SummaryBackground and objectives Several factors might alter serum phosphate homeostasis and induce hyperhosphatemia in patients with chronic kidney disease (CKD) not requiring dialysis. However, whether and to what extent hyperphosphatemia is associated with a poor prognosis in different CKD patient groups remain to be elucidated.Design, setting, participants & measurements We utilized the "Prevenzione Insufficienza Renale Progressiva" (PIRP) database, a large project sponsored by the Emilia-Romagna Health Institute. PIRP is a collaborative network of nephrologists and general practitioners located in the Emilia-Romagna region, Italy, aimed at increasing awareness of CKD complications and optimizing CKD patient care. We identified 1716 patients who underwent a GFR and serum phosphorous assessment between 2004 and 2007. We tested whether phosphate levels Ն4.3 mg/dl are associated with the risk of CKD progression or all causes of death.Results Older age and male sex were associated with lower phosphate levels. Instead, higher phosphate levels were noted in patients with diabetes. Patients with phosphate levels Ն4.3 mg/dl were at an increased risk of starting dialysis or dying (hazard ratio 2.04; 95% confidence interval [1.44, 2.90]). Notably, subgroup analyses revealed that the magnitude of the risk associated with hyperphosphatemia varied depending on age, sex, diabetes, and different stages of CKD.Conclusions These analyses lend support to the hypothesis that phosphorous abnormalities might have a negative effect on the residual renal function and prognosis in different groups of CKD patients. However, the risk associated with hyperphosphatemia might vary in specific CKD patient subgroups.
Most imaging studies on the human pain system have concentrated so far on the spatial distribution of pain-related activity. In the present study, we investigated similarities and differences between the spatial and temporal patterns of brain activity related to touch vs. pain perception. To this end, we adopted an event-related functional magnetic resonance imaging (fMRI) paradigm allowing us to separately assess the activity related to stimulus anticipation, perception, and coding. The fMRI signal increases following brief mechanical noxious or non-noxious stimulation of the hand dorsum were largely overlapping in the contralateral and ipsilateral hemispheres, including portions of the parietal, insular, frontal and cingulate cortices. Higher activity following noxious stimulation was found in the contralateral mid-anterior insular cortex, in the anterior mid-cingulate cortex (aMCC) and in the adjacent dorso-medial frontal cortex. Significant decreases in fMRI signals following both tactile and painful stimuli were found in perigenual cingulate (pACC)/medial prefrontal cortex (MPF) and in the posterior cingulate/precuneus/paracentral lobule; more intense decreases were found in the pACC/MPF following painful stimuli. fMRI signal increases in the contralateral insula and in aMCC, but not in the parietal cortex, were more prolonged following painful than tactile stimuli. Moreover, a second peak of signal increases (albeit of lower intensity) was found in anterior insula and aMCC during pain intensity rating. These results show specific spatio-temporal patterns of cortical activity related to processing noxious vs. non-noxious mechanical stimuli.
The complexity of traffic control systems, as well as the growing volume of traffic, interconnected missions types and mission demands on the operators, indicates that critical attention should still be paid to the problem of operator's cognitive workload (WL). On the other hand, the development of traffic control towards on-line measurement of cooperative aspects between humans and machines, is part of the more general need to measure the human agents “situation awareness” in industrial environment. The University of Modena and Reggio Emilia was partner of the European Artemis project “Designing Dynamic Distributed Cooperative Human-Machine Systems” (D3CoS 2011–2014) [1] to define affordable methods, techniques and tools addressing the specification, development and evaluation of cooperative systems where human and machine agents are in charge of common tasks, assigned to the system as a whole. One of the basic keys to reach an optimal human-machine cooperation is the measure of the human operator workload. In order to setup a possible method for the objective evaluation of cognitive workload we had to investigate aspects of the functional status of human operators interacting with a simulator in maritime domains. We recorded objective psycho-physiological measures: eye blinks, respiration rate and amplitude, electrodermal activity, heart rate variability, and blood pressure. They were analyzed and correlated with subjective self-assessed responses from two questionnaires: NASA-TLX and Rating Scale Mental Effort (RSME), with the aim to realize a mathematical model for classifying the operators' mental workload. The purpose of this paper is to present the methods, applied on a pilot study, that we carried out to discriminate the WL intensity, based on psycho-physiological signals alone
We applied the Fos method in rats subjected to horizontal optokinetic stimulation (OKS) to study whether optokinetic information is transferred through the commissural pretectal fibres from one optic tract nucleus (NOT) to the opposite. In binocular as well as in monocular nasalward OKS, the highest Fos immunoreactivity was found in the NOT contralateral to the nasalward stimulation, as expression of the activation either of direction-selective cells and of commissural neurons. Even the opposite NOT showed many Fos-positive cells activated by the opposite nucleus throughout the commissural pretectal pathway. They might be the GABA positive cells, which are thought to allow the activation in one nucleus to be transformed into inhibition of the opposite side. In monocular temporalward OKS, the inhibition on direction-selective cells and the consequent silencing of commissural neurons caused the faint immunoreactivity in the NOT contralateral to eye stimulated. In the opposite nucleus the few Fos-positive cells emerged as a consequence of the lack of the normal tonic commissurally mediated inhibition.
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