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Utility of urgent colonoscopy in acute lower gastro-intestinal bleeding:a single-center experience

Gastroenterology Report 2014年第4期2卷 300-305页

作者： Mazen Albeldawi Duc Ha Paresh Mehta rocio Lopez Sunguk Jang Madhusudhan R.Sanaka John J.Vargo Department of Gastroenterology and Hepatology Cleveland ClinicClevelandOHUSA Department of Internal Medicine Cleveland ClinicClevelandOHUSA Department of Quantitative Sciences Cleveland ClinicClevelandOHUSA

*** role of urgent colonoscopy in lower gastro-intestinal bleeding(LGIB)remains *** the last two decades,a number of studies have indicated that urgent colonoscopy may facilitate the identification and treatment of bleeding lesions;however,studies comparing this approach to elective colonoscopy for LGIB are *** determine the utility and assess the outcome of urgent colonoscopy as the initial test for patients admitted to the intensive care unit(ICU)with acute *** patients who underwent colonoscopy at our institution for the initial evaluation of acute LGIB between January 2011 and January 2012 were analysed *** were grouped into urgent *** colonoscopy,depending on the timing of colonoscopy after admission to the *** colonoscopy was defined as being performed within 24 hours of admission and those performed later than 24 hours were considered *** included length of hospital stay,early re-bleeding rates,and the need for additional diagnostic or therapeutic *** logistic regression analysis was performed to identify factors associated with increased transfusion ***-seven patients underwent colonoscopy for the evaluation of suspected LGIB,24 of which were *** was no significant difference in patient demographics,co-morbidities,or medications between the two *** who underwent urgent colonoscopy were more likely to present with hemodynamic instability(P=0.019)and require blood transfusions(P=0.003).No significant differences in length of hospital stay,re-bleeding rates,or the need for additional diagnostic or therapeutic interventions were *** requiring blood transfusions(n=27)were more likely to be female(P=0.016)and diabetics(P=0.015).Fourteen patients re-bled at a median of 2 days after index *** with hemodynamic instability were more likely to re-bleed[HR 3.8(CI 1.06–13.

关键词： acute lower gastro-intestinal bleeding urgent colonoscopy elective colonoscopy outcomes

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文化商和观点采择对创造了影响的研究

文化商和观点采择对创造了影响的研究

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作者： CASTANEDA SANCHEZ DIANA rocio 华南理工大学

学位级别：硕士

技术发展加强了全球范围内的相互联系,增加了市场和工作场所的复杂性和多样化。因此,组织必须处理来自不同文化背景的利益相关者。由于这些事实,追求创新对当今组织来说已变得越来越具有挑战性。在全球情况下,员工在多元文化环境中产生... 详细信息

技术发展加强了全球范围内的相互联系,增加了市场和工作场所的复杂性和多样化。因此,组织必须处理来自不同文化背景的利益相关者。由于这些事实,追求创新对当今组织来说已变得越来越具有挑战性。在全球情况下,员工在多元文化环境中产生新颖和有益的想法的能力至关重要。企业需要他们的创意,不仅要成功,还要在当今全球市场中生存下去。在多元文化中产生创意对当前市场的复杂性作出相应的反应,同时使企业知识更丰富。本学位论文寻求更深入了解观点采择,文化商与创造力之间的关系。这项研究认为,个人的文化文化智慧不仅提高了他们产生创造性想法的能力,这些想法需要从不同的背景中汲取知识,而且与他们的观点也有积极的联系。使他们能够避免不和谐环境的可能造成的损害,从而有效地从中受益。探索文化智力理论与创造力之间现有的理论差距可以有助于理解文化多样性与其创造力效益之间的关系,同时提供有关如何在多元文化背景下提升个人创造力潜力的重要知识。同时提供关于如何在多元文化背景下提升个人创造力的潜力。为了支持提出的论文陈述,进行了包含多文化远程同伴测试的自管理网络调查。结果说明动机文化商维度和行为文化商维度是多元文化创意的有力预测因素。研究结果显示了重要的发现。第一,文化商的维度(四部曲)跟个人观点采择正相关,第二,在国外的年数不会对多元文化的创造力产生直接影响,反而目前生活在一个外国,这对于结合来自不同文化的知识的能力有积极的影响。最后,认知文化商维度对创造力提升有弱的影响。这些研究结果在经验数据的支持下,对文化商与创造力文献产生了重大影响,并在面对跨文化协作迫切需要创新和实现包括所有人平等的和谐繁荣世界的迫切需要时具有实际意义。

关键词：创造力文化智力观点采择多元文化氛围多元文化经验

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Does serotonin reuptake inhibitor therapy increase the risk of post-sphincterotomy bleeding in patients undergoing endoscopic retrograde cholangio-pancreatography?

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World Journal of Gastrointestinal Endoscopy 2017年第4期9卷 171-176页

作者： Divya Yadav John Vargo rocio Lopez Prabhleen Chahal Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland Clinic Department of Quantitative Health Sciences Cleveland Clinic

AIM To evaluate the risk of immediate and delayed bleeding following sphincterotomy *** This retrospective cohort study was conducted with all patients who underwent endoscopic sphincterotomy during January 2006 to September 2015 at a tertiary academic center. Patients were grouped according to pre procedural usage of serotonin reuptake inhibitors(SRIs). Both groups were matched for demographic and clinical characteristics. Patients with thrombocytopenia,increased international normalized ratio, or a history of bleeding or coagulation disorders, concurrent use of other antiplatelet/anticoagulants were excluded from the *** A total of 447 patients were included, of which 219(45.9%) used SRIs and 228(54.1%) cases did *** was no significant difference in acute or delayed bleeding during endoscopic sphincterotomy between the two groups.(8.2% vs 12.3%, P = 0.16).CONCLUSION The use of SRIs was not associated with an increased risk of post-sphincterotomy bleeding. To our best knowledge, this is the first study to explore this asso-ciation.

关键词：血清素举起禁止者柱子 -- sphincterotomy 流血内视镜检查法内视镜后退 cholangiopancreatography 胃肠的流血

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改善地铁网络的攻击承受力 ——以委内瑞拉加拉加斯地铁为例

改善地铁网络的攻击承受力 ——以委内...

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作者： rocio Isabel Tinoco Sanchez 北京交通大学

学位级别：硕士

委内瑞拉是一个位于南美洲北海岸的国家,经济资源短缺,并且与世界上一些具有高度影响力的国家的政治关系不稳定,这使得国防部采取极端的保护措施,以避免对该国交通系统最重要的组成部分之一——地铁网络的攻击。本研究的主要目的是寻找... 详细信息

委内瑞拉是一个位于南美洲北海岸的国家,经济资源短缺,并且与世界上一些具有高度影响力的国家的政治关系不稳定,这使得国防部采取极端的保护措施,以避免对该国交通系统最重要的组成部分之一——地铁网络的攻击。本研究的主要目的是寻找提高地铁网络攻击容忍度的可行方法。我们采用复杂网络方法评估加拉加斯地铁网络的鲁棒性,模拟随机和有计划的攻击,并定量测量结构变化以反映攻击的破坏程度。基于仿真结果,我们发现关键节点保护策略可以提高地铁系统的鲁棒性,并且节点12、13、24、31、46和47是关键节点。增加现有节点之间的连通性,以创建一个更具交错性的网络是很有必要的,一旦受到任何类型的干扰（有意的或无意的）,该网络能够维持运行。此外,加强安全系统、协议、设备和人员也很重要,尤其是在那些关键站点。加强与地铁网络相连的地面交通可能是在网络中创建更多环路的另一个策略,这能够提高连通性和鲁棒性。

关键词：复杂网络地铁网络网络参数网络安全

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食管闭锁和气管食管瘘患儿的长期结局

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Gastroenterology Report 2016年第4期4卷 310-314,I0002页

作者： Richard H.Cartabuke rocio Lopez Prashanthi N.Thota Department of Internal Medicine Cleveland ClinicClevelandOHUSA Department of Biostatistics Cleveland ClinicClevelandOHUSA Department of Gastroenterology and Hepatology Cleveland ClinicClevelandOHUSA

目的:评估食管闭锁合并(或不合并)气管食管瘘(EA/TEF)患儿的长期(不局限于儿童时期)并发症和临床结局。本研究旨在通过临床症状、诊断试验和治疗干预评估一家三甲医院EA/TEF患儿吞咽和呼吸系统并发症。方法:纳入2011-2014年间先天性EA/... 详细信息

目的:评估食管闭锁合并(或不合并)气管食管瘘(EA/TEF)患儿的长期(不局限于儿童时期)并发症和临床结局。本研究旨在通过临床症状、诊断试验和治疗干预评估一家三甲医院EA/TEF患儿吞咽和呼吸系统并发症。方法:纳入2011-2014年间先天性EA/TEF患儿,收集这些患儿的人口统计特征、疾病分类和分型、临床症状、影像学、内镜下及支气管镜下发现及其治疗情况。结果:共计43例患儿纳入研究,其中以白人居多,中位年龄8岁(四分位间距320岁)。20例(62.5%,20/32)为C型异常(EA合并远端TEF)。21例(48.8%)有烧心症状,19例(44.1%)有反酸症状,31例(72.1%)吞咽固体食物困难。26例患儿接受钡餐检查,其中17例(65.4%)狭窄,20例(76.9%)动力不足,4例(15.4%)出现复发瘘。30例患儿接受上消化道内镜检查,其中21例(70.0%)发现狭窄,6例(20.0%)出现需外科干预的复发瘘。8例患儿行胃底折叠术。呼吸功能评估显示31例(72.1%)患儿有咳嗽和气梗,32例有呼吸困难和哮喘,19例(44.2%)患儿有反复的呼吸系统感染。其他发现包括气管软化(86.7%)和限制性肺病(54.5%)。结论:EA/TEF患儿残留的食管和气管具有较高的病理风险,需要长期随访来监测临床症状和治疗反应。

关键词：食管闭锁气管食管瘘胃食管反流病食管动力不足吸入性肺炎

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Testicular expression of the TGF-<i>β</i>1 system and the control of Leydig cell proliferation

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Advances in Bioscience and Biotechnology 2013年第10期4卷 1-7页

作者： Gonzalez Candela rocio Calandra Ricardo Saul Gonzalez-Calvar Silvia Ines Institute of Biology and Experimental Medicine National Council for Scientific and Technical Research Buenos Aires Argentina Research Center of Biomedical Biotechnology Environmental and Diagnostic Studies Maimónides University Buenos Aires Ar- gentina

Transforming growth factor beta 1 (TGF-β1) is a key regulator that modulates male reproductive function. Testicular TGF-β1 modulates the steroidogenesis of Leydig cells, the organization of peritubular myoid cells, testis development and spermatogenesis. Several studies have indicated that TGF-β1 is involved in the tight balance between proliferative and apoptotic responses in the Leydig cells. In the present review, we summarize the direct effects of this cytokine in Leydig cells under normal and pathological conditions. We analyze the effect of TGF-β1 inLeydig cells depending on the type of receptors involved in the signaling pathway of TGF-β1. Our group has been analyzing the canonical and non canonical intracellular signaling pathways of TGF-β1 that are involved in the expression of proliferative and apoptotic markers in Leydig cells. On the basis of our studies and from those of other authors we conclude that the balance between the expression of TGF-β1 receptors and co receptors is of relevance in Leydig cell physiology and pathophisiology.

关键词： TGF-β1 Leydig ALK Endoglin

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用以鉴别诊断克罗恩病与缺血性结肠炎的CT小肠造影影像学特征

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Gastroenterology Report 2017年第3期5卷 219-225,I0002页

作者： Min Chen Erick M.Remer Xiuli Liu rocio Lopez Bo Shen Department of Gastroenterology/Hepatology Cleveland Clinic FoundationClevelandOHUSA Department of Gastroenterology Zhongnan Hospital of Wuhan UniversityWuhanHubeiChina Section of Abdominal Imaging Imaging InstituteCleveland Clinic FoundationClevelandOHUSA

背景与目的:由于克罗恩病(CD)与缺血性结肠炎(ISC)的临床处理不同,因此对这两种疾病的鉴别诊断是非常重要的。ISC易被误诊为CD,尤其是对于老年人群。这两种疾病各自的影像学特征尚未被发明了。本研究的目的是评估CT小肠造影(CTE)用于CD... 详细信息

背景与目的:由于克罗恩病(CD)与缺血性结肠炎(ISC)的临床处理不同,因此对这两种疾病的鉴别诊断是非常重要的。ISC易被误诊为CD,尤其是对于老年人群。这两种疾病各自的影像学特征尚未被发明了。本研究的目的是评估CT小肠造影(CTE)用于CD与ISC鉴别诊断的价值。方法:通过Cleveland Clinic Foundation的电子医疗记录,检索确诊为CD和ISC的病例。入组其中接受过CTE检查者,无论其是否同时接受了肠镜和组织病理检查。由一名胃肠影像学专家盲法重新阅读CTE图像。计算每一项CTE影像学特征鉴别CD与ISC的灵敏度、特异度、准确性、阳性预测值及阴性预测值。采用Kappa系数(κ)来评估CTE与参考标准的诊断一致性。结果:共计34例患者纳入研究,其中CD 17例,ISC 17例。对CD与ISC进行鉴别诊断,CTE图像中黏膜强化和“靶征”缺失诊断CD的灵敏度均为100%,但这两种影像学特征的特异度较低,分别为35.3%和76.5%。CTE图像中的狭窄诊断CD的灵敏度仅为64.7%,但其特异度高达100%。黏膜强化、狭窄、“靶征”缺失鉴别CD与ISC的准确性分别为67.7%、82.4%和88.2%。联合应用黏膜强化和“靶征”缺失,其鉴别诊断的准确性可达100%。在鉴别CD与ISC方面,CTE与参考标准具有较好的一致性(κ=0.882)。结论:在鉴别CD与ISC方面,CTE似乎具有较高的临床价值。

关键词： CT小肠造影克罗恩病缺血性结肠炎鉴别诊断

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Characterization of patients with both alcoholic and nonalcoholic fatty liver disease in a large United States cohort

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World Journal of Hepatology 2019年第10期11卷 710-718页

作者： George Khoudari Amandeep Singh Mazen Noureddin Danielle Fritze rocio Lopez Imad Asaad Eric Lawitz Fred Poordad Kris V Kowdley Naim Alkhouri Department of Hospital Medicine Cleveland Clinic FoundationClevelandOH 44195United States Department of Gastroenterology and Hepatology Cleveland ClinicClevelandOH 44195United States Department of Gastroenterology and Hepatology Cedars Sinai Medical CenterLos AngelesCA 90048United States Department of General Surgery Texas Liver Institute and University of Texas HealthSan AntonioTX 78215United States Department of Quantitative Health Sciences Cleveland ClinicClevelandOH 44195United States Department of Gastroenterology Metro Health SystemClevelandOH 44109United States Texas Liver Institute and University of Texas Health San AntonioTX 78215United States Swedish Liver Care Network Swedish Medical CenterSeattleWA 98122United States

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is the hepatic manifestation of the metabolic syndrome(MetS)and is characterized by steatosis in the absence of significant alcohol ***,MetS and significant alcohol intake coexist in certain individuals which may lead to the development of *** To assess the clinical characteristics of patients with both alcoholic and NAFLD(BAFLD)in a large cohort in the United *** Adults from the National Health and Nutrition Examination Survey between 2003-2014 were *** was diagnosed based on elevated alanine aminotransferase(ALT)and being overweight or obese in the absence of other liver *** patients met the criteria for NAFLD but also had either MetS or type 2 diabetes and consumed excessive amounts of *** and multivariable analysis were performed to assess differences between NAFLD and BAFLD and to compare severity based on a validated fibrosis score(FIB4 index).RESULTS The prevalence of NAFLD was at 25.9%(95%CI;25.1-26.8)and that of BAFLD was 0.84%(0.67,1.02)which corresponds to an estimated 1.24 million Americans affected by *** to NAFLD,patients with BAFLD were more likely to be male,smokers,have higher ALT,aspartate aminotransferase,triglycerides,and lower platelets;P2.67 was 3.2(1.4,7.0),P=0.004].CONCLUSION A significant percentage of the American general population is afflicted by BAFLD and these patients tend to have more advanced liver fibrosis.

关键词： Non-alcoholic fatty liver disease Alcoholic liver disease Fatty liver disease

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Higher prevalence of colon polyps in patients with Barrett’s esophagus:a case-control study

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Gastroenterology Report 2014年第4期2卷 281-287页

作者： Arthi Kumaravel Prashanthi N.Thota Hyun-Ju Lee Tushar Gohel Mehulkumar K.Kanadiya rocio Lopez Madhusudhan R.Sanaka Center of Excellence for Barrett’s Esophagus Department of Gastroenterology and HepatologyCleveland ClinicClevelandOhioUSA Department of Biostatistics Cleveland ClinicClevelandOhioUSA

Background and aims:Barrett’s esophagus(BE)and colorectal neoplasms share similar risk *** studies have shown variable prevalence of colon polyps in patients with *** aims were to determine the prevalence and incidence of colon polyps in patients with BE,compared to those without ***:In this case-control study,the study group included patients,aged 50–75 years,with biopsy-proven BE,who underwent colonoscopy at Cleveland Clinic from January 2002 to December *** control group consisted of age-and sex-matched patients who underwent colonoscopy and also an endoscopy with no evidence of BE during the same time *** criteria for both groups were family-or personal previous history of colon cancer or polyps,prior colonic resection,inflammatory bowel disease and familial polyposis *** demographics,comorbidities,medication use and endoscopic and colonoscopic details were collected,including biopsy ***:A total of 519 patients were included in the study;173 patients with BE in the study group and 346 without BE in the control *** age at index colonoscopy was 618 years and 75%of patients were *** index colonoscopy,patients with BE were more likely to have polyps than controls(45%vs 32%,respectively;P=0.003).Patients underwent between one and five colonoscopies during the *** multivariate analysis—after adjusting for age,gender and diabetes—patients with BE were 80%more likely to have any type of polyp,and 50%more likely to have adenomas found during ***:Patients with BE had higher prevalence and incidence of colon *** has important clinical implications for screening and surveillance in BE patients.

关键词： Barrett’s esophagus colon polyps cancer prevention

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Characteristics of GaN Thin Films Using Magnetron Sputtering System

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Journal of Modern Physics 2016年第15期7卷 2028-2037页

作者： Hasina F. Huq rocio Y. Garza Roman Garcia-Perez Electrical Engineering University of Texas Pan American Edinburg USA

The paper presents a polycrystalline GaN thin film with a hexagonal wurtzite structure under the optimized sputtering conditions of 40 W RF power, 5 mT working pressure, using pure nitrogen gas with a substrate temperature of 700°C. The study examines the effects of surface disorders and incorporates it in the thin films characteristics. A radio frequency (RF) Ultra High Vacuum (UHV) Magnetron Sputtering System has been used for the deposition of Gallium Nitride (GaN) on silicon, sapphire and glass substrates with different parameters. The power is varied from 40 W to 50 W, and the pressure from 4 mT to 15 mT. The effects of the RF sputtering powers and gas pressures on the structural properties are investigated experimentally. Sputtering at a lower RF power of 15 W does increase the N atomic percentage, however the deposition rate is substantially slower and the films are amorphous. GaN deposited on both silicon and sapphire wafer resulted in thin films close to stoichiometric once the N2 concentration is 60% or higher. It is also observed that the substrate cooling/heating effects improve the quality of the thin films with fewer defects present at the surface of the GaN epi-structure.

关键词： GaN UHV Magnetron Sputtering RF Power HEMT Thin Film Characterization

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