Search

The study analyses through an interdisciplinary approach the wattle‐and‐daub building technique used on the Po Plain of northern Italy, focusing on the archaeological evidence from the Etruscan site of Forcello, near Bagnolo San Vito (Mantua) (540–375 bce). Wattle and daub is widespread across different times and periods, and is particularly common in regions such as the Po Plain, where stone sources for construction are not immediately available. Thanks to a combined archaeometric, geological and anthracological study, the paper provides new insights on a fifth‐century bce building structure from Forcello. The findings reveal information on the life history of this feature, including its construction, maintenance and final destruction. The research also sheds a new light on the wattle‐and‐daub technique and on the interaction between people and the Po Plain Etruscan palaeoenvironment. [ABSTRACT FROM AUTHOR]

Abstract: The Messinian–Quaternary history of tectonic and climatic control on sedimentation in the eastern Southern Alps, northern Italy, was reconstructed using an integrated petrographic and sedimentological analysis of five sedimentary successions. These units mainly consist of fluvial conglomerates of the Tagliamento sequence, deposited within the eastern Southern Alps since the Upper Miocene (“Messinian Salinity Crisis”). At that time, the closure of marine gateways between the Atlantic Ocean and the Mediterranean Sea caused a drop in sea level, causing exchanged fluvial erosion and widening of the Alpine catchments. Sediment composition in the Upper Miocene to Lower Pliocene units shows an abrupt change in the source areas: from sediments characterized by carbonate rock fragments to detritus rich in low-grade metamorphic grains. In spite of tectonic activity within the eastern Southern Alps, no major modifications in sediment supply took place during the Pliocene–Early Pleistocene time span. In the Middle Pleistocene the first major expansion of the Alpine glaciers triggered a change in drainage patterns and a marked increase in erosion rates. Predominantly climatic control on sedimentation in the Tagliamento basin and the erosion of the Carnic Alps produced sediments rich in quartz, siltstone and metamorphic rock fragments, deposited in the Upper Pleistocene unit and in modern river sediments. [Copyright &y& Elsevier]

Abstract: Quantitative provenance analysis of the Quaternary sediments from the Collina di Torino and the Po alluvial plain was assessed by using statistical techniques. This method, based on high-resolution heavy mineral analysis on modern and ancient sands processed by compositional biplot and linear mixing model, allowed reconstruction of the drainage change of the western Po River and its tributaries in the last 1Ma. Mineralogical and statistical analyses discriminate three groups in the Quaternary samples. Sediments from the Po alluvial plain are rich in garnet, epidote and minor amphiboles. Detritus from the western slope of the Collina di Torino is characterized by epidote-rich assemblages, actinolite, blue-green hornblende and chloritoid. Heavy minerals from sediments of the northwestern slope include epidote-group minerals, glaucophane and hypersthene. A linear mixing model was used to compare detrital modes from modern and Quaternary detritus, and to identify the best modern analogue for any sample of ancient sedimentary deposit. Statistical analysis indicates that the first mineralogical group compares best with detritus of the modern Po River. Detritus from the second and third group compare best with sediments of the modern Dora Riparia River and Stura di Lanzo River, respectively. These results outline how the distribution of the Middle-Late Pleistocene fluvial deposits of the Collina di Torino is linked with the ancient Alpine watercourses, before the shifting of the Po River on the northern edge of the hill. During the Middle Pleistocene, rivers draining the Piedmont Zone of the Western Alps (PaleoDora Riparia and PaleoStura di Lanzo rivers) ran across the hill, while the PaleoPo River, which drained the Dora Maira Massif (Internal Massif), flowed to the south of the Collina di Torino. At the end of the Pleistocene, the PaleoPo River was diverted to the north to its present-day position in the alluvial plain. This case history shows how quantitative provenance analysis based on orogenic sediments is the key to reconstruct Quaternary drainage evolution of the foreland basin. [Copyright &y& Elsevier]

Background: In February 2020 the corona virus disease 2019 (COVID-19) infection started spreading throughout Italy, hitting the Lombardy region very hard. Despite the high diffusion, only a subset of patients developed severe COVID-19: around 25% of them developed acute kidney injury (AKI) and one-third of them died. Elderly patients and patients with high comorbidities were identified as being at higher risk of severe COVID-19., Methods: Our prospective observational cohort study includes 392 consecutive patients hospitalized for COVID-19 in Milan (median age 67 years, 75% male). We evaluated the relationship between blood pressure at presentation, presence of AKI at Emergency Department admission and during hospitalization, and total in-hospital mortality (24%)., Results: Although 58% of our study patients reported a history of hypertension (HYP) (86% on treatment), 30% presented with low blood pressure levels. Only 5.5% were diagnosed with AKI on admission; 75% of hypertensive patients discontinued therapy during hospitalization (only 20% were on treatment at discharge). Gender and hypertension were strongly associated with AKI at admission (odds ratio 11). Blood pressure was inversely correlated with increased risk of AKI upon admission, regardless of the severity of respiratory distress. Age over 65, history of hypertension, and severity of respiratory distress were the main predictors of AKI, which developed in 34.7% of cases during hospitalization. AKI was associated with increased in-hospital mortality. Hypertension and low blood pressure at presentation were the main predictors of in-hospital mortality, together with age over 65, baseline pulmonary involvement, and severity of illness., Conclusions: In patients hospitalized for COVID-19, hypertension and low blood pressure at presentation are important risk factors for AKI and mortality. Early reduction of antihypertensive therapy may improve outcomes in patients with SARS-CoV-2 infection.

Background and Aim of Work: Despite national descriptions of awareness, knowledge, and perceptions about the exposure to the biological risk among nurses employed in renal-dialysis care are pivotal to increase work safety, there is a paucity of data on these descriptions in the Italian context. This study aimed at describing Italian nurses' awareness and knowledge about biological risk in delivering care for renal-dialysis patients, and their experiences of biological accidents., Methods: A pilot survey using cross-sectional data collection and convenience sampling procedure. 124 nurses were enrolled receiving a 7-item questionnaire: Questions 1, 2, and 7 were referred to the awareness about educational learning needs, questions 3 and 4 explored nurses' knowledge about biological risk, questions 5 and 6 collected accident-related information., Results: Overall, nurses' awareness and knowledge about biological risk appeared almost limited. Surprisingly, 52% of the enrolled nurses experienced a biological accident, and 29.5% reported to know colleagues who developed work-related disease after a biological accident. We found positive significant associations between awareness and knowledge., Conclusions: This pilot study highlighted the need to further describe Italian nurses' awareness and knowledge about biological risk in delivering care for renal-dialysis patients, as well as the need of up-to-date epidemiological description about biological accidents. Accordingly, future studies are highly recommended to provide robust evidence aimed at supporting policy makers, educators, clinicians, regulators, and managers.

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago.

Purpose: Evaluation of the phenotype of primary hyperparathyroidism (PHPT), adherence to International Guidelines for parathyroidectomy (PTx), and rate of surgical cure., Method: From January 2014-January 2016, we performed a prospective, multicenter study in patients with newly diagnosed PHPT. Biochemical and instrumental data were collected at baseline and during 1-year follow-up., Results: Over the first year we enrolled 604 patients (age 61 ± 14 years), mostly women (83%), referred for further evaluation and treatment advice. Five hundred sixty-six patients had sporadic PHPT (93.7%, age 63 ± 13  years), the remaining 38 (6.3%, age 41 ± 17  years) had familial PHPT. The majority of patients (59%) were asymptomatic. Surgery was advised in 281 (46.5%). Follow-up data were available in 345 patients. Eighty-seven of 158 (55.1%) symptomatic patients underwent PTx. Sixty-five (53.7%) of 121 asymptomatic patients with at least one criterion for surgery underwent PTx and 56 (46.3%) were followed without surgery. Negative parathyroid imaging studies predicted a conservative approach [symptomatic PHPT: OR 18.0 (95% CI 4.2-81.0) P < 0.001; asymptomatic PHPT: OR 10.8, (95% CI 3.1-37.15) P < 0.001). PTx was also performed in 16 of 66 (25.7%) asymptomatic patients without surgical criteria. Young age, serum calcium concentration, 24 h urinary calcium, positive parathyroid imaging (either ultrasound or MIBI scan positive in 75% vs. 16.7%, P = 0.001) were predictors of parathyroid surgery. Almost all (94%) of patients were cured by PTx., Conclusions: Italian endocrinologists do not follow guidelines for the management of PHPT. Negative parathyroid imaging studies are strong predictors of a non-surgical approach. PTx is successful in almost all patients.

Objective: Familial hypocalciuric hypercalcemia (FHH) syndrome is a rare benign condition, inherited as an autosomal dominant trait, in which inactivating mutations of the calcium-sensing receptor (CASR) gene affects the body's ability to regulate calcium homeostasis. Its outcome is featured by increased levels of serum calcium, moderate hypophosphatemia, and inadequately normal or elevated circulating parathyroid hormone levels. Affected patients are mostly asymptomatic and do not benefit from surgical resection of their mildly enlarged parathyroids., Design: We evaluated for hypercalcemia an Italian family that was identified via a young adult male proband referred to our center for parathyroidectomy., Methods: The patients and the family members were evaluated both biochemically and genetically as suspected FHH subjects. An in vitro functional study was performed by site-directed mutagenesis, and CASR activity was monitored by measuring intracellular calcium ([Ca(2)(+)](i))., Results: The patient had a novel germline heterozygous CASR mutation (c.361&#95;364GATT; p.D121del/fsX122). The mutation caused a premature stop codon at codon 122, exiting a truncated protein. The biochemical phenotype of all family members carrying the heterozygous deletion was concordant with classic FHH syndrome., Conclusions: Our findings confirm the role of CASR gene mutational analysis to offer a valuable addition for the recognition of FHH in hypercalcemic patients not yet characterized for a positive familial history of hypercalcemia, the only condition that identifies CASR gene mutations in hypercalcemia.

Background: Dent's disease is an inherited tubulopathy caused by CLCN5 gene mutations. While a typical phenotype characterized by low-molecular-weight (LMW) proteinuria, hypercalciuria, nephrocalcinosis, nephrolithiasis, rickets and progressive renal failure in various combinations often enables a clinical diagnosis, less severe sub-clinical cases may go under-diagnosed., Methods: By single-strand conformation polymorphism analysis and direct sequencing, we screened 40 male patients from 40 unrelated families for CLCN5 gene mutations. Twenty-four of these patients had the prominent features of Dent's disease, including LMW proteinuria, hypercalciuria and nephrocalcinosis., Results: We identified 24 mutations in the CLCN5 gene in 21/24 patients with a typical phenotype and in 3/16 patients with a partial clinical picture of Dent's disease. Overall, 10 novel CLCN5 mutations were identified (E6fsX11, W58fsX97, 267 del E, Y272C, N340K, F444fsX448, W547X, Q600X, IVS3 +2 G>C and IVS3 -1 G>A), extending the number of mutations identified so far from 75 to 85. The CLCN5 coding sequence was normal in three patients. In the group with an incomplete Dent's disease phenotype, we detected two intronic mutations and one silent substitution leading to the up regulation of an alternatively spliced isoform., Conclusions: Our data confirm the genetic heterogeneity of Dent's disease. In most classic cases, the clinical diagnosis is confirmed by genetic tests.