Determinación de cistatina C como marcador de función renal en pacientes normo albuminúricos con Diabetes Mellitus tipo 2

Antecedentes: la identificación temprana del deterioro de la función renal es crucial en los pacientes diabéticos. Clínicamente la cistatina C sérica podría ser el indicador más sensible de tasa de filtrado glomerular. Objetivo: proponer el uso de cistatina C como prueba de rutina para evaluar la función renal en pacientes diabéticos tipo 2. Metodología: se realizó un estudio observacionalde corte transversal en 115 pacientes diabéticos tipo 2 normo albuminúricos, estableciendo la tasa de filtrado glomerular con valores de cistatina C y fórmula de Cockroft–Gault. A aquellos con un filtrado glomerular < 60 ml/min se realizó depuración de creatinina en orina de 24 horas; y se comparó los resultados con el programa estadístico SPSS 17, presentando los datos entablas de contingencia con análisis de riesgo y test de significancia de X2. Resultados: la tasa de filtrado glomerular obtenida con cistatina C, tuvo un valor promedio de 99ml/min±19.07, mientras que la de Cockroft-Gault un valor de 79.85ml/min±23.63 reflejando mejor correlación con aclaramiento de creatinina en orina de 24 horas que obtuvo un valor de 74.95ml/min±37.41.Al relacionar los valores con la depuración de creatinina en orina de 24 horas, no hubo una relación significativa entre ambos parámetros (p=0.14). Conclusión: la tasa de filtrado glomerular con cistatina C presenta una gran dispersión en la correlación conla depuración de creatinina en orina de 24 horas; este hecho, junto a diversos factores que influyen en su variabilidad, y el mayor coste de su determinación, hacen poco justificable su uso para valorar función renal

Percutaneous Dilatational Tracheostomy in a Cardiac Surgical Intensive Care Unit: A Single-Center Experience

BACKGROUND: A significant proportion of cardiac surgery intensive care unit (CSICU) patients require long-term ventilation, necessitating tracheostomy placement. The goal of this study was to evaluate the long-term postoperative outcomes and complications associated with percutaneous dilatational tracheostomy (PDT) in CSICU patients. METHODS: All patients undergoing PDT after cardiac, thoracic, or vascular operations in the CSICU between January 1, 2013 and January 1, 2021 were identified. They were evaluated for mortality, decannulation time, and complications including bleeding, infection, and need for surgical intervention. Multivariable regression models were used to identify predictors of early decannulation and the complication rate. RESULTS: Ninety-three patients were identified for this study (70 [75.3%] male and 23 [24.7%] female). Furthermore, 18.3% of patients had chronic obstructive pulmonary disease (COPD), 21.5% had history of stroke, 7.5% had end-stage renal disease, 33.3% had diabetes, and 59.1% were current smokers. The mean time from PDT to decannulation was 39 days. Roughly one-fifth (20.4%) of patients were on dual antiplatelet therapy and 81.7% had anticoagulation restarted 8 hours post-tracheostomy. Eight complications were noted, including 5 instances of bleeding requiring packing and 1 case of mediastinitis. There were no significant predictors of decannulation prior to discharge. Only COPD was identified as a negative predictor of decannulation at any point in time (hazard ratio, 0.28; 95% confidence interval, 0.08-0.95; p=0.04). CONCLUSION: Percutaneous tracheostomy is a safe and viable alternative to surgical tracheostomy in cardiac surgery ICU patients. Patients who undergo PDT have a relatively short duration of tracheostomy and do not have major post-procedural complications

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Determinación de cistatina C como marcador de función renal en pacientes normo albuminúricos con Diabetes Mellitus tipo 2

Antecedentes: la identificación temprana del deterioro de la función renal es crucial en los pacientes diabéticos. Clínicamente la cistatina C sérica podría ser el indicador más sensible de tasa de filtrado glomerular. Objetivo: proponer el uso de cistatina C como prueba de rutina para evaluar la función renal en pacientes diabéticos tipo 2. Metodología: se realizó un estudio observacionalde corte transversal en 115 pacientes diabéticos tipo 2 normo albuminúricos, estableciendo la tasa de filtrado glomerular con valores de cistatina C y fórmula de Cockroft–Gault. A aquellos con un filtrado glomerular < 60 ml/min se realizó depuración de creatinina en orina de 24 horas; y se comparó los resultados con el programa estadístico SPSS 17, presentando los datos entablas de contingencia con análisis de riesgo y test de significancia de X2. Resultados: la tasa de filtrado glomerular obtenida con cistatina C, tuvo un valor promedio de 99ml/min±19.07, mientras que la de Cockroft-Gault un valor de 79.85ml/min±23.63 reflejando mejor correlación con aclaramiento de creatinina en orina de 24 horas que obtuvo un valor de 74.95ml/min±37.41.Al relacionar los valores con la depuración de creatinina en orina de 24 horas, no hubo una relación significativa entre ambos parámetros (p=0.14). Conclusión: la tasa de filtrado glomerular con cistatina C presenta una gran dispersión en la correlación conla depuración de creatinina en orina de 24 horas; este hecho, junto a diversos factores que influyen en su variabilidad, y el mayor coste de su determinación, hacen poco justificable su uso para valorar función renal

Percutaneous Dilatational Tracheostomy in a Cardiac Surgical Intensive Care Unit: A Single-Center Experience

Background: A significant proportion of cardiac surgery intensive care unit (CSICU) patients require long-term ventilation, necessitating tracheostomy placement. The goal of this study was to evaluate the long-term postoperative outcomes and complications associated with percutaneous dilatational tracheostomy (PDT) in CSICU patients. Methods: All patients undergoing PDT after cardiac, thoracic, or vascular operations in the CSICU between January 1, 2013 and January 1, 2021 were identified. They were evaluated for mortality, decannulation time, and complications including bleeding, infection, and need for surgical intervention. Multivariable regression models were used to identify predictors of early decannulation and the complication rate. Results: Ninety-three patients were identified for this study (70 [75.3%] male and 23 [24.7%] female). Furthermore, 18.3% of patients had chronic obstructive pulmonary disease (COPD), 21.5% had history of stroke, 7.5% had end-stage renal disease, 33.3% had diabetes, and 59.1% were current smokers. The mean time from PDT to decannulation was 39 days. Roughly one-fifth (20.4%) of patients were on dual antiplatelet therapy and 81.7% had anticoagulation restarted 8 hours post-tracheostomy. Eight complications were noted, including 5 instances of bleeding requiring packing and 1 case of mediastinitis. There were no significant predictors of decannulation prior to discharge. Only COPD was identified as a negative predictor of decannulation at any point in time (hazard ratio, 0.28; 95% confidence interval, 0.08–0.95; p=0.04). Conclusion: Percutaneous tracheostomy is a safe and viable alternative to surgical tracheostomy in cardiac surgery ICU patients. Patients who undergo PDT have a relatively short duration of tracheostomy and do not have major post-procedural complications

Circulation des marchandises et réseaux commerciaux dans les Pyrénées (XIIe - XIXe siècle)

Les Pyrénées témoignent de la vigueur des échanges : les populations y commercent en toutes circonstances. Les sources font état d’échanges sur chacun des versants et entre le nord et le sud de la chaîne, et mettent en évidence un négoce transpyrénéen intéressant des marchés plus larges où la montagne et ses hommes ne participent qu’au transit des produits. Si une première approche permet d’entrevoir globalement le trafic, un certain nombre de questions se pose sur sa nature précise, l’influence des marches de part et d’autre des Pyrénées ou le rôle des marchands. Réunissant des chercheurs venus des deux côtés des Pyrénées, ces journées se fixent comme objectif de tester toutes les approches du sujet sous l’angle de l’histoire économique, sociale, culturelle, anthropologique et juridique.Els Pirineus testimonien el vigor dels intercanvis, on les poblacións hi comercien en totes les circunstancies les ions mostren intercanvis en cada vessant de la serralada i a la vegada entre totes dues vessants. Alhora evidencien un negoci transpirinenc que afecta uns mercats mes amplis en que la muntanya i els homes contribueixenn tan sols, en el transit. Una primera aproximacio permet percebre el comerç global Resten les questions sobre el sèu carácter précis l’influencio dels mercats en totes dues ports deis Pirineus, o bé el paper dels mercaders. L’objectiu d’aquestes jornades, que reuneixen investigadors tant del nord com del sud, és aproximar se aquest tema a traves de la historia económica, social, cultural, antropológica i jurídica