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Dell'Orso G, Bagnasco F, Giardino S, Pierri F, Ferrando G, Di Martino D, Micalizzi C, Guardo D, Volpi S, Sabatini F, Miano M, Gattorno M, Dufour C, Faraci M. Hematopoietic stem cell transplantation for inborn errors of immunity: 30-year single-center experience. Front Immunol 2023; 14:1103080. [PMID: 36825011 PMCID: PMC9941625 DOI: 10.3389/fimmu.2023.1103080] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) represents an effective treatment for a variety of inborn errors of immunity (IEI). We report the experience of children affected by IEI who received allo-HSCT over a period of 32 years at IRCCS Istituto Giannina Gaslini, Genoa, Italy. HSCTs were performed in 67 children with IEI. Kaplan-Meier estimates of overall survival (OS) rate at 5 years in the whole group of patients was 83.4% after a median follow-up of 4 years. Median age at transplant was 2.5 years. Eight allo-HSCTs were complicated by either primary or secondary graft failure (GF), the overall incidence of this complication being 10.9%. Incidence of grade 3-4 acute GvHD (aGvHD) was 18.7%, significantly lower in the haploidentical transplant cohort (p = 0.005). Year of transplant (≤2006 vs. >2006) was the main factor influencing the outcome. In fact, a significant improvement in 5-year OS was demonstrated (92.5% >2006 vs. 65% ≤2006, p = 0.049). Frequency of severe aGvHD was significantly reduced in recent years (≤2006 61.5%, vs. >2006 20%, p = 0.027). A significant progress has been the introduction of the TCR αβ/CD19-depleted haploidentical platform, which was associated with the absence of severe aGvHD. However, it was associated with 23.5% incidence of GF. All but one patient experiencing GF in the this specific cohort were successfully retransplanted. In summary, allo-HSCT is confirmed to be an effective treatment for children with IEI, even in the absence of an HLA-matched donor.
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Affiliation(s)
- Gianluca Dell'Orso
- Hematopoietic Stem Cell Transplantation Unit, Department of Hematology-Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Bagnasco
- Scientific Directorate, Epidemiology and Biostatistics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Giardino
- Hematopoietic Stem Cell Transplantation Unit, Department of Hematology-Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Filomena Pierri
- Hematopoietic Stem Cell Transplantation Unit, Department of Hematology-Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giulia Ferrando
- Infectious Diseases Unit and COVID-Hospital, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Daniela Guardo
- Hematology Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Volpi
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Federica Sabatini
- Stem Cells and Cell Therapies Laboratory, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Miano
- Hematology Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Carlo Dufour
- Hematology Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit, Department of Hematology-Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Giardino S, Bagnasco F, Falco M, Miano M, Pierri F, Risso M, Terranova P, Martino DD, Massaccesi E, Ricci M, Chianucci B, Dell'Orso G, Sabatini F, Podestà M, Lanino E, Faraci M. HAPLOIDENTICAL STEM CELL TRANSPLANTATION AFTER TCR αβ +AND CD19 + CELLS DEPLETION IN CHILDREN WITH CONGENITAL NON-MALIGNANT DISEASE. Transplant Cell Ther 2022; 28:394.e1-394.e9. [PMID: 35405368 DOI: 10.1016/j.jtct.2022.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 10/07/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND . Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) represents a valuable alternative for children with non-malignant disease and ex-vivo negative selection of TCR αβ+-cells is an emerging graft manipulation option that carries several potential advantages in terms of reduced risk of Graft versus Host Disease (GvHD) and improved immune reconstitution. METHODS . We reported all consecutive patients with a diagnosis of non-malignant disease who received a TCR-αβ+ and CD19+depleted haplo-HSCT at "IRCCS Istituto Giannina Gaslini" from 2013 to 2019; the conditioning regimen was myeloablative or non-myeloablative, depending on underlying disease; all patients received anti-thymocyte globulin and rituximab. No post-transplant GvHD prophylaxis was given in presence of a TCR-αβ+ cell-dose in the graft lower than the threshold of 1 × 105/kg of the recipient's weight. RESULTS . Among 20 HSCTs, engraftment occurred in 17 (85%) after a median of 14 and 12 days from graft infusion for neutrophils and platelets respectively. Primary graft failure was diagnosed in 3 (15%) patients, two (10%) experienced secondary rejection; all of these underwent a second HSCT. The cumulative incidence of a-GvHD and c-GvHD was 15% (2 grade 1, 1 grade 4) at 90 days and 5% (1 grade 1) at 7 months, respectively. Cytomegalovirus reactivation requiring pre-emptive treatment was observed in 9 patients (45%). One patient developed a JC virus-related progressive multifocal leukoencephalopathy, successfully managed with donor-derived virus-specific T-cell infusions. A complete immunological recovery was reached in most patients within 6 months. After a median follow-up of 4 years, 18 patients are alive, with a cumulative survival probability of 90%. CONCLUSION . Haplo-HSCT after ex-vivo TCR-αβ+/CD19+ negative selection may be considered a good option for children with non-malignant diseases since it ensures a high engraftment rate with an acceptable risk of graft failure, very low incidence of significant GvHD, and good immune reconstitution with low frequency of severe virus-related disease. However, the control of viral infection/reactivation should be kept high in order to promptly provide pre-emptive treatments and approaches of antiviral adoptive immunotherapy.
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Affiliation(s)
- Stefano Giardino
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy.
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Michela Falco
- Laboratory of Clinical and Experimental Immunology, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Miano
- Hematology Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Filomena Pierri
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Risso
- Immunohematology and Transfusional Department, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Terranova
- Laboratory of Hematology, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Margherita Ricci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Liguria, Italy
| | - Benedetta Chianucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Liguria, Italy
| | - Gianluca Dell'Orso
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Federica Sabatini
- Stem Cells and Cell Therapies Laboratory, IRCSS IstitutoGianninaGaslini, Genoa, Italy
| | - Marina Podestà
- Stem Cells and Cell Therapies Laboratory, IRCSS IstitutoGianninaGaslini, Genoa, Italy
| | - Edoardo Lanino
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Maura Faraci
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
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Amodeo S, Cavoretto PI, Seidenari A, Paci G, Germano C, Monari F, Donno V, Giambanco L, Avagliano L, Di Martino D, Fusé F, Masturzo B, Chiantera V, Facchinetti F, Ferrazzi E, Candiani M, Bulfamante G, Farina A. Second trimester uterine arteries pulsatility index is a function of placental pathology and provides insights on stillbirth aetiology: A multicenter matched case-control study. Placenta 2022; 121:7-13. [DOI: 10.1016/j.placenta.2022.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/21/2022] [Accepted: 02/24/2022] [Indexed: 12/21/2022]
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Musa M, Rossini R, Di Martino D, Riccardi MP, Clemenza M, Gorini G. Combining Micro-Raman Spectroscopy and Scanning Electron Microscopy Mapping: A Stony Meteorite Study. Materials (Basel) 2021; 14:ma14247585. [PMID: 34947185 PMCID: PMC8709099 DOI: 10.3390/ma14247585] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022]
Abstract
Meteorite characterisation represents a privileged and unique opportunity to increase our knowledge about the materials composing the Universe and, particularly, the Proto Solar System. Moreover, meteorites studies evolve contextually with the development of analytical technologies. In the present paper, the results from an unclassified stony meteorite (chondrite) characterisation have been reported on the basis of the innovative analytical protocol presented here. Advanced Mapping by micro-Raman Spectroscopy and Scanning Electron Microscopy equipped with Energy Dispersive Spectroscopy have been combined to disclose molecular and elemental features on the same regions sample at a micrometric resolution. Thanks to their non-destructive properties, the mapping tools of both instruments have been applied to single chondrules analysis and the best match between the mineralogical information and the chemical composition has been obtained. This combined approach proved to be highly suitable in disclosing the crystallinity features of the phases, with in-depth spatial and morphological details too.
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Affiliation(s)
- Maya Musa
- Department of Earth and Environmental Sciences, University of Pavia, 27100 Pavia, Italy; (M.M.); (M.P.R.)
| | - Riccardo Rossini
- Physics Department and INFN Section, University of Milan Bicocca, 20126 Milan, Italy; (R.R.); (M.C.); (G.G.)
| | - Daniela Di Martino
- Physics Department and INFN Section, University of Milan Bicocca, 20126 Milan, Italy; (R.R.); (M.C.); (G.G.)
- Correspondence:
| | - Maria Pia Riccardi
- Department of Earth and Environmental Sciences, University of Pavia, 27100 Pavia, Italy; (M.M.); (M.P.R.)
| | - Massimiliano Clemenza
- Physics Department and INFN Section, University of Milan Bicocca, 20126 Milan, Italy; (R.R.); (M.C.); (G.G.)
| | - Giuseppe Gorini
- Physics Department and INFN Section, University of Milan Bicocca, 20126 Milan, Italy; (R.R.); (M.C.); (G.G.)
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Soldavini CM, Di Martino D, Sabattini E, Ornaghi S, Sterpi V, Erra R, Invernizzi F, Tine' G, Giardini V, Vergani P, Ossola MW, Ferrazzi E. sFlt-1/PlGF ratio in hypertensive disorders of pregnancy in patients affected by COVID-19. Pregnancy Hypertens 2021; 27:103-109. [PMID: 34998223 PMCID: PMC8653398 DOI: 10.1016/j.preghy.2021.12.001] [Citation(s) in RCA: 3] [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: 09/09/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 01/21/2023]
Abstract
Objectives To analyze soluble Fms-like tyrosine Kinase 1 (sFlt-1) and Placental Growth Factor (PlGF) ratio concentrations in COVID-19 pregnant patients with and without Hypertensive Disorders of Pregnancy (HDP), compared with non COVID-19 pregnant patients with HDP and a control group. Study design We recruited and obtained a complete follow-up of 19 COVID-19 pregnant patients with HDP and of 24 COVID-19 normotensive pregnant patients. Demographic, clinical and sFlt-1/PlGF ratio findings were compared with a group of 185 non COVID-19 pregnant patients with HDP and 41 non COVID normotensive patients. Findings were based on univariate analysis and on a multivariate adjusted model, and a case by case analysis of COVID-19 pregnant patients with an abnormal sFlt-1/PlGF ratio > 38 at recruitment. Main outcome measures sFlt-1/PlGF ratio. Results We confirmed a significant higher prevalence of HDP in women affected by COVID-19 compared to control population. sFlt-1/PlGF ratio was found high in HDP patients, with and without of Sars-Cov2 infection. COVID-19 patients with worse evolution of the disease showed greater rates of obesity and other comorbidities. sFlt/PlGF ratio proved not to be helpful in the differential diagnosis of the severity of this infection. Conclusions COVID-19 pregnant patients showed a higher prevalence of HDP compared to non COVID-19 controls, as well as higher comorbidity rates. In spite of the possible common endothelial target and damage, between Sars-Cov-2 infection and HDP, the sFlt1/PlGF ratio did not correlate with the severity of this syndrome.
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Affiliation(s)
- Chiara Maria Soldavini
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Di Martino
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Sabattini
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Ornaghi
- Obstetrics Unit, Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| | - Vittoria Sterpi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Erra
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Invernizzi
- Obstetrics Unit, Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| | - Gabriele Tine'
- Department of Economics and Quantitative Methods, University of Milano Bicocca, Monza, Italy
| | - Valentina Giardini
- Obstetrics Unit, Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| | - Patrizia Vergani
- Obstetrics Unit, Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy; University of Milano Bicocca, Monza, Italy
| | - Manuela Wally Ossola
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Italy.
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Stampalija T, Quadrifoglio M, Casati D, Zullino S, Maggi V, Di Martino D, Rosti E, Mastroianni C, Signorelli V, Ferrazzi E. First trimester placental volume is reduced in hypertensive disorders of pregnancy associated with small for gestational age fetus. J Matern Fetal Neonatal Med 2021; 34:1304-1311. [PMID: 31232131 DOI: 10.1080/14767058.2019.1636026] [Citation(s) in RCA: 4] [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: 01/01/2023]
Abstract
INTRODUCTION Trophoblastic invasion and placental growth are critical for pregnancy outcome. The placental volume can be assessed by 3 D ultrasound using Virtual Organ Computer-aided Analysis (VOCAL). Epidemiological and clinical data suggest that there are two different clinical phenotypes of hypertensive disorders of pregnancy (HDP) that coexist at any gestational age: HDP associated to fetal growth impairment and HDP associated to appropriate for gestational age fetal growth. The aim of this study was to determine whether placental volume in the first trimester of pregnancy differs between women with HDP associated or not to fetal growth impairment and uncomplicated pregnancies. METHODS This is a retrospective cross-sectional study of prospectively recruited data in which maternal characteristics, Doppler velocimetry of uterine arteries, and three-dimensional (3 D) volume of the placenta were collected at 11 + 1 - 13 + 6 gestational weeks. The placental quotient (PQ) was calculated as placental volume/crown rump length. RESULTS In a 2-year period, we prospectively collected first trimester data of 1322 women. For the purposes of this cross-sectional study, 57 women that delivered a SGA fetus, 34 that developed HDP-AGA, and six that developed HDP-SGA, respectively, were included in the study as cases. The control group was made of 117 uncomplicated pregnancies. The PQ was higher in women with uncomplicated pregnancies (PQ median 16.36 cm3/cm) than in all other study groups (PQ in SGA: 13.02 cm3/cm, p < .001; PQ in HDP-AGA: 12.65 cm3/cm, p = .002; and PQ in women with HDP-SGA: 8.33 cm3/cm [IQR 6.50-10.13], p < .001). The lowest PQ was observed in women with HDP-SGA and was significantly lower than PQ in either women with SGA or those with HDP-AGA (p = .02 and p = .04, respectively). The mean uterine artery pulsatility index was the highest in women with HDP-SGA (median 2.30) compared to all other groups (uncomplicated pregnancies 1.48, p < .0001; women with SGA 1.59, p = .001; and women with HDP-AGA 1.75, p = .009). DISCUSSION Our findings suggest that HDP associated with SGA is characterized by impaired placental growth and perfusion as soon as in the first trimester of pregnancy. The role of PQ, isolated or in association with other biophysical parameters, to predict HDP with fetal growth impairment remains to be evaluated.
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Affiliation(s)
- Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Mariachiara Quadrifoglio
- Unit of Fetal Medicine and Prenatal Diagnosis, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Daniela Casati
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Sara Zullino
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Valeria Maggi
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Daniela Di Martino
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Eleonora Rosti
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Cristina Mastroianni
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Valentina Signorelli
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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D'Ambrosi F, Iurlaro E, Tassis B, Di Maso M, Erra R, Cetera GE, Cesano N, Di Martino D, Ossola MW, Ferrazzi EM. Sociodemographic characteristics of pregnant women tested positive for COVID-19 admitted to a referral center in Northern Italy during lockdown period. J Obstet Gynaecol Res 2021; 47:1751-1756. [PMID: 33650278 PMCID: PMC8013282 DOI: 10.1111/jog.14729] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/23/2021] [Accepted: 02/12/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION We investigated association between sociodemographic characteristics and COVID-19 disease among pregnant women admitted to our unit, the largest high-risk maternity unit in the Milan metropolitan area. METHODS Between March 1, 2020 and April 30, 2020, 896 pregnant women were admitted to our Institution and tested for COVID-19. We collected information regarding their sociodemographic characteristics. Additional information on geographical area of residence, number of family members, number of family members tested positive for COVID-19, and clinical data was collected for women tested positive for COVID-19. Odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of developing COVID-19 according to sociodemographic characteristics were estimated by unconditional logistic regression models. RESULTS Among the 896 women enrolled, 50 resulted positive for COVID-19. Pregnant women aged ≥35 years had a significantly lower risk of developing the infection (crude OR = 0.29; 95% CI:0.16-0.55). Conversely, foreign women (crude OR = 3.32; 95% CI:1.89-5.81), unemployed women (crude OR = 3.09; 95% CI: 1.77-5.40), and women with an unemployed partner (crude OR = 3.16; 95% CI: 1.48-6.79) showed a significantly higher risk of infection. Ethnicity was positively associated with the risk of developing COVID-19 (mutually adjusted OR = 2.15; 95% CI:1.12-4.11) in the multivariate analysis. Foreign women with COVID-19 were more likely to have a lower education level (p < 0.01), to be unemployed (p < 0.01), and to live in larger families (p < 0.01) compared to Italian pregnant women. CONCLUSIONS The socioeconomic conditions described are characteristic of immigration patterns in our metropolitan area. These factors may increase the risk of viral transmission, reducing the effectiveness of lockdown and social distancing.
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Affiliation(s)
- Francesco D'Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Iurlaro
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Tassis
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Roberta Erra
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia E Cetera
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Cesano
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Di Martino
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Manuela W Ossola
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Maria Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Di Martino D, Chiaffarino F, Patanè L, Prefumo F, Vergani P, Ornaghi S, Savasi V, Spinillo A, Cromi A, D’Ambrosi F, Tassis B, Iurlaro E, Parazzini F, Ferrazzi E. Assessing risk factors for severe forms of COVID-19 in a pregnant population: A clinical series from Lombardy, Italy. Int J Gynaecol Obstet 2021; 152:275-277. [PMID: 33098568 PMCID: PMC9087617 DOI: 10.1002/ijgo.13435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
In 250 pregnant women with either asymptomatic, non‐severe, or severe SARS‐CoV‐2 infection, obesity turned out to be the main determinant of severe COVID‐19 illness.
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Affiliation(s)
- Daniela Di Martino
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Francesca Chiaffarino
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Luisa Patanè
- Department of Obstetrics and GynecologyPapa Giovanni XXIII HospitalBergamoItaly
| | - Federico Prefumo
- Division of Obstetrics and GynaecologyASST Spedali CiviliBresciaItaly
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Patrizia Vergani
- Department of Maternal Fetal MedicineFondazione MBBMSan Gerardo HospitalMonzaItaly
- University of Milano BicoccaMonzaItaly
| | - Sara Ornaghi
- Department of Maternal Fetal MedicineFondazione MBBMSan Gerardo HospitalMonzaItaly
- University of Milano BicoccaMonzaItaly
| | - Valeria Savasi
- Department of Woman, Mother and NeonateSacco Hospital‐ASST‐Fatebenefratelli‐SaccoMilanItaly
- Department of Clinical and Biological SciencesUniversity of MilanMilanItaly
| | - Arsenio Spinillo
- Department of Obstetrics and GynecologyIRCCS Foundation Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Antonella Cromi
- Department of Obstetrics and GynecologyUniversity of InsubriaVareseItaly
| | - Francesco D’Ambrosi
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Beatrice Tassis
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Enrico Iurlaro
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Fabio Parazzini
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
| | - Enrico Ferrazzi
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
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D'Ambrosi F, Rossi G, Soldavini CM, Maggi V, Cetera GE, Carbone IF, Di Martino D, Di Maso M, Ferrazzi E. Management of gestational diabetes in women with a concurrent severe acute respiratory syndrome coronavirus 2 infection, experience of a single center in Northern Italy. Int J Gynaecol Obstet 2020; 152:335-338. [PMID: 33099770 PMCID: PMC9087777 DOI: 10.1002/ijgo.13434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 01/10/2023]
Abstract
Objective In this study we describe the management of women with gestational diabetes (GD) and an ongoing severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. The aim of the study is to evaluate whether coronavirus disease 2019 (COVID‐19) can further complicate pregnancies, and if the protocol we usually use for GD pregnancies is also applicable to patients who have contracted a SARS‐CoV‐2 infection. Methods This is a retrospective study analyzing all pregnant women with GD and concomitant COVID‐19 admitted to our institution for antenatal care between March 1 and April 30, 2020. Results Among pregnant women with GD and a concomitant SARS‐CoV‐2 infection, the mean age was 32.9 (SD 5.6) years. Two patients (33%) were of white racial origin and four (67%) were of non‐white racial origin. All patients were diagnosed with COVID‐19 during the third trimester of pregnancy. Two women were asymptomatic and four were symptomatic. Only two (33.3%) women received treatment with insulin. None of the patients required intensive care or mechanical ventilation. No complications were found among the neonates. Conclusion COVID‐19 was not found to worsen the prognosis of patients with GD or of their offspring. Glycemic monitoring, diet therapy, and insulin, when needed, are sufficient for good metabolic control and favorable maternal and fetal outcomes.
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Affiliation(s)
- Francesco D'Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Rossi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Maria Soldavini
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Maggi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Emily Cetera
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilma Floriana Carbone
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Di Martino
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Ferrazzi E, Tiso G, Di Martino D. Folic acid versus 5- methyl tetrahydrofolate supplementation in pregnancy. Eur J Obstet Gynecol Reprod Biol 2020; 253:312-319. [PMID: 32868164 DOI: 10.1016/j.ejogrb.2020.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
Folate (vitamin B9) is widely accepted to protect against fetal neural tube defects. The main sources of dietary folate are folic acid-fortified foods and folic acid-containing dietary supplements. However, folic acid is inactive in the human body and must be converted by the liver into the active molecule 5-methyltetrahydrofolate (5-MTHF). 5-MTHF functions as a methyl donor in many metabolic reactions, including the conversion of homocysteine into methionine, the biosynthesis of glycine from serine, and the biosynthesis of DNA precursor molecules. Therefore, folate is fundamental for growth, especially in the embryonic and fetal stages. Prescription of folic acid to women in the preconception period and during pregnancy is a consolidated practice. However, it can pose health risks in certain conditions, such as megaloblastic anemia, where it will conceal megaloblastic anemia due to vitamin B12 deficiency and in cases of reduced hepatic transformation of folic acid (e.g. due to genetic variants or during some pharmacotherapies). Some of these risks can be avoided by supplementation with 5-MTHF rather than folic acid. Because 5-MTHF does not require activation, it is immediately available to mother and fetus and does not accumulate in blood like folic acid does in cases of reduced hepatic transformation. This paper reviews the advantages and disadvantages of folate supplementation with folic acid versus 5-MTHF, with a focus on maternal and fetal health.
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Affiliation(s)
- Enrico Ferrazzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Obstertics Unit, Dept of Woman Child and Neonate, Milan, Italy.
| | - Giulia Tiso
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Obstertics Unit, Dept of Woman Child and Neonate, Milan, Italy
| | - Daniela Di Martino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Obstertics Unit, Dept of Woman Child and Neonate, Milan, Italy
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11
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Cappiello G, Camarda L, Pulito G, Tarantino A, Di Martino D, Russi V, Stramazzo L, Ragusa C, Guarino G, Ripani U. Continuous Femoral Catheter for Postoperative Analgesia After Total Knee Arthroplasty. Med Arch 2020; 74:54-57. [PMID: 32317836 PMCID: PMC7164727 DOI: 10.5455/medarh.2020.74.54-57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/29/2022] Open
Abstract
Introduction: Postoperative pain management in the total knee replacement (TKR) represent a fundamental step for a positive outcome, allowing rapid mobilization, already on the first day. Further, continuous peripheral nerve block techniques have been reported to allow effective and safe control of acute postoperative pain, ensuring the implementation and completion of an accurate and intensive joint rehabilitation program. Aim: The aim of this study was to assess early mobility and compliance of patients that underwent TKR surgery using the femoral block. Methods: For the study, all patients that underwent TKR from 2015 to 2018 with ASA score between II-III was evaluated. Patients underwent vital parameters monitoring and were treated initially with midazolam (0.05mg / kg) e.v. combined sciatic block + femoral perineural catheter positioning using a peripheral nerve stimulation-assisted technique. Results: Intraoperatively, satisfactory analgesia was guaranteed in all patients, associated with a complete muscle relaxation of the affected limb. High patient compliance, associated with good control of acute postoperative pain was obtained in the first 24 hours after surgery (VAS 0- 1). The ROM outcomes were good in all rehabilitation stages, managing to reach 90 degrees bending on the seventh day with an average KSS score of 88-90. Patient satisfaction and impact on quality of life were assessed with the SF-36 showing average scores of 78. Conclusion: Continuous femoral nerve blocking ensures good postoperative analgesia in TKR allowing an early joint mobilization, a rapid functional recovery of the knee and increasing patient compliance during the post-operative rehabilitation program.
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Affiliation(s)
- Giovanni Cappiello
- Department of Anesthesia, Analgesia and Intensive Care, Vito Fazzi Hospital, Lecce, Italy
| | - Lawrence Camarda
- Department of Orthopaedic and Traumatology (DICHIRONS), University of Palermo, Palermo, Italy
| | - Giuseppe Pulito
- Department of Anesthesia, Analgesia and Intensive Care, Vito Fazzi Hospital, Lecce, Italy
| | - Andrea Tarantino
- Department of Anesthesia, Analgesia and Intensive Care, Vito Fazzi Hospital, Lecce, Italy
| | - Daniela Di Martino
- Department of Anesthesia, Analgesia and Intensive Care, Vito Fazzi Hospital, Lecce, Italy
| | - Valentina Russi
- Department of Orthopaedic and Traumatology (DICHIRONS), University of Palermo, Palermo, Italy
| | - Leonardo Stramazzo
- Department of Orthopaedic and Traumatology (DICHIRONS), University of Palermo, Palermo, Italy
| | - Clara Ragusa
- Department of Biopathology and Medical and Forensic Biotechnologies (DIBIMEF), Section of Anaesthesiology, Analgesia, Emergency and Intensive Care, Policlinico "P. Giaccone," University of Palermo, Palermo, Italy
| | - Gianmarco Guarino
- Department of Anesthesia, Analgesia and Intensive Care, Vito Fazzi Hospital, Lecce, Italy
| | - Umberto Ripani
- Pain Therapy Center, Division of Anesthesia, Analgesia and Intensive Care, Department of Emergency, Ospedali Riuniti di Ancona, Ancona, Italy
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Masturzo B, Di Martino D, Prefumo F, Cavoretto P, Germano C, Gennarelli G, Roletti E, Bottazzoli E, Fusè F, Ferrazzi E, Morano D, Farina A. Higher rate of early-onset preeclampsia in pregnancies following oocyte donation according to increasing maternal age. Arch Gynecol Obstet 2019; 300:861-867. [PMID: 31520261 DOI: 10.1007/s00404-019-05291-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/22/2019] [Accepted: 09/03/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the influence of maternal age on the incidence of early-onset preeclampsia requiring delivery before 34 weeks of gestation in pregnancies obtained after oocyte donation. METHODS We carried out a prospective cohort analysis of 431 single and twin pregnancies, admitted to 3 Tertiary Referral Hospital in Northern Italy between 2008 and 2017. The rate of early-onset PE was calculated and stratified according to maternal age (from 30 to 49 years). A reference population of 11,197 single pregnancies collected prospectively at the first trimester of pregnancy in the same geographic area of Italy and in same hospitals was used to calculate the expected incidence of early-onset PE. RESULTS In women who delivered after 24 weeks of gestation, the rate of early-onset PE was much higher in oocyte-donation pregnancies, reaching 6.7% (29/431), than the expected rate of 0.5% of the cohort of reference. The mean early PE rate was 4.1% (10/242) in singletons and 10.1% (19/189) in twin pregnancies. According to maternal age, the rate of early PE was 1.16% and 3.12% at 30 years, and 4.98% and 13.14% at 49 years in single and twin pregnancies obtained after oocyte donation, respectively. CONCLUSION Pregnancies obtained after oocyte donation delivering after 24 weeks had a higher risk of early-onset PE requiring delivery before 34 weeks of gestation, than the general population. The risk is directly correlated with the increase of maternal age and is also higher in twin pregnancies.
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Affiliation(s)
- Bianca Masturzo
- Department of Surgical Sciences, OIRM S. Anna Hospital, University of Turin, Turin, EU, Italy
| | - Daniela Di Martino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, EU, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, EU, Italy
| | - Paolo Cavoretto
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, EU, Italy
| | - Chiara Germano
- Department of Surgical Sciences, OIRM S. Anna Hospital, University of Turin, Turin, EU, Italy
| | - Gianluca Gennarelli
- Department of Surgical Sciences, OIRM S. Anna Hospital, University of Turin, Turin, EU, Italy
| | - Enrica Roletti
- Gynecology and Obstetrics Department, Maggiore University Hospital, Parma, EU, Italy
| | - Elisa Bottazzoli
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Eu, Italy
| | - Federica Fusè
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Eu, Italy
| | - Enrico Ferrazzi
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, EU, Italy
| | - Danila Morano
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Cona, Ferrara, EU, Italy
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, EU, Italy.
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Abstract
Umbilical cord blood is a source of hematopoietic stem cells essential to treat life-threatening diseases, such as leukemia and lymphoma. However, only a very small percentage of parents donate upon delivery. The decision to donate the cord blood occurs at a very specific time and when parents likely experience emotional, informational, and decisional overloads; these features of cord blood donation make it different from other pro-social activities. In collaboration with an OB-GYN clinic in Milan, Italy, we conducted the first randomized controlled trial that applies tools from behavioral science to foster cord blood donation, and quantified the gains that informational and behavioral "nudges" can achieve. We found that information and "soft" commitments increased donations; approaching expecting parents closer to the delivery date and providing them with multiple reminders, moreover, had the strongest impact. However, a significant portion of women who expressed consent to donate could not do so because of organizational constraints. We conclude that simple, non-invasive behavioral interventions that address information gaps and procrastination, and that increase the salience of the activity can substantially enhance altruistic donations of cord blood, especially when coupled with organizational support.
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Affiliation(s)
| | | | | | - Daniela Di Martino
- Department of Woman, Mother, and Neonate, Buzzi Children's Hospital, Biological and Clinical Sciences, University of Milan, Milan, Italy
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14
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Ferrazzi E, Stampalija T, Monasta L, Di Martino D, Vonck S, Gyselaers W. Maternal hemodynamics: a method to classify hypertensive disorders of pregnancy. Am J Obstet Gynecol 2018; 218:124.e1-124.e11. [PMID: 29102503 DOI: 10.1016/j.ajog.2017.10.226] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The classification of hypertensive disorders of pregnancy is based on the time at the onset of hypertension, proteinuria, and other associated complications. Maternal hemodynamic interrogation in hypertensive disorders of pregnancy considers not only the peripheral blood pressure but also the entire cardiovascular system, and it might help to classify the different clinical phenotypes of this syndrome. OBJECTIVE This study aimed to examine cardiovascular parameters in a cohort of patients affected by hypertensive disorders of pregnancy according to the clinical phenotypes that prioritize fetoplacental characteristics and not the time at onset of hypertensive disorders of pregnancy. STUDY DESIGN At the fetal-maternal medicine unit of Ziekenhuis Oost-Limburg (Genk, Belgium), maternal cardiovascular parameters were obtained through impedance cardiography using a noninvasive continuous cardiac output monitor with the patients placed in a standing position. The patients were classified as pregnant women with hypertensive disorders of pregnancy who delivered appropriate- and small-for-gestational-age fetuses. Normotensive pregnant women with an appropriate-for-gestational-age fetus at delivery were enrolled as the control group. The possible impact of obesity (body mass index ≥30 kg/m2) on maternal hemodynamics was reassessed in the same groups. RESULTS Maternal age, parity, body mass index, and blood pressure were not significantly different between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and hypertensive disorders of pregnancy/small-for-gestational-age groups. The mean uterine artery pulsatility index was significantly higher in the hypertensive disorders of pregnancy/small-for-gestational-age group. The cardiac output and cardiac index were significantly lower in the hypertensive disorders of pregnancy/small-for-gestational-age group (cardiac output 6.5 L/min, cardiac index 3.6) than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group (cardiac output 7.6 L/min, cardiac index 3.9) but not between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and control groups (cardiac output 7.6 L/min, cardiac index 4.0). Total vascular resistance was significantly higher in the hypertensive disorders of pregnancy/small-for-gestational-age group than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group and the control group. All women with hypertensive disorders of pregnancy showed signs of central arterial dysfunction. The cardiovascular parameters were not influenced by gestational age at the onset of hypertensive disorders of pregnancy, and no difference was observed between the women with appropriate-for-gestational-age fetuses affected by preeclampsia or by gestational hypertension with appropriate-for-gestational-age fetuses. Women in the obese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and obese/hypertensive disorders of pregnancy/small-for-gestational-age groups showed a significant increase in cardiac output, as well as significant changes in other parameters, compared with the nonobese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and nonobese/hypertensive disorders of pregnancy/small-for-gestational-age groups. CONCLUSION Significantly low cardiac output and high total vascular resistance characterized the women with hypertensive disorders of pregnancy associated with small for gestational age due to placental insufficiency, independent of the gestational age at the onset of hypertension. The cardiovascular parameters were not significantly different in the women with appropriate-for-gestational-age or small-for-gestational-age fetuses affected by preeclampsia or gestational hypertension. These findings support the view that maternal hemodynamics may be a candidate diagnostic tool to identify hypertensive disorders in pregnancies associated with small-for-gestational-age fetuses. This additional tool matches other reported evidence provided by uterine Doppler velocimetry, low vascular growth factors in the first trimester, and placental pathology. Obesity is associated with a significantly higher cardiac output and outweighs other determinants of hemodynamics in pregnancy; therefore, in future studies on hypertensive disorders, obesity should be studied as an additional disease and not simply as a demographic characteristic.
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Faraci M, Bagnasco F, Leoni M, Giardino S, Terranova P, Subissi L, Di Duca M, Di Martino D, Lanino E. Evaluation of Chimerism Dynamics after Allogeneic Hematopoietic Stem Cell Transplantation in Children with Nonmalignant Diseases. Biol Blood Marrow Transplant 2017; 24:1088-1093. [PMID: 29292059 DOI: 10.1016/j.bbmt.2017.12.801] [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: 09/25/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022]
Abstract
It is recognized that chimerism following hematopoietic stem cell transplantation (HSCT) is a dynamic process. The aims of this study were to describe the evolution of chimerism in children with nonmalignant diseases who underwent allogeneic HSCT, and to analyze the risk factors influencing chimerism status. A total of 101 HSCTs were performed in 85 patients with nonmalignant diseases. The donor was unrelated in 62.4% of HSCTs. Reduced-intensity conditioning (RIC) regimen was administered in 48.5% of patients. Acute graft-versus-host disease (aGVHD) occurred in 51.7% and chronic GVHD (cGVHD) in 39.7% of patients. Analysis of chimerism was performed through amplification of 9 specific short tandem repeats by polymerase chain reaction at engraftment and 1, 6, and 12 months after HSCT. Upon first evaluation, complete chimerism (CC) was detected in 34.7% and mixed chimerism (MC) in 55.4%, whereas graft failure occurred in 9.9% of patients. Severe aGVHD was associated with CC (P = .031). The last chimerism evaluation showed CC in 72.1%, stable MC in 12.8%, and progressive MC in 3.5%. CC was associated with a higher incidence of aGVHD (P = .016) and cGVHD (P = .022), whereas the RIC regimen was associated with graft failure (P = .026). One- and 3-year overall survival (OS) was 87.4% and 80.5%, respectively, with a lower OS at 3 years in patients with CC compared with those with MC (P = .008). aGVHD and cGVHD represent factors favoring CC, thus close, careful follow-up of chimerism is recommended in patients affected by nonmalignant disease.
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Affiliation(s)
- Maura Faraci
- Hematopoetic Stem Cell Transplant Unit, Hematology-Oncology, G. Gaslini Institute, Genoa, Italy.
| | | | - Massimiliano Leoni
- Hematopoetic Stem Cell Transplant Unit, Hematology-Oncology, G. Gaslini Institute, Genoa, Italy
| | - Stefano Giardino
- Hematopoetic Stem Cell Transplant Unit, Hematology-Oncology, G. Gaslini Institute, Genoa, Italy
| | - Paola Terranova
- Clinical and Experimental Hematology Unit, G. Gaslini Institute, Genoa, Italy
| | - Lorenzo Subissi
- Department of Epidemiology, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Marco Di Duca
- Laboratory of Pathophysiology of Uremia, G. Gaslini Institute, Genoa, Italy
| | - Daniela Di Martino
- Hematopoetic Stem Cell Transplant Unit, Hematology-Oncology, G. Gaslini Institute, Genoa, Italy
| | - Edoardo Lanino
- Hematopoetic Stem Cell Transplant Unit, Hematology-Oncology, G. Gaslini Institute, Genoa, Italy
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Faraci M, Giardino S, Bagnasco F, Morreale G, Terranova MP, Di Martino D, Lanino E. Allogeneic hematopoietic stem cell transplantation in congenital disorders: A single-center experience. Pediatr Transplant 2017. [PMID: 28649784 DOI: 10.1111/petr.12997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the treatment of choice for a variety of congenital disorders. We report the experience of children affected by congenital diseases other than bone marrow failure syndromes who received allo-HSCT over a period of 25 years at G. Gaslini Paediatric Research Institute. HSCTs were performed in 57 children with congenital diseases (25 with congenital immunodeficiencies, 10 with severe combined immunodeficiencies, and 22 with metabolic diseases). Overall survival rate at 3 years in the whole group of patients was 76.9%, with a trend in favor of better outcome in children with metabolic diseases and in those who received cord blood cells (85.9%) vs bone marrow cells (72.4%).
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Affiliation(s)
- Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Giardino
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Bagnasco
- Epidemiology, Biostatistics and Committees Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppe Morreale
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
| | - M Paola Terranova
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
| | - Daniela Di Martino
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
| | - Edoardo Lanino
- Hematopoietic Stem Cell Transplantation Unit, Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini, Genoa, Italy
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Piuri G, Ferrazzi E, Bulfoni C, Mastricci L, Di Martino D, Speciani AF. Longitudinal changes and correlations of bioimpedance and anthropometric measurements in pregnancy: Simple possible bed-side tools to assess pregnancy evolution. J Matern Fetal Neonatal Med 2016; 30:2824-2830. [PMID: 27892802 DOI: 10.1080/14767058.2016.1265929] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 12/16/2022]
Abstract
PURPOSE The aim of this study was to assess longitudinal changes of bioimpedance analysis compared with anthropometric measurements in low-risk pregnant woman recruited in the first trimester and to observe possible differences in these indices in women who developed high-risk pregnancies. MATERIALS AND METHODS Bioimpedance indices for the three trimesters of pregnancies were calculated separately for uneventful pregnancies delivered of newborns > the 10th centile. These findings were compared with anthropometric measurements. Data of women who developed hypertensive disorders of pregnancy (HDP) or delivered SGA newborns were calculated and compared. RESULTS Significantly longitudinal increases were observed in these pregnancies for total body water (TBW), free fat mass, fat mass, and extra-cellular water. These increases were paralleled body mass index (BMI), skinfolds, and waist measurements. The correlations between these two sets of findings were poor. Women who developed HDP with AGA fetuses showed significantly different bioimpedance from normal cases. TBW indices were highly significantly different since the first trimester. In pregnancies delivered of SGA newborns, these indices were opposite of the values observed in patients with HDP-AGA, TBW in these patients was significantly reduced compared with normal pregnancies. CONCLUSIONS The bioelectrical impedance is a fast, simple, noninvasive way to assess the TBW content in pregnancy. Our findings are in agreement with the hypothesis that bioimpedance might help to identify early in gestation patients at risk of developing different clinical phenotypes of hypertensive disease of pregnancy and SGA fetuses.
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Affiliation(s)
- Gabriele Piuri
- a Inflammation Society , Church Hill , Orpington , BR6OHH , Kent, UK
| | - Enrico Ferrazzi
- b Department of Woman, Mother, and Neonate, Unit of Obstetrics, Buzzi Children's Hospital , University of Milan School of Medicine , Milan , Italy EU
| | - Camilla Bulfoni
- b Department of Woman, Mother, and Neonate, Unit of Obstetrics, Buzzi Children's Hospital , University of Milan School of Medicine , Milan , Italy EU
| | - Luciana Mastricci
- b Department of Woman, Mother, and Neonate, Unit of Obstetrics, Buzzi Children's Hospital , University of Milan School of Medicine , Milan , Italy EU
| | - Daniela Di Martino
- b Department of Woman, Mother, and Neonate, Unit of Obstetrics, Buzzi Children's Hospital , University of Milan School of Medicine , Milan , Italy EU
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Rizzo G, Prefumo F, Ferrazzi E, Zanardini C, Di Martino D, Boito S, Aiello E, Ghi T. The effect of fetal sex on customized fetal growth charts. J Matern Fetal Neonatal Med 2016; 29:3768-75. [PMID: 26836365 DOI: 10.3109/14767058.2016.1149565] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the effect of fetal sex on singleton pregnancy growth charts customized for parental characteristics, race, and parity Methods: In a multicentric cross-sectional study, 8070 ultrasonographic examinations from low-risk singleton pregnancies between 16 and 40 weeks of gestation were considered. The fetal measurements obtained were biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). Quantile regression was used to examine the impact of fetal sex across the biometric percentiles of the fetal measurements considered together with parents' height, weight, parity, and race. RESULTS Fetal gender resulted to be a significant covariate for BDP, HC, and AC with higher values for male fetuses (p ≤ 0.0009). Minimal differences were found among sexes for FL. Parity, maternal race, paternal height and maternal height, and weight resulted significantly related to the fetal biometric parameters considered independently from fetal gender. CONCLUSION In this study, we constructed customized biometric growth charts for fetal sex, parental, and obstetrical characteristics using quantile regression. The use of gender-specific charts offers the advantage to define individualized normal ranges of fetal biometric parameters at each specific centile. This approach may improve the antenatal identification of abnormal fetal growth.
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Affiliation(s)
- Giuseppe Rizzo
- a Department of Obstetrics and Gynecology , Università Roma Tor Vergata , Roma , Italy
| | - Federico Prefumo
- b Department of Obstetrics and Gynecology , Università of Brescia , Italy
| | - Enrico Ferrazzi
- c Department of Obstetrics and Gynecology , Università of Milan Buzzi Children's Hospital , Italy
| | - Cristina Zanardini
- b Department of Obstetrics and Gynecology , Università of Brescia , Italy
| | - Daniela Di Martino
- c Department of Obstetrics and Gynecology , Università of Milan Buzzi Children's Hospital , Italy
| | - Simona Boito
- d Department of Obstetrics and Gynecology , Università of Milan 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy , and
| | - Elisa Aiello
- a Department of Obstetrics and Gynecology , Università Roma Tor Vergata , Roma , Italy
| | - Tullio Ghi
- e Department of Obstetrics and Gynecology , Università of Parma , Italy
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Di Martino D, Cetin I, Frusca T, Ferrazzi E, Fuse' F, Gervasi MT, Plebani M, Todros T. Italian Advisory Board: sFlt-1/PlGF ratio and preeclampsia, state of the art and developments in diagnostic, therapeutic and clinical management. Eur J Obstet Gynecol Reprod Biol 2016; 206:70-73. [PMID: 27639603 DOI: 10.1016/j.ejogrb.2016.08.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 07/24/2016] [Revised: 08/14/2016] [Accepted: 08/19/2016] [Indexed: 12/20/2022]
Abstract
Extensive research has been published, showing the usefulness of angiogenic markers in both diagnosis and subsequent prediction and management of preeclampsia and placenta-related disorders. Recent evidence provides a helpful cut off for the Elecsys ratio sFlt-1 to PlGF, that predicts preeclampsia development in women with sign and symptoms, before its clinical onset in the short term. In Europe, no accordance exists for the use of such kind of test in clinical practice; only German guidelines have recently taken it into account, as a diagnostic aid for preeclampsia, in conjunction with other clinical findings. This panel of Italian experts recently met, in order to review the literature and to promote the evaluation of the clinical utility of sFlt-1/PlGF ratio at the Italian country level, as regards: prediction of preeclampsia during the first trimester, prediction or exclusion of new onset or recurrence in patients with risk factors for preeclampsia, triage of patients suffering from gestational hypertension, evaluation of disease severity, prediction of adverse maternal and fetal outcomes.
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Affiliation(s)
- Daniela Di Martino
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy.
| | - Irene Cetin
- Department of Mother and Child, Hospital Luigi Sacco, Center for Fetal Research "Giorgio Pardi", School of Medicine, University of Milan, Milan, Italy
| | - Tiziana Frusca
- Department of Mother and Child, Hospital of Parma, School of Medicine, University of Parma, Parma, Italy
| | - Enrico Ferrazzi
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy
| | - Federica Fuse'
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy
| | | | - Mario Plebani
- Department of Laboratory Medicine, Hospital of Padova, Padova, Italy
| | - Tullia Todros
- Department of Mother and Fetus, Hospital of Turin, Obstetrics and Gynecology Unit, School of Medicine, University of Turin, Turin, Italy
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Torino A, Di Martino D, Fusco P, Collina U, Marullo L, Ferraro F. Hot Topics in Airway Management During Gastrointestinal Endoscopy. ACTA ACUST UNITED AC 2016. [DOI: 10.4172/2161-069x.1000377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Affiliation(s)
- Sara Zullino
- a Department of Woman , Mother and Neonate, Buzzi Children's Hospital, Biological and Clinical Sciences, University of Milan , Milan , Italy and
| | - Daniela Di Martino
- a Department of Woman , Mother and Neonate, Buzzi Children's Hospital, Biological and Clinical Sciences, University of Milan , Milan , Italy and
| | - Tamara Stampalija
- b Unit of Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo , Trieste , Italy
| | - Enrico Ferrazzi
- a Department of Woman , Mother and Neonate, Buzzi Children's Hospital, Biological and Clinical Sciences, University of Milan , Milan , Italy and
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Ferraro F, Fusco P, Di Martino D, Torino A. Assessment of Ventilation During the Performance of Elective Endoscopic-Guided Percutaneous Tracheostomy: What's New 10 Years Later? Chest 2015; 148:e26-e28. [PMID: 26149559 DOI: 10.1378/chest.15-0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Fausto Ferraro
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy.
| | - Pierluigi Fusco
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
| | - Daniela Di Martino
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
| | - Annarita Torino
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
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Di Martino D, Beverina L, Sassi M, Brovelli S, Tubino R, Meinardi F. Straightforward fabrication of stable white LEDs by embedding of inorganic UV-LEDs into bulk polymerized polymethyl-methacrylate doped with organic dyes. Sci Rep 2014; 4:4400. [PMID: 24638041 PMCID: PMC3957127 DOI: 10.1038/srep04400] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/27/2014] [Indexed: 11/09/2022] Open
Abstract
Stable white-emitting down-converted LEDs are straightforwardly prepared by bulk polymerization of an organic dye doped polymethyl-methacrylate (PMMA) shell directly on top of a highly efficient commercial blue-emitting InGaN LED. Our optimized polymerization procedure allows for extending the form factor of achievable luminescence converter (LUCO) material beyond the conventional thin film form and to directly produce devices with light bulb design. The selected organic dyes, the blue-emitting Coumarin 30 and a red-emitting diketopyrrolopyrrole derivative, exhibit high compatibility with the free radical polymerization reaction of the PMMA matrix and ensure high stability of the final hybrid device. The control of both the thickness of the PMMA shell and the concentration of the dopant dyes allow for fine tuning of the emission color of the LUCO LED and to obtain white light with CIE chromatic coordinates x = 0.32 and y = 0.33, with rendering index as high as 80. This simple and versatile procedure is not dye-exclusive and is therefore extendable to other molecular systems for color-tunable efficient solid-state lighting sources.
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Affiliation(s)
- Daniela Di Martino
- Dipartimento di Scienza dei Materiali, Università degli Studi di Milano-Bicocca, via Cozzi 55, I 20125 Milano, Italy
| | - Luca Beverina
- Dipartimento di Scienza dei Materiali, Università degli Studi di Milano-Bicocca, via Cozzi 55, I 20125 Milano, Italy
| | - Mauro Sassi
- Dipartimento di Scienza dei Materiali, Università degli Studi di Milano-Bicocca, via Cozzi 55, I 20125 Milano, Italy
| | - Sergio Brovelli
- Dipartimento di Scienza dei Materiali, Università degli Studi di Milano-Bicocca, via Cozzi 55, I 20125 Milano, Italy
| | - Riccardo Tubino
- Dipartimento di Scienza dei Materiali, Università degli Studi di Milano-Bicocca, via Cozzi 55, I 20125 Milano, Italy
| | - Francesco Meinardi
- Dipartimento di Scienza dei Materiali, Università degli Studi di Milano-Bicocca, via Cozzi 55, I 20125 Milano, Italy
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Di Martino D, Terranova MP, Valetto A, Scarso L, Faraci M, Lanino E, Morreale G. An unusual pattern of B-cell immunological reconstitution after allogeneic stem cell transplantation: a possible correlation with CMV reactivation? Pediatr Transplant 2009; 13:1050-2. [PMID: 19077137 DOI: 10.1111/j.1399-3046.2008.01107.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
IR after HSCT is a slow process that involves several components of the immune response, and, in allogeneic setting, it can be delayed by GvHD and immuno-suppressive therapy. Our study on IR post-HSCT included a child with FA who underwent MUD transplantation. To evaluate B, T and NK cell reconstitution and to investigate the differentiation of B lymphocyte repertoire, this patient was carefully monitored at various time points by IgHCDR3 (third complementarity determining region of the immunoglobulin heavy chain) fingerprinting and by FACS analysis. IgHCDR3 fingerprinting showed a strong oligoclonality of IgM and IgG profiles from day +60 to +180 post-transplant. CMV reactivation was present at the same time points and overlapped the clonal pattern shown in IgHCDR3 fingerprinting. Immunophenotype analysis showed early repopulation of T and NK cells following HSCT, whereas B cells increased first at one yr post-transplant. The overlapping of virus reactivation and B-cell clonal expansion seems to suggest that B lymphocytes may be involved in the CMV immunological response, at least in the early time points after HSCT when the immune repertoire is still reconstituting.
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Affiliation(s)
- Daniela Di Martino
- Department of Paediatric Haematology and Oncology, G. Gaslini Institute, Genova, Italy.
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Faraci M, Lanino E, Micalizzi C, Morreale G, Di Martino D, Banov L, Comoli P, Locatelli F, Soresina A, Plebani A. Unrelated hematopoietic stem cell transplantation for Cernunnos-XLF deficiency. Pediatr Transplant 2009; 13:785-9. [PMID: 19067926 DOI: 10.1111/j.1399-3046.2008.01028.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cernunnos-XLF deficiency is a rare CI characterized by a defective DNA DSB repair mechanism. Its clinical manifestations are growth retardation, dysmorphic features, malformations, and severe B- and T-cell lymphopenia. BM failure may complicate the clinical picture. To date, there have been no described patients with CSy undergoing allogeneic HSCT. We report a case of CSy treated successfully with unrelated allogeneic HSCT after a reduced-intensity conditioning regimen. Two yr after HSCT, the patient maintains full donor engraftment, normal hematopoiesis, and progressively improving immune competence, thus suggesting that HSCT may be the treatment of choice for CSy.
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Affiliation(s)
- Maura Faraci
- Department of Hematology-Oncology and Hematopoietic Stem Cell Unit, G Gaslini Children Research Institute, Genoa, Italy
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Terranova MP, Di Michele P, Scuderi F, Valetto A, Di Martino D, Martino DD. N,N,N-trimethylglycine (betaine) improves analysis of CDR3 diversification in children reconstituting their immune repertoire after hematopoietic stem-cell transplantation. Transplantation 2007; 83:996-7. [PMID: 17460574 DOI: 10.1097/01.tp.0000258728.02932.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Neutron diffraction data with high real-space resolution are reported for an extensive series of cesium germanate glasses with 2, 5, 10, 15, 18, 21, 25, and 30 mol % Cs(2)O, and also for pure GeO(2) in its vitreous, quartz, and rutile forms. The results for pure GeO(2) show that neutron diffraction can clearly identify an increase in the Ge-O coordination number above the tetrahedral value of four. The results for cesium germanate glasses give strong evidence that the Ge-O coordination number rises to a maximum of 4.36 +/- 0.03 for 18 mol % Cs(2)O and then declines. This behavior may be associated with the germanate anomaly in the thermophysical properties. A model is developed for the composition-dependence of the Ge-O coordination number, and according to this model the rise in the coordination number involves the formation of mostly GeO(5) units, rather than GeO(6) units. Our results also show that the low alkali anomaly is a longer range phenomenon, and is not associated with a preference for the formation of nonbridging oxygens for very low alkali oxide content.
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Affiliation(s)
- Alex C Hannon
- ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, Oxon, OX11 0QX, United Kingdom.
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Di Martino D, Terranova MP, Scuderi F, Di Michele P, Iacovone S, Scarso L, Dallorso S, Dini G, Morreale G, Valetto A. VH3 and VH6 Immunoglobulin M Repertoire Reconstitution after Hematopoietic Stem-Cell Transplantation in Children. Transplantation 2005; 79:98-107. [PMID: 15714176 DOI: 10.1097/01.tp.0000147461.71610.66] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/26/2022]
Abstract
BACKGROUND Immune reconstitution after hematopoietic stem-cell transplantation (HSCT) occurs gradually. Thus, a variable period of immunodeficiency may be present, leading to immunomediated complications, such as graft-versus-host disease (GVHD) and opportunistic infections. METHODS To better understand the kinetics of B-cell repertoire reconstitution in children, 49 pediatric patients were analyzed before and after transplantation by immunoglobulin (Ig) HCDR3 fingerprinting, which is a molecular technique that analyzes one of the hypervariable segments of the Ig heavy chain, which provides the amino acid residues that are essential to interact with antigens. RESULTS In healthy donors, the CDR3 fingerprinting profile shows 16 to 20 bands, and each band corresponds to a particular length of CDR3. This situation is considered polyclonal. Patients analyzed just after transplantation show strong oligoclonality, because only a few CDR3 bands are detected within the first 3 to 6 months. CONCLUSIONS The authors' data show a significant lag in diversification of the B-cell repertoire, which reaches the polyclonal situation of normal healthy donors approximately 6 months after HSCT. This period may vary depending on the type of transplant (autologous vs. allogeneic) and on the immunosuppressive therapy related to GVHD.
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Affiliation(s)
- Daniela Di Martino
- Laboratory of Hematology, Department of Pediatric Hematology and Oncology, G. Gaslini Institute, Genoa, Italy.
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Valetto A, Bertini V, Rapalini E, Baldinotti F, Di Martino D, Simi P. Molecular and cytogenetic characterization of a structural rearrangement of the Y chromosome in an azoospermic man. Fertil Steril 2004; 81:1388-90. [PMID: 15136108 DOI: 10.1016/j.fertnstert.2003.09.069] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2003] [Revised: 09/30/2003] [Accepted: 09/30/2003] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To better define an abnormal karyotype found in a male with primary infertility. DESIGN Case report. SETTING Molecular and cytogenetics unit in a university-affiliated hospital. PATIENT(S) A 41-year-old, azoospermic, but otherwise healthy male. INTERVENTION(S) Lymphocytic karyotype and genetic counseling. MAIN OUTCOME MEASURE(S) Metaphases were studied by standard G- and Q-banding, followed by fluorescence in situ hybridization (FISH) and polymerase chain reaction to analyze specific Y chromosome regions. RESULT(S) Chromosomal analysis and FISH allowed us to define the propositus's karyotype as 45,X/46,X,idic(Yp)/46,XY (71%, 26%, and 3% of analyzed metaphases, respectively). Molecular analysis of azoospermic factor (AZF) regions showed deletion of AZFb and AZFc. CONCLUSION(S) A 45,X/46,X,idic(Yp) mosaicism is associated with a very broad spectrum of phenotypes, including patients with Ullrich-Turner syndrome, patients with various degrees of genital ambiguity, or normal males. In the presence of a normal masculinization in otherwise healthy males azoospermia is a distinct feature that can be explained by partial deletion of AZF regions.
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Di Martino D, Dallorso S, Terranova P, Scarso L, Morreale G, Valetto A. B-cell repertoire reconstitution after hematopoietic stem cell transplantation in children evaluated by immunoglobulin heavy chain third complementarity determining region fingerprinting. Haematologica 2004; 89:506-8. [PMID: 15075092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Immunodeficiency after hematopoietic stem cell transplantation leads to a high risk of opportunistic infections. We evaluated B-lymphocyte reconstitution in 36 children by heavy chain third complementarity determining region (CDR3)-fingerprinting and immunophenotypic analysis. The time necessary to return to the normal immunoglobulin heavy chain-CDR3 polyclonal situation was basically related to the type of transplant and this process did not recapitulate fetal ontogenesis.
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Montalto G, Giannitrapani L, Soresi M, Florena A, Di Martino D, Franco V, Carroccio A, Cervello M. Circulating intercellular adhesion molecule-1 in chronic hepatitis C patients with normal or elevated aminotransferase before and after alpha-interferon treatment. Intervirology 2003; 46:35-42. [PMID: 12566697 DOI: 10.1159/000068122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2001] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Intercellular adhesion molecule-1 (ICAM-1) plays a fundamental role during liver inflammation. In fact, weak ICAM-1 expression is physiologically restricted to the endothelium of portal vessels and to sinusoidal lining cells, but it becomes markedly evident on sinusoidal lining cells and at the surface of hepatocytes during inflammatory liver diseases. The aim of this study was to evaluate the behaviour of soluble ICAM-1 (sICAM-1) in chronic hepatitis C (CH-C) patients with persistently normal aminotransferase in comparison with patients with CH-C and elevated aminotransferase, and its changes during alpha-interferon (IFN) therapy. Immunohistochemical localization of ICAM-1 was also performed on liver tissue specimens of both groups. METHODS Sixty subjects were divided into 3 groups: group A included 19 patients with CH-C and persistently normal aminotransferase; group B included 21 patients with CH-C and persistently elevated aminotransferase levels, and group C included 20 healthy subjects representing the control group. The first two groups were treated with recombinant alpha-IFN 2b at a dose of 6 MU 3 times a week for 3 months and followed up with 3 MU 3 times a week for another 3 months. RESULTS Baseline values of serum ICAM-1 in groups A and B were significantly higher than those in group C (p < 0.0001). The median baseline value of sICAM-1 in group A (525.0 ng/ml) was lower than that of group B (561.0 ng/ml), but the difference was not statistically significant. Furthermore, there was a trend toward higher ICAM-1 values as histological severity increased (Mantel-Haenszel chi(2) 8.8, p < 0.003). Post-treatment sICAM-1 serum values showed a marked decrease in both groups, but only among responder patients, while ICAM-1 levels were unchanged in non-responders. Immunohistochemical localization showed no staining for ICAM-1 in normal liver specimens, while there was a quite similar staining for ICAM-1 in the two groups of patients, consistent with an inflammatory process. CONCLUSIONS This study shows that circulating ICAM-1 levels in most patients with CH-C and persistently normal aminotransferase are higher than those in a control group and the fact that ICAM-1 molecules are also expressed on the hepatocyte membrane suggests that they could play an important role, in association with other molecules, in the intercellular adhesion processes during the induction and maintenance phases of the immune response. In both groups, only patients responding to alpha-IFN therapy showed a marked decrease in serum ICAM-1 below baseline values.
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Affiliation(s)
- Giuseppe Montalto
- Istituto di Medicina Interna e Geriatria, Università di Palermo, Palermo, Italy.
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Castagnola E, Dallorso S, Faraci M, Morreale G, Di Martino D, Cristina E, Scarso L, Lanino E. Long-lasting hypogammaglobulinemia following rituximab administration for Epstein-Barr virus-related post-transplant lymphoproliferative disease preemptive therapy. J Hematother Stem Cell Res 2003; 12:9-10. [PMID: 12662431 DOI: 10.1089/152581603321210082] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cazzaniga G, Lanciotti M, Rossi V, Di Martino D, Aricò M, Valsecchi MG, Basso G, Masera G, Micalizzi C, Biondi A. Prospective molecular monitoring of BCR/ABL transcript in children with Ph+ acute lymphoblastic leukaemia unravels differences in treatment response. Br J Haematol 2002; 119:445-53. [PMID: 12406084 DOI: 10.1046/j.1365-2141.2002.03838.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [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: 11/20/2022]
Abstract
Children with Philadelphia-chromosome-positive (Ph+) acute lymphoblastic leukaemia (ALL) represent a subgroup at very high risk for treatment failure, despite intensive chemotherapy. However, recent retrospective studies showed that Ph+ childhood ALL is a heterogeneous disease with regard to treatment response. We have prospectively monitored, by reverse transcription polymerase chain reaction (RT-PCR) during follow-up, the presence of the BCR/ABL fusion transcript in Ph+ ALL children diagnosed in the Italian multicentre Associazione Italiana Ematologia Oncologia Pediatrica ALL-AIEOP-95 therapy protocol. To our knowledge, this is the first report on the evaluation of minimal residual disease (MRD) in childhood Ph+ ALL prospectively enrolled in an intensive, Berlin-Frankfurt-Munster (BFM)-type treatment protocol. Twenty-seven of 36 (75.0%) Ph+ patients consecutively enrolled into the high-risk group of the AIEOP-ALL protocol between May 1995 and October 1999 were successfully analysed. Twenty were good responders to the pre-phase of prednisone/intrathecal methotrexate treatment (PGR) and seven were poor responders (PPR). Within the PPR group, the RT-PCR monitoring constantly showed positivity for the BCR/ABL fusion transcript and all the patients died of disease progression. In contrast, highly sensitive qualitative RT-PCR monitoring revealed heterogeneity within the PGR group of Ph+ childhood ALL patients. Three different subgroups could be defined, according to the clearance of Ph+ cells within the first 5 months of treatment. This provides useful information on the capability of chemotherapy to reduce the leukaemic clone, with prognostic implications.
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Affiliation(s)
- Giovanni Cazzaniga
- Centro Ricerca M. Tettamanti, Clinica Pediatrica Università di Milano Bicocca, Monza, Italy
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Montalto G, Giannitrapani L, Soresi M, Virruso L, Martino DD, Gambino R, Carroccio A, Cervello M. Circulating E-selectin levels in chronic hepatitis C patients with normal or elevated transaminase before and after alpha-interferon treatment. Inflammation 2001; 25:101-8. [PMID: 11321356 DOI: 10.1023/a:1007118605861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/12/2022]
Abstract
E-selectin, an adhesion molecule of the selectin family, is involved in leukocyte adhesion to the endothelium and in the cellular immunological reactions. Expression of this molecule, in fact, is physiologically absent, but it becomes evident on sinusoidal lining cells during inflammatory liver disease. The aim of this study was to evaluate the behavior of E-selectin in chronic hepatitis C (CH-C) patients with persistently normal transaminase in comparison to patients with CH-C and elevated transaminase, and its changes during alpha-interferon therapy. Immunohistochemical localization of E-selectin was also performed on liver tissue specimens of both groups. Fifty-eight subjects were divided into 3 groups: group A included 18 patients with CH-C and persistently normal transaminase; group B 20 patients with CH-C and persistently elevated transaminase levels and group C included 20 healthy subjects, representing the control group. The first two groups were treated with r-IFN alpha at a dose of 6 MU 3 times a week for 3 months and followed-up with 3 MU 3 times a week for another 3 months. Serum baseline values of E-selectin in groups A and B were significantly higher than those in group C (P < 0.04), but there was no difference between groups A and B. Furthermore, there was a trend toward higher E-selectin values as histological severity increased (r = 0.69; P < 0.0001). Post-treatment E-selectin serum values showed a moderate decrease in both groups, but only among responder patients; while E-selectin levels were unchanged in non responders. Immunohistochemical localization showed no staining for E-selectin in normal liver specimens, while there was a quite similar staining for E-selectin in the two groups of patients. In conclusion, this study shows that serum E-selectin levels in patients with CH-C and persistently normal transaminase are higher than in controls and they are associated with severity of liver disease. Liver of these patients express E-selectin molecules, suggesting an activation of the immune system almost identical to that of patients with CH-C and elevated transaminase. In both groups only responder patients showed a moderate decrease below baseline serum values.
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Affiliation(s)
- G Montalto
- Istituto di Medicina Interna e Geriatria, Cattedra di Medicina Interna, Universitá di Palermo, Italy
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