New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of working group on CKD-MBD of the Italian Society of Nephrology

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago

New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of working group on CKD-MBD of the Italian Society of Nephrology

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS). Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18\u20134.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20\u201312.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses. Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists. ANN NEUROL 2021;89:780\u2013789

Coupling land use evolution and subsidence in the Po Delta, Italy: Revising the past occurrence and prospecting the future management challenges

The Po River delta is characterized by a large system of shallow lagoons, wetlands, and reclaimed lands. Like many other deltaic regions, the Po Delta has largely subsided due to natural processes and anthropogenic activities, with a strong impact on its geomorphological evolution and significant socio- economic consequences. This paper aimed at highlighting the evolution of the study area over the last 120 years, analysing the land-uses changes in relation to the land subsidence, and using these findings to discuss the main management issues of this fragile low lying area in the decades to come. The analysis of the land use evolution from 1892 to 2015 and the information derived from the metrics measurement suggest a simplification of the land use with a decrease of the saltmarsh extent and an enlargement of the agricultural cover. The analysis of land subsidence, mainly due to gas-bearing groundwater withdrawal, confirms a strong impact on the delta territory, and in particular on its geomorphological asset. In the early 1900s the elevation of the delta plain ranged between 121.0 and +1.6 m above msl, while in 2007 it reduced between 122.8 to +0.3 m above msl. The land reclamation projects have largely increased the farmland usable for crop production but the concurrent loss of land elevation has resulted in a territory extremely difficult to be managed. Because of its elevation, the delta is particularly vulnerable to weather and marine events. As a consequence, the present management of the area is mainly aimed at maintaining the agricultural productivity. Unfortunately, if the human impactswill continue with the actual trend, the stability of the natural ecosystems, such as the wetlands, which represent important socioeconomic realities, will be further undermined. Surely, the conservation of these natural environments should be a priority in the future land use management

Evidence of the present relative land stability of Venice, Italy, from land, sea, and space observations

The Venice Lagoon in Italy is a unique environment vulnerable to loss in surface elevation relative to the mean sea level. We present detailed synthetic aperture radar (SAR) interferometric analyses on persistent point targets for the historical center of Venice, the tourist area of Sottomarina, and the Zennare farmland close to the southern lagoon edge. The selected areas are characterized by different degrees of development and our analyses show the remarkable capability of SAR Interferometric Point Target Analysis (IPTA) to map land displacement rates in densely urbanized zones and to detect movement information on isolated structures with a mm/year accuracy. A detailed analysis of the time series from 1992 to 2000 provided by IPTA shows that the vertical component of the measured displacements are the superposition of a short timescale, generally seasonal, movement on the order of 1 cm that is likely related to the fluctuation of environmental variables (temperature, piezometric head in the aquifer system underlying the lagoon, sea/lagoon water level) and a long-term ground deformation associated with building construction, the geomorphology of the area, and the human development of natural resources. If Venice is confirmed to be generally stable, significant long-term subsidence on the order of 4 mm/year is detected at the Sottomarina coastland. The highest displacement rates, of up to 8\u201310 mm/year, are recorded in the farmland bounding the lagoon margin where the movements are found to be highly site-specific