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1.
Sensors (Basel) ; 24(6)2024 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-38544030

RESUMEN

The comfort and safety of a cyclist are directly influenced by the vibrational behavior of the handlebar. Hence, the objective of this article is to comparatively assess the vibrational characteristics of two bicycle handlebars: one made of steel and the other made of braided composite material. The transmissibility function represents the relationship between the excitation applied to both handlebars through their stems and the corresponding response in the handle area, which was experimentally obtained by applying a random vibrating signal (constant amplitude of 0.01 g2/Hz) using a shaker. This signal was applied in a frequency range between 100 Hz and 1200 Hz, and the response was measured at one of the two cantilevered ends of the handlebar. Different sensors, including a laser vibrometer and a control accelerometer in the shaker, were utilized. The transmissibility, natural frequencies and damping functions were obtained. Subsequently, another experimental analysis was carried out with the instrumented handlebars mounted on a bicycle, placing three accelerometers and a GPS meter and traveling through a real test circuit, with a rough surface, speed bumps and areas with shaped warning bands. Power Spectral Density (PSD) curves were obtained for the steel and carbon-fiber-composite handlebars in order to quantify the signal intensity. Finally, a fatigue analysis was carried out in order to evaluate the expected life of both handlebars under the experimentally applied load, which is considered the reference cycle. This study offers a comparative analysis of the vibration behavior exhibited by steel and carbon-fiber-composite bicycle handlebars under experimentally applied load. In conclusion, data on natural frequencies, damping functions and fatigue life expectancy for both handlebar materials were obtained. Our study provides valuable insights into the vibrational behavior and performance characteristics of steel and carbon-fiber-composite bicycle handlebars, contributing to the understanding of their comfort and safety implications for cyclists.

2.
Liver Int ; 42(8): 1783-1792, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35643936

RESUMEN

BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) has become a major public health problem, but the prevalence of fibrosis associated with non-alcoholic steatohepatitis (NASH) is largely unknown in the general population. This study aimed to provide an updated estimation of the prevalence of NASH fibrosis in Spain. METHODS: This was an observational, retrospective, cross-sectional, population-based study with merged data from two Spanish datasets: a large (N = 12 246) population-based cohort (ETHON), including transient elastography (TE) data, and a contemporary multi-centric biopsy-proven NASH cohort with paired TE data from tertiary centres (N = 501). Prevalence for each NASH fibrosis stage was estimated by crossing TE data from ETHON dataset with histology data from the biopsy-proven cohort. RESULTS: From the patients with valid TE in ETHON dataset (N = 11 440), 5.61% (95% confidence interval [95% CI]: 2.53-11.97) had a liver stiffness measurement (LSM) ≥ 8 kPa. The proportion attributable to NAFLD (using clinical variables and Controlled Attenuation Parameter) was 57.3% and thus, the estimated prevalence of population with LSM ≥ 8 kPa because of NAFLD was 3.21% (95% CI 1.13-8.75). In the biopsy-proven NASH cohort, 389 patients had LSM ≥ 8 kPa. Among these, 37% did not have significant fibrosis (F2-4). The estimated prevalence of NASH F2-3 and cirrhosis in Spain's adult population were 1.33% (95% CI 0.29-5.98) and 0.70% (95% CI 0.10-4.95) respectively. CONCLUSIONS: These estimations provide an accurate picture of the current prevalence of NASH-related fibrosis in Spain and can serve as reference point for dimensioning the therapeutic efforts that will be required as NASH therapies become available.


Asunto(s)
Diagnóstico por Imagen de Elasticidad , Enfermedad del Hígado Graso no Alcohólico , Adulto , Estudios Transversales , Fibrosis , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/epidemiología , Cirrosis Hepática/etiología , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Prevalencia , Estudios Prospectivos , Estudios Retrospectivos , España/epidemiología
3.
Am J Gastroenterol ; 116(11): 2241-2249, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-34074812

RESUMEN

INTRODUCTION: The effect of branched-chain amino acid (BCAA) supplementation on muscle mass in patients with cirrhosis and sarcopenia is unknown. METHODS: This is a pilot, prospective, randomized, and double-blind study of a cohort of 32 patients with cirrhosis and sarcopenia diagnosed by computed tomography scan who underwent a nutritional and physical activity intervention for 12 weeks. They were divided into 2 groups (placebo: 17 patients; BCAA: 15 patients). The study protocol was registered at ClinicalTrials.gov (NCT04073693). RESULTS: Baseline characteristics were similar in both groups. After treatment, only the BCAA group presented a significant improvement in muscle mass (43.7 vs 46 cm2/m2; P = 0.023). Seventeen patients (63%) presented improvement in muscle mass overall, which was more frequent in the BCAA group (83.3 vs 46.7%; P = 0.056). Regarding frailty, there was a significant improvement in the Liver Frailty Index in the global cohort (n = 32) after the 12 weeks (4.2 vs 3.9; P < 0.001). This difference was significant in both groups: in the placebo group (4.2 vs 3.8; P < 0.001) and in the BCAA group (4.2 vs 3.9; P < 0.001). After treatment, the BCAA group had a higher increase in zinc levels than the placebo group (Δzinc: 12.3 vs 5.5; P = 0.026). In addition, there was a trend for greater improvement of albumin levels in the BCAA group (Δalbumin: 0.19 vs 0.04; P = 0.091). DISCUSSION: BCAA supplementation improves muscle mass in cirrhotic patients with sarcopenia.


Asunto(s)
Aminoácidos de Cadena Ramificada/uso terapéutico , Cirrosis Hepática/complicaciones , Músculo Esquelético/efectos de los fármacos , Sarcopenia/etiología , Sarcopenia/terapia , Nivel de Atención , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos
4.
Liver Int ; 41(9): 2076-2086, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-33896100

RESUMEN

BACKGROUND AND AIM: Histological score systems may not fully capture the essential nonalcoholic steatohepatitis (NASH) features, which is one of the leading causes of screening failure in clinical trials. We assessed the NASH distribution and its components across the fibrosis stages and their impact on the prognosis and their relationship with the concept of metabolic-associated fatty liver disease (MAFLD). METHODS: Spanish multicenter study including 1893 biopsy-proven nonalcoholic fatty liver disease (NAFLD) patients from HEPAmet registry. NASH was diagnosed by NAS score ≥4 (including steatosis, ballooning and lobular inflammation) and fibrosis by Kleiner score. The presence of MAFLD was determined. Progression to cirrhosis, first episode of decompensated cirrhosis and death were collected during the follow-up (4.7 ± 3.8 years). RESULTS: Fibrosis was F0 34.3% (649/1893), F1 27% (511/1893), F2 16.5% (312/1893), F3 15% (284/1893) and F4 7.2% (137/1893). NASH diagnosis 51.9% (982/1893), and its individual components (severe steatosis, ballooning and lobular inflammation), increased from F0 (33.6%) to F2 (68.6%), and decreased significantly in F4 patients (51.8%) (P = .0001). More than 70% of non-NASH patients showed some inflammatory activity (ballooning or lobular inflammation), showing a similar MAFLD rate than NASH (96.2% [945/982] vs. 95.2% [535/562]) and significantly higher than nonalcoholic fatty liver (NAFL) subjects (89.1% [311/349]) (P < .0001). Progression to cirrhosis was similar between NASH (9.5% [51/539]) and indeterminate NASH (7.9% [25/316]), and higher than steatosis (5% [14/263]) (logRank 8.417; P = .015). Death and decompensated cirrhosis were similar between these. CONCLUSIONS: The prevalence of steatohepatitis decreased in advanced liver disease. However, most of these patients showed some inflammatory activity histologically and had metabolic disturbances. These findings should be considered in clinical trials whose main aim is to prevent cirrhosis progression and complications, liver transplant and death.


Asunto(s)
Enfermedad del Hígado Graso no Alcohólico , Biopsia , Humanos , Hígado/patología , Cirrosis Hepática/patología , Estudios Longitudinales , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Enfermedad del Hígado Graso no Alcohólico/patología
5.
Hepatol Res ; 51(10): 1064-1072, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34324766

RESUMEN

AIM: Non-malignant portal vein thrombosis (PVT) is a complication of liver cirrhosis. The aim of this study was to evaluate the annual incidence of PVT and related risk factors. METHODS: We retrospectively reviewed clinical, laboratory, and radiological data collected prospectively from September 2016 to September 2017. A follow-up of 36 months was performed in a subset of patients to determine the cumulative incidence of PVT and related complications. RESULTS: The study included 567 patients. The incidence of PVT at 12, 24, and 36 months was 3.7%, 0.8%, and 1.4%, respectively. Patients with PVT were compared with patients without PVT, and showed differences in albumin (p = 0.04), aspartate aminotransferase (p = 0.04), hemoglobin (p = 0.01), and prothrombin activity (p = 0.01). The presence of hydropic decompensation (57.1% vs. 30.1%; p 0.004), gastroesophageal varices (76.2% vs. 39.5%; p = 0.05), variceal bleeding (52.4% vs. 22.7%; p < 0.001), hepatic encephalopathy (38.1% vs. 9.9%; p = 0.01), spontaneous bacterial peritonitis (9.5% vs. 1.7%; p < 0.001), and use of beta-blockers (71.4% vs. 27.7%; p < 0.001) were significantly associated. In the multivariate analysis, use of beta-blockers and hepatic encephalopathy appeared as risk factors, and high albumin levels a protective factor. CONCLUSIONS: The incidence of PVT was 3.7%. Beta-blockers and hepatic encephalopathy were risks factors. High albumin levels were a protective factor.

6.
Dermatol Ther ; 33(3): e13369, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32243057

RESUMEN

Adalimumab (ADA) is a recombinant human monoclonal antibody indicated for the treatment of psoriasis that specifically inhibits tumor necrosis factor. Until recently we only had the presentation of 40 mg of ADA, being the standard dose in adults an initial administration of 80 mg, followed by 40 mg every 2 weeks. Newly the presentation of 80 mg of ADA has been commercialized, allowing the administration of the standard dose or a higher dose, with fewer injections. In this study, we retrospectively studied 11 patients with psoriasis who have received treatment with the presentation of 80 mg of ADA in two dermatology departments of two hospitals in Spain since its commercialization until June 2019. At the end of the study, an improvement in the mean final Psoriasis Area Severity Index (PASI) of all patients was observed, without any patient presenting any adverse effects. This study shows the efficacy and safety of 80 mg of ADA in a sample of 11 patients with psoriasis.


Asunto(s)
Anticuerpos Monoclonales Humanizados , Psoriasis , Adalimumab/efectos adversos , Adulto , Anticuerpos Monoclonales Humanizados/efectos adversos , Humanos , Psoriasis/diagnóstico , Psoriasis/tratamiento farmacológico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , España , Resultado del Tratamiento
7.
Dermatol Online J ; 26(8)2020 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-32941721

RESUMEN

Pilomatrixoma is a benign adnexal tumor very common in pediatric age and in young adults that derives from follicular matrix cells. Although clinically it usually presents as a subcutaneous nodule of bluish color less than 3cm in size, multiple clinicopathological variants have been described in the literature. Among these we can find the giant pilomatrixoma, a rare clinical variant that reaches a size greater than or equal to 4cm and can simulate the clinical presentation of a malignant neoplasm. We report a 59-year-old man with an exophytic and ulcerated nodule in the left parotid region that was removed with the suspected diagnosis of a cutaneous squamous cell carcinoma. Histopathological analysis showed a proliferation of basaloid cells with areas of transition to ghost cells, under granulation tissue, hemorrhage, and an ulcerated epidermis. Thus, the diagnosis of giant pilomatrixoma was made. We reviewed the literature and found a total of 53 articles that report a total of 71 cases of giant pilomatrixoma. It is important to recognize this clinical subtype of pilomatrixoma because, apart from the possibility of being clinically confused with malignant lesions, the clinicopathological differential diagnosis must be made with the proliferating pilomatrixoma and pilomatrixcarcinoma.


Asunto(s)
Enfermedades del Cabello/patología , Pilomatrixoma/patología , Neoplasias Cutáneas/patología , Diagnóstico Diferencial , Epidermis/patología , Humanos , Masculino , Persona de Mediana Edad
8.
Clin Gastroenterol Hepatol ; 17(5): 997-999, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30077785

RESUMEN

Nonalcoholic fatty liver disease (NAFLD) is a well-recognized health problem, with an estimated worldwide prevalence of 25%.1 It is associated with metabolic syndrome (MetSx) and complications such as cirrhosis and hepatocellular carcinoma. However, the main cause of death in patients with NAFLD is derived from cardiovascular disease, and outcome seems to be determined by the degree of hepatic fibrosis.2 The prevalence of NAFLD and associated cardiovascular risk factors in asymptomatic patients in Mexico are poorly documented, despite having one of the highest rates of obesity and metabolic syndrome worldwide.3.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Cirrosis Hepática/epidemiología , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Adulto Joven
9.
Gastroenterol Hepatol ; 42(10): 657-676, 2019 Dec.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31771785

RESUMEN

Alcohol-related liver disease (ARLD) is the most prevalent cause of advanced liver disease and liver cirrhosis in Europe, including Spain. According to the World Health Organization the fraction of liver cirrhosis attributable to alcohol use in Spain is 73.8% among men and 56.3% among women. ARLD includes various stages such as steatohepatitis, cirrhosis and hepatocellular cancer. In addition, patients with underlying ARLD and heavy alcohol intake may develop alcoholic hepatitis, which is associated with high mortality. To date, the only effective treatment to treat ARLD is prolonged withdrawal. There are no specific treatments, and the only treatment that increases life expectancy in alcoholic hepatitis is prednisolone. For patients with alcoholic hepatitis who do not respond to treatment, some centres offer the possibility of an early transplant. These clinical practice guidelines aim to propose recommendations on ARLD taking into account their relevance as a cause of advanced chronic liver disease and liver cirrhosis in our setting. This paper aims to answer the key questions for the clinical practice of Gastroenterology, Hepatology, as well as Internal Medicine and Primary Health Centres, making the most up-to-date information regarding the management and treatment of ARLD available to health professionals. These guidelines provide evidence-based recommendations for the clinical management of this disease.


Asunto(s)
Hepatopatías Alcohólicas/diagnóstico , Hepatopatías Alcohólicas/terapia , Algoritmos , Humanos , Hepatopatías Alcohólicas/etiología
10.
Gac Med Mex ; 155(3): 298-306, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31219462

RESUMEN

Preoperative assessment in non-cardiac surgery is essential to reducing the rate of in-hospital complications. Its purpose is to identify patients with higher levels of risk. Preoperative assessment should not be restricted to cardiovascular aspects, but it should focus on all organs and systems and include medication reconciliation. The purpose of this article is to approach the performance of a preoperative assessment in non-cardiac surgery from the perspective of the internist, with the purpose to help prevent adverse events and improve the overall outcome.


La valoración preoperatoria en cirugía no cardiaca es fundamental para disminuir la tasa de complicaciones hospitalarias; su finalidad es identificar pacientes con riesgos mayores. La valoración preoperatoria no se debe limitar a los aspectos cardiovasculares, sino enfocarse en todos los órganos y sistemas e incluir la conciliación de medicamentos. El objetivo de este escrito es abordar la realización de una valoración preoperatoria en cirugía no cardiaca desde la perspectiva del médico internista, con el fin de ayudar a prevenir eventos adversos y mejorar el desenlace general.


Asunto(s)
Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/métodos , Procedimientos Quirúrgicos Operativos/métodos , Enfermedades Cardiovasculares/prevención & control , Humanos , Procedimientos Quirúrgicos Operativos/efectos adversos
11.
Gastroenterol Hepatol ; 41(5): 328-349, 2018 May.
Artículo en Inglés, Español | MEDLINE | ID: mdl-29631866

RESUMEN

Non-alcoholic fatty liver disease (NAFLD) is the main cause of liver diseases in Spain and the incidence is raising due to the outbreak of type 2 diabetes and obesity. This CPG suggests recommendation about diagnosis, mainly non-invasive biomarkers, and clinical management of this entity. Life-style modifications to achieve weight loss is the main target in the management of NAFLD. Low caloric Mediterranean diet and 200 minutes/week of aerobic exercise are encouraged. In non-responders patients with morbid obesity, bariatric surgery or metabolic endoscopy could be indicated. Pharmacological therapy is indicated in patients with NASH and fibrosis and non-responders to weight loss measures. NAFLD could influence liver transplantation, as a growing indication, the impact of steatosis in the graft viability, de novo NAFLD rate after OLT and a raised cardiovascular risk that modify the management of this entity. The current CPG was the result of the First Spanish NAFLD meeting in Seville.


Asunto(s)
Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/terapia , Humanos , Guías de Práctica Clínica como Asunto
17.
J Cutan Med Surg ; 24(6): 638, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32463302

Asunto(s)
Rinofima , Humanos
19.
Arch Esp Urol ; 67(7): 650-3, 2014 Sep.
Artículo en Inglés, Español | MEDLINE | ID: mdl-25241841

RESUMEN

OBJECTIVE: To describe two clinical cases of staghorn stones in renal allografts and to perform a review of this condition. METHODS/RESULTS: Case 1. 71-year-old woman with a renal transplant and recurrent UTI presented lithiasis in the graft on renal ultrasound. We started medical treatment and later one ESWL session was performed. The subsequent evolution of the patient was bad, requiring transplant nephrectomy. Case 2. 68-year old woman with renal transplant presented acute deterioration of renal function due to staghorn stones. Emergency ureteral catheter insertion was carried out, medical treatment was started and after one ESWL session she had a good subsequent evolution and normal function of the graft. CONCLUSIONS: Staghorn stones occupy most of the collecting system. They are usually made of struvite. They form in the context of urinary tract infections caused by urea splitting germs. Long-term persistence of staghorn calculi in the kidney causes functional and anatomical deterioration that can lead to kidney loss.


Asunto(s)
Cálculos Renales/diagnóstico por imagen , Cálices Renales , Trasplante de Riñón , Complicaciones Posoperatorias/diagnóstico por imagen , Anciano , Femenino , Humanos , Radiografía
20.
Artículo en Inglés | MEDLINE | ID: mdl-39099245

RESUMEN

BACKGROUND AND AIM: Type 2 Diabetes mellitus (T2DM), age, and obesity are risk factors for metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to assess the performance of non-invasive tests (NITs) for the diagnosis of metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis in high-risk subjects. METHODS: Multicentre cross-sectional study that included 124 biopsy-proven MASLD in more than 50 years-old patients with overweight/obesity and T2DM. Vibration-controlled transient elastography, Fibrosis-4 index (FIB-4), Non-alcoholic fatty liver disease fibrosis score (NFS), OWLiver Panel (OWLiver DM2 + Metabolomics-Advanced Steatohepatitis Fibrosis Score -MASEF) and FibroScan-AST were performed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC) were calculated. NITs were assessed individually and in sequential/parallel combinations. RESULTS: 35 (28.2%) patients had early MASH and 66 (53.2%) had MASH with significant fibrosis (at-risk MASH). The OWLiver Panel correctly classified 86.1% as MASH, showing an accuracy, sensitivity, specificity, PPV, and NPV of 0.77, 0.86, 0.35, 0.85, and 0.36, respectively. Class III obesity, diabetes control, or gender did not impact on the performance of the OWLiver Panel (p > 0.1). NITs for at-risk MASH showed an AUC > 0.70 except for NFS. MASEF showed the highest accuracy and NPV for at-risk MASH (AUC 0.77 [0.68-0.85], NPV 72%) and advanced fibrosis (AUC 0.80 [0.71-0.88], NPV 92%). Combinations of NITs for the identification of at-risk MASH did not provide any additional benefit over using MASEF alone. CONCLUSION: One-step screening strategy with the OWLiver Panel has high accuracy to detect MASH and at-risk MASH in high-risk subjects for MASLD.

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