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

Derivati del pirazolo aventi attività antifungina

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A New Synthetic Entry to 3-Carboxamido-4-carboxylic Acid Derivatives of Isoxazole and Pyrazole

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Contribution of Geosciences to Cultural Heritage Conservation Assessment: The Case Study of the Loggiato dei Cappuccini in Comacchio (Italy)

Geoscience disciplines play a pivotal role in the assessment of the conservation state of Cultural Heritage to orient the subsequent restoration interventions. In this report, we exemplify the potential of petrographic and thermographic analyses for the evaluation of the conservation state of a unique symbol of the architectural heritage in the challenging lagoon environment of Comacchio city (Ferrara Province, northeastern Italy). This study focuses on the Loggiato dei Cappuccini, starting from the historical analysis of the maintenance and restorations that this simple and pleasant monument has undergone over time. The degradation morphologies and the related triggering causes, characterized by macroscopic observations, were contextualized based on the recent restoration interventions. The current state of conservation has been evaluated quali-quantitatively, combining optical petrographic analyses of the main construction materials with thermographic analyses of the structures. The results of this study highlight the detrimental effects of previous restoration interventions on the long-term conservation state of the monument, emphasizing the need for a general environmental evaluation preliminarily to any conservative action. In particular, geoscience can contribute to a knowledge-based choice of materials that minimize the risk for alveolization and detachments

Clinical Update on the Use of Immuno Modulators (antiCD3, GAD, Diapep277, Anti-IL1) in Type 1 Diabetes

In type 1 diabetes, beta cells are attacked and destroyed by auto reactive T cells causing major impairment of blood glucose metabolism and, ultimately, the development of life-threatening complications. Currently, the treatment of this chronic disease is based on the use of endogenous insulin and no curative therapies are available. Treatment approaches in this respect need to be directed toward the primary causes of the disease tackling beta cells' auto reactive T cells. The goal of any curative intervention in type 1 diabetes is the preservation of insulin-secreting cells. This may be achieved by the abrogation of the pathogenic reactivity to beta cell auto antigens while preserving full capacity to generate a normal immune response against foreign antigens. In this review, some of the most promising drugs for immune intervention in type 1 diabetes are presented and discussed including phase 3 clinical trials that involve: DiaPep277, Anti-CD3 Otelixizumab, Glutamic Acid Decarboxylase ( GAD) and anti-IL1 receptor antagonist. These approaches are currently being tested in international multicenter trials and all of them have a very similar outcome in terms of a beneficial effect on beta cells