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Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Introduction: the external support device VasQ is intended to promote arteriovenous fistula (AVF) maturation by maintaining the optimal anastomotic angle in order to minimize blood flow disturbances around the anastomotic area. The aim of the study is to assess efficacy and safety of the VasQ device both in brachiocephalic and radiocephalic fistulae., Methods: a single institution prospective study was conducted with implantation of the VasQ device during AVF creation. Clinical and Doppler ultrasounds evaluations were performed at day-1, 1, 6, and 12 months for assessment of device-related adverse events, AVF maturation and patency. Moreover, volume flow rate and diameter of outflow vein were measured. A total of 16 patients were enrolled. Ten brachiocephalic and 6 radiocephalic AVFs were created with VasQ. Preoperatively cephalic vein diameter was 3.6 ± 0.9 mm., Results: our population included 13 male and 3 females patients, 9 end stage kidney disease in conservative therapy, 4 dialysis treated patients, and 3 transplanted patients; mean age was 74.0 ± 8.1 years; no severe device-related adverse events were observed. Primary patency at 1, 6, and 12 months was 100%, 87.5%, and 67.7%, respectively, while secondary patency was 100%, 100%, and 78.3%, respectively. Comparing brachiocephalic to radiocephalic AVFs no significant differences in patency rates were seen. Overall maturation rate was 94% (15/16). Mean vein diameter measured with Doppler ultrasound at postoperative day-1 and at 1, 6, and 12 months was 5.0 ± 1.0, 5.9 ± 0.9, 7.2 ± 1.6, and 7.9 ± 1.4 mm, respectively, with a mean flow rate at the brachial artery of 841 ± 176, 1052 ± 224, 1261 ± 490, and 1348 ± 477 ml/min, respectively., Conclusions: in our limited experience VasQ was safe, with high maturation and patency rates. Positive results suggest a potential benefit for VasQ in AVF.

According to international recommendations, young adults should sleep at least 7 h per night and experience good sleep quality to avoid physical and mental health problems. University students are particularly exposed to the risk of sleep issues due to their tendency to go to bed late at night and other social and environmental factors. Here, we aimed to objectively characterize the weekly sleep habits using actigraphy (in terms of quantity, quality, and timing) in 82 Italian university students (mean age = 23.89, SD = 2.51 yrs, 44 women). Exploratory analyses were performed using linear mixed-effect regression to account for several factors (e.g., gender, circadian preferences, depressive symptomatology). We showed that participants spent in bed (TIB) about 7 h and 31 min during weekdays and 7 h and 46 min during the weekend, with 76.83% of the sample showing a TIB longer than 7 h. Women students spent more time in bed than men (~25 min) and went to bed earlier (~29 min). One-third of the sample showed a sleep efficiency <85%, whereas 70.73% of the sample showed a wake after sleep onset >40 min, with no differences between men and women. Depressive symptoms, alcohol and coffee consumption affected sleep onset latency, whereas circadian preference was strongly associated with bed and waketime. Moreover, most of the students did not take daytime naps to catch-up with sleep loss. Overall, our sample spent adequate time in bed, but they experienced a moderate low sleep quality, mainly due to high wake after sleep onset.

Sleep is considered the optimal state to consolidate hippocampal-dependent memories. A particular memory process is mnemonic discrimination. Mnemonic discrimination refers to the ability to differentiate between novel and previously encountered information. Previous studies have found that mnemonic discrimination is impaired by sleep deprivation, whereas nocturnal sleep seems to protect memory representations when compared to a similar period of wakefulness. In this study we tested whether a daytime nap can facilitate mnemonic discrimination as assessed by the Mnemonic Similarity Task. Thirty-eight participants performed incidental learning of 256 images of unique everyday items at about 12:00 PM. Fifteen minutes later, in a recognition test, they were presented with 192 images: 64 targets (Old), 64 foils (New) and 64 lures (Similar to targets). For each image they had to decide whether it was already presented, never presented, or similar to an image presented during the encoding session. Then participants were split into a Nap group (N=19), who had a 90-min nap opportunity in the lab, and a Wake group (N=19), who stayed in the lab playing a low-arousing game. At 3:00 PM all participants performed a delayed recognition test, similar to the immediate test but with different images. Similar memory discrimination was observed in both the Nap and Wake group. The lack of a beneficial effect of sleep could be due to the differences between diurnal and nocturnal sleep and/or the potential role of videogames in facilitating memory discrimination during wakefulness., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Speeding up grape must fermentation would be of great economic benefit. We subjected Saccharomyces cerevisiae VIN13 and two recombinant VIN13-strains expressing ATF1 alleles under two different promoters (either PGK1 or HXT7 ) to four styles of grape must fermentations; we then assessed the effect of constantly stirring a must fermentation (isomixing). The four different fermentation setups were as follows: isomixed, closed in an ANKOM Rf Gas productions system; isomixed, open in a stirred tall tube cylinder; static, closed constituting a conventional fermentation in a wine bottle equipped with an airlock and static; and static, open in a tall tube cylinder (without stirring). We report on major fermentation parameters and the volatile aroma compositions generated in the finished wines. The primary fermentations of the strains subjected to constant stirring finished after 7 days, whereas the static fermentations reached dryness after 19 days. The wines derived from isomixed fermentations produced approximately 0.7% less ethanol compared to the unstirred fermentations. The speed that the isomixed fermentation took to reach completion may provide an alternative to static fermentations in the preparation of base wines for sparkling wine production. The observed increase of volatiles of isomixed fermentations merits further investigation.

Background: Coupled-plasma filtration adsorption (CPFA) is a sorbent-based technology aimed at removing soluble mediators of septic shock. We present our experience on the use of CPFA in septic shock severe burn patients with acute kidney injury (AKI) needing renal replacement therapy (RRT) with the main goal to evaluate efficacy and safety of CPFA in this specific subset of septic shock patients., Methods: In this observational study, we retrospectively reviewed the medical notes of all burn patients admitted to our adult Burn Center who received CPFA, as part of the septic shock treatment requiring RRT, between January 2001 and December 2017 (CPFA group). We compared CPFA group with all the burn patients admitted to our Center in the same period of time, with the same range of relevant clinical characteristics, who developed AKI and were treated with RRT, but not CPFA (control group). We collected demographic characteristics, burn size, Sequential Organ Assessment Failure (SOFA) score, microbiological data, and patient outcome, in terms of in-hospital mortality rate and the probability of survival calculated using the revised Baux score. We also collected data regarding CPFA safety (hemorrhagic episodes, catheter associated-complications, hypersensitivity reactions) and efficiency (number and duration of CPFA sessions, plasma treated amount, plasma processed dose)., Results: 39 severe burn patients were treated with CPFA (CPFA group) (mean age 46.0 years, range 40.0-56.0 years; mean burn size 48.0% TBSA, range 35.0-60.0% TBSA), and 87 patients treated with RRT, but not CPFA, who had similar clinical characteristics (control group). Observed mortality rate was 51.3% in the CPFA group and 77.1% in the control group (p 0.004). Regarding factors affecting survival in the CPFA group, SOFA score on the 1st day of CPFA resulted significant (OR 2.016, 95% CI, 1.221-3.326; p < 0.004) in the multivariate analysis logistic model., Conclusions: CPFA treatment for burn patients with AKI-RRT and septic shock, sustained by bacterial strains non or poorly responsive to therapy, was associated with a lower mortality rate, compared to RRT alone. However, further research, such as large prospective studies, is required to clarify the role of CPFA in the treatment of burns with septic shock and AKI-RRT., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Faith and spirituality are important in the lives of many individuals, and therefore, many patients. This study was performed to determine whether faith and spirituality are active part of the healthcare field and patients' receipt of these sometimes delicate topics. The nuances of the concepts of faith, spirituality, and religion and their implications in the healthcare setting are discussed. Benefits and detriments of faith and spirituality are reviewed in terms of how they relate to the health of the patient and to the healthcare field. With the focus of healthcare shifting to holistic care, this conversation may be more necessary than ever in practice, yet it seems many providers are not discussing these matters with patients. The study analyzes whether healthcare providers are discussing these topics with patients and how the discussion is received or would be received by patients. Findings demonstrate the infrequency of the discussion regardless of the fact that the majority of patients consider themselves faithful or spiritual. This study was approved by the Clarkson University Institutional Review Board on June 18, 2104.

Citrate anticoagulation has risen in interest so it is now a real alternative to heparin in the ICUs practice. Citrate provides a regional anticoagulation virtually restricted to extracorporeal circuit, where it acts by chelating ionized calcium. This issue is particularly true in patients ongoing CRRT, when the "continuous" systemic anticoagulation treatment is per se a relevant risk of bleeding. When compared with heparin most of studies with citrate reported a longer circuit survival, a lower rate of bleeding complications, and transfused packed red cell requirements. As anticoagulant for CRRT, the infusion of citrate is prolonged and it could potentially have some adverse effects. When citrate is metabolized to bicarbonate, metabolic alkalosis may occur, or for impaired metabolism citrate accumulation leads to acidosis. However, large studies with dedicated machines have indeed demonstrated that citrate anticoagulation is well tolerated, safe, and an easy to handle even in septic shock critically ill patients.

Background: A clinical audit is used to verify the application of evidence-based clinical guidelines. Our regional section of the Italian Society of Nephrology was the first to establish a region-based program of clinical audits of compliance with guidelines for treating osteodystrophy and anemia of patients on chronic dialysis. This study summarizes the main results of the 2 audits of the Piemonte region., Methods: Structured questionnaires were sent twice to all of the 22 dialysis centers of Piemonte and to the Center of Valle D'Aosta for an Audit on Osteodystrophy (in 2000 and 2004) and for the Audit on Anemia (2003). The questionnaires were meant to evaluate the clinical schedule of treatment relative to calcium-phosphate balance and anemia in dialysis patients., Results: All centers responded, showing low levels of agreement with the targets of Italian guidelines. In sum, in 2000 only 27% of centers had more than 70% of patients with serum phosphate <5.5 mg/dL, but that rate had increased to 33% in 2004. Only 35% (in 2000) and 40% (in 2004) of the centers had more than 90% of patients with Kt/V >1.2. The Audit on Anemia showed a median of 42% of patients with hemoglobin between 11 and 12 g/dL, and only 2 centers had more than 70% of patients above this target., Conclusions: The first result of our pioneering experience was that we found that compliance with minimal levels of care was still inadequate, with regard to hyperphosphatemia, dialysis adequacy and anemia. Nevertheless, the 2nd Audit on Osteodystrophy showed a relative improvement in the results. But, most importantly, this open regional report has encouraged comparisons, and motivated centers to adopt a strategy of understanding, addressing and correcting inadequate levels of care, and furthermore increased satisfaction with the care being offered.

Background: Ascorbate supplementation for patients on regular dialysis treatment (RDT) is advised to obviate deficiency and improve epoetin response in those with functional iron deficiency. However, clear-cut safety concerns regarding hyperoxalemia are still poorly understood. This study tries to establish safety/efficacy profiles of ascorbate and oxalate during long-term intravenous ascorbate supplementation., Methods: A prospective study was performed in 30 patients on RDT showing ascorbate deficiency (plasma ascorbate < 2.6 mg/L [<15 micromol/L]): 18 patients were administered intravenous ascorbate during 18 months (250 mg/wk, subsequently increased to 500 mg), and 12 patients were taken as reference untreated cases. Plasma ascorbate and oxalate assays and dialytic balance determinations were performed (ion chromatography and reverse-phase high-performance liquid chromatography, respectively) at baseline, during treatment, and 12 months after withdrawal., Results: Plasma ascorbate levels increased dose dependently with supplementation (1.6 +/- 0.8 mg/L [9.1 +/- 4.6 mumol/L] at baseline, 2.8 +/- 1.8 mg/L [15.9 +/- 10.1 micromol/L]) with 250 mg of ascorbate, and 6.6 +/- 2.8 mg/L [37.5 +/- 16.0 micromol/L] with 500 mg/wk of ascorbate), but only normalized with greater dosages for several months in 94% of patients. Baseline plasma oxalate levels increased from 3.2 +/- 0.8 mg/L (35.8 +/- 8.8 micromol/L) to 3.6 +/- 0.8 mg/L (39.5 +/- 9.1 micromol/L) and 4.5 +/- 0.9 mg/L (50.3 +/- 10.4 micromol/L) with 250 and 500 mg, respectively ( P < 0.001). The calcium oxalate saturation threshold was exceeded by 7 of 18 patients (40%) during 6 months therapy with 500 mg/wk. Ascorbate dialysis removal increased from 37.8 +/- 23.2 mg (215 +/- 132 micromol) to 99.6 +/- 51.7 mg (566 +/- 294 micromol) during supplementation (P < 0.001), with corresponding increases in oxalate removal from 82.5 +/- 33.2 mg (917 +/- 369 micromol) to 111.2 +/- 32.6 mg/L (1,236 +/- 362 micromol; P < 0.01). Withdrawal reverted plasma levels and dialysis removal to initial values. Values for untreated patients did not change during 1 year of follow-up., Conclusion: Patients on RDT may resolve ascorbate deficiency with intravenous supplementation of 500 mg/wk, but this implies a significant risk for oxalate supersaturation. Oxalate measurements are strongly recommended during long-term ascorbate therapy.

Background: Guidelines for treating anemia in dialysis patients accept, as high-end range of serum ferritin useful to optimize erythropoietin therapy, values high as 500 to 900 microg/L, on the hypothesis that ferritin might be not representative of iron overload., Methods: A superconducting quantum interference device (SQUID) was used to make direct noninvasive magnetic measurements of nonheme hepatic iron content in 40 dialysis patients treated with intravenous iron, and liver iron content was compared with biochemical markers of iron status., Results: Only 12/40 (30%) patients showed normal hepatic iron content (SQUID <400 microg/g), while 32.5% had mild (400 to 1000 microg/g) and 37.5% severe (>1000 microg/g) iron overload, although 28/40 patients (70%) had serum ferritin below 500 microg/L. Among many parameters, hepatic iron content was only correlated with ferritin (r= 0.324, P= 0.04). The receiver operating characteristic (ROC) analysis showed the best specificity/sensitivity ratio to identify iron overload for ferritin >340 microg/L (W = 0.716). Multivariate logistic regression analysis demonstrated that an increase in serum ferritin of 100 microg/L and female gender were independent variables associated with moderate to severe hepatic iron overload: OR 1.71 (95% CI 1.10 to 2.67) and OR 10.68 (95% CI 1.81 to 63.15), respectively., Conclusion: Hepatic iron overload is frequent in dialysis patients with ferritin below currently proposed high-end ranges, and the diagnostic power of ferritin in indicating true iron stores is better than presumed. Safety concerns should prompt a reevaluation of acceptable iron parameters, focusing on potential gender-specific differences, to avoid potentially harmful iron overload in a majority of dialysis patients, mainly females.