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Background Patients with stage 4/5 chronic kidney disease (CKD) suffer from various symptoms. The retention of uremic solutes is thought to be associated with those symptoms. However, there are relatively few rigorous studies on the potential links between uremic toxins and symptoms in patients with CKD. Methods The EQUAL study is an ongoing observational cohort study of non-dialyzed patients with stage 4/5 CKD. EQUAL patients from Germany, Poland, Sweden and the UK were included in the present study (n = 795). Data and symptom self-report questionnaires were collected between April 2012 and September 2020. Baseline uric acid and parathyroid hormone and 10 uremic toxins were quantified. We tested the association between uremic toxins and symptoms and adjusted P-values for multiple testing. Results Symptoms were more frequent in women than in men with stage 4/5 CKD, while levels of various uremic toxins were higher in men. Only trimethylamine N-oxide (TMAO; positive association with fatigue), p-cresyl sulfate (PCS) with constipation and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (negative association with shortness of breath) demonstrated moderately strong associations with symptoms in adjusted analyses. The association of phenylacetylglutamine with shortness of breath was consistent in both sexes, although it only reached statistical significance in the full population. In contrast, TMAO (fatigue) and PCS and phenylacetylglutamine (constipation) were only associated with symptoms in men, who presented higher serum levels than women. Conclusion Only a limited number of toxins were associated with symptoms in persons with stage 4/5 CKD. Other uremic toxins, uremia-related factors or psychosocial factors not yet explored might contribute to symptom burden.

Background Whether a very low-protein diet supplemented with ketoanalogues (sVLPD), compared with a standard low-protein diet (LPD), improves outcomes in patients with chronic kidney disease (CKD) under stable nephrology care is undefined. Objectives To compare the effectiveness of sVLPD compared with LPD in patients regularly seen in tertiary nephrology care. Methods Participants were patients with CKD stages 4-5, followed for at least 6 mo, randomly allocated to receive sVLPD or LPD [0.35 or 0.60 g/kg ideal body weight (IBW)/d, respectively], stratified by center and CKD stage. The primary outcome was time to renal death, defined as the first event between end-stage renal disease (ESRD) and all-cause mortality; secondary outcomes were the single components of the primary outcome, cardiovascular outcome, and nutritional status. Results We analyzed 223 patients (sVLPD, n = 107; LPD, n = 116). Mean age was 64 y, 61% were male, and 35% had diabetes. Median protein intake (PI), which was 0.8 g/kg IBW/d at baseline in both groups, was 0.83 and 0.60 g/kg IBW/d in LPD and sVLPD, respectively, during the trial with a large decrease only in sVLPD (P = 0.011). During a median of 74.2 mo, we recorded 180 renal deaths (141 dialysis and 39 deaths before dialysis). Risk of renal death did not differ in sVLPD compared with LPD (HR: 1.17; 95% CI: 0.88, 1.57; P = 0.28). No difference was observed for ESRD (HR: 1.12; 95% CI: 0.81, 1.56; P = 0.51), mortality (HR: 0.95; 95% CI: 0.62, 1.45; P = 0.82), or time to fatal/nonfatal cardiovascular events (P = 0.2, log-rank test). After 36 mo, still active patients were 45 in sVLPD and 56 in LPD. No change of nutritional status emerged during the study in any arm. Conclusions This long-term pragmatic trial found that in patients with CKD under stable nephrology care, adherence to protein restriction is low. Prescribing sVLPD compared with standard LPD is safe but does not provide additional advantage to the kidney or patient survival.

An aortic aneurysm is a ruinous condition that compromises the aortic wall. If inaccurately monitored, it could evolve in an extensive dilatation of the vessel and eventually in the aorta's devastating rupture with low survival rates. The recent attempts to increase clinical remission and disease clearance have only partially alleviated the disease-related poor prognosis. Indeed, aortic aneurysm events annually increase their impact on the National Health Systems of industrialized countries. In recent years, liquid biopsy tests have gained attention as a valuable alternative to traditional diagnostics. Classified as small extracellular vesicles of endosomal origin, exosomes are 30-150 nm diameter vesicles, which are physiologically produced by all cell types and secreted through an exocytosis process in blood, urine, cerebrospinal fluid, and other body fluids. Representing the molecular footprint of the cells of origin, exosomes have been recently considered to design a reliable liquid biopsy for non-invasive monitoring of disease evolution and a valuable tool to monitor the therapy response. Metalloproteinases have been reported as specific markers of aortic aneurysm in terms of disease staging and progression. Of interest, it has been demonstrated a specular metalloproteinase expression in the extracellular vesicles of patients, thus constituting a personal "barcode" of disease progression. This evidence could potentially allow the definition of innovative liquid biopsy approaches for monitoring the disease together with a comprehensive aortic aneurysm-derived exosomes molecular characterization and trapping.

An aortic aneurysm is a ruinous condition that compromises the aortic wall. If inaccurately monitored, it could evolve in an extensive dilatation of the vessel and eventually in the aorta's devastating rupture with low survival rates. The recent attempts to increase clinical remission and disease clearance have only partially alleviated the disease-related poor prognosis. Indeed, aortic aneurysm events annually increase their impact on the National Health Systems of industrialized countries. In recent years, liquid biopsy tests have gained attention as a valuable alternative to traditional diagnostics. Classified as small extracellular vesicles of endosomal origin, exosomes are 30-150 nm diameter vesicles, which are physiologically produced by all cell types and secreted through an exocytosis process in blood, urine, cerebrospinal fluid, and other body fluids. Representing the molecular footprint of the cells of origin, exosomes have been recently considered to design a reliable liquid biopsy for non-invasive monitoring of disease evolution and a valuable tool to monitor the therapy response. Metalloproteinases have been reported as specific markers of aortic aneurysm in terms of disease staging and progression. Of interest, it has been demonstrated a specular metalloproteinase expression in the extracellular vesicles of patients, thus constituting a personal "barcode" of disease progression. This evidence could potentially allow the definition of innovative liquid biopsy approaches for monitoring the disease together with a comprehensive aortic aneurysm-derived exosomes molecular characterization and trapping.

The presence of proteinuria, i.e. an abnormal amount of proteins in the urine is a well documented cardiovascular (CV) and renal risk factor either in the general population or in high-risk populations such as patients with type 2 diabetes, previous CV disease and patients under regular nephrology care. Indeed, the increase in proteinuria levels, even if of small entity, is associated to a faster decline in renal function over time, increased risk of End-Stage-Kidney-Disease and CV mortality. The deleterious effect of proteinuria on the kidney is attributable to the primitive glomerular damage as well as to the direct toxicity the proteinuria exerts on the tubule-interstitium. In addition, the more general association with the increased CV risk can be explained by the evidence that proteinuria can be considered a marker of systemic and renal endothelial damage. A reduction in proteinuria over time (a 30% decrease after 6 months of treatment in proteinuria is considered acceptable) as response to antihypertensive or antiproteinuric drugs protects against the development of all mentioned endpoints. Further studies are needed to better clarify: What is the normal value of proteinuria excretion, how many measures should be done during follow-up to truely assess the risk of future outcomes, what is the exact prognostic role of proteinuria.

Infections to the peritoneal catheter are common in Peritoneal Dialysis (PD). We report the clinical case of a 49-year-old male patient in PD, who showed an atypical manifestation of tunnel infection caused by Staphylococcus aureus. The infection was characterized by a little abscess, on the left pararectal abdominal line, 6 cm far from exit-site of the peritoneal catheter. The diagnosis was made using ultrasonography (US), which showed a fistulous communication from subcutaneous cuff to the skin. We treated the infection conservatively by performing cuff-shaving and drainage of the abscess, associated to antibiotic therapy (teicoplanin). Due to the persistence of the infection, we added oral and topical rifampicin, and advanced medication with freez-dried collagen plant impregnated with extended-release gentamicin. The complete resolution of the infection allowed us to avoid removing the catheter.

Lithium has always been used as a first-choice therapy in bipolar disorders. However, its therapeutic index is restricted by placing patients at risk of potential nephrotoxic effects ranging from polyuria, to Insipid Nephrogenic Diabetes, to chronic kidney disease with a slow reduction of renal function over time. The Nephrologist has the role to diagnose chronic lithium nephropathy, monitoring its evolution and optimizing the management of risks associated with the treatment. In fact, the main objective, to be shared with the psychiatrist, is to encourage the maintenance of therapy even in the presence of nephropathy. Renal ultrasound, a safe, repeatable and low-cost technique, is essential to pursue this goal as it not only confirms the diagnosis of chronic lithium nephropathy hypothesized on the basis of the history and clinical picture, but is also helpful in monitoring its evolution. In this paper, we report a case of chronic lithium nephropathy in order to analyze the etiopathogenesis of renal damage, the clinical-laboratory and histological picture and, in particular, the fundamental role of ultrasound imaging.

2 páginas.-- 1 figura.-- 7 referencias.-- Comunicación presentada en el 19th International Conference of Humic Substances and their Contribution to the Climate Change Mitigation 16–21 September 2018 Albena Resort, Bulgaria, Restoring humus in soil represents a key factor for improving soil quality. Digestates from anaerobic digestion (AD) can be successfully applied as soil amendments. Here, we investigated changes of the organic matter (OM) composition of digestates from solid-state anaerobic digestion (AD) of straw and pig slurry at different percolate recirculation frequency. Atomic ratios, thermostability indexes, O-alkyl C/alkyl C ratio and Py-GC/MS results consistently showed a positive effect of the highest number (4) of percolate recirculations per day on OM features, resulting in a more stable OM in digestate.

Up to now, it is unknown how anaerobic digestion of biowastes affects the chemical composition of water-soluble organic matter (WSOM) in the digestate and, thus, the potential distribution and mobility of hydrophobic organic contaminants. The aim of the present work was to estimate the proportions of hydrophilic (HI) and hydrophobic (HO) fractions of WSOM in anaerobic digestates obtained from different mixtures of biomass. The overall goal was correlating proportions of HI and HO fractions to the different chemical characteristics of the biowastes subjected to anaerobic digestion. More than 70% of WSOM was with the HI fractions of digestates derived from 1:1 mixtures of the organic part of municipal solid wastes and sewage sludge. Larger HO fractions were observed for digestates derived from energy crop plus smaller contributions of poultry manure, stomach residue, and apple residues, likely due to the concentration of fibers during the digestion. Ratios between HO fractions in digestates and in their corresponding ingestates were used as indicators of the transformation of WSOM during the process.

A number of digestates obtained from various mixtures of organic wastes were analyzed by FTIR spectroscopy. A general evidence emerging from FTIR spectra was the large variability in the composition of fresh organic substrates both in terms of chemical complexity and seasonal variations. FTIR spectra of the organic fraction of municipal solid waste reflected their chemical composition rich in proteins, fatty acids, carbohydrates and phenolic groups whereas those of sewage sludge samples indicated a notable content of inorganic materials which obviously were found unchanged in digestates. Digestates obtained by energy crops, poultry manure, stomach residue and others agro-industrial residue sampled in different sections of the digestion plan reflected the high content of protinaceous materials from poultry manure and stomach residues in the feed-in mixtures. Fourier Self Deconvolution (FSD) of FTIR spectra proved to be very useful in evidencing changes in relative intensity of peaks both in feed-in mixtures and in digestates.

Fluorescence spectroscopy was applied to the characterization of a number of digestates obtained by various mixtures of organic waste. Different results were obtained for digestates produced by anaerobic digestion of a 1:1 mixture of the organic fraction of municipal solid waste and sewage sludge under mesophilic and thermophilic conditions. Under thermophilic condition emission maxima located at higher ? than those obtained under mesophilic conditions were observed. In general, higher fluorescence intensity (FI) were obtained in emission spectra of digestates as compared to their corresponding substrates, whereas FI of digestates under thermophilic condition were lower than those of digestates under mesophilic conditions. Digestates obtained by energy crops, poultry manure, stomach residue and others agro-industrial residue sampled in different sections of the digestion plant exhibited an increase of FI values of the peak at highest ? in synchronous-scan spectra from the first digester to the storage tank. Excitation emission matrix (EEM) of all digestates revealed a typical peak characterized by very low excitation ? (250-265) and relatively high ? (410-442) which could not be included in the classification of EEM peaks reported in literature for natural organic matter and therefore it was referred to as peak E. Our results indicated that this peak can be used to identify and characterize digestates with respect to other different samples of natural OM.

The wide range of fluorophore responses to pH available in the literature reflects the complex nature and heterogeneous composition of natural organic matter so that the study of fluorescence spectra to pH changes is not an easy task. However, since early 80’s it is well known that humic substances tend to have a linear structure at high pH and coil up when pH decreases so that changes in fluorescence intensity and/or wavelength values with changing pH can be attributed to conformational changes in the molecules hiding or exposing fluorescing parts. In general, more rigid structures provide better fluorescent yields since a spherocolloidal configuration could mask some fluorophores inside their structure. Here the response to pH changes (4, 6, 8, 10) of fluorescence spectra of digestates produced by anaerobic digestion of a 1:1 mixture of the organic fraction of municipal solid waste and sewage sludge under mesophilic and thermophilic conditions was studied. Our results showed that emission spectra of digestates exhibited a shift to higher values and a general increase of FI up to pH 8 and a more or less slight decrease of FI from pH 8 to pH 10. The response to pH modifications of synchronous-scan spectra was more complex and articulated.

Digestates obtained from a 1:1 mixture of the organic fraction of municipal solid waste and sewage sludge under mesophilic and thermophilic conditions evidenced a shift of the high temperature exotherm toward higher temperature with respect to feed-in material indicating stabilization attained by the OM during the process. A further shift of this exotherm toward higher temperature associated to lower enthalpy values were observed for thermophilic digestates with respect to mesophilic digestates. These results were explained by a major degradation of OM attained under stronger operative conditions. Lower enthalpy values were calculated for both mesophilic and thermophilic digestates with respect to feed-in mixtures. DSC applied to digestates obtained by energy crops, poultry manure, stomach residue and others agro-industrial residue sampled in different sections of the digestion plant showed a strong exotherm at lower temperature indicating lower thermal stability of the substrate. Lower enthalpy values of the high-temperature exotherm were calculated for digestates sampled from the storage tank, whereas higher H values were calculated for digestates retrieved from the second digester.

La digestione anaerobica (DA), in assenza di ossigeno e in presenza di opportuni microrganismi, trasforma la sostanza organica (SO) delle biomasse di scarto in biogas costituito prevalentemente da metano ed anidride carbonica. Alla fine del processo, la sostanza organica si riduce del 60-70% e il prodotto finale, il digestato, è caratterizzato da elevata stabilità biologica, elevata presenza di molecole recalcitranti ed elevato contenuto in nutrienti. L’analisi termica in Calorimetria a Scansione Differenziale (DSC) è stata applicata alla caratterizzazione di acidi umici e fulvici di diversa origine e di materiali compostati ottenuti da matrici diverse ma pochi lavori sono reperibili in letteratura sui prodotti della DA. Lo scopo di questo lavoro è utilizzare la DSC in associazione con la procedura di deconvoluzione (FSD) degli spettri FTIR ottenuti prima e dopo il riscaldamento a 400 °C e 550 °C allo scopo di identificare i gruppi funzionali responsabili dell’effetto termico osservato sulle curve di campioni tal quali della frazione organica dei residui solidi urbani (FORSU1 e FORSU2)) e di fanghi di depurazione (FD1 e FD2) prelevati nel comune di Bagnacavallo (RA) e miscelati nel rapporto 1:1, nonchè dei digestati (D) ottenuti in seguito al processo di DA in fase mesofila. Il campione di FORSU1 conteneva in parte residui di scarti alimentari provenienti da una locale azienda di ristorazione. I termogrammi delle matrici in ingresso presentano un picco esotermico tra i 200-400 °C generalmente attribuito alla combustione di carboidrati come cellulosa e composti lignocellulosici ed uno ad alta temperatura, intorno a 510 °C, attribuito alla combustione di strutture aromatiche. Gli FD presentano un picco endotermico aggiuntivo a 160 °C dovuto alla disidratazione. La differente composizione dei due campioni di FORSU si ripercuote sui rispettivi termogrammi. Infatti, la FORSU 2 è caratterizzata dal picco esotermico alle medie temperature spostato a valori più alti, indice di una matrice più ricca di cellulosa e lignina. Le differenze tra i due campioni di FORSU riscontrate nei profili DSC sono confermate dalla maggiore intensità dei picchi attribuibili a proteine e fenoli provenienti dagli scarti di ristorazione nella traccia FSD della FORSU 1. Gli spettri FTIR degli FD sono dominati da picchi attribuiti agli inerti che permangono anche a 550 °C. Le tracce FSD di questi campioni consentono, invece, di assegnare il picco alle medie temperature a decarbossilazione e deamminazione di gruppi proteici. I termogrammi dei D sono caratterizzati da due endoterme (a 150 °C e 230 °C) e da un’esoterma a più alta temperatura (540 °C) rispetto alle matrici in ingresso a conferma dell’avvenuta stabilizzazione della SO alla fine del processo. L’elevato contenuto in inerti degli FD si riflette sulla composizione dei D che presentano spettri FTIR e tracce FDS simili agli FD.

La conversione di substrati organici complessi in metano, attraverso la digestione anaerobica (DA), avviene attraverso una catena trofica anaerobica alla quale partecipano diversi gruppi di microrganismi che si differenziano sia per i substrati metabolizzati che per i prodotti che ne derivano. La temperatura, in questo processo, rappresenta un parametro estremamente importante poiché provoca un radicale cambiamento nella composizione della comunità batterica e dunque una variazione nelle velocità di reazione. Scopo del presente lavoro è di confrontare le caratteristiche chimiche e spettroscopiche dei digestati (D) ottenuti dalla frazione organica dei rifiuti solidi urbani (FORSU) e dei fanghi di depurazione (FD) miscelati nel rapporto 1:1 in regime mesofilo a 35°C (FORSU1m e FORSU2m, FD1m e FD2m) e in regime termofilo a 55°C (FORSU3t e FD3t). D1m, D2m, D1t, D2t e D3t rappresentano i corrispondenti digestati. La sperimentazione condotta in termofilia ha mostrato i risultati migliori e più promettenti in termini di produzione di biogas. Inoltre, rispetto alla fase mesofila, è stata ottenuta una maggiore riduzione dei solidi volatili, mentre l’aumento di temperatura ha comportato una diminuzione dei tenori di TOC nelle matrici in uscita. La DA in termofilia provoca un maggior decremento di HA+FA ma permette di ottenere, pur con perdite di frazione umica, un aumento del grado complessivo di umificazione. Tutti i campioni in ingresso e i digestati sono stati analizzati in spettroscopia infrarossa in trasformata di Fourier (FTIR), spettroscopia di fluorescenza convenzionale in eccitazione, emissione e scansione sincrona, fluorescenza tridimensionale sotto forma di matrici contour (EEM). Lo spettro FTIR dell’ FD3t mostra un contenuto iniziale di inerti inferiore rispetto agli altri FD e questo si ripercuote anche nei D ottenuti in regime termofilo (stesso andamento degli spettri FTIR). Negli spettri in scansione sincronica e in emissione dei campioni di entrambe le serie si osserva lo stesso andamento: gli spettri dei D presentano dei massimi spostati a maggiore lunghezza d’onda rispetto alle matrici in entrata. In particolare, i massimi dei Dt sono spostati a λ maggiori rispetto ai Dm. Questo risultato conferma il fatto che i D presentano un struttura molecolare più complessa delle matrici di partenza e il processo in regime termofilo raggiunge livelli ossidativi più spinti rispetto a quelli raggiunti in mesofilia.

Marketing researchers employ the Five-Factor Model to describe branded products through attributes used for human personality. Marker attributes used to elicit brand personality dimensions can also influence consumers’ intention to purchase. Two connected studies, carried out on two samples of 91 and 557 subjects, respectively, show that brand personality-marker attributes predict intention to purchase, but only to the extent that such attributes are vivid and, in particular, when they elicit emotional responses (i.e., when they are emotionally interesting). These findings have several implications for people involved in developing strategies for persuasive communication.