Diabetes mellitus y su asociación con depresión crónica en adultos en la población peruana / Diabetes mellitus and its association with chronic depression in adults in the Peruvian population

RESUMEN Objetivo: Determinar la asociación entre diabetes mellitus y depresión crónica en adultos en la población peruana. Materiales y métodos: Se realizó un estudio cuantitativo, de tipo observacional, de corte transversal y correlacional, a partir de los datos recogidos por la encuesta demográfica y de salud familiar del 2020 (Endes 2020). La muestra estuvo conformada por 14 245 adultos. La variable dependiente fue la depresión (con depresión/sin depresión); las variables independientes fueron diabetes mellitus (sí/no), índice de riqueza (los más pobres, pobre, medio, rico, más rico), educación (inicial-preescolar y primaria, secundaria, superior no universitaria, superior universitaria y posgrado), alcoholismo (sí/no) y área de residencia (urbano/rural). Para el análisis estadístico, se empleó el programa SPSS, versión 23, donde se realizó un análisis univariado de los datos mediante la determinación de las frecuencias y porcentajes. Posteriormente, en la fase analítica, se utilizó el análisis bivariado y multivariado por regresión logística para evaluar la fuerza de asociación entre las variables (p < 0,05). Resultados: El 15,7 % de adultos entre los 27 y 59 años presentaron depresión crónica; además, en el análisis bivariado se encontró asociación de la variable resultado y las covariables diabetes mellitus, nivel de educación e índice de riqueza (p < 0,05). La depresión es más frecuente en grupos socioeconómicos más bajos, con tasas más altas entre la población pobre (16,63 %) y menos educada, especialmente en aquellos con educación inicial-preescolar y primaria (18,88 %). En contraste, las clases ricas y más ricas muestran tasas menores de depresión (15,27 % y 12,04 %, respectivamente). Por otro lado, en el análisis multivariado se realizó la estimación del riesgo y se encontró que ser diabético aumentó el riesgo 1,66 veces más de padecer depresión en relación con los no diabéticos. Conclusiones: Existe asociación entre depresión crónica y diabetes mellitus en la población adulta de 27 a 59 años, además, el bajo índice de riqueza y tener menor grado de educación son factores de riesgo para el trastorno depresivo crónico.

ABSTRACT Objective: To determine the association between diabetes mellitus and chronic depression in adults in the Peruvian population. Materials and methods: A quantitative, observational, cross-sectional and correlational study was carried out, based on the data collected by the 2020 Encuesta Demográfica y de Salud Familiar (ENDES - Demographic and Family Health Survey, 2020). The sample was made up of 14,245 adults; depression was considered as a dependent variable (with depression/without depression), and the independent variables were diabetes mellitus (Yes/No), wealth index (the poorest, poor, middle class, rich, the richest), education (kindergarten-preschool and primary, secondary, non-university higher, university higher and graduate), alcoholism (Yes/No), area of residence (urban/rural). The program used for the statistical analysis was IBM SPSS: Release 23. A univariate data analysis was carried out by determining the frequencies and percentages. Subsequently, in the analytical phase, bivariate and multivariate analyses by logistic regression were used to evaluate the strength of the association between the variables (p < 0.05). Results: A total of 15.7 % of adults between 27 and 59 years of age experienced chronic depression. Furthermore, the bivariate analysis revealed an association between the outcome variable and covariates-diabetes mellitus, level of education and wealth index-(p < 0.05). Depression is more common in lower socioeconomic groups, with higher rates among the poor (16.63 %) and less educated population, especially in those with kindergarten, preschool and primary education (18.88 %). In contrast, the rich and richest classes show lower rates of depression (15.27 % and 12.04 %, respectively). On the other hand, in the multivariate analysis, the risk estimation was carried out, and it was found that having diabetes increased the risk of suffering depression by 1.66 times compared to patients who did not have diabetes. Conclusions: There is an association between chronic depression and diabetes mellitus in the adult population aged 27 to 59 years; in addition, a low wealth index and a lower level of education are risk factors for chronic depressive disorder.

Design, Development and Testing of a Monitoring System for the Study of Proton Exchange Fuel Cells and Stacks.

This article is about the design, development and validation of a new monitoring architecture for individual cells and stacks to facilitate the study of proton exchange fuel cells. The system consists of four main elements: input signals, signal processing boards, analogue-to-digital converters (ADCs) and a master terminal unit (MTU). The latter integrates a high-level graphic user interface (GUI) software developed by National Instruments LABVIEW, while the ADCs are based on three digital acquisition units (DAQs). Graphs showing the temperature, currents and voltages in individual cells as well as stacks are integrated for ease of reference. The system validation was carried out both in static and dynamic modes of operation using a Ballard Nexa 1.2 kW fuel cell fed by a hydrogen cylinder, with a Prodigit 32612 electronic load at the output. The system was able to measure the voltage distributions of individual cells, and temperatures at different equidistant points of the stack both with and without an external load, validating its use as an indispensable tool for the study and characterization of these systems.

Fibroblast growth factor 21 is expressed and secreted from skeletal muscle following electrical stimulation via extracellular ATP activation of the PI3K/Akt/mTOR signaling pathway.

Fibroblast growth factor 21 (FGF21) is a hormone involved in the regulation of lipid, glucose, and energy metabolism. Although it is released mainly from the liver, in recent years it has been shown that it is a "myokine", synthesized in skeletal muscles after exercise and stress conditions through an Akt-dependent pathway and secreted for mediating autocrine and endocrine roles. To date, the molecular mechanism for the pathophysiological regulation of FGF21 production in skeletal muscle is not totally understood. We have previously demonstrated that muscle membrane depolarization controls gene expression through extracellular ATP (eATP) signaling, by a mechanism defined as "Excitation-Transcription coupling". eATP signaling regulates the expression and secretion of interleukin 6, a well-defined myokine, and activates the Akt/mTOR signaling pathway. This work aimed to study the effect of electrical stimulation in the regulation of both production and secretion of skeletal muscle FGF21, through eATP signaling and PI3K/Akt pathway. Our results show that electrical stimulation increases both mRNA and protein (intracellular and secreted) levels of FGF21, dependent on an extracellular ATP signaling mechanism in skeletal muscle. Using pharmacological inhibitors, we demonstrated that FGF21 production and secretion from muscle requires the activation of the P2YR/PI3K/Akt/mTOR signaling pathway. These results confirm skeletal muscle as a source of FGF21 in physiological conditions and unveil a new molecular mechanism for regulating FGF21 production in this tissue. Our results will allow to identify new molecular targets to understand the regulation of FGF21 both in physiological and pathological conditions, such as exercise, aging, insulin resistance, and Duchenne muscular dystrophy, all characterized by an alteration in both FGF21 levels and ATP signaling components. These data reinforce that eATP signaling is a relevant mechanism for myokine expression in skeletal muscle.

Mechanical Disturbance of Osteoclasts Induces ATP Release That Leads to Protein Synthesis in Skeletal Muscle through an Akt-mTOR Signaling Pathway.

Muscle and bone are tightly integrated through mechanical and biochemical signals. Osteoclasts are cells mostly related to pathological bone loss; however, they also start physiological bone remodeling. Therefore, osteoclast signals released during bone remodeling could improve both bone and skeletal muscle mass. Extracellular ATP is an autocrine/paracrine signaling molecule released by bone and muscle cells. Then, in the present work, it was hypothesized that ATP is a paracrine mediator released by osteoclasts and leads to skeletal muscle protein synthesis. RAW264.7-derived osteoclasts were co-cultured in Transwell® chambers with flexor digitorum brevis (FDB) muscle isolated from adult BalbC mice. The osteoclasts at the upper chamber were mechanically stimulated by controlled culture medium perturbation, resulting in a two-fold increase in protein synthesis in FDB muscle at the lower chamber. Osteoclasts released ATP to the extracellular medium in response to mechanical stimulation, proportional to the magnitude of the stimulus and partly dependent on the P2X7 receptor. On the other hand, exogenous ATP promoted Akt phosphorylation (S473) in isolated FDB muscle in a time- and concentration-dependent manner. ATP also induced phosphorylation of proteins downstream Akt: mTOR (S2448), p70S6K (T389) and 4E-BP1 (T37/46). Exogenous ATP increased the protein synthesis rate in FDB muscle 2.2-fold; this effect was blocked by Suramin (general P2X/P2Y antagonist), LY294002 (phosphatidylinositol 3 kinase inhibitor) and Rapamycin (mTOR inhibitor). These blockers, as well as apyrase (ATP metabolizing enzyme), also abolished the induction of FDB protein synthesis evoked by mechanical stimulation of osteoclasts in the co-culture model. Therefore, the present findings suggest that mechanically stimulated osteoclasts release ATP, leading to protein synthesis in isolated FDB muscle, by activating the P2-PI3K-Akt-mTOR pathway. These results open a new area for research and clinical interest in bone-to-muscle crosstalk in adaptive processes related to muscle use/disuse or in musculoskeletal pathologies.

Serious Games as a Method for Enhancing Learning Engagement: Student Perception on Online Higher Education During COVID-19.

The COVID-19 pandemic has enforced social isolation in many countries worldwide, which forced teachers at all levels of education, including the university context, to adapt new teaching strategies. This study presents a method developed in this regard, that is, serious games were used as a complement to synchronous online classes to ensure the continuity of pedagogical activities in a physiology course at Universidad Andrés Bello, Chile. Using serious games is a strategy in the field of gamification, which is a commonly used learning strategy for online teaching as necessitated by COVID-19. This study is quantitative in nature and conducted a questionnaire survey on 108 second-year undergraduate nursing students to determine their perception about this innovation. The results demonstrate that the students well valued the proposed pedagogical innovative model in terms of motivation and engagement. Moreover, they reported that the model can serve as a meaningful learning experience. These perceptions suggest that the model is an efficient strategy for implementing the physiology curricula in the context of online teaching. Moreover, the results imply that the model should be applied to other courses and disciplines in the undergraduate program and provide support that it is a valid strategy for face-to-face teaching. Lastly, the finding points to the potential of the model to be explored as a learning strategy in the age of education post-COVID-19.

Meniscal fixation is a successful treatment for hypermobile lateral meniscus in soccer players.

PURPOSE: To report the outcomes (subjective function, return to play, complications and reoperations) of arthroscopic all-inside meniscal fixation in a large sample of soccer players with hypermobile lateral meniscus. METHODS: Between 2010 and 2015, 55 patients undergoing surgical treatment for hypermobile lateral meniscus at Mutualidad Catalana de Futbolistas (Barcelona, Spain) were identified. Patients with open physes, associated injuries, discoid meniscus, or clinical follow-up less than 6 months were excluded. Once identified, all patients were contacted over the phone to collect cross-sectional data on International Knee Documentation Committee (IKDC) score, postoperative Tegner score, and postoperative visual analogue scale (VAS) for pain. In addition, complications and reoperations were retrospectively collected. RESULTS: Forty-six cases (in 45 patients) with a mean (SD) age of 26.3 (9.5) years and mean (SD; range) follow-up of 43 (19.5; 8-73) months were included. The pre- and post-operative median (range) Tegner score was 9 (6-9) and 8 (0-9), respectively. Compared to the preoperative period, the postoperative Tegner score was equal in 27/46 (59%) cases and lower in 16/46 (35%) cases (3 missing values). Return to play was possible in 38/46 (82%) cases, from which 27/46 (59%) corresponded to the same pre-injury activity level. Postoperatively, the median (range) VAS for pain was 1 (0-9), and the mean (SD) subjective IKDC was 86.2 (16.7). Three of the 46 cases (6.5%) required a reoperation because of pain in one patient (meniscal suture failure) and meniscal tear in two patients. CONCLUSIONS: All-inside meniscal fixation is a successful treatment for hypermobile lateral meniscus, which allows acceptable return to play and good function in soccer players at a low reoperation rate. However, according to the present cross-sectional case series, players should be advised that return to the same pre-injury activity level is achieved in only 27 of 46 (59%) of the cases. Surgeons facing with the difficult problem of hypermobile lateral meniscus in soccer players should consider meniscus fixation as an easy and successful option. LEVEL OF EVIDENCE: Level IV-Therapeutic Case Series.

Oxoisoaporphines and Aporphines: Versatile Molecules with Anticancer Effects.

Cancer is a disease that involves impaired genome stability with a high mortality index globally. Since its discovery, many have searched for effective treatment, assessing different molecules for their anticancer activity. One of the most studied sources for anticancer therapy is natural compounds and their derivates, like alkaloids, which are organic molecules containing nitrogen atoms in their structure. Among them, oxoisoaporphine and sampangine compounds are receiving increased attention due to their potential anticancer effects. Boldine has also been tested as an anticancer molecule. Boldine is the primary alkaloid extract from boldo, an endemic tree in Chile. These compounds and their derivatives have unique structural properties that potentially have an anticancer mechanism. Different studies showed that this molecule can target cancer cells through several mechanisms, including reactive oxygen species generation, DNA binding, and telomerase enzyme inhibition. In this review, we summarize the state-of-art research related to oxoisoaporphine, sampangine, and boldine, with emphasis on their structural characteristics and the relationship between structure, activity, methods of extraction or synthesis, and anticancer mechanism. With an effective cancer therapy still lacking, these three compounds are good candidates for new anticancer research.

Maloclusión de clase III, tratamiento ortodoncico. Revisión de la literatura / Class III malocclusion orthodontic treatment. Literature review

El propósito de la presente revisión bibliográfica es la presentación de alternativas para el tratamiento de las maloclusiones de clase III. Para lo cual se realizó una búsqueda de artículos científicos y reportes de casos clínicos de esta maloclusión, en diversas revistas científicas de ortodoncia y ortopedia. Concluyendo que se debe realizar un buen diagnóstico esquelético y dental que permita la diferenciación entre las maloclusiones clase III de origen dental o de origen esquelético, y de esta forma enfocar el plan de tratamiento de acuerdo a la edad del paciente y origen de la misma. Cuando son de origen dental se cuenta con alternativas como planos inclinados de oclusión, arco de Eschler o arcos de protrusión que permiten interceptar el problema antes de que se desarrolle una maloclusion esquelética. Al ser de origen esqueletal el tratamiento es encaminado a resolver el problema, por medio de aparatos extraorales que produce un crecimiento diferencial del maxilar o mandíbula que son las causantes de estas displasias. En pacientes que han terminado el crecimiento se tiene dos alternativas de tratamiento, una es la compensación dentaria (camuflaje) mediante la proinclinación de los incisivos superiores y retroinclinación de los inferiores sea mediante distalización o extracciones en el arco inferior; la otra alternativa es la combinación de ortodoncia con cirugía cuando la discrepancia maxilo mandibular es grande. (AU)

The purpose of this literature review is to present alternatives for the treatment of Class III malocclusion. For which a search was conducted of scientific articles and clinical case reports of this malocclusion in various magazines orthodontic and orthopedic. Determining that should make proper skeletal and dental diagnosis to differentiate between class III malocclusions of skeletal origin or dental origin, and thus focus the treatment plan according to the patient's age and origin of it. When they are of dental origin there are alternatives such as inclined planes of occlusion Eschler arc or arcs that allow protrusion to trap the problem before it develops a skeletal malocclusion. As origin of skeletal treatment is aimed at solving the problem, through extraoral devices that produce differential growth of the maxilla or mandible that are responsible for these dysplasias. In patients who have completed growth has two treatment alternatives, one is the dental compensation (camouflage) by proclined upper incisors and lower retroclined either by distalization or extractions in the lower arch, the other alternative is the combination of orthodontic surgery when maxilla mandibular discrepancy is large. (AU)

Aprendizaje cooperativo para la formación universitaria en alfabetización en salud / Cooperative learning for university education in health literacy

Introducción: La difusión de los conocimientos biosanitarios y la rapidez con la que se difunden en Internet puede generar aprendizajes erróneos por falta de una formación científica adecuada, de ahí la necesidad de realizar intervenciones formativas sobre alfabetización en salud. Sujetos y métodos: Se ha realizado un estudio descriptivo cuasiexperimental para comprobar la eficacia de una estrategia educativa en torno a la alfabetización en salud. La muestra objeto de estudio procede de un posgrado oficial destinado a la formación de futuros profesores. Los estudiantes trabajaron un contenido mediante técnicas de aprendizaje tutorizado cooperativo. El instrumento de medida ha sido la evaluación de los conocimientos científicos adquiridos y las emociones experimentadas por los estudiantes. Resultados y conclusiones: El análisis estadístico realizado permite comprobar que la metodología empleada facilita la alfabetización en salud. Se discute su proyección desde el medio universitario a la sociedad, haciendo hincapié en los paralelismos existentes entre la alfabetización en salud y el empoderamiento de los pacientes

Introduction: The dissemination of biosanitary knowledge and the speed with which they spread on the Internet, can generate erroneous learning due to lack of adequate scientific training. Hence the need to carry out training interventions on health literacy. Subjects and methods: A descriptive, quasi-experimental study was carried out to verify the effectiveness of an educational strategy around health literacy. The sample under study comes from an official postgraduate course for the training of future professors. Students worked on content using cooperative tutoring learning techniques. The instrument of measurement has been the evaluation of the acquired scientific knowledge and the emotions experienced by the students. Results and conclusions: The statistical analysis performed shows that the methodology used facilitates health literacy. It discusses its projection from the university to society, emphasizing the parallels between the health literacy and the empowerment of patients

Early molecular response and microanatomical changes in the masseter muscle and mandibular head after botulinum toxin intervention in adult mice.

BACKGROUND: Masseter muscle paralysis induced by botulinum toxin type A (BoNTA) evokes subchondral bone loss in mandibular heads of adult rats and growing mice after 4 weeks. However, the primary cellular and molecular events leading to altered bone remodeling remain unexplored. Thus, the aim of the current work has been to assess the molecular response that precedes the early microanatomical changes in the masseter muscle and subchondral bone of the mandibular head in adult mice after BoNTA intervention. METHODS: A pre-clinical in vivo study was performed by a single intramuscular injection of 0.2 U BoNTA in the right masseter (experimental) of adult BALB/c mice. The contralateral masseter was injected with vehicle (control). Changes in mRNA levels of molecular markers of bone loss or muscle atrophy/regeneration were addressed by qPCR at day 2 or 7, respectively. mRNA levels of receptor activator of nuclear factor-κB ligand (RANKL) was assessed in mandibular heads, whilst mRNA levels of Atrogin-1/MAFbx, MuRF-1 and Myogenin were addressed in masseter muscles. In order to identify the early microanatomical changes at day 14, fiber diameters in transversal sections of masseter muscles were quantified, and histomorphometric analysis was used to determine the bone per tissue area and the trabecular thickness of subchondral bone of the mandibular heads. RESULTS: An increase of up to 4-fold in RANKL mRNA levels were detected in mandibular heads of the BoNTA-injected sides as early as 2 days after intervention. Moreover, a 4-6 fold increase in Atrogin-1/MAFbx and MuRF-1 and an up to 25 fold increase in Myogenin mRNA level were detected in masseter muscles 7 days after BoNTA injections. Masseter muscle mass, as well as individual muscle fiber diameter, were significantly reduced in BoNTA-injected side after 14 days post-intervention. At the same time, in the mandibular heads from the treated side, the subchondral bone loss was evinced by a significant reduction in bone per tissue area (-40%) and trabecular thickness (-55%). CONCLUSIONS: Our results show that masseter muscle paralysis induced by BoNTA leads to significant microanatomical changes by day 14, preceded by molecular changes as early as 2 days in bone, and 7 days in muscle. Therefore, masseter muscle atrophy and subchondral bone loss detected at 14 days are preceded by molecular responses that occur during the first week after BoNTA intervention.

Confirmed clinical case of chronic kidney disease of nontraditional causes in agricultural communities in Central America: a case definition for surveillance / Caso clínico confirmado de enfermedad renal crónica de causas no tradicionales en comunidades agrícolas de Centroamérica: una definición de caso para la vigilancia

Over the last 20 years, many reports have described an excess of cases of chronic kidney disease (CKD) in the Pacific coastal area of Central America, mainly affecting male farmworkers and signaling a serious public health problem. Most of these cases are not associated with traditional risk factors for CKD, such as aging, diabetes mellitus, and hypertension. This CKD of nontraditional causes (CKDnT) might be linked to environmental and/or occupational exposure or working conditions, limited access to health services, and poverty. In response to a resolution approved by the Directing Council of the Pan American Health Organization (PAHO) in 2013, PAHO, the U.S. Centers for Disease Control and Prevention, and the Latin American Society of Nephrology and Hypertension (SLANH) organized a consultation process in order to expand knowledge on the epidemic of CKDnT and to develop appropriate surveillance instruments. The Clinical Working Group from SLANH was put in charge of finding a consensus definition of a confirmed clinical case of CKDnT. The resulting definition establishes mandatory criteria and exclusion criteria necessary for classifying a case of CKDnT. The definition includes a combination of universally accepted definitions of CKD and the main clinical manifestations of CKDnT. Based on the best available evidence, the Clinical Working Group also formulated general recommendations about clinical management that apply to any patient with CKDnT. Adhering to the definition of a confirmed clinical case of CKDnT and implementing it appropriately is expected to be a powerful instrument for understanding the prevalence of the epidemic, evaluating the results of interventions, and promoting appropriate advocacy and planning efforts

En los 20 últimos años, en muchos informes se ha descrito un número inusual de casos de enfermedad renal crónica (ERC) en la costa del Pacífico de Centroamérica, que afecta principalmente a trabajadores agrícolas varones y señala un grave problema de salud pública. La mayoría de estos casos no se asocia con los factores de riesgo tradicionales de ERC, como envejecimiento, diabetes mellitus e hipertensión. Esta ERC de causas no tradicionales (ERCnT) podría estar vinculada con la exposición laboral o ambiental o las condiciones de trabajo, el escaso acceso a los servicios de salud y la pobreza. En respuesta a una resolución aprobada por el Consejo Directivo de la Organización Panamericana de la Salud (OPS) en el 2013, la OPS, los Centros para el Control y la Prevención de Enfermedades de los Estados Unidos y la Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH) organizaron un proceso de consulta para ampliar los conocimientos sobre la epidemia de ERCnT y elaborar instrumentos apropiados para la vigilancia. El Grupo Clínico de Trabajo de la SLANH tuvo la responsabilidad de consensuar una definición de caso clínico confirmado de ERCnT. En la definición resultante se establecen criterios obligatorios y criterios de exclusión necesarios para clasificar un caso como de ERCnT. La definición incluye una combinación de definiciones de ERC universalmente aceptadas y las principales manifestaciones clínicas de ERCnT. Sobre la base de los mejores datos científicos disponibles, el Grupo Clínico de Trabajo también formuló recomendaciones generales acerca del manejo clínico, que se aplican a cualquier paciente con ERCnT. Se espera que la adopción de la definición de caso confirmado de ERCnT y su aplicación adecuada sean una herramienta poderosa para conocer la prevalencia de la epidemia, evaluar los resultados de las intervenciones y promover acciones apropiadas de sensibilización y planificación.

NOX2 Inhibition Impairs Early Muscle Gene Expression Induced by a Single Exercise Bout.

Reactive oxygen species (ROS) participate as signaling molecules in response to exercise in skeletal muscle. However, the source of ROS and the molecular mechanisms involved in these phenomena are still not completely understood. The aim of this work was to study the role of skeletal muscle NADPH oxidase isoform 2 (NOX2) in the molecular response to physical exercise in skeletal muscle. BALB/c mice, pre-treated with a NOX2 inhibitor, apocynin, (3 mg/kg) or vehicle for 3 days, were swim-exercised for 60 min. Phospho-p47(phox) levels were significantly upregulated by exercise in flexor digitorum brevis (FDB). Moreover, exercise significantly increased NOX2 complex assembly (p47(phox)-gp91(phox) interaction) demonstrated by both proximity ligation assay and co-immunoprecipitation. Exercise-induced NOX2 activation was completely inhibited by apocynin treatment. As expected, exercise increased the mRNA levels of manganese superoxide dismutase (MnSOD), glutathione peroxidase (GPx), citrate synthase (CS), mitochondrial transcription factor A (tfam) and interleukin-6 (IL-I6) in FDB muscles. Moreover, the apocynin treatment was associated to a reduced activation of p38 MAP kinase, ERK 1/2, and NF-κB signaling pathways after a single bout of exercise. Additionally, the increase in plasma IL-6 elicited by exercise was decreased in apocynin-treated mice compared with the exercised vehicle-group (p < 0.001). These results were corroborated using gp91-dstat in an in vitro exercise model. In conclusion, NOX2 inhibition by both apocynin and gp91dstat, alters the intracellular signaling to exercise and electrical stimuli in skeletal muscle, suggesting that NOX2 plays a critical role in molecular response to an acute exercise.

Characterization of a multiprotein complex involved in excitation-transcription coupling of skeletal muscle.

BACKGROUND: Electrical activity regulates the expression of skeletal muscle genes by a process known as "excitation-transcription" (E-T) coupling. We have demonstrated that release of adenosine 5'-triphosphate (ATP) during depolarization activates membrane P2X/P2Y receptors, being the fundamental mediators between electrical stimulation, slow intracellular calcium transients, and gene expression. We propose that this signaling pathway would require the proper coordination between the voltage sensor (dihydropyridine receptor, DHPR), pannexin 1 channels (Panx1, ATP release conduit), nucleotide receptors, and other signaling molecules. The goal of this study was to assess protein-protein interactions within the E-T machinery and to look for novel constituents in order to characterize the signaling complex. METHODS: Newborn derived myotubes, adult fibers, or triad fractions from rat or mouse skeletal muscles were used. Co-immunoprecipitation, 2D blue native SDS/PAGE, confocal microscopy z-axis reconstruction, and proximity ligation assays were combined to assess the physical proximity of the putative complex interactors. An L6 cell line overexpressing Panx1 (L6-Panx1) was developed to study the influence of some of the complex interactors in modulation of gene expression. RESULTS: Panx1, DHPR, P2Y2 receptor (P2Y2R), and dystrophin co-immunoprecipitated in the different preparations assessed. 2D blue native SDS/PAGE showed that DHPR, Panx1, P2Y2R and caveolin-3 (Cav3) belong to the same multiprotein complex. We observed co-localization and protein-protein proximity between DHPR, Panx1, P2Y2R, and Cav3 in adult fibers and in the L6-Panx1 cell line. We found a very restricted location of Panx1 and Cav3 in a putative T-tubule zone near the sarcolemma, while DHPR was highly expressed all along the transverse (T)-tubule. By Panx1 overexpression, extracellular ATP levels were increased both at rest and after electrical stimulation. Basal mRNA levels of the early gene cfos and the oxidative metabolism markers citrate synthase and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α) were significantly increased by Panx1 overexpression. Interleukin 6 expression evoked by 20-Hz electrical stimulation (270 pulses, 0.3 ms each) was also significantly upregulated in L6-Panx1 cells. CONCLUSIONS: We propose the existence of a relevant multiprotein complex that coordinates events involved in E-T coupling. Unveiling the molecular actors involved in the regulation of gene expression will contribute to the understanding and treatment of skeletal muscle disorders due to wrong-expressed proteins, as well as to improve skeletal muscle performance.

A New, Scalable and Low Cost Multi-Channel Monitoring System for Polymer Electrolyte Fuel Cells.

In this work a new, scalable and low cost multi-channel monitoring system for Polymer Electrolyte Fuel Cells (PEFCs) has been designed, constructed and experimentally validated. This developed monitoring system performs non-intrusive voltage measurement of each individual cell of a PEFC stack and it is scalable, in the sense that it is capable to carry out measurements in stacks from 1 to 120 cells (from watts to kilowatts). The developed system comprises two main subsystems: hardware devoted to data acquisition (DAQ) and software devoted to real-time monitoring. The DAQ subsystem is based on the low-cost open-source platform Arduino and the real-time monitoring subsystem has been developed using the high-level graphical language NI LabVIEW. Such integration can be considered a novelty in scientific literature for PEFC monitoring systems. An original amplifying and multiplexing board has been designed to increase the Arduino input port availability. Data storage and real-time monitoring have been performed with an easy-to-use interface. Graphical and numerical visualization allows a continuous tracking of cell voltage. Scalability, flexibility, easy-to-use, versatility and low cost are the main features of the proposed approach. The system is described and experimental results are presented. These results demonstrate its suitability to monitor the voltage in a PEFC at cell level.

Caracterización de los programas de especialización en nefrología de América Latina / Characterization of nephrology training programs in Latin-America

Objetivo: Caracterizar los componentes curriculares aplicados para la formación de médicos nefrólogos en Latinoamérica. Sujetos y métodos: Estudio descriptivo que incluye nueve países latinoamericanos. Se solicitó a cada uno los programas vigentes de especialización en nefrología. Se analizaron diferentes variables curriculares y se adoptó, como marco epistemológico, el modelo de educación médica basada en competencias, y como referencia, las dimensiones del Accreditation Council for Graduate Medical Education (ACGME) de Estados Unidos. Resultados: Los programas de los nueve países (Argentina, Bolivia, Chile, Costa Rica, Ecuador, Guatemala, México, Perú y Uruguay) buscan mejorar el perfil del especialista y cubrir demandas sanitarias. Las plazas se adecuan a la capacidad de los centros y los aspirantes se seleccionan por concursos abiertos. Todos contemplan formación de internista como condición de ingreso o dentro del programa, que causa disparidad en cargas horarias. Algunos no explicitan perfil del graduado. El modelo dominante es 'posgrado con residencia', con estructuras y organización heterogéneas. Los contenidos son pertinentes y existe equivalencia en las competencias que se deben desarrollar, que mayoritariamente coinciden con las del ACGME, salvo 'habilidades interpersonales y comunicación' y 'práctica basada en sistemas de salud’, que tienen menor peso. Todos destinan el 75% de la carga horaria para tareas de 'formación en servicio con responsabilidades crecientes bajo supervisión' e incluyen actividades académicas. Las evaluaciones están integradas en el programa con herramientas adecuadas para evaluar competencias. Conclusiones: Se debería unificar el nivel de posgrado y duración, definir claramente las competencias del 'producto que se va a formar', incluir más 'habilidades interpersonales' y 'práctica en sistemas de salud', y establecer actividades de atención primaria de la salud

Aim: To characterized curricular components apply for nephrology medical training in Latin-America. Subjects and methods: Descriptive study including nine countries. It was request to current Nephrology Training Programs. We analized different curricular variables, taking as epistemological hallmark the competence-based medical education and dimensions from Accreditation Council for Graduate Medical Education (ACGME) from USA as reference. Results. Programs from nine countries (Argentina, Bolivia, Costa Rica, Chile, Ecuador, Guatemala, Mexico, Peru and Uruguay) look to improve the specialist profile and cover sanitary demands. The positions suit the centers capacity and applicants are selected in open competition. The programs include internal medicine training causing disparity in duty hours. Some of them don’t explicit graduate profile. The predominant model is ‘postgraduate course with residency’ with heterogeneous structures and organization. Contents are pertinent and there is equivalence within competences to develop that generally match with ACGME except for 'interpersonal and communication skills' and 'system-based practice' with less impact. All programs destiny 75% of duty hours for clinical practice-based learning with progressive responsibilities under guidance and supervision including academic activities. Evaluations are integrated to the program with adequate tools for competence assessment. Conclusions: Postgraduate level and duration should be unified, defining clearly competences of program’s graduate and establishing primary health care activities into the curriculum

Confirmed clinical case of chronic kidney disease of nontraditional causes in agricultural communities in Central America: a case definition for surveillance.

Over the last 20 years, many reports have described an excess of cases of chronic kidney disease (CKD) in the Pacific coastal area of Central America, mainly affecting male farmworkers and signaling a serious public health problem. Most of these cases are not associated with traditional risk factors for CKD, such as aging, diabetes mellitus, and hypertension. This CKD of nontraditional causes (CKDnT) might be linked to environmental and/or occupational exposure or working conditions, limited access to health services, and poverty. In response to a resolution approved by the Directing Council of the Pan American Health Organization (PAHO) in 2013, PAHO, the U.S. Centers for Disease Control and Prevention, and the Latin American Society of Nephrology and Hypertension (SLANH) organized a consultation process in order to expand knowledge on the epidemic of CKDnT and to develop appropriate surveillance instruments. The Clinical Working Group from SLANH was put in charge of finding a consensus definition of a confirmed clinical case of CKDnT. The resulting definition establishes mandatory criteria and exclusion criteria necessary for classifying a case of CKDnT. The definition includes a combination of universally accepted definitions of CKD and the main clinical manifestations of CKDnT. Based on the best available evidence, the Clinical Working Group also formulated general recommendations about clinical management that apply to any patient with CKDnT. Adhering to the definition of a confirmed clinical case of CKDnT and implementing it appropriately is expected to be a powerful instrument for understanding the prevalence of the epidemic, evaluating the results of interventions, and promoting appropriate advocacy and planning efforts.

Renal replacement therapy in Latin American end-stage renal disease.

The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (r2 0.86; P < 0.05) and life expectancy at birth (r2 0.58; P < 0.05). The HD prevalence and the kidney Tx rate correlated significantly with the same indexes, whereas the PD rate showed no correlation with these variables. A tendency to rate stabilization/little growth was reported in the most regional countries. As in previous reports, the global incidence rate correlated significantly only with GNI (r2 0.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The prevalence of RRT continues to increase, particularly in countries with 100% public health or insurance coverage for RRT, where it approaches rates comparable to those displayed by developed countries with a better GNI. The incidence also continues to increase in both countries that have not yet extended its coverage to 100% of the population as well as in those that have an adequate program for timely detection and treatment of chronic kidney disease (CKD) and its associated risk factors. PD is still an underutilized strategy for RRT in the region. Even though renal Tx is feasible, its growth rate is still not as fast as it should be in order to compensate for the increased prevalence of patients on waiting lists. Diagnostic and prevention programs for hypertension and diabetes, appropriate policies promoting the expansion of PD and organ procurement as well as transplantation as cost-effective forms of RRT are needed in the region. Regional cooperation among Latin American countries, allowing the more developed to guide and train others in starting registries and CKD programs, may be one of the key initiatives to address this deficit.