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Avadhani R, Ziai WC, Thompson RE, Mould WA, Lane K, Nanni A, Iacobelli M, Sharrock MF, Sansing LH, Van Eldik LJ, Hanley DF. Clinical Trial Protocol for BEACH: A Phase 2a Study of MW189 in Patients with Acute Nontraumatic Intracerebral Hemorrhage. Neurocrit Care 2024; 40:807-815. [PMID: 37919545 PMCID: PMC10959780 DOI: 10.1007/s12028-023-01867-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023]
Abstract
Patients with acute spontaneous intracerebral hemorrhage (ICH) develop secondary neuroinflammation and cerebral edema that can further damage the brain and lead to increased risk of neurologic complications. Preclinical studies in animal models of acute brain injury have shown that a novel small-molecule drug candidate, MW01-6-189WH (MW189), decreases neuroinflammation and cerebral edema and improves functional outcomes. MW189 was also safe and well tolerated in phase 1 studies in healthy adults. The proof-of-concept phase 2a Biomarker and Edema Attenuation in IntraCerebral Hemorrhage (BEACH) clinical trial is a first-in-patient, multicenter, randomized, double-blind, placebo-controlled trial. It is designed to determine the safety and tolerability of MW189 in patients with acute ICH, identify trends in potential mitigation of neuroinflammation and cerebral edema, and assess effects on functional outcomes. A total of 120 participants with nontraumatic ICH will be randomly assigned 1:1 to receive intravenous MW189 (0.25 mg/kg) or placebo (saline) within 24 h of symptom onset and every 12 h for up to 5 days or until hospital discharge. The 120-participant sample size (60 per group) will allow testing of the null hypothesis of noninferiority with a tolerance limit of 12% and assuming a "worst-case" safety assumption of 10% rate of death in each arm with 10% significance and 80% power. The primary outcome is all-cause mortality at 7 days post randomization between treatment arms. Secondary end points include all-cause mortality at 30 days, perihematomal edema volume after symptom onset, adverse events, vital signs, pharmacokinetics of MW189, and inflammatory cytokine concentrations in plasma (and cerebrospinal fluid if available). Other exploratory end points are functional outcomes collected on days 30, 90, and 180. BEACH will provide important information about the utility of targeting neuroinflammation in ICH and will inform the design of future larger trials of acute central nervous system injury.
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Affiliation(s)
- Radhika Avadhani
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
| | - Wendy C Ziai
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard E Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - W Andrew Mould
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
| | - Karen Lane
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
| | - Angeline Nanni
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
| | - Michael Iacobelli
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
| | - Matthew F Sharrock
- Division of Neurocritical Care, Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lauren H Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Linda J Van Eldik
- Sanders-Brown Center on Aging and Department of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Daniel F Hanley
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA.
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Nanni A, Colonna M, Liberati G, Bonoli A. A novel process for the complete recycling of exhausted coffee capsules with a fully circular approach: Design of the industrial plant and Techno-Economic analysis of the process. Waste Manag 2024; 174:114-125. [PMID: 38041980 DOI: 10.1016/j.wasman.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/07/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
The objective of this paper is to present the technical and feasibility analysis of an innovative mechanical recycling system for exhausted coffee capsules. This recycling process involved the sorting of spent coffee grounds (SGC) and the subsequent drying and melt-mixing of a portion of these grounds with the remaining capsule components, mainly composed of polypropylene (PP), along with optional virgin PP. These newly developed composite materials exhibited mechanical and rheological properties comparable or even surpassing those of virgin PP. They were also successfully utilized for the injection of new capsule shells, thus alignin with the principles of the circular economy. In addition to the technical aspects, this paper present a comprehensive Techno-Economic Analysis (TEA) of the proposed recycling processes, considering the inclusion of virgin PP (0-20 %) and the initial moisture content (MSGC) of SGC(5-55 %) as varying factors. An industrial plant, designed to handle up to 190 million exhausted coffee capsules and produce up to 1500 tons of recycled compund was appropriately sized. The analysis revealed that processes are profitable across all examined scenarios and that the Net Present Value ranged between 800 k€ (for vPP = 20 % and MSGC = 55 %) and 2000 k€ (for vPP = 0 % and MSGC = 5 %).
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Affiliation(s)
- A Nanni
- SPORT TECHNOLOGY LAB - DICAM, University of Bologna, Via Terracini 28, 40131 Bologna, Italy; RE-SPORT srl, via G. Fanin 48, 40127 Bologna, Italy; AgroMateriae srl, Via Granarolo 177/3, 48018 Faenza RA, Italy.
| | - M Colonna
- SPORT TECHNOLOGY LAB - DICAM, University of Bologna, Via Terracini 28, 40131 Bologna, Italy; RE-SPORT srl, via G. Fanin 48, 40127 Bologna, Italy
| | - G Liberati
- Raw Materials Engineering and Circular Economy LAB - DICAM, University of Bologna, Via Terracini 28, 40131, Bologna, Italy
| | - A Bonoli
- Raw Materials Engineering and Circular Economy LAB - DICAM, University of Bologna, Via Terracini 28, 40131, Bologna, Italy
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Palm ME, Edwards TL, Wieber C, Kay MT, Marion E, Boone L, Nanni A, Jones M, Pham E, Hildreth M, Lane K, McBee N, Benjamin DK, Bernard GR, Dean JM, Dwyer JP, Ford DE, Hanley DF, Harris PA, Wilkins CH, Selker HP. Development, implementation, and dissemination of operational innovations across the trial innovation network. J Clin Transl Sci 2023; 7:e251. [PMID: 38229905 PMCID: PMC10790103 DOI: 10.1017/cts.2023.658] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 01/18/2024] Open
Abstract
Improving the quality and conduct of multi-center clinical trials is essential to the generation of generalizable knowledge about the safety and efficacy of healthcare treatments. Despite significant effort and expense, many clinical trials are unsuccessful. The National Center for Advancing Translational Science launched the Trial Innovation Network to address critical roadblocks in multi-center trials by leveraging existing infrastructure and developing operational innovations. We provide an overview of the roadblocks that led to opportunities for operational innovation, our work to develop, define, and map innovations across the network, and how we implemented and disseminated mature innovations.
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Affiliation(s)
- Marisha E. Palm
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Terri L. Edwards
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cortney Wieber
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Marie T. Kay
- University of Utah Health, Salt Lake City, UT, USA
| | - Eve Marion
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Leslie Boone
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Angeline Nanni
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michelle Jones
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eilene Pham
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Meghan Hildreth
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Lane
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nichol McBee
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Gordon R. Bernard
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Jamie P. Dwyer
- University of Utah Health, Salt Lake City, UT, USA
- Utah Clinical and Translational Sciences Institute, Salt Lake City, UT, USA
| | - Daniel E. Ford
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel F. Hanley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul A. Harris
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Biostatistics, and Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Consuelo H. Wilkins
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Harry P. Selker
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
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Lane K, Palm ME, Marion E, Kay MT, Thompson D, Stroud M, Boyle H, Hillery S, Nanni A, Hildreth M, Nelson S, Burr JS, Edwards T, Poole L, Waddy SP, Dunsmore SE, Harris P, Wilkins C, Bernard GR, Dean JM, Dwyer J, Benjamin DK, Selker HP, Hanley DF, Ford DE. Approaches for enhancing the informativeness and quality of clinical trials: Innovations and principles for implementing multicenter trials from the Trial Innovation Network. J Clin Transl Sci 2023; 7:e131. [PMID: 37396815 PMCID: PMC10308427 DOI: 10.1017/cts.2023.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
One challenge for multisite clinical trials is ensuring that the conditions of an informative trial are incorporated into all aspects of trial planning and execution. The multicenter model can provide the potential for a more informative environment, but it can also place a trial at risk of becoming uninformative due to lack of rigor, quality control, or effective recruitment, resulting in premature discontinuation and/or non-publication. Key factors that support informativeness are having the right team and resources during study planning and implementation and adequate funding to support performance activities. This communication draws on the experience of the National Center for Advancing Translational Science (NCATS) Trial Innovation Network (TIN) to develop approaches for enhancing the informativeness of clinical trials. We distilled this information into three principles: (1) assemble a diverse team, (2) leverage existing processes and systems, and (3) carefully consider budgets and contracts. The TIN, comprised of NCATS, three Trial Innovation Centers, a Recruitment Innovation Center, and 60+ CTSA Program hubs, provides resources to investigators who are proposing multicenter collaborations. In addition to sharing principles that support the informativeness of clinical trials, we highlight TIN-developed resources relevant for multicenter trial initiation and conduct.
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Affiliation(s)
- Karen Lane
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marisha E. Palm
- Tufts Medical Center, Boston, MA, USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Eve Marion
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Marie T. Kay
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dixie Thompson
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mary Stroud
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Helen Boyle
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Shannon Hillery
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Angeline Nanni
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meghan Hildreth
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Nelson
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeri S. Burr
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Terri Edwards
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori Poole
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Salina P. Waddy
- Division of Clinical Innovation, National Center for Advancing Translational Sciences, Bethesda, MD, USA
| | - Sarah E. Dunsmore
- Division of Clinical Innovation, National Center for Advancing Translational Sciences, Bethesda, MD, USA
| | - Paul Harris
- Vanderbilt School of Medicine, Nashville, TN, USA
| | - Consuelo Wilkins
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gordon R. Bernard
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J. Michael Dean
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jamie Dwyer
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Harry P. Selker
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
- Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Daniel F. Hanley
- Acute Care Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel E. Ford
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ceretti E, Covolo L, Cappellini F, Nanni A, Sorosina S, Taranto M, Gasparini A, Castro PD, Brusaferro S, Gelatti U. Assessing the state of Web-based communication for public health: a systematic review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Communicating strategically is a key issue for health organisations and, over the past decade, healthcare communication via social media and websites has generated a great deal of studies. As for systematic reviews, there is, however, fragmentary evidence on this type of communication. The aim of this research was to summarise the evidence on Web institutional health communication for public health authorities to evaluate aim-specific key points based on existing studies.
Methods
Guided by the PRISMA statement, we conducted a comprehensive review across two electronic databases (PubMed and Web of Science) from 2011 until 7 October 2021, searching for studies investigating institutional health communication. Two independent researchers reviewed the articles for inclusion, and assessment of methodological quality was based on the Kmet appraisal checklist.
Results
78 articles were selected. Most of the studies targeted health promotion/disease prevention (n = 35), followed by crisis communication (n = 24), general health (n = 13), and misinformation correction/health promotion (n = 6). Engagement and message framing were the most analysed aspects. Few studies focused on campaign effectiveness. Only 18 studies had an experimental design. Kmet evaluation was used to distinguish studies presenting a solid structure from lacking studies. In particular, considering the 0·75-point threshold, out of 74 studies, 28 were excluded (37·8% of the total). Studies above this threshold were used to identify a series of aim-specific and medium-specific suggestions, as communication strategies employed differ quite greatly.
Conclusions
Overall, findings suggest that no single strategy works best in the case of Web-based healthcare communication. The extreme variability of outcomes and the lack of a unitary measure for assessing the end-points of a specific campaign or study leads us to reconsider the tools we use to evaluate the efficacy of Web-based health communication.
Key messages
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Affiliation(s)
- E Ceretti
- Department of Medicine, Università degli Studi di Brescia , Brescia, Italy
| | - L Covolo
- Department of Medicine, Università degli Studi di Brescia , Brescia, Italy
| | - F Cappellini
- Department of Medicine, Università degli Studi di Brescia , Brescia, Italy
| | - A Nanni
- Post-graduate School of Public Health, Università degli Studi di Brescia , Brescia, Italy
| | - S Sorosina
- Post-graduate School of Public Health, Università degli Studi di Brescia , Brescia, Italy
| | - M Taranto
- Italian National Institute of Health , Rome, Italy
| | - A Gasparini
- Italian National Institute of Health , Rome, Italy
| | - P De Castro
- Italian National Institute of Health , Rome, Italy
| | - S Brusaferro
- Italian National Institute of Health , Rome, Italy
| | - U Gelatti
- Department of Medicine, Università degli Studi di Brescia , Brescia, Italy
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Covolo L, Della Vedova AM, Croce M, Zamperoni S, Nanni A, Sorosina S, Gelatti U. Knowledge and attitudes related to the COVID-19: role of media communication and emotional factors. Eur J Public Health 2021. [PMCID: PMC8574849 DOI: 10.1093/eurpub/ckab165.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The COVID-19 pandemic was characterized by difficult communication challenges due also to scientific uncertainty regarding the nature and management of the new coronavirus. The aim of the study was to assess the impact of media information on the population's COVID-19-related knowledge, behavior and emotional state. Methods In a cross-sectional study, data from July to September 2020 was collected via survey posted on social media (SM). It included also an analysis of participants' e-health literacy (e-HEALS), and depression, anxiety, and stress symptoms using DASS-21 tool. Results Of the 2,140 subjects, as a main source of information, 69% indicated institutional websites and 26% SM. Fifty-four percent believed expert information to be crucial in changing their behavior. However 30% of health professionals (HP) and 37% of non-HP found expert (scientists) communication hard to understand. Despite high education level (44.3% graduates), 19% denied knowing of the virus origin. Others believed the human manipulation theory (33% of the total and 29% of HP). The e-HEALS score in these subjects was lower than those reporting the natural origin of virus (28.4 ± 6.2 vs 30.5 ± 6.1, p<.001). Young people aged <35 y reported signs of depression (41%), anxiety (28%) and stress (36%) more than older participants (p=.0001). As for infection concern, it was higher in females (58% p<.001), those not living alone (56% p<.01), those living with a senior (62% p<.01) or with those at high risk of COVID-19 (64%p<.001). Greater worry meant stricter guideline adherence (hand washing 56% p<.0001; surface sanitation 42% p<.0001; social distancing 77% p<.0001) and mask usage before mandate (45% p<.0001). Conclusions Although the sample was overall well informed and followed preventive measures, institutional communication was found to be confusing especially by experts. The findings highlighted the strong psychological impact on the community, young people especially. Key messages The study confirms the importance of putting effort on population health literacy and more effective institutional communication strategies. Proactive and timely psychological interventions should be provided to address the mental health needs of the population resulting from the pandemic.
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Affiliation(s)
- L Covolo
- Section of Public Health and Human Sciences, University of Brescia, Brescia, Italy
| | - AM Della Vedova
- Section of Neuroscience, University of Brescia, Brescia, Italy
| | - M Croce
- Degree Course in Health Assistance, University of Brescia, Brescia, Italy
| | - S Zamperoni
- Degree Course in Health Assistance, University of Brescia, Brescia, Italy
| | - A Nanni
- Post-graduate School of Public Health, University of Brescia, Brescia, Italy
| | - S Sorosina
- Post-graduate School of Public Health, University of Brescia, Brescia, Italy
| | - U Gelatti
- Section of Public Health and Human Sciences, University of Brescia, Brescia, Italy
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Nanni A, Ricci A, Versari A, Messori M. Wine derived additives as poly(butylene succinate) (PBS) natural stabilizers for different degradative environments. Polym Degrad Stab 2020. [DOI: 10.1016/j.polymdegradstab.2020.109381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nanni A, Messori M. Effect of the wine lees wastes as cost‐advantage and natural fillers on the thermal and mechanical properties of poly(3‐hydroxybutyrate‐co‐hydroxyhexanoate) (PHBH) and poly(3‐hydroxybutyrate‐co‐hydroxyvalerate) (PHBV). J Appl Polym Sci 2019. [DOI: 10.1002/app.48869] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A. Nanni
- Department of Engineering "Enzo Ferrari"University of Modena and Reggio Emilia Via Pietro Vivarelli 10/1, 41125 Modena Italy
| | - M. Messori
- Department of Engineering "Enzo Ferrari"University of Modena and Reggio Emilia Via Pietro Vivarelli 10/1, 41125 Modena Italy
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Nanni A, Meredith S, Gati S, Holm K, Harmon T, Ginsberg A. Strengthening global vaccine access for adolescents and adults. Vaccine 2017; 35:6823-6827. [PMID: 29122384 DOI: 10.1016/j.vaccine.2017.10.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 12/28/2022]
Abstract
Global immunization efforts to date have heavily focused on infants and children, with noted success on public health. Healthy adolescents and adults contribute to the economic growth and development of countries but efforts to ensure vaccine coverage for these groups receive inadequate global attention and resources. Emerging epidemics for a number of infectious diseases including Ebola, Zika, dengue, malaria and the continuing epidemics of tuberculosis and several sexually transmitted infections, including HIV, HPV and Hepatitis B, have high incidence and prevalence in adolescents and adults. New vaccines under development for these diseases and under-used vaccines such as for human papilloma virus will have the greatest health and economic impact in these populations. Global consensus, political will, policies, global and country infrastructure, and financing mechanisms are needed to accelerate access for the billions of adolescents and adults living under the threat of devastating infectious disease outbreaks and epidemics, especially in lower income countries. The global health community and countries cannot afford to delay planning for implementation of adolescent and adult vaccine programs that will potentially save millions of lives and strengthen global and national economies. The article examines this next challenge and suggests a research agenda and a framework for action to galvanize global and national policy decision-makers to begin preparations for future immunization challenges.
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Affiliation(s)
| | - Stefanie Meredith
- Global Health Consulting, 8 rue St. Jean CH-1260, Nyon, Switzerland.
| | | | - Karin Holm
- Council for International Organizations of Medical Sciences, Case postale 2100, CH-1211 Geneva, Switzerland.
| | - Tom Harmon
- Independent Consultant, 410 Madison St. NE #2, Minneapolis, MN 55413, USA.
| | - Ann Ginsberg
- Aeras, 1405 Research Blvd., Rockville, MD 20850, USA.
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Ozawa S, Privor-Dumm LA, Nanni A, Durden E, Maiese BA, Nwankwo CU, Brodovicz KG, Acosta CJ, Foley KA. Evidence-to-policy gap on hepatitis A vaccine adoption in 6 countries: Literature vs. policymakers’ beliefs. Vaccine 2014; 32:4089-96. [DOI: 10.1016/j.vaccine.2014.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 04/23/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
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Gilchrist SAN, Nanni A. Lessons learned in shaping vaccine markets in low-income countries: a review of the vaccine market segment supported by the GAVI Alliance. Health Policy Plan 2012; 28:838-46. [PMID: 23174880 DOI: 10.1093/heapol/czs123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The Global Alliance for Vaccines and Immunization (GAVI) anticipated that growing demand for new vaccines could sufficiently impact the vaccines market to allow low-income countries (LICs) to self-finance new vaccines. But the time required to lower vaccine prices was underestimated and the amount that prices would decline overestimated. To better understand how prices in the LIC vaccine market can be impacted, the vaccine market was retrospectively examined. DESIGN GAVI archives and the published literature on the vaccine markets in LICs were reviewed for the purpose of identifying GAVI's early assumptions for the evolution of vaccine prices, and contrasting these retrospectively with actual outcomes. RESULTS The prices in Phases I and II of GAVI-supported vaccines failed to decline to a desirable level within a projected 5-year timeframe. GAVI-eligible countries were unable to sustain newly introduced vaccines without prolonged donor support. Two key lessons can be applied to future vaccine market-shaping strategies: (1) accurate demand forecasting together with committed donor funding can increase supply to the LIC vaccines market, but even greater strides can be made to increase the certainty of purchase; and (2) the expected time to lower prices took much longer than 5 years; market competition is inherently linked to the development time for new vaccines--a minimum of 5-10 or more years. Other factors that can lower vaccine prices include: large-scale production or alternate financing mechanisms that can hasten vaccine price maturation. CONCLUSIONS The impacts of competition on vaccine prices in the LIC new-vaccines market occurred after almost 10 years. The time for research and development, acquisition of technological know-how and to scale production must be accounted for to more accurately predict significant declines on vaccine prices. Alternate financing mechanisms and the use of purchase agreements should also be considered for lowering prices when planning new vaccine introductions.
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Affiliation(s)
- Shawn A N Gilchrist
- President S Gilchrist Consulting Services Inc, 8 Covebank Crescent, Brampton, Ontario, Canada L6P 2X5.
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Gilchrist SAN, Nanni A, Levine O. Benefits and effectiveness of administering pneumococcal polysaccharide vaccine with seasonal influenza vaccine: an approach for policymakers. Am J Public Health 2012; 102:596-605. [PMID: 22397339 PMCID: PMC3489371 DOI: 10.2105/ajph.2011.300512] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2011] [Indexed: 11/04/2022]
Abstract
For the influenza pandemic of 2009-2010, countries responded to the direct threat of influenza but may have missed opportunities and strategies to limit secondary pneumococcal infections. Delivering both vaccines together can potentially increase pneumococcal polysaccharide vaccine (PPV23) immunization rates and prevent additional hospitalizations and mortality in the elderly and other high-risk groups. We used PubMed to review the literature on the concomitant use of PPV23 with seasonal influenza vaccines. Eight of 9 clinical studies found that a concomitant program conferred clinical benefits. The 2 studies that compared the cost-effectiveness of different strategies found concomitant immunization to be more cost-effective than either vaccine given alone. Policymakers should consider a stepwise strategy to reduce the burden of secondary pneumococcal infections during seasonal and pandemic influenza outbreaks.
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Gentile A, Militerno G, Schares G, Nanni A, Testoni S, Bassi P, Gollnick NS. Evidence for bovine besnoitiosis being endemic in Italy--first in vitro isolation of Besnoitia besnoiti from cattle born in Italy. Vet Parasitol 2011; 184:108-15. [PMID: 21978744 DOI: 10.1016/j.vetpar.2011.09.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 07/13/2011] [Accepted: 09/05/2011] [Indexed: 11/16/2022]
Abstract
Until 2009, bovine besnoitiosis had never been considered endemic in Italy and the only report on the disease in this country referred to animals imported from France shortly before. However, recently, an autochthonous outbreak of bovine besnoitiosis was reported in four herds located at the intersection of the borders between Emilia-Romagna, Toscana and Marche (Northern Apennine Mountains), which has led to an increased awareness concerning this disease. The present study describes a further outbreak of bovine besnoitiosis in Italy. The afflicted herd was a dairy herd with no evidence for contact with cattle from regions known to be endemic for bovine besnoitiosis. The farm investigation was initiated after a three-year old Holstein Friesian dairy cow with generalized thickening and lichenification of the skin was diagnosed with bovine besnoitiosis. The clinical diagnosis was confirmed by gross pathology, histopathology, serology and PCR. Bradyzoites released from tissue cysts obtained from the skin of this animal enabled the first in vitro isolation of Besnoitia besnoiti in Italy. This isolate was named Bb-Italy1. Sequencing of a 2118 bp spanning region including the complete internal transcribed spacer 1 and parts of the 18S and the 5.8S rRNA gene from DNA extracted from skin-derived zoites revealed a 99.9% identity to sequences known for other B. besnoiti isolated from cattle in Europe. Two GKO mice which had been inoculated intraperitoneally with bovine skin-derived bradyzoites became ill 7 days post inoculation. Parasitophorous vacuoles with multiplying zoites were observed in the cell culture inoculated with peritoneal fluids of these mice and a B. besnoiti infection in the mice and in the cell culture could be confirmed by real-time PCR. A serological investigation in the afflicted herd using immunoblots and an immunofluorescent antibody test (IFAT) revealed an overall herd seroprevalence of 9.7% (31/321), whereas within the female animals older than 2 years 17.0% (29/171) of the dams were tested positive. With one exception, an imported cow from Germany, all the seropositive animals were born in Italy. In connection with previously described autochthonous cases of bovine besnoitiosis the case described herein suggests that bovine besnoitiosis should be considered endemic in Italy.
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Affiliation(s)
- A Gentile
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, I-Ozzano Emilia, Bologna, Italy.
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Galuppi R, Militerno G, Bassi P, Nanni A, Testoni S, Tampieri MP, Gentile A. Evidence for bovine parafilariosis in Italy: first isolation of Parafilaria bovicola (Tubangui, 1934) from autochthonous cattle. Vet Parasitol 2011; 184:88-91. [PMID: 21871737 DOI: 10.1016/j.vetpar.2011.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 07/21/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
Abstract
In May and July 2010 and in March 2011, the presence of multiple bleeding nodules at the level of the neck, shoulders, withers, back and rump in five cattle from three herds in north-central Italy were observed. A diagnosis of parafilariosis was made. Fragments of adult females of Parafilaria bovicola could be identified from the derma of three to five bioptic extirpates. Larvated eggs and free larvae were observed in serohemorrhagic exudates. This paper is the first report of the occurrence of parafilariosis in Italy and subsequent to the various outbreaks reported, it can now be said that bovine parafilariosis is also currently present in Italy.
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Affiliation(s)
- R Galuppi
- Department of Veterinary Medical Sciences, University of Bologna, Italy.
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Levine OS, Hajjeh R, Wecker J, Cherian T, O'Brien KL, Knoll MD, Privor-Dumm L, Kvist H, Nanni A, Bear AP, Santosham M. A policy framework for accelerating adoption of new vaccines. Hum Vaccin 2010; 6:1021-4. [PMID: 21150269 PMCID: PMC3060382 DOI: 10.4161/hv.6.12.13076] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 07/13/2010] [Accepted: 07/20/2010] [Indexed: 11/19/2022]
Abstract
Rapid uptake of new vaccines can improve health and wealth and contribute to meeting Millennium Development Goals. In the past, however, the introduction and use of new vaccines has been characterized by delayed uptake in the countries where the need is greatest. Based on experience with accelerating the adoption of Hib, pneumococcal and rotavirus vaccines, we propose here a framework for new vaccine adoption that may be useful for future efforts. The framework organizes the major steps in the process into a continuum from evidence to policy, implementation and finally access. It highlights the important roles of different actors at various times in the process and may allow new vaccine initiatives to save time and improve their efficiency by anticipating key steps and actions.
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Affiliation(s)
- Orin S Levine
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Nanni A, Brusasca G, Calori G, Finardi S, Tinarelli G, Zublena M, Agnesod G, Pession G. Integrated assessment of traffic impact in an Alpine region. Sci Total Environ 2004; 334-335:465-471. [PMID: 15504532 DOI: 10.1016/j.scitotenv.2004.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/01/2004] [Indexed: 05/24/2023]
Abstract
This paper reports the results of an integrated assessment of traffic impact on a tourist-popular high altitude region which includes mountain passes and road tunnels. A modeling system for air quality assessment and management has been established and revised. The system has been used to evaluate the impact of traffic due to the re-opening of the Mont Blanc tunnel: the increase in NO(x) concentrations ranges from 50% at the bottom of the upper valley to 150% near to tunnel entrance.
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Affiliation(s)
- A Nanni
- ARIANET Srl, Via Gilino, 9-20128 Milano, Italy.
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Misuri A, Lucertini G, Nanni A, Viacava A, Belardi P. Predictive value of transcutaneous oximetry for selection of the amputation level. J Cardiovasc Surg (Torino) 2000; 41:83-7. [PMID: 10836229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Transcutaneous oximetry was studied to select the correct amputation level for limb ischemic necrosis with possible identification of threshold value. METHODS The method was evaluated in 30 cases (20 patients, 5 males and 15 females, of ages ranging from 61 to 93, average 73.1+/-8.5) where patients underwent amputation because of severe leg ischemia. Surgical operations were: minor amputation (toe or transmetatarsal) in 23 cases, below knee amputation in 7. Oxygen tension was measured at the dorsum foot and at the third superior of the anteromedial calf aspect. RESULTS Results were classified as success (primary or delayed healing) or failure (necrosis at the surgical wound). Amputation was successful in 17/30 cases with oxygen tension of 0-65 mmHg (mean 32.5+/-16.1) and failed in 13/30 with oxygen tension of 0-57 mmHg (mean 7.8+/-17.3). The difference was statistically significant (p=0.0004). Sensitivity of the method resulted 88.2%, specificity 84.6%, diagnostic accuracy 86.7%, positive predictive value 88.2% and negative predictive value 84.6%. A threshold of 20 mmHg was identified: 15/17 successful cases showed values greater than 20 mmHg, while 11/13 failed cases presented values lower than the threshold. CONCLUSIONS Following our observations and according to some reported studies, we believe transcutaneous oximetry to be the best method for selection of amputation level This is a simple, noninvasive and accurate method, which has showed itself superior to other techniques (i.e., Doppler and radioisotope).
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Affiliation(s)
- A Misuri
- Section of Vascular Surgery, University of Genoa, Italy
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Servadei F, Nasi MT, Cremonini AM, Giuliani G, Cenni P, Nanni A. Importance of a reliable admission Glasgow Coma Scale score for determining the need for evacuation of posttraumatic subdural hematomas: a prospective study of 65 patients. J Trauma 1998; 44:868-73. [PMID: 9603091 DOI: 10.1097/00005373-199805000-00021] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients who have an acute subdural hematoma with a thickness of 10 mm or less and with a shift of the midline structures of 5 mm or less often can be treated nonoperatively. We wonder whether the knowledge of the clinical status both in the prehospital determination and on admission to the neurosurgical center can predict the need for evacuation of subdural hematomas as well as the computed tomographic (CT) parameters. METHODS From January 1, 1994, to May 31, 1996, 65 comatose patients harboring an acute subdural hematoma of 5 mm or more and not brain dead were admitted to our intensive care unit. Of the 65 patients, 15 patients were initially managed conservatively according to a protocol based on clinical, CT, and intracranial pressure parameters. During the study period, the use of long-lasting paralytic agents has been eliminated to allow detection of clinical deterioration in the Glasgow Coma Scale (GCS) score from the prehospital determination to the hospital admission assessment. RESULTS Of the 15 patients initially managed conservatively, two were subsequently operated on because of evolving parenchymal hematomas. When comparing demographic, clinical, and CT parameters between the surgical group of patients and the patients initially conservatively treated, hematoma thickness (mean, 17.1 mm vs. 7.5 mm, p < 0.0001) and shift of the midline structures (mean, 12.8 mm vs. 4.7 mm, p < 0.008) were predictive of the need for surgery. A statistically significant change in the GCS score between prehospital determination and admission assessment was shown in the surgical group of patients (mean GCS score, 8.4 vs. 6.7, p < 0.01), and it was not present (mean GCS score, 7.3 vs. 7.2) in the patients initially conservatively treated. Functional outcomes were present in 23 cases (35.4%); functional outcomes in the initially conservatively treated patients were reached by 10 patients (66.7%). CONCLUSIONS Nonoperative management for selected cases of acute subdural hematomas is at least as safe as surgical management. GCS scoring at the scene and in the emergency room combined with early and subsequent CT scanning is crucial when making the decision for nonoperative management. This strategy requires that administration of long-lasting sedatives and paralytic medications be avoided before the patient arrives at the neurosurgical center.
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Affiliation(s)
- F Servadei
- Division of Neurosurgery, Ospedale Maurizio Bufalini, Cesena, Italy.
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Simoni G, Borsetto M, Nanni A, Copello F. [Analysis of risk factors in patients operated for abdominal aortic aneurysm]. Minerva Cardioangiol 1997; 45:471-6. [PMID: 9489315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of the associated risk factors on the early results of elective repair of abdominal aortic aneurysms has been evaluated in a series of 270 consecutive patients. Clinical, hematological and instrumental data concerning cardiovascular, pulmonary and metabolic diseases have been collected for each patient, as well as the type and the results of the surgical procedure. METHODS The graft was straight aortic in 82 cases (30.3%), aorto-bisiliac in 130 (48.1%) and aorto-bifemoral in 58 cases (21.6%); the 237 uneventful patients (87.8%) have been discharged 8 days after the operation (mean) and 24 (8.9%) underwent to coronary-aortic bypass graft (CABG) previously. RESULTS Postoperative complications have been observed in 33 patients (12.2%): 24.3% pulmonary, 21.2% cardiac and 15.1% renal and among these 13 patients died (4.8% of the complete series and 39.4% of those with complications) because of pulmonary (38.4%), cardiac (30.7%) and renal causes (23.3%) mainly. Despite the complications occurred mainly in patients with associated risk factors, the multivariate analysis has shown that only the chronic obstructive pulmonary disease (COPD) plays a fundamental role (p < 0.005). On the contrary, among the patients died not one single risk factor reached statistical significance, although the COPD was close (p = 0.1). CONCLUSIONS These data underline the need of a careful evaluation and treatment of associated diseases in patients undergoing elective repair for an AAA; namely a screening for asymptomatic coronary artery disease, since the CABG can significantly reduce morbility and mortality rates, and for COPD. In addition a more careful monitoring of patients with long clamping time could reduce the possible related renal complications. Up to now, since the surgical procedures is already standardized, the precise diagnosis and treatment of associated risk factors represent the winning strategy for the achievement of better results.
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Affiliation(s)
- G Simoni
- Clinica Chirurgica B, Università degli Studi, Genova
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Servadei F, Nasi M, Nanni A, Cremonini A, Cenni P, Giuliani G. Surgical indications in comatose patients with an acute subdural hematoma: A prospective study of 65 patients. Clin Neurol Neurosurg 1997. [DOI: 10.1016/s0303-8467(97)81313-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Servadei F, Nanni A, Nasi MT, Zappi D, Vergoni G, Giuliani G, Arista A. Evolving brain lesions in the first 12 hours after head injury: analysis of 37 comatose patients. Neurosurgery 1995; 37:899-906; discussion 906-7. [PMID: 8559338 DOI: 10.1227/00006123-199511000-00008] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
From January 1, 1990, to April 30, 1994, 412 patients were admitted to our intensive care unit in coma after head injuries. Our study group consisted of 37 patients who were retrospectively identified as harboring lesions or developing new lesions within a 12-hour period from the time of admission. We defined the evolution of a lesion as an increase or decrease in the size of an already present hematoma or as the appearance of a totally new lesion. There were 25 male and 12 female patients (mean age, 34.9 yr), and the cause of trauma was road traffic accidents in 32 patients. Nine patients presented with shock, and six had evidence of abnormal coagulation at admission. Patients were divided into two different groups. In Group 1, 15 patients harbored lesions that evolved toward reabsorption. In Group 2, 22 patients harbored hematomas that evolved toward lesions requiring surgical removal. Fifteen of these patients had initial diagnoses of diffuse injury that evolved in this manner, whereas the remaining seven patients had already been operated upon and had developed second, noncontiguous, surgical lesions. Patients with lesions that required surgical evacuation had their computed tomographic (CT) scans obtained earlier and had a higher incidence of clinical deterioration. There was a significant difference in the evolution of the different lesions (P < 0.001), with subdural hematomas being more prone to reabsorption and intracerebral and extradural hematomas being more likely to increase in size or to appear as new lesions. Second CT scans were obtained because of clinical deterioration in 10 patients and because of increase in intracranial pressure in 5 patients. Scheduled CT scans were obtained in 13 patients, whereas in the remaining 9 patients, the diagnosis emerged from a combination of scheduled CT scans and intracranial pressure monitoring. There was a trend toward a poorer result among the patients with clinical deterioration, which, however, was not significant. A significant proportion of post-traumatic patients, particularly those who are unconscious, harbor early evolving intracranial lesions. When the first CT scan is performed within 3 hours after injury, a CT scan should be repeated within 12 hours.
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Affiliation(s)
- F Servadei
- Division of Neurosurgery, Ospedale Maurizio, Bufalini, Cesena, Italy
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