A clinical score to predict mortality in septic acute kidney injury patients requiring continuous renal replacement therapy: the HELENICC score.

BACKGROUND: This study aimed to identify predictors of early (7-day) mortality in patients with septic acute kidney injury (AKI) who required continuous renal replacement therapy (CRRT). METHODS: Prospective cohort of 186 septic AKI patients undergoing CRRT at a tertiary hospital, from October 2005 to November 2010. RESULTS: After multivariate adjustment, five variables were associated to early mortality: norepinephrine utilization, liver failure, medical condition, lactate level, and pre-dialysis creatinine level. These variables were combined in a score, which demonstrated good discrimination, with a C-statistic of 0.82 (95% CI = 0.76-0.88), and good calibration (χ 2 = 4.3; p = 0.83). SAPS 3, APACHE II and SOFA scores demonstrated poor performance in this population. CONCLUSIONS: The HEpatic failure, LactatE, NorepInephrine, medical Condition, and Creatinine (HELENICC) score outperformed tested generic models. Future studies should further validate this score in different cohorts.

Optimal force for maxillary protraction facemask therapy in the early treatment of class III malocclusion.

BACKGROUND: The facemask is used to treat early class III malocclusion, in combination with expansion therapy. There is a great deal of controversy in literature regarding the effectiveness of protraction facemask treatment as studies report results anywhere from considerable changes to lack of any maxillary improvement. This controversy may be due to the fact that the process of placing the orthopaedic facemask on patients has, in part, been done empirically, without the use of literature containing the clinical parameters for facemask placement for maxillary protraction. OBJECTIVE: To determine the optimal magnitude, duration, and direction that should be used in maxillary protraction facemask therapy. SEARCH METHODS: A systematic search was carried out in the following databases: Medline, Google Scholar, Embase, Cochrane, Lilacs, Scielo, with no restriction placed on the year of publication, in English and Spanish, using MeSH terms and free-text terms. SELECTION CRITERIA: Clinical trials, systematic reviews, meta-analysis, cohort studies, case-control studies, and cross-sectional studies were included, whereas literature reviews, case reports, case series, symposiums, compendiums, pilot studies, and expert opinions were excluded. DATA COLLECTION AND ANALYSIS: Data selection and extraction were blinded and performed independently, and the methodology was evaluated using various scales. RESULTS: A total of 223 articles were found. After eliminating repeated articles and those that did not meet the selection criteria, 14 remained for analysis. Regarding magnitude, there were values ranging from 180 to 800g per side; there were force vector direction values between 20 and 30 degrees below the occlusal plane or parallel to the occlusal plane; and a duration ranging from 10 to 24 hours of use per day. CONCLUSIONS: There is no scientific evidence that would allow for the definition of adequate parameters for force magnitude, direction, and duration for maxillary protraction facemask treatment in class III patients.

Screen time in Mexican children: findings from the 2012 National Health and Nutrition Survey (ENSANUT 2012).

OBJECTIVE: To provide descriptive information on the screen time levels of Mexican children. MATERIALS AND METHODS: 5 660 children aged 10-18 years from the 2012 National Health and Nutrition Survey (ENSANUT 2012) were studied. Screen time (watching television, movies, playing video games and using a computer) was self-reported. RESULTS: On average, children engaged in 3 hours/day of screen time, irrespective of gender and age. Screen time was higher in obese children, children from the northern and Federal District regions of the country, children living in urban areas, and children in the highest socioeconomic status and education categories. Approximately 33% of 10-14 year olds and 36% of 15-18 year olds met the screen time guideline of ≤ 2 hours/day. CONCLUSIONS: 10-18 year old Mexican children accumulate an average of 3 hours/day of screen time. Two thirds of Mexican children exceed the recommended maximal level of time for this activity.

Noncanonical Wnt/Ror2 signaling regulates cell-matrix adhesion to prompt directional tumor cell invasion in breast cancer.

Cell-extracellular matrix (ECM) interactions represent fundamental exchanges during tumor progression, yet how particular signal-transduction factors prompt the conversion of tumor cells into migratory populations capable of systemic spread during metastasis remains elusive. We demonstrate that the noncanonical Wnt receptor, Ror2, regulates tumor cell-driven matrix remodeling and invasion in breast cancer. Ror2 loss-of-function (LOF) triggers the disruption of E-cadherin within tumor cells, accompanied by an increase in tumor cell invasion and collagen realignment in three-dimensional cultures. RNA sequencing of Ror2-deficient organoids further uncovered alterations in actin cytoskeleton, cell adhesion, and collagen cross-linking gene expression programs. Spatially, we pinpoint the up-regulation and redistribution of α5 and ß3 integrins together with the production of fibronectin in areas of invasion downstream of Ror2 loss. Wnt/ß-catenin-dependent and Wnt/Ror2 alternative Wnt signaling appear to regulate distinct functions for tumor cells regarding their ability to modify cell-ECM exchanges during invasion. Furthermore, blocking either integrin or focal adhesion kinase (FAK), a downstream mediator of integrin-mediated signal transduction, abrogates the enhanced migration observed upon Ror2 loss. These results reveal a critical function for the alternative Wnt receptor, Ror2, as a determinant of tumor cell-driven ECM exchanges during cancer invasion and metastasis.

Chronic kidney disease risk prediction scores assessment and development in Mexican adult population.

Background: Chronic kidney disease (CKD) is a major public health problem, with considerable growth in prevalence and mortality in recent years. Screening of CKD at primary care is crucial for the implementation of prevention strategies. The aims of this study are to assess CKD risk prediction scores and to develop a risk prediction score for the Mexican adult population. Methods: Data from the Mexican National Health and Nutrition Survey 2016 was utilized and 3463 participants ≥ 20 years old were included. Reduced renal function with Glomerular filtration rate and/or the presence of albuminuria was defined as CKD. Multiple logistic regression models were performed for the creation of a training and validation model. Additionally, several models were validated in our Mexican population. Results: The developed training model included sex, age, body mass index, fast plasma glucose, systolic blood pressure, and triglycerides, as did the validation model. The area under the curve (AUC) was 0.78 (95% CI: 0.72, 0.79) for training model, and 0.76 (95% CI: 0.71, 0.80) in validation model for Mexican adult population. Age, female gender, presence of diabetes and hypertension, elevated systolic and diastolic blood pressure, serum and urinary creatinine, and higher HbA1c were significantly associated with the prevalent chronic kidney disease. Previous CKD risk predictive models were evaluated with a representative sample of the Mexican adult population, their AUC was between 0.61 and 0.78. Conclusion: The designed CKD risk predictive model satisfactorily predicts using simple and common variables in primary medical care. This model could have multiple benefits; such as, the identification of the population at risk, and prevention of CKD.

Lactate clearance is associated with mortality in septic patients with acute kidney injury requiring continuous renal replacement therapy: A cohort study.

The aim of the study was to assess the clinical utility of lactate measured at different time points to predict mortality at 48 hours and 28 days in septic patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).Consecutive critically ill patients with septic AKI requiring CRRT were prospectively studied. Variables were collected at initiation of CRRT and 24 hours later.In total, 186 patients were analyzed. Overall mortality at 48 hours was 28% and at 28 days was 69%. Initial lactate, lactate at 24 hours and the proportion of patients with a lactate clearance superior to 10% were different between survivors at 28 days [2.0 mmol/L, 1.95 mmol/L and 18/45 (40%)] and nonsurvivors [3.46 mmol, 4.66 mmol, and 18/94 (19%)]. Multivariate analysis demonstrated that lactate at 24 hours and lactate clearance, but not initial lactate, were independently associated to mortality. Area under the ROC curves for 28-day mortality was 0.635 for initial lactate; 0.828 for lactate at 24 hours and 0.701 for lactate clearance.Lactate clearance and lactate after 24 hours of CRRT, but not initial lactate, were independently associated with mortality in septic AKI patients undergoing CRRT. Serial lactate measurements may be useful prognostic markers than initial lactate in these patients.

Screen time in Mexican children: findings from the 2012 National Health and Nutrition Survey (ENSANUT 2012) / Tiempo frente a pantalla en niños y adolescentes mexicanos: resultado de la Encuesta Nacional de Salud y Nutrición 2012

Objective. To provide descriptive information on the screen time levels of Mexican children. Materials and methods. 5 660 children aged 10-18 years from the 2012 National Health and Nutrition Survey (ENSANUT 2012) were studied. Screen time (watching television, movies, playing video games and using a computer) was self-reported. Results. On average, children engaged in 3 hours/day of screen time, irrespective of gender and age. Screen time was higher in obese children, children from the northern and Federal District regions of the country, children living in urban areas, and children in the highest socioeconomic status and education categories. Approximately 33% of 10-14 year olds and 36% of 15-18 year olds met the screen time guideline of ≤2 hours/day. Conclusions. 10-18 year old Mexican children accumulate an average of 3 hours/day of screen time. Two thirds of Mexican children exceed the recommended maximal level of time for this activity.

Objetivo. Describir los hallazgos sobre el tiempo frente a una pantalla en niños y adolescentes mexicanos. Material y métodos. Una muestra representativa de 5 560 niños y adolescentes (10-18 años) respondió la Encuesta Nacional de Salud y Nutrición 2012 (ENSANUT 2012). El tiempo frente a pantalla incluyó ver televisión, películas, videojuegos y computadora. Resultados. Los niños y adolescentes pasan en promedio tres horas diarias frente a una pantalla. El porcentaje frente a pantalla fue mayor en obesos, pertenecientes a las regiones del norte y D.F., aquéllos que viven en áreas urbanas y de nivel socioeconómico y educativo alto. Aproximadamente 33% de los niños y 36% de los adolescentes cumplen con las recomendaciones internacionales de tiempo frente a pantalla (≤2 horas/día). Conclusiones. Los niños y adolescentes pasan en promedio tres horas diarias frente a una pantalla. Dos tercios de los participantes exceden las recomendaciones internacionales sobre tiempo ocupado en esta actividad.