Safety and treatment compliance of subcutaneous immunotherapy: A 30-year retrospective study

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Photosynthetic Membranes Part 71. Laboratory-scale photomineralization of n-alkanols in aqueous solution by photocatalytic membranes immobilizing titianium dioxide

Kinetics of photocatalytic oxidn. of methanol, ethanol, n-propanol, n-heptanol, and n-decanol to yield intermediates, and photomineralization of intermediates to yield carbon dioxide and water, was studied in aq. soln. using a lab.-scale photoreactor and photocatalytic membranes immobilizing 30\ub13 wt.% of TiO2, in the presence of stoichiometric quantities of hydrogen peroxide as oxygen donor. The whole vol. of the irradiated soln. was 4.000\ub10.005 L, and the ratio between this vol. and the geometrical apparent surface of the irradiated side of the photocatalytic membrane 3.8\ub10.1 cm. A kinetic model was used, by which mineralization of substrate to CO2 was supposed to occur through one single intermediate (kinetic consts. k1), mediating the behavior of all the numerous real intermediates formed in the path from the substrate to CO2 (kinetic consts. k2). A competitive Langmuirian adsorption of both substrate and "intermediate" was also supposed to be operative, expressed by the apparent adsorption consts. K1 and K2. By Langmuir - Hinshelwood treatment of the initial rate data, the starting values of the k and K couples were obtained, from which, by a set of differential equations, the final optimized parameters, k1 and K1, k2 and K2 were calcd. While in the case of alkanoic acids, values of k1 and k2 were roughly coincident, in the case of n-alkanols investigated in this work, k2 values were higher than k1 of the same mols. This is interpreted on the basis of the closer behavior, from the photocatalytic point of view, of alkanols to hydrocarbons compared to their corresponding carboxylic acids. Furthermore, values of k2 for methanol were practically the same as those of k1 for the corresponding acid. This behavior confirms the suggestion of being methanoic acid the most representative intermediate for photodegrdn. of methanol

Le concessioni di lavori e di servizi (Cap. VII)

Il contributo concerne la disciplina delle concessioni di lavori e servizi contenuta nel nuovo codice dei contratti (d.lgs. n. 50 del 2016) alla luce della direttiva n. 2014/23/UE. In particolare si è approfondito l'oggetto e l'ambito di applicazione delle concessioni, le procedure di aggiudicazione e di affidamento delle concessioni , il subappalto e la possibilità di modificare i contratti in corso, il riparto di giurisdizione.This contribution relates to the rules on works concessions and services contained in the new contract code (Legislative Decree No 50 of 2016) in the light of Directive No. 2014/23 / EU. In particular, the scope of the concessions, the procedures for the award and the granting of concessions, the subcontracting and the possibility of modifying existing contracts, the division of jurisdiction, have been examined

Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial

Background The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes. Methods TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50\ue2\u80\u9375 years with type 2 diabetes inadequately controlled with metformin monotherapy (2\ue2\u80\u933 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15\ue2\u80\u9345 mg) or a sulfonylurea (5\ue2\u80\u9315 mg glibenclamide, 2\ue2\u80\u936 mg glimepiride, or 30\ue2\u80\u93120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856. Findings Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57\uc2\ub73 months. The primary outcome occurred in 105 patients (1\uc2\ub75 per 100 person-years) who were given pioglitazone and 108 (1\uc2\ub75 per 100 person-years) who were given sulfonylureas (hazard ratio 0\uc2\ub796, 95% CI 0\uc2\ub774\ue2\u80\u931\uc2\ub726, p=0\uc2\ub779). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0\uc2\ub70001). Moderate weight gain (less than 2 kg, on average) occurred in both groups. Rates of heart failure, bladder cancer, and fractures were not significantly different between treatment groups. Interpretation In this long-term, pragmatic trial, incidence of cardiovascular events was similar with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as add-on treatments to metformin. Both of these widely available and affordable treatments are suitable options with respect to efficacy and adverse events, although pioglitazone was associated with fewer hypoglycaemia events. Funding Italian Medicines Agency, Diabete Ricerca, and Italian Diabetes Society

A survey of clinical features of allergic rhinitis in adults

Background: Allergic rhinitis (AR) has high prevalence and substantial socio-economic burden.Material/Methods: The study included 35 Italian Centers recruiting an overall number of 3383 adult patients with rhinitis (48% males, 52% females, mean age 29.1, range 18-45 years). For each patient, the attending physician had to fill in a standardized questionnaire, covering, in particular, some issues such as the ARIA classification of allergic rhinitis (AR), the results of skin prick test (SPT), the kind of treatment, the response to treatment, and the satisfaction with treatment.Results: Out of the 3383 patients with rhinitis, 2788 (82.4%) had AR: 311 (11.5%) had a mild intermittent, 229 (8.8%) a mild persistent, 636 (23.5%) a moderate-severe intermittent, and 1518 (56.1%) a moderate-severe persistent form. The most frequently used drugs were oral antihistamines (77.1%) and topical corticosteroids (60.8%). The response to treatment was judged as excellent in 12.2%, good in 41.3%, fair in 31.2%, poor in 14.5%, and very bad in 0.8% of subjects. The rate of treatment dissatisfaction was significantly higher in patients with moderate-to-severe AR than in patients with mild AR (p<0.0001). Indication to allergen immunotherapy (AIT) was significantly more frequent (p<0.01) in patients with severe AR than with mild AR.Conclusions: These findings confirm the appropriateness of ARIA guidelines in classifying the AR patients and the association of severe symptoms with unsuccessful drug treatment. The optimal targeting of patients to be treated with AIT needs to be reassessed