Protein Diet Restriction Slows Chronic Kidney Disease Progression in Non-Diabetic and in Type 1 Diabetic Patients, but Not in Type 2 Diabetic Patients: A Meta-Analysis of Randomized Controlled Trials Using Glomerular Filtration Rate as a Surrogate

<div><p>Background/ Objective</p><p>Studies, including various meta-analyses, on the effect of Protein Diet Restriction on Glomerular Filtration Rate (GFR) in Chronic Kidney Disease (CKD) have reported conflicting results. In this paper, we have provided an update on the evidence available on this topic. We have investigated the reasons why the effect has been inconsistent across studies. We have also compared the effect on GFR in various subgroups including type 1 diabetics, type 2 diabetics and non-diabetics.</p><p>Method</p><p>We searched for Randomized Controlled Trials on this intervention from MEDLINE, EMBASE, and other information sources. The PRISMA guidelines, as well as recommended meta-analysis practices were followed in the selection process, analysis and reporting of our findings. The effect estimate used was the change in mean GFR. Heterogeneity across the considered studies was explored using both subgroup analyses and meta-regression. Quality assessment was done using the Cochrane risk of bias tool and sensitivity analyses.</p><p>Results</p><p>15 randomized controlled trials, including 1965 subjects, were analyzed. The pooled effect size, as assessed using random-effects model, for all the 15 studies was -0.95 ml/min/1.73m²/year (95% CI: -1.79, -0.11), with a significant p value of 0.03. The combined effect estimate for the non-diabetic and type 1 diabetic studies was -1.50 ml/min/1.73m²/year (95% CI: -2.73, -0.26) with p value of 0.02. The effect estimate for the type 2 diabetic group was -0.17 ml/min/1.73m²/year (95% CI: -1.88, 1.55) with p value of 0.85. There was significant heterogeneity across the included studies (I² = 74%, p value for Q < 0.0001), explained by major variations in the percentage of type 2 diabetic subjects, the number of subjects and overall compliance level to diet prescribed.</p><p>Conclusion</p><p>Our findings suggest that protein diet restriction slows chronic renal disease progression in non-diabetic and in type 1 diabetic patients, but not in type 2 diabetic patients.</p></div

The PRISMA flow diagram for the study selection process.

<p>From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. doi:<a href="http://dx.doi.org/10.1371/journal.pmed1000097" target="_blank">10.1371/journal.pmed1000097</a>.</p

Forest Plot of all the included studies ^a.

<p>The forest plot for all included studies pooled together using a random-effects model. ^a em, mean decline in experimental group; es, standard deviation in experimental group; en, number of subjects in experimental group; cm, mean decline in control group; cs, standard deviation in control group; cn, number of subjects in control group, MD, mean difference; I2, variability due to heterogeneity; Q, chi-square test; K, number of included studies.</p

Non-volatile Reconfigurable Digital Optical Diffractive Neural Network Based on Phase Change Material

Optical diffractive neural networks have triggered extensive research with their low power consumption and high speed in image processing. In this work, we propose a reconfigurable digital all-optical diffractive neural network (R-ODNN) structure. The optical neurons are built with Sb2Se3 phase-change material, making our network reconfigurable, digital, and non-volatile. Using three digital diffractive layers with 14,400 neurons on each and 10 photodetectors connected to a resistor network, our model achieves 94.46% accuracy for handwritten digit recognition. We also performed full-vector simulations and discussed the impact of errors to demonstrate the feasibility and robustness of the R-ODNN

Schematic diagram of touch screen layouts and sizes.

Schematic diagram of touch screen layouts and sizes.</p

The dependent variables and definitions in each experiment.

The dependent variables and definitions in each experiment.</p

Additional file 2 of Serum cystatin C is associated with the prognosis in acute myocardial infarction patients after coronary revascularization: a systematic review and meta-analysis

Additional file 2. Quality evaluation scale for prevalence studies

Effects of sizes on operation performance (operation time, error rate, accuracy) and workload in click experiments.

Effects of sizes on operation performance (operation time, error rate, accuracy) and workload in click experiments.</p

Zoom experiment interface(The map in figure is similar but not identical to the original image and is for illustrative purposes only, the map in figure is from USGS National Map Viewer (public domain): http://viewer.nationalmap.gov/viewer/).

Zoom experiment interface(The map in figure is similar but not identical to the original image and is for illustrative purposes only, the map in figure is from USGS National Map Viewer (public domain): http://viewer.nationalmap.gov/viewer/).</p