Mercato elettrico europeo: analisi delle prescrizioni tecnico-economiche per il servizio di regolazione della frequenza

In questi ultimi decenni il settore elettrico ha subito profondi cambiamenti passando da una struttura verticalmente integrata ad un contesto di libero mercato. Tale processo di liberalizzazione ha ricevuto un forte impulso grazie alla Direttiva 96/92/CE, che ha portato alla nascita, sebbene con modalità e tempi differenti, dei mercati elettrici a carattere perlopiù nazionale. Alla base di questo cambiamento vi è il concetto di assimilare l’energia elettrica ad una qualsiasi altra merce, ed in quanto tale essa deve poter circolare in modo libero in ambito comunitario. Questa evoluzione del sistema elettrico, ha interessato anche la gestione della regolazione della frequenza. In passato infatti era gestito dalle società verticalmente integrate, le quali si occupavano dell’intera filiera (produzione,trasmissione, distribuzione) che quindi decidevano in maniera del tutto autonoma a quali impianti demandare questo servizio. Con il passaggio al contesto liberalizzato, la gestione della regolazione della frequenza è stata affidata all’Operatore del sistema il quale dovrà reperire le risorse necessarie per attuare la regolazione della frequenza, dai produttori in modo trasparente e senza discriminazioni. Pertanto ciascun Operatore del Sistema ha stabilito delle regole, contenute nei rispettivi codici di rete, con cui gestisce questo servizio. Un primo scopo di questo elaborato è quello di analizzare le prescrizioni per il servizio di regolazione della frequenza e le modalità con cui i produttori vengono retribuiti per il servizio svolto in Italia, Spagna, Francia e Germania, verificando poi che queste siano in linea con le prescrizioni previste a livello internazionale dall’UCTE. Ma l’evoluzione del sistema elettrico è tuttora in atto infatti l’UE con l’emanazione del terzo pacchetto energetico ha affidato all’ENTSO-E (il nuovo organismo a livello europeo che coordina gli operatori del sistema di trasmissione e che sostituisce l’UCTE) il compito di delineare le linee guida che porteranno alla nascita, entro il 2014, del “Mercato Unico dell’Energia” in ambito europeo. Quindi in secondo luogo, con il seguente elaborato si analizzeranno le modalità con cui il mercato unico dell’energia sta prendendo forma

The Renal Problems in X-Ray Based Imaging Techniques Using lodinated Radiographic Contrast Agents

Iodinated radiographic contrast agents (IRCA) are pharmaceuticals commonly used for improving the visibility of internal organs and structures in X-ray based imaging techniques such as radiography, angiography and contrast-enhanced computed tomography scans, and for performing cardiac catheterizations and percutaneous coronary interventions. Like all other pharmaceuticals, however, these agents are not completely devoid of risk. The main risk is their nephrotoxicity. Following the description of Contrast-Induced Nephropathy (CIN) and its pathogenesis, the conditions favoring the development of CIN are discussed in depth. The main predisposing condition is a pre-existing renal impairment, particularly when associated with diabetes mellitus. Then, measures to prevent CIN are suggested. The important rules in CIN prevention are: monitoring renal function, discontinuation of potentially nephrotoxic drugs, use of either iodixanol or iopamidol at the lowest dosage possible. Above all, the main procedure for prevention of CIN is an adequate hydration of the patient with either isotonic sodium chloride or sodium bicarbonate solutions

The potential use of biomarkers in predicting contrast-induced acute kidney injury.

Contrast-induced acute kidney injury (CI-AKI) is a problem associated with the use of iodinated contrast media, causing kidney dysfunction in patients with preexisting renal failure. It accounts for 12% of all hospital-acquired kidney failure and increases the length of hospitalization, a situation that is worsening with increasing numbers of patients with comorbidities, including those requiring cardiovascular interventional procedures. So far, its diagnosis has relied upon the rise in creatinine levels, which is a late marker of kidney damage and is believed to be inadequate. Therefore, there is an urgent need for biomarkers that can detect CI-AKI sooner and more reliably. In recent years, many new biomarkers have been characterized for AKI, and these are discussed particularly with their use in known CI-AKI models and studies and include neutrophil gelatinase-associated lipocalin, cystatin C (Cys-C), kidney injury molecule-1, interleukin-18, N-acetyl-β-d-glucosaminidase, and L-type fatty acid-binding protein (L-FABP). The potential of miRNA and metabolomic technology is also mentioned. Early detection of CI-AKI may lead to early intervention and therefore improve patient outcome, and in future any one or a combination of several of these markers together with development in technology for their analysis may prove effective in this respect

Social capital in chronic disease: an ethnographic study

Chronically ill conditions are particularly difficult to manage because of their impact both on the social and on the corporal sphere to such an extent as to involve a series of problems that negatively alter the quality of life of affected patients. Chronicity has also a considerable ef-fect on social capital. In the current literature, it is known that social capital may contribute to a range of advantages to people health. Chronic Venous Disease (CVD) includes several pathologi-cal alterations of the venous system of the lower limbs that cause a wide range of symptoms and signs. The aim of this study is to explore, with a qualitative approach, the dynamics of social cap-ital within people's experience of CVD and describe the roles of family and friends and the health care system. The method used is based on face-to-face semistructured interviews was performed, following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Six-teen patients were included: 11 women and 5 men. The results obtained are completely in line with the current literature, which shows a certain difficulty in terms of daily activities, pain management; work-related difficulties; non-coverage of healthcare costs for medications and drugs prescribed. In the context of social capital, the bonding social capital of the patients inter-viewed was more positively perceived in the role of CVD management than by the patients' fami-lies. Another interesting result concerns the total absence of knowledge of patient associations with CVD. Thus, alongside the biographical destruction that CVD entails, there is evidence of the scarce relevance and presence of health policies capable of improving the quality of life of these people not only from a social and medical point of view but also from an economic point of vie

RAAS Inhibitor Prescription and Hyperkalemia Event in Patients With Chronic Kidney Disease: A Single-Center Retrospective Study

Hyperkalemia is common in patients treated with renin–angiotensin–aldosterone system inhibitors (RAASis), and it represents the main cause of the large gap reported between guideline recommendations and real-world practice in chronic kidney disease (CKD). We conducted a CKD-population-based restrospective study to determine the prevalence of patients with CKD treated with RAASis, incidence of hyperkalemia in patients with CKD treated with RAASis, and proportion of patients with RAASi medication change after experiencing incident hyperkalemia. Among 809 patients with CKD analyzed, 556 (68.7%) were treated with RAASis, and RAASi prescription was greater in stages 2–4 of CKD. Hyperkalemia occurred in 9.2% of RAASi-treated patients, and the adjusted rate of hyperkalemia among patients with stage 4–5 CKD was 3-fold higher compared with patients with eGFR > 60 ml/min/1.73 m(2). RAASi treatment was discontinued in 55.3% of the patients after hyperkalemia event (74.2% discontinued therapy, 3.2% received a reduced dose, and 22.6% reduced the number of RAASi drugs). This study shows that the incidence of hyperkalemia is frequently observed in patients with CKD patients with RAASis, and that rates increase with deteriorating levels of kidney function from stages 1 to 3. RAASi medication change following an episode of hyperkalemia occurred in almost half of the patients after experiencing hyperkalemia

the choice of the iodinated radiographic contrast media to prevent contrast induced nephropathy

In patients with preexisting renal impairment, particularly those who are diabetic, the iodinated radiographic contrast media may cause contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI), that is, an acute renal failure (ARF), usually nonoliguric and asymptomatic, occurring 24 to 72 hours after their intravascular injection in the absence of an alternative aetiology. Radiographic contrast media have different osmolalities and viscosities. They have also a different nephrotoxicity. In order to prevent CIN, the least nephrotoxic contrast media should be chosen, at the lowest dosage possible. Other prevention measures should include discontinuation of potentially nephrotoxic drugs, adequate hydration with i.v. infusion of either normal saline or bicarbonate solution, and eventually use of antioxidants, such as N-acetylcysteine, and statins

Effect of paricalcitol vs calcitriol on hemoglobin levels in chronic kidney disease patients: a randomized trial

Recent studies suggest that vitamin D deficiency represents an additional cofactor of renal anemia, with several mechanisms accounting for this relationship. In line with it, the administration of vitamin D or its analogues has been associated with an improvement of anemia. There are no data, however, about a direct effect of paricalcitol on hemoglobin (Hb) levels. Therefore, we conducted a study to determine whether paricalcitol, compared to calcitriol, improves anemia in patients with chronic kidney disease (CKD)

New-onset hemodialysis-related headache presenting as migraine aura

Hemodialysis headache (HDH) is an infrequent new-onset symptom, occurring mainly in old uremic patients. Type of pain is nonspecific, occurs during hemodialysis treatment, assuming features similar to tension-type headache and representing a problem, also as regards the therapy to be taken. International Headache Society (IHS) has placed this form of headache among the headaches disorders of homeostasis. We found a case of new-onset HDH in old uremic man, presenting with migraine aura features. A similar case has not been reported in literature, placing us some questions: why and how does this happen? What are the mechanisms involved? Role of trigeminal-vascular system and cortical spreading depression as regards the aura could be considered, through the activation of neuroinflammatory events, lastly causing migraine aura. Moreover, the administration of flunarizine strongly improved migraine symptoms in our patient, as happens in migraine syndromes. Definitely, this case leads us to think that some mechanisms involved in headaches will need to be further clarified

Precision Nephrology Is a Non-Negligible State of Mind in Clinical Research:Remember the Past to Face the Future

CKD is a major public health problem. It is characterized by a multitude of risk factors that, when aggregated, can strongly modify outcome. While major risk factors, namely, albuminuria and low estimated glomerular filtration rate (eGFR) have been well analyzed, a large variability in disease progression still remains. This happens because (1) the weight of each risk factor varies between populations (general population or CKD cohort), countries, and single individuals and (2) response to nephroprotective drugs is so heterogeneous that a non-negligible part of patients maintains a high cardiorenal risk despite optimal treatment. Precision nephrology aims at individualizing cardiorenal prognosis and therapy. The purpose of this review is to focus on the risk stratification in different areas, such as clinical practice, population research, and interventional trials, and to describe the strategies used in observational or experimental studies to afford individual-level evidence. The future of precision nephrology is also addressed. Observational studies can in fact provide more adequate findings by collecting more information on risk factors and building risk prediction models that can be applied to each individual in a reliable fashion. Similarly, new clinical trial designs can reduce the individual variability in response to treatment and improve individual outcomes