Radical improvement of signs and symptoms in systemic lupus erythematosus when treated with hemodiafiltration with endogenous reinfusion dialysis

Lupus nephritis is one of the most serious complications of systemic lupus erythematosus (SLE). In the kidney immune complexes (ICs) and autoantibodies activate mesangial cells that secrete the cytokines that further amplify inflammatory processes. We present a case of a 42-year-old woman presented Lupus Nephritis, with periods of exacerbation of SLE, with necrotic-like skin lesions, psoriatic arthritis without skin psoriasis, purpura to lower limb, petechial rash, joint pain, fever, eyelid edema with bilateral conjunctival hyperemia and itching When she was subjected to Hemodiafiltration with Endogenous Reinfusion (HFR) dialysis treatment with super high flux membrane Synclear 02 (SUPRA treatment), fever and joint pain was reduced immediately, subsequently all of her skin damages are reduced and she gradually decreased quantity of prednisone and immunosuppressor per die until completely suspend. As well known that SUPRA treatment remove cytokine from blood ; moreover was used the High-performance liquid chromatography coupled with Quadrupole Time-of-flight Mass Spectrometer (HPLC-QTOF-MS) for identification of proteins captured by resin bed during a dialysis session of the patient. With this technique was identified several biomarker of kidney injuries, uremic toxins, fragments of Immunoglobulins, antigen involved in anti-phospholipid syndrome and a new marker (α-defensin) that correlate significantly with disease activity. The removal of these different proteins can explain the improvement in the patient’s symptoms and the normalization of her LES, confirming that SUPRA are a suitable technique for LN treatment

Machine Learning Classification of Mediterranean Forest Habitats in Google Earth Engine Based on Seasonal Sentinel-2 Time-Series and Input Image Composition Optimisation

The sustainable management of natural heritage is presently considered a global strategic issue. Owing to the ever-growing availability of free data and software, remote sensing (RS) techniques have been primarily used to map, analyse, and monitor natural resources for conservation purposes. The need to adopt multi-scale and multi-temporal approaches to detect different phenological aspects of different vegetation types and species has also emerged. The time-series composite image approach allows for capturing much of the spectral variability, but presents some criticalities (e.g., time-consuming research, downloading data, and the required storage space). To overcome these issues, the Google Earth engine (GEE) has been proposed, a free cloud-based computational platform that allows users to access and process remotely sensed data at petabyte scales. The application was tested in a natural protected area in Calabria (South Italy), which is particularly representative of the Mediterranean mountain forest environment. In the research, random forest (RF), support vector machine (SVM), and classification and regression tree (CART) algorithms were used to perform supervised pixel-based classification based on the use of Sentinel-2 images. A process to select the best input image (seasonal composition strategies, statistical operators, band composition, and derived vegetation indices (VIs) information) for classification was implemented. A set of accuracy indicators, including overall accuracy (OA) and multi-class F-score (Fm), were computed to assess the results of the different classifications. GEE proved to be a reliable and powerful tool for the classification process. The best results (OA = 0.88 and Fm = 0.88) were achieved using RF with the summer image composite, adding three VIs (NDVI, EVI, and NBR) to the Sentinel-2 bands. SVM and RF produced OAs of 0.83 and 0.80, respectively

ANALISI GEOSPAZIALI PER LA VALUTAZIONE DELLA BIOMASSA ALL’INTERNO DI UN AREA PROTETTA NEL CONTEST DELL’AREA METROPOLITANA DI ROMA

La Città Metropolitana di Roma Capitale (Italia) rappresenta una vasta area, i cui scopi non sono solo istituzionali, ma riguardano anche funzioni specifiche, come la promozione e il coordinamento dello sviluppo economico e sociale. Le aree naturali dei parchi inclusi nell’area metropolitana sono in grado di fornire servizi ecosistemici e risorse come prodotti agricoli e forestali. Lo sfruttamento razionale delle risorse di biomassa prodotte nell’area metropolitana può essere un’opportunità per sostituire i combustibili fossili, rendere la città più rispettosa del clima e, al tempo stesso, rilanciare la gestione sostenibile delle foreste che sono spesso abbandonate e a rischio di processi di degrado. L’obiettivo di questo lavoro è quello di indagare e aggiornare l’attuale distribuzione dei principali tipi forestali del Parco Naturale Regionale di Bracciano-Martignano, attraverso tecniche GIS e Remote Sensing, al fine di valutare il potenziale di biomassa presente nelle aree forestali. I risultati hanno confermato l’importanza dei dati satellitari Sentinel-2 per le applicazioni riguardo la vegetazione, consentendo di mappare specie e superfici e di effettuare altri studi su scala regionale con un’elevata precisione generale. L’analisi della distribuzione dei tipi forestali, eseguita all’interno del parco, ha mostrato che sono disponibili circa 20.000 t di biomassa legnosa all’anno, a indicare che la gestione razionale delle foreste può essere strategica per affrontare sia il degrado forestale che l’approvvigionamento energetico della città

The Longevity of Fruit Trees in Basilicata (Southern Italy): Implications for Agricultural Biodiversity Conservation

In the Mediterranean basin, agriculture and other forms of human land use have shaped the environment since ancient times. Intensive and extensive agricultural systems managed with a few cultured plant populations of improved varieties are a widespread reality in many Mediterranean countries. Despite this, historical cultural landscapes still exist in interior and less intensively managed rural areas. There, ancient fruit tree varieties have survived modern cultivation systems, preserving a unique genetic heritage. In this study, we mapped and characterized 106 living fruit trees of ancient varieties in the Basilicata region of southern Italy. Tree ages were determined through tree ring measurements and radiocarbon analyses. We uncovered some of the oldest scientifically dated fruit trees in the world. The oldest fruit species were olive (max age 680 +/- 57 years), mulberry (647 +/- 66 years), chestnut (636 +/- 66 years), and pear (467 +/- 89 years). These patriarchs hold a unique genetic resource; their preservation and genetic maintenance through agamic propagation are now promoted by the Lucan Agency for the Development and Innovation in Agriculture (ALSIA). Each tree also represents a hub for biodiversity conservation in agrarian ecosystems: their large architecture and time persistence guarantee ecological niches and micro-habitats suitable for flora and fauna species of conservation significance

ANALISI DI LUNGO PERIODO DELLA TRASFORMAZIONE DEL PAESAGGIO FORESTALE NELL’AREA METROPOLITANA DI ROMA CAPITALE A SUPPORTO DELLA GOVERNANCE DEL TERRITORIO PER LA TRANSIZIONE ECOLOGICA

Restoring the forest ecosystem’s functionality is as an urgent action for biodiversity conservation and carbon mitigation as well as for achieving the 2030 Agenda of United Nations sustainability goals. By developing a landscape dynamics framework to guide future management and planning policies we characterised the historical trend of forest area changes from 1936 to 2010 in the Metropolitan City of Rome Capital (Italy). Remote sensing-based products and historical forest maps, coupled with landscape pattern metrics and fragmentation analysis have been implemented. Two main forest landscape dynamics were reconstructed: I) the increase of forest cover fragmentation in the lowland areas; (II) the rise in forest area by recently established forest in the interior sectors of the mountain landscape, mainly within protected areas. Results revealed the urgent need to establish new protected areas and rewilding spaces. The proposed framework can be used for testing the effectiveness of environmental planning and management in other forest landscapes to achieve the Agenda 2030 goals and EU 2030 Biodiversity Strategy

Effectiveness of a randomized intervention by a geriatric team in frail hospital inpatients in non‐geriatric settings: FRAILCLINIC project

Background: Little research has been undertaken on the benefits of frailty management within different hospital settings. The objective of this study is to provide evidence on the viability and effectiveness of frailty management in non‐geriatric hospital settings on mortality and functional decline after discharge. Methods: Data from the FRAILCLINIC (NCT02643069) study were used. FRAILCLINIC is a randomized controlled trial developed in non‐geriatric hospital inpatient settings (emergency room, cardiology and surgery) from Spain (2), Italy (2) and the United Kingdom (1). Inpatients must met frailty criteria (according to the Frailty Phenotype and/or FRAIL scale), ≥75 years old. The control group (CG) received usual care. The intervention group (IG) received comprehensive geriatric assessment (CGA) and a coordinated intervention consisting in recommendations to the treating physician about polypharmacy, delirium, falls, nutrition and physical exercise plus a discharge plan. The main outcomes included functional decline (worsening ≥5 points in Barthel Index) and mortality at 3 months. We used multivariate logistic regression models adjusted by age, gender and the Charlson index. Intention‐to‐treat (ITT) and per‐protocol (PP) analyses were used. Results: Eight hundred twenty one participants (IG: 416; mean age 83.00 ± 4.91; 51.44% women; CG: 405; mean age 82.46 ± 6.03; 52.35% women) were included. In the IG, 77.16% of the participants followed the geriatric team's recommendations as implemented by the treating physicians. The intervention showed a benefit on functional decline and mortality [OR: 0.67(0.47–0.96), P‐value 0.027 and 0.29(0.14–0.57), P‐value < 0.001, respectively) when fully followed by the treating physician. A trend to benefit (close to statistical significance) in functional decline and mortality were also observed when any of the recommendations were not followed [OR (95% CI): 0.72 (0.51–1.01), P‐value: 0.055; and 0.64 (0.37–1.10), P‐value: 0.105, respectively]. Conclusions: An individualized intervention in frail in‐patients reduces the risk of functional deterioration and mortality at 3 months of follow‐up when a care management plan is designed and followed

Acute GVHD prophylaxis plus ATLG after myeloablative allogeneic haemopoietic peripheral blood stem-cell transplantation from HLA-identical siblings in patients with acute myeloid leukaemia in remission : final results of quality of life and long-term outcome analysis of a phase 3 randomised study

Background We previously showed that human anti-T-lymphocyte globulin (ATLG) plus ciclosporin and methotrexate given to patients with acute leukaemia in remission, having allogeneic haemopoietic stem-cell transplantation with peripheral blood stem cells from an HLA-identical sibling donor after myeloablative conditioning, significantly reduced 2-year chronic graft-versus-host disease (cGVHD) incidence and severity, without increasing disease relapse and infections, and improves cGVHD-free and relapse-free survival (cGRFS). The aim of an extended follow-up study was the assessment of long-term outcomes, which are, in this context, scarcely reported in the literature. We report unpublished data on quality of life (QoL) from the original study and the results of a follow-up extension. Methods In the original open-label study, patients with acute myeloid and lymphoblastic leukaemia in first or subsequent remission, having sibling HLA-identical allogeneic peripheral blood stem-cell transplantation, were randomly assigned (1:1) to receive ATLG plus standard GVHD prophylaxis with ciclosporin and short-term methotrexate (ATLG group) or standard GVHD prophylaxis without ATLG (non-ATLG group). Conditioning regimens were cyclophosphamide 120 mg/kg with either total body irradiation (12 Gy) or busulfan (12 . 8 mg/kg intravenously or 16 mg/kg orally), with or without etoposide (30-60 mg/kg). Randomisation was stratified according to centre and disease risk. The primary endpoint was cumulative incidence of cGVHD at 2 years. The primary and secondary endpoints, excluding QoL, have been published. QoL, assessed using European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-HDC29 questionnaires, was an unpublished secondary endpoint, which we now report here. A follow-up extension was then done, with the primary endpoint cumulative incidence of cGVHD. Enrolment has been completed for both studies. Findings In the original study, from Dec 14, 2006, to Feb 2, 2012, 161 patients were enrolled and 155 were randomly assigned to either the ATLG group (n=83) or to the non-ATLG group (n=72). In the follow-up study, which started on Feb 7, 2017, and was completed on June 30, 2017, 61 patients were included in the ATLG group and 53 were included in the non-ATLG group. Global health status showed a more favourable time course in the ATLG group compared with the non-ATLG group (p=0 . 02; treatment by visit interaction). ATLG was descriptively superior to non-ATLG at 24 months for physical function (points estimate -14.8 [95% CI -26.4 to-3.1]; p= 0.014) and social function (-19.1 [-38.0 to -0.2]; p=0.047), gastrointestinal side-effects (8 . 8 [2.5-15.1]; p=0 . 008) and effect on family (13.5 [1.2-25.8]; p=0.032). Extended follow-up (median 5 . 9 years [IQR 1.7-7.9]) confirmed a lower 5-year cGVHD incidence (30.0% [95% CI 21.4-41.9] vs 69.1% [59.1-80.1]; analysis for entire follow-up, p Interpretation The addition of ATLG to standard GVHD prophylaxis improves the probability of surviving without disease relapse and cGVHD after myeloablative peripheral blood stem-cell transplantation from an HLA-identical sibling donor for patients with acute leukaemia in remission. Further additional benefits are better QoL and shorter immunosuppressive treatment compared with standard GVHD prophylaxis without ATLG. Therefore, in this setting, ATLG plus standard GVHD prophylaxis should be preferred over the standard GVHD prophylaxis alone. Copyright (C) 2019 Elsevier Ltd. All rights reserved.Peer reviewe