Impacto de la nefrectomía radical en la función renal y factores pronósticos de eventos cardiovasculares adversos / Impact of radical nephrectomy on kidney function and prognostic factors for adverse cardiovascular events

INTRODUCCIÓN Y OBJETIVOS: Analizar la evolución de la función renal tras nefrectomía e investigar la existencia de factores de riesgo de aparición de eventos cardiovasculares adversos (ECVA) durante el seguimiento a largo plazo. MATERIAL Y MÉTODOS: Estudio retrospectivo de los pacientes a los que se realizó una nefrectomía radical por neoplasia renal en nuestro hospital en el periodo comprendido entre enero del 1996 y enero del 2016. Analizamos la función renal posnefrectomía y durante seguimiento a largo plazo. Estudiamos los predictores de ECVA mediante análisis multivariante. RESULTADOS: Se produjo un descenso marcado de la filtración glomerular tras nefrectomía (-21,2ml/min), que posteriormente durante el seguimiento se mantuvo estable en la mayoría de casos. En el análisis de regresión logística, donde valoramos en nuestro grupo de pacientes qué factores se muestran como predictores de la aparición de un evento cardiovascular, la presencia de enfermedad cardiovascular previa (0,270, IC del 95%, 0,123-0,594, p > 0,001), diabetes (0,364, IC del 95%, 0,162-0,818, p = 0,015) e hipertensión arterial de novo (0,239, IC del 95%, 0,098-0,581, p = 0,002) se asociaron de manera independiente con la aparición de ECVA. CONCLUSIÓN: Tras nefrectomía se produce un deterioro de la función renal marcado que se mantiene estable durante los años sucesivos en la mayoría de pacientes. Aproximadamente la mitad de los pacientes presentan una tasa estimada de filtración glomerular menor de 60 ml/min tras la nefrectomía. La presencia de enfermedad cardiovascular previa, diabetes e hipertensión arterial denovo tras nefrectomía fueron factores predictores para la aparición de ECVA tras la cirugía

INTRODUCTION AND OBJECTIVES: To analyze the evolution of kidney function after radical nephrectomy and to evaluate risk factors for adverse cardiovascular events during a long follow-up. MATERIAL AND METHODS: Retrospective study of patients submitted to radical nephrectomy due to renal cancer from January of 1996 to January of 2016. We evaluated their renal function after nephrectomy and during follow-up. We analyzed the possible predictive factors for adverse cardiovascular events with univariate and multivariate logistic regression analyses. RESULTS: There was an acute drop in glomerular filtration rate (GFR) after nephrectomy (21.2 ml/min), which stabilized during follow-up in most cases. We evaluated the possible predictive factors for adverse cardiovascular events with logistic regression analyses, which presented previous cardiovascular disease (0,270, 95% CI 0,123-0,594, P<.001), diabetes (0,364, 95% CI 0,162-0,818 P=.015) and de novo hypertension (0,239, 95% CI 0,098-0,581, P=.002) as independently associated with the occurrence of adverse cardiovascular events. CONCLUSIÓN: There was a deleterious effect in renal function after nephrectomy which remained stable during subsequent years in most patients. Approximately half of our patients had a GFR lower than 60 mL/min after nephrectomy. Previous cardiovascular disease, diabetes and de novo hypertension were shown as risk factors for adverse cardiovascular events

Impact of radical nephrectomy on kidney function and prognostic factors for adverse cardiovascular events. / Impacto de la nefrectomía radical en la función renal y factores pronósticos de eventos cardiovasculares adversos.

INTRODUCTION AND OBJECTIVES: To analyze the evolution of kidney function after radical nephrectomy and to evaluate risk factors for adverse cardiovascular events during a long follow-up. MATERIAL AND METHODS: Retrospective study of patients submitted to radical nephrectomy due to renal cancer from January of 1996 to January of 2016. We evaluated their renal function after nephrectomy and during follow-up. We analyzed the possible predictive factors for adverse cardiovascular events with univariate and multivariate logistic regression analyses. RESULTS: There was an acute drop in glomerular filtration rate (GFR) after nephrectomy (21.2ml/min), which stabilized during follow-up in most cases. We evaluated the possible predictive factors for adverse cardiovascular events with logistic regression analyses, which presented previous cardiovascular disease (0,270, 95% CI 0,123-0,594, P<.001), diabetes (0,364, 95% CI 0,162-0,818 P=.015) and de novo hypertension (0,239, 95% CI 0,098-0,581, P=.002) as independently associated with the occurrence of adverse cardiovascular events. CONCLUSION: There was a deleterious effect in renal function after nephrectomy which remained stable during subsequent years in most patients. Approximately half of our patients had a GFR lower than 60mL/min after nephrectomy. Previous cardiovascular disease, diabetes and de novo hypertension were shown as risk factors for adverse cardiovascular events.

Evaluating the conservation state of the páramo ecosystem: An object-based image analysis and CART algorithm approach for central Ecuador.

Ecuadorian páramo ecosystems (EPEs) function as water sources, contain large soil carbon stores and high levels of biodiversity, and support human populations. The EPEs are mainly herbaceous páramo (HP). To inform policy and management and help drive ecological science toward a better understanding of the HP ecosystem, and the relationships among its multiple ecosystem services, we asked: (1) What is the state of the HP regarding its land use/land cover (LULC)?; and (2) Is the HP being pushed away from its natural state or it is regenerating? To answer these questions, we assessed the LULC in central EPEs using Landsat 8 imagery, Object-Based Image Analysis (OBIA) and a Classification and Regression Trees (CART) algorithm. Results show that two-fifths of the paramo ecosystem remain as native HP (NHP) and two-fifths as anthropogenic HP (AHP). Although the anthropic alteration of the pedogenesis of young paramo soil leads to the establishment of AHP, we found evidence of regeneration and resilience of the NHP. The results of this study will be useful to scientists and decision-makers with interest in páramo ecosystems in central Ecuador. The proposed methodology is simple, fast, and could be implemented in other landscapes to establish comprehensive monitoring systems useful in landscape assessment and planning.

[The extracellular matrix of the central nervous system: chondroitin sulphate type proteoglycans and neural repair]. / La matriz extracelular del sistema nervioso central: los proteoglicanos del tipo condroitinsulfato y la reparación neural.

AIM: In this paper we present a review of the main features of the extracellular matrix (ECM) of the central nervous system (CNS). DEVELOPMENT: Proteoglycans (PG) are glycoproteins, a very common type of protein in the ECM. Among the PG, the most abundant type is the hyalectan or lectican family. The PG is formed by two main components; a protein and a sugar chain, which that is termed glycosaminoglycan (GAG). These GAGs are polymers of two simple sugars. The hyalectan family has GAGs of the Chondroitin sulphate type (CS), and for this reason they are termed PG-CS. PG-CS are linked to the hyaluronic acid (HA) and other molecules of the ECM in order to form a three-dimensional network. This network has several important roles in the maintenance of the homeostasis of the CNS. CONCLUSIONS: Several hypotheses have been proposed to elucidate the failure of the CNS regeneration after an injury or in several pathologies. It has been suggested that PG-CS, which expression is up-regulated after CNS injury, may play some role in this process of inhibition of the CNS regeneration. Furthermore, we present an approach to the therapeutic potential of the CNS regeneration after the inactivation of the PG-CS up-regulation.

La matriz extracelular del sistema nervioso central: los proteoglicanos del tipo condroitinsulfato y la reparación neural / The extracellular matrix of the central nervous system: chondroitin sulphate type proteoglycans and neural repair

Objetivo. En este artículo realizamos un estudio de las características de la matriz extracelular (MEC) del sistema nervioso central (SNC). Desarrollo. Los proteoglicanos (PG) son glicoproteínas, un tipo de molécula muy abundante en la MEC. Dentro de este grupo de PG destacan los hialectanos o lecticanos. Los hialectanos se caracterizan por poseer dos componentes: la proteína eje y la fracción glucídica, que está formada por los glucosaminoglicanos (GAG). Los GAG están formados por la polimerización de dímeros de azúcares sencillos. Los GAG de los hialectanos son del tipo condroitinsulfato (CS). Por esta razón, estos PG se denominan PG del tipo CS (PG-CS). Los PG-CS se unen al ácido hialurónico y a otras moléculas de la MEC para formar una red tridimensional de naturaleza proteica, que cumple funciones muy importantes en la homeostasis del tejido nervioso. Conclusiones. Diversas hipótesis se han planteado para tratar de explicar la falta de regeneración del SNC tras la lesión neural o en ciertas patologías. Se ha propuesto que los PG-CS, cuya expresión se incrementa tras las lesiones del SNC, pudieran desempeñar algún papel en este proceso de inhibición de la capacidad regenerativa neural. En este sentido, realizamos finalmente un análisis de las aproximaciones terapéuticas, experimentales, que se realizan para tratar de inducir la regeneración del SNC tras la actuación sobre los PG-CS de la MEC (AU)

Aim. In this paper we present a review of the main features of the extracellular matrix (ECM) of the central nervous system (CNS). Development. Proteoglycans (PG) are glycoproteins, a very common type of protein in the ECM. Among the PG, the most abundant type is the hyalectan or lectican family. The PG is formed by two main components; a protein and a sugar chain, which that is termed glycosaminoglycan (GAG). These GAGs are polymers of two simple sugars. The hyalectan family has GAGs of the Chondroitin sulphate type (CS), and for this reason they are termed PG-CS. PG-CS are linked to the hyaluronic acid (HA) and other molecules of the ECM in order to form a three-dimensional network. This network has several important roles in the maintenance of the homeostasis of the CNS. Conclusions. Several hypotheses have been proposed to elucidate the failure of the CNS regeneration after an injury or in several pathologies. It has been suggested that PG-CS, which expression is up-regulated after CNS injury, may play some role in this process of inhibition of the CNS regeneration. Furthermore, we present an approach to the therapeutic potential of the CNS regeneration after the inactivation of the PG-CS up-regulation (AU)

[Anthropometric values in a very elderly institutionalized population]. / Valores antropométricos en una población institucionalizada muy anciana.

The purpose of the present study has been to determine, in a population group over 80 years of age in a publicly-funded geriatric institution, the anthropometric parameters that represent reference values for the study of nutritional status. These parameters allow detection of alterations in the nutritional status which, once corrected, will contribute to maintaining an appropriate quality of life in a population group that is highly sensitive to the associated morbidity and mortality processes. In order to carry out this study, a sample of 56 healthy elderly individuals was selected (13 men and 43 women) with a mean age of 86.5 +/- 4.8 years and a range from 80 to 101 years. The parameters measured were: weight, height, tricipital fold, brachial perimeter and the following values calculated on the basis of these figures: body mass index, percentage of body fat, brachial muscular area, brachial muscular perimeter, brachial adipose area and the ratio of muscle to adipose tissue. These values were processed statistically with the assistance of the RSB-SIGMA computer software, with calculation of the percentiles, the mean, and the comparison between the sexes. The criterion for statistical significance was set at p < 0.05. Our results confirm the presence of significant differences in the muscle parameters, which are greater in men than in women, whereas the fat parameters are higher in the latter. Thus, it is concluded that weight, height, brachial muscle area and brachial muscle perimeter are significantly higher in men whereas tricipital fold, percentage of body fat, the brachial adipose area and the muscle to adipose tissue ratio are significantly superior among women. There are no significant differences by gender in the body mass index and the brachial perimeter.

Valores antropométricos en una población institucionalizada muy anciana / Anthropometric values in a very elderly institutionalized population

El objetivo del presente trabajo ha sido determinar, en un grupo de población de más de 80 años de una residencia geriátrica pública, los parámetros antropométricos que constituyen valores de referencia para el estudio del estado nutricional. Estos parámetros permiten detectar alteraciones en el estado nutricional que corrregidas ayudarán a mantener una adecuada calidad de vida en un grupo de población muy sensible a los procesos asociados de morbimortalidad. Para la realización de este estudio se seleccionó una muestra de 56 ancianos sanos (13 varones y 43 mujeres), con una media de edad de 86,5 +/- 4,8 años y un rango comprendido entre 80 y 101 años. Los parámetros medidos fueron: peso, talla, pliegue tricipital, perímetro braquial y los valores calculados a partir de éstos: índice de masa corporal, porcentaje de grasa corporal, área muscular braquial, perímetro muscular braquial, área adiposa braquial y el índice adiposo muscular. Estos valores fueron procesados estadísticamente con ayuda del programa informático RSB-SIGMA y se calcularon los percentiles, la media, y la comparación entre sexos. Se estableció como criterio de diferencias significativas una p<0,05. Nuestros resultados constatan la presencia de diferencias significativas en los parámetros musculares, los cuales son mayores en los varones que en las mujeres, mientras que los parámetros grasos son más elevados en éstas últimas. Así se concluye que, peso, tala, área muscular braquial y perímetro muscular braquial son significativamente más elevados en los varones que en las mujeres. Por otra parte el pliegue tricipital, el porcentaje de grasa corporal, el área adiposa braquial y el índice adiposo muscular lo son en mujeres. No hay diferencias significativas por sexos en el índice de masa corporal y el perímetro braquial (AU)

The purpose of the present study has been to determine, in a population group over 80 years of age in a publicly- funded geriatric institution, the anthropometric parameters that represent reference values for the study of nutritional status. These parameters allow detection of alterations in the nutritional status which, once corrected, will contribute to maintaining an appropriate quality of life in a population group that is highly sensitive to the associated morbidity and mortality processes. In order to carry out this study, a sample of 56 healthy elderly individuals was selected (13 men and 43 women) with a mean age of 86.5 ± 4.8 years and a range from 80 to 101 years. The parameters measured were: weight, height, tricipital fold, brachial perimeter and the following values calculated on the basis of these figures: body mass index, percentage of body fat, brachial muscular area, brachial muscular perimeter, brachial adipose area and the ratio of muscle to adipose tissue. These values were processed statistically with the assistance of the RSB-SIGMA computer software, with calculation of the percentiles, the mean, and the comparison between the sexes. The criterion for statistical significance was set at p < 0.05. Our results confirm the presence of significant differences in the muscle parameters, which are greater in men than in women, whereas the fat parameters are higher in the latter. Thus, it is concluded that weight, height, brachial muscle area and brachial muscle perimeter are significantly higher in men whereas tricipital fold, percentage of body fat, the brachial adipose area and the muscle to adipose tissue ratio are significantly superior among women. There are no significant differences by gender in the body mass index and the brachial perimeter (AU)