Reporting di sostenibilità degli operatori logistici in Europa: analisi degli indicatori

Obiettivi: L’affermazione di una nuova concezione del valore, basata sulle qualità e non sull’insostenibile aumento delle quantità di merci e consumi, induce gli operatori logistici alla ricerca di azioni che possano essere nel contempo economicamente efficienti ed efficaci, ecologicamente sopportabili e socialmente giuste. Il presente lavoro ha l’obiettivo di investigare e identificare le azioni sostenibili - economiche, ambientali e sociali - intraprese dagli operatori logistici. Metodologia: Il quadro teorico è stato costruito attraverso lo studio della letteratura accademica nazionale e internazionale. La parte empirica è stata sviluppata attraverso l’analisi dei più recenti report di sostenibilità degli operatori logistici operanti in Europa, redatti secondo gli standard della Global Reporting Initiative. Risultati: Gli operatori logistici possono contribuire in modo significativo al cambiamento paradigmatico in atto, facilitando e favorendo, in qualità di fornitori di servizi, il raggiungimento della sostenibilità della supply chain. Limiti della ricerca: Il presente lavoro costituisce la fase preliminare di un più approfondito progetto di ricerca che indaghi le iniziative di sostenibilità degli operatori logistici a livello mondiale e che consideri un arco temporale di osservazione utile a tracciare il trend in atto. Implicazioni pratiche: Sia l’accademia che il mondo professionale possono trovare utile l’analisi della letteratura sul tema e i primi risultati ottenuti, in quanto sono posti in evidenzia i principali tratti di sostenibilità degli operatori logistici che già hanno intrapreso il percorso verso la sostenibilità. Originalità del lavoro: Gli studi della letteratura esistente sugli operatori logistici e la sostenibilità si basano quasi esclusivamente sulla sostenibilità ambientale e l’ecoefficienza, mentre manca un approccio sistemico capace di superare i problemi odierni mediante la valorizzazione della multidimensionalità. Il lavoro contribuisce a colmare questo gap

Alkaline phosphatases in the complex chronic kidney disease-mineral and bone disorders

Alkaline phosphatases (APs) remove the phosphate (dephosphorylation) needed in multiple metabolic processes (from many molecules such as proteins, nucleotides, or pyrophosphate). Therefore, APs are important for bone mineralization but paradoxically they can also be deleterious for other processes, such as vascular calcification and the increasingly known cross-talk between bone and vessels. A proper balance between beneficial and harmful activities is further complicated in the context of chronic kidney disease (CKD). In this narrative review, we will briefly update the complexity of the enzyme, including its different isoforms such as the bone-specific alkaline phosphatase or the most recently discovered B1x. We will also analyze the correlations and potential discrepancies with parathyroid hormone and bone turnover and, most importantly, the valuable recent associations of AP's with cardiovascular disease and/or vascular calcification, and survival. Finally, a basic knowledge of the synthetic and degradation pathways of APs promises to open new therapeutic strategies for the treatment of the CKD-Mineral and Bone Disorder (CKD-MBD) in the near future, as well as for other processes such as sepsis, acute kidney injury, inflammation, endothelial dysfunction, metabolic syndrome or, in diabetes, cardiovascular complications. However, no studies have been done using APs as a primary therapeutic target for clinical outcomes, and therefore, AP's levels cannot yet be used alone as an isolated primary target in the treatment of CKD-MBD. Nonetheless, its diagnostic and prognostic potential should be underlined

Lack of evidence does not justify neglect. how can we address unmet medical needs in calciphylaxis

Calcific uraemic arteriolopathy (CUA), or calciphylaxis, is a rare disease predominantly occurring in comorbidity with dialysis. Due to the very low frequency of CUA, prospective studies on its management are lacking and even anecdotal reports on treatment remain scarce. Therefore, calciphylaxis is still a challenging disease with dismal prognosis urgently requiring adequate strategies for diagnosis and treatment.In an attempt to fill some of the current gaps in evidence on various, highly debated and controversial aspects of dialysis-associated calciphylaxis, 13 international experts joined the 1st Consensus Conference on CUA, held in Leuven, Belgium on 21 September 2015. The conference was supported by the European Calciphylaxis Network (EuCalNet), which is a task force of the ERA-EDTA scientific working group on Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBD). After an intense discussion, a 9-point Likert scale questionnaire regarding 20 items on calciphylaxis was anonymously answered by each participant. These 20 items addressed unsolved issues in terms of diagnosis and management of calciphylaxis. On the one hand, the analysis of the expert opinions identified areas of general consensus, which might be a valuable aid for physicians treating such a disease with less experience in the field. On the other hand, some topics such as the pertinence of skin biopsy and administration of certain treatments revealed divergent opinions. The aim of the present summary report is to provide some guidance for clinicians who face patients with calciphylaxis in the current setting of absence of evidence-based medicin

Mineral and bone disorders in chronic kidney disease and end-stage renal disease patients: new insights into vitamin D receptor activation

Progressive loss of kidney function leads to reduced production of calcitriol (1,25-dihydroxyvitamin D; active vitamin D) and an imbalance in serum calcium (Ca) and phosphorus (P) levels, which are associated with progression of renal failure as well as increased rates of cardiovascular (CV) events and mortality. In addition, multifactorial hypocalcemia and resistance to parathyroid hormone (PTH) can lead to prolonged and excessive synthesis and secretion of PTH, eventually leading to development of secondary hyperparathyroidism and renal osteodystrophy. These changes associated with chronic kidney disease (CKD), extending beyond bone and related biochemical abnormalities, have prompted the development of the term CKD–mineral and bone disorder to describe its systemic nature. Excessive P loading, among other factors, will promote vascular calcification (VC), and PTH production will affect bone remodeling. Although administration of calcitriol increases serum Ca levels and decreases PTH, it is also associated with elevated Ca × P product. Therefore, compounds that selectively activate vitamin D receptors (VDR activators), potentially reducing Ca–P toxicity and distinctly affecting pathogenic mechanisms of VC, might enhance CV and renal protection, increase the vitamin D therapeutic window, and thus provide a significant clinical benefit. Moreover, selective VDR activators have been associated with improvement in survival, at least among dialysis patients. Thus, selective VDR activators should be considered a novel and interesting approach to enhance the standard of care in CKD patients

Vitamina D nativa o attivata: quale forma è indispensabile?

Abstract non disponibil

Horizontal network collaboration by entrepreneurial ventures: a supply chain finance perspective

Purpose – The present paper aims at understanding how horizontal network collaborations between small and medium enterprises (SMEs) can be designed and implemented to take advantage of a supply chain finance (SCF) perspective. Design/methodology/approach – This study presents an SCF literature background identifying four literature gaps, and in response to them it adopts an action research approach. The empirical analysis is developed on a network-case study: a horizontal collaboration project between small businesses of the Italian wine industry and their supply chains. Findings – SMEs can play an active role in developing – in terms of design and implementation – their collaborative networks by taking advantage of an SCF perspective for themselves, and their customers, based on the reorganization of relationships interface processes. Taking this perspective can be a concrete and crucial way to sustain the development of SMEs and their supply chains in an actual competitive context. Research limitations/implications – The paper identifies the theoretical gaps in the literature, suggests new research areas that deserve to be more deeply investigated and connects case-related results to the key concepts. The empirical part presents a real case application that proposes a complete roadmap for managers and practitioners who wish to experience similar projects. Practical implications – This network-case study storyline, presenting an overview of ten years of meetings, with related purposes, is suggesting a roadmap for design and implementation of horizontal network as managerial implications. These kinds of active research projects, with a collaborative mixed team of academics and practitioners, and involving a multilayer group of participants, are positive examples for closing the bridge between companies and academia, which enhance this network of small businesses active in trying to improve their competitiveness working together. Originality/value – The value of the paper is to embrace a supply chain-oriented perspective for an SME, independent of the financial system and based on inventory flow management. Very little literature focuses on inventory-based research within the SCF framework, designed for real implementation in horizontal network collaboration by entrepreneurial ventures

Phosphate overload accelerates vascular aging in uremic patients

Vascular calcification is a very common event in atients affected by diabetes and chronic kidney disease (CKD). Recently, it has been well documented that abnormalities in mineral and bone metabolism in CKD patients are associated with increased morbidity and mortality. Elevated serum phosphate and calcium-phosphate product levels play an important role in the pathogenesis of vascular mineralization in uremic patients and also appear to be associated with increased cardiovascular mortality. Together with classical passive precipitation of calcium-phosphate in soft tissues, during the last decade it has been demonstrated that inorganic phosphate may cause extraskeletal calcification directly through a real “ossification” of the tunica media in the vasculature of CKD patients. Therefore, control of phosphate retention is now an even more crucial target of treatment in patients affected by chronic kidney disease

It is no longer the time to disregard thyroid metastases from breast cancer: A case report and review of the literature

Background: Metastases to the thyroid gland are more frequent than previously thought, although most of them are occult or not clinically relevant. Overall, only 42 cases of metastases to thyroid from breast cancer have been reported thus far. Here we report the case of a patient with breast cancer metastatic to the thyroid. We also review the 42 previously reported cases (published between 1962 and 2012). This is the first review about metastases to thyroid gland from breast cancer. Case presentation: A 64-year-old woman of Caucasian origin was diagnosed with a lobular invasive carcinoma of the breast (luminal A, stage II). She received adjuvant chemotherapy, followed by endocrine therapy. During follow- up, fine-needle cytology of a thyroid nodule revealed malignant cells that were estrogen-positive, which suggested a diagnosis of metastases to the thyroid. Imaging did not reveal any other metastatic site and showed only enlargement of the left thyroid lobe and an inhomogeneous pattern of colloid and cystic degeneration and calcifications. The patient underwent left hemithyroidectomy. Histology of thyroid tissue showed a colloid goitre containing dispersed small atypical neoplastic cells with eccentric nuclei. Immunohistochemistry showed cytokeratin-19 and oestrogen receptor, but not tireoglobulin, e-cadherin or cytokeratin-7, thereby confirming metastases from a lobular breast carcinoma. Hormonal treatment is ongoing. Conclusion: This case report and first review of the literature on metastases to thyroid from breast cancer highlight the importance of a correct early diagnostic work-up in such cases. Indeed, a primary lesion should be distinguished from metastases given the different treatment protocol related to primary cancer and the clinical impact on prognosis