La sobrehidratación persistente asocia un riesgo significativo de infección peritoneal por gérmenes entéricos en pacientes tratados con diálisis peritoneal

[Abstract] Background: Overhydration (OH) complicates frequently the clinical course of Peritoneal Dialysis (PD) patients, and keeps a controversial association with the risk of peritoneal infection. The main objective of this study was to disclose an association between persistent OH and the risk of enteric peritonitis in a relatively large sample of patients undergoing PD. Method: Following a prospective design, we monitorized systematically body composition of patients treated with PD in our unit (2011–2016), searching for a correlation with the ensuing risk of peritonitis, with an emphasis on the association between persistent OH (main study variable) and the risk of infection by enteric pathogens (main outcome). Essential demographic, clinical and laboratory variables with a potential influence on the risk of peritonitis were recorded. We used multivariate survival analysis to clarify the specific effect of different body composition parameters on the main outcome. Main results: We included 139 patients for analysis (mean follow-up 24 months). Sixty-three patients suffered at least one peritonitis, and 17 had at least one diagnosis of enteric peritonitis. Univariate analysis disclosed a general trend to an increased risk of enteric peritonitis in overhydrated patients, as evidenced by associations of this outcome with mean extracellular water/intracellular water (ECW/ICW)(p = 0007), OH/ECW (p = 0033) and ECW/total body water (ECW/TBW)(p = 0004) ratios, but not with absolute OH values. Multivariate analysis confirmed similar associations or trends (RR 3,48, 95 % CI 1,03–14,59, p = 0,046, highest versus lowest tertile of ECW/ICW, RR 2,31, 95 % CI 0,98-6,56, p = 0,061, highest versus lowest tertile of OH/ECW, and RR 6,33, 95 % CI 1,37-19,37, p = 0,011, highest versus lowest tertile of ECW/TBW). On the contrary, no apparent association was detected between OH and the overall risk of peritoneal infection.[Resumen] Antecedentes y objetivos. La sobrehidratación (SH) es frecuente, y a menudo persistente, en pacientes tratados con diálisis peritoneal (DP), y mantiene una asociación controvertida con el riesgo de infección peritoneal. El objetivo principal de este estudio fue desvelar una posible asociación entre la presencia de SH y el riesgo subsiguiente de infección peritoneal por gérmenes entéricos, en una población relativamente amplia de pacientes tratados con DP. Método Según diseño prospectivo, monitorizamos de manera sistemática la composición corporal de pacientes tratados con DP en nuestra unidad (2011-2016), buscando una posible correlación con el riesgo de peritonitis durante el seguimiento, con un interés particular en la asociación entre SH persistente (variable de estudio principal) y el riesgo de infección peritoneal por patógenos entéricos (variable resultado principal). Para el análisis tuvimos en cuenta variables demográficas, clínicas y de laboratorio con influencia potencial en el riesgo de infección peritoneal. Utilizamos técnicas de análisis multivariante para clarificar el efecto específico de diferentes parámetros de composición corporal sobre la variable resultado principal. Resultados principales. Incluimos 139 pacientes, con seguimiento medio de 24 meses. Sesenta y tres pacientes sufrieron al menos una peritonitis, y 17 al menos una infección por gérmenes entéricos. El análisis univariante mostró una tendencia general a mayor riesgo de infección peritoneal entérica en pacientes sobrehidratados, que se hacía evidente cuando se usaba el cociente agua extracelular/agua intracelular (AEC/AIC) (p=0,007), el cociente SH/AEC (SH/AEG) (p=0,033), o el cociente AEC/agua corporal total (AEC/ACT) (p=0,004), pero no cuando se usaba la SH absoluta, como variable de estudio. El análisis multivariante confirmó estas asociaciones o tendencias (RR: 3,48; IC 95%: 1,03-14,59; p=0,046, tercil mayor versus menor para AEC/AIC, RR: 2,31; IC 95%: 0,98-6,56; p=0,061, tercil mayor versus menor para SH/AEC, y RR: 6,33; IC 95%: 1,37-19,37; p=0,011, tercil mayor versus menor para AEC/ACT). Por el contrario, no observamos asociación consistente entre SH y riesgo general de infección peritoneal. Conclusión. La SH persistente asocia un riesgo significativo de infección peritoneal por patógenos entéricos, en pacientes tratados con DP

Chemical imaging of phase separated polymer blends by fluorescence microscopy

Blends of poly(vinylacetate) (PVAc) and poly(cyclohexylmethacrylate) (PCHMA) labeled by copolymerization with 4-methacryloylamine-48-nitrostilbene (Sb), with (1-pyrenylmethyl)methacrylate (Py), or with 3-(methacryloylamine)propyl-N-carbazole (Cbz) were prepared by casting dilute solutions in tetrahydrofurane (THF) or chloroform. Films about 10 mm thick were formed. Phase separation in two types of domains is observed by transmission optical microscopy (TOM) and epifluorescence microscopy (EFM): small craters of 1 to 10 mm placed at the polymer–air interface and larger domains, on the scale of 100 mm. The morphology of samples depends on the composition of the polymer blend and on solvent. The green fluorescence of Sb, the violet of Py, or the blue of Cbz provides imaging of the distribution of PCHMA in the different domains and in the matrix. It is thus observed that (i) superficial craters and large domains are formed mainly by PCHMA and (ii) the matrix is composed of PVAc in films cast from THF and it is a blend of the two polymers, homogeneous at the submicrometric scale, for chloroform. The emission intensity of Py, recorded by microfluorescence spectroscopy (MFS), yields a mapping similar to imaging detection. It is remarkable that in films cast from chloroform, the smaller domains are distributed with a 2D hexatic order disrupted by dislocations and disclinations, whereas in films cast from THF, a larger heterogeneity is found, denoting different mechanisms of solvent evaporation.This work was supported by CICYT (Spain) and Brite-Euran (EU) under Grants PB95-0247 and BE-97-4672, respectively

The Val158Met polymorphism of the catechol-O-methyltransference gene is not associated with long-term treatment outcomes in carpal tunnel syndrome: A randomized clinical trial

DESIGN: Randomized clinical trial. OBJECTIVE: To investigate the association of the Val158Met polymorphism with pain and function outcomes in women with carpal tunnel syndrome (CTS) who received surgery or manual therapy including desensitization manoeuvres of the central nervous system. METHODS: A pre-planned secondary analysis of a randomized controlled trial investigating the efficacy of manual therapy including desensitization manoeuvres of the central nervous system vs. surgery in 120 women with CTS was conducted. Women were randomized to receive 3 sessions of manual therapy (n = 60) or decompression of the carpal tunnel (n = 60). The primary outcome was intensity of pain (mean pain and the worst pain), and secondary outcomes included function and symptoms severity subscales of the Boston Carpal Tunnel Questionnaire. Outcomes were assessed at baseline, and 1, 3, 6, and 12 months after the intervention. Rs4680 genotypes were determined after amplifying the Val158Met polymorphism by polymerase chain reactions. We classified subjects according to their Val158Met polymorphism: Val/Val, Val/Met, or Met/Met. The primary aim (treatment group*Val158Met*time) was examined with repeated measures ANCOVA with intention-to-treat analysis. RESULTS: At 12 months, 111 (92%) women completed the follow-up. No interaction was observed between the Val158Met genotype and any outcome: mean pain intensity (F = 0.60; P = 0.69), worst pain intensity (F = 0.49; P = 0.61), function (F = 0.12; P = 0.88) or symptom severity (F = 0.01; P = 0.98). CONCLUSION: The current clinical trial did not show an association between the Val158Met polymorphism and changes in pain and function outcomes after either surgery or physical therapy in women with CTS.Funding: The study was funded by a research project grant (FIS PI11/01223) from the Health Institute Carlos III and PN I+D+I 2012-2014, Spanish Government

Significado de la celularidad peritoneal basal: más allá del diagnóstico de infección peritoneal en diálisis peritoneal

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Interculturalidad: problemáticas y perspectivas diversas

Este libro es una muestra de la ampliación de los horizontes reflexivos en torno a la interculturalidad. Se puede, se debe, hoy pensar la filosofía, la política pública, la universidad, la formación del profesorado, las luchas sociales, etc, en clave intercultural. No por un mero afán academicista sino como base para desde ahí construir sociedades interculturales. Hoy ya es lugar común saber que lo intercultural nació vinculado a la simple idea de diversidad; sin embargo, más que nunca es necesario pensarla como posibilidad de ruta crítica de mucho del accionar humano. Este trabajo se publica en el contexto post paro nacional de octubre de 2019. Ahí quedó claro que la interculturalidad tiene que ver con históricas cargas racistas-coloniales y con contemporáneas desigualdades económicas que cruzan geopolíticas globales, regionales y nacionales. Esto nos muestra la necesidad de tomarnos en serio una interculturalidad que apunte a la abolición de las asimetrías sociales en conexión con la apuesta por la construcción de una verdadera plurinacionalidad. Una que exija el respeto a la diferencia en términos políticos y equidad en términos económicos

Hif-1α knockdown reduces glycolytic metabolism and induces cell death of human synovial fibroblasts under normoxic conditions

[Abstract] Increased glycolysis and HIF-1α activity are characteristics of cells under hypoxic or inflammatory conditions. Besides, in normal O2 environments, elevated rates of glycolysis support critical cellular mechanisms such as cell survival. The purpose of this study was to analyze the contribution of HIF-1α to the energy metabolism and survival of human synovial fibroblasts (SF) under normoxic conditions. HIF-1α was silenced using lentiviral vectors or small-interfering RNA (siRNA) duplexes. Expression analysis by qRT-PCR and western blot of known HIF-1α target genes in hypoxia demonstrated the presence of functional HIF-1α in normoxic SF and confirmed the glycolytic enzyme glyceraldehyde-3-phosphate dehydrogenase (GAPDH) as a HIF-1α target even in normoxia. HIF-1α silencing induced apoptotic cell death in cultured SF and, similarly, treatment with glycolytic, but not with OXPHOS inhibitors, induced SF death. Finally, in vivo HIF-1α targeting by siRNA showed a significant reduction in the viability of human SF engrafted into a murine air pouch. Our results demonstrate that SF are highly dependent on glycolytic metabolism and that HIF-1α plays a regulatory role in glycolysis even under aerobic conditions. Local targeting of HIF-1α provides a feasible strategy to reduce SF hyperplasia in chronic arthritic diseases.Instituto de Salud Carlos III; FIS 12/439Instituto de Salud Carlos III; RETICS RD12/009Instituto de Salud Carlos III; CP13/00014Comunidad de Madrid; RAPHYME-CM S2010/BMD235