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

Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic Club for the study and treatment of esophageal varices (NIEC).

BACKGROUND & AIMS: The clinical importance of portal hypertensive gastropathy (PHG) as a source of gastrointestinal bleeding in patients with cirrhosis is poorly defined. We investigated the natural history of this condition in a large series of patients. METHODS: All patients with cirrhosis seen at 7 hospitals during June and July 1992 were followed up with clinical and endoscopic examinations every 6 months for up to 3 years. Gastropathy was classified according to the classification of the New Italian Endoscopic Club. RESULTS: The prevalence of gastropathy was 80% and was correlated with the duration of disease, presence and size of esophagogastric varices, and a previous history of endoscopic variceal sclerotherapy. During 18+/-8 months of follow-up, gastropathy was stable in 29% of patients, deteriorated in 23%, improved in 23%, and fluctuated with time in 25%. The evolution of gastropathy with time was identical in patients with and without previous or current sclerotherapy. Acute bleeding from gastropathy occurred in 8 of 315 patients (2.5%). The bleeding-related mortality rate was 12.5%. Chronic bleeding occurred in 34 patients (10.8%). CONCLUSIONS: PHG is common in patients with cirrhosis, and its prevalence parallels the severity of portal hypertension. Gastropathy can progress from mild to severe and vice versa or even disappear completely. Bleeding from this lesion is relatively uncommon and rarely severe. Sclerotherapy of esophageal varices does not seem to influence the natural history of this condition

Attainable yield and soil texture as drivers of maize response to nitrogen: a synthesis analysis for Argentina

The most widely used approach for prescribing fertilizer nitrogen (N) recommendations in maize (Zea Mays L.) in Argentina is based on the relationship between grain yield and the available N (kg N ha−1), calculated as the sum of pre-plant soil NO3--N at 0−60 cm depth (PPNT) plus fertilizer N (Nf). However, combining covariates related to crop N demand and soil N supply at a large national scale remains unexplored for this model. The aim of this work was to identify yield response patterns associated to yield environment (crop N demand driver) and soil texture (soil N supply driver). A database of 788 experiments (1980−2016) was gathered and analyzed combining quadratic-plateau regression models with bootstrapping to address expected values and variability on response parameters and derived quantities. The database was divided into three groups according to soil texture (fine, medium and coarse) and five groups based on the empirical distribution of maximum observed yields (from Very-Low = 13.1 Mg ha−1) resulting in fifteen groups. The best model included both, attainable yield environment and soil texture. The yield environment mainly modified the agronomic optimum available N (AONav), with an expected increase rate of ca. 21.4 kg N Mg attainable yield−1, regardless of the soil texture. In Very-Low yield environments, AONav was characterized by a high level of uncertainty, related to a poor fit of the N response model. To a lesser extent, soil texture modified the response curvature but not the AONav, mainly by modifying the response rate to N (Fine > Medium > Coarse), and the N use efficiencies. Considering hypothetical PPNT levels from 40 to 120 kg N ha−1, the expected agronomic efficiency (AENf) at the AONav varied from 7 to 31, and 9–29 kg yield response kg fertilizer N (Nf)−1, for Low and Very-High yield environments, respectively. Similarly, the expected partial factor productivity (PFPNf) at the AONav ranged from 62 to 158, and 55–99 kg yield kg Nf−1, for the same yield environments. These results highlight the importance of combining attainable yield environment and soil texture metadata for refining N fertilizer recommendations. Acknowledging the still low N fertilizer use in Argentina, space exists to safely increasing N fertilizer rates, steering the historical soil N mining profile to a more sustainable agro-environmental scenario in the Pampas.Fil: Correndo, Adrián A.. Kansas State University; Estados UnidosFil: Gutiérrez Boem, Flavio Hernán. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: García, Fernando O.. Universidad Nacional de Mar del Plata. Facultad de Ciencias Agrarias; ArgentinaFil: Alvarez, Carolina. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Álvarez, Cristian. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Angeli, Ariel. I+D CREA; ArgentinaFil: Barbieri, Pablo Andres. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Mar del Plata. Facultad de Ciencias Agrarias; Argentina. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Barraco, Mirian Raquel. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Berardo, Angel. Laboratorio de Suelo S.a.; ArgentinaFil: Boxler, Miguel. Private Consultant; ArgentinaFil: Calviño, Pablo Antonio. Private Consultant; ArgentinaFil: Capurro, Julia E.. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Carta, Héctor. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Caviglia, Octavio Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Entre Ríos. Facultad de Ciencias Agropecuarias; ArgentinaFil: Ciampitti, Ignacio Antonio. Kansas State University; Estados UnidosFil: Diaz Zorita, Martin. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de La Pampa. Facultad de Agronomía; ArgentinaFil: Díaz Valdéz, Santiago. Bayer Crop Science; ArgentinaFil: Echeverría, Hernán E.. Universidad Nacional de Mar del Plata. Facultad de Ciencias Agrarias; ArgentinaFil: Espósito, Gabriel Pablo. Universidad Nacional de Río Cuarto. Facultad de Agronomía y Veterinaria; ArgentinaFil: Ferrari, Manuel. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Ferraris, Gustavo Nestor. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Gambaudo, Sebastian Pedro. Universidad Nacional del Litoral. Facultad de Ciencias Agrarias; Argentina. Private Consultant; ArgentinaFil: Gudelj, Vicente. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Ioele, Juan P.. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Melchiori, Ricardo J. M.. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Molino, Josefina. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Orcellet, Juan Manuel. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Pagani, Agustin. Clarion Inc.; ArgentinaFil: Pautasso, Juan Manuel. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Reussi Calvo, Nahuel Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Laboratorio de Suelo S.a.; ArgentinaFil: Redel, Matías. Private Consultant; ArgentinaFil: Rillo, Sergio. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Rimski-korsakov, Helena. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Sainz Rozas, Hernan Rene. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Mar del Plata. Facultad de Ciencias Agrarias; Argentina. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Saks, Matías. Bunge Argentina S.A; ArgentinaFil: Tellería, María Guadalupe. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Ventimiglia, Luis. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Zorzín, Jose L.. Private Consultant; ArgentinaFil: Zubillaga de Sanahuja, María de Las Mercedes. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Salvagiotti, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Santa Fe. Estación Experimental Agropecuaria Oliveros; Argentin

Vitrectomy in Small idiopathic MAcuLar hoLe (SMALL) study: conventional internal limiting membrane peeling versus inverted flap

\ua9 The Author(s), under exclusive licence to The Royal College of Ophthalmologists 2024. Background: To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small idiopathic macular hole. Methods: Retrospective, multicentre cohort study including consecutive eyes with a ≤250 μm idiopathic macular hole treated with primary vitrectomy. The primary outcome was best-corrected visual acuity (BCVA) change and macular hole closure rate. Closure patterns on optical coherence tomography (OCT) and rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery were considered as secondary outcomes. Results: A total of 389 and 250 eyes were included in the conventional ILM peeling group and in the inverted flap group, respectively. Hole closure rate was comparable between the two groups (98.5% in the ILM peeling group and 97.6% in the inverted flap group). Mean BCVA was comparable between the two groups at baseline (p = 0.331). At 12 months, mean BCVA was 0.14 \ub1 0.19 logMAR in the conventional ILM peeling group and 0.17 \ub1 0.18 logMAR in the inverted flap group (p = 0.08). At 12 months, 73% of eyes had a U-shape closure morphology in the conventional ILM peeling group versus 55% in the inverted flap group. At 12 months, ELM recovery rate was 96% and 86% in the conventional ILM peeling group and in the inverted flap group, respectively (p < 0.001); EZ recovery rate was 78% and 69%, respectively (p = 0.04). Conclusions: The inverted flap technique provides no advantages in terms of visual outcome and closure rate in small idiopathic macular hole surgery. Additionally, this technique seems to impair postoperative restoration of external retinal layers compared with conventional peeling

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 < 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