Is serum phosphorus control related to parathyroid hormone control in dialysis patients with secondary hyperparathyroidism?

Background Elevated serum phosphorus (P) levels have been linked to increased morbidity and mortality in dialysis patients with secondary hyperparathyroidism (SHPT) but may be difficult to control if parathyroid hormone (PTH) is persistently elevated. We conducted a post hoc analysis of data from an earlier interventional study (OPTIMA) to explore the relationship between PTH control and serum P. Methods The OPTIMA study randomized dialysis patients with intact PTH (iPTH) 300–799 pg/mL to receive conventional care alone (vitamin D and/or phosphate binders [PB]; n = 184) or a cinacalcet-based regimen (n = 368). For patients randomized to conventional care, investigators were allowed flexibility in using a non-cinacalcet regimen (with no specific criteria for vitamin D analogue dosage) to attain KDOQI™ targets for iPTH, P, Ca and Ca x P. For those assigned to the cinacalcet-based regimen, dosages of cinacalcet, vitamin D sterols, and PB were optimized over the first 16 weeks of the study, using a predefined treatment algorithm. The present analysis examined achievement of serum P targets (≤4.5 and ≤5.5 mg/dL) in relation to achievement of iPTH ≤300 pg/mL during the efficacy assessment phase (EAP; weeks 17–23). Results Patients who achieved iPTH ≤ 300 pg/mL (or a reduction of ≥30% from baseline) were more likely to achieve serum P targets than those who did not, regardless of treatment group. Of those who did achieve iPTH ≤ 300 pg/mL, 43% achieved P ≤4.5 mg/dL and 70% achieved P ≤5.5 mg/dL, versus 21% and 46% of those who did not achieve iPTH ≤ 300 pg/mL. Doses of PB tended to be higher in patients not achieving serum P targets. Patients receiving cinacalcet were more likely to achieve iPTH ≤300 pg/mL than those receiving conventional care (73% vs 23% of patients). Logistic regression analysis identified lower baseline P, no PB use at baseline and cinacalcet treatment to be predictors of achieving P ≤4.5 mg/dL during EAP in patients above this threshold at baseline. Conclusions This post hoc analysis found that control of serum P in dialysis patients was better when serum PTH levels were lowered effectively, regardless of treatment received

Caveolin-1, breast cancer and ionizing radiation

Breast cancer (BC) recovery has increased in recent years thanks to efforts of Omics-based research in this field. However, despite the important results obtained, BC remains a complex multifactorial pathology that is difficult to treat appropriately. Caveolin-1 (CAV1), the basic constituent protein of specialized plasma membrane invaginations called caveolae, is emerging as a potential therapeutic biomarker in BC. This factor may modulate BC response to chemotherapy and radiation therapy. In addition, recent reports describe the key role of CAV1 during cell response to oxidative stress. The aim of the present review was to describe the biological roles of CAV1 in BC considering its contrasting dual functions as an oncogene and as a tumor suppressor. In addition, we report on how CAV1 may contribute to tumor cell response to ionizing radiation treatment. Finally, new roles of CAV1 in BC both on epithelium and stroma may be useful as prognostic indicators for patient treatment and help clinicians in the selection of the best personalized therapy

Re: Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate

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Practical indications for the prevention and management of SARS-CoV-2 in ambulatory dialysis patients : lessons from the first phase of the epidemics in Lombardy

Confronting the SARS-CoV-2 outbreak has allowed us to appreciate how efficiently highly-resourced settings can respond to crises. However even such settings are not prepared to deal with the situation, and lessons are only slowly being learnt. There is still an urgent need to accelerate protocols that lead to the implementation of rapid point-of-care diagnostic testing and effective antiviral therapies. In some high-risk populations, such as dialysis patients, where several individuals are treated at the same time in a limited space and overcrowded areas, our objective must be to ensure protection to patients, the healthcare team and the dialysis ward. The difficult Italian experience may help other countries to face the challenges. The experience of the Lombardy underlines the need for gathering and sharing our data to increase our knowledge and support common, initially experience-based, and as soon as possible evidence-based position to face this overwhelming crisis

Um caso para competências: avaliar o valor do traço-baseado: Avaliação de desempenho para os funcionários não-faculdade da Universidade

A case study analyzed how supervisors at one university selected competencies, or trait-based skills, for non-faculty employees. This case study provides a valuable contribution by focusing on employees at one institution type–a large, public research university. While it has been documented that non-faculty employees provide important contributions to higher education, there is more to be discovered about this population of university employee, noted as more than 2 million U.S. employees in 2011. The research question guiding this study was: Within a university setting, how are employee competencies valued by job title within colleges and divisions? Multiple correspondence analysis evaluated supervisor competency selection for 1,836 non-supervisory and 565 supervisory employees using data from this university’s 2012 performance appraisal. For non-supervisory employees, the first dimension accounted for 65.11% of adjusted inertia, or explained variance. The second dimension accounted for 23.89% of adjusted inertia. For supervisory employees, the first dimension accounted for 86.57% of adjusted inertia. The second dimension accounted for 8.26% of adjusted inertia. The key study finding was that, despite the availability of other higher-education specific competency alternatives and best practices for competency use in the appraisal, this institution’s implementation of competencies was found to be mechanical. This study proposed best practices for this and similarly situated institutions as to how competencies can be used to develop employees and improve their performance.Un estudio de caso analizado cómo supervisores en una Universidad seleccionan las competencias o habilidades basadas en el rasgo, no Facultad empleados. Este estudio de caso proporciona una valiosa contribución al centrarse en los empleados en un tipo de institución, una Universidad de investigación grande, público. Mientras que se ha documentado que no Facultad empleados brindan importantes aportes a la educación superior, hay más por descubrir acerca de esta población de empleados de la Universidad, señaló como empleados de los Estados Unidos más de 2 millones en 2011. ¿Fue la pregunta de investigación que guía este estudio: dentro de un ámbito universitario, cómo son las competencias del empleado valoradas por título del trabajo en universidades y divisiones?  Análisis de correspondencia múltiple había evaluado supervisor competencias selección de 1.836 no supervisión y 565 empleados supervisión utilizando los datos de evaluación del desempeño de la Universidad 2012. Empleados sin supervisión, la primera dimensión representaron el 65.11% de inercia ajustada o explicó la varianza. La segunda dimensión 23.89% de inercia ajustada. Para los empleados de supervisión, la primera dimensión representaron 86.57% de inercia ajustada. La segunda dimensión 8.26% de inercia ajustada. El hallazgo clave del estudio fue a pesar de la disponibilidad de otras alternativas de la competencia específica de la educación superior y las mejores prácticas para el uso de competencias en la evaluación, implementación de esta institución de competencias fue encontrado para ser mecánico. Este estudio propone instituciones situación similar en cuanto a cómo las competencias se pueden utilizar para desarrollar a empleados y mejorar su desempeño y mejores prácticas para esto.Um estudo de caso analisado como supervisores numa Universidade selecionado competências ou habilidades baseadas em traço, para os empregados não-docente. Este estudo de caso fornece uma contribuição valiosa, centrando-se sobre os funcionários em um tipo de instituição – uma grande, pública, Universidade. Embora tem sido documentado que os funcionários não-faculdade fornecem importantes contribuições para o ensino superior, há mais a ser descoberto sobre esta população de funcionários da Universidade, observou-se como funcionários de Estados Unidos mais de 2 milhões em 2011. A pergunta de pesquisa orientar este estudo foi: dentro de um cenário de Universidade, como são competências do empregado valorizadas pelo cargo dentro de faculdades e divisões? Análise de correspondência múltipla avaliada seleção de competências de supervisor para 1.836 não-supervisão e 565 funcionários supervisão usando os dados de avaliação de desempenho de 2012 da Universidade. Para empregados não-supervisão, primeira dimensão representou 65.11% da inércia ajustada ou variância, explicou. A segunda dimensão representou 23.89% da inércia ajustada. Para funcionários de fiscalização, a primeira dimensão representou 86.57% de inércia ajustada. A segunda dimensão representaram 8.26% da inércia ajustada. A conclusão do estudo chave era que apesar da disponibilidade de outras alternativas de competência específica de ensino superior e as melhores práticas para uso de competência na avaliação, implementação desta instituição de competências foi encontrada para ser mecânico. Este estudo propõe-se similarmente situadas instituições quanto como competências podem ser usadas para desenvolver os funcionários e melhorar o seu desempenho e melhores práticas para isso