Evolution of Quality of Life and Treatment Adherence after One Year of Intermittent Bladder Catheterisation in Functional Urology Unit Patients.

OBJECTIVE: To determine patient difficulties and concerns when performing IBC (Intermittent Bladder Catheterisation), as well as the evolution of adherence, quality of life, and emotional state of patients one year after starting IBC. METHOD: A prospective, observational, multicentre study conducted in 20 Spanish hospitals with a one-year follow-up. Data sources were patient records and the King's Health Questionnaire on quality of life, the Mini-Mental State Examination (MMSE), and the Hospital Anxiety and Depression Scale (HADS). Perceived adherence was measured using the ICAS (Intermittent Catheterization Adherence Scale) and perceived difficulties with IBC were assessed using the ICDQ (Intermittent Catheterization Difficulty Questionnaire). For data analysis, descriptive and bivariate statistics were performed for paired data at three points in time (T1: one month, T2: three months, T3: one year). RESULTS: A total of 134 subjects initially participated in the study (T0), becoming 104 subjects at T1, 91 at T2, and 88 at T3, with a mean age of 39 years (standard deviation = 22.16 years). Actual IBC adherence ranged from 84.8% at T1 to 84.1% at T3. After one year of follow-up, a statistically significant improvement in quality of life (p ≤ 0.05) was observed in all dimensions with the exception of personal relationships. However, there were no changes in the levels of anxiety (p = 0.190) or depression (p = 0.682) at T3 compared to T0. CONCLUSIONS: Patients requiring IBC exhibit good treatment adherence, with a significant proportion of them performing self-catheterisation. After one year of IBC, a significant improvement in quality of life was noted, albeit with a significant impact on their daily lives and their personal and social relationships. Patient support programmes could be implemented to improve their ability to cope with difficulties and thus enhance both their quality of life and the maintenance of their adherence.

Quality of Life and Autonomy in Patients with Intermittent Bladder Catheterization Trained by Specialized Nurses.

Intermittent bladder catheterization (IBC) involves regular urine draining using a catheter, which is removed immediately after urinary elimination. It allows for the patient's urological health to be managed and their renal function to be preserved, and it promotes autonomy. Compliance with the prescribed number of daily catheterizations, which must be conducted by the patient, and infection prevention measures are crucial. To identify the patients requiring IBC, and to determine their adherence (whether they followed the prescribed guidelines and their difficulty in carrying out the procedure, as well as to assess how the IBC influences their quality of life and state of mind after receiving self-care training from a specialized nurse), we carried out a prospective, multicenter observational study in 24 Spanish hospitals with one month of monitoring and a sample of 99 patients. The sources of information were the patients' clinical records, the King's Health Questionnaire, the Mini-Mental State Examination (MMSE), and the hospital anxiety and depression scale (HADS). Descriptive and bivariate statistics were used to analyses the paired data. After recruitment (n = 99), 79 patients completed the questionnaire at a mean age of 35.2 years (SD = 20.5 years). In total, 53.5% (53) of the sample consisted of men and 32.3% (32) had neurological damage as the reason for prescription; 67% (67.7) performed self-catheterization and 86.7% adhered to the IBC. After one month of monitoring, a statistically significant improvement in quality of life was observed in all criteria, with the exception of personal relationships (p < 0.005), as well as an improvement in anxiety and depression levels (p < 0.001). Patients who require IBC show good adherence to the IBC with a significant percentage of self-catheterization. After one month of IBC, a significant improvement in the patients' quality of life and mood was observed. These results could be attributed to adequate patient training and adequate personalization of the IBC materials by the specialized nurses.

Forest stratification shapes allometry and flight morphology of tropical butterflies.

Studies of altitudinal and latitudinal gradients have identified links between the evolution of insect flight morphology, landscape structure and microclimate. Although lowland tropical rainforests offer steeper shifts in conditions between the canopy and the understorey, this vertical gradient has received far less attention. Butterflies, because of their great phenotypic plasticity, are excellent models to study selection pressures that mould flight morphology. We examined data collected over 5 years on 64 Nymphalidae butterflies in the Ecuadorian Chocó rainforest. We used phylogenetic methods to control for similarity resulting from common ancestry, and explore the relationships between species stratification and flight morphology. We hypothesized that species should show morphological adaptations related to differing micro-environments, associated with canopy and understorey. We found that butterfly species living in each stratum presented significantly different allometric slopes. Furthermore, a preference for the canopy was significantly associated with low wing area to thoracic volume ratios and high wing aspect ratios, but not with the relative distance to the wing centroid, consistent with extended use of fast flapping flight for canopy butterflies and slow gliding for the understorey. Our results suggest that microclimate differences in vertical gradients are a key factor in generating morphological diversity in flying insects.

Effect of Sample Collection (Manual Expression vs. Pumping) and Skimming on the Microbial Profile of Human Milk Using Culture Techniques and Metataxonomic Analysis.

Human milk microbiota is a unique bacterial community playing a relevant role in infant health, but its composition depends on different factors (woman health, lactation stage, and geographical lactation). However, information is lacking regarding some other factors that may affect the bacterial community of human milk. In this study we aimed to study the impact of the sample collection method and the skimming procedure using culture-dependent and culture-independent techniques to study the human milk microbial profile. One set of milk samples was provided by women (n = 10) in two consecutive days; half of the samples were collected the first day by manual expression and the other half on the second day by pumping. The rest of the participants (n = 17) provided milk samples that were fractionated by centrifugation; the bacterial profiles of whole milk and skimmed milk were compared by culture techniques in 10 milk samples, while those of whole milk, fat and skimmed milk were subjected to metataxonomic analysis in seven samples. Globally, the results obtained revealed high interindividual variability but that neither the use of single-use sterile devices to collect the sample nor the skimming procedure have a significant impact of the microbial profile of human samples.

Microbiota of human precolostrum and its potential role as a source of bacteria to the infant mouth.

Human milk represents a source of bacteria for the initial establishment of the oral (and gut) microbiomes in the breastfed infant, however, the origin of bacteria in human milk remains largely unknown. While some evidence points towards a possible endogenous enteromammary route, other authors have suggested that bacteria in human milk are contaminants from the skin or the breastfed infant mouth. In this work 16S rRNA sequencing and bacterial culturing and isolation was performed to analyze the microbiota on maternal precolostrum samples, collected from pregnant women before delivery, and on oral samples collected from the corresponding infants. The structure of both ecosystems demonstrated a high proportion of taxa consistently shared among ecosystems, Streptococcus spp. and Staphylococcus spp. being the most abundant. Whole genome sequencing on those isolates that, belonging to the same species, were isolated from both the maternal and infant samples in the same mother-infant pair, evidenced that in 8 out of 10 pairs both isolates were >99.9% identical at nucleotide level. The presence of typical oral bacteria in precolostrum before contact with the newborn indicates that they are not a contamination from the infant, and suggests that at least some oral bacteria reach the infant's mouth through breastfeeding.

Desobediência, Alargamento da Punição e Segurança Pública: Jovens Usuários de Drogas em Conflito com a Lei / Disobedience, Punishment Widening and Public Security: Young Drug Users in Conflit with the Law / Desobediencia, Ampliación de la Punición y Seguridad Pública: Jovenes Usuarios de Drogas en Conflicto con la Ley

O objetivo deste artigo é problematizar o dispositivo de obediência, tomado neste texto como um articulador entre a moral cristã, o sistema jurídico-penal e a segurança pública no contexto da juventude em conflito com a lei. Discutimos aqui os efeitos que a produção de obediência assegura, em termos institucionais, para os jovens em conflito com a lei que cumprem medida socioeducativa de internação. Nesse cenário, chamamos a atenção especialmente para aqueles que são, simultaneamente, usuários de drogas e cometem ato infracional associado ao tráfico de drogas. A sobreposição dessas duas configurações implica em uma relação jurídicapenal que se alarga, a partir do dispositivo da obediência, como estratégia de governo para o possível cerceamento perpétuo da liberdade do jovem a outras instituições e saberes, que passam a atuar também em um viés policialesco. O referencial analítico que sustenta o presente trabalho parte da contribuição do pensamento foucaultiano ao campo da psicologia social....(AU)

This article intends to reflect the idea of disobedience, specially within the articulation between christianism and its morality, and a juridical-penal legislation that has some effects in public security, mainly in what refers to the youth in conflict with the law. Our starting point is Foucault's concept of device, discussing mostly the effects of an obeying production that intends to reach a parcel of the youth that is equally a drug user and has committed an infracional act associated with drug trafficking. In this matter, we focus our anaylisis in the youth that is complying educational correction measures. The ascension of both of theses aspects shapes the widening of a juridical-penal articulation that develops a type of government directed to this population, producing a policement way of thinking the practices that revolve them. In order to do so, we based our analysis in Foucault's epistemological point of view, as well as in social psychology studies....(AU)

El objetivo de este artículo es problematizar el precepto de obediencia, designado en este texto como un articulador entre la moral cristiana, el sistema jurídico-penal y la seguridad publica en el contexto de la juventud en conflicto con la ley. Analizamos aquí los efectos que la producción de obediencia garantiza, en termos institucionales, para los jóvenes en conflicto con ley que cumplen medida socioeducativa de internación. En este panorama, llamamos la atención especialmente para aquellos que son, simultáneamente, usuarios de drogas y cometen acto delictivo asociado al tráfico de drogas. La adición de estas dos configuraciones implican en una relación jurídico-penal que se amplía, a partir del precepto de la obediencia, como estratégica de gobierno para el posible cercenamiento perpetuo de la libertad del joven a otras instituciones y saberes, que pasan a actuar también en un sesgo policiaco. El referencial analítico que sostiene el presente trabajo parte de la contribución del pensamiento foucaultiano al campo de la Psicología social....(AU)

Uma discussão sobre disciplina: juventude em conflito com a lei e cárcere / Discussing about discipline: the youth in conflict with the law and the incarceration / Discusión sobre la disciplina: la juventud en conflicto con la ley y el encarcelamiento

A presente escrita tem o objetivo de investigar a articulação entre os saberes psicológicos e jurídicos, problematizando seus efeitos na construção discursos sobre a população infanto-juvenil em conflito com a lei. Como procedimentos metodológicos foram realizadas consultas a documentos em nível estadual e nacional, bem como pesquisa bibliográfica sobre estudos referentes ao tema da juventude em conflito com a lei, visita a um Centro de Referência Especializado de Assistência Social (CREAS) e em um presídio masculino estadual, localizado em Campo Grande - MS. Nossa análise se dá a partir da perspectiva foucaultiana, discutindo a produção do encarceramento como forma de punição aplicada à população jovem. Concluímos que o encarceramento, a partir da segurança, opera como uma intervenção proposta para tratar de questões sociais, mas que, contudo, acaba subordinando-as a lógicas individualizantes. (AU)

This article discusses the articulation between psychological and legal epistemological field, problematising their effects on discourses about the youth in conflict with the law. The methodological approach is based on the Brazilian national and regional documents related to youth in conflict with the law, as well on bibliography studies directed to this population, a visit to a Brazilian Specialised Social Services Centre (CREAS) and a visit to a male prison in Campo Grande/Brazil. Our analysis is built on the perspective of Michel Foucault in order to discuss the production of imprisonment as punishment directed to young population. As a conclusion, we state the incarceration is used, in the security discourse, as a strategy to manage social questions into an individual perspective. (AU)

La presente escrita tiene el objetivo de investigar la articulación entre los saberes psicológicos y jurídicos, indagando sus efectos en la composición de uma esfera de comprensión acerca de la población infantil y juvenil en conflicto con la ley. Como procedimientos metodológicos, fueron realizadas consultas a documentos en nível estadual y nacional, así como uma búsqueda bibliográfica sobre estúdios referidos al tema de la juventud en conflicto con la ley, visita a un Centro de Referência Especializado de Assistência Social (CREAS) y en uma prisión estatal masculina, ubicada em Campo Grande - MS. Nuestra análisis ocurrea partir del panorama de Foucault, debatiendo la formación del encarcelamiento como un método punitivo utilizado a los jóvenes. Concluímos que la encarcelacíon, a partir de la seguridad, actua como una intervención propuesta para manejar cuestiones sociales, pero que, sin embargo,acaba subordinándo las a lógicas que, todavia, individualizan. (AU)

Chlamydia trachomatis regulates growth and development in response to host cell fatty acid availability in the absence of lipid droplets.

Chlamydia trachomatis (Ct) is a Gram-negative obligate intracellular pathogen of humans that causes significant morbidity from sexually transmitted and ocular diseases globally. Ct acquires host fatty acids (FA) to meet the metabolic and growth requirements of the organism. Lipid droplets (LDs) are storehouses of FAs in host cells and have been proposed to be a source of FAs for the parasitophorous vacuole, termed inclusion, in which Ct replicates. Previously, cells devoid of LDs were shown to produce reduced infectious progeny at 24 hr postinfection (hpi). Here, although we also found reduced progeny at 24 hpi, there were significantly more progeny at 48 hpi in the absence of LDs compared to the control wild-type (WT) cells. These findings were confirmed using transmission electron microscopy where cells without LDs were shown to have significantly more metabolically active reticulate bodies at 24 hpi and significantly more infectious but metabolically inert elementary bodies at 48 hpi than WT cells. Furthermore, by measuring basal oxygen consumption rates (OCR) using extracellular flux analysis, Ct infected cells without LDs had higher OCRs at 24 hpi than cells with LDs, confirming ongoing metabolic activity in the absence of LDs. Although the FA oleic acid is a major source of phospholipids for Ct and stimulates LD synthesis, treatment with oleic acid, but not other FAs, enhanced growth and led to an increase in basal OCR in both LD depleted and WT cells, indicating that FA transport to the inclusion is not affected by the loss of LDs. Our results show that Ct regulates inclusion metabolic activity and growth in response to host FA availability in the absence of LDs.

A lei em conflito com os jovens: problematizando políticas públicas / The law in conflict with the young: problematising public policies / La ley em conflicto com los jóvenes: problematizando políticas públicas

Este artigo tem como objetivo principal analisar as diferentes lógicas de atendimento à população juvenil em conflito com a lei a partir da elaboração das políticas públicas nos diferentes momentos históricos do cenário brasileiro. Para isso, se analisaram as legislações anteriores que atendiam a esses jovens – com ênfase nas continuidades e descontinuidades dos códigos de menores de 1927 e 1979 - e o atual Estatuto da Criança e do Adolescente. Compreende-se que, apesar das diferenças de racionalidades entre os códigos, estão presentes, nas antigas legislações, dispositivos de continuidade de lógicas discriminantes atualmente ilegítimas, mas que, de certa forma, ainda vigoram. Conclui-se que, mesmo com a vigência do Estatuto da Criança e do Adolescente, é possível perceber, especialmente no que tange às medidas socioeducativas, a presença de lógicas que constam nos antigos códigos de menores. (AU)

The main objective of this article is to analyze the different logics of care for the youth population who are in conflict with the law, based on the evolution of public policies through different historical moments in the Brazilian context. To achieve this, we analyzed the previous legislation regarding these young people - with emphasis on the continuities and discontinuities of the juvenile codes of 1927 and 1979 - and the present Statute of Children and Adolescents. Despite the differences in rationalities between the codes, there are mechanisms in the old laws which maintain discriminatory logics that are currently illegitimate but still in force. In the end, despite the existing Statute of Children and Adolescents, the presence of logics contained in the old juvenile codes can be noted, especially with regard to socio-educational measures. (AU)

El objetivo principal de este artículo es analizar las diferentes lógicas de atención a la población juvenil en conflicto con la ley a partir de la elaboración de las políticas públicas en diferentes momentos históricos del escenario brasileño. Para lograrlo, se analizaron las legislaciones anteriores que contemplaban a esos jóvenes -con énfasis en las continuidades y discontinuidades de los códigos de menores de 1927 y 1979- y el actual Estatuto del Niño y del Adolescente. A pesar de las diferencias de racionalidades entre los códigos, se puede comprender que están presentes, en las antiguas legislaciones, dispositivos de continuidad de lógicas discriminantes actualmente ilegítimas, pero que, de alguna manera, todavía están en vigor. Se concluye que, aunque el Estatuto del Niño y del Adolescente esté vigente, es posible percibir la presencia de lógicas que constan en los antiguos códigos de menores, sobre todo en lo que se refiere a medidas socioeducativas. (AU)

A lei em conflito com os jovens: problematizando políticas públicas / The law in conflict with the young: problematising public policies / La ley em conflicto com los jóvenes: problematizando políticas públicas

Este artigo tem como objetivo principal analisar as diferentes lógicas de atendimento à população juvenil em conflito com a lei a partir da elaboração das políticas públicas nos diferentes momentos históricos do cenário brasileiro. Para isso, se analisaram as legislações anteriores que atendiam a esses jovens – com ênfase nas continuidades e descontinuidades dos códigos de menores de 1927 e 1979 - e o atual Estatuto da Criança e do Adolescente. Compreende-se que, apesar das diferenças de racionalidades entre os códigos, estão presentes, nas antigas legislações, dispositivos de continuidade de lógicas discriminantes atualmente ilegítimas, mas que, de certa forma, ainda vigoram. Conclui-se que, mesmo com a vigência do Estatuto da Criança e do Adolescente, é possível perceber, especialmente no que tange às medidas socioeducativas, a presença de lógicas que constam nos antigos códigos de menores.

The main objective of this article is to analyze the different logics of care for the youth population who are in conflict with the law, based on the evolution of public policies through different historical moments in the Brazilian context. To achieve this, we analyzed the previous legislation regarding these young people - with emphasis on the continuities and discontinuities of the juvenile codes of 1927 and 1979 - and the present Statute of Children and Adolescents. Despite the differences in rationalities between the codes, there are mechanisms in the old laws which maintain discriminatory logics that are currently illegitimate but still in force. In the end, despite the existing Statute of Children and Adolescents, the presence of logics contained in the old juvenile codes can be noted, especially with regard to socio-educational measures.

El objetivo principal de este artículo es analizar las diferentes lógicas de atención a la población juvenil en conflicto con la ley a partir de la elaboración de las políticas públicas en diferentes momentos históricos del escenario brasileño. Para lograrlo, se analizaron las legislaciones anteriores que contemplaban a esos jóvenes -con énfasis en las continuidades y discontinuidades de los códigos de menores de 1927 y 1979- y el actual Estatuto del Niño y del Adolescente. A pesar de las diferencias de racionalidades entre los códigos, se puede comprender que están presentes, en las antiguas legislaciones, dispositivos de continuidad de lógicas discriminantes actualmente ilegítimas, pero que, de alguna manera, todavía están en vigor. Se concluye que, aunque el Estatuto del Niño y del Adolescente esté vigente, es posible percibir la presencia de lógicas que constan en los antiguos códigos de menores, sobre todo en lo que se refiere a medidas socioeducativas.

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study) / Alteraciones del metabolismo mineral, fracturas vertebrales, y calcificaciones aórticas en receptores estables de trasplante renal: papel del género (estudio EMITRAL)

Antecedentes y objetivos: La relación entre las alteraciones del metabolismo mineral, las fracturas óseas y las calcificaciones vasculares en receptores de un trasplante renal no han sido establecidas. Método: Realizamos un estudio transversal en 727 receptores estables procedentes de 28 centros de trasplante españoles. Se determinaron de manera centralizada los parámetros del metabolismo mineral; también se centralizó la semicuantificación de las fracturas vertebrales y de las calcificaciones de la aorta abdominal. Resultados: La deficiencia de vitamina D (25OHD3 < 15ng/ml) fue más frecuente en mujeres y en los estadios CKD-T I-III (29,6 vs. 44,4%; p=0,003). La relación inversa y significativa observada entre los niveles de 25OHD3 y PTH fue modificada por el género de tal manera que la pendiente fue mayor en las mujeres que en los hombres (p=0,01). Un 15% de los receptores mostró alguna fractura vertebral (VFx) con un grado de deformidad ≥2. Los factores relacionados con la VFx diferían en función del género: en los hombres, la edad (OR: 1,04; IC 95%: 1,01-1,06) y el tratamiento con CsA (OR: 3,2; IC 95: 1,6-6,3); en las mujeres la edad (OR: 1,07; IC 95%: 1,03-1,12) y los niveles de PTH (OR per 100pg/ml increase: 1,27; IC 95%: 1,043-1,542). Las calcificaciones de la aorta abdominal fueron comunes (67,2%) y se relacionaron con los factores de riesgo clásicos, pero no con los parámetros del metabolismo mineral. Conclusiones: La deficiencia de vitamina D es más frecuente en las mujeres receptoras de un trasplante renal y en los estadios más tempranos de la CKD-T, y es un factor que contribuye al desarrollo de hiperparatiroidismo secundario. Las VFx prevalentes están relacionadas con unos niveles más elevados de PTH solamente en las mujeres (AU)

Background and objectives: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. Method: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. Results: Vitamin D deficiency (25OHD3 < 15 ng/ml) was more common in female recipients at CKD-T stages I–III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100 pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. Conclusions: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients (AU)

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study).

BACKGROUND AND OBJECTIVES: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. METHOD: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. RESULTS: Vitamin D deficiency (25OHD3<15ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. CONCLUSIONS: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.

Chlamydia trachomatis growth and development requires the activity of host Long-chain Acyl-CoA Synthetases (ACSLs).

The obligate-intracellular pathogen Chlamydia trachomatis (Ct) has undergone considerable genome reduction with consequent dependence on host biosynthetic pathways, metabolites and enzymes. Long-chain acyl-CoA synthetases (ACSLs) are key host-cell enzymes that convert fatty acids (FA) into acyl-CoA for use in metabolic pathways. Here, we show that the complete host ACSL family [ACSL1 and ACSL3-6] translocates into the Ct membrane-bound vacuole, termed inclusion, and remains associated with membranes of metabolically active forms of Ct throughout development. We discovered that three different pharmacologic inhibitors of ACSL activity independently impede Ct growth in a dose-dependent fashion. Using an FA competition assay, host ACSLs were found to activate Ct branched-chain FAs, suggesting that one function of the ACSLs is to activate Ct FAs and host FAs (recruited from the cytoplasm) within the inclusion. Because the ACSL inhibitors can deplete lipid droplets (LD), we used a cell line where LD synthesis was switched off to evaluate whether LD deficiency affects Ct growth. In these cells, we found no effect on growth or on translocation of ACSLs into the inclusion. Our findings support an essential role for ACSL activation of host-cell and bacterial FAs within the inclusion to promote Ct growth and development, independent of LDs.

Non-albuminuric renal disease among subjects with advanced stages of chronic kidney failure related to type 2 diabetes mellitus.

Urinary albumin excretion has been consistently found to be normal in a significant number of subjects with early stages of diabetic kidney disease. This study was aimed to estimate the prevalence and characteristics of non-albuminuric chronic kidney disease associated with type 2 diabetes mellitus among subjects who reach advanced stages of renal failure. Study population was composed of incident patients with advanced chronic kidney disease (glomerular filtration rate <30 mL/min) related to type 2 diabetes in a tertiary hospital from Gran Canaria (Spain) during a period of 2 years. Subjects were classified as normoalbuminuric (urinary albumin-to-creatine ratio [UACR] <30 mg/g), microalbuminuric (UACR ≥30 and <300 mg/g), or proteinuric (UACR ≥300 mg/g). Of 78 eligible patients, 21.8% had normoalbuminuria, 20.5% had microalbuminuria, and 57.7% had proteinuria. Individuals with normoalbuminuria were mostly women and had a lower prevalence of smoking and polyneuropathy than subjects with microalbuminuria or proteinuria. They also presented greater measures of body mass index and waist circumference, higher values of total and LDL cholesterol, and lower values of HbA1c and serum creatinine than subjects with microalbuminuria or proteinuria. Multivariate analysis demonstrated that female sex (positively) and HbA1c and polyneuropathy (negatively) were independently associated with absence of albuminuria. In conclusion, around 20% of subjects with diabetes-related advanced chronic kidney disease, characteristically women, have normal urinary albumin excretion. HbA1c and polyneuropathy are inversely related to this non-albuminuric form of nephropathy.

Clinical relevance of pretransplant anti-HLA donor-specific antibodies: does C1q-fixation matter?

UNLABELLED: Anti-HLA donor-specific antibodies (DSA) identified by single antigen bead array (SAB) are questioned for their excess in sensitivity and lack of event prediction after transplantation. POPULATION AND METHODS: We retrospectively evaluated specific types of preformed DSA (class I, class II or C1q-fixing) and their impact on graft survival. Kidney transplantations performed across negative CDC-crossmatch were included (n=355). Anti-HLA antibodies were tested using SAB to identify DSA and their capacity to fix C1q. RESULTS: Twenty-eight patients with pretransplant DSA(+) with MFI>2000 were selected to assess C1q fixation. DSA were C1q+ in 15 patients and C1q- in 13, without significant differences in demographics, acute rejection, graft loss or renal function. The maximum MFI of DSA in patients with C1q-fixing DSA was significantly higher (p=0.008). Patients with DSA class-I suffered more antibody-mediated rejection (AMR) and had worse graft survival than class-II. The capacity of DSA I to fix C1q did not correlate with rejection, graft function or graft loss. CONCLUSIONS: C1q testing in pretransplant sera with DSA was unable to predict acute antibody-mediated rejection or early graft loss, but the presence of DSA class I compared to DSA only class II did. Despite non-fixing complement in vitro, pretransplant C1q-negative DSA I can mediate rejection and graft loss.

Flexible tethering of primase and DNA Pol α in the eukaryotic primosome.

The Pol α/primase complex or primosome is the primase/polymerase complex that initiates nucleic acid synthesis during eukaryotic replication. Within the primosome, the primase synthesizes short RNA primers that undergo limited extension by Pol α. The resulting RNA-DNA primers are utilized by Pol δ and Pol ε for processive elongation on the lagging and leading strands, respectively. Despite its importance, the mechanism of RNA-DNA primer synthesis remains poorly understood. Here, we describe a structural model of the yeast primosome based on electron microscopy and functional studies. The 3D architecture of the primosome reveals an asymmetric, dumbbell-shaped particle. The catalytic centers of primase and Pol α reside in separate lobes of high relative mobility. The flexible tethering of the primosome lobes increases the efficiency of primer transfer between primase and Pol α. The physical organization of the primosome suggests that a concerted mechanism of primer hand-off between primase and Pol α would involve coordinated movements of the primosome lobes. The first three-dimensional map of the eukaryotic primosome at 25 Å resolution provides an essential structural template for understanding initiation of eukaryotic replication.

Factores clínicos y farmacológicos relacionados con los requerimientos de fotocoagulación láser en pacientes con nefropatía diabética secundaria a diabetes mellitus tipo 2 / Clinical and pharmacological factors related to the requirements of laser photocoagulation in patients with diabetic nephropathy due to type 2 diabetes mellitus

Fundamento y objetivo: La retinopatía diabética es una complicación microvascular de la diabetes mellitus cuya prevalencia está estrechamente relacionada con la presencia de nefropatía y la hipertensión. Los objetivos fueron estudiar qué factores clínicos y farmacológicos se relacionan con una mayor necesidad de fotocoagulación láser en pacientes con nefropatía y retinopatía diabética y, en segundo lugar, determinar las características diferenciales entre ambos subgrupos de pacientes diabéticos tipo 2 según si/no hubieran recibido fotocoagulación láser. Pacientes y métodos: Estudio descriptivo transversal de 63 pacientes seguidos en consulta de Nefropatía Diabética. A los pacientes se les dividió en 2 grupos según hubiesen recibido o no previamente fotocoagulación. En cada subgrupo se estudiaron variables de tipo demográfico, antropométrico, analítico, factores de riesgo cardiovascular y tratamiento que recibían los pacientes para el control de la hipertensión arterial, diabetes u otras enfermedades asociadas. Resultados: Se observó que el grupo que había recibido fotocoagulación tenía más años de evolución de la diabetes, más antecedentes de enfermedad cardiovascular y un aclaramiento de creatinina inferior. Asimismo, el porcentaje de pacientes tratados con carvedilol era significativamente superior en el subgrupo que no había recibido fotocoagulación, mientras que el porcentaje de pacientes tratados con betabloqueantes era significativamente superior en el subgrupo que sí la había recibido, no observándose diferencias en el grado de control de la tensión arterial. Conclusiones: Los factores clínicos y farmacológicos relacionados con una mayor necesidad de fotocoagulación fueron el tiempo de evolución de la diabetes, la historia previa de enfermedad cardiovascular, el grado de insuficiencia renal y el tratamiento con betabloqueantes (AU)

Background and objetive: Diabetic retinopathy is a microvascular complication of diabetes mellitus whose prevalence is closely related to the presence of nephropathy and hypertension. The aim was to study clinical and pharmacological factors that are associated with an increased need for laser photocoagulation in patients with diabetic nephropathy and retinopathy. Patients and methods: Cross sectional study of 63 patients followed in the Diabetic Nephropathy consultation. Patients were divided into 2 groups according to whether or not previously have received photocoagulation. In each subgroup were studied demographic variables, anthropometric, laboratory, cardiovascular risk factors and treatment received by each patient for the control of hypertension, diabetes and others diseases. Results: We observed that the group had received photocoagulation had more years of diabetes evolution, more history of cardiovascular disease and a lower creatinine clearance. Similary, the percentage of patients treated with carvedilol was significantly higher in the subgroup who had not received photocoagulation while the percentage of patients treated with beta-blockers was significantly higher in the subgroup that received photocoagulation; no significant differences was observed in the degree of control blood pressure. Conclusions: Clinical and pharmacological factors related to the requirements of laser photocoagulation were years of diabetes evolution, history of cardiovascular disease, the stage of kidney disease and the treatment with beta-blokers (AU)

[Clinical and pharmacological factors related to the requirements of laser photocoagulation in patients with diabetic nephropathy due to type 2 diabetes mellitus]. / Factores clínicos y farmacológicos relacionados con los requerimientos de fotocoagulación láser en pacientes con nefropatía diabética secundaria a diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: Diabetic retinopathy is a microvascular complication of diabetes mellitus whose prevalence is closely related to the presence of nephropathy and hypertension. The aim was to study clinical and pharmacological factors that are associated with an increased need for laser photocoagulation in patients with diabetic nephropathy and retinopathy. PATIENTS AND METHODS: Cross sectional study of 63 patients followed in the Diabetic Nephropathy consultation. Patients were divided into 2 groups according to whether or not previously have received photocoagulation. In each subgroup were studied demographic variables, anthropometric, laboratory, cardiovascular risk factors and treatment received by each patient for the control of hypertension, diabetes and others diseases. RESULTS: We observed that the group had received photocoagulation had more years of diabetes evolution, more history of cardiovascular disease and a lower creatinine clearance. Similarly, the percentage of patients treated with carvedilol was significantly higher in the subgroup who had not received photocoagulation while the percentage of patients treated with beta-blockers was significantly higher in the subgroup that received photocoagulation; no significant differences was observed in the degree of control blood pressure. CONCLUSIONS: Clinical and pharmacological factors related to the requirements of laser photocoagulation were years of diabetes evolution, history of cardiovascular disease, the stage of kidney disease and the treatment with beta-blockers.

Vascular calcification and 25-hydroxyvitamin D levels in non-dialysis patients with chronic kidney disease stages 4 and 5.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death among chronic kidney disease (CKD) patients. Vascular calcification is highly prevalent in this population and is an independent predictor of cardiovascular mortality. Vascular calcification in uraemic patients is known to be an active and regulated process subject to the action of many promoting and inhibitory factors. The role of vitamin D in this process remains controversial. We evaluated the relationship between serum levels of 25-hydroxyvitamin D (25(OH)D) and vascular calcification evaluated by plain X-ray images, in predialysis patients with CKD stages 4 and 5. METHODS: We performed a cross-sectional study with 210 CKD patients stages 4 and 5 managed at our predialysis unit. Patients were 63.5 ± 13 years of age, 60.5% males, 64.8% diabetics and 47.1% with a history of CVD. Plain X-ray images of pelvis, hands and lateral lumbar spine from all subjects were studied for calculation of semiquantitative vascular calcification scores as described by Adragao and Kauppila. RESULTS: We found a high prevalence of vascular calcification in our population. Adragao scores revealed only 47 patients (22.4%) without vascular calcification and 120 (57.1%) with scores higher than 3. Kauppila scores revealed only 29 patients (13.8%) without aortic calcifications and 114 patients (54.3%) with scores higher than 7. Higher vascular calcification scores were related to older age, diabetes, history of CVD and lower levels of 25(OH)D. Only 18.5% of patients had adequate levels of 25(OH)D (> 30 ng/mL), 53.7% of them had insufficient levels (15-30 ng/mL) and 27.8% had deficient levels (< 15 ng/mL). Multivariate analysis showed that age, diabetes and CVD were directly associated and 25(OH)D levels were inversely associated with vascular calcifications. CONCLUSIONS: Our results show an independent and negative association between serum levels of 25(OH)D and vascular calcification. Further and larger prospective studies are needed to clarify the possible role of vitamin D deficiency in the development of vascular calcification in CKD patients.