Chronic kidney disease and urological disorders: systematic use of uroflowmetry in nephropathic patients

Background. Chronic kidney disease (CKD) is a highly prevalent condition. Urologic disorders are known causes of CKD, but often remain undiagnosed and underestimated also for their insidious onset and slow progression. We aimed to evaluate the prevalence of urological unrecognized diseases in CKD patients by uroflowmetry. Methods. We enrolled consecutive stable CKD outpatients. The patients carried out two questionnaires, the International Prostate Symptom Score and Incontinence Questionnaire-Short Form, and they also underwent uroflowmetry, evaluating max flow rate (Qmax), voiding time and voided volume values. Results. A total of 83 patients (43 males, mean age of 59.8613.3 years) were enrolled. Our study showed 28 males and 10 females with a significant reduction of Qmax (P<0.001) while 21 females reported a significant increase of Qmax (P<0.001) with a prevalence of 49.5% of functional urological disease. Moreover, we showed a significant association between Qmax and creatinine (P¼0.013), estimated glomerular filtration rate (P¼0.029) and voiding volume (P¼0.05). We have not shown significant associations with age (P¼0.215), body mass index (P¼0.793), systolic blood pressure (P¼0.642) or diastolic blood pressure (P¼0.305). Moreover, Pearson’s chi-squared test showed a significant association between Qmax altered with CKD (v2 ¼1.885, P¼0.170) and recurrent infection (v2¼8.886, P¼0.012), while we have not shown an association with proteinuria (v2¼0.484, P¼0.785), diabetes (v2¼0.334, P¼0.563) or hypertension (v2¼1.885, P¼0.170).Conclusions. We showed an elevated prevalence of urological diseases in nephropathic patients; therefore, we suggest to include uroflowmetry in CKD patient assessment, considering the non-invasiveness, repeatability and low cost of examination. Uroflowmetry could be used to identify previously unrecognized urological diseases, which may prevent the onset of CKD or progression to end-stage renal disease and reduce the costs of management

The potential role of advanced glycation end products in food allergy pathogenesis

prevalence has dramatically increased in the last two decades. Among dietary factors, it has been hypothesized that advanced glycation endproducts(AGEs), present at high level in junk food, could be involved in FA pathogenesis. AGEs are a heterogeneous group of compounds deriving from sugars(sweets and beverages), autoclaved/processed foods, microwaved foods, more roasted/barbecued meat. To evaluate the AGEs levels in FA children compared with healthy controls and subjects with respiratory allergy. Methods: We evaluated paediatric patients with challenge-proven FA, children with respiratory allergy(RA) and age and sex-matched healthy controls. Subcutaneous AGEs levels were evaluated through the AGE reader. Food-frequency questionnaires were evaluated in all study subjects. In vitro studies were performed on human enterocytes(Caco-2 cells) stimulated with 200 mg/ml of BSA-AGE for 24and48 hours to evaluate effects on gut barrier function: mucin2(mucus production), transpithelial electrical resistance(TEER), ZO-1, occludin expression(intestinal permeability). The direct effects elicited on peripheral blood mononuclear cells (PBMCs) after the treatment with 200 mg/ml of BSA-AGE for 48hours, 4and 7days of treatment were also evaluated. RESULTS: 115 subjects were evaluated and subdivided into 3 groups: group 1 patients with FA (n=31); group 2 patients with RA (n=18), group 3 healthy controls (n=66). The consumption of food containing AGEs was higher in subjects with FA compared to RA children and healthy controls (p<0.05). FA and RA children presented significant higher subcutaneous AGEs levels compared to healthy controls (p<0.05). Linear regression analysis confirmed a significant positive correlation between subcutaneous levels of AGEs and consumption of food containing AGEs. Human enterocytes exposed to BSA-AGE treatment showed a reduction of TEER, of Muc2 and tight junction proteins (Occludin and ZO-1). Moreover, the treatment with BSA-AGE on human PBMCs stimulates pro-inflammatory cytokines TNF-α and Th2 cytokines(IL-5 and IL-13)production , but it was unable to modulate IL-10 production. Finally, after7days of treatment with BSAAGE, we found a low percentage of proliferating CD4+T. CONCLUSIONS: Current hypotheses and models of FA do not adequately explain the dramatic increase observed in the last years

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6&nbsp;years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P &lt; 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100&nbsp;years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Doing Social Research on Online Communities: The Benefits of Netnography

In social science research, Netnography has become a widely accepted research method. It has been used to tackle a wide variety of topics from culture to identity, social relationships and civic empowerment. Netnography can be broadly defined as a qualitative research approach that adapts the traditional ethnographic techniques to the study of the ―net‖, which is the online communities, practices and cultures formed through computer-mediated communications. Both Ethnography and Netnography are naturalistic and unobtrusive approaches, interested in studying social practices in their everyday context (Kozinets, 2010). They are both multi-method, methodologically flexible and adaptive, not confining themselves to following specific procedures, but rather remaining open to issues arising from the field (Varis, 2014). However, Netnography differs from Ethnography under some crucial points. Entering the online culture diverges from face-to-face entrée in terms of accessibility and research design. From a data collection perspective, Netnography is far less time consuming; however, it requires a new set of skills due to the specificities of computer-mediated communication and its dramatically increased field site accessibility, which requires choices about field sites and decisions about types of data to gather and analyse. Moreover, it is far less intrusive than traditional Ethnography as it allows for researcher invisibility: the cyberspace makes it possible for researchers to be unseen from people observed. This allows to document the explicit language of informants without the risk of obtrusiveness and disturbance. This paper presents the methodological specificities of Netnography focusing on its context of application, the definition of the method, the research design: from the objectives and research questions‘ setting, to sites‘ selection and cultural entrée, from the type of data to be collected, to the way to classify, analyse and represent them. The paper will also discuss some examples of netnographic studies in social sciences

Testing attention restoration in a virtual reality driving simulator

Objectives: Attention Restoration Theory (ART) suggests that walking or being in natural settings, as opposed to urban environments, benefits cognitive skills because it is less demanding on attentional resources. However, it is unclear whether the same occurs when the person is performing a complex task such as driving, although it is proven that driving through different road environments is associated with different levels of fatigue and may engage attention differently. The present study investigated whether exposure to rural vs. urban road environments while driving would affect attentional capacity in young people after the drive, in line with the classic ART paradigms. Methods: We asked 38 young participants to complete the Sustained Attention to Response Task (SART) before and after being exposed to a rural or urban road in a virtual reality environment while driving in a full vehicle immersive driving simulator. Changes in SART performance based on environmental exposure where explored in terms of target sensitivity, accuracy, reaction times, and inverse efficiency. We analyzed potential road type effects on driving speed and accuracy. Possible effects of driving on attention were tested by comparing the sample performance to that of a control group of 15 participants who did not drive and sat on the passenger seat instead. Results: Exposure to rural or urban road environments in the driving sample was not associated with any significant changes in attentional performance. The two exposure groups did not differ significantly in terms of driving behavior. Comparisons between the driving sample and the control group controlling for age indicated that participants who drove were more accurate but slower at the SART than those who were passengers. Conclusion: The present study does not support the hypothesis that a short drive in a natural setting may promote attention restoration as compared to an urban setting. Methodological considerations as well as recommendations for future research are discussed

Multiuse Polystyrene Plates for Phasing Out Single‐Use Plastics: Chemical Performances and Environmental Impact Assessment Through a Life Cycle Approach

European governments are addressing plastic pollution by implementing the Directive EU 2019/904 that bans single‐use items like cutlery, plates, straws, and beverage stirrers. One strategy proposed by several industries to continue their production is the conversion of single‐use items into multiuse items. Herein, the focus is on the production of polystyrene reusable plates and the suitability of this product for microwave and dishwasher use is assessed: in proper conditions, the structure is preserved without cuts or visible deformations, and the chemical stability is guaranteed. To get a full picture of the benefits and impacts of this new product, a life cycle assessment methodology is applied to compare the performances of one reusable plate with 20 single‐use plates. Results indicate that proper use is crucial: a reusable plate disposed after one use is more impactful than a single‐use plate. In contrast, the reuse of plates for 20 times allows to reduce carbon footprint and acidification potential. Eutrophication and ozone layer depletion, on the other hand, increase due to the washing phase. The solutions that can mitigate these issues and enhance the sustainability of the reusable plates include the improvement of the detergent compositions and the use of electricity from renewable sources

Prebiotic Therapy with Inulin Associated with Low Protein Diet in Chronic Kidney Disease Patients: Evaluation of Nutritional, Cardiovascular and Psychocognitive Parameters

A relationship between dysbiotic gut microbiome and chronic kidney disease (CKD) has been recently documented; it contributes to CKD-related complications, including cardiovascular disease. Aim: We tested how a low-protein diet (LPD)—with or without oral inulin supplementation as a prebiotic—modulates some inflammatory, atherosclerosis and endothelial dysfunction indices and nutritional markers, as well as psychocognitive functions in CKD patients. We conducted a prospective, case–control study on CKD patients on conservative therapy, divided in two groups: the intervention group treated with LPD (0.6 g/kg/day) plus inulin (19 g/day) and a control group treated with LPD without inulin, for six consecutive months. Clinical and hematochemical parameters as well as instrumental, and psychocognitive assessments (by SF-36 survey and MMSE, HAM-D, BDI-II) were recorded in all the participants at baseline (T0), at three months (T1) and at six months (T2). A total of 41 patients were enrolled: 18 in the intervention group and 23 in the control group. At T2, in both groups, we observed a significant reduction of serum nitrogen and phosphorus (p 0.01) and serum uric acid (p 0.03), and an improvement in metabolic acidosis (bicarbonates, p 0.01; base excess, p 0.02). Moreover, at T2 the intervention group showed a reduction in serum insulin (p = 0.008) and fasting glucose levels (p = 0.022), HOMA-IR (p = 0.004), as well as lower total serum cholesterol (p = 0.012), triglycerides (p = 0.016), C-reactive protein (p = 0.044) and homocysteine (p = 0.044) and higher HDL (p &lt; 0.001) with respect to baseline. We also observed a significant amelioration of some quality of life and functional status indices (SF-36 survey) among the intervention group compared to controls, without a significant improvement in the cognitive state (MMSE). On the other hand, an amelioration in mood (by HAM-D and BDI-II) was found in the intervention group and in controls (only by BID-II). In conclusion, LPD in association with oral inulin supplementation improved glycemic and lipid metabolism and ameliorated the systemic inflammatory state, likely reducing cardiovascular risk in CKD patients and this may represent a promising therapeutic option, also improving quality of life and mood