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ABSTRACT The feeling that life has meaning or purpose is essential for human beings. Absence of meaning can lead to an existential vacuum. Purpose in life, akin to meaning in life, derives from the humanistic psychology theory of Frankl, and they are considered synonymous. Other scholars, however, regard the two constructs as distinct. The objective of the review was to map both concepts in the gerontological literature, examining how they manifest in aging. The review of the databases was carried out between January 2019 and March 2020. Thirty articles were included. In the context of aging, results were conflicting. The literature review yielded evidence to affirm that meaning and purpose in life are distinct concepts, despite sharing the same existential-philosophical roots.

Abstract A new plasma heating mechanism for Microwave Discharge Ion Sources (MDIS) was discovered. Unprecedented beam stability was observed during the commissioning of the Proton Source for the European Spallation Source (PS-ESS) where several thousand source configurations were tested using a custom software tool. Data analysis and plasma simulation revealed that the new behaviour is generated by a completely new plasma heating schema activated by a precise magnetic configuration peculiarity. The stability showed in this configuration, denominated High Stability Microwave Discharge Ion Source (HSMDIS), is excellent and the emittance of the produced beam is lower than produced by standard MDIS configuration. High linearity between power and beam current was observed making easier the use of the source. This new mode of operation can be easily implemented in all existing sources.

Objective Although benign epilepsy with centrotemporal spikes (BECTS) is an idiopathic, age-related epilepsy syndrome with favorable outcome, recent studies have shown impairment in specific neuropsychological tests. The objective of this study was to analyze the comorbidity between dyslexia and BECTS. Method Thirty-one patients with clinical and electroencephalographic diagnosis of BECTS (group A) and 31 paired children (group B) underwent a language and neuropsychological assessment performed with several standardized protocols. Our findings were categorized as: a) dyslexia; b) other difficulties; c) without difficulties. Our results were compared and statistically analyzed. Results Our data showed that dyslexia occurred in 19.4% and other difficulties in 74.2% of our patients. This was highly significant when compared with the control group (p

At the Istituto Nazionale di Fisica Nucleare–Laboratori Nazionali del Sud (INFN-LNS), the commissioning of the high intensity proton source for the European Spallation Source (PS-ESS) has been recently completed. Optical emission spectroscopy measurements carried out with PS-ESS permitted, in a noninvasive way, the evaluation of the electron density, temperature, and relative abundances of the neutral components of a hydrogen plasma. This approach is helpful in finding the optimal source parameters exploiting protons or H_{2}^{+} beams production.

Our aim was to clarify the correlation of attention deficit hyperactivity disorder (ADHD) with epilepsy and behavior problems. This was a cross-sectional study. Sixty children with idiopathic epilepsy were interviewed using the MTA-SNAP IV Teacher and Parent Rating Scale, Vineland Adaptive Behavior Scales and Conners’ Rating Scales. We used the chi-square test to analyze the correlation of epilepsy variables in patients with and without ADHD with a significance level of 0.05. Eight patients had ADHD symptoms (13%), seven had the inattentive ADHD subtype and only three had behavioral problems. When epileptic patients with and without ADHD symptoms were compared we found no significant difference in regard to epilepsy variables. All patients were controlled and 43% were either without AED or undergoing withdrawal. Our study revealed a low comorbidity of ADHD symptoms and epilepsy due to low interference of seizures and drug treatment on the comorbid condition.

OBJECTIVES: To evaluate the presence of neurological soft signs (NSS) and to correlate them with the Wechsler Intelligence Scale for Children (WISC III) in patients with rolandic epilepsy (RE). METHODS: Forty children and adolescents aged between 9 and 15 years were studied. They were divided into two groups: G1 - patients with RE (n=20) - and G2 - healthy controls without epilepsy (n=20). They were assessed with the Quick Neurological Screening Test (QNST II) - clinical trial to search for NSS -, and the WISC III - neuropsychological test. RESULTS: No statistical difference between groups was found in WISC III and QNST II. However, children with poorer motor skills had worse performance in the QNST II and also in the execution intelligence quotient - IQ (p=0.001) and in total IQ (p=0.004), thus showing a positive correlation between them. CONCLUSIONS: The QNST II is a good screening tool for the neurologist to detect abnormalities in fine motor skills.

Electron cyclotron resonance ion sources based charge breeders (ECR-CB) are fundamental devices for Isotope Separation On Line (ISOL) facilities aiming at postaccelerating radioactive ion beams (RIBs). Presently, low intensity RIBs do not allow a conventional tuning of the ECR-CB: as a consequence, it has to be set with a stable 1+ pilot beam first, switching then to the radioactive one without changing any parameter; this procedure is usually called “blind tuning.” Besides having different masses, pilot and radioactive beams can also differ in terms of the rms transverse emittance ε_{rms} and/or longitudinal energy spread ΔE, so the choice of a given pilot beam can determine the overall performances of the final breeding stage. This paper shows a numerical study of how the capture efficiency of the PHOENIX charge breeder is affected by the aforementioned beam paramaters: the analysis reveals the two-step nature of the process, highlighting the role of the injection optics and the plasma capture capability in the overall performances of this device. The simulations predict highest efficiency for ε_{rms}

The present paper describes important features of the immune response induced by the Cry1Ac protein from Bacillus thuringiensis in mice. The kinetics of induction of serum and mucosal antibodies showed an immediate production of anti-Cry1Ac IgM and IgG antibodies in serum after the first immunization with the protoxin by either the intraperitoneal or intragastric route. The antibody fraction in serum and intestinal fluids consisted mainly of IgG1. In addition, plasma cells producing anti-Cry1Ac IgG antibodies in Peyer's patches were observed using the solid-phase enzyme-linked immunospot (ELISPOT). Cry1Ac toxin administration induced a strong immune response in serum but in the small intestinal fluids only anti-Cry1Ac IgA antibodies were detected. The data obtained in the present study confirm that the Cry1Ac protoxin is a potent immunogen able to induce a specific immune response in the mucosal tissue, which has not been observed in response to most other proteins.

This work describes the utilization of an injected ^{23}Na^{1+} ion beam as a diagnostics of the helium plasma of a charge breeder electron cyclotron resonance ion source. The obtained data allows estimating the upper limit for the ion-ion collision mean-free path of the incident sodium ions, the lower limit of ion-ion collision frequencies for all charge states of the sodium ions and the lower limit of the helium plasma density. The ion-ion collision frequencies of high charge state ions are shown to be at least on the order of 1–10 MHz and the plasma density is estimated to be on the order of 10^{11} cm^{-3} or higher. The experimental results are compared to simulations of the ^{23}Na^{1+} capture into the helium plasma. The results indicate that the lower breeding efficiency of light ions in comparison to heavier elements is probably due to different capture efficiencies in which the in-flight ionization of the incident 1+ ions plays a vital role.

Acetaminophen or paracetamol is a widely used analgesic and antipyretic drug and appears to be safe if used at normal therapeutic doses, but in large doses produce liver and / or kidney damage in humans and experimental animals. Prostaglandin endoperoxide synthase (PGES) and cytochrome P-450 are the key enzymes in humans as they are responsible for the analgesic and toxicity effects of paracetamol, respectively. At present, the development of new derivatives still has few impacts on clinical applications of safe compounds. Thus, in this work are discussed, a series of approaches on the design and development of acetaminophen derivatives. Some efforts were realized in our own research group.

Pinhole and CCD based quasi-optical x-ray imaging technique was applied to investigate the plasma of an electron cyclotron resonance ion source (ECRIS). Spectrally integrated and energy resolved images were taken from an axial perspective. The comparison of integrated images taken of argon plasma highlights the structural changes affected by some ECRIS setting parameters, like strength of the axial magnetic confinement, RF frequency and microwave power. Photon counting analysis gives precise intensity distribution of the x-ray emitted by the argon plasma and by the plasma chamber walls. This advanced technique points out that the spatial positions of the electron losses are strongly determined by the kinetic energy of the electrons themselves to be lost and also shows evidences how strongly the plasma distribution is affected by slight changes in the RF frequency. [ABSTRACT FROM AUTHOR]

Electron cyclotron resonance ion sources (ECRIS) are widely used plasma based machines for the production of intense ion beams in science and industry. The performance of modern devices is limited by the presence of the density cut-off, above which electromagnetic (EM) waves sustaining the plasma are reflected. We hereby discuss the systematic data analysis of electrostatic wave generation in an ECR prototype operating at 3.75 GHz–0.1 THz. In particular, electron Bernstein waves (EBW) have been excited. EBW have already been generated in large-scale plasma devices for thermonuclear fusion purposes. In ion sources where Lc ∼ λRF (Lc being the plasma chamber size and λRF the pumping wave wavelength) the EM field assumes a modal behaviour; thus both plasma and EM field self-organize so that no optical-like wave launching is possible (i.e. the cavity effect dominates on the optical path). The collected data, however, supported by 3D full-wave simulations, actually demonstrate that a Budden-type X-B conversion scenario can be established above some critical RF power thresholds, operating in an off-ECR regime. The generation and absorption of the EBW has been demonstrated by the presence of three peculiar signatures: along with the establishment of an overdense plasma, generation of supra-thermal electrons and modification (non-linear broadening) of the EM spectrum measured within the plasma have been observed. At the threshold establishing such a heating regime, the collected data provide evidence for a fast rotation of the electron fluid. [ABSTRACT FROM AUTHOR]

The ion beam-plasma interaction is a relevant topic in several fields of plasma physics, from fusion devices to modern ion sources. This paper discusses the numerical modelling of the whole beam-plus-plasma-target system in case of 1+  ions entering an ECR-based charge breeder (ECR-CB). The model is able to reproduce the ion capture and the creation of the first charge states in the selected physics case, i.e. the interaction of a 85Rb1+ ions with the plasma of the 14.5 GHz PHOENIX ECR-CB installed at the Laboratoire de Physique Subatomique et de Cosmologie (LPSC) of Grenoble. The results show that a very narrow window of physical parameters for both the beam (energy and energy spread especially) and plasma (ion temperature, density, density structural distribution, self-generated ambipolar fields) exists which is able to reproduce very well the experimental results, providing an exhaustive picture of the involved phenomena. Possible non-linear interactions and the role played by the eventual onset of instabilities are also discussed. [ABSTRACT FROM AUTHOR]

Background: This study examines the management and outcomes of large paranasal sinus osteomas (PSO), especially those abutting or encasing critical structures of the skull base and orbit., Methodology: A multicentric retrospective analysis was conducted between June 2007 and September 2023. The study included surgically treated (regardless the type of approach chosen) PSO, exceeding 3 cm in diameter and/or located in critical anatomical areas. An analysis was performed to assess the association between the critical relationships, size, presence of residual disease, and incidence of intra- and postoperative complications., Results: The series included 160 patients. Most PSO were diagnosed due to clinical symptoms, predominantly for those located in the frontal sinus. Residual disease was observed in 9.4% of patients, with its occurrence influenced by PSO size and relationships with specific anatomical structures. Thirty-five/160 (21.9%) of patients experienced one or more intra- and/or postoperative complications. Intraoperative complications were associated with the proximity of PSO to the cribriform plate. Long-term complications were more frequently observed in cases involving the anterior and posterior plate of the frontal bone., Conclusions: This study highlights the complexities involved in managing large PSO, demonstrating that size and anatomical relationships of these osteomas can critically influence surgical decisions, residual disease, and complication rate. The study's retrospective design limited the collection of standardized symptom outcomes, highlighting the need for future studies to address this apect.

Introduction: Chronic kidney disease-associated pruritus (CKD-aP) is a common, yet underdiagnosed condition among patients on hemodialysis. Considering the lack of established treatment pathways, we sought to evaluate the use of antidepressant, systemic antihistamines, or gabapentinoid medications among patients with CKD-aP in the year following pruritus assessment., Methods: We included 6209 patients on hemodialysis in the analysis. We retrospectively extracted clinical and patient-reported data from electronic health records. The intensity of CKD-aP was assessed by KDQOL-36 and 5-D Itch questionnaires. Prescription of antidepressant, antihistamine, and gabapentinoids was ascertained by the occurrence of a relevant active medical order in patients' medical records., Results: We observed a consistent and graded association between the severity of CKD-aP and the use of antidepressant, systemic antihistamines, and gabapentinoid medications. This association remained consistent and intensified over the duration of the year after pruritus screening. This trend was robust even after accounting for potential confounding factors., Conclusions: Patterns of antipruritic medication use in a cohort of patients with CKD-aP was identified and the frequent use of off-label treatments in the absence of approved therapies was highlighted. These observations reflect clinical practices aimed at managing severe pruritus but do not imply a causal relationship between the medications and pruritus severity. Even though we cannot exclude the possibility that these drugs have been prescribed to treat medical conditions warranting their use, previous evidence suggested that doctors may also use such medications in an attempt to buffer CKD-aP. These findings underline the importance of further elucidating current treatment strategies adopted in clinical practice to address CKD-aP., Competing Interests: Declarations. Conflict of Interest: Jasmine Ion Titapiccolo, Luca Neri, Hans-Juergen Arens, Len Usvyat, Stefano Stuard are employees of Fresenius Medical Care. Marco Soro and Thilo Schaufler are employees of CSL Vifor and have CSL share options. Hans-Juergen Arens has share options/ownership in Fresenius Medical Care, Abbott Laboratories, and AbbVie Inc. Len Usvyat has share options/ownership in Fresenius Medical Care and he is inventor of patents in the field of dialysis. Len Usvyat is an advisory board member for Privacy Analytics Inc. Ethical Approval: All the patients consented to their data being used for secondary data analysis and research. Ethical approval was waived by the Ethics Committee of the Hospital Clinic of Barcelona, Spain with the protocol number Reg. HCB/2022/0586. All research was performed in accordance with relevant guidelines and regulations and in particular in accordance with the World Medical Association Declaration of Helsinki regarding the ethical principles for medical research involving human subjects. Patients were involved in the initial design of the study through feedback gathered in patient-reported outcomes from previous quality of life assessments. Additionally, the results of this study will be shared with the patient community through appropriate channels to inform them of the findings and potential implications for future treatment strategies. We are committed to patient-centered research while always safeguarding patient confidentiality., (© 2024. The Author(s).)

Pneumocephalus, defined as the presence of gas within the intracranial space, typically results from head trauma, surgery, or diagnostic/therapeutic procedures that disrupt the dura. However, spontaneous or non-traumatic pneumocephalus is rare. This video article presents a case report of a 64-year-old woman referred to the Department of Otolaryngology with a severe frontal headache and clear nasal discharge (rhinorrhea) after performing the Valsalva maneuver to relieve ear fullness. The patient had previously been diagnosed with sphenoidal meningocele and was awaiting skull base reconstruction surgery. A computed tomography (CT) scan of the brain and paranasal sinuses revealed significant pneumocephalus, with a defect in the sellar floor and cerebrospinal fluid (CSF) pooling in the sphenoid sinus. An endoscopic trans-sphenoidal repair of the CSF leak was promptly performed, and a post-operative CT scan showed complete resolution of the pneumocephalus. At the 2-month follow-up, the defect had healed optimally, with no intracranial complications observed. Pneumocephalus is a rare clinical condition, and prompt, accurate diagnosis, along with early intervention, is crucial to prevent neurological complications., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Polyphenol oxidase (PPO) is among the most detrimental enzymes in processed plant foods, being responsible for enzymatic browning. To propose a "mild" alternative to traditional enzymatic inactivation methods, this study investigated the effect of cold atmospheric plasma (CAP) on PPO inactivation and highlighted the role of different sugars on both inactivation and structural modification of this enzyme. Different model systems were prepared in phosphate buffer using a purified PPO either alone or added with glucose, fructose, sucrose, and trehalose at different concentrations. CAP treatments (6 KV; 23 KHz; duty cycle 10%) were applied at times ranging from 5 to 30 min. Different spectroscopic analyses were conducted before and after treatments to evaluate the PPO activity and changes in tertiary and secondary structures. CAP induced a significant reduction (p < 0.05) in PPO activity across all systems, ranging from 70% to 94% after 30 min of treatment. Among sugars, fructose enhanced (p < 0.05) the PPO inactivation (+23% on average with respect to the phosphate buffer system), possibly by promoting the loss of secondary structures containing the copper-binding site of the catalytic pocket. The effect of other sugars on PPO inactivation was strictly dependent on their type and concentration; specifically, disaccharides at the highest concentrations and treatment times showed a protective effect on the structure and functionality of the protein. Thus, the results of this study highlight that sugars can modulate the effectiveness of CAP, offering promising perspectives for optimizing this food processing technology. PRACTICAL APPLICATION: Cold atmospheric plasma (CAP) is a promising nonthermal technology for food preservation. In particular, surface dielectric barrier discharge (SDBD) CAP could be applied as an alternative to chemical and thermal treatments to inactivate polyphenol oxidase (PPO), an enzyme responsible for browning reactions and quality loss in most processed fruit and vegetable products. However, as shown by this study, PPO inactivation induced by CAP is affected by sugars. Specifically, fructose can positively influence the inactivation of this enzyme. Therefore, CAP potentially could find main applications for the PPO stabilization of high fructose-content plants (e.g., pears, apples, bananas, grapes, peppers, and squashes)., (© 2024 Institute of Food Technologists.)

Adeno-associated viral (AAV) vector-mediated gene therapy has emerged as a promising alternative to liver transplantation for monogenic metabolic hepatic diseases. AAVs are non-integrative vectors that are maintained primarily as episomes in quiescent cells like adult hepatocytes. This quality, while advantageous from a safety perspective due to a decreased risk of insertional mutagenesis, becomes a disadvantage when treating dividing cells, as it inevitably leads to the loss of the therapeutic genome. This is a challenge for the treatment of hereditary liver diseases that manifest in childhood. One potential approach to avoid vector genome loss involves putting scaffold/matrix attachment regions (S/MARs) into the recombinant AAV (rAAV) genome to facilitate its replication together with the cellular genome. We found that the administration of AAVs carrying the human β-interferon S/MAR sequence to neonatal and infant mice resulted in the maintenance of higher levels of viral genomes. However, we also observed that its inclusion at the 3' end of the mRNA negatively impacted its stability, leading to reduced mRNA and protein levels. This effect can be partially attenuated by incorporating nonsense-mediated decay (NMD)-inhibitory sequences into the S/MAR containing rAAV genome, whose introduction may aid in the development of more efficient and longer-lasting gene therapy rAAV vectors.

Introduction: Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) in patients with anaemia of chronic kidney disease may lead to increased ESA doses to achieve target haemoglobin levels; however, elevated doses may be associated with increased mortality. Furthermore, patients with hyporesponsiveness to ESAs have poorer clinical outcomes than those who respond well to ESAs. Incidence and clinical characteristics of patients with ESA hyporesponsiveness were explored in a real-world setting., Methods: This was a retrospective study of electronic medical records of adults with stage 5 chronic kidney disease receiving renal replacement therapy and ESA treatment, from 1 January 2015 to 31 December 2021. The primary objective was ESA hyporesponsiveness rate/1000 days, with a hyporesponsive event defined as ESA use at an elevated dose, according to National Institute for Health and Care Excellence (NICE) criteria. Other hyporesponsiveness definitions applied were erythropoietin resistance index-defined ESA hyporesponsiveness (ERI) Kidney Disease Improving Global Outcomes (KDIGO) and a clinical practicality algorithm., Results: In total, 85,259 patients were included in the analysis; 59.9% were male, median (interquartile range) ESA starting dose was 733.3 (400.0, 1200.0) IU/week and follow-up duration was 2.2 (1.0, 4.2) years. Incidence of ESA hyporesponsiveness varied when applying different definitions; NICE 0.05/1000 days (5.2% of patients), ERI 0.40/1000 days (40.7%), KDIGO 0.15/1000 days (15.4%), and clinical practicality algorithm 0.48/1000 days (47.9%). ESA doses remained higher in hyporesponsive versus responsive patients, yet haemoglobin levels were similar between groups., Conclusion: The results from this study, which applied multiple hyporesponsiveness definitions to a large, geographically diverse population of patients with anaemia of CKD, showed variation in ESA hyporesponsiveness incidence rates depending on definitions used and higher ESA doses in hyporesponsive versus responsive patients. These results underscore the need for individualised clinical assessment and thorough evaluation when considering ESA dose adjustments to reach haemoglobin targets. Graphical abstract available for this article., Trial Registration: NCT05530291., Competing Interests: Declarations. Conflict of Interest: Hans-Jürgen Aren, Luca Neri, Astrid Feuersenger, Mario Garbelli and Otto Arkossy are employees of Fresenius Medical Care, contracted by Astellas Pharma Global Development Inc. to conduct the study. Hans-Jürgen Aren reports Fresenius Medical Care stock shares. Christopher Atzinger and Alina Jiletcovici are employees of Astellas Pharma Global Development Inc. Alina Jiletcovici reports Eli Lilly stock shares. Robert Snijder is an employee of Astellas Pharma Europe B.V. Kirsten Leyland, Najib Khalife and Mahmood Ali are employees of Astellas Pharma Europe Ltd. Ethical Approval: All data were pseudonymised and all patients provided written informed consent for access and secondary use of their pseudonymised clinical data for research purposes. According to the National Institutes of Health definition of human subject research, this study falls under the exempt human subjects research category [27]., (© 2024. The Author(s).)

Utero-vaginal prolapse is a common condition in the female population. In addition to well-known predisposing risk factors malnutrition, autosomal dominant polycystic kidney disease (ADPKD) and dialysis technique may favour its occurrence or aggravation, especially in patients with end-stage kidney disease (ESKD). Depending on severity, a relative contraindication to peritoneal dialysis (PD) could be considered. We report the cases of two patients with a grade IV utero-vaginal prolapse who successfully started PD after obliterative surgery (partial colpocleisis by Le Fort).

The saffron composition is being widely studied for authenticity and traceability, but very few works have been carried out to investigate the relationship between the chemical and physico-chemical properties of saffron solutes and their technological functionality in colloidal systems. This study aims at evaluating the surface properties of saffron extracts obtained using solvents of different polarities to achieve extracts with different compositions in terms of the pattern and content of polar and medium polarity crocins. The air-water surface was evaluated alone and in the presence of Tween 20 at different surfactant-extract ratios. Saffron extracts were able to decrease the surface tension of the aqueous phase, indicating the presence of surface-active compounds. In the mixed saffron extract-Tween 20 systems, competitive adsorption at the air-water interface occurred when the surfactant was present at a low concentration, while at concentrations higher than the CMC, Tween 20 hindered the adsorption of the extract surface-active compounds. The results highlight the interesting technological functionality of saffron extracts for applications in colloidal systems. To better exploit their use in the design and development of formulated foods, nutraceutics and pharma products, further studies are needed to unravel the relationship between the composition of saffron extracts and corresponding surface activity.

Rationale & Objective: End-stage kidney disease (ESKD) negatively affects patients' physical, emotional, and social functioning. Furthermore, adjustment to dialysis require substantial lifestyle changes that may further impact on patients physical and emotional well-being. However, the relationship between Health-Related Quality of life impairment with future adverse outcomes in dialysis is not well characterized. Our study aims to investigate the relationship between Health-Related Quality of Life (HRQoL) and patients' survival and hospitalization rates within a large European dialysis network., Methods: A historical cohort study was conducted to evaluate association of HRQoL with hospitalization and mortality rates over a 12-month follow-up period. Patients responded to a self-administered survey as part of a Continuous Quality Improvement Program implemented in clinics affiliated with the Spanish FMC-Nephrocare organization. Health-Related Quality of Life (HRQoL) was measured with the KDQOL-36. Potential confounders included socio-demographic characteristics, comorbidities, biochemical parameters, dialysis treatment. We used Cox's Proportional Hazard regression to assess the hazard of death and Logistic Regression to assess the likelihood of hospital admissions during 12-month follow-up period., Results: A total of 2280 (51.5%) completed the self-administrated survey, and 1838 patients met the inclusion/exclusion criteria of the study. Higher HRQoL scores were associated with significantly lower mortality and hospitalization risk. Risk estimates were robust to adjustment for potential confounders., Conclusions: Several dimensions of HRQoL are associated with patient-centered outcomes (i.e., mortality and hospitalizations at 1 year). Patient-Reported Outcomes contribute unique pieces of information characterizing patients' health. Residual confounding cannot be fully ruled out; moreover, the high attrition rate could result in selection bias, which may limit the generalizability of the findings to a broader population., (© 2024. The Author(s).)

Wearable devices have a significant impact on society, and recent advancements in modern sensor technologies are opening up new possibilities for healthcare applications. Continuous vital sign monitoring using Internet of Things solutions can be a crucial tool for emergency management, reducing risks in rescue operations and ensuring the safety of workers. The massive amounts of data, high network traffic, and computational demands of a typical monitoring application can be challenging to manage with traditional infrastructure. Cloud computing provides a solution with its built-in resilience and elasticity capabilities. This study presents a Cloud-based monitoring architecture for remote vital sign tracking of paramedics and medical workers through the use of a mobile wearable device. The system monitors vital signs such as electrocardiograms and breathing patterns during work sessions, and it is able to manage real-time alarm events to a personnel management center. In this study, 900 paramedics and emergency workers were monitored using wearable devices over a period of 12 months. Data from these devices were collected, processed via Cloud infrastructure, and analyzed to assess the system's reliability and scalability. The results showed a significant improvement in worker safety and operational efficiency. This study demonstrates the potential of Cloud-based systems and Internet of Things devices in enhancing emergency response efforts., Competing Interests: Gian Angelo Geminiani was employed by G&G Technologies Srl, Marcello Modica was employed by LogConsulting, Antonio Augello was employed by Accyourate SpA. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Background: The appropriate prescription of dialysate calcium concentration for hemodialysis is debated. We investigated the association between dialysate calcium and all-cause, cardiovascular mortality and sudden cardiac death., Methods: In this historical cohort study, we included adult incident hemodialysis patients who initiated dialysis between 1 January 2010 and 30 June 2017 who survived for at least 6 months (grace period). We evaluated the association between dialysate calcium 1.25 or 1.50 mmol/l and outcomes in the 2 years after the grace period, using multivariable Cox regression models. Moreover, we examined the association between the serum dialysate to calcium gradient and outcomes., Results: We included 12 897 patients with dialysate calcium 1.25 mmol/l and 26 989 patients with dialysate calcium 1.50 mmol/l. The median age was 65 years, and 61% were male. The unadjusted risk of all-cause mortality was higher for dialysate calcium 1.50 mmol/l [hazard ratio (HR) 1.07, 95% confidence intervals (CI) 1.01-1.12]. However, in the fully adjusted model, no significant differences were noted (HR 1.05, 95% CI 0.99-1.12). Similar results were observed for the risk of cardiovascular mortality (HR 1.03, 95% CI 0.94-1.13). Adjusted risk of sudden cardiac death was lower for dialysate calcium 1.50 mmol/l (HR 0.81, 95% CI 0.67-0.97). Significant and positive associations with all outcomes were observed with larger serum-to-dialysate calcium gradients, primarily mediated by the serum calcium level., Conclusions: In contrast to the unadjusted analysis that showed a higher risk for dialysate calcium of 1.50 mmol/l, after adjusting for confounders, there were no significant differences in the risk of all-cause and cardiovascular mortality between dialysate calcium concentrations of 1.50 and 1.25 mmol/l. After adjustment, a lower risk of sudden cardiac death was observed in patients with dialysate calcium 1.50 mmol/l. A higher serum-to-dialysate calcium gradient is associated with an increased risk for adverse outcomes., Competing Interests: The data were extracted from EuCliD®, which is managed by Fresenius Medical Care (FME). P.C., F.B., S.S., and L.N. are employees at FMC. S.S. holds stocks from FMC. K.t.Me., H.B., and J.K. received a speaker's fee from FMC. J.K. also received a speaker's fee from Baxter Healthcare., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Introduction: The management of anemia in chronic kidney disease (CKD-An) presents significant challenges for nephrologists due to variable responsiveness to erythropoietin-stimulating agents (ESAs), hemoglobin (Hb) cycling, and multiple clinical factors affecting erythropoiesis. The Anemia Control Model (ACM) is a decision support system designed to personalize anemia treatment, which has shown improvements in achieving Hb targets, reducing ESA doses, and maintaining Hb stability. This study aimed to evaluate the association between ACM-guided anemia management with hospitalizations and survival in a large cohort of hemodialysis patients., Methods: This multi-center, retrospective cohort study evaluated adult hemodialysis patients within the European Fresenius Medical Care NephroCare network from 2014 to 2019. Patients treated according to ACM recommendations were compared to those from centers without ACM. Data on demographics, comorbidities, and dialysis treatment were used to compute a propensity score estimating the likelihood of receiving ACM-guided care. The primary endpoint was hospitalizations during follow-up; the secondary endpoint was survival. A 1:1 propensity score-matched design was used to minimize confounding bias., Results: A total of 20,209 eligible patients were considered (reference group: 17,101; ACM adherent group: 3108). Before matching, the mean age was 65.3 ± 14.5 years, with 59.2% men. Propensity score matching resulted in two groups of 1950 patients each. Matched ACM adherent and non-ACM patients showed negligible differences in baseline characteristics. Hospitalization rates were lower in the ACM group both before matching (71.3 vs. 82.6 per 100 person-years, p < 0.001) and after matching (74.3 vs. 86.7 per 100 person-years, p < 0.001). During follow-up, 385 patients died, showing no significant survival benefit for ACM-guided care (hazard ratio = 0.93; p = 0.51)., Conclusions: ACM-guided anemia management was associated with a significant reduction in hospitalization risk among hemodialysis patients. These results further support the utility of ACM as a decision-support tool enhancing anemia management in clinical practice.

A deeper knowledge of the effect of wheat origin on the volatile organic compounds (VOCs) profile of craft wheat beer is crucial for its quality improvement and local product valorisation. The VOCs profile of 17 craft wheat beers obtained by common and durum, heritage and modern, wheat varieties grown in different fields sited at different altitudes was analysed. Data were processed by multivariate analysis using different approaches. Partial least square (PLS) analysis evidenced that wheat concentration was the highest source of VOCs variance, followed by, wheat species, wheat ancientness, and altitude of cultivation. An insight into the effect of wheat concentration was given by sparse PLS analysis (sPLS). The effect of wheat variety was explored by linear discriminant analysis (LDA), which permitted to correctly classify craft beers made with wheat of different origin (species and variety) on the basis of their VOCs profile. sPLS regression analysis permitted to find a combination of VOCs able to predict the altitude of wheat cultivation as well as to correctly classify wheat beers made with wheat cultivated at different altitudes. A further 'one versus all' approach by Soft Independent Modelling of Class Analogies (SIMCA) permitted to correctly authenticate beers made with different cereal species. Finally, shape analysis by generalized Procrustes analysis (GPA) revealed that the differences among samples were conserved and reflected from wheat kernels to wheat beers. This study suggests a promising use of volatiles fingerprinting with a combination of different statistical approaches to authenticate beer made with wheat of different origin and cultivated at different altitudes, thus stressing out the importance of territory in craft beer production, which, until now, was a neglected topic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Familial Hypocalciuria Hypercalcemia (FHH) is an inherited disease with autosomal dominant transmission characterized by the presence of usually mild-to-moderate hypercalcemia, hypophosphatemia, hypocalciuria, and normal or moderately increased PTH values. Generally, FFH is asymptomatic although symptoms related to elevated plasma calcium values such as asthenia, intense thirst, polyuria, polydipsia or confusional state may occur. Three types of FHH, which differ in the genetic alterations underlying the condition, are described. The majority of FHH cases are classified as type 1 (about 65 percent of cases), due to mutation in the gene for the calcium-sensitive receptor CASR, expressed on chromosome (Chr) 3q13.3-21, which encodes for a calcium-sensitive receptor G-protein-coupled protein of the plasma membrane. FHH types 2 and 3 are due to GNA11 and AP2S1 mutations, respectively, and other genes involved in the pathogenesis of the disease have likely yet to be identified. Rarely, familial hypocalciuric hypercalcemia may not recognize a genetic cause but be caused by autoantibodies directed against CASR. The frequency of the disease is not known and is estimated, probably by default, because of paucisymptomatic presentation of the disease, to be around 1:80000 cases. Recognition of FHH is especially important for differential diagnosis with primary hyperparathyroidism, which has a much higher incidence, about 1:1000 cases. This allows for the identification of patients at risk for chondrocalcinosis and/or pancreatitis. Clinical suspicion must be raised in cases of hypercalcaemia associated with hypocalciuria, and genetic analysis is fundamental in the differential diagnosis toward forms of primary hyperparathyroidism that might result in unnecessary surgical interventions. We describe a clinical case in which a novel inactivating mutation of CASR leading to FHH type 1 was found., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

The management of end-stage kidney disease (ESKD) has been constantly evolving over the last decade with the development of targeted approaches. In this field, telemedicine and remote monitoring are based on the availability of new cyclers that allow for bidirectional communication (between patient and physician) and for the application of the Sharesource cloud-based platform. These technologies allow patients with ESKD to undergo automated peritoneal dialysis (APD) at home. However, these approaches are not well standardized and largely applied yet. Therefore, this study aimed to elaborate a protocol for the utilization of the Sharesource platform to facilitate the practical management of patients treated with APD. A series of expert meetings were held between September 2022 and January 2023 in Italy. The participants (ten nephrologists and five nurses) from nine Italian public dialysis centers shared their opinions, examined the current scientific literature in the field, and reviewed the key characteristics of the Sharesource system to achieve a common position on this topic. A detailed and practical document containing experts' opinions and suggestions on the use of the Sharesource platform for the management of patients treated with APD was produced. This expert opinion might represent a new useful instrument in clinical practice for managing patients undergoing home-based peritoneal dialysis (PD) through the Sharesource platform, which is valid not only for Italy. These recommendations pave the way to novel patient-centered and personalized therapeutic approaches for ESKD and highlight the advantages of telemedicine and remote monitoring in the management of patients with ESKD undergoing PD and its positive impact on their quality of life.

Introduction: This study aimed to develop, implement, and test a visuo-haptic simulator designed to explore the buoyancy phenomenon for freshman engineering students enrolled in physics courses. The primary goal was to enhance students' understanding of physical concepts through an immersive learning tool. Methods: The visuo-haptic simulator was created using the VIS-HAPT methodology, which provides high-quality visualization and reduces development time. A total of 182 undergraduate students were randomly assigned to either an experimental group that used the simulator or a control group that received an equivalent learning experience in terms of duration and content. Data were collected through pre- and post-tests and an exit-perception questionnaire. Results: Data analysis revealed that the experimental group achieved higher learning gains than the control group ( p = 0.079). Additionally, students in the experimental group expressed strong enthusiasm for the simulator, noting its positive impact on their understanding of physical concepts. The VIS-HAPT methodology also reduced the average development time compared to similar visuo-haptic simulators. Discussion: The results demonstrate the efficacy of the buoyancy visuo-haptic simulator in improving students' learning experiences and validate the utility of the VIS-HAPT method for creating immersive educational tools in physics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Neri, Noguez, Escobar-Castillejos, Robledo-Rella, García-Castelán, Gonzalez-Nucamendi, Magana and Benes.)

Background: Outcomes from cardiopulmonary resuscitation (CPR) following sudden cardiac arrest are suboptimal. Postresuscitation targeted temperature management has been shown to have benefit in subjects with sudden cardiac arrest due to ventricular fibrillation, but there are few data for outcomes from sudden cardiac arrest due to pulseless electrical activity. In addition, intra-CPR cooling is more effective than postresuscitation cooling. Physical cooling is associated with increased protein kinase B activity. Therefore, our group developed a novel peptide, TAT-PHLPP9c, which regulates protein kinase B. We hypothesized that when given during CPR, TAT-PHLPP9c would improve survival and neurologic outcomes following pulseless electrical activity arrest., Methods and Results: In 24 female pigs, pulseless electrical activity was induced by inflating balloon catheters in the right coronary and left anterior descending arteries for ≈7 minutes. Advanced life support was initiated. In 12 control animals, epinephrine was given after 1 and 3 minutes. In 12 peptide-treated animals, 7.5 mg/kg TAT-PHLPP9c was also administered at 1 and 3 minutes of CPR. The balloons were removed after 2 minutes of support. Animals were recovered and neurologically scored 24 hours after return of spontaneous circulation. Return of spontaneous circulation was more common in the peptide group, but this difference was not significant (8/12 control versus 12/12 peptide; P =0.093), while fully intact neurologic survival was significantly more common in the peptide group (0/12 control versus 11/12 peptide; P <0.00001). TAT-PHLPP9c significantly increased myocardial nicotinamide adenine dinucleotide levels., Conclusions: TAT-PHLPP9c resulted in improved survival with full neurologic function after sudden cardiac arrest in a swine model of pulseless electrical activity, and the peptide shows potential as an intra-CPR pharmacologic agent.

Urban greening can improve cities' air quality by filtering the main gaseous pollutants such as tropospheric ozone (O 3 ). However, the pollutant removal capacity offered by woody species strongly depends on eco-physiological and morphological traits. Woody species with higher stomatal conductance (g s ) can remove more gases from the atmosphere, but other species can worsen air quality due to high O 3 forming potential (OFP), based on their emitting rates of biogenic volatile organic compounds (bVOCs) and Leaf Mass per Area (LMA). Presently, there is a lack of data on eco-physiological (g s , bVOCs emissions) and foliar traits (LMA) for several ornamental species used in urban greening programs, which does not allow assessment of their O 3 removal capacity and OFP. This study aimed to (i) parameterize g s , assess bVOCs emissions and LMA of 14 ornamental woody species commonly used in Mediterranean urban greening, and (ii) model their Net O 3 uptake. The g s Jarvis model was parameterized considering various environmental conditions alongside isoprene and monoterpene foliar bVOCs emission rates trapped in the field and quantified by gas chromatography-mass spectrometry. The results are helpful for urban planning and landscaping; suggesting that Catalpa bignonioides and Gleditsia triacanthos have excellent O 3 removal capacity due to their high maximum g s (g max ) equal to 0.657 and 0.597 mol H 2 O m -2 s -1 . Regarding bVOCs, high isoprene (16.75 μg g dw -1 h -1 ) and monoterpene (13.12 μg g dw -1 h -1 ) emission rates were found for Rhamnus alaternus and Cornus mas. In contrast, no bVOCs emissions were detected for Camellia sasanqua and Paulownia tomentosa. In conclusion, 11 species showed a positive Net O 3 uptake, while the use of large numbers of R. alaternus, C. mas, and Chamaerops humilis for urban afforestation planning are not recommended due to their potential to induce a deterioration of outdoor air quality., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The development of acute kidney injury (AKI) in polytrauma patients is a common and serious complication, with an incidence ranging from 6% to 50%. Polytrauma is a complex pathological condition that involves the collaboration of various specialists. On one hand, hemodynamic stabilization through fluid therapy and aminic support, with specific attack protocols, managed by anesthetists. On the other hand, if necessary, the initiation of renal replacement therapy such as Continuous Renal Replacement Therapy (CRRT), managed by nephrologists. CRRT is chosen both for managing fluid balance and ensuring the removal of toxic substances, as well as for proper control of electrolytes and acid-base balance., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Objective: We describe an uncharacteristic vestibular-ocular reflex (VOR) pattern, studied by video head impulse tests (VHIT) in patients suffering from unilateral isolated posterior semicircular canal (PSC) hypofunction. In these patients, we found an upward sliding of the eyes, followed by an oblique downward catch-up saccade during horizontal head impulse to the healthy side., Methods: We present a retrospective study of all VHIT exams presenting isolated PSC hypofunction between May 2020 and November 2022., Results: We found 37 patients, which led to the discovery of such incongruent eye movement in 19 cases; their gain data are shown and compared to the remaining 18 cases in which such an anomaly was absent. A control group of 31 healthy subjects was recruited to define the reference criteria for VHIT gain values. The correlation between the amplitude of the vertical saccade and the relative functional imbalance of the vertical semicircular canals was studied., Conclusions: We have observed that in approximately half of the subjects with isolated CSP deficiency, there is a VOR anomaly. A possible pathophysiological explanation of the unbalanced effect of vertical semicircular canal stimulation of a labyrinth during horizontal head thrust toward the opposite side is proposed. The planar incongruity of the response of the VOR described here appears more evident at the onset of the CSP deficit. Current VHIT systems do not detect this incongruent eye reflex. They can lead to an error in gain evaluation (pseudo-deficit) of the lateral semicircular canal of the healthy side and problems in performing the test (trace rejected). In the future, software for VHIT should take into account the possibility of non-coplanar ocular responses to cephalic stimuli., (Copyright © 2024 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

Wearable electronics are increasingly common and useful as health monitoring devices, many of which feature the ability to record a single-lead electrocardiogram (ECG). However, recording the ECG commonly requires the user to touch the device to complete the lead circuit, which prevents continuous data acquisition. An alternative approach to enable continuous monitoring without user initiation is to embed the leads in a garment. This study assessed ECG data obtained from the YouCare device (a novel sensorized garment) via comparison with a conventional Holter monitor. A cohort of thirty patients (age range: 20-82 years; 16 females and 14 males) were enrolled and monitored for twenty-four hours with both the YouCare device and a Holter monitor. ECG data from both devices were qualitatively assessed by a panel of three expert cardiologists and quantitatively analyzed using specialized software. Patients also responded to a survey about the comfort of the YouCare device as compared to the Holter monitor. The YouCare device was assessed to have 70% of its ECG signals as "Good", 12% as "Acceptable", and 18% as "Not Readable". The R-wave, independently recorded by the YouCare device and Holter monitor, were synchronized within measurement error during 99.4% of cardiac cycles. In addition, patients found the YouCare device more comfortable than the Holter monitor (comfortable 22 vs. 5 and uncomfortable 1 vs. 18, respectively). Therefore, the quality of ECG data collected from the garment-based device was comparable to a Holter monitor when the signal was sufficiently acquired, and the garment was also comfortable., (© 2024. The Author(s).)

This study explores the effect of spray-drying (SD) inlet temperatures (T inlet 120 and 150 °C) and wall material on the chemical and physico-chemical properties of microencapsulated hop extracts (MHE). Hop extract was formulated with maltodextrin (MD) and gum Arabic (GA) used in single or in combination with β-cyclodextrin (βCD). MHE were evaluated for physical properties, bitter acids (BA), total polyphenol content (TPC) and encapsulation efficiency (TPC EE), and antioxidant capacity (AOC). Powders produced at T inlet 150 °C exhibited the highest flowability and generally higher TPC yield. Besides T inlet , MD enabled the obtaining of MHE with the highest encapsulation efficiency. Other physico-chemical and antioxidant properties differently varied depending on the T inlet . Overall, the βCD addition positively affected α-acids, and β-acids of MHE obtained at T inlet 120 °C. ATR-FTIR analysis showed hydrogen bond formation between hop compounds and βCD. Multifactorial ANOVA highlighted that T inlet , W, and their interaction influenced almost all the chemical and physico-chemical properties of MHE., Competing Interests: The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript., (© 2024 The Authors. Published by Elsevier B.V.)

Differentiating orofacial odontogenic pain/disorders from pain/disorders associated with maxillary sinusitis is important to avoid unnecessary dentalprocedures and to properly refer patients to colleagues/dentists and vice versa., Aim: To analyze the association between apical lesions and sinus changes and to evaluate the agreement between the diagnoses of an endodontist, a radiologist, an oral and maxillofacial surgeon, and an otolaryngologist., Materials and Method: 385 axial, coronal, and sagittal MSCT scans were selected using an image archiving andcommunication system (PACS). The examinations had been performed between 2018 and 2022., Results: Apical lesions were observed in 36.10% of sinusitis cases, 73.8% of unilateralsinusitis cases, 48.7% of sinus floor discontinuity cases, and 67.2% of cases in which endodontic treatment had been performed. Agreement between the diagnoses made by the endodontist and those made by the other investigators was high for most study variables (k &gt; 0.60). The exceptions were mucosal thickening, for which agreement between the endodontist and the other investigators was intermediate (k=0.397), and the presence of periapicallesions (k=0.010), previous endodontic treatment (k=0.013), and mucosal thickness (k=0.024), for which agreement between endodontists and radiologists was low. Conclusions: There was an association between sinus changes and apical lesions., Competing Interests: The authors declare no potential conflicts of interest regarding the research, authorship, and/or publication of this article., (Copyright© 2024 Sociedad Argentina de Investigación Odontológica.)

ADHD is a neurodevelopmental disorder that children and adults can develop. A complex interplay of genetic and environmental factors may underlie interindividual variability in ADHD and potentially related aggressive behavior. Using high-resolution molecular biology techniques, we investigated the impact of some MAOA and SLC6A4 variations on ADHD and aggressive behavior in a group of 80 Italian children with ADHD and in 80 healthy controls. We found that homozygous genotypes of MAOA rs6323 and rs1137070 were associated with an increased risk of ADHD ( p = 0.02 and p = 0.03, respectively), whereas the heterozygous genotypes (GT of rs6323 and CT of rs1137030) ( p = 0.0002 and p = 0.0006) were strongly linked to a lower risk of developing this disorder. In patients with aggressive behavior, we highlighted only a weak negative association of both MAOA polymorphisms (heterozygous genotypes) with aggressiveness, suggesting that these genotypes may be protective towards specific changes in behavior ( p = 0.05). Interestingly, an increase in the GG genotype of rs6323 ( p = 0.01) and a decrease in GT genotype ( p = 0.0005) was also found in patients without aggressive behavior compared to controls. Regarding 5HTT gene genotyping, no allele and genotype differences have been detected among patients and controls. Our work shows that defining a genetic profile of ADHD may help in the early detection of patients who are more vulnerable to ADHD and/or antisocial and aggressive behavior and to design precision-targeted therapies.

The olive fruit fly ( Bactrocera oleae Rossi) is the most dangerous pest of olive fruits and negatively influences the chemical and sensory quality of the oil produced. Organic farms have few tools against this pest and are constantly looking for effective and sustainable products such as geomaterials, i.e., zeolite. Since a particle film covers the canopy, a study was carried out on the olive tree's responses to zeolite foliar coating. The tested treatments were natural zeolite (NZ), zeolite enriched with ammonium (EZ), and Spintor-Fly ® (SF). EZ was associated with higher photosynthetic activity with respect to the other treatments, while no differences were found between SF and NZ. Foliar treatments affect the amount of BVOC produced in both leaves and olives, where 26 and 23 different BVOCs (biogenic volatile organic compounds) were identified but not the type of compounds emitted. Foliar treatment with EZ significantly affected fruit size, and the olive fruit fly more frequently attacked the olives, while treatment with NZ had olives with similar size and attack as those treated with Spintor-Fly ® ; no difference in oil quantity was detected. Oil produced from olives treated with NZ presented higher values of phenolic content and intensities of bitterness and spiciness than oils from those treated with EZ and SF. According to the results of this study, using zeolite films on an olive tree canopy does not negatively influence plant physiology; it has an impact on BVOC emission and the chemical and sensory characteristics of the oil.

Cystic fibrosis is an autosomal recessive disorder caused by mutations of the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein. The most recent therapeutic approach to cystic fibrosis aims to correct structural and functional abnormalities of CFTR protein. CFTR modulators including ivacaftor-tezacaftor-elexacaftor are used in patients with F508del mutation, with clinical improvement. To date, there are no experiences of CFTR modulator therapy in cystic fibrosis patients with organ transplantation and severe renal impairment. We report the case of a patient diagnosed with cystic fibrosis with F508del mutation, who underwent liver transplantation at the age of 19 and started hemodialysis at the age of 24 due to end-stage renal disease secondary to membranous glomerulonephritis. She was treated with Kaftrio (ivacaftor-tezacaftor-elexacaftor) with clinical benefits on appetite, improvement of body mass index, and reduction of pulmonary exacerbations. A reduction of dosage to 75% of the standard dose was required due to alterations of the liver function. Conclusions. Use of CFTR modulators in patient with cystic fibrosis, liver transplant and end-stage renal disease could be considered safe but a clinical and laboratoristic monitoring of hepatic function is needed., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Objectives. The results are presented of the 8th National Census (Cs-22) of the Peritoneal Dialysis Project Group of the Italian Society of Nephrology relating to the characteristics of the Centers in Italy which used PD in 2022. Materials and methods. The 227 non-pediatric centers which used Peritoneal Dialysis (PD) in 2022 took part. The data requested were sent in aggregate form. For the first time, the resources available and training were investigated as well as home visits. The Centers have been divided into Quartiles according to the number of prevalent PD patients at 31/12/2022. Results. Centers with a smaller PD program (<9 pts) are characterized by 1. smaller overall size - 2. fewer personnel (doctors/nurses) dedicated to PD - 3. greater recourse to external personnel for training - 4. Less incremental prescription and evaluation of peritoneal permeability - 5. higher drop-out to HD in particular for choice/impossibility to continue and for adequacy/catheter-related issues. A lower peritonitis rate was recorded in Centers with a more extensive PD program (≥25 pts). Home visits are carried out regularly by a small minority of Centers. Conclusions. The analysis shows an association between size of Center PD program and available resources, PD modality and outcome., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)