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Gastrointestinal (GI) adverse events in renal transplant patients are a common cause of mycophenolate mofetil (MMF) dose reductions, which result in an increased risk of graft rejection because of a low immunosuppression. This study investigated whether conversion from MMF to enteric-coated mycophenolate sodium (EC-MPS) in renal transplant patients with serious GI side-effects, alleviated these symptoms and allowed administration of higher doses of EC-MPS. Nineteen renal transplant patients with severe MMF-related GI side-effects underwent a progressive reduction in MMF dose until symptoms disappeared. At this point, 12-h AUC(MMF) was evaluated and patients were shifted to an equimolar dose of EC-MPS. The EC-MPS dose was then progressively increased until the highest recommended dose was reached or GI symptoms re-appeared. Four weeks post-conversion, AUC(EC-MPS) was determined. Conversion led to a mean increase in EC-MPS dose of 68% (P < 0.0001), with a corresponding rise in AUC(0-12) (60.5%, P < 0.0006) associated with significant benefits in terms of both quality of life (Kidney Transplant Questionnaire, P < 0.01) and GI symptoms (Gastrointestinal Symptom Rating Scale, P < 0.0001), using validated questionnaires. In five of 19 patients, the EC-MPS dose could not be increased because of the prompt insurgence of GI symptoms. Renal function and biochemical parameters remained stable post-conversion and no rejection episodes occurred. These findings suggest that, in selected patients, EC-MPS may be better tolerated than MMF when GI symptoms are particularly important and permits higher mycophenolic acid exposure, when required.

Based on the analysis of the R&S-Mediobanca survey on multinationals, in 2006 the 17 Italians were small, but not "midgets", as a result of domestic and mostly transnational M&As. In the last ten years, their economic performance and financial structure have been always very sound and in line with the other multinationals. Their labour productivity has been lower than the average, but has improved since 1997. Italian manufacturing multinationals, however, show lower ratios than those of the utilities sector. Given the dire economic outlook worldwide, the Author believes that multinationals, Government and Unions in Italy should provide social support, mostly at labour level, and implement measures aimed at increasing size and productivity, fostering globalisation, and improving corporate governance. Keywords: multinationals, size, ratios, manufacturing companies, utilities, crisis, outlook, social support, corporate governance Parole chiave: multinazionali, dimensione, indicatori, manifatturiere, servizi, crisi, previsioni, ammortizzatori sociali, corporate governance Jel Classification: L25

Italian government's grants to industrial companies have decreased in recent years. Moreover, during the period 2000-2007, less than 25% of total incentives was aimed at sustaining industrial R&D and internationalization activities. In the absence of an effective public aid policy, in 2007 Italian industrial companies were still focused on traditional manufacturing industries and were suffering the increasing competition from emerging countries. The added value of their manufacturing activity has decreased, their technological growth has slowed down, their financial indebtedness has dropped, while their return on equity has increased. The performance of most industrial companies that had received the government's aids has not improved, with the exception of the so-called Made in Italy and the Transportation equipment manufacturing sectors, whose economic performance has improved with state subsidies. Keywords: government grants, manufacturing industries, capital structure Parole chiave: agevolazioni del governo, settori manifatturieri, struttura economico-finanziaria Jel Classification: H81, L52

BACKGROUND: Despite the high prevalence of sleep disorders in patients with kidney disease, no relationship has been demonstrated between sleep quality and the degree of renal function in cross-sectional studies. A prospective trial was, therefore, started in patients with chronic renal failure (CRF) to evaluate whether a link exists between the modifications of these parameters observed during a three-year follow-up period. METHODS: Sleep quality was determined by the Pittsburgh Sleep Quality Index (PSQI) at baseline and after two and three years (Time 0, 2 and 3, respectively) in 78 patients with various degrees of CRF in association with the main clinical and biochemical variables. RESULTS: The baseline PSQI averaged 6.2+/-3.8 (range: 0-21, with higher values indicating worse sleep quality) and was significantly increased at both Time 2 and 3 (8.8+/-3.7 and 10.2+/-3.5, respectively, P

Renal sinus lipomatosis (RSL) represents an abnormal proliferation of the adipose tissue surrounding the renal pelvis of uncertain origin, associated with aging, obesity, steroid excess, infections, and calculosis. It represents a rare complication in transplanted kidneys, and, despite the accurate and prolonged radiological followup of transplanted organs, only a few cases of RSL have been described in graft recipients, with no remarkable effects on renal function. The diagnosis relies on ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), and, finally, percutaneous biopsy. We describe the case of an extensive RSL in a 38-year-old renal transplant recipient, diagnosed by ultrasonography and computed tomography. The patient underwent a radiologic study because of an acute, asymptomatic renal impairment, that led to the diagnosis of a RSL of unusual dimensions, associated with a discrete hydronephrosis. Paradoxically, after a short course of steroids, the recovery of renal function and the partial resolution of calyceal dilatation were observed. The rarity of this affection, the need of a differential diagnosis with fat-containing tumors, and the possibility of parenchymal inflammation associated with RSL, potentially responsive to steroids, are also discussed.

Background Persistent or "de novo" anemia (plasma hemoglobin 11 g/dL were maintained for the entire 1-year follow-up period, with average EPO-Z doses 3.4% higher than the corresponding doses of previous ESA; in the naive group, the target value was reached between the first and third months and remained stable throughout the study. Mean corpuscular volume did not vary in either group. No change was observed in glomerular filtration rate, nor in proteinuria or in main laboratory data. No drug-related side effect was reported. Conclusions EPO-Z may be considered a valid alternative to different ESAs in renal transplant recipients, with an interesting pharmaco-economic profile, considering its lower cost.

Massimo Sabbatini,1 Gianluca Garofalo,1 Silvio Borrelli,2 Sossio Vitale,1 Massimiliano Torino,1 Domenico Capone,3 Luigi Russo,3 Antonio Pisani,1 Rosa Carrano,1 Riccardo Gallo,1 Stefano Federico11Nephrology, Department of Public Health, University Federico II of Naples, 2Department of Nephrology, Second University of Naples, 3Department of Neurosciences, Unit of Clinical Pharmacology, University Federico II of Naples, Naples, ItalyPurpose: The aim of this study was to determine the prevalence of nonadherence in a cohort of renal transplant recipients (RTRs) and to evaluate prospectively whether more intense clinical surveillance and reduced pill number enhanced adherence.Patients and methods: The study was carried out in 310 stable RTRs in whom adherence, life satisfaction, and transplant care were evaluated by specific questionnaires (time 0). The patients under tacrolimus (TAC; bis in die [BID]) were then shifted to once-daily TAC (D-TAC) to reduce their pill burden (Shift group) and were followed up for 6 months to reevaluate the same parameters. Patients on cyclosporin or still on BID-TAC constituted a time-control group.Results: The prevalence of nonadherence was 23.5% and was associated with previous rejection episodes (P

This paper aims to review and summarize the theme of technology transfer. Introducing the topic, first of all, the Authors will focus on the peculiarities of Italian small- and medium-sized enterprises. They will begin comparing the productive structure of Italian economy with other countries’; then they will focus on small-sized enterprises and their low innovation and co-operation capabilities. A relevant part of this work will be on the strategic relevance of the technology transfer; finally the authors will describe the role of RIDITT: this acronym stands for Italian Network for Innovation and technology transfer to SMEs.

Despite the great prevalence of sleep disorders and the low quality of sleep in patients with renal diseases, to date no study has evaluated these problems in renal transplant patients.The aim of the study was to assess sleep quality (SQ) in 301 kidney graft recipients by the Pittsburgh Sleep Quality Index (PSQI, range 0-21, with higher scores indicating worse SQ), in comparison with PSQI of both patients on haemodialysis (HD) (n = 245) and normal control subjects (n = 169).PSQI of renal transplant patients averaged 6.46+/-3.71, a value significantly lower than in HD patients (8.52+/-3.81, P0.001), but higher than in control subjects (3.54+/-1.61, P0.0001 vs both transplant and dialysis patients). No correlation was found between PSQI and the main biochemical parameters of transplant patients. When the patients were divided into 'good' (PSQI5) or 'poor' (PSQI5) sleepers, a significant risk of psychological problems was associated with the condition of 'poor sleeper' (OR: 2.3; P0.02), with no further correlation detected in either of the two groups.These data demonstrate that SQ in renal transplant patients is surprisingly low, despite a well preserved renal function, and that poor sleep in these patients is also secondary to psychological problems. The use of PSQI in such patients represents a useful tool for the investigation of SQ and quality of life.

A case of visceral Leishmaniasis in a renal transplant recipient is reported because of its peculiar clinical presentation: the presence of most clinical signs of the disease, such as high-grade fever, marked leucopenia, and splenomegaly, but persistent negativity of serology and of bone marrow smear. Forty days after the first bone marrow biopsy, the diagnosis was made possible by a second biopsy, and the treatment was started with antimonial compounds, which led to complete remission of symptoms. A relapse was observed 1 month after discontinuation of therapy, successfully treated with a new cycle of the same drug and allopurinol. The diagnosis of Leishmaniasis must always be considered in immunosuppressed transplant recipients with fever and leucopenia of unknown origin, even when serology and bone marrow smear are negative.

An original graphic method is developed which, starting from the investment expenditure time chart, allows the user to carry out a medium-term financial programming through the representation of the various capital sources. The method also provides simultaneously two different indications concerning the profitability of the projects. By way of example, the method is applied to the case of a 160 MW thermal power plant.

Two new indices, valid for Italian industry, are presented here. The first has a general structure, the same as that of the ENR, and is based on a group of a few fundamental construction factors. The second, of technical origin, is meaningful only for the individual components of installation and is developed in this paper for various plant components of the chemical industry. An initial approximation index for petroleum refineries is also worked out.