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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1517-1520页

作者： Javier Arredondo Montero department of Pediatric Surgery Complejo Asistencial Universitario de LeónCastilla y LeónLeón 24008Spain

Recent medical literature shows that the application of artificial intelligence(AI)models in gastrointestinal pathology is an exponentially growing field,with pro-mising models that show very high *** inflammatory bowel disease(IBD),recent reviews demonstrate promising diagnostic and prognostic AI ***,studies are generally at high risk of bias(especially in AI models that are image-based).The creation of specific AI models that improve diagnostic performance and allow the establishment of a general prognostic fo-recast in IBD is of great interest,as it may allow the stratification of patients into subgroups and,in turn,allow the creation of different diagnostic and therapeutic protocols for these *** surgical models,predictive models of post-operative complications have shown great potential in large-scale *** this work,the authors present the development of a predictive algorithm for early post-surgical complications in Crohn's disease based on a Random Forest model with exceptional predictive ability for complications within the *** pre-sent work,based on logical and reasoned,clinical,and applicable aspects,lays a solid foundation for future prospective work to further develop post-surgical prognostic tools for *** next step is to develop in a prospective and mul-ticenter way,a collaborative path to optimize this line of research and make it applicable to our patients.

关键词： Survivor bias Data analysis Machine learning Ethics Critical thinking Postsurgical Complications Inflammatory bowel disease Gastrointestinal surgery

Bone metastases as initial presentation of hepatocellular carcinoma

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World Journal of Hepatology 2017年第29期9卷 1158-1165页

作者： Luzdivina Monteserin Alicia Mesa Maria Soledad Fernandez-Garcia Arantza Gadanon-Garcia Manuel Rodriguez María Varela department of Gastroenterology and Hepatology Complejo Asistencial Universitario de León department of Radiology Hospital Universitario Central de Asturias department of Pathology Hospital Universitario Central de Asturias department of Traumatology Hospital Universitario Central de Asturias Liver Unit Hospital Uni-versitario Central de Asturias

Extra-hepatic spread is present in 5% to 15% of patients with hepatocellular carcinoma(HCC) at the time of diagnosis. The most frequent sites are lung and regional lymph nodes. Here, we report 3 cases of unsuspected HCC with symptoms due to bone lesions as initial presentation. Morphological characteristics and immunohistochemistry from the examined bone were the key data for diagnosis. None of the patients had an already known chronic liver disease. Differential diagnoses with HCC upon ectopic liver disease or hepatoid adenocarcinoma were shown. Therapy with the orally active multikinase inhibitor sorafenib plus symptomatic treatment was indicated.

关键词： Hepatocellular carcinoma Bone metastases Liver cirrhosis Sorafenib

Psychic Neuronal Hypersynchronies: A New Psychiatric Paradigm?

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Health 2014年第16期6卷 2089-2099页

作者： Javier Alvarez-Rodriguez Servicio de Psiquiatría Complejo Asistencial Universitario León Spain

This paper deals with certain psychic automatisms that appear suddenly in the consciousness of the subject in a passive or automatic way and that usually are diagnosed as psychiatric symptoms or manifestations of an epileptic partial seizure. These mental automatisms are described in many writings by mystics, philosophers, literates, composers, and many different great artists and creators from human history, but they did not confer any pathological value on these experiences. The analysis of the epileptogenic activity gives us arguments to propose that these automatic experiences are due to neuronal circuits physiologically adapted to fire in a hypersynchronous way. With these data we enunciate an innovative hypothesis: these psychic experiences are manifestations of an adaptive neuronal network for which we propose the term psychic hypersynchrony. Finally, we discuss the consequences of this hypothesis, especially in the epileptic, psychiatric, and neuropsychopharmacologic fields.

关键词： Glutamate Hypothesis of Schizophrenia Kindling Learning Long Term Potentiation Memory Mysticism Neuropsychopharmacological Drugs Partial Seizures Reflex Epilepsies

Timely reperfusion for ST-segment elevation myocardial infarction:Effect of direct transfer to primary angioplasty on time delays and clinical outcomes

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World Journal of Cardiology 2014年第6期6卷 424-433页

作者： Rodrigo Estévez-Loureiro ángela López-Sainz Armo Pérez de Prado Carlos Cuellas Ramón Calvio Santos Norberto Alonso-Orcajo Jorge Salgado Fernández Jose Manuel Vázquez-Rodríguez Maria López-Benito Felipe Fernández-Vázquez Division of Cardiology Complejo Asistencial Universitario de León (CAULE)24071 LeonSpain Division of Cardiology Complejo Hospitalario Universitario A Coru?a (CHUAC)15006 La Coru?aSpain

Primary percutaneous coronary intervention(PPCI) is the preferred reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction(STEMI) when it can be performed expeditiously and by experienced operators. In spite of excellent clinical results this technique is associated with longer delays than thrombolysis and this fact may nullify the benefit of selecting this therapeutic option. Several strategies have been proposed to decrease the temporal delays to deliver PPCI. Among them,prehospital diagnosis and direct transfer to the cath lab,by-passing the emergency department of hospitals,has emerged as anattractive way of diminishing delays. The purpose of this review is to address the effect of direct transfer on time delays and clinical events of patients with STEMI treated by PPCI.

关键词： Primary angioplasty Direct transfer STsegment elevation myocardial infarction network Primary percutaneous coronary intervention Myocardial infarction

Psychiatric Symptoms of Epileptic Nature: An Old Hypothesis in Light of Current Psychopharmacologic Advances

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Open Journal of Psychiatry 2015年第1期5卷 113-120页

作者： Javier Alvarez-Rodriguez departamento de Psiquiatría Complejo Asistencial Universitario de León León Spain

This paper analyses a hypothesis according to which many positive psychiatric symptoms should be interpreted as symptoms of epileptic nature. When we first raised this proposition, almost fifteen years ago, it was inconsistent with the widespread conviction among psychiatrists that psychopharmacological drugs used to suppress psychiatric symptoms were proconvulsant. But lately, there have appeared numerous neuroscientific investigations that defend the anticonvulsant effect of most psychopharmacological drugs, hence supporting our hypothesis. We have carried out bibliographical reviews in search of the pro- or anticonvulsant role of these substances, particularly lithium, selective serotonin reuptake inhibitors, dual antidepressants, and antipsychotic *** researches show abundant evidence regarding the anticonvulsant action of these substances, a fact that contributes to a better comprehension of paradoxical relationship between epilepsy and psychoses.

关键词： Antipsychotic Drugs Dual Antidepressants Lithium Mental Automatisms SSRIs

The Hypothesis of Hyperia from the Perspective of Neuronal Plasticity

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Open Journal of Medical Psychology 2016年第1期5卷 17-26页

作者： Javier Álvarez-Rodríguez Servicio de Psiquiatría Complejo Asistencial Universitario de León León Spain

We analyze certain mental automatisms appearing in the consciousness with phenomenological features of simple partial seizures (SPSs). We propose to include all these phenomena into a cognitive function to which we term hyperia. In this paper, we analyze the similarities between the nature of this cognitive function and the mechanisms used by our brain to elicit neuronal plasticity.

关键词： Bipolar Disorder Glutamate Partial Seizures RDoC Repetition Reflex Epilepsies Schizophrenia

Hypersynchronic Mental Automatisms: An Innovative Psychiatric Hypothesis Reaffirming Its Validity for Fifteen Years

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Health 2015年第1期7卷 41-51页

作者： Javier Alvarez-Rodriguez Jefe de Servicio de Psiquiatría Complejo Asistencial Universitario de León León Spain

This paper deals with certain psychic automatisms that are usually diagnosed as psychiatric symptoms or as simple partial seizures. These mental automatisms are described in many writings by mystics, philosophers, literates, composers, and many different great artists and creators from human history, but they have never conferred any pathological value on these experiences. We have carried out previous scientific researches in which we found abundant arguments suggesting that these automatisms are due to neuronal nets physiologically adapted to fire in a hypersynchronous way. With these pieces of information we propose an audacious hypothesis: these automatic experiences are manifestations of a cognitive cerebral function that, until now, has been insufficiently delimited. We propose the term hyperia to denominate this cognitive function, which we consider responsible for clairvoyant and/or telepathic cognitions. Finally, we discuss the relevant consequences of this hypothesis, particularly in the fields of epilepsy, psychiatry, and neuropsychopharmacology.

关键词： Bipolar Disorder Glutamate Hippocampus Learning Long-Term Potentiation Schizophrenia Reflex Epilepsies

Tenofovir vs lamivudine plus adefovir in chronic hepatitis B:TENOSIMP-B study

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World Journal of Gastroenterology 2017年第41期23卷 7459-7469页

作者： Manuel Rodríguez Juan Manuel Pascasio Enrique Fraga Javier Fuentes Martín Prieto Gloria Sánchez-Antolín Jose Luis Calleja Esther Molina María Luisa García-Buey María Angeles Blanco Javier Salmerón María Lucía Bonet Jose Antonio Pons Jose Manuel González Miguel Angel Casado Francisco Jorquera 无 Division of Gastroenterology and Hepatology.Hospital universitario Central de Asturias Unit for the Clinical Management of Digestive Diseases IBISHospital Universitario Virgen del Rocío Liver Transplantation and Hepatology Unit Gastroenterology ServiceHospital Universitario Reina Sofía Digestive Medicine Service Hospital Universitario Miguel Servet Hepatology Unit Digestive Medicine ServiceHospital Universitari i Politècnic La Fe Hepatology Unit Hospital Universitario Rio Hortega Liver Unit Hospital Universitario Puerta de Hierro de MajadahondaUniversidad Autónoma de Madrid Digestive Medicine Service Hospital Clínico de Santiago de Compostela Liver Unit Hospital Universitario de La Princesa Digestive Medicine Service Hospital General Universitario Gregorio Maranon Digestive Medicine Unit Complejo Hospitalario de Granada Digestive Medicine Service Hospital Universitario Son Espases Hepatology Unit IMIB Hospital Universitario Virgen de la Arrixaca Digestive Medicine Service Hospital Clínico Universitario de Valladolid Pharmacoeconomics and Outcomes Research Iberia Division of Gastroenterology and Hepatology Complejo Asistencial Universitario de León the TENOSIMP-B Research Group

AIM To demonstrate the non-inferiority(15% non-inferiority limit) of monotherapy with tenofovir disoproxil fumarate(TDF) vs the combination of lamivudine(LAM) plus adefovir dipivoxil(ADV) in the maintenance of virologic response in patients with chronic hepatitis B(CHB) and prior failure with *** This study was a Phase IV prospective, randomized, open, controlled study with 2 parallel groups(TDF and LAM+ADV) of adult patients with hepatitis B e antigen(HBe Ag)-negative CHB, prior failure with LAM, on treatment with LAM+ADV for at least 6 mo, without prior resistance to ADV and with an undetectable viral load at the start of the study, in 14 Spanish hospitals. The follow-up time for each patient was 48 wk after randomization, with quarterly visits in which the viral load, biochemical and serological parameters, adverse effects, adherence to treatment and consumption of hospital resources were *** Forty-six patients were evaluated [median age: 55.4 years(30.2-75.2); 84.8% male], including 22 patients with TDF and 24 with LAM+ADV. During study development, hepatitis B virus DNA(HBV-DNA) remained undetectable, all patients remained HBe Ag negative, and hepatitis B surface antigen(HBs Ag) positive. Alanine aminotransferase(ALT) values at the end of the study were similar in the 2 groups(25.1± 7.65, TDF vs 24.22 ± 8.38, LAM+ADV, P = 0.646). No significant changes were observed in creatinine or serum phosphorus values in either group. No significant differences between the 2 groups were noted in the identification of adverse effects(AEs)(53.8%, TDF vs 37.5%, LAM+ADV, P = 0.170), and none of the AEs which occurred were serious. Treatment adherence was 95.5% and 83.3% in the TDF and the LAM+ADV groups, respectively(P = 0.488). The costs associated with hospital resource consumption were significantly lower with the TDF treatment than the LAM+ADV treatment(€4943 ± 1059 vs €5811 ± 1538, respectively, P < 0.001).CONCLUSION TDF monotherapy proved to be safe

关键词： Tenofovir Lamivudine+Adefovir Efficacy Safety Adherence Costs Hepatitis B

Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic:Short and middle term outcomes

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World Journal of Methodology 2024年第2期14卷 107-126页

作者： Jacobo Trébol Ana Carabias-Orgaz María Carmen Esteban-Velasco Asunción García-Plaza Juan Ignacio González-Munoz Ana Belén Sánchez-Casado Felipe Carlos Parreno-Manchado Marta Eguía-Larrea José Antonio Alcázar-Montero Cirugía General y del Aparato Digestivo Complejo Asistencial Universitario de SalamancaSalamanca 37007SalamancaSpain Cirugía Universidad de SalamancaSalamanca 37007SalamancaSpain Oftalmología Complejo Asistencial Universitario de SalamancaSalamanca 37007SalamancaSpain

BACKGROUND The first wave of coronavirus disease 2019(COVID-19)pandemic in Spain lasted from middle March to the end of June *** population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable *** our centre,we managed patients previously and newly diagnosed with *** established a strategy based on limiting perioperative social contacts,preoperative screening(symptoms and reverse transcriptionpolymerase chain reaction)and creating separated in-hospital COVID-19-free pathways for non-infected *** also adopted some practice modifications(surgery in different facilities,changes in staff and guidelines,using continuously changing personal protective equipment…),that supposed new *** To analyse cancer patients with a decision for surgery managed during the first wave,focalizing on outcomes and pandemic-related *** We prospectively included adults with a confirmed diagnosis of colorectal,oesophago-gastric,liver-pancreatic or breast cancer with a decision for surgery,regardless of whether they ultimately underwent *** analysed short-term outcomes[30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection]and outcomes after 3 years(adjuvant therapies,oncological events,death,SARS-CoV-2 infection and vaccination).We also investigated modifications to usual *** From 96 included patients,seven didn’t receive treatment that period and four never(3 due to COVID-19).Operated patients:28 colon and 21 rectal cancers;laparoscopy 53.6%/90.0%,mortality 3.57%/0%,major complications 7.04%/25.00%,anastomotic leaks 0%/5.00%,3-years disease-free survival(DFS)82.14%/52.4%and overall survival(OS)78.57%/76.2%.Six liver metastases and six pancreatic cancers:no mortality,one major complication,three grade A/B liver failures,one bile leak;3-year DFS 0%/33.3%and OS 50.0%/33.3%(liver metastases/pancreatic carcinoma).5 g

关键词： COVID-19 SARS-CoV-2 Colon cancer Rectal cancer Breast cancer Liver cancer Pancreatic cancer Gastric cancer Oesophageal cancer Surgery

Prospective application of a bleeding and ischemic risks-adjusted antithrombotic protocol in elderly patients revascularized with everolimus-eluting stents:EPIC05-Sierra75 study

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Journal of Geriatric Cardiology 2022年第5期19卷 354-366页

作者： Jose M de la Torre Hernandez Ramon Lopez Palop Jesus M Jimenez Mazuecos Pilar Carrillo Sáez Alejandro Gutierez-Barrios Eduardo Pinar Belen Cid Luis Fernandez Tamara Garcia Camarero Cristóbal Urbano-Carrillo Juan F Oteo Dominguez Victor A Jimenez Diaz Antonio EGomez Menchero Eladio Galindo Fernández Juan GCórdoba Soriano Raymundo Ocaranza Eduardo ArroyoÚcar Koldobika Garcia San Roman Silvio Leal Ginés Martínez Cáceres Jose A Linares Vicente Georgina Fuertes Ferre Xavier Carrillo Juan CRama Merchán Catia Costa Juan Sanchis Renato Fernandes Alberto Rodrigues Jose M Vegas Valle Hélder Pereira Armando Perez de Prado Cardiology department Hospital Universitario Marqués de ValdecillaIDIVALSantanderSpain Cardiology department Hospital Universitario San JuanAlicanteSpain Cardiology department Complejo Hospitalario Universitario de AlbaceteAlbaceteSpain Cardiology department Hospital Universitario Puerta del MarCadizSpain Cardiology department Hospital Clínico Universitario Virgen de la ArrixacaMurciaSpain Cardiology department Hospital Clinico Universitario de SantiagoCIBERCVSantiago de CompostelaSpain Cardiology department Hospital Universitario de CrucesBilbaoSpain Cardiology department Hospital Regional Universitario de MálagaMalagaSpain Cardiology department Hospital Universitario Puerta de HierroMadridSpain Cardiology department Hospital Alvaro CunqueiroVigoSpain Cardiology department Hospital Juan Ramon JimenezHuelvaSpain Cardiology department Hospital Universitario de BadajozBadajozSpain Cardiology department Hospital Universitario Lucus AugustiLugoSpain Cardiology department Hospital de Torrevieja/VinalopóRibera SaludTorreviejaSpain Cardiology department Hospital Santa CruzLisboaPortugal Cardiology department Hospital Clínico Universitario Lozano BlesaZaragozaSpain Cardiology department Hospital Universitario Miguel ServetZaragozaSpain Cardiology department Hospital Germans Trias i PujolBadalonaSpain Cardiology department Hospital de MeridaMeridaSpain Cardiology department Hospital São BernardoSetúbalPortugal Cardiology department Hospital Clinico Universitario de ValenciaUniversidad de ValenciaCIBERCVValenciaSpain Cardiology department Hospital do Espirito SantoEvoraPortugal Cardiology department Centro Hospitalar de Vilanova de GaiaVilanova de GaiaPortugal Cardiology department Hospital de CabueñesGijonSpain Cardiology department Hospital Garcia de OrtaAlmadaPortugal Cardiology department Complejo Asistencial Universitario de LeónLeonSpain

OBJECTIVES Elderly patients show a higher incidence of ischemic and bleeding events after percutaneous transluminal coron-ary intervention(PCI).We sought to investigate outcomes in elderly patients treated with antithrombotic strategy guided by bleeding and ischemic risks after revascularization with last generation everolimus-eluting stent(EES).METHODS Prospective multicenter registry including patients over 75 years revascularized with EES and antithrombotic ther-apy guided by clinical presentation,PCI complexity and PRECISE DAPT ***-primary safety endpoints were:(1)composite of cardiac death,myocardial infarction and stent thrombosis and;(2)bleeding(BARC 2-5).Primary efficacy endpoint was target lesion revascularization.A matched group of patients revascularized with current drug-eluting stents and no such tailored antith-rombotic therapy was used as *** Finally,1064 patients were included in SIERRA-75 cohort,80.8±4.2 years,36.6%women,71%acute coronary syn-dromes(ACS)and 53.6%complex ***-primary safety endpoint of major adverse cardiovascular events was met in 6.2%,co-primary safety endpoint of bleeding in 7.8%and primary efficacy endpoint of TKLR in 1.5%.The multivariable adjusted model showed no significant association of the prescribed short/long dual antiplatelet therapy(DAPT)durations with any endpoint suggesting a well tailored *** stent thrombosis reported in the subgroup with 1-3 months DAPT *** compared to control group,bleeding BARC 2-5 was significantly lower in SIERRA-75 group(7.4%vs.10.2%,P=0.04)as well as the net safety-efficacy endpoint(14.3%vs.18.5%,P=0.02).CONCLUSIONS In elderly population,the application of this risks-adjusted antithrombotic protocol after revascularization with last generation EES seems to be associated with an improved prognosis in terms of ischemic and bleeding outcomes.

关键词： patients bleeding antithrombotic