RESUMEN
OBJECTIVE: A paucity of data exists on the role of the interview day in programs and applicants' final rank list. The objective of our study was to investigate the impact interview day has on our programs and our interviewees' final rank list. METHODS: For the 2020 appointment year, our program used an Electronic Residency Application System Application Scoring Tool and Interview Scoring Tool to generate the preliminary rank list for our pulmonary and critical care fellowship applicants. The final rank list was decided after interviewers' discussion during the program's rank list meeting. We aimed to correlate the preliminary and final lists. We also surveyed applicants on the importance of interview day in generating their rank list. RESULTS: The final and the preliminary rank lists were strongly correlated (rs(47) = 0.87, P < 0.001). There was a stronger correlation between the final rank and the rank based on the application score (rs(47) = 0.84, P < 0.001) than the rank based on the interview score (rs(47) = 0.64, P < 0.001). For the postinterview survey, 48 applicants were surveyed-20 replied with a response rate of 42% and 18 respondents (90%) rated the interview experience as important or very important in their rank list decisions. CONCLUSIONS: The programs rank list correlated more with the candidates' written application than their interview day performance; however, interview experience greatly influenced the applicants' rank lists. In the coronavirus disease 2019 pandemic, in which all interviews are virtual, programs should make diligent efforts to construct virtual interview days, given their importance to applicants in generating their final rank list for the match.
Asunto(s)
COVID-19 , Internado y Residencia , COVID-19/epidemiología , Humanos , Encuestas y CuestionariosRESUMEN
High blood pressure is a common cause of chronic kidney disease. Because CD40, a member of the tumor necrosis factor receptor family, has been linked to the progression of kidney disease in ischemic nephropathy, we studied the role of Cd40 in the development of hypertensive renal disease. The Cd40 gene was mutated in the Dahl S genetically hypertensive rat with renal disease by targeted-gene disruption using zinc-finger nuclease technology. These rats were then given low (0.3%) and high (2%) salt diets and compared. The resultant Cd40 mutants had significantly reduced levels of both urinary protein excretion (41.8 ± 3.1 mg/24 h vs. 103.7 ± 4.3 mg/24 h) and plasma creatinine (0.36 ± 0.05 mg/dl vs. 1.15 ± 0.19 mg/dl), with significantly higher creatinine clearance compared with the control S rats (3.04 ± 0.48 ml/min vs. 0.93 ± 0.15 ml/min), indicating renoprotection was conferred by mutation of the Cd40 locus. Furthermore, the Cd40 mutants had a significant attenuation in renal fibrosis, which persisted on the high salt diet. However, there was no difference in systolic blood pressure between the control and Cd40 mutant rats. Thus, these data serve as the first evidence for a direct link between Cd40 and hypertensive nephropathy. Hence, renal fibrosis is one of the underlying mechanisms by which Cd40 plays a crucial role in the development of hypertensive renal disease.
Asunto(s)
Presión Sanguínea/genética , Antígenos CD40/genética , Hipertensión/genética , Enfermedades Renales/prevención & control , Riñón/metabolismo , Mutación , Proteinuria/prevención & control , Animales , Linfocitos B/metabolismo , Antígenos CD40/metabolismo , Movimiento Celular , Creatinina/sangre , Dieta Hiposódica , Modelos Animales de Enfermedad , Fibrosis , Predisposición Genética a la Enfermedad , Hipertensión/metabolismo , Hipertensión/fisiopatología , Riñón/patología , Riñón/fisiopatología , Enfermedades Renales/genética , Enfermedades Renales/metabolismo , Enfermedades Renales/fisiopatología , Activación de Linfocitos , Fenotipo , Fosforilación , Inhibidor 1 de Activador Plasminogénico/metabolismo , Proteinuria/genética , Proteinuria/metabolismo , Proteinuria/fisiopatología , Ratas Endogámicas Dahl , Ratas Mutantes , Eliminación Renal , Cloruro de Sodio Dietético , Linfocitos T/metabolismo , Factores de Tiempo , Familia-src Quinasas/metabolismoRESUMEN
For people enrolled in Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL), we sought to examine whether variation exists in the baseline medical therapy of different geographic regions and if any variations in prescribing patterns were associated with physician specialty. Patients were grouped by location within the United States (US) and outside the US (OUS), which includes Canada, South America, Europe, South Africa, New Zealand, and Australia. When comparing US to OUS, participants in the US took fewer anti-hypertensive medications (1.9 ± 1.5 vs. 2.4 ± 1.4; P < .001) and were less likely to be treated with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (46% vs. 62%; P < .001), calcium channel antagonist (37% vs. 58%; P < .001), and statin (64% vs. 75%; P < .05). In CORAL, the identification of variations in baseline medical therapy suggests that substantial opportunities exist to improve the medical management of patients with atherosclerotic renal-artery stenosis.
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Antihipertensivos/uso terapéutico , Aterosclerosis/patología , Hipertensión Renal/diagnóstico , Hipertensión Renal/tratamiento farmacológico , Obstrucción de la Arteria Renal/terapia , Anciano , Antihipertensivos/farmacología , Aterosclerosis/terapia , Canadá , Manejo de la Enfermedad , Europa (Continente) , Femenino , Humanos , Internacionalidad , Modelos Lineales , Masculino , Medicina , Persona de Mediana Edad , Análisis Multivariante , Nueva Zelanda , Pautas de la Práctica en Medicina , Estudios Prospectivos , Obstrucción de la Arteria Renal/patología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Sudáfrica , América del Sur , Estados UnidosRESUMEN
The diagnosis of renal artery stenosis (RAS) has become increasingly common in part due to greater awareness of ischemic renal disease and increased use of diagnostic techniques. Over 90 % of RAS cases are caused by atherosclerotic renovascular disease (ARVD). Patients with ARVD are at high risk for fatal and nonfatal cardiovascular and renal events. The mortality rate in patients with ARVD is high, especially with other cardiovascular or renal comorbidities. Recent clinical studies have provided substantial evidence concerning medical therapy and endovascular interventional therapeutic approaches for ARVD. Despite previous randomized clinical trials, the optimal therapy for ARVD remained uncertain until the results of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial were released recently. CORAL demonstrated that optimal medical therapy was equally effective to endovascular therapy in the treatment of ARVD. Clinicians can now practice with more evidence-based medicine to treat ARVD and potentially decrease mortality in patients with ARVD using optimal medical therapy.
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Angioplastia de Balón/métodos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Aterosclerosis/patología , Obstrucción de la Arteria Renal/terapia , Anciano , Antihipertensivos/uso terapéutico , Procedimientos Endovasculares/métodos , Medicina Basada en la Evidencia , Femenino , Humanos , Hipertensión Renal/mortalidad , Hipertensión Renal/patología , Hipertensión Renal/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Obstrucción de la Arteria Renal/mortalidad , Obstrucción de la Arteria Renal/patología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Stents , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: People with atherosclerotic renal artery stenosis may benefit from renin-angiotensin inhibitors, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers, but little is known about the factors associated with their use. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Cardiovascular Outcomes in Renal Atherosclerotic Lesions study (ClinicalTrials.gov identified: NCT00081731) is a prospective, international, multicenter clinical trial that randomly assigned participants with atherosclerotic renal artery stenosis who received optimal medical therapy to stenting versus no stenting from May 2005 through January 2010. At baseline, medication information was available from 853 of 931 randomly assigned participants. Kidney function was measured by serum creatinine-based eGFR at a core laboratory. RESULTS: Before randomization, renin-angiotensin inhibitors were used in 419 (49%) of the 853 participants. Renin-angiotensin inhibitor use was lower in those with CKD (eGFR<60 ml/min per 1.73 m(2)) (58% versus 68%; P=0.004) and higher in individuals with diabetes (41% versus 27%; P<0.001). Presence of bilateral renal artery stenosis or congestive heart failure was not associated with renin-angiotensin inhibitor use. Although therapy with renin-angiotensin inhibitors varied by study site, differences in rates of use were not related to the characteristics of the site participants. Participants receiving a renin-angiotensin inhibitor had lower systolic BP (mean ± SD, 148 ± 23 versus 152 ± 23 mmHg; P=0.003) and more often had BP at goal (30% versus 22%; P=0.01). CONCLUSIONS: Kidney function and diabetes were associated with renin-angiotensin inhibitor use. However, these or other clinical characteristics did not explain variability among study sites. Patients with renal artery stenosis who received renin-angiotensin inhibitor treatment had lower BP and were more likely to be at treatment goal.
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Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Aterosclerosis/terapia , Obstrucción de la Arteria Renal/terapia , Sistema Renina-Angiotensina/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Aterosclerosis/diagnóstico , Aterosclerosis/tratamiento farmacológico , Aterosclerosis/etnología , Aterosclerosis/fisiopatología , Presión Sanguínea/efectos de los fármacos , Comorbilidad , Femenino , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Riñón/efectos de los fármacos , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Obstrucción de la Arteria Renal/diagnóstico , Obstrucción de la Arteria Renal/tratamiento farmacológico , Obstrucción de la Arteria Renal/etnología , Obstrucción de la Arteria Renal/fisiopatología , Factores de Riesgo , Stents , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
Atherosclerotic renal artery stenosis (ARAS) is a common and complicated disease, which can result in high blood pressure and loss of kidney function. Although progress has been made in the understanding and treatment of hypertension in relation to ARAS, much less progress has been made in the area of renal function. Here we discuss current treatment options in regard to medical therapy and revascularization. We also describe the proposed mechanisms leading to renal dysfunction, including the CD40 signaling cascade, which is a particularly attractive signaling mechanism that may provide a mechanistic rationale for the development of renal disease in ARAS.