Gluten-free meals in public catering.

BACKGROUND: The Piedmont Region, the Food Hygiene and Nutrition Services of the Local Healthcare Authorities of the Piedmont Region (coordinated by ASL TO 3), and the Italian Coeliac Association Piedmont Onlus, have created a theoretical-practical training pathway for Food Business Operators to ensure a safe gluten-free meal. STUDY DESIGN: The aim of the study is to perform a retrospective analysis of the data collected in order to assess whether the Food Business Operators will be able to manage in the short, medium and long term audits (3-month audits, 6-month audits and 1-year audits) all the production stages of a gluten-free meal (storage, production. METHODS: We have analysed the check-list used for assessing the gluten free meal, recorded from 2010 to 2016 by the staff of the Food Hygiene and Nutrition Services. They were filled out during three educational audits and they refer to 81 facilities. RESULTS: Two-hundred and forty-three audits were conducted (3 per facility). During all stages of production of gluten-free meals (short, medium and long term), non-compliant aspects had decreased (not statistically significant). The data analysis showed a slight increase in non-compliant aspects after a 1-year storage, the trend of non-compliant aspects slightly decreased during the three production stages, the service stage registered a slight upward trend, and finally, during the basic requirements stage and control plan stage, non-compliant aspects were in sharp decline (statistically significant). CONCLUSIONS: The decrease of non-compliance guarantees safety and protection of the celiac subject, even if storage and services must be monitored more carefully in the medium term.

Waiting list for kidney transplant. Some patients wait too long.

The selection of a kidney graft recipient should be made not only taking into account biological and clinical parameters, for assuring the maximum possible clinical success; the ethical objective to allow every patient equal opportunity of receiving a transplant should also be pursued. In every waiting list of transplant candidates a proportion of patients remains in the list for a particularly long time. The present analysis aimed to find out the factors associated with a prolonged waiting time, in order to allow the implementation of patient selection criteria able to balance unfavourable factors. The analysis of the waiting list of our kidney transplant centre allowed to observe that blood group 0, anti-HLA immunisation, presence of rare HLA antigens and, at a lesser extent, HLA homozygosity are associated with a longer waiting time for a kidney transplant.

Ex vivo lung perfusion increases the pool of lung grafts: analysis of its potential and real impact on a lung transplant program.

BACKGROUND: Among the strategies to increase the number of lung transplants, ex vivo lung perfusion (EVLP) represents a novel technique to expand the donor pool. METHODS: Data from donors referred to our center were retrospectively analyzed to identify grafts that could potentially be potentially reconditioned by EVLP and for comparison with those obtained by clinical application of EVLP program in our center. RESULTS: Among 75 rejected lungs, 23 organs have been identified as potentially treatable with EVLP with a hypothetic increase of lung transplant activity of 53%. After the introduction of the EVLP program in our center, lung transplantation with reconditioned grafts was performed in 7 (23%) patients with a 30% increase in transplant procedures. CONCLUSION: Although less than expected, EVLP increased the number of lungs suitable for transplantation.

Role of non-HLA genetic polymorphisms in graft-versus-host disease after haematopoietic stem cell transplantation.

Graft-versus-host disease (GvHD) is the main complication after haematopoietic stem cells transplantation (HSCT) and acute forms (aGvHD) occur in 20-40% of cases even after donor (D) and recipient (R) HLA matching, apparently because of D/R minor histocompatibility antigen (mHA) mismatches and cytokine polymorphisms. The genotype of cytokines and mHA of 77 haematological R following HSCT from HLA identical siblings were determined to detect genetic polymorphisms correlated with GvHD. We analysed TNFA (-863 C/A, -857 C/T and G/A at positions -574, -376, -308, -244, -238), IL-10 (-1082 G/A, -819 C/A, -592 C/T), IL-1B (T/C +3953), IL-1RA (VNTR), HA-1 (H/R allele) and CD-31 (C/G at codon 125, A/G at codon 563). Allele frequencies were in Hardy-Weinberg equilibrium and similar to those of 77 healthy controls. We observed positive correlations between a lower risk of clinically significant aGvHD and both the presence of -1082G -819C -592C IL-10 haplotype when both R and D are considered together and the absence of R IL-1RA allele 2. Furthermore, we observed an association between the absence of TNF-A -238 A allele and the risk of extensive chronic GvHD. mHA and cytokines genotyping would thus seem a valid source of information for the prior identification of recipients with a higher risk of aGvHD.