48 research outputs found
Bone, inflammation and the bone marrow niche in chronic kidney disease. what do we know
No full textRecent improvements in our understanding of physiology have altered the way in which bone is perceived: no longer is it considered as simply the repository of divalent ions, but rather as a sophisticated endocrine organ with potential extraskeletal effects. Indeed, a number of pathologic conditions involving bone in different ways can now be reconsidered from a bone-centred perspective. For example, in metabolic bone diseases like osteoporosis (OP) and renal osteodystrophy (ROD), the association with a worse cardiovascular outcome can be tentatively explained by the possible derangements of three recently discovered bone hormones (osteocalcin, fibroblast growth factor 23 and sclerostin) and a bone-specific enzyme (alkaline phosphatase). Further, in recent years the close link between bone and inflammation has been better appreciated and a wide range of chronic inflammatory states (from rheumatoid arthritis to ageing) are being explored to discover the biochemical changes that ultimately lead to bone loss and OP. Also, it has been acknowledged that the concept of the bone-vascular axis may explain, for example, the relationship between bone metabolism and vessel wall diseases like atherosclerosis and arteriosclerosis, with potential involvement of a number of cytokines and metabolic pathways. A very important discovery in bone physiology is the bone marrow (BM) niche, the functional unit where stem cells interact, exchanging signals that impact on their fate as bone-forming cells or immune-competent haematopoietic elements. This new element of bone physiology has been recognized to be dysfunctional in diabetes (so-called diabetic mobilopathy), with possible clinical implications. In our opinion, ROD, the metabolic bone disease of renal patients, will in the future probably be identified as a cause of BM niche dysfunction. An integrated view of bone, which includes the BM niche, now seems necessary in order to understand the complex clinical entity of chronic kidney disease-mineral and bone disorders and its cardiovascular burden. Bone is thus becoming a recurrently considered paradigm for different inter-organ communications that needs to be considered in patients with complex diseases
Magnesium-based interventions for normal kidney function and chronic kidney disease
No full textMagnesium (Mg) is one of the most important cations in the body, playing an essential role in biological systems as co-factor for more than 300 essential enzymatic reactions. In the general population, low levels of Mg are associated with a high risk of cardio-vascular disease (CVD). Despite the accumulating literature data, the effect of Mg administration on mortality in chronic kidney disease (CKD) patients has never been investigated as a primary end-point. We conducted a systematic search of studies assessing the benefits and harms of Mg in CKD (stages 1 to 5 and 5D), and considered all randomized controlled trials (RCTs) and quasi-RCTs evaluating Mg-based interventions in CKD. As a phosphate binder, Mg salts offer a plausible opportunity for doubly favorable effects via reduction of intestinal phosphate absorption and addition of potentially beneficial effects via increasing circulating Mg levels. Mg supplementation might have a favorable effect on vascular calcification, although evidence for this is very slight. Although longitudinal data describe an association between low serum Mg levels and increased total and cardiovascular mortality, in patients with CKD, the existing RCTs reporting the effect of Mg supplementation on mortality failed to demonstrate any favorable effect. As with many other variables that influence hard end-points in nephrology, the role of Mg in CKD patients needs to be investigated in more depth. Additional research that is well-designed and directly targeting the role of Mg is needed as a consequence of limited existing evidenc
Blueprint for a european calciphylaxis registry initiative. the european calciphylaxis network (eucalnet)
No full textCalcific uraemic arteriolopathy (CUA) is a rare disease and continues to be a clinical challenge. The typical course of CUA is characterized by painful skin discolouration and induration evolving to necrotic ulcerations. Medial calcification of cutaneous arterioles and extensive extracellular matrix remodelling are the hallmarks of CUA. The epidemiology and risk factors associated with this disease are still not fully understood. Moreover, CUA treatment strategies vary significantly among centres and expert recommendations are heterogeneous. Registries may provide important insights and information to increase our knowledge about epidemiology and clinical aspects of CUA and may help to optimize its therapeutic management. In 2006, we established an internet-based registry in Germany (www.calciphylaxie.de) to allow online notification of patients with established or suspected CUA. The registry includes a comprehensive database with questions covering >70 parameters and items regarding patient-related and laboratory data, clinical background and presentation as well as therapeutic strategies. The next phase will be to allow international patient registration via www.calciphylaxis.net as part of the multinational EuCalNet (European Calciphylaxis Network) initiative, which is supported by the ERA-EDTA scientific working group 'CKD-MBD'. Based on the valuable experience with the previous German CUA registry, EuCalNet will be a useful tool to collect data on the rare disease CUA and may become a basis for prospective controlled trials in the near future
Pro : Cardiovascular calcifications are clinically relevant
No full textIt is increasingly acknowledged that mineral and bone disorders (MBDs) contribute to the excessively high cardiovascular (CV) disease morbidity and mortality observed in patients with chronic kidney disease (CKD). There is ongoing debate as to whether screening for CV calcification, one of the hallmarks of CKD-MBD, should be implemented in clinical practice in patients with CKD. Issues to be considered in this controversy relate to prevalence, severity, relevance, and last but not least, modifiability and reversibility of vascular and valvular calcifications in the setting of CKD. The recent expansion of the armamentarium to treat CKD-MBD (calcium-free phosphate binders and calcimimetics) creates new opportunities. Mounting experimental and clinical evidence indicates that progression of CV calcification may indeed be attenuated. Whether this will translate into better outcomes remains to be proven. We acknowledge that hard outcome data so far are limited and, overall, yielded inconclusive results. Nevertheless, in an era in which personalized medicine has gained much popularity, we consider it reasonable, awaiting the results of additional studies, to screen for CV calcification in selected individuals. This policy may help to stratify CV risk and to guide therapy. We speculate that such an approach will ultimately improve outcomes and reduce health costs
Invisible wounds: rethinking recognition in decolonial narratives of illness and disability
No full textWorking at the interface of literary studies, decolonial theory, and disability studies, my dissertation draws on literature and film across a variety of genres, including fiction by Ralph Ellison, Gabriel García Márquez, Toni Morrison, and Junot Díaz, to demonstrate how literary narratives about illness and disability contribute to understanding racial formations and ameliorating colonial wounds. The dissertation develops a critical framework for understanding the ways in which a sustained encounter between critical race studies, disability studies, and the medical humanities can generate new conceptions of health and healing. I accomplish this through a reassessment of the writings of decolonial theorist Frantz Fanon, a physician who used narrative case studies and ethnography to illuminate the imbrication of race, illness, and disability. By introducing a decolonial perspective to the study of narratives of illness and disability, this project not only challenges the medical humanities and disability studies to consider the experience of race and the effects of colonialism, but also foregrounds questions of disability and illness within the fields of race theory and postcolonial studies, where they have until now received minimal scholarly attention. Chapter one argues that Fanon’s clinical and philosophical perspective offers the medical humanities critical tools with which to dismantle binaries at the center of Western hegemonic thought and which serve to perpetuate Eurocentrism. As I build a theory of decolonial embodiment in chapter two, I work with Fanon’s and Ralph Ellison’s scathing critiques of Mark Robson’s 1949 Home of the Brave, a Hollywood film that problematically conflates blackness and disability. Read against the grain, the film also illuminates the limits of Eurocentric psychiatry’s understanding of the black subject. In chapter three I perform a comparative reading of Toni Morrison’s iconic neo-slave narrative Beloved and Gabriel García Márquez’s underexplored Of Love and Other Demons to examine the healing power of love in a decolonial context. My final chapter examines ethnographies of illness by medical anthropologists Paul Farmer and Cheryl Mattingly in light of Fanon’s The Wretched of the Earth, which itself can be understood as a radical form of ethnography, to argue that beyond recognizing the suffering of people of color it is essential to take seriously the need to create a new narrative of the human that is not defined by European standards.Ph.D.Includes bibliographical referencesby Carolyn Margaret Ureñ
Blueprint for a European calciphylaxis registry initiative: European Calciphylaxis Network (EuCalNet)
No full textCalcific uraemic arteriolopathy (CUA) is a rare disease and continues to be a clinical challenge. The typical course of CUA is
characterized by painful skin discolouration and induration evolving to necrotic ulcerations. Medial calcification of cutaneous
arterioles and extensive extracellular matrix remodelling are the hallmarks of CUA. The epidemiology and risk factors
associated with this disease are still not fully understood. Moreover, CUA treatment strategies vary significantly among centres
and expert recommendations are heterogeneous. Registries may provide important insights and information to increase our
knowledge about epidemiology and clinical aspects of CUA and may help to optimize its therapeutic management. In 2006, we
established an internet-based registry in Germany (www.calciphylaxie.de) to allow online notification of patients with
established or suspected CUA. The registry includes a comprehensive database with questions covering >70 parameters and
items regarding patient-related and laboratory data, clinical background and presentation as well as therapeutic strategies. The
next phase will be to allow international patient registration via www.calciphylaxis.net as part of the multinational EuCalNet
(European Calciphylaxis Network) initiative, which is supported by the ERA-EDTA scientific working group ‘CKD-MBD’. Based on
the valuable experience with the previous German CUA registry, EuCalNet will be a useful tool to collect data on the rare disease
CUA and may become a basis for prospective controlled trials in the near future
Contra fato, há argumento: leitura de uma revista cultural de resistência
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Comunicação e Expressão. Curso de Pós-Graduação em LiteraturaLeitura de Argumento - revista mensal de cultura, que teve publicado apenas quatro números. A revista foi lançada pela editora Paz e Terra e circulou entre os meses de outubro de 1973 e fevereiro de 1974, sob a direção de Barbosa Lima Sobrinho. A partir das informações extraídas da indexação do periódico na base de dados desenvolvida pelo projeto "Poéticas contemporâneas: histórias e caminhos", observou-se uma postura de crítica e resistência ao que estava político e culturalmente instituído no cenário brasileiro e latino-americano da época, o que levou a entender que a revista pretendia divulgar o seu projeto cultural. Este apresenta-se através de uma conjunto de textos que afirmam uma noção de cultura, uma posição da crítica literária e também o ideal de integração da América Latina
Analysis and processing of academic data from a higher institution with tools for big data
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