Does Cystatin C have a role as metabolic surrogate in peritoneal dialysis beyond its association with residual renal function? / Teria a Cistatina C um papel como substituto metabólico na diálise peritoneal além de sua associação com a função renal residual?

ABSTRACT Introduction: It has been suggested that cystatin C levels are modified by obesity and inflammation. Furthermore, cystatin C has been associated with cardiovascular events and mortality outcomes. Aim: To study the association of cystatin C with the metabolic profile and cardiovascular disease of peritoneal dialysis patients. Methods: Data collected included clinical, laboratorial, and multifrequency bioimpedance assessment of 52 stable peritoneal dialysis patients. Minimal residual renal function was defined as > 2mL/min/1.73m2. Results: Serum cystatin C was not significantly associated with peritoneal or urinary cystatin C excretion. Negative correlation of cystatin C with normalized protein catabolic rate (rho -0.33, p = 0.02) and a trend towards positive correlation with relative body fat (rho 0.27, p = 0.05) were not independent from residual renal function. Cystatin C was not significantly associated with cardiovascular disease (p = 0.28), nor with glycated hemoglobin (p = 0.19) or c-reactive protein (p = 0.56). In the multivariate model, both age and diabetes were the strongest predictors of cardiovascular disease (odds ratio 1.09, p = 0.029 and odds ratio 29.95, p = 0.016, respectively), while relative body fat was negatively associated with cardiovascular disease (p = 0.038); neither cystatin C (p = 0.096) nor minimal residual renal function (p = 0.756) reached a significant association with cardiovascular disease. Conclusions: In this group of peritoneal dialysis patients, cystatin C did not correlate with the metabolic or inflammatory status, nor cardiovascular disease, after adjustment for residual renal function.

RESUMO Introdução: Tem sido sugerido que os níveis de cistatina C são modificados pela obesidade e inflamação. Além disso, a cistatina C tem sido associada a eventos cardiovasculares e desfechos de mortalidade. Objetivo: Estudar a associação da cistatina C com o perfil metabólico e doença cardiovascular de pacientes em diálise peritoneal. Métodos: Os dados coletados incluíram avaliação clínica, laboratorial e de bioimpedância múltipla de 52 pacientes estáveis em diálise peritoneal. A função renal residual mínima foi definida como > 2mL/min/1,73m2. Resultados: A cistatina C sérica não esteve significativamente associada à excreção peritoneal ou urinária. A correlação negativa da cistatina C com a taxa catabólica protéica normalizada (rho -0,33, p = 0,02) e uma tendência de correlação positiva com a gordura corporal relativa (rho 0,27, p = 0,05) não foram independentes da função renal residual. A cistatina C não se associou significativamente à doença cardiovascular (p = 0,28), nem com hemoglobina glicada (p = 0,19) ou proteína C reativa (p = 0,56). No modelo multivariado, idade e diabetes foram os mais fortes preditores de doença cardiovascular (razões de probabilidade 1,09, p = 0,029 e 29,95, p = 0,016, respectivamente) enquanto a gordura corporal relativa se associou negativamente à doença cardiovascular (p = 0,038). A cistatina C não se associou significativamente com doença cardiovascular (p = 0,096), tampouco a função residual mínima (p = 0,756). Conclusão: Neste grupo de pacientes em diálise peritoneal, a cistatina C não se correlacionou com o estado metabólico ou inflamatório, nem com doença cardiovascular, após ajuste para função renal residual.

Does Cystatin C have a role as metabolic surrogate in peritoneal dialysis beyond its association with residual renal function?

INTRODUCTION: It has been suggested that cystatin C levels are modified by obesity and inflammation. Furthermore, cystatin C has been associated with cardiovascular events and mortality outcomes. AIM: To study the association of cystatin C with the metabolic profile and cardiovascular disease of peritoneal dialysis patients. METHODS: Data collected included clinical, laboratorial, and multifrequency bioimpedance assessment of 52 stable peritoneal dialysis patients. Minimal residual renal function was defined as > 2mL/min/1.73m2. RESULTS: Serum cystatin C was not significantly associated with peritoneal or urinary cystatin C excretion. Negative correlation of cystatin C with normalized protein catabolic rate (rho -0.33, p = 0.02) and a trend towards positive correlation with relative body fat (rho 0.27, p = 0.05) were not independent from residual renal function. Cystatin C was not significantly associated with cardiovascular disease (p = 0.28), nor with glycated hemoglobin (p = 0.19) or c-reactive protein (p = 0.56). In the multivariate model, both age and diabetes were the strongest predictors of cardiovascular disease (odds ratio 1.09, p = 0.029 and odds ratio 29.95, p = 0.016, respectively), while relative body fat was negatively associated with cardiovascular disease (p = 0.038); neither cystatin C (p = 0.096) nor minimal residual renal function (p = 0.756) reached a significant association with cardiovascular disease. CONCLUSIONS: In this group of peritoneal dialysis patients, cystatin C did not correlate with the metabolic or inflammatory status, nor cardiovascular disease, after adjustment for residual renal function.

Reconfiguração do horário de trabalho para turnos de 12h: que impactos na saúde? / Redefining work schedules for 12-hour shifts: which health impacts? / Reconfiguración de la jornada laboral para turnos de 12 horas: ¿qué impactos en la salud?

Num contexto normativo que amplia a margem para configuração de horários de trabalho ao abrigo de um "regime de adaptabilidade", acentua-se o debate sobre os turnos de 12h, em virtude de uma conjuntura que mobiliza mais trabalhadores para tais horários, bem como das evidências de impactos na saúde. A partir da análise da mudança de um horário 3x8h para 2x12h numa empresa portuguesa, este estudo explora os fatores e condições considerados de risco agravado em jornadas de 12h. Os resultados revelam que os trabalhadores, no confronto com os constrangimentos do trabalho nestes horários, constroem estratégias de preservação de si e do coletivo, ainda que estas estratégias comportem custos para a saúde. A ponderação (no imediato e a longo prazo) que cada trabalhador faz sobre a sustentabilidade do trabalho em 12h convoca, simultaneamente, para debate: as especificidades do conteúdo de trabalho, a fase do percurso profissional e as suas exigências concretas, e os imperativos de conciliação com a vida fora do trabalho. (AU)

The normative context that enlarges the scope to shape work schedules under an "adaptability regime" has sharpened the debate about 12-hour shifts, given a conjuncture that leads more workers into such schedules and given the evidence of the impacts on health. Based on the analysis of the change from a 3x8h schedule into a 2x12h schedule in a Portuguese company, this study explores the factors and conditions considered to be aggravated risks in 12-hour journeys. The findings indicate that the workers, when confronted with the constraints of the work in these schedules, build preservation strategies for themselves and for the group, though such strategies entail health costs. The deliberation each worker does (immediately and in the long term) about the sustainability of the work in 12 hours calls simultaneously for debate: the specificities of the work content, the stage of the professional path and its specific demands, and the imperatives of reconciliation with life outside work. (AU)

En un contexto normativo que amplía el margen para el ajuste de la jornada laboral en virtud de un "régimen de adaptabilidad", se intensifica el debate sobre los turnos de 12 horas, debido a una coyuntura que moviliza más trabajadores para esos horarios, así como a las evidencias de los impactos en la salud. A partir del análisis del cambio de un horario de 3 x 8 horas para 2 x 12 horas en una empresa portuguesa, este estudio explora los factores y condiciones que se consideran de riesgo agravado en jornadas de 12 horas. Los resultados revelan que los trabajadores, al enfrentarse con las limitaciones del trabajo en estos horarios, construyen estrategias de autopreservación y de preservación del colectivo, aunque estas estrategias conlleven costes para la salud. La ponderación (en lo inmediato y en el largo plazo) que cada trabajador hace sobre la sostenibilidad de trabajar 12 horas llama al mismo tiempo para el debate: los detalles del contenido del trabajo, la fase de la carrera y sus requisitos específicos, y los requisitos de reconciliación con la vida fuera del trabajo. (AU)

The effect of the cell death suppressor vMIA on the production of a recombinant protein in the adenovirus-293 expression system.

Apoptosis is a major problem in animal cell cultures during production of biopharmaceuticals, such as recombinant proteins or viral vectors. A 293 cell line constitutively expressing vMIA (viral mitochondria-localized inhibitor of apoptosis) was constructed and examined on production of a model recombinant protein, green fluorescent protein (GFP) in the adenovirus-293 expression system, and on production of a model infectious adenoviral vector. vMIA-293 cells were more resistant than the parental 293 cells to apoptosis induced by either oxidative stress, or by adenovirus infection. The yield of GFP produced in vMIA-293 cell cultures was consistently higher (approximately 140%) compared to that in the parental cells. vMIA reduced production of adenovirus infectious particles, which was not due to a decline of adenovirus replication, since adenoviral DNA replication rate in vMIA-293 cells was higher than that in the parental cells. In conclusion, introduction of the vMIA gene into the 293 cell line is a promising strategy to improve recombinant protein production in the adenovirus-293 expression system.