Monitoring the occurrence of diabetes mellitus and its major complications: the combined use of different administrative databases

OBJECTIVE: Diabetes mellitus is a growing public health problem, for which efficient and timely surveillance is a key policy. Administrative databases offer relevant opportunities for this purpose. We aim to monitor the incidence of diabetes and its major complications using administrative data. STUDY DESIGN AND METHODS: We study a population of about 850000 inhabitants in the Veneto Region (Italy) from the end of year 2001 to the end of year 2004. We use four administrative databases with record linkage. Databases of drug prescriptions and of exemptions from medical charge were linked to identify diabetic subjects; hospital discharge records and mortality data were used for the assessment of macrovascular and renal complications and vital status. RESULTS: We identified 30230 and 34620 diabetic subjects at the start and at the end of the study respectively. The row prevalence increased from 38.3/1000 (95% CI 37.2 – 39.5) to 43.2/1000 (95% CI 42.3 – 44) for males and from 34.7/1000 (95% CI 33.9 – 35.5) to 38.1/1000 (95% CI 37.4 – 39) for females. The mean row incidence is 5.3/1000 (95% CI 5 – 5.6) person years for males and 4.8/1000 (95% CI 4.4 – 5.2) person years for females. The rate of hospitalisations for cardiovascular or kidney diseases is greatly increased in diabetic people with respect to non diabetics for both genders. The mortality relative risk is particularly important in younger age classes: diabetic males and females aged 45–64 years present relative risk for death of 1.7 (95% CI 1.58 – 1.88) and 2.6 (95% CI 2.29 – 2.97) respectively. CONCLUSION: This study provides a feasible and efficient method to determine and monitor the incidence and prevalence of diabetes and the occurrence of its complications along with indexes of morbidity and mortality

Elevated urinary levels of urokinase-type plasminogen activator receptor (uPAR) in pancreatic ductal adenocarcinoma identify a clinically high-risk group

BACKGROUND: The urokinase plasminogen activator receptor is highly expressed and its gene is amplified in about 50% of pancreatic ductal adenocarcinomas; this last feature is associated with worse prognosis. It is unknown whether the level of its soluble form (suPAR) in urine may be a diagnostic-prognostic marker in these patients. METHODS: The urinary level of suPAR was measured in 146 patients, 94 pancreatic ductal adenocarcinoma and 52 chronic pancreatitis. Urine from 104 healthy subjects with similar age and gender distribution served as controls. suPAR levels were normalized with creatinine levels (suPAR/creatinine, ng/mg) to remove urine dilution effect. RESULTS: Urinary suPAR/creatinine values of pancreatic ductal adenocarcinoma patients were significantly higher (median 9.8; 25(th)-75(th )percentiles 5.3-20.7) than those of either healthy donors (median 0; 0-0.5) or chronic pancreatitis patients (median 2.7; 0.9-4.7). The distribution of values among cancer patients was widespread and asymmetric, 53% subjects having values beyond the 95(th )percentile of healthy donors. The values of suPAR/creatinine did not correlate with tumour stage, Ca19-9 or CEA levels. Higher values correlated with poor prognosis among non-resected patients at univariate analysis; multivariate Cox regression identified high urinary suPAR/creatinine as an independent predictor of poor survival among all cancer patients (odds ratio 2.10, p = 0.0023), together with tumour stage (stage III odds ratio 2.65, p = 0.0017; stage IV odds ratio 4.61, p < 0.0001) and female gender (odds ratio 1.85, p = 0.01). CONCLUSIONS: A high urinary suPAR/creatinine ratio represents a useful marker for the identification of a subset of patients with poorer outcome

Mode of action of fibrous amphiboles: the case of Biancavilla (Sicily, Italy)

Background. The inhalation of fibrous amphiboles can result in pulmonary fibrosis, lung cancer and mesothelioma. Although these fibres have the same disease-causing potential, their different morphologies and chemical composition can determine different biological activities. An unusual cluster of mesothelioma was evidenced in Biancavilla (Sicily) where no inhabitant had been significantly exposed to asbestos.Objective. We herein discuss the mechanism of action of amphiboles, focusing on the fibres identified in the study area.Results. Human lung carcinoma cells have been exposed to two different materials: prismatic fluoro-edenite and fibres with fluoro-edenitic composition. Only in the second case, they exhibit features typical of transformed cells, such as multinucleation, pro- survival activity and pro-inflammatory cytokine release. Accordingly, in vivo studies demonstrated that the fibrous sample only could induce a mesotheliomatogenic effect. Conclusions. Fibres with fluoro-edenitic composition behave similarly to the asbestos crocidolite, whose connection with inflammation and lung cancer is well established

Serum Albumin Is Inversely Associated With Portal Vein Thrombosis in Cirrhosis

We analyzed whether serum albumin is independently associated with portal vein thrombosis (PVT) in liver cirrhosis (LC) and if a biologic plausibility exists. This study was divided into three parts. In part 1 (retrospective analysis), 753 consecutive patients with LC with ultrasound-detected PVT were retrospectively analyzed. In part 2, 112 patients with LC and 56 matched controls were entered in the cross-sectional study. In part 3, 5 patients with cirrhosis were entered in the in vivo study and 4 healthy subjects (HSs) were entered in the in vitro study to explore if albumin may affect platelet activation by modulating oxidative stress. In the 753 patients with LC, the prevalence of PVT was 16.7%; logistic analysis showed that only age (odds ratio [OR], 1.024; P = 0.012) and serum albumin (OR, -0.422; P = 0.0001) significantly predicted patients with PVT. Analyzing the 112 patients with LC and controls, soluble clusters of differentiation (CD)40-ligand (P = 0.0238), soluble Nox2-derived peptide (sNox2-dp; P &lt; 0.0001), and urinary excretion of isoprostanes (P = 0.0078) were higher in patients with LC. In LC, albumin was correlated with sCD4OL (Spearman's rank correlation coefficient [r(s)], -0.33; P &lt; 0.001), sNox2-dp (r(s), -0.57; P &lt; 0.0001), and urinary excretion of isoprostanes (r(s), -0.48; P &lt; 0.0001) levels. The in vivo study showed a progressive decrease in platelet aggregation, sNox2-dp, and urinary 8-iso prostaglandin F2 alpha-III formation 2 hours and 3 days after albumin infusion. Finally, platelet aggregation, sNox2-dp, and isoprostane formation significantly decreased in platelets from HSs incubated with scalar concentrations of albumin. Conclusion: Low serum albumin in LC is associated with PVT, suggesting that albumin could be a modulator of the hemostatic system through interference with mechanisms regulating platelet activation

Analisi Numerica di Metasuperfici Planari Riconfigurabili che sfruttano Nanomateriali Tunabili

Questa tesi si occupa di descrivere lo studio di una metasuperficie planare riconfigurabile, operante nella banda frequenziale a 5.8 GHz ,che sfrutta materiali innovativi, a basso costo e a basso consumo di potenza per generare riflessioni anomale del fascio d’onda incidente in maniera dinamica. I metamateriali sono compositi artificiali aventi una struttura tridimensionale periodica, progettata per produrre un materiale non disponibile in natura che possiede delle proprietà elettromagnetiche anomale promettenti. Alcune caratteristiche che rendono i metamateriali interessanti sono le piccole dimensioni delle strutture elementari comparate alla lunghezza d’onda della radiazione elettromagnetica con cui esse interagiscono e la periodicità con cui queste strutture elementari vengono replicate. Nel primo capitolo di questo elaborato vengono introdotte le tematiche che riguardano i metamateriali, le limitazioni di queste strutture e quindi l’utilizzo di strutture semplificate come le metasuperfici. E’ posta particolare attenzione alla tematica della riconfigurabilità che in questo studio viene trattata in diversi modi: tramite capacità variabili e tramite materiali ferroelettrici. Il secondo capitolo descrive la progettazione delle celle elementari definendo il caso di studio sul quale ci siamo concentrati ed è fornita un'analisi dei risultati di fase dell’onda piana riflessa dalla metasuperficie al variare della capacità inserita nella struttura elementare. Vengono inoltre presentati alcuni risultati sperimentali del comportamento capacitivo di materiali ferroelettrici che verranno usati, come l’ossido di afnio zirconio. Il terzo capitolo è dedicato alla trattazione dei risultati ottenuti a riguardo dei diagrammi di radiazione per le differenti configurazioni di celle unitarie di cui è composta la MS 20x20 progettata, sottolineando le capacità da beam steerer. Vengono inoltre discussi i risultati della simulazione EM relativi all’antenna utilizzata come feeder

Numerical and experimental analysis of the dynamic behavior of main engine foundations

The value of a super-yacht project can be measured in terms of cost, size, autonomy, design and lately also in terms of comfort on board, since the competition among the various shipyards is now being played on quality of living onboard, as well as on more traditional aspects such as design, cost and performance. Since the on-board comfort has become a performance parameter, the vibration and noise level are topics of increasing interest to ship-owners, ship designers and builders. The engine-mount loading is the primary source of vibrations onboard boats. Indeed, the increased sophistication of the on board outfitting has required lower limits levels on vibration and noise over the last decade. By contrast, the current trend aims at producing faster ships, equipped with increasingly powerful engines, which imply, in the absence of proper measures of contrast, higher levels of vibration and noise. In order to improve the comfort level onboard their superyachts, Azimut|Benetti Shipyards, in cooperation with the Naval Architecture Section of the DITEN Department of the University of Genova and with the DIA Department of the University of Trieste, began an investigation campaign of the dynamic response of the marine Diesel engine foundations. The dynamic behavior of the Diesel engine foundation is a paramount importance to evaluate its effectiveness in the coupling system between the Diesel engine and the ship structures. An accurate study of the dynamic behavior of these elements allows both avoiding high levels of vibrations in the low frequency range and limiting the structure-borne noise levels in the high frequency range. The knowledge of dynamic response of Diesel engine foundations is a key factor for the comfort assessment in the first phase of ship and superyacht design with regards to noise and vibration characteristics. Given the labour time needed to perform a dynamic FE analysis, with particular reference to mobility analyses, in this study a procedure to individuate the optimum dimensional characteristics of engine foundations numerical models has been performed, in order to achieve in reasonable calculation times reliable results. The investigation has been supported by a wide measurement campaign by which it has been possible to make a validation of numerical results. Copyright \ua9 2015 by the International Society of Offshore and Polar Engineers (ISOPE)

Evidence‐based policy on road safety: the effect of the demerit points system on seat belt use and health outcomes

Objective: To assess the effect of a demerit points system, introduced in Italy in July 2003, on the prevalence of seat belt use (intermediate outcome) and the number of road traffic deaths and injuries (health outcomes)

Mode of action of fibrous amphiboles: the case of Biancavilla (Sicily, Italy)

BACKGROUND. The inhalation of fibrous amphiboles can result in pulmonary fibrosis, lung cancer and mesothelioma. Although these fibres have the same disease-causing potential, their different morphologies and chemical composition can determine different biological activities. An unusual cluster of mesothelioma was evidenced in Biancavilla (Sicily) where no inhabitant had been significantly exposed to asbestos. OBJECTIVE. We herein discuss the mechanism of action of amphiboles, focusing on the fibres identified in the study area. RESULTS. Human lung carcinoma cells have been exposed to two different materials: prismatic fluoro-edenite and fibres with fluoro-edenitic composition. Only in the second case, they exhibit features typical of transformed cells, such as multinucleation, prosurvival activity and pro-inflammatory cytokine release. Accordingly, in vivo studies demonstrated that the fibrous sample only could induce a mesotheliomatogenic effect. Conclusions. Fibres with fluoro-edenitic composition behave similarly to the asbestos crocidolite, whose connection with inflammation and lung cancer is well established

Elevated urinary levels of urokinase-type plasminogen activator receptor (uPAR) in pancreatic ductal adenocarcinoma identify a clinically high-risk group

Abstract Background The urokinase plasminogen activator receptor is highly expressed and its gene is amplified in about 50% of pancreatic ductal adenocarcinomas; this last feature is associated with worse prognosis. It is unknown whether the level of its soluble form (suPAR) in urine may be a diagnostic-prognostic marker in these patients. Methods The urinary level of suPAR was measured in 146 patients, 94 pancreatic ductal adenocarcinoma and 52 chronic pancreatitis. Urine from 104 healthy subjects with similar age and gender distribution served as controls. suPAR levels were normalized with creatinine levels (suPAR/creatinine, ng/mg) to remove urine dilution effect. Results Urinary suPAR/creatinine values of pancreatic ductal adenocarcinoma patients were significantly higher (median 9.8; 25th-75th percentiles 5.3-20.7) than those of either healthy donors (median 0; 0-0.5) or chronic pancreatitis patients (median 2.7; 0.9-4.7). The distribution of values among cancer patients was widespread and asymmetric, 53% subjects having values beyond the 95th percentile of healthy donors. The values of suPAR/creatinine did not correlate with tumour stage, Ca19-9 or CEA levels. Higher values correlated with poor prognosis among non-resected patients at univariate analysis; multivariate Cox regression identified high urinary suPAR/creatinine as an independent predictor of poor survival among all cancer patients (odds ratio 2.10, p = 0.0023), together with tumour stage (stage III odds ratio 2.65, p = 0.0017; stage IV odds ratio 4.61, p Conclusions A high urinary suPAR/creatinine ratio represents a useful marker for the identification of a subset of patients with poorer outcome.</p