Esiste un cutoff alla penetranza della dialisi peritoneale? Come superarlo?

Il centro di Brescia ha un'incidenza della DP del 35% e oltre 30 anni di esperienza. Nonostante ciò, ha un cutoff di prevalenza a 80 pazienti, che non riesce a superare. Questo breve scritto sintetizza alcune possibili soluzioni per incrementare l'utilizzo della DP

Incremental peritoneal dialysis: a 10 year single-centre experience

INTRODUCTION: Incremental dialysis consists in prescribing a dialysis dose aimed towards maintaining total solute clearance (renal + dialysis) near the targets set by guidelines. Incremental peritoneal dialysis (incrPD) is defined as one or two dwell-times per day on CAPD, whereas standard peritoneal dialysis (stPD) consists in three-four dwell-times per day. PATIENTS AND METHODS: Single-centre cohort study. Enrollement period: January 2002-December 2007; end of follow up (FU): December 2012. INCLUSION CRITERIA: incident patients with FU ≥6 months, initial residual renal function (RRF) 3-10 ml/min/1.73 sqm BSA, renal indication for PD. RESULTS: Median incrPD duration was 17 months (I-III Q: 10; 30). There were no statistically significant differences between 29 patients on incrPD and 76 on stPD regarding: clinical, demographic and anthropometric characteristics at the beginning of treatment, adequacy indices, peritonitis-free survival (peritonitis incidence: 1/135 months-patients in incrPD vs. 1/52 months-patients in stPD) and patient survival. During the first 6 months, RRF remained stable in incrPD (6.20 ± 2.02 vs. 6.08 ± 1.47 ml/min/1.73 sqm BSA; p = 0.792) whereas it decreased in stPD (4.48 ± 2.12 vs. 5.61 ± 1.49; p < 0.001). Patient survival was affected negatively by ischemic cardiopathy (HR: 4.269; p < 0.001), peripheral and cerebral vascular disease (H2.842; p = 0.006) and cirrhosis (2.982; p = 0.032) and positively by urine output (0.392; p = 0.034). Hospitalization rates were significantly lower in incrPD (p = 0.021). Eight of 29 incrPD patients were transplanted before reaching full dose treatment. CONCLUSIONS: IncrPD is a safe modality to start PD; compared to stPD, it shows similar survival rates, significantly less hospitalization, a trend towards lower peritonitis incidence and slower reduction of renal function

The Italian Consensus Conference on Pain in Neurorehabilitation: rationale and methodology

Pain is very common in the neurorehabilitation setting, where it may not only represent a target for treatment but can also negatively influence rehabilitation procedures directly or through the side effects of painkillers. To date, there are neither guidelines nor consensus on how to assess and treat pain in neurorehabilitation. Because of the very scanty pieces of evidence on this topic, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was promoted under the auspices of different scientific societies. This article illustrates the rationale, methodology, and topics of the ICCPN. The recommendations of the ICCPN will offer some information on how to deal with pain in neurorehabilitation and may represent the starting point for further studies

The Italian Consensus Conference on Pain in Neurorehabilitation: rationale and methodology

Pain is very common in the neurorehabilitation setting, where it may not only represent a target for treatment but can also negatively influence rehabilitation procedures directly or through the side effects of painkillers. To date, there are neither guidelines nor consensus on how to assess and treat pain in neurorehabilitation. Because of the very scanty pieces of evidence on this topic, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was promoted under the auspices of different scientific societies. This article illustrates the rationale, methodology, and topics of the ICCPN. The recommendations of the ICCPN will offer some information on how to deal with pain in neurorehabilitation and may represent the starting point for further studies

Three-Dimensional Printing of Fetal Models of Congenital Heart Disease Derived From Microfocus Computed Tomography: A Case Series

This article presents a case series of n = 21 models of fetal cardiovascular anatomies obtained from post mortem microfocus computed tomography (micro-CT) data. The case series includes a broad range of diagnoses (e.g., tetralogy of Fallot, hypoplastic left heart syndrome, dextrocardia, double outlet right ventricle, atrio-ventricular septal defect) and cases also had a range of associated extra-cardiac malformations (e.g., VACTERL syndrome, central nervous system anomalies, renal anomalies). All cases were successfully reconstructed from the microfocus computed tomography data, demonstrating the feasibility of the technique and of the protocols, including in-house printing with a desktop 3D printer (Form2, Formlabs). All models were printed in 1:1 scale as well as with the 5-fold magnification, to provide insight into the intra-cardiac structures. Possible uses of the models include education and training

Ripensare ecosistemi educativi e formativi capacitanti nella prospettiva del principio di reciprocità

This contribution is the result of a collective work carried out within the «Learning circle Economics of reciprocity» within the Siref 2021 Summer School. The basic theme on which the contribution intends to reflect is that of rethinking generative ecosystems that can «enable» society as a whole towards an approach to «reciprocity», in contrast to the growing forms of poverty. In this perspective it is necessary to promote new active labor policies towards decent work, new educational policies towards a culture of sustainability; new perspectives of meaning related to the dimensions of fraternity, care, relationality, planetary solidarity towards possible models of sustainable development.Il presente contributo è frutto di un lavoro collettaneo realizzato nell’ambito del “Learning circle Economia di reciprocità” all’interno della Summer School Siref 2021. Il tema di fondo sul quale il contributo intende riflettere è quello di ripensare ecosistemi generativi che possano “capacitare” la società nella sua interezza verso un approccio alla “reciprocità”, in contrasto alle crescenti forme di po vertà. In questa prospettiva è necessario promuovere nuove politiche attive del lavoro verso un lavoro dignitoso, nuove politiche educative verso una cultura della sostenibilità; nuove prospettive di significato correlate alle dimensioni della fraternità, della cura, della relazionalità, della solidarietà planetaria verso possibili modelli di sviluppo sostenibile

Automated Analysis of Proliferating Cells Spatial Organisation Predicts Prognosis in Lung Neuroendocrine Neoplasms

SIMPLE SUMMARY: Lung neuroendocrine neoplasms (lung NENs) are categorised by morphology, defining a classification sometimes unable to reflect ultimate clinical outcome, particularly for the intermediate domains of adenocarcinomas and large-cell neuroendocrine carcinomas. Moreover, subjectivity and poor reproducibility characterise diagnosis and prognosis assessment of all NENs. The aim of this study was to design and evaluate an objective and reproducible approach to the grading of lung NENs, potentially extendable to other NENs, by exploring a completely new perspective of interpreting the well-recognised proliferation marker Ki-67. We designed an automated pipeline to harvest quantitative information from the spatial distribution of Ki-67-positive cells, analysing its heterogeneity in the entire extent of tumour tissue—which currently represents the main weakness of Ki-67—and employed machine learning techniques to predict prognosis based on this information. Demonstrating the efficacy of the proposed framework would hint at a possible path for the future of grading and classification of NENs. ABSTRACT: Lung neuroendocrine neoplasms (lung NENs) are categorised by morphology, defining a classification sometimes unable to reflect ultimate clinical outcome. Subjectivity and poor reproducibility characterise diagnosis and prognosis assessment of all NENs. Here, we propose a machine learning framework for tumour prognosis assessment based on a quantitative, automated and repeatable evaluation of the spatial distribution of cells immunohistochemically positive for the proliferation marker Ki-67, performed on the entire extent of high-resolution whole slide images. Combining features from the fields of graph theory, fractality analysis, stochastic geometry and information theory, we describe the topology of replicating cells and predict prognosis in a histology-independent way. We demonstrate how our approach outperforms the well-recognised prognostic role of Ki-67 Labelling Index on a multi-centre dataset comprising the most controversial lung NENs. Moreover, we show that our system identifies arrangement patterns in the cells positive for Ki-67 that appear independently of tumour subtyping. Strikingly, the subset of these features whose presence is also independent of the value of the Labelling Index and the density of Ki-67-positive cells prove to be especially relevant in discerning prognostic classes. These findings disclose a possible path for the future of grading and classification of NENs

Italian guidelines for primary headaches: 2012 revised version

The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105–190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version

«A foglia ed a gemma». Letture dall'opera poetica di Andrea Zanzotto

Il volume attraversa passo a passo l'opera poetica di Andrea Zanzotto, proponendo letture di liriche esemplari. Indice: Massimo Cacciari, I classici di Zanzotto; Matteo Giancotti, Nei cimiteri fonti, da A che valse [1938-1942]; Michael Jakob, Distanza, da Dietro il paesaggio, 1951; Rodolfo Zucco, Contro monte, da Elegia, 1954; Uberto Motta, Dal cielo, da Vocativo, 1957; Pier Vincenzo Mengaldo, Palpebra alzata, da IX Ecloghe, 1962; Massimo Natale, Retorica su: lo sbandamento, il principio «resistenza», V, da La Beltà, 1968; Natascia Tonelli, Ipersonetto, XII (Sonetto di sembianti e diva), da Il Galateo in Bosco, 1978; Laura Barile, Eurosia e Vocabilità, fotoni, da Fosfeni, 1983; Giuseppe Sandrini, Docile, riluttante, da Idioma, 1986; Luca Bragaja, Erbe e Manes, Inverni, da Meteo, 1996; Stefano Verdino, Luna starter di feste bimillenarie, da Sovrimpressioni, 2001; Luigi Tassoni, Gentile e forte creatura della Vallata, da Conglomerati, 2009