Maternal folic acid supplementation does not impact skeletal muscle function and metabolism in male and female CD-1 mouse offspring.

Folic acid fortification of all white flour, enriched pasta, and cornmeal products became mandatory in Canada to reduce risk of neural tube defects at birth. Furthermore, Health Canada and the Society of Obstetricians and Gynaecologists of Canada recommend women take daily prenatal folic acid supplements in addition to folic acid fortified foods during pregnancy. However, the influence of maternal folic acid supplementation on offspring development, specifically the highly abundant and metabolically active skeletal muscle, is currently unknown. Thus, the purpose of this study was to determine the effect of supplemental folic acid (four times higher than normal dietary consumption), in utero and throughout suckling on muscle size, function, and metabolism in male and female CD-1 mouse offspring. The major findings were that maternal exposure to supplemental folic acid (i) had no impact on postpartum growth rates or muscle mass in female and male offspring, (ii) had no impact on skeletal muscle contractile kinetics in females and male offspring, and (iii) increased maximal phosphofructokinase activity in extensor digitorum longus of female and male offspring. These findings suggest that exposure to folic acid supplementation in utero and throughout suckling at levels four times higher than recommended had minimal effect on skeletal muscle size, function, and metabolism regardless of sex. Future research is needed explore the underlying biological pathways and mechanisms affected by folic acid supplementation during pregnancy and lactation on offspring skeletal muscle tissue, specifically in humans.

The Quality of Discharge Summaries After Acute Kidney Injury.

Background: Acute kidney injury (AKI) increases the risk of hospital readmission, chronic kidney disease, and death. Therefore, effective communication in discharge summaries is essential for safe transitions of care. Objective: The objectives of this study were to determine the quality of discharge summaries in AKI survivors and identify predictors of higher quality discharge summaries. Design: Retrospective chart review. Setting: Tertiary care academic center in Ontario, Canada. Patients: We examined the discharge summary quality of 300 randomly selected adult patients who survived a hospitalization with AKI at our tertiary care hospital, stratified by AKI severity. We included 150 patients each from 2015 to 2016 and 2018 to 2019, before and after introduction of a post-AKI clinic in 2017. Measurements: We reviewed charts for 9 elements of AKI care to create a composite score summarizing discharge summary quality. Methods: We used multivariable logistic regression to identify predictors of discharge summary quality. Results: The median discharge summary composite score was 4/9 (interquartile range, 2-6). The least frequently mentioned elements were baseline creatinine (n = 55, 18%), AKI-specific follow-up labs (n = 66, 22%), and medication recommendations (n = 80, 27%). The odds of having a higher quality discharge summary (composite score ≥4/9) was greater for every increase in baseline creatinine of 25 µmol/L (adjusted odds ratio [aOR]: 1.27; 95% confidence interval [CI]: 1.03, 1.56), intrarenal etiology (aOR: 2.32; 95% CI: 1.26, 4.27), and increased AKI severity (stage 2 aOR: 2.57; 95% CI: 1.35, 4.91 and stage 3 aOR: 3.36; 95% CI: 1.56, 7.22). There was no association between discharge summary quality and the years before and after introduction of a post-AKI clinic (aOR: 0.77; 95% CI: 0.46, 1.29). Limitations: The single-center study design limits generalizability. Conclusions: Most discharge summaries are missing key AKI elements, even in patients with severe AKI. These gaps suggest several opportunities exist to improve discharge summary communication following AKI.

Contexte: L'insuffisance rénale aiguë (IRA) augmente le risque de réadmission à l'hôpital, d'insuffisance rénale chronique et de décès. Une communication efficace est essentielle dans le résumé de départ pour assurer une transition sécuritaire des soins. Objectifs: Cette étude visait à évaluer la qualité des résumés de départ des survivants d'un épisode d'IRA et à identifier les facteurs prédictifs d'un résumé de départ de meilleure qualité. Conception: Examen rétrospectif des dossiers médicaux. Cadre: Un centre universitaire de soins tertiaires d'Ottawa (Ontario) au Canada. Sujets: Nous avons examiné la qualité du résumé de départ de 300 patients adultes ayant survécu à une hospitalisation pour IRA dans notre hôpital de soins tertiaires. Les patients ont été sélectionnés au hasard et stratifiés selon la gravité de l'IRA. Nous avons retenu 150 patients pour la période 2015-2016 et 150 patients pour la période 2018-2019; soit les périodes précédant et suivant l'introduction d'une clinique post-IRA en 2017. Mesures: Nous avons examiné les dossiers médicaux à la recherche de neuf éléments des soins d'IRA afin de créer un score composite évaluant la qualité du résumé de départ. Méthodologie: La régression logistique multivariée a été employée pour identifier les facteurs prédictifs de la qualité d'un résumé de départ. Résultats: Le score composite médian était de 4/9 (intervalle interquartile: 2-6). Les éléments les moins souvent mentionnés dans le résumé de départ étaient le taux de créatinine initial (n= 55; 18 %), les analyses de laboratoires liées spécifiquement au suivi de l'IRA (n= 66; 22 %) et les recommandations portant sur la médication (n= 80; 27 %). Les probabilités d'avoir un résumé de départ de qualité supérieure (score composite ≥4/9) étaient plus élevées pour chaque augmentation de 25 µmol/L de la créatinine initiale (RC corrigé [RCc] = 1,27; IC 95: 1,03-1,56), lorsque l'étiologie était intrarénale (RCc: 2,32; IC 95: 1,26-4,27) et la gravité de l'IRA accrue ([stade 2] RCc: 2,57; IC 95: 1,35-4,91; et [stade 3] RCc: 3,36; IC 95: 1,56-7,22). Aucune association n'a été observée entre la qualité du résumé de départ et la période étudiée, soit avant ou après l'introduction de la clinique post-IRA (RCc: 0,77; IC 95: 0,46-1,29). Limites: L'étude est monocentrique, ce qui limite la généralisabilité des résultats. Conclusion: Certains éléments clés des soins de l'IRA étaient absents de la plupart des résumés de départ, même chez les patients gravement atteints d'IRA. Ces lacunes indiquent qu'il est possible d'améliorer la communication du résumé de départ à la suite d'un épisode d'IRA.

Preprint Servers in Kidney Disease Research: A Rapid Review.

Preprint servers, such as arXiv and bioRxiv, have disrupted the scientific communication landscape by providing rapid access to research before peer review. medRxiv was launched as a free online repository for preprints in the medical, clinical, and related health sciences in 2019. In this review, we present the uptake of preprint server use in nephrology and discuss specific considerations regarding preprint server use in medicine. Distribution of kidney-related research on preprint servers is rising at an exponential rate. Survey of nephrology journals identified that 15 of 17 (88%) are publishing original research accepted submissions that have been uploaded to preprint servers. After reviewing 52 clinically impactful trials in nephrology discussed in the online Nephrology Journal Club (NephJC), an average lag of 300 days was found between study completion and publication, indicating an opportunity for faster research dissemination. Rapid review of papers discussing benefits and risks of preprint server use from the researcher, publisher, or end user perspective identified 53 papers that met criteria. Potential benefits of biomedical preprint servers included rapid dissemination, improved transparency of the peer review process, greater visibility and recognition, and collaboration. However, these benefits come at the risk of rapid spread of results not yet subjected to the rigors of peer review. Preprint servers shift the burden of critical appraisal to the reader. Media may be especially at risk due to their focus on "late-breaking" information. Preprint servers have played an even larger role when late-breaking research results are of special interest, such as during the global coronavirus disease 2019 pandemic. Coronavirus disease 2019 has brought both the benefits and risks of preprint servers to the forefront. Given the prominent online presence of the nephrology community, it is poised to lead the medicine community in appropriate use of preprint servers.

Influence of longitudinal radiation exposure from microcomputed tomography scanning on skeletal muscle function and metabolic activity in female CD-1 mice.

Microcomputed tomography (µCT) is an imaging technology to assess bone microarchitecture, a determinant of bone strength. When measured in vivo, µCT exposes the skeletal site of interest to a dose of radiation, in addition to nearby skeletal muscles as well. Therefore, the aim of this study was to determine the effects of repeated radiation exposure from in vivo µCT on muscle health - specifically, muscle morphometrics, contractile function, and enzyme activity. This study exposed the right hind limb of female mice to either a low (26 cGy) or moderate (46 cGy) dose, at 2, 4, and 6 months of age, while the left hind limb of the same animal was exposed to a single dose at 6 months to serve as a nonirradiated control. Muscle weight, cross-sectional area, isometric contractile function, and representative maximal enzyme activities of amino acid, fatty acid, glucose, and oxidative metabolism in extensor digitorum longus (EDL) and soleus were assessed. Low-dose radiation had no effect. In contrast, moderate-dose radiation resulted in a 5% increase in time-to-peak tension and 16% increase in half-relaxation time of isometric twitches in EDL, although these changes were not seen when normalized to force. Moderate-dose radiation also resulted in an ~33% decrease in citrate synthase activity in soleus but not EDL, with no changes to the other enzymes measured. Thus, three low doses of radiation over 6 months had no effect on contractile function or metabolic enzyme activity in soleus and EDL of female mice. In contrast, three moderate doses of radiation over 6 months induced some effects on metabolic enzyme activity in soleus but not EDL Future studies that wish to investigate muscle tissue that is adjacent to scanned bone should take radiation exposure dose into consideration.