Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Wide range temperature stability of palladium on ceria-praseodymia catalysts for complete methane oxidation

Catalytic oxidation is the most effective technology to control methane emissions from both mobile and stationary sources. Palladium-based materials are widely viewed as the most active catalysts for the methane abatement reaction, even though the high-temperature PdO/Pd transition is linked to a decrease in catalytic activity. Aimed at minimizing this phenomenon, this work compares the catalytic activity and the thermal stability of different Pd-impregnated cerium-praseodymium mixed oxides prepared via Solution Combustion Synthesis. Although the palladium deposition on pure ceria allows obtaining a highly active system, the introduction of praseodymium enhances the thermal stability of the catalyst in an extended temperature range. X-ray photoelectron spectra show that the presence of praseodymium retains Pd in a more oxidized form, thus stabilizing the high-temperature active phase. This effect, as evident from X-ray diffractograms and Raman analyses, was attributed to a strong interaction of palladium particles with praseodymium, thereby hindering their reduction to the metallic form. Moreover, Pr doping played a significant role during methane oxidation in the presence of 5% H2O, improving both activity and stability compared to Pd on pure ceria. On the whole, Pd/Ce90Pr10 (2 wt% palladium supported on a mixed oxide with a praseodymium content of 10% on a cerium-praseodymium molar basis) was found to be the most promising catalyst amongst the studied materials in both dry and wet conditions, benefitting from the synergistic effect of ceria and praseodymia in improving the Pd activity and stability

CO2 hydrogenation to methanol over Zr- and Ce-doped indium oxide

In recent decades, climate change has become a major issue that needs to be addressed. Many efforts have been made on the reduction of CO2 emissions and its conversion in energy carriers and high value-added products such as methane, methanol, dimethyl-ether, and hydrocarbons. The present study focuses on the development of catalysts for hydrogenating CO2 to methanol, which is a useful chemical and an alternative liquid fuel. According to the literature, In2O3-based catalysts are particularly selective in the hydrogenation of CO2 to methanol, reducing the production of CO even at high space velocities compared to the more common ternary catalysts such as Cu/ZnO/Al2O3 or Cu/ZnO/ZrO2. Therefore, the effects of CeO2 and ZrO2 on In2O3-based catalysts were investigated in the present study. The InxCe100− x and the InxZr100− x mixed oxides catalysts were synthesized via gel-oxalate coprecipitation by varying the atomic ratios between the elements. Subsequently, they were analysed with several characterisation techniques to rationalise the catalytic performances that were obtained by testing the samples in a fixed bed reactor under different reaction conditions. The addition of different amounts Ce or Zr modified the structure and morphology of the samples and promoted the adsorption of CO2 from 1.8 mmolCO2⋅gcat − 1 up to 10.6 mmolCO2⋅gcat − 1. ZrO2 stabilises the structure and the results suggests that the greater specific activity (168 mgCH3OH⋅gIn2O3 − 1 ⋅h− 1 at 300 ◦C and 2.5 MPa of In40Zr60) could be ascribed to the electronic promotion of Zr. On the contrary, the addition of CeO2 did not reveal a beneficial effect on the activity. Concerning the stability, In2O3-ZrO2 binary oxides seemed to be affected mainly by sintering; whereas In2O3-CeO2 were affected by at least three deactivating phenomena: sintering, reduction of In2O3 to metallic indium and coking. Consequently, the deactivation rate of these binary oxides increased from 1.04 ⋅ 10− 2 h− 1 of the In100 to 4.13 ⋅ 10− 2 h− 1 of the In40Ce60

Praseodymium doping in ceria-supported palladium nanocatalysts as an effective strategy to minimize the inhibiting effects of water during methane oxidation

The present study reports an improved design for Pd/Ce-Pr catalysts. Pd-impregnated nanostructured ceria-praseodymia catalysts with different compositions were comprehensively characterized and tested for dry and wet methane oxidation. The strong PdO-PrOx interaction, detected via XRD, TPR/TPO, Raman and HRTEM analyses, retains Pd mainly in its oxidized form in the materials with high praseodymium content, thus resulting in a lower activity. Conversely, the introduction of a limited amount of Pr in ceria allows to obtain a more active catalyst (2% of Pd supported on a mixed oxide with 10% of Pr) than the typical Pd/CeO2 systems. Hence, the simultaneous presence of Pd in its reduced and oxidized forms results to be a key factor for high activity. Additionally, the higher hydrophobicity of this sample, investigated through NMR and in situ FTIR, markedly reduces the H2O inhibition effect typical of Pd-based materials, paving the way for using this system in real applications

Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study

Background: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy. Methods: Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018-2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of ≥ 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site. Results: LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15-1.096, P = 0.003). The rate of ≥ 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56-0.85, P < 0.001) and MEDIUM-volume (OR 0.72, 95% c.i. 0.62-0.83, P < 0.001) centres was lower than in VERY HIGH-volume centres. Of the 4676 rectal cancer patients, the rate of ≥ 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41-0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56-0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60-0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52-0.94, P = 0.019) volume centres (vs. VERY HIGH). Conclusion: Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes

Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study

Background: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy. Methods: Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018-2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of ≥ 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site. Results: LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15-1.096, P = 0.003). The rate of ≥ 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56-0.85, P < 0.001) and MEDIUM-volume (OR 0.72, 95% c.i. 0.62-0.83, P < 0.001) centres was lower than in VERY HIGH-volume centres. Of the 4676 rectal cancer patients, the rate of ≥ 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41-0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56-0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60-0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52-0.94, P = 0.019) volume centres (vs. VERY HIGH). Conclusion: Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes

Kidney dysfunction and related cardiovascular risk factors among patients with type 2 diabetes

Background. Kidney dysfunction is a strong predictor of end-stage renal disease and cardiovascular (CV) events. The main goal was to study the clinical correlates of diabetic kidney disease in a large cohort of patients with type 2 diabetes mellitus (T2DM) attending 236 Diabetes Clinics in Italy.Methods. Clinical data of 120 903 patients were extracted from electronic medical records by means of an ad hoc-developed software. Estimated glomerular filtration rate (GFR) and increased urinary albumin excretion were considered. Factors associated with the presence of albuminuria only, GFR &lt; 60 mL/min/1.73 m(2) only or both conditions were evaluated through multivariate analysis.Results. Mean age of the patients was 66.6 +/- 11.0 years, 58.1% were male and mean duration of diabetes was 11.1 +/- 9.4 years. The frequency of albuminuria, low GFR and both albuminuria and low GFR was 36.0, 23.5 and 12.2%, respectively. Glycaemic control was related to albuminuria more than to low GFR, while systolic and pulse pressure showed a trend towards higher values in patients with normal kidney function compared with those with both albuminuria and low GFR. Multivariate logistic analysis showed that age and duration of disease influenced both features of kidney dysfunction. Male gender was associated with an increased risk of albuminuria. Higher systolic blood pressure levels were associated with albuminuria, with a 4% increased risk of simultaneously having albuminuria and low GFR for each 5 mmHg increase.Conclusions. In this large cohort of patients with T2DM, reduced GFR and increased albuminuria showed, at least in part, different clinical correlates. A worse CV risk profile is associated with albuminuria more than with isolated low GFR