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To describe epidemiological and clinical features of patients confirmed as having SARS-CoV-2 infection and managed in isolation at home. We performed a multicenter retrospective study enrolling all SARS-CoV-2-positive adults evaluated from 28 February to 31 May 2020 at one of nine COVID-19 Units in southern Italy: we included patients receiving care at home and those admitted to hospital. We defined patients with not-severe disease if they were asymptomatic or experienced a mild infection that did not need oxygen (O2) therapy and those with a severe infection if hospitalized and required O2 therapy. We enrolled 415 patients with SARS-CoV-2 infection: 77 were managed in isolation at home, 338 required hospital management. The 77 patients in home isolation were less frequently male than hospitalized patients (55% vs. 64%; < 0.01) and were younger (median age 45 years (IQR:19) vs 62 (IQR 22); p < 0.01), had a lower Charlson comorbidity index (median 0 (IQR2) vs 6 (IQR 3); p < 0.01), and included fewer subjects with an underlying chronic disease (36% vs 59%; p < 0.01). According to a binomial logistic regression analysis, a younger age (OR: 0.96 (95% IC: 0.94–0.98), p < 0.01) and a low Charlson comorbidity index (OR: 0.66 (95% IC: 0.54 –0.83); p < 0.01) were independent factors associated with at-home management. The identification of subjects with SARS-CoV-2 infection who could be managed in home isolation is useful in clinical practice. A younger age and no comorbidities were identified as factors independently associated with home management.

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.

Objective The aim of this study is to determine the effectiveness of using a leg support exoskeleton (legX) in different modes on simulated work tasks which emulate real-world job tasks. Background Prolonged kneeling and squatting tasks increase the risk of work-related musculoskeletal disorders at the knee in industrial occupations. Methods We evaluated legX capable of spring assistance throughout one’s range of motion and/or locking support at a fixed angular position. Participants performed a dynamic panel task, alternating between hip and knee height, and a sustained floor level task with and without the exoskeleton. The exoskeleton was evaluated in spring mode, locking mode, and spring + locking mode for the panel task and only in locking mode for the floor task. The participants’ ( N = 15) muscle activity was recorded for the right lumbar erector spinae, thoracic erector spinae, tibialis anterior, rectus femoris, semitendinosus, and lateral gastrocnemius. Results Significant reduction of the rectus femoris activity was observed with the exoskeleton (median reduction: 22%–56% and peak reduction: 12%–48% for the panel task and median reduction: 57% and peak reduction:34% during the floor task). Conclusion legX significantly reduces rectus femoris activity during squatted static (floor) and dynamic (panel) work and may reduce pain and discomfort associated with squatting and potentially reduce the risk of developing knee disorders. Dynamic tasks benefit from both locking modes and spring assistance, the greatest benefit occurring with a combination of the two. Application These results show that the legX can be beneficial to activities such as electrical panel work, grinding, sanding of larger surfaces, and concrete laying.

This qualitative research aims to unravel the challenges encountered by the Filipino medical technology deans when performing their functions and to describe their ways to overcome them. The deans disclosed that the most common dilemma they encountered rested on people, resources, workload, and personal. People related challenges, for instance, were obviously displayed by the faculty members and staffs’ resistance to certain policies and plans laid out by the university. At times, conflict among them arises which eventually gave rise to informal leaders. The deans, however, agreed that problem along this facet could be resolved by appropriate communication. Moreover, they encountered problems on resources during the operation- facilities, budget, manpower, and time management were among them. They were able to manage to go through by prioritizing the purchase of the needed resources and proportionally allocating them to the units of the department. Some deans were resourceful and creative enough to innovate the resources available to suit these to their present requirements. Along with workload-related strategies. Some deans got a hard time in class scheduling and giving teaching assignments because of their doing some administrative roles, they ran short of time to do these. To resolve, faculty restructuring was done so that some academic tasks could be delegated. Finally, the deans did face personal-related challenges. They became enemies to themselves as indicated by their feelings of isolation, self-adjustment to keep even to the stakeholders they dealt with, and exhaustion. To combat, they set time for self-reflection and adapt ways to reach out the people around them. In spite of the efforts of the deans and despite of the available resources they have, they were still facing some challenges in managing the department. Their unresolved problems will hamper the program operation. Their disclosures implied the need for the top management and other stakeholders to revisit the organization to identify the resources the deans needed for an efficient and effective program operation.

This paper discusses the control of a medical exoskeleton swing leg that has a “passive” (unactuated) knee. Previous work in legged locomotion has demonstrated the feasibility of achieving natural, energy efficient walking with minimally actuated robotic systems. This work will present early results for a medical exoskeleton that only has actuation that powers the flexion and extension of the biological hip. In this work, a hybrid model of the state dependent kinematics and dynamics of the swing leg will be developed and parameterized to yield swing hip dynamics as a function of desired knee flexion dynamics. This model is used to design swing hip motions that control the flexion behavior of the passive swing knee in a human-like manner. This concept was tested by a paraplegic user wearing a new minimally actuated exoskeleton. The presented results show that a human-like swing phase can be achieved with an exoskeleton that has fewer actuated degrees of freedom than current medical exoskeletons.Copyright © 2013 by ASME

Lower-extremity powered exoskeletons have traditionally used four to ten powered degrees of freedom to provide gait assistance for individuals with spinal cord injury (SCI). Systems with numerous high-impedance powered degrees of freedom commonly suffer from cumbersome walking dynamics and decreased utility due to added weight and increased control complexity. We propose a new approach to powered exoskeleton design that minimizes actuation and control complexity by embedding intelligence into the hardware. This paper describes a minimalistic system that uses a single motor for each exoskeleton leg in conjunction with a bio-inspired hip-knee coupling mechanism to enable users to walk, sit, and stand. Operating in concert with a custom orthotic knee joint, the exoskeleton hip joint has been designed to mimic the biarticular coupling of human leg muscles thus allowing a single actuator to power both hip and knee motions simultaneously. The implementation of this design resulted in a system that provides comparable performance to existing exoskeletons. This system has been tested on paraplegic subjects and has successfully enabled patients to stand up, sit down, and ambulate in numerous real world situations.Copyright © 2013 by ASME

This paper proposes a design for a knee-ankle prosthesis which ultimately controls two linear hydraulic actuators using a single pump. The design takes advantage of the fact that the knee and ankle never produce large positive powers simultaneously during stair-climbing, and that the ankle produces more positive power than the knee during walking. This makes the prosthesis lighter and smaller. During walking, the ankle joint adds forward propulsive power similar to that of an intact ankle. During stair climbing, the knee joint provides assistance like that of an intact knee. The hydraulic nature of the prosthetic allows it to function in a semi-active mode, where it behaves similar to a microcontroller controlled passive transfemoral prosthesis.

Participation in development is advocated for various noble reasons and is often permeated with lofty sentiments of "empowerment" and "ownership". At its most basic, the concept describes the engagement of socially and economically marginalized peoples in decision-making over their own lives (see Guijt and Shah, 1998: 1). However, despite such claims of 'good' development, a number of scholars have written substantial critiques of participation. Drawing upon the framework of governmentality, in combination with a brief discussion of post-colonialism, this thesis argues that, with the associated hierarchies of developed and developing, donor and recipient, and so forth, the practices of participation in development serve to legitimize development interventions and govern the conduct of particular groups of people. Through the use of semi-structured interviews, archival information and organizational documents, this study provides a critical assessment of participation in development thinking and practice from a Caribbean perspective.

1. 1. The influence of sex on the chain elongation, dehydrogenation and incorporation of fatty acids has been studied using a microsomal system. 2. 2. A significant sex difference was found in the elongation of palmitic acid to stearic acid. Female rats performed the elongation with a capacity about twice as high as that of male rats. 3. 3. No sex differences were detected in the ability to perform the dehydrogenation and chain-elongation steps leading from linoleic acid to arachidonic acid. The incorporation of arachidonic acid into complex lipids was not influenced by the sex.

Malonyl coenzyme A is synthesized by transacylating S-malonyl-N-decanoyl cysteamine with coenzyme A. A simplified procedure for the preparation of S-malonyl-N-decanoyl cysteamine, using cysteamine as starting material, is described.

Linoleic acid-1-14C was incubated with subcellular fractions of rat liver to study the mechanism of polyunsaturated fatty acid synthesis. The most effective system for the chain elongation of linoleic acid to eicosadienoic acid was liver microsomes plus malonyl coenzyme A with cofactors, NADPH, and ATP. Under anaerobic conditions, the chain elongation reaction could be separated quantitatively from the dehydrogenation reaction which otherwise required the same system. The chain elongation of linoleic acid was inhibited by saturated fatty acids of which myristic and pentadecanoic acids were most effective. Mono-unsaturated and polyunsaturated fatty acids also act as inhibitors. From consideration of reaction kinetics and inhibition by other fatty acids, the conversion of linoleic acid to γ-linolenic acid seems preferred over the conversion of linoleic acid to homolinoleic acid.

Il trapianto di rene da donatore dopo morte cardiaca (DCD) rappresenta una valida opzione per incrementare il numero di organi disponibili, mantenendo standard di sopravvivenza e di funzionalità del graft sovrapponibili ai trapianti da donatore per morte cerebrale (DBD). Il Centro di Riferimento Trapianti dell’Emilia Romagna ha attivato un programma di donazione da DCD a partire da Gennaio 2016. Il presente studio è stato condotto con lo scopo di analizzare la casistica dei trapianti di rene eseguiti nei primi 30 mesi di attività del programma, confrontando gli outcome dei DCD con quelli dei trapianti da donatore DBD eseguiti nello stesso periodo. Sono stati inoltre indagati eventuali fattori prognostici predittivi di funzionalità renale. Nel periodo esaminato sono stati eseguiti 16 trapianti di rene da 10 donatori DCD (5 SCD-DCD e 5 ECD-DCD). Non sono state osservate Primary Non Function(PNF). Sono state osservate 2 graft loss entro 12 mesi, entrambe conseguenti a transplantectomia per rottura dell’arteria renale in corso di complicanza infettiva. Due pazienti sono deceduti in seguito a tali complicanze infettive. La DGF ha avuto un’incidenza del 44%. In termini di funzionalità del trapianto non sono state osservate differenze nei valori di creatininemia ed eGFR alla dimissione, a 12 ed a 24 mesi rispetto ai DBD. Le caratteristiche di marginalità del donatore (ECD-DCD o KDPI >65%) correlavano con una più elevata incidenza di DGF e valori di funzione renale peggiori alla dimissione. Nessuno dei fattori analizzati, tra cui lo Score di Karpinsky, ha mostrato correlazione con i valori di creatiniemia e filtrato glomerulare a 12 e 24 mesi. Kidney transplant from donor after circulatory death (DCD) represents a valid choice to increase the incidence of renal transplantation, presenting recipients' and grafts' survival rates comparable to those from brain dead donors (DBD). In January 2016, the Transplant Referral Center in the Emilia Romagna region has started a DCD program. In the present study we report on the first 30 months of the program as far as our own Center in Bologna is concerned, and we provide a comparison with DBD transplants performed over the same period. From January 2016 to September 2018, 16 kidney transplants from 10 DCD donors (5 SCD-DCD and 5 ECD-DCD) have been performed, with two graft-loss at 12 months of follow-up, both due to renal artery rupture caused by infectious arteritis with consequent transplantectomy. Two patients died due to sepsis. Seven (44%) delay graft function (DGF) have been reported. No differences have been found between DCD and DBD in terms of kidney function (serum creatinine and eGFR evaluated at discharge, 12 and 24 months of follow-up). Kidney from marginal donors (ECD-DCD or KDPI >65%) were associated with a higher rate of DGF and worst graft function at discharge. All the predicting factors that have been analysed, including Karpinsky Score, failed to show an association with serum creatinine and eGFR at 12 and 24 months of follow up.

Aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-specific reverse transcriptase-polymerase chain reaction (RT-PCR) represents the diagnostic gold standard. We explored the value of chest ultrasonography to predict positivity to SARS-CoV-2 on RT-PCR in suspected COVID-19 cases. Patients & methods: Consecutive patients with suspect COVID-19 were included if they had fever and/or history of cough and/or dyspnea. Lung ultrasound score (LUSS) was computed according to published methods. Results: A total of 76 patients were included. A 3-variable model based on aspartate transaminase (AST) > upper limit of normal, LUSS >12 and body temperature >37.5°C yielded an overall accuracy of 91%. Conclusion: A simple LUSS-based model may represent a powerful tool for initial assessment in suspected cases of COVID-19., Lay abstract The gold standard for diagnosis of COVID-19 is RT-PCR. During a pandemic emergency, it may be useful to identify suspect symptomatic patients who may safely be observed without undergoing testing for COVID-19. In this work, a simple model based on the findings of lung ultrasound, AST levels and fever showed an overall accuracy of 91% to predict the results of RT-PCR.

Background/Aims: The coronavirus disease 2019 (CO­VID-19) pandemic is the major current health emergency worldwide, adding a significant burden also to the community of nephrologists for the management of their patients. Here, we analyzed the impact of COVID-19 infection in renal patients to assess the time to viral clearance, together with the production and persistence of IgG and IgM antibody response, in consideration of the altered immune capacity of this fragile population. Methods: Viral clearance and antibody kinetics were investigated in 49 renal patients recovered from COVID-19 infection: 7 of them with chronic decompensated renal failure, 31 under dialysis treatment, and 11 kidney transplant recipients. Results: The time span between the diagnosis of infection and recovery based on laboratory testing (2 negative nasopharyngeal swabs in consecutive days) was 31.7 ± 13.3 days. Three new positive cases were detected from 8 to 13 days following recovery. At the first serological determination after swab negativization, all the patients developed IgG and IgM antibodies. The semiquantitative analysis showed a progressive increase in IgG and a slow reduction in IgM. Discussion/Conclusion: In subjects with decompensated chronic kidney disease, under dialysis and in transplant recipients, viral clearance is lengthened compared to the general population. However, in spite of their common status of immunodepression, all of them were able to produce specific antibodies. These data might provide useful insights for monitoring and planning health-care activities in the weak category of patients with compromised renal function recovered from COVID-19.

Highlights • Helmet CPAP is effective to treat mild and moderate ARDS secondary to SARS COV 2. • Lung recruitment is not the only pathological mechanism responsible of CPAP effect. • Patients that improve PaO2/FiO2 ratio after one hour of CPAP have a lower mortality, Background During the COVID-19 outbreak, a very high number of infected patients developed pneumonia and many of them complicated with acute respiratory distress syndrome. The optimal management of respiratory failure and the role of lung ultrasound imaging in the evaluation of efficacy of treatment are unknown. Methods In March 2020 we treated 18 patients with mild and moderate ARDS secondary to SARS-CoV-2 with non-invasive continuous positive airway pressure therapy (NI-CPAP). All patients underwent lung ultrasound imaging to verify the entity of lung recruitment after NI-CPAP initiation. Results After one hour of treatment we observed a significant improvement in PaO2/FiO2 ratio in 10 patients. Notably, only 50% of them reached an effective improvement in lung aeration detectable with lung ultrasound. In the other 50% or patients the improvement in PaO2/FiO2 might be related to blood redistribution and reverse of hypoxic vasoconstriction. Conclusion NI- CPAP is a valid therapeutic option in mild and moderate ARDS secondary SARS-CoV-2. Lung recruitment detected by means of lung ultrasound is a relevant but not the exclusive mechanism that underlies the therapeutic efficacy of NI-CPAP in this clinical setting.

La colonizzazione da KPC nei pazienti sottoposti a trapianto di rene non si associa ad un peggiore outcome del graft e della sopravvivenza del paziente. Le infezioni da KPC sono un evento più raro ma con impatto negativo sull’outcome del trapianto