Simulating the impact of crossover kidney transplantation on the nord italia transplant program

The increasing number of patients affected by chronic kidney disease makes it necessary to rely on living donors. However, a patient often cannot exploit her potential donor, due to blood or tissue incompatibility. Therefore, crossover transplantation programs have been developed in several countriesin order to increase the number of people receiving a kidney from a living donor. After reviewing the essential medical facts needed for the subsequent results, we quickly introduce two known algorithms for crossover transplantation. Next, we consider a dataset provided by the Nord Italia Transplant program, and we apply the above algorithms in order to highlight the benefits of these efficient procedures

The 3-T Model of Informed Consent for Nonstandard Risk Donors: A Proposal for Transplant Clinical Practice

Background. The risk of disease transmission from nonstandard risk donors (NSRDs) is low, and outcomes are similar or better relative to transplants performed with standard criteria donors. However, NSRDs have posed new ethical challenges to the informed consent (IC) process. Based on the shared decision-making model, coinciding with the 3 main timings of the IC process ([1] pretransplant assessments and waiting list registration, [2] time on the waiting list, and [3] time of the organ offer), we put forward a model (3-T Model) to summarize the knowledge on IC for NSRDs and to deliver conceptual and practical support to transplant providers on this emergent issue. Methods. We searched PubMed and analyzed data from our area to provide evidence and ethical arguments to promote standardization of the timing of patient information, degree of patient participation, and disclosure of donor risk factors throughout the 3 stages of the time continuum leading to the potential acceptance of NSRDs. Results. Each of the 3 timings carries special ethical significance and entails well-defined duties for transplant providers relative to patient involvement and information of the benefits and risks associated with NSRDs. Based on our framework, experience, and interpretation of the literature, we put forward a list of recommendations to combine standardization (ie, timing, content, and degree of patient participation) and individualization of IC. Conclusions. The 3-T Model may enable the prevention of physicians' arbitrariness and the promotion of patient-centered care. Future studies will assess the effectiveness of the 3-T Model in transplant clinical practice

Efficacy and Safety of a First Line Combined Therapeutic Approach for Young CLL Patients with Advanced or Progressive Disease Stratified According to the Biologic Features: First Analysis of the GIMEMA Multicenter Study LLC0405.

Eighty-one previously untreated CLL patients, ≤60 years, with advanced/progressive disease were included in the GIMEMA LLC0405 prospective multicenter study. Patients were stratified according to the biologic features. High risk (HR) patients were defined by the presence of: 1) 17p- (≥20% of analyzed cells), or 2) 11q- with ≥1 additional unfavorable factor (IGHV germline; Zap-70+ ≥10%; CD38+ ≥7%), or 3) germline IGHV or mutated VH3-21 and ≥2 unfavorable factors (Zap-70; CD38; 6q-; trisomy 12). Low risk (LR) patients were defined by the absence of the above features. HR patients received 4 monthly courses of fludarabine and campath-1H (FluCam; Flu 30 mg/m2 iv; Cam 30 mg iv, days 1-3). Responding patients underwent post-induction therapy: reduced intensity PBSC allogeneic transplant or, in the absence of a sibling donor, an autologous PBSC transplant or, in the absence of a sufficient harvest, Cam sc, 30 mg weekly for a maximum of 12 weeks. For LR patients, treatment included 6 monthly courses of fludarabine and cyclophosphamide (FC; fludarabine 30 mg/m2 iv and cyclophosphamide 250 mg/m2, days 1-3). All patients received bactrim prophylaxis. FluCam-treated patients underwent weekly CMV antigenemia monitoring and valacyclovir prophylaxis (2g/8h). In the presence of severe granulocytopenia, G-CSF was recommended and darbepoietin given in case of anemia (Hb <11g/dl). MRD was monitored in peripheral blood (PB) and marrow by four color-flow cytometry. The median age of patients was 55 years (range: 30-60), Rai stages III-IV were recorded in 23% of cases, 35% of patients showed “bulky” nodes (Ǿ ≥5 cm), 35% had 100 x 109/L or more PB lymphocytes and 51% increased β2 M values. A HR profile was found in 43 patients (53%) and a LR profile in 38 (47%). Within HR patients, 93% were IGHV unmutated, 69% CD38+, 80% Zap-70+, 40% 11q- and 21% 17p-. LR patients showed one or more unfavorable biologic factors in less than a third of cases (IgVH unmutated 21%, CD38+ 17%, Zap-70+ 29%); 13q- was recorded in 42% of cases, no detectable abnormalities in 39%, trisomy 12+ in 11% and 6q- in 8%. On an intention-to treat basis, a response was observed in 79% of HR cases (CR 26%, MRD- 19%) and in 87% of LR cases (CR 55%, MRD- 18%). In univariate analysis, age, IgG levels, β2 M, IgVH status, CD38 and Zap-70 played a significant role on CR achievement in HR patients, while CD38 was the only significant parameter for LR patients. As post-remission therapy, 2 HR patients received Cam , while 11 underwent a transplant procedure (allogeneic: 4, autologous: 7). The PFS probability at 36 months was 44% (95% CI: 36.9-51.8) for HR patients and 64% (95%CI: 53.6-76.7) for LR patients. In univariate analysis, β2 M and Zap-70 showed a significant effect on the PFS of HR patients, while a higher PB lymphocyte count (≥60x109/L) was associated with a lower PFS (p=0.07) in LR patients. The CR rate and PFS at 36 months after FluCam were 18% and 18% for 11q- patients, and 11% and 49% for 17p- patients. The OS probability at 36 months was 81% (95% CI: 71-93.3) for HR patients and 89% (95%CI:80.2-98.6) for LR patients. Cytogenetic abnormalities played a significant role (p=.02) on OS probability of HR patients. In particular, 17p- was associated with a lower survival probability (p=.04), while the OS of LR patients was influenced by the lymphocyte count (p=0.05). All transplanted patients are alive with a median follow-up of 31 months (range:16-42). Granulocytopenia was observed in 21% of cases treated with FluCam and in 32% of those treated with FC. Grade III-IV infections were recorded in 7% of FluCam-treated patients and in 13% of FC- treated patients. Asymptomatic CMV reactivation was detected in 3 FluCam-treated cases (7%). No FluCam-related deaths were observed, while 4 FC-related deaths were recorded (febrile granulocytopenia, 2 cases; cerebral hemorrhage, 1; cerebral abscesses of unknown origin, 1). In conclusion, an unfavorable biologic profile was observed in about half young CLL patients requiring first line treatment. Front-line FluCam was well tolerated and effective for most young CLL patients with an unfavorable biologic profile. However, our results suggest that FluCam is not the optimal treatment approach for 11q- patients. Front-line FC was associated with a high CR rate and prolonged PFS and OS probabilities in patients with a favorable biologic profile. Nevertheless, in young CLL patients FC-related severe granulocytopenia was a frequent reason of treatment failure

Energy content and carbon emission audit of building materials

The main thesis examined in this research is that "the embedded energy of construction is much more significant than the operational energy for buildings in a tropical country such as Sri Lanka". All building elements (e.g. brickwall), materials (e.g. bricks) and "primitive" raw materials (e.g. clay) are placed in an aggregation-decomposition hierarchy. The process analysis carried out here basically captures most of the energy inputs associated with levels 1 and 2 in the IFIAS (1974) scheme, and accounts for around 90% of the embedded energy in a product. These calculations are based on Tonnes of Oil Equivalent (TOE). The data required to estimate these embedded energies were collected from building materials manufacturers. A computerised database was implemented using a relational database management system. This can be used to represent and calculate the embedded energies and carbon coefficients of building materials and elements that are hierarchically arranged. It can also handle multiple sources of data and perform calculations to give the average, maximum and minimum embedded energies, which are also classified according to fuel type and process stage. Though the analysis was done assuming that the final building is located in the City of Colombo, these database values can be used, with some caution, for buildings even outside the Colombo City or District. The embedded energy requirements were also calculated on the basis of the lowest quality energy (bio-equivalent energy), in addition to the more conventional basis of TOE. According to energy quality calculations carried out (based on efficiency considerations), 1GJ of energy from electricity is equivalent to 5 GJ of biomass energy, 1 GJ of fossil fuel energy is equivalent to 1.8 GJ of biomass energy and 1 GJ of electrical energy is equivalent to 2.78 GJ of fossil fuel energy. It is seen that the price per unit of biomass energy based on the actual prices of products is around one third of the actual price per unit of biomass energy. For fossil fuel and electricity on the other hand, the actual prices of products are much higher than the actual prices of the energy sources used for their production. In order to minimise adverse energy effects and to give a beneficial effect to halting global warming, policy measures to promote timber products are desirable. It is also seen that though materials which use timber fuels (e.g. bricks and tiles) consume more energy, the use of timber fuels is more competitive when compared on a bio-equivalent unit basis. Furthermore, with respect to carbon emissions, wood fuels are considered to be self sustaining. The use of timber, whether as a construction material or a fuel, will require properly planned re-forestation strategies. The energy contribution from walls for a typical two storey house is from 10 - 44%; for a single storey house it is from 29 - 49%. The contribution from roofs for the two storey house is from 4 - 7%, whereas it is 8 - 16% for the single storey house. The contribution from windows is 0.6 - 3% for the single storey house and 0.2 - 4.5% for the two storey. house. The contribution from the floor slab for the two storey house is 6 - 7%. The above ranges are a result of the difference of the between the use of low and high energy materials. The ratio between total embedded energy and annual operational energy for the buildings selected lies between 14 to 35 for the houses while for an office building with air conditioning loading it is 5. Though air conditioning has a large contribution towards the annual operational energy of a building, the total number of air conditioned buildings are small for a developing country such as Sri Lanka. Nevertheless, the results of the analysis show that the focus of energy efficient designs for buildings with air conditioning has to be on the operational energy. On the other hand, for houses, which are largely not air conditioned, the way to promote efficiency is by reducing the embedded energy through the appropriate choice of building materials. This is borne out not only by the high ratio of construction to operational energy ratio obtained, but also by the fact that the ratios for houses with low energy materials is almost half those for the houses with high energy materials. Key Words : Embedded Energy, Process Analysis, Building Materials, Carbon Emissions, Energy Databas

Recommendations for self-monitoring in pediatric diabetes: A consensus statement by the ISPED

none165noScaramuzza, Andrea; Cherubini, Valentino; Tumini, Stefano; Bonfanti, Riccardo; Buono, Pietro; Cardella, Francesca; D’Annunzio, Giuseppe; Frongia, Anna Paola; Lombardo, Fortunato; Monciotti, Anna Carla Maria; Rabbone, Ivana; Schiaffini, Riccardo; Toni, Sonia; Zucchini, Stefano; Frontino, Giulio; Iafusco, Dario; Arnaldi, Claudia; Banin, Patrizia; Barbetti, Fabrizio; Beccaria, Luciano; Benelli, Marzia; Berardi, Rosario; Biagioni, Martina; Bianchi, Giuliana; Bizzarri, Carla; Blasetti, Annalisa; Bobbio, Adriana; Boccato, Stefano; Bontempi, Franco; Bruzzese, Mariella; Cadario, Francesco; Calcaterra, Valeria; Cannatà, Alessandra; Cappa, Marco; Cardani, Roberta; Cardinale, Giuliana Marcella; Carloni, Ines; Castaldo, Vincenzo; Cauvin, Vittoria; Cerutti, Franco; Cester, Anna Maria; Chessa, Margherita; Chiarelli, Francesco; Chiari, Giovanni; Chiumello, Giuseppe; Cicchetti, Mario; Cirillo, Dante; Citriniti, Felice; Citro, Giuseppe; Coccioli, Maria Susanna; Cotellessa, Mario; Crinò, Antonino; De Berardinis, Fiorella; De Filippo, Gianpaolo; De Giorgi, Giovanni; De Luca, Filippo; De Marco, Rosaria; Delvecchio, Maurizio; Faleschini, Elena; Federico, Giovanni; Fifi, Anna Rita; Fontana, Franco; Franzese, Adriana; Frezza, Elda; Frongia, Annapaola; Gaiero, Alberto; Galderisi, Alfonso; Gallo, Francesco; Gargantini, Luigi; Ghione, Silvia; Giorgetti, Chiara; Gualtieri, Antonella; Guasti, Monica; Guerraggio, Lucia; Iannilli, Antonio; Ingletto, Dario; Iossa, Carmine; Iovene, Brunella; Iughetti, Lorenzo; Kaufmann, Peter; La Loggia, Alfonso; Lazzaro, Nicola; Lenzi, Lorenzo; Lera, Riccardo; Lia, Rosanna; Lo Presti, Donatella; Lorini, Renata; Lucchesi, Sonia; Luceri, Sergio; Madeo, Simona Filomena; Maffeis, Claudio; Mainetti, Benedetta; Mammi, Francesco; Manca Bitti, Maria Luisa; Marigliano, Marco; Marinari, Alessandra; Marinaro, Anna Maria; Meloni, Gianfranco; Marsciani, Alberto; Mastrangelo, Lisa; Mastrangelo, Costanzo; Meschi, Franco; Minasi, Domenico; Minenna, Adelaide; Minuto, Nicola; Monciotti, Carlamaria; Morganti, Gianfranco; Mozzillo, Enza; Nugnes, Rosa; Paradiso, Emanuela; Pardi, Daniela; Pasquino, Bruno; Patrizia Patera, Ippolita; Pennati, Cristina; Pepe, Rossella; Piccini, Barbara; Perrotta, Angelo; Piccinno, Elvira; Pinelli, Leonardo; Piredda, Gavina; Pocecco, Mauro; Ponzi, Giuseppe; Prandi, Elena; Predieri, Barbara; Prisco, Francesco; Quinci, Maria; Ricciardi, Maria Rossella; Rigamonti, Andrea; Ripoli, Carlo; Sabbion, Alberto; Salardi, Silvana; Salvatoni, Alessandro; Salvo, Caterina; Salzano, Giuseppina; Saporiti, Anna; Sardi, Rita; Schieven, Eleonardo; Scipione, Mirella; Soci, Cristina; Soro, Miriam; Spallino, Luisa; Stamati, Filomena; Suprani, Tosca; Savastio, Silvia; Taccardi, Rosa Anna; Tarchini, Luis; Tomaselli, Letizia; Tonini, Giorgio; Torelli, Cataldo; Tornese, Gianluca; Trada, Michela; Valerio, Giuliana; Vanelli, Maurizio; Vanini, Roberto; Vascotto, Marina; Vergerio, Amedeo; Viscardi, Matteo; Zaffani, Silvana; Zampolli, Maria; Zanatta, Manuela; Zanette, Giorgio; Zanfardino, Angela; Zecchino, Clara; Zedda, Maria Antonietta; Zuccotti, Gian VincenzoScaramuzza, Andrea; Cherubini, Valentino; Tumini, Stefano; Bonfanti, Riccardo; Buono, Pietro; Cardella, Francesca; D’Annunzio, Giuseppe; Frongia, Anna Paola; Lombardo, Fortunato; Monciotti, Anna Carla Maria; Rabbone, Ivana; Schiaffini, Riccardo; Toni, Sonia; Zucchini, Stefano; Frontino, Giulio; Iafusco, Dario; Arnaldi, Claudia; Banin, Patrizia; Barbetti, Fabrizio; Beccaria, Luciano; Benelli, Marzia; Berardi, Rossana; Biagioni, Martina; Bianchi, Giuliana; Bizzarri, Carla; Blasetti, Annalisa; Bobbio, Adriana; Boccato, Stefano; Bontempi, Franco; Bruzzese, Mariella; Cadario, Francesco; Calcaterra, Valeria; Cannatà, Alessandra; Cappa, Marco; Cardani, Roberta; Cardinale, Giuliana Marcella; Carloni, Ines; Castaldo, Vincenzo; Cauvin, Vittoria; Cerutti, Franco; Cester, Anna Maria; Chessa, Margherita; Chiarelli, Francesco; Chiari, Giovanni; Chiumello, Giuseppe; Cicchetti, Mario; Cirillo, Dante; Citriniti, Felice; Citro, Giuseppe; Coccioli, Maria Susanna; Cotellessa, Mario; Crinò, Antonino; De Berardinis, Fiorella; De Filippo, Gianpaolo; De Giorgi, Giovanni; De Luca, Filippo; De Marco, Rosaria; Delvecchio, Maurizio; Faleschini, Elena; Federico, Giovanni; Fifi, Anna Rita; Fontana, Franco; Franzese, Adriana; Frezza, Elda; Frongia, Annapaola; Gaiero, Alberto; Galderisi, Alfonso; Gallo, Francesco; Gargantini, Luigi; Ghione, Silvia; Giorgetti, Chiara; Gualtieri, Antonella; Guasti, Monica; Guerraggio, Lucia; Iannilli, Antonio; Ingletto, Dario; Iossa, Carmine; Iovene, Brunella; Iughetti, Lorenzo; Kaufmann, Peter; La Loggia, Alfonso; Lazzaro, Nicola; Lenzi, Lorenzo; Lera, Riccardo; Lia, Rosanna; Lo Presti, Donatella; Lorini, Renata; Lucchesi, Sonia; Luceri, Sergio; Madeo, Simona Filomena; Maffeis, Claudio; Mainetti, Benedetta; Mammi, Francesco; Manca Bitti, Maria Luisa; Marigliano, Marco; Marinari, Alessandra; Marinaro, Anna Maria; Meloni, Gianfranco; Marsciani, Alberto; Mastrangelo, Lisa; Mastrangelo, Costanzo; Meschi, Franco; Minasi, Domenico; Minenna, Adelaide; Minuto, Nicola; Monciotti, Carlamaria; Morganti, Gianfranco; Mozzillo, Enza; Nugnes, Rosa; Paradiso, Emanuela; Pardi, Daniela; Pasquino, Bruno; Patrizia Patera, Ippolita; Pennati, Cristina; Pepe, Rossella; Piccini, Barbara; Perrotta, Angelo; Piccinno, Elvira; Pinelli, Leonardo; Piredda, Gavina; Pocecco, Mauro; Ponzi, Giuseppe; Prandi, Elena; Predieri, Barbara; Prisco, Francesco; Quinci, Maria; Ricciardi, Maria Rossella; Rigamonti, Andrea; Ripoli, Carlo; Sabbion, Alberto; Salardi, Silvana; Salvatoni, Alessandro; Salvo, Caterina; Salzano, Giuseppina; Saporiti, Anna; Sardi, Rita; Schieven, Eleonardo; Scipione, Mirella; Soci, Cristina; Soro, Miriam; Spallino, Luisa; Stamati, Filomena; Suprani, Tosca; Savastio, Silvia; Taccardi, Rosa Anna; Tarchini, Luis; Tomaselli, Letizia; Tonini, Giorgio; Torelli, Cataldo; Tornese, Gianluca; Trada, Michela; Valerio, Giuliana; Vanelli, Maurizio; Vanini, Roberto; Vascotto, Marina; Vergerio, Amedeo; Viscardi, Matteo; Zaffani, Silvana; Zampolli, Maria; Zanatta, Manuela; Zanette, Giorgio; Zanfardino, Angela; Zecchino, Clara; Zedda, Maria Antonietta; Zuccotti, Gian Vincenz