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Refractory hepatic encephalopathy in a patient with hypothyroidism: Another element in ammonia metabolism

World Journal of Gastroenterology 2017年第28期23卷 5246-5252页

作者： Fernando Díaz-Fontenla Marta Castillo-Pradillo Arantxa Díaz-Gómez Luis Ibanez-Samaniego Pilar Gancedo Juan Adan Guzmán-de-Villoria Pilar Fernández-García Rafael Banares-Canizares Rita García-Martínez Unidad de Hepatología Servicio de Aparato DigestivoHospital General Universitario Gregorio Maranón Instituto de Investigación sanitaria hospital Gregorio Maranón Servicio de Aparato Digestivo Hospital Santa Bárbara Servicio de Radiodiagnóstico Hospital General Universitario Gregorio Maranón Centro de Investigación Biomédica en Red de Salud Mental Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Facultad de Medicina Universidad San Pablo CEU

Hepatic encephalopathy(HE) remains a diagnosis of exclusion due to the lack of specific signs and symptoms. Refractory HE is an uncommon but serious condition that requires the search of hidden precipitating events(i.e.,portosystemic shunt) and alternative diagnosis. Hypothyroidism shares clinical manifestations with HE and is usually considered within the differential diagnosis of HE. Here,we describe a patient with refractory HE who presented a large portosystemic shunt and post-ablative hypothyroidism. Her cognitive impairment,hyperammonaemia,electroencephalograph alterations,impaired neuropsychological performance,and magnetic resonance imaging and spectroscopy disturbances were highly suggestive of HE,paralleled the course of hypothyroidism and normalized after thyroid hormone replacement. There was no need for intervention over the portosystemic shunt. The case findings support that hypothyroidism may precipitate HE in cirrhotic patients by inducing hyperammonaemia and/or enhancing ammonia brain toxicity. This case led us to consider hypothyroidism not only in the differential diagnosis but also as a precipitating factor of HE.

关键词： Hepatic encephalopathy Hypothyroidism Cognitive impairment Cirrhosis Portosystemic shunt Magnetic resonance spectroscopy

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Simultaneous bilateral robotic partial nephrectomy: Case report and critical evaluation of the technique

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World Journal of clinical Cases 2014年第6期2卷 224-227页

作者： Claudio Giberti Fabrizio Gallo Maurizio Schenone Pierluigi Cortese Department of Urology San Paolo Hospital

We report our first simultaneous bilateral robot assisted partial nephrectomy(RAPn) in order to show and critically discuss the feasibility of this procedure. Materials and methods A 69-year-old male patient visited our department due to incidental finding of bilateral mesorenal small masses(2.5 cm on the right and 3.5 cm on the left) suspicious for malignancy. We started from the right side with patient in flank position. Port placement: 12-mm periumbilical camera port, two 8-mm robotic ports in wide ‘‘V''configuration, additional 12 mm assistant port on the midline between the umbilicus and symphysis pubis. A right unclamping RAPn with sliding clip renorrhaphy was performed. The trocars were removed and the robot undocked. Without interrupting the anesthesiological procedures, the patient was reported in supine position and, after 180 degrees rotation of the surgical bed, was newly placed in contralateral flank position. Using both the previous periumbilical and midline ports, two other 8-mm robotic trocars were placed. The robot was then redocked and RAPn was also performed on the left side using the same previously reported technique. Results Total time: 285 min. Estimated blood losses: 150 cc. Postoperativeperiod: uneventful. Pathological examination: bilateral renal cell carcinoma, negative surgical margins. Conclusions Our experience was encouraging and confirmed the feasibility and safety of this procedure. The planning of our technique was time and cost effective with cosmetic benefit for the patient. However, we think that an appropriate selection of the patients and a skill in robotic renal surgery are advisable before approaching this type of surgery.

关键词： Robotics nephrectomy Renal cell carcinoma Remote operation robotics

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Rare case of cryptogenic brain abscess caused by Raoultella ornithinolityca

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World Journal of clinical Cases 2017年第7期5卷 299-302页

作者： Marianna Luongo Department of neurosurgery San Carlo Hospital

Cerebral abscess is a potentially fatal neurosurgical condition,despite improvements in technology,new antimicrobial agents and modern neurosurgical instruments and techniques.I report the case of a 64-yearold woman,affected by a right frontobasal brain abscess,compressing the homolateral frontal horn of lateral ventricle,with a second mass partially occupying the right orbital *** presented also with inflammatory sinusopathy involving the right maxillary,ethmoid and frontal *** 14 d of clinical observation and antimicrobial therapy,the patient received a computed tomography scan,which showed growth of the cerebral mass,with a ring of peripheral contrast enhancement and surrounding *** promptly underwent neurosurgical treatment and recovered well,except for the sight in her right eye,which remained compromised,as before the *** is believed to be the first case of cryptogenic cerebral abscess caused by Raoultella ornithinolityca isolated from the brain,with more than 1-year follow-up.

关键词： Brain abscess Headache Raoultel a ornithinolityca Visual loss

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Gastric and duodenal polyps in familial adenomatous polyposis patients: Conventional endoscopy vs virtual chromoendoscopy(fujinon intelligent color enhancement) in dysplasia evaluation

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World Journal of clinical Oncology 2017年第2期8卷 168-177页

作者： Gabriele Lami Andrea Galli Giuseppe Macrì Emanuele Dabizzi Maria Rosa Biagini Mirko Tarocchi Luca Messerini Rosa Valanzano Stefano Milani Simone Polvani Gastroenterology Research Unit Department of Experimental and Clinical Biomedical Sciences "Mario Serio"University of Florence clinical Gastroenterology Unit Careggi University Hospital Gastroenterology and Gastrointestinal Endoscopy San Raffaele Hospital Division of Pathological Anatomy Department of Experimental and Clinical MedicineUniversity of Florence Surgical Unit Department of Translational Surgery and MedicineUniversity of Florence

AIM To test the fujinon intelligent color enhancement(FICE) in identifying dysplastic or adenomatous polyps in familial adenomatous polyposis(FAP) *** Seventy-six consecutive FAP patients, already treated by colectomy and members of sixty-five families, were enrolled. A FICE system for the upper gastro-intestinal tract with an electronic endoscope system and a standard duodenoscope(for side-viewing examination) were used by two expert examiners. Endoscopic resection was performed with diathermic loop for polyps ≥ 6 mm and with forceps for polyps n-fixed biopsy specimens were analyzed by two expert gastrointestinal pathologists blinded to size, location and number of FAPassociated fundic gland *** Sixty-nine(90.8%) patients had gastric polyps(34 only in the corpus-fundus, 7 only in the antrum and 28 in the whole stomach) and 52(68.4%) in duodenum(7 in the bulb, 35 in second/third duodenal portion, 10 both in the bulb and the second portion of duodenum). In the stomach fundus after FICE evaluation, 10 more polyps were removed from 10 patients for suspicious features of dysplasia or adenomas, but they were classified as cystic fundic gland after histology. In the antrum FICE identified more polyps than traditional endoscopy, showing a better tendency to identify adenomas and displastic areas. In the duodenum FICE added a significant advantage in identifying adenomas in the bulb and identified more polyps in the Ⅱ/Ⅲ *** FICE significantly increases adenoma detection rate in FAP patients but does not change any Spigelman stage and thus does not modify patient's prognosis and treatment strategies.

关键词： Fujinon intelligent color enhancement Familial adenomatous polyposis Spigelman Endoscopy Polyp Adenoma Stomach Duodenum

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Exclusive breastfeeding greater than 50%, success of education in a university hospital in Bogotá: Case-control study

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World Journal of clinical Pediatrics 2024年第1期13卷 23-30页

作者： Marcela Murillo Galvis Sofia Ortegon Ochoa Clara Eugenia Plata García Maria Paula Valderrama Junca Dayanna Alejandra Inga Ceballos Daniel Mauricio Mora Gómez Claudia M Granados Martin Rondón Department of Pediatrics Hospital Universitario San IgnacioBogotá110111Colombia Department of clinical Epidemiology and Biostatistics Pontifica Universidad JaverianaBogotá110111Colombia

BACKGROUnD Maintenance rates of exclusive breastfeeding(EBF)worldwide are low,thus,one of the objectives of the summary of policies on breastfeeding(BF)in world nutrition goals for 2025 are that at least 50%of infants under six months of age receive EBF that *** Objective of this study is to document the rates of EBF in children born in san Ignacio University hospital(HUSI)and identify factors associated with *** To document the percentages of EBF in those that were born at HUSI and identify factors associated to their *** This is a study of cases and controls in an analytic,retrospective cohort that took children born alive between January 2016 and January 2019 at HUSI located in the city of Bogotá,*** Receiving information about BF at HUSI was able to maintain EBF up until 4 mo(OR=1.65;95%CI:1.02-2.66).The presence of gynecologic and obstetric comorbidities(OR=0.32;95%CI:0.12-0.83),having mastitis(OR=0.56;95%CI:0.33-0.94),and receiving information from mass media(OR=0.52;95%CI:0.31-0.84)are factors associated with not maintaining *** Receiving education at a Women-and Child-Friendly Institution was the only significant factor to achieve EBF until 4 mo,with a frequency greater than the one reported in the country,which matches multiple studies where counseling and individualized support on BF achieve this *** about BF and early detection of obstetric/gynecologic complications must be strengthened among the healthcare staff in charge of mothers during ***,strategies must be promoted to continue BF such as creating milk banks with the objective of increasing BF rates even when mothers return to work.

关键词： Breastfeeding Women-and Child-Friendly Institutional Strategy Strategies Adherence Education

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Are metabolic factors still important in the era of direct antiviral agents in patients with chronic hepatitis C?

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World Journal of Gastroenterology 2013年第41期19卷 6947-6956页

作者： Alessandro Grasso Federica Malfatti Roberto Testa Gastroenterology Unit Department of Internal MedicineSan Paolo Hospital

The high rate of sustained viral response(SVR)to boceprevir or telaprevir-based triple therapy in hepatitis C(HCV)-related,non-cirrhotic na ve patients or relapsers to previous antiviral treatment leads clinicians to believe that the impact of metabolic host factors on SVR is minimal when triple therapy is used,unlike what is observed with the peginterferon and ribavirin *** concept is strongly expressed by some opinion leaders on the basis of the data derived from subanalyses of registrative trials as well as from a post-hoc analysis of the phaseⅡC208 clinical *** perception of unrestrainable therapeutic success with the use of newer,more powerful antivirals is now reinforced by the brilliant results obtained with sofosbuvir,an HCV nS5B polymerase inhibitor,as well as by the data from the phaseⅡandⅢstudies on the various combinations of second-generation nS3/4A inhibitors and nS5A and/or nS5B ***,a great deal of concern has emerged from the real world scenario in which patients are often older and have more comorbidities than patients in the"world of trials".Furthermore,many of them have advanced fibrosis and previous failure with peginterferon and ribavirin *** data from the recent literature suggest that the host metabolic factors may play a minor but non-negligible role in these difficult-to-treat patients,an issue that will hopefully be investigated in further *** editorial aims to provide a detailed analysis of the role that host metabolic factors played in the past and what role they may play in the era of direct antiviral agents.

关键词： Metabolic factors Insulin resistance Direct antiviral agents Chronic hepatitis C

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Current status of the genetic susceptibility in attenuated adenomatous polyposis

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World Journal of Gastrointestinal Oncology 2019年第12期11卷 1101-1114页

作者： Víctor Lorca Pilar Garre Laboratorio de Oncología Molecular Grupo de Investigación Clínica y Traslacional en OncologíaHospital Clínico San CarlosMadrid 28040Spain Laboratorio de Oncología Molecular Servicio de OncologíaHospital Clínico San CarlosMadrid 28040Spain

Adenomatous polyposis(AP)is classified according to cumulative adenoma number in classical AP(CAP)and attenuated AP(AAP).Genetic susceptibility is the major risk factor in CAP due to mutations in the known high predisposition genes APC and ***,the contribution of genetic susceptibility to AAP is lower and less *** predisposition genes have been recently proposed,and some of them have been validated,but their scarcity hinders accurate risk estimations and prevalence *** is a heterogeneous condition in terms of severity,clinical features and ***,clinicians do not have strong discriminating criteria for the recommendation of the genetic study of known predisposition genes,and the detection rate is *** and knowledge of new AAP high predisposition genes are of great importance to offer accurate genetic counseling to the patient and family *** review aims to update the genetic knowledge of AAP,and to expound the difficulties involved in the genetic analysis of a highly heterogeneous condition such as AAP.

关键词： Attenuated adenomatous polyposis Genetic susceptibility High predisposition gene Genetic heterogeneity Colorectal cancer

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Effectiveness and safety of first-generation protease inhibitors in clinical practice:Hepatitis C virus patients with advanced fibrosis

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World Journal of Gastroenterology 2015年第30期21卷 9163-9174页

作者： Javier Salmeron Carmen Vinaixa Ruben Berenguer Juan Manuel Pascasio Juan Jose sanchez Ruano Miguel angel Serra Ana Gila Moises Diago Manuel Romero-Gomez Jose Maria navarro Milagros Testillano Conrado Fernandez Dolores Espinosa Isabel Carmona Jose Antonio Pons Francisco Jorquera Francisco Javier Rodriguez Ramon Perez Jose Luis Montero Rafael Granados Miguel Fernandez Ana Belen Martin Paloma Munoz de Rueda Rosa Quiles CIBERehd Instituto de Salud Carlos Ⅲ28029 MadridSpain Unit for clinical Management of Digestive Diseases Complejo Hospitalario Universitario de Granada Instituto de Investigacion Biosanitaria de Granada University hospital Politecnico La Fe Unit for clinical Management of Digestive Diseases University Hospital Virgen Del Rocio hospital Toledo University Clinic hospital of Valencia University General hospital of Valencia Unit for clinical Management of Digestive Diseases University Hospital Nuestra Senora de Valme Department of Gastroenterology and Hepatology Agencia sanitaria Costa del Sol University hospital Cruces Gastroenterology Unit University Hospital Fundacion Alcorcon University hospital Virgen Macarena University hospital Virgen de la Arrixaca hospital of Leon University General hospital Reina Sofia Department Gastroenterology and Hepatology University Hospital Central de Asturias University hospital Reina Sofia University hospital De Gran Canaria Dr. negrin hospital san Pedro de Alcantara

AIM:To evaluates the effectiveness and safety of the first generation,nS3/4A protease inhibitors(PIs) in clinical practice against chronic C virus,especially in patients with advanced fibrosis. METHODS:Prospective study and non-experimental analysis of a multicentre cohort of 38 Spanish hospitals that includes patients with chronic hepatitis C genotype 1,treatment-na?ve(Tn) or treatment-experienced(TE),who underwent triple therapy with the first generation nS3/4A protease inhibitors,boceprevir(BOC) and telaprevir(TVR),in combination with pegylated interferon and ribavirin. The patients were treatment in routine practice settings. Data on the study population and on adverse clinical and virologic effects were compiled during the treatment period and during follow ***:One thousand and fifty seven patients were included,405(38%) were treated with BOC and 652(62%) with TVR. Of this total,30%(n = 319) were Tn and the remaining were TE:28%(n = 298) relapsers,12%(n = 123) partial responders(PR),25%(n = 260) null-responders(nR) and for 5%(n = 57) with prior response unknown. The rate of sustained virologic response(SVR) by intention-to-treatment(ITT) was greater in those treated with TVR(65%) than in those treated with BOC(52%)(P ntention-to-treatment(m ITT) no were found significant differences. By degree of fibrosis,56% of patients were F4 and the highest SVR rates were recorded in the non-F4 patients,both Tn and TE. In the analysis by groups,the Tn patients treated with TVR by ITT showed a higher SVR(P = 0.005). However,by m ITT there were no significant differences between BOC and TVR. In the multivariate analysis by m ITT,the significant SVR factors were relapsers,IL28 B CC and non-F4; the type of treatment(BOC or TVR) was not significant. The lowest SVR values were presented by the F4-nR patients,treated with BOC(46%) or with TVR(45%). 28% of the patients interrupted the treatment,mainly by non-viral response(51%):this outcome was

关键词： Hepatitis C Boceprevir Telaprevir First-generation protease inhibitors Advanced fibrosis

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T cell metabolism in obesity and beyond:comments on‘DsbA-L deficiency in T cells promotes diet-induced thermogenesis through suppressing IFn-y production’

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Journal of Molecular Cell Biology 2021年第5期13卷 389-391页

作者： Haiyan Zhou Feng Liu national clinical Research Center for Metabolic Diseases Metabolic Syndrome Research Centerand Department of Metabolism and EndocrinologyThe Second Xiangya Hospital of Central South UniversityChangsha 410011China Department of Pharmacology University of Texas Health Science Center at San AntonioSan AntonioTX 78229USA

T cells have long been known as the core of adaptive immunity and play piv-otal roles in host defense(Zhu et al.,2010).There are two main types of T cells in our body,cytotoxic T cells(CD8^(+))and helper T(Th)cells(CD4^(+)),the latter comprised of Th1,Th2,Th17,and Treg *** evidence supports that metabolic reprogramming of T cells leads to dramatic changes in tissue microenvironments,which may alter whole-body energy homeostasis and metabolism,beyond their roles in adaptive immunity(Varanasi et al.,2020).

关键词： metabolism immunity

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Orthostatic Intolerance and Coagulation Abnormalities:An Update

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neuroscience Bulletin 2019年第1期35卷 171-177页

作者： Wei Quan Yuchen Wang Selena Chen Junbao Du Department of Pediatrics Peking University First Hospital Department of clinical Medicine Peking University Health Science Center Department of Biochemistry and Cellular Biology University of California at San Diego Key Laboratory of Molecular Cardiovascular Science of the Ministry of Education

Orthostatic intolerance(OI)is a series of clinical symptoms that develop during long-term standing in the upright position,with clinical manifestations of frequent,recurrent,or persistent dizziness,fatigue,and heart p... 详细信息

关键词： HUT Hg Orthostatic Intolerance and Coagulation Abnormalities:An Update vWF

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