Small steps towards the potential of ‘preventive’ treatment of early phosphate loading in chronic kidney disease patients

Few clinical studies have investigated the value of phosphate (P)-lowering therapies in early chronic kidney disease (CKD) patients in whom hyperphosphataemia has not yet clearly developed and they report conflicting and even unexpected results. In this issue of Clinical Kidney Journal, de Krijger et al. found that sevelamer carbonate (4.8 g/day for 8 weeks) did not induce a significant reduction of pulse wave velocity (PWV) and that fibroblast growth factor 23 (FGF23) did not decrease despite a decline in 24-h urine P excretion. To some extent these findings challenge the concept that 'preventive' P binder therapy to lower FGF23 is a useful approach, at least over this short period of time. Interestingly, in a subgroup of patients with absent or limited abdominal vascular calcification, treatment did result in a statistically significant reduction in adjusted PWV, suggesting that PWV is amenable to improvement in this subset. Interpretation of the scarce and heterogeneous observations described in early CKD remains difficult and causality and/or the possibility of 'preventive' treatment may not yet be completely disregarded. Moreover, de Krijger et al. contribute to the identification of new sources of bias and methodological issues that may lead to more personalized treatments, always bearing in mind that not all patients and not all P binders are equal

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

The spectrum of activity of vitamin D goes beyond calcium and bone homeostasis, and growing evidence suggests that vitamin D contributes to maintain musculoskeletal health in healthy subjects as well as in patients with chronic kidney disease (CKD), who display the combination of bone metabolism disorder, muscle wasting, and weakness. Here, we review how vitamin D represents a pathway in which bone and muscle may interact. In vitro studies have confirmed that the vitamin D receptor is present on muscle, describing the mechanisms whereby vitamin D directly affects skeletal muscle. These include genomic and non‐genomic (rapid) effects, regulating cellular differentiation and proliferation. Observational studies have shown that circulating 25‐hydroxyvitamin D levels correlate with the clinical symptoms and muscle morphological changes observed in CKD patients. Vitamin D deficiency has been linked to low bone formation rate and bone mineral density, with an increased risk of skeletal fractures. The impact of low vitamin D status on skeletal muscle may also affect muscle metabolic pathways, including its sensitivity to insulin. Although some interventional studies have shown that vitamin D may improve physical performance and protect against the development of histological and radiological signs of hyperparathyroidism, evidence is still insufficient to draw definitive conclusions

Condiciones de bioseguridad y percepción del riesgo: hacia la construcción de un mapa de riesgo en la Facultad de Ciencias Veterinarias de la Universidad Nacional de La Plata

A risk map represents the risk perception status on biosafety and safety in the workplace of a particular group. The objective of this work was to evaluate an instrument to collect information to build a risk map in the Faculty of Veterinary Sciences, National University of La Plata. An exploratory study was performed using voluntary semi-structured interviews and surveys. Participant involvement was low. 89.2% of participants were university teachers and 10.8% were technical staff members with different degrees of training. Biosafety measures use was reported by 84.8 % of the surveyed population, although 66.7 % of them considered those measures insufficient. Biosafety training was reported by 19.6 % of participants, which considered it positive, while 58.7 % indicated absence training. It is concluded that there is confusion with the definition and scope of biosafety, and risk perception is heterogeneous in the surveyed population. The voluntary nature of the study as well as its electronic distribution limited the level of participation and future studies should emphasize representative participation of technical staff.Un mapa de riesgo representa el estado de situación sobre bioseguridad, seguridad laboral y percepción del riesgo de un colectivo particular. Con el objetivo de recolectar información para construir un instrumento que posibilite conformar dicho mapa en la FCV-UNLP se implementó un estudio exploratorio de tipo cuali-cuantitativo, basado en entrevistas semiestructuradas y encuestas. Se constató una baja participación. El 89,2% de las respuestas correspondió a personal docente y 10,8% a personal no docente, rubro que incluyó a técnicos idóneos. Con referencia a la aplicación de medidas de bioseguridad, el 84,8% respondió afirmativamente, pero el 66,7% de los mismos, opinó que las mismas eran insuficientes. Con respecto a la capacitación, 58,7% indicó no haberla recibido, 19,6% que sí la habían recibido, calificándola positivamente, y el resto no respondió. Se concluye que existe confusión sobre la definición y el alcance de la bioseguridad, la percepción del riesgo es heterogénea, el carácter optativo del instrumento y la distribución electrónica limitaron el nivel de participación y deberá preverse la participación representativa de técnicos en las entrevistas

La zona norte de Formentera

Abstract not availabl

El rebliment sedimentari de la galeria del Tragus a la cova des Pas de Vallgornera (Llucmajor, Mallorca)

La presència d’un important jaciment de Myotragus associat a un rebliment sedimentari format per llims i arenes a la Galeria del Tragus, localitzada en la part més interna de la cova des Pas de Vallgornera, ha dut a la descripció i anàlisi sedimentològica de la seqüència sedimentaria que inclou les restes paleontològiques. Aquesta seqüència està formada per una base arenosa interpretada com a de procedència eòlica, la qual cosa implicaria una clara obertura de la cavitat en el moment de la seva deposició, que està recoberta per dipòsits argilosos de decantació i materials llimosos dipositats per escorrentia. El conjunt indica la transició des d’unes condicions climàtiques àrides i fredes a un episodi més humit i càlid, tot això en un context cronològic probablement del Pleistocè inicial

Contracting externalities and multiple equilibria in sectors: Theory and evidence

We consider an economy where the production technology has constant returns to scale but where in the descentralized equilibrium there are aggregate increasing returns to scale. The result follows from a positive contracting externality among firms. If a firms is surrounded by more firms, employees have more opportunities outside their own firm. This improves employees' incentives to invest in the presence of ex post renegotiation at the firm level, at not cost. Our leading result is that if a region is sparsely populated or if the degree of development in the region is low enough, there are multiple equilibria in the level of sectorial employment. From the theoretical model we derive a non-linear first-order censored difference equation for sectoral employment. Our results are strongly consistent with the multiple equilibria hypothesis and the existence of a sectoral critical scale (below wich the sector follows a delocation process). The scale of the regions' population and the degree of development reduce the critical scale of the sector.Incomplete contracts, development, multiple equilibria, delocation trap

Lower Cretaceous (Hauterivian-Albian) ammonite biostratigraphy in the Maestrat Basin (E Spain)

Peer reviewedPublisher PD