Dose-effect and pharmacokinetics of estrogens given to correct bleeding time in uremia

Dose-effect and pharmacokinetics of estrogens given to correct bleeding time in uremia. Conjugated estrogens have a significant and long-lasting effect in shortening bleeding time in patients with end-stage renal disease. The studies so far available indicate that repeated estrogen administrations are necessary to short bleeding time in uremia in a dose range of 95 to 325mg. With the present study we wanted to establish whether single or repeated doses are required to induce a significant shortening of bleeding time in uremia, and the minimum cumulative dose of conjugated estrogens necessary to control bleeding time for a prolonged period of time, and to check whether the prolonged effect of estrogens on bleeding time in uremia is due to an accumulation of the drug or its metabolites in the blood. Fifteen uremics on chronic hemodialysis were studied. A pilot study carried out in five uremic patients indicated that single or repeated estrogen infusions of 0.3 mg/kg did not significantly influence bleeding time values. Therefore the subsequent studies have been carried out using daily infusion of 0.6 mg/kg. A single estrogen infusion of 0.6 mg/kg shortened bleeding time in all patients. The effect was transient and bleeding time returned to pre-infusion values within 72 hours. A 50% decrease of bleeding time or a shortening of bleeding time more than 30 to 15 minutes or less was obtained in all patients with four or five infusions (0.6 mg/kg) spaced 24 hours apart. The effect lasted for 14 days. At day 25 from the last infusion all the patients had bleeding time values comparable with the pre-infusion ones. Pharmacokinetic parameters of both estrone sulfate and equilin sulfate, the major components of the estrogen mixture we used, were comparable in both controls and uremics and can be described assuming a two compartmental model. After repeated administrations of conjugated estrogens no accumulation of estrone sulfate and equilin sulfate or their metabolites was detectable in blood in both uremics and controls

Testing TSO-DSO interaction schemes for the participation of distribution energy resources in the balancing market : the SmartNet simulator

Many projections of near-future electricity system foresee a constantly increasing necessity of power flexibility services. In particular, thanks to the growing presence of renewable generation and innovative load technologies, distribution resources are becoming attractive productsin ancillary services markets. In order to open the market gates to distribution flexibility, constant interactions between transmission and distribution system operators are required and the European project SmartNet is investigating in detail the possible coordination schemes among these two actors. The paper describes the SmartNet simulator, one of the main tools developed within the project, whi ch precisely estimates the impact of TSO -DSO coordination schemes from the bidding and market clearing perspective, taking into account the consequent effects on the network physics at both transmission and distribution level

TSO-DSO coordination to acquire services from distribution grids: Simulations, cost-benefit analysis and regulatory conclusions from the SmartNet project

The continuously growing distributed generation and the business potential for demand response are gradually enabling significant provision of flexibility and reserve towards distribution networks. For this reason, transmission and distribution system operators need to coordinate their operation in order to develop efficient market arrangements that can help utilize all the resources capable of providing ancillary services. SmartNet project investigated the potential interaction schemes between network operators, together with the possible new services devoted to the optimal distribution grid management. This paper summarizes the main challenges in simulating complex electricity systems and flexibility markets for three European countries (Italy, Denmark and Spain) in 2030 scenarios. The simulation results are then analyzed using cost-benefit analysis and regulatory conclusions are deduced.European Commission's H2020 under grant agreement No 691405

A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG

: Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p = 0.02 and p = 0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach