Serum Free Light Chains Removal by HFR Hemodiafiltration in Patients with Multiple Myeloma and Acute Kidney Injury. a Case Series

Background/Aims: Multiple myeloma (MM) represents 10% of all haematologic malignancies. Renal involvement occurs in 50% of MM patients; of them, 12-20% have acute kidney injury (AKI), with 10% needing dialysis at presentation. While hemodialysis (HD) has no effect upon circulating and tissue levels of monoclonal proteins, novel apheretic techniques aim at removing the paraproteins responsible for glomerular / tubular deposition disease. High cut-off HD (HCO-HD) combined with chemotherapy affords a sustained reduction of serum free light chains (FLC) levels. One alternative technology is haemodiafiltration with ultrafiltrate regeneration by adsorption on resin (HFR–SUPRA), employing a “super high-flux” membrane (polyphenylene S-HF, with a nominal cut-off of 42 kD). Aim of our pilot study was to analyze the effectiveness of HFR-SUPRA in reducing the burden of FLC, while minimizing albumin loss and hastening recovery of renal function in 6 subjects with MM complicated by AKI. Methods: Six HD-dependent patients with MM were treated with 5 consecutive sessions of HFR-SUPRA on a Bellco® monitor, while simultaneously initiating chemotherapy. Levels of albumin and FLC were assessed, calculating the rates of reduction. Renal outcome, HD withdrawal and clinical follow-up or death were recorded. Results: All patients showed a significant reduction of FLC, whereas serum albumin concentration remained unchanged. In three, HD was withdrawn, switching to a chemotherapy alone regimen. The other patients remained HD-dependent and died shortly thereafter for cardiovascular complications. Conclusion: Our study suggests that HFR-SUPRA provides a rapid and effective reduction in serum FLC in patients with MM and AKI

The Embioptera from the Strait of Sicily Islands: first records from Pantelleria and Lampedusa and new data from Lampione (Sicily, Italy)

The occurrence of Embioptera in the Strait of Sicily islands was up to date known only from Lampione (the smallest of the Pelagie islands), where the only species reported was provisionally assigned to Embia ramburi Rimski-Korsakow, 1905. Based on material recently collected by the authors, the presence of Embioptera is here reported for the first time in the Islands of Pantelleria (Sicily, Trapani) and Lampedusa (Sicily, Agrigento). In the Island of Pantelleria the occurrence of the typical small silky tunnels produced by Embioptera has been verified in many sites, from sea level to Montagna Grande (836 m). In many of these sites, several juveniles and some adult or subadult specimens were collected and reared, obtaining an adult male belonging to Cleomia guareschii Stefani, 1953. Moreover, a single adult male of E. ramburi was collected in Lampedusa, the largest of the Pelagian Islands. Finally, the fauna of Embioptera from Lampione remains still poorly known, as it was possible to examine only two females recently collected in the island, and identified as Embia sp

Expression of interferon-inducible chemokines and sleep/wake changes during early encephalitis in experimental African trypanosomiasis

Background: Human African trypanosomiasis or sleeping sickness, caused by the parasite Trypanosoma brucei, leads to neuroinflammation and characteristic sleep/wake alterations. The relationship between the onset of these alterations and the development of neuroinflammation is of high translational relevance, but remains unclear. This study investigates the expression of interferon (IFN)-γ and IFN-inducible chemokine genes in the brain, and the levels of CXCL10 in the serum and cerebrospinal fluid prior to and during the encephalitic stage of trypanosome infection, and correlates these with sleep/wake changes in a rat model of the disease. Methodology/Principal findings: The expression of genes encoding IFN-γ, CXCL9, CXCL10, and CXCL11 was assessed in the brain of rats infected with Trypanosoma brucei brucei and matched controls using semi-quantitative end-point RT-PCR. Levels of CXCL10 in the serum and cerebrospinal fluid were determined using ELISA. Sleep/wake states were monitored by telemetric recording. Using immunohistochemistry, parasites were found in the brain parenchyma at 14 days post-infection (dpi), but not at 6 dpi. Ifn-γ, Cxcl9, Cxcl10 and Cxcl11 mRNA levels showed moderate upregulation by 14 dpi followed by further increase between 14 and 21 dpi. CXCL10 concentration in the cerebrospinal fluid increased between 14 and 21 dpi, preceded by a rise in the serum CXCL10 level between 6 and 14 dpi. Sleep/wake pattern fragmentation was evident at 14 dpi, especially in the phase of wake predominance, with intrusion of sleep episodes into wakefulness. Conclusions/Significance: The results show a modest increase in Cxcl9 and Cxcl11 transcripts in the brain and the emergence of sleep/wake cycle fragmentation in the initial encephalitic stage, followed by increases in Ifn-γ and IFN-dependent chemokine transcripts in the brain and of CXCL10 in the cerebrospinal fluid. The latter parameter and sleep/wake alterations could provide combined humoral and functional biomarkers of the early encephalitic stage in African trypanosomiasis

Serum anti‐müllerian hormone levels and risk of premature ovarian insufficiency in female childhood cancer survivors: Systematic review and network meta‐analysis

Background: Female childhood cancer survivors (CCS) might have impaired ovarian reserves, especially after alkylating agents or radiotherapy. The purpose of this systematic review and network meta‐analysis is to evaluate the role of serum anti‐Müllerian hormone (AMH) for ovarian reserve screening and the risk of premature ovarian insufficiency (POI) according to the subtype of childhood cancer. (2) Methods: PRISMA‐NMA guidelines were followed. We carried out a network meta‐analysis based on a random effects model for mixed multiple treatment comparisons to rank childhood cancers effects on fertility by surface under the cumulative ranking curve (SUCRA). Studies were selected only if they had an age‐matched control group. Quality assessment was performed using Newcastle–Ottawa Scale. The co‐primary outcomes were mean AMH levels and the incidence of POI. (3) Results: A total of 8 studies (1303 participants) were included. Women treated for a neuroblastoma during infancy were more likely to be ranked first for impaired AMH levels (SUCRA = 65.4%), followed by mixed CCS (SUCRA = 29.6%). The greatest rates of POI were found in neuroblastoma survivors (SUCRA = 42.5%), followed by acute lymphoid leukemia (SUCRA = 26.3%) or any other neoplasia (SUCR A= 20.5%). (4) Conclusions: AMH represents a trustworthy approach for ovarian reserve screening. Direct and indirect comparisons found no differences in mean AMH levels and POI risk between subtypes of CCS and healthy controls. SUCRA analysis showed that female neuroblastoma survivors were more at risk for reduced serum AMH levels and increased risk of POI

Gestión del talento humano y desempeño laboral de los colaboradores del supermercado Plaza Vea Ceres, Ate 2019

La presente investigación tuvo como objetivo general identificar en qué medida la gestión de talento humano se relaciona con el desempeño laboral de los colaboradores del Supermercado Plaza Vea Ceres, Ate 2019. El diseño de la investigación fue no experimental de corte transversal y nivel correlacional. La población objeto de estudio estuvo conformado por 35 son colaboradores del área de caja del Supermercado Plaza Vea Ceres, se trabajó con el total de la población, es decir se trabajó con una muestra censal. La técnica que se utilizó fue la encuesta, el instrumento fue el cuestionario, el cual se obtuvo un alfa de Cronbach de 0.903, lo cual significa que tuvo una confiabilidad muy alta y una validación de contenido del 84% por parte de los expertos. De manera global, se concluye que existe una relación positiva alta entre gestión de talento humano y desempeño laboral; es decir que una adecuada gestión del talento humano genera mejora significativa del desempeño laboral de los colaboradores, Se realizó la prueba de normalidad tomando como estadístico de Shapiro Wilk por tener una muestra de 35 colaboradores, dando como nivel de significancia (bilateral) de 0.000 el cual es menor al 0.05, por lo tanto, las variables no tienen una distribución normal y se acepta el estadístico no paramétrico, por consiguiente el coeficiente de correlación llegaría a ser del Rho Spearman dando como resultado (Rho= 0.755); denotando una correlación positiva alta, quedando confirmado con la significancia estadística

Common Law, Charity, and Human Rights as Responses to the Socio-Economic Crisis in Galicia, Spain

This article presents the findings of a research project analyzing the effects of the Spanish socio-economic crisis on rural areas. It describes the perceptions of social workers in the public sector engaged in community practice and the perceptions of social leaders working for public and private human service organizations within the province of Ourense, Spain. It explores how the current economic crisis has affected people, health care units and the social workers’ scope of action. The study relied on secondary data, surveys and qualitative interviews. Study findings suggest that the adopted measures for responding to the effects of the crisis have been scarce. The primary responses to the crisis include privatization of human services and the transfer of responsibility from government to civil society organizations. Instead of focusing on charity, this study in Galicia, Spain proposes a greater focus on rural social work and on the promotion and defense of human rights by civic and other organizations

Radiation therapy affects YAP expression and intracellular localization by modulating lamin A/C levels in breast cancer

The microenvironment of breast cancer actively participates in tumorigenesis and cancer progression. The changes observed in the architecture of the extracellular matrix initiate an oncogene-mediated cell reprogramming, that leads to a massive triggering of YAP nuclear entry, and, therefore, to cancer cell proliferation, invasion and probably to increased radiation-resistance. However, it is not yet fully understood how radiotherapy regulates the expression and subcellular localization of YAP in breast cancer cells experiencing different microenvironmental stiffnesses. To elucidate the role of extracellular matrix stiffness and ionizing radiations on YAP regulation, we explored the behaviour of two different mammary cell lines, a normal epithelial cell line (MCF10A) and a highly aggressive and invasive adenocarcinoma cell line (MDA-MB-231) interacting with polyacrylamide substrates mimicking the mechanics of both normal and tumour tissues (~1 and ~13 kPa). We report that X-ray radiation affected in a significant way the levels of YAP expression, density, and localization in both cell lines. After 24 h, MCF10A and MDA-MB231 increased the expression level of YAP in both nucleus and cytoplasm in a dose dependent manner and particularly on the stiffer substrates. After 72 h, MCF10A reduced mostly the YAP expression in the cytoplasm, whereas it remained high in the nucleus of cells on stiffer substrates. Tumour cells continued to exhibit higher levels of YAP expression, especially in the cytoplasmic compartment, as indicated by the reduction of nuclear/ cytoplasmic ratio of total YAP. Then, we investigated the existence of a correlation between YAP localization and the expression of the nuclear envelope protein lamin A/C, considering its key role in modulating nuclear deformability and changes in YAP shuttling phenomena. As supposed, we found that the effects of radiation on YAP nucleus/cytoplasmic expression ratio, increasing in healthy cells and decreasing in tumour ones, were accompanied by lower and higher lamin A/C levels in MCF10A and MDAMB-231 cells, respectively. These findings point to obtain a deeper knowledge of the role of the extracellular matrix and the effects of X-rays on YAP and lamin A/C expression that can be used in the design of doses and timing of radiation therapy

Healthcare-associated Clostridium difficile infection: role of correct hand hygiene in cross-infection control

Introduction - Clostridium difficile (CD) is the most common cause of health-care-associated infectious diarrhea and incidence and severity have increased in recent years. The main cause of hospital’s acquired cross infections can be attributed to incorrect hand hygiene. We described the epidemiology of CD infection (CDI) in a teaching hospital in Southern Italy during a two years surveillance period and evaluated the health-care workers compliance to hand hygiene.Methods - CDI Incidence rates were calculated as the number of patients with positive C. difficile toxin assay per 10,000 patient-days. Compliance with hand hygiene was the ratio of the number of performed actions to the number of opportunities observed. Approximately 400 Hand Hygiene (HH) opportunities/year /ward were observed.We finally checked out if any correlation could be found.Results - From January 2015 to December 2016 a total number of 854 CD determinations were performed in patients with clinical symptoms of diarrhea. The search for toxins A and B was positive in 175 cases (21,2 %), confirming the diagnosis of CDI.Compliance to hand hygiene was significantly inversely associated with the number of CDIs: the lower the compliance of  health-care workers with hand hygiene the higher was the number of cases of CDIs (p=0.003).Conclusion - According to our results proper handwashing of health-care workers appears to be a key intervention in interrupting CD cross infections regardless of age and type of department in which the patient is admitted.