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Active healthy ageing (AHA) is a goal that several world organisations promote and is essential for modern societies where the average age is increasing. Physical activity (PA), including exercise, is a central aspect of achieving this goal, even though a high percentage of the population has high levels of sedentariness and low levels of PA. Therefore, this narrative review aimed to summarise and critically evaluate the existing literature that investigates technology-induced changes in PA levels and the possibility that these may produce active lifestyles, promoting AHA; this is unclear in the apparently healthy older adult population. Training protocols delivered via a website, similar to mobile applications, seem capable of increasing not only physical fitness but also PA levels, at least in the short term. Wearable active tracker devices (WATs), alone or together with websites, can lead to an increase in step count and average daily moderate PA in outdoor environments, as well as in specifically designed applications. Technology that can offer virtual physical games is an effective strategy to promote PA by overcoming certain barriers that may limit its practice in apparently healthy older adults. Currently, information and communication technologies (ICTs), and more generally new digital technologies, show great potential in increasing PA levels and reducing sedentary levels, at least in the short term. The heterogeneity of the proposed interventions and the frequent lack of follow-ups do not allow us to evaluate the effectiveness in the long term, which is crucial for the AHA process. [ABSTRACT FROM AUTHOR]

Research has shown that higher levels of physical activity are associated with better cognitive performance in children. However, the benefits of physical activity on academic achievement and specifically on mathematics performance need to be further explored. Therefore, this study aimed to investigate the effects of a complex physical activity (CPA) intervention program, including cognitive involvement, on children's mathematics performance. The participants were 128 children (aged 12–13 years) attending third grade in three middle schools. They were randomly allocated into a CPA intervention (n = 64) or a waitlist control group (n = 64), the latter of which was given a regular and easy-to-perform activity program. At baseline and after the intervention, students' physical fitness was measured using a battery of standardized motor tests (20 m shuttle run test, curl-up test, push-up test, and sit and reach test). In addition, the AC-MT 11-14 test was administered to allow a standardized and comprehensive assessment of arithmetic problem-solving and arithmetic reasoning abilities. In comparison to the control, the intervention group showed significant improvements (p < 0.001) in comprehension and production (d = 1.88), arithmetic reasoning (d = 2.50), and problem solving (d = 1.32), as well as in 20 m shuttle run test (d = 1.81), push-up test (d = 1.88), curl-up (d = 3.52), and sit and reach (d = 2.52). No significant changes were found in the control group. In conclusion, findings showed that a 12-week CPA intervention program can improve mathematical performance in children in the third grade of middle school. CPA intervention may be an effective method to improve academic performance and avoid student failure. [ABSTRACT FROM AUTHOR]

Several studies have shown a relevant presence of anxiety feelings among renal transplant patients. This study examines the impact of transplant-related stress and social support on anxiety. Two hypotheses were examined: H1: High transplant-related stressors and low social support are related to high anxiety (additive hypothesis); H2: Social support moderates the detrimental impact of transplant-related stressors on anxiety (buffer hypothesis). One hundred and four kidney transplant recipients (54% male), with a mean age of 50.8 (SD = 12.6), volunteered to participate in a cross-sectional study that included a face-to-face interview and several self-administered scales. Hierarchical regression analyses indicated that higher transplant-related stressors are associated with higher levels of anxiety (F change(2, 92) = 17.4,p < .001, ∆R2 = 24%), but, contrary to our prediction, social support was not directly related with anxiety. However, social support has a moderating effect on the relationship between high transplant-related stressors and anxiety (F change(1, 91) = 5.2,p < .05, ∆R2 = 3%). The results are consistent with the hypothesis that social support has a buffering role on the patients’ distress following renal transplantation and suggest that their psychological well-being could benefit from enhancing the perception of social support in post-operative care. [ABSTRACT FROM PUBLISHER]

Simple Summary: To date, the influence that physical activity (PA)/physical exercise (PE) can exert on the human gut microbiota (GM) is still poorly understood. Several issues arise in structuring research in this area, starting from the association between PA/PE and diet. Indeed, the diet of an individual is a key factor for the composition of the GM and those who regularly practice PA/PE, generally, have dietary patterns favorable to the creation of an ideal environment for the proliferation of a GM capable of contributing to the host's health. It is therefore difficult to establish with certainty whether the effects generated on the GM are due to a PA protocol, the type of diet followed, or to both. In addition, most of the available studies use animal models to investigate a possible correlation between PA/PE and changes in the GM, which may be not necessarily applied to humans. Evidence suggests that aerobic PA/PE seems capable of producing significant changes in GM; training parameters, likewise, can differentially influence the GM in young or elderly people and these changes appear to be transient and reversible. Several studies have been conducted to find at least an association between physical activity (PA)/ physical exercise (PE) and the possibility to modulate the gut microbiome (GM). However, the specific effects produced on the human GM by different types of PA/PE, different training modalities, and their age-related effects are not yet fully understood. Therefore, this systematic review aims to evaluate and summarize the current scientific evidence investigating the bi-directional relationship between PA/PE and the human GM, with a specific focus on the different types/variables of PA/PE and age-related effects, in healthy and unhealthy people. A systematic search was conducted across four databases (Web of Science, Medline (PubMed), Google Scholar, and Cochrane Library). Information was extracted using the populations, exposure, intervention, comparison, outcomes (PICOS) format. The Oxford Quality Scoring System Scale, the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool, and the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies were used as a qualitative measure of the review. The protocol was registered in PROSPERO (code: CRD42022302725). The following data items were extracted: author, year of publication, study design, number and age of participants, type of PA/PE carried out, protocol/workload and diet assessment, duration of intervention, measurement tools used, and main outcomes. Two team authors reviewed 694 abstracts for inclusion and at the end of the screening process, only 76 full texts were analyzed. Lastly, only 25 research articles met the eligibility criteria. The synthesis of these findings suggests that GM diversity is associated with aerobic exercise contrary to resistance training; abundance of Prevotella genus seems to be correlated with training duration; no significant change in GM richness and diversity are detected when exercising according to the minimum dose recommended by the World Health Organizations; intense and prolonged PE can induce a higher abundance of pro-inflammatory bacteria; PA does not lead to significant GM α/β-diversity in elderly people (60+ years). The heterogeneity of the training parameters used in the studies, diet control, and different sequencing methods are the main confounders. Thus, this systematic review can provide an in-depth overview of the relationship between PA/PE and the human intestinal microbiota and, at the same time, provide indications from the athletic and health perspective. [ABSTRACT FROM AUTHOR]

Solid organ transplant patients are at a higher risk for poor CoronaVirus Disease‐2019 (COVID‐19)‐related outcomes and have been included as a priority group in the vaccination strategy worldwide. We assessed the safety and efficacy of a two‐dose vaccination cycle with mRNA‐based COVID‐19 vaccine (BNT162b2) among 82 kidney transplant outpatients followed in our center in Rome, Italy. After a median of 43 post‐vaccine days, a SARS‐CoV‐2 anti‐Spike seroprevalence of 52.4% (n = 43/82) was observed. No impact of the vaccination on antibody‐mediated rejection or graft function was observed, and no significant safety concerns were reported. Moreover, no de novo HLA‐donor‐specific antibodies (DSA) were detected during the follow‐up period. Only one patient with pre‐vaccination HLA‐DSA did not experience an increased intensity of the existing HLA‐DSA. During the follow‐up, only one infection (mild COVID‐19) was observed in a patient after receiving the first vaccine dose. According to the multivariable logistic regression analysis, lack of seroconversion after two‐dose vaccination independently associated with patient age ≥60 years (OR = 4.50; P =.02) and use of anti‐metabolite as an immunosuppressant drug (OR = 5.26; P =.004). Among younger patients not taking anti‐metabolites, the seroconversion rate was high (92.9%). Further larger studies are needed to assess the best COVID‐19 vaccination strategy in transplanted patients. [ABSTRACT FROM AUTHOR]

The aim of this work was to assess the level of microbial contamination and resistance of bacteria isolated from a highthroughput heavy pig slaughterhouse (approx. 4600 pigs/day) towards antimicrobials considered as critical for human, veterinary or both chemotherapies. Samples, pre-operative and operative, were obtained in 4 different surveys. These comprised environmental sampling, i.e. air (ntotal = 192) and surfaces (ntotal = 32), in four different locations. Moreover, a total of 40 carcasses were sampled in two different moments of slaughtering following Reg. (CE) 2073/2005. Overall, 60 different colonies were randomly selected from VRBGA plates belonging to 20 species, 15 genera and 10 families being Enterobacteriaceae, Moraxellaceae and Pseudomonadaceae the most represented ones. Thirty-seven isolates presented resistance to at least one molecule and seventeen were classified as multi-drug resistant. Enterobacteriaceae, particularly E. coli, displayed high MIC values towards trimethoprim, ampicillin, tetracycline and sulphametoxazole with MICmax of 16, 32, 32 and 512 mg/L, respectively. Moreover, isolated Pseudomonas spp. showed high MIC values in critical antibiotics such as ampicillin and azithromycin with MICmax of 32 and 64 mg/L, respectively. Additionally, in vitro biofilm formation assays demonstrated that fifteen of these isolates can be classified as strong biofilm formers. Results demonstrated that a high diversity of bacteria containing antibiotic resistant and multiresistant species is present in the sampled abattoir. Considering these findings, it could be hypothesised that the processing environment could be a potential diffusion determinant of antibiotic resistant bacteria through the food chain and operators. [ABSTRACT FROM AUTHOR]

Background: Few studies explored the role of hypothermic machine perfusion (HMP) in the sub‐group of non‐standard renal grafts with a biopsy‐proven advanced histological impairment. This study aimed to investigate the role of HMP in grafts with a Karpinski Score >3 in terms of the need for dialysis, creatinine reduction ratio at day‐7 (CRR7), and 3‐year graft survival. Methods: Twenty‐three perfused grafts with Karpinski Score >3 evaluated between November 2017 and December 2018 were retrospectively analyzed and compared with a control group of 32 non‐perfused grafts transplanted between January 2014 and October 2017. Results: After transplantation, perfused grafts had fewer cases requiring dialysis (8.7% vs. 34.4%; p = 0.051), a better reduction in serum creatinine (median at 7 days: 2.2 vs. 4.3 mg/dl; p = 0.045), and shorter length of hospital stay (median 11 vs. 15 days; p = 0.01). Three‐year death‐censored graft survival was better in the perfused cases (91.3% vs. 77.0%; p = 0.16). In perfused grafts, initial renal resistance (RR) had the best predictive value for renal function recovery after the first week, as defined by CRR7 ≤ 70% (AUC = 0.83; p = 0.02). A cut‐off value of 0.5 mm Hg/ml/min showed a sensitivity of 82.4%, a specificity of 83.3%, and diagnostic odds ratio = 23.4. After dividing the entire population into a Low‐RR (n = 8) and a High‐RR Group (n = 15), more cases with CRR7 ≤ 70% were reported in the latter group (86.7 vs. 13.3%; p = 0.03). Conclusion: HMP yielded promising results in kidneys with Karpinski Score >3. Initial RR should be of interest in selecting non‐standard organs for single kidney transplantation even in impaired histology. [ABSTRACT FROM AUTHOR]

The decline of allograft kidney function in the long term remains a significant issue in renal transplantation, with drug nephrotoxicity and cardiovascular complications as important risk factors. Our study aimed to evaluate the estimated glomerular filtration rate (eGFR) trend and metabolic cardiovascular risk factors over 10 years in a cohort of kidney transplant (KT) recipients converted from twice-daily (TD) tacrolimus (Tac) to once-daily (OD)-Tac. We enrolled 55 consecutive KT recipients who had been at the outpatient clinic between 2009 and 2011. Thirty-seven reached the 10-year follow-up. We compared the observed eGFR with the expected eGFR trend described in KT-recipients and monitored blood pressure and metabolic cardiovascular risk factors. The observed eGFR remained stable throughout the complete follow-up (P =.188). The observed decline of eGFR was significantly lower compared with the expected decline for KT patients (P <.001). The blood pressure was maintained within target values. The monitoring of plasma glucose levels demonstrated the stability of median values (P =.686), as well as cholesterol level (P =.250), high-density lipoprotein (HDL) cholesterol (P =.294), and triglycerides (P =.592) throughout the follow-up. The monitoring of tacrolimus plasma level demonstrated that median trough levels remained constant (median values 4.4-5.5 ng/mL) throughout the entire follow-up period (P =.149). We suggest that the reasonable control of metabolic risk factors for cardiovascular disease over long-term follow-up may significantly contribute to the preservation of eGFR compared with the decline expected in KT recipients. [ABSTRACT FROM AUTHOR]

This study examined the relations between appraisal of transplant-related stressors, coping, and adjustment dimensions following kidney transplantation (KT). Two models were tested: (1) the main effects model proposing that stress appraisal and coping strategies are directly associated with adjustment dimensions; and (2) the moderating model of stress proposing that each coping strategy interacts with stress appraisal. Importantly, there is a lack of research examining the two models simultaneously among recipients of solid organ transplantation. A total of 174 KT recipients completed the questionnaires. Predictors of post-transplant adjustment included appraisal of transplant-related stressors and coping strategies (task-, emotion-, and avoidance-focused). Adjustment dimensions were psychological distress, worries about the transplant, feelings of guilt, fear of disclosure of transplant, adherence, and responsibility for the functioning of the new organ. The main and moderating effects were tested with regression analyses. Appraisal of transplant-related stressors and emotion-oriented coping were related to all adjustment dimensions, except of adherence and responsibility. Task-oriented coping was positively related to responsibility. Avoidance-oriented coping was negatively correlated with adherence. Only 1 out of 18 hypothesized interactive terms was significant, yielding a synergistic interaction between appraisal of transplant-related stressors and emotion-oriented coping on the sense of guilt. The findings have the potential to inform interventions promoting psychosocial adjustment among KT recipients. [ABSTRACT FROM AUTHOR]

We report the prevalence of BK virus ( BKV) infection before renal transplantation and the dynamics of BKV viremia from pre- to post-transplantation. We assessed 60 kidney transplanted patients from a single cohort in Italy, treated with identical immunosuppressive therapy, for BK viremia at pre-transplantation, 12 h, and three and six months post-transplantation. Polymerase chain reaction showed that the prevalence of plasma BKV replication - considered a marker of infection - was 20% in pre-transplant patients. All pre-transplant-positive patients remained positive post-transplant, whereas the majority of pre-transplant-negative patients remained negative. Viremia dynamics classification revealed three clusters of patients: Cluster A++, pre-transplant-positive patients (20%) who tested positive at least once post-transplant; Cluster B−+, pre-transplant-negative patients (28%) who tested positive at least once post-transplant; and Cluster C- -, pre-transplant-negative patients (52%) who remained negative throughout. These clusters presented significant differences related to the prevalence of substantially positive patients with high plasma viral load (>103 copies/mL) in cluster A, but not in donors' or grafts' characteristics. We suggest that pre-transplant viral status should be considered as an additional risk factor for post-transplant BKV replication. Therefore, pre-transplant BKV infection screening in kidney transplant patients should be performed for improving planning of personalized immunosuppressant schemes and specific post-transplant surveillance. [ABSTRACT FROM AUTHOR]

Tumor thrombus in the inferior vena cava (IVC) occurs in 4-10% of patients with renal cell carcinoma (RCC) and poses a challenge for the surgical team. Because there is no systemic therapy available to significantly reduce tumor burden, surgical intervention is the only treatment. However, the surgical approach is associated with significant morbidity and mortality. When the thrombus extends above the diaphragm, the use of cardiopulmonary bypass (CPB) and accompanying deep hypothermic circulatory arrest (DHCA) has usually been advocated. However, complications inherent to CPB and DHCA, such as coagulopathy and central nervous system complications, have led us to search for an alternative surgical approach to these tumors. The purpose of this study is to describe the surgical technique used in five patients with large RCC with tumor thrombus extending into the supradiaphragmatic IVC and Right atrium (RA), Right atrium, who underwent extensive resection without CPB and DHCA. [ABSTRACT FROM AUTHOR]

We report the surgical management of a bilateral renal artery aneurysm diagnosed in a 41-year-old patient with a history of recurrent abdominal pain. The preoperative contrast-enhanced computed tomography showed a complex saccular aneurysm on both renal arteries within the renal hilum. The characteristics of aneurysms precluded endovascular procedures, and a double-step bilateral ex vivo reconstruction with kidney autotransplantation was planned. The intra- and postoperative period was uneventful. Imaging and laboratory examinations show preservation of renal function, and patient is symptom-free at 10-month follow up. [ABSTRACT FROM AUTHOR]

Abstract In our 3-year experience, we treated 63 patients with Molecular Adsorbent Recirculating System (MARS). The patients were divided as follows: 10 primary non-function (PNF) 16%, 10 delayed non-function (DNF) 16%, 16 Fulminant hepatitis (FH) 24%, 23 acute decompensation of chronic liver disease (ACLF) 38%, and 4 hepatic resection 6%. All patients who underwent MARS treatment had bilirubin >15 mg/dL, Glasgow Coma Score between 9 and 11, ammonium >160 µg/dL and non-coagulability. The determining factors taken into consideration for the continuation of MARS treatment were: an improvement in Glasgow Coma Score, and a decrease in ammonium and bilirubin. We also monitored hemodynamic parameters, acid–base equilibrium, and blood gas analysis before and after each treatment. In order to determine patients' neurological conditions, we not only took into account the Glasgow Coma Score, which does not give mathematically precise results but also took into account the fact that patients with hepatic coma had lower cerebral mean velocity in the cerebral arteries than patients without encephalopathy. For this reason, in the last 22 patients we monitored cerebral perfusion, determined by mean flow velocity (V [sub mean] ) in the middle cerebral artery. Our results were expressed as mean ± SD and we analyzed the differences between mean values for each variable, before and after treatment by means of Student's t -test. At the end of treatment, we obtained significant P -values for bilirubin, ammonium, Glasgow Coma Score and creatinine. In 16/20 patients, we could demonstrate a clear correlation between the improvement in clinical conditions (especially neurological status) and improvement in cerebral perfusion, measured by color Doppler US. [ABSTRACT FROM AUTHOR]