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

An application of sequence stratigraphy to Mars: the Eberswalde fan delta

We present a review of our work on an intriguing feature on Mars, the Eberswalde delta-like feature, based on detailed geological analyses aimed to recognize and map the depositional environments and to infer their evolution through time. The topset-foreset-bottomset geometry, typical of delta progradation, has been observed in the Eberswalde outcrops allowing to interpret this feature as a fan delta. We distinguished delta plain, delta front and prodelta depositional sub-environments in the exposed stratigraphic succession. The delta plain is made of distributary channels and interdistributary areas, in which crevasse splays delivered coarser sediments from the channels. Polygonal shrinkage cracks formed probably after exposure in the interdistributary areas. At places the polygons have been reworked by more recent distributary channels causing the formation of intrabasinal breccia. In the delta front inertia and friction-related processes appear to be dominant in different phases of the fan delta evolution, suggesting fluctuations of the controls on sedimentation through time. The dynamics of the recognized depositional environments has been evaluated in terms of sequence stratigraphy, recognizing geometries such as offlap and downlap, erosional truncations and stacking patterns, entering them in a stratigraphic framework. The sedimentary architecture of the fan delta appears to be organized in three cycles, which we tentatively interpreted as depositional sequences. The evolution of these sequences would have been controlled by relative water level fluctuations showing a longer term trend toward decreasing water content inside the basin. The evolution of the Eberswalde fan delta appears to be controlled by autogenic processes within the single discharge lobes. Allogenic processes, such as tectonic activity and/or climatic forcing, would have instead caused fluctuations of the level of the water table in the lake, consequently driving the switching among the deltaic lobes

Extracorporeal photochemotherapy for the treatment of glomerulopathies with associated nephrotic syndrome

Introduction: Patients with glomerulopathies associated with nephrotic syndrome have few effective treatment options. Here we report on the use of extracorporeal photochemotherapy (ECP) in 6 patients in whom glomerulopathy failed to respond to pharmacologic therapy. ECP is a promising immunomodulatory therapy associated with few side effects, that has been successfully used in the treatment of other immune-mediated conditions such as solid organ transplant rejection and graft-versus-host disease. Methods: In this study, patients underwent 12 months of ECP. In all patients, progressive improvement in proteinuria was noted during the follow-up period, and total cholesterol and triglyceride levels also returned to near-normal values. Results: In the 4 patients who had adequate renal function at study initiation, improvement of renal function was observed, as indicated by improved glomerular filtration rates (GFRs) and decreased proteinuria to creatininuria (Pru/Cru) ratios. In contrast, renal function progressively worsened in the 2 patients with inadequate renal function at study initiation. Conclusions: The results suggest that ECP is a feasible treatment for patients with glomerulopathies associated with nephrotic syndrome who have adequate baseline renal function. Additional clinical evaluation will have to be performed to better define the patient population in which ECP is most effective

Evolution and depositional environments of the Eberswalde fan delta, Mars

The Eberswalde crater and its contributing basins have been analyzed in detail in order to reconstruct the geological evolution of the water-related landforms with particular focus on the Eberswalde delta-like feature. Based on a complex strata organization characterized by a topset–foreset–bottomset geometry, typical of delta progradation on Earth, we interpret the Eberswalde feature to be a fan delta associated with a lacustrine system. Depositional sub-environments have been recognized and mapped and the sedimentary processes discussed. A sequence stratigraphy approach has been used to evaluate the system, which we interpret to result from three depositional sequences. These sequences suggest relative water level fluctuations and a longer trend over time towards decreasing water content inside the basin

Stressful life events, social support, attachment security and alexithymia in vitiligo: A case-control study

Background: It has often been suggested that stress might trigger vitiligo. However, only one study supported this hypothesis, and no study explored the role of other personality or social factors. Methods: Out-patients experiencing a recent onset or exacerbation of vitiligo (n = 31) were compared with out-patients with skin conditions in which psychosomatic factors are commonly were regarded as negligible (n = 116). Stressful events during the last 12 months were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia and social support were assessed with the 'Experiences in Close Relationships' questionnaire, the Toronto Alexithymia Scale (TAS-20), and the Multidimensional Scale of Perceived Social Support, respectively. Results: Cases and controls did not differ regarding the total number of events and the number of undesirable, uncontrollable or major events. Three or more uncontrollable events had occurred more frequently among cases than controls. Perceived social support was lower in cases than in controls. Cases scored higher than controls on anxious attachment, tended towards higher scores on avoidant attachment and were classified more often as insecure. Cases scored higher than controls on the TAS-20 and were classified more often as alexithymic or borderline alexithymic. The occurrence of many uncontrollable events, alexithymia and anxious attachment were associated with vitiligo also in multiple logistic regression analysis. Conclusions: These findings suggest that vulnerability to vitiligo is not increased by stressful events, except for many uncontrollable events. Alexithymia, insecure attachment and poor social support appear to increase susceptibility to vitiligo, possibly through deficits in emotion regulation or reduced ability to cope effectively with stress. Copyright © 2003 S. Karger AG, Basel

Screen-detected multiple primary lung cancers in the ITALUNG trial

Occurrence of multiple primary lung cancers (MPLC) in individuals undergoing low-dose computed tomography (LDCT) screening has not been thoroughly addressed. We investigated MPLC in subjects recruited in the ITALUNG randomized clinical trial. Cases of cytologically/histologically proven MPLC detected at screening LDCT or follow-up CT were selected and pathologically re-evaluated according to the WHO 2015 classification. Overall 16 MPLC were diagnosed at screening LDCT (n=14, all present at baseline) or follow-up CT (n=2) in six subjects (4 in one subject, 3 in two and 2 in three subjects), representing 0.43% of the 1,406 screenees and 15.8% of the 38 subjects with at least one screen-detected primary lung cancer. MPLC included 9 adenocarcinomas in three subjects and a combination of 7 different tumour histotypes in three subjects. MPLC, mostly adenocarcinomas, are not uncommon in smokers and ex-smokers with at least one LDCT screen detected primary lung cancer