New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of working group on CKD-MBD of the Italian Society of Nephrology

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago

New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of working group on CKD-MBD of the Italian Society of Nephrology

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago

Aneurysms and pseudoaneurysms in dialysis access

Aneurysms are a common and often difficult complication seen with arteriovenous vascular access for haemodialysis. The purpose of this narrative review is to define and describe the scale of the problem and suggested therapeutic strategies. A narrative review of the published literature illustrated by individual cases is presented with the aim of summarising the relevant literature. The definitions of aneurysm are inconsistent throughout the literature and therefore systematic review is impossible. They vary from qualitative descriptions to quantitative definitions using absolute size, relative size and also size plus characteristics. The incidence and aetiology are also ill defined but separation into true aneurysms and false, or pseudoaneurysms may be helpful in planning treatment, which may be conservative, surgical or radiological. The lack of useful definitions and classification along with the multitude of management strategies proposed make firm evidence based conclusions difficult to draw. Further robust well designed studies are required to define best practice for this common problem

Ti-Nb-Ta-Y-REE oxides in the NYF pegmatites of Baveno and Cuasso al Monte, Southern Alps (Italy)

Denver (Colorado) US

Effects of different peritoneal dialysis fluids on the TH1/TH2 balance

Background. Peritoneal dialysis (PD) is associated with a depression of T cell function, as suggested by the impaired production of cytokines by Th cells collected from PD patients. Although treatment biocompatibility could be implicated in this immune dysfunction, it has been poorly investigated, thus far. Therefore, we undertook a study aiming to analyze the effects of different peritoneal dialysis fluids on the Th1/Th2 balance in PD patients. Methods. Twenty three patients on continuous ambulatory peritoneal dialysis (CAPD) were evaluated. Seven patients were on CAPD with icodextrin solution (ICO-PD), seven with glucose and lactate/bicarbonate-buffered solution (LAC/BIC-PD), and nine with glucose and lactate-buffered solution (LAC-PD). The Th1/Th2 balance was evaluated by measuring IFN-gamma (Th1 subset) and IL-4 (Th2 subset), both in circulating and peritoneum-derived Th lymphocytes unstimulated or stimulated by phytohemoagglutinin (PHA). Moreover inflammatory, nutritional and dialysis-related parameters were recorded. Eight normal subjects comprised the control group (CON). Results. Circulating T cells: IFN-gamma was significantly lower in the LAC-PD group (p<0.05) compared to the ICO-PD and LAC/BIC-PD groups. The IFN-gamma/IL-4-producing cell ratio was significantly lower in PD patients than in CON. Peritoneal T cells: after 24-h PHA stimulation, IFN-gamma increased in all patients, but the rise was less pronounced in the LAC-PD group (p<0.05) than in the other two PD groups. The Th1/Th2 ratio was significantly lower in the LAC-PD group when compared both to LAC/BIC-PD and ICO-PD groups. In addition, the LAC-PD group presented a significantly higher rate of peritoneal infections compared to the other PD groups. Conclusions. CAPD with lactate-buffered peritoneal fluid has deleterious effects on the Th1 cell subset, while the use of more biocompatible fluids, bicarbonate-buffered and icodextrin, is associated with a more physiologically representative Th1/Th2 balance and a reduced peritonitis rate

Tazzoliite: a new mineral with a pyrochlore-related structure from Euganei hills, Padova (Italy).

Tazzoliite, ideally Ba 2CaSr 0.5Na 0.5Ti 2Nb 3SiO 17[PO 2(OH) 2] 0.5, is a new mineral (IMA 2011-018) from Monte delle Basse, Euganei Hills, Galzignano Terme, Padova, Italy. It occurs as lamellar pale orange crystals, which are typically a few m m thick and up to 0.4 mm long, closely associated with a diopsidic pyroxene and titanite. Tazzoliite is transparent. It has a white streak, a pearly lustre, is not fluorescent and has a hardness of 6 (Mohs' scale). The tenacity is brittle and the crystals have a perfect cleavage along 010. The calculated density is 4.517 g cm -3. Tazzoliite is biaxial (-) with 2V meas of 3c50\ub0, it is not pleochroic and the average refractive index is 2.04. No twinning was observed. Electronmicroprobe analyses gave the following chemical formula: (Ba 1.93Ca 1.20Sr 0.52Na 0.25Fe 2+0.10) \u3a34(Nb 2.88Ti 2.05Ta 0.07Zr 0.01V 5+0.01) \u3a35.02SiO 17[(P 0.13Si 0.12S 0.07) \u3a30.32O 0.66(OH) 0.66] [F 0.09(OH) 0.23] \u3a30.32. Tazzoliite is orthorhombic, space group Fmmm, with unit-cell parameters a = 7.4116(3), b = 20.0632(8), c = 21.4402(8) \uc5, V = 3188.2(2) \uc5 3 and Z = 8. The crystal structure, obtained from single-crystal X-ray diffraction data, was refined to R 1(F2) = 0.063. It consists of a framework of Nb(Ti) octahedra and BaO 7 polyhedra sharing apexes or edges, and Si tetrahedra sharing apexes with Nb(Ti) octahedra and BaO 7 polyhedra. The structure, which is related to the pyrochlore structure, contains three Nb(Ti) octahedra: two are Nb dominant and one is Ti dominant. Chains of A2O 8 polyhedra [A2 being occupied by Sr(Ca, Fe)] extend along [100] and are surrounded by Nb octahedra. Channels formed by six Nb(Ti) octahedra and two tetrahedra, or four A1O 8(OH) polyhedra (A1 being occupied by Ba), alternate along [100]. The channels are partially occupied by [PO 2(OH) 2] in two possible mutually exclusive positions, alternating with fully occupied A3O 7 polyhedral pairs [A3 being occupied by Ca(Na)]. The seven strongest X-ray powder diffraction lines [d in \uc5 (I/I 0) (hkl)] are: 3.66 (60) (044), 3.16 (30) (153), 3.05 (100) (204), 2.98 (25) (240), 2.84 (50) (064), 1.85 (25) (400) and 1.82 (25) (268). Raman spectra of tazzoliite were collected in the range 150-3700 cm -1 and confirm the presence of OH groups. Tazzoliite is named in honour of Vittorio Tazzoli in recognition of his contributions to the fields of mineralogy and crystallography