The optimal intake of artificial nutrition in critically ill patients remains unclear. While calorie and protein intakes affect glomerular function in patients with chronic kidney disease, their relation to renal function at the acute phase of intensive care is insufficiently documented. We aimed to study associations of a low-calorie and low-protein diet with renal outcomes in critically ill patients. This post hoc analysis of the NUTRIREA-3 randomized-controlled trial included 3036 mechanically ventilated patients with shock. Calorie and protein intakes during the first 7 days were either low (6 kcal/kg and 0.2–0.4 g protein/kg/d) or standard (25 kcal/kg and 1.0–1.3 g protein/kg/d). The primary outcome was the incidence of acute kidney disease (AKD) during the ICU stay (up to ICU discharge or day 90 after inclusion, whichever occurred first). AKD during the ICU stay occurred in 669 (44.6
RATIONALE:Patients with severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)-related diffuse alveolar hemorrhage (DAH) face high mortality. In the PEXIVAS trial, plasma exchange (PLEX) did not reduce death or end-stage kidney disease, but only 9% had severe DAH. OBJECTIVES:This study aimed to assess whether PLEX lowers mortality in patients with severe DAH. METHODS:We emulated a target trial using retrospective data from a national multicenter cohort of patients with severe AAV-related DAH. The primary endpoint was 30-day mortality after intensive care unit (ICU) admission, analyzed using a Cox model adjusted for prespecified confounders. MEASUREMENTS AND MAIN RESULTS:We included 184 patients (median age 66 [53-75] years; 51% female; 51% with granulomatosis with polyangiitis; 53% MPO (Myeloperoxydase)-ANCA positive). Of these, 144 (78.3%) received PLEX, and 40 (21.7%) did not. Baseline characteristics were similar, except for more severe renal impairment (creatinine 357 vs 171 µmol/L, P = .01) and more frequent cyclophosphamide use (77% vs 55%, P = .01) in the PLEX group. Severity at ICU admission (median Simplified Acute Physiology Score II score: 42) and mechanical ventilation needs (54%) were comparable between groups. At 30 days, overall survival was 85%. No significant difference in mortality was observed between the PLEX and no-PLEX groups: 30-day survival was 85% (95% CI, 81-90) with PLEX vs 88% (95% CI, 77-96) without (hazard ratio, 1.23; 95% CI, 0.57-3.89). Secondary outcomes were also similar. CONCLUSIONS:In this emulated target trial, PLEX did not reduce 30-day mortality in patients with severe AAV-related DAH.
Background: The therapeutic landscape of metastatic prostate cancer has rapidly evolved with the integration of biomarker-driven strategies, particularly targeting homologous recombination repair (HRR) alterations. Poly(ADP-ribose) polymerase inhibitors (PARPi) have demonstrated clinically meaningful benefit, especially in Breast Cancer genes 1/2-altered tumors, through synthetic lethality. However, the expansion of PARPi across multiple Treatment settings has introduced substantial complexity in patient selection, Treatment sequencing, and biomarker interpretation. This review aims to move beyond a descriptive synthesis of clinical trials and provide a clinically applicable, decision-oriented framework for the use of PARP inhibitors in metastatic prostate cancer. Methods: We conducted a narrative review of pivotal phase II and III trials published between 2020 and 2026 evaluating PARPi as monotherapy or in combination strategies. Evidence was critically analyzed with a focus on biomarker relevance, Treatment positioning, and real-world applicability. Evidence Synthesis: PARPi consistently improve radiographic progression-free survival, with the most robust and clinically meaningful benefit observed in BRCA-altered disease. In contrast, non-BRCA HRR alterations demonstrate heterogeneous and often limited predictive value, highlighting the limitations of a binary biomarker approach. Combination strategies in first-line metastatic castration-resistant prostate cancer (mCRPC) have expanded therapeutic options but raise important concerns regarding toxicity, overTreatment, and unclear benefit in biomarker-unselected populations. In parallel, variability in molecular testing strategies and access continues to limit real-world implementation. Conclusions: PARP inhibitors represent a cornerstone of precision oncology in metastatic prostate cancer, but their optimal use requires a refined, biomarker-informed approach. In this context, we propose a pragmatic 2026 clinical decision framework integrating molecular characteristics, prior Treatment exposure, and clinical factors. This approach aims to bridge the gap between clinical trial evidence, guideline recommendations, and real-world practice.
Background There are currently no tools available for observing the psychological processes that guide shared decision-making at the end of life. Objectives This article aims to formalize a methodological framework for the design of an exploratory scientific study based on participant observation by psychologists. The main objective of the tool is to enable the observation of the psychological distress of patients and the psychological experiences of all those involved in shared medical decision-making (patients, relatives, professionals) during the end-of-life decision-making process. Methods An observation tool for psychologists in palliative care was developed through an integrative methodology based on a structured review of the literature. A preliminary version of the observation tool was submitted to 11 expert psychologists practicing in end-of-life care, via the Delphi method. Quantitative and qualitative analyses of the comments and content of individual and group interviews were conducted. Statistical analysis focused on measures of central tendency, dispersion, and distribution. Results The final version of the observation tool comprises 57 items. The tool was applied in 54 palliative care cases; 44 complete data sets were obtained. Statistical analysis demonstrates good acceptability, feasibility, and reliability of the tool. Conclusion The tool enables psychologists to observe shared decision-making by focusing on the psychological determinants of the process. Without any psychometric ambitions, the observation tool is designed to facilitate participant observation in a psychological context and adequately fulfils the objectives for which it was developed.
La prise en charge des dysfonctions pelvipérinéales repose largement sur l’imagerie par résonance magnétique, examen de référence, permettant une analyse morphologique et dynamique des prolapsus, notamment dans les cas complexes. Cependant, en France, les pratiques sont hétérogènes. En réponse, la Société d’imagerie de la femme a proposé un compte-rendu standardisé en 2022 afin d’uniformiser les pratiques. Un manque d’uniformité dans les protocoles d’imagerie par résonance magnétique et la terminologie utilisée sont toujours observés. Notre consensus vise donc à homogénéiser ces pratiques grâce à un protocole unique et un compte-rendu structuré. L’imagerie par résonance magnétique dynamique pelvipérinéale permet d’identifier et de classer les prolapsus selon la classification de Baden et Walker, tout en facilitant la communication médicale et permettant l’amélioration de la prise en charge des patientes.
