The role of basiliximab in the evolving renal transplantation immunosuppression protocol

Basiliximab is a chimeric mouse-human monoclonal antibody directed against the alpha chain of the interleukin-2 (IL-2) receptor on activated T lymphocytes. It was shown in phase III trials to reduce the number and severity of acute rejection episodes in the first year following renal transplantation in adults and children, with a reasonable cost-benefit ratio. The drug does not increase the incidence of opportunistic infections or malignancies above baseline in patients treated with conventional calcineurin inhibitor-based immunosuppression. In the field of renal transplantation, basiliximab does not increase kidney or patient survival, despite the reduction in the number of rejection episodes. Basiliximab may reduce the incidence of delayed graft function. In comparison with lymphocyte-depleting antibodies basiliximab appears to have equal efficacy in standard immunological risk patients. Recently, IL-2 receptor monoclonal antibodies have been used with the objective of reducing or eliminating the more toxic elements of the standard immunosuppression protocol. Several trials have incorporated basiliximab in protocols designed to avoid or withdraw rapidly corticosteroids, as well as protocols which substitute target-of-rapamycin (TOR) inhibitors for calcineurin inhibitors

SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern

According to the Italian national statistical institute, severe bacterial infections (SBI) in Italy are responsible for 1.7% of mortality under five years of age and their recognition is often challenging, especially in the first stages of the disease. We tried to estimate the prevalence of SBI in our target population and to identify signs and symptoms that could guide in the initial evaluation of a child with a possible SBI

Effectiveness of the GAEC cross compliance standard Protection of permanent pasture: prohibition to convert permanent pasture into arable crops in avoiding habitat deterioration

By the end of the 19th and beginning of the 20th century new developments in agricultural technology caused an intensification of the agricultural practices. Species adapted to the diversity of structures or resources of high naturalistic value farmlands, like permanent pasture, cannot survive under increasingly high intensity agricultural management. The Italian MD n.30125 dated 22/12/2009 (Standard 4.1) defines, among the measures for the protection of permanent pasture and avoidance the deterioration of habitats, the prohibition to convert permanent pasture into arable crops and to till with the exception of agricultural practices related to the renewal and/or thickening of the sward and to the drainage water management. Permanent pastures biodiversity performs key ecological services and if correctly assembled in time and space can lead to agroecosystems capable of sponsoring their own soil fertility, crop protection and productivity. The vegetative cover of permanent pasture prevents soil erosion, replenishes ground water and controls flooding by enhancing infiltration and reducing runoff. The changes of land use or some practices change insect community and vegetation diversity. Physical disturbance of the soil caused by tillage increases risk of erosion and reduces the recycling of nutrients and proper balance between organic matter, soil organism and plant diversity. Is necessary a habitat preservation policy because after a change, even a return to past management would not completely re-establish the complex structure of habitats

Estrés laboral de los cuidadores(as) de hogares protegidos públicos DIRIS Lima - Norte 2022

Objetivo: Determinar el nivel de estrés laboral de los cuidadores(as) de Hogares Protegidos públicos DIRIS Lima-Norte 2022”. Metodología: Cuantitativa descriptiva de diseño no experimental de corte transversal. La muestra estuvo conformada por 40 cuidadores(as) de los Hogares Protegidos públicos DIRIS Lima-Norte. La técnica que se utilizó fue la encuesta y el instrumento que se aplicó fue el cuestionario de Burnout de Maslach (MBI) modificado y validado por 5 jueces expertos con V Aiken mayoritario a 0.60 con la confiabilidad de Alfa Cronbach 0.91. Resultados: El 55% de los cuidadores(as) encuestados dan un resultado de nivel medio de estrés laboral, 33% nivel bajo y 13% nivel alto. En la dimensión de agotamiento emocional y despersonalización tienen un nivel alto, el primero con un 63% y el segundo con 60%. Mientras tanto en la dimensión de realización personal tienen un nivel bajo con un 48%. Conclusión: Existe un nivel medio con un 55% de estrés laboral en los cuidadores de los HP Diris Lima Norte.Objective: To determine the level of occupational stress of caregivers of public sheltered homes DIRIS Lima-Norte 2022". Methodology: Quantitative descriptive non-experimental cross-sectional design. The sample consisted of 40 caregivers of the DIRIS Lima-North public sheltered homes. The technique used was the survey and the instrument applied was the Maslach Burnout Questionnaire (MBI) modified and validated by 5 expert judges with a majority Aiken V of 0.60 with a reliability of Cronbach's Alpha 0.91. Results: 55% of the caregivers surveyed gave a result of medium level of work stress, 33% low level and 13% high level. In the dimension of emotional exhaustion and depersonalization they have a high level, the former with 63% and the latter with 60%. Meanwhile, in the dimension of personal fulfillment they have a low level with 48%. Conclusion: There is a medium level with 55% of work stress in the caregivers of the HP Diris Lima Norte

A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis < 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11 years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study

Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated.Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD.Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence.Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31–0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13–0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35–0.99).Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner

Dissolved iron speciation and first characterization of organic ligands in the eastern Ross Sea

Iron (Fe) is the most important trace element in the ocean ecosystem, being a micronutrient required for phytoplankton growth and thus involved in marine primary productivity and carbon export. The dissolved Fe (dFe) is the most bioavailable fraction and about 99.9% of the dFe is complexed with organic ligands (L), the nature of which is largely unknown. The concentrations of L can be determined by the electrochemical technique of competitive ligand exchange-adsorptive cathodic stripping voltammetry (CLE-AdCSV), which also allow the binding affinity of Fe to be assessed through the values of the conditional stability constants (logK’Fe’L). However, CLE-AdCSV does not give details about the L nature. High performance liquid chromatography - electrospray ionization - mass spectrometry (HPLC-ESI-MS/MS) is a powerful new approach to characterize the Fe-binding ligands, thanks to the fragmentation patern of the MS/MS spectra. To date, the eastern sector is the most unexplored area of the Ross Sea, but its study has high scientific interest. In fact, it is the area where water masses from the western sector of Antarctica pass through and it is the gateway for the iron and organic ligands rich glacial meltwater coming from the nearby Amundsen Sea. In this work, the total concentration and speciation data of dFe determined in seawater samples collected during the austral summer of 2019-20 in the eastern Ross Sea (ESRS) and along the Ross Ice Shelf (RIS) in the framework of the ESTRO (Effect of the eaSTern inflow of water on the ROss Sea salinity field variability) project are presented. Principal component analysis (PCA) was used to explore correlations between dFe, speciation parameters, and the biogeochemistry of the area. This allowed us to assess the possible sources of dFe and L and to highlight the differences between the different water masses in this area. The subsurface samples were characterized by greater spatial dFe variability than the deep samples. Dissolved Fe average concentrations were higher in the ESRS (2.21 ± 1.20 nM) than those sampled along the RIS (0.62 ± 0.10 nM). In the ESRS, the distribution of Fe parameters was more controlled by the physical parameters, rather than the biological component. Particularly stable complexes were identified by CLE-AdSV between dFe and L (average logK’Fe’L = 13.4) and the HPLC-ESI-MS/MS analyses showed the presence of several organic ligands having different masses in the seawater samples