Vascular calcification progression modulates the risk associated with vascular calcification burden in incident to dialysis patients

Background: It is estimated that chronic kidney disease (CKD) accounts globally for 5 to 10 million deaths annually, mainly due to cardiovascular (CV) diseases. Traditional as well as non-traditional CV risk factors such as vascular calcification are believed to drive this disproportionate risk burden. We aimed to investigate the association of coronary artery calcification (CAC) progression with all-cause mortality in patients new to hemodialysis (HD). Methods: Post hoc analysis of the Independent study (NCT00710788). At study inception and after 12 months of follow-up, 414 patients underwent computed tomography imaging for quantification of CAC via the Agatston methods. The square root method was used to assess CAC progression (CACP), and survival analyses were used to test its association with mortality. Results: Over a median follow-up of 36 months, 106 patients died from all causes. Expired patients were older, more likely to be diabetic or to have experienced an atherosclerotic CV event, and exhibited a significantly greater CAC burden (p = 0.002). Survival analyses confirmed an independent association of CAC burden (hazard ratio: 1.29; 95% confidence interval: 1.17–1.44) and CACP (HR: 5.16; 2.61–10.21) with all-cause mortality. CACP mitigated the risk associated with CAC burden (p = 0.002), and adjustment for calcium-free phosphate binder attenuated the strength of the link between CACP and mortality. Conclusions: CAC burden and CACP predict mortality in incident to dialysis patients. However, CACP reduced the risk associated with baseline CAC, and calcium-free phosphate binders attenuated the association of CACP and outcomes, suggesting that CACP modulation may improve survival in this population. Future endeavors are needed to confirm whether drugs or kidney transplantation may attenuate CACP and improve survival in HD patients

The evolving world of chronic kidney disease mineral bone disorder

Chronic kidney disease - mineral and bone disorder (CKD-MBD) is associated with a significant morbidity and mortality. In vitro and animal models suggest that phosphorous, calcium, parathyroid hormone, and vitamin D abnormalities, mediate the cardiovascular and bone diseases that characterise CKD-MBD and increase the risk of death. Currently, mineral abnormalities are corrected through phosphorous restriction, phosphate binders, calcimimetics and vitamin D administration. Nonetheless, data in humans that support the use of these compounds are still scarce, mainly based on observational studies. Thus, a considerable number of doubts and questions still challenge clinicians dealing with CKD patients and mineral metabolism imbalances. We herein critically review clinical evidence that support the use of different drugs in CKD-MBD

Impact of DEL22q11, trisomy 21, and other genetic syndromes on surgical outcome of conotruncal heart defects

Objective: Genetic syndromes occur in more than 20% of patients with conotruncal heart defects. We investigated the impact of genetic syndromes on the surgical outcome of conotruncal anomalies in infancy. Methods: This retrospective study reviews the outcome of 787 patients (median age 6.3 months) who underwent primary (598) or staged (189) repair of a conotruncal defect between 1992 and 2007. Results: Proven genetic syndrome was diagnosed in 211 patients (26.8%), including del22q11 (91 patients), trisomy 21 (29 patients), VACTERL (18 patients), and other syndromes (73 patients). Primary repair was accomplished in 80.9% of nonsyndromic patients and 74.4% of syndromic patients (P ¼ .18) Fifteen-year cumulative survival was 84.3% 2.3% in nonsyndromic patients and 73.2% 4.2% in syndromic patients (P<.001). Primary and staged repair allowed similar 15-year survival (81.4% 4.5% vs 79.1% 5.1%, P ¼ .8). Freedom from noncardiac cause of death was significantly lower in syndromic patients (P ¼ .0056). Fifteen- year Kaplan–Meier survival was 87.6% 3.9% for del22q11, 95.8% 4.1% for trisomy 21, 56.8% 6.3% for VACTERL, and 62.3% 12.7% for patients with other syndromes (P ¼ .022). Total intensive care unit stay was 10.8 4.9 days in syndromic patients and 5.1 1.7 days in nonsyndromic patients (P<.001). Freedom from reintervention 15 years after repair was 79.6% 4.9%in nonsyndromic patients and 62.4% 7.4%in syndromic patients (P ¼ .007). Conclusion: Del22q11 and trisomy 21 do not represent risk factors for mortality after repair of conotruncal anomalies, whereas other syndromes adversely affect the surgical outcome for predominant noncardiac attrition. Higher morbidity and lower mid-term freedom from reintervention can be predicted in syndromic patients

Retrieval of foreign-broadened water vapor continuum coefficients from emitted spectral radiance in the H2O rotational band from 240 to 590 cm −1

The paper presents a novel methodology to retrieve the foreign-broadened water vapor continuum absorption coefficients in the spectral range 240 to 590 cm−1 and is the first estimation of the continuum coefficient at wave numbers smaller than 400 cm−1 under atmospheric conditions. The derivation has been accomplished by processing a suitable set of atmospheric emitted spectral radiance observations obtained during the March 2007 Alps campaign of the ECOWAR project (Earth COoling by WAter vapor Radiation). It is shown that, in the range 450 to 600 cm−1, our findings are in good agreement with the widely used Mlawer, Tobin-Clough, Kneizys-Davies (MT_CKD) continuum. Below 450 cm−1 however the MT_CKD model overestimates the magnitude of the continuum coefficient.Published15816-158331.8. Osservazioni di geofisica ambientaleJCR Journalreserve

Efficacy of hemostatic powders as monotherapy or rescue therapy in gastrointestinal bleeding related to neoplastic or non-neoplastic lesions

Background Hemostatic powder (HP) in gastrointestinal bleeding (GIB) is mainly used as rescue therapy after failure of conventional hemostatic procedures (CHP). Aim To define the best field of application and the efficacy of HP as first choice monotherapy or rescue therapy. Methods We compared the efficacy of HP monotherapy, HP rescue therapy, and CHP in the management of active GIB due to neoplastic and non-neoplastic lesions. Results A total of 108 patients, 43 treated with HP as either first choice or rescue therapy and 65 with CHP, were included in the study. The most frequent sources of bleeding were peptic ulcer and malignancy. Immediate hemostasis rates were: HP monotherapy = 100% in peptic ulcer and 100% in malignancy; HP rescue therapy = 93.2% in peptic ulcer and 85.7% in malignancy; CHP = 77.9% in peptic ulcer and 41.7 in malignancy. Definitive hemostasis rates were: HP monotherapy = 50% in peptic ulcer and 45.5% in malignancy; HP rescue therapy = 73.3% in peptic ulcer and 85.7% in malignancy; CHP = 69.1% in peptic ulcer and 33.3% in malignancy. No difference was found in terms of additional intervention between the three groups. Conclusions HP is highly effective as monotherapy and rescue therapy in GIB. GIB related to malignancy may be the best field of application of HP, but confirmatory studies are necessary

Thromboembolic and bleeding risk in atrial fibrillation patients with chronic kidney disease: role of anticoagulation therapy

Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related; several independent risk factors of AF are often frequent in CKD patients. AF prevalence is very common among these patients, ranging between 15% and 20% in advanced stages of CKD. Moreover, the results of several studies showed that AF patients with end stage renal disease (ESRD) have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD and vitamin K antagonists (VKAs), remaining the only drugs allowed, although they show numerous critical issues such as a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients

Towards developmental modelling of tree root systems

Knowledge of belowground structures and processes is essential for understanding and predicting ecosystem functioning, and consequently in the development of adaptive strategies to safeguard production from trees and woody plants into the future. In the past, research has mainly been concentrated on growth models for the prediction of agronomic or forest production. Newly emerging scientific challenges, e.g. climate change and sustainable development, call for new integrated predictive methods where root systems development will become a key element for understanding global biological systems. The types of input data available from the various branches of woody root research, including biomass allocation, architecture, biomechanics, water and nutrient supply, are discussed with a view to the possibility of incorporating them into a more generic developmental model. We discuss here the main focus of root system modelling to date, including a description of simple allometric biomass models, and biomechanical stress models, and then build in complexity through static growth models towards architecture models. The next progressive and logical step in developing an inclusive developmental model that integrates these modelling approaches is discussed.Knowledge of belowground structures and processes is essential for understanding and predicting ecosystem functioning, and consequently in the development of adaptive strategies to safeguard production from trees and woody plants into the future. In the past, research has mainly been concentrated on growth models for the prediction of agronomic or forest production. Newly emerging scientific challenges, e.g. climate change and sustainable development, call for new integrated predictive methods where root systems development will become a key element for understanding global biological systems. The types of input data available from the various branches of woody root research, including biomass allocation, architecture, biomechanics, water and nutrient supply, are discussed with a view to the possibility of incorporating them into a more generic developmental model. We discuss here the main focus of root system modelling to date, including a description of simple allometric biomass models, and biomechanical stress models, and then build in complexity through static growth models towards architecture models. The next progressive and logical step in developing an inclusive developmental model that integrates these modelling approaches is discussed.Knowledge of belowground structures and processes is essential for understanding and predicting ecosystem functioning, and consequently in the development of adaptive strategies to safeguard production from trees and woody plants into the future. In the past, research has mainly been concentrated on growth models for the prediction of agronomic or forest production. Newly emerging scientific challenges, e.g. climate change and sustainable development, call for new integrated predictive methods where root systems development will become a key element for understanding global biological systems. The types of input data available from the various branches of woody root research, including biomass allocation, architecture, biomechanics, water and nutrient supply, are discussed with a view to the possibility of incorporating them into a more generic developmental model. We discuss here the main focus of root system modelling to date, including a description of simple allometric biomass models, and biomechanical stress models, and then build in complexity through static growth models towards architecture models. The next progressive and logical step in developing an inclusive developmental model that integrates these modelling approaches is discussed.Peer reviewe

Single-center open-label randomized study of anemia management improvement in ESRD patients with secondary hyperparathyroidism

Whether anemia and mineral bone abnormalities (chronic kidney disease\u2013mineral bone disorder [CKD-MBD]) are associated still remains to be elucidated. Both anemia and CKD-MBD have been associated with adverse cardiovascular outcome and poor quality of life. However, recent evidence suggests that use of large doses of erythropoietin-stimulating agents (ESAs) to correct hemoglobin (Hb) may be detrimental in CKD. The Optimal Anemia Treatment in End Stage Renal Disease (ESRD) (Optimal ESRD Treatment) study will assess whether lowering of parathyroid hormone (PTH) is associated with a reduction in ESA consumption. The Optimal ESRD Treatment study is a pilot single-center open-label study with blinded end point (a prospective randomized open blinded end-point [PROBE] design) enrolling 50 patients on maintenance dialysis. Eligible patients with intact PTH (iPTH) 300-540 pg/mL and Hb 10-11.5 g/dL will be randomized 1:1 to strict PTH control (150-300 pg/mL) versus standard care (PTH range 300-540 pg/mL). Available drugs for CKD-MBD and anemia treatment will be managed by the attending physician to maintain the desired levels of PTH (according to study arm allocation) and Hb (10-11.5 g/dL). Echocardiographic data for cardiac structure and function as well as arterial stiffness will be assessed at study inception and completion. The Optimal ESRD Treatment study should shed light on the complicated interplay of anemia and CKD-MBD and on the feasibility of clinical trials in this domain. The study results are expected in the spring of 2017