Cardiac effects of renal ischemia.

Mortality in acute kidney injury (AKI) remains very high, yet the cause of death is often failure of extrarenal organs. We and others have demonstrated remote organ dysfunction after renal ischemia. The term "cardiorenal syndrome" was first applied to the "cross talk" between the organs by the National Heart, Lung, and Blood Institute of the National Institutes of Health, and the clinical importance is being increasingly appreciated. Nevertheless, more information is needed to effectively address the consequences of renal injury on the heart. Since AKI often occurs in patients with comorbidities, we investigated the effect of renal ischemia in the setting of existing cardiac failure. We hypothesized that the cardiac effects of renal ischemia would be significantly amplified in experimental cardiomyopathy. Male Sprague-Dawley rats with preexisting cardiac and renal injury due to low-dose doxorubicin were subjected to bilateral renal artery occlusion. Cardiac structure and function were examined 2 days after reperfusion. Loss of functional myocardial tissue with decreases in left ventricular pressure, increases in apoptotic cell death, inflammation, and collagen, and greater disruption in ultrastructure with mitochondrial fragmentation were seen in the doxorubicin/ischemia group compared with animals in the groups treated with doxorubicin alone or following ischemia alone. Systemic inflammation and cardiac abnormalities persisted for at least 21 wk. These results suggest that preexisting comorbidities can result in much more severe distant organ effects of acute renal injury. The results of this study are relevant to human AKI.NEW & NOTEWORTHY Acute kidney injury is common, expensive, and deadly, yet morbidity and mortality are often secondary to remote organ dysfunction. We hypothesized that the effects of renal ischemia would be amplified in the setting of comorbidities. Sustained systemic inflammation and loss of functional myocardium with significantly decreased systolic and diastolic function, apoptotic cell death, and increased collagen and inflammatory cells were found in the heart after renal ischemia in the doxorubicin cardiomyopathy model (vs. renal ischemia alone). Understanding the remote effects of renal ischemia has the potential to improve outcomes in acute kidney injury.

Renal, but not platelet or skin, extracellular vesicles decrease oxidative stress, enhance nascent peptide synthesis, and protect from ischemic renal injury.

Acute kidney injury (AKI) is deadly and expensive, and specific, effective therapy remains a large unmet need. We have demonstrated the beneficial effects of transplanted adult tubular cells and extracellular vesicles (EVs; exosomes) derived from those renal cells on experimental ischemic AKI, even when administered after renal failure is established. To further examine the mechanisms of benefit with renal EVs, we tested the hypothesis that EVs from other epithelia or platelets (a rich source of EVs) might be protective, using a well-characterized ischemia-reperfusion model. When given after renal failure was present, renal EVs, but not those from skin or platelets, markedly improved renal function and histology. The differential effects allowed us to examine the mechanisms of benefit with renal EVs. We found significant decreases in oxidative stress postischemia in the renal EV-treated group with preservation of renal superoxide dismutase and catalase as well as increases in anti-inflammatory interleukin-10. In addition, we propose a novel mechanism of benefit: renal EVs enhanced nascent peptide synthesis following hypoxia in cells and in postischemic kidneys. Although EVs have been used therapeutically, these results serve as "proof of principle" to examine the mechanisms of injury and protection.NEW & NOTEWORTHY Acute kidney injury is common and deadly, yet the only approved treatment is dialysis. Thus, a better understanding of injury mechanisms and potential therapies is needed. We found that organ-specific, but not extrarenal, extracellular vesicles improved renal function and structure postischemia when given after renal failure occurred. Oxidative stress was decreased and anti-inflammatory interleukin-10 increased with renal, but not skin or platelet, exosomes. We also propose enhanced nascent peptide synthesis as a novel protective mechanism.

Inseguridad del agua en hogares mexicanos: comparación de resultados de las Ensanut Continua 2021 y 2022.

OBJETIVO: Estimar la magnitud de inseguridad del agua en México de acuerdo con características sociodemográficas, comparando información de las Encuestas Nacionales de Salud y Nutrición Continua 2021 y 2022 (Ensanut Continua 2021 y 2022). Material y métodos. Para estimar la inseguridad del agua se utilizó la Escala de Experiencias de Inseguridad del Agua en el Hogar (HWISE, por sus siglas en inglés) y las características sociodemográficas de los hogares entrevistados. Se describieron las variables de estudio con proporciones e intervalos de confianza al 95%. RESULTADOS: Se incluyó información de la Ensanut 2021 (12 463 hogares) y Ensanut 2022 (10 356 hogares) que respondieron la escala HWISE. La prevalencia de inseguridad del agua en 2021 fue de 16.3% y en 2022 de 16.5%. En 2021, 15.2% de hogares en localidades rurales tuvieron inseguridad del agua y en 2022 fueron 17.2%. En 2021, la región con menor proporción de hogares con inseguridad del agua fue Frontera, pero para 2022 la prevalencia de inseguridad del agua en esta región aumentó 18.9 puntos porcentuales entre 2021 y 2022. CONCLUSIONES: México debe tener un plan de acción intensivo para resolver el deterioro ambiental, la escasez y contaminación del agua pues la seguridad hídrica para la población es un asunto de seguridad nacional.

Low Load With BFR vs. High Load Without BFR Eccentric Hamstring Training Have Similar Outcomes on Muscle Adaptation.

ABSTRACT: Jones, MJ, Dominguez, JF, Macatugal, C, Coleman, K, Reed, B, and Schroeder, ET. Low load with BFR vs. high load without BFR eccentric hamstring training have similar outcomes on muscle adaptation. J Strength Cond Res 37(1): 55-61, 2023-A key principle of hamstring injury rehabilitation is developing high eccentric force capability through resistance training (RT). However, it can take months before high-load RT is deemed safe and appropriate for rehabilitating serious hamstring injuries. Low-load blood flow restriction (BFR) RT has been identified as an effective alternative when high-load RT is contraindicated but has been scarcely investigated in the hamstring. To address this gap in knowledge, we sought to compare the effect of longitudinal BFR RT with traditional RT on eccentric hamstring power, strength, lean mass, perceived soreness, and acute muscle swell in healthy adults (n = 40; 19 F, 21 M; mean ± SD; age: 24.3 ± 2.6 years). Our crossover design compared the effects of low-load (30% 1RM) eccentric lower extremity training with BFR (BFR-ELET) with traditional high-load (80% 1RM) eccentric lower extremity training (TRAD-ELET) without BFR biweekly for 6 weeks. Outcomes were tested pre/post-intervention with significance at α = 0.05. Both interventions yielded dependent variable outcomes that did not differ significantly except for muscle swell assessed by bioelectrical impedance analysis, which decreased significantly more in the BFR-ELET condition compared with TRAD-ELET (mean ± SD: -0.32 ± 0.02, Φ° 50 kHz), CI: -0.35 to -0.28, Φ° 50 kHz, p < 0.001, Cohen's d = 2.95). Our findings support BFT-ELET as an effective alternative to TRAD-ELET for enhancing strength and identify myocellular swelling as a potential mediator for strength outcomes associated with BFR training.

Role of coagulation in persistent renal ischemia following reperfusion in an animal model.

Ischemic acute kidney injury is common, deadly, and accelerates the progression of chronic kidney disease, yet has no specific therapy. After ischemia, reperfusion is patchy with early and persistent impairment in regional renal blood flow and cellular injury. We tested the hypothesis that intrarenal coagulation results in sustained renal ischemia following reperfusion, using a well-characterized model. Markedly decreased, but heterogeneous, microvascular plasma flow with microthrombi was found postischemia by intravital microscopy. Widespread tissue factor expression and fibrin deposition were also apparent. Clotting was accompanied by complement activation and inflammation. Treatment with exosomes derived from renal tubular cells or with the fibrinolytic urokinase, given 24 h postischemia when renal failure was established, significantly improved microvascular flow, coagulation, serum creatinine, and histological evidence of injury. These data support the hypothesis that intrarenal clotting occurs early and the resultant sustained ischemia is a critical determinant of renal failure following ischemia; they demonstrate that the coagulation abnormalities are amenable to therapy and that therapy results in improvement in both function and postischemic inflammation.NEW & NOTEWORTHY Ischemic renal injury carries very high morbidity and mortality, yet has no specific therapy. We found markedly decreased, heterogeneous microvascular plasma flow, tissue factor induction, fibrin deposition, and microthrombi after renal ischemia-reperfusion using a well-characterized model. Renal exosomes or the fibrinolytic urokinase, administered after renal failure was established, improved microvascular flow, coagulation, renal function, and histology. Data demonstrate that intrarenal clotting results in sustained ischemia amenable to therapy that improves both function and postischemic inflammation.

Social factors and chronic pain: the modifying effect of sex in the Stockholm Public Health Cohort Study.

OBJECTIVES: To assess the relationship between social factors (socio-economic status, household load and job strain) and chronic pain occurrence, and the role of gender in this relationship. METHODS: We used data corresponding to 8 years of follow-up of the Stockholm Public Health Cohort Study (2006-2014) to compute Adjusted Incidence Rate Ratios (IRRs) and additive interaction measures of chronic pain episodes, social factors, and sex in 16 687 subjects. RESULTS: For men, increased rates of chronic pain occurrence were observed for skilled workers (IRR = 1.27, 95% CI: 0.99, 1.61) and lower non-manual employees (IRR = 1.37, 95% CI: 1.05, 1.78), compared with unskilled workers; subjects with high household load (IRR = 1.39; 95% CI: 1.03, 1.88), compared with those with a null score; and subjects with active jobs (IRR = 1.27, 95% CI: 1.06, 1.51), compared with those with low-strain jobs. For women, we observed decreased rates of chronic pain occurrence in lower (IRR = 0.82, 95% CI: 0.68, 0.99), intermediate (IRR = 0.74, 95% CI: 0.63, 0.88) and higher non-manual employees (IRR = 0.65, 95% CI: 0.54, 0.79), compared with unskilled workers. Compared with subjects with a null score, women with low household load showed a lower rate of chronic pain occurrence (IRR = 0.85; 95% CI: 0.72, 1.00). Compared with subjects with low-strain jobs, those with passive jobs (IRR = 1.21; 95% CI: 1.02, 1.44) and high-strain jobs (IRR = 1.46; 95% CI: 1.02, 2.09) showed higher rates of chronic pain occurrence. CONCLUSION: In general, our analysis yielded different, if not opposite, results when data were stratified by sex. Sex may then represent an effect modifier of the relationship between social factors and chronic pain.

High incidence of stroke and mortality in pediatric critical care patients with COVID-19 in Peru.

INTRODUCTION: Pediatric critical care patients with COVID-19 treated in Peru have higher mortality than those previously reported from other countries. Pediatric providers have reported a high number of patients without comorbidities presenting with hemorrhagic strokes associated with COVID-19. We present a study analyzing the factors associated with mortality in this setting. METHODS: Prospective case-control study that included patients <17 years old admitted to a pediatric critical care unit with a positive test confirming COVID-19. The primary outcome was mortality. Fisher's exact test and the Mann-Whitney U test were used for the analysis. RESULTS: Forty-seven patients were admitted to critical care. The mortality of our study is 21.3%. The mortality of patients with neurological presentation was 45.5%, which was significantly higher than the mortality of acute COVID-19 (26.7%) and MIS-C (4.8%), p 0.18. Other risk factors for mortality in our cohort were strokes and comorbidities. Only one patient presenting with hemorrhagic stroke had an undiagnosed comorbidity. CONCLUSION: Cerebrovascular events associated with COVID-19 in pediatric patients, including infants, must be recognized as one of the more severe presentations of this infection in pediatric patients. IMPACT: Pediatric patients with COVID-19 can present with hemorrhagic and ischemic strokes on presentation. Neurological presentation in pediatric patients with COVID-19 has high mortality. Mortality of pediatric patients with COVID-19 is associated with comorbidities. Pediatric presentation and outcomes of COVID-19 in different regions can be novel to previously described.

Socioeconomic status and occurrence of chronic pain: a meta-analysis.

OBJECTIVE: To examine the association between socioeconomic status (SES) and the occurrence of chronic pain, defined as pain that persists or recurs for >3 months. METHODS: We performed a structured search in Medline, Embase, WHO Global Index Medicus and Conference Proceedings Citation Index-Science databases to identify cohort and case-control studies on chronic pain and SES and its subgroups (SES combined index, educational level, income and occupational status). We extracted study characteristics, outcome measures and measures of association and their 95% CIs. Literature search, data extraction and risk of bias assessment were conducted by two independent researchers. We performed main and subgroup meta-analyses using random-effects model, and formally assessed heterogeneity and publication bias. RESULTS: A total of 45 studies, covering a population of ∼175 000 individuals, were meta-analysed, yielding a pooled Odds Ratio (OR) of 1.32 (95% CI: 1.21, 1.44) and 1.16 (95% CI: 1.09, 1.23) for low and medium SES levels, respectively, compared with high level. We obtained similar results in all the subgroup analyses. Heterogeneity was generally moderate to high across strata, and some evidence of publication bias for low socioeconomic status was found. CONCLUSION: Our results support a moderate increase in the risk of chronic pain for low and medium SES when compared with high SES, a feature that remained constant in all measures of exposure or outcome used. Further prospective research on populations from developing countries are needed to confirm our findings as the studies available for this meta-analysis were carried out exclusively in developed countries.

Social factors and pain worsening: a retrospective cohort study.

BACKGROUND: Pain, specifically chronic pain, is a major public health issue worldwide with considerable health-related consequences and large economic impact. The relation between socioeconomic status and pain occurrence is well established. However, little is known on the relation between socioeconomic factors and worsening of pain, including progression from non-chronic pain to chronic pain. METHODS: To assess the relation between socioeconomic status and pain worsening, we used the Stockholm Public Health Cohort Study from 2006 to 2014 and analysed data of 9721 participants who completed follow-up. The adjusted incidence rate ratios (IRRs) of moderate and severe pain worsening episodes were computed, using a pain amplification model, which encompasses spreading, somatisation, and psychological distress components. Multiple imputation analysis was performed subsequently to adjust for cohort attrition. RESULTS: Compared with non-skilled workers, self-employed subjects (IRR=1.18; 95% confidence interval [CI], 1.01-1.39) and non-manual employees were at higher risk of moderate worsening (lower non-manual employees: IRR=1.21; 95% CI, 1.03-1.41; intermediate non-manual employees: IRR=1.26; 95% CI, 1.10-1.44; higher non-manual employees: IRR=1.25; 95% CI, 1.08-1.45). This risk increase was limited to worsening starting at stage 0 (non-chronic pain). No association was found between socioeconomic status and severe pain worsening. CONCLUSION: Our results support a moderate association between intermediate and high socioeconomic status, and moderate pain worsening. This association could be explained by the heterogeneous composition of the socioeconomic variable used in this cohort, and by changes in exposure and other time-varying covariables' status during follow-up.

Challenges to implementing electronic trial data collection in primary care: a qualitative study.

BACKGROUND: Within-consultation recruitment to primary care trials is challenging. Ensuring procedures are efficient and self-explanatory is the key to optimising recruitment. Trial recruitment software that integrates with the electronic health record to support and partially automate procedures is becoming more common. If it works well, such software can support greater participation and more efficient trial designs. An innovative electronic trial recruitment and outcomes software was designed to support recruitment to the Runny Ear randomised controlled trial, comparing topical, oral and delayed antibiotic treatment for acute otitis media with discharge in children. A qualitative evaluation investigated the views and experiences of primary care staff using this trial software. METHODS: Staff were purposively sampled in relation to site, role and whether the practice successfully recruited patients. In-depth interviews were conducted using a flexible topic guide, audio recorded and transcribed. Data were analysed thematically. RESULTS: Sixteen staff were interviewed, including GPs, practice managers, information technology (IT) leads and research staff. GPs wanted trial software that automatically captures patient data. However, the experience of getting the software to work within the limited and complex IT infrastructure of primary care was frustrating and time consuming. Installation was reliant on practice level IT expertise, which varied between practices. Although most had external IT support, this rarely included supported for research IT. Arrangements for approving new software varied across practices and often, but not always, required authorisation from Clinical Commissioning Groups. CONCLUSIONS: Primary care IT systems are not solely under the control of individual practices or CCGs or the National Health Service. Rather they are part of a complex system that spans all three and is influenced by semi-autonomous stakeholders operating at different levels. This led to time consuming and sometimes insurmountable barriers to installation at the practice level. These need to be addressed if software supporting efficient research in primary care is to become a reality.

Integrating intraseasonal grassland dynamics in cross-scale distribution modeling to support waterbird recovery plans.

Despite much discussion about the utility of remote sensing for effective conservation, the inclusion of these technologies in species recovery plans remains largely anecdotal. We developed a modeling approach for the integration of local, spatially measured ecosystem functional dynamics into a species distribution modeling (SDM) framework in which other ecologically relevant factors are modeled separately at broad scales. To illustrate the approach, we incorporated intraseasonal water-vegetation dynamics into a cross-scale SDM for the Common Snipe (Gallinago gallinago), which is highly dependent on water and vegetation dynamics. The Common Snipe is an Iberian grassland waterbird characteristic of European agricultural meadows and a member of one of the most threatened bird guilds. The intraseasonal dynamics of water content of vegetation were measured using the standard deviation of the normalized difference water index time series computed from bimonthly images of the Sentinel-2 satellite. The recovery plan for the Common Snipe in Galicia (northwestern Iberian Peninsula) provided an opportunity to apply our modeling framework. Model accuracy in predicting the species' distribution at a regional scale (resulting from integration of downscaled climate projections with regional habitat-topographic suitability models) was very high (area under the curve [AUC] of 0.981 and Boyce's index of 0.971). Local water-vegetation dynamic models, based exclusively on Sentinel-2 imagery, were good predictors (AUC of 0.849 and Boyce's index of 0.976). The predictive power improved (AUC of 0.92 and Boyce's index of 0.98) when local model predictions were restricted to areas identified by the continental and regional models as priorities for conservation. Our models also performed well (AUC of 0.90 and Boyce's index of 0.93) when projected to updated water-vegetation conditions. Our modeling framework enabled incorporation of key ecosystem processes closely related to water and carbon cycles while accounting for other factors ecologically relevant to endangered grassland waterbirds across different scales, allowed identification of priority areas for conservation, and provided an opportunity for cost-effective recovery planning by monitoring management effectiveness from space.

Integración de las Dinámicas Intraestacionales de los Pastizales al Modelado de la Distribución a través de Diversas Escalas para Respaldar los Planes de Recuperación de Aves Acuáticas Resumen A pesar A pesar del potencial de la teledetección para la conservación, la inclusión de estas tecnologías en los planes de recuperación de especies es muy poco habitual. En este trabajo, desarrollamos una estrategia de modelado para la integración de dinámicas ecosistémicas funcionales locales medidas espacialmente dentro de un marco de trabajo del modelado de distribución de especies (MDE), en el cual otros factores ecológicamente relevantes se modelan por separado y a escalas más generales. Para ilustrar la estrategia incorporamos las dinámicas Intraestacionales de la vegetación acuática en un MDE multiescala escalas para la agachadiza común (Gallinago gallinago), la cual es sumamente dependiente de las dinámicas del agua y la vegetación. La agachadiza común es un ave acuática de los pastizales ibéricos, característica de las praderas agrícolas de Europa y miembro de uno de los grupos de aves más amenazados. Medimos las dinámicas intraestacionales del contenido de agua de la vegetación con la desviación estándar de la serie temporal del índice de diferencia normalizada de agua a partir de las imágenes bimensuales del satélite Sentinel-2. El plan de recuperación para la agachadiza común en Galicia (noroeste de la península ibérica) proporcionó una oportunidad para aplicar nuestro marco de trabajo. La capacidad del modelo para predecir la distribución de la especie a una escala regional (resultante de la integración de proyecciones climáticas a escala reducida con modelos regionales de idoneidad hábitat-topografía) fue muy alta (área bajo la curva [AUC] de 0.981 e índice de Boyce de 0.971). El poder de predicción aumentó (AUC de 0.92 e índice de Boyce de 0.98) cuando las predicciones de los modelos locales estuvieron restringidos a áreas identificadas por los modelos continentales y regionales como prioritarias para la conservación. Nuestros modelos también tuvieron un buen desempeño (AUC de 0.90 e índice de Boyce de 0.93) cuando los proyectamos hacia las condiciones actualizadas de vegetación acuática. Nuestro marco de trabajo permitió la incorporación de procesos ecosistémicos clave intimamente relacionados con los ciclos del agua y del carbono a la vez que representaba otros factores ecológicamente relevantes para las aves acuáticas amenazadas de pastizal, a través de diferentes escalas. También permitió la identificación de áreas prioritarias para la conservación y proporcionó oportunidades para la planificación rentable de la recuperación al monitorear la efectividad del manejo desde el espacio.

[Behavior and factors associated with anemia inMexican women of childbearing age. Ensanut 2018-19]. / Comportamiento y factores asociados con la anemia en mujeres mexicanas en edad fértil. Ensanut 2018-19.

OBJECTIVE: To study the behavior of anemia in 2006, 2012 and 2018-19, its severity and associated factors in Mexican women between 20 and 49 years of age. MATERIALS AND METHODS: The Ensanut 2006, 2012 and 2018-19 has a methodological design that allows comparisons between them. Capillary hemoglobin (Hb) classified anemia with Hb values <12dL. Pregnant women were excluded. Anemia was associated with individual and sociodemographic factors using a logit regression model. RESULTS: The reduction in anemia from 2006 to 2012 was significant, but not the increase for 2018-19. Anemia was associated with a higher number of pregnancies, and being 35 to 49 years of age. A BMI≥30 (k/m2), tertile 3 of wellness condition, not being indigenous and living in the Center and Mexico City were protective of anemia. CONCLUSIONS: Anemia continues to be a public health problem, especially in women 35 to 49 years of age with more than four pregnancies.

OBJETIVO: Estudiar el comportamiento de la anemia en los años 2006, 2012 y 2018-19, su severidad y factores asociados en mujeres mexicanas de 20 a 49 años de edad. MATERIAL Y MÉTODOS: Las Ensanut 2006, 2012 y 2018-19 tienen un diseño metodológico que permite comparaciones entre ellas. Mediante hemoglobina capilar <12dL se clasificó anemia. Se excluyó a quienes estuvieron embarazadas. Se asoció anemia con factores sociodemográficos mediante regresión logística. RESULTADOS: La reducción de anemia de 2006 a 2012 fue significativa, pero no el incremento para 2018-19. Se asoció anemia con un mayor número de embarazos, y tener de 35 a 49 años de edad. Fueron factores protectores de anemia un IMC≥30(k/m2), tercil 3 de CB, no ser indígena y vivir en Cen-tro y Ciudad de México. CONCLUSIONES: La anemia continúa siendo un problema de salud pública, sobre todo en mujeres de 35 a 49 años de edad con más de cuatro embarazos.

Renal Tubular Cell-Derived Extracellular Vesicles Accelerate the Recovery of Established Renal Ischemia Reperfusion Injury.

Ischemic renal injury is a complex syndrome; multiple cellular abnormalities cause accelerating cycles of inflammation, cellular damage, and sustained local ischemia. There is no single therapy that effectively resolves the renal damage after ischemia. However, infusions of normal adult rat renal cells have been a successful therapy in several rat renal failure models. The sustained broad renal benefit achieved by relatively few donor cells led to the hypothesis that extracellular vesicles (EV, largely exosomes) derived from these cells are the therapeutic effector in situ We now show that EV from adult rat renal tubular cells significantly improved renal function when administered intravenously 24 and 48 hours after renal ischemia in rats. Additionally, EV treatment significantly improved renal tubular damage, 4-hydroxynanoneal adduct formation, neutrophil infiltration, fibrosis, and microvascular pruning. EV therapy also markedly reduced the large renal transcriptome drift observed after ischemia. These data show the potential utility of EV to limit severe renal ischemic injury after the occurrence.

[Evolution of food insecurity in Mexican households: 2012-2016]. / Evolución de la inseguridad alimentaria en los hogares mexicanos: 2012-2016.

OBJECTIVE: To describe three relevant aspects of household food insecurity (FI) in Mexico: its magnitude, its distribution by social and nutritional vulnerability characteristics; its evolution between 2012 and 2016 and the effect of food assistance programs on FI in Mexican households. MATERIALS AND METHODS: Data on 9 019 households were drawn from the 2016 National Health and Nutrition Survey (Ensanut 2016 for its Spanish initials) and were compared with data from the 2012 Ensanut. An analysis of differences in differences was made to measure the effect of food assis-tance programs on the evolution of FI. RESULTS: As many as 69.5% of households were classified as FI. Families located in rural areas (78.0%) and residing in southern Mexico (76.3%). Households with support from a food assistance program experienced a decrease in moderate and severe FI between 2012 and 2016. CONCLUSIONS: Findings can be used to design and target public policies seeking to improve food security governance in Mexico.

OBJETIVO: Describir tres aspectos importantes de la inse­guridad alimentaria (IA) en México: la magnitud y distribución de acuerdo con características de vulnerabilidad social, su evolución entre 2012 y 2016 y el efecto de los programas sociales de ayuda alimentaria en la IA de los hogares mexicanos. MATERIAL Y MÉTODOS: Se incluyó información de 40 809 y 9 019 hogares provenientes de la Ensanut 2012 y 2016, respectivamente. Se realizó un análisis de diferencias en diferencias para medir el efecto de los programas de ayuda alimentaria en la evolución de la IA. RESULTADOS: El 69.5% de los hogares se clasificó en IA. Los más afectados por la IA fueron hogares más pobres (85.8%) y de áreas rurales (78.0%). En el periodo 2012-2016, la prevalencia de IA moderada y severa disminuyó en hogares con apoyo de programas de ayuda alimentaria. CONCLUSIONES: Los resultados presentados son una herramienta para mejorar el diseño y focalización de políticas públicas y fortalecer la gobernanza de la seguridad alimentaria en México.

High levels of circulating TNFR1 increase the risk of all-cause mortality and progression of renal disease in type 2 diabetic nephropathy.

BACKGROUND: Several studies have demonstrated that levels of circulating inflammatory markers such as tumour necrosis factorα (TNFα), are associated with early progression of diabetic nephropathy (DN). The aim of this study was to investigate whether there is an association between circulating TNFα receptor and disease progression in patients with advanced type 2 DN and severe proteinuria. METHODS: Between 2006 and 2011, we measured levels of circulating soluble TNFα receptor 1 (TNFR1) and soluble TNFα receptor 2 (TNFR2) at baseline and 4 and 12 months in 101 patients included in a multicenter randomized controlled trial to compare the effect of optimal doses of renin-angiotensin system blockers in monotherapy or in combination (dual blockade) to slow progression of established type 2 DN. The primary composite endpoint was a >50% increase in baseline serum creatinine, end-stage renal disease, or death. RESULTS: The median follow-up was 32 months (IQR, 18-48), during which time 28 patients (22.7%) achieved the primary endpoint. The TNFR1 level, but not the TNFR2 level, was correlated with other inflammatory markers. Cox regression analysis showed that the highest TNFR1 levels (HR, 2.60; 95%CI, 1.11-86.34) and baseline proteinuria (HR 1.32; 95%CI 1.15-1.52) were associated with the primary endpoint. The mixed model analysis revealed that TNFR1 and the TNFR2 levels did not change after starting treatment with renin-angiotensin system blockers. CONCLUSIONS: Our results show that the highest levels of TNFR1 are independently associated with progression of renal disease and death in type 2 DN. The renin angiotensin blockers have no effect on these inflammatory markers.

Renal C3 complement component: feed forward to diabetic kidney disease.

BACKGROUND: Diabetic nephropathy is the main cause of end-stage renal disease and has reached epidemic proportions. METHODS: Comprehensive genomic profiling (RNAseq) was employed in the ZS (F1 hybrids of Zucker and spontaneously hypertensive heart failure) model of diabetic nephropathy. Controls were lean littermates. RESULTS: Diabetic nephropathy in obese, diabetic ZS was accelerated by a single episode of renal ischemia (DI). This rapid renal decline was accompanied by the activation of the renal complement system in DI, and to a lesser extent in sham-operated diabetic rats (DS). In DI there were significant increases in renal mRNA encoding C3, C4, C5, C6, C8, and C9 over sham-operated lean normal controls (LS). Moreover, mRNAs encoding the receptors for the anaphylatoxins C3a and C5a were also significantly increased in DI compared to LS. The classic complement pathway was activated in diabetic kidneys with significant increases of C1qa, C1qb, and C1qc mRNAs in DI over LS. In addition, critical regulators of complement activation were significantly attenuated in DI and DS. These included mRNAs encoding CD55, decay accelerating factor, and CD59, which inhibit the membrane attack complex. C3, C4, and C9 proteins were demonstrated in renal tubules and glomeruli. The complement RNAseq data were incorporated into a gene network showing interactions among C3-generating renal tubular cells and other immune competent migratory cells. CONCLUSIONS: We conclude that local activation of the complement system mediates renal injury in diabetic nephropathy.

Energy expenditure and heart rate responses to increased loading in individuals with motor complete spinal cord injury performing body weight-supported exercises.

OBJECTIVE: To examine acute metabolic and heart rate responses in individuals with motor complete spinal cord injury (SCI) during stepping and standing with body weight support (BWS). DESIGN: Cohort study. SETTING: Therapeutic exercise research laboratory. PARTICIPANTS: Nonambulatory individuals with chronic, motor complete SCI between T5 and T12 (n=8) and healthy, able-bodied controls (n=8). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Oxygen consumption (V˙o2) and heart rate. RESULTS: Individuals with motor complete SCI performed standing and stepping exercises in a BWS system with manual assistance of lower body kinematics. V˙o2 and heart rate responses were assessed in relation to level of BWS. Weight support was provided by an overhead lift at high (≥50% BWS) or low (20%-35% BWS) levels during stepping and standing. Although participants with motor complete SCI were unable to stand or step without assistance, levels of V˙o2 and heart rate were elevated by 38% and 37%, respectively, when load was maximized during stepping (ie, low BWS). Participants without an SCI (able-bodied group) had a similar acute response to exercise. None of the participants met the target range for V˙o2 response in any of the tasks. However, stepping was sufficient to enable half of the participants in the SCI group to attain the target range for heart rate response to exercise. CONCLUSIONS: Individuals with motor complete SCI exhibit cardiovascular responses during body weight-supported exercise. Findings indicate that body weight-supported stepping provides a minimal cardiovascular challenge for individuals with paraplegia. Emphasis on low weight support during locomotor training can trigger additional heart rate adaptations.

Vibrationally specific photoionization cross sections of acrolein leading to the X̃²A' ionic state.

The vibrational branching ratios in the photoionization of acrolein for ionization leading to the X̃²A' ion state were studied. Computed logarithmic derivatives of the cross section and the corresponding experimental data derived from measured vibrational branching ratios for several normal modes (ν9, ν10, ν11, and ν12) were found to be in relatively good agreement, particularly for the lower half of the 11-100 eV photon energy range considered. Two shape resonances have been found near photon energies of 15.5 and 23 eV in the photoionization cross section and have been demonstrated to originate from the partial cross section of the A' scattering symmetry. The wave functions computed at the resonance complex energies are delocalized over the whole molecule. By looking at the dependence of the cross section on the different normal mode displacements together with the wave function at the resonant energy, a qualitative explanation is given for the change of the cross sections with respect to changing geometry.

Use of Stable Isotopes (δ13C and δ15N) to Infer Post-Breeding Dispersal Strategies in Iberian Populations of the Kentish Plover.

Beaches are among the habitats most frequented by migratory birds for breeding and/or wintering. However, threats such as human pressure and sea level rise can reduce the availability of these habitats for different species. The presence of alternative areas, such as salt pans and brackish habitats, is essential for many migratory shorebird populations. This study addresses the post-breeding dispersal of the Kentish plover (Charadrius alexandrinus) in the Iberian Peninsula by analysing C and N isotopes in feathers. The study was conducted at six locations along the Iberian coast, which were categorized into three areas: the NW Atlantic coast, the Atlantic coast of Andalusia, and the Mediterranean coast. Although linear mixed models did not reveal any significant effects of sex or coastal area on isotopic levels, the variability in the data suggests different habitat-use strategies in the post-reproductive period. Isotopic levels in birds from the northwest of the Iberian Peninsula exhibit greater fidelity to a single habitat type, while those from the Mediterranean coast and the Atlantic coast of Andalusia show greater variability, indicating different individual dispersal strategies. The lack of alternative habitats for the northwest Iberian population, the reduction in available habitat due to rising sea levels, and human pressure together pose a serious threat to the survival of this species, already with an unfavourable conservation status.

The Temporary Incapacity (TI) register as a complementary system to traditional epidemiological surveillance during the COVID-19 pandemic in Spain.

INTRODUCTION: During the COVID-19 pandemic, a set of social measures were adopted for the preservation of business activity and the protection of workers. One of these measures was issuing the Temporary Disability (TD) for COVID-19 cases, close contacts, and especially vulnerable workers. OBJETIVE: This study analyzes whether the TD registry could be used as a complementary source to traditional epidemiological surveillance. METHODS: A longitudinal study of time series was carried out with a cross-correlation analysis of TD and COVID-19 cases reported to the National Epidemiological Surveillance Network (RENAVE). The analysis included six pandemic waves between 10/03/2020 and 31/12/2021 in Spain. Cross-correlation coefficients (r) were calculated using a time lag of -14 days. RESULTS: During the study period, 2,253,573 TD processes were recorded in Spain and 4,894,802 COVID-19 cases were reported to RENAVE. Significant positive correlations were observed at time lags of -7, -10, and -14, indicating that TD notification preceded RENAVE notification. In the first and sixth pandemic waves, TD notification preceded RENAVE by 12 and 7 days, respectively. Negative correlations between the two series were observed in the second and fourth waves, coinciding with a lower number of reported cases. In the third and fifth waves, TD notification also preceded RENAVE (lags -1, -5 and -14, -7, respectively). CONCLUSIONS: The results confirm the usefulness of TD registry as a complementary system to traditional epidemiological surveillance in Spain, by detecting COVID-19 cases in the 7, 10, and 14 days prior. A better positive correlation is observed in waves where more cases were reported.