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High power laser science and engineering 10, 1 - 37 (2022). doi:10.1017/hpl.2021.59, Published by Cambridge Univ. Press, Cambridge

Membranoproliferative GN (MPGN) was recently reclassified as alternative pathway complement–mediated C3 glomerulopathy (C3G) and immune complex–mediated membranoproliferative GN (IC-MPGN). However, genetic and acquired alternative pathway abnormalities are also observed in IC-MPGN. Here, we explored the presence of distinct disease entities characterized by specific pathophysiologic mechanisms. We performed unsupervised hierarchical clustering, a data-driven statistical approach, on histologic, genetic, and clinical data and data regarding serum/plasma complement parameters from 173 patients with C3G/IC-MPGN. This approach divided patients into four clusters, indicating the existence of four different pathogenetic patterns. Specifically, this analysis separated patients with fluid-phase complement activation (clusters 1–3) who had low serum C3 levels and a high prevalence of genetic and acquired alternative pathway abnormalities from patients with solid-phase complement activation (cluster 4) who had normal or mildly altered serum C3, late disease onset, and poor renal survival. In patients with fluid-phase complement activation, those in clusters 1 and 2 had massive activation of the alternative pathway, including activation of the terminal pathway, and the highest prevalence of subendothelial deposits, but those in cluster 2 had additional activation of the classic pathway and the highest prevalence of nephrotic syndrome at disease onset. Patients in cluster 3 had prevalent activation of C3 convertase and highly electron-dense intramembranous deposits. In addition, we provide a simple algorithm to assign patients with C3G/IC-MPGN to specific clusters. These distinct clusters may facilitate clarification of disease etiology, improve risk assessment for ESRD, and pave the way for personalized treatment.

This paper reviews current trends and dynamics in the European industry for insurance intermediation services. We highlight the challenges of new regulatory and supervisory arrangements and the consequences they might imply for the industry structure and the organizational behavior of Italian brokerage firms, with a focus on the direct and indirect costs of compliance.

Questo lavoro si inserisce nel filone di ricerca dell’analisi dei rapporti tra finanza innovativa, svolta da una particolare categoria di intermediari finanziari quali le banche di credito cooperativo (Bcc), e sistemi regionali di innovazione quando questi ultimi assumono, in particolare, la fisionomia di distretti tecnologici. Si è pensato di contestualizzare questo saggio in un periodo molto problematico, quale il 2006-2011, contrassegnato dalla crisi internazionale che, soprattutto a partire dal 2009, ha assunto i connotati di uno shock non solo finanziario bensì anche strutturale con pesanti ricadute sull’economia reale del nostro Paese. Questa scelta trova una sua rationell’evidenza empirica delle forti ricadute che in Italia tale crisi ha esercitato sui livelli di redditività degli intermediari finanziari 1 : nel caso specifico delle Bccsi è riscontrato un calo degli utili e dell’indice Roe– Return on Equity– di oltre il 30% nell’anno 2009 e di oltre il 50% nell’anno 2010 mentre timidi segni di ripresa si sono riscontrati solo nell’anno 2011. Le ricadute si sono avute anche sul trend di sviluppo del mercato del private equitye venture capitalove si è verificato un significativo rallentamento nel ricorso da parte di imprese target (imprese di nuova istituzione e di piccola e/o piccolissima dimensione) al canale finanziario (Aifi, 2011). Questo in un contesto generale in cui si sono manifestati diversi fattori che fino all’estate del 2007 invece erano totalmente assenti quali, ad esempio: la rarefazione della liquidità che aveva consentito ai diversi intermediari finanziari di portare a termine importanti progetti di finanziamento; un maggior rigore delle banche nel processo di valutazione del merito creditizio incrementando la predilezione dell’uso di hard informatione garanzie riferibili a tangible assets; da qui, in ultimo, una minore disponibilità generale del credito. In un tale contesto, si è ritenuto utile cercare di individuare quali prospettive sono ravvisabili nel particolare segmento della finanza innovativa per le Bcc, in uno scenario di mercato ove tutti gli intermediari finanziari sono alla ricerca di strade percorribili per incrementare i propri margini reddituali.

Apert syndrome is a rare congenital disorder characterized by craniosynostosis, midface hypoplasia and symmetric syndactyly of hands and feet. Abnormalities associated with Apert syndrome include premature fusion of coronal sutures system (coronal sutures and less frequently lambdoid suture) resulting in brachiturricephalic dismorphism and impaired skull base growth. After this brief explanation it is clear that these anatomical abnormalities may have a negative impact on the ability to perform essential functions. Due to the complexity of the syndrome a multidisciplinary (respiratory, cerebral, maxillo-mandibular, dental, ophthalmic and orthopaedic) approach is necessary in treating the psychological, aesthetic and functional issues. The aim of this paper is to analyse the different functional issues and surgical methods trying to enhance results through a treatment plan which includes different specialities involved in Apert syndrome treatment. Reduced intellectual capacity is associated to the high number of general anaesthesia the small patients are subject to. Therefore the diagnostic and therapeutic treatment plan in these patients has established integrated and tailored surgical procedures based on the patients' age in order to reduce the number of general anaesthesia, thus simplifying therapy for both Apert patients and their family members.

In the medical field, the attention to the environmental impact of industrial processes and products is still limited. In recent years there has been an increased sensitivity towards the environment; meanwhile, the economic burden of hazardous waste disposal is becoming evident. Dialysis is a "big producer" of waste and it has been estimated that disposal costs can be up to 10-40% of the cost of disposables. So there are several reasons of interest on "ecodialysis": the high amount of waste defined as "potentially hazardous", which requires a very expensive management and the recyclability potential of the non-contaminated waste, that has not yet been fully explored in dialysis. This primary study has been performed in collaboration with the Politecnico di Torino. Its aim has been to define a schedule of activities by a few brainstorming sessions. This schedule is to be readily performed or it should be developed in detail to optimize, by reducing and recycling, the waste production during the dialysis session. The discussion identified seven basic points for the eco-sustainability of haemodialysis to: [1] reduce packaging; [2] facilitate separation of materials, and [3] their discharge; [4] differentiate materials; [5] clearly highlight the potentially hazardous materials; [6] improve the recyclability of plastic products; [7] propose a path of recovery and reuse. Although a full optimization requires a close cooperation with the manufacturers and is achievable only in the long term, the reduction of one pound of potentially contaminated materials could presently lead, on a national scale, to a saving of several million euros, which can be better employed in investments to improve our treatments.