ASSOCIATION OF CALCIFEDIOL LEVELS WITH VERTEBRAL FRACTURES, VASCULAR CALCIFICATIONS AND MORTALITY.

The best biomarker of Vitamin D status is calcifediol [25(OH)D]. We investigated the relationship between serum calcifediol levels and vertebral fractures (VF), vascular calcifications (VC) and mortality in hemodialysis patients. Within a multicenter, cross-sectional study in 18 hospital based dialysis centers in Italy, we included 387 hemodialysis patients (143 F, 37% ; 244 M, 63%), mean age 64±14 (SD) years, median dialytic age 49 months, BMI 25± 4 Kg/m2. We determined total 25(OH)D using the LIASON® 25 OH Vitamin D kit (DiaSorin Inc., Stillwater MN, USA). We evaluated VF with a computerized analysis of scanned L-L vertebral X-rays (T4 to L5). Reduction of > 20% of vertebral body height was considered a VF, while reductions between 15% and 20% were considered borderline fractures (BF). Fracture severity was estimated as mild, moderate or severe (reduction: 20–25%, 25–40% or >40%, respectively). VC assessments were also centralized. Witteman's method (Lancet, 1994) was used for blinded assessments in duplicate. VC were quantified by measuring the length of calcific deposits along the anterior and posterior wall of the aorta (mild 0.1-5 cm, moderate 5.1-10 cm and severe >10 cm). We also evaluated the presence or absence of calcifications of the iliac arteries in the same radiograph (mild 0.1-3 cm, moderate 3.1-5 cm and severe >5cm). Any differences in VC were resolved by consensus. Follow up was 2.7±0.5 years. Bone markers were: Ca 9.15±0.68 mg/dl, P 4.8± 1.28 mg/dl, median ALP 83 U/L and median PTH 244 pg/ml. We found a median 25(OH)D level of 28.9 ng/ml. Nine ( 2.3%) patients had vitamin D deficiency (30 ng/ml). We found that 55% of patients had VF and 30.9% of patients had BF. Prevalence of VC was 80.6% (mild 20.1%, moderate 30.8%, severe 29.7%) in the aorta and 55,1% in the iliac arteries. Males had more VF than Females (60% versus 48%, P=0.019). No associations were found between VF and biochemical parameters including calcifediol levels (p=0.662), while we found an association between low calcifediol levels and a higher prevalence of severe aortic calcifications (36.8 vs 28.2, p=0.0044). Furthermore, we found a OR 1.85 (1.04-3.29 CI, p=0.0367) for Aortic Calcification in patients with calcifediol levels lower than the median value of 29 ng/ml. During follow-up (2.7±0.5 years) mortality was of 19.9%. No association was found between mortality and calcifediol levels (p=0.5394). In conclusion, despite good control of bone and mineral metabolism parameters, hemodialysis patients showed high prevalence of VF and VC. Our study suggests that high calcifediol levels could be protective against progression of severe aortic calcificatio

Diagnosis of Iron Deficiency in Patients Undergoing Hemodialysis

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Sosiaalisen median hyödyntäminen Nuori Yrittäjyys -ohjelman näkyvyyden lisäämiseksi

Opinnäytetyön aiheena ovat sosiaalinen media ja yrittäjyyskasvatus. Työn tarkoituksena on antaa Etelä-Savon ammattiopistolle ideoita, kuinka opiskelijat saataisiin kiinnostumaan yrittäjyyskoulutuksesta sosiaalista mediaa hyödyntämällä. Yrittäjyyskoulutuksella tässä opinnäytetyössä tarkoitetaan Nuori Yrittäjyys-ohjelmaa, joka on osa kasainvälistä Junior Achievement – Young Enterprise -verkostoa. Tutkimusongelmat työssä olivat, kuinka Etelä-Savon ammattiopiston opiskelijat saataisiin kiinnostumaan Nuori Yrittäjyys-ohjelmasta sosiaalista mediaa hyödyntämällä ja mitkä ovat ne sosiaalisen median kanavat, joiden kautta nuoret tavoitetaan ja minkälainen sisältö heitä kiinnostaa. Teoreettinen viitekehys koostui yrittäjyydestä, yrittäjyyskasvatuksesta ja markkinoimisesta sosiaalisessa mediassa. Teoriaosuudessa käsitellään myös sisältömarkkinointia ja sisältöstrategiaa. Kyseessä on laadullinen tutkimus. Aineistonkeruumenetelmänä työssä käytettiin teemahaastattelua. Haastattelun kaksi pääteemaa olivat sosiaalinen media ja NY-yrittäjyys. Tutkimusjoukoksi valikoitui työn aiheen ja tutkimusongelmien perusteella viisi Etelä-Savon ammattiopiston nuorta opiskelijaa, jotka eivät ole itse NY-yrittäjiä, mutta tietävät ohjelman ja pääasiat siitä. Tutkimuksen perusteella kävi ilmi, että nuoret käyttävät sosiaalista mediaa paljon ja se on tehokas tapa tavoittaa nuoret. Nuoret käyttävät eniten Instagramia, Facebookia, Snapchatia ja Youtubea. Sisällön osalta heitä kiinnostavat selvästi eniten kuvat ja videot. Johtopäätelmänä voidaan sanoa, että toimeksiantajan tulisi hyödyntää sosiaalista mediaa NY-yrittäjyyden markkinoimisessa nuorille. NY-yrittäjyyden markkinoimisessa tulisi hyödyntää etenkin nykyisiä NY-yrittäjiä, sillä heillä on sosiaalisen median osaamista ja nuoret olisivat kiinnostuneita seuraamaan yrittäjien itse julkaisemaa sisältöä sosiaalisessa mediassa. Seuraamalla NY-yrittäjiä nuoret voisivat kiinnostua siitä itsekin. NY-yrittäjyyden esilletuomisessa voisi hyödyntää etenkin sisältömarkkinointia.The main subject of this thesis is social media and entrepreneurship education. The objec- tive of this thesis was to give the client ideas how students of South Savo Vocational College would get engaged in entrepreneurship education by using social media. In this case entrepreneurship education is the Nuori Yrittäjyys program, which is part of a worldwide Junior Achievement – Young Enterprise network. The research problems were how students of South Savo Vocational College would get in- terested in the Nuori Yrittäjyys -program by using social media and what are the social me- dia channels for reaching young people and what kind of content they are interested in. The theoretical framework consisted of entrepreneurship, entrepreneurship education and social media marketing. The theoretical part also discusses content marketing and content marketing strategy. This thesis was a qualitative study. The research method used was a theme interview. Two themes in the interview were social media and the Nuori Yrittäjyys program. The interviewees were young students of South Savo Vocational College, who are not NY-entrepreneurs yet, but they know what that is all about. The results of the research were clear. Young people use social media a lot and it is an ef- fective way to reach them. The social media channels they use the most are Instagram, Facebook, Snapchat and Youtube. They are most interested in photos and videos. The commissioner should use social media to market the NY-program. The current NY-en- trepreneurs could market the NY-program for students on social media channels. They should use especially content marketing. That way students could possibly get interested in the NY-program as well

Матеріали інформаційно-методичного забезпечення дисципліни «Правоохоронне право (Суд)»

Одержані знання дозволять студентам сформувати фаховий світогляд, пізнати органічні зв’язки даної навчальної дисципліни з іншими академічними курсами. Вибіркова дисципліна «Правоохоронне право (Суд)» межує з такими правовими дисциплінами, як ”Судові та правоохоронні органи України”, «Цивільне право», «Кримінальне право», «Цивільний процес», «Кримінальний процес», «Адміністративне судочинство», «Господарське право», «Господарський процес» та інші.Вибіркова дисципліна «Правоохоронне право (Суд)» займає особливе місце в навчальному плані і є невід’ємним фактором правової системи й основним недержавним інститутом захисту особистості, її прав і свобод. Зміст цієї навчальної дисципліни складається із знань, що регулюють діяльність суду – захисника у сфері судочинства, судового захисту прав та інтересів людей

Daily green tea extract supplementation reduces prothrombotic and inflammatory states in dialysis patients

Cardiovascular disease (CVD) remains the most common cause for excess morbidity and mortality in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) under chronic dialysis. ESRD patients have increased oxidative stress and endothelial dysfunction alongside increased levels of inflammation related proteins, which has prompted the exploration of anti-inflammatory and antioxidant treatments to improve outcomes. As green tea is increasingly well recognized for its antioxidant properties, we probed the effect of consumption of 1 capsule daily of green tea as a commercially available, decaffeinated green tea capsule (1 g, catechin content 68 mg) for 6 months on fibrinogen and inflammation in dialysis patients. Chronic hemodialysis patients (N = 25) were recruited and fibrinogen, FDP-D-dimer, high sensitivity (hs) CRP and the mononuclear cell protein expression of p22(phox), were assessed before, i.e. baseline and after 6 months of ingestion of 1 green tea capsule per day. After 6 months of daily green tea capsule ingestion, dialysis patients showed reduced protein expression of p22(phox) (p < 0.0001), reduced hsCPR (p = 0.032) and fibrinogen (p = 0.022) levels and increased FDP-D-dimer (p = 0.0019) compared to their values at baseline. These results document lower oxidative stress and inflammation with green tea capsule ingestion and suggest a likely positive impact of green tea treatment on the atherosclerotic process of ESRD patients under dialysis

Hemodiafiltration With Online Regeneration of Ultrafiltrate: Effect on Heme-Oxygenase-1 and Inducible Subunit of Nitric Oxide Synthase and Implication for Oxidative Stress and Inflammation

Hemodiafiltration with regeneration of ultrafiltrate (HFR) has a positive impact on inflammation and oxidative stress (OxSt), risk factors for cardiovascular disease (CVD), the most common cause of excess morbidity and mortality for end-stage renal disease (ESRD) patients. However, studies have been of limited duration. This study extends our previous study of HFR effects by evaluating the effect on mononuclear cell protein expression of heme-oxygenase-1 (HO-1), induced by OxSt, and inducible subunit of nitric oxide synthase (iNOS), and plasma level of interleukin-1β (Il-1β) and oxidized low-density lipoproteins (OxLDL), marker of OxSt, for a 12-month period. Fourteen ESRD patients stable on hemodialysis over a period of at least 2 years and on conventional bicarbonate dialysis were switched to be treated with HFR. Blood samples were collected at baseline, after 3, 6, 9 and 12 months. HO-1 and iNOS protein expression were evaluated by Western blot, OxLDL by enzyme-linked immunosorbent assay (ELISA), and Il-1β by enzyme amplified sensitivity immumoassay assay. HFR significantly increased HO-1 at the 9 and 12 months (ANOVA = P < 0.00001): 0.17 ± 0.11 (baseline) versus 0.48 ± 0.20, P < 0.043 and 0.59 ± 0.32, P < 0.004, respectively. Il-1β declined (ANOVA = P < 0.0001) since the 3 months from 169.92 ± 92.39 pg/mL (baseline) to 39.03 ± 10.01 (12 months), P < 0.0001. HFR also reduced plasma OxLDL: 475.4 ± 110.8 ng/mL (baseline) versus 393.1 ± 101.9 ng/mL (12 months), P < 0.04. iNOS showed no changes upon HFR treatment. These results together with our previous results indicate that HFR improves OxSt and inflammation. Given the strong relationships between OxSt and inflammation with CVD, their reduction might provide a beneficial impact by reducing the risk of atherosclerotic CVD in dialysis patients

"Of coronary arteries and men": The fight of a dialysis patient against his coronary arteries

Acute myocardial infarction (AMI) in dialysis patients is associated with high mortality rate. Large randomized controlled trials documenting the benefits of revascularization in the general population have excluded chronic dialysis patients. Few observational data suggest that revascularization may provide a survival benefit compared with medical treatment alone also in these patients. We report a case of a dialysis patient who survived five documented AMIs, underwent five coronary angiographies in 11 years, had several episodes of angina pectoris and underwent percutaneous transluminal coronary angioplasty (PTCA) with stenting and heart surgery for coronary bypassing. It represents a highly unusual therapeutic approach and might contribute to support also in dialysis patients the use of revascularization to improve survival

Optimizing Patient Surgical Management Using WhatsApp Application in the Italian Healthcare System

Introduction: Smartphones changed the method by which doctors communicate with each other, offer modern functionalities sensitive to the context of use, and can represent a valuable ally in the healthcare system. Studies have shown that WhatsApp\u2122 application can facilitate communication within the healthcare team and provide the attending physician a constant oversight of activities performed by junior team members. The aim of the study was to use WhatsApp between two distant surgical teams involved in a program of elective surgery to verify if it facilitates communication, enhances learning, and improves patient care preserving their privacy. Methods: We conducted a focused group of surgeons over a 28-month period (from March 2013 to July 2015), and from September 2014 to July 2015, a group of selected specialists communicated healthcare matters through the newly founded "WhatsApp Surgery Group." Each patient enrolled in the study signed a consent form to let the team communicate his/her clinical data using WhatsApp. Communication between team members, response times, and types of messages were evaluated. Results: Forty six (n = 46) patients were enrolled in the study. A total of 1,053 images were used with an average of 78 images for each patient (range 41-143). 125 h of communication were recorded, generating 354 communication events. The expert surgeon had received the highest number of questions (P, 0.001), while the residents asked clinical questions (P, 0.001) and were the fastest responders to communications (P, 0.001). Conclusion: Our study investigated how two distant clinical teams may exploit such a communication system and quantifies both the direction and type of communication between surgeons. WhatsApp is a low cost, secure, and fast technology and it offers the opportunity to facilitate clinical and nonclinical communications, enhance learning, and improve patient care preserving their privacy

Adult Vascular Wall Resident Multipotent Vascular Stem Cells, Matrix Metalloproteinases, and Arterial Aneurysms

Evidences have shown the presence of multipotent stem cells (SCs) at sites of arterial aneurysms: they can differentiate into smooth muscle cells (SMCs) and are activated after residing in a quiescent state in the vascular wall. Recent studies have implicated the role of matrix metalloproteinases in the pathogenesis of arterial aneurysms: in fact the increased synthesis of MMPs by arterial SMCs is thought to be a pivotal mechanism in aneurysm formation. The factors and signaling pathways involved in regulating wall resident SC recruitment, survival, proliferation, growth factor production, and differentiation may be also related to selective expression of different MMPs. This review explores the relationship between adult vascular wall resident multipotent vascular SCs, MMPs, and arterial aneurysms

Hepatic ischemia reperfusion injury: A systematic review of literature and the role of current drugs and biomarkers

Hepatic ischemia reperfusion injury (IRI) is not only a pathophysiological process involving the liver, but also a complex systemic process affecting multiple tissues and organs. Hepatic IRI can seriously impair liver function, even producing irreversible damage, which causes a cascade of multiple organ dysfunction. Many factors, including anaerobic metabolism, mitochondrial damage, oxidative stress and secretion of ROS, intracellular Ca2+ overload, cytokines and chemokines produced by KCs and neutrophils, and NO, are involved in the regulation of hepatic IRI processes. Matrix Metalloproteinases (MMPs) can be an important mediator of early leukocyte recruitment and target in acute and chronic liver injury associated to ischemia. MMPs and neutrophil gelatinase-associated lipocalin (NGAL) could be used as markers of I-R injury severity stages. This review explores the relationship between factors and inflammatory pathways that characterize hepatic IRI, MMPs and current pharmacological approaches to this disease