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Patients with chronic kidney disease or end-stage renal disease experience tremendous cardiovascular risk. Cardiovascular events are the leading causes of death in these patient populations, thus the interest in non-traditional risk factors such as hyperhomocysteinemia, folic acid and vitamin B12 metabolism is growing. Hyperhomocysteinemia is commonly found in CKD patients because of impaired renal metabolism and reduced renal excretion. Folic acid, the synthetic form of vitamin B9, is critical in the conversion of homocysteine to methionine like vitamin B12. Folic acid has also been shown to improve endothelial function without lowering homocysteine, suggesting an alternative explanation for the effect of folic acid on endothelial function. Whether hyperhomocysteinemia represents a reliable marker of cardiovascular risk and cardiovascular mortality or a therapeutic target in this population remains unclear. However, it is reasonable to consider folic acid with or without methylcobalamin supplementation as appropriate adjunctive therapy in patients with CKD. The purpose of this review is to summarize the characteristics of homocysteine, folic acid, and vitamin B12 metabolism, the mechanism of vascular damage, and the outcome of vitamin supplementation on hyperhomocysteinemia in patients with CKD, ESRD, dialysis treatment, and in kidney transplant recipients.

We followed with great interest the numerous reports published by the Annals 1–9 as regards the impact of the COVID-19 pandemic on different rheumatic autoimmune systemic diseases (ASD), including the survey study by Costa et al 9 that underlined the usefulness of telerheumatology in the management of patients with psoriatic arthritis in COVID-19 era. On the same topic, the world literature encompasses a large number of anecdotal observations, cohort studies and telephone surveys.1–15 Overall, the observed prevalence of symptomatic COVID-19, usually as mild-moderate disease, in patients with chronic arthritis was comparable to that found in the general population, while worse outcomes represented almost rare events.1–15 Conversely, increased percentages of symptomatic COVID-19 were observed in patient cohorts with connective tissue diseases, especially systemic lupus or systemic vasculitis.6 7 Of note, in ASD complicated by COVID-19, the baseline use of immune modifiers, namely, conventional synthetic (csDMARD), biological (bDMARD) and targeted synthetic disease-modifying antirheumatic drugs (tsDMARD), was not associated with worse COVID-19 disease outcomes.3–5 9 10 Almost invariably these monocentre studies focused on ASD patients’ populations from limited geographical areas.1–15 Given the heterogeneous distribution of pandemic infection within the same country, we investigated the impact of COVID-19 in ASD patients’ populations from three distinct regions of Italy (northern, Emilia Romagna; central, Tuscany; and southern, Calabria), characterised by different spread of the COVID-19 pandemic, prevalent in northern Italy with a marked gradient north-south.16 Our 6-week multicentre telephone survey of 1641 unselected patients with ASD confirmed the quite benign clinical course of COVID-19 in ASD, along with the safety of baseline use of either …

Psoriasis is a common chronic inflammatory disease of the skin that is increasingly being considered as a systemic inflammatory disorder due to its association with cardiovascular, metabolic, pulmonary, renal, liver, and neurologic diseases. Renal involvement is rare but well documented and psoriasis is recognized as an independent factor for CKD and ESKD. A careful monitoring of the urinalysis and of renal function is recommended in psoriatic patients, especially those with moderate-to-severe disease. In case of pathologic findings, the execution of a renal biopsy appears necessary to make an accurate diagnosis and to establish the most appropriate therapeutic strategies to prevent the progression of kidney damage. The mechanisms of kidney involvement are different and not yet fully clarified. We present here two case reports of renal dysfunction during psoriasis. In one case, we diagnosed IgA nephropathy with particularly severe clinical presentation; in the other, an advanced kidney injury due to nephrotoxicity after prolonged CNI treatment.

Obiettivo. Analisi dell’effetto cardioprotettivo perioperatorio dell’anestesia peridurale toracica (TEA) in un paziente car- diopatico sottoposto a chirurgia non cardiaca. Materiali e metodi. Paziente di 59 anni affetto da patologia neoplastica, BPCO severa, insufficienza renale cronica e car- diopatia ipertensiva (ASA IV), viene sottoposto ad intervento chirurgico di cistectomia radicale e resezione duodeno-digiu- nale. In fase preoperatoria si posiziona un catetere epidurale (T10) e si somministra un bolo di Levobupivacaina (75 mg) e Fentanest (0,05 mg). Si procede a monitoraggio intraoperato- rio con CardioQ che evidenzia uno stato ipotensivo iniziale con bassa portata e basse resistenze. Trascorsi 150 minuti si somministra un bolo peridurale con Levobupivacaina (25 mg) e Fentanest (0,005 mg). Al termine della chirurgia si procede alla somministrazione mediante pompa infusionale di Levo- bupivacaina (1.25 mg/ml) e Morfina (0,05 mg/ml) alla veloci- ta di 5 ml/h; Il paziente si trasferisce in UTI dove si continua l’infusione peridurale per le successive 24h. Ridotta la velocitàdi infusione si sospende la stessa e dopo 4 h si assiste a com- parsa di dolore toracico con sottoslivellamento del tratto ST- T in sede antero-laterale e relativa diagnosi di angina instabi- le. Risultati. Dall’analisi del monitoraggio intraoperatorio e postoperatorio (Tabelle I, II) non si rileva alcuna alterazione dei parametri emodinamici ed elettrocardiografici suggestiva di un evento ischemico. I suddetti parametri si sono mantenu- ti nel range di valori fisiologici per tutta la durata dell’infusio- ne peridurale, e successivamente in seguito alla sospensione della stessa si è verificata la comparsa dell’evento ischemico, correlato all’aumento delle resistenze vascolari periferiche come documentato dal PRAM. Discussione. La TEA, attraverso il controllo del dolore perio- peratorio e della risposta simpatico-adrenergica, determina una vasodilatazione delle arterie coronarie stenotiche e una riduzione degli episodi di ischemia miocardica 1,2. Dall’analisi della letteratura 3 e dai dati obiettivi emersi si ipotizza che la sospensione del protocollo anestesiologico attraverso la TEA abbia indotto una riduzione della cardioprotezione e di con- seguenza un incremento del rischio potenziale di malattia coronarica acuta.

In this paper, an extensive investigation of hybrid molecular/Si field-effect memories is presented, where redox ferrocene (Fc) molecules play the role of the memory charge storage nodes. Engineering of the organic linkers between Fc and Si is achieved by grafting Fc with different linker lengths. The study shows a clear correlation between results from atomistic computational density functional theory, electrochemical measurements (cyclic voltammetry) and electrical data obtained by a detailed study on capacitors and pseudo-MOS devices. Physical-chemical analyses (atomic force microscopy, high-resolution transmission electron microscopy, and X-ray photoelectron spectroscopy), corroborate the quality of molecular layers on devices.

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In this paper an extensive investigation of hybrid molecular/silicon field-effect memories is presented, where Redox Ferrocene (Fc) molecules play the role of the memory charge storage nodes. Engineering of the organic linkers between Fc and Si is achieved by grafting Fc with different linker lengths. The study shows a clear correlation between results from atomistic computational Density Functional Theory (DFT), electrochemical measurements (Cyclic Voltammetry) and electrical data obtained by a detailed study on Pseudo-MOS devices. Physical-chemical analyses (Atomic Force Microscopy, high-resolution Transmission Electron Microscopy, X-Ray Photoclectron Spectroscopy), were used to monitor the molecular layers.

De novo satellited non-acrocentric chromosomes are very rare findings in prenatal diagnosis. Here we report the first case of a de novo 18ps, associated with del(18p), detected at prenatal diagnosis. A 37 years old woman underwent Chorionic Villus Sampling (CVS) for advanced maternal age. Cytogenetic analysis on direct CVS preparation (CVSc) revealed a male karyotype with a nonfamilial satellited 18ps and a reciprocal translocation t(17;19)(P11.1;q11) of maternal origin. The mesenchimal CVS culture (CVSm) showed a mosaic of cell lines with various involvement of chromosome 18: 18ps [36/70]/ r(18) [25/70]/ del(18p) [3/70]/ -18 [6/70]. Amniotic fluid cells (AFC) confirmed the homogeneous karyotype found at CVSc. The molecular cytogenetic characterization, performed on AFC, allowed the following diagnosis: 46,XY, +15, dic(15;18)(p11.1;p11.2), t(17;19)(p11.1;q11)mat. ish dic(15;18)(tel 18p-, D15Z1+, wcp18-, wcp 18+, D18Z1+, tel 18q+). The foetal autopsy disclosed subtle facial dysmorphisms and corpus callosum hypoplasia. In case of prenatal detection of de novo terminal ectopic NORs an accurate cytogenetic and molecular analysis should be performed in order to rule out subtle unbalancements.