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The European "Floods Directive" requires European River district authorities to create flood damage and risk maps, but the process of assessing flood damage is complex and lacks established methods. Flood risk assessment also requires an understanding of how industrial equipment is vulnerable to flood events and the potential for toxic releases in such scenarios. In this study a practical case is presented regarding multicomponent flood risks in the Secchia River catchment, a tributary of the Po River, and proposes a new risk chain model for evaluating the environmental impact of soil and groundwater contamination in the event of a flood caused by the failure of storage tanks containing hazardous materials. The model is demonstrated using an illustrative case and shown to be a useful tool for managing the risk of such events. Our methodology presents a multi-component model for assessing environmental risk resulting from technological accidents triggered by natural disasters. In particular, we focus on the failure of storage tanks containing hazardous materials due to flooding. The proposed method first evaluates the probability of tank failure under defined flood conditions, including flood height, velocity, and probability of occurrence. To simplify the analysis, we consider all tanks to be unanchored atmospheric storage tanks. The final output of the method for each tank is a monetary estimation of the hypothetical costs for environmental remediation after tank failure, including the contamination of soil and groundwater by the spilled liquid. Our methodology proposed a conservative approach by assuming that all stored liquids are contaminants and by using a fixed value for the density of the stored liquid.To evaluate the probability of tank failure, it has been considered four types of failure dynamics: buckling, displacement, floating and overturning. The tank failure assessment is based on our recent study that developed vulnerability different dynamic models for unanchored steel atmospheric tanks. Our methodology not only evaluates the probability of tank failure during flood events, but also analyses the potential consequences of failure, including direct damages to the tank and costs associated with recovering the spilled product and mitigating contamination in the affected area. The results of this study can be used to develop strategies for minimizing the risks of tank collapse during flood events and to increase awareness of potential NaTech risks. The ultimate goal of this study is to create a comprehensive procedure for evaluating and comparing the dynamics of tank collapse during flood events, including the potential environmental consequences, and providing risk managers with a full understanding of the risks associated with tank failure during flooding, including potential NaTech risks.

Flooding is among the leading climatic threats to people’s livelihoods, affecting development prospects worldwide. While the danger is already substantial, climate change and rapid urbanization in flood zones will likely further drive-up flood risks. The support from flood risk assessment studies, which quantify the impacts of hazardous events on the built environment, economy and society, is fundamental for defining and implementing strategies to manage and reduce flood risk effectively. However, according to the typology of considered assets, there are different methodologies for flood risk assessment. While for direct physical and monetary dimensions, the scientific community offers a variety of widely used models, the application of models beyond these dimensions is much less frequent, and the selection and implementation of a model for estimating indirect losses or impacts for a given application case are not straightforward.This work presents the lesson learnt from the recent updating process of the Flood Risk Management Plan of Po River District Authority carried out in the context of the MOVIDA project ((https://sites.google.com/view/movida-project, 2022), in compliance with the European Floods Directive (2007/60/EC). The analysis spread across the following assets: residential buildings, crops, dairy farms, commercial and industrial sectors, strategic facilities, roads and railways, cultural heritage, environment and population. In particular, this study critically examines and discusses the needs and challenges faced by the research consortium to implement a comprehensive impact. Furthermore, the major bottlenecks for the different assets are explored across the standard dimensions: state of art, data availability and openness, spatial/temporal resolution and scale, methodology framework and implementation.

Natural hazards pose a significant threat to industrial areas and their surrounding environment, in particular considering that extreme natural events are expected to occur more frequently and exposure will increase due to urbanization growth. A NATECH event is defined as a NAtural hazard triggering TECHnological disasters which could affect people, the environment, other facilities and systems. NATECH research began less than thirty years ago and in the last decade these complex phenomena have been investigated by academia and industry. However, NATECH knowledge and methodology have some gaps that must be filled for better risk prevention and management. In fact, it is mainly focused on technological vulnerability or assessing its occurrence probability, yet possible consequences are only partial investigated. The aim of this study is to develop a theoretical framework to assess the environmental impact on soil and groundwater due to NATECH events triggered by flood. This is accomplished by harmonizing existing algorithms and methods for the natural and technological risk component with the new developed environmental soil and groundwater risk component into a coherent modelling chain. The proposed framework utilizes data from natural driven forces (e.g. flood height and velocity) and their probabilities of occurrence. These driven forces are applied to storage tanks through an existing vulnerability model. In order to evaluate resistance pressures, the model requires tank geometries and hypothetical filling level distribution. In addition, a simplified environmental risk model is applied at site scale depending on the stored product (e.g. gasoline, petroleum, etc.) in order to evaluate an affected area and its potential degree of contamination of soil and groundwater. The proposed framework is applied to a realistic case study and results and critical points would be discussed. We believe that the general theoretical framework could be adapted to any natural triggering phenomena (e.g. earthquakes, lighting, etc.), in order to assess environmental impacts due to NATECH events.

The estimation of flood damage plays a key role for planning and implementing flood risk prevention and mitigation measures. While many contributions can be found in the scientific literature about inundation damage to buildings and infrastructures, estimation of losses to the agricultural sector is currently poorly discussed. Even if different conceptual or physically based models have been proposed for the agricultural sector as well, studies testing their application to real cases are still not sufficiently abundant due to the difficulties in finding appropriate inundation and damage data. The present work attempts to contribute in this matter by investigating the impacts of a recent inundation event: the selected case study is the flood event occurred the 6th December 2020 in Northern Italy (Emilia-Romagna region), caused by the formation of a breach on the right levee of the Panaro River. The area is mainly devoted to agriculture, with farmers growing prevalently winter wheat, sorghum and forage crops, such as alfalfa. The inundation footprint has been reproduced by means of a detailed 2D hydraulic model settled with HEC-RAS software (v. 6.0). The model focuses on the accurate reproduction of water depth and permanence required for the estimation of damages to agriculture activities. Model validation refers to different observed data: (a) inundation extent, (b) maximum water depth and (c) duration of water presence; data has been collected from various sources: remote sensing images, surveys to local land owners and interviews to authorities involved in the inundation management. Although representative of a preliminary investigation, the study provides additional insights towards a better estimation of potential impacts of inundation events on agriculture activities.

Low Vitamin D (VD) levels in COVID-19 patients have been related to increased disease severity and worse outcomes. However, most of these trials designs were not-controlled and retrospective, including patients with demographic differences and biases potentially influencing the reported associations between lower VD levels and severe COVID-19. Aim of this study was to prospectively evaluate VD levels influence on disease severity in a COVID-19 patients cohort matched for age, sex and comorbidities with control subjects. Patients admitted to San Raffaele University Hospital for COVID-19 from March to June 2021 were consecutively enrolled in this study, which was approved by the local IRB, after giving their informed consent. Severe (i. e. those needing high flow oxygen therapy) and non-severe COVID-19 patients matched for age, sex and comorbidities were recruited at admission in Emergency Department (ED). Control subjects from the outpatient Endocrinology Unit of the same Hospital were enrolled in the same period. We excluded patients with comorbidities and therapies influencing VD metabolism. 25OH-VD levels were evaluated at admission in ED and VD deficiency was defined by serum 25OH-VD below 20 ng/mL. A total of 73 COVID-19 patients and 30 control subjects were included in the study. No differences regarding age, sex and comorbidities were found between patients and control groups, but 25OH-VD levels were statistically lower in COVID-19 patients (13.3 vs 23.6 ng/mL, p Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

As supply chain management is becoming demand driven, logistics service providers need to use real-time information efficiently and integrate new technologies into their business. Synchromodal logistics has emerged recently to improve flexibility in supply chains, cooperation among stakeholders, and utilization of resources. We survey the existing scientific literature and real-life developments on synchromodality. We focus on the critical success factors of synchromodality and six categories of enabling technologies. We identify open research issues and propose the introduction of a new stakeholder, which takes on the role of orchestrator to coordinate and provide services through a technology-based platform.

Slow steaming, i.e., the possibility to ship vessels at a significantly slower speed than their nominal one, has been widely studied and implemented to improve the sustainability of long-haul supply chains. However, to create an efficient symbiosis with the paradigm of synchromodality, an evolution of slow steaming called smart steaming is introduced. Smart steaming is about defining a medium speed execution of shipping movements and the real-time adjustment (acceleration and deceleration) of traveling speeds to pursue the entire logistic system’s overall efficiency and sustainability. For instance, congestion in handling facilities (intermodal hubs, ports, and rail stations) is often caused by the common wish to arrive as soon as possible. Therefore, smart steaming would help avoid bottlenecks, allowing better synchronization and decreasing waiting time at ports or handling facilities. This work aims to discuss the strict relationships between smart steaming and synchromodality and show the potential impact of moving from slow steaming to smart steaming in terms of sustainability and efficiency. Moreover, we will propose an analysis considering the pros, cons, opportunities, and risks of managing operations under this new policy.

In a climate change framework extreme natural events are going to occur more frequently and intensively as a result of global warming. Therefore, the effects and consequences of climate-related natural hazards, such as flooding, heatwaves, drought, landslides and others, have the potential to become more disastrous and extensive. Consequences of such events are of particular concern considering that today’s societies are interconnected in complex and dynamic socio-technological networks and, hence, dependent more than before on Critical Infrastructures (CI) systems (such as transport, energy, water, ICT systems, etc.). Furthermore, there are also events of Natural Hazards Trigger Technological Disasters (also known as NaTech events), whereby an industrial accident caused by a natural event could affect people, the environment, and other facilities and systems. This work reviews studies in the fields of risk assessment of CI systems affected by natural hazards and NaTech events.This study identifies and classifies: the methodologies applied (qualitative or quantitative), the type of infrastructures exposed (transport, electricity, oil, gas, water and waste water and telecommunications systems, industrial or nuclear plant) and hazard considered (flood, earthquake, lighting, landslide, avalanche, storm surge, heat and cold waves, wind), the scale of application and the level of spatial resolution.The work provides a comparison of the scientific studies, the objectives and analysis methods to assess risk employed in the fields of CI systems and NaTech events in order to highlight similarities and differences and to guide the most suitable approach for each application case.

Globally, about a third of all losses related to natural hazards are due to flooding. Many studies focused their attention on the estimation of flood damages to buildings and infrastructures. However, floods cause significant losses to the agricultural sector too and negatively affect rural economies due to their impacts on agricultural productivity.Several tools to quantify flooding economic impacts on the agricultural sector have been proposed, such as the AGRIDE-c conceptual model, and the Joint Research Centre (JRC) depth-damage functions. However, the tools have rarely been validated against data collected from surveys.The aim of this study is the comparison between the flood economic impacts on agriculture computes using both AGRIDE-c and the JRC tool and the ones retrieved from surveys.A questionnaire for estimating flood economic impacts on agriculture was prepared and submitted to farmers shortly after the flooding event. The selected case study area was the town of Nonantola (near the city of Modena, Northern Italy), where a flooding event occurred on 6th December 2020. The flood was caused by the collapse of about 80m levee portion along the right bank of Panaro River resulting in an inundated area around 2000 hectares. The flood involved the Nonantola town where residential buildings and an active industrial area are located, although the dominant land use is agricultural land. The main local crops are represented by forage, wheat, vineyards, fruits (pears and plums) and sugar beet.The questionnaire is divided into four main sections: The first section is related to the generic information on the farm, the second section to the data on the inundation and damage to crops, the third section to the information on past flood events and risk mitigation strategies eventually adopted during past and present events, the fourth section data to the insurance coverage.Two existing crop damage models (AGRIDE-c and the JRC) were calibrated using three types of data: crop yields, crop selling prices and crop cost of production. Crop yields were obtained from the Italian National Statistical Institute (ISTAT), crop selling prices and costs of production were instead available from official sources such as ISMEA and Coldiretti (Italian association of farmers).Finally, the proposed approach will allow the comparison between the damages experienced by farmers evaluated from questionnaires and the damages estimated by the two models in order to evaluate how the models simulate data directly collected from the field surveys.

To improve efficiency and sustainability in synchromodal logistics, it becomes crucial to mitigate the disruptive effects caused by non-synchronized operations. In this work, we study the Synchronized Location-Transshipment Problem in which the decisions on the facilities to select are fundamental to ensure the synchronization of flows and the correct exploiting of just-in-time logistics and cross-docking operations. We propose a Mixed-Integer Linear Programming formulation for the problem and perform an economic analysis to address several realistic situations based on different sizes of the transshipment facilities and location types. The results of the tests allow us to derive managerial insights and to define future research lines.

Soil erosion continues to be a threat to soil quality, impacting crop production and ecosystem services delivery. The quantitative assessment of soil erosion, both by water and by wind, is mostly carried out by modeling the phenomenon via remote sensing approaches. Several empirical and process-based physical models are used for erosion estimation worldwide, including USLE (or RUSLE), MMF, WEPP, PESERA, SWAT, etc. Furthermore, the amount of sediment produced by erosion phenomena is obtained by direct measurements carried out in experimental sites. Data collection for this purpose is very complex and expensive; in fact, we have few cases of measures distributed at the basin scale to monitor this phenomenon. In this work, we propose a methodology based on an expeditious way to monitor the volume of hilly lakes with GPS, sonar sensor and aquatic drone. The volume is obtained by means of an automatic GIS procedure based on the measurements of lake depth and surface area. Hilly lakes can be considered as sediment containers. Time-lapse measurements make it possible to estimate the silting rate of the lake. The volume of 12 hilly lakes in Tuscany was measured in 2010 and 2018, and the results in terms of silting rate were compared with the estimates of soil loss obtained by RUSLE and MMF. The analyses show that all the lakes measured are subject to silting phenomena. The sediment estimated by the measurements corresponds well to the amount of soil loss estimated with the models used. The relationships found are significant and promising for a distributed application of the methodology, which allows rapid estimation of erosion phenomena. Substantial differences in the proposed comparison (mainly found in two cases) can be justified by particular conditions found on site, which are difficult to predict from the models. The proposed approach allows for a monitoring of basin-scale erosion, which can be extended to larger domains which have hilly lakes, such as, for example, the Tuscany region, where there are more than 10,000 lakes.

Climate change and subsidence will likely have a significant role to increase coastal flooding risk. The socio-economic impact of inundations can be very relevant, and, in a context of climate change, it is necessary to develop effective methods for assessing coastal flood hazard suitable for large-scale studies. This work focuses on the application of a new modelling approach for mapping flooding hazard for future scenarios characterized by sea level rise and ground lowering due to subsidence. The flood intensity index approach (Iw, Dottori et al. 2015) will be used to quantitatively evaluate the flood extent. This recent methodology allows to create reliable scenarios with low computational costs. The effects of the storm surge are assessed using a base scenario corresponding to 100 years return period event. IW inputs are represented by water height set as storm level plus a part of wave height. The scenarios will be created by quantitatively combining IPCC sea level rise projections with subsidence data that will be compared to high-resolution digital terrain models. The study area of this work is the ∼205 km long coastal plain of Northern Italy, from Venice to Rimini, composed of low-lying sandy beaches and which includes the Po delta area. The coast is characterized by large portions of the territory below mean sea level and by geological features made by recent quaternary sediments which have a natural subsidence rate. In the past (1960-1980) the subsidence rate had an exceptional increase caused by excessive groundwater withdrawal for agricultural and industrial activities, human consumption and by natural gas extraction.

The study was performed in central-northern Anatolia (from Ankara to Amasya) to investigate the relationships of the Sakarya Zone units and the Izmir–Ankara–Erzincan suture (IAES) melange. It reveals that all the Sakarya Zone units are metamorphic and three main tectonostratigraphic units have been distinguished for the first time: the BAA (metasiliciclastic rocks capped by metacarbonates and varicoloured phyllite), the BKC (poly-metamorphic garnet-bearing micaschist and metabasite with a well-preserved relict HP–LT amphibole in a low-amphibolitic to greenschist-facies framework) and the AMC (meta-arkose passing vertically to carbonate–phyllitic alternations and, then, to a thick succession of prevailing acidic to intermediate–basic metavolcanites and volcanic-rich metasediments). The BAA and AMC, whose metamorphic frameworks are of Cimmerian age, underlie the Mesozoic carbonate cover sequences (e.g. t2-3, j3–k1) that often show tectonic detachments and slicing. The piling up of the BAA above the HP–LT BKC can be correlated to the tectonic superposition of two similar units (i.e. the Cimmerian Çangaldağ Complex and the Alpine Middle–Upper Cretaceous Domuzdağ Complex, respectively) defined by previous authors in other sectors of the Central Pontides front. The ophiolitic melange generally underlies the Sakarya Zone, but locally (e.g. SE of Amasya) tectonically rests above the latter, probably owing to back-thrusting that occurred during the Tertiary syn-collisional shortenings and the later strike-slip tectonics. We hypothesize that, also in these areas, the Sakarya Zone–IAES consists of a complex tectonic stack of different units, belonging to different palaeogeographic domains and orogenic events (Cimmerian versus Alpine orogenies), but originated within a single long-lived (since Late Triassic to Paleocene/Eocene times), prograding subduction–accretion system in front of the Laurasian continent.

Synchro-modal supply chain eco-NET (SYNCHRO-NET) is a Horizon 2020 European research project aimed at overcoming the stress due to the increasing transportation distances, the higher complexity, and the vulnerability of international supply chains. In order to foster sustainability, quality, and reliability of such supply chains, SYNCHRO-NET mainly exploits the impact and the possible benefits coming from slow/smart-steaming and synchro-modality transportation strategies, and the related business models. The aim of this paper is to summarize and disseminate the main developments and scientific contributions coming from the project. In particular, the working core of the SYNCHRO-NET solution is an integrated and cloud-based eco-system of optimization and simulation software modules that supports stakeholders&rsquo, decisions in freight transportation and logistics management at strategic, operational, and real-time levels. The platform has achieved a high grade of automation in several processes to overcome all the issues related to human-based operations. The efficiency and effectiveness of the overall platform have been tested on three case studies considering pan-European and regional trade lanes, as well as commercial activities between the Far East and European ports. The project results and outputs also allow us to analyze barriers and opportunities of the approach, industrial and academic developments, and relations with emerging technologies.

In seguito alla forte siccità dell’estate 2017 è sorta la necessità di avere un quadro il quanto più possibile esaustivo e approfondito della riserva di acqua in Toscana. In questo contesto si inserisce l’aggiornamento del catasto degli invasi, che, oltre alla realizzazione di un inventario unico (ad oggi disperso in più archivi con informazioni e date di aggiornamento diverse) fornisca una stima di massima della capacità di invaso inrelazione alle necessità idriche stagionali del territorio. Quest’ultimo punto è stato realizzato grazie ad una serie di sopralluoghi su un subset degli invasi regionali che permettono di mettere in relazione la tipologia e la superficie dell'invaso con il proprio volume.

Globalization and e-commerce facilities have yielded in the recent years an incredibly huge increment of freight movements. Consequently, the underlying supply chains have become more and more complex to manage for the shipping companies, in terms of costs, distances, times, and environmental sustainability. SYNCHRO-NET, a H2020 European research project, aims to de-stress the international supply chains by fostering cost-effective and greener transportation alternatives. Besides other important actions, the SYNCHRO-NET framework provides an optimization and simulation toolset to support decision-making in freight logistics planning at a strategic level. The synchronized use of different transportation modes and the exploitation of smart steaming strategies for ship movements are the two main aspects considered in this innovative optimization system. In this paper, we present the optimization toolset developed, its contribution with respect to the existing platforms, and the experimental set-up implemented to evaluate its performance, usability, and effectiveness. The system is, in fact, currently under evaluation by several world-wide leading companies in freight logistics and transportation. However, the toolset potentialities go beyond the SYNCHRO-NET context, being the system an open-source project that makes use of open data formats and technologies.

Open image in new window In this work, we tested the use of passive seismic for the characterization of potentially unstable rock blocks in the Pietra di Bismantova site, a wide slab of calcareous sandstone located in the Northern Apennines of Italy. Ambient vibrations recordings with broad-band 3-component seismometers were carried out on potentially unstable areas such as 5 rock blocks and 1 rock column located close to the top of the 100 m-high cliff. The rock blocks are also monitored by means of crackmeters. Seismic noise recordings were processed with a standard sequence and noise spectra and spectral ratios have been evaluated. Preliminary results are promising since in some cases a significant frequency peak can be observed, indicating resonance effects due to the vibration of the rock pillars. In addition, for the most favorable case, noise polarization analysis presents vibration direction values at given frequency in a limited angle range, reasonably corresponding to the direction of maximum displacement. Future investigations could address additional noise measurements and their correlation with the crackmeter datasets in order to understand possible relationship between change in resonance frequency or signal polarization and crackmeter hysteresis path. Moreover, new ambient noise surveys could be planned as a pilot investigation campaign, with the aim of designing extensometer monitoring network tuned on the most critical situations.

BACKGROUND In haemodialysis (HD) patients, anaemia is associated with reduced survival. Despite treatment with erythropoiesis-stimulating agents (ESAs), a large number of patients with chronic kidney disease show resistance to this therapy and require much higher than usual doses of ESAs in order to maintain the recommended haemoglobin (Hb) target, and recent studies suggest that hepcidin (HEP) may mediate the ESA resistance index (ERI). High-volume online haemodiafiltration (HV-OL-HDF) has been shown to improve anaemia and to reduce the need for ESAs in HD patients; this effect is associated with a reduced inflammatory state in these patients. The aim of the REDERT study (role of haemodiafiltration on ERI) was to investigate the effect of different dialysis techniques on ERI and HEP levels in chronic dialysis patients. METHODS A single cross-over, randomized, multicentre study (A-B or B-A) was designed. Forty stable HD patients from seven different dialysis units (male 65%, mean age 67.6 ± 14.7 years and mean dialytic age 48 ± 10 months) were enrolled. Patients were randomized to the standard bicarbonate dialysis (BHD) with low-flux polysulfone (PS) membrane group or to the HV-OL-HDF group with high-flux PS membranes and exchange volume of >20 L/session. After 6 months, patients were shifted to the other dialytic group for a further 6 months. Clinical data, Hb, ESA doses and iron metabolism were recorded every month. HEP, beta2-microglobulin (b2MG) and C-reactive protein (CRP) were determined every 3 months, and ERI was calculated monthly as the weekly ESA dose per kilogram of body weight divided by Hb level. Data were analysed using paired-samples t-test, Wilcoxon signed-rank test and Spearman's correlation coefficient. RESULTS Dialysis efficiency for small molecules assessed as Kt/V was significantly increased in HV-OL-HDF from 1.47 ± 0.24 to 1.49 ± 0.16; P < 0.01. A significant reduction of b2MG was obtained in HV-OL-HDF from month 3 whereas CRP values were not significantly changed during the study period either in BHD or HV-OL-HDF.ERI was significantly reduced in HV-OL-HDF at month 3 and 6 (from 9.1 ± 6.4 UI/weekly/Kg/Hb to 6.7 ± 5.3 UI/weekly/Kg/Hb; P < 0.05) due to a higher ESA consumption in BHD in spite of similar Hb levels. HEP levels were reduced in HV-OL-HDF with respect to BHD after 3 and 6 months. Iron consumption was not significantly different during BHD or HV-OL-HDF treatment as well as transferrin, ferritin and TSAT levels. A significant positive linear correlation between HEP and ERI (r(2) = 0.258, P < 0.001) was observed. CONCLUSIONS In a uraemic patient population with low-grade inflammation treated with HV-OL-HDF, we observed a significant reduction of ERI values as well as HEP levels. The positive correlation between these two parameters supports a role for HEP in the development of ERI in the dialytic population. Moreover, the lower b2MG and the higher Kt/V achieved in HV-OL-HDF confirms the better depurative effect of this technique in comparison with BHD with respect to middle molecules and small-molecular-weight molecules.

We studied 54 patients in replacement dialytic therapy divided into two groups: Group 1, 26 patients with normal parathyroid hormone (PTH) (10-80 pg/ml): and Group 2, 28 patients with elevated PTH (80-400 pg/ml). Total T lymphocytes, CD4, CD8, and CD4/CD8 ratio were evaluated. We found a reduction of total T lymphocytes in both groups compared with controls. A decrease of CD4 and CD4/CD8 ratio with a rise of CD8 occurred in Group 2 but not in Group 1. In Group 2, PTH presented a linear correlation with CD8 and a reverse correlation with total T cells. CD4, and CD4/CD8 ratio. PTH might act on T-cellular immunity with an immunosuppressive effect from the earlier phases of hyperparathyroidism.

Resistance to erythropoiesis-stimulating agents (ESAs) is often associated with chronic inflammation. Here, we investigated how anaemia, ESA resistance and the plasma levels of biological markers of inflammation could influence all-cause and cardiovascular disease morbidity and mortality.Seven hundred and fifty-three haemodialysis (HD) patients (mean age 66 ± 14.2 years, mean dialytic age 70 ± 77 months and diabetes 18.8%) were enrolled and followed-up for 36 months. Demographic, clinical and laboratory data, co-morbidity conditions, administered drugs, all-cause mortality and fatal/non-fatal cardiovascular (CV) events were recorded. We measured ESA resistance index, C-reactive protein (CRP) and interleukin-6 (IL-6).Six hundred and fifty-one patients (86.4%) received ESAs. Patients with haemoglobin level11 g/dL (n = 225) showed increased risk of CV [relative risk (RR) 1.415, 95% confidence interval (CI) 1.046-1.914] and overall mortality (RR 1.897, 95% CI 1.423-2.530) versus patients with haemoglobin levels11 g/dL. ESA resistance values categorized into quartiles (Quartile I5.6, Quartile II 5.7-9.6, Quartile III 9.7-15.4 and Quartile IV15.4) correlated with all-cause mortality and fatal/non-fatal CV events (RR 1.97, 95% CI 1.392-2.786; RR 1.619, 95% CI 1.123-2.332, respectively). Furthermore, albumin was significantly reduced versus reference patients and correlated with all-cause mortality and CV events; CRP levels were higher in hyporesponders (Quartile IV) (P0.001) and predicted all-cause mortality and CV events. IL-6 but not CRP was a strong predictor of ESA resistance.ESA responsiveness can be considered a strong prognostic factor in HD patients and seems to be tightly related to protein-energy wasting and inflammation.

Preoperative screening for coronary artery disease is recommended in high-risk renal transplant candidates. Aim of this study was to prospectively assess the value of a comprehensive risk stratification strategy including clinical, resting echo, and dipyridamole stress echo findings before renal transplantation.The study group consisted of 71 renal transplant candidates (47 men; age 54+/-11 years) fulfilling one or more of the following high-risk clinical criteria: history of coronary artery disease, wall motion abnormalities at resting echo, dialysis dependency lasting5 years, presence of 2 or more risk factors. Clinical history, resting echo, and dipyridamole stress echo (up to 0.84 mg over 10 min + atropine up to 1 mg) were obtained in all subjects.Mean number of risk factors was 2.5+/-1.0. Known coronary artery disease and diabetes were present, respectively, in 2 (3%) and 11 (15%) persons. No patient had left ventricular ejection fraction45%. Left ventricular hypertrophy was found in 53 (74%) cases. Stress echo showed 100% safety and 97% overall feasibility. Inducible ischemia (new wall motion abnormalities) was detected in 3 (4%) subjects. During follow-up (36+/-12 months), 8 (11%) cardiac events occurred: 2 deaths, 2 myocardial infarctions, 3 coronary interventions, and 1 pulmonary edema. The perioperative period and subsequent follow-up (22+/-12 months) was uneventful among 32 patients who received renal transplantation. Four-year event-free survival was 92% in those without ischemia; it was 96% in the non-diabetic population. Diabetes (HR=4.78), age (HR=1.14), and left ventricular mass index (HR=1.02) were independent prognostic indicators among clinical and resting echo variables. The global chi-square of the statistical model was 18.8; it increased to 27.3 (+45%) after the addition of stress echo result.Renal transplant candidates can undergo effective stratification of risk by combining clinical, resting echo and dipyridamole stress echo findings.

Twenty six adult patients were treated with high dose intravenous immuneglobulin (Endobulin-Immuno) for idiopathic membranous nephropathy and nephrotic syndrome.Pulse doses of 0.4 g/Kg b. wt. for 3 consecutive days were given and repeated twice after 3 weeks. Afterwards, one pulse dose every 3 weeks has been administered for a 12 months period. At the end of the study, 11 patients had a complete remission (daily proteinuria