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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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Elderly patients with acute coronary syndromes: a continuous tsunami

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Journal of Geriatric Cardiology 2019年第2期16卷 100-102页

作者： Francesc Formiga Albert ariza-Sole Geriatric Medicine Unit Internal Medicine DepartmentBellvitge University HospitalL Hospitalet de LlobregatBarcelonaSpain Department of Cardiology Bellvitge University HospitalL'Hospitalet de LlobregatBarcelonaSpain

The progressive ageing of the population and the high incidence of acute coronary syndromes(ACS)in the elderly is leading to an important increase in the number of elderly patients admitted for ACS.[1]Nevertheless,the information about the optimal clinical management in this age group is scarce due to the exclusion of older patients from clinical trials.[2]Higher comorbidity and frailty are common in this clinical setting and they are associated with higher rates of complications and consumption of healthcare resources.[3]These are the main reasons for launching this special issue about management of ACS in the elderly,in which several experts in the field address some of the most important questions about how to deal with ACS in patients at older ages.

关键词： Acute coronary syndromes Management Prognosis The elderly

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Complex Systems in Economics and Where to Find Them

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Journal of Systems Science & Complexity 2021年第1期34卷 314-338页

作者： GOMES orlando GUBAREVA Mariya ISCAL-Lisbon Accounting and Business School Instituto Politécnico de Lisboaand CEFAGE-ISCAL/IPL Research CenterISCALAv.Miguel Bornbarda 201069-035 LisbonPortugal Accounting and Business School Instituto Politécnico de Lisboa SOCIUS-Research Centre in Economic and Organizational Sociology CSG-Research in Social Sciences and Management

The economy as a whole and most of its constituent parts, like markets, government institutions, firms, or households, are inherently complex conceptual constructions. Micro-level diversity,decentralized interaction, self-organization, adaptation and learning, emergence, and evolution, are some of the fundamental features that the above entities share and that allow to classify them as being complex entities. In a complex economic system, existing structures of interaction are in constant mutation as individual agents contact and influence one another and, by doing so, reshape the macro environment in which socio-economic relations unfold. Notwithstanding the observed pervasiveness of complexity in economics, there are a few areas of economic thought where the discussion on the theme has gained an exceptional relevance. In this article, six of such areas are identified and their complex nature is highlighted and scrutinized. These pertain to:(i) Knowledge interactions and technological innovation;(ii) Corporate design and organizational learning;(iii) Public policies directed at market regulation;(iv) Banking and financial markets;(v) Environmental economics, sustainability,and climate change;and(vi) income inequality.

关键词： Agent-based models complex networks complex systems emergent phenomena evolutionary nature market regulation public policies

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Robust Control of a Bevel-Tip Needle for Medical Interventional Procedures

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IEEE/CAA Journal of Automatica Sinica 2020年第1期7卷 244-256页

作者： Surender Hans Felix orlando Maria Joseph Department of Electrical Engineering Indian Institute of Technology RoorkeeRoorkeeUttarakhand 247667India

In minimally invasive surgery, one of the main objectives is to ensure safety and target reaching accuracy during needle steering inside the target organ. In this research work, the needle steering approach is determined using a robust control algorithm namely the integral sliding mode control(ISMC) strategy to eliminate the chattering problem associated with the general clinical scenario. In general, the discontinuity component of feedback control input is not appropriate for the needle steering methodology due to the practical limitations of the driving actuators. Thus in ISMC, we have incorporated the replacement of the discontinuous component using a super twisting control(STC)input due to its unique features of chattering elimination and disturbance observation characteristics. In our study, the kinematic model of an asymmetric flexible bevel-tip needle in a soft-tissue phantom is used to evaluate stability analysis. A comparative study based on the analysis of chattering elimination is executed to determine the performance of the proposed control strategy in real-time needle steering with conventional sliding mode control using vision feedback through simulation and experimental results. This validates the efficacy of the proposed control strategy for clinical needle steering.

关键词： Minimal invasive surgery needle steering nonholonomic system robust control sliding mode control

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Cardiogenic shock:approaching the truth

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Journal of Geriatric Cardiology 2022年第2期19卷 95-97页

作者： Isaac Llaó Albert ariza-Solé Cardiology Department Intensive Cardiac Care UnitBellvitge University HospitalL’Hospitalet de LlobregatBarcelonaSpain

Cardiogenic shock(CS)is a severe clinical condition characterized initially by reduced cardiac output with abnormal organ perfusion which commonly leads to a multiorgan *** expansion of cardiac critical care units,development of reperfusion networks and progress of mechanical circulatory support(MCS),mortality of CS due to acute myocardial infarction(AMI)remains as high as 40%−50%.[1]Clinical outcomes in non-AMI patients are less established but remains similarly disappointing.

关键词： cardiac mortality acute

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Products of Distributions,Conservation Laws and the Propagation of δ'-Shock Waves

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Chinese Annals of Mathematics,Series B 2012年第3期33卷 367-384页

作者： Carlos orlando R. SARRICO CMAF University of LisbonAv.Prof.Gama Pinto 21649-003Portugal

This paper contains a study of propagation of singular travelling waves u（x, t） for conservation laws ut ＋ [Ф（u）]x = ψ（u）, where Ф, ψ are entire functions taking real values on the real axis. Conditions for the propagation of wave profiles β ＋ mδ and β ＋ mδt are presented （β is a real continuous function, m ≠ 0 is a real number and δ＇ is the derivative of the Dirac measure 5）. These results are obtained with a consistent concept of solution based on our theory of distributional products. Burgers equation ut ＋（u2/2）x = 0, the iffusionless Burgers-Fischer equation ut ＋ a（u2/2）x = ru（1 - u/k） with a, r, k being positive numbers, Leveque and Yee equation ut ＋ ux = μx（1 - u）（u - u/k） with μ ≠ 0, and some other examples are studied within such a setting. A ＂tool box＂ survey of the distributional products is also included for the sake of completeness.

关键词： Conservations laws Travelling waves δ^-shock waves δ-shock waves δ-solitons Propagation of distributional wave profiles

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Optimization of the treatment with immunosuppressants and biologics in inflammatory bowel disease

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World Journal of Gastroenterology 2014年第29期20卷 9675-9690页

作者： Sara Renna Ambrogio orlando Division of Internal Medicine ‘‘Villa Sofia-V.Cervello’’ Hospital

Many placebo controlled trials and meta-analyses evaluated the efficacy of different drugs for the treatment of inflammatory bowel disease (IBD), including immunosuppressants and biologics. Their use is indicated in moderate to severe disease in non responders to corticosteroids and in steroid-dependent patients, as induction and maintainance treatment. Infliximab, as well as cyclosporine, is considered a second line therapy in the case of severe ulcerative colitis, or non-responders to intravenous corticosteroids. An adequate dosage and duration of therapy with thiopurines should be reached before evaluating their efficacy. Methotrexate is a valid option in patients with Crohn’s disease but its use is confined to patients who are intolerant or non-responders to thiopurines. Evidence for the use of methotrexate in ulcerative colitis is insufficient. The use of thalidomide and mycophenolate mofetil is not recommended in patients with inflammatory bowel disease, these treatments could be considered in case of failure of all other therapeutic options. In patients with moderately active ulcerative colitis, refractory to thiopurines, the use of tacrolimus is considered an alternative to biologics. An increase of the dose or a decrease in the interval of administration of biological treatment could be useful in the presence of an incomplete clinical response. In the case of primary failure of an anti-tumor necrosis factor alpha a switch to another one should be considered. Data on the efficacy of combination therapy are up to now insufficient to consider this strategy in all IBD patients. The final outcome of the treatment should be considered the clinical remission, with mucosa healing, and not the clinical response. The evaluation of serum concentration of thiopurine methyl transferase activity, thiopurine metabolites, biologic serum levels and antibiologic antibodies could be useful for the management of the treatment but it has not been routinely applied in cl

关键词： Inflammatory bowel disease Optimization Immosuppressants Biologics Crohn's disease Ulcerative colitis

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Assessment of forest dieback on the Moroccan Central Plateau using spectral vegetation indices

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Journal of Forestry Research 2023年第3期34卷 793-808页

作者： Youssef Dallahi Amal Boujraf Modeste Meliho Collins Ashianga orlando Laboratory of Microbial Biotechnologies Agrosciences and Environment(BioMAgE)Faculty of Sciences SemlaliaCadi Ayyad UniversityMarrakechMorocco Laboratoire des Productions Végétale Animales et Agro-industrieEquipe de BotaniqueBiotechnologie et Protection des PlantesFacultédes SciencesUniversitéIbn TofailKenitraMorocco Sociétés TerritoiresHistoires et PatrimoinesFacultédes Lettres et des Sciences HumainesUniversitéMohammed VRabatMorocco Rabat Morocco

Cork oak forests in Morocco are rich in resources and services thanks to their great biological diversity,playing an important ecological and socioeconomic *** degradation of the forests has been accentuated in recent years by signifi cant human pressure and eff ects of climate change;hence,the health of the stands needs to be *** this study,the Google Engine Earth platform was leveraged to extract the normalized diff erence vegetation index(NDVI)and soil-adjusted vegetation index,from Landsat 8 OLI/TIRS satellite images between 2015 and 2017 to assess the health of the Sibara Forest in *** results highlight the importance of interannual variations in NDVI in forest monitoring;the variations had a signifi cantly high relationship(p<0.001)with dieback *** was positively and negatively correlated with mean annual precipitation and mean annual temperature with respective coeffi cients of 0.49 and−0.67,highlighting its ability to predict phenotypic changes in forest *** interannual variation in NDVI between 2016 and 2017 seemed to confi rm fi eld observations of cork oak dieback in 2018,with the largest decreases in NDVI(up to−38%)in December in the most-aff ected *** of the infl uence of ecological factors on dieback highlighted the role of substrate as a driver of dieback,with the most severely aff ected plots characterized by granite-granodiorite substrates.

关键词： Forest health monitoring Remote sensing Dieback Vegetation indices Sibara forest

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Correlative microscopy of Purkinje cells

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BIOCELL 2012年第1期36卷 1-29页

作者： orlando J.CASTEJÓN Instituto de Investigaciones Biologicas“Drs.orlando Castejón and Haydee Viloria de Castejón”.Facultad de Medicina.Universidad del Zulia.Maracaibo.Venezuela

The Purkinje cell and their synaptic contacts have been described using(1)light microsocopy,(2)transmission and scanning electron microscopy,and freeze etching technique,(3)conventional and field emission scanning electron microscopy and cryofracture methods,(4)confocal laser scanning microscopy using intravital stain FM64,and(5)immunocytochemical techniques for Synapsin-I,PSD9-5,GluR1 subunit of AMPA receptors,N-cadherin,and CamKII *** outer surface and inner content of plasma membrane,cell organelles,cytoskeleton,nucleus,dendritic and axonal processes have been exposed and analyzed in a three-dimensional *** intramembrane morphology,in bi-and three-dimensional views,and immunocytochemical labeling of synaptic contacts with parallel and climbing fibers,basket and stellate cell axons have been *** etching technique,field emission scanning microscopy and cryofracture methods,and GluR1 immunohistochemistry showed the morphology and localization of postsynaptic *** cell shows N-cadherin and CamKII alpha *** correlative microscopy approach provides a deeper understanding of structure and function of the Purkinje cell,a new three-dimensional outer and inner vision,a more detailed study of afferent and intrinsic synaptic junctions,and of intracortical circuits.

关键词： cerebellar cells synaptic contacts electron microscopy immunohistochemistry

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