Kidney transplantation with presymptomatic COVID-19–positive surgeon

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A two-phase problem with Robin conditions on the free boundary

We study for the first time a two-phase free boundary problem in which the solution satisfies a Robin boundary condition. We consider the case in which the solution is continuous across the free boundary and we prove an existence and a regularity result for minimizers of the associated variational problem. Finally, in the appendix, we give an example of a class of Steiner symmetric minimizers

Renal Toxicities in Cancer Patients Receiving Immune-Checkpoint Inhibitors: A Meta-Analysis

Aim: We performed a meta-analysis of the available clinical trials of immune-checkpoint inhibitors to assess risk differences and relative risks of renal toxicity. Methods: 17 randomized phase III studies were selected, including 10,252 patients. Results: The administration of immune-checkpoint inhibitors resulted in an overall low-grade, high-grade and all-grade renal toxicity Risk Difference of: 0.746% (95% CI 0.629% to 1.15%, p < 0.001—random), 0.61% (95% CI, 0.292–0.929%, p < 0.001—fixed) and 1.2% (95% CI, 0.601–1.85%—random), respectively. The pooled Relative Risk of low-grade, high-grade and all-grade renal toxicity was: 2.185 (95% CI 1.515–3.152—fixed), 2.610 (95% CI, 1.409–4.833, p = 0.002—fixed) and 2.473 (95% CI, 1.782–3.431, p < 0.001—fixed), respectively. An increased risk of renal toxicity was evident in some subgroups more than others. Conclusion: Immune-checkpoint inhibitors are associated with an increased risk of renal toxicity

Monitoring the habitat use of common Bottlenose Dolphins (Tursiops truncatus) using passive acoustics in a Mediterranean marine protected area

The Mediterranean Tursiops truncatus subpopulation has been classified as Vulnerable on the IUCN Red List because of its decline. This species in coastal areas is exposed to a wide variety of threats: directed kills, bycatch, reduced prey availability caused by environmental degradation and overfishing, habitat degradation including disturbances from boat traffic and noise. Despite the increase in boat traffic in the Mediterranean Sea, the effect on T. truncatus' habitat use has been studied in little detail and few data have been published. This study represents the first attempt to characterise spatial and temporal habitat use by T. truncatus and its relation to boat traffic in the Isole Pelagie Marine Protected Area (Italy) on the basis of an originally developed passive acoustic monitoring system (PAM). The devices were deployed in 2 areas in the southern waters of Lampedusa, during 2 separate years (2006 and 2009), each time for 3 months (from July to September) and in 6 time slots (3 diurnal and 3 nocturnal). Acoustic analysis showed that T. truncatus used the Southern coastal area of Lampedusa independently of the year, primarily during the early summer, a period coinciding with the peak of calving season. Dolphin occurrences appeared independent of boat traffic, with the exception of the smallest temporal scale (time slots): dolphin occurrences were more prevalent during the night when the level of boat traffic was lower. This study provides evidence on T. truncatus habitat use in the Mediterranean Sea and reveals that boat traffic could be one of the factors influencing it, thus stressing the need for further detailed investigation regarding this topic

Immunological effects of a single hemodialysis treatment

Immune disorders, involving both innate and adaptive response, are common in patients with end-stage renal disease under chronic hemodialysis. Endogenous and exogenous factors, such as uremic toxins and the extracorporeal treatment itself, alter the immune balance, leading to chronic inflammation and higher risk of cardiovascular events. Several studies have previously described the immune effects of chronic hemodialysis and the possibility to modulate inflammation through more biocompatible dialyzers and innovative techniques. On the other hand, very limited data are available on the possible immunological effects of a single hemodialysis treatment. In spite of the lacking information about the immunological reactivity related to a single session, there is evidence to indicate that mediators of innate and adaptive response, above all complement cascade and T cells, are implicated in immune system modulation during hemodialysis treatment. Expanding our understanding of these modulations represents a necessary basis to develop pro-tolerogenic strategies in specific conditions, like hemodialysis in septic patients or the last session prior to kidney transplant in candidates for receiving a graft

Vitamin B supplementation and nutritional intake of methyl donors in patients with chronic kidney disease: A critical review of the impact on epigenetic machinery

Cardiovascular morbidity and mortality are several-fold higher in patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) than in the general population. Hyperhomocysteinemia has undoubtedly a central role in such a prominent cardiovascular burden. The levels of homocysteine are regulated by methyl donors (folate, methionine, choline, betaine), and cofactors (vitamin B6, vitamin B12,). Uremia-induced hyperhomocysteinemia has as its main targets DNA methyltransferases, and this leads to an altered epigenetic control of genes regulated through methylation. In renal patients, the epigenetic landscape is strictly correlated with the uremic phenotype and dependent on dietary intake of micronutrients, inflammation, gut microbiome, inflammatory status, oxidative stress, and lifestyle habits. All these factors are key contributors in methylome maintenance and in the modulation of gene transcription through DNA hypo-or hypermethylation in CKD. This is an overview of the epigenetic changes related to DNA methylation in patients with advanced CKD and ESRD. We explored the currently available data on the molecular dysregulations resulting from altered gene expression in uremia. Special attention was paid to the efficacy of B-vitamins supplementation and dietary intake of methyl donors on homocysteine lowering and cardiovascular protection

Integrated geophysical survey to recognize ancient Picentia’s buried walls, in the Archaeological Park of Pontecagnano – Faiano (Southern Italy)

There is no information on previous geophysical prospections carried out in the Archaeological Park of Pontecagnano- Faiano, in order to reconstruct the ancient settlement of Picentia, an Etrusco-Campanian and Roman settlement near Salerno (Southern Italy). Therefore, an integrated geophysical survey based on magnetic, geoelectric and ground-penetrating radar (GPR) prospections was executed in the Park. The methods provided a basic map of buried ancient structures at depth from 0.1-0.2 to about 1.5 meters. Magnetic data were processed analyzing the analytical signal of the vertical derivative of the measured gradient and this substantially reduced a strong fence effect. The results of the geophysical prospections showed archaeological structures located close to those discovered in the excavated areas. The shape of the anomalies are usually elongated with well-defined geometrical characteristics. Many anomalies are arranged along orthogonal directions and they are very coherent with the excavated structures, namely the quarters structures of the ancient Picentia

Multidisciplinarity in Transition Pathways for Patients With Kidney Disease: The Current State of Play

In the field of medical care, successful transition from pediatric-centered to adult-oriented healthcare can provide a sense of continuity in the development of youth, and prepare them to accept responsibility for and manage their own chronic kidney condition in complete autonomy. The so-called transition process requires the presence of some basic aspects: a multidisciplinary team, which acts as a bridge between child and adult services; a comprehensive clinical, cognitive, psychological, and social change for the young people; the involvement of family and caregivers. Within the framework of transition and chronicity during the developmental age, we selected international papers explaining models which agreed on some important steps in the transition process, although many differences can be observed between different countries. In fact, in Europe, the situation appears to be heterogeneous as regards certain aspects: the written transition plan, the educational programmes, the timing of transfer to adult services, the presence of a transition coordinator, a dedicated off-site transition clinic. We then analyzed some studies focusing on patients with renal diseases, including the first to contain a standardized protocol for transition which was launched recently in the USA, and which seems to have already achieved important positive, although limited, results. In Italy, the issue of transition is still in its infancy, however important efforts in the management of chronic kidney disease have already been initiated in some regions, including Emila Romagna, which gives us hope for the future of many young people