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Levy JJ, Lima JF, Miller MW, Freed GL, O'Malley AJ, Emeny RT. Machine Learning Approaches for Hospital Acquired Pressure Injuries: A Retrospective Study of Electronic Medical Records. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:926667. [PMID: 35782577 PMCID: PMC9243224 DOI: 10.3389/fmedt.2022.926667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background Many machine learning heuristics integrate well with Electronic Medical Record (EMR) systems yet often fail to surpass traditional statistical models for biomedical applications. Objective We sought to compare predictive performances of 12 machine learning and traditional statistical techniques to predict the occurrence of Hospital Acquired Pressure Injuries (HAPI). Methods EMR information was collected from 57,227 hospitalizations acquired from Dartmouth Hitchcock Medical Center (April 2011 to December 2016). Twelve classification algorithms, chosen based upon classic regression and recent machine learning techniques, were trained to predict HAPI incidence and performance was assessed using the Area Under the Receiver Operating Characteristic Curve (AUC). Results Logistic regression achieved a performance (AUC = 0.91 ± 0.034) comparable to the other machine learning approaches. We report discordance between machine learning derived predictors compared to the traditional statistical model. We visually assessed important patient-specific factors through Shapley Additive Explanations. Conclusions Machine learning models will continue to inform clinical decision-making processes but should be compared to traditional modeling approaches to ensure proper utilization. Disagreements between important predictors found by traditional and machine learning modeling approaches can potentially confuse clinicians and need to be reconciled. These developments represent important steps forward in developing real-time predictive models that can be integrated into EMR systems to reduce unnecessary harm.
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Affiliation(s)
- Joshua J. Levy
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
- Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Jorge F. Lima
- Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Megan W. Miller
- Department of Wound Care Services, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Gary L. Freed
- Department of Wound Care Services, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
- Department of Plastic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - A. James O'Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Rebecca T. Emeny
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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Akpolat ND, Unlu S. The effect of a restricted diet on the results of fractional microneedle radiofrequency therapy: A comparison of vegan and omnivorous participants in terms of the antiaging effect of radiofrequency therapy. Lasers Surg Med 2022; 54:964-969. [PMID: 35708109 DOI: 10.1002/lsm.23577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/22/2022] [Accepted: 06/02/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of the present study was to compare the results of fractional microneedle radiofrequency (FMR) therapy in vegan and omnivorous participants. METHODS A total of 30 vegan and 30 omnivorous women who were treated with FMR therapy for combating aging were included in the study. The clinical results were examined in Months 3 and 6 based on the Fitzpatrick Wrinkle Scale (FWS). Individual satisfaction was investigated in Month 6 using the Patient's Global Impression of Change (PGIC). RESULTS At the onset of the treatment, there was no significant difference with regard to the FWS scores in both groups. The decrease in the FWS score was significantly lower in vegans after 3 months (p = 0.01). Vegans had worsened clinical outcomes by Month 6 (p = 0.01). The PGIC scores were significantly lower in vegans (p = 0.01). CONCLUSION A vegan diet adversely affects the outcome of FMR therapy.
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Abstract
Wound healing is a complex and energy-demanding process. The relationship between nutrition and wound healing has been recognized for many centuries. Several studies have indicated that nutritional deficiencies are more prevalent among patients with chronic wounds. Malnutrition may alter the inflammatory response, collagen synthesis, and wound tensile strength, all of which are crucial for wound healing. Although the specific role of nutrition and supplementation in wound care remains uncertain, it is necessary to identify and correct nutritional imbalances to avoid any potential deterioration of the healing process. It is also important to recognize the differences in pathophysiology between acute and chronic wounds. A burn, surgical, or a traumatic wound is different from a diabetic foot ulcer, which is different from a pressure ulcer. Chronic wounds are more prevalent in the aging population, and patients often have underlying comorbidities, such as diabetes mellitus, peripheral vascular disease, connective tissue disease, or other systemic illnesses that may alter energy metabolism and contribute to impaired healing. Management approaches to acute wound care may not apply universally to chronic wounds. In this review, we discuss the available data and possible roles for nutrition in wound healing.
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Kendall JA, Haberl JK, Hartsgrove C, Murphy LF, DeLuca R, Diaz-Segarra N, Kirshblum SC. Surveillance for Pressure Injuries on Admission to Inpatient Rehabilitation Hospitals During the COVID-19 Pandemic. Arch Phys Med Rehabil 2021; 102:1932-1938. [PMID: 34252395 PMCID: PMC8270737 DOI: 10.1016/j.apmr.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022]
Abstract
Objective To determine if the incidence of pressure injuries (PIs) on admission to an inpatient rehabilitation hospital (IRH) system of care was increased during the early coronavirus disease 2019 (COVID-19) pandemic period. Design Retrospective survey chart review of consecutive cohorts. Admissions to 4 acute IRHs within 1 system of care over the first consecutive 6-week period of admitting patients positive for COVID-19 during the initial peak of the COVID-19 pandemic, April 1-May 9, 2020. A comparison was made with the pre–COVID-19 period, January 1-February 19, 2020. Setting Four acute IRHs with admissions on a referral basis from acute care hospitals. Participants A consecutive sample (N=1125) of pre–COVID-19 admissions (n=768) and COVID-19 period admissions (n=357), including persons who were COVID-19–positive (n=161) and COVID-19–negative (n=196). Main Outcome Measures Incidence of PIs on admission to IRH. Results Prevalence of PIs on admission during the COVID-19 pandemic was increased when compared with the pre–COVID-19 period by 14.9% (P<.001). There was no difference in the prevalence of PIs in the COVID-19 period between patients who were COVID-19–positive and COVID-19–negative (35.4% vs 35.7%). The severity of PIs, measured by the wound stage of the most severe PI the patient presented with, worsened during the COVID-19 period compared with pre–COVID-19 (χ2 32.04%, P<.001). The length of stay in the acute care hospital before transfer to the IRH during COVID-19 was greater than pre–COVID-19 by 10.9% (P<.001). Conclusions During the early part of the COVID-19 pandemic time frame, there was an increase in the prevalence and severity of PIs noted on admission to our IRHs. This may represent the significant burden placed on the health care system by the pandemic, affecting all patients regardless of COVID-19 status. This information is important to help all facilities remain vigilant to prevent PIs as the pandemic continues and potential future pandemics that place strain on medical resources.
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Affiliation(s)
- Jamila A Kendall
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ.
| | | | - Caitlin Hartsgrove
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ
| | | | - Robert DeLuca
- Kessler Institute for Rehabilitation, West Orange, NJ; Kessler Foundation, West Orange, NJ
| | - Nicole Diaz-Segarra
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ
| | - Steven C Kirshblum
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ; Rutgers New Jersey Medical School, Newark, NJ; Kessler Foundation, West Orange, NJ; Select Medical Corporation, Mechanicsburg, PA
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Kline A, Kamalapathy P, Bruce K, Raskin K, Schwab J, Lozano-Calderón S. Nutritional Predictors of Wound Infection in Patients with Lower Extremity Soft Tissue Sarcoma. Ann Surg Oncol 2021; 28:7952-7960. [PMID: 33978885 DOI: 10.1245/s10434-021-10082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Soft tissue sarcoma (STS) frequently requires high-risk surgery that predisposes patients to complex wounds. Past studies have identified a variety of tumor characteristics as risk factors for wound infection (WI); however, physiologic characteristics have not yet been studied in this population. Thus, the objective of this study is to identify any nutritional indicators and physiologic characteristics associated with the development of WI. PATIENTS AND METHODS 633 patients from a large tertiary care center institution were identified with lower extremity STS removed from 1992 to 2017. The primary outcomes of interest were WI at patient's surgical site within 90 days of surgery and additional procedure due to wound infection. Patients' laboratory values, comorbidities, and other characteristics were assessed using multivariable analysis to determine risk factors for WI. Receiver operator characteristic (ROC) curves were used for analysis of plasma glucose and albumin levels to determine a useful risk threshold. Significance was determined to be p < 0.05. RESULTS Postoperative plasma glucose levels were significantly higher among patients with WI compared with those without (p < 0.001) and showed predictivity in ROC analysis (AUC 0.77, 95% CI 0.72-0.82). Preoperative albumin (p < 0.001) and prognostic nutritional index score (p = 0.002) were significantly lower among patients with WI. Partial thromboplastin time (PTT), international normalized ratio (INR), white blood cell count (WBC), and platelet count values had no effect on WI. Smoking elevated risk for WI (OR 1.64, p < 0.01). Significant risk factors were the same when assessed for those with WI undergoing additional procedures. CONCLUSIONS Postoperative plasma glucose levels, preoperative albumin levels, and smoking status are useful nutritional variables in predicting WI in STS excisional procedures.
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Affiliation(s)
- Adam Kline
- Department of Orthopaedic Surgery, Division Musculoskeletal Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, Division Musculoskeletal Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Katharine Bruce
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Kevin Raskin
- Department of Orthopaedic Surgery, Division Musculoskeletal Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Schwab
- Department of Orthopaedic Surgery, Division Musculoskeletal Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Santiago Lozano-Calderón
- Department of Orthopaedic Surgery, Division Musculoskeletal Oncology, Massachusetts General Hospital, Boston, MA, USA.
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Sanson G, Barbin I, De Matteis D, Marzinotto I, Zanetti M. Stage-related implications of community-acquired pressure injuries for the acute medical inpatients. J Clin Nurs 2020; 30:712-724. [PMID: 33325127 DOI: 10.1111/jocn.15598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/12/2020] [Accepted: 12/04/2020] [Indexed: 01/10/2023]
Abstract
AIMS To analyse the prevalence of any-stage pressure injuries at hospital admission and their impact on short-, mid- and late-term mortality. Patient characteristics associated with pressure injuries and the impact on hospital costs were also investigated. BACKGROUND In medical patients acutely admitted to hospital, no study analysed the presence of pre-existing pressure injuries and the related short- and long-term mortality according to the overall stages of severity thereof. DESIGN Retrospective cohort study following the STROBE guideline. METHODS In a population of 7217 acute medical inpatients, the presence and staging of pressure injuries were assessed at hospital admission. The impact of pressure injury on 30-, 180- and 365-day mortality was analysed by multivariate Cox regression models. RESULTS The prevalence of community-acquired pressure injuries was 14.9% (stage-1: 8.1%; stage-2: 3.5%; stage-3: 1.6%; stage-4: 1.1%; unstageable: 0.5%). Hemiplegia/paraplegia, anaemia, poor functional status, high nutritional risk, clinical instability and systemic inflammatory response, but not hydration status, were found to be associated with the occurrence of stage-2-and-above pressure injuries. An increasing difference was found in Diagnosis-Related Groups (DRG) weight according to pressure injury stages. A distinct and progressively increasing risk-of-death for any-stage pressure injury was shown after 365-days. A significantly increased mortality risk for all considered time intervals was found for unstageable and stage-4 pressure injuries. CONCLUSIONS In acute medical inpatients, the presence of community-acquired pressure injuries is part of a multidimensional clinical complexity. The presence and staging of pressure injuries have an independent dramatic impact on of early-to-late mortality and hospital costs. RELEVANCE TO CLINICAL PRACTICE This study documented as community-acquired pressure injuries are highly prevalent and represents an independent predictor of outcomes in strict dependence of the progression of thereof stage. The presence of community-acquired pressure injuries should be interpreted as a critical marker of frailty and increased vulnerability.
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Affiliation(s)
- Gianfranco Sanson
- School of Nursing, Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Ilaria Barbin
- School of Nursing, Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Ilaria Marzinotto
- School of Nursing, Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Michela Zanetti
- Internal Medicine Department, University Hospital, Trieste, Italy
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Matsukawa T, Suto K, Kanaya M, Izumiyama K, Minauchi K, Yoshida S, Oda H, Miyagishima T, Mori A, Ota S, Hashimoto D, Teshima T. Validation and comparison of prognostic values of GNRI, PNI, and CONUT in newly diagnosed diffuse large B cell lymphoma. Ann Hematol 2020; 99:2859-2868. [PMID: 32970194 DOI: 10.1007/s00277-020-04262-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/07/2020] [Indexed: 01/06/2023]
Abstract
Diffuse large B cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin lymphoma. Emerging evidence indicates that poor nutritional status determined with nutritional indices such as geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status score (CONUT) was associated with poor prognosis of DLBCL. We conducted this multicenter retrospective study to validate and compare prognostic values of the three indices in 615 newly diagnosed DLBCL patients. The overall survival (OS) in patients with poor nutritional status determined with each of these nutritional indices were significantly inferior compared with that in those without nutritional risks (5-year OS in patients with GNRI < 95.7 and GNRI ≥ 95.7 were 56.4% and 83.5%, P < 0.001; PNI < 42.4 and PNI ≥ 42.4 were 56.1% and 81.0%, P < 0.001; CONUT > 4 and CONUT ≤ 4 were 53.1% and 77.1%, P < 0.001). GNRI and CONUT were independent prognostic predictors for OS (GNRI < 95.7, hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.22-2.74, P = 0.0032; CONUT > 4, HR 1.53, 95% CI 1.05-2.23, P = 0.028) after multivariate analyses. Nutritional status determined with GNRI affected OS more strongly in the patients with nongerminal center B cell-like (nonGCB) DLBCL compared with that in those with GCB-type DLBCL. In conclusion, baseline poor nutritional status determined based on GNRI or CONUT was an independent risk factor of newly diagnosed DLBCL, and GNRI was also useful as an independent prognostic factor for patients with nonGCB-type DLBCL.
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Affiliation(s)
- Toshihiro Matsukawa
- Department of Internal Medicine/Hematology, Kushiro Rosai Hospital, 13-23 Nakazono-Cho, Kushiro, 085-8533, Japan.
| | - Keito Suto
- Department of Internal Medicine/Hematology, Kushiro Rosai Hospital, 13-23 Nakazono-Cho, Kushiro, 085-8533, Japan.,Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Minoru Kanaya
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | | | - Shota Yoshida
- Department of Internal Medicine/Hematology, Kushiro Rosai Hospital, 13-23 Nakazono-Cho, Kushiro, 085-8533, Japan
| | - Hisashi Oda
- Department of Internal Medicine/Hematology, Kushiro Rosai Hospital, 13-23 Nakazono-Cho, Kushiro, 085-8533, Japan
| | - Takuto Miyagishima
- Department of Internal Medicine/Hematology, Kushiro Rosai Hospital, 13-23 Nakazono-Cho, Kushiro, 085-8533, Japan
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Daigo Hashimoto
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takanori Teshima
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Choi BK, Kim MS, Kim SH. Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units: A prospective observational study. J Tissue Viability 2020; 29:252-257. [PMID: 32800513 DOI: 10.1016/j.jtv.2020.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Oral-mucosal pressure injury (PI) is the most commonly encountered medical device-related PIs. This study was performed to identify risk factors and construct a risk prediction model for oral-mucosal PI development in intubated patients in the intensive care unit. METHODS The study design was prospective, observational with medical record review. The inclusion criteria stipulated that 1) participants should be > 18 years of age, 2) there should be ETT use with holding methods including adhesive tape, gauze tying, and commercial devices. Data of 194 patient-days were analysed. The identification and validation of risk model development was performed using SPSS and the SciKit learn platform. RESULTS The risk prediction logistic models were composed of three factors (bite-block/airway, commercial ETT holder, and corticosteroid use) for lower oral-mucosal PI development and four factors (commercial ETT holder, vasopressor use, haematocrit, and serum albumin level) for upper oral-mucosal PI development among 10 significant input variables. The sensitivity and specificity for lower oral-mucosal PI development were 85.2% and 76.0%, respectively, and those for upper oral-mucosal PI development were 60.0% and 89.1%, respectively. Based on the results of the machine learning, the upper oral-mucosal PI development model had an accuracy of 79%, F1 score of 88%, precision of 86%, and recall of 91%. CONCLUSIONS The development of lower oral-mucosal PIs is affected by immobility-related factors and corticosteroid use, and that of upper oral-mucosal PIs by undernutrition-related factors and ETT holder use. The high sensitivities of the two logit models comprise important minimum data for positively predicting oral-mucosal PIs.
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Affiliation(s)
- Byung Kwan Choi
- Department of Neurosurgery, College of Medicine, Pusan National University, Busan, South Korea.
| | - Myoung Soo Kim
- Department of Nursing, Pukyong National University, Busan, South Korea.
| | - Soo Hyun Kim
- The Artificial Kidney Room, Busan Medical Center, Busan, South Korea.
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Hirahara N, Matsubara T, Fujii Y, Kaji S, Hyakudomi R, Yamamoto T, Uchida Y, Miyazaki Y, Ishitobi K, Kawabata Y, Tajima Y. Preoperative geriatric nutritional risk index is a useful prognostic indicator in elderly patients with gastric cancer. Oncotarget 2020; 11:2345-2356. [PMID: 32595832 PMCID: PMC7299529 DOI: 10.18632/oncotarget.27635] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/25/2020] [Indexed: 12/28/2022] Open
Abstract
Background: The geriatric nutritional risk index (GNRI) was developed to evaluate the prognosis in elderly hospitalized patients at risk of malnutrition and related morbidity and mortality. This study aimed to evaluate the relationship between preoperative GNRI and long-term outcomes in elderly gastric cancer patients. Materials and Methods: We retrospectively reviewed 297 consecutive patients aged ≥ 65 years who underwent laparoscopic gastrectomy with R0 resection and evaluated their overall survival (OS) and cancer-specific survival (CSS). Results: In the univariate analyses, OS was significantly associated with the American Society of Anesthesiologists Physical Status (ASA-PS), tumor size, tumor differentiation, pathological stage, carcinoembryonic antigen (CEA), C-reactive protein, postoperative complications, and GNRI, whereas in the univariate analyses of CSS, ASA-PS, tumor size, tumor differentiation, pathological stage, CEA, postoperative adjuvant chemotherapy, and GNRI were significantly associated with poor prognosis. In the multivariate analysis, ASA-PS, tumor differentiation, pathological stage, and GNRI were significant independent prognostic factors of OS, whereas ASA-PS, pathological stage, and CEA were significant independent prognostic factors of CSS. Conclusions: GNRI is significantly associated with OS and CSS in elderly gastric cancer patients and is an independent predictor of OS. It is a simple, cost-effective, and promising nutritional index for predicting OS in elderly patients.
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Affiliation(s)
- Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Takeshi Matsubara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yusuke Fujii
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Shunsuke Kaji
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshiko Miyazaki
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yasunari Kawabata
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Christovam AC, Theodoro V, Mendonça FAS, Esquisatto MAM, dos Santos GMT, do Amaral MEC. Activators of SIRT1 in wound repair: an animal model study. Arch Dermatol Res 2019; 311:193-201. [DOI: 10.1007/s00403-019-01901-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 12/15/2022]
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Zhao R, Jia T, Shi H, Huang C. A versatile probe for serum albumin and its application for monitoring wounds in live zebrafish. J Mater Chem B 2019; 7:2782-2789. [DOI: 10.1039/c9tb00219g] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A versatile probe for serum albumin and its application in monitoring wounds in live zebrafish.
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Affiliation(s)
- Rongrong Zhao
- The Education Ministry Key Laboratory of Resource Chemistry, Shanghai Key Laboratory of Rare Earth Functional Materials, and Shanghai Municipal Education Committee Key Laboratory of Molecular Imaging Probes and Sensors
- Department of Chemistry
- Shanghai Normal University
- Shanghai 200234
- China
| | - Ti Jia
- The Education Ministry Key Laboratory of Resource Chemistry, Shanghai Key Laboratory of Rare Earth Functional Materials, and Shanghai Municipal Education Committee Key Laboratory of Molecular Imaging Probes and Sensors
- Department of Chemistry
- Shanghai Normal University
- Shanghai 200234
- China
| | - Hongyuan Shi
- Department of Radiology
- The First Affiliated Hospital of Nanjing Medical University
- Nanjing
- P. R. China
| | - Chusen Huang
- The Education Ministry Key Laboratory of Resource Chemistry, Shanghai Key Laboratory of Rare Earth Functional Materials, and Shanghai Municipal Education Committee Key Laboratory of Molecular Imaging Probes and Sensors
- Department of Chemistry
- Shanghai Normal University
- Shanghai 200234
- China
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12
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Najafi E, Ahmadi M, Mohammadi M, Beigmohammadi MT, Heidary Z, Vatanara A, Khalili H. Topical pentoxifylline for pressure ulcer treatment: a randomised, double-blind, placebo-controlled clinical trial. J Wound Care 2018; 27:495-502. [DOI: 10.12968/jowc.2018.27.8.495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Elham Najafi
- Pharmacist, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Motahareh Ahmadi
- Clinical Pharmacist, Department of Clinical Pharmacy, Homozgan University of Medical Sciences, Bandar-Abbas, Iran
| | - Mostafa Mohammadi
- Anesthesiologist, Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Taghi Beigmohammadi
- Anesthesiologist, Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zinat Heidary
- Clinical Pharmacist, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Vatanara
- Faculty Member, Department of Pharmaceutical Sciences, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Clinical Pharmacist, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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13
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Ní Chróinín D, Basic D, Conforti D, Shanley C. Functional deterioration in the month before hospitalisation is associated with in-hospital functional decline: an observational study. Eur Geriatr Med 2018; 9:321-327. [PMID: 34654235 DOI: 10.1007/s41999-018-0041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Functional deterioration preceding acute hospital admission may be associated with poorer in-hospital outcomes. We sought to investigate the association between functional decline in the month preceding admission and in-hospital outcomes. MATERIALS AND METHODS Consecutive patients admitted under geriatric medicine over 5 years were prospectively included. Pre-hospital decline was defined as decrease in Modified Barthel Index (MBI) between pre-morbid status (1 month prior) and admission. The primary outcome was in-hospital functional decline (decline in MBI and/or new assistance/aid to mobilise). Secondary outcomes included length-of-stay (LOS; highest quartile), in-hospital falls and death. RESULTS Amongst 1458 patients (mean age 82.0; 60.91% female), 76.89% (1121/1458) experienced pre-hospital MBI decline. On univariate logistic regression, pre-hospital MBI decline was associated with in-hospital functional decline (OR 15.83, p < 0.001). Adjusting for age, nursing home residence, pre-morbid MBI, in-hospital referral source, dementia, adverse drug reaction and number of active diagnoses, pre-hospital decline was independently associated with in-hospital functional decline (OR 15.22, CI 10.89-21.26, p < 0.001). On univariate analysis, those with pre-hospital decline had more in-hospital falls (OR 2. 91, p = 0.02). Adjusting for age, sex, dementia, number of active diagnoses, and ambulation, no strong association was observed between pre-hospital decline and in-hospital falls (OR 1.86, p = 0.08). Prolonged LOS ≥ 20 days was more common amongst patients with pre-hospital decline on univariate (OR 1.95, p < 0.001) but not adjusted analyses (p = 0.14). No association was observed with in-hospital death. CONCLUSION Pre-hospital functional decline was associated with poorer in-hospital functional outcomes. Exploration of early interventions to optimise function in such patients is needed.
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Affiliation(s)
- Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia. .,UNSW South Western Sydney Clinical School, UNSW, Liverpool, Australia.
| | - David Basic
- Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia.
| | - David Conforti
- Department of Geriatric Medicine, Liverpool Hospital, Locked Mail Bag 7103, Liverpool, 1871, NSW, Australia
| | - Chris Shanley
- Centre for Applied Nursing Research, Western Sydney University, Sydney, Australia.,Ingham Institute of Applied Medical Research, Liverpool, Australia
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Milcheski DA, Mendes RRDS, Freitas FRD, Zaninetti G, Moneiro AA, Gemperli R. Brief hospitalization protocol for pressure ulcer surgical treatment: outpatient care and one-stage reconstruction. Rev Col Bras Cir 2017; 44:574-581. [PMID: 29267554 DOI: 10.1590/0100-69912017006005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/23/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate a brief hospitalization protocol for the treatment of pressure ulcers, proposed by the Complex Wound Group of Clinical Hospital of University of Sao Paulo Medical School, particularly in regard to selection of patients, hospitalization time, cutaneous covering, complications and sore recurrence. METHODS retrospective cohort of 20 consecutive patients with 25 pressure lesions Grade IV. All patients were ambulatorily prepared and were hospitalized for surgical one time procedure for pressure lesion closing. RESULTS in total, 27 flaps were performed to close 25 wounds. Three patients showed minor dehiscence (11.1%). There was no recurrence during the post-surgical follow-up period. No patient suffered a new surgery and no flap showed partial or total necrosis. Median time of hospitalization was 3.6 days (2-6 days) and median follow-up was 91 months (2-28 months). All patients maintained their lesions closed, and there was no recurrence during follow-up. CONCLUSION the brief hospitalization protocol was considered adequate for the resolution of pressure wounds, showing an average time of hospitalization of 3.6 days and rate of minor surgical wound dehiscence of 11.1%.
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Affiliation(s)
- Dimas André Milcheski
- - Faculty of Medicine, University of São Paulo, Plastic Surgery Division, Hospital das Clínicas, São Paulo, SP, Brasil
| | | | - Fernando Ramos de Freitas
- - Faculty of Medicine, University of São Paulo, Plastic Surgery Division, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Guilherme Zaninetti
- - Faculty of Medicine, University of São Paulo, Plastic Surgery Division, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Araldo Ayres Moneiro
- - Faculty of Medicine, University of São Paulo, Plastic Surgery Division, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Rolf Gemperli
- - Faculty of Medicine, University of São Paulo, Plastic Surgery Division, Hospital das Clínicas, São Paulo, SP, Brasil
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Tsuji T, Satoh K, Okuno E, Sobue A, Nishide Y, Tanaka S, Kogo M. The utility of vacuum-assisted closure therapy for skin necrosis secondary to cervical abscess in the elderly. Auris Nasus Larynx 2016; 44:749-753. [PMID: 27932078 DOI: 10.1016/j.anl.2016.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 10/07/2016] [Accepted: 11/02/2016] [Indexed: 11/28/2022]
Abstract
Vacuum-assisted closure (VAC) systems have been used as negative-pressure dressings in various fields, including decubitus ulcer, trauma, and wound dehiscence. To the best of our knowledge, few reports have examined the utility of VAC therapy for neck abscess in an oldest-old patient. We present here a rare case of neck abscess secondary to parotid abscess, resulting in extensive skin necrosis. Successful management included emergency drainage following epithelial induction through a VAC system without using skin grafting. Two months after surgical intervention, the cervical wound was completely healed without a solid scar. We consider the VAC therapy to be a key factor leading to the complete healing in the elderly under low serum albumin condition.
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Affiliation(s)
- Tadataka Tsuji
- Department of Oral and Maxillofacial Surgery, Saiseikai Matsusaka General Hospital, 15-6 Asahimachi 1-ku, Matsusaka, Mie 515-8557, Japan; The First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Koichi Satoh
- Department of Oral and Maxillofacial Surgery, Saiseikai Matsusaka General Hospital, 15-6 Asahimachi 1-ku, Matsusaka, Mie 515-8557, Japan
| | - Emi Okuno
- Department of Oral and Maxillofacial Surgery, Saiseikai Matsusaka General Hospital, 15-6 Asahimachi 1-ku, Matsusaka, Mie 515-8557, Japan
| | - Akiko Sobue
- Department of Oral and Maxillofacial Surgery, Saiseikai Matsusaka General Hospital, 15-6 Asahimachi 1-ku, Matsusaka, Mie 515-8557, Japan
| | - Yoshiya Nishide
- Department of Radiology, Saiseikai Matsusaka General Hospital, 15-6 Asahimachi 1-ku, Matsusaka, Mie 515-8557, Japan
| | - Susumu Tanaka
- The First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Mikihiko Kogo
- The First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
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Tsaras K, Chatzi M, Kleisiaris CF, Fradelos EC, Kourkouta L, Papathanasiou IV. Pressure Ulcers: Developing Clinical Indicators in Evidence-based Practice. A Prospective Study. Med Arch 2016; 70:379-383. [PMID: 27994301 PMCID: PMC5136439 DOI: 10.5455/medarh.2016.70.379-383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/28/2016] [Indexed: 12/18/2022] Open
Abstract
Aims and objectives: It is widely recognized that Intensive Care Unit (ICU) patients have a greater likelihood of developing pressure ulcers in comparison to hospital or home care patients. Accordingly, this study aimed to evaluate whether specific clinical characteristics could be used as clinical indicators towards pressure ulcers prevention. Method: We monitored 210 hospitalized ICU patients during a 12-month period. Pressure ulcers were assessed following the current guidelines. Clinical characteristics such as gender, age, hospitalized days, hemodialysis treatment, hematocrit, and serum albumin levels were considered as the most common predictors for pressure ulcers development. The significance of associations was controlled using multiple logistic regression after adjusting for clinical characteristics and was presented as adjusted odds ratio (AOR). Results: The prevalence of pressure ulcers was 24.3%. Logistic regression revealed that patients with increased age AOR=1.04; (CI: 1.01-1.07) and last-long hospitalization AOR=1.17; (CI: 1.11-1.23) were significantly more likely to present pressure ulcers compared to the younger ones and patients with less length of stay, respectively. We also found that patients under hemodialysis treatment were more likely to present pressure ulcers AOR=4.09; (CI: 1.12-14.98) compared to patients that did not underwent hemodialysis and the risk of pressure ulcers development was decreased by 9% for every single unit of hematocrit value increase AOR=0.91; (CI: 0.82-0.99). Conclusion: Our data analysis confirms that the clinical characteristics that were studied are independently associated with pressure ulcers development, and therefore, it is a crucial incentive to consider that these specific clinical characteristics are important indicators in the evidence-based practice.
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Affiliation(s)
- Konstantinos Tsaras
- Nursing Department, Technological Educational Institute of Thessaly, Larissa, Greece
| | | | | | | | - Lambrini Kourkouta
- Nursing Department, "Alexander" Technological Educational Institute of Thessaloniki, Thessaloniki, Greece
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18
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Chen IW, Yang HM, Chiu CH, Yeh JT, Huang CH, Huang YY. Clinical Characteristics and Risk Factor Analysis for Lower-Extremity Amputations in Diabetic Patients With Foot Ulcer Complicated by Necrotizing Fasciitis. Medicine (Baltimore) 2015; 94:e1957. [PMID: 26554804 PMCID: PMC4915905 DOI: 10.1097/md.0000000000001957] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Patients with diabetes are at a higher risk of having diabetic foot ulcers (DFUs) or necrotizing fasciitis (NF). The present study aims to examine the clinical characteristics and associated risk factors for lower-extremity amputation (LEA) in patients with DFU complicated by NF.We retrospectively reviewed patients treated at a major diabetic foot center in Taiwan between 2009 and 2014. Of the 2265 cases 110 had lower-extremity NF. Limb preservation outcomes were classified as major LEA, minor LEA, or limb-preserved. Clinical characteristics, laboratory data, and bacterial culture results were collected for analysis.Of the 110 patients with NF, 100 had concomitant DFUs (NF with DFU) and the remaining 10 had no DFU (NF without DFU). None of the NF patients without DFU died nor had their leg amputated. Two NF patients with DFU died of complications. The amputation rate in the surviving 98 NF patients with DFU was 72.4% (46.9% minor LEA and 25.5% major LEA). Seventy percent of the NF patients without DFU had monomicrobial infections (60% with Streptococcus species), and 81.4% NF patients with DFU had polymicrobial infections. Anaerobic organisms were identified in 66% of the NF patients with DFU. Multinomial logistic regression analysis revealed an association between high-grade Wagner wound classification (Wagner 4 and Wagner 5) and LEA (adjusted odds ratio [aOR] = 21.856, 95% confidence interval [95% CI] = 1.625-203.947, P = 0.02 and aOR = 20.094, 95% CI = 1.968-205.216, P = 0.01 for major and minor LEA, respectively) for NF patients with DFU. In addition, a lower serum albumin level was associated with major LEA (OR = 0.066, P = 0.002).In summary, once DFUs were complicated by NF, the risk of amputation increased. Empirical treatment for NF patients with DFU should cover polymicrobial infections, including anaerobic organisms. The high-grade wound classification and low serum albumin level were associated with LEA.
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Affiliation(s)
- I-Wen Chen
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine (I-WC, H-MY, C-HH, Y-YH), Molecular Infectious Disease Research Center, Division of Pediatric Infectious Diseases, Department of Pediatrics (C-HC); and Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan (J-TY)
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Montalcini T, Moraca M, Ferro Y, Romeo S, Serra S, Raso MG, Rossi F, Sannita WG, Dolce G, Pujia A. Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury. J Transl Med 2015; 13:305. [PMID: 26376778 PMCID: PMC4573301 DOI: 10.1186/s12967-015-0660-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/02/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The association between malnutrition and worse outcomes as pressure ulcers and mortality is well established in a variety of setting. Currently none investigation was conducted in patients with long-term consequences of the acquired brain injury in which recovery from brain injury could be influenced by secondary complications. The aim of this study was to investigate the association between various nutritional status parameters (in particular albumin) and pressure ulcers formation and short-term mortality in minimal conscious state patients. METHODS In this prospective, observational study of 5-months duration, a 30 patients sample admitted to a Neurological Institute was considered. All patients underwent a complete medical examination. Anthropometric parameters like mid-arm circumference and mid-arm muscle circumference and nutritional parameters as serum albumin and blood hemoglobin concentration were assessed. RESULTS At univariate and logistic regression analysis, mid-arm circumference (p = 0.04; beta = -0.89), mid-arm muscle circumference (p = 0.050; beta = -1.29), hemoglobin (p = 0.04, beta -1.1) and albumin (p = 0.04, beta -7.91) were inversely associated with pressure ulcers. The area under the ROC curve for albumin to predict sores was 0.76 (p = 0.02) and mortality was 0.83 (p = 0.03). Patient with lower albumin had significantly higher short-term mortality than those with higher serum albumin (p = 0.03; χ(2) test = 6.47). CONCLUSION Albumin, haemoglobin and mid-arm circumference are inversely associated with pressure ulcers. Albumin is a prognostic index in MCS patients. Since albumin and haemoglobin could be affected by a variety of factors, this association suggests to optimize nutrition and investigate on other mechanism leading to mortality and pressure ulcers.
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Affiliation(s)
- Tiziana Montalcini
- Clinical Nutrition Unit, Department of Medical and Surgical Science, University Magna Grecia, Viale S. Venuta, 88100, Catanzaro, Italy.
| | - Marta Moraca
- Clinical Nutrition Unit, Department of Medical and Surgical Science, University Magna Grecia, Viale S. Venuta, 88100, Catanzaro, Italy.
| | - Yvelise Ferro
- Clinical Nutrition Unit, Department of Medical and Surgical Science, University Magna Grecia, Viale S. Venuta, 88100, Catanzaro, Italy.
| | - Stefano Romeo
- Clinical Nutrition Unit, Department of Medical and Surgical Science, University Magna Grecia, Viale S. Venuta, 88100, Catanzaro, Italy.
- Department of Molecular and Clinical Medicine, Sahlgrenska Center for Cardiovascolar and Metabolic Research, University of Gothenburg, Gothenburg, Sweden.
| | | | | | | | | | | | - Arturo Pujia
- Clinical Nutrition Unit, Department of Medical and Surgical Science, University Magna Grecia, Viale S. Venuta, 88100, Catanzaro, Italy.
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