Preventive strategies for acute kidney injury in cancer patients

Acute kidney injury (AKI) is a common complication of cancer that occurs in up to 50% of neoplastic patients during the natural history of their disease; furthermore, it has a huge impact on key outcomes such as overall prognosis, length of hospitalization and costs. AKI in cancer patients has different causes, either patient-, tumour-or treatment-related. Patient-related risk factors for AKI are the same as in the general population, whereas tumour-related risk factors are represented by compression, obstruction, direct kidney infiltration from the tumour as well by precipitation, aggregation, crystallization or misfolding of paraprotein (as in the case of multiple myeloma). Finally, treatment-related risk factors are the most common observed in clinical practice and may present also with the feature of tumour lysis syndrome or thrombotic microangiopathies. In the absence of validated biomarkers, a multidisciplinary clinical approach that incorporates adequate assessment, use of appropriate preventive measures and early intervention is essential to reduce the incidence of this life-threatening condition in cancer patients

Regulation at the Source? Comparing Upstream and Downstream Climate Policies

Climate policies can be applied either upstream, where fossil fuels are extracted, or downstream, where emissions are generated. Specific policy instruments can be defined for either level, and can take the form of a price signal such as through a tax, or a quantity limit such as through direct regulation or a permit market. In this study, we present an agent-based model to compare the performance of these different instruments and regulation levels. Since policy coverage is often limited, i.e. not all firms being under the regulator's control, we also examine the impact of incomplete coverage on relative policy performance. Our analysis shows that only upstream regulation leads to an increase in fossil fuel prices, which is benefitial under limited coverage as it also affects firms not directly affected by the policy instruments; that prices under quantity-based regulation can decline after an initial peak, stabilizing at a lower level than under the tax; and that direct regulation is more efficient when applied upstream. © 2021.This study has received funding through an ERC Advanced Grant from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement no. 741087). I.S. acknowledges financial support from the Russian Science Foundation (RSF grant number 19-18-00262)

Genetic heterogeneity in Italian families with IgA nephropathy: suggestive linkage for two novel IgA nephropathy loci.

IgA nephropathy (IgAN) is the most common glomerulonephritis worldwide, but its etiologic mechanisms are still poorly understood. Different prevalences among ethnic groups and familial aggregation, together with an increased familial risk, suggest important genetic influences on its pathogenesis. A locus for familial IgAN, called "IGAN1," on chromosome 6q22-23 has been described, without the identification of any responsible gene. The partners of the European IgAN Consortium organized a second genomewide scan in 22 new informative Italian multiplex families. A total of 186 subjects (59 affected and 127 unaffected) were genotyped and were included in a two-stage genomewide linkage analysis. The regions 4q26-31 and 17q12-22 exhibited the strongest evidence of linkage by nonparametric analysis (best P=.0025 and .0045, respectively). These localizations were also supported by multipoint parametric analysis, in which peak LOD scores of 1.83 ( alpha =0.50) and 2.56 ( alpha =0.65) were obtained using the affected-only dominant model, and by allowance for the presence of genetic heterogeneity. Our results provide further evidence for genetic heterogeneity among families with IgAN. Evidence of linkage to multiple chromosomal regions is consistent with both an oligo/polygenic and a multiple-susceptibility-gene model for familial IgAN, with small or moderate effects in determining the pathological phenotype. Although we identified new candidate regions, replication studies are required to confirm the genetic contribution to familial IgA

The IgA nephropathy Biobank. An important starting point for the genetic dissection of a complex trait

BACKGROUND: IgA nephropathy (IgAN) or Berger's disease, is the most common glomerulonephritis in the world diagnosed in renal biopsied patients. The involvement of genetic factors in the pathogenesis of the IgAN is evidenced by ethnic and geographic variations in prevalence, familial clustering in isolated populations, familial aggregation and by the identification of a genetic linkage to locus IGAN1 mapped on 6q22–23. This study seems to imply a single major locus, but the hypothesis of multiple interacting loci or genetic heterogeneity cannot be ruled out. The organization of a multi-centre Biobank for the collection of biological samples and clinical data from IgAN patients and relatives is an important starting point for the identification of the disease susceptibility genes. DESCRIPTION: The IgAN Consortium organized a Biobank, recruiting IgAN patients and relatives following a common protocol. A website was constructed to allow scientific information to be shared between partners and to divulge obtained data (URL: ). The electronic database, the core of the website includes data concerning the subjects enrolled. A search page gives open access to the database and allows groups of patients to be selected according to their clinical characteristics. DNA samples of IgAN patients and relatives belonging to 72 multiplex extended pedigrees were collected. Moreover, 159 trios (sons/daughters affected and healthy parents), 1068 patients with biopsy-proven IgAN and 1040 healthy subjects were included in the IgAN Consortium Biobank. Some valuable and statistically productive genetic studies have been launched within the 5(th )Framework Programme 1998–2002 of the European project No. QLG1-2000-00464 and preliminary data have been published in "Technology Marketplace" website: . CONCLUSION: The first world IgAN Biobank with a readily accessible database has been constituted. The knowledge gained from the study of Mendelian diseases has shown that the genetic dissection of a complex trait is more powerful when combined linkage-based, association-based, and sequence-based approaches are performed. This Biobank continuously expanded contains a sample size of adequately matched IgAN patients and healthy subjects, extended multiplex pedigrees, parent-child trios, thus permitting the combined genetic approaches with collaborative studies

How carbon pricing affects multiple human needs : an agent-based model analysis

Unidad de excelencia María de Maeztu CEX2019-000940-MClimate policy is urgently needed to reduce emissions, but must also be evaluated in regard to its impact on human quality of life. To identify policy approaches that are able to achieve effective mitigation together with high levels of well-being, multiple human needs must be taken into account. To this end, we present an agent-based model that is able to describe the interaction between various economic sectors on the supply-side and individuals with heterogeneous incomes and needs on the demand-side. Individuals make choices under both income and time constraints; the latter being needed for non-market activities and time-intensive forms of consumption such as low-carbon modes of transport. The following climate policy instruments are considered: a carbon tax, permit trading, direct regulation, and investments in low-carbon infrastructure. Impacts are analyzed in regard to three different types of mitigation: avoid, shift, and improve. Results show that to achieve emission reductions together with high levels of well-being, carbon pricing is best combined with effective improvements of low-carbon infrastructure; revenue recycling should be progressive; and unnecessary abatement costs should be avoided. A comparison is provided with traditional formulations of social welfare

Nuvole di punti e Fotogrammetria da drone per la modellazione 3D dell\u2019abbazia di Sant\u2019Eustachio a Nervesa della Battaglia (TV)

L'abbazia benedettina di Sant'Eustachio a Nervesa della Battaglia (TV), posta nel bosco del Mon-tello a ridosso del fiume Piave, risale alla prima met\ue0 dell'XI sec. e raggiunse il massimo splendore nel XVI sec. (qui mons. Giovanni Della Casa compose nel 1552 il celebre \u201cGalateo\u201d). Segu\uec una lenta decadenza con vari saccheggi e spogliazione dei beni, aggravata nel 1866 con la soppressione degli Ordini e delle Corporazioni religiose; il colpo di grazia avvenne durante la Prima Guerra Mondiale, con la distruzione di circa il 70% dell'abbazia, trovatasi in mezzo alla \u201cBattaglia del Piave\u201d. Il complesso abbaziale era composto dalla chiesa (36,77 x 20,01 m) a croce latina con tre navate, dal chiostro a pianta trapezia (15,26 x 12,35 m) e dalla parte conventuale (di lunghezza 45,58 m), originariamente su tre piani, che circondava il chiostro e si congiungeva alla chiesa. Il lavoro qui presentato \ue8 stato svolto per una tesi di laurea magistrale in Architettura presso l\u2019Universit\ue0 degli Studi di Udine ed ha riguardato la modellazione 3D dello stato di fatto, la ricostruzione 3D della situazione ante 1918 ed un\u2019ipotesi di restauro e valorizzazione. \uc8 stato eseguito un rilevamento topografico con una stazione Leica TRCA 1103, anche per ottenere il piano quotato dell\u2019intera collina, un rilevamento fotogrammetrico sia da terra, con CCD Panasonic DMC-TZ25 e Canon EOS M, che aereo mediante drone, ancora con la Canon EOS M, ed anche un rilevamento laser scanning con il sistema Faro Focus3D S120. Per elaborare ed integrare questi cinque dataset sono stati utilizzati diversi software, ad esempio mediante MeshLab e Pointools. Le elaborazioni di maggior interesse sono quelle sulle immagini con software di Structure from motion, quali 123DCatch e VisualSfM per i primi tentativi con approccio \u201ccloud computing\u201d e poi Agisoft Photoscan per ottenere il modello finale. Dopo l\u2019estrazione&matching delle features, \ue8 stato eseguito l\u2019orientamento delle immagini, sfruttando opportunamente le coordinate acquisite topograficamente e per scansione laser. Le successive fasi automatiche sono la generazione della sparse cloud, quella della dense cloud, la costruzione delle mesh del DSM ed il texture mapping di quest\u2019ultimo. Sono state ricavate una serie di ortofoto su vari piani (quattro prospetti e tre sezioni raster in scala 1:100) che poi sono state vettorializzate ed opportunamente migliorate in ambiente CAD (le corrispondenti sette rappresentazioni vector) quali dettagliate mappe del degrado; sono state create anche tre piante-sezioni a diversa quota in scala 1:100. A partire dal modello 3D delle rovine, \ue8 stato quindi creato un modello solido 3D virtuale dell\u2019intero complesso antecedente alla Prima Guerra Mondiale, facendo riferimento ad informazioni documentarie e ad immagini d\u2019epoca, alcune di fonte militare. Infine \ue8 stato creato un ulteriore modello 3D virtuale, quello del progetto dell\u2019ipotetico restauro e basato proprio sul modello 3D ante 1918, i cui volumi saranno ricreati mediante una struttura tubolare che ripropone gli spigoli dell\u2019estradosso e dell'intradosso. L'idea di fondo \ue8 quella di proteggere e garantire solidit\ue0 strutturale ai pochi muri rimasti e, allo stesso tempo, di valorizzare il sito. I tubi di acciaio dell'intradosso saranno disposti a gruppi di quattro nella posizione originaria della pilastratura della navata centrale, mentre gli archi tra le campate saranno realizzati con un telaio metallico mascherato da due fasce in legno. L\u2019originario soffitto a cassettoni sar\ue0 ricostruito con un telaio in acciaio rivestito di legno e cassettoni in vetro. L'estradosso sar\ue0 costituito ancora da una struttura tubolare e, per la copertura, da un sistema di teli abbassabili in caso di maltempo. In definitiva, questo esempio illustra come le tecniche geomatiche hanno permesso di costruire il modello 3D dello stato di fatto, ma anche come esso \ue8 stato restaurato virtualmente per modellare lo stato originario e come quest\u2019ultimo abbia guidato il progetto di restauro dei volumi crollati

The basics of onco-nephrology in the renal clinic

Onconephrology is a rapidly evolving subspecialty that covers all areas of renal involvement in cancer patients. The complexity of the field may benefit from well-defined multidisciplinary management by a dedicated team. Patients with cancer frequently suffer from concurrent chronic kidney disease (CKD), with a prevalence ranging from 12% to 53% at the time of cancer diagnosis. Taking into account the incidence of cancer and the prevalence of CKD in the Italian population, we estimate that about 44,000 patients suffered from both diseases in 2020. Since there is an increasing necessity to address the needs of this population in dedicated outpatient clinics, it is critical to highlight some basic characteristics and to suggest areas of development. Our experience in the nephrological management of cancer patients clearly suggests the need to implement dedicated multidisciplinary teams and to create onconephrology clinics (at least within larger, referral, hospitals). Furthermore, it must be kept in mind that not only is CKD common in cancer patients, but also that the concomitant presence of these two conditions too often excludes cancer patients from clinical trials, thus limiting their access to therapies that could potentially improve their outcomes. Indeed, the Renal Insufficiency and Cancer Medications (IRMA) study found that cancer patients with CKD or on dialysis are often undertreated, or are exposed to either ineffective or toxic anticancer agents. Finally, the aim of this article is to initiate a debate about what an onconephrology outpatient clinic might look like, in order to ensure the highest quality of care for this growing patient population