Archivio istituzionale della ricerca - Università dell'Insubria
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Lipoprotein(a) as an early marker of cardiovascular events in high-risk subjects: insights from the Moli-sani cohort study
No full textBackground and aims: Epidemiological studies have revealed the role of lipoprotein(a) [Lp(a)] in the etiopathogenesis of cardiovascular disease (CVD). We analyzed the association between Lp(a) and the risk of a major cardiovascular event in subjects with previous CVD. Methods: The analysis was conducted on the Moli-sani study population (24,325 individuals aged ≥35 years, recruitment from 2005 to 2010), focusing on subjects with prior CVD. Data from standardized questionnaires and blood pressure, anthropometric, and lab measurements were collected. Lp(a) levels were measured using biobanked samples. The cohort was followed for cardiovascular events. The association between Lp(a) levels and risk of major adverse cardiovascular events was analyzed using Kaplan–Meier and Cox regression models. Results: In total, 1,284 subjects reported a history of CVD at baseline. The mean ± SD Lp(a) level was 23.3 ± 26.0 mg/dl and 51 subjects (4.0%) had levels ≥90 mg/dl. After a median of 7.3 years, 307 CVD events were recorded and validated. Subjects belonging to the highest Lp(a) level group (≥90 mg/dl) showed a worse trend during early follow-up compared with the lowest level group (<30 mg/dl), with a peak during the first 18 months [hazard ratio (HR) = 3.43, 95% confidence interval (CI): 1.43–8.27]. This increase was higher in subjects with dyslipidemia not treated with statins and those with multiple previous CVD events (HR = 11.0, 95% CI: 1.98–61.1; HR = 25.6, 95% CI: 7.83–83.8). Conclusions: High Lp(a) levels were associated with an increased risk of early secondary cardiovascular events in individuals with a history of multiple CVDs or non-treated dyslipidemia, suggesting that lipoprotein(a) is a modifiable biomarker that can be measured at different times for CVD risk assessment
Emerging Economic Challenges in the 2030 Agenda: Rethinking Models of Responsible Growth with a Particular Focus on the Italian Case
No full textThis contribution critically investigates the economic challenges that hinder the implementation of the United Nations 2030 Agenda, with particular reference to the Italian case. Persistent inequalities, regional disparities, and the regressive effects of the COVID-19 pandemic are analyzed as structural obstacles to sustainable development. The essay explores alternative growth paradigms—such as the circular economy and redistributive fiscal policies—while emphasizing the role of corporate responsibility and sustainable finance in fostering regenerative economic models. By integrating national strategies with global instruments, the paper outlines policy directions aimed at inclusiveness, resilience, and long-term sustainability. Ultimately, reducing inequality emerges as a systemic condition for achieving the Sustainable Development Goals and ensuring social cohesion
Modelling emergency disaster mortality around the world: a network-based distributional inference approach
No full textORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in solid organ transplant recipients
No full textObjectives: We aimed to address existing knowledge gaps regarding risk stratification, best use of diagnostic resources, optimal treatment, and general management of SARS-CoV-2 infection in solid organ transplant (SOT) recipients. As high-quality evidence specific to this fragile population is lacking, our final aim was to provide an expert consensus evidence-informed guidance that can aid clinicians in their daily practice. Methods: This study was conducted within the Working Package 4 (fragile population cohorts) of the H2020-funded ORCHESTRA study (https://orchestra-cohort.eu). Eight infectious disease and one clinical pharmacology specialists conducted a comprehensive scoping literature review which covered five key areas: the role of SOT as a risk factor for evolution to severe disease; the optimal use of diagnostic resources, considering cost–benefit ratios and appropriateness of active screening; population-specific therapeutic management, including antiviral use and drug–drug interactions and appropriate duration of treatment; the potential need for withdrawal of immunosuppressive agents and management of potential donors and recipients with recent and/or ongoing SARS-CoV-2 infection at the time of transplantation. On the basis of this review, a 28-item questionnaire was developed and administered to a panel of experts through two rounds, following the Delphi methodology. Results: The panel consisted of 21 experts, 13 females and 8 males, from Italy (n = 11), Spain (n = 5), Switzerland (n = 2), Brazil (n = 1), United States (n = 1), and United Kingdom (n = 1). Consensus was achieved for 18 out of 28 items after the first round and for 9 out of 13 items after the second round, according to agreement/disagreement levels obtained for each question and round, ten statements were finally produced. Discussion: The consensus statements derived from this study offer a framework for standardizing care and improving outcomes in SOT recipients affected by SARS-CoV-2 infection in a field where high-quality evidence specific to this high-risk population is currently lacking
Updates on Donor-Derived Infection in Solid Organ Transplantation, Report from the 2024 GTI (Infection and Transplantation Group) Annual Meeting
No full textThe annual meeting of the French GTI (Transplantation and Infection Group) focused on donor-derived infections (DDIs) in solid organ transplant (SOT) recipients. Given the ongoing organ shortage, rigorous donor screening is essential to detect potential infectious risks. Donor evaluation should include medical history, travel, vaccination status, serologies, and exposures. Various pathogens are of concern, including viruses (HIV, hepatitis, BK polyomavirus), multidrug-resistant bacteria, fungi, and emerging arboviruses like West Nile virus and dengue. HIV-positive donor to HIV-positive recipient (D+/R+) transplantations are increasingly accepted, with promising outcomes. Hepatitis E (HEV) is now the most common viral hepatitis and may lead to chronic infection in SOT recipients, requiring ribavirin treatment. Non-Candida fungal infections, though rare, are associated with high mortality and demand early recognition. Climate change and globalization are expanding the range of vector-borne infections, necessitating seasonal and regional screening. BK polyomavirus remains a major complication in kidney transplant recipients, and monitoring viral load is critical. Bacterial infections from donors are uncommon but should be evaluated based on site, organism, resistance profile, and treatment history. Overall, maintaining safety in transplantation requires constant vigilance, updated knowledge, and personalized risk-benefit analysis to adapt to emerging infectious threats—especially amid ongoing organ scarcity
Coherent radiation in axially oriented industrial-grade tungsten crystals: A viable path for an innovative γ-rays and positron sources
No full textIt is well known that the alignment of an high-energy electron beam with specific crystal directions leads to a significant increase of the coherent radiation emission. This enhancement can be exploited to create an intense photon source. An elective application is an innovative positron source design for future lepton colliders. Such scheme takes advantage of lattice coherent effects by employing a high-Z crystalline radiator, followed by an amorphous metallic converter, to generate positrons via a two-step electromagnetic process. Additional applications can be in neutron production through photo-transmutation and radionuclide generation via photo-nuclear reactions. In this work, we present experimental results obtained from beam tests at CERN's PS facility using commercial industrial-grade tungsten crystals. The obtained results demonstrate the robust performance of industrial-grade radiators, even with their inherent imperfections, suggesting that it is possible to simplify the supply process and it is not strictly necessary to rely on highly specialized research infrastructures
Intraclass Switching of IL-23 Inhibitors in Psoriasis: Effectiveness, Patterns, and Predictors of Response - A Retrospective Multicenter Study in Italy
No full textBackground: IL-23 inhibitors are highly effective therapies for psoriasis, but some patients may need to discontinue the treatment. Intraclass switching is a potential strategy, though data on its effectiveness remain limited. Objective: To evaluate the patterns and effectiveness of intraclass switching among IL-23 inhibitors in a real world setting. Methods: This retrospective, multicenter study included adult patients with plaque psoriasis who switched between IL-23 inhibitors. Clinical and demographic data were analyzed, and univariable and multivariable analyses identified predictors of treatment response. Results: We analyzed 116 patients (120 switches). Switching occurred from guselkumab (45.0%), tildrakizumab (44.2%), and risankizumab (10.8%), mainly due to secondary ineffectiveness (82.5%). Risankizumab was the most common post-switch agent (70.0%), followed by guselkumab (23.3%) and tildrakizumab (6.7%). PASI90 rates were 28.5% at week 16, 49.5% at week 36, and 60.7% at week 52. Withdrawal occurred in 12.5% of cases, mainly due to lack of efficacy (66.7%) or adverse events (26.7%). Univariate analysis showed lower PASI90 achievement in PsA patients at weeks 16 after the switch (p = 0.0209) and 36 (p = 0.026) and in those with BMI ≥25 at week 52 (p = 0.0108). Patients switching from risankizumab had lower PASI90 rates at weeks 16 (p = 0.0489) and 36 (p = 0.0349), while those switching to risankizumab had higher PASI90 rates at week 16 (p = 0.0257). Multivariate analysis confirmed BMI >25 was associated with reduced PASI90 at weeks 36 (p = 0.0403) and 52 (p = 0.0462). Conclusions: Intraclass switching among IL-23 inhibitors is an effective strategy, with risankizumab emerging as the most favorable option
