Potential Mechanisms Involved in Chronic Kidney Disease of Unclear Etiology.

BACKGROUND AND OBJECTIVES: The etiology of chronic kidney disease of unclear etiology, also known as Mesoamerican nephropathy, remains unclear. We investigated potential etiologies for Mesoamerican nephropathy in an immigrant dialysis population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Migrants with Mesoamerican nephropathy kidney failure (n=52) were identified by exclusion of known causes of kidney disease and compared using a cross-sectional survey with demographically similar patients with kidney failure from other causes (n=63) and age/sex/place of origin-matched healthy participants (n=16). Survey results were extended to the bench; C57BL/6 mice (n=73) received 10-15 weekly intraperitoneal injections of paraquat (a reactive oxygen species-generating herbicide) or vehicle. Kidney function, histology, and expression of organic cation transporter-2 (proximal tubule entry for paraquat) and multidrug and toxin extrusion 1 (extrusion pathway) were examined. Kidney biopsies from Nicaraguan patients with acute Mesoamerican nephropathy were stained for the above transporters and compared with patients with tubulointerstitial nephritis and without Mesoamerican nephropathy. RESULTS: Patients with Mesoamerican nephropathy and kidney failure were young agricultural workers, almost exclusively men; the majority were from Mexico and El Salvador; and they had prior exposures to agrochemicals, including paraquat (27%). After adjustment for age/sex, exposure to any agrochemical or paraquat was associated with Mesoamerican nephropathy kidney failure (odds ratio, 4.86; 95% confidence interval, 1.82 to 12.96; P=0.002 and odds ratio, 12.25; 95% confidence interval, 1.51 to 99.36; P=0.02, respectively). Adjusted for age/sex and other covariates, 1 year of agrochemical exposure was associated with Mesoamerican nephropathy kidney failure (odds ratio, 1.23; 95% confidence interval, 1.04 to 1.44; P=0.02). Compared with 16 matched healthy controls, Mesoamerican nephropathy kidney failure was significantly associated with exposure to paraquat and agrochemicals. Paraquat-treated male mice developed kidney failure and tubulointerstitial nephritis consistent with Mesoamerican nephropathy. Organic cation transporter-2 expression was higher in male kidneys versus female kidneys. Paraquat treatment increased organic cation transporter-2 expression and decreased multidrug and toxin extrusion 1 expression in male kidneys; similar results were observed in the kidneys of Nicaraguan patients with Mesoamerican nephropathy. CONCLUSIONS: Exposure to agrochemicals is associated with Mesoamerican nephropathy, and chronic exposure of mice to paraquat, a prototypical oxidant, induced kidney failure similar to Mesoamerican nephropathy.

Validation of the Spanish version of the Problem Areas in Diabetes (PAID-SP) Scale.

This study aimed to assess the psychometric properties of the Spanish version of the Problem Areas in Diabetes (PAID-SP) Scale. Data were collected from patients with type 1 and type 2 diabetes. The findings suggested that the PAID-SP is a reliable and valid measure of diabetes-specific emotional problems.

Use of the radial approach in primary angioplasty: results in 1029 consecutive patients and analyses in unfavorable subgroups.

INTRODUCTION AND OBJECTIVES: The transradial approach is associated with a reduction in vascular access-related complications after primary percutaneous coronary interventions. The purpose of this study was to examine the feasibility of the routine use of transradial access in primary angioplasty and to evaluate how it affects subgroups with less favorable characteristics. METHODS: We analyzed 1029 consecutive patients with an ST-segment elevation acute coronary syndrome treated with primary angioplasty. RESULTS: Transradial access was the primary approach in 93.1% of the patients. The success rate of primary angioplasty was 95.9%, and 87.6% of the patients were event-free 30 days after the procedure. Crossover was required in 3.0% of the patients with primary transradial access, and this rate remained stable over the years. Predictors of the need for crossover were age older than 75 years (odds ratio=2.50, 95% confidence interval, 1.09-5.71; P=.03) and a history of ischemic heart disease (odds ratio=2.65; 95% confidence interval, 1.12-6.24; P=.02). Primary transfemoral access use was higher in women older than 75 years. Use of the transradial approach in this subgroup did not affect reperfusion time or the success of angioplasty, although there was a greater need for crossover (10.9% vs 2.6%; P=.006). Among patients in cardiogenic shock, the transradial approach was used in 51.5%; reperfusion times and angioplasty success rates were similar to those obtained with transfemoral access, but there was a greater need for crossover. CONCLUSIONS: Transradial access can be used safely and effectively in most primary angioplasty procedures. In older women and in patients in cardiogenic shock, there is a higher crossover requirement, with no detriment to reperfusion time.

El uso del acceso radial en la angioplastia primaria: resultados en 1.029 pacientes consecutivos y análisis en subgrupos desfavorables / Use of the radial approach in primary angioplasty: results in 1029 consecutive patients and analyses in unfavorable subgroups

INTRODUCCIÓN Y OBJETIVO:S: El acceso radial reduce las complicaciones vasculares tras la angioplastia primaria. El objetivo es examinar la factibilidad del acceso radial sistemático en la angioplastia primaria y evaluar cómo afecta a los subgrupos menos favorables. MÉTODOS: Se ha analizado a 1.029 pacientes consecutivos con síndrome coronario agudo con elevación del segmento ST tratados con angioplastia primaria. RESULTADOS: En el 93,1% de los pacientes, el acceso radial ha sido el acceso primario. La tasa de éxito de angioplastia primaria fue del 95,9%, y el 87,6% de los pacientes estaban libres de eventos clínicos a los 30 días del procedimiento. La tasa de cruce vascular fue del 3,0%, estable durante el periodo estudiado. La edad mayor de 75 años (odds ratio = 2,50; intervalo de confianza del 95%, 1,09-5,71; p = 0,03) y la historia de cardiopatía isquémica previa (odds ratio = 2,65, intervalo de confianza del 95%, 1,12-6,24; p = 0,02) fueron predictores de necesidad de cruce. En las mujeres y los mayores de 75 años, el uso del acceso femoral primario fue mayor. Sin embargo, en este subgrupo de pacientes el acceso radial no afectó a los tiempos de reperfusión ni al éxito de la angioplastia, aunque sí se observó una mayor tasa de cruce (el 10,9 frente al 2,6%; p = 0,006). En los pacientes en shock cardiogénico, el acceso radial se utilizó en el 51,5% de los casos, con tiempos de reperfusión y tasas de éxito de la angioplastia similares a los del acceso femoral, aunque con mayor necesidad de cruce. CONCLUSIONES: El acceso radial se puede utilizar de manera segura y eficaz en la mayoría de las angioplastias primarias. En mujeres de edad avanzada y en pacientes en shock, aumenta la necesidad de cruce sin penalizar los tiempos de reperfusión

INTRODUCTION AND OBJECTIVES: The transradial approach is associated with a reduction in vascular access-related complications after primary percutaneous coronary interventions. The purpose of this study was to examine the feasibility of the routine use of transradial access in primary angioplasty and to evaluate how it affects subgroups with less favorable characteristics. METHODS: We analyzed 1029 consecutive patients with an ST-segment elevation acute coronary syndrome treated with primary angioplasty. RESULTS: Transradial access was the primary approach in 93.1% of the patients. The success rate of primary angioplasty was 95.9%, and 87.6% of the patients were event-free 30 days after the procedure. Crossover was required in 3.0% of the patients with primary transradial access, and this rate remained stable over the years. Predictors of the need for crossover were age older than 75 years (odds ratio=2.50, 95% confidence interval, 1.09-5.71; P=.03) and a history of ischemic heart disease (odds ratio=2.65; 95% confidence interval, 1.12-6.24; P=.02). Primary transfemoral access use was higher in women older than 75 years. Use of the transradial approach in this subgroup did not affect reperfusion time or the success of angioplasty, although there was a greater need for crossover (10.9% vs 2.6%; P=.006). Among patients in cardiogenic shock, the transradial approach was used in 51.5%; reperfusion times and angioplasty success rates were similar to those obtained with transfemoral access, but there was a greater need for crossover. CONCLUSIONS: Transradial access can be used safely and effectively in most primary angioplasty procedures. In older women and in patients in cardiogenic shock, there is a higher crossover requirement, with no detriment to reperfusion time

The histone deacetylase inhibitor SAHA sensitizes acute myeloid leukemia cells to a combination of nucleoside analogs and the DNA-alkylating agent busulfan.

Fludarabine (Flu), clofarabine (Clo) and busulfan (Bu) are used in allogeneic hematopoietic stem cell transplant (allo-HSCT). We reported that combining [Flu + Clo + Bu] had a synergistic cytotoxicity in AML cells. We hypothesized that combining [Flu + Clo + Bu] with the histone deacetylase inhibitor SAHA will further enhance cytotoxicity. We exposed the acute myeloid leukemia (AML) cell lines KBM3/Bu250(6) and OCI-AML3 to Flu, Clo, Bu and SAHA alone and in various combinations. [Flu + Clo + Bu + SAHA] resulted in synergistic cytotoxicity, which can be attributed to (1) activated DNA-damage response and cell cycle checkpoint activation through the ATM-CHK2-P53 (or P73) pathway or ATM-CHK2-cdc25-cdc2 pathway, (2) histone modifications and (3) activated apoptosis pathway. The [Flu + Clo + Bu + SAHA] combination causes mitochondrial outer membrane permeabilization, leakage of cytochrome c and Smac/Diablo into the cytosol with caspase activation, and release of apoptosis-inducing factor (AIF) into the nucleus resulting in nuclear fragmentation and cell death. These results provide a mechanistic basis for using SAHA in future clinical trials with double nucleoside analog-busulfan combinations in pretransplant conditioning therapy.

Intravascular ultrasound measurement of the aortic lumen.

Intravascular ultrasound (IVUS) has been successfully used to guide the implantation of stents in the thoracic aorta. However, its accuracy in measuring the diameter of the aortic lumen has not been clearly established. Thirteen patients with thoracic aortic disease underwent IVUS, and lumen diameter measurements were compared with those obtained by CT or magnetic resonance imaging. A total of 31 comparable measurements were obtained. The correlation was good (r=0.98; P< .001), with IVUS tending to give a larger minimum diameter than CT (systematic error, 0.59+/-1.8 mm; P=.077). Given that the aorta is often not circular, the diameter obtained by IVUS was also compared to the mean diameter obtained by CT, and it was found that these two measurements were more closely related (P=.425), except in aortic segments with significant eccentricity (i.e., >10%). In conclusion, IVUS was a reliable tool for measuring the diameter of the aorta, particularly in concentric segments where stents are normally placed. Consequently, IVUS could supplement conventional imaging techniques.

Utilidad del ultrasonido intravascular para la medición de la luz aórtica / Intravascular ultrasound measurement of the aortic lumen

El ultrasonido intravascular (IVUS) se ha utilizado con éxito para guiar la implantación de endoprótesis en aorta torácica. Sin embargo, su precisión para medir la luz aórtica no está definitivamente establecida. Evaluamos con IVUS a 13 pacientes con enfermedad de la aorta torácica, comparando el diámetro luminal con las medidas de tomografía computarizada (TC) o resonancia magnética. Se obtuvieron 31 mediciones comparables. La correlación fue buena (r = 0,98; p < 0,001), con un ligero sesgo positivo del IVUS respecto al diámetro mínimo por TC (error sistemático, 0,59 ± 1,8 mm; p = 0,077). Dado que la aorta con frecuencia no es circular, se comparó también con el diámetro medio de la TC, obteniéndose mayor aproximación a las medidas de IVUS (p = 0,425), excepto en segmentos con excentricidad significativa (> 10%). En conclusión, el IVUS resulta fiable para la medición de diámetros aórticos, especialmente en segmentos concéntricos donde se fijan las endoprótesis, y puede complementar las técnicas de imagen convencionales (AU)

Intravascular ultrasound (IVUS) has been successfully used to guide the implantation of stents in the thoracic aorta. However, its accuracy in measuring the diameter of the aortic lumen has not been clearly established. Thirteen patients with thoracic aortic disease underwent IVUS, and lumen diameter measurements were compared with those obtained by CT or magnetic resonance imaging. A total of 31 comparable measurements were obtained. The correlation was good (r=0.98; P < .001), with IVUS tending to give a larger minimum diameter than CT (systematic error, 0.59±1.8 mm; P=.077). Given that the aorta is often not circular, the diameter obtained by IVUS was also compared to the mean diameter obtained by CT, and it was found that these two measurements were more closely related (P=.425), except in aortic segments with significant eccentricity (i.e., >10%). In conclusion, IVUS was a reliable tool for measuring the diameter of the aorta, particularly in concentric segments where stents are normally placed. Consequently, IVUS could supplement conventional imaging techniques (AU)

Determination of Pd, Pt and Rh in vehicles escape fumes by GF-AAS and ICP-OES.

Automotive exhaust gases from vehicles using catalytic converters were filtered through cellulose filter papers to collect suspended particles expulsed along with the engine's escape fumes. A specially designed sample collector was used for supporting the filter papers during collection. The collector was manufactured from a new car's exhaust pipe. A cellulose circular paper filter, 11 cm diameter, was attached to one end of the pipe and kept centered by pressing it against the borders of the pipe by means of a perforated aluminum cap, slightly wider than the pipe, used to cover this end of the collector. Filter papers loaded with the solid particles were acid-digested using a modified domestic microwave oven to bring the solid material into solution. The resulting solutions were analyzed for Pt by graphite furnace atomic absorption spectrometry (GF-AAS) and for Pd and Rh by inductively coupled plasma (ICP-OES). Results indicate that concentration of these analytes in the particulate is higher for new vehicles, having new catalytic converters, than for old ones. Maximum Pd, Pt and Rh in the samples analyzed were found to be 5.36, 12.60 and 1.03 microg g(-1), respectively.

Tratamiento endovascular de la disección aórtica aguda tipo B a través de la aorta ascendente / Endovascular treatment of acute type-B aortic dissection through the ascending aorta

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A novel surgical approach to marginal soft tissue recessions: two-year results of 11 case studies.

This article describes a surgical procedure used to achieve gingival coverage in denuded roots in mandibular canines. The first surgical stage involves an apically displaced partial-thickness flap in the area adjacent to the recession. A laterally displaced graft is then employed to cover the recession. Although the technique involves a two-stage surgery, a palatal graft is not required and the surgical procedure only affects one site. This article also presents the clinical results 24 months after the second-stage surgery in 11 deep and wide recessions affecting misaligned mandibular canines.

Accuracy of combined clinical findings and fine needle aspiration cytology for the diagnosis in palpable breast tumors

Objetivo. Un estudio prospectivo para evaluar el nivel de confianza y valor predictivo de la biopsia por aspiración con aguja fina fue llevado a cabo en el Servicio de Oncología, Hospital 20 de Noviembre del ISSSTE en la Ciudad de México. Material y método. Los casos clínicos que se presentaron de manera consecutiva de 1992 a 1994 con tumor mamario palpable, confirmado histológicamente, fueron incluidos en el estudio. Se realizó un aspirado por paciente y éstos fueron revisados por el mismo patólogo en todos los casos. Se determinaron sensibilidad, especificidad y valor predictivo de la prueba. La edad, características de los bordes tumorales, tamaño y movilidad del tumor fueron evaluados por análisis Bayesiano. Resultados. De 213 aspirados, 199 fueron adecuados para diagnóstico; 98 (46 por ciento) fueron diagnósticos de carcinoma, 13 fueron acelulares y uno sugestivo para carcinoma. Los diagnósticos citológicos acelulares fueron considerados como negativos y los sugestivos como positivos para propósitos de análisis. La edad promedio y el tamaño tumoral fueron: 46.6 años (rango 14-90) y 3.7 cm (rango 1-13), respectivamente. Se calcularon sensibilidad (.932), especificidad (.973) y valor predictivo de la prueba (96.9 por ciento). Observamos una alta probabilidad de resultados verdaderos positivos [P(D+/T+)] > 0.8 en pacientes entre los 40 y 60 años de edad, tumores con bordes irregulares, tamaño tumoral > 2 cm y en lesiones fijas. Conclusiones. La prueba tiene un alto nivel de confianza y en presencia de dos o más de los factores clínicos mencionados, se pueden tomar decisiones definitivas en el diseño del tratamiento sin necesidad de confirmación histológica

Patología anorrectal en pacientes de alto riesgo de infección por HIV / Anorectal pathology in HIV patients

Se estudiaron 208 pacientes de alto riesgo de infección por HIV en cinco años y medio. Se definieron los factores de riesgo y de analizaron los estudios realizados. Se describieron las lesiones encontradas, los tratamientos efectuados y los resultados obtenidos

Patología anorrectal en pacientes de alto riesgo de infección por HIV / Anorectal pathology in HIV patients

Se estudiaron 208 pacientes de alto riesgo de infección por HIV en cinco años y medio. Se definieron los factores de riesgo y de analizaron los estudios realizados. Se describieron las lesiones encontradas, los tratamientos efectuados y los resultados obtenidos

Valoración de la respuesta isquémica en el tratamiento con nifedipina: informe preliminar / Evaluation of ischemic response in the treatment with nifedipine: preliminary report

Se oferece el resultado preliminar de un estudio con 13 pacientes que presentan cardiopatía isquémica, a los cuales se les realizó las pruebas ergométricas pre y postratamiento con nifedipina, demostrándose a pesar de lo pequeño de la muestra, efectos beneficiosos de la droga, tanto clínicos como electrocardiográficos

Valoración de la respuesta isquémica en el tratamiento con nifedipina: informe preliminar / Evaluation of ischeic response in the treatment with nifedipine: preliminary report

Se oferece el resultado preliminar de un estudio con 13 pacientes que presentan cardiopatía isquémica, a los cuales se les realizó las pruebas ergométricas pre y postratamiento con nifedipina, demostrándose a pesar de lo pequeño de la muestra, efectos beneficiosos de la droga, tanto clínicos como electrocardiográficos (AU)