Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study)

Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study).BackgroundHyperphosphatemia underlies development of hyperparathyroidism, osteodystrophy, extraosseous calcification, and is associated with increased mortality in hemodialysis patients.MethodsTo determine whether calcium acetate or sevelamer hydrochloride best achieves recently recommended treatment goals of phosphorus ≤5.5mg/dL and Ca × P product ≤55mg2/dL2, we conducted an 8-week randomized, double-blind study in 100 hemodialysis patients.ResultsComparisons of time-averaged concentrations (weeks 1 to 8) demonstrated that calcium acetate recipients had lower serum phosphorus (1.08mg/dL difference, P = 0.0006), higher serum calcium (0.63mg/dL difference, P < 0.0001), and lower Ca × P (6.1mg2/dL2 difference, P = 0.022) than sevelamer recipients. At each week, calcium acetate recipients were 20% to 24% more likely to attain goal phosphorus [odds ratio (OR) 2.37, 95% CI 1.28–4.37, P = 0.0058], and 15% to 20% more likely to attain goal Ca × P (OR 2.16, 95% CI 1.20–3.86, P = 0.0097). Transient hypercalcemia occurred in 8 of 48 (16.7%) calcium acetate recipients, all of whom received concomitant intravenous vitamin D. By regression analysis hypercalcemia was more likely with calcium acetate (OR 6.1, 95% CI 2.8–13.3, P < 0.0001). Week 8 intact PTH levels were not significantly different. Serum bicarbonate levels were significantly lower with sevelamer hydrochloride treatment (P < 0.0001).ConclusionCalcium acetate controls serum phosphorus and calcium-phosphate product more effectively than sevelamer hydrochloride. Cost-benefit analysis indicates that in the absence of hypercalcemia, calcium acetate should remain the treatment of choice for hyperphosphatemia in hemodialysis patients

Morphometric characteristics of lumbar vertebral pedicles in Mexican population. Implications for transpedicular lumbar fusion surgery

Introduction. Spinal fusion surgery using transpedicular fixation is the most common technique for surgical treatment of spinal pathologies of any etiology. The morphometric characteristics of the vertebral pedicle determine the size and shape of pedicle implants. The objective of this study is to determine the morphometric characteristics of the lumbar vertebral pedicle in Mexican population by direct measurement of bone parts. Materials and Methods. We analyzed 65 L1–L5 cadaver lumbar spines from a collection of bone specimens from the Department of Human Anatomy. Pedicle width, height, and length were determined bilaterally in each sample studied. We obtained measures of central tendency, and parametric correlation tests were performed with a 95% confidence interval to determine if significant differences exist between the lumbar vertebral levels. Results. Pedicle width increased from L1 to L5. We obtained a minimum mean value of 7.40 ± 1.84 mm at L1 and a maximum mean value of 14.74 ± 3.77 mm at L5. Pedicle height decreased from L1 to L4 with a subsequent increase at L5. We obtained a maximum mean value of 18.32 ± 4.15 mm at L5 and minimum mean value of 14.09 mm ± 2.75 at L4. Significant differences were observed (P < 0.05) when groups were compared. Conclusions. This study accurately describes the morphometric characteristics of the lumbar vertebral pedicle. These data will be useful for correct selection and positioning of transpedicular screws

Safe Areas for the Placement of Standard Shoulder Arthroscopy Portals: An Anatomical Study

The abundant vascular structures that surround the shoulder joint are complex and variable, complicating arthroscopy approaches. The aim of this study is to determine safe and risky areas around standard posterior and standard anterior portals, and accounting for the distribution of neurovascular structures of small and medium diameters that can lead to intra-articular bleeding during surgery. The standard posterior portal, and standard anterior portal were placed as described in the literature, and punch dissection was performed 2.5 cm around the trocar in situ. The arrangement of each identified structure was photographically documented and digitalized for each anatomic plane; the distance to the trocar and the diameter of each structure were measured. Based on each digitalized anatomic plane, safe and risky tissue areas were determined, and a clock face coordinate system was used to represent these areas. The safe area around the standard posterior portal was located between 11 and 1 o´clock for the left shoulder and 11 and 2 o´clock for the right shoulder. For the standard anterior portal, the safe area was located between 2 and 3 o´clock for the left shoulder and between 9 and 12 o´clock for the right shoulder. However, we did document a risk of injuring the cephalic vein 5 times, the axillary artery 3 times and the deltoid branch of the thoracoacromial artery once. This study reports quantitatively the total number of small diameter structures present in the two shoulder arthroscopic portals evaluated. The safe areas proposed in this study must be evaluated to propose new access points for performing arthroscopic procedures on the shoulder

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

¿Paisanos, pochos o aliados políticos?

El propósito de este trabajo es analizar el desarrollo de las relaciones entre Estados Unidos y México y evaluar sus implicaciones para el papel que tendrán en el futuro los chicanos en el diseño y aplicación de las políticas que norman estas relaciones. Se revisan los vínculos entre la población de origen mexicano en Estados Unidos, el gobierno mexicano y los propios mexicanos. Se presenta una síntesis histórica de esta relación, se examina el desarrollo reciente de los hechos más relevantes ocurridos en Estados Unidos y México y que estén ligados a los problemas de los chicanos, y se analizan las implicaciones de estos acontecimientos en el futuro inmediato

Immigrants, Immigrant Policy, and Foundation of the Next Century's Latino Politics: The Declining Salience of the Civil Rights Agenda in an Era of High Immigration

The fundamental question that we ask in this paper is whether the public policy needs of immigrant Latinos can be understood as part of the civil rights agenda. Our tentative answer is that they are distinct. If this is the case, we indicate that the policy needs of immigrants will steadily eclipse the civil rights issues that have galvanized Latino elites and, to a lesser extent, Latinos as a whole from the 1960s to the present.Article can also be found at http://civilrightsproject.ucla.ed