Results From a Network Meta-Analysis

CONTEXT: Secondary hyperparathyroidism (SHPT) is a complication of chronic kidney disease (CKD) affecting mineral and bone metabolism and characterized by excessive parathyroid hormone (PTH) production and parathyroid hyperplasia. OBJECTIVE: The objective of this analysis was to compare the efficacy and adverse effects of extended-release calcifediol (ERC) and paricalcitol (PCT) by assessing their effect on the biomarkers PTH, calcium, and phosphate in patients with non-dialysis CKD (ND-CKD). METHODS: A systematic literature research was performed in PubMed to identify randomized control trials (RCTs). Quality assessment was done with the GRADE method. The effects of ERC vs PCT were compared using random effects in a frequentist setting. RESULTS: Nine RCTs comprising 1426 patients were included in the analyses. The analyses were performed on 2 overlapping networks, due to nonreporting of outcomes in some of the included studies. No head-to-head trials were identified. No statistically significant differences in PTH reduction were found between PCT and ERC. Treatment with PCT showed statistically significant increases in calcium compared with ERC (0.2 mg/dL increase; 95% CI, -0.37 to -0.05 mg/dL). No differences in effects on phosphate were observed. CONCLUSION: This network meta-analysis showed that ERC is comparable in lowering PTH levels vs PCT. ERC displayed avoidance of potentially clinically relevant increases in serum calcium, offering an effective and well-tolerated treatment option for the management of SHPT in patients with ND-CKD.publishersversionpublishe

Degree of equity ownership in cross-border acquisitions of Brazilian firms by multinationals: a strategic response to institutional distance

This study analyzes how foreign multinational enterprises respond to uncertainty in their cross-border acquisitions in emerging economies and, specifically in Brazil, given the institutional differences that separate the home and host countries. We analyze how institutional distance impacts multinational enterprises strategy in taking a partial or full ownership stake in their Brazilian acquisitions. We propose that the equity stake is a strategic response to the uncertainty of operating in institutionally distant countries. In an study based on secondary data of 736 acquisitions between 2008 and 2012, we tested statistically the relation between nine dimensions of institutional distance and the equity stake acquired. Results show differentiated effects albeit with significant evidence that greater geographic distance lead multinational enterprises to take a partial equity stake, while financial and cultural distance leads to a full acquisition. This study has two contributions: reinforces the understanding of the institutional challenges of entering emerging economies, and puts forth how firms’ strategies may incorporate structural solutions that minimize risks and investments when facing institutional uncertaintiesEn este artigo se analiza cómo las empresa multinacionales (EMNs) extranjeras responden a la incertidumbre en las adquisiciones de empresas en economías emergentes y, específicamente, en Brasil, ante las diferenciasinstitucionales que separan los países de origen y destino de lasinversiones. Se evalúa cómo la distancia institucional influye en la estrategia de las multinacionales extranjeras en la toma de propiedad parcial o total del capital en las adquisiciones en Brasil. Se propone que el grado de propiedad es una respuesta estratégica frente a la incertidumbre de operar en mercados institucionalmente más lejanos. En un estudio con base en datos secundarios de 736 adquisiciones realizadas entre 2008 y 2012, se ha puesto estadísticamente a prueba la relación entre nueve dimensiones de distancia institucional y el nivel de propiedad adquirido. Los resultados muestran efectos diferenciados, pero con evidencia significativa de que mayores distancias geográficas conducen a la toma de propiedad parcial, mientras que una mayor distancia financiera y cultural conduce a la toma de propiedad total. Este estudio aporta dos contribuciones: subraya el entendimiento de los desafíosinstitucionales de entrar en economías emergentes, y propone cómo las estrategias de las empresas pueden incorporar formas estructurales que disminuyan riesgos e inversiones frente a las incertidumbres institucionalesEste artigo analisa a forma como as empresas multinacionais(EMNs) estrangeirasrespondem à incerteza nas aquisições de empresas em economias emergentes e, especificamente, no Brasil, face às diferençasinstitucionais que separam os países de origem e destino dosinvestimentos. Analisamos como a distância institucional impacta a estratégia das multinacionais estrangeiras na tomada de propriedade parcial ou total do capital nas aquisições no Brasil. Propomos que o grau de propriedade é uma resposta estratégica diante da incerteza de operar em mercados institucionalmente mais distantes. Num estudo baseado em dados secundários de 736 aquisições realizadas entre 2008 e 2012, testamos estatisticamente a relação entre nove dimensões de distância institucional e o grau de propriedade adquirido. Os resultados mostram efeitos diferenciados, mas com evidência significativa que maior distância geográfica conduz à tomada de posse parcial, enquanto maior distância financeira e cultural à tomada de posse total. Este estudo tem duas contribuições: reforça o entendimento dos desafios institucionais de entrar em economias emergentes, e propõe como as estratégias das empresas podem incorporar modos estruturais que minimizam riscos e investimentos em relação as incertezas institucionai

A Comparative Proteomic Analysis of Praziquantel-Susceptible and Praziquantel-Resistant Schistosoma mansoni Reveals Distinct Response Between Male and Female Animals

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Methods of Ryegrass Establishment (\u3cem\u3eLolium multiflorum\u3c/em\u3e Lam.) Affecting Optimal Sward Height to Maximize the Intake Rate

In integrated systems it is common to use the no-tillage method. The adoption of this method improves the system\u27s sustainability (Laurent et al. 2011). It is necessary to understand the effects of the integrated systems on sward structure and its consequences in the grazing process and in animal production. The intake rate of grazing animals is primarily responsible for the animal performance (Coleman 2006), which short-termdepends mainly on sward structure (Laca and Demment 2006). The sward height has great influence on the animal decision on where to take the next bite (Mcgilloway et al. 1999). The hypothesis of this work was: is there an optimum sward height for ryegrass (Lolium multiflorum Lam.) to maximize the intake rate by grazing animals and does this height vary depending on the existence of the base layer of straw canopy

towards harmonization and excellence in training

Nephrology is a young medical specialty that has evolved and expanded during the last 4 decades of the past century, becoming recognized as one of the most innovative and challenging medical specialties. The training of nephrology takes place mainly in public hospitals, and there are important variations in the duration and assessment of training among the European countries. The Union of European Medical Specialties (UEMS) Renal Section and the European Renal Association- European Dialysis and Transplant Association have been working jointly since 2010 to harmonize European nephrology training and more recently to establish the European Certificate in Nephrology (ECN). The first two editions of the ECN were held in early 2017 and 2018. In total, 122 candidates from 26 countries have sat for the exam, with a success rate of 59% (72/ 122). To date, Switzerland has adopted the exam as their national training assessment and we expect that other countries will join Switzerland in the near future. Fostering the development and importance of the ECN requires that member states work to increase the academic and professional profile of the ECN within their countries. The ECN should be considered a 'quality mark' and a sign of high achievement in nephrology training in Europe. If holding the ECN becomes advantageous for employment or improving scientific careers, the number of candidates will increase and the sustainability of the ECN will be guaranteed. A recent, positive development is the pre-agreement between the UEMS Renal Section, UK Renal Association and Royal Colleges of the UK to adopt a unique pan-European exam beginning in 2020. However, any decision to commence the pan-European exam will depend, in part, on strong candidate enrolment for the ECN 2019 edition. Thus support of the national societies is crucial for the sustainability and growth of a European exam, because of their capacities to influence strategic policies in hospitals, universities and medical associations, with a longer-term aim to increase the professional recognition of the European exam.publishersversionpublishe

Survival with low- and high-flux dialysis

FUNDING COSMOS is sponsored by the Bone and Mineral Research Unit (Hospital Universitario Central de Asturias), SAFIM (Sociedad Asturiana Fomento Investigaciones O´ seas), the European Renal Association–European Dialysis and Transplant Association, the National Program of I þ D þ I 2008–2011 and Instituto de Salud Carlos III (ISCIII), the ISCIII Retic REDinREN (RD06/0016/1013, RD12/0021/0023 and RD16/ 0009/0017), the ISCIII (ICI14/00107, PI17/00384 and PI20/ 00633), Fondo Europeo de Desarrollo Regional (FEDER), Plan Estatal de I þ D þ I 2013–2016, Plan de Ciencia, Tecnologia e Innovacion 2013–2017 y 2018–2022 del Principado de Asturias (GRUPIN14-028, IDI-2018-000152), Fundacio´n Renal I ´nigo A ~ ´ lvarez de Toledo (FRIAT) and the Spanish Society of Nephrology (Estudio Estrate´gico de la SEN). Logistics (meetings, secretarial help, printing of materials, development of website for data entry, etc.) have been financially supported by AMGEN Europe and FRIAT. The authors are not aware of any additional relationships, funding or financial holdings that might be perceived as affecting the objectivity of this study. COSMOS participating centres: see Supplementary Appendix.Background. Besides advances in haemodialysis (HD), mortality rates are still high. The effect of the different types of HD membranes on survival is still a controversial issue. The aim of this COSMOS (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) analysis was to survey, in HD patients, the relationship between the use of conventional low- or high-flux membranes and all-cause and cardiovascular mortality. Methods. COSMOS is a multicentre, open-cohort, 3-year prospective study, designed to evaluate mineral and bone disorders in the European HD population. The present analysis included 5138 HD patients from 20 European countries, 3502 randomly selected at baseline (68.2%), plus 1636 new patients with <1 year on HD (31.8%) recruited to replace patients who died, were transplanted, switched to peritoneal dialysis or lost to follow-up by other reasons. Cox-regression analysis with timedependent variables, propensity score matching and the use of an instrumental variable (facility-level analysis) were used. Results. After adjustments using three different multivariate models, patients treated with high-flux membranes showed a lower all-cause and cardiovascular mortality risks fhazard ratio (HR) = 0.76 [95% confidence interval (CI) 0.61-0.96] and HR = 0.61 (95% CI 0.42-0.87), respectivelyg, that remained significant after matching by propensity score for all-cause mortality (HR = 0.69, 95% CI 0.52-0.93). However, a facility-level analysis showed no association between the case-mix-adjusted facility percentage of patients dialysed with high-flux membranes and all-cause and cardiovascular mortality. Conclusions. High-flux dialysis was associated with a lower relative risk of all-cause and cardiovascular mortality. However, dialysis facilities using these dialysis membranes to a greater extent did not show better survival.publishersversionpublishe

Incidence of Esophageal Thermal Injury Using a Safety Protocol During Atrial Fibrillation Ablation

Objective: Catheter ablation has been a common procedure used for the management of atrial fibrillation (AF). Atrioesophagel fistula (AEF) is one of the most feared complications of AF ablation. Although it is a rare complication, severe esophageal thermal injury must be avoided. It is important to describe a safe method of preventing esophageal injuries without increasing AF recurrence. Methods: A retrospective cohort study of consecutive patients who underwent radiofrequency AF catheter ablation during 1 year-period wa conducted. One hundred and four patients were enrolled divided in two groups: one with a maximum recorded esophageal temperature (ET) < 38 °C and other with a maximum recorded ET ≥ 38 °C. The primary endpoint was detection of endoscopic esophageal lesions after AF ablation and the secondary endpoint was AF recurrence according to the maximum ET reached during the procedure. Results: The maximum ET was on average 37.3 ± 1.0 °C. Only 4 (3.8%) patients had esophageal lesion diagnosed by upper gastrointestinal endoscopy. There were no cases of esophageal perforation. The AF recurrence rate was 9.6% during the follow-up (10 patients, 3 from the ET max < 38 °C group and 7 from the ET max ≥ 38 °C group; p = 0.181). The maximum ET was not associated with AF recurrence after catheter ablation (OR = 1.65, 95% CI = 0.84-3.24, p = 0.14). Conclusions: A low incidence of esophageal injury after AF ablation with the use of a specific esophageal protection protocol was found. There was no esophageal perforation. The AF recurrence rate was similar to that described in the literature

Incidence of Esophageal Thermal Injury Using a Safety Protocol During Atrial Fibrillation Ablation

Objective: Catheter ablation has been a common procedure used for the management of atrial fibrillation (AF). Atrioesophagel fistula (AEF) is one of the most feared complications of AF ablation. Although it is a rare complication, severe esophageal thermal injury must be avoided. It is important to describe a safe method of preventing esophageal injuries without increasing AF recurrence. Methods: A retrospective cohort study of consecutive patients who underwent radiofrequency AF catheter ablation during 1 year-period wa conducted. One hundred and four patients were enrolled divided in two groups: one with a maximum recorded esophageal temperature (ET) < 38 °C and other with a maximum recorded ET ≥ 38 °C. The primary endpoint was detection of endoscopic esophageal lesions after AF ablation and the secondary endpoint was AF recurrence according to the maximum ET reached during the procedure. Results: The maximum ET was on average 37.3 ± 1.0 °C. Only 4 (3.8%) patients had esophageal lesion diagnosed by upper gastrointestinal endoscopy. There were no cases of esophageal perforation. The AF recurrence rate was 9.6% during the follow-up (10 patients, 3 from the ET max < 38 °C group and 7 from the ET max ≥ 38 °C group; p = 0.181). The maximum ET was not associated with AF recurrence after catheter ablation (OR = 1.65, 95% CI = 0.84-3.24, p = 0.14). Conclusions: A low incidence of esophageal injury after AF ablation with the use of a specific esophageal protection protocol was found. There was no esophageal perforation. The AF recurrence rate was similar to that described in the literature

Produção de milho e soja em sistema integrado sob plantio direto com diferentes combinações de pastos e categorias animais

The adoption of no-till system (NTS) combined with crop-livestock integration (CLI) has been a strategy promoted in Brazil, aiming to maximize areas yield and increase agribusiness profitability. This study aimed to evaluate grains yield and phytotechnical attributes from maize and soybean culture by CLI system under NTS after winter annual pure and diversified pastures with the absence or presence of grazing animals. The experiment was installed in Castro (Parana State, Brazil) on in a dystrophic Humic Rhodic Hapludox with a clay texture, using experimental design of randomized complete blocks in 4 x 2 factorial scheme with three replications. Treatments included four pasture combinations (diversified or pure) and animal categories (light and heavy) subjected or not to grazing animals during the winter. During 2008/09 and 2009/10 summers, the area was cultivated with soybeans and maize, respectively, with yield assessment of grains and phytotechnical attributes. Treatments did not alter the yield and weight of a thousand seeds (WTS) of soybeans. In maize culture, the grazing animal during the winter increased the plant population and grains yield, but gave slight decrease in WTS. Pasture combinations (diversified or pure) and animal categories (light and heavy) did not interfere in soybean culture, but benefited the maize crop.A adoção do sistema de plantio direto (SPD), aliado a integração lavoura pecuária (ILP) tem sido uma estratégia fomentada no Brasil, visando maximizar o rendimento das áreas e aumentar a lucratividade do agronegócio. O objetivo deste trabalho foi avaliar o rendimento de grãos e atributos fitotécnicos nas culturas de milho e soja, em sistema de ILP, sob plantio direto, após o cultivo de pastos anuais de inverno, puros ou diversificados, com ausência ou presença de animais em pastejo de diferentes categorias. O experimento foi instalado no município de Castro (PR), em um Latossolo Bruno distrófico textura argilosa, empregando-se delineamento experimental de blocos completos aleatorizados, em esquema fatorial 4 x 2, com três repetições. Os tratamentos incluíram quatro combinações de pastagens (diversificadas ou puras) e categorias de animais (leves e pesados), submetidas ou não ao pastejo animal durante o inverno. Durante o verão de 2008/09 e 2009/10 a área foi cultivada com soja e milho, respectivamente, e procederam-se avaliações de rendimento de grãos e atributos fitotécnicos. Os tratamentos não alteraram o rendimento e o peso de mil sementes (PMS) de soja. Na cultura do milho, o pastejo animal, durante o inverno, aumentou a população de plantas e o rendimento de grãos, mas proporcionou ligeira diminuição no PMS. As combinações de pastos (diversificados ou puros) e categorias de animais (leves e pesados) não interferiram na cultura da soja, mas beneficiaram a cultura do milho.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico - CNPqConselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq