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The gold standard treatment for high-risk NMIBC is BCG immunotherapy. Some studies suggested an immomodulatory effects for commonly used drugs (ie, ACE-I and ARBs). We aimed to determine whether these drugs impact the prognosis of patients with high-risk NMIBC treated with BCG.Retrospective analysis on 208 patients from a single academic center with primary high-risk NMIBC treated with transurethral resection followed by 6 weekly instillations of BCG and up to 12 monthly maintenance instillations. ARBs or ACE-I use at the time of treatment initiation was recorded. Inverse probability of treatment weighting (IPTW) was used to adjust for clinical and pathological covariates. IPTW-adjusted Kaplan-Meier curves and weighted Cox proportional hazards regression were used to compare 2-yr failure-free (2-yr FFS), failure-free (FFS), overall recurrence-free (RFS) and progression-free survival (PFS).A total of 68 patients were on ACE-I, and 38 on ARBs and treatment respectively. At a median follow-up of 26 months, ACE-I treatment had no significant impact on cancer-related outcomes. Conversely, patients treated with ARBs experienced significant improvements in 2-yr FFS (HR 0.3; 0.1-0.9, P = .004), FFS (HR 0.4, 0.1-0.9, P = .005), and PFS (HR 0.001;0.001-0.001, P.001). No significant impact was found for ARB use in RFS (HR 0.6; P = .09). Sensitivity analyses confirmed these results.our findings support a potential role of the angiotensin-renin system in bladder cancer development. We identified ARBs as potential beneficial drugs that seems to act in synergy with BCG-immunotherapy.

The emergency room (ER) is the first gateway for patients with sepsis to inpatient units, and identifying best practices and benchmarks to be applied in this setting might crucially result in better patient’s outcomes. In this study, we want to evaluate the results in terms of decreased the in-hospital mortality of patients with sepsis of a Sepsis Project developed in the ER. All patients admitted to the ER of our Hospital from the 1st January, 2016 to the 31stJuly 2019 with suspect of sepsis (MEWS score ≥ of 3) and positive blood culture upon ER admission were included in this retrospective observational study. The study comprises of two periods: Period A: From the 1st Jan 2016 to the 31st Dec 2017, before the implementation of the Sepsis project. Period B: From the 1st Jan 2018 to the 31stJul 2019, after the implementation of the Sepsis project. To analyze the difference in mortality between the two periods, a univariate and multivariate logistic regression was used. The risk of in-hospital mortality was expressed as an odds ratio (OR) and a 95% confidence interval (95% CI). Overall, 722 patients admitted in ER had positive BC on admissions, 408 in period A and 314 in period B. In-hospital mortality was 18.9% in period A and 12.7% in period B (p = 0.03). At multivariable analysis, mortality was still reduced in period B compared to period A (OR 0.64, 95% CI 0.41–0.98; p = 0.045). Having an infection due to GP bacteria or polymicrobial was associated with an increased risk of death, as it was having a neoplasm or diabetes. A marked reduction in in-hospital mortality of patients with documented BSI associated with signs or symptoms of sepsis after the implementation of a sepsis project based on the application of sepsis bundles in the ER.

COVID-19 remains a major world health problem, and its clinical manifestations can vary from an oligosymptomatic form to severe pulmonary infection, which can require invasive ventilation and is strictly related to death. Identifying risk factors for adverse outcomes is essential for performing adequate care and contrasting high mortality. Chronic kidney disease (CKD) is a widespread comorbidity and is a known risk factor for death during SARS-CoV-2 infection. The present study evaluates the death risk assessment during the COVID-19 pandemic in (CKD) patients, considering the baseline value of an estimated glomerular filtration rate (eGFR) and other possible risk factors. We retrospectively assessed the mortality risk in 150 patients with COVID-19 between 1 October and 31 December 2020. We evaluated eGFR, haemoglobin, albumin, uric acid, cholesterol, triglycerides, and significant risk factors, such as diabetes mellitus and cardiovascular disease in every patient. We had 53 deaths (35.3%) during the observational period, significantly related to age, eGFR, albumin, and baseline nephropathy. In the multivariable analysis, only baseline eGFR and age were independent predictors of death during SARS-CoV-2 infection, with an OR equal to 0.96 and 1.067, respectively. In conclusion, by our analysis, age, and the baseline eGFR were the only reliable predictors of death during COVID-19 in CKD patients.

The emergency room (ER) is the first gateway for patients with sepsis to inpatient units, and identifying best practices and benchmarks to be applied in this setting might crucially result in better patient’s outcomes. In this study, we want to evaluate the results in terms of decreased the in-hospital mortality of patients with sepsis of a Sepsis Project developed in the ER. All patients admitted to the ER of our Hospital from the 1st January, 2016 to the 31stJuly 2019 with suspect of sepsis (MEWS score ≥ of 3) and positive blood culture upon ER admission were included in this retrospective observational study. The study comprises of two periods: Period A: From the 1st Jan 2016 to the 31st Dec 2017, before the implementation of the Sepsis project Period B: From the 1st Jan 2018 to the 31stJul 2019, after the implementation of the Sepsis project. To analyze the difference in mortality between the two periods, a univariate and multivariate logistic regression was used. The risk of in-hospital mortality was expressed as an odds ratio (OR) and a 95% confidence interval (95% CI). Overall, 722 patients admitted in ER had positive BC on admissions, 408 in period A and 314 in period B. In-hospital mortality was 18.9 % in period A and 12.7% in period B (p=0.03). At multivariable analysis, mortality was still reduced in period B compared to period A (OR 0.64, 95% CI 0.41-0.98; p=0.045). Having an infection due to GP bacteria or polymicrobial was associated with an increased risk of death, as it was having a tumor or diabetes.A marked reduction in in-hospital mortality of patients with documented BSI associated with signs or symptoms of sepsis after the implementation of a sepsis project based on the application of sepsis bundles in the ER.

Background Automated peritoneal dialysis (APD) has been proved benefit from remote monitoring (RM), but evidences are limited. In this study, we compared clinical outcomes and quality of life (QoL) in two group of patients undergoing APD, with and without exposure of RM. Methods This is a retrospective cohort study, comparing outcomes in two groups of APD patients monitored during 6 months with RM (group A: n = 35) or standard care (group B: n = 38 patients). In our clinical practice, we assign the RM system to patients who live more distant from the PD center or difficulty in moving. We evaluated emergency visits, hospitalizations, peritonitis, overhydration, and dropout. QoL was assessed with the Kidney Disease Quality of life-Short Form (KDQOL-SF). We included four additional questions focused on patient’s perception of monitoring, safety and timely problems solution (Do you think that home-therapy monitoring could interfere with your privacy? Do you think that your dialysis sessions are monitored frequently enough? Do you think that dialysis-related issues are solved timely? Do you feel comfortable carrying out your home-based therapy?). Results The case group presented a higher comorbidity score, according to Charlson Comorbidity Index (group A: 5.0; IQR 4.0–8.0 versus group B: 4.0; IQR 3.0–6.0) (p = 0.042). The results in group A showed a reduction in the urgent visits due to acute overhydration (group A: 0.17 ± 0.45 versus group B: 0.66 ± 1.36) (p: 0.042) and in the number of disease-specific hospitalization (group A n = 2.0; 18.2% versus group B n = 7.0; 77.8%) (p = 0.022). We did not find any difference between the two groups in terms of hospitalization because of all-cause, peritonitis, overhydration, and dropout. The analysis of KDQOL-SF subscales was similar in the two groups; on the contrary, the answers of our pointed questions have showed a significant difference between the two groups (group A: 100 IQR 87.5–100.0 versus group B 87.5; IQR 75.0–100.0) (p: 0.018). Conclusion RM improved clinical outcomes in PD patients, reducing the emergency visits and the hospitalizations, related to nephrological problems, especially in patients with higher comorbidity score. The acceptance and satisfaction of care were better in patients monitored with RM than with standard APD.

© 2019 Elsevier Ltd Research has indicated that craving is one of the strongest predictors of treatment outcome and relapse in Alcohol Use Disorders (AUD) but there is little consensus on the factors that may influence its activation and escalation. Research has also shown that desire thinking is an important cognitive process which may exacerbate craving in problem drinkers. The aim of present study was to explore, for the first time, the role of desire thinking in prospectively predicting relapse, craving and binge drinking in patients receiving treatment for AUD. One hundred and thirty-five patients admitted to two rehabilitation centres and two outpatient services for addiction and mental health problems were administered baseline, treatment completion and three months follow-up measures of anxiety and depression, AUD severity, binge drinking frequency, craving and desire thinking. Results indicated that the verbal perseveration component of desire thinking at treatment completion was the only significant predictor of relapse at follow-up over and above baseline AUD severity and binge drinking frequency. Furthermore, the imaginal prefiguration component of desire thinking and craving levels at treatment completion were found to predict craving levels at follow-up independently of AUD severity and binge drinking frequency at baseline. Finally, both the imaginal prefiguration and verbal perseveration components of desire thinking at treatment completion were found to be the only predictors of binge drinking frequency at follow-up independently of AUD severity and binge drinking frequency at baseline. Treatments for AUD should aim to reduce desire thinking in people to enhance clinical outcomes and reduce relapse risk.

The Coronavirus disease 2019 (COVID-19) pandemic continues to affect millions worldwide and has posed unique challenges to healthcare professionals. Caring for patients during a pandemic may have negative impacts on their mental health. We describe the first part of a study using a mixed-method sequential explanatory design (QUANT→QUAL). This quantitative part examines the experiences of healthcare professionals during the pandemic in a University Hospital in Italy. We performed a cross-sectional hospital-based survey involving all healthcare professionals between 19 May 2020 and 3 June 2020. Perceived Stress Scale, Patient Health Questionnaire, and General Anxiety Disorder scores were calculated, in order to assess how the pandemic emergency changed the occupational and social habits of the healthcare professionals. The mean age of the 275 respondents was 47 years and females accounted for 80.2%. A total of 29.8% had a Perceived Stress Scale (PSS) score ≥25, 22.9% scored ≥15 on the Patient Health Questionnaire (PHQ-9) scale, and 17.1% scored ≥15 on the General Anxiety Disorder (GAD) scale. Stress symptoms were mostly manifested for interviewees over 55, females, those who live far from their family, those who have only one child, and those who had a qualification lower than high school or who had a medical specialization. Our findings show a relevant level of psychological distress, anxiety, and depression in up to 30% of the sample, highlighting a significant psychological burden in all professionals.

Decision-making in urologic oncology involves integrating multiple clinical data to provide an answer to the needs of a single patient. Although the practice of medicine has always been an “art” involving experience, clinical data, scientific evidence and judgment, the creation of specialties and subspecialties has multiplied the challenges faced every day by physicians. In the last decades, with the field of urologic oncology becoming more and more complex, there has been a rise in tools capable of compounding several pieces of information and supporting clinical judgment and experience when approaching a difficult decision. The vast majority of these tools provide a risk of a certain event based on various information integrated in a mathematical model. Specifically, most decision-making tools in the field of urologic focus on the preoperative or postoperative phase and provide a prognostic or predictive risk assessment based on the available clinical and pathological data. More recently, imaging and genomic features started to be incorporated in these models in order to improve their accuracy. Genomic classifiers, look-up tables, regression trees, risk-stratification tools and nomograms are all examples of this effort. Nomograms are by far the most frequently used in clinical practice, but are also among the most controversial of these tools. This critical, narrative review will focus on the use, diffusion and limitations of nomograms in the field of urologic oncology.

We performed a pilot study to evaluate the feasibility of future research about the presence of subclinical kidney damage after Gadolinium-based contrast media exposure. The future study aims to understand which are the behaviors of two markers of kidney damage, such as urinary NephroCheck (NC) and/or neutrophil gelatinase-associated lipocalin (NGAL). Specifically, after GBCM exposure, NC urinary detection should identify proximal tubule damage while NGAL urinary detection should be related to distal tubule damage. We performed a pilot study in patients who had Gadolinium exposure. The feasibility of future study is reached when at least 90% of candidates completed the pilot study. In each patient, we tested urinary NC and NGAL levels 24 h before magnetic resonance imaging (MRI) and 12–24 h after the exposure. Furthermore, we evaluated the administration of other nephrotoxic agents, the presence of comorbidity, and kidney function by S-creatinine and urine protein before the MRI. We enrolled 35 candidates of whom 33 patients completed all study procedures. Our population had a mean age of 60.7 ± 14.8 years with normal kidney function with a median S-creatinine equal to 0.7 mg/dl (Interquartile range [IQR] 0.6–0.91). Urinary NC levels increased from 0.21 ng2/ml2 (IQR 0.11–0.4) before MRI to 0.34 ng2/ml2 (IQR 0.16–0.86) (p = 0.005). Conversely, we did not appreciate any significant modification in urinary NGAL (p = 0.53). Our pilot study seems adequate in terms of feasibility and encourages us to focus our future research on renal proximal tubule, as the principal site of subclinical kidney damage after Gadolinium exposure.

Background: A major problem of aging is the disruption of metabolic homeostasis. This is particularly relevant in the brain where it provokes neurodegeneration. Caloric restriction is a physiologic intervention known to delay the deleterious consequences of aging in several species ranging from yeast to mammals. To date, most studies on experimental models have started this dietary intervention from weaning, which is very difficult to be translated to human beings. Here, we study the effects of a more realistic dietary regimen in rats, starting at an advanced age and lasting for six months. Methods: we analyzed in the cortex and hippocampus, the proteins involved in the energetic balance of the cells, cholesterol metabolism, oxidative stress response, inflammation, synaptic impairment, and brain trophism. Results: our results suggest that caloric restriction in late life can revert only some age-related changes studied here.

Follow-up of automated peritoneal dialysis (APD) has been improved by data transmission by cellular modem and internet cloud. With the new remote patient monitoring (RPM) technology, clinical control and prescription of dialysis are performed by software (Baxter Claria-Sharesource), which allows the center to access home operational data. The objective of this pilot study was to determine the impact of RPM compared to traditional technology, in clinical, organizational, social, and economic terms in a single center. We studied 21 prevalent APD patients aged 69 ± 13 years, on dialysis for a median of 9 months, for a period of 6 months with the traditional technology and 6 months with the new technology. A relevant portion of patients lived in mountainous or hilly areas. Our study shows more proactive calls from the center to patients after the consultation of RPM software, reduction of calls from patients and caregivers, early detection of clinical problems, a significant reduction of unscheduled visits, and a not significant reduction of hospitalizations. The analysis also highlighted how the RPM system lead to relevant economic savings, which for the health system have been calculated € 335 (mean per patient-month). With the social costs represented by the waste of time of the patient and the caregiver, we calculated € 685 (mean per patient-month). In our pilot report, the RPM system allowed the accurate assessment of daily APD sessions to suggest significative organizational and economic advantages, and both patients and healthcare providers reported good subjective experiences in terms of safety and quality of follow-up.

Introduction Medium cutoff (MCO) membranes for hemodialysis (HD) remove more effectively large middle molecules than high-flux (HF) membranes. In patients on in-center short frequent HD regimen (5 sessions per week, 2 hours and 30 minutes per session) the effect of MCO on middle weight uremic toxins has not been elucidated. Methods This retrospective study included 15 patients previously performing short frequent HD with HF dialyzer (HF-HD), that were switched to short frequent HD with MCO dialyzer (MCO-HD) for 2 months, and returned to HF-HD. The primary endpoint was the predialysis concentration of α1-acid glycoprotein during the different study phases. Secondary endpoints were predialysis concentration of other middle molecules, albumin, and assessment of the quality of life using the 36-item short-form health survey (SF-36). Findings During MCO-HD phase there was a reduction in mean ± SD α1-acid glycoprotein concentration (98.71 ± 25.2 vs. 88.6 ± 24.6 mg/dL, P = 0.107), followed by an increment 2 months after returning to HF-HD (89.18 ± 26.12 vs. 97.33 ± 31.29 mg/dL, P = 0.002); however, only the second variation was statistically significant. MCO-HD provided lower median predialysis concentration of prolactin (16 [10.2-25.6] vs. 14.1 [11.7-34.8] ng/mL, P = 0.036). Single-pool Kt/V, standard Kt/V, predialysis β2-microglobulin, myoglobin, and SF-36 questionnaire remained stable during the first two phases (pre-MCO and MCO). β2-Microglobulin increased in the post-MCO phase (20.02 ± 8.14 vs. 21.27 ± 7.64 μg/mL, P = 0.000). Mean predialysis concentration of albumin reduced significantly from pre-MCO vs. MCO phases (39.9 ± 3.7 vs. 38.3 ± 3.3 g/L, P = 0.020) and rebounded significantly from MCO vs. post-MCO phases (38.7 ± 3.1 vs. 41.3 ± 3.0 g/L, P = 0.007). Discussion In this retrospective analysis, short frequent MCO-HD promotes a reduction in prolactin, a middle weight uremic toxin, and trends toward a reduction in α1-acid glycoprotein. No patients developed hypoalbuminemia. These findings are encouraging and deserve investigation in prospective studies.

Background and Aims Uremic toxins are markedly accumulated in chronic kidney disease (CKD) patients. Among these two protein-bound compounds, indoxyl sulfate (IXS) and p-cresyl sulfate (PCS) derived from gut bacterial transformation, play an important role. Recent evidences demonstrate their toxic effects in vitro and may contribute in vivo to CKD progression and mortality in uremic patients. For this reason, bacterial metabolism and its metabolites are therapeutic targets in CKD. While, several studies have evaluated possible associations between these two compounds and renal function decline in CKD, while no study has evaluated them according to the stage of progression (CKD stage). In this study, PCS and IXS are considered to highlight the possible role as biomarkers in the prediction of renal function and CKD progression (GFR stage 1-5). Method In our observational, prospective study we evaluated total (t) and free (f) PCS and IXS plasmatic fractions using Ultra High Performance Liquid Chromatography Infinity 1260 (Agilent technologies) coupled to an API 3200™ triple quadrupole mass spectrometry (ABSciex). Data were shown as mean ± SD or median (25th-75th). Statistical analysis was done by SPSS version 24.0 Results We evaluated 80 CKD patients: 54.68 ± 12.88 yrs, 39 F and 41 M. The median creatinine was 1.58 (0.90-3.32) mg/dL, median urea 58.50 (42.0-121.25) mg/dL and eGFR (CKD-EPI) 42 (17.25-85.75) mL/min/1.73 m2. On the table 1, it was summarized the levels of PCS and IXS in all patients and classified by GFR (G) stages. We found the statistically significant increase of total and free fractions of PCS (p Moreover, the increase of PCS and IXS predicts the eGFR decline significantly, according to the linear regression model using eGFR as dependent variable: PCSt (R-squared (R2)= 0.34, p Conclusion In conclusion, in our study we show the strong correlations between and PCS and IXS and eGFR and we found the significantly increase of PCS and IXS (total and free) with the progression of CKD in all G stage (1-5). We highlight the use of mass spectrometry in the evaluation of renal function especially in the earliest stages of CKD with the possibility of measuring minimum concentrations of PCSf and IXSf. Assuming the predictive value of PCS and IXS towards the reduction of eGFR, we could hypothesize the identification of cut-offs based on confidence intervals, for the prediction and progression of renal function impairment.

Background: ACUsmart (Medica S.P.A., Italy) is a new-generation, continuous renal replacement therapy (CRRT) machine for critically ill patients with acute kidney injury. We designed a multicenter international pilot study to provide a description of outlines of the ACUsmart system, evaluation aspects of functionality, usability, and feasibility, discriminating reasons of possible treatment’s withdrawals or discontinuations and highlighting strong and weak points of the machine. Methods: Data of 23 CRRT (and 11 plasma exchange) treatments were collected from 4 intensive care units. Parameters such as treatment duration, downtime, delivered dose, and number and type of alarms were recorded. The general perception of the machine was quantified through the administration of a survey to each component of the evaluating staff. Results: A total treatment time of 447 h was carried with ACUsmart. Eleven continuous veno-venous hemofiltration, 4 continuous veno-venous hemodialysis , and 8 continuous veno-venous hemodiafiltration were performed. The average percentage of net treatment duration with respect to total treatment duration was 92.37%. The mean prescribed dose and delivered dose were 26.33 and 24.10 mL/kg/h, respectively. In general, the machine was rated by users involved as practical and easy to use, although few components need to be slightly improved. Conclusion: ACUsmart is a new multifunctional machine that meets most of the features required in a fourth-generation CRRT equipment.

BackgroundBiomarkers can play a critical role by facilitating diagnosis and stratification of disease, as well as assessment or prediction of disease severity. Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 product ([TIMP-2] × [IGFBP7]) predict the development and progression of AKI and recently procalcitonin (PCT), a widely used biomarker for sepsis diagnosis and management, has been associated with AKI occurrence in ICU patients. To assess combinations of [TIMP-2] × [IGFBP7] and PCT results for prediction and risk stratification of short-term outcomes in septic and non-septic patients, a retrospective cohort analysis of critically ill patients was performed in a multidisciplinary ICU. ROC curve analysis was used in order to evaluate predictive performance of combined results of [TIMP-2] × [IGFBP7] and PCT at the time of admission for AKI development. To verify the utility of adding [TIMP-2] × [IGFBP7] and PCT results for risk assessment, we evaluated the predictive value of having a single-marker positivity compared to a double-marker positivity using the widely used cut-off of 0.3 (ng/mL)2/1000 for [TIMP-2] × [IGFBP7] and 0.5 μg/L for PCT. Risk assessment for AKI occurrence within 48 h, acute kidney disease (AKD) and mortality at 7 days was performed by logistic/Cox regression analysis.Results433 patients were analysed, of whom 168 had AKI within 48 h (93 septic and 65 non-septic patients). Combination of [TIMP-2] × [IGFBP7] and PCT showed a good predictive ability for AKI occurrence (AUC 0.81, 95% CI 0.77–0.86,p p p = 0.001).ConclusionsAlthough combining the results of [TIMP-2] × [IGFBP7] and PCT may be a useful tool to identify and stratify ICU patients at high risk for septic AKI and short-term adverse outcomes, data should be confirmed in a large prospective study.

Background Cell cycle arrest biomarkers as TIMP-2*IGFBP7 are elevated in the Acute Kidney Stress and can predict the probability of developing Acute Kidney Injury (AKI). Approximately 25% of those patients with AKI deteriorate clinically and are unable to maintain adequate homeostasis, eventually requiring continuous renal replacement therapy. However, when clinical improvement occurs, the ideal mode of weaning patients from CRRT is an unmet medical need. Methods We performed a prospective single-center study of AKI patients treated with CRRT between October 2017 to April 2019 in a multidisciplinary ICU of an Italian hospital. All patients admitted to ICU requiring CRRT were enrolled. Urine samples for measuring urinary TIMP-2*IGFBP7 levels were collected immediately upon enrollment and at the moment when CRRT was discontinued. The primary endpoint was independence from RRT for at least 7 days after CRRT discontinuation. Renal recovery, which was defined as serum creatinine (SCr) level 2(ng/ml) 2 /1000 at enrollment were longer CRRT-dependent. The ROC-AUC values for the prediction of successful discontinuation with TIMP-2*IGFBP7 concentrations at enrollment, at discontinuation of CRRT and with the final model were 0.828, 0.814 and 0.882, respectively. The risk for CRRT discontinuation failure was nearly 5 times higher patients with a positive biomarker at CRRT discontinuation (OR 4.879, P=0.043), and 3.5 times higher in patients with a TIMP-2*IGFBP7 concentration >2(ng/ml) 2 /1000 at patient enrollment (OR 3.515, P=0.016). Multivariate Cox regression analysis showed a significant association between successful discontinuation of CRRT and TIMP-2*IGFBP7-negative patients at CRRT discontinuation (RR 0.436, 95% CI 0.202-0.939, P=0.034). Kaplan-Meier curves revealed that TIMP-2*IGFBP7 concentration

© 2017 The Australian Psychological Society.Background: Impulsivity is considered a core clinical feature in borderline personality disorder (BPD). Evidence also indicates that impulsivity is part of the biological vulnerability for BPD. The purpose of the study was to verify if the presence of substance-related and addictive disorders (SRADs) may increase impulsivity and aggression in BPD. Methods: Eighty patients (27 with BPD, 26 with BPD and SRAD, 27 with other personality disorders (OPDs)) completed a comprehensive assessment for personality disorder symptoms, impulsivity, and aggressive behaviour. Results: BPD patients with SRAD showed higher scores on impulsivity and aggression compared with other groups. Furthermore, no significant difference was observed between BPD and OPD patients on impulsivity and aggression. Conclusion: The presence of SRAD was found to be a mediator between BPD and impulsive and aggressive behaviour. The findings are discussed and directions for future research presented.

Kidney transplantation (KT) may restore fertility in chronic kidney disease (CKD). The reasons why maternofetal outcomes are still inferior to the overall population are only partially known. Comparison with the CKD population may offer some useful insights for management and counselling.Aim of this study was to analyse the outcomes of pregnancy after KT, compared with a large population of nontransplanted CKD patients and with low-risk control pregnancies, observed in Italy the new millennium.We selected 121 live-born singletons after KT (Italian study group of kidney in pregnancy, national coverage about 75%), 610 live-born singletons in CKD, and 1418 low-risk controls recruited in 2 large Italian Units in the same period (2000-2014). The following outcomes were considered: maternal and fetal death; malformations; preterm delivery; small for gestational age (SGA) baby; need for the neonatal intensive care unit; doubling of serum creatinine or increase in CKD stage. Data were analyzed according to kidney diseases, renal function (staging according to CKD-epidemiology collaboration), hypertension, maternal age, parity, ethnicity.Maternofetal outcomes are less favourable in CKD and KT as compared with the low-risk population. CKD stage and hypertension are important determinants of results. Kidney transplantation patients with estimated glomerular filtration rate greater than 90 have worse outcomes compared with CKD stage 1 patients; the differences level off when only CKD patients affected by glomerulonephritis or systemic diseases ("progressive CKD") are compared with KT. In the multivariate analysis, risk for preterm and early-preterm delivery was linked to CKD stage (2-5 vs 1: relative risk 3.42 and 3.78) and hypertension (RR 3.68 and 3.16) while no difference was associated with being a KT or a CKD patient.The maternofetal outcomes in patients with kidney transplantation are comparable with those of nontransplanted CKD patients with similar levels of kidney function impairment and progressive and/or immunologic kidney disease.

Impulsivity has often been related to aggressive and self-mutilative behavior in Borderline Personality Disorder (BPD). Many authors focused on the key role of emotion dysregulation in explaining vulnerability to dysfunctional behavior in BPD in addition to trait impulsivity. Furthermore, recent works have shed light on a gap in empirical research concerning the specific mechanisms by which a lack of affective regulation produces aggression proneness. The purpose of the study was to investigate the role of impulsivity and emotion dysregulation in determining vulnerability to aggression and deliberate self-harm in a sample of BPD outpatients. Enrolled patients with BPD (N =79) completed a comprehensive assessment for personality disorder symptoms, trait impulsivity, emotional dysregulation, aggressive and self - mutilative behavior. Trait impulsivity significantly predicted both aggressive and self-mutilative proneness. Furthermore, emotion dysregulation was found significantly to account for the vulnerability to aggression and self-injury, in addition to the variance explained by impulsivity. In conclusion, these findings support evidence that emotion dysregulation plays an important role in increasing the risk of dysfunctional behavior in impulsive BPD individuals.

Large-scale longitudinal studies show that specific borderline personality disorder (BPD) symptoms are more likely to remit over time, suggesting that clinical features of BPD may vary between younger patients and older ones. The objective of the present report is to provide a direct comparison between younger (age 18-25 years; n = 44) and older (age 40-59 years; n = 49) BPD patients on the nine DSM-4 BPD criteria (self-harm, emotional dysregulation, impulsiveness, and work and social functioning). Younger and older patients reported similar levels of impulsiveness, emotional dysregulation, and work and social functional impairment. Younger adults were more likely to show anger and self-damaging behaviors compared with older patients, which in turn were more likely to endorse chronic emptiness. In conclusion, older patients with BPD are still impaired in impulsiveness, emotional regulation, and social functioning; treatments for older BPD population should be long term and focused on emotion dysregulation and impulsive behaviors.

Introduction Desire Thinking (DT) is a voluntary cognitive process aimed at orienting to prefigure images, information, and memories about positive target-related experience. It comprises of two components: Imaginal Prefiguration and the Verbal Perseveration. DT has been found to be positively associated with alcohol use, gambling, nicotine use, and problematic Internet use. Despite this, neither qualitative nor quantitative reviews have been undertaken to critically summarize findings about the association between DT and addictive behaviours. The aim of this systematic review and meta-analysis is to evaluate the strength of the association between DT and addictive behaviours. Method In accordance to PRISMA criteria, a research was conducted on PubMed and PsycInfo. A manual search of reference lists was also run. Search terms were: “addiction / gambling / alcohol / tobacco / nicotine / drug / cocaine / marijuana / cannabis / opioid / heroin / methadone / internet” AND “Desire Thinking”. Results Ten studies were included. Both components of DT were found to be associated with addictive behaviours (alcohol use, nicotine use, gambling, problematic Internet use) in both clinical and community samples. The strength of the association between Verbal Perseveration and addictive behaviours appears to be stronger for alcohol and nicotine use than Internet use. The association between DT and addictive behaviours is not moderated by age. Conclusion DT is present across different addictive behaviours. The assessment of DT and tailored interventions aimed to reduce the propensity to engage in DT should be considered in the treatment of addictive behaviours.

The COronaVIrus Disease 19 (COVID-19) pandemic is an emerging reality in nephrology. In a continuously changing scenario, we need to assess our patients’ additional risk in terms of attending hemodialysis treatments, follow-up peritoneal dialysis, and kidney transplant visits. The prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-20 infection in the general population plays a pivotal role in estimating the additional COVID-19 risk in chronic kidney disease (CKD) patients. Unfortunately, local prevalence is often obscure, and when we have an estimation, we neglect the number of asymptomatic subjects in the same area and, consequently, the risk of infection in CKD patients. Furthermore, we still have the problem of managing COVID-19 diagnosis and the test’s accuracy. Currently, the gold standard for SARS-CoV-2 detection is a real-time reverse transcription-polymerase chain reaction (rRT-PCR) on respiratory tract samples. rRT-PCR presents some vulnerability related to pre-analytic and analytic problems and could impact strongly on its diagnostic accuracy. Specifically, the operative proceedings to obtain the samples and the different types of diagnostic assay could affect the results of the test. In this scenario, knowing the local prevalence and the local screening test accuracy helps the clinician to perform preventive measures to limit the diffusion of COVID-19 in the CKD population.

The metacognitive approach conceptualizes the relationship between anger and rumination as driven by metacognitive beliefs, which are information individuals hold about their own cognition and about coping strategies that impact on it. The present study aimed to test the prospective predictive impact of metacognitive beliefs and rumination on anger in a community sample. Seventy-six participants were recruited and engaged in a 2-week anger, rumination, and metacognitive beliefs monitoring protocol. A multi-wave panel design was employed to test whether metacognitive beliefs and rumination have a prospective impact on anger. Metacognitive beliefs and rumination were found to have a significant prospective impact on anger that was independent from the number of triggering events. Metacognitive beliefs about the need to control thoughts were shown to have a direct impact on subsequent anger, independently from rumination. These findings provide support for the potential value for applying metacognitive theory and therapy to anger-related problems. Aggr. Behav. 9999:1-9, 2017. © 2017 Wiley Periodicals, Inc.

Background: Hemolytic uremic syndrome (HUS) can be triggered by Shiga toxin producing Escherichia coli (STEC) infection or it can be defined as atypical HUS (aHUS) if it is related to uncontrolled complement activation. aHUS is characterized by a high incidence of recurrence after kidney transplantation, and it can also occur de novo in transplant recipients. Eculizumab is used both to prevent and to treat aHUS following kidney transplantation. In this paper, we report our centre experience and we present 4 cases of HUS in patients who underwent kidney transplantation. Methods: This is a single-center experience about HUS development in transplanted patients. Results: Patient 1 with end-stage renal disease (ESRD) due to STEC-HUS undergoing kidney transplantation without prophylactic therapy with eculizumab. Patient 2 with HUS secondary to an episode of diarrhea at 8 years old. After a slow progression to ESRD, she underwent kidney transplantation and she received prophylactic therapy with eculizumab due to the presence of anti-complement factor H antibodies. Patient 3 underwent pre-emptive living donor ABO-incompatible kidney transplantation and developed HUS secondary to antibody-mediated rejection. Patient 4 developed de novo HUS 16 years after kidney transplantation without a known cause. Conclusion: The correct diagnosis of HUS and the identification of the complement component alterations in case of aHUS are important parameters required to predict the risk of post-transplant recurrence of the disease. In the cases we reported, eculizumab has been found to be effective both to prevent and to treat aHUS following kidney transplantation.

Francesco Ramponi,1,2 Claudio Ronco,1,3 Giacomo Mason,1 Enrico Rettore,4 Daniele Marcelli,5,6 Francesca Martino,1,3 Mauro Neri,1,7 Alejandro Martin-Malo,8 Bernard Canaud,5,9 Francesco Locatelli10 1International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, 2Department of Economics and Management, University of Padova, Padova, 3Department of Nephrology, San Bortolo Hospital, Vicenza, 4Department of Sociology and Social Research, University of Trento, FBK-IRVAPP & IZA, Trento, Italy; 5Europe, Middle East, Africa and Latin America Medical Board, Fresenius Medical Care,, Bad Homburg, Germany; 6Danube University, Krems, Austria; 7Department of Management and Engineering, University of Padova, Vicenza, Italy; 8Nephrology Unit, Reina Sofia University Hospital, Córdoba, Spain; 9School of Medicine, Montpellier University, Montpellier, France; 10Department of Nephrology, Manzoni Hospital, Lecco, Italy Background: Clinical studies suggest that hemodiafiltration (HDF) may lead to better clinical outcomes than high-flux hemodialysis (HF-HD), but concerns have been raised about the cost-effectiveness of HDF versus HF-HD. Aim of this study was to investigate whether clinical benefits, in terms of longer survival and better health-related quality of life, are worth the possibly higher costs of HDF compared to HF-HD.Methods: The analysis comprised a simulation based on the combined results of previous published studies, with the following steps: 1) estimation of the survival function of HF-HD patients from a clinical trial and of HDF patients using the risk reduction estimated in a meta-analysis; 2) simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; and 3) application of state-specific health-related quality of life coefficients and differential costs derived from the literature. Several Monte Carlo simulations were performed, including simulations for patients with different risk profiles, for example, by age (patients aged 40, 50, and 60 years), sex, and diabetic status. Scatter plots of simulations in the cost-effectiveness plane were produced, incremental cost-effectiveness ratios were estimated, and cost-effectiveness acceptability curves were computed.Results: An incremental cost-effectiveness ratio of €6,982/quality-adjusted life years (QALY) was estimated for the baseline cohort of 50-year-old male patients. Given the commonly accepted threshold of €40,000/QALY, HDF is cost-effective. The probabilistic sensitivity analysis showed that HDF is cost-effective with a probability of ~81% at a threshold of €40,000/QALY. It is fundamental to measure the outcome also in terms of quality of life. HDF is more cost-effective for younger patients.Conclusion: HDF can be considered cost-effective compared to HF-HD. Keywords: cost-effectiveness, hemodialysis, hemodiafiltration

BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. Studies have suggested a possible prognostic role of copeptin in determining the rate of progressive kidney function decline in ADPKD patients. However, it remains unresolved whether the changes in copeptin levels are specific for ADPKD or merely reflect a decline in glomerular filtration rate (GFR) regardless of the etiology of chronic kidney disease (CKD). METHODS We performed a case-control study in ADPKD and non-ADPKD (control) patients. Patients were categorized based on the GFR-category (G-stage, KDIGO). We evaluated urea, creatinine, cystatin C, and copeptin in plasma and correlated these levels with estimated glomerular filtration rate (eGFR) (CKD-EPI). All p-values were two sided, and p

Aims: The study aimed to determine whether the available literature supports a positive or negative influence of dialysis on regulatory T-cells (Tregs). Methods: We performed a systematic search and a meta-analysis. Mean differences in Tregs number of chronic kidney disease stages G5 on dialysis patients (CKD G5D) and healthy controls (HCs) were compared. Random effects model was applied. The software used was general package for meta-analysis (version 4.3-0, depends R (≥2.9.1)). Results: Five studies were included in the meta-analysis. The mean difference in percentage of Tregs on CD4+ T-cells between CKD G5D and HCs was not statistically different. Moreover, CKD GFR stages G5 not on dialysis (CKD G5) versus HC (p = 0.002; mean difference in Treg percentage was -2.47% in CKD G5 vs. HC) and CKD G5 versus CKD G5D (not significant). Conclusion: This meta-analysis demonstrates an association between the uremic state and lower Tregs, and supports the hypothesis that hemodialysis alter Tregs. Our findings highlight the need for new clinical studies. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=449242.

BACKGROUND: Emotional instability and dyscontrolled behaviours are central features in borderline personality disorder (BPD). Recently, some cognitive dysfunctional mechanisms, such as anger rumination, have been found to increase negative emotions and promote dyscontrolled behaviours. Even though rumination has consistently been linked to BPD traits in non-clinical samples, its relationship with problematic behaviour has yet to be established in a clinical population. AIM: The purpose of the study was to explore the relationships between emotional dysregulation, anger rumination and aggression proneness in a clinical sample of patients with BPD. METHODS: Enrolled patients with personality disorders (93 with BPD) completed a comprehensive assessment for personality disorder symptoms, anger rumination, emotional dysregulation and aggression proneness. RESULTS: Anger rumination was found to significantly predict aggression proneness, over and above emotional dysregulation. Furthermore, both BPD diagnosis and anger rumination were significant predictors of aggression proneness. CONCLUSION: Future research should examine whether clinical techniques aimed at reducing rumination are helpful for reducing aggressive and other dyscontrolled behaviours in treating patients with BPD. Copyright © 2015 John Wiley & Sons, Ltd. Language: en

Background Peritoneal dialysis (PD) is frequently complicated by high rates of peritonitis, which result in hospitalization, technique failure, transfer to hemodialysis, and increased mortality. Early diagnosis, and identification of contributing factors are essential components to increasing effectiveness of care. In previous reports, neutrophil gelatinase-associated lipocalin (NGAL), a lipocalin which is a key player in innate immunity and rapidly detectable in peritoneal dialysis effluent (PDE), has been demonstrated to be a useful tool in the early diagnosis of peritonitis. This study investigates predictive value of PDE NGAL concentration as a prognostic indicator for PD-related peritonitis. Methods A case-control study with 182 PD patients was conducted. Plasma and PDE were analyzed for the following biomarkers: C-reactive protein (CRP), blood procalcitonin (PCT), leucocytes and NGAL in PDE. The cases consisted of patients with suspected peritonitis, while controls were the patients who came to our ambulatory clinic for routine visits without any sign of peritonitis. The episodes of peritonitis were defined in agreement with International Society for Peritoneal Dialysis guidelines. Continuous variables were presented as the median values and interquartile range (IQR). Mann-Whitney U test was used to compare continuous variables. Univariate and multivariate logistic regression were used to evaluate the association of biomarkers with peritonitis. Receiver operating characteristic (ROC) curve analysis was used to calculate area under curve (AUC) for biomarkers. Finally we evaluated sensitivity, and specificity for each biomarker. All statistical analyses were performed with SPSS version 17.0 (SPSS Inc., Chicago, IL, USA). Results During the 19-month study, of the 182 patients, 80 had a clinical diagnosis of peritonitis. C-reactive protein levels ( p < 0.001), PCT ( p < 0.001), NGAL in PDE ( p < 0.001), and white blood cells (WBC) in PDE ( p < 0.001) were all significantly different in patients with and without peritonitis. In univariate analysis, CRP (odds ratio [OR] 1,339; p = 0.001), PCT (OR 2,473; p < 0,001), WBC in PDE (OR 3,986; p < 0,001), and NGAL in PDE (OR 36.75 p < 0.001) were significantly associated with episodes of peritonitis. In multivariate regression analysis, only WBC (OR 24.84; p = 0,012), and peritoneal NGAL levels (OR 136.6; p = 0,01) were independent predictors of peritonitis events. Moreover, AUC for NGAL in peritoneal effluent was 0,936 ( p < 0.001) while AUC for CRP, PCT, and WBC count in peritoneal effluent were 0,704 ( p = 0.001), 0.762 ( p = 0.039), 0,975 ( p < 0.001), respectively. Finally, combined WBC and peritoneal NGAL test increased the specificity (= 96%) of the single test. Conclusions These results identify NGAL in peritoneal effluent as a reliable marker of peritonitis episodes in PD patients. Collectively, our findings demonstrate that the use of peritoneal NGAL cooperatively with current clinical diagnostic tools as a prognostic indicator, presents a valuable diagnostic tool in PD-associated peritonitis.

In our society the school is one of the most exclusive places to educate the new generations, so we put trust and many expectations on it. As institution, it has a particular organization of spaces, times, rules, roles and its practices are based on rigorous hierarchies, discipline and authority, training children and young people to become suitable for the society in which they live. School reflects the dominant educational culture and spreads ideas that even if unconsciously internalized, have an indepth action on students. Its spaces are often detached and devoid of beauty and sensibility; inside school everything is under control and quantified, making learning and knowledge influenced by the market laws of our society. It rather focuses the attention on profit and results than on every student's personal path and makes culture something to get close to in a bored attitude and without any interest and passion. That's why in these years Paolo Mottana, a professor of the University of Milan-Bicocca, elaborated a theoretical reflection called "joyful and diffused education" to think about education again and to create educational experiences out of the school as we know it; in this new way of thinking about education the entire society and not only the school is the best context in which children and young people can learn and live rich, deep and exciting experiences. The town becomes an important experience place, in which young people can be real actors and not only spectators of their learning activities and of the city life. But town has to change its spaces, times and rhythms to welcome young generations, to pay them attention, to take care of them and to set their vitality, creativity and competences off. Starting from the joyful and diffused education reflection, Paolo Mottana and his research group elaborated the "Educational District", an experimental project in collaboration with some lower secondary schools of a district in Milan. It wants to foster a more inductive way of learning, which starts from the students' curiosity and the experiences lived out of the school, building real and diversified ways of discovering, far from the simulations and simplified experiences lived in the traditional school system. It also wants to satisfy young people's need for independence and involvement, promoting their attitudes, making them co-planners and letting them play a main role in their schooling, which needs to be more individual and personalized. The school needs to become a more open and flexible place, a "hole", a base, a meeting point to go and come back to talk, discuss and rework the experiences lived in the town. In this way school could get closer to young people's life and create strong links with the territory, being not the only educational institution and recognizing the importance of sharing this responsibility, this task with the territory and the entire society, trying to make a real cultural revolution

BACKGROUND: Anger and depressive ruminations have recently received empirical attention as processes related to borderline personality disorder (BPD). The Emotional Cascade Model (Selby, Anestis, & Joiner, 2008) suggests that negative affect (such as anger and sadness) may trigger rumination, which in turn may increase the duration and extent of negative affect, leading to dysregulated behaviours aimed at reducing such intense and unpleasant emotions. AIM: The aim of this study is to explore the relationships between emotional dysregulation, anger and depressive ruminations, and their role in predicting dysregulated behaviours (such as aggression and self-harm) in a clinical sample of patients with BPD. METHODS: Ninety-one patients with a diagnosis of BPD were recruited from three outpatient community mental health centres and asked to complete a comprehensive assessment for personality disorder symptoms, emotion dysregulation, anger and depressive ruminations, aggression, and self-harm. RESULTS: Anger and depressive ruminations were found to be significantly associated to, respectively, self-harm and aggression, beyond the variance accounted by emotional dysregulation. CONCLUSIONS: Rumination may act as a mediator between emotional dysregulation and dysregulated behaviours in BPD. Future research should examine whether clinical techniques aimed at reducing rumination may be helpful in reducing dysregulated behaviours in patients with BPD. "This is the pre-peer reviewed version of the following article: Martino, F., Caselli, G., Di Tommaso, J., Sassaroli, S., Spada, M.M ., Valenti, B., Berardi, D., Sasdelli, A and Menchetti, M (2017) Anger and depressive ruminations as predictors of dysregulated behaviours in borderline personality disorder. Clinical Psychology and Psychotherapy., which has been published in final form at 10.1002/cpp.2152 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving."

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic diseases with a reported prevalence of 1:400 to 1:1000. Since the intact kidneys can compensate for the loss of glomerular filtration in ADPKD patients, renal insufficiency usually remains undetected until almost the fourth decade of life. Hereafter, reliable diagnostic and prognostic biomarkers to identify ADPKD progression are urgently needed. Several studies and systematic reviews tried to identify markers or predictors of rapid disease progression of ADPKD. The aim of this study is to review predictors of rapid disease progression of ADPKD that can be useful to the clinician. We will describe several factors associated with rapid progression of ADPKD derived from retrospective or cross-sectional studies, suggesting the best and most useful predictors that may help to patients management in clinical practice. We will attempt to identify the most useful predictors of rapid disease progression of ADPKD: established TKV growth rate >5% per year, annual estimated glomerular filtration rate decline >5 mL/min/1.73 m2, truncating PKD1 mutations and elevated plasma copeptin level. The combination of several factors that can predict the rapid ADPKD progression is more accurate than a single-marker strategy. The "PRO-PKD" risk scoring system combined with TKV, can be useful in order to evaluate the ADPKD patients and they appear to be appropriate predictors of progression disease. Moreover levels of copeptin and some urinary markers can be matched to these factors for improved patient assessment in rapid progression.

Desire thinking is a conscious and voluntary cognitive process orienting to prefigure images, information and memories about positive target-related experience. Desire thinking has been found to be associated with both craving and alcohol use in clinical and non-clinical populations, however its role in predicting craving and problematic drinking patterns has never been investigated using a longitudinal design. The central aim of the present study was to explore the role of desire thinking at Time 2 (3months post-baseline) in predicting craving and binge drinking and Time 3 (6months post-baseline), controlling for levels of both these constructs and Time 1 (baseline). One hundred and thirty three non-hazardous drinkers were assessed on craving and binge drinking at Times 1 and 3, and on desire thinking at Time 2. Findings showed that desire thinking at Time 2 predicted craving and binge drinking at Time 3, controlling for craving and binge drinking at Time 1. Furthermore, the imaginal prefiguration component of desire thinking at Time 2 was found to mediate the relationship between craving at Times 1 and 3; conversely the verbal perseveration component of desire thinking at Time 2 was found to mediate the relationship between binge drinking at Times 1 and 3. The implications of these findings are discussed.

The aim of the current study was to validate the Italian version of the Attitude Toward Personality Disorders Questionnaire (APDQ), assess its psychometric properties, and investigate nurses' attitudes toward patients with personality disorders. An Italian version of the APDQ was produced and administered to nurses working in the Bologna Mental Health Department. The instrument demonstrated good psychometric proprieties and a robust structure and supported the five-factor solution of the original English version. Findings showed that nurses experience negative feelings toward patients with personality disorders and found them difficult to care for. Attitude was found to be better among less experienced nurses and among those working in inpatient settings. The Italian version of the APDQ appears to be a useful instrument for assessing clinicians' attitudes in a variety of settings. Italian nurses were inclined to perceive these patients in a negative manner, frequently expressing aversive feelings.

The metacognitive approach conceptualizes the relationship between anger and rumination as driven by metacognitive beliefs, which are information individuals hold about their own cognition and about coping strategies that impact on it. The present study aimed to test the prospective predictive impact of metacognitive beliefs and rumination on anger in a community sample. Seventy-six participants were recruited and engaged in a 2-week anger, rumination, and metacognitive beliefs monitoring protocol. A multi-wave panel design was employed to test whether metacognitive beliefs and rumination have a prospective impact on anger. Metacognitive beliefs and rumination were found to have a significant prospective impact on anger that was independent from the number of triggering events. Metacognitive beliefs about the need to control thoughts were shown to have a direct impact on subsequent anger, independently from rumination. These findings provide support for the potential value for applying metacognitive theory and therapy to anger-related problems. Aggr. Behav. 43:421-429, 2017. © 2017 Wiley Periodicals, Inc.

Abdominal aortic calcification (AAC) is reported as a predictor for cardiovascular events in general population and in hemodialysis patients. At present, there are no AAC data in peritoneal dialysis. The purpose of this study was to evaluate the prognostic role of AAC score on cardiovascular events in peritoneal dialysis patients. Seventy-four peritoneal dialysis patients were enrolled. AAC was measured on baseline lateral abdomen radiographs by the semi-quantitative method as described by Kauppila. The other cardiovascular risk factors were obtained from patient history and blood examination. The Kaplan-Meier method was used to evaluate freedom from cardiovascular events, and differences were assessed with the log-rank statistic. Multivariate Cox regression models addressed time to cardiovascular events. The median period of follow-up was 30.5months (IQR 19.4-32.7). During follow-up, there were 29 cardiovascular events (39.2%). In univariable analysis, patient's age (HR=1.050; P=0.001), urine output (HR=0.999; P=0.02), and AAC stratified by tertiles (overall P-value

Aim: The aim of this study was to identify factors that may affect treatment retention in a 1-year psychosocial program for adult personality disorders. Methods: The sample consists of patients admitted to the Adult Personality Disorder Outpatient Programme of the Bologna Community Mental Health Centre in the period 2003–2008. At the beginning of the program, patients were evaluated through a comprehensive assessment including sociodemographic form, diagnostic interviews and self-report questionnaires. Patients who dropped out from treatment were retrospectively compared with patients who completed the program. Results: Out of 39 patients enrolled in the program, 20 (51.3%) dropped out and 19 (48.7%) completed the treatment. Out of 20 patients who dropped out, 14 terminated the treatment within the first 2 months. The dropout group and the group which remained showed significant differences in diagnosis (borderline personality disorder [BPD]), demographic data (age, time from first contact with psychiatric services), clinical variable (impulsiveness) and subjective experience (motivation, treatment expectation, therapeutic relation perception and barriers to access). BPD and subjective evaluation were found to be predictors of premature termination in the sample. In detail, BPD patients who experienced a less satisfactory therapeutic relationship and reported many external problems were more likely to drop out of the program. Conclusion: Important factors contributing to dropout were identified, with potential implication for clinical practice. Further efforts need to be made to find ways to retain BPD patients who find the first subjective experience of the service more problematic.

There is a paucity of research concerning the identification of features implicated in treatment refusal by personality disorder. This study aims to identify clinical factors that may affect treatment uptake to a specialist psychosocial programme for personality disorder. Following a lengthy assessment, 39 patients (out of a total of 60 referrals) were offered entry to the programme. Fourteen patients who did not take up the offer of treatment and 25 patients who started the programme are compared on a number of demographic, diagnostic and clinical variables, including severity of presentation and subjective experience of the assessment process. The results show that, relative to non-refusers, refusers were significantly younger, single, had a higher frequency of borderline personality disorder (BPD), experienced a less satisfactory relationship with the assessing clinician and had lower treatment expectations. Several dimensions measuring severity of presentation did not make a significant contribution to treatment uptake. A logistic regression analysis showed that assessment-related variables total score and BPD were significant predictors of treatment refusal. The low sample size and the specialist nature of the service are important limitations with regard to the generalizability of the findings. Copyright © 2010 John Wiley & Sons, Ltd.

In this paper we investigate the electrochemical behavior of iron hexacyanocobaltate (FeHCC) in comparison to the cobalt hexacyanoferrate (CoHCF). The best results were achieved on electrochemical synthesized film of FeHCC on the TiO2 modified electrodes. The chemical and physical characterizations confirm the formation of the FeHCC with the classical cubic crystal structure of the Prussian blue analogs, with cell parameter a very close to 10 A, as well as the formation of micro aggregates of TiO2 covered by FeHCC. The synthesis was performed on various substrates such as glassy carbon (GC), graphite foil (GF) and indium tin oxide (ITO) in order to develop new technological applications.