RESUMEN
Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract. It is regarded as one of the most prevalent causes of acute kidney injury (AKI), accounting for 5%-10% of cases. Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction. The aim of the present article is to review and synthesize available evidence on obstructive uropathy, providing a clinical guideline for clinicians. A literature review on obstructive uropathy in the context of AKI was performed, focusing on the least clarified aspects regarding diagnosis and management. Recent literature searching was conducted in English and top-level evidence articles including systematic reviews, metanalyses and large series were prioritized. Acute obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the kidney. Early recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection. A multidisciplinary approach, including urologists, nephrologists, and other medical specialties, is best suited to correctly manage concomitant hemodynamic changes, fluid and electrolyte imbalances, and other related issues. Obstructive uropathy is one of the leading causes of AKI. Recognition of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challenging. A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.
RESUMEN
Background: The improvement of absent or partial response in the medical treatment of erectile dysfunction (ED) has led to the development of minimally invasive new treatment modalities in the field of regenerative medicine. Methods: A literature review on stem cell therapy for the treatment of ED was performed. We searched for the terms "erectile dysfunction" and "stem cell therapy" in PubMed and Clinicaltrials.gov. Literature searching was conducted in English and included articles from 2010 to 2022. Results: New treatment modalities for ED involving stem cell therapy are not only conceived with a curative intent but also aim to avoid unnecessary adverse effects. Several sources of stem cells have been described, each with unique characteristics and potential applications, and different delivery methods have been explored. A limited number of interventional studies over the past recent years have provided evidence of a safety profile in their use and promising results for the treatment of ED, although there are not enough studies to generate an appropriate protocol, dose or cell lineage, or to determine a mechanism of action. Conclusions: Stem cell therapy is a novel treatment for ED with potential future applications. However, most urological societies agree that further research is required to conclusively prove its potential benefit.
RESUMEN
Clouds are one of the most influential components of Earth's climate system. Specifically, the midlatitude clouds play a vital role in shaping Earth's albedo. This study investigates the connection between baroclinic activity, which dominates the midlatitude climate, and cloud-albedo and how it relates to Earth's existing hemispheric albedo symmetry. We show that baroclinic activity and cloud-albedo are highly correlated. By using Lagrangian tracking of cyclones and anticyclones and analyzing their individual cloud properties at different vertical levels, we explain why their cloud-albedo increases monotonically with intensity. We find that while for anticyclones, the relation between strength and cloudiness is mostly linear, for cyclones, in which clouds are more prevalent, the relation saturates with strength. Using the cloud-albedo strength relationships and the climatology of baroclinic activity, we demonstrate that the observed hemispheric difference in cloud-albedo is well explained by the difference in the population of cyclones and anticyclones, which counter-balances the difference in clear-sky albedo. Finally, we discuss the robustness of the hemispheric albedo symmetry in the future climate. Seemingly, the symmetry should break, as the northern hemisphere's storm track response differs from that of the southern hemisphere due to Arctic amplification. However, we show that the saturation of the cloud response to storm intensity implies that the increase in the skewness of the southern hemisphere storm distribution toward strong storms will decrease future cloud-albedo in the southern hemisphere. This complex response explains how albedo symmetry might persist even with the predicted asymmetric hemispheric change in baroclinicity under climate change.
RESUMEN
Some of the effects of past climate dynamics on plant and animal diversity make-up have been relatively well studied, but to less extent in fungi. Pleistocene refugia are thought to harbour high biological diversity (i.e. phylogenetic lineages and genetic diversity), mainly as a product of increased reproductive isolation and allele conservation. In addition, high extinction rates and genetic erosion are expected in previously glaciated regions. Some of the consequences of past climate dynamics might involve changes in range and population size that can result in divergence and incipient or cryptic speciation. Many of these dynamic processes and patterns can be inferred through phylogenetic and coalescent methods. In this study, we first delimit species within a group of closely related edible ectomycorrhizal Amanita from North America (the American Caesar's mushrooms species complex) using multilocus coalescent-based approaches; and then address questions related to effects of Pleistocene climate change on the diversity and genetics of the group. Our study includes extensive geographical sampling throughout the distribution range, and DNA sequences from three nuclear protein-coding genes. Results reveal cryptic diversity and high speciation rates in refugia. Population sizes and expansions seem to be larger at midrange latitudes (Mexican highlands and SE USA). Range shifts are proportional to population size expansions, which were overall more common during the Pleistocene. This study documents responses to past climate change in fungi and also highlights the applicability of the multispecies coalescent in comparative phylogeographical analyses and diversity assessments that include ancestral species.
Asunto(s)
Amanita/clasificación , Evolución Biológica , Filogenia , Refugio de Fauna , Amanita/genética , Teorema de Bayes , Cambio Climático , ADN de Hongos/genética , Genes Fúngicos , Genética de Población , Modelos Genéticos , Datos de Secuencia Molecular , Técnicas de Tipificación Micológica , América del Norte , Filogeografía , Densidad de Población , Análisis de Secuencia de ADNRESUMEN
Crohn's disease (CD) can be associated with respiratory involvement. Multiple pulmonary nodules are an infrequent finding in patients with CD. When they are found, histology usually shows sterile necrobiotic nodules, which are spherical aggregates of neutrophils, which frequently cavitate. We report a patient with inactive CD treated with mesalazine, who presented with multiple pulmonary nodules. Transthoracic biopsy of one of the nodules disclosed a benign, nongranulomatous inflammatory lymphoid infiltration. The radiographic abnormalities responded well to oral prednisone. Focal, nongranulomatous lymphoid infiltration thus must be considered in the differential diagnosis of multiple pulmonary nodules in patients with CD.