A comparison of the epidemiology of kidney replacement therapy between Europe and the United States: 2021 data of the ERA Registry and the USRDS.

BACKGROUND AND HYPOTHESIS: This paper compares the most recent data on the incidence and prevalence of kidney replacement therapy (KRT), kidney transplantation rates, and mortality on KRT from Europe to those from the United States (US), including comparisons of treatment modalities (haemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx)). METHODS: Data were derived from the annual reports of the European Renal Association (ERA) Registry and the United States Renal Data System (USRDS). The European data include information from national and regional renal registries providing the ERA Registry with individual patient data. Additional analyses were performed to present results for all participating European countries together. RESULTS: In 2021, the KRT incidence in the US (409.7 per million population (pmp)) was almost 3-fold higher than in Europe (144.4 pmp). Despite the substantial difference in KRT incidence, approximately the same proportion of patients initiated HD (Europe: 82%, US: 84%), PD (14%; 13% respectively), or underwent pre-emptive KTx (4%; 3% respectively). The KRT prevalence in the US (2436.1 pmp) was 2-fold higher than in Europe (1187.8 pmp). Within Europe, approximately half of all prevalent patients were living with a functioning graft (47%), while in the US, this was one third (32%). The number of kidney transplantations performed was almost twice as high in the US (77.0 pmp) compared to Europe (41.6 pmp). The mortality of patients receiving KRT was 1.6-fold higher in the US (157.3 per 1000 patient years) compared to Europe (98.7 per 1000 patient years). CONCLUSIONS: The US had a much higher KRT incidence, prevalence, and mortality compared to Europe, and despite a higher kidney transplantation rate, a lower proportion of prevalent patients with a functioning graft

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Analysis of the essentiality of phosphatidylserine decarboxylase in endocrine resistant breast cancer cells

200 p.Uno de los mayores problemas en la clínica a la hora de tratar el cáncer de mama es el desarrollo de resistencia a las terapias endocrinas, debido a su alta frecuencia y mayor agresividad. Se ha demostrado que las células madre cancerígenas (CSC del inglés cancer stem cells) están involucradas en el inicio y progresión tumoral, así como en el desarrollo de resistencia a diversas terapias. Un análisis computacional identificó a la fosfatidilserina descarboxilasa (PISD), una enzima involucrada en el metabolismo de los fosfolípidos, como un candidato involucrado en ambas resistencias. Se demuestra que la reducción de los niveles de expresión de PISD afecta sobre todo a las células resistentes a tamoxifeno y a inhibidores de aromatasa en cuestión de proliferación y CSC, tanto in vitro como in vivo. El mecanismo por el que las células resistentes se ven más afectadas no está totalmente esclarecido, pero se propone una reactivación de la vía del receptor de estrógeno. Por otro lado, la generación de células que sobre expresan de manera estable PISD muestra que el aumento en la expresión de PISD no es suficiente para alterar la proliferación celular en condiciones adherentes. Sin embargo, el aumento de los niveles de PISD revela una tendencia en el aumento de las poblaciones de CSC. En conclusión, los datos sugieren que las células endocrinas resistentes dependen más de PISD para proliferar, para mantener las poblaciones de CSC y formar tumores, sin embargo, su sobre expresión no es suficiente para impulsar el fenotipo de resistencia a tratamientos endocrinos.CICbioGUN

Anisotropia sismikoaren erabilera arazo tektonikoen ebaspenean (II): kasu praktikoak

Eskualde kontinental eta ozeanikoetan detektatzen den anisotropia sismikoa (A.S.) plaken dinamikari loturiko prozesu tektonikoen fruitua den mantuko fabrikak sortua da. Ozeanoetan, ozeanoaren erdiko gandorretan sortzen den akrezio prozesuak goi-mantuan intentsitate handiko fabrika kristalografikoak sortzen ditu, hauek, anisotropiaren eragile nagusiak direlarik. Orientazio hauek oso egonkorrak dira, subdukzio-zonetan ere kontserbatuz. Eskualde kontinentaletan, A.S.-ak, jatorri litosferikoa izan dezake, hau da, iraganeko prozesu orogenikoek sortutako deformazioen emaitza izatea, edo iturri astenosferikoa, hots, astenosferan gertatzen den egungo jarioak sortutakoa. Lehenengo kasuan, rifting-prozesuak eta osagai transkurrenteak dituzten talkak, prozesu tektoniko garrantzitsuenak dira, A.S.-aren iturri gisa. Eskualde kontinentaletako ikerketa zinematikoetan, bereziki erabiltzen diren datu anisotropoakSKS fasearen polarizazio-pararnetroak dira. Kate piriniarra, fase honen erabilpenaren bidezko zona orogenikoen ikerketaren kasu praktiko gisa azaltzen da. Anisotropiaren jatorria litosferikoa da nagusiki, orogenia hertziniarrean (katearen kanpoko aldeetan) eta pirinianean (barneko aldeetan) zehar gertatutako deformazio prozesuetan eskuratutakoa, hain zuzen

Anisotropia sismikoaren erabilera arazo tektonikoen ebaspenean (II): kasu praktikoak

Eskualde kontinental eta ozeanikoetan detektatzen den anisotropia sismikoa (A.S.) plaken dinamikari loturiko prozesu tektonikoen fruitua den mantuko fabrikak sortua da. Ozeanoetan, ozeanoaren erdiko gandorretan sortzen den akrezio prozesuak goi-mantuan intentsitate handiko fabrika kristalografikoak sortzen ditu, hauek, anisotropiaren eragile nagusiak direlarik. Orientazio hauek oso egonkorrak dira, subdukzio-zonetan ere kontserbatuz. Eskualde kontinentaletan, A.S.-ak, jatorri litosferikoa izan dezake, hau da, iraganeko prozesu orogenikoek sortutako deformazioen emaitza izatea, edo iturri astenosferikoa, hots, astenosferan gertatzen den egungo jarioak sortutakoa. Lehenengo kasuan, rifting-prozesuak eta osagai transkurrenteak dituzten talkak, prozesu tektoniko garrantzitsuenak dira, A.S.-aren iturri gisa. Eskualde kontinentaletako ikerketa zinematikoetan, bereziki erabiltzen diren datu anisotropoakSKS fasearen polarizazio-pararnetroak dira. Kate piriniarra, fase honen erabilpenaren bidezko zona orogenikoen ikerketaren kasu praktiko gisa azaltzen da. Anisotropiaren jatorria litosferikoa da nagusiki, orogenia hertziniarrean (katearen kanpoko aldeetan) eta pirinianean (barneko aldeetan) zehar gertatutako deformazio prozesuetan eskuratutakoa, hain zuzen

A Sox2-Sox9 signalling axis maintains human breast luminal progenitor and breast cancer stem cells

Increased cancer stem cell content during development of resistance to tamoxifen in breast cancer is driven by multiple signals, including Sox2-dependent activation of Wnt signalling. Here, we show that Sox2 increases and estrogen reduces the expression of the transcription factor Sox9. Gain and loss of function assays indicate that Sox9 is implicated in the maintenance of human breast luminal progenitor cells. CRISPR/Cas knockout of Sox9 reduces growth of tamoxifen-resistant breast tumours in vivo. Mechanistically, Sox9 acts downstream of Sox2 to control luminal progenitor cell content and is required for expression of the cancer stem cell marker ALDH1A3 and Wnt signalling activity. Sox9 is elevated in breast cancer patients after endocrine therapy failure. This new regulatory axis highlights the relevance of SOX family transcription factors as potential therapeutic targets in breast cancer

Vidas que hacen barrio : nos queda la palabra

Este trabajo pretende recuperar el pasado mediante la memoria, a través de historias orales y fotografías para tener un mejor conocimiento del barrio y potenciar la relación intergeneracional e intercultural del amplio abanico de edades de los alumnos del centro. La metodología consiste en realizar entrevistas y cuestionarios a alumnos mayores que acuden al centro, y que han vivido siempre en el barrio, por parte de alumnos jóvenes de distintas nacionalidades. Mediante estas entrevistas, consulta de archivos y fondos bibliográficos, se rescata el pasado del barrio de Tetuán, se observa la evolución social, laboral, cultural y urbanística del distrito donde se encuentra el colegio. La evaluación del proyecto consiste en una exposición de fotografías antiguas, una publicación de historias de vida en el barrio y la realización de un video.Adjuntan dos anexos, uno con las entrevistas y el otro con relatos y fotografías del barrio..Madrid (Comunidad Autónoma). Consejería de Educación. Dirección General de Mejora de la Calidad de la EnseñanzaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

Live donor kidney transplantation. Situation analysis and roadmap

El trasplante renal de donante vivo (TRDV) es la opción terapéutica con las mejores expectativas de supervivencia para el injerto y para el paciente con insuficiencia renal terminal; sin embargo, este tipo de trasplantes ha experimentado un descenso progresivo en los últimos años en España. Entre las posibles explicaciones del descenso de actividad se encuentra la coincidencia en el tiempo con un aumento en el número de donantes renales fallecidos, tanto por muerte encefálica como por asistolia controlada, que podría haber generado una falsa impresión de ausencia de necesidad del TRDV. Además, la disponibilidad de un mayor número de riñones para trasplante habría supuesto un incremento en la carga de trabajo de los profesionales que pudiera enlentecer los procesos de donación en vida. Otro posible argumento radica en un posible cambio de actitud hacia posturas más conservadoras a la hora de informar a pacientes y a familiares acerca de esta opción terapéutica, a raíz de los artículos publicados respecto al riesgo de la donación a largo plazo. Sin embargo, existe una importantísima variabilidad en la actividad entre centros y comunidades autónomas, no explicada por el volumen de trasplante procedente de otros tipos de donante. Este dato, unido a que la indicación de donación renal en vida se realiza de manera mayoritaria en situación de enfermedad renal crónica avanzada (ERCA) y que el tiempo en diálisis es un factor pronóstico negativo respecto a la supervivencia postrasplante, permite concluir que el descenso depende además de otros factores. Por este motivo, en la reunión anual de equipos de trasplante renal, celebrada en la sede de la Organización Nacional de Trasplantes (ONT) en 2018, se constituyó un grupo de trabajo formado por equipos de trasplante renal, el grupo de trasplantes de la Sociedad Española de Nefrología (SEN) (SENTRA), la Sociedad Española de Trasplantes (SET) y la ONT, con el objetivo de identificar otras causas que condicionaron el descenso de la actividad de este tipo de trasplantes en España y su posible relación con la gestión del proceso de donación de vivo. El grupo de trabajo diseñó un cuestionario de autoevaluación, que fue cumplimentado por las 33 unidades de trasplante renal de donante vivo activas en España. El cuestionario contiene preguntas sobre las diferentes fases del proceso de donación de vivo: información inicial, estudio del donante vivo e información de los riesgos, consentimiento, recursos humanos (RRHH), nefrectomía, trasplante y seguimiento posterior. El análisis de las respuestas ha dado como resultado la creación de un análisis de debilidades, amenazas, fortalezas y oportunidades (DAFO) del programa a nivel nacional y ha permitido elaborar recomendaciones específicas dirigidas a mejorar cada una de las fases del proceso de donación en vida. El documento, denominado Análisis de situación del trasplante renal de donante vivo y hoja de ruta ha sido también revisado por un panel de expertos en TRDV, representantes de varias sociedades científicas implicadas (Asociación Española de Urología [AEU], Sociedad Española de Enfermería Nefrológica [SEDEN], Sociedad Española de Inmunología [SEI/GETH]), el Grupo de Trabajo Enfermedad Renal Crónica Avanzada (ACERCA), la Asociación de Pacientes para la Lucha Contra la Enfermedad Renal (ALCER) y sometido posteriormente a consulta pública. Tras incluir las mejoras sugeridas, el documento final ha sido adoptado institucionalmente en el Consejo Interterritorial de Trasplantes (CIT) del Sistema Nacional de Salud. El trabajo realizado y las recomendaciones para optimizar el TRVD se describen a lo largo del presente artículo, organizados por los diferentes apartados del proceso de donación.Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spain have adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process

A comparison of the epidemiology of kidney replacement therapy between Europe and the United States:2021 data of the ERA Registry and the USRDS

BACKGROUND AND HYPOTHESIS: This paper compares the most recent data on the incidence and prevalence of kidney replacement therapy (KRT), kidney transplantation rates, and mortality on KRT from Europe to those from the United States (US), including comparisons of treatment modalities (haemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx)).METHODS: Data were derived from the annual reports of the European Renal Association (ERA) Registry and the United States Renal Data System (USRDS). The European data include information from national and regional renal registries providing the ERA Registry with individual patient data. Additional analyses were performed to present results for all participating European countries together.RESULTS: In 2021, the KRT incidence in the US (409.7 per million population (pmp)) was almost 3-fold higher than in Europe (144.4 pmp). Despite the substantial difference in KRT incidence, approximately the same proportion of patients initiated HD (Europe: 82%, US: 84%), PD (14%; 13% respectively), or underwent pre-emptive KTx (4%; 3% respectively). The KRT prevalence in the US (2436.1 pmp) was 2-fold higher than in Europe (1187.8 pmp). Within Europe, approximately half of all prevalent patients were living with a functioning graft (47%), while in the US, this was one third (32%). The number of kidney transplantations performed was almost twice as high in the US (77.0 pmp) compared to Europe (41.6 pmp). The mortality of patients receiving KRT was 1.6-fold higher in the US (157.3 per 1000 patient years) compared to Europe (98.7 per 1000 patient years).CONCLUSIONS: The US had a much higher KRT incidence, prevalence, and mortality compared to Europe, and despite a higher kidney transplantation rate, a lower proportion of prevalent patients with a functioning graft