The Doppler backscattering(DBS)diagnostic is widely used to measure the localized density fluctuations and the propagation velocity of turbulent structures.Microwave is launched at a frequency that approaches a cutoff...The Doppler backscattering(DBS)diagnostic is widely used to measure the localized density fluctuations and the propagation velocity of turbulent structures.Microwave is launched at a frequency that approaches a cutoff layer in the plasma at an angle oblique to the cutoff layer.A new Q-band multichannel DBS system based on a comb generator has been designed and tested for application on the HL-3 tokamak.With the comb generator and heterodyne scheme,the stability and flexibility of the new DBS system are improved.The new DBS diagnostic has a high output power(~10 dBm),good power flatness(<5 dB in Q-band),and frequency stability,and the inter-frequency separation is tunable remotely.This article introduces the system design,laboratory test results,and initial experimental results from the HL-3 tokamak.With the help of the newly developed multichannel DBS,the turbulence information can be studied with high temporal and spatial resolution.展开更多
In this article,we discuss the recently published article by Soni et al.This study explores the effectiveness of a comprehensive digital health program,RESET care,which integrates personalized dietary plans,structured...In this article,we discuss the recently published article by Soni et al.This study explores the effectiveness of a comprehensive digital health program,RESET care,which integrates personalized dietary plans,structured exercise,and cognitive behavioral therapy delivered through a mobile app equipped with Internet of Things devices such as body composition analyzers and smartwatches.Metabolic dysfunction-associated liver disease(MASLD),a global health burden affecting approximately 25%of the population,demands sustainable lifestyle modifications as its primary management strategy.The study reports that 100%of participants in the comprehensive intervention group(diet+exercise+cognitive behavioral therapy)achieved a weight reduction≥7%(6.99±2.98 kg,7.00%±3.39%;P=0.002),a clinically significant threshold for MASLD improvement.In addition,participants showed a mean weight reduction of 6.99 kg(101.10±17.85 vs 94.11±17.38,P<0.001)and a body mass index reduction of 2.18 kg/m²(32.90±3.02 vs 30.72±3.41,P<0.001).These results underscore the potential of digital health platforms to provide scalable,evidence-based solutions for the treatment of MASLD.While these results highlight the potential of digital platforms in the scalable and personalized management of MASLD,the small study sample size and short duration of follow-up limit the generalizability of the results.Future large-scale,long-term trials are needed to confirm sustained benefits,cost-effectiveness,and broader applicability.This letter contextualizes the study within the evolving landscape of MASLD management and emphasizes the clinical implications of integrating digital technologies into standard care.展开更多
BACKGROUND Heart transplantation is the last and best option for end-stage heart failure management.Early mortality rates have significantly decreased,enabling patients to survive longer with fewer complications,a tre...BACKGROUND Heart transplantation is the last and best option for end-stage heart failure management.Early mortality rates have significantly decreased,enabling patients to survive longer with fewer complications,a trend observed even in our setting.The primary shared challenge has centered on achieving surgical success and immediate survival.The question arises about the medium-and long-term survival of patients with heart transplant in Mexico.AIM To present the results of the medium and long-term follow-up of heart transplant patients.METHODS This was a retrospective study of a single medical unit,and we selected patients who received heart transplants from July 21,1988 to September 30,2023.Selection criteria encompassed age,sex,and primary indication for heart transplantation across all groups.Patients with incomplete information or who died within 30 postoperative days were excluded.Data of primary pathology,ischemic,extracorporeal circulation,aortic cross-clamping times,length of ventilatory support,stay in postoperative therapy,hospitalization,and functional class were analyzed.RESULTS The causes of morbidity,mortality,and percentage of survival at 1,5,and 10 years were examined.Overall,257 heart transplants were performed during the study period.Of the total cases,22 with incomplete data and 47 who died within 30 postoperative days were excluded for the middle-and long-term survival analyses.Of the remaining 188 patients,heart transplantation was performed(males:146,females:42).The average age of the participants was 44.43±14.48 years.The primary indications included ischemic cardiomyopathy(42.55%)and dilated cardiomyopathy(39.36%).The mean durations of mechanical ventilator support,intensive care stay,and hospital stay were 57.55±103.50 hours,9.96±8.59 days,and 19.49±18.23 days,respectively.One-,five-,and ten-year survival rates were 90.7%,71.3%,and 60.3%,respectively.Of the patients,94%and 6%were in functional classes I and II,respectively.Infection and neurological hemorrhagic or ischemic stroke(26%)were the main causes of mortality in the first year.Subsequently,chronic rejection manifesting as graft vasculopathy increased in frequency(30%).CONCLUSION In our setting,heart transplantation yields medium-and long-term survival and quality of life outcomes comparable to those achieved by other international centers.展开更多
BACKGROUND MicroRNAs play a key role in regulating gene expression in human cells.Singlenucleotide variants in these molecules have been linked to cancer development,particularly breast cancer(BrC).AIM To analyze the ...BACKGROUND MicroRNAs play a key role in regulating gene expression in human cells.Singlenucleotide variants in these molecules have been linked to cancer development,particularly breast cancer(BrC).AIM To analyze the association of three microRNA polymorphisms with the risk of BrC in women from western Mexico.METHODS This case-control study included 71 women diagnosed with BrC and 215 women without BrC.Genotypes were determined using a real-time polymerase chain reaction allelic discrimination assay.Multiple genetic models-dominant,recessive,over-dominant,additive,and multiple comparison-were applied to assess the risk.RESULTS The over-dominant model showed that the C/T genotype of MIR196A2(rs11614913)is a protective factor against the ductal histological subtype of BrC in women from western Mexico[odds ratio(OR)=0.4687,95%confidence interval(CI):0.2205-0.9963,P=0.0489].A protective effect was also observed for the C/A genotype(OR=0.2612,95%CI:0.0900-0.7582,P=0.0135)and A allele(OR=0.2826,95%CI:0.0993-0.8044,P=0.0179)of MIR618(rs2682818).No significant association was found between MIR200C(rs73262897)and BrC risk.CONCLUSION The C/T genotype of rs11614913 in MIR196A2,and C/A genotype and A allele of rs2682818 in MIR618,are associated with a protective effect against BrC in women from western Mexico.展开更多
Diabetes mellitus(DM) that occurs because of chronic liver disease(CLD) is known as hepatogenous diabetes(HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely st...Diabetes mellitus(DM) that occurs because of chronic liver disease(CLD) is known as hepatogenous diabetes(HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely studied for long time. Patients suffering from this condition have low frequency of risk factors of type 2 DM. Its incidence is higher in CLD of viral, alcoholic and cryptogenic etiology. Its pathophysiology relates to liver damage, pancreatic dysfunction, interactions between hepatitis C virus(HCV) and glucose metabolism mechanisms and genetic susceptibility. It associates with increased rate of liver complications and hepatocellular carcinoma, and decreased 5-year survival rate. It reduces sustained virological response in HCV infected patients. In spite of these evidences, the American Diabetes Association does not recognize HD. In addition, the impact of glucose control on clinical outcomes of patients has not been evaluated. Treatment of diabetes may be difficult due to liver insufficiency and hepatotoxicity of antidiabetic drugs. Notwithstanding, no therapeutic guidelines have been implemented up to date. In this editorial, authors discuss the reasons why they think that HD may be a neglected pathological condition and call attention to the necessity for more clinical research on different fields of this disease.展开更多
Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being ...Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. In the present review, we discuss the main epidemiologic characteristics associated with steroid use, with emphasis on the identification of high risk populations. Additionally we present the pathophysiology of corticosteroid induced hyperglycemia as well as the pharmacokinetics and pharmacodynamics associated with steroid use. We propose a treatment strategy based on previous reports and the understanding of the mechanism of action of both, the different types of glucocorticoids and the treatment options, in both the ambulatory and the hospital setting. Finally, we present some of the recent scientific advances as well as some options for future use of glucocorticoids.展开更多
Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increas...Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes;nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient’s quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.展开更多
Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all ...Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all playing an important role. The physiopathology of migraine is complex and still not fully understood. Many different neuropeptides, neurotransmitters and brain pathways have been implicated. In connection with the myriad mechanisms and pathways implicated in migraine, a variety of multisystemic comorbidities(e.g., cardiovascular, psychiatric and other neurological conditions) have been found to be closely associated with migraine. Recent reports demonstrate an increased frequency of gastrointestinal(GI) disorders in patients with migraine compared with the general population. Helicobacter pylori infection, irritable bowel syndrome, gastroparesis, hepatobiliary disorders, celiac disease and alterations in the microbiota have been linked to the occurrence of migraine. Several mechanisms involving the gut-brain axis, such as a chronic inflammatory response with inflammatory and vasoactive mediators passing to the circulatory system, intestinal microbiota modulation of the enteric immunological milieu and dysfunction of the autonomic and enteric nervous system, have been postulated to explain these associations. However, the precise mechanisms and pathways related to the gut-brain axis in migraine need to be fully elucidated. In this review, we survey the available literature linking migraine with GI disorders. We discuss the possible physiopathological mechanisms, and clinical implications as well as several future areas of interest for research.展开更多
Helicobacter pylori (H. pylori) affects nearly half of the world’s population and, thus, is one of the most frequent and persistent bacterial infections worldwide. H. pylori is associated with peptic ulcer...Helicobacter pylori (H. pylori) affects nearly half of the world’s population and, thus, is one of the most frequent and persistent bacterial infections worldwide. H. pylori is associated with peptic ulcer disease, gastric ulcers, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Various diagnostic methods exist to detect infection, and the choice of one method or another depends on several factors, such as accessibility, advantages and disadvantages of each method, cost, and the age of patients. Once H. pylori infection is diagnosed, the clinician decides whether treatment is necessity, according to the patient’s clinical condition. Typically, eradication of H. pylori is recommended for treatment and prevention of the infection. Cure rates with the standard triple therapy are acceptable, and effective quadruple therapies, sequential therapies, and concomitant therapies have been introduced as key alternatives to treat H. pylori infection. In this work, we review the main diagnostic methods used to identify H. pylori infection and to confirm eradication of infection. In addition, key factors related to treatment are reviewed.展开更多
AIM： To investigate the differences in injury patterns caused by arterial, venous or arteriovenous mesenteric occlusion. METHODS： Male Wistar rats were separated equally into four groups. Occlusion was performed by ...AIM： To investigate the differences in injury patterns caused by arterial, venous or arteriovenous mesenteric occlusion. METHODS： Male Wistar rats were separated equally into four groups. Occlusion was performed by clamping the superior mesenteric artery （A）, the mesenteric vein （V） or both （AV） for 30 min, followed by 60 min of reperfusion. A control group received sham surgery only. Intestinal sections were examined for histological damage and serum tumor necrosis factor-α （TNF-α）, endothelin-1 （ET-1）, P-selectin, antithrombin Ⅲ （AT Ⅲ） and soluble intracellular adhesion molecule-1 （ICAM-1） concentrations were measured. RESULTS： All groups showed significant mucosal injury compared to controls. Furthermore, mucosal injury was significantly more severe in the V and AV groups compared to the A group （3.6 ± 0.55, 3.4 ± 0.55 and 2± 0.71, respectively, P = 0.01）. ICAM-1 was similarly elevated in all groups, with no significant differences between the groups. P-selectin levels were significantly elevated in the V and AV groups but not the A group （1.4 ± 0.5 ng/mL, 2.52 ± 0.9 ng/mL and 0.02± 0.01 ng/mL, respectively, P = 0.01） and ET-1 was significantly elevated in the A and V groups but not the AV group （0.32 ± 0.04 pg/mL, 0.36 ± 0.05 pg/mL and 0.29 ± 0.03 pg/mL, respectively, P = 0.01） compared to sham controls. ATⅢ levels were markedly depleted in the V and AV groups, but not in the A group （29.1 ± 5.2 pg/mL, 31.4 ±21.8 pg/mL and 55.8± 35.6 pg/mL, respectively, P = 0.01）, compared to controls. Serum TNF-α was significantly increased in all groups compared to sham controls （1.32 ± 0.87 ng/mL, 1.79 ± 0.20 ng/mL and 4.4 ± 0.69 ng/mL, for groups A, V and AV, respectively, P = 0.01）, with higher values in the AV group. CONCLUSION： Different patterns of response to ischemia/reperfusion are associated with venous, arterial or arteriovenous occlusion. Venous and arteriovenous occlusion was associated with the most severe alterations展开更多
Alcoholism and cirrhosis,which are two of the most serious health problems worldwide,have a broad spectrum of clinical outcomes.Both diseases are influenced by genetic susceptibility and cultural traits that differ gl...Alcoholism and cirrhosis,which are two of the most serious health problems worldwide,have a broad spectrum of clinical outcomes.Both diseases are influenced by genetic susceptibility and cultural traits that differ globally but are specific for each population.In contrast to other regions around the world,Mexicans present the highest drinking score and a high mortality rate for alcoholic liver disease with an intermediate category level of per capita alcohol consumption.Mexico has a unique history of alcohol consumption that is linked to profound anthropological and social aspects.The Mexican population has an admixture genome inherited from different races,Caucasian,Amerindian and African,with a heterogeneous distribution within the country.Thus,genes related to alcohol addiction,such as dopamine receptor D2 in the brain,or liver alcoholmetabolizing enzymes,such as alcohol dehydrogenase classⅠpolypeptide B,cytochrome P450 2E1 and aldehyde dehydrogenase class 2,may vary from one individual to another.Furthermore,they may be inherited as risk or non-risk haplogroups that confer susceptibility or resistance either to alcohol addiction or abusive alcohol consumption and possibly liver disease.Thus,in this era of genomics,personalized medicine will benefit patients if it is directed according to individual or population-based data.Additional association studies will be required to establish novel strategies for the prevention,care and treatment of liver disease in Mexico and worldwide.展开更多
Common gastrointestinal diseases such as radiation enteritis(RE),acute pancreatitis,inflammatory bowel diseases(IBD)and drug-induced hepatotoxicity share pathophysiological mechanisms at the molecular level,mostly inv...Common gastrointestinal diseases such as radiation enteritis(RE),acute pancreatitis,inflammatory bowel diseases(IBD)and drug-induced hepatotoxicity share pathophysiological mechanisms at the molecular level,mostly involving the activation of many pathways of the immune response,ultimately leading to tissue injury.Increased oxidative stress,inflammatory cytokine release,inflammatory cell infiltration and activation and the up-regulation of inflammatory transcription factors participate in the pathophysiology of these complex entities.Treatment varies in each specific disease,but at least in the cases of RE and IBD immunosuppressors are effective.However,full therapeutic responses are not always achieved.The pathophysiology of ischemiareperfusion(IR)injury shares many of these mechanisms.Brief and repetitive periods of ischemia in an organ or limb have been shown to protect against subsequent major IR injury in distant organs,a phenomenon called remote ischemic preconditioning(RIP).This procedure has been shown to protect the gut,pancreas and liver by modulating many of the same inflammatory mechanisms.Since RIP is safe and tolerable,and has shown to be effective in some recent clinical trials,I suggest that RIP could be used as a physiologicallyrelevant adjunct treatment for non-ischemic gastrointestinal inflammatory conditions.展开更多
BACKGROUND Pyogenic liver abscess(PLA)is a rare disease with an estimated incidence that varies widely across the globe,being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europ...BACKGROUND Pyogenic liver abscess(PLA)is a rare disease with an estimated incidence that varies widely across the globe,being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada.Even though there are multiple microorganisms capable of producing an abscess in the liver,including Entamoeba histolytica,fungi,and viruses,most abscesses are derived from bacterial infections.The epidemiology of PLA in Mexico is currently unknown.AIM To describe the clinical,demographic and microbiologic characteristics of PLA in Mexico.METHODS This is a retrospective study carried out in two centers,and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess.We collected demographic,clinical,and microbiological information,treatment,complications,and outcomes.A logistic regression analysis was used to determine the association between different variables and mortality rates.RESULTS A total of 345 patients were included in this study.233(67.5%)had confirmed PLA,133(30%)patients had no positive culture and negative serology and 9(2.5%)had mixed abscesses.The mean age was 50 years(ranging from 16-97 years)and 63%were female.65%of the patients had positive cultures for Extended Spectrum Beta-Lactamases(ESBL)-Escherichia coli and Klebsiella pneumoniae.Cefotaxime was administered in 60%of cases.The most common sources of infection were ascending cholangitis and cholecystitis in 34(10%)and 31(9%),respectively.The median length of hospital stay was 14 d.165 patients underwent percutaneous catheter drainage.The inpatient mortality rate was 63%.Immunocompromised state[OR 3.9,95%CI:1.42-10.46],ESBL-Escherichia coli[OR 6.7,95%CI:2.7-16.2]and Klebsiella pneumoniae[OR 4-8,95%CI:1.6-14.4]predicted inpatient mortality by multivariate analysis.CONCLUSION The prevalence of PLA is increasing in Mexico and has a very high mortality rate.ESBL-Escherichia coli and Klebsiella pneumoniae are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.展开更多
First described in 1996,the drug reaction,eosinophilia,and systemic symptoms syndrome(DReSS) is considered,along with Stevens-Johnson syndrome and toxic epidermal necrolysis,a severe cutaneous drug reaction. It is cha...First described in 1996,the drug reaction,eosinophilia,and systemic symptoms syndrome(DReSS) is considered,along with Stevens-Johnson syndrome and toxic epidermal necrolysis,a severe cutaneous drug reaction. It is characterized by the presence of a maculopapular erythematous skin eruption,fever,lymphadenopathy,influenza-like symptoms,eosinophilia,and visceral involvement such as hepatitis,pneumonitis,myocarditis,pericarditis,nephritis,and colitis. The prognosis of patients with DReSS is related to the severity of visceral involvement. The mortality ranges from approximately 5% to 10%,and death is mainly due to liver failure,which is also the organ most commonly involved in this syndrome. Although it was previously hypothesized in 1994,DReSS syndrome can lead to reactivation of one or more human herpesvirus family members. Now being included as diagnostic criteria in a proposed diagnostic score system,this reactivation can be detected up to 2-3 wk after DReSS syndrome onset. Other causes of mortality in DReSS syndrome include myocardial or pulmonary lesions and hemophagocytosis. We reviewed the literature of previously reported case-series of DReSS and liver involvement,highlighting the pattern of liver damage,the treatment used,and the outcome.展开更多
Clostridium difficile (C. difficile) is a spore-forming, toxin-producing, gram-positive anaerobic bacterium that is the principal etiologic agent of antibiotic-associated diarrhea. Infection with C. difficile (CDI) is...Clostridium difficile (C. difficile) is a spore-forming, toxin-producing, gram-positive anaerobic bacterium that is the principal etiologic agent of antibiotic-associated diarrhea. Infection with C. difficile (CDI) is characterized by diarrhea in clinical syndromes that vary from selflimited to mild or severe. Since its initial recognition as the causative agent of pseudomembranous colitis, C. difficile has spread around the world. CDI is one of the most common healthcare-associated infections and a significant cause of morbidity and mortality among older adult hospitalized patients. Due to extensive antibiotic usage, the number of CDIs has increased. Diagnosis of CDI is often difficult and has a substantial impact on the management of patients with the disease, mainly with regards to antibiotic management. The diagnosis of CDI is primarily based on the clinical signs and symptoms and is only confirmed by laboratory testing. Despite the high burden of CDI and the increasing interest in the disease, episodes of CDI are often misdiagnosed. The reasons for misdiagnosis are the lack of clinical suspicion or the use of inappropriate tests. The proper diagnosis of CDI reduces transmission, prevents inadequate or unnecessary treatments, and assures best antibiotic treatment. We review the options for the laboratory diagnosis of CDI within the settings of the most accepted guidelines for CDI diagnosis, treatment, and prevention of CDI.展开更多
The ITER neutron shielding blocks are located between the outer shell and the inner shell of the vacuum vessel to provide neutron shielding. Considering the combined loads acting on the shielding blocks during ITER pl...The ITER neutron shielding blocks are located between the outer shell and the inner shell of the vacuum vessel to provide neutron shielding. Considering the combined loads acting on the shielding blocks during ITER plasma operation, the structure of the shielding blocks must be evaluated. Using the finite element method with ANSYS analysis software, static structural analysis is performed, including elastic analysis and limit analysis for one typical shielding block. The evaluated results based on RCC-MR code show that the structure of this shielding block can meet the design requirement.展开更多
基金supported by National Natural Science Foundation of China(Nos.12105087,12275096,and 11922503)the Joint Funds of the National Natural Science Foundation of China(No.U21A20440)the Science and Technology Planning Project of Sichuan Province(No.2023YFG0139)。
文摘The Doppler backscattering(DBS)diagnostic is widely used to measure the localized density fluctuations and the propagation velocity of turbulent structures.Microwave is launched at a frequency that approaches a cutoff layer in the plasma at an angle oblique to the cutoff layer.A new Q-band multichannel DBS system based on a comb generator has been designed and tested for application on the HL-3 tokamak.With the comb generator and heterodyne scheme,the stability and flexibility of the new DBS system are improved.The new DBS diagnostic has a high output power(~10 dBm),good power flatness(<5 dB in Q-band),and frequency stability,and the inter-frequency separation is tunable remotely.This article introduces the system design,laboratory test results,and initial experimental results from the HL-3 tokamak.With the help of the newly developed multichannel DBS,the turbulence information can be studied with high temporal and spatial resolution.
文摘In this article,we discuss the recently published article by Soni et al.This study explores the effectiveness of a comprehensive digital health program,RESET care,which integrates personalized dietary plans,structured exercise,and cognitive behavioral therapy delivered through a mobile app equipped with Internet of Things devices such as body composition analyzers and smartwatches.Metabolic dysfunction-associated liver disease(MASLD),a global health burden affecting approximately 25%of the population,demands sustainable lifestyle modifications as its primary management strategy.The study reports that 100%of participants in the comprehensive intervention group(diet+exercise+cognitive behavioral therapy)achieved a weight reduction≥7%(6.99±2.98 kg,7.00%±3.39%;P=0.002),a clinically significant threshold for MASLD improvement.In addition,participants showed a mean weight reduction of 6.99 kg(101.10±17.85 vs 94.11±17.38,P<0.001)and a body mass index reduction of 2.18 kg/m²(32.90±3.02 vs 30.72±3.41,P<0.001).These results underscore the potential of digital health platforms to provide scalable,evidence-based solutions for the treatment of MASLD.While these results highlight the potential of digital platforms in the scalable and personalized management of MASLD,the small study sample size and short duration of follow-up limit the generalizability of the results.Future large-scale,long-term trials are needed to confirm sustained benefits,cost-effectiveness,and broader applicability.This letter contextualizes the study within the evolving landscape of MASLD management and emphasizes the clinical implications of integrating digital technologies into standard care.
文摘BACKGROUND Heart transplantation is the last and best option for end-stage heart failure management.Early mortality rates have significantly decreased,enabling patients to survive longer with fewer complications,a trend observed even in our setting.The primary shared challenge has centered on achieving surgical success and immediate survival.The question arises about the medium-and long-term survival of patients with heart transplant in Mexico.AIM To present the results of the medium and long-term follow-up of heart transplant patients.METHODS This was a retrospective study of a single medical unit,and we selected patients who received heart transplants from July 21,1988 to September 30,2023.Selection criteria encompassed age,sex,and primary indication for heart transplantation across all groups.Patients with incomplete information or who died within 30 postoperative days were excluded.Data of primary pathology,ischemic,extracorporeal circulation,aortic cross-clamping times,length of ventilatory support,stay in postoperative therapy,hospitalization,and functional class were analyzed.RESULTS The causes of morbidity,mortality,and percentage of survival at 1,5,and 10 years were examined.Overall,257 heart transplants were performed during the study period.Of the total cases,22 with incomplete data and 47 who died within 30 postoperative days were excluded for the middle-and long-term survival analyses.Of the remaining 188 patients,heart transplantation was performed(males:146,females:42).The average age of the participants was 44.43±14.48 years.The primary indications included ischemic cardiomyopathy(42.55%)and dilated cardiomyopathy(39.36%).The mean durations of mechanical ventilator support,intensive care stay,and hospital stay were 57.55±103.50 hours,9.96±8.59 days,and 19.49±18.23 days,respectively.One-,five-,and ten-year survival rates were 90.7%,71.3%,and 60.3%,respectively.Of the patients,94%and 6%were in functional classes I and II,respectively.Infection and neurological hemorrhagic or ischemic stroke(26%)were the main causes of mortality in the first year.Subsequently,chronic rejection manifesting as graft vasculopathy increased in frequency(30%).CONCLUSION In our setting,heart transplantation yields medium-and long-term survival and quality of life outcomes comparable to those achieved by other international centers.
基金Supported by Patronage of the Autonomous University of Nayarit,Quality Postgraduate Program with resources from the 15%Special Tax allocated to the UAN 2022.
文摘BACKGROUND MicroRNAs play a key role in regulating gene expression in human cells.Singlenucleotide variants in these molecules have been linked to cancer development,particularly breast cancer(BrC).AIM To analyze the association of three microRNA polymorphisms with the risk of BrC in women from western Mexico.METHODS This case-control study included 71 women diagnosed with BrC and 215 women without BrC.Genotypes were determined using a real-time polymerase chain reaction allelic discrimination assay.Multiple genetic models-dominant,recessive,over-dominant,additive,and multiple comparison-were applied to assess the risk.RESULTS The over-dominant model showed that the C/T genotype of MIR196A2(rs11614913)is a protective factor against the ductal histological subtype of BrC in women from western Mexico[odds ratio(OR)=0.4687,95%confidence interval(CI):0.2205-0.9963,P=0.0489].A protective effect was also observed for the C/A genotype(OR=0.2612,95%CI:0.0900-0.7582,P=0.0135)and A allele(OR=0.2826,95%CI:0.0993-0.8044,P=0.0179)of MIR618(rs2682818).No significant association was found between MIR200C(rs73262897)and BrC risk.CONCLUSION The C/T genotype of rs11614913 in MIR196A2,and C/A genotype and A allele of rs2682818 in MIR618,are associated with a protective effect against BrC in women from western Mexico.
基金Supported by the Department of Endocrinology and Service of Gastroenterology of the Faculty of MedicineAutonomous University of Nuevo Leon
文摘Diabetes mellitus(DM) that occurs because of chronic liver disease(CLD) is known as hepatogenous diabetes(HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely studied for long time. Patients suffering from this condition have low frequency of risk factors of type 2 DM. Its incidence is higher in CLD of viral, alcoholic and cryptogenic etiology. Its pathophysiology relates to liver damage, pancreatic dysfunction, interactions between hepatitis C virus(HCV) and glucose metabolism mechanisms and genetic susceptibility. It associates with increased rate of liver complications and hepatocellular carcinoma, and decreased 5-year survival rate. It reduces sustained virological response in HCV infected patients. In spite of these evidences, the American Diabetes Association does not recognize HD. In addition, the impact of glucose control on clinical outcomes of patients has not been evaluated. Treatment of diabetes may be difficult due to liver insufficiency and hepatotoxicity of antidiabetic drugs. Notwithstanding, no therapeutic guidelines have been implemented up to date. In this editorial, authors discuss the reasons why they think that HD may be a neglected pathological condition and call attention to the necessity for more clinical research on different fields of this disease.
文摘Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. In the present review, we discuss the main epidemiologic characteristics associated with steroid use, with emphasis on the identification of high risk populations. Additionally we present the pathophysiology of corticosteroid induced hyperglycemia as well as the pharmacokinetics and pharmacodynamics associated with steroid use. We propose a treatment strategy based on previous reports and the understanding of the mechanism of action of both, the different types of glucocorticoids and the treatment options, in both the ambulatory and the hospital setting. Finally, we present some of the recent scientific advances as well as some options for future use of glucocorticoids.
文摘Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes;nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient’s quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.
文摘Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all playing an important role. The physiopathology of migraine is complex and still not fully understood. Many different neuropeptides, neurotransmitters and brain pathways have been implicated. In connection with the myriad mechanisms and pathways implicated in migraine, a variety of multisystemic comorbidities(e.g., cardiovascular, psychiatric and other neurological conditions) have been found to be closely associated with migraine. Recent reports demonstrate an increased frequency of gastrointestinal(GI) disorders in patients with migraine compared with the general population. Helicobacter pylori infection, irritable bowel syndrome, gastroparesis, hepatobiliary disorders, celiac disease and alterations in the microbiota have been linked to the occurrence of migraine. Several mechanisms involving the gut-brain axis, such as a chronic inflammatory response with inflammatory and vasoactive mediators passing to the circulatory system, intestinal microbiota modulation of the enteric immunological milieu and dysfunction of the autonomic and enteric nervous system, have been postulated to explain these associations. However, the precise mechanisms and pathways related to the gut-brain axis in migraine need to be fully elucidated. In this review, we survey the available literature linking migraine with GI disorders. We discuss the possible physiopathological mechanisms, and clinical implications as well as several future areas of interest for research.
文摘Helicobacter pylori (H. pylori) affects nearly half of the world’s population and, thus, is one of the most frequent and persistent bacterial infections worldwide. H. pylori is associated with peptic ulcer disease, gastric ulcers, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Various diagnostic methods exist to detect infection, and the choice of one method or another depends on several factors, such as accessibility, advantages and disadvantages of each method, cost, and the age of patients. Once H. pylori infection is diagnosed, the clinician decides whether treatment is necessity, according to the patient’s clinical condition. Typically, eradication of H. pylori is recommended for treatment and prevention of the infection. Cure rates with the standard triple therapy are acceptable, and effective quadruple therapies, sequential therapies, and concomitant therapies have been introduced as key alternatives to treat H. pylori infection. In this work, we review the main diagnostic methods used to identify H. pylori infection and to confirm eradication of infection. In addition, key factors related to treatment are reviewed.
文摘AIM： To investigate the differences in injury patterns caused by arterial, venous or arteriovenous mesenteric occlusion. METHODS： Male Wistar rats were separated equally into four groups. Occlusion was performed by clamping the superior mesenteric artery （A）, the mesenteric vein （V） or both （AV） for 30 min, followed by 60 min of reperfusion. A control group received sham surgery only. Intestinal sections were examined for histological damage and serum tumor necrosis factor-α （TNF-α）, endothelin-1 （ET-1）, P-selectin, antithrombin Ⅲ （AT Ⅲ） and soluble intracellular adhesion molecule-1 （ICAM-1） concentrations were measured. RESULTS： All groups showed significant mucosal injury compared to controls. Furthermore, mucosal injury was significantly more severe in the V and AV groups compared to the A group （3.6 ± 0.55, 3.4 ± 0.55 and 2± 0.71, respectively, P = 0.01）. ICAM-1 was similarly elevated in all groups, with no significant differences between the groups. P-selectin levels were significantly elevated in the V and AV groups but not the A group （1.4 ± 0.5 ng/mL, 2.52 ± 0.9 ng/mL and 0.02± 0.01 ng/mL, respectively, P = 0.01） and ET-1 was significantly elevated in the A and V groups but not the AV group （0.32 ± 0.04 pg/mL, 0.36 ± 0.05 pg/mL and 0.29 ± 0.03 pg/mL, respectively, P = 0.01） compared to sham controls. ATⅢ levels were markedly depleted in the V and AV groups, but not in the A group （29.1 ± 5.2 pg/mL, 31.4 ±21.8 pg/mL and 55.8± 35.6 pg/mL, respectively, P = 0.01）, compared to controls. Serum TNF-α was significantly increased in all groups compared to sham controls （1.32 ± 0.87 ng/mL, 1.79 ± 0.20 ng/mL and 4.4 ± 0.69 ng/mL, for groups A, V and AV, respectively, P = 0.01）, with higher values in the AV group. CONCLUSION： Different patterns of response to ischemia/reperfusion are associated with venous, arterial or arteriovenous occlusion. Venous and arteriovenous occlusion was associated with the most severe alterations
基金Supported by The National Council of Science and Technology,(Conacyt-Fondo Sectorial,Mexico),Grant No.Salud-2010-1-139085 awarded to Roman S
文摘Alcoholism and cirrhosis,which are two of the most serious health problems worldwide,have a broad spectrum of clinical outcomes.Both diseases are influenced by genetic susceptibility and cultural traits that differ globally but are specific for each population.In contrast to other regions around the world,Mexicans present the highest drinking score and a high mortality rate for alcoholic liver disease with an intermediate category level of per capita alcohol consumption.Mexico has a unique history of alcohol consumption that is linked to profound anthropological and social aspects.The Mexican population has an admixture genome inherited from different races,Caucasian,Amerindian and African,with a heterogeneous distribution within the country.Thus,genes related to alcohol addiction,such as dopamine receptor D2 in the brain,or liver alcoholmetabolizing enzymes,such as alcohol dehydrogenase classⅠpolypeptide B,cytochrome P450 2E1 and aldehyde dehydrogenase class 2,may vary from one individual to another.Furthermore,they may be inherited as risk or non-risk haplogroups that confer susceptibility or resistance either to alcohol addiction or abusive alcohol consumption and possibly liver disease.Thus,in this era of genomics,personalized medicine will benefit patients if it is directed according to individual or population-based data.Additional association studies will be required to establish novel strategies for the prevention,care and treatment of liver disease in Mexico and worldwide.
文摘Common gastrointestinal diseases such as radiation enteritis(RE),acute pancreatitis,inflammatory bowel diseases(IBD)and drug-induced hepatotoxicity share pathophysiological mechanisms at the molecular level,mostly involving the activation of many pathways of the immune response,ultimately leading to tissue injury.Increased oxidative stress,inflammatory cytokine release,inflammatory cell infiltration and activation and the up-regulation of inflammatory transcription factors participate in the pathophysiology of these complex entities.Treatment varies in each specific disease,but at least in the cases of RE and IBD immunosuppressors are effective.However,full therapeutic responses are not always achieved.The pathophysiology of ischemiareperfusion(IR)injury shares many of these mechanisms.Brief and repetitive periods of ischemia in an organ or limb have been shown to protect against subsequent major IR injury in distant organs,a phenomenon called remote ischemic preconditioning(RIP).This procedure has been shown to protect the gut,pancreas and liver by modulating many of the same inflammatory mechanisms.Since RIP is safe and tolerable,and has shown to be effective in some recent clinical trials,I suggest that RIP could be used as a physiologicallyrelevant adjunct treatment for non-ischemic gastrointestinal inflammatory conditions.
文摘BACKGROUND Pyogenic liver abscess(PLA)is a rare disease with an estimated incidence that varies widely across the globe,being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada.Even though there are multiple microorganisms capable of producing an abscess in the liver,including Entamoeba histolytica,fungi,and viruses,most abscesses are derived from bacterial infections.The epidemiology of PLA in Mexico is currently unknown.AIM To describe the clinical,demographic and microbiologic characteristics of PLA in Mexico.METHODS This is a retrospective study carried out in two centers,and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess.We collected demographic,clinical,and microbiological information,treatment,complications,and outcomes.A logistic regression analysis was used to determine the association between different variables and mortality rates.RESULTS A total of 345 patients were included in this study.233(67.5%)had confirmed PLA,133(30%)patients had no positive culture and negative serology and 9(2.5%)had mixed abscesses.The mean age was 50 years(ranging from 16-97 years)and 63%were female.65%of the patients had positive cultures for Extended Spectrum Beta-Lactamases(ESBL)-Escherichia coli and Klebsiella pneumoniae.Cefotaxime was administered in 60%of cases.The most common sources of infection were ascending cholangitis and cholecystitis in 34(10%)and 31(9%),respectively.The median length of hospital stay was 14 d.165 patients underwent percutaneous catheter drainage.The inpatient mortality rate was 63%.Immunocompromised state[OR 3.9,95%CI:1.42-10.46],ESBL-Escherichia coli[OR 6.7,95%CI:2.7-16.2]and Klebsiella pneumoniae[OR 4-8,95%CI:1.6-14.4]predicted inpatient mortality by multivariate analysis.CONCLUSION The prevalence of PLA is increasing in Mexico and has a very high mortality rate.ESBL-Escherichia coli and Klebsiella pneumoniae are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.
文摘First described in 1996,the drug reaction,eosinophilia,and systemic symptoms syndrome(DReSS) is considered,along with Stevens-Johnson syndrome and toxic epidermal necrolysis,a severe cutaneous drug reaction. It is characterized by the presence of a maculopapular erythematous skin eruption,fever,lymphadenopathy,influenza-like symptoms,eosinophilia,and visceral involvement such as hepatitis,pneumonitis,myocarditis,pericarditis,nephritis,and colitis. The prognosis of patients with DReSS is related to the severity of visceral involvement. The mortality ranges from approximately 5% to 10%,and death is mainly due to liver failure,which is also the organ most commonly involved in this syndrome. Although it was previously hypothesized in 1994,DReSS syndrome can lead to reactivation of one or more human herpesvirus family members. Now being included as diagnostic criteria in a proposed diagnostic score system,this reactivation can be detected up to 2-3 wk after DReSS syndrome onset. Other causes of mortality in DReSS syndrome include myocardial or pulmonary lesions and hemophagocytosis. We reviewed the literature of previously reported case-series of DReSS and liver involvement,highlighting the pattern of liver damage,the treatment used,and the outcome.
文摘Clostridium difficile (C. difficile) is a spore-forming, toxin-producing, gram-positive anaerobic bacterium that is the principal etiologic agent of antibiotic-associated diarrhea. Infection with C. difficile (CDI) is characterized by diarrhea in clinical syndromes that vary from selflimited to mild or severe. Since its initial recognition as the causative agent of pseudomembranous colitis, C. difficile has spread around the world. CDI is one of the most common healthcare-associated infections and a significant cause of morbidity and mortality among older adult hospitalized patients. Due to extensive antibiotic usage, the number of CDIs has increased. Diagnosis of CDI is often difficult and has a substantial impact on the management of patients with the disease, mainly with regards to antibiotic management. The diagnosis of CDI is primarily based on the clinical signs and symptoms and is only confirmed by laboratory testing. Despite the high burden of CDI and the increasing interest in the disease, episodes of CDI are often misdiagnosed. The reasons for misdiagnosis are the lack of clinical suspicion or the use of inappropriate tests. The proper diagnosis of CDI reduces transmission, prevents inadequate or unnecessary treatments, and assures best antibiotic treatment. We review the options for the laboratory diagnosis of CDI within the settings of the most accepted guidelines for CDI diagnosis, treatment, and prevention of CDI.
文摘The ITER neutron shielding blocks are located between the outer shell and the inner shell of the vacuum vessel to provide neutron shielding. Considering the combined loads acting on the shielding blocks during ITER plasma operation, the structure of the shielding blocks must be evaluated. Using the finite element method with ANSYS analysis software, static structural analysis is performed, including elastic analysis and limit analysis for one typical shielding block. The evaluated results based on RCC-MR code show that the structure of this shielding block can meet the design requirement.
