Stage 5 Chronic Kidney Disease: Epidemiological Analysis in a NorthEastern District of Italy Focusing on Access to Nephrological Care

BACKGROUND

We conducted a retrospective epidemiological study about the prevalence of stage 5 chronic kidney disease (CKD) in a high-income district, comparing some demographic characteristics and outcomes of those patients who had nephrological consultations and those who had not.

RESULTS

In a district of 400,000 adult subjects in 2020, 925 patients had an estimated glomerular filtration rate (eGFR) under 15 mL/min and CKD. In the same period, 747 (80.4%) patients were assessed by nephrologists, while 178 (19.6%) were not. Age (88 vs. 75, p < 0.0001), female gender (66.3% vs. 47%, p < 0.001), and eGFR (12 vs. 9 mL/min, p < 0.001) were significantly different in the patients assessed by a nephrologist as compared those who did not have nephrological care. Furthermore, unfollowed CKD patients had a significantly higher death rate, 83.1% versus 14.3% (p < 0.0001).

CONCLUSIONS

About 20% of ESKD patients did not receive a nephrologist consultation. Older people and women were more likely not to be referred to nephrology clinics. Unfollowed patients with stage 5 CKD had a significantly higher death rate.

Extracorporeal therapy in the treatment of sepsis: In vitro assessment of the effect of an absorbent cartridge on the circulating bacterial concentration and its interaction with the antibiotic therapy

Sepsis is one of the major causes of death worldwide. In its physiopathological process, a broad spectrum of pro and antiinflammatory mediators plays a strategic role, leading to a sepsis induced state of immunoparalysis. The rationale behind the employment of extracorporeal purification techniques as a complement to therapy for sepsis is based on their ability to remove the mediators involved. Until now, attention was focused on the immunomodulation allowed by purification therapies. However, the focus of studies on the application possibilities that these techniques offer as a supplement to antimicrobial therapy and resuscitation of critically ill patients must be extended. In this study, the possible removal by adsorption that the Jafron^® HA330 cartridge operates against bacteria (S. aureus) was evaluated in vitro. Subsequently, it was evaluated whether the adsorptive capabilities toward bacteria were maintained by using a cartridge functionalized with Vancomycin and whether the latter maintains its bactericidal activity. This study showed that HA330 reduces the circulating bacterial load, even in the presence of pre-adsorbed Vancomycin. Vancomycin, once adsorbed by the cartridge, does not guarantee its bactericidal activity during the 2-h of hemoperfusion treatment.

Pharmacological characterization of the nociceptin/orphanin FQ receptor antagonist SB-612111 [(-)-cis-1-methyl-7-[[4-(2,6-dichlorophenyl)piperidin-1-yl]methyl]-6,7,8,9-tetrahydro-5H-benzocyclohepten-5-ol]: in vitro studies

The compound SB-612111 [(-)-cis-1-methyl-7-[[4-(2,6-dichlorophenyl)piperidin-1-yl]methyl]-6,7,8,9-tetrahydro-5H-benzocyclohepten-5-ol] was recently identified as a selective antagonist for the nociceptin/orphanin FQ (N/OFQ) peptide receptor (NOP). In the present study, the in vitro pharmacological profile of SB-612111 at human recombinant NOP receptors expressed in Chinese hamster ovary (CHO) cells [receptor binding, guanosine 5'-O-(3-[(35)S]thio)triphosphate (GTPgamma[(35)S]) binding, and cAMP level experiments] as well as at native NOP receptors expressed in peripheral (mouse and rat vas deferens, guinea pig ileum) and central (mouse cerebral cortex synaptosomes releasing [(3)H]5-HT) preparations was evaluated and compared with that of the standard nonpeptide antagonist (+/-)J-113397 [(+/-)-trans-1-[1-cyclooctylmethyl-3-hydroxymethyl-4-piperidyl]-3-ethyl-1,3-dihydro-2H-benzimidazol-2-one]. SB-612111 produced a concentration-dependent displacement of [(3)H]N/OFQ binding to CHO(hNOP) cell membranes, showing higher affinity and NOP selectivity over classical opioid receptors than (+/-)J-113397. SB-612111 and (+/-)J-113397 competitively antagonized the effects of N/OFQ on GTPgamma[(35)S] binding in CHO(hNOP) cell membranes (pK(B), 9.70 and 8.71, respectively) and on cAMP accumulation in CHO(hNOP) cells (pK(B), 8.63 and 7.95, respectively), being per se inactive. In isolated peripheral tissues of mice, rats, and guinea pigs and in mouse cerebral cortex synaptosomes preloaded with [(3)H]5-HT, SB-612111 competitively antagonized the inhibitory effects of N/OFQ, with pA(2) values in the range of 8.20 to 8.50. In parallel experiments, (+/-)J-113397 was found to be 2- to 9-fold less potent than SB-612111. In the electrically stimulated tissues, 1 microM SB-612111 did not modify the effects of classical opioid receptor agonists. In conclusion, the results of the present study demonstrated that SB-612111 is among the most potent and NOP-selective nonpeptide antagonists identified to date.

Identification of an achiral analogue of J-113397 as potent nociceptin/orphanin FQ receptor antagonist

To date, J-113397 represents the most potent and selective non peptide NOP receptor antagonist widely used in pharmacological studies. However, the synthesis, purification, and enantiomer separation of this molecule, which contains two chiral centers, is rather difficult and low-yielding. Here, we synthesized and tested a series of simplified J-113397 analogues to investigate the importance of the stereochemistry and the influence of the substituents at position 3 of the piperidine nucleus and on the nitrogen atom of the benzimidazolidinone nucleus. The compound coded as Trap-101, an achiral analogue of J-113397, combines a pharmacological profile similar to that of the parent compound with a practical, high-yielding preparation.

Arthroscopic monopolar radiofrequency thermal stabilization for chronic lateral ankle instability: a preliminary report on 10 cases

This study represents a preliminary review of 10 patients having undergone arthroscopic monopolar thermal stabilization for ankle instability from October 1996 to June 1998. All patients in this study expressed mild to moderate chronic ankle instability complaints and were dissatisfied with their attempts at conservative care. Subjective clinical results were evaluated in all patients having undergone this procedure utilizing a modified version of the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. In addition, eight of these patients underwent pre- and postoperative stress radiographs. The average age of the patient population in this study was 34.5 +/- 9.26 years. The preoperative AOFAS scores averaged 58.3 +/- 8.96 and the postoperative were 88.1 +/- 11.09 points. Patients returned to full activities on the average of 3 months. Postoperative ankle varus stress test reduced on the average of 2.8 degrees +/- 2.77 degrees, while the anterior drawer measurements reduced 4.8 +/- 1.83 mm. The reduction in anterior drawer test amounted to an approximate 60% decrease in talar excursion postoperatively. All patients who underwent this procedure achieved ankle stability and commented that they would undergo the procedure again.

Arthroscopy of the calcaneocuboid and talonavicular joints

The authors describe the anatomy, portal placement, technique, indications, and preliminary results of seven cases of calcaneocuboid or talonavicular joint pathology that underwent elective investigational diagnostic or therapeutic arthroscopy with a follow up of 3-14 months. All patients had failed available conservative therapy. Results of treatment were five excellent and two good cases. Two patients required arthrotomy. There were no complications associated with portal placement, arthroscopic technique, or instrumentation. Arthroscopy of the calcaneocuboid and talonavicular joints has proven to be a relatively safe and valuable diagnostic and therapeutic tool. It is hoped that advances in small joint arthroscopy application will encourage further technological evolution in arthroscopic instrumentation and establish a foundation for further arthroscopic exploration of the small joints of the foot.

[Changes in the plasma levels of T3-T4 and TSH during surgical stress and anesthesia with isoflurane]

The authors describe the blood level changes of T3, T4 and TSH in 17 patients undergoing urological surgery and isoflurane anaesthesia. The data were statistically processed and showed that isoflurane, used as the only anesthetic agent in 1.5%-2% concentrations, is not sufficient to block hormonal changes of the hypothalamus-hypophysis-thyroid axis caused by surgical stress.

[Evaluation of the efficacy of cefoperazone sodium in the treatment of infections in intensive therapy]

The efficacy and tolerability of Cefoperazone sodium in the treatment of infections primarily of the lower respiratory and/or urinary tract were assessed. The drug was given to 16 intensive care patients encountered over a period of a few months. The results appear to be satisfactory and suggest that the drug is suitable for use in the treatment of intensive care infections.

[Pathology of infections in the resuscitation and intensive care center of the Biella Hospital]

A survey was conducted into the problems of infections in intensive care units. After a short report on the survey methodology, the equipment most frequently involved in infection and the germs implicated are described. Results and conclusions agree with data from the literature reported in the introduction.

[Posttraumatic fat embolism. Clinical case contribution]

Various aspects of post-traumatic fat embolism are discussed in relation to aetiopathogenesis, therapy and clinical development. Four significant cases are described. This research shows the importance of prevention and early diagnosis in limiting serious consequences, and makes clear the advantages of a right therapeutic technique.