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Aim Data on the outcome of chronic kidney disease (CKD) patients who are hospitalized and start unplanned urgent haemodialysis (HD) are lacking. This prospective, longitudinal, observational study aimed to define the hospital mortality rate and associated factors in CKD patients who start unplanned urgent HD. Methods Between January 2003 and December 2009, all patients with CKD who were hospitalized, diagnosed with ESRD and started unplanned urgent haemodialysis at Haemodialysis Service of the Catholic University of Rome, Italy were recruited. Exclusion criteria were: acute renal failure, prior history of dialysis, multiple organ failure, coma, and dementia. Hospital mortality rate was the primary outcome. Results Three and hundred sixteen patients were studied: 99 died after 19.5 ± 27.3 days and 217 survived until discharge. Of these, 154 were prescribed chronic HD and 63 restored renal function. Patients who died were significantly older and had a higher Charlson Comorbidity Index score. The mortality rates were 51.1% in patients with 81–90 years, 37.8% with 71–80 years, 34.1% with 61–70 years and 13.9% with age ≤60 years. Logistic regression analysis showed that age only was an independent risk factor for all-cause mortality. Conclusions In CKD patients who need hospitalization and start unplanned urgent haemodialysis the mortality is very high and significantly related to age.

Rhabdomyolysis is a syndrome due to a damage of skeletal muscle and the leakage of intracellular contents into the extracellular fluid and the circulation. Several causes may induce rhabdomyolysis and the major one is the crush syndrome. Most cases of non-traumatic rhabdomyolysis are related to drugs. Many molecules are subject to hepatic metabolism and the concomitant use of drugs, as statins, with other medications acting as substrates of the same isoenzymes can interact and increase the risk of myopathy. Subclinical rise of creatine kinase may be the expression of rhabdomyolysis that can present as a medical emergency such as acute kidney injury (AKI), compartment syndrome, cardiac dysrhythmias and disseminated intravascular coagulopathy. The main pathophysiological mechanisms of myoglobinuric-related AKI are renal vasoconstriction, formation of intraluminal casts and direct cytotoxicity promoted by heme-protein. The aim of this review is to analyze the pathophysiology of myolysis, the causes of rhabdomyolysis and especially the link between the liver and the kidney, which can represent the connecting element for the development of the syndrome.

Both active and passive immunization strategies against Staphylococcus aureus have thus far failed to show efficacy in humans. With the attempt to develop an effective S. aureus vaccine, we selected five conserved antigens known to have different roles in S. aureus pathogenesis. They include the secreted factors α-hemolysin (Hla), ess extracellular A (EsxA), and ess extracellular B (EsxB) and the two surface proteins ferric hydroxamate uptake D2 and conserved staphylococcal antigen 1A. The combined vaccine antigens formulated with aluminum hydroxide induced antibodies with opsonophagocytic and functional activities and provided consistent protection in four mouse models when challenged with a panel of epidemiologically relevant S. aureus strains. The importance of antibodies in protection was demonstrated by passive transfer experiments. Furthermore, when formulated with a toll-like receptor 7-dependent (TLR7) agonist recently designed and developed in our laboratories (SMIP.7-10) adsorbed to alum, the five antigens provided close to 100% protection against four different staphylococcal strains. The new formulation induced not only high antibody titers but also a Th1 skewed immune response as judged by antibody isotype and cytokine profiles. In addition, low frequencies of IL-17-secreting T cells were also observed. Altogether, our data demonstrate that the rational selection of mixtures of conserved antigens combined with Th1/Th17 adjuvants can lead to promising vaccine formulations against S. aureus.

During bacterial pathogenesis extensive contacts between the human and the bacterial extracellular proteomes take place. The identification of novel host-pathogen interactions by standard methods using a case-by-case approach is laborious and time consuming. To overcome this limitation, we took advantage of large libraries of human and bacterial recombinant proteins. We applied a large-scale protein microarray-based screening on two important human pathogens using two different approaches: (I) 75 human extracellular proteins were tested on 159 spotted Staphylococcus aureus recombinant proteins and (II) Neisseria meningitidis adhesin (NadA), an important vaccine component against serogroup B meningococcus, was screened against ≈2300 spotted human recombinant proteins. The approach presented here allowed the identification of the interaction between the S. aureus immune evasion protein FLIPr (formyl-peptide receptor like-1 inhibitory protein) and the human complement component C1q, key players of the offense-defense fighting; and of the interaction between meningococcal NadA and human LOX-1 (low-density oxidized lipoprotein receptor), an endothelial receptor. The novel interactions between bacterial and human extracellular proteins here presented might provide a better understanding of the molecular events underlying S. aureus and N. meningitidis pathogenesis.

Autonomic nervous system is involved in body weight regulation. Gastrointestinal manifestations of systemic sclerosis (SSc) can influence patients’ nutritional status and facilitate the development of protein–energy malnutrition. The aim of the study is to assess the nutritional status of SSc patients and to explore its possible correlation with autonomic dysfunction using heart rate variability (HRV). We enrolled 19 SSc subjects and 19 healthy subjects as controls. Body mass index (BMI) and body surface area (BSA) were collected and recorded in all patients. HRV was measured and the domains of low frequencies (LF, index of the sympathetic modulation) and high frequencies (HF, index of the parasympathetic modulation) were recorded. As assessed by the LF/HF RATIO, sympathovagal balance is altered in SSc patients because of increased sympathetic modulation and reduced parasympathetic activity. BMI positively correlates with LF (r=0.57; p less than 0.01) and LF/HF RATIO during daytime (r= 0.46; p less than 0.05). Similarly, BSA positively correlates with LF (r= 0.51; p less than 0.05), LF day time (r= 0.53; p less than 0.05) and LF/HF RATIO night time (r=-0.51; p less than 0.05). In SSc patients the autonomic dysfunction is characterized by increased sympathetic modulation. We observed a correlation between autonomic dysfunction and nutritional status in SSc patients.

Autonomic dysfunction (AD) in systemic sclerosis (SSc) was already confirmed through heart rate variability (HRV) analysis. Cardio-pulmonary exercise testing (CPET) is a useful tool in early detection of exercise tolerance in SSc patients. Aim of the study was to assess the relationships existing between AD and exercise tolerance.Thirty-two [4 M, 28 F; median age: 47.5 (20-65) years] consecutive SSc patients were enrolled. All patients underwent pulmonary function testing, incremental symptom-limited CPET and twenty-four hours ECG Holter recording with HRV analysis in time and frequency domain. Multiple regression analysis was performed in order to identify independent HRV predictors of exercise tolerance and cardiac efficiency during the effort.HRV analysis showed significant differences in power in low and high frequency (LF and HF, respectively) and their ratio (LF/HF) compared to healthy controls. Nocturnal ratio be- tween power in low and high frequency at HRV (LF/HFnight) was shown to be the only independent positive predictor of maximal work load (R2=18.6%, p=0.014) and maximal oxygen consumption (V' O2 peak) expressed both as absolute value (R2=24.2%, p=0.004) and as corrected for body weight (R2=21.6%, p=0.007). A positive linear relationship was also found between nocturnal LF (LFnight) and the oxygen uptake/work rate (V'O2/W) slope (R2=15.8%, p=0.024).In SSc patients without cardiopulmonary involvement AD is associated with better exercise tolerance and cardiac function during physical effort. Further studies are needed to confirm these results.

Aim Autonomic dysfunction (AD) is an early feature of systemic sclerosis (SSc). A regular endothelial function is a prerequisite for normal response of the myocardial blood flow (MBF) to cold pressure test (CPT). The aim of the study was to evaluate the relation between MBF and AD at rest and after CPT in asymptomatic SSc patients. Methods Twenty SSc patients and 10 age-, sex- and body mass index-matched healthy controls underwent cardiac magnetic resonance at rest and after CPT. All subjects underwent 24 hours ambulatory 3-channel electrocardiogram Holter to evaluate AD by heart rate variability. Results We did not observe any significant difference in MBF (mL/g/min) at rest and after CPT between SSc patients and healthy controls. Delta of MBF (difference between MBF after CPT and rest MBF) was lower (P = 0.039) in SSc patients than healthy controls (0.28 [0.04-0.40] vs 0.33 [0.24-0.54]). The low frequency/high frequency (LF/HF) was higher (P = 0.002) in SSc patients than healthy controls (3 [1.7-6] vs 1.8 [1.1-2.8]). The high frequencies (HF), modulated mainly by paraympathetic system, was lower (P = 0.003) in SSc patients than healthy controls (30 [16-42] vs 36.5 [24-44]). Sympathetic hyperactivity, due to reduction of parasympathetic activity (HF), is present in SSc patients. A negative correlation was observed between Delta of MBF and LF/HF (r = -0.572, P = 0.0031). Conclusion AD, characterized by sympathovagal imbalance due to a reduced parasympathetic tone with high LF/HF ratio, could be responsible for the reduced myocardial vasodilatory response after CPT.

In this paper we study the initialization step of decoding algorithms for efficient error-control coding techniques, and its dependence of the channel characteristics over which transmission is performed. LDPC and Polar codes are selected as efficient error-control codes operating over different channels. Channels under study are the classic Additive White Gaussian noise channel, the Rayleigh fading channel, and the Middleton's Class A impulsive noise channel. An efficient initialization step is performed when the initialization step uses estimates based on the corresponding probability density function of the channel, evaluated for the two possible transmitted signals of a binary transmission. However, real time evaluation of these estimates can be an operation of high complexity. A low complexity alternative decoding strategy is proposed, based on the estimation of square Euclidean distances propagated using antilog operations, in combination with a simple signal amplitude limiter. This low complexity strategy avoids the need of channel characteristics estimation, and results into a reasonable good BER performance, especially for decoding LDPC codes.

We describe a successive cancellation list CRC (Cyclic Redundancy Check)-aided decoder for polar codes over AWGN (Additive White Gaussian Noise) Channel, Fading Channel and Impulsive Noise Channel. Simulation results show the advantage of this decoding method over the original proposed by Arikan.

In this paper, the BER performance of a soft distance successive cancellation decoder for Polar codes is analyzed in the presence of impulsive noise, modelled using both the Middleton's Class A model and the symmetric alpha-stable model, for impulsive noise channels. This algorithm avoids estimation of the signal-to-noise ratio of the channel, and simplifies the initialization step of the classic successive cancellation decoder for Polar codes. These two simplifications are obtained without any significant loss in BER performance with respect to the classic SC decoder operating over the same channels, as we show by means of BER performance simulations. Impulsive noise is characterized by strong peak amplitude values that are added to the amplitude of the transmitted signal, thus significantly increasing the BER. A simple strategy based on the use of signal amplitude limiters can be used to mitigate this effect. We have applied limiters to both decoders, resulting in significant BER performance improvements.

The uptake of Cd and some biomarkers of exposure and effects have been investigated in specimens of land snail Cornu aspersum exposed to vaporized CdCl

La tesis busca reflexionar sobre cómo se construyen sentidos sobre el mal (y el bien) en una de las villas con mayor extensión geográfica de la ciudad de Córdoba. Cada capítulo busca desmenuzar las relaciones sociales que se configuran entre los vecinos a partir de distinciones nativas que establecen entre quiénes serían, desde sus propias miradas, vecinos malos y buenos. Esta configuración nativa de malos y buenos se relaciona con las trayectorias de vida de los vecinos en las cuales se juegan valores morales asociados con las mismas y a partir de los cuáles son señalados como malos quienes han tenido o tienen relación con prácticas delictivas o ilegales tales como robo, venta y consumo de droga y prostitución.A su vez, la tesis complejiza las relaciones que se establecen entre santos de moralidad dudosa o ambigua como San La Muerte y Pomba Gira y sus devotos, tanto en un plano material a través de grutas, altares, ofrendas y favores; como en un plano sobrenatural a través de sueños y apariciones.En cada capítulo se juega la posibilidad de usar el mal de santidades y devotos para "hacerse respetar", es decir para hacer frente a las acusaciones de maldad de otros vecinos. El mal aparece siempre como una estrategia en potencia de la cual pueden echar mano incluso los que se autodefinen como buenos para obtener respeto, regular el comportamiento de otros, obtener poder, entre otras cosas. Fil: Liberatori Banegas, Marina Gabriela. Autor; . Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Antropología de Córdoba. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Instituto de Antropología de Córdoba; Argentina

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Introduction: The shoulder joint is considered unstable due to poor bone congruence and due to being exposed to large ranges of motion. The scapular muscles provide a stable base for the humerus during movements at extreme amplitudes of arm elevation above the head. The scapular protractors are continually required during different activities of daily living and sports. Considering the biomechanical aspects of the protractors, some studies have reported different methods of evaluating their strength using the hand held dynamometer (HHD). Despite the HHD is an instrument that has demonstrated excellent reliability and validity for measures of muscular strength in the lower and upper limbs, there is a lack of studies that tested and found the validity of the HHD force measurements for the scapular protractors in relation to the dynamometer isokinetic considered gold standard for these measures. Objective: To perform a concurrent validity of the HHD scapular protraction measures at two different positions in three different populations. Methods: Sixty subjects of both sexes, divided into three groups, group glenoumeral instability (GI), swimmers group (SG) and healthy group (HG) participated in the study. All subjects were evaluated by the HHD in two positions, sitting and supine position, and by Biodex. Results: A moderate correlation was found between the HHD measurements in the sitting and supine positions in relation to Biodex for all individuals. There was a strong correlation between the measurements of HHD in sitting position and Biodex for all groups. Conclusion: The data suggest that the HHD is a valid instrument to measure the force of the protractors of the scapula in the sitting position, since these measures are closer to the measures of the Biodex and to provide better stability than the position lying in supine, independent of the shoulder condition. Introdução: A articulação do ombro é considerada instável devido à pobre congruência óssea e devido a estar exposta a grandes amplitudes de movimento. Os músculos escapulares proporcionam uma base estável para o úmero, durante os movimentos em amplitudes extremas de elevação do braço acima da cabeça. Os protratores da escápula são continuamente exigidos durante diferentes atividades de vida diária e esportivas. Considerando os aspectos biomecânicos dos protratores, alguns estudos têm reportado diferentes métodos de avaliação da sua força usando o dinamômetro hand held (HHD). Apesar de ser um instrumento que tem demonstrado excelente confiabilidade e validade para as medidas de força muscular nos membros inferiores e superiores, existe uma escassez de estudos que testaram e encontraram a validade das medidas de força do HHD para os protratores da escápula em relação ao dinamômetro isocinético considerado padrão ouro para essas medidas. Objetivo: Foi realizar uma validação concorrente das medidas de protração escapular do HHD em duas posições diferentes, em três diferentes populações. Métodos: Participaram do estudo 60 sujeitos de ambos os sexos, divididos em três grupos, grupo instabilidade glenoumeral (GI), grupo nadadores (GN) e grupo saudáveis (GS). Todos os sujeitos foram avaliados pelo HHD em duas posições, decúbito dorsal e sentado e também pelo Biodex. Resultados: Foi encontrada uma correlação moderada entre as medidas de HHD nas posições sentada e deitada em relação ao Biodex para todos os indivíduos. Houve forte correlação entre as medidas do HHD na posição sentado e Biodex para todos os grupos. Conclusão: Os dados encontrados sugerem que o HHD é uma ferramenta válida para medir a força dos protratores da escápula na posição sentado, uma vez que essas medidas estão mais próximas das medidas do Biodex e por proporcionar melhor estabilidade que a posição deitada em supino, independente da condição do ombro.

Objectives Obese children are often taller than age-matched subjects. Reports on GH and IGF-I levels in obese individuals are controversial, with normal and reduced GH-IGF-I levels having been reported in this group of patients. Thus, the aim of this study was to analyse insulin-like growth factor type 1 receptor (IGF-IR) mRNA expression in obese children. Methods Forty-seven pre-pubertal children were included in this study: 29 were obese and taller than their target height, and 18 were normal eutrophic controls. Fasting blood samples were collected for IGF-IR mRNA expression in isolated lymphocytes and serum IGF-I, ALS, IGFBP-3, and IGFBP-1 concentration analysis. Results Relative IGF-IR gene expression (2− ΔΔCT) was significantly (P = 0.025) higher in obese children (median 1.87) than in controls (1.15). Fourteen of the 29 obese subjects showed 2− ΔΔCT values greater than or equal to 2, while only 2 individuals in the control group showed values above 2 (P = 0.01). Obese children showed significantly (P = 0.01) higher IGF-I concentrations than the control group (237 ng/ml and 144 ng/ml, respectively). Among obese patients, 65.5% had IGF-I values above the 75 percentile of the control group (P = 0.02). ALS concentration was significantly (P = 0.04) higher in the obese group, while IGFBP-3 levels were similar in obese and control children. IGFBP-1 concentration was lower in obese children, while insulin levels and HOMA-IR index were higher than in controls. Conclusions The higher IGF-IR mRNA expression observed in obese children, associated with the higher IGF-I and ALS and the lower IGFBP-1 levels, suggest that the higher stature observed in these children may be due to increased IGF-I bioactivity.

Background: Many patients admitted to a Department of Internal Medicine have different degrees of heart and kidney dysfunction. Mortality, morbidity and cost of care greatly increase when cardiac and renal diseases coexist. Methods: A retrospective cohort study was conducted on 1,087 patients admitted from December 2009 to December 2012 to evaluate the prevalence of the cardiorenal syndrome (CRS) and clinical features. Results: Out of 1,087 patients discharged from our unit during the study period, 190 (17.5%) were diagnosed as having CRS and classified into five types. CRS was more common in males (68.9%). CRS type 1 was associated with higher age (79.9 ± 8.9 years) and accounted for 61.5% of all deaths (p < 0.001), representing a risk factor for mortality (OR 4.23, 95% CI 1.8-10). Congestive heart failure was significantly different among the five CRS types (p < 0.0001) with a greater frequency in type 1 patients. Infectious diseases were more frequent in CRS types 1, 3 and 5 (p < 0.05). Pneumonia presented a statistically higher frequency in CRS types 1 and 5 compared to other classes (p < 0.01), and community-acquired infections were statistically more frequent in CRS types 1 and 5 (p < 0.05). The distribution of community-acquired pneumonia was different among the classes (p < 0.01) with a higher frequency in CRS types 1, 3 and 5. Conclusion: CRS is a condition that is more frequently observed in the clinical practice. The identification of predisposing trigger factors, such as infectious diseases, particularly in the elderly, plays a key role in reducing morbidity and mortality. An early recognition can be useful to optimize therapy, encourage a multidisciplinary approach and prevent complications.

En este artículo busco reflexionar, etnográficamente, sobre diferentes moralidades configuradas en torno a una muerte acontecida en una villa de Córdoba. Ludo Hernández era un joven de 18 años quien era acusado de incurrir en prácticas delictivas tales como robos, consumo y venta de drogas, entre otras. Murió asesinado el 29 de diciembre de 2010. A partir de allí los vecinos de La Tela construyeron diversos relatos sobre esta muerte; muchos de ellos vinculados con cuestionamientos morales relacionados con su conducta, con la educación recibida por su familia, y por consiguiente, con la reputación de la misma. Su madre, por su parte, intentaba “limpiar” la memoria del muerto, a la vez que canalizar el sufrimiento. Intentaré reconstruir las diferentes explicaciones en torno a esta muerte, para ello compararé la muerte de Ludo Hernández, con la de otro joven quien también fue asesinado en la villa, pero en un contexto completamente diferente, puesto que era considerado por sus vecinos como un “chico bueno” y por tanto, su muerte fue llorada y considerada “injusta”.

The hypercoagulability of patients with nephrotic syndrome could be an important trigger for arterial and venous thrombotic events. Arterial thromboses are less frequent than venous thromboses and the most common locations are femoral arteries. The association of stroke and nephrotic syndrome is extremely rare. Here we report the case of a patient with stroke as first manifestation of nephrotic syndrome. Ischemic stroke can be the first manifestation of nephrotic syndrome and should be considered as a possible complication of the syndrome, when the commonest causes of ischemic stroke are excluded and especially in presence of pre-existing glomerular disease.

Patients with small vessel vasculitis present fluctuating antineutrophil cytoplasmic antibodies (ANCA) levels to the point that positive ANCA may be missed even if only up to 10% of patients with microscopic polyangiitis (MPA) are ANCA-negative. The first-line treatment of MPA is the association of steroids and cyclophosphamide, especially in the presence of a rapidly progressive glomerulonephritis. Plasmapheresis, intravenous immunoglobulins, and tumor necrosis factor inhibitors have been proposed as alternative to standard therapy. Disseminated intravascular coagulation (DIC) is a possible event in the course of small vessel vasculitis. Gabexate mesylate is a protease inhibitor able to suppress endothelial cell injury, and it may be administered to treat DIC related to different diseases. In ANCA-associated vasculitis, cytokines play a key role in promoting endothelial damage. DIC-related thrombocytopenia may be misinterpreted as drug-induced because of the immunosuppressive properties of cyclophosphamide. Two cases of ANCA-positive MPA associated with DIC and treated with gabexate are reported in the literature with improvement of both hematological disorder and renal function. Our patient presented a rapidly progressive glomerulonephritis, and the renal biopsy showed MPA, in the absence of ANCA. After two weeks of steroid treatment, our patient developed a DIC. This case represents the first report of ANCA-negative MPA managed with gabexate, which showed improvement of coagulation disorders and kidney function. In conclusion, the anti-inflammatory properties of gabexate could be helpful in MPA at increased bleeding risk when immunosuppressive treatment is contraindicated, even in ANCA-negative vasculitis.

European Directive on Sustainable Use of Pesticides requires that the people making inspections of sprayers in use have an official license, recognized at national level, released by the competent Authority. In Italy, Authorities responsible of training and upgrading of sprayers inspectors are Regional and Provincial administrations. They make this job in collaboration with research institutes that provide qualified teachers.With the aim to homogenize in the whole country the activity of training and licensing of sprayers inspectors the rules for training courses and the criteria for releasing licenses have been defined by ENAMA. Training courses shall have a duration of at least 40 hours subdivided between theory (60% of total time) and practical (40% of total time).Topics treated during courses are: criteria to apply pesticides, main sprayer types used in agriculture and relative components, test methods and equipment used to carry out the inspections of sprayers in use and to adjust them. The exam to get the inspector license shall consist in: a) filling of a questionnaire with multiple answers (at least 80% of answers have to be correct); the questions are selected among a database approved by ENAMA Working Group; b) oral test; c) practical exam consisting in the complete inspection of one sprayer.In order to guarantee the same quality level of sprayers inspections in the different European countries and to guarantee the mutual recognition of inspections made it is considered necessary to reach in short terms an agreement to harmonize the activity of training, licensing and upgrading of sprayers inspectors across Europe.