glutathione) which neutralize the free radicals (reactive oxygen species) released as a by-product of the Krebs cycle, wounds with deficient blood supply are deficient in free radical quenchers and are further damaged by exposure to oxygen as a result of reperfusion injury/oxygen toxicity. Topical hyperbaric oxygen (THOT®) uses low oxygen tensions in the hyperbaric range to stimulate angiogenesis, while preventing excessive oxygen toxicity. The result is the induction of marked angiogenesis, with increasing capacity for quenching reactive oxygen species, resulting in wound healing of ischemic wounds. Case Presentation: This case report describes a 95-year-old Caucasian female who presented with a stage IV chronic necrotic ulcer on her lower left leg. Surgical pathology results revealed calcifying vasculopathy, which is thought to be responsible for deficient blood supply to the leg, leading to a necrotic, chronic leg ulcer of her left leg. After traditional wound therapies were unsuccessful, she was considered for leg amputation. The introduction of adjunctive treatment with topical hyperbaric oxygen therapy saw complete healing of the wound within 15 weeks. The wound remained closed, without the presence of scar tissue, with no signs of wound breakdo

关键词： Limb Salvage Necrotic Leg Ulcers Topical Hyperbaric Oxygen Angiogenesis Hypoxic Wounds TcPO2

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Early performance of two tropical dry forest species after assisted migration to pine-oak forests at different altitudes:strategic response to climate change

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Journal of Forestry Research 2020年第4期31卷 1215-1223页

作者： pilar Angélica Gómez-ruiz Cuauhtémoc Sáenz-Romero Roberto Lindig-Cisneros Catedrática CONACYT Centro de Investigaciónde Ciencias Ambientales CICAFacultad de Ciencias NaturalesUniversidad Autónoma del CarmenCiudad del CarmenCampecheMexico Instituto de Investigaciones Agropecuarias y Forestales Universidad Michoacana de San Nicolás de Hidalgo(IIAFUMSNH)MoreliaMexico Instituto de Investigaciones en Ecosistemas y Sustentabilidad(IIES) Universidad Nacional Autónoma de MéxicoCampus MoreliaMoreliaMexico

Assisted migration has been proposed as a strategy for adaptive management of forest species in response to expected effects of climate change,but it is controversial for several *** dry forests are among the most threatened ecosystems in the *** Mexico,historically,land-use change and deforestation have been decreasing forest cover,and climate change is shifting the potential distribution of different forest types,exacerbating the risk of local *** altitudinal migration could be a feasible strategy for reducing local extinctions in response to climate change and lack of landscape *** objective was to evaluate survival and growth of Albizia plurijuga and Ceiba aesculifolia,two tropical deciduous forests species in *** transplanted 4-month-old seedlings to experimental raised beds at three altitudes(2100,2400 and 2700 m a.s.l.),exceeding their upper regional limit of distribution(2000 m a.s.l.).We also tested seed germination at each *** monitored the experiment for 10 *** both species,as altitude increased and cold weather was more prevalent,plant performance *** species,differences in individual growth were significant among *** survival was 18.5%for *** and 24.5%for *** species had higher survival and better growth at lower altitude,and no seedling emergence at any *** conclude that assisted migration can be implemented for each species by an upward attitudinal shift within,and not exceeding,400 m beyond their present upper altitudinal limit of *** results indicate that for many species that show altitudinal gradients at regional scales,unless current climate conditions change,the potential to establish outside their range is minimal.

关键词： Albizia plurijuga Ceiba aesculifolia Climate change Fabaceae Forest management Mitigation strategy Range expansion

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Recent insights into the characteristics and role of peritoneal macrophages from ascites of cirrhotic patients

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World Journal of Gastroenterology 2021年第41期27卷 7014-7024页

作者： pilar García-Peñarrubia Antonio Joséruiz-Alcaraz Miriam ruiz-Ballester Tamara Nadira Ramírez-Pávez María Martínez-Esparza Department of Biochemistry and Molecular Biology B and Immunology School of MedicineUniversity of MurciaMurcia 30100Spain

Macrophages are a diverse myeloid cell population involved in innate and adaptive immune responses,embryonic development,wound repair,and regulation of tissue *** cells link the innate and adaptive immunities and are crucial in the development and sustainment of various inflammatory *** are tissue-resident cells in steady-state conditions;however,they are also recruited from blood monocytes after local pathogen invasion or tissue *** macrophages vary based on their cell complexity,phenotype,and functional *** cells regulate inflammation and control bacterial infections in the ascites of decompensated cirrhotic *** recent work reported several phenotypic and functional characteristics of these cells under both healthy and pathological conditions.A direct association between cell size,CD14/CD16 expression,intracellular level of GATA-6,and expression of CD206 and HLA-DR activation/maturation markers,indicate that the large peritoneal macrophage CD14^(high)CD16^(high)subset constitutes the mature phenotype of human resident peritoneal macrophages during ***,elevated expression of CD14/CD16 is related to the phagocytic *** novel large CD14^(high)CD16^(high)peritoneal subpopulation is increased in the ascites of cirrhotic patients and is highly sensitive to lipopolysaccharide(LPS)-induced activation,thereby exhibiting features of inflammatory ***,phosphorylation of ERK1/2,PKB/Akt,and c-Jun is remarkably increased in response to LPS in vitro,whereas that of p38 MAPK is reduced compared with the monocyte-derived macrophages from the blood of healthy ***,in vitro activated monocyte-derived macrophages from ascites of cirrhotic patients secreted significantly higher levels of IL-6,IL-10,and TNF-αand lower amounts of IL-1βand IL-12 than the corresponding cells from healthy donor’s *** on these results,other authors have recently reported that the sur

关键词： Cirrhosis Inflammation Peritoneal macrophages Phenotypic markers Activation routes

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Ambispective comparative study of two surgical strategies for liver hydatidosis

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World Journal of Gastroenterology 2012年第6期18卷 546-550页

作者： Jose M Ramia Francisco ruiz-Gomez Roberto De la Plaza pilar Veguillas Jose Quiones Jorge García-Parreo Department of Surgery Hepato-Bilio-Pancreatic Surgery UnitGuadalajara University HospitalGuadalajara 19002Spain

AIM:To investigate the morbidity,mortality,recurrence and technical aspects of two distinct surgical strategies that were implemented in successive ***:Ninty-two patients with 113 cysts underwent surgical *** study was divided into 2 *** from first period(P1) were compiled *** surgical strategy was conservative *** second period(P2) included a prospective study conducted according to a protocol following the criterion that radical procedures should be performed whenever it is technically ***:Patients of both periods showed no statistically significant differences in age,gender,cyst location or *** the P2 group,patients exhibited more preoperative jaundice,and cyst size was smaller(P < 0.05).Changes in surgical strategy increased the rate of radical surgery,decreases morbidity and in-hospital stay(P < 0.001).A negative result in P2 was the death of two old patients(4.8%) who had undergone conser-vative *** rate of radical surgery in P2 was around 75%.CONCLUSION:Radical surgery should be the technique of choice whenever it is feasible,because it diminishes morbidity and in-hospital *** surgery must be employed only in selected cases.

关键词：手术包虫病发病率死亡率保守性肝囊肿统计学

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Acute postoperatory visual loss following bilateral lung transplantation surgery:a case series

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International Journal of Ophthalmology(English edition) 2017年第5期10卷 822-825页

作者： Rosa Gutierrez-Bonet Jorge ruiz-Medrano Maria Alarcon-Tomas Mónica Hijos pilar Cifuentes-Canorea Puerta de Hierro University Hospital Ophthalmology Department Madrid 28222 Spain Jules Gonin Eye Hospital Lausanne 1002 Switzerland Clinico San Carlos University Hospital Madrid 28040 Spain

Dear Editor,I am Rosa Gutiérrez Bonet,former ophthalmology resident at Puerta de Hierro University Hospital,Madrid,Spain.I write to present four cases of cortical blindness（CB）after bilateral lung transplant（LT）.

关键词： lung Acute postoperatory visual loss following bilateral lung transplantation surgery a case series case

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A High-Resolution Modeling Strategy to Assess Impacts of Climate Change for Mesoamerica and the Caribbean

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American Journal of Climate Change 2016年第2期5卷 202-228页

作者： Robert Oglesby Clinton Rowe Alfred Grunwaldt Ines Ferreira Franklyn ruiz Jayaka Campbell Luis Alvarado Francisco Argenal Berta Olmedo Alejandro del Castillo pilar Lopez Edwards matos Yosef Nava Carlos Perez Joel Perez Department of Earth and Atmospheric Sciences University of Nebraska Lincoln NE USA Climate Change and Sustainability Division Inter-American Development Bank Washington DC USA Instituto de Hidrología Meteorología y Estudios Ambientales de Colombia Bogota Colombia University of the West Indies Kingston Jamaica Instituto Meteorológico Nacional Costa Rica San Jose Costa Rica Servicio Meteorológico Nacional de Honduras Dirección General de Aeronáutica Civil Tegucigalpa Honduras Empresa de Transmisión Eléctrica Paname?a Ciudad de Panamá Panamá Water Center for the Humid Tropics of Latin America and the Caribbean (CATHALAC) Ciudad de Panamá Panamá Unidad de Análisis Meteorológico Empresa de Transmisión Eléctrica Paname?a Ciudad de Panamá Panamá Instituto Nacional de Ecología y Cambio Climático Mexico City Mexico National Weather Service MARN San Salvador El Salvador

Mesoamerica and the Caribbean are low-latitude regions at risk for the effects of climate change. Global climate models provide large-scale assessment of climate drivers, but, at a horizontal resolution of 100 km, cannot resolve the effects of topography and land use as they impact the local temperature and precipitation that are keys to climate impacts. We developed a robust dynamical downscaling strategy that used the WRF regional climate model to downscale at 4 - 12 km resolution GCM results. Model verification demonstrates the need for such resolution of topography in order to properly simulate temperatures. Precipitation is more difficult to evaluate, being highly variable in time and space. Overall, a 36 km resolution is inadequate;12 km appears reasonable, especially in regions of low topography, but the 4 km resolution provides the best match with observations. This represents a tradeoff between model resolution and the computational effort needed to make simulations. A key goal is to provide climate change specialists in each country with the information they need to evaluate possible future climate change impacts.

关键词： Regional Climate Models Dynamical Downscaling Strategy Mesoamerica and Caribbean Climate Change

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Inflammatory status in human hepatic cirrhosis

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World Journal of Gastroenterology 2015年第41期21卷 11522-11541页

作者： María Martínez-Esparza María Tristán-Manzano Antonio J ruiz-Alcaraz pilar García-Penarrubia Departamento de Bioquímica Biología Molecular (B) e Inmunología Facultad de Medicina IMIB Regional Campus of International Excellence "Campus Mare Nostrum" Universidad de Murcia

This review focuses on new findings about the inflammatory status involved in the development of human liver cirrhosis induced by the two main causes, hepatitis C virus(HCV) infection and chronic alcohol abuse, avoiding results obtained from animal models. When liver is faced to a persistent and/or intense local damage the maintained inflammatory response gives rise to a progressive replacement of normal hepatic tissue by non-functional fibrotic scar. The imbalance between tissue regeneration and fibrosis will determine the outcome toward health recovery or hepatic cirrhosis. In all cases progression toward liver cirrhosis is caused by a dysregulation of mechanisms that govern the balance between activation/homeostasis of the immune system. Detecting differences between the inflammatory status in HCV-induced vs alcoholinduced cirrhosis could be useful to identify specific targets for preventive and therapeutic intervention in each case. Thus, although survival of patients with alcoholic cirrhosis seems to be similar to that of patients with HCV-related cirrhosis(HCV-C), there are important differences in the altered cellular and molecular mechanisms implicated in the progression toward human liver cirrhosis. The predominant features of HCV-C are more related with those that allow viral evasion of the immune defenses, especially although not exclusively, inhibition of interferons secretion, natural killer cells activation and T cell-mediated cytotoxicity. On the contrary, the inflammatory status of alcohol-induced cirrhosis is determined by the combined effect of direct hepatotoxicity of ethanol metabolites and increases of the intestinal permeability, allowing bacteria and bacterial products translocation, into the portal circulation, mesenteric lymph nodes and peritoneal cavity. This phenomenon generates a stronger pro-inflammatory response compared withHCV-related cirrhosis. Hence, therapeutic intervention in HCV-related cirrhosis must be mainly focused to counter

关键词： Inflammation Macrophages Cirrhosis Alcohol Hepatitis C virus Cytokines Liver

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Pulmonary arterial hypertension related to human immunodeficiency virus infection:A case series

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World Journal of Cardiology 2014年第6期6卷 495-501页

作者： Inês Araújo Cristina Enjuanes-Grau Carmen Jimenez Lopez-Guarch Dariusz Narankiewicz Maria J ruiz-Cano Teresa Velazquez-Martin Juan Delgado pilar Escribano 3~(rd) Medicine Department S?o Francisco Xavier HospitalCHLO1449-005 LisboaPortugal Cardiology Department University Hospital of Canarias38320 La LagunaTenerifeSpain Teresa Velazquez-Martin Juan DelgadoPilar EscribanoPulmonary Hypertension UnitUniversity Hospital of 12 de Octubre28041 MadridSpain Internal Medicine Department Carlos Haya Hospital29010 MálagaSpain Pulmonary Hypertension Unit University Hospital of 12 de Octubre28041 MadridSpain

AIM: To present 18 new cases of human immunodeficiency virus(HIV)-related pulmonary arterial hypertension(PAH) with presenting features,treatment options and follow-up ***: This is a single-centre,retrospective,observational study that used prospectively collected data,conducted during a 14-year period on HIV-related PAH patients who were referred to a pulmonary hy-pertension unit. All patients infected with HIV were consecutively admitted for an initial evaluation of PAH during the study period and included in our study. Right heart catheterisation was used for the diagnosis of PAH. Specific PAH treatment was started according to the physician's judgment and the recommendations for idiopathic PAH. The data collected included demographic characteristics,parameters related to both HIV infection and PAH and disease ***: Eighteen patients were included. Intravenous drug use was the major risk factor for HIV infection. Risk factors for PAH,other than HIV infection,were present in 55.5% patients. The elapsed time between HIV infection and PAH diagnoses was 12.2 ± 6.9 years. At PAH diagnosis,94.1% patients had a CD4 cell count > 200 cells/μL. Highly active antiretroviral therapy(present in 47.1% patients) was associated with an accelerated onset of PAH. Survival rates were 93.8%,92.9% and 85.7% at one,two and three years,respectively. Concerning specific therapy,33.3% of the patients were started on a prostacyclin analogue,and the rest were on oral drugs,mainly phosphodiesterase-5 inhibitors. During the follow-up period,specific therapy was de-escalated to oral drugs in all of the living ***: The survival rates of HIV-related PAH patients were higher,most likely due to new aggressive specific therapy. The majority of patients were on oral specific therapy and clinically stable. Moreover,sildenafil appears to be a safe therapy for less severe HIVrelated PAH.

关键词：人的免疫不全病毒感染肺的动脉的高血压处理

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Acute Respiratory Distress Syndrome (ARDS) Case Report after a Caesarean Section Related to the Immune Reconstitution Inflammatory Syndrome

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Open Journal of Anesthesiology 2014年第8期4卷 197-201页

作者： álvaro Ramiro ruiz pilar Reboto Cortés Ignacio García Sánchez Juan Emilio Losa Miguel Miró Murillo Santiago García del Valle y Manzano Hospital Universitario Fundación Alcorcón Madrid Spain

During pregnancy, a cellular immunosuppressant status is produced. It is characterized by anti-inflammatory cellular responses that allow embryonic implantation. The reversal of these changes during the postpartum period may result in overt clinical manifestations of otherwise quiescent or latent infections. We present an Acute Respiratory Distress Syndrome (ARDS) case after a caesarean section related to the Immune Reconstitution Inflammatory Syndrome (IRIS) in a Guinean black woman. The patient was treated with large doses of corticosteroids showing a great clinical and radiological improvement.

关键词： Immune Reconstitution Inflammatory Syndrome Mycobacterium Tuberculosis Pregnancy

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Acalculous cholecystitis due to Salmonella enteritidis

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World Journal of Gastroenterology 2008年第41期14卷 6408-6409页

作者： Maria Lourdes ruiz-Rebollo Gloria Sánchez-Antolín Félix García-Pajares Maria Antonia Vallecillo-Sande pilar Fernández-Orcajo Rosario Velicia-Llames Agustín Caro-Patón Gastroenterology Unit Hospital Río Hortega

Acute acalculous cholecystitis (AAC) is defi ned as an acute infl ammation of the gallbladder in the absence of stones. We herein report a case of a young man who developed AAC after a Salmonella enteritidis gastroint... 详细信息

关键词：胆囊炎年轻人传染性沙门氏菌属肠炎

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