Successful treatment of BK virus associated-nephropathy in a human immunodeficiency virus-positive kidney transplant recipient

BK virus (BKV) is an opportunistic pathogen in those with impaired immunity. Viral replication is generally asymptomatic but is able to induce cytopathic alterations in renal cells. If BKV infection is left untreated, it leads to BKV-associated nephropathy (BKVAN) and graft loss. There is scarce experience in the management of BKV infection in kidney transplant recipients living with HIV. We report the successful treatment of BKVAN in an HIV-positive kidney transplant recipient who experienced BKV replication in the immediate post-transplantation period. A change in therapy from calcineurin inhibitor to sirolimus, steroid withdrawal and a short course of an immunomodulatory agent (leflunomide) controlled BKV viremia in the absence of drug side-effects or impairment of graft function

Al di là del Repubblicanesimo: Modernità politica e origini dello Stato

[Italiano]: Il volume raccoglie gli interventi tenutisi al Convegno Internazionale Al di là del repubblicanesimo. Modernità politica e origini dello Stato. Esperienze e discipline a confronto (1350-1600), celebrato a Napoli nell’aprile del 2018, e incorpora un certo numero di altri contributi, ritenuti in linea con lo spirito dell’operazione. I lavori, nel loro insieme, conformano il quadro della ricca varietà di tradizioni e linguaggi intellettuali che dialogano e s’incrociano nel grande snodo della modernità, grosso modo tra XIV e XVII secolo: dalla tradizione giuridica a quella dell’ars dictaminis, a quella umanistica rinascimentale e post-rinascimentale, nutrite di pensiero classico, la riflessione investe le strutture concettuali e discorsive che – tra conflitti, contraddizioni e adattamenti – concorrono a formare l’idea moderna di Stato. Il “caso di studio” della Napoli aragonese (1442-1503), dimostra come questa realtà, storicamente determinata, abbia rappresentato un laboratorio d’avanguardia di tale modernità etica e socio-politica europea. L’ultima sezione affronta, da un punto di vista storico-critico e filosofico-politico, le sfide che l’epoca contemporanea pone alla modernità politica e alla dottrina, ma forse ancor più alla realtà stessa, dello Stato. Sullo sfondo, l’invito ad esplorare un approccio rinnovato alla concettualizzazione della politica e dei comportamenti pubblici, a partire dalla riflessione sul pensiero europeo tra basso Medioevo e prima Età moderna ./[English]: The volume collects the interventions held at the International Conference Beyond Republicanism. Political modernity and the origins of the State. Comparing experiences and disciplines (1350-1600), that took place in Naples during April 2018. It also includes a number of external contributions deemed in line with the spirit of the conference. The works included in the volume describe the rich variety of intersecting traditions and specialist languages that, roughly between the fourteenth and seventeenth centuries, cross their paths during the great junction of modernity: from the juridical tradition to that of the ars dictaminis, to the humanities of the Reinassance and post-Reinassance period, all nourished by classical thought, the book’s reflection invests the conceptual and discursive structures which - amid conflicts, contradictions and adaptations - combine to form the modern idea of ​​the State. The "case study" of Aragonese Naples (1442-1503) demonstrates how this historically determined reality has represented an avant-garde laboratory of the European ethical and socio-political modernity. The last section addresses, from a historical-critical and philosophical-political point of view, the challenges that the contemporary era poses to political modernity and doctrine, and perhaps even more so to the nature of the State itself. In the background, the volume suggests to explore a renewed approach to the conceptualization of politics and public behavior, starting with a reflection on European thought between the late Middle Ages and the early modern age

Sigurnost rada u anatomskom laboratoriju s formalinom i inovativno praćenje procjene profesionalne izloženosti formaldehidu

This review is directed at preventive health professionals, anatomic pathologists and technicians to focus their attention on the rapidly growing field of safe formalin practices. An updated overview of the most recent improvements in preventive measures versus formaldehyde (FA) in the anatomic pathology laboratories (APL) is provided. The occupational hygienist role and the required knowledge for a modern and clear occupational exposure assessment are described. Real-time, in-continuous, commercial analyzers for repeated FA exposure assessment are considered to evaluate technical changes in air monitoring programs, introduced to mitigate FA emissions, in compliance with the adopted limit values. To better choose the adequate instrumentation, the main features of each FA monitoring instrument recently introduced on the market are listed. Moreover, the main features of the modern workflow setting in APL are summarized. A computer-based scientific and non-scientific reports search by key-words was performed on PubMed, Web of Science, Google Scholar and Google Patents databases, querying the following topics: i) grossing workstation for ergonomic layout, ii) commercially available direct reading tools to measure formalin, iii) real-time, in-continuous FA monitoring instruments for sale. This review represents a useful tool to summarize the technical requirements and expert know-how necessary to minimize FA emissions and produce an exhaustive FA assessment in the APL.Ovaj pregled usmjeren je na preventivne zdravstvene radnike, anatomske patologe i tehničare kako bi svoju pozornost usredotočili na brzo rastuće područje sigurnih formalinskih praksi. Ažurirani pregled nudi najnovija poboljšanja preventivnih mjera u odnosu na formaldehid (FA) u laboratorijima za anatomsku patologiju (APL). Opisana je uloga higijeničara na radu i potrebna znanja za modernu i jasnu procjenu izloženosti na radu. Komercijalni analizatori u stvarnom vremenu za kontinuiranu procjenu izloženosti FA razmatraju se za procjenu tehničkih promjena u programima praćenja zraka, uvedenim radi ublažavanja emisija FA, u skladu s prihvaćenim graničnim vrijednostima. Kako bi se bolje odabrala odgovarajuća instrumentacija, navedene su glavne značajke svakog instrumenta za praćenje FA koji je nedavno predstavljen na tržištu. Štoviše, sažete su glavne značajke suvremenih postavki tijeka rada u APL-u. Računalno zasnovano pretraživanje znanstvenih i neznanstvenih izvješća po ključnim riječima provedeno je u bazama podataka PubMed, Web of Science, Google Scholar i Google Patents, s težištem na sljedeće teme: i) prikupljanje radnih stanica za ergonomski raspored, ii) komercijalno dostupni alati za izravno očitanje mjerenja formalina, iii) instrumenti za kontinuirano praćenje FA u stvarnom vremenu u prodaji. Ovaj pregled predstavlja koristan alat za sažimanje tehničkih zahtjeva i stručnog znanja potrebnog za minimiziranje emisija FA i izradu iscrpne procjene FA u APL-u

Partition Functions of Non-Abelian Quantum Hall States

Partition functions of edge excitations are obtained for non-Abelian Hall states in the second Landau level, such as the anti-Read-Rezayi state, the Bonderson-Slingerland hierarchy and the Wen non-Abelian fluid, as well as for the non-Abelian spin-singlet state. The derivation is straightforward and unique starting from the non-Abelian conformal field theory data and solving the modular invariance conditions. The partition functions provide a complete account of the excitation spectrum and are used to describe experiments of Coulomb blockade and thermopower.Comment: 42 pages, 3 figures; published version; minor corrections to sect. 4.

Transcatheter Aortic Valve Implantation: The New Challenges of Cardiac Rehabilitation

Transcatheter aortic valve implantation (TAVI) is an increasingly widespread percutaneous intervention of aortic valve replacement (AVR). The target population for TAVI is mainly composed of elderly, frail patients with severe aortic stenosis (AS), multiple comorbidities, and high perioperative mortality risk for surgical AVR (sAVR). These vulnerable patients could benefit from cardiac rehabilitation (CR) programs after percutaneous intervention. To date, no major guidelines currently recommend CR after TAVI. However, emerging scientific evidence shows that CR in patients undergoing TAVI is safe, and improves exercise tolerance and quality of life. Moreover, preliminary data prove that a CR program after TAVI has the potential to reduce mortality during follow-up, even if randomized clinical trials are needed for confirmation. The present review article provides an overview of all scientific evidence concerning the potential beneficial effects of CR after TAVI, and suggests possible fields of research to improve cardiac care after TAVI

Kidney Disease in HIV Infection

Antiretroviral therapy (ART) has significantly improved life expectancy of infected subjects, generating a new epidemiological setting of people aging withHuman Immunodeficiency Virus (HIV). People living with HIV (PLWH), having longer life expectancy, now face several age-related conditions as well as side effects of long-term exposure of ART. Chronic kidney disease (CKD) is a common comorbidity in this population. CKD is a relentlessly progressive disease that may evolve toward end-stage renal disease (ESRD) and significantly affect quality of life and risk of death. Herein, we review current understanding of renal involvement in PLWH, mechanisms and risk factors for CKD as well as strategies for early recognition of renal dysfunction and best care of CKD

Ažuriranje podataka o prožimanju zaštitnih medicinskih rukavica antineoplastičnim lijekovima

Occupational exposure to antineoplastic drugs (ADs) handling and administration is one of the main risks in the healthcare sector. Dermal absorption represents the primary route of exposure to ADs. Personal preventive equipment, especially medical gloves, is crucial to safeguard the workers health in ADs handling; thus, chemicals permeating through protective materials is an essential aspect to estimate and consider. Several studies on permeation through medical gloves reported that breakthrough time and permeation rate are the values that must be studied, observing that physical-chemical properties of drugs, PPE materials and thickness, and temperature are crucial features to estimate them. In the European Union, standardized permeation testing is not mandatory for gloves used in ADs manipulation, in contrast with the United States, that proposed stringent requirements in the American Society of Testing and Materials International standard D6978-05. This review would help identify the main characteristics of the best protective glove used by employees frequently exposed to ADs: the major aspects implicated in permeation, reported in the literature, are listed and discussed.Radna izloženost rukovanju i primjeni antineoplastičnih lijekova (AD) jedan je od glavnih rizika u zdravstvenom sektoru. Kožna apsorpcija predstavlja primarni put izlaganju AD-ima. Osobna preventivna oprema, posebno medicinske rukavice, presudna je za zaštitu zdravlja radnika u radu s AD-ima; prema tome, kemikalije koje prodiru kroz zaštitne materijale bitan su aspekt za procjenu i razmatranje. Nekoliko studija o prožimanju kroz medicinske rukavice izvijestilo je da su vrijeme proboja i brzina prodiranja vrijednosti koje se moraju proučavati, primjećujući da su fizičko-kemijska svojstva lijekova, OZO materijali i debljina i temperatura ključne značajke za njihovu procjenu. U Europskoj uniji, standardizirano ispitivanje prožimanja nije obvezno za rukavice koje se koriste u manipulaciji ADs, za razliku od Sjedinjenih Država koje su predložile stroge zahtjeve u međunarodnom standardu D6978-05 Američkog društva za ispitivanje i materijale. Ovaj pregled pomogao bi identificirati glavne karakteristike najbolje zaštitne rukavice koju koriste zaposlenici često izloženi AD-ima: glavni aspekti uključeni u prožimanje, priopćeni u literaturi, navedeni su i raspravljeni

Ocjena rizika od profesionalne izloženosti antineoplastičnim lijekovima putem osobne zaštitne opreme u zdravstvenom sektoru: dio I. – medicinske rukavice

Antineoplastic drugs (ADs) are essential tools in cancer treatment, but their cytotoxicity poses a risk to workers involved in their handling. In a hospital environment fundamental strategies for minimising exposure involve proper use of safety cabinets and closed-circuit transfer devices, along with personnel training and increased awareness of risks. However, medical gloves remain the first line of defence. In this respect the evaluation of glove materials and best choices can improve hospital safety management and prevent potential hazards and long-term consequences. The aim of this study was to assess contamination of gloves in samples taken from AD administration and preparation units of nine Italian hospitals and to raise awareness of the importance of evaluating chemico-physical properties of gloves. Our findings show that 33 % of the analysed gloves were positive for at least one AD, with contaminations ranging from 0.6 to 20,729 pg/cm2. We proposed the alert glove values (AGVs) for each AD as a limit value for contamination assessment and good practice evaluation. Our findings also point to multiple AD contamination (43 % of positive findings in preparation units), calculated as total AGV (AGV-T), and confirm that gloves should be replaced after 30 min of AD handling, based on cumulative permeation and area under the curve (AUC), to maintain safety and limit dermal exposure.Antineoplastični lijekovi (AD) imaju raširenu i ključnu primjenu u liječenju karcinoma, ali zbog svoje citotoksičnosti predstavljaju rizik za zdravstvene radnike koji njima rukuju. U bolničkom okružju osnovne strategije za smanjenje izloženosti obuhvaćaju pravilnu primjenu zatvorenih sustava za rukovanje i prijenos tih lijekova te obuku osoblja i povećanje svijesti o rizicima. Ipak, prva crta obrane i dalje su medicinske rukavice. U tom smislu, ocjena materijala rukavica i izbor onih najboljih može unaprijediti sigurnost i spriječiti moguće opasnosti i dugoročne posljedice. Cilj je ovog istraživanja bio ocijeniti onečišćenje uzoraka rukavica uzetih nakon pripreme i primjene antineoplastičnih lijekova u devet talijanskih bolnica te ukazati na važnost ocjene fizikalno-kemijskih svojstava takvih rukavica. Pokazalo se da je 33 % analiziranih rukavica bilo pozitivno na barem jedan antineoplastični lijek, a onečišćenje se kretalo u rasponu od 0,6 do 20,729 pg/cm2. Naš novi parametar, koji smo nazvali kritične vrijednosti rukavica (izv. alert glove values, krat. AGV), izračunan za svaki pojedini antineoplastični lijek kao 95. percentil, može dobro poslužiti za usporedbu ocjena onečišćenja. Naši rezultati također upozoravaju na onečišćenje s više antineoplastičnih lijekova odjednom (43 % pozitivnih uzoraka u pripremnim jedinicama), koje je izračunano kroz ukupni AGV, te na potrebu da se rukavice zamijene 30 minuta nakon rukovanja antineoplastičnim lijekom s obzirom na kumulativnu propusnost i površinu ispod krivulje kako bi se sačuvala sigurnost i ograničila izloženost putem kože