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The study aims to analyze the effects of relational marketing and social networks on the satisfaction of university students. The research focuses on two academic activities: administrative procedures and academic communication. A theoretical model based on Relational Marketing was designed, and the Structural Equation Model (SEM) was applied to evaluate the reliability and validity of the constructs, as well as to test the relationships of the structural model. An exploratory factorial analysis was carried out using the PLS-SEM method, which measured the model's capacity through the coefficient of determination R2, an appropriate approach for research in management sciences. The study was conducted with a sample of 708 students. The results allow for the acceptance of the proposed hypotheses, indicating that there is a positive relationship between the relationship attributes based on social networks (Facebook, Instagram, and Youtube) and communication with students. It is accepted that the more relationship attributes universities use, the better the academic procedures will be on social networks, and finally, it is determined that there is greater satisfaction and student relationship when academic procedures are carried out through social networks.

We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection. Resumen: Presentamos el caso de un varón afecto por neumonía SARS-CoV-2 grave, que a la vez comienza con una glomerulonefritis rápidamente progresiva p-ANCA positiva. Se comentan las distintas posibilidades terapéuticas haciendo hincapié en la idoneidad de su administración según el momento evolutivo de la infección.

Urban development in the areas surrounding active volcanoes has led to increasing risks in southern Peru. In order to evaluate the hazard, the Instituto Geológico, Minero y Metalúrgico (INGEMMET) created a Volcano Observatory (OVI) to carry out detailed geological investigations to understand eruption histories and provide volcanic hazard maps. The generation of geological information on volcanoes has allowed the identification of scenarios and zoning of potentially impacted areas. This information has also allowed OVI to implement surveillance networks giving priority to the volcanoes that pose the greatest risk to the population, infrastructure, and economic activities. Since 2006, OVI has been running volcanic monitoring networks with a multidisciplinary approach, improving real-time transmission, and making timely forecasts. Based on geological information and the risk posed by the volcanoes, the greatest efforts have been made to monitor Sabancaya, Misti, Ubinas, and Ticsani volcanoes. Following the order of priorities, monitoring of Coropuna, Huaynaputina, Tutupaca and, Yucamane volcanoes has also been developed. In addition, OVI carries out routine education activities and diffusion of information that serve to manage volcanic risk in Peru. El desarrollo urbano en zonas aledañas a volcanes activos ha conllevado a la generación de riesgos cada vez mayores en el sur del Perú. Con la finalidad de evaluar el peligro, el Instituto Geológico, Minero y Metalúrgico (INGEMMET) creó un observatorio vulcanológico (OVI) para realizar estudios geológicos detallados que permitan conocer las historias eruptivas y elaborar mapas de peligros volcánicos. La generación de información geológica sobre los volcanes ha permitido la identificación de escenarios y la zonificación de áreas con potencial a ser afectadas. Esta información también ha permitido al OVI implementar sus redes de monitoreo priorizando los volcanes que representan mayor riesgo para la población, la infraestructura y las actividades económicas. Desde el año 2006, el OVI viene implementando redes de vigilancia volcánica con un enfoque multidisciplinario, mejorando la transmisión en tiempo real y realizando pronósticos oportunos. En base a la información geológica y el nivel de riesgo de los volcanes, se han puesto los mayores esfuerzos en monitorear los volcanes Sabancaya, Misti, Ubinas y Ticsani. Siguiendo el orden de prioridades, el OVI ha comenzado, también, el monitoreo de los volcanes Coropuna, Huaynaputina, Tutupaca y Yucamane. Además, el observatorio desarrolla actividades permanentes de educación y difusión de la información que sirven a la gestión del riesgo volcánico en el Perú.

Introduction: Postural balance is the result of a complex interaction of sensory input which keeps us upright. Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Our objective was to analyse postural stability and its relationship with the risk of falls in haemodialysis patients using a force platform. Material and methods: This was a prospective cross-sectional study. Postural balance was recorded using a force platform in prevalent haemodialysis patients. We collected epidemiological, dialysis, analytical and treatment data. The incidence of falls was recorded over the six months following the tests. The postural stability analysis was performed with a portable strain gauge platform (AMTI AccuGait®) and a specific software unit for stabilometry (Balance Trainer® program). We measured 31 balance parameters; the balance variables used were: Area95; Area effect; VyMax; Xrange and Yrange. The stabilometry studies were performed in three situations: with eyes open (EO); with eyes closed (EC); and with the patient performing a simultaneous task (COG). We performed one study at the start of the dialysis session, and a second study at the end. Stabilometry was measured in a control group under similar conditions. Results: We studied 32 patients with a mean age of 68 years old; of this group, 20 subjects were male and 12 were female. Their mean weight was 74 kg, with a mean BMI of 27.6 kg/m2. In the controls, there were no significant differences in the stabilometry between the three situations studied. Both pre- and post-haemodialysis, patients with closed eyes showed greater imbalance, and there were significant differences with the other situations and controls. We found a significant increase in instability after the haemodialysis session, and greater instability in the 13 patients with diabetes (p

Hypomagnesaemia in haemodialysis (HD) is associated with increased mortality risk: its relationship with dialysis fluid (DF). Introduction: Low concentrations of magnesium (Mg) in blood have been linked to the development of diabetes, hypertension, arrhythmias, vascular calcifications and an increased risk of death in the general population and in haemodialysis patients. The composition of the dialysis fluid in terms of its magnesium concentration is one of the main determinants of magnesium in haemodialysis patients. Objective: To study magnesium concentrations in haemodialysis patients, their predictive mortality rate and what factors are associated with hypomagnesaemia and mortality in haemodialysis. Methods: Retrospective study of a cohort of prevalent haemodialysis patients followed up for two years. Serum magnesium was measured every six months. The analysis used the initial and average magnesium values for each patient, comparing patients with magnesium below the mean (2.1 mg/dl) with those with magnesium above the mean. During the follow-up, three types of dialysis fluid were used: type 1, magnesium 0.5 mmol/l; type 3, magnesium 0.37 mmol/l (both with acetate); and type 2, magnesium 0.5 mmol/l with citrate. Results: We included 137 haemodialysis patients in the study, of which 72 were male and 65 were female, with a mean age of 67 (15) [26–95] years old. Of this group, 57 patients were diabetic, 70 were on online haemodiafiltration (OL-HDF) and 67 were on high-flow haemodialysis (HF-HD). The mean magnesium of the 93 patients with dialysis fluid type 1 was 2.18 (0.37) mg/dl. In the 27 patients with dialysis fluid type 3 it was 2.02 (0.42) mg/dl. And in the 17 with dialysis fluid type 2 it was 1.84 (0.24) mg/dl (p = 0.01). There was a pronounced direct relationship between Mg and P and albumin. After a mean follow-up of 16.6 (8.9) [3–24] months, 77 remained active, 24 had died and 36 had been transplanted or transferred. Patients with magnesium above than 2.1 mg/dl had a longer survival (p = 0.008). The survival of patients with the three types of dialysis fluid did not differ significantly (Log-Rank, p = 0.424). Corrected for blood magnesium, patients with dialysis fluid with citrate have better survival (p = 0.009). The COX regression analysis shows how age, serum albumin, magnesium, dialysis technique and type of dialysis fluid have an independent predictive mortality rate. Conclusions: Low serum magnesium levels have a greater association with an increased risk of mortality compared to high levels. The type of dialysis fluid affects the magnesium concentration and the risk of death. Resumen: La hipomagnesemia en hemodiálisis (HD) se asocia a mayor riesgo de mortalidad: su relación con el líquido de diálisis (LD). Introducción: Concentraciones bajas de magnesio (Mg) en sangre se han relacionado con el desarrollo de diabetes, hipertensión arterial, arritmias, calcificaciones vasculares y con mayor riesgo de muerte, en población general y en hemodiálisis. La composición del LD y su concentración de Mg es uno de los principales determinantes de la magnesemia en los pacientes en HD. Objetivo: Estudiar las concentraciones de magnesio en los pacientes en HD, su valor predictivo de mortalidad y qué factores se asocian a la hipomagnesemia y mortalidad en HD. Métodos: Estudio retrospectivo de una cohorte de pacientes prevalentes en HD seguidos 2 años. Cada 6 meses se determina el Mg sérico. En el análisis se utiliza el Mg inicial y el medio de cada paciente, comparando los pacientes con Mg por debajo de la media, 2,1 mg/dl, con los que están por encima. Durante el seguimiento se han utilizado 3 tipos de LD: tipo 1, magnesio de 0,5 mmol/l y tipo 3, Mg 0,37 mmol/l ambos con acetato y tipo 2, 0,5 mmol/l de Mg con citrato. Resultados: Se han incluido en el estudio 137 pacientes en hemodiálisis, 72 hombres y 65 mujeres, con una edad media de 67(15) [26–95] años. 57 pacientes eran diabéticos y 70 pacientes estaban en hemodiafiltración en línea (HDF-OL) y 67 en hemodiálisis de alto flujo (HD-HF). El Mg medio de los 93 pacientes con LD tipo 1 era: 2,18(0,37)mg/dl, en 27 con el tipo 3: 2,02 (0,42)mg/dl y los 17 con tipo 2: 1,84 (0,24)mg/dl (p = 0,01). El Mg se relaciona de forma directa significativa con el P y con la albumina. Después de un seguimiento medio de 16,6(8,9)[3–24] meses, 77 seguían activos, 24 habían fallecido y 36 se habían trasplantado o trasladado. Los pacientes con un Mg superior a 2,1 mg/dl tienen una supervivencia mayor, p = 0,008. La supervivencia de los pacientes con los tres tipos de LD no difería significativamente, Log-Rank, p = 0,424. Corregido por la magnesemia, los pacientes con LD con citrato tienen mejor supervivencia, p = 0,009. En el análisis de regresión de COX se observa como la edad, albumina sérica, Mg, técnica de diálisis y tipo de LD tienen valor predictivo de mortalidad independiente. Conclusiones: Los magnesios séricos bajos respecto a los altos se asocian a mayor riesgo de mortalidad. El tipo de LD influye en la concentración de Mg y en el riesgo de muerte.

The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment. Resumen: La relación entre parásitos y glomerulonefritis (GN) está bien documentada en determinadas parasitosis, no así en casos de Strongyloides stercolaris (S. stercolaris), donde hay pocos casos descritos, siendo la mayoría GN de cambios mínimos. Reportamos un caso de hiperinfestación por S. stercolaris en un paciente afectado de una GN membranosa tratado con corticoides por vía oral con resultado fatal para el paciente. Este caso nos aporta una doble enseñanza: en primer lugar, acerca de una asociación rara de estrongiloidiasis y GN membranosa, y en segundo lugar, sobre la importancia de establecer un diagnóstico de sospecha y tratamiento adecuados ante determinadas infecciones o enfermedades con poca expresividad clínica antes de iniciar cualquier tratamiento inmunosupresor.

Rubus niveus o mora es una especie originaria de Asia. Esta planta se ha dispersado por varios continentes por sus usos antropogénicos y sus características biológicas. La alta adaptabilidad que presenta le ha permitido establecerse en nuevos ambientes y volverse invasora, como es el caso de las Islas Galápagos, Ecuador. Desde su llegada a estas islas, la mora ha ido desplazando plantas nativas, y hasta el momento ninguno de los métodos de control utilizados ha resultado efectivo. Estudiar la diversidad genética de esta planta usando marcadores moleculares podría servir para explicar el éxito de su invasión y para desarrollar medidas de control efectivas. Por lo expuesto, en el presente estudio se evaluó la viabilidad de marcadores microsatélites heterólogos para el análisis de la diversidad genética de esta especie en las Islas Galápagos. Para ello se colectaron y analizaron 68 muestras de diferentes localidades de las islas Santa Cruz, San Cristóbal, Isabela y Floreana, y 10 muestras del Ecuador continental. Se escogieron 15 marcadores microsatélites y todos amplificaron exitosamente, demostrando transferibilidad de una especie a otra. Los 15 loci resultaron monomórficos para las muestras amplificadas de las Islas Galápagos y Ecuador continental. Estos resultados no permitieron determinar la diversidad genética de la mora en las muestras estudiadas. Nuestro estudio con microsatélites y otros similares en especies del género Rubus, encontraron loci monomórficos. Por lo tanto, sugerimos llevar a cabo el secuenciamiento del genoma de la mora y así utilizar otros marcadores moleculares como los polimorfismos de un solo nucleótido para dilucidar el nivel de diversidad de esta especie.

Abstract Background Artificial Mitochondrial Transfer or Transplant (AMT/T) can be used to reduce the stress and loss of viability of damaged cells. In MitoCeption, a type of AMT/T, the isolated mitochondria and recipient cells are centrifuged together at 4 °C and then co-incubated at 37 °C in normal culture conditions, inducing the transfer. Ultraviolet radiation (UVR) can affect mitochondria and other cell structures, resulting in tissue stress, aging, and immunosuppression. AMT/T could be used to repair UVR cellular and mitochondrial damage. We studied if a mitochondrial mix from different donors (Primary Allogeneic Mitochondrial Mix, PAMM) can repair UVR damage and promote cell survival. Results Using a simplified adaption of the MitoCeption protocol, we used peripheral blood mononuclear cells (PBMCs) as the recipient cell model of the PAMM in order to determine if this protocol could repair UVR damage. Our results showed that when PBMCs are exposed to UVR, there is a decrease in metabolic activity, mitochondrial mass, and mtDNA sequence stability as well as an increase in p53 expression and the percentage of dead cells. When PAMM MitoCeption was used on UVR-damaged cells, it successfully transferred mitochondria from different donors to distinct PBMCs populations and repaired the observed UVR damage. Conclusion Our results represent an advancement in the applications of MitoCeption and other AMT/T. We showed that PBMCs could be used as a PAMM source of mitochondria. We also showed that these mitochondria can be transferred in a mix from different donors (PAMM) to UVR-damaged, non-adherent primary cells. Additionally, we decreased the duration of the MitoCeption protocol.

This article explores the critical factors of consumption in Mexico, Ecuador, and Colombia, due to confinement and social distancing. Besides, which are the factors that influence the purchase decision. In the proposed model, we tested from quantitative research with a sample of 2,065 online consumers. We analyzed the following statistics: CFA, structural equations, invariance of measurement instruments, and multi-group analysis with the Smart Pls 3 and EQS 6.3 software. The study reveals that time, space, and place in the consumption process is more visible in the purchasing behavior with social distancing, healthy distance, and the commercial restriction caused by the health contingency. In addition to being a health and humanitarian crisis, the pandemic has severe economic consequences worldwide as 1) the increase in unemployment rates, 2) collapsed health systems, 3) education models overwhelmed by technology, 4) supply chains interrupted by the closure of borders, 5) international and domestic tourism suspended due to a lack of sanitary protocols,6) social coexistence curtailed by significantly increased infections and 7) a decreasing demand by consumers for the closure of companies. Despite being Latin American countries, cultural differences were not the priority of consumption in the crisis period due to Covid-19. They significantly change purchasing behaviors, and all have adapted to online and home delivery purchases by the social factor, local consumption, and consumers' attitude. The article presents several considerations on the main factors of consumption in Covid-19 in collectivist countries (North American and South America) such as Mexico, Colombia, and Ecuador and finds no substantial differences with consumers. There are practical implications for companies to adopt online channels and to create sales strategies in the face of the endemic pandemic.

El confinamiento como una de las medidas decretadas en la emergencia sanitaria por el gobierno ecuatoriano para contrarrestar el impacto del virus SARS-CoV-2 o Covid-19, se ha visto reflejado en el comportamiento del consumidor. El propósito de este estudio es conocer los efectos que esta medida emergente ocasiona en el consumo de las personas, utilizando la medición de variables relacionadas con los factores personales, sociales, psicológicos y culturales. Se encuestó una muestra de 658 consumidores en cinco ciudades del Ecuador: Cuenca, Guayaquil, Loja, Machala y Quito. Se utilizó el Modelo de Ecuaciones Estructurales (SEM) para comprobar las hipótesis teóricas. Estas teorías fueron aceptadas considerando tres dimensiones: las cargas de los indicadores analizadas a través del test Loadings >0.7; la confiabilidad de consistencia interna medida a través del test de confiabilidad compuesta (CR) y Cronbach Alpha >0.7, para los constructos de comportamiento de compra, factores sociales, personales, psicológicos y culturales; y la validez convergente observadas a través del test Average Variance Extracted (AVE) > 0.5 para los cinco constructos. Los resultados muestran que las relaciones entre el comportamiento del consumidor y los factores personales, sociales, psicológicos y culturales se encuentran asociadas significativamente, lo cual proporciona algunas pautas para entender el comportamiento del consumidor y satisfacer mejor las necesidades en tiempo de crisis.

Introduction: Kt/V has been used as a synonym for hemodialysis dose. Patient survival improved with a Kt/V > 1; this target was subsequently increased to 1.2 and 1.3. The HEMO study revealed no significant relationship between Kt/V and mortality. The relationship between Kt/V and mortality often shows a J-shaped curve. Is V the confounding factor in this relationship? The objective of this study is to determine the relationship between mortality and Kt/V, Kt and body water content (V) and lean mass (bioimpedance). Methods: We studied a cohort of 127 prevalent hemodialysis patients, who we followed-up for an average of 36 months. Kt was determined by ionic dialysance, and V and nutrition parameters by bioimpedance. Kt/V, Kt corrected for body surface area (Kt/BSA) and target Kt/BSA were calculated. The mean data from 18,998 sessions were used as hemodialysis parameters, with a mean of 155 sessions per patient. Results: Mean age was 70.4 ± 15.3 years and 61% were male; 76 were dialyzed via an arteriovenous fistula and 65 were on online hemodiafiltration. Weight was 70.6 (16.8) kg; BSA 1.8 (0.25) m2; total body water (V) 32.2 (7.41) l and lean mass index (LMI) 11.1 (2.7) kg/m2. Mean Kt/V was 1.84 (0.44); Kt 56.1(7) l and Kt/BSA 52.8 (10.4) l. The mean target Kt/BSA was 49.7 (4.5) l. Mean Kt/BSA − target Kt/BSA + 6.4 (7.0) l. Patients with a higher Kt/V had worse survival rates than others; with Kt this is not the case. Higher Kt/V values are due to a lower V, with poorer nutrition parameters. LMI and serum albumin were the parameters that best independently predicted the risk of death and are lower in patients with a higher Kt/V and lower V. Conclusion: Kt/V is not useful for determining dialysis doses in patients with low or reduced body water. Kt or the Kt/BSA are proposed as an alternative. Resumen: Introducción: El Kt/V se ha usado como sinónimo de dosis de hemodiálisis. La supervivencia de los pacientes mejoraba con un Kt/V > 1; este objetivo posteriormente fue elevado a 1,2 y a 1,3. En el estudio HEMO no se demostró una relación significativa entre Kt/V y la mortalidad. La relación Kt/V y mortalidad con frecuencia es una curva en «J». ¿Es la V el factor de confusión de esa relación? El objetivo de este estudio es buscar la relación de la mortalidad con el Kt/V, Kt y con el contenido de agua corporal (V) y masa magra (bioimpedancia). Métodos: Se ha estudiado una cohorte de 127 pacientes prevalentes en hemodiálisis seguidos durante una media de 36 meses. Se determinó el Kt por dialisancia iónica y la V y parámetros de nutrición mediante bioimpedancia. Se ha calculado el Kt/V y el Kt alcanzado corregido para superficie corporal (Ktsc) y el Ktsc objetivo. Como parámetros de hemodiálisis se ha utilizado la media de los datos de 18.998 sesiones, con una media de 155 sesiones por paciente. Resultados: La edad media fue 70,4 (15,3) años y un 61% eran hombres; 76 se dializaban mediante fístula arteriovenosa y 65 estaban en HDF-OL. Peso: 70,6 (16,8) kg; superficie corporal: 1,8 (0,25) m2; agua corporal total: 32,2 (7,4) l; índice de masa magra (LTI): 11,1 (2,7) kg/m2. El Kt/V medio fue 1,84 (0,44); Kt: 56,1 (7) l, y el Ktsc, 52,8 (10,4) l. El Ktsc objetivo medio era de 49,7 (4,5) l. La media del Ktsc – Ktsc objetivo: +6,4 (7,0) l. Los pacientes con un Kt/V mayor tienen peor supervivencia que el resto. Con el Kt no existe esta relación. Los Kt/V mayores se deben a una V menor, con peores parámetros de nutrición. La albúmina sérica y el LTI son los parámetros que se relacionan con el riesgo de muerte de forma independiente y son menores en los pacientes con mayor Kt/V y menor V. Conclusión: El Kt/V no es útil para determinar la dosis de diálisis en pacientes con un agua corporal pequeña o disminuida. Se propone el Kt o el Ktsc como alternativa. Keywords: Kt/V, Kt, Hemodialysis, Mortality, Nutrition, Total body water, Palabras clave: Kt/V, Kt, Hemodiálisis, Mortalidad, Nutrición, Agua corporal total

The fresh or cryopreserved human umbilical cord (HUC) and its byproducts, such as cells and extracts, have different uses in tissue regeneration. Defining what HUC byproduct is more effective in a particular application is a challenge. Furthermore, the methods of isolation, culture and preservation, may affect cell viability and regenerative properties. In this article, we review the HUC and its byproducts’ applications in research and clinical practice. We present our results of successful use of HUC as a patch to treat gastroschisis and its potential to be applied in other conditions. Our in vitro results show an increase in proliferation and migration of human fibroblasts by using an acellular HUC extract. Our goal is to promote standardization of procedures and point out that applications of HUC and its byproducts, as well as the resulting advances in regenerative medicine, will depend on rigorous quality control and on more research in this area.

Increased acetataemia during haemodialysis sessions has been associated with a number of abnormalities, including increased oxidative stress, pro-inflammatory cytokines and nitric oxide synthesis. Citric acid may play an alternative role to acetate as a dialysate stabilizer given that the effect of citrate on complement and leukocyte activation is different to that of acetate. The purpose of this study was to compare the inflammatory effect in immunocompetent blood cells of acetate dialysate and citrate dialysate. Materials and methods: The effect of acetate and/or citrate was investigated in the whole blood of uremic patients and in healthy in vitro samples. Four types of dialysate were tested: dialysate 1, acetate-free with 1 mmol/L of citrate; dialysate 2, with 0.8 mmol/L of citrate and 0.3 mmol/L of acetate; dialysate 3, citrate-free with 3 mmol/L of acetate; and dialysate 4, citrate-free with 4 mmol/L of acetate. The cell types used were: human monocyte culture (THP-1); and peripheral blood mononuclear cells (PBMCs) from healthy subjects and uremic patients on haemodialysis. ICAM-1 was determined and levels of reactive oxygen species and total microvesicles were quantified. Results: Unlike the citrate dialysates, the dialysates with acetate (dialysate 3 and dialysate 4) induced increased ICAM-1 expression density in THP-1 cells; an increase in ICAM-1 expression was observed in the immunocompetent cells of healthy subjects with acetate dialysate (dialysate 3 and dialysate 4) but not with citrate dialysate (dialysate 1 and dialysate 2). No significant ICAM-1 differences were found between the different dialysates in the cells of haemodialysed patients. Reactive oxygen species expression and the number of microvesicles increased significantly with acetate dialysate but not with citrate dialysate in the cells of both healthy subjects and haemodialysed patients. Conclusion: At the concentrations in which it is generally used in clinical practice, acetate-based dialysate increases oxidative stress and the total number of microvesicles and may induce another pro-inflammatory stimuli in uremic patients on haemodialysis. Citrate dialysates do not induce this activation, which could make them a suitable alternative in clinical practice. Resumen: El líquido de diálisis con citrato no induce in vitro estrés oxidativo ni inflamación en comparación con el acetato.El incremento de la acetatemia durante la sesión de hemodiálisis se ha asociado a una serie de alteraciones: aumento del estrés oxidativo, de las citocinas proinflamatorias y de la síntesis de óxido nítrico. El ácido cítrico puede jugar un papel alternativo al acetato como estabilizante del líquido de diálisis (LD). El citrato en comparación con el acetato tiene un patrón diferente en cuanto a la activación leucocitaria y del complemento. El objetivo de este estudio es comparar el acetato con el citrato en el LD respecto a su efecto inflamatorio en las células inmunocompetentes de la sangre. Material y métodos: El efecto del acetato o citrato fue investigado en sangre completa de pacientes urémicos y controles sanos in vitro, enfrentada a 4 tipos de LD: el LD 1, con 1 mmol/L de citrato y libre de acetato; LD 2, con 0,8 mmol/L de citrato y 0,3 mmol/L de acetato; LD 3, con 3 mmol/L de acetato sin citrato y LD 4, con 4 mmol/L de acetato sin citrato. Los tipos de células utilizados fueron: cultivo de monocitos humanos (THP-1); células mononucleares de sangre periférica (PBMC) de controles sanos y pacientes urémicos en HD. Se determinó ICAM-1, la cuantificación de los niveles de especies reactivas de oxígeno (ROS) y la cuantificación de microvesículas totales. Resultados: Los LD con acetato (L3 y L4) indujeron un incremento en la densidad de expresión de ICAM-1 en las células THP-1, no así los de citrato; con células inmunocompetentes de sujetos sanos los LD con acetato (L3 y L4) respecto a los con citrato (L1 y L2) observamos un incremento en la expresión de ICAM-1; con células de pacientes en hemodiálisis no existían diferencias significativas entre los diferentes LD. Tanto en las células de sujetos sanos como en las de los dializados, se incrementaron significativamente la expresión de especies reactivas de oxígeno y las microvesículas con los LD con acetato y no con citrato. Conclusiones: El acetato en el LD, en las concentraciones que se utilizan habitualmente en la práctica clínica, aumenta el estrés oxidativo y las microvesículas totales, y puede actuar como coadyuvante de los otros estímulos proinflamatorios a los que están sometidos los pacientes urémicos en hemodiálisis. Los LD con citrato no producen esta activación, por lo que podrían ser una alternativa en la clínica. Keywords: Haemodialysis, Dialysate, Acetate, Citrate, Inflammation, Biocompatibility, Palabras clave: Hemodiálisis, Dializado, Acetato, Citrato, Inflamación, Biocompatibilidad

The addition of phosphorus (P) to the dialysate (LD) in the form of enema Casen® is common practice in patients with hypophosphatemia. The estimation of the amount to be used and the identification of the problems that may occur are not well defined. As a result of our work we propose a practical approach of how to proceed to increase phosphate concentration in the hemodialysate. We present a reasoned formula to calculate how much enema has to be added and the problems that may arise.

Introduction: In post-dilution online haemodiafiltration (OL-HDF), the only recommendation concerning the dialysate, or dialysis fluid, refers to its purity. No study has yet determined whether using a high dialysate flow (Qd) is useful for increasing Kt or ultrafiltration-infusion volume. Objective: Study the influence of Qd on Kt and on infusion volume in OL-HDF. Material and methods: This was a prospective crossover study. There were 37 patients to whom 6 sessions of OL-HDF were administered at 3 different Qds: 500, 600 and 700 mL/min. A 5008® monitor was used for the dialysis in 21 patients, while an AK-200® was used in 17. The dialysers used were: 20 with FX 800® and 17 with Polyflux-210®. The rest of the parameters were kept constant. Monitor data collected were effective blood flow, effective dialysis time, final Kt and infused volume. Results: We found that using a Qd of 600 or 700 mL/min increased Kt by 1.7% compared to using a Qd of 500 mL/min. Differences in infusion volume were not significant. Increasing Qd from 500 mL/min to 600 and 700 mL/min increased dialysate consumption by 20% and 40%, respectively. Conclusions: With the monitors and dialysers currently used in OL-HDF, a Qd higher than 500 mL/min is unhelpful for increasing the efficacy of Kt or infusion volume. Consequently, using a high Qd wastes water, a truly important resource both from the ecological and economic points of view.

En el área de las relaciones internacionales se ha abierto el debate acerca de cuál será el futuro del sistema internacional, que a su vez involucra el debate de si la República Popular de China se convertirá, después del rápido crecimiento económico, su naciente desarrollo militar, y su impulso a la cooperación internacional, en una superpotencia. Este artículo se concentrará en la pregunta de si China surgirá como una potencia detentora de un orden internacional heredado por Estados Unidos, o se convertirá en retadora del statu quo generando violencia entre los Estados. Para ello se analizarán las aportaciones hechas por algunos analistas al debate. Se establece que Estados Unidos es la única superpotencia actualmente, mientras China espera ascender como una potencia en el sistema internacional. Concluye que el ascenso pacífico o revisionista de China dependerá en gran medida de su relación con Estados Unidos, que definirá el tipo de potencia que China podría llegar a ser.

Background Current guidelines establish the same hemoglobin (Hb) and iron biomarkers targets for hemodialysis (HD) and peritoneal dialysis (PD) in patients receiving erythropoiesis-stimulating agents (ESAs) even though patients having PD are usually younger, more active and less comorbid. Unfortunately, specific renal anemia [anemia in chronic kidney disease (aCKD)] trials or observational studies on PD are scanty. The aims of this study were to describe current aCKD management, goals and adherence to clinical guidelines, identifying opportunities for healthcare improvement in PD patients. Methods This was a retrospective, nationwide, multicentre study including patients from 19 PD units. The nephrologists collected baseline data, demographics, comorbidities and data related to anemia management (laboratory values, previously prescribed treatments and subsequent adjustments) from electronic medical records. The European adaptation of KDIGO guidelines was the reference for definitions, drug prescriptions and targets. Results A total of 343 patients (mean age 62.9 years, 61.2% male) were included; 72.9% were receiving ESAs and 33.2% iron therapy [20.7% intravenously (IV)]. Eighty-two patients were receiving ESA without iron therapy, despite 53 of them having an indication according to the European Renal Best Practice guidelines. After laboratory results, iron therapy was only started in 15% of patients. Among ESA-treated patients, 51.9% had an optimal control [hemoglobin (Hb) 10–12 g/dL] and 28.3% between 12–12.9 g/dL. Seventeen patients achieved Hb >13 g/dL, and 12 of them remained on ESA after overshooting. Only three patients had Hb <10 g/dL without ESAs. Seven patients (2%) met criteria for ESA resistance (epoetin dose >300 IU/kg/week). The highest tertile of erythropoietin resistance index (>6.3 UI/kg/week/g/dL) was associated with iron deficiency and low albumin corrected by renal replacement therapy vintage and hospital admissions in the previous 3 months. Conclusion Iron therapy continues to be underused (especially IV). Low albumin, iron deficiency and prior events explain most of the ESA hyporesponsiveness. Hb targets are titrated to/above the upper limits. Thus, several missed opportunities for adequate prescriptions and adherence to guidelines were identified. [ABSTRACT FROM AUTHOR]

Background Patients on hemodialysis are at high-risk for complications derived from coronavirus disease 2019 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity 3 months after the booster dose. Methods This is a multicentric and prospective study assessing immunoglobulin G anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results A total of 711 patients [67% male, median age (range) 67 (20–89) years] were included. Of these, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, P  = .001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, P  = .693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated with mRNA-1273 booster (P  = .001), lower time from booster (P  = .043) and past breakthrough SARS-CoV-2 infection (P  < .001). Conclusions In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated with mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

In conclusion, KTRs developed lower vaccine response rates and anti-Spike antibody titres and lost antibodies faster than other CKD cohorts, and BNT162b2 was associated with lower anti-Spike antibody titres than mRNA-1273. SENCOVAC is a prospective multicentric study promoted by the Spanish Society of Nephrology (S.E.N.), which included four cohorts of adults with chronic kidney disease (CKD): kidney transplant recipients (KTRs), haemodialysis (HD), peritoneal dialysis (PD) and non-dialysis (ND)-CKD patients [glomerular filtration rate (GFR) <30 mL/min/1.73 m SP 2 sp ] [[1]]. The response rate, anti-Spike antibody titres and rate of loss of anti-Spike antibodies were similar for PD, HD and ND-CKD patients. Among patients with negative baseline anti-Spike antibodies, mRNA-1273 was also associated with higher antibody titres 3 months after vaccination (P = 0.009) (Supplementary data, Figure S4). [Extracted from the article]

Background Acute kidney injury (AKI) may develop in coronavirus disease 2019 (COVID-19) patients and may be associated with a worse outcome. The aim of this study is to describe AKI incidence during the first 45 days of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Spain, its reversibility and the association with mortality. Methods This was an observational retrospective case–control study based on patients hospitalized between 1 March and 15 April 2020 with SARS-CoV-2 infection and AKI. Confirmed AKI cases were compared with stable kidney function patients for baseline characteristics, analytical data, treatment and renal outcome. Patients with end-stage kidney disease were excluded. Results AKI incidence was 17.22% among 3182 admitted COVID-19 patients and acute kidney disease (AKD) incidence was 6.82%. The most frequent causes of AKI were prerenal (68.8%) and sepsis (21.9%). Odds ratio (OR) for AKI was increased in patients with pre-existent hypertension [OR 2.58, 95% confidence interval (CI) 1.71–3.89] and chronic kidney disease (CKD) (OR 2.14, 95% CI 1.33–3.42) and in those with respiratory distress (OR 2.37, 95% CI 1.52–3.70). Low arterial pressure at admission increased the risk for Stage 3 AKI (OR 1.65, 95% CI 1.09–2.50). Baseline kidney function was not recovered in 45.73% of overall AKI cases and in 52.75% of AKI patients with prior CKD. Mortality was 38.5% compared with 13.4% of the overall sample population. AKI increased mortality risk at any time of hospitalization (hazard ratio 1.45, 95% CI 1.09–1.93). Conclusions AKI is frequent in COVID-19 patients and is associated with mortality, independently of acute respiratory distress syndrome. AKD was also frequent and merits adequate follow-up. [ABSTRACT FROM AUTHOR]