Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments

The Oxford Classification of IgA Nephropathy (IgAN) identified mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T) as independent predictors of outcome. Whether it applies to individuals excluded from the original study and how therapy influences the predictive value of pathology remain uncertain. The VALIGA study examined 1147 patients from 13 European countries that encompassed the whole spectrum of IgAN. Over a median follow-up of 4.7 years, 86% received renin-angiotensin system blockade and 42% glucocorticoid/immunosuppressive drugs. M, S, and T lesions independently predicted the loss of estimated glomerular filtration rate (eGFR) and a lower renal survival. Their value was also assessed in patients not represented in the Oxford cohort. In individuals with eGFR less than 30 ml/min per 1.73 m 2, the M and T lesions independently predicted a poor survival. In those with proteinuria under 0.5 g/day, both M and E lesions were associated with a rise in proteinuria to 1 or 2 g/day or more. The addition of M, S, and T lesions to clinical variables significantly enhanced the ability to predict progression only in those who did not receive immunosuppression (net reclassification index 11.5%). The VALIGA study provides a validation of the Oxford classification in a large European cohort of IgAN patients across the whole spectrum of the disease. The independent predictive value of pathology MEST score is reduced by glucocorticoid/immunosuppressive therapy

Polypharmacy in older people: lessons from 10\ua0years of experience with the REPOSI\ua0register

As a consequence of population aging, we have witnessed in internal medicine hospital wards a progressive shift from a population of in-patients relatively young and mainly affected by a single ailment to one of ever older and more and more complex patients with multiple chronic diseases, followed as out-patients by many different specialists with poor integration and\ua0inevitably treated with multiple medications. Polypharmacy (defined as the chronic intake of five or more drugs) is associated with increased risks of drug\u2013drug interactions and related adverse effects, prescription and intake errors, poor compliance, re-hospitalization and mortality. With this background, the Italian Society of Internal Medicine chose to start in 2008 a prospective register called REPOSI (REgistro POliterapie SIMI, Societ\ue0 Italiana di Medicina Interna) in internal medicine and geriatric hospital wards. The country wide register is an ongoing observatory on multimorbidity and polypharmacy in the oldest old, with the goal to improve prescription appropriateness and, thus to avoid potentially inappropriate medications. The main findings of the register, that has accrued so far, 7005 older patients throughout a 10\ua0year period, are summarized herewith, with special emphasis on the main patterns of poor prescription appropriateness and related risks of adverse events

Euclid. IV. The NISP Calibration Unit

The near-infrared calibration unit (NI-CU) onboard Euclid's Near-Infrared Spectrometer and Photometer (NISP) is the first astronomical calibration lamp based on light-emitting diodes (LEDs) to be operated in space. Euclid is a mission in ESA's 'Cosmic Vision 2015-2025' framework, to explore the dark universe and provide a next-level characterisation of the nature of gravitation, dark matter, and dark energy. Calibrating photometric and spectrometric measurements of galaxies to better than 1.5% accuracy in a survey homogeneously mapping ~14000 deg^2 of extragalactic sky requires a very detailed characterisation of near-infrared (NIR) detector properties, as well their constant monitoring in flight. To cover two of the main contributions - relative pixel-to-pixel sensitivity and non-linearity characteristics - as well as support other calibration activities, NI-CU was designed to provide spatially approximately homogeneous (=100 from ~15 ph s^-1 pixel^-1 to >1500 ph s^-1 pixel^-1. For this functionality, NI-CU is based on LEDs. We describe the rationale behind the decision and design process, describe the challenges in sourcing the right LEDs, as well as the qualification process and lessons learned. We also provide a description of the completed NI-CU, its capabilities and performance as well as its limits. NI-CU has been integrated into NISP and the Euclid satellite, and since Euclid's launch in July 2023 has started supporting survey operations

Euclid. IV. The NISP Calibration Unit

International audienceThe near-infrared calibration unit (NI-CU) onboard Euclid's Near-Infrared Spectrometer and Photometer (NISP) is the first astronomical calibration lamp based on light-emitting diodes (LEDs) to be operated in space. Euclid is a mission in ESA's 'Cosmic Vision 2015-2025' framework, to explore the dark universe and provide a next-level characterisation of the nature of gravitation, dark matter, and dark energy. Calibrating photometric and spectrometric measurements of galaxies to better than 1.5% accuracy in a survey homogeneously mapping ~14000 deg^2 of extragalactic sky requires a very detailed characterisation of near-infrared (NIR) detector properties, as well their constant monitoring in flight. To cover two of the main contributions - relative pixel-to-pixel sensitivity and non-linearity characteristics - as well as support other calibration activities, NI-CU was designed to provide spatially approximately homogeneous (=100 from ~15 ph s^-1 pixel^-1 to >1500 ph s^-1 pixel^-1. For this functionality, NI-CU is based on LEDs. We describe the rationale behind the decision and design process, describe the challenges in sourcing the right LEDs, as well as the qualification process and lessons learned. We also provide a description of the completed NI-CU, its capabilities and performance as well as its limits. NI-CU has been integrated into NISP and the Euclid satellite, and since Euclid's launch in July 2023 has started supporting survey operations