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

Serum pepsinogen C: a useful marker of Helicobacter pylori eradication?

Medical treatment for Helicobacter pylori (Hp) infection is now recommended in several types of gastroduodenal disease, and its success is usually monitored by hystology. The end-points of our work were to identify the most suitable serum index of Hp eradication among pepsinogen A (PGA), pepsinogen C (PGC), PGA/PGC ratio, gastrin, and IgG anti-Hp (IGG). We studied a total of 289 Hp positive (Giemsa staining) patients, who were treated with 40 mg/day omeprazole (140 cases) or with 480 mg/day bismuth subsalicylate (149 cases) for 4 weeks. All the patients also received 1 g/day metronidazole + 2 g/day amoxycillin for the first 2 weeks of treatment. Two months after the end of therapy, the patient underwent a second endoscopy and Hp histological assessment: the infection was eradicated in 192 and still present in the remaining 97 subjects. Gastrin, PGA, PGC, and IGG were measured before and after therapy. All indices significantly decreased after therapy in eradicated patients, while PGA and gastrin significantly decreased after therapy in both eradicated and noneradicated patients, although in the latter group the variations were less pronounced. We calculated the per cent decrease of the studied indices. PGC, with a decrease of more than 25%, was found to be the most accurate biochemical index. Variation in PGC levels before and after treatment were correlated with corresponding variations in Hp bacterial load. In conclusion, between the different biochemical parameters evaluated, PGC showed the highest clinical efficiency

Paolo Veronese. L'illusione della realt\ue0.

Catalogo della mostra monografica definitiva internazionale sul pittore rinascimentale Paolo Veronese, uno dei massimi esponenti dell'arte veneta del '500. Il libro contiene saggi originali di studiosi di fama internazionale e le schede delle migliori della migliori opere pittoriche e grafiche dell'artista

Barrett\u2019s Esophagus and Adenocarcinoma Risk The Experience of the North-Eastern Italian Registry (EBRA)

Objective: To establish the incidence and risk factors for progression to highgrade intraepithelial neoplasia (HG-IEN) or Barrett\u2019s esophageal adenocarcinoma (BAc) in a prospective cohort of patients with esophageal intestinal metaplasia [(BE)]. Background: BE is associated with an increased risk of BAc unless cases are detected early by surveillance. No consistent data are available on the prevalence of BE-related cancer, the ideal surveillance schedule, or the risk factors for cancer. Methods: In 2003, a regional registry of BE patients was created in northeast Italy, establishing the related diagnostic criteria (endoscopic landmarks, biopsy protocol, histological classification) and timing of follow-up (tailored to histology) and recording patient outcomes. Thirteen centers were involved and audited yearly. The probability of progression to HG-IEN/BAc was calculated using the Kaplan-Meier method; the Cox regression model was used to calculate the risk of progression.Results: HG-IEN (10 cases) and EAc (7 cases) detected at the index endoscopy or in the first year of follow-up were considered to be cases of preexisting disease and excluded; 841 patients with at least 2 endoscopies {median, 3 [interquartile range (IQR): 2\u20134); median follow-up = 44.6 [IQR: 24.7\u2013 60.5] months; total 3083 patient-years} formed the study group [male/female = 646/195; median age, 60 (IQR: 51\u201368) years]. Twenty-two patients progressed to HG-IEN or BAc (incidence: 0.72 per 100 patient-years) after a median of 40.2 (26.9\u201350.4) months. At multivariate analysis, endoscopic abnormalities, that is, ulceration or nodularity (P = 0.0002; relative risk [RR] = 7.6; 95% confidence interval, 2.63\u201321.9), LG-IEN (P = 0.02, RR = 3.7; 95% confidence interval, 1.22\u201311.43), and BE length (P = 0.01; RR = 1.16; 95% confidence interval, 1.03\u20131.30) were associated with BE progression. Among the LG-IEN patients, the incidence of HG-IEN/EAc was 3.17 patient-years, that is, 6 times higher than in BE patients without LG-IEN. Conclusions: These results suggest that in the absence of intraepithelial neoplastic changes, BE carries a low risk of progression to HG-IEN/BAc, and strict surveillance (or ablative therapy) is advisable in cases with endoscopic abnormalities, LG-IEN or long BE segments

Millimeter-wave beam scattering and induced broadening by plasma turbulence in the TCV tokamak

The scattering of millimeter-wave beams from electron density fluctuations and the associated beam broadening are experimentally demonstrated. Using a dedicated setup, instantaneous deflection and (de-)focusing of the beam due to density blobs on the beam path are shown to agree with full-wave simulations. The detected time-averaged wave power transmitted through the turbulent plasma is reproduced by the radiative-transfer model implemented in the WKBeam code, which predicts a ∼50% turbulence-induced broadening of the beam cross-section. The role of core turbulence for the considered geometry is highlighted

FERMI Seeded FEL Progress Report

FERMI, the seeded Free Electron Laser (FEL) located at the Elettra laboratory in Trieste, Italy, welcomed in December 2012 the first external users on the FEL-1 line. This line is based on a single stage of High Gain Harmonic Generation (HGHG), seeded by a UV laser, and covers wavelengths between 80 and 20 nm. The photon energy reached more than 300 \uf06dJ. The second FEL line, FEL-2, covering the lower wavelength range between 20 and 4 nm thanks to a double stage cascaded HGHG scheme, has generated its first coherent photons in October 2012. The latter is the first experimental demonstration of a seeded free electron laser configured as a two-stage cascade operating in the "fresh bunch injection\u201d mode, where the second stage is seeded by the light produced by the first stage. This paper describes the status of the operation and user experiments with FEL-1 and reports about the progress in the commissioning of FEL-2