Bone fragility in patients with diabetes mellitus: A consensus statement from the working group of the Italian Diabetes Society (SID), Italian Society of Endocrinology (SIE), Italian Society of Gerontology and Geriatrics (SIGG), Italian Society of Orthopaedics and Traumatology (SIOT)

Bone fragility is one of the possible complications of diabetes, either type 1 (T1D) or type 2 (T2D). Bone fragility can affect patients of different age and with different disease severity depending on type of diabetes, disease duration and the presence of other complications. Fracture risk assessment should be started at different stages in the natural history of the disease depending on the type of diabetes and other risk factors. The risk of fracture in T1D is higher than in T2D, imposing a much earlier screening and therapeutic intervention that should also take into account a patient's life expectancy, diabetes complications etc. The therapeutic armamentarium for T2D has been enriched with drugs that may influence bone metabolism, and clinicians should be aware of these effects.Considering the complexity of diabetes and osteoporosis and the range of variables that influ-ence treatment choices in a given individual, the Working Group on bone fragility in patients with diabetes mellitus has identified and issued recommendations based on the variables that should guide screening of bone fragility and management of diabetes and bone fragility: (A) ge, (B)MD, (C)omplications, (D)uration of disease, & (F)ractures (ABCD&F). Consideration of these parameters may help clinicians identify the best time for screening, the appropriate glycaemic target and anti-osteoporosis drug for patients with diabetes at risk of or with bone fragility.(c)& nbsp;2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved

Pedagogia nas Produções Acadêmicas da Pós-Graduação em Educação no RS: Análise dos Movimentos de Sentidos

Pedagogy in Academic Production of Graduate Education in RS: Analysis of the Movements of SensesRESUMOO texto sistematiza estudo dos sentidos de Pedagogia e de Curso de Pedagogia, nas teses e dissertações da Pós-graduação em Educação pública no RS, concluídas entre 2010 e 2019. Comparou-se os sentidos e avaliou-se a evidência de uma defesa da Pedagogia como ciência da Educação. O aporte teórico-metodológico teve por base a Análise de Movimentos de Sentidos – AMS. Observou-se que na produção acadêmica, assim como no cotidiano dos cursos licenciatura em Pedagogia, a concepção de Pedagogia é negligenciada ou, quando evidenciada, é superficial, permitindo imprecisões relativas à descrição da abrangência e especificidade do Curso e do entendimento acerca desta área do conhecimento.Palavras-chave: Pedagogia; Análise dos Movimentos de Sentidos; Pesquisa em Educação. ABSTRACTThe text systematizes study of the meanings of Pedagogy and Pedagogy Course, in the theses and dissertations of the Postgraduate in Education, publics, in RS, finish between 2010 and 2019. The meanings were compared and the existence or referral of a defense was evaluated. of Pedagogy as a science of Education. The theoretical and methodological contribution was based on the Analysis of Sense Movements - AMS. It was observed that in the academic production, as in the daily life of the degree courses in Pedagogy, the conception of Pedagogy is neglected or, when evidenced, is superficial, allowing evident inaccuracies regarding the description of the Course's comprehensiveness and specificity and the understanding about this area of knowledge.Keywords: Pedagogy; analysis of sense movements; research in educatio

SUPERVISED INTERNSHIP IN THE PEDAGOGY COURSE: WHAT THE PEDAGOGICAL PROJECTS SAY AND WHAT SENSES PRODUCED BY GRADUATES

Se presenta un análisis de los Proyectos pedagógicos (PP) de los cursos de pedagogía en las cinco universidades federales de Rio Grande do Sul, con el objetivo de resaltar los significados en las referencias en relación con las pasantías supervisadas. Se asumió que la pasantía supervisada sería el tiempo y el espacio privilegiado para el contacto, el trabajo y la inserción en el campo profesional, a través del proyecto y la orientación de los maestros del Curso. En cuanto a los aspectos teóricos y metodológicos, se llevaron a cabo dos etapas. En el primero, se realizó un análisis documental de los Proyectos pedagógicos de los cinco cursos de pedagogía. En la segunda etapa, se envió un cuestionario a un grupo de graduados del curso de Pedagogía en una de las cinco universidades, compuesto de preguntas destinadas a contemplar y relacionarse con el análisis realizado en los PP. Las preguntas fueron sobre la concepción, experiencia / experiencia y la evaluación de la pasantía supervisada en el curso de pedagogía en esa universidad. Once interlocutores, diez mujeres y un hombre, graduados del Curso entre 2013 y 2020, participaron en las entrevistas. Los datos fueron analizados por el Análisis del Movimiento de los Sentidos, una técnica desarrollada por el grupo de investigación en el que trabajamos. Una de las percepciones, después del estudio, es que hay una pasantía supervisada prevista en los proyectos pedagógicos. Sin embargo, no se encontraron significados y conceptos de pasantías supervisadas. Del mismo modo, los discursos de los alumnos lo describen como una práctica, no con poca frecuencia, disociándolo de la teoría y considerándolo una prioridad que no se ve en el Curso.An analysis of the Pedagogical Projects (PP) of the Pedagogy courses at the five Federal Universities of Rio Grande do Sul is presented, aiming to highlight the meanings in referrals in relation to the Supervised Internships. It was assumed that the supervised internship would be the privileged time and space for contact, work and insertion in the professional field, through project and guidance by the teachers of the Course. As for the theoretical and methodological aspects, two stages were carried out. In the first, there was a documentary analysis of the Pedagogical Projects of the five Pedagogy courses. In the second stage, a questionnaire was sent to a group of graduates of the Pedagogy course at one of the five universities, composed of questions aimed at contemplating and relating to the analysis carried out in the PPs. The questions were about the conception, experience / experience and the evaluation of the Supervised Internship in the Pedagogy Course at that university. Eleven interlocutors, ten women and one man, graduating from the Course between 2013 and 2020, participated in the interviews. The data were analyzed by the Analysis of Movement of Senses, a technique developed by the research group in which we work. One of the perceptions, after the study, is that there is a supervised internship foreseen in the pedagogical projects. However, no supervised internship meanings and conceptions were found. Likewise, the speeches of the alumni describe it as a practice, not infrequently, dissociating it from the theory and considering it a priority not seen in the Course.Apresenta-se análise dos Projetos Pedagógicos (PP) dos cursos de Pedagogia das cinco Universidades Federais do Rio Grande do Sul, objetivando evidenciar os sentidos em encaminhamentos em relação aos Estágios Supervisionados. Partiu-se do suposto que o estágio supervisionado seria o tempo e o espaço privilegiados para o contato, o trabalho e a inserção no campo profissional, mediante projeto e orientação por parte dos professores do Curso. Quanto aos aspectos teóricos e metodológicos, foram realizadas duas etapas. Na primeira, aconteceu análise documental dos Projetos Pedagógicos dos cinco cursos de Pedagogia. Na segunda etapa foi enviado um questionário para um grupo de egressos do curso de Pedagogia de uma das cinco universidades, composto por questões objetivando contemplar e relacionar à análise realizada nos PPs. As questões versavam sobre a concepção, vivência/experiência e a avaliação do Estágio Supervisionado no Curso de Pedagogia naquela universidade. Onze interlocutores, dez mulheres e um homem, egressos do Curso entre 2013 e 2020, participaram das entrevistas. Os dados foram analisados pela Análise de Movimentos de Sentidos, técnica elaborada pelo grupo de pesquisa no qual se trabalha. Uma das percepções, após o estudo, é haver estágio supervisionado previsto nos projetos pedagógicos. Entretanto, não foram encontrados expressos sentidos e concepções de estágio supervisionado. Do mesmo modo, os discursos dos egressos descrevem como prática, não raramente, dissociando-a da teoria e considerando-a prioridade não vislumbrada no Curso

Proposition of critical levels and nutrient sufficiency ranges in leaves of 'White Moscato' (Vitis vinifera 'Muscat') and 'Bordeaux' (Vitis labrusca 'Ives')

The Compositional Nutrients Diagnosis (CND) can establish indexes that establish deficiency, normality or excess, and even critical levels (CL) or sufficiency ranges (SR) in grapevine leaves. However, this information is scarce in 'White Moscato' and 'Bordeaux' cultivars cultivated in subtropical regions of the world. The study aimed to propose the CND, CL and SR indexes of nutrients in leaves of 'Bordeaux' and 'White Moscato' grapevine cultivars, cultivated in subtropical conditions. Leaves were collected from 105 'White Moscato' and 'Bordeaux' vineyards. Leaves were prepared, dried, ground and subjected to chemical nutrient analysis. Productivity was evaluated. The nutritional status of the grapevine was calculated using the CND method. The CND-r2 indexes were effective in establishing the nutritional status of 'White Moscato' and 'Bordeaux' grapevines, in relation to the concentration of nutrients in leaves of N, P, K, Ca, Mg, B, Cu, Fe, Mn and Zn in deficient, adequate and excessive concentrations. The application of the CND method in the grapevine database showed lower SRs for macronutrients N, K, Ca, Mg and S, and the breadth of the nutritional range for nutrients N, K, Mg, and Fe was smaller than reported in literature. The CND methodology established the critical level and nutrient sufficiency ranges suitable under current grapevine production conditions. Multi-nutrient combinations were more effective than the analysis of a single nutrient in expressing that the limitation of a certain element can reduce the productivity of the grapevines

Full characterization of plasmids from Achromobacter ruhlandii isolates recovered from a single patient with cystic fibrosis (CF)

In the last decade Achromobacter spp. has been associated with chronic colonization in patients with cystic fibrosis (CF). Although Achromobacter xylosoxidans is the most frequent species recovered within this genus, other species such as A. ruhlandii have also been reported in these patients. Descriptions of mobile elements are scarce in Achromobacter and none of them have been originated in A. ruhlandii. The aim of this study was to report the full characterization of a plasmid which was maintained in four clonally related A. ruhlandii isolates. Between 2013 and 2015, nine A. ruhlandii isolates were recovered from a pediatric patient with CF at a hospital in Buenos Aires. Four selected clonally related isolates were sequenced by Illumina MiSeq, annotated using RAST and manually curated. The presence of a unique plasmid of 34096-bp and 50 CDS was observed in the four isolates, displaying only 1 nucleotide substitution translated into one amino acid change among them. These plasmids have a class 1 integron containing the aac-(6′)-Ib gene, a mercury resistance operon region and the relE/stbE toxin/antitoxin system. Plasmids showed 79% similarity and 99% identity with pmatvim-7 from Pseudomonas aeruginosa. This is the first full description and characterization of a plasmid from A. ruhlandii which was maintained over time

Risk of recurrence and conditional survival in complete responders treated with TKIs plus or less locoregional therapies for metastatic renal cell carcinoma

PURPOSE: We retrospectively analyzed the risk of recurrence and conditional Disease-Free Survival (cDFS) in 63 patients with complete remission during treatment with tirosin kinase inhibitor (TKI), alone or with local treatment in metastatic renal cell carcinoma. RESULTS: 37% patients achieve CR with TKI alone, while 63% with additional loco-regional treatments. 49% patients recurred after CR, with a median Disease free survival of 28.2 months. Patients treated with multimodal approaches present lower rate of recurrence (40% vs 61%) and longer Disease free survival compared to patient treated with TKI alone (16.5 vs 41.9 months, p=0.039).Furthermore the rate of recurrence was higher in patients with brain (88%), pancreatic (71%) and bone metastasis (50%). Patients who continued TKI therapy after complete response had a longer disease free survival than patients who stopped therapy, although the difference was not significant (42.1 vs 25.1 months, p=0.254). 2y-cDFS was better in patients treated with multimodal treatment and who continued TKIs than the other patient arms.NS: The prognostic value of CR depends on the site where was obtained and how was obtained (with or without locoregional treatment). Cessation of TKI should be carefully considered in complete responder patients

Are Urologists Ready for Interpretation of Multiparametric MRI Findings? A Prospective Multicentric Evaluation

Aim: To assess urologists’ proficiency in the interpretation of multiparametric magnetic resonance imaging (mpMRI). Materials and Methods: Twelve mpMRIs were shown to 73 urologists from seven Italian institutions. Responders were asked to identify the site of the suspicious nodule (SN) but not to assign a PIRADS score. We set an a priori cut-off of 75% correct identification of SN as a threshold for proficiency in mpMRI reading. Data were analyzed according to urologists’ hierarchy (UH; resident vs. consultant) and previous experience in fusion prostate biopsies (E-fPB, defined as <125 vs. ≥125). Additionally, we tested for differences between non-proficient vs. proficient mpMRI readers. Multivariable logistic regression analyses (MVLRA) tested potential predictors of proficiency in mpMRI reading. Results: The median (IQR) number of correct identifications was 8 (6–8). Anterior nodules (number 3, 4 and 6) represented the most likely prone to misinterpretation. Overall, 34 (47%) participants achieved the 75% cut-off. When comparing consultants vs. residents, we found no differences in terms of E-fPB (p = 0.9) or in correct identification rates (p = 0.6). We recorded higher identification rates in urologists with E-fBP vs. their no E-fBP counterparts (75% vs. 67%, p = 0.004). At MVLRA, only E- fPB reached the status of independent predictor of proficiency in mpMRI reading (OR: 3.4, 95% CI 1.2–9.9, p = 0.02) after adjusting for UH and type of institution. Conclusions: Despite urologists becoming more familiar with interpretation of mpMRI, their results are still far from proficient. E-fPB enhances the proficiency in mpMRI interpretation

Diagnostic and prognostic potential of the proteomic profiling of serum-derived extracellular vesicles in prostate cancer

Extracellular vesicles (EVs) and their cargo represent an intriguing source of cancer biomarkers for developing robust and sensitive molecular tests by liquid biopsy. Prostate cancer (PCa) is still one of the most frequent and deadly tumor in men and analysis of EVs from biological fluids of PCa patients has proven the feasibility and the unprecedented potential of such an approach. Here, we exploited an antibody-based proteomic technology, i.e. the Reverse-Phase Protein microArrays (RPPA), to measure key antigens and activated signaling in EVs isolated from sera of PCa patients. Notably, we found tumor-specific protein profiles associated with clinical settings as well as candidate markers for EV-based tumor diagnosis. Among others, PD-L1, ERG, Integrin-β5, Survivin, TGF-β, phosphorylated-TSC2 as well as partners of the MAP-kinase and mTOR pathways emerged as differentially expressed endpoints in tumor-derived EVs. In addition, the retrospective analysis of EVs from a 15-year follow-up cohort generated a protein signature with prognostic significance. Our results confirm that serum-derived EV cargo may be exploited to improve the current diagnostic procedures while providing potential prognostic and predictive information. The approach proposed here has been already applied to tumor entities other than PCa, thus proving its value in translational medicine and paving the way to innovative, clinically meaningful tools

GPIIb/IIIa Receptor Antagonism Using Small Molecules Provides no Additive Long-Term Protection after Percutaneous Coronary Intervention as Compared to Clopidogrel Plus Aspirin

Background: There is some controversy as to whether tirofiban or eptifibatide, two small anti-aggregating drugs (AAD), may reduce the incidence of composite ischemic events within one year in patients undergoing percutaneous coronary intervention (PCI) in the real clinical world. Methods: We compared consecutive patients on oral double AAD (with clopidogrel and aspirin) who underwent PCI (n=207) and patients who were on single AAD and received a second AAD, just prior to PCI, and either high-dose tirofiban or double-bolus eptifibatide (double AAD plus small molecules group, n=666). The primary end point (incidence of composite ischemic events within one year) included death, acute myocardial infarction, unstable angina, stent thrombosis or repeat PCI or coronary bypass surgery (related to the target vessel PCI failure) and was modelled by Cox's regression. Results: There were 89 composite ischemic events: 24 (11.6%) in double AAD alone and 65 (9.8%) in double AAD plus small molecules groups (log-rank test: p=0.36). Incidences by type of ischemic events were similar between the 2 groups. Based on 21 potential covariates fitted simultaneously, adjusted hazard ratios (HR and 95% confidence intervals) showed that age (HR 1.03, 1.01-1.06, p=0.01), diabetes (HR 1.68, 1.01-2.79, p=0.05) and intra aortic balloon pump (HR 5.12, 2.36-11.10, p=0.0001) were significant risk factors whereas thrombolysis by tenecteplase (HR 0.35, 0.13-0.98, p=0.05) and having had hypertension or anti-hypertensive treatment (HR 0.58, 0.36-0.93, p=0.03) were significant protectors for events. Whether small molecules were present provided a non significant additional benefit as compared to double AAD alone (HR 0.83, 0.51-1.36, p=0.46). Pre-PCI CK-MB were not useful to predict events (HR 1.01, 0.99-1.01, p=0.17). Conclusions: In clinical world patients undergoing PCI (rescue plus primary <13%) while on double AAD, based on clopidogrel plus aspirin, small molecules (tirofiban or eptifibatide) provided no additive long-term protection against the occurrence of composite ischemic events whereas thrombolysis by tenecteplase did. © Schiariti et al