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IgA Nephropathy: Are We Doing Enough?

Open Journal of Nephrology 2023年第2期13卷 116-125页

作者： Jose Lucas Daza Yaroslad de la Cruz Luis Puello gerardo gutierrez Alexander Ariza Antonio Vasquez Orlando Ariza Department of Internal Medicine Nephrology University of Buenos Aires Buenos Aires Argentina Department of Internal Medicine Hematology University of Buenos Aires Buenos Aires Argentina Department of Internal Medicine University of Buenos Aires Buenos Aires Argentina Department of Internal Medicine Cardiology University of Buenos Aires Buenos Aires Argentina

Immunoglobulin A nephropathy (IgAN) was first identified and described as a disease by Berger and Hinglais in 1968. It is the most common primary glomerulopathy worldwide [1], most prevalent in East Asians and Caucasians and rare in black individuals. There are four key elements that contribute to IgAN, which determine the severity, course, and prognosis of the disease: circulating IgA immunocomplexes that favor mesangial deposition, the efficiency of the reticuloendothelial system, mesangial cell affinity and reaction to mesangial accumulation of poorly glycosylated IgA1, and the renal tendency to glomerulosclerosis and interstitial fibrosis. Clinical manifestations among patients with IgAN include hematuria, approximately 40% to 50% of cases present with one or more episodes of hematuria, usually preceded by upper respiratory tract infections. Between 30% and 40% present with hematuria and non-nephrotic range proteinuria that may be associated with arterial hypertension and impaired renal function. The TESTING study reveal a significant decrease in outcomes such as the risk of a 40% decrease in glomerular filtration rate or the need for renal replacement therapy in the group treated with steroids. The decrease in renal function compared to the group treated in the previously mentioned STOP-IgAN trial was 4 times less than in the TESTING study. Are we doing enough? Obviously, more trials are required with the use of adequate nephroprotection measures. We present 3 patients with a diagnosis of IgA nephropathy who attend the follow-up consultation and voluntarily decide to take part in the review.

关键词： Immunoglobulin A Nephropathy (IgAN) Inhibition of the Renin-Angiotensin System (ACEI/ARA II) End-Stage Renal Disease (ESRD)

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Can Peripheral Venous Gases Replace Arterial Gases in a Patient with Chronic Kidney Disease?

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Open Journal of Nephrology 2023年第2期13卷 150-160页

作者： Jose Lucas Daza Yaroslad de la Cruz gerardo gutierrez Luis Puello Victor Aldana Antonio Vasquez Orlando Ariza Alexander Ariza Andres Cardenas Department of Internal Medicine Nephrology University of Buenos Aires Buenos Aires Argentina Department of Internal Medicine Cardiology and Epidemiology School of Medicine Universidad de Los Andes Bogotá Colombia Department of Internal Medicine University of Buenos Aires Buenos Aires Argentina Department of Internal Medicine Cardiology University of Buenos Aires Buenos Aires Argentina Department of Internal Medicine Hematology University of Buenos Aires Buenos Aires Argentina Department of General Medicine University Cooperativa Santa MartaColombia

Introduction: Metabolic acidosis (MA) is a frequent alteration in chronic kidney disease (CKD) that is associated with numerous complications, which is why its correction is recommended. Oral sodium bicarbonate is currently the treatment of choice. Objective: The objective is to determine if venous bicarbonate is equal to arterial bicarbonate in the follow-up of a patient with chronic kidney disease. Materials Methods: Single-center Cross-sectional studies in a cohort of adult patients with stage 4 - 5 CKD. Samples were taken between January 2022 and January 2023, in a Clinic in the city of Ibague/ Colombia obtained from the radial artery. The inclusion criteria were: not being treated with alkaline at the time of inclusion. Results: A total of 71 patients were included, 73.2% male (52) and 26.8% female (19), with different stages: stage 3 with 5.6% (4), stage 4 with 60.6% (43), stage 5 with 33.8% (23). 66.2% were diabetic, 88.7% had arterial hypertension, and 15.5% of the patients presented hematoma as a complication and pain associated with arterial puncture. The result of mean venous bicarbonate was 18.8 with a standard deviation of 2.3, arterial bicarbonate a mean of 19.4 with a standard deviation of 2.1 with a value of P 0.46, venous pH with a mean of 7.37 with a standard deviation of 0.48 and a mean arterial pH of 7.38 with a standard deviation of 0.48 with a P value of 0.01. Values of venous bicarbonate compared to arterial bicarbonate showed no statistically significant difference in patients with chronic kidney disease, but there were more complications such as hematoma and pain in patients in the arterial puncture cohort, because of this result venous bicarbonate corresponds to arterial bicarbonate, but has less risk of complications associated with the procedure. Conclusion: Metabolic acidosis is a frequent alteration in advanced chronic kidney disease, these results showed that the values of arterial and venous bicarbonate have no statistically significa

关键词： MA (Metabolic Acidosis) CKD (Chronic Kidney Disease) GFR (Glomerular Filtration Rate)

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Phase equilibrium modelling of the amphibolite facies metamorphism in the Yelapa-Chimo Metamorphic Complex, Mexico

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Geoscience Frontiers 2021年第1期12卷 293-312页

作者： Fabian gutierrez-Aguilar Peter Schaaf Gabriela Solís-Pichardo gerardo F.Arrieta-García Teodoro Hernandez-Trevino Carlos Linares-Lopez Posgrado en Ciencias de la Tierra Instituto de GeofísicaUniversidad Nacional Autonoma de MexicoAv.Universidad 3000Ciudad de Mexico04510Mexico Laboratorio Universitario de Geoquímica Isotopica(LUGIS) Instituto de GeofísicaUniversidad Nacional Autonoma de MexicoAv.Universidad 3000Ciudad de Mexico04510Mexico Laboratorio Universitario de Geoquímica Isotopica(LUGIS) Instituto de GeologíaUniversidad Nacional Autonoma de MexicoAv.Universidad 3000Ciudad de Mexico04510Mexico Instituto de Geofísica Universidad Nacional Autonoma de MexicoAv.Universidad 3000Ciudad de Mexico04510Mexico

The Yelapa-Chimo Metamorphic Complex forms part of the Jalisco Block in western Mexico and exposes a wide range of Early Cretaceous metamorphic rocks;such as paragneiss,orthogneiss,amphibolites,and ***,the pressure-temperature(P-T)conditions of metamorphism and partial melting remain poorly studied in the *** elucidate metamorphic P-T conditions,phase equilibrium modelling was applied to two sillimanite-garnet paragneisses,one amphibole-orthogneiss,and one ***-garnet paragneisses exhibit a lepidoblastic texture with a biotite+sillimanite+kyanite+garnet+quartz+plagioclase+K-feldspar mineral ***-orthogneiss and amphibolite display a nematoblastic texture with an amphibole+(1)plagioclase+quartz+(1)titanite assemblage and an amphibole+(2)plagioclase+(2)titanite+ilmenite retrograde mineral *** calculated for the two sillimanite-garnet paragneiss samples show P-T peak conditions at~6-7.5 kbar and~725-740℃.The results for amphibole-orthogneiss and the amphibolite yield P-T peak conditions at~8.5-10 kbar and~690-710℃.The mode models imply that metasedimentary and metaigneous units can produce up to~20 vol%and~10 vol%of melt,*** within a closed system during isobaric heating suggests that melt compositions of metasedimentary and metaigneous units are likely to have direct implications for the petrogenesis of the Puerto Vallarta *** new data indicate that the Yelapa-Chimo Metamorphic Complex evolved through a metamorphic gradient between~23-33℃km^-1and the metamorphic rocks formed at depths between~22 km and~30 km with a burial rate of~2.0 km Ma^-***,the P-T data for both metasedimentary and metaigneous rocks provide new constraints on an accretionary framework,which is responsible for generating metamorphism and partial melting in the YelapaChimo Metamorphic Complex during the Early Cretaceous.

关键词： Phase equilibrium modelling Yelapa-Chimo Metamorphic Complex Amphibolite facies Partial melting

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Evaluation of VEGF gene polymorphisms and proliferative diabetic retinopathy in Mexican population

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International Journal of Ophthalmology(English edition) 2017年第1期10卷 135-139页

作者： Roberto Gonzalez-Salinas Maria C Garcia-gutierrez gerardo Garcia-Aguirre Virgilio Morales-Canton Raul Velez-Montoya Vidal R Soberon-Ventura Victoria Gonzalez Rodrigo Lechuga Pablo Garcia-Solis David G Garcia-gutierrez Marco Vinicio Garcia-Solis Manuel Saenz de Viteri Juan C Solis-S Biomedical Research Department Autonomous University of QueretaroQueretaro 76170Mexico Retina Department Asociation to Prevent Blindness in MexicoMexico City 04030Mexico Research Department Asociation to Prevent Blindness in MexicoMexico City 04030Mexico Retina Department General Hospital of Queretaro(ISSSTE)Queretaro 76000Mexico Universidad La Salle School of Medicine Mexico City 06140Mexico

AIM： To assess if the included vascular endothelial growth factor （VEGF） polymorphisms rs3025035, rs3025021 and rs2010963 are associated to proliferative retinopathy in a Mexican population with type 2 diabetes mellitus （T2DM）. METHODS： A case-control study was conducted in adult individuals with T2DM associated to proliferative retinopathy or non-proliferative retinopathy from Oct. 2014 to Jun. 2015 from the Retina Department of the Asociation to Prevent Blindness in Mexico. The selected patients were adults with a diagnosis of T2DM ≥5y. All subjects had a comprehensive ocular examination and the classification of the retinopathy severity was made considering the Early Treatment Diabetic Retinopathy Study （ETDRS） standardization protocols. Genomic DNA was extracted from whole fresh blood. All samples were genotyped by qPCR for selected VEGF polymorphisms. Hardy-Weinberg equilibrium was calculated by comparing Chi-square values between the expected and the observed values for genotype ***： In total 142 individuals were enrolled, 71 individuals with T2DM and associated proliferative retinopathy and 71 individuals with non-proliferative retinopathy. One-sided Fisher’s exact test was performed for rs3025021 [OR （95% CI）=0.44（0.08-2.2）; P=0.25] and rs2010963 [OR （95% CI）=0.63（0.25-1.6）; P=0.23]. The minor allelic frequencies obtained were 26% for rs3025021, 10% for rs3025035 and 61% for rs2010963. The pairwise linkage disequilibrium between the three SNP was assessed, and was as follows： rs3025021 vs rs3025035： D’=1.0, r2=0.1043, P≤0.0001; rs3025021 vs rs2010963： D’=0.442, r2=0.0446, P=0.149; rs3025035 vs rs2010963： D’=0.505, r2=0.0214, P=***： This is the first analysis involving VEGF polymorphisms and proliferative diabetic retinopathy in a Mexican population. A major finding of the present study is that none of the polymorphisms studied was significantly associated with proliferative retinopathy. Based on these results, we can infer that differ

关键词： vascular endothelial growth factor polymor-phism proliferative diabetic retinopathy non-proliferative diabetic retinopathy rs3025021 rs3025035 rs2010963

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Marine turtle hatchlings use multiple sensory cues to orient their crawling towards the sea:biological and conservation policy implications

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Advances in Bioscience and Biotechnology 2011年第2期2卷 47-51页

作者： Alma Lilia Fuentes-Farias Gabriel gutierrez-Ospina Esperanza Melendez Herrera Veronica Camarena-Ramirez gerardo Ochoa-Tovar Julieta Mendoza-Torreblanca Armida Baez-Saldana Raquel Martinez-Mendez Jaime Urrutia-Fucugauchi Maria Luisa Garcia Zepeda Laboratorio de Ecofisiologia Facultad de BiologiaUniversidad Michoacana de San Nicolas de HidalgoCiudad UniversitariaMorelia MichoacanMexico58230 Laboratorio de Biologia de Sistemas Instituto de Investigaciones BiomedicasUniversidad Nacional Autonoma de MexicoCiudad UniversitariaMexico D.F.04510 Laboratorio de Paleomagnetismo Instituto de GeofisicaUniversidad Nacional Autonoma de MexicoCiudad UniversitariaMexico D.F.04510 Laboratorio de Paleontologia Facultad de BiologiaUniversidad Michoacana de San Nicolas de HidalgoCiudad UniversitariaMorelia MichoacanMexico58230 Laboratorio de Neuromorfometría Instituto Nacional de PediatríaMéxico D.F.04530

The ability of sea turtle hatchlings to find the seashore soon after hatching is thought to be exclusively dependent upon visual information. Target-oriented movements in most vertebrates, however, relay on combining information gathered through different sensory systems. Hence, in this work, we investigated whether olfactory and/or magnetic information might complement visual cues during hatchling’s seaward crawling. Acute olfactory deprivation and distorted magnetic sensation in visually competent hatchlings resulted in a scattering of seaward crawling routes among cardinal points, some of them being different from those strongly preferred by control hatchlings. In addition, blindfolded hatchlings also displayed a striking misrouting while crawling on the beach surface in spite of having intact olfactory and magnetic senses. Together these results support the notion that visual information is crucial for seaward crawling, but also that olfactory and magnetic information complement visual cues when turtle hatchlings display this behavior. Hence, the present observations suggest that multisensory cues are used by turtle hatchlings while crawling towards the sea. This work also has important implications on the design of species conservation measures and policies. In the near future, efforts must be made to identify and preserve the local natural sources of odors and magnetic cues, in addition to preventing the perturbing effects of artificial lighting on adult and hatchling turtle crawling behavior.

关键词： Olfaction Magnetoreception Vision Chelonia aggasizi Seaward orientation Reptiles Intermodal interactions Multisensory integration

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2型糖尿病患者强化血糖控制的利与弊

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英国医学杂志中文版 2020年第9期23卷 505-521页

作者： Rene Rodriguez-gutierrez Jose gerardo Gonzalez-Gonzalez Jorge A Zuniga-Hernandez- Rozalina G McCoy 吴量(译) 潘洁敏(校) Plataforma INVEST Medicina UANL-KER Unit(KER Unit México) Subdireccion de InvestigacionUniversidad Autónoma de Nuevo LeónMonterrey64460Mexico Knowledge and Evaluation Research Unit in Endocrinology Mayo ClinicRochesterMN 55905USA Endocrinology Division Department of Internal MedicineUniversity Hospital"Dr JoséE González"Universidad Autonoma de Nuevo LeonMonterrey64460MexicoPlataforma INVEST Medicina UANL-KER Unit(KER Unit México)Subdireccion de InvestigacionUniversidad Autónoma de Nuevo LeónMonterrey64460Mexico Endocrinology Division Department of Internal MedicineUniversity Hospital"Dr JoséE González"Universidad Autonoma de Nuevo LeonMonterrey64460MexicoDivision of Community Internal MedicineDepartment of MedicineMayo ClinicRochesterMN 55905USA Division of Health Care Policy and Research Department of Health Sciences ResearchMayo ClinicRochesterMN 55905USA 上海交通大学附属第六人民医院内分泌代谢科

糖尿病是全球主要的健康问题,治疗花费高,有较高的发病率、致残率和死亡率,显著影响患者生活质量。绝大多数糖尿病患者属于2型糖尿病。从既往研究看,减少2型糖尿病并发症的主要策略是加强血糖控制。然而大量证据表明,除了降低非致死性... 详细信息

糖尿病是全球主要的健康问题,治疗花费高,有较高的发病率、致残率和死亡率,显著影响患者生活质量。绝大多数糖尿病患者属于2型糖尿病。从既往研究看,减少2型糖尿病并发症的主要策略是加强血糖控制。然而大量证据表明,除了降低非致死性心肌梗死的发生率外,强化(相对于适度)血糖控制对重要的微血管和大血管并发症预后没有显著获益。但是,严格的血糖控制却会增加严重低血糖的风险,并会增加药物种类、副作用和成本等额外负担。此外,来自心血管结局研究的数据表明,使用特定类别的降糖药可大大改善心血管、肾脏和死亡的结果,而这些效应在很大程度上不是由降糖作用带来的。因此,为2型糖尿病患者提供基于循证医学的、以患者为中心的诊疗,需要转变范式并脱离以血糖为中心的糖尿病管理观点。与其优先考虑加强血糖控制,不如将重点放在确保患者获得足够的糖尿病照护,使血糖目标和患者的目标与情况保持一致,最大程度地减少短期和长期并发症,减轻治疗负担以及改善生活质量上。

关键词：严重低血糖循证医学糖尿病管理血糖控制大血管并发症以患者为中心 2型糖尿病降糖作用

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Management of Complex Wounds with Dermal Substitute Assisted by a Negative Pressure System

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Modern Plastic Surgery 2023年第4期13卷 95-105页

作者： Cuahutémoc Márquez Espriella Ruiz Garza Jorge gerardo Barbosa Villarreal Fernando Dávila Díaz Rodrigo Cuervo Vergara Marco Antonio Campollo López Ana Priscila gutierrez Alvarez Mauricio Chama Naranjo Alfredo García Corral Jesús Ricardo Pérez Benítez Omar Alberto Pulido López Ricardo Alberto Jaimes Duran Edwing Michel Garibaldi Bernot Mauro Cortes Aguilar Carlos Manuel García Córdova Carlos Emiliano Camacho Rodriguez Hayah Camacho Rodriguez Hayah Martinez Villalobos Claudia Nallely Ochoa Contreras Erick Cesar Randall Cruz Soto Herrera Lozano Luis Arturo Department of Plastic and Reconstructive Surgery Hospital Central Sur Petróleos Mexicanos Mexico City Mexico

Introduction: The standard treatment for complex wound care is autografting. The advent of dermal substitutes has provided a novel tool for the preparation of the bed to be grafted. However, most types of dermal matrices require the application of a skin graft a second time. Currently, other strategies have been developed to improve the vascularization process, such as negative pressure wound therapy (NPWT), which has been reported to reduce the time required for vascular growth and dermal matrix integration and thus achieve a shorter waiting period for autologous graft application. The present study aims to evaluate the effectiveness and safety of dermal matrix management associated with NPWT in the treatment of complex wounds. Methods: Seven patients with a diagnosis of complex wounds were enrolled in this study between July 1, 2015, and June 31, 2016. After debridement and having an adequate wound bed, patients who met the criteria for the application of combined therapy were treated with dermal substitutes and a negative pressure system. The percentage of graft integration into the wound bed, complications, length of hospital stay, and duration of therapy were analyzed. Results: The mean age was 42.5 ± 16 (39 - 54) years old;three women and four men were included in the study. The approximate size of skin loss was 120.7 ± 75 cm2 (25 - 250 cm2). The combined therapy of dermal matrix plus NPWT was instituted in all cases for a period of 14 days. There were no complications, with 100% graft integration in 6 of 7 cases. Patients were discharged after a mean hospital stay of 5.4 days. Conclusions: This study demonstrates that the utilization of combined dermal matrix plus NPWT therapy can be performed safely and effectively in patients with complex wounds with low complication rates and a short hospital stay.

关键词： Negative Pressure Wound Therapy Complex Wound Dermal Matrix Wound Therapy

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