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The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international prospective, longitudinal, observational study examining the relationship between dialysis unit practices and outcomes for hemodialysis (HD) patients in seven developed countries France, Germany, Italy, Spain, United Kingdom, Japan and the United States. Results of the DOPPS in Italy are the subject of this report.A national representative sample of 20 dialysis units (21 in Germany) was randomly selected in each of the European DOPPS countries (Euro-DOPPS). In these units, the HD in-center patients were included on a facility census, and their survival rates continuously monitored. A representative sample of incident (269 in Italy, 1553 in the Euro-DOPPS) and prevalent (600 in Italy, 3038 in the Euro-DOPPS) patients was randomly selected from the census for more detailed longitudinal investigation with regard to medical history, laboratory values and hospital admission.Comparing the Italian and Euro-DOPPS cohorts we found comparable mean age for prevalent patients (61.4 vs. 59.5 yrs), but incident patients were older in Italy. Italian prevalent patients had less cardiovascular disease, more satisfactory nutritional status and more frequent use of native vascular access. These data were associated with a comparable mortality (15.7 vs. 16.3 deaths/100 patient yrs), but morbidity was lower in Italy. Kt/V levels were comparable in the two cohorts (1.32 vs. 1.37), but 35% of Italian patients showed a Kt/V below the recommended target. Moreover, hemoglobin levels were below 11 g/dL in 60% of Italian patients.The DOPPS results bring to light several positive aspects and the opportunity for further possible improvements for Italian patients, but at the same time highlight some critical points that could represent a risk for dialysis quality.

Communities of poor, low-income immigrants with limited English proficiency and disproportionate health burdens pose unique challenges to health providers and policy makers. NewYork-Presbyterian Hospital developed the Regional Health Collaborative, a population-based health care model to improve the health of the residents of Washington Heights-Inwood. This area is a predominantly Hispanic community in New York City with high rates of asthma, diabetes, heart disease, and depression. NewYork-Presbyterian created an integrated network of patient-centered medical homes to form a "medical village" linked to other providers and community-based resources. The initiative set out to document the priority health needs of the community, target high-prevalence conditions, improve cultural competence among providers, and introduce integrated information systems across care sites. The first six months of the program demonstrated a significant 9.2 percent decline in emergency department visits for ambulatory care-sensitive conditions and a 5.8 percent decrease in hospitalizations that was not statistically significant. This initiative offers a model for other urban academic medical centers to better serve populations facing social and cultural barriers to care.

La tuberculose est une maladie provoquée par des bactéries du genre Mycobacterium et, plus particulièrement, de l'espèce tuberculosis. Cette infection cause en 2012 la mort de 1,3 millions de personnes sur les 8,6 millions qui ont développées la maladie cette même année dans le monde. Ces chiffres fournis par l'Organisation Mondiale de la santé sont alarmants et rappellent que la tuberculose se positionne en 2ème, après le VIH, dans le classement des maladies infectieuses meurtrière. Les populations les plus touchées se trouvent dans les pays sous-développées. La tuberculose est contagieuse lors de la phase active de la maladie et possède un risque de transmission élevée. En effet, les bactéries se propagent par les voie aérienne et une faible quantité inhalée (une dizaine de bacilles) suffit pour développer la maladie.

The Washington Heights-Inwood section of Manhattan is a predominantly poor Hispanic community with disproportionately high rates of chronic disease, including asthma, diabetes, and congestive heart failure. In October 2010, NewYork-Presbyterian Hospital, in association with the Columbia University Medical Center, launched an integrated network of patient-centered medical homes that were linked to other providers and community-based resources and formed a "medical village." Three years later, a study of 5,852 patients who had some combination of diabetes, asthma, and congestive heart failure found that emergency department visits and hospitalizations had been reduced by 29.7 percent and 28.5 percent, respectively, compared to the year before implementation of the network. Thirty-day readmissions and average length-of-stay declined by 36.7 percent and 4.9 percent, respectively. Patient satisfaction scores improved across all measures. Financially, NewYork-Presbyterian experienced a short-term return on investment of 11 percent. Some of the gain was a result of increased reimbursements from New York State. Nonetheless, these findings demonstrate that academic medical centers can improve outcomes for poor communities by building regional care models centering on medical homes that incorporate patient-centered processes and are linked through information systems and service collaborations to hospitals, specialty practices, and community-based providers and organizations.

Malnutrition is highly prevalent in geriatric populations, particularly in persons living in Nursing Homes (NH). Inadequate nutrition is one of the main risk factors for the onset of frailty and may contribute to the subsequent development of disability and mortality among NH residents. An optimal nutritional status and, wherever necessary, supplementation with macronutrients and micronutrients, may reduce the risk of mortality. Dementia is also prevalent among NH residents. The aim of the present study was to evaluate the relationship between mortality, and several risk factors and clinical characteristics of NH residents, including disability, nutritional status, and cognitive decline in a sample of NH residents in Palermo (Italy). This in an observational prospective study. Ninety four residents (53 women and 41 men) living in the NH “Karol Residenza Sanitaria Assistenziale” from Palermo were recruited for the study. The age range of the NH residents was between 58 and 96 years old. We included in the analyses demographic and anthropometric parameters (age, sex, body weight at baseline and during hospitalization, body mass index [BMI]), disability (ADL, IADL), cognitive and depression (MMSE, GDS), n of drugs used, multimorbidity (CIRS), laboratory parameters (serum albumin, hemoglobin, triglycerides), anorexia, and mortality during hospitalization.

According to many studies, extracorporeal dialysis with convective methods is associated with better clinical outcomes and a survival benefit compared to diffusive techniques. However, there is no full agreement on the actual superiority of this kind of renal replacement therapy on hard end-points such as mortality. We performed a retrospective epidemiological cohort study to provide "real-world" evidence on the impact of convective and non-convective dialysis techniques on all-cause and cardiac mortality and biochemical outcomes among dialysis patients in Sicily, the southernmost region of Italy. Data of all incident adult patients (N = 6529) who have started chronic extracorporeal dialysis over the period 2009-2015 were retrieved from the Sicilian Registry of Nephrology, Dialysis and Transplantation. There were 1558 patients receiving convective techniques (23.86%). Overall mortality rate was 45.21% with a significant difference between convective (31.39%) and non-convective (49.55%) groups (P 0.0001). After adjustment for potential confounders in multiple Cox regression models of increasing complexity, the mortality risk remained significantly lower for patients treated with convective methods (HR, 0.581; 95%CI, 0.525 to 0.643; P 0.0001). Moreover, the convective group had a better blood chemistry profile, improved dialysis efficacy, and reduced mortality rate from cardiac diseases compared to the non-convective group. As a sensitivity analysis, patients were categorized according to propensity score quartiles and the hazard ratio for both all-cause and cardiac mortality was significantly lower for the convective group in each quartile. In conclusion, despite the observational and retrospective design, the results of the present study further support the use of convective therapies for the treatment of end-stage renal disease.

Tuberculosis remains a serious threat to human health world-wide, and improved efficiency of medical treatment requires a better understanding of the pathogenesis and the discovery of new drugs. In the present study, we performed a whole-cell based screen in order to complete the characterization of 168 compounds from the GlaxoSmithKline TB-set. We have established and utilized novel previously unexplored host-model systems to characterize the GSK compounds, i.e. the amoeboid organisms D. discoideum and A. castellanii, as well as a microglial phagocytic cell line, BV2. We infected these host cells with Mycobacterium marinum to monitor and characterize the anti-infective activity of the compounds with quantitative fluorescence measurements and high-content microscopy. In summary, 88.1% of the compounds were confirmed as antibiotics against M. marinum, 11.3% and 4.8% displayed strong anti-infective activity in, respectively, the mammalian and protozoan infection models. Additionally, in the two systems, 13–14% of the compounds displayed pro-infective activity. Our studies underline the relevance of using evolutionarily distant pathogen and host models in order to reveal conserved mechanisms of virulence and defence, respectively, which are potential “universal” targets for intervention. Subsequent mechanism of action studies based on generation of over-expresser M. bovis BCG strains, generation of spontaneous resistant mutants and whole genome sequencing revealed four new molecular targets, including FbpA, MurC, MmpL3 and GlpK.

Triptorelin depot is largely used to treat central precocious puberty (CPP) in children. Areas covered: This review updates triptorelin depot treatment of CPP, focusing on trials that compared 3.75 mg/28 day treated and untreated children till the adult height (AH). Efficacy of the new 11.25 mg/90 days or 22.5 mg/6 month formulations in suppressing pituitary-gonadal axis in short-term trials is also addressed. Short- and long-term safety was summarized. Expert commentary: Long experience on triptorelin depot use in children with CPP is available. Outcome differences on AH are reported; they may be due to heterogenicity of treated patients; some items remain to be optimized. No long term-adverse events on reproductive function are reported; additional studies would clarify if CPP per sè or triptorelin depot administration may increase hyperandrogenism and/or polycystic ovary syndrome risk in adulthood. The quarterly formulation seems to be able to suppress pituitary-gonadal axis and pubertal development and to determine similar end-results as monthly formulation, but additional trials are needed. Few data are available for the 22.5 mg/6 month formulation. Triptorelin depot treatment of CPP should be restricted to tertiary pediatric endocrinology centers, considering that some uncertainties still exist and that rare but serious adverse events may occur.

Italy was the first European country hit by SARS-CoV-2 infection, particularly northern regions. After the beginning of national lockdown (March 9th, 2020), we observed a significant decrease in pediatric emergency department consultations (daily pediatric visits; pre-lockdown, 16 (11–22); lockdown, 3 (1–3); phase 2, 3 (3–5), p

Background and aim: Over 80% (365/454) of the nation’s centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. Methods: We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. Results: Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20–1.51], positive healthcare workers (IRR 1.09, 95% CI 1.02–1.17), test-all policy (IRR 5.94, 95% CI 3.36–10.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001–1.003) (all p < 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94–0.98) (p < 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence ≥ 229 per 100,000 and at ≥ 3 positive healthcare workers. Conclusions: Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center’s testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely.

Central precocious puberty (CPP) is due to the premature activation of the hypothalamic–pituitary–gonadal axis, which is responsible for the appearance of secondary sexual characteristics. It occurs before the age of 8 and 9 in girls and boys, respectively. CPP shows higher incidence in females than in males. Causes of CPP are similar in both sexes, but the idiopathic form is more frequent in girls, while organic forms are more frequent in males. Recent studies demonstrated a role of some genetic variants in the pathogenesis of CPP. The diagnostic evaluation based on accurate physical examination, assessment of the pituitary–gonadal axis, pelvic sonography in girls, and determination of bone age. Magnetic resonance of the central nervous system should be done in all boys and selected girls. Since the 1980s, pharmacologic treatment involves the use of gonadotropin-releasing hormone (GnRH) analogs. These drugs are characterized by few side effects and long-term safety. Many data are available on the outcome of GnRH analog treated female patients, while poor data are reported in boys. Adult height is improved in both sexes.

The Scleractinia coral biomineralization process is a representative example of a heterogeneous process of nudeation and growth of biogenic CaCO3 over a mineral phase. Indeed, even if the biomineralization process starts before settlement, the bulk formation of the skeleton takes place only when the larvae attach to a solid substrate, which can be Mg-calcite from coralline algae, and the following growth proceeds on the Mg-calcite surface of the formed baseplate of the planula. Despite this peculiarity and central role of the Mg-calcite substrate, the in vitro overgrowth of CaCO3 on single crystals of Mg-calcite, or calcite, in the presence of magnesium ions and the soluble organic matrix (SOM) extracted from coral skeletons has not been performed until now. In this study, the SOMs from Stylophora pistillata and Oculina patagonica skeletons were used in a set of overgrowth experiments. The overgrown CaCO3 was characterized by microscopic, diffractometric, and spectroscopic techniques. Our results showed that CaCO3 overgrowth in the presence of S. pistillata or O. patagonica SOM produces different effects. However, there appears to be a minor distinction between samples when magnesium ions are present in solution. Moreover, the Mg-calcite substrate appears to be a favorable substrate for the overgrowth of aragonite, differently from calcite. These observations fit with the observed settling of coral larvae on Mg-calcite-based substrates and with the in vivo observation that in the planula aragonite forms on first-formed Mg-calcite crystals. The overall results of this study highlight the importance of magnesium ions, either in the solution or in the substrate, in defining the shape, morphology, and polymorphism of biodeposited CaCO3. They also suggest a magnesium-dependent biological control on the deposition of coral skeletons.

Nell’ottobre dell’anno 2002, per volontà della direttrice della Casa di Reclusione di Saluzzo, Dott.sa Marta Costantino, è stato attivato un Laboratorio Teatrale per i detenuti. E' stata questa la prima azione di apertura verso il territorio, la prima occasione pubblica in cui l'Istituto invitava la comunità ad entrare per condividere il progetto teatrale e creare un ponte di dialogo tra il dentro e il fuori le mura. Il percorso laboratoriale termina, ogni anno, con uno nuovo spettacolo che viene rappresentato per più di mille persone., Publifarum, N. 32 (2020): Da dietro le sbarre: arte, letteratura e carcere dall'ottocento a oggi

The increasing demand for food and the need for a sustainability vision in the agri-food sector have boosted novel approaches for food management, enhancing the valorization of wastes and by-products belonging to the food industry. Herein, we present a novel paper-based origami device to assess the amount of both glucosinolate and glucose in a food waste product belonging to Brassicaceae plants, to evaluate the quality value and the correct management of waste samples. The device has been designed as an origami paper-based platform constituted of two paper-based biosensors to work synergistically in a multiplexed detection. In detail, a monoenzymatic biosensor and a bienzymatic biosensor were configured for the detection of glucose and glucosinolates, respectively, using filter paper pads preloaded with glucose oxidase and/or myrosinase. To complete the paper-based platform, the enzyme-preloaded pads were combined with office paper-based electrodes modified with Carbon black/Prussian Blue nanoparticles for the measurement of enzymatic by-product at a low applied potential (i.e., 0 V versus Ag/AgCl). Overall, this paper-based platform measured glucose and glucosinolate (i.e., sinigrin) with a linear range up to 2.5 and 1.5 mM, and detection limits of 0.05 and 0.07 mM, respectively. The repeatability corresponded to an RSD% equal to 5% by testing 10 mM of glucose, and 10% by testing 1 mM of sinigrin. The accuracy of the developed multiplex device was evaluated by recovery studies at two different levels of sinigrin, i.e., 0.25 and 0.5 mM, obtaining recoveries values equal to (111 ± 3) % and (86 ± 1) %, respectively. The multiplex detection of both glucose and glucosinolate in Brassicaceae samples evaluates the quality values of the waste sample, ensuring the quality of the re-used food product waste by using an eco-designed analytical tool. The combination of paper-based devices for quality control of food waste with the re-use of these food products represents a sustainable approach that perfectly matches sustainable agrifood practices as well as the overall approach of the circular economy. Graphical abstract