Volatile metabolites produced by different flor yeast strains during wine biological ageing.

Sherry white wine called Fino is produced by dynamic biological ageing under the action of flor yeasts using traditional practices aimed at ensuring uniform quality and characteristics over time. These kinds of yeasts provide typical sensory properties to Fino wines. Although there are studies of the volatile composition of these wines submitted to biological ageing in wood barrels, there is a lack of knowledge on the particular volatile profile produced by different flor yeast strains from Sherry zone wineries. For this reason, the aim of this study was to analyse the volatile profiles produced by 15 pure culture flor velum yeasts, with the goal of observing their suitability for obtaining high quality Fino sherry wines. Volatile composition was determined by dual sequential stir bar sorptive extraction, followed by GC-MS analysis. All yeast strains studied produced the increase of most acetals, highlighting acetaldehyde diethylacetal which was the compound that most increased. Among terpenes, nerolidol and farnesol underwent remarkable increases. However, results showed that in a month of biological ageing, significant differences were observed among the volatile metabolites produced by flor yeast strains studied. Only some of them stood out for their high production of volatile compounds characteristic of Sherry Fino wines, which are good candidates for producing starter cultures.

Guía clínica española del acceso vascular para hemodiálisis / Spanish clinical guidelines on vascular access for haemodialysis

El acceso vascular para hemodiálisis es esencial para el enfermo renal tanto por su morbimortalidad asociada como por su repercusión en la calidad de vida. El proceso que va desde la creación y mantenimiento del acceso vascular hasta el tratamiento de sus complicaciones constituye un reto para la toma de decisiones debido a la complejidad de la patología existente y a la diversidad de especialidades involucradas. Con el fin de conseguir un abordaje consensuado, el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV), que incluye expertos de las cinco sociedades científicas implicadas (nefrología [S.E.N.], cirugía vascular [SEACV], radiología vascular e intervencionista [SERAM-SERVEI], enfermedades infecciosas [SEIMC] y enfermería nefrológica [SEDEN]), con el soporte metodológico del Centro Cochrane Iberoamericano, ha realizado una actualización de la Guía del Acceso Vascular para Hemodiálisis publicada en 2005. Esta guía mantiene una estructura similar, revisando la evidencia sin renunciar a la vertiente docente, pero se aportan como novedades, por un lado, la metodología en su elaboración, siguiendo las directrices del sistema GRADE con el objetivo de traducir esta revisión sistemática de la evidencia en recomendaciones que faciliten la toma de decisiones en la práctica clínica habitual y, por otro, el establecimiento de indicadores de calidad que permitan monitorizar la calidad asistencial.

Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support.

Monitoring Cole-Cole parameters during haemodialysis (HD).

UNLABELLED: The investigation of the hydration process during the haemodialysis treatment sessions is very important for the development of methods for predicting the unbalanced fluid shifts and hypotension crisis hence improving the quality of the haemodialysis procedure. Bioimpedance measurements can give valuable information about the tissue under measurement, therefore characterizing the tissue. In this work we propose a non-invasive method based on local multifrequency bioimpedance measurements that allow us to determine the fluid distribution and variations during haemodialysis. METHODS: Clinical measurements were done using 10 HD patients during 60 HD sessions. Bioimpedance data, ultrafiltration volume, blood volume and blood heamatocrit variations were recorded continuously during the HD sessions. Bioimpedance of the local tissue was measured with a 4-elctrode impedance system using surface electrodes with sampling rate of 1meas./4min. at 6 different frequencies. The measured impedances were fitted into Cole-Cole model and the Cole-Cole parameters were continuously determined for each measurement point during the HD session. ANALYSIS: The 4 Cole-Cole parameters (R 00, R 0, Fc,alpha) and their variations were evaluated. Impedance values at infinite and zero (R 00, R 0) frequencies were extrapolated from Cole-Cole mathematical model. These values are assumed to represent the impedance of total tissue fluid and the impedance of the extracellular space respectively.

[Advance directives in chronic dialysis patients]. / Documento de voluntades anticipadas de pacientes con insuficiencia renal crónica terminal en tratamiento sustitutivo mediante diálisis.

BACKGROUND AND OBJECTIVE: Knowledge of the life-sustaining treatment preferences of the dialysis patients would be extremely helpful to substitute decision-makers and nephrologists in deciding whether to continue or stop a treatment. The population of the Mediterranean countries show this opinion with less frequency. The objective of this study is: 1) the knowledge of the patient's view for the advance directives; it may increase the likelihood to get the correct decisions of the staff when complications break the normal course of chronic dialysis, and 2) the statement of the advance directives. MATERIAL AND METHOD: We distributed 135 questionnaires to patients with chronic renal failure in dialysis treatment of the Sabadell's Hospital to explore demographic information about responders and not-responders and explore the rate of questionnaires was completed about the cardiopulmonary resuscitation, respirator, tube feeding and dialysis in case of coma, persistent vegetative state, severe dementia and terminal illness. We explore about the representative of patients and in case of not-responders about the cause to not answer. RESULTS: Sixty-four of 135 patients (47,8%) did not want cardiopulmonary resuscitation, respirator, tube feeding or dialysis in case of coma, persistent vegetative state, severe dementia or terminal illness. Compared with patients who wanted the treatments, those who did not were older (71,2 versus 62,2 years; p = 0.002). There was no difference in the other demographic questions, including sex (p=0.674), cause of kidney failure (p=0.815), comorbid conditions (p=0.824), and social status (language of questionnaire -0.155- and standard of education -0.288-). Advance care planning does not occur solely within the context of the physician-patient relationship; the respondents reported the representative in the family, essentially. The patients not-responders doesn t want to think in those situations and also they show doubt about the interpretation of their answers. CONCLUSIONS: near 50% patients in chronic dialysis want to stop certain treatments in case of resuscitation cardiopulmonary, coma, persistent vegetative state, severe dementia or terminal illness. The older patients want the limitation of treatments more frequently.

[Choosing not to dialysis in chronic renal failure in stage V (Renal Failure). Evolution of the characteristics of patients between 1992-1995 and 2000-2003]. / Elección de no diálisis en insuficiencia renal crónica en estadio V (fallo renal). Evolución de las características de los pacientes entre 1992-1995 y 2000-2003.

BACKGROUND: The incidence of chronic renal failure increase with the age. The selection of patient to dialysis has been increasing in spite of the high comorbidity. Moreover, in our clinical practice the aged patient is not contraindicated to dialysis. However, in the nephrology clinical practice not all the patients start the treatment with dialysis. OBJECTIVE The aim of our study has been to compare the characteristics of the patients who had not been dialyzed between the periods 1992-1995 and 2000-2003 to analyze the trend of the nephrology clinical practice. MATERIAL AND METHODS: Comparative study of the characteristics and the evolution of patients with chronic renal failure in stage V, (renal failure) not incorporated to dialysis in one hospital during four years between the periods the 1992-1995 ( period A) and 2000-2003 (period B). RESULTS: Start dialysis (period A versus period B): 116 patients, age 59.9+15.5 years vs. 229 patients, age 64.0+15.8 years (p<0.05). Non-dialysis (period A versus period B): 38 patients, age 77.5+9.3 years vs. 37 patients, age 81.7+6.2 years (p<0.01). Renal function: serum creatinina 7.4+2.4 mg/dl vs. 5.3+1.2 mg/dl (p<0.001), MDRD estimate glomerular filtration 6.9+2.4 mg/dl ml/min/1.73 m2 vs. 10.0+2.3 ml/min/1.73 m2 (p<0.001). Primary renal disease: unknown etiology 31.5 % vs. 24.3 %, nephroangiosclerosis 23.6 % vs. 32.4 %, diabetes 28.9 % vs. 21.6 %. Functional status: dependent patients 34.2 % vs 83.8 % (p<0.001). The principal reason for non-dialysis were: personal decision: 26.3 % vs. 35.1 %, dementia 15.8 % vs. 29.7 %, brief life expectancy because of serious co-existing diseases 13.1 % vs. 21.7 % and serious chronic illness with inability for themselves care 44.7 % vs. 13.1 %. Comorbid conditions: 2.3+1.0 vs. 3.0+1.5 (p<0.05). Survival: 55+168 days vs. 168+236 days (p<0.001). CONCLUSION: Most of the patients that don't begin dialysis are elderly together with a poor functional capacity and with more autonomy in their decisions. The identification of patients with renal failure (stage V) was detected early in the last period than in the following one. The conservative management of non-dialyzed uremic patients is a significative nephrology clinical practice due to more survival of those persons.

[Secondary amyloidosis (AA-type) due to localized cutaneous vasculitis]. / Amiloidosis secundaria asociada a vasculitis cutánea localizada.

We report a case of a 49 year old man, diagnosed soon after the outcome of casual proteinuria, of AA-type amyloidosis in relation to small and medium vessel cutaneous vasculitis without systemic involvement. This combination is a rare entity and only two cases of cutaneous hypersensibility vasculitis complicated with AA-type amyloidosis had been reported. We describe the results of the use of several immunosuppressive drugs during four years follow up with temporally total remission of the disease.

Elección de no diálisis en insuficiencia renal crónica en estadio V (fallo renal). Evolución de las características de los pacientes entre 1992-1995 y 2000-2003 / Choosing not to dialysis in chronic renal failure in stage V (renal failure). Evolution of the characteristics of patients between 1992-1995 and 2000-2003

Introducción: La insuficiencia renal crónica (IRC) es una patología que aumenta su incidencia con la edad. La aceptación de pacientes para diálisis ha ido aumentando en los últimos años a pesar del incremento de la comorbilidad, no considerándose la edad como contraindicación para el tratamiento sustitutivo renal. No obstante, en la práctica clínica nefrológica hay pacientes que no son incluidos en diálisis. Objetivo: Comparar las características de los pacientes con IRC no incluidos en diálisis en los períodos 1992-1995 y 2000-2003 para analizar las tendencias evolutivas de la práctica clínica nefrológica. Material y método: Estudio comparativo de las características basales y la evolución de los pacientes con IRC en estadio de fallo renal (estadio V) en quienes se decidió la elección de No-Diálisis atendidos en un sólo hospital durante 4 años entre los períodos de 1992-1995 (período A) y 2000-2003 (período B). La elección de No-Diálisis fue por decisión del paciente si era autónomo o de sus representantes legales en caso contrario. Resultados: SI-Diálisis: (período A versus período B): n:116 pacientes, edad: 59,9 + 15,5 años vs n: 229 pacientes, edad: 64,0 + 15,8 años (p < 0,05). NO-Diálisis: (período A versus período B): n: 38 pacientes, 24,6% de la IRC que inició diálisis, edad: 77,5 + 9,3 años vs n: 37 pacientes, 13,9% de la IRC que inició diálisis, edad: 81,7 + 6,2 años (p < 0,01). Funcionalismo renal: creatinine sérica 7,4 + 2,4 mg/dl vs 5,3 + 1,2 mg/dl (p < 0,001); filtrado glomerular estimado por MDRD abreviado: 6,9 + 2,4 ml/min/1,73 m2 vs 10,0 + 2,3 ml/min/1,73 m2 (p < 0,001). Enfermedad renal primaria principales: etiologia no aclarada 31,5% vs 24,3%, nefroangiosclerosis 23,6% vs 32,4%, diabetes 28,9 vs 21,6. Los motivos principales de la elección de no diálisis fueron: decisión personal 26,3% vs 35,1%, incompetencia mental persistente 15,8% vs 29,7%, pronóstico mortal a corto plazo 13,1% vs 21,7% y deterioro crónico severo con incapacidad de cuidarse 44,7% vs 13,5%. Autonomia funcional: pacientes dependientes 34,2% vs 83,8% (p < 0,001). Comorbilidades: 2,3 + 1,0 vs 3,0 + 1,5 procesos (p < 0,05), insuficiencia cardíaca 36,8% vs 48,8%, enfermedad cerebro-vascular 47,3% vs 51,3%, artropatía invalidante 13,1% vs 43,2%. Supervivencia media 55 + 168 días vs 168 + 236 días (p < 0,001). Conclusión: Los pacientes que no inician diálisis en los últimos años son más viejos, tienen peor capacidad física y son más autónomos en su capacidad de decisión. La identificación de los pacientes con IRC en estadio V se hace de forma más precoz y el seguimiento es más prolongado en el último período. El manejo nefrológico conservador de la IRC estadio V es una práctica clínica nefrológica significativa debido a la mayor supervivencia de estos pacientes

Background: The incidence of chronic renal failure increase with the age. The selection of patient to dialysis has been increasing in spite of the high comorbidity. Moreover, in our clinical practice the aged patient is not contraindicated to dialysis. However, in the nephrology clinical practice not all the patients start the treatment with dialysis. Objective: The aim of our study has been to compare the characteristics of the patients who had not been dialyzed between the periods 1992-1995 and 2000- 2003 to analyze the trend of the nephrology clinical practice. Material and met- hods: Comparative study of the characteristics and the evolution of patients with chronic renal failure in stage V (renal failure) not incorpored to dialysis in one hospital during four years between the periods the 1992-1995 (period A) and 2000-2003 (period B). Results: Start dialysis (period A versus period B): 116 patients, age 59.9 + 15.5 years vs 229 patients, age 64.0 + 15.8 years (p < 0.05). Non-dialysis (period A versus period B): 38 patients, age 77.5 + 9.3 years vs 37 patients, age 81.7 + 6.2 years (p < 0.01). Renal function: serum creatinina 7.4 + 2.4 mg/dl vs 5.3 + 1.2 mg/dl (p < 0.001), MDRD estimate glomerular filtration 6.9 + 2.4 mg/dl ml/min/1.73 m2 vs 10.0 + 2.3 ml/min/1.73 m2 (p < 0.001). Primary renal disease: unknown etiology 31.5% vs 24.3%, nephroangiosclerosis 23.6% vs 32.4%, diabetes 28.9% vs 21.6%. Functional status: dependent patients 34.2% vs 83.8% (p < 0.001). The principal reason for non-dialysis were: personal decision: 26.3% vs 35.1%, dementia 15.8% vs 29.7%, brief life expectancy because of serious co-existing diseases 13.1% vs. 21.7% and serious chronic illness with inability for themselves care 44.7% vs 13.1%. Comorbid conditions: 2.3 + 1.0 vs 3.0 + 1.5 (p < 0.05). Survival: 55 + 168 days vs 168 + 236 days (p < 0.001). Conclusión: Most of the patients that don’t begin dialysis are elderly together with a poor functional capacity and with more autonomy in their decisions. The identification of patients with renal failure (stage V) was detected early in the last period than in the following one. The conservative management of non-dialyzed uremic patients is a significative nephrology clinical practice due to more survival of those persons

Documento de voluntades anticipadas de pacientes con insuficiencia renal crónica terminal en tratamiento sustitutivo mediante diálisis / Advance directives in chronic dialysis patients

Fundamento y objetivo: En la cultura latina no hay experiencia sobre estudios que definan la opinión de los pacientes con enfermedades crónicas acerca de cómo quisieran ser tratados en caso de complicaciones severas que inhabiliten su calidad de vida y su capacidad para decidir. El objetivo del estudio es: 1) tener el conocimiento de esas opiniones que podrían facilitar las decisiones de los médicos que tratan a estos enfermos, en el caso especial de surgir complicaciones que alteren esa capacidad de decidir de los pacientes, y 2) la invitación a la verdadera elaboración de un documento de voluntades anticipadas. Material y método: Se facilita un cuestionario a 135 pacientes de la Unidad de Hemodiálisis del hospital de Sabadell, en el que se les pregunta si desearían limitaciones terapéuticas (resucitación cardiopulmonar en caso de paro cardiorrespiratorio, ventilación mecánica, alimentación artificial, seguir en proceso de diálisis) en caso de estar en coma profundo, estado vegetativo, demencia profunda irreversible o enfermedad crónica en fase terminal. Se establecen diferencias epidemiológicas entre los pacientes que manifiestan desear esas limitaciones en esas circunstancias y los que no lo hacen. Se pregunta sobre el representante en caso de incapacidad y acerca de los motivos por los que no contestan a los pacientes que no responden el cuestionario. Resultados: Entre los dos grupos de pacientes, tan sólo la edad les diferencia significativamente (p = 0,002) pues el promedio de edad de los enfermos que quisieran limitaciones es de 71,2 años y el del que no manifiestan querer limitaciones es de 62,2 años. El sexo (p = 0,674), comorbilidad (p = 0,824), estudios (p = 0,288), factores culturales como el idioma (p = 0,155) y nefropatía primaria (p = 0,815) no ofrecen diferencias entre ambos grupos. Un 47,8% de los pacientes de nuestro medio tratados con diálisis crónica, se manifiestan abiertamente partidarios de limitar esfuerzos terapéuticos en alguna de las circunstancias mencionadas. La mayoría de pacientes que realizan voluntades anticipadas tienen como representante un familiar, especialmente hijos. Los que no responden al cuestionario no lo hacen principalmente por rechazar la posibilidad de pensar en ello y también por desconfianza. Conclusiones: En nuestro medio, casi el 50% de los pacientes tratados mediante hemodiálisis periódica son partidarios de limitar ciertos tratamientos en circunstancias de pronóstico infausto, siendo los enfermos más ancianos los más partidarios a manifestar la voluntad sobre esas limitaciones

Background and objective: Knowledge of the life-sustaining treatment preferences of the dialysis patients would be extremely helpful to substitute decision-makers and nephrologists in deciding whether to continue or stop a treatment. The population of the Mediterranean countries show this opinion with less frequency. The objective of this study is: 1) the knowledge of the patient´s view for the advance directives; it may increase the likelihood to get the correct decisions of the staff when complications break the normal course of chronic dialysis, and 2) the statement of the advance directives. Material and method: We distributed 135 questionnaires to patients with chronic renal failure in dialysis treatment of the Sabadell´s Hospital to explore demographic information about responders and not-responders and explore the rate of questionnaires was completed about the cardiopulmonary resuscitation, respirator, tube feeding and dialysis in case of coma, persistent vegetative state, severe dementia and terminal illness. We explore about the representative of patients and in case of notresponders about the cause to not answer. Results: Sixty-four of 135 patients (47,8%) did not want cardiopulmonary resuscitation, respirator, tube feeding or dialysis in case of coma, persistent vegetative state, severe dementia or terminal illness. Compared with patients who wanted the treatments, those who did not were older (71,2 versus 62,2 years; p = 0.002). There was no difference in the other demographic questions, including sex (p = 0.674), cause of kidney failure (p = 0.815), comorbid conditions (p = 0.824), and social status (language of questionnaire —0.155— and standard of education —0.288—). Advance care planning does not occur solely within the context of the physician-patient relationship; the respondents reported the representative in the family, sons and daughters, particulary. The patients not-responders doesn´t want to think in those situations and also they show doubt about the interpretation of their answers. Conclusions: Near 50% patients in chronic dialysis want to stop certain treatments in case of resuscitation cardiopulmonary, coma, persistent vegetative state, severe dementia or terminal illness. The older patients want the limitation of treatments more frequently

Amiloidosis secundaria asociada a vasculitis cutánea localizada / Secondary amyloidosis (AA-type) due to localized cutaneous vasculitis summary

Presentamos el caso de un paciente de 49 años de edad, diagnosticado a raíz del hallazgo de proteinuria aislada, de amiloidosis AA asociada a vasculitis de mediano y pequeño calibre con afectación exclusivamente cutánea. Esta asociación es muy poco frecuente y sólo se han descrito dos casos de vasculitis por hipersensibilidad y amiloidosis AA. Comentamos la evolución a lo largo de cuatro años en que ha sido tratado con distintos inmunosupresores, consiguiendo algún período de remisión completa de la enfermedad

We report a case of a 49 years old man, diagnosed soon after the outcome of casual proteinuria, of AA-type amyloidosis in relation to small and medium vessel cutaneous vasculitis without systemic involvement. This combination is a rare entity and only two cases of cutaneous hipersensiblility vasculitis complicated with AA-type amyloidosis had been reported. We describe the results of the use of several inmunossupressive drugs during four years follow up with temporally total remission of the disease

Diagnóstico y pronóstico de la enfermedad ateroembólica / Diagnosis and prognosis of atheroembolic disease

La enfermedad ateroembólica suele desencadenarse a partir de técnicas diagnósticasy terapéuticas vasculares invasivas, o a partir del tratamiento con anticoagulanteso fibrinolíticos. Se caracteriza por la oclusión de arteriolas desde placasateromatosas, con componente de colesterol, liberadas en general desde la aorta.El riñón es probablemente el órgano que más se afecta por su localización próximaa la aorta abdominal, y por la cantidad de flujo sanguíneo que recibe.Describimos los factores epidemiológicos de 19 casos diagnosticados por criterioshistológicos en 18 de ellos, resaltando la eosinofilia y la insuficiencia renalprogresiva como datos clínicos orientativos de la enfermedad, en pacientes connefropatía isquémica y arteriosclerosis generalizada. Un 53% de los pacientes sepresentan con el antecedente de cateterismo o maniobra quirúrgica vascular; un26% de manera totalmente espontánea.Resaltamos la importancia de la biopsia renal en el diagnóstico de la enfermedadateroembólica, y su mal pronóstico general con una mortalidad del 63% enun seguimiento medio de 18 meses. Resaltamos el fallo multiorgánico como causade fallecimiento en los pacientes que se presentan con formas similares a una vasculitissistémica. Y resaltamos la insuficiencia renal con requerimiento de diálisis,como índice de mal pronóstico en los enfermos que se presentan de forma subaguda.El conocimiento de la enfermedad y su prevención resultan las terapéuticasmás eficaces

Atheroembolic disease is recognized as an iatrogenic complication from an invasivevascular procedure, such as manipulation of the aorta during angiographyor vascular surgery, and after anticoagulant and fibrinolytic therapy. Cholesterolcrystal embolism is caused by showers of cholesterol crystals from an atheroscleroticaorta that occlude small arteries. The kidney is a frequent target organ for cholesterol emboli because of proximity of the renal arteries to abdominal aortaand it receive an enormous amount of blood flows.We describe the epidemiologic agents of 19 cases that were diagnosed by histologicsections of the affected tissues; the eosinophilia and the renal failure arethe clinical features that guide to the diagnosis, in patients with ischemic nephropathyand general atherosclerosis. 53% among patients had a previous invasiveprocedure and 26% occurred spontaneously.We remark the importance of the kidney’s biopsy in diagnosis of the atheroembolicdisease and their bad prognosis with 63% of death rate in 18 months ofaverage follow-up. We report patients with the multiple cholesterol emboli syndromemimicking systemic vasculitis: they died by multivisceral acute failure. Thesubacute presentation of atheroembolic disease with progressive renal failure treatedwith hemodialysis is a sign of bad prognosis. The knowledge of the diseaseand their prevention are the better treatment

[Ischemic renal disease: revascularization or conservative treatment?]. / Nefropatía isquémica: revascularización o tratamiento médico conservador?

Ischemic nephropathy is recognized as a distinct cause of renal insufficiency and it is defined as a significant reduction in glomerular filtration rate in patients with hemodynamically significant renovascular occlusive disease. We argue the epidemiologic and clinical manifestations of atherosclerotic renovascular disease, and we evaluate the pronostic agents. Published studies of the outcome of revascularization for renal-artery stenosis have been excellent, offering a durable patency and functional improvement but they have had numerous limitations. The atherosclerosis is a systemic disease and it provides the general prognosis of patients. We conclude that ischemic renal disease is a nephropathy of smoker men, with proteinuria excretion similar to nephropathy with unilateral stenosis. The age of patients is the clinical feature that decide the treatment: surgery, angioplasty/stent or medical management. Comparative analysis of percutaneous transluminal angioplasty and operation for renal revascularization and medically treated patients have proved that the advanced chronic renal insufficiency is associated with an unfavourable response of treatment of the ischemic nephropathy. But, in this nephropathy the revascularization can be the better therapy for selected patients. The revascularization with angioplasty/stent for patients with unilateral renal stenosis and chronic renal insufficiency has a doubtful effectiveness, as the chronic renal failure is result of nephroangiosclerosis.

[Diagnosis and prognosis of atheroembolic disease]. / Diagnóstico y pronóstico de la enfermedad ateroembólica.

Atheroembolic disease is recognized as an iatrogenic complication from an invasive vascular procedure, such as manipulation of the aorta during angiography or vascular surgery, and after anticoagulant and fibrinolytic therapy. Cholesterol crystal embolism is caused by showers of cholesterol crystals from an atherosclerotic aorta that occlude small arteries. The kidney is a frequent target organ for cholesterol emboli because of proximity of the renal arteries to abdominal aorta and it receive an enormous amount of blood flows. We describe the epidemiologic agents of 19 cases that were diagnosed by histologic sections of the affected tissues; the eosinophilia and the renal failure are the clinical features that guide to the diagnosis, in patients with ischemic nephropathy and general atherosclerosis. 53% among patients had a previous invasive procedure and 26% occurred spontaneously. We remark the importance of the kidney's biopsy in diagnosis of the atheroembolic disease and their bad prognosis with 63% of death rate in 18 months of average follow-up. We report patients with the multiple cholesterol emboli syndrome mimicking systemic vasculitis: they died by multivisceral acute failure. The subacute presentation of atheroembolic disease with progressive renal failure treated with hemodialysis is a sign of bad prognosis. The knowledge of the disease and their prevention are the better treatment.

Ritmo nictameral de la presión arterial / Nictameral rythm and neurohumoral relationship. Dippers and non-dippers patients

No disponible

A plant defense response effector induces microbial apoptosis.

Osmotin is a tobacco PR-5 protein that has antifungal activity and is implicated in host-plant defense. We show here that osmotin induces apoptosis in Saccharomyces cerevisiae. Induction of apoptosis was correlated with intracellular accumulation of reactive oxygen species and was mediated by RAS2, but not RAS1. Osmotin treatment resulted in suppression of transcription of stress-responsive genes via the RAS2/cAMP pathway. It was therefore concluded that osmotin induced proapoptotic signaling in yeast. The results indicate that the ability of antimicrobial proteins to induce microbial apoptosis could be an important factor in determining a pathogen's virulence and could therefore be targeted for the design of new antifungal drugs.

Resistance to the plant PR-5 protein osmotin in the model fungus Saccharomyces cerevisiae is mediated by the regulatory effects of SSD1 on cell wall composition.

The capacity of plants to counter the challenge of pathogenic fungal attack depends in part on the ability of plant defense proteins to overcome fungal resistance by being able to recognize and eradicate the invading fungi. Fungal genes that control resistance to plant defense proteins are therefore important determinants that define the range of fungi from which an induced defense protein can protect the plant. Resistance of the model fungus Saccharomyces cerevisiae to osmotin, a plant defense PR-5 protein, is strongly dependent on the natural polymorphism of the SSD1 gene. Expression of the SSD1-v allele afforded resistance to the antifungal protein. Conversely, yeast strains carrying the SSD1-d allele or a null ssd1Delta mutation displayed high sensitivity to osmotin. The SSD1-v protein mediates osmotin resistance in a cell wall-dependent manner. Deletion of SSD1-v or SSD1-d impeded sorting of the PIR proteins (osmotin-resistance factors) to the cell wall without affecting mRNA levels, indicating that SSD1 functions in post-transcriptional regulation of gene expression. The sensitivity of ssd1Delta cells to osmotin was only partially suppressed by over-accumulation of PIR proteins in the cell wall, suggesting an additional function for SSD1 in cell wall-mediated resistance. Accordingly, cells carrying a null ssd1 mutation also displayed aberrant cell-wall morphology and lower levels of alkali-insoluble cell-wall glucans. Therefore SSD1 is an important regulator of fungal cell-wall biogenesis and composition, including the deposition of PIR proteins which block the action of plant antifungal PR-5 proteins.

Fungal cell wall phosphomannans facilitate the toxic activity of a plant PR-5 protein.

Osmotin is a plant PR-5 protein. It has a broad spectrum of antifungal activity, yet also exhibits specificity for certain fungal targets. The structural bases for this specificity remain unknown. We show here that full sensitivity of Saccharomyces cerevisiae cells to the PR-5 protein osmotin is dependent on the function of MNN2, MNN4 and MNN6. MNN2 is an alpha-1, 2-mannosyltransferase catalyzing the addition of the first mannose to the branches on the poly l,6-mannose backbone of the outer chain of cell wall N-linked mannans. MNN4 and MNN6 are required for the transfer of mannosylphosphate to cell wall mannans. Null mnn2, mnn4 or mnn6 mutants lack phosphomannans and are defective in binding osmotin to the fungal cell wall. Both antimannoprotein antibody and the cationic dye alcian blue protect cells against osmotin cytotoxicity. MNN1 is an alpha-1,3-mannosyltransferase that adds the terminal mannose to the outer chain branches of N-linked mannan, masking mannosylphosphate. Null mnn1 cells exhibit enhanced osmotin binding and sensitivity. Several cell wall mannoproteins can bind to immobilized osmotin, suggesting that their polysaccharide constituent determines osmotin binding. Our results demonstrating a causal relationship between cell surface phosphomannan and the susceptibility of a yeast strain to osmotin suggest that cell surface polysaccharides of invading pathogens control target specificity of plant PR-5 proteins.

Osmotin, a plant antifungal protein, subverts signal transduction to enhance fungal cell susceptibility.

The plant pathogenesis-related protein osmotin is an antifungal cytotoxic agent that causes rapid cell death in the yeast S. cerevisiae. We show here that osmotin uses a signal transduction pathway to weaken defensive cell wall barriers and increase its cytotoxic efficacy. The pathway activated by osmotin includes the regulatory elements of the mating pheromone response STE4, STE18, STE20, STE5, STE11, STE7, FUS3, KSS1, and STE12. Neither the pheromone receptor nor its associated G protein alpha subunit GPA1 are required for osmotin action. However, mutation of SST2, a negative regulator of G alpha proteins, resulted in supersensitivity to osmotin. Phosphorylation of STE7 was rapidly stimulated by osmotin preceding any changes in cell vitality or morphology. These results demonstrate that osmotin subverts target cell signal transduction as part of its mechanism of action.