Sustained low-efficiency dialysis with regional citrate anticoagulation in critically ill patients with COVID-19 associated AKI: A pilot study

Acute Kidney Injury (AKI) is a frequent complication in critically ill patients with Coronavirus disease 2019 (COVID-19), and it has been associated with worse clinical outcomes, especially when Kidney Replacement Therapy (KRT) is required. A condition of hypercoagulability has been frequently reported in COVID-19 patients, and this very fact may complicate KRT management. Sustained Low Efficiency Dialysis (SLED) is a hybrid dialysis modality increasingly used in critically ill patients since it allows to maintain acceptable hemodynamic stability and to overcome the increased clotting risk of the extracorporeal circuit, especially when Regional Citrate Anticoagulation (RCA) protocols are applied. Notably, given the mainly diffusive mechanism of solute transport, SLED is associated with lower stress on both hemofilter and blood cells as compared to convective KRT modalities. Finally, RCA, as compared with heparin-based protocols, does not further increase the already high hemorrhagic risk of patients with AKI. Based on these premises, we performed a pilot study on the clinical management of critically ill patients with COVID-19 associated AKI who underwent SLED with a simplified RCA protocol. Low circuit clotting rates were observed, as well as adequate KRT duration was achieved in most cases, without any relevant metabolic complication nor worsening of hemodynamic status

Genome of Herbaspirillum seropedicae Strain SmR1, a Specialized Diazotrophic Endophyte of Tropical Grasses

The molecular mechanisms of plant recognition, colonization, and nutrient exchange between diazotrophic endophytes and plants are scarcely known. Herbaspirillum seropedicae is an endophytic bacterium capable of colonizing intercellular spaces of grasses such as rice and sugar cane. The genome of H. seropedicae strain SmR1 was sequenced and annotated by The Paraná State Genome Programme—GENOPAR. The genome is composed of a circular chromosome of 5,513,887 bp and contains a total of 4,804 genes. The genome sequence revealed that H. seropedicae is a highly versatile microorganism with capacity to metabolize a wide range of carbon and nitrogen sources and with possession of four distinct terminal oxidases. The genome contains a multitude of protein secretion systems, including type I, type II, type III, type V, and type VI secretion systems, and type IV pili, suggesting a high potential to interact with host plants. H. seropedicae is able to synthesize indole acetic acid as reflected by the four IAA biosynthetic pathways present. A gene coding for ACC deaminase, which may be involved in modulating the associated plant ethylene-signaling pathway, is also present. Genes for hemagglutinins/hemolysins/adhesins were found and may play a role in plant cell surface adhesion. These features may endow H. seropedicae with the ability to establish an endophytic life-style in a large number of plant species

The German National Registry of Primary Immunodeficiencies (2012-2017)

Introduction: The German PID-NET registry was founded in 2009, serving as the first national registry of patients with primary immunodeficiencies (PID) in Germany. It is part of the European Society for Immunodeficiencies (ESID) registry. The primary purpose of the registry is to gather data on the epidemiology, diagnostic delay, diagnosis, and treatment of PIDs. Methods: Clinical and laboratory data was collected from 2,453 patients from 36 German PID centres in an online registry. Data was analysed with the software Stata® and Excel. Results: The minimum prevalence of PID in Germany is 2.72 per 100,000 inhabitants. Among patients aged 1–25, there was a clear predominance of males. The median age of living patients ranged between 7 and 40 years, depending on the respective PID. Predominantly antibody disorders were the most prevalent group with 57% of all 2,453 PID patients (including 728 CVID patients). A gene defect was identified in 36% of patients. Familial cases were observed in 21% of patients. The age of onset for presenting symptoms ranged from birth to late adulthood (range 0–88 years). Presenting symptoms comprised infections (74%) and immune dysregulation (22%). Ninety-three patients were diagnosed without prior clinical symptoms. Regarding the general and clinical diagnostic delay, no PID had undergone a slight decrease within the last decade. However, both, SCID and hyper IgE- syndrome showed a substantial improvement in shortening the time between onset of symptoms and genetic diagnosis. Regarding treatment, 49% of all patients received immunoglobulin G (IgG) substitution (70%—subcutaneous; 29%—intravenous; 1%—unknown). Three-hundred patients underwent at least one hematopoietic stem cell transplantation (HSCT). Five patients had gene therapy. Conclusion: The German PID-NET registry is a precious tool for physicians, researchers, the pharmaceutical industry, politicians, and ultimately the patients, for whom the outcomes will eventually lead to a more timely diagnosis and better treatment

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

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Come la valenza emotiva delle immagini interferisce con l’abilità di ricerca visiva

Introduzione: Il fenomeno Change Blindness (CB) evidenzia il fallimento in cui le persone incorrono quando devono rilevare un cambiamento in una scena visiva. Il CB è determinato dalla presenza di un’interruzione del segnale visivo che impedisce il rilevamento dell’avvenuto cambiamento. Il Flicker Task riproduce tale condizione, presentando due immagini, una originale A e una modificata A’, in successione, intervallate da una schermata grigia di 80 ms. Le immagini sono ripetute ciclicamente finché non viene rilevato il cambiamento. Durante la ricerca visiva (RV), l’osservatore rivolge la propria attenzione prima verso alcune zone di “interesse centrale” e poi verso altre, definite a “interesse marginale”. Tale paradigma è un compito di RV che permette di utilizzare immagini complesse, consentendo di valutare l’influenza della valenza emotiva delle immagini esplorate sulla prestazione attenzionale. Metodo: 124 bambini di 7-14 anni e 22 adulti dovevano osservare attentamente le immagini e premere un tasto appena rilevavano il cambiamento. Venivano presentate 24 prove, metà con cambiamento centrale/marginale; 4 per ciascuna valenza emotiva (positiva, negativa e neutra). Le immagini duravano 240 ms e la schermata grigia 80 ms. Le immagini sono state selezionate dall’International Affective Picture System. Risultati: L’ANOVA sui tempi di risposta ha evidenziato un effetto principale dell’Età (F4,141=23,38;p<.001), del Cambiamento (F1,141=401,42;p<.001) e della Valenza (F2,282=24,07;p<.001). È risulta significativa anche l’interazione Età x Cambiamento x Valenza. Conclusioni: La valenza delle immagini interferisce con la prestazione di RV in tutti i gruppi di bambini, ma non negli adulti. I soggetti impiegano meno tempo a rilevare il cambiamento nelle immagini con valenza neutra rispetto a quelle a valenza emotiva. La maggior attrattività delle immagini emotive sembra interferire e quindi rallentare lo svolgimento del compito

La ricerca visiva nell’autismo: influenza della valenza emotiva degli stimoli

Introduzione. Esistono evidenze contrastanti circa le capacità di ricerca visiva (RV) nell’autismo. Alcuni autori riportano una maggiore abilità di RV, altri ne evidenziano una compromissione. Inoltre, è nota nell’autismo una difficoltà nel processamento delle informazioni emotive. Sarebbe dunque importante valutare la RC con stimoli più ecologici, considerando anche l’influenza della valenza emotiva degli stimoli sulla prestazione attenzionale. Nel presente studio abbiamo usato un compito di RV, usando come stimoli delle fotografie; due immagini, una originale e una modificata, intervallate da una schermata grigia di 80 ms, venivano presentate ciclicamente finché non era rilevato il cambiamento. Durante questo compito il soggetto rivolge la propria attenzione prima verso alcune zone di interesse (cambiamento centrale: CC) e poi verso altre (cambiamento marginale: CM). Abbiamo dunque valutato le abilità di RV di bambini con diagnosi di disturbi dello spettro autistico (AU) e di Controllo (C) utilizzando immagini emotive tratte dall’International Affective Picture System. Metodo. A 20 bambini AU e 20 C sono state presentate 24 immagini, metà con CC e metà con CM; 4 per valenza: negativa (NG), positiva (PS) e neutra (NU). Le immagini duravano 240 ms e la schermata grigia 80 ms. Risultati. L’ANOVA Gruppo(2)xCambiamento(3)xValenza(3) sui tempi di risposta (TR) ha evidenziato l’effetto del Cambiamento (F1,38=169,81;p<.001) e della Valenza (F2,76=12,93;p<.001) e l’interazione GruppoxCambiamentoxValenza (F2,76=12,79;p<.001). Conclusioni. Gli stimoli emotivi interferiscono (rallentando i TR) con la prestazione attenzionale. I due gruppi non si differenziano nella RV di CC. Nella ricerca di CM, i bambini AU mostrano TR maggiori con immagini NU e TR minori con immagini PS rispetto ai C. Ciò evidenzia una mancanza di interferenza degli stimoli positivi; i bambini AU trattano gli stimoli PS come quelli NU

Una ricerca-intervento sullo sviluppo delle competenze di vita negli ipertesi attraverso la promozione della capacità di regolazione emozionale

Tra le competenze di vita considerate fondamentali dall’Organizzazione Mondiale della Sanità per la promozione della salute sono presenti: la gestione delle emozioni e dello stress, l’empatia e l’autoconsapevolezza. Queste competenze sono tutte strettamente connesse all’ambito emotivo. La letteratura ha evidenziato come le persone con ipertensione arteriosa presentino un deficit nella capacità di elaborazione emozionale (Alessitmia). Obietto di questo studio è valutare l’efficacia di una psicosalutogenesi di Promozione della Capacità di Regolazione Emozionale (PROCRE), per ridurre i livelli di pressione arteriosa e migliorare il controllo della salute nei pazienti ipertesi. Hanno partecipato allo studio 90 pazienti ipertesi, selezionati presso il Centro per il Trattamento dell’Ipertensione della Iª Clinica Medica del Policlinico Umberto I° di Roma. Cinque gruppi di 12 soggetti hanno costituito il gruppo PROCRE e 30 persone in lista d’attesa il gruppo di controllo. I due gruppi erano omogenei per utilizzo di farmaci antipertensivi, e bilanciati per genere e livello di alessitimia. Prima e dopo il trattamento, e a un follow-up a 3 mesi sono state valutate alcune caratteristiche psicologiche (Alessitimia e Locus of control della Salute) e fisiologiche (Misurazione clinica della pressione arteriosa) ed è stata eseguita un’anamnesi medico-psicologica. I gruppi PROCRE hanno partecipato a 12 sedute con cadenza settimanale di 2 ore ciascuna; con sedute alterne di esperienze di “gioco” centrate su alcuni aspetti emozionali, ed elaborazione delle esperienze emozionali quotidiane. Alla fine del trattamento si è fatto un colloquio individuale per pianificare come utilizzare, nella quotidianità, le competenze emozionali eventualmente sviluppate. I principali risultati hanno indicato nei gruppi PROCRE: una diminuzione dei valori pressori (sia sistolici p<.0004 che diastolici p<.000001) e un aumento del Locus of control della Salute (p<.02). Sebbene preliminari, questi risultati sembrano confermare che una psicosalutogenesi che faciliti lo sviluppo di competenze emozionali consente anche di migliorare la salute fisica del paziente, riducendo i livelli di pressione arteriosa

Promoting the ability of emotional self-regulation in people affected by hypertension

Hypertensive patients show a deficit in emotional regulation (Alexithymia). Aim of our study was to verify whether a 10 group sessions in Promoting Emotional Regulation Skills (PERS) allows decreasing blood pressure (BP) in hypertensive patients. The results confirm the efficacy of PERS in reducing BP and this decrease persist at the 3 months follow up

Interrogating Medical Tourism: Ireland, Abortion, and Mobility Rights

Medical tourism in Ireland, like in many Western states, is built around assumptions about individual agency, choice, possibility, and mobility. One specific form of medical tourism—the flow of women from Ireland traveling in order to secure an abortion—disrupts and contradicts these assumptions. One legacy of the bitter, contentious political and legal battles surrounding abortion in Ireland in the 1980s and 1990s has been securing the right of mobility for all pregnant Irish citizens to cross international borders to secure an abortion. However, these mobility rights are contingent upon nationality, social class, and race, and they have enabled successive Irish governments to avoid any responsibility for providing safe, legal, and affordable abortion services in Ireland. Nearly twenty years after the X case discussed here, the pregnant female body moving over international borders—entering and leaving the state—is still interpreted as problematic and threatening to the Irish state