Aliskiren and the dual complement inhibition concept

In this issue of Clinical Kidney Journal, Plasse et al. report on the use of high-dose aliskiren as an adjunct therapy in a patient treated with eculizumab for haemolytic uraemic syndrome (HUS). This follows the recent description of the complement factor 3 (C3) activating activity of the enzyme renin and the successful therapeutic use of the direct renin inhibitor aliskiren in three cases of C3 glomerulopathy/dense deposit disease. We discuss the potential clinical and pathophysiological implications of these reports on nephropathies linked to complement, from HUS to C3 glomerulopathy to immunoglobulin A nephropathy as well as the concept of dual complement inhibition for kidney diseaseResearch by the authors was supported by FIS CP14/00133, PI16/ 02057, PI18/01366, PI19/00588, PI19/00815, DTS18/00032, ERAPerMed- JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009), Fondos FEDER, FRIAT, Sociedad Española de Nefrología, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM

Photodiodes based in La0.7Sr0.3MnO3/single layer MoS2 hybrid vertical heterostructures

The fabrication of artificial materials by stacking of individual two-dimensional (2D) materials is amongst one of the most promising research avenues in the field of 2D materials. Moreover, this strategy to fabricate new man-made materials can be further extended by fabricating hybrid stacks between 2D materials and other functional materials with different dimensionality making the potential number of combinations almost infinite. Among all these possible combinations, mixing 2D materials with transition metal oxides can result especially useful because of the large amount of interesting physical phenomena displayed separately by these two material families. We present a hybrid device based on the stacking of a single layer MoS2 onto a lanthanum strontium manganite (La0.7Sr0.3MnO3) thin film, creating an atomically thin device. It shows a rectifying electrical transport with a ratio of 103, and a photovoltaic effect with Voc up to 0.4 V. The photodiode behaviour arises as a consequence of the different doping character of these two materials. This result paves the way towards combining the efforts of these two large materials science communities.Comment: 1 table, 4 figures (+9 supp. info. figures

Temporal variability analysis reveals biases in electronic health records due to hospital process reengineering interventions over seven years

[EN] Objective To evaluate the effects of Process-Reengineering interventions on the Electronic Health Records (EHR) of a hospital over 7 years. Materials and methods Temporal Variability Assessment (TVA) based on probabilistic data quality assessment was applied to the historic monthly-batched admission data of Hospital La Fe Valencia, Spain from 2010 to 2016. Routine healthcare data with a complete EHR was expanded by processed variables such as the Charlson Comorbidity Index. Results Four Process-Reengineering interventions were detected by quantifiable effects on the EHR: (1) the hospital relocation in 2011 involved progressive reduction of admissions during the next four months, (2) the hospital services re-configuration incremented the number of inter-services transfers, (3) the care-services re-distribution led to transfers between facilities (4) the assignment to the hospital of a new area with 80,000 patients in 2015 inspired the discharge to home for follow up and the update of the pre-surgery planned admissions protocol that produced a significant decrease of the patient length of stay. Discussion TVA provides an indicator of the effect of process re-engineering interventions on healthcare practice. Evaluating the effect of facilities¿ relocation and increment of citizens (findings 1, 3¿4), the impact of strategies (findings 2¿3), and gradual changes in protocols (finding 4) may help on the hospital management by optimizing interventions based on their effect on EHRs or on data reuse. Conclusions The effects on hospitals EHR due to process re-engineering interventions can be evaluated using the TVA methodology. Being aware of conditioned variations in EHR is of the utmost importance for the reliable reuse of routine hospitalization data.F.J.P.B, C.S., J.M.G.G. and J.A.C. were funded Universitat Politecnica de Valencia, project "ANALISIS DE LA CALIDAD Y VARIABILIDAD DE DATOS MEDICOS". www.upv.es. J.M.G.G.is also partially supported by: Ministerio de Economia y Competitividad of Spain through MTS4up project (National Plan for Scientific and Technical Research and Innovation 2013-2016, No. DPI2016-80054-R); and European Commission projects H2020-SC1-2016-CNECT Project (No. 727560) and H2020-SC1-BHC-2018-2020 (No. 825750). The funders did not play any role in the study design, data collection and analysis, decision to publish, nor preparation of the manuscript.Perez-Benito, FJ.; Sáez Silvestre, C.; Conejero, JA.; Tortajada, S.; Valdivieso, B.; Garcia-Gomez, JM. (2019). Temporal variability analysis reveals biases in electronic health records due to hospital process reengineering interventions over seven years. PLoS ONE. 14(8):1-19. https://doi.org/10.1371/journal.pone.0220369S119148Aguilar-Savén, R. S. (2004). Business process modelling: Review and framework. International Journal of Production Economics, 90(2), 129-149. doi:10.1016/s0925-5273(03)00102-6Poulymenopoulou, M. 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Workflow mining: discovering process models from event logs. IEEE Transactions on Knowledge and Data Engineering, 16(9), 1128-1142. doi:10.1109/tkde.2004.47Weijters AJMM, Van Der Aalst WMP, Alves De Medeiros AK. Process Mining with the HeuristicsMiner Algorithm [Internet]. Available: https://pdfs.semanticscholar.org/1cc3/d62e27365b8d7ed6ce93b41c193d0559d086.pdfShim, S. J., & Kumar, A. (2010). Simulation for emergency care process reengineering in hospitals. Business Process Management Journal, 16(5), 795-805. doi:10.1108/14637151011076476Svolba, G., & Bauer, P. (1999). Statistical Quality Control in Clinical Trials. Controlled Clinical Trials, 20(6), 519-530. doi:10.1016/s0197-2456(99)00029-xKahn, M. G., Raebel, M. A., Glanz, J. M., Riedlinger, K., & Steiner, J. F. (2012). A Pragmatic Framework for Single-site and Multisite Data Quality Assessment in Electronic Health Record-based Clinical Research. 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To err is human: building a safer health system. A report of the Committee on Quality of Health Care in America. 2000. p. 287. National Academies Press

MYH9-related disease : it does exist, may be more frequent than you think and requires specific therapy

Altres ajuts: Sources of support: FIS/Fondos FEDER (REDinREN RD016/0009), Sociedad Española de Nefrología, FRIAT, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. Salary support: ISCIII Rio Hortega to M.V.P.-G.In this issue of ckj, Tabibzadeh et al. report one of the largest series of patients with MYH9 mutations and kidney disease. The cardinal manifestation of MYH9-related disease is thrombocytopenia with giant platelets. The population frequency of pathogenic MYH9 mutations may be at least 1 in 20 000. The literature abounds in misdiagnosed cases treated for idiopathic thrombocytopenic purpura with immune suppressants and even splenectomy. Additional manifestations include neurosensorial deafness and proteinuric and hematuric progressive kidney disease (at some point, it was called Alport syndrome with macrothrombocytopenia), leucocyte inclusions, cataracts and liver enzyme abnormalities, resulting in different names for different manifestation combinations (MATINS, May-Hegglin anomaly, Fechtner, Epstein and Sebastian syndromes, and deafness AD 17). The penetrance and severity of kidney disease are very variable, which may obscure the autosomal dominant inheritance. A correct diagnosis will both preclude unnecessary and potentially dangerous therapeutic interventions and allow genetic counselling and adequate treatment. Morphological erythrocyte, granulocyte and platelet abnormalities may allow the future development of high-throughput screening techniques adapted to clinical peripheral blood flow cytometers

La prospectiva como marco de análisis para el aprovechamiento turístico de los hongos comestibles silvestres (HCS) en el centro de México

Los hongos comestibles silvestres (HCS) han sido aprovechados históricamente por las comunidades forestales, pues constituyen un componente fundamental de su cultura alimentaria y un recurso estratégico de subsistencia. Además, representan una oportunidad para la diversificación productiva local a partir del impulso del turismo rural orientado al micoturismo. Por este motivo, se delinea un marco de análisis teórico metodológico desde el enfoque de prospectiva. Como procedimiento metodológico se realizó una revisión de literatura del micoturismo y de los HCS en revistas científicas. Como resultado se identificaron 48 variables que inciden en la conformación del sistema micoturístico y que son una aproximación para generar escenarios futuros del aprovechamiento recreativo de los hongos comestibles silvestres.CONACYT- Universidad Autónoma del Estado de Méxic

Adolf Loos

L’interesse per Adolf Loos [1870-1933] ha il valore di una scelta: egli è tra coloro che appartengono al nostro mondo. [...] Ci resta, per confortarci della scelta, insieme con i suoi scritti, la testimonianza delle sue opere, dove il pensiero di quegli stessi scritti è tradotto in maniera più immediata per comunicarsi a noi. E sono quasi tutte queste opere delle lezioni di coerenza, di intelligenza, di finezza, di mestiere e di gusto, davvero somme. Ma proprio qui bisogna insistere che il loro valore non è tanto nel senso profetico, cioè nell’aver indicato vie che sarebbero state proseguite da altri, ma proprio nella rivelazione di un messaggio poetico, valido in sé, quale permanente fonte d’ispirazione. L’attualità di Adolf Loos, oltre questo suo valore, con il quale si classifica comunque tra i grandi, è nell’aver affrontato tutti insieme quei problemi della sua epoca che permangono nella storia: la relazione tra produzione e architettura considerata come oggetto di consumo; il linguaggio architettonico anche nelle sue istanze più rappresentative e monumentali; l’aderenza alla razionalità dei materiali e del costruire; la possibilità di essere decorativi senza compiacersi dell’ornato (il che, alla lettura delle sue opere, dovrebbe chiarificare la sua posizione apodittica contro l’ornato stesso) e, infine, la continua verifica dello stile nell’ambito di un giudizio morale. E. N. Rogers, Attualità di Adolf Loos [The Modernity of Adolf Loos], Casabella Continuità, No. 233, dedicated to Adolf Loos, November 1959Interest in Adolf Loos [1870-1933] has the value of a choice: he is among those who belong to our world. [...] We are left to comfort ourselves with this choice together with his writings, the testimony of his works, where the thinking of these writings is translated more immediately in order to communicate to us. And almost all of these works are lessons of consistency, intelligence, finesse, craft, and taste, supreme recapitulations. Nonetheless, at this point, we must insist that their value lies not so much in a prophetic sense, that is, in having indicated ways that could be continued by others, but precisely in the revelation of a poetic message, valid in and of itself, as a durable source of inspiration. The relevance of Adolf Loos, beyond this value, thanks to which he still ranks among the greats, is in having faced en bloc those problems of his time that found a place in history: the relationship between production and architecture seen as an object of consumption; the architectural language, including its most representative and monumental instances; adherence to the rationality of materials and construction methods; the possibility of being decorative without complacently welcoming ornamentation (which, upon reading his works, ought to clarify his apodictic position against ornamentation itself) and, finally, the continuous verification of style within the context of a moral judgement. E. N. Rogers, Attualità di Adolf Loos [The Modernity of Adolf Loos], Casabella Continuità, No. 233, dedicated to Adolf Loos, November 19

Comparison of knowledge, attitudes and hand hygiene behavioral intention in medical and nursing students.

Introduction: Hand hygiene is crucial to prevent cross infection. Healthcare students are in a prime position to learn hand hygiene skills. The aim of this study was to analyze hand hygiene behavioral intentions of healthcare students before and after contact with the patient and to compare the knowledge of and attitude towards hand hygiene between medical and nursing students. Methods: In a descriptive survey research design, convenience selection of a sample of medical students (n=657) and nursing students (n=303) was done from modules taught by the Department of Preventive Medicine and Public Health in both Medicine and Nursing undergraduate degrees in four Spanish universities. The hand hygiene Questionnaire, a validated instrument to evaluate behavior, knowledge, and attitudes, was used. Results: A significantly lower percentage of students reported always or almost always carrying out hand hygiene before contact with the patient or invasive procedures in comparison to the percentage complying after contact with secretions or with the patient. Although hand hygiene knowledge appears acceptable, its importance is not sufficiently valued.Conclusions: There are deficiencies in behavioral intention, knowledge, and attitudes related to hand hygiene in medical and nursing students. Better results are observed among nursing students, especially those who have received specific training

Phosphate, microbiota and ckd

Phosphate is a key uremic toxin associated with adverse outcomes. As chronic kidney disease (CKD) progresses, the kidney capacity to excrete excess dietary phosphate decreases, triggering compensatory endocrine responses that drive CKD-mineral and bone disorder (CKD-MBD). Eventu-ally, hyperphosphatemia develops, and low phosphate diet and phosphate binders are prescribed. Recent data have identified a potential role of the gut microbiota in mineral bone disorders. Thus, parathyroid hormone (PTH) only caused bone loss in mice whose microbiota was enriched in the Th17 cell-inducing taxa segmented filamentous bacteria. Furthermore, the microbiota was required for PTH to stimulate bone formation and increase bone mass, and this was dependent on bacterial production of the short-chain fatty acid butyrate. We review current knowledge on the relationship between phosphate, microbiota and CKD-MBD. Topics include microbial bioactive compounds of special interest in CKD, the impact of dietary phosphate and phosphate binders on the gut microbiota, the modulation of CKD-MBD by the microbiota and the potential therapeutic use of microbiota to treat CKD-MBD through the clinical translation of concepts from other fields of science such as the optimization of phosphorus utilization and the use of phosphate-accumulating organisms.This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 860329, FIS/Fondos FEDER (PI18/01366, PI20/00744, PI19/00815, DTS18/00032, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009), Sociedad Española de Nefrología, FRIAT, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-C

Deciphering the quality of SARS-CoV-2 specific T-cell response associated with disease severity, immune memory and heterologous response

SARS-CoV-2 specific T-cell response has been associated with disease severity, immune memory and heterologous response to endemic coronaviruses. However, an integrative approach combining a comprehensive analysis of the quality of SARS-CoV-2 specific T-cell response with antibody levels in these three scenarios is needed. In the present study, we found that, in acute infection, while mild disease was associated with high T-cell polyfunctionality biased to IL-2 production and inversely correlated with anti-S IgG levels, combinations only including IFN-γ with the absence of perforin production predominated in severe disease. Seven months after infection, both non-hospitalised and previously hospitalised patients presented robust anti-S IgG levels and SARS-CoV-2 specific T-cell response. In addition, only previously hospitalised patients showed a T-cell exhaustion profile. Finally, combinations including IL-2 in response to S protein of endemic coronaviruses were the ones associated with SARS-CoV-2 S-specific T-cell response in pre-COVID-19 healthy donors’ samples. These results could have implications for protective immunity against SARS-CoV-2 and recurrent COVID-19 and may help for the design of new prototypes and boosting vaccine strategies