Analisi di processo applicata agli accessi vascolari per emodialisi

Abstract non disponibil

Please, sir, pull down your socks!

A 48-year-old male patient presented at the regular followupvisit seven months after a successful kidney transplant.After discussion of blood chemistries with the doctor, thepatient underwent a physical examination. As usual, heunbuttoned his shirt and undid his trouser belt. Inspectionof the limbs, after pulling up his trousers, confirmed thepresence of ankle oedema; the graft was quite firm, with nomurmurs in the area

Everolimus, Cyclosporine, and Thrombotic Microangiopathy: Clinical Role and Preventive Tools in Renal Transplantation

INTRODUCTION: Thrombotic microangiopathy (TMA) is characterized by endothelial cell injury and formation of fibrin thrombi within capillary and arterioles. In renal allograft recipients, TMA mainly presents as hemolytic uremic syndrome. Its occurrence is rare, and diagnosis requires a high degree of suspicion. Drug toxicity, in particular from calcineurin inhibitors (CNIs) and mTOR inhibitors (mTORi), is the most common cause posttransplant and has recently been emphasized in the setting of lung transplantation. OBJECTIVE: The goal of this study was to investigate the role of mTORi as an added risk factor in the development of TMA to propose strategies for modulation of immunosuppressive (IS) therapy. PATIENTS AND METHODS: From a database of 496 renal graft recipients, we analyzed 350 renal graft biopsy specimens gathered at our center from 1998 to 2012. In patients undergoing combined therapy with mTORi and CNI, we compared drugs levels in TMA-affected and TMA-free groups, using mTORi and CNI TLC and the summation of [everolimus TLC+(cyclosporine C2/100)] (Σ) as a surrogate marker of combined exposition to 2 drugs. Receiver-operating characteristic analysis of association of EVL TLC+(C2/100) was performed for patients exposed to mTORi. RESULTS: Histologic features of TMA were found in 36 patients (prevalence of 7.3%). The caseload was divided into 2 groups: not drug-related TMA (n=19) and drug-related TMA (n=17). Despite the prevalence of TMA in patients exposed to mTORi being greater (8 of 153; prevalence, 5.3%) compared with therapies without mTORi (9 of 324; prevalence, 2.8%), statistical difference was not reached. Patients treated with mTORi who developed de novo drug-related TMA had higher blood levels of IS drugs compared with those who did not develop TMA. Receiver-operating characteristic analysis found a significant threshold of 12.5 ng/mL (area under the curve, 0.803; P=.006). CONCLUSIONS: Results confirm the pivotal role of IS drugs in the onset of de novo TMA. On the basis of literature, we could speculate a sequence of endothelial damage by CNI, on which everolimus fits hindering the repair of endothelial injury. Therefore, high blood levels of CNI and mTORi seem to predispose patients to posttransplant TMA. Combined monitoring of these 2 drugs might be used to prevent the complication. Σ [everolimus TLC + (cyclosporine C2/100)]>12.5 ng/mL should be avoided as a surrogate risk factor for adverse effects

Treatment of wounds colonized by multidrug resistant organisms in immune-compromised patients: a retrospective case series.

Immune-compromised patients incur a high risk of surgical wound dehiscence and colonization by multidrug resistant organisms. Common treatment has been debridement and spontaneous secondary healing.All immune-compromised patients referred to our Institution between March 1, 2010 and November 30, 2011 for dehiscent abdominal wounds growing multidrug resistant organisms were treated by serial wound debridements and negative pressure dressing. They were primarily closed, despite positive microbiological cultures, when clinical appearance was satisfactory.Nine patients were treated by direct wound closure, five had been treated previously by secondary intention healing.According to our results, fast healing can be safely obtained by closure of a clinically healthy wound, despite growth of multidrug resistant organisms, even in immune-compromised patients

Caratterizzazione flessionale del rinforzo di pavimentazioni bituminose con interstrati sintetici

Uno degli aspetti fondamentali della circolazione stradale è rappresentato dalla conservazione della qualità, in termini di comfort e sicurezza trasmessa all’utente, della sovrastruttura stradale. L’obiettivo della manutenzione stradale è di garantire un livello soddisfacente delle caratteristiche funzionali lungo tutto l’arco della vita utile dell’infrastruttura. Le ridotte disponibilità economiche di enti ed amministrazioni pubbliche, spingono i ricercatori ed i tecnici del settore ad individuare soluzioni tecniche e progettuali, in grado di coniugare economicità e durabilità degli interventi. Negli ultimi decenni, si è cercato di studiare l’effetto prodotto dall’eventuale inserimento di un interstrato di rinforzo all’interno della sovrastruttura. Lo studio, sviluppato e descritto nel presente documento, ha l’obiettivo di migliorare la comprensione dell’effettivo contributo che i materiali di rinforzo possono produrre all’interno degli strati legati di una pavimentazione flessibile. Gli obiettivi dell’indagine sperimentale, descritta nel presente documento, possono essere sintetizzati in tre punti fondamentali: - caratterizzazione flessionale di pavimentazioni bituminose con interstrati sintetici, in particolare lo scopo dell’indagine verte a quantificare il miglioramento del comportamento meccanico della pavimentazione dotata di rinforzo; - analisi del comportamento a fessurazione della pavimentazione, rinforzata e non, con particolare attenzione nei confronti del reflective cracking; - valutazione del collegamento tra i due strati bituminosi in presenza di interstrato sintetico. Per raggiungere tali obiettivi sono state eseguite due serie di prove di flessione su 3 punti (3PB) e prove di taglio Leutner

A Phenomenological Study of Powerful Women (Perseverence, Adult Development, Self-Esteem).

This study examined the phenomenon of powerful women, in an effort to generate data to assist women who are seeking new forms of personhood. A scale consisting of five dimensions--assertive, competent, perceptive, nurturant, and spiritual--was used to select 8 women from the Esalen community to participate in the study. The women were divided into two groups based on rankings by members of the Esalen community on the five dimensions. One group represented high scoring women and the other group represented low scoring women. An interview format was used to generate data. The interview protocols for the two groups were analyzed and compared for similarities and differences. Results showed perseverence to be a distinctive factor between the two groups. Both groups reported the importance of relationships to self, to others, and to the universe; risk-taking; and the development of an attitude of humor and play to their identity. The low scoring group expressed more self-disapproval, fewer risk-taking activities, and less spiritual development than the high scoring group. Only the high scoring group identified their self-esteem with feminism and their spiritual development with the Goddess. A definition of power is included and practical applications of the findings for counseling practice and personal growth are discussed.Ph.D.School counselingUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/160638/1/8520871.pd

How severe are the EBA macroeconomic scenarios for the Italian Economy? A joint probability approach

Measures of the severity of macroeconomic scenarios have been widely used in the literature, but a consistent methodology for their calculation has not been developed yet. Against this background, we provide a general method for calculating the joint probability of observing a macroeconomic scenario, which can be applied to various structural models. By doing so, we can attach probabilities to scenarios produced with multidimensional economic models to compare their severity and plausibility. We apply our methodology to the 2016 and 2018 EBA stress test scenarios and also provide reverse stress test applications. Our results show that for the Italian economy, the 2016 and 2018 EBA scenarios are unlikely, especially the 2016 one. The reverse stress tests allow us to identify the key variables that affect our probabilities

Which is the preferred vascular access in diabetic patients? A view from Europe

No abstract available