Medical Nutritional Therapy for Patients with Chronic Kidney Disease not on Dialysis: The Low Protein Diet as a Medication

The 2020 Kidney Disease Outcome Quality Initiative (KDOQI) Clinical Practice Guideline for Nutrition in chronic kidney disease (CKD) recommends protein restriction to patients affected by CKD in stages 3 to 5 (not on dialysis), provided that they are metabolically stable, with the goal to delay kidney failure (graded as evidence level 1A) and improve quality of life (graded as evidence level 2C). Despite these strong statements, low protein diets (LPDs) are not prescribed by many nephrologists worldwide. In this review, we challenge the view of protein restriction as an "option" in the management of patients with CKD, and defend it as a core element of care. We argue that LPDs need to be tailored and patient-centered to ensure adherence, efficacy, and safety. Nephrologists, aligned with renal dietitians, may approach the implementation of LPDs similarly to a drug prescription, considering its indications, contra-indications, mechanism of action, dosages, unwanted side effects, and special warnings. Following this framework, we discuss herein the benefits and potential harms of LPDs as a cornerstone in CKD management

Real-world outcomes of PARP inhibitor maintenance in advanced ovarian cancer: a focus on disease patterns and treatment modalities at recurrence

Background: The utilization of poly-ADP-ribose polymerase (PARP) inhibitors (PARPi) as a first-line maintenance therapy for advanced ovarian cancer has increased significantly, with ∼80% of patients potentially eligible. This expansion has led to a rise in the population experiencing platinum-sensitive recurrence, yet data on first recurrence during PARPi are limited. This real-world study from a high-volume referral center aims to elucidate recurrence rates, disease distribution, and treatment modalities at the time of progression in PARPi-treated patients. Materials and methods: We analyzed our prospectively maintained database to identify patients receiving first-line PARPi maintenance from January 2019 to December 2022 at our institution. Results: A total of 373 cases were identified, 51.5% of which had a BRCA mutation. With a median follow-up of 38 months, 44.8% of patients experienced recurrence, with 90.3% having a platinum-free interval exceeding 6 months. Recurrences were oligometastatic in 44.9% of cases, with BRCA mutations strongly predicting this pattern (hazard ratio 3.014, confidence interval 1.486-6.113, P = 0.002). The median progression-free survival was 39 months, significantly longer for BRCA-mutated and homologous recombination deficiency-positive patients. Over one-third of platinum-sensitive recurrent patients were candidates for local treatments, and PARPi administration was prolonged in 53.7%. Conclusions: Despite the notable survival improvement, a significant proportion of the population will experience a platinum-sensitive recurrence on PARPi, for which local treatments are often a viable option. Our study highlights the need for further research to determine whether the ablation of oligometastatic sites has a significant impact on post-recurrence survival and to identify if there are patient categories that would benefit from personalized follow-up due to their susceptibility to oligometastatic recurrences and local treatments

Quantum-secured time transfer between precise timing facilities: a field trial with simulated satellite links

Global Navigation Satellite Systems (GNSSs), such as GPS and Galileo, provide precise time and space coordinates globally and constitute part of the critical infrastructure of modern society. To reliably operate GNSS, a highly accurate and stable system time is required, such as the one provided by several independent clocks hosted in Precise Timing Facilities (PTFs) around the world. The relative clock offset between PTFs is periodically measured to have a fallback system to synchronize the GNSS satellite clocks. The security and integrity of the communication between PTFs is of paramount importance: if compromised, it could lead to disruptions to the GNSS service. Therefore, securing the communication between PTFs is a compelling use-case for protection via Quantum Key Distribution (QKD), since this technology provides information-theoretic security. We have performed a field trial demonstration of such a use-case by sharing encrypted time synchronization information between two PTFs, one located in Oberpfaffenhofen (Germany) and one in Matera (Italy)—more than 900 km apart. To bridge this large distance, a satellite-QKD system is required, plus a “last-mile” terrestrial link to connect the optical ground station (OGS) to the actual location of the PTF. In our demonstration, we have deployed two full QKD systems to protect the last-mile connection at both locations and have shown via simulation that upcoming QKD satellites will be able to distribute keys between Oberpfaffenhofen and Matera, exploiting already existing OGSs

Nutritional status and the risk of malnutrition in older adults with chronic kidney disease – implications for low protein intake and nutritional care: A critical review endorsed by ERN-ERA and ESPEN

Increased life expectancy is posing unprecedented challenges to healthcare systems worldwide. These include a sharp increase in the prevalence of chronic kidney disease (CKD) and of impaired nutritional status with malnutrition-protein-energy wasting (PEW) that portends worse clinical outcomes, including reduced survival. In older adults with CKD, a nutritional dilemma occurs when indications from geriatric nutritional guidelines to maintain the protein intake above 1.0 g/kg/day to prevent malnutrition need to be adapted to the indications from nephrology guidelines, to reduce protein intake in order to prevent or slow CKD progression and improve metabolic abnormalities. To address these issues, the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Renal Nutrition group of the European Renal Association (ERN-ERA) have prepared this conjoint critical review paper, whose objective is to summarize key concepts related to prevention and treatment of both CKD progression and impaired nutritional status using dietary approaches, and to provide guidance on how to define optimal protein and energy intake in older adults with differing severity of CKD. Overall, the authors support careful assessment to identify the most urgent clinical challenge and the consequent treatment priority. The presence of malnutrition-protein-energy wasting (PEW) suggests the need to avoid or postpone protein restriction, particularly in the presence of stable kidney function and considering the patient's preferences and quality of life. CKD progression and advanced CKD stage support prioritization of protein restriction in the presence of a good nutritional status. Individual risk-benefit assessment and appropriate nutritional monitoring should guide the decision-making process. Higher awareness of the challenges of nutritional care in older adult patients with CKD is needed to improve care and outcomes. Research is advocated to support evidence-based recommendations, which we still lack for this increasingly large patient subgroup

International time transfer between precise timing facilities secured with a quantum key distribution network

Global Navigation Satellite Systems (GNSSs), such as GPS and Galileo, provide precise time and space coordinates globally and constitute part of the critical infrastructure of modern society. To reliably operate GNSS, a highly accurate and stable system time is required, such as the one provided by several independent clocks hosted in Precise Timing Facilities (PTFs) around the world. Periodically, the relative clock offset between PTFs is measured to have a fallback system to synchronize the GNSS satellite clocks. The security and integrity of the communication between PTFs is of paramount importance: if compromised, it could lead to disruptions to the GNSS service. Therefore, it is a compelling use-case for protection via Quantum Key Distribution (QKD), since this technology provides information-theoretic security. We have performed a field trial demonstration of such use-case by sharing encrypted time synchronization information between two PTFs, one located in Oberpfaffenhofen (Germany) and one in Matera (Italy) - more than 900km apart as the crow flies. To bridge this large distance, a satellite-QKD system is required, plus a "last-mile" terrestrial link to connect the optical ground station (OGS) to the actual location of the PTF. In our demonstration we have deployed two full QKD systems to protect the last-mile connection at both the locations and have shown via simulation that upcoming QKD satellites will be able to distribute keys between Oberpfaffenhofen and Matera exploiting already existing OGSs

Confocal laser endomicroscopy for the detection of mucosal changes in ileal pouch after restorative proctocolectomy

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Reporting quality of randomized trials in the diet and exercise literature for weight loss

BACKGROUND: To adequately assess individual studies and synthesize quantitative research on weight loss studies, transparent reporting of data is required. The authors examined the reporting quality of randomized trials in the weight loss literature, focusing exclusively on subject characteristics as they relate to enrollment, allocation, and follow-up. METHODS: An extensive literature review, which included a computerized search of the MEDLINE database, manual searches of bibliographic references, and cross-referencing of 92 review articles was conducted. A checklist, based on CONSORT recommendations, was used to collect information on whether or not authors reported age, gender, co-morbid disease, medication use, race/ethnicity, and postmenopausal status. Also tracked was whether or not initial and final sample size was reported and stratified by gender. RESULTS: Of 604 possible articles, 231 articles met eligibility criteria. Important subject characteristics were not reported as the following breakdown indicates: age (11%), gender (4%), race/ethnicity (86%), co-morbid disease states (34%), and medication use (92%). Additionally, 21% of articles failed to report initial sample size by gender while 69% neglected to report final sample size by gender. CONCLUSION: Inadequate reporting can create difficulties with interpretation and can lead to biased results receiving false credibility. The quality of reporting for weight loss studies needs considerable improvement

brainlife.io: a decentralized and open-source cloud platform to support neuroscience research

Neuroscience is advancing standardization and tool development to support rigor and transparency. Consequently, data pipeline complexity has increased, hindering FAIR (findable, accessible, interoperable and reusable) access. brainlife.io was developed to democratize neuroimaging research. The platform provides data standardization, management, visualization and processing and automatically tracks the provenance history of thousands of data objects. Here, brainlife.io is described and evaluated for validity, reliability, reproducibility, replicability and scientific utility using four data modalities and 3,200 participants.The brainlife.io project development and operations were supported by awards to F.P.: grant nos. NIH NIBIB 01EB029272, R01EB030896NSF and R01EB030896; NSF BCS 1734853 and 1636893; ACI 1916518, IIS 1912270; a gift from the Kavli Foundation; Wellcome Trust grant no. 226486/Z/22/Z and a Microsoft Investigator Fellowship. Additional funding was provided to support data collection used by the team, research that used brainlife.io or infrastructure that supported the platform: grant no. NIMH UM1NS132207 BRAIN CONNECTS: Center for Mesoscale Connectomics (Principal Investigator K. Ugurbil), grant no. NIMH R01MH133701 (C.R.). NSF grant award nos. 2004877 (S.V.-B.),1541335 and 2232628 (S.M.), 1445604 and 2005506 (D.Y.H.),1341698 and 1928224 (M. Norman), 1445606 (S.T.B.), 1928147 (S.Sanalevici). NIH grant award nos. 1U54MH091657 (HCP data, Principal Investigators D. Van Essen and K. Ugurbil), U01DA041048, U01DA050989, U01DA051016, U01DA041022, U01DA051018, U01DA051037, U01DA050987, U01DA041174, 01DA041106, U01DA041117, U01DA041028, U01DA041134, U01DA050988, U01DA051039, U01DA041156, 01DA041025, U01DA041120, U01DA051038, U01DA041148, U01DA041093, U01DA041089, U24DA041123, 24DA041147 (ABCD Study, multiple Principal Investigators), P41EB017183 (J.V.), NIH NIBIB R01EB030896 (A.P.) and ANR-20-NEUC-0004-01 (mulitple Principal Investigators). Multiple philanthropic contributions to the HBN (M. Milham)