bluuebunny/crossref_metadata_2025 huggingface dataset:
HCFMUSP: Resiliência como Resposta à Pandemia de COVID-19
Authors: Pedroso Marcelo Caldeira , Pires João Teixeira , Malik Ana Maria , Pereira Antonio José Rodrigues
Published: May 2021

ABSTRACT The teaching case describes a set of emergency actions taken by HCFMUSP to manage the needs brought by the COVID-19 pandemic in Brazil. The case objective considers the issues related to the impact of the pandemic mostly in healthcare operations, emphasizing how to: (a) adapt health system governance in response to a crisis (crisis management); (b) manage the health system capacity, which traditionally is not so resilient; (c) deal with a new disease (knowledge management). Thus, it should allow gathering elements for the management of future crises.
Our Calendar Stopped! The Organizational Change at UFPB due to COVID-19
Authors: Teixeira-de-Carvalho Diana Lucia , Dias Junior Jose Jorge Lima , Kruta-Bispo Ana Carolina
Published: May 2021

ABSTRACT This teaching case aims to analyze the context of the Federal University of Paraíba, which experiences the impacts of social isolation due to COVID-19, especially in conducting undergraduate classes, considering that the activities face-to-face were suspended. The case presents the facts related to the possibility of implementing a supplementary calendar, based on the concept of remote emergency teaching. Because of this scenario, the Pro-Rectory of Graduation managers needed to plan carefully to manage the uncertainties and resistance to changes that such a proposal would represent, mainly because there were no models to be based on since practically all public HEIs have suspended graduation classes. The case raises a significant dilemma: in the face of the challenges of implementing a supplementary remote calendar, is it better to follow or step back? The pedagogical objectives of this teaching case involve: analyzing the impact of COVID-19 on organizational behavior; discuss aspects related to the implementation of organizational changes; identify the use of data for decision-making and support for organizational change; and making decisions in the face of managerial dilemmas. Its analysis can be done by undergraduate students, in Administration and Public Management courses.
Stay at Home, Casa Porto Delivers: Humanized Entrepreneurship during Pandemic
Authors: Vinhas Valéria Quiroga , Lopes Ana Luiza Szuchmacher V.
Published: May 2021

ABSTRACT This teaching case describes the trajectory of the entrepreneur Raphael Vidal. The information presented makes it possible to link the history and beliefs of the subject-entrepreneur Raphael to the decisions regarding Casa Porto project in the context of the COVID-19 pandemic. Aspects of his entrepreneurial attitude as a basis for the way he has been conducting Casa Porto are exposed. In addition, elements related to the decision to open, conduct, and maintain a business in situations of crisis are displayed. And more importantly, nuances related to other spheres involved in the understanding of the entrepreneur as a social being are addressed.
Pandemic Fights in a Network! COVID-19 Challenges in Northeast Brazil
Authors: Andrade Raphael Jesus Campos de , Sousa-Filho José Milton de , Almeida Fátima Evaneide Barbosa de , Câmara Samuel Façanha
Published: May 2021

ABSTRACT With the occurrence of the COVID-19 pandemic in 2020, it became imperative to adopt emergency measures to prevent a crisis in the health system in northeastern Brazil. In this context, Miguel Bastos, manager of Sistema Indústria, a class entity in the northeastern industrial sector, dedicated all his efforts to coordinate an emerging network of institutions involved in research, development, innovation, manufacturing, and maintenance of products demanded by a health system. Thus, this teaching case aims to allow students to understand the context of a cooperation network created to meet the needs of the health sector in combating the pandemic of COVID-19. Given the difficulties inherent in a leadership process involving seven different institutions, how should the protagonist organize this network to meet the expected demands? The case has as target audience undergraduate Business Administration students, as well as lato sensu graduate courses, in subjects such as Business Strategy, Cooperation Networks, Public-Private Partnerships, among others that address the themes proposed in the present case. It is noteworthy that authors collected data from participant observation, secondary data, and interviews. The characters are real, but the names are fictitious.
Separation of aligning and leveling stages to control mandibular incisor inclination: A randomized clinical trial
Authors: THEERASOPON Pornpat , LINDAUER Steven J. , CHAROEMRATROTE Chairat
Published: May 2021

ABSTRACT Objective: To determine whether separating the alignment and leveling phases can reduce proclination of the mandibular incisors. Methods: Eligibility criteria included Class I subjects with an irregularity index of 3-5 mm, 3-4 mm curve-of-Spee (COS), and non-extraction treatment. Thirty adults were randomly allocated into two groups: (1) Control group was leveled and aligned simultaneously with flat archwires progressively to 0.016x0.022-in stainless-steel; (2) Experimental group was aligned first with 0.014-in-superelastic NiTi with mild accentuated COS, then leveled using 0.016x0.022-in beta-titanium accentuated COS archwires and gradually reduced the curve until flat. Mandibular incisor position and inclination were evaluated by cephalometric analysis. COS and irregularity index were evaluated in study models. Assessment was conducted twice after 0.016-in NiTi and after 0.016x0.022-in stainless-steel archwire placements. Dental changes from cephalograms and models were compared within group using paired t-test and between groups using independent t-test. Results: Control group: Round-wire-phase, mandibular incisors tipped labially (4.38° and 1 mm) with intrusion (-1.13 mm); Rectangular-wire-phase, mandibular incisors further intruded and proclined (-0.63 mm and 1.38°). Experimental group: During aligning with round accentuated COS archwires, mandibular incisors tipped very slightly labially (0.75° and 0.50 mm) with no significant intrusion; during leveling with rectangular archwires, incisors majorly intruded (1.75 mm) with slight proclination (1.81°). The experimental group had significant less incisor proclination (control: 5.76°, experimental: 2.56°) with more incisor intrusion (control: -1.75 mm, experimental: -2.13 mm). The COS in experimental group showed significant greater reduction (-2.88 mm) than that of the control group (-1.69 mm). Conclusion: In control group, mandibular incisor proclination was markedly observed in round archwires, with further proclination caused by rectangular archwires. In experimental group, minimal proclination was exhibited when accentuated COS round archwires were used for aligning. Leveling with rectangular archwires caused less proclination with more COS reduction.
An Analytical Model of the Institutional Design of Specialized Anti-corruption Courts in the Global South: Brazil and Indonesia in Comparative Perspective*
Authors: Madeira Lígia Mori , Geliski Leonardo
Published: May 2021

ABSTRACT This article introduces the Brazilian experience of fighting corruption through specialized courts, presenting their creation, main characteristics, and convergences and divergences in comparison with the well-known case of the specialized court of Indonesia. The study proposes an analytical model of the specialized anti-corruption courts’ institutional design. It adopts a qualitative approach using content analysis based on reports issued by multilateral agencies, legislative and judicial documents, and interviews. While in Brazil, specialized courts receive great notoriety and resources, in Indonesia, courts are neglected in terms of financial and human resources, recruitment, supervision, and support. Different from Indonesia, the process of creating specialized courts was endogenous in Brazil, controlled and conducted by members of the judiciary in courts and lobbying other government branches. The internal movement around the policies to address corruption and the direct connection between judges and international organizations led to the executive’s support and legislation change in Congress.
ALAVANCANDO A EFICÁCIA DE SERVIÇOS INTENSIVOS EM CONHECIMENTO: O PAPEL DOS CLIENTES E DOS PRESTADORES DE SERVIÇO
Authors: SILVA SIMONE SANTOS DA , SANTOS JULIANA BONOMI
Published: May 2021

RESUMO Esta pesquisa desenvolve um modelo teórico que relacionou as ações de participação dos clientes em serviços intensivos em conhecimento (SIC), as ações dos prestadores de serviço para estimular o envolvimento dos clientes e a eficácia dos serviços. Cinco hipóteses foram testadas por meio de equações estruturais, e os dados foram coletados por meio do levantamento de uma amostra de 106 usuários de serviços de fisioterapia, personal trainers, pilates e reeducação postural global. Os resultados mostram que não basta educar clientes; prestadores precisam ter empatia e criar um vínculo emocional com eles. Adicionalmente, a educação dos clientes e a empatia emocional influenciam de maneira diferenciada o fornecimento de feedback e até que ponto os clientes seguem as instruções. Este estudo contribui para a literatura, ao promover uma visão holística sobre os fatores que influenciam a participação do cliente e sua eficácia em SIC
Antropologia e pandemia: escalas e conceitos
Authors: Rui Taniele , França Isadora Lins , Machado Bernardo Fonseca , Rossi Gustavo , Arruti José Maurício
Published: May 2021

Resumo Diante da profusão de respostas intelectuais à pandemia do Sars-Cov-2, este artigo propõe sistematizar algumas das publicações realizadas pelas ciências humanas nos meses de março a junho de 2020. Inicialmente pensado como conteúdo para estudantes dos cursos de graduação, foram lidos textos presentes no volume Sopa de Wuhan, no site n-1 edições, no “Observatório do CEMI - COVID-19” (CEMI/Unicamp), no Boletim Cientistas Sociais e o Coronavírus (Anpocs), e no site antropoLÓGICAS EPIDÊMICAS (UFRGS). A leitura dessa produção, marcada por textos relativamente curtos, em formatos variados, de rápida escrita e circulação, com caráter ora ensaístico, ora analítico, sugere dois principais eixos temáticos referentes 1) à problemática da escala; 2) à problemática do biopoder e dos governos. Ao fazer um recorte instantâneo das reações mais imediatas à crise, observamos perspectivas e conceitos-chave lançados pelas ciências humanas para compreensão do mundo contemporâneo.
A pandemia de Covid-19 na UTI
Authors: Pereira Everson Fernandes
Published: May 2021

Resumo Neste artigo, traço alguns comentários sobre a taxa de ocupação de leitos de UTI a partir do caso de Porto Alegre, Brasil, nos primeiros seis meses de pandemia de Sars-CoV-2. Argumento como a produção e o uso dessas taxas, por parte da Prefeitura Municipal, ganha ares técnicos que deixam de lado uma série de complexidades. Acompanhando os dados de ocupação dos leitos e as medidas adotadas pela prefeitura da cidade, argumento como as escolhas e decisões políticas no combate à pandemia são baseadas em outros critérios que não exclusivamente técnicos. Apoio-me em discussões sobre quantificação da sociedade e política dos números em diálogo com a noção de “necropolítica” de Achille Mbembe. Tento pensar a taxa como um dispositivo da necropolítica que, ao legitimar a flexibilização da quarentena, expõe populações vulneráveis aos riscos.
Painéis comunitários: a disputa pela verdade da pandemia nas favelas cariocas
Authors: Menezes Palloma Valle , Magalhães Alexandre Almeida de , Silva Caíque Azael Ferreira da
Published: May 2021

Resumo O presente artigo descreve e analisa a experiência dos painéis comunitários de mapeamento da Covid-19 organizados por moradores de favelas da cidade do Rio de Janeiro. Tais painéis são dispositivos que quantificam a extensão e intensidade da pandemia nesses territórios, apresentando arranjos diversos que envolvem dados produzidos por moradores, serviços de saúde ou órgãos públicos. Mobilizados a partir da inconsistência ou falta de informações sistematizadas sobre a pandemia em seus territórios, os painéis operam uma disputa pela verdade da pandemia nas favelas, num contexto de desvalorização das políticas de combate ao vírus e negacionismo. A tensão produzida com os painéis chama a atenção para a existência de tais territórios no tecido urbano e as relações que o poder público sustenta em cada local. Para compreender esse processo, partiremos de dados compilados pelo Dicionário de Favelas Marielle Franco, notícias de jornal, sites dos coletivos promotores desses painéis, bem como falas públicas de moradores dessas localidades.
Vejez y vida cotidiana en tiempos de pandemia: estrategias, decisiones y cambios
Authors: Osorio-Parraguez Paulina , Jorquera Pamela , Araya Tessini Matías
Published: May 2021

Resumen En el presente artículo se presentan experiencias de personas mayores que muestran la diversidad en la vida cotidiana en la vejez durante la pandemia por Covid-19 en Chile. Para ello se aplicaron entrevistas a distancia a una mujer, a un hombre y a una pareja de personas mayores de distintas condiciones socioeconómicas y etarias. Los resultados muestran una serie de estrategias desplegadas para sobrellevar los cambios y alteraciones de su vida diaria, en el ámbito laboral, afectivo, económico, residencial y familiar. Se concluye que las personas mayores poseen distintas fortalezas y capacidad de agencia, adquiridas a partir de su experiencia biográfica, las cuales les permite afrontar la crisis sociosanitaria, desde su posición como población vulnerable y de alto riesgo. Sus estrategias no sólo se encuentran marcadas por su condición de vejez, sino que también están cruzadas por la posición social, condición laboral, género y residencial.
São João em tempos de Covid-19: os impactos da pandemia do novo coronavírus nas experiências de participantes de quadrilhas juninas no interior cearense
Authors: Castro Thiago Silva de , Paiva Antonio Cristian Saraiva
Published: May 2021

Resumo Com foco nas experiências dos participantes de quadrilhas juninas da cidade de Sobral, localizada na região norte do estado do Ceará, este artigo propõe apresentar os impactos da pandemia de Covid-19 no cotidiano dos indivíduos. A partir de uma reflexão sobre as interseccionalidades de gênero, sexualidade, classe e raça entrecruzadas nas experiências sociais e subjetivas de dançarinos de tradicionais festejos de São João, analisa-se os efeitos da interrupção dos trabalhos dos grupos juninos, em função do estado de quarentena decretado pelo governo cearense, sobre seus cotidianos e sobre os modos de preparar as quadrilhas. Com base nessa realidade etnográfica, amparando-se diretamente nos discursos expressos pelos participantes diante das circunstâncias geradas pelo novo coronavírus, busca-se pensar sobre como essas pessoas se sentem afetadas social e subjetivamente pelo estado pandêmico.
Seismic performance assessment of reinforced concrete wall piers for out-of-plane seismic loads
Authors: Kim Tae-Hoon , Eum Ki-Young
Published: May 2021

The purpose of this study is to assess the seismic performance of reinforced concrete wall piers for out-of-plane seismic loads, and to provide a method for developing a new evaluation procedure. A non-linear finite element analysis program, RCAHEST (Reinforced Concrete Analysis in Higher Evaluation System Technology), is used to carry out all the seismic analyses of reinforced concrete wall piers. The wall piers were modelled using a combination of reinforced concrete shell elements and newly developed interface elements with six degrees of freedom. The reinforced concrete shell interface element is used to account for local discontinuous deformations at the boundary plane caused by abrupt changes in stiffness where members with different thickness are connected. Novel damage indices were modified to provide a means of quantifying numerically the seismic performance level in wall piers sustained under earthquake loading. Six reinforced concrete wall pier specimens were loaded in the weak direction under cyclic loading. The failure mode of the wall piers was either compression failure of the concrete or fracture of the longitudinal reinforcing bars due to low-cycle fatigue. The proposed numerical method for the seismic performance assessment of reinforced concrete wall piers for out-of-plane seismic loads is verified by comparison with the experimental and analytical results.
Identification of Megalin as the Sole Rat Kidney Sialoglycoprotein Containing Poly α2,8 Deaminoneuraminic Acid
Authors: ZIAK MARTIN , KERJASCHKI DONTSCHO , FARQUHAR MARILYN G. , ROTH JÜRGEN
Published: May 2021

Recently, poly α2,8 deaminoneuraminic acid (poly α2,8 KDN) was demonstrated in various embryonic and adult mammalian tissues. This study reports the purification and characterization of the single poly α2,8 KDN-bearing glycoprotein from rat kidney. Amino acid sequences of proteolytic fragments shared homology with megalin, a member of the LDL receptor family. Immunochemical analysis supported this finding, since immunoprecipitated poly α2,8 KDN-bearing glycoprotein was immunoreactive with anti-megalin antibodies in Western blotting and conversely immunoprecipitated megalin was immunoreactive with the monoclonal anti-poly α2,8 KDN antibody. Furthermore, receptor-associated protein affinity-purified megalin reacted with the anti-poly α2,8 KDN antibody. By immunoelectron microscopy, labeling for both poly α2,8 KDN and megalin coincided in the brush border, endocytic invaginations and vesicles, and apical dense tubules of proximal convoluted tubules. Immunoreactivity for poly α2,8 KDN on purified megalin was abolished by β-elimination reaction but not by N-glycosidase F treatment. These data identified megalin as the sole glycoprotein of rat kidney, which contains poly α2,8 KDN present on O-glycosidically linked oligosaccharides. Furthermore, this study shows that megalin carries N-glycosidically linked hybrid and complex-type oligosaccharides terminating with sialic acid. Both poly α2,8 KDN and sialic acids on megalin may contribute to the binding of Ca2+ and cationic ligands.
ATP Release Mechanisms in Primary Cultures of Epithelia Derived from the Cysts of Polycystic Kidneys
Authors: WILSON PATRICIA D. , HOVATER JEFFREY S. , CASEY CASH C. , FORTENBERRY JAMES A. , SCHWIEBERT ERIK M.
Published: May 2021

Autosomal dominant polycystic kidney disease (ADPKD) cyst enlargement is exacerbated by accumulation of fluid within the lumen of the cyst. Extracellular nucleotides and nucleosides stimulate fluid and chloride (Cl-) secretion across epithelia and are potent autocrine and paracrine agonists within tissues. This study tests the hypothesis that ATP may be released by ADPKD epithelial cells. Once released, extracellular nucleotides and their metabolites may become “trapped” in the cyst lumen. As a consequence, extracellular ATP may augment ADPKD cyst enlargement through stimulation of salt and water secretion across ADPKD epithelia that encapsulate ADPKD cysts. To test this hypothesis, bioluminescence detection assays of ATP released from primary cultures of human ADPKD epithelial cells were compared with non-ADPKD human epithelial primary cultures. ADPKD cultures release comparable or greater amounts of ATP than non-ADPKD cultures derived from proximal tubule or cortex. ATP release in both ADPKD and non-ADPKD primary epithelial monolayers was directed largely into the apical medium; however, basolateral-directed ATP release under basal and stimulated conditions was also observed. Hypotonicity potentiated ATP release into the apical and basolateral medium in a reversible manner. Reconstitution of isotonic conditions with specific osmoles or inhibition with mechanosensitive ion channel blockers dampened hypotonicity-induced ATP release. “Flashfrozen” cyst fluids from ADPKD cysts, harvested from multiple donor kidneys, were screened by luminometry. A subset of cyst fluids contained as much as 0.5 to 10 μM ATP, doses sufficient to stimulate purinergic receptors. Taken together, these results show that ADPKD and non-ADPKD human epithelial primary cultures release ATP under basal and stimulated conditions and that ATP is released in vitro and into the cyst fluid by cystic epithelial cells in concentrations sufficient to stimulate ATP receptors. It is hypothesized that extracellular nucleotide release and signaling may contribute detrimentally to the gradual expansion of cyst fluid volume that is a hallmark of ADPKD.
Hypocomplementemia Discloses Genetic Predisposition to Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura
Authors: NORIS MARINA , RUGGENENTI PIERO , PERNA ANNALISA , ORISIO SILVIA , CAPRIOLI JESSICA , SKERKA CHRISTINE , VASILE BEATRICE , ZIPFEL PETER F. , REMUZZI GIUSEPPE
Published: May 2021

Familial hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) carry a very poor outcome and have been reported in association with decreased serum levels of the third complement component (C3). Uncontrolled consumption in the microcirculation, possibly related to genetically determined deficiency in factor H—a modulator of the alternative pathway of complement activation—may account for decreased C3 serum levels even during disease remission and may predispose to intravascular thrombosis. In a case-control study by multivariate analysis, we correlated putative predisposing conditions, including low C3 serum levels, with history of disease in 15 cases reporting one or more episodes of familial HUS and TTP, in 25 age- and gender-matched healthy controls and in 63 case-relatives and 56 control-relatives, respectively. The relationship between history of disease, low C3, and factor H abnormalities was investigated in all affected families and in 17 controls. Seventy-three percent of cases compared with 16% of controls (P < 0.001), and 24% of case-relatives compared with 5% of control-relatives (P = 0.005) had decreased C3 serum levels. At multivariate analysis, C3 serum level was the only parameter associated with the disease within affected families (P = 0.02) and in the overall study population (P = 0.01). Thus, subjects with decreased C3 serum levels had a relative risk of HUS or TTP of 16.56 (95% confidence interval [CI], 1.66 to 162.39) within families and of 27.77 (95% CI, 2.44 to 314.19) in the overall population, compared to subjects with normal serum levels. Factor H abnormalities were found in four of the cases, compared with three of the healthy family members (P = 0.02) and none of the controls (P = 0.04) and, within families, factor H abnormalities were correlated with C3 reduction (P < 0.05). Reduced C3 clusters in familial HUS and TTP is likely related to a genetically determined deficiency in factor H and may predispose to the disease. Its demonstration may help identify subjects at risk in affected families.
A Cholesteryl Ester Transfer Protein Gene Mutation and Vascular Disease in Dialysis Patients
Authors: KIMURA HIDEKI , GEJYO FUMITAKE , YAMAGUCHI TOMOKO , SUZUKI SATORU , IMURA TOSHIO , MIYAZAKI RYOICHI , ARAKAWA MASAAKI
Published: May 2021

Among patients undergoing maintenance hemodialysis, a decreased high-density lipoprotein cholesterol (HDL-C) concentration is among the most common abnormalities of lipid metabolism and apparently is an independent risk factor for vascular disease. A common missense mutation of cholesteryl ester transfer protein gene, D442G (Asp 442 to Gly), increases HDL-C levels through the reduced activity of cholesteryl ester transfer from HDL to VLDL, but the mutation also may lead to reduced activity of reverse cholesterol transport. To investigate the effect of the D442G polymorphism on atherosclerotic complications in dialysis patients, the genotype and allele frequency of the polymorphism were determined in 414 unselected dialysis patients and 220 control subjects, and postprandial serum lipid levels were measured in the dialysis patients. A similar genotype distribution was found between hemodialysis patients and healthy control subjects, and in dialysis patients with and without vascular disease. Serum levels of total cholesterol and HDL-C did not differ between patients with and without the mutation and in patients with and without vascular disease. However, patients with sub-median HDL-C levels (<45 mg/dl) had an independent odds ratio of 1.8 for vascular disease (95% confidence interval, 1.04 to 3.2; P < 0.05). In this low-HDL-C subgroup, patients with the D442G mutation had a significantly higher prevalence of vascular disease than those with no mutation (54.5% versus 24.4%; P < 0.05), and an independent odds ratio of 4.9 (95% confidence interval, 1.05 to 22.65; P < 0.05). In conclusion, the D442G mutation is an independent risk factor for atherosclerotic complications in dialysis patients with HDL-C levels below 45 mg/dl.
Pathophysiology of Edema Formation in Children with Nephrotic Syndrome Not Due to Minimal Change Disease
Authors: VANDE WALLE JOHAN G. J. , DONCKERWOLCKE RAYMOND A. , KOOMANS HEIN A.
Published: May 2021

It has been shown that children with nephrotic syndrome due to minimal change disease (MCD) can present with avid salt retention and stimulated vasoactive hormones, as well as with stable edema. The present study examines these conditions in children with nephrotic syndrome not due to MCD (non-MCD). In six children with hypovolemic symptoms (congenital nephrotic syndrome in four), strong sodium retention (fractional sodium excretion, FENa, 0.2 ± 0.2%) was found. Lithium clearance (FELi) and maximal water excretion (V
max) were suppressed, suggesting avid sodium reabsorption throughout the nephron. Aldosterone, renin, and norepinephrine were elevated. Sixteen other children with non-MCD had stable edema. FENa was 1.8 ± 1.1%, whereas FELi, V
max, and hormones were normal, and not different from data in 35 nonproteinuric children. In children with MCD, 12 presented with hypovolemic symptoms and strong sodium retention (FENa 0.3 ± 0.3%), whereas 15 were stable (FENa 1.1 ± 0.7%). Regarding tubular sodium handling and hormones, the same distinction could be made as for the children with non-MCD. However, hypoproteinemia differed. In the children with non-MCD lesions, plasma colloid osmotic pressure was significantly lower in the hypovolemic types (4.2 ± 0.4 mmHg) than in those with stable edema (13.0 ± 3.8 mmHg; P < 0.05); in MCD, no such difference existed (respectively, 8.1 ± 3.0 and 9.9 ± 2.2 mmHg). In summary, children with nephrotic syndrome may present with pathophysiologic pictures of decreased effective circulating volume or of stable edema, regardless of whether they have non-MCD or MCD. The pathogenesis of the hypovolemic picture seems to be different, since it is associated with extreme hypoproteinemia only in the children with non-MCD.
The Peritoneal Membrane in Peritoneal Dialysis Patients
Authors: CHAGNAC AVRY , HERSKOVITZ PEARL , WEINSTEIN TALIA , ELYASHIV SIMCHA , HIRSH JUDITH , HAMMEL ILAN , GAFTER UZI
Published: May 2021

The surface area of the peritoneal membrane in contact with dialysate is an important determinant of solute transport across the peritoneum. Yet there is no method for its estimation in peritoneal dialysis patients. In this study, stereologic methods were applied to computerized tomography (CT) imaging of the peritoneal membrane to estimate the peritoneal membrane surface area. The method was first validated by implementing stereologic methods on a phantom of known surface area. The phantom was a distorted bottle filled with contrast media. Series of thin helical CT sections were performed, and random sections were obtained after reconstruction. A transparent counting grid was placed over the random sections. The surface area was estimated using 9, 18, and 36 random sections. To calculate the coefficient of variation (CV) of the method, 20 different combinations of 9, 18, and 36 random sections were used. With 36 random sections, the error in estimation of the bottle's surface area was - 9.4% to + 8.8%. The CV was 5.0%. Decreasing the number of sections used to 18 and 9 yielded a CV of 7.8 and 12.3%, respectively. This method was then applied to the peritoneal membrane, which was visualized by instilling dialysate containing contrast media into the peritoneal cavity of peritoneal dialysis patients. The estimated peritoneal membrane surface area of six patients was 0.55 ± 0.04 m2. This novel method permits the measurement of the peritoneal membrane surface area with a high degree of accuracy.
Mortality in End-Stage Renal Disease
Authors: VONESH EDWARD F. , MORAN JOHN
Published: May 2021

Recent registry studies comparing mortality between peritoneal dialysis (PD) and hemodialysis (HD) patients show conflicting results. The purpose of this study is to determine whether previously published results showing higher mortality for patients treated with PD versus HD in the United States continue to hold true over the period 1987-1993. National mortality rates for PD and HD were extracted from the U.S. Renal Data System (USRDS) annual reports for the cohort periods: 1987-1989, 1988-1990, 1989-1991, 1990-1992, and 1991-1993. Using Poisson regression, death rates per 100 patient years were compared between PD and HD for each cohort period controlling for age, gender, race, and cause of end-stage renal disease (diabetes versus nondiabetes). When incident patients and patients with a prior transplant were included in the analysis, starting with the 1989-1991 cohort, we found little or no difference in the relative risk (RR PD:HD) of death between PD and HD (1987-1989: RR = 1.17, P < 0.001; 1988-1990: RR = 1.12, P < 0.001; 1989-1991: RR = 1.06, P = NS; 1990-1992: RR = 1.06, P = NS; 1991-1993: RR = 1.08, P = 0.043). After a test for goodness-of-fit, separate analyses for diabetic patients and nondiabetic patients were done to examine unexplained variation in death rates. For nondiabetic patients, there was less than a 1% difference in the adjusted 1-yr survival between PD and HD from 1989-1993 (1989-1991: RR = 1.05, P = NS; 1990-1992: RR = 1.04, P = NS; 1991-1993: RR = 1.07, P < 0.01). Among diabetic patients, the PD:HD death rate ratio varied significantly according to gender and age. For the average male diabetic patient, there was little or no difference in risk between PD and HD from 1989-1993 (1989-1991: RR = 1.02, P = NS; 1990-1992: RR = 1.05, P = NS; 1991-1993: RR = 1.08, P < 0.01). For diabetic patients under the age of 50, those treated with PD had a significantly lower risk of death than those treated with HD (1989-1993: 0.84 ≤ RR ≤ 0.89, P < 0.005). Over the same period, female diabetic patients treated with PD had a higher risk, on average, than HD (1.18 ≤ RR ≤ 1.19, P < 0.001) as did diabetic patients over the age 50 (1.28 ≤ RR ≤ 1.30, P < 0.001). Unlike previously published results that were restricted to prevalent-only patients, this national study of both prevalent and incident patients found little or no difference in overall mortality between PD and HD. The recent trends in mortality likely reflect the inclusion of incident patients, but they may also reflect changes in case-mix differences and/or improved PD practice. Additional incident-based studies that allow for additional case-mix adjustments are needed to better compare outcomes between HD and PD.
The ETA Receptor Blocker LU 135252 Prevents Chronic Transplant Nephropathy in the “Fisher to Lewis” Model
Authors: ORTH STEPHAN R. , ODONI GIULIO , AMANN KERSTIN , STRZELCZYK PIOTR , RASCHACK MANFRED , RITZ EBERHARD
Published: May 2021

The effect of the orally highly bioavailable and specific endothelin A (ETA) receptor antagonist LU 135252 was assessed in a model of chronic renal allograft nephropathy. Kidneys of Fisher rats were orthotopically grafted to Lewis rats. Fisher autografts and kidneys after uninephrectomy served as controls. All animals received low-dose cyclosporin A (CsA; 1.5 mg/kg body wt) for 10 d after surgery. Allotransplanted animals were then randomized to receive standard diet or a diet designed to deliver 30 mg of LU 135252/kg body wt per d for 35 wk. BP was monitored telemetrically. Treatment with LU 135252 did not affect systolic or diastolic pressure. Indices of glomerulosclerosis (GSI), and tubulointerstitial and vascular damage were measured. Chronic transplant nephropathy was almost completely prevented by LU 135252 compared with untreated allografts or kidneys of uninephrectomized controls, i.e., GSI 0.7 ± 0.12 versus 1.6 ± 0.25 (P < 0.001) versus 0.7 ± 0.06 (P < 0.001). Allograft weight and serum creatinine were significantly lower in treated versus untreated animals. The results are consistent with the notion that ETA receptor-mediated events play a role in the genesis of chronic transplant nephropathy.
Influence of Donor Factors on Early Function of Graft Kidneys
Authors: SURI DEEPIKA , MEYER TIMOTHY W.
Published: May 2021

Factors which influence graft function can be divided into donor factors that affect both kidneys from the same donor equally and postdonor factors that affect each kidney individually. This study assessed the influence of donor factors on graft function early after transplantation. Sixty-one donors who provided kidneys that were transplanted locally into two separate recipients were identified. Recipient creatinine clearance values were estimated from serum creatinine concentrations using a computer model. Pairwise ANOVA showed that donor factors accounted for 35 to 45% of the variation in recipient creatinine clearance from 2 d to 2 wk posttransplantation. Although donor factors had a large aggregate effect during this period, individual factors that influenced graft function could not be identified from analysis of donor medical records. At 6 mo after transplantation, the effect of donor factors on graft function was no longer discernible. These results show that the condition of the donor exerts an important influence on graft function early after transplantation. More detailed study is required to identify individual factors that contribute to this effect.
Effect of Danaparoid Sodium on Proteinuria, von Willebrand Factor, and Hard Exudates in Patients with Diabetes Mellitus Type 2
Authors: VAN DER PIJL JOHAN W. , LEMKES HERMAN H. P. J. , FRÖLICH MARIJKE , VAN DER WOUDE FOKKO J. , VAN DER MEER FELIX J. M. , VAN ES LEENDERT A.
Published: May 2021

In diabetic nephropathy, heparan sulfate glycosaminoglycan side chains are reduced in glomerular basement membranes proportionally to the degree of proteinuria. Recently, it was demonstrated that additional therapy with danaparoid sodium, a mixture of sulfated glycosaminoglycans with mainly heparan sulfate, lowered proteinuria in type 1 diabetes patients with diabetic nephropathy. A randomized placebo-controlled parallel study was performed with 750 anti-Xa units of danaparoid sodium once daily in type 2 diabetes patients with severe proteinuria. The aim of the study was to evaluate the possible effects of danaparoid sodium on proteinuria, endothelial dysfunction, and hard exudates in the retina and to determine the safety/tolerability of this drug. Twenty-two patients completed the study, and one patient had to stop prematurely after 6 wk of danaparoid sodium treatment because of urticaria at the injection sites. Apart from a small decrease of hemoglobin and minor skin hematomas at the injection site in five patients in the danaparoid sodium group, no other safety parameters showed any clinically or statistically significant difference between and within groups. The relative change in time of both the urinary albumin and protein excretion rate corrected for creatinine did not differ between both treatment arms (P = 0.2 and 0.49, respectively). No retinal complications or changes of hard exudates occurred. von Willebrand factor was elevated in both groups, but was not influenced by either treatment modality. Contrary to the beneficial effects that occurred in type 1 diabetes patients with diabetic nephropathy, treatment for 8 wk with 750 anti-Xa units of danaparoid sodium gave no reduction of proteinuria, hard exudates, and von Willebrand factor.
Transmembrane Proteins in the Tight Junction Barrier
Authors: FANNING ALAN S. , MITIC LAURA L. , ANDERSON JAMES MELVIN
Published: May 2021

Three types of transmembrane proteins have been identified within the tight junction, but it remains to be determined how they provide the molecular basis for regulating the paracellular permeability for water, solutes, and immune cells. Several of these proteins localize specifically within the continuous cell-to-cell contacts of the tight junction. One of these, occludin, is a cell adhesion molecule that has been demonstrated to influence ion and solute permeability. The claudins are a family of four-membrane spanning proteins; unexpectedly, other members of this family have already been characterized without recognizing their relationship to tight junctions. Junction adhesion molecule, the most recently identified tight junction component, is a member of the Ig superfamily and influences the paracellular transmigration of immune cells. A plaque of cytoplasmic proteins under the junction may be responsible for scaffolding the transmembrane proteins, creating a link to the perijunctional actin cytoskeleton and transducing regulatory signals that control the paracellular barrier.
Gentamicin Inhibits Renal Protein and Phospholipid Metabolism in Rats
Authors: SUNDIN DAVID P. , SANDOVAL RUBEN , MOLITORIS BRUCE A.
Published: May 2021

Studies were undertaken to characterize the mechanism of aminoglycoside-induced nephrotoxicity. Early time points in gentamicin treatment (1 to 3 d) were used to investigate the development of toxic events without the complication of gross morphologic cellular alterations. Enzyme activities of cortical homogenates and brush border membrane (BBM) preparations documented little effect on specific activities or the ability to isolate representative membrane fractions. In vivo protein synthesis experiments demonstrated that gentamicin reduced cellular protein synthesis after 2 d of treatment. This inhibition increased to 50% on the third day. Total cellular proteins synthesis was inhibited to the same extent as BBM protein synthesis. However, gentamicin had different effects on homogenate versus BBM phospholipids. The total phospholipid contents in cortical homogenates and BBM from treated animals were increased, compared with control animals. A significant decrease in phospholipid synthesis was observed only in homogenates from treated animals. When effects on individual phospholipids were investigated, only an increase in phosphatidylinositol levels was observed in cortical homogenates from treated rats. However, gentamicin treatment was demonstrated to increase the levels of phosphatidylinositol and phosphatidylcholine, while decreasing the level of sphingomyelin (SPH), in BBM. Incorporation of 32P into SPH, phosphatidylserine, and phosphatidylethanolamine was inhibited in cortical homogenates from gentamicin-treated animals; among BBM phospholipids, however, a significant decrease was observed only for SPH synthesis. It was concluded that inhibition of phospholipid degradation was quantitatively the major contributor to the effects of gentamicin on phospholipid metabolism. Confocal microscopic studies, using tracer amounts of fluorescently labeled gentamicin, revealed gentamicin in large, mostly basal structures. Correlative electron microscopic studies, using photo-oxidation techniques, demonstrated that these structures consisted of lysosomal, Golgi complex, and mitochondrial structures. These observations suggest retrograde trafficking of gentamicin and indicate a general mechanism of gentamicin-induced nephrotoxicity.
Silica Exposure in Anti-Neutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis and Lupus Nephritis
Authors: HOGAN SUSAN L. , SATTERLY KAREN K. , DOOLEY MARY ANNE , NACHMAN PATRICK H. , JENNETTE J. CHARLES , FALK RONALD J.
Published: May 2021

Anti-neutrophil cytoplasmic autoantibody (ANCA)-associated small-vessel vasculitis (SVV) and systemic lupus erythematosus (SLE) are rare diseases with unknown causes. Silica dust exposure has been suggested to be an environmental factor that may increase the risk of developing these and other autoimmune disorders. This is a report of two case-control studies to determine whether silica dust exposure is independently associated with ANCA-SVV with glomerulonephritis and SLE nephritis. Patients were screened through a collaborative network of 225 private practice and university nephrologists (the Glomerular Disease Collaborative Network). Patients with ANCA-SVV or SLE, all with biopsy-proven renal involvement, were included. Control subjects were patients without ANCA-SVV or SLE who had been referred to the same renal clinics and were matched for gender, race, and age (within 5 yr). Exposures to silica, exposures to other environmental agents, and smoking histories were evaluated using a self-administered questionnaire. Enrollment consisted of 65 patients with ANCA-SVV and 51 patients with SLE nephritis. Silica dust exposure was reported by 46% of patients with ANCA-SVV, compared with 20% of control subjects (P = 0.001). The odds ratio of silica dust exposure was 4.4 times greater for patients with ANCA-SVV, compared with control subjects (95% confidence interval, 1.36 to 13.4; P = 0.013). The odds ratios for silica dust exposure were similar for patients with ANCA-SVV with lung or sinus vasculitis (odds ratio, 4.5; 95% confidence interval, 0.99 to 20.83; P = 0.054) and those without lung or sinus vasculitis (odds ratio, 4.7; 95% confidence interval, 1.34 to 16.24; P = 0.016). Silica dust exposure was reported by 12% of patients with SLE nephritis, compared with 25% of control subjects (P = 0.047). The odds ratio for exposure to silica dust was not statistically different for patients with SLE nephritis, compared with control subjects (odds ratio, 0.001; 95% confidence interval, <0.01 to >100; P = 0.993). Activities and environments known to cause high levels of exposure to silica dust were associated with ANCA-SVV but not with SLE nephritis.
Impact of Sodium and Ultrafiltration Profiling on Hemodialysis-Related Symptoms
Authors: OLIVER MATTHEW J. , EDWARDS LLOYD J. , CHURCHILL DAVID N.
Published: May 2021

Dialysate sodium and ultrafiltration profiling are two methods to reduce symptoms during hemodialysis. The objective of the study was to determine the efficacy of combining these techniques to reduce symptoms in chronic hemodialysis patients. Blood volume changes were measured to determine whether any benefit of profiling could be explained through this mechanism. Patients were randomized to profiled dialysate sodium and ultrafiltration or constant dialysate sodium and ultrafiltration. The study was a two-period, two-treatment, crossover design with repeated measures. The primary outcome was hypotension and/or symptomatic events observed by the dialysis nurse. Secondary outcomes were symptom survey scores, weights, BP, and blood volume changes. Thirty-three patients were randomized. On standard treatment, 30.6% of dialysis sessions were symptomatic compared with 20.4% on profiled treatments. The odds ratio for the development of hypotension or symptomatic event on profiled treatments was 0.61 (95% confidence interval, 0.39 to 0.96) compared with standard treatment. Patients had lower symptom scores by questionnaire in both the intradialytic and the interdialytic periods during profiled treatments. Predialysis weight was greater during profiled treatments by 0.3 kg (P = 0.008), but there were no differences in postdialysis weight, BP, or thirst. There was no difference in maximum decrease in blood volume during the two treatments (standard, -11.2%; profiled, -10.0%; P = 0.08), but there was a significant difference in the rate of change in blood volume (standard, -2.96%/h; profiled, -1.96%/h; P < 0.001). Decrease in blood volume, rate of change in blood volume, and predialysis weights were not associated with hypotension or symptomatic dialysis sessions. In conclusion, dialysate sodium and ultrafiltration profiling significantly reduces hemodialysis-related symptoms. Profiling reduces the slope of the blood volume curve during dialysis, but blood volume changes are not predictive of symptomatic events for an individual patient.
Renal Function and Nutritional Status at the Start of Chronic Dialysis Treatment
Authors: JANSEN MAARTEN A. M. , KOREVAAR JOHANNA C. , DEKKER FRIEDO W. , JAGER KITTY J. , BOESCHOTEN ELISABETH W. , KREDIET RAYMOND T.
Published: May 2021

Early start of dialysis has been hypothesized to prevent deterioration of nutritional status and to lead to a better clinical outcome. According to the National Kidney Foundation/Dialysis Outcomes Quality Initiative guidelines, dialysis should be started when renal Kt/Vurea falls below 2.0/wk or the protein equivalent of total nitrogen appearance normalized to body weight (nPNA) falls below 0.8 g/kg per d. The present study was performed 0 to 4 wk before the start of dialysis treatment in 114 incident Dutch patients with chronic renal failure who all had received pre-end-stage renal disease care. The objectives were (1) to analyze the relationship of different levels of residual renal function with parameters of nutritional status and (2) to investigate the relationship of renal Kt/Vurea and nPNA in this population. The mean GFR at the start of dialysis treatment was 6.2 ml/min per 1.73 m2, and the Kt/Vurea was 1.3/wk. Only 10% of the patients fulfilled the Dialysis Outcomes Quality Initiative criterion of Kt/Vurea > 2.0/wk. In contrast, 69% met the nPNA norm of 0.8 g/kg per d. Seventy-one percent of these patients had a normal nutritional status as scored by subjective global assessment and also other parameters of nutritional status, such as body mass index, and serum albumin fell within the normal range in the majority of the patients. Dutch predialysis patients reached a higher nPNA with the same level of Kt/Vurea compared with U.S. predialysis patients. Implications of these findings are that guidelines on the initiation of dialysis treatment derived from one population are not necessarily valid in other populations.