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Molinari S, Fossati C, Nicolosi ML, Di Marco S, Faraguna MC, Limido F, Ocello L, Pellegrinelli C, Lattuada M, Gazzarri A, Lazzerotti A, Sala D, Vimercati C, Capitoli G, Daolio C, Biondi A, Balduzzi A, Cattoni A. Endocrine, auxological and metabolic profile in children and adolescents with Down syndrome: from infancy to the first steps into adult life. Front Endocrinol (Lausanne) 2024; 15:1348397. [PMID: 38654931 PMCID: PMC11036865 DOI: 10.3389/fendo.2024.1348397] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Down syndrome (DS) is the most common chromosomal disorder worldwide. Along with intellectual disability, endocrine disorders represent a remarkable share of the morbidities experienced by children, adolescents and young adults with DS. Auxological parameters are plotted on syndrome-specific charts, as growth rates are reduced compared to healthy age- and gender-matched peers. Furthermore, children with DS are at increased risk for thyroid dysfunctions, diabetes mellitus, osteopenia and obesity compared to general population. Additionally, male individuals with DS often show infertility, while women tend to experience menopause at an overall younger age than healthy controls. Given the recent outstanding improvements in the care of severe DS-related comorbidities, infant mortality has dramatically decreased, with a current average life expectancy exceeding 60 years. Accordingly, the awareness of the specificities of DS in this field is pivotal to timely detect endocrine dysfunctions and to undertake a prompt dedicated treatment. Notably, best practices for the screening and monitoring of pediatric endocrine disorders in DS are still controversial. In addition, specific guidelines for the management of metabolic issues along the challenging period of transitioning from pediatric to adult health care are lacking. By performing a review of published literature, we highlighted the issues specifically involving children and adolescent with DS, aiming at providing clinicians with a detailed up-to-date overview of the endocrine, metabolic and auxological disorders in this selected population, with an additional focus on the management of patients in the critical phase of the transitioning from childhood to adult care.
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Affiliation(s)
- Silvia Molinari
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Chiara Fossati
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maria Laura Nicolosi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Santo Di Marco
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Francesca Limido
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Laura Ocello
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Martina Lattuada
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Alessandra Gazzarri
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Debora Sala
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Chiara Vimercati
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giulia Capitoli
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Cecilia Daolio
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Andrea Biondi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Cattoni A, Molinari S, Capitoli G, Masera N, Nicolosi ML, Barzaghi S, Marziali G, Lazzerotti A, Gazzarri A, Vimercati C, Sala D, Biondi A, Galimberti S, Fossati C. Thyroid Function Tests in Children and Adolescents With Trisomy 21: Definition of Syndrome-Specific Reference Ranges. J Clin Endocrinol Metab 2023; 108:2779-2788. [PMID: 37279507 DOI: 10.1210/clinem/dgad333] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023]
Abstract
CONTEXT The lack of syndrome-specific reference ranges for thyroid function tests (TFT) among pediatric patients with Down syndrome (DS) results in an overestimation of the occurrence of hypothyroidism in this population. OBJECTIVE To (a) outline the age-dependent distribution of TFT among pediatric patients with DS; (b) describe the intraindividual variability of TFT over time; and (c) assess the role of elevated thyrotropin (TSH) in predicting the future onset of overt hypothyroidism. METHODS In this retrospective, monocentric, observational analysis, we included 548 patients with DS (0-18 years) longitudinally assessed between 1992 and 2022. Exclusion criteria were abnormal thyroid anatomy, treatments affecting TFT, and positive thyroid autoantibodies. RESULTS We determined the age-dependent distribution of TSH, FT3, and FT4 and outlined the relative nomograms for children with DS. Compared with non-syndromic patients, median TSH levels were statistically greater at any age (P < .001). Median FT3 and FT4 levels were statistically lower than controls (P < .001) only in specific age classes (0-11 for FT3, 11-18 years for FT4). TSH levels showed a remarkable fluctuation over time, with a poor (23%-53%) agreement between the TSH centile classes at 2 sequential assessments. Finally, the 75th centile was the threshold above which TSH values predicted future evolution into overt hypothyroidism with the best statistical accuracy, with a satisfactory negative predictive value (0.91), but poor positive predictive value (0.15). CONCLUSION By longitudinally assessing TFT in a wide pediatric DS population, we outlined the syndrome-specific reference nomograms for TSH, FT3, and FT4 and demonstrated a persistent upward shift of TSH compared to non-syndromic children.
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Affiliation(s)
- Alessandro Cattoni
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza (MB), Italy
| | - Silvia Molinari
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | - Giulia Capitoli
- B4 Center of Bioinformatics, Biostatistics e Bioimaging, University of Milano-Bicocca, 20854 Vedano al Lambro (MB), Italy
| | - Nicoletta Masera
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | | | - Silvia Barzaghi
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | - Giulia Marziali
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | | | - Alessandra Gazzarri
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | - Chiara Vimercati
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | - Debora Sala
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
| | - Andrea Biondi
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza (MB), Italy
| | - Stefania Galimberti
- B4 Center of Bioinformatics, Biostatistics e Bioimaging, University of Milano-Bicocca, 20854 Vedano al Lambro (MB), Italy
| | - Chiara Fossati
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza (MB), Italy
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Sala D, Engelberger F, Mchaourab HS, Meiler J. Modeling conformational states of proteins with AlphaFold. Curr Opin Struct Biol 2023; 81:102645. [PMID: 37392556 DOI: 10.1016/j.sbi.2023.102645] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [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: 03/21/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 07/03/2023]
Abstract
Many proteins exert their function by switching among different structures. Knowing the conformational ensembles affiliated with these states is critical to elucidate key mechanistic aspects that govern protein function. While experimental determination efforts are still bottlenecked by cost, time, and technical challenges, the machine-learning technology AlphaFold showed near experimental accuracy in predicting the three-dimensional structure of monomeric proteins. However, an AlphaFold ensemble of models usually represents a single conformational state with minimal structural heterogeneity. Consequently, several pipelines have been proposed to either expand the structural breadth of an ensemble or bias the prediction toward a desired conformational state. Here, we analyze how those pipelines work, what they can and cannot predict, and future directions.
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Affiliation(s)
- D Sala
- Institute of Drug Discovery, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany. https://twitter.com/sala_davide
| | - F Engelberger
- Institute of Drug Discovery, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany. https://twitter.com/fengel97
| | - H S Mchaourab
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA. https://twitter.com/Mchaourablab
| | - J Meiler
- Institute of Drug Discovery, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany; Center for Structural Biology, Vanderbilt University, Nashville, TN 37240, USA; Center for Scalable Data Analytics and Artificial Intelligence (ScaDS.AI), Dresden/Leipzig, Germany.
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Sala D, Batebi H, Ledwitch K, Hildebrand PW, Meiler J. Targeting in silico GPCR conformations with ultra-large library screening for hit discovery. Trends Pharmacol Sci 2023; 44:150-161. [PMID: 36669974 PMCID: PMC9974811 DOI: 10.1016/j.tips.2022.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/21/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023]
Abstract
The use of deep machine learning (ML) in protein structure prediction has made it possible to easily access a large number of annotated conformations that can potentially compensate for missing experimental structures in structure-based drug discovery (SBDD). However, it is still unclear whether the accuracy of these predicted conformations is sufficient for screening chemical compounds that will effectively interact with a protein target for pharmacological purposes. In this opinion article, we examine the potential benefits and limitations of using state-annotated conformations for ultra-large library screening (ULLS) in light of the growing size of ultra-large libraries (ULLs). We believe that targeting different conformational states of common drug targets like G-protein-coupled receptors (GPCRs), which can regulate human physiology by switching between different conformations, can offer multiple advantages.
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Affiliation(s)
- D Sala
- Institute of Drug Discovery, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany
| | - H Batebi
- Institute of Medical Physics and Biophysics, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany
| | - K Ledwitch
- Center for Structural Biology, Vanderbilt University, Nashville, TN 37240, USA; Department of Chemistry, Vanderbilt University, Nashville, TN 37235, USA
| | - P W Hildebrand
- Institute of Medical Physics and Biophysics, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany
| | - J Meiler
- Institute of Drug Discovery, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany; Center for Structural Biology, Vanderbilt University, Nashville, TN 37240, USA; Department of Chemistry, Vanderbilt University, Nashville, TN 37235, USA.
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Faraguna MC, Lepri I, Clavenna A, Bonati M, Vimercati C, Sala D, Cattoni A, Melzi ML, Biondi A. The bronchiolitis epidemic in 2021-2022 during the SARS-CoV-2 pandemic: experience of a third level centre in Northern Italy. Ital J Pediatr 2023; 49:26. [PMID: 36803828 PMCID: PMC9942300 DOI: 10.1186/s13052-023-01425-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The aim of this study is to compare the 2021-2022 bronchiolitis season to the four previous years (2017-2018, 2018-2019, 2019-2020, 2020-2021) to see if there was an anticipation of the peak, an overall increase of cases, and an increased need of intensive care. METHODS A retrospective single-centre study in the San Gerardo Hospital Fondazione MBBM, Monza, Italy was performed. Emergency Departments (ED) visits of patients aged < 18 years and ≤ 12 months were analyzed: the incidence of bronchiolitis on total assessments, the urgency level at triage and the hospitalization rate were compared. Data of children admitted to the Pediatric Department due to bronchiolitis were analyzed in terms of need of intensive care, respiratory support (type and duration), length of hospital stay, main etiological agent, patient characteristics. RESULTS During 2020-2021 (first pandemic period) an important reduction in the ED attendance for bronchiolitis was observed, while in 2021-2022 there was an increase in incidence of bronchiolitis (13% of visits in infants < 1 year) and in the rate of urgent accesses (p = 0.0002), but hospitalization rates did not differ compared to previous years. Furthermore, an anticipated peak in November 2021 was observed. In the 2021-2022 cohort of admitted children to the Pediatric Department, a statistically significative increased need of intensive care unit was detected (Odds Ratio 3.1, 95% CI 1.4-6.8 after adjustment for severity and clinical characteristics). Instead, respiratory support (type and duration) and length of hospital stay did not differ. RSV was the main etiological agent and RSV-bronchiolitis determined a more severe infection (type and duration of breathing support, intensive care need and length of hospital stay). CONCLUSIONS During Sars-CoV-2 lockdowns (2020-2021), there was a dramatic decrease of bronchiolitis and others respiratory infections. In the following season, 2021-2022, an overall increase of cases with an anticipated peak was observed and data analysis confirmed that patients in 2021-2022 required more intensive care than children in the four previous seasons.
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Affiliation(s)
| | - Irene Lepri
- Residency in Pediatrics, University of Milano Bicocca, Monza, Italy.
| | - Antonio Clavenna
- grid.4527.40000000106678902Laboratory for Mother and Child Health, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Bonati
- grid.4527.40000000106678902Laboratory for Mother and Child Health, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Vimercati
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Debora Sala
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Alessandro Cattoni
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Maria Luisa Melzi
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Andrea Biondi
- grid.415025.70000 0004 1756 8604Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy ,grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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Joseph C, Cooper J, Schricker A, Sala D, Woods C. Use of an active esophageal cooling device in zero-fluoroscopy settings without intracardiac echocardiography. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.600] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Active esophageal cooling is increasingly being utilized during radiofrequency (RF) ablation to achieve pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). In addition to data showing decreases in severe esophageal injury with active esophageal cooling, placement of a commercially available cooling device can be identified on intracardiac echocardiography (ICE), allowing implementation in zero-fluoroscopy settings. In the case of procedures that do not have ICE available, an alternative method to determine proper placement of an esophageal cooling device is needed in zero-fluoroscopy settings..
Purpose
To describe a large single-center approach to visualizing an active esophageal cooling device into a 3D mapping system.
Methods
We reviewed data on patients treated with RF ablation for PVI procedures over the time frame 1/1/2020 to 12/31/21. Active esophageal cooling was phased in towards the end of 2020. For all cases, transseptal puncture was performed with the use of transesophageal echocardiography (TEE). After successful transseptal puncture, the TEE probe was removed, and either a single-sensor LET probe or an active esophageal cooling device was placed. For the active cooling device, the distal tip was cut, and an SL-1 (0.032 inch, 150 cm length) guidewire was placed through the central lumen of the cooling device (used for gastric suctioning and enteral feeding). The guidewire was pinned via a pin block to the 3D mapping system (EnSite, Abbott). Unipolar configuration was used to generate a 3D map, which was then visualized during device placement. Placement was confirmed after visualizing the guidewire tip on the 3D map passing below the coronary sinus (Figure 1).
Results
A total of 417 cases were performed over the study timeframe. The mean age of patients was 65±10 years, and 40% were female. A total of 5 complications were recorded (3 pericardial effusions, 1 pseudoaneurysm, and 1 air embolism). A total of 156 patients received LET monitoring, and 261 received active esophageal cooling. The mean procedure length was 109±24 minutes for cases utilizing LET monitoring, and 93±11 minutes for cases utilizing active esophageal cooling. Visualization of the active esophageal cooling device on the cardiac mapping system was possible in all cases.
Conclusions
We describe here the largest series to date utilizing active esophageal cooling in a zero-fluoroscopy, zero-ICE setting. With increasing efforts to reduce fluoroscopy, this approach allows pursuit of zero-fluoroscopy even in systems without the availability of ICE, while maintaining procedural speed and safety.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Attune Medical
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Affiliation(s)
- C Joseph
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - J Cooper
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - A Schricker
- Mills-Peninsula Medical Center , Burlingame , United States of America
| | - D Sala
- Mills-Peninsula Medical Center , Burlingame , United States of America
| | - C Woods
- Mills-Peninsula Medical Center , Burlingame , United States of America
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Clavenna A, Zanini A, Pelucchi M, Bersani C, Canevini MP, Sala D, Albizzati A, Biondi A, Bonati M. Trend of Emergency Department Accesses for Mental Disorders by Adolescents During the Pandemic Period. Pediatr Emerg Care 2022; 38:e1233-e1235. [PMID: 35358152 DOI: 10.1097/pec.0000000000002686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVES The aim of this study was to evaluate access to a pediatric emergency department (PED) in a large hospital, in particular to estimate the prevalence of potentially avoidable accesses and the characteristics of return visits. METHODS Clinical health records from the PED of San Gerardo Hospital, Monza, Italy, were retrospectively reviewed. The study population was composed of subjects younger than 18 years who attended the PED during the period from October 1, 2017, to November 30, 2017.Accesses were defined nonurgent if characterized by white or green triage codes and patient's discharge as the outcome and were defined potentially avoidable if nonurgent and with no diagnostic/therapeutic procedures performed except a visit by the ED pediatrician.Return visits were defined as accesses that occurred within 72 hours of the first index visit. RESULTS A total of 2064 children and adolescents younger than 18 years had at least 1 ED attendance between October and November 2017, for a total of 2364 accesses.The most frequent diagnoses were upper respiratory tract infections (29.5% of accesses), followed by gastroenteritis (7.0%) and abdominal pain (7.0%). In all, 1810 accesses (88%) were classified as "nonurgent," and 1228 (60%) potentially avoidable, 373 of which were probably avoidable because they occurred when the primary care physician was available.The number of return visits was 98 (5% of the accesses): 74 were nonurgent, 31 of which potentially avoidable. On 17 occasions, both index and return visits were potentially avoidable. CONCLUSIONS We confirm that most of the accesses to a PED are nonurgent and potentially avoidable. Interventions are needed to improve the appropriateness of use of emergency services.
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Affiliation(s)
| | - Antonio Clavenna
- From the Department of Public Health, Laboratory for Mother and Child Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - Massimo Cartabia
- From the Department of Public Health, Laboratory for Mother and Child Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - Debora Sala
- Department of Pediatrics, Hospital S. Gerardo/Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
| | - Andrea Biondi
- Department of Pediatrics, Hospital S. Gerardo/Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
| | - Maurizio Bonati
- From the Department of Public Health, Laboratory for Mother and Child Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
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Lo Vecchio A, Krzysztofiak A, Montagnani C, Valentini P, Rossi N, Garazzino S, Raffaldi I, Di Gangi M, Esposito S, Vecchi B, Melzi ML, Lanari M, Zavarise G, Bosis S, Valenzise M, Cazzato S, Sacco M, Govoni MR, Mozzo E, Cambriglia MD, Bruzzese E, Di Camillo C, Pata D, Graziosi A, Sala D, Magurano F, Villani A, Guarino A, Galli L. Complications and risk factors for severe outcome in children with measles. Arch Dis Child 2020; 105:896-899. [PMID: 30636224 DOI: 10.1136/archdischild-2018-315290] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE AND DESIGN Risk factors for severe measles are poorly investigated in high-income countries. The Italian Society for Paediatric Infectious Diseases conducted a retrospective study in children hospitalised for measles from January 2016 to August 2017 to investigate the risk factors for severe outcome defined by the presence of long-lasting sequelae, need of intensive care or death. RESULTS Nineteen hospitals enrolled 249 children (median age 14.5 months): 207 (83%) children developed a complication and 3 (1%) died. Neutropaenia was more commonly reported in children with B3-genotype compared with other genotypes (29.5% vs 7.7%, p=0.01). Pancreatitis (adjusted OR [aOR] 9.19, p=0.01) and encephalitis (aOR 7.02, p=0.04) were related to severe outcome in multivariable analysis, as well as C reactive protein (CRP) (aOR 1.1, p=0.028), the increase of which predicted severe outcome (area under the receiver operating characteristic curve 0.67, 95% CI 0.52 to 0.82). CRP values >2 mg/dL were related to higher risk of complications (OR 2.0, 95% CI 1.15 to 3.7, p=0.01) or severe outcome (OR 4.13, 95% CI 1.43 to 11.8, p<0.01). CONCLUSION The risk of severe outcome in measles is independent of age and underlying conditions, but is related to the development of organ complications and may be predicted by CRP value.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Andrzej Krzysztofiak
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Piero Valentini
- Pediatrics Branch, Department of Women and Child Health, 'A. Gemelli' University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Nadia Rossi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Irene Raffaldi
- Department of Pediatrics and Neonatology, Ospedale Civile di Ciriè, Turin, Italy
| | - Maria Di Gangi
- Pediatric Infectious Disease Unit, Children Hospital 'ISMEP Di Cristina', Palermo, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Universita degli Studi di Perugia, Perugia, Italy
| | - Barbara Vecchi
- Pediatric Unit and Neonatal Intensive Care Unit, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Maria Luisa Melzi
- Pediatric Department, Milano-Bicocca University MBBM Foundation, Monza, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences - Pediatric Emergency Unit, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giorgio Zavarise
- Pediatric Unit, Hospital of Negrar 'Sacro Cuore Don Calabria', Verona, Italy
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariella Valenzise
- Pediatric Unit, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Salvatore Cazzato
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Michele Sacco
- Pediatric Unit, Research Institute Hospital 'Casa Sollievo della Sofferenza' San Giovanni Rotondo, Foggia, Italy
| | | | - Elena Mozzo
- Pediatric Unit, Hospital of Dolo, Verona, Italy
| | - Maria Donata Cambriglia
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Chiara Di Camillo
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy.,Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy
| | - Davide Pata
- Pediatrics Branch, Department of Women and Child Health, 'A. Gemelli' University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Debora Sala
- Pediatric Department, Milano-Bicocca University MBBM Foundation, Monza, Italy
| | - Fabio Magurano
- National Measles Reference Laboratory (ISS) and the Network of Subnational Reference Laboratory for Measles and Rubella, MoRoNet, Rome, Italy
| | - Alberto Villani
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Luisa Galli
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy.,National Measles Reference Laboratory (ISS) and the Network of Subnational Reference Laboratory for Measles and Rubella, MoRoNet, Rome, Italy
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Saettini F, Pelagatti MA, Sala D, Moratto D, Giliani S, Badolato R, Biondi A. Early diagnosis of PI3Kδ syndrome in a 2 years old girl with recurrent otitis and enlarged spleen. Immunol Lett 2017; 190:279-281. [PMID: 28842185 DOI: 10.1016/j.imlet.2017.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Received: 06/14/2017] [Revised: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 12/13/2022]
Abstract
Heterozygous gain of function mutations in the gene encoding p110δ subunit of PI3K have been recently associated with activated PI3K-δ syndrome (APDS), a novel combined immune deficiency characterized by recurrent sinopulmonary infections, lymphopenia, reduced class-switched memory B cells, lymphadenopathy, CMV and/or EBV viremia and EBV-related lymphoma. Here we report a dominant gain of function PIK3CD mutation (E1021K) in a patient presenting with recurrent otitis media, massive splenomegaly, and persistent EBV-viraemia. The immunological studies showed low IgA level, but normal IgM, IgG, and normal antibody response to diphtheria and tetanus toxoid vaccination. Analysis of B lymphocyte subsets revealed abnormal expansion of transitional B cells, and low percentage of switched CD27+IgD- and CD27+IgD+ memory B cells. Analysis of T cell compartment unveiled prevalence of terminally differentiated cells. This study suggests that PIK3CD gain of function mutations should be suspected despite incomplete phenotype in patients with early onset splenomegaly, persistent EBV viremia and abnormal B and T cell subsets despite normal IgG levels. Currently the optimal treatment is still debated, but prompt management can hopefully diminish incidence of severe long-lasting sequelae (i.e. bronchiectasis, ear and sinus damage).
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Affiliation(s)
- F Saettini
- Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy; Università degli Studi di Milano-Bicocca, Monza, Italy.
| | - M A Pelagatti
- Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - D Sala
- Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - D Moratto
- Nocivelli Institute for Molecular Medicine, Department of Molecular and Translational Medicine, University of Brescia, and Cytogenetics and Clinical Genetics Unit, Laboratory Department, Spedali Civili, Brescia, Italy
| | - S Giliani
- Nocivelli Institute for Molecular Medicine, Department of Molecular and Translational Medicine, University of Brescia, and Cytogenetics and Clinical Genetics Unit, Laboratory Department, Spedali Civili, Brescia, Italy
| | - R Badolato
- Università degli Studi di Brescia, Brescia, Italy
| | - A Biondi
- Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy; Università degli Studi di Milano-Bicocca, Monza, Italy
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11
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Rubio-Briones J, Casanova J, Martínez F, Domínguez-Escrig JL, Fernández-Serra A, Dumont R, Ramírez-Backhaus M, Gómez-Ferrer A, Collado A, Rubio L, Molina A, Vanaclocha M, Sala D, Lopez-Guerrero JA. PCA3 as a second-line biomarker in a prospective controlled randomized opportunistic prostate cancer screening programme. Actas Urol Esp 2017; 41:300-308. [PMID: 28342633 DOI: 10.1016/j.acuro.2016.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 09/01/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES PCA3 performance as a single second line biomarker is compared to the European Randomised Study of Screening for Prostate Cancer risk calculator model 3 (ERSPC RC-3) in an opportunistic screening in prostate cancer (PCa). MATERIAL AND METHODS 5,199 men, aged 40-75y, underwent prostate-specific antigen (PSA) screening and digital rectal examination (DRE). Men with a normal DRE and PSA ≥3ng/ml had a PCA3 test done. All men with PCA3 ≥35 underwent an initial biopsy (IBx) -12 cores-. Men with PCA3 <35 were randomized 1:1 to either IBx or observation. We compared them to those obtained with ERSPC RC-3. RESULTS PCA3 test was performed on 838 men (16.1%). In PCA3(+) and PCA3(-) groups, global PCa detection rates were 40.9% and 14.7% with a median follow-up (FU) of 21.7 months (P<.001). In the PCA3(+) arm (n=301, 35.9%), PCa was identified in 115 men at IBx (38.2%). In the randomized arm, 256 underwent IBx and PCa was found in 46 (18.0%) (P<.001). The biopsy-sparing potential would have been 64.1% as opposed to 76.6% if we had used ERSPC RC-3. However, the estimated false negative cases for HGPCa would have been reduced by 37.1% (89 to 56 patients). Moreover, if we had applied PCA3-35 to avoid IBx, 14.7% PCa and 9.1% of clinical significant PCa patients would not have been diagnosed during this FU. CONCLUSIONS When PCA3-35 is used as a second-line biomarker when PSA ≥3ng/ml and DRE is normal, IBx could be avoided in 12.5% less than if ERSPC RC-3 is used and would reduce the false negative cases by 36.2%. At a FU of 21.7 months, this dual protocol would miss 9.1% of clinically significant PCa, so strict FU is mandatory with established biopsy criteria based on PSA and DRE in cases with PCA3 <35.
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Affiliation(s)
- J Rubio-Briones
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - J Casanova
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - F Martínez
- Departamento de Estadística, Universidad de Valencia, Valencia, España
| | - J L Domínguez-Escrig
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - A Fernández-Serra
- Biología Molecular, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - R Dumont
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - M Ramírez-Backhaus
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - A Gómez-Ferrer
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - A Collado
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - L Rubio
- Biología Molecular, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - A Molina
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica en la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, España
| | - M Vanaclocha
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica en la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, España
| | - D Sala
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica en la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, España
| | - J A Lopez-Guerrero
- Biología Molecular, Fundación Instituto Valenciano de Oncología, Valencia, España
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12
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Motta S, Sala D, Sala A, Cazzaniga G, Giudici G, Villa N, Biondi A, Selicorni A. Hodgkin lymphoma in a patient with mosaic trisomy 18: First clinical observation. Am J Med Genet A 2015; 170:777-80. [DOI: 10.1002/ajmg.a.37504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 11/25/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Serena Motta
- Department of Pediatrics; University of Milano-Bicocca; Monza e Brianza per il Bambino e la sua Mamma (MBBM) Foundation; Monza Italy
| | - Debora Sala
- Department of Pediatrics; University of Milano-Bicocca; Monza e Brianza per il Bambino e la sua Mamma (MBBM) Foundation; Monza Italy
| | - Alessandra Sala
- Department of Pediatrics; University of Milano-Bicocca; Monza e Brianza per il Bambino e la sua Mamma (MBBM) Foundation; Monza Italy
| | - Giovanni Cazzaniga
- Department of Pediatrics; Tettamanti Research Center; University of Milano-Bicocca, MBBM Foundation; Monza Italy
| | - Giovanni Giudici
- Department of Pediatrics; Tettamanti Research Center; University of Milano-Bicocca, MBBM Foundation; Monza Italy
| | - Nicoletta Villa
- Medical Genetics Laboratory; San Gerardo Hospital; Monza Italy
| | - Andrea Biondi
- Department of Pediatrics; University of Milano-Bicocca; Monza e Brianza per il Bambino e la sua Mamma (MBBM) Foundation; Monza Italy
| | - Angelo Selicorni
- Department of Pediatrics; Pediatric Genetic Unit; University of Milano-Bicocca, MBBM Foundation; Monza Italy
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13
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Cargnello M, Sala D, Chen C, D'Arienzo M, Gorte RJ, Murray CB. Structure, morphology and catalytic properties of pure and alloyed Au–ZnO hierarchical nanostructures. RSC Adv 2015. [DOI: 10.1039/c5ra06910f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A novel preparation of Au@ZnO and Au/Cd–ZnO structures is reported.
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Affiliation(s)
- M. Cargnello
- Department of Chemistry
- University of Pennsylvania
- Philadelphia
- USA
| | - D. Sala
- Department of Chemistry
- University of Pennsylvania
- Philadelphia
- USA
- INSTM
| | - C. Chen
- Department of Chemical and Biomolecular Engineering
- University of Pennsylvania
- Philadelphia
- USA
| | - M. D'Arienzo
- INSTM
- Department of Materials Science
- University of Milano-Bicocca
- I-20125 Milano
- Italy
| | - R. J. Gorte
- Department of Chemical and Biomolecular Engineering
- University of Pennsylvania
- Philadelphia
- USA
| | - C. B. Murray
- Department of Chemistry
- University of Pennsylvania
- Philadelphia
- USA
- Department of Materials Science and Engineering
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Neagoe RM, Sala D, Voidazan S, Bancu S, Kiss L, Suciu H. Transthoracic versus Transhiatal esophagectomy: a permanent dilemma. our 15-year experience. Chirurgia (Bucur) 2013; 108:780-787. [PMID: 24331314] [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] [Accepted: 12/01/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Controversy still exists regarding the optimal surgical management of esophageal cancer. This study was performed to determine and compare early and late morbidity,mortality and overall survival after transthoracic (TTE) and transhiatal esophagectomies (THE). METHODS Between 1997-2011, 100 patients underwent TTE or THE for squamous esophageal carcinoma (90 patients)and adenocarcinoma (10 patients). Assessed parameters included patient demographics, operative data, pathology results, postoperative morbidity and mortality and 1-3 year survival. RESULTS Thoracic approach was preferred in cases of more advanced tumors, located in the upper and mid-third of the esophagus, in patients with a better cardiopulmonary status. Perioperative blood loss was significantly higher after transthoracic resections (p=0.0004) and these surgeries took significantly longer than transhiatal esophagectomies(p=0.02). We identified complications in 70.7% patients who under went TTE and in 59.3% patients with transhiatal approach. Respiratory complications were statistically significant in the TTE- group (p-0.0003). The 30-day mortality rates were 12.2% for patients in TTE group and 10.1% in THE patients group, respectively. The mortality ratefor the entire period of the study has been calculated at 84.4%.We have identified a survival rate after 1 year of 62.2%, after 2 years of 39.3% and after 3 years - 15.1%. CONCLUSIONS According to the results of this study, both procedures appear to be acceptable depending on surgeon preference and appropriate patient selection.
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Sala D, Chomto S, Hill S. Long-Term Outcomes of Short Bowel Syndrome Requiring Long-Term/Home Intravenous Nutrition Compared in Children With Gastroschisis and Those With Volvulus. Transplant Proc 2010; 42:5-8. [DOI: 10.1016/j.transproceed.2009.12.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alkmim Teixeira R, Martinelli Filho M, Borba E, Bonfa E, Nishioka S, Pedrosa A, Costa R, Sosa E, Foley PWX, Muhyaldeen S, Chalil S, Smith REA, Sanderson JE, Leyva F, Pentimalli F, Visram N, Sala D, Sagone A, Lerecouvreux M, Probst V, Sacher F, Leenhardt A, Sadoul N, Le Heuzey JY, Carlioz R, Blanc JJ, Pernencar S, Morais J, De Ponti R, Marazzi R, Zoli L, Caravati F, Salerno-Uriarte JA, Dixen U, Lamberts M, Skielboe AK, Dalsgaard J, Stender S, Jensen GB, Nageh MF, Kim JJ, Yao J, Khairallah FS, Hamati F, Perress D, Schneider A, Alonso J, Gupta M, Hegazy R, Lotfy W, Ammar R, Fattouh A, Kyriakou P, Kyriakou P, Bostanitis I, Zafiris A, Makridis I, Bountonas G, Raptopoulou-Gigi M, Kloppe A, Thiere A, Mijic D, Zarse M, Lemke B, Kaba RA, Lyne JC, Markides V, Wong T, Ernst S, Mabo P, Abbey S, Tassin A, Cebron JP, Solnon A, Dupuis JM, Zorio Grima E, Cano Perez O, Navarro Manchon J, Rodriguez Diez S, Rueda Soriano J, Osca Asensi J, Sancho Tello De Carranza MJ, Salvador Sanz A. FLASH SESSION ORAL & POSTER PRESENTATION. Europace 2009. [DOI: 10.1093/europace/euq199] [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: 11/14/2022] Open
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Agostoni C, Giovannini M, Sala D, Usuelli M, Livio L, Francescato G, Braga M, Riva E, Martiello A, Colombo C, Marangoni F, Galli C. Double-blind, placebo-controlled trial comparing effects of supplementation of two micronutrient sprinkles on fatty acid status in Cambodian infants. J Pediatr Gastroenterol Nutr 2007; 44:136-42. [PMID: 17204967 DOI: 10.1097/01.mpg.0000243429.24463.2f] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Infants in developing countries require early dietary interventions to prevent nutritional deficiencies, above all protein, energy, iron and zinc. To what extent these interventions may affect the fatty acid (FA) status is still unknown. OBJECTIVES To examine and compare the effects of 2 micronutrient "sprinkles" supplementations (iron 12.5 mg + folic acid 150 microg, iron/folate and iron 12.5 mg + folic acid 150 microg + zinc 5 mg + vitamins A, C and D3, mineral/micronutrient [MMN]) versus placebo on the FA status of Cambodian infants. METHODS A total of 204 infants age 6 mo and living in Kompong Chhnang Province, Cambodia, were randomly assigned to receive daily supplementation of MMN (n = 68) and iron/folate (n = 68) or placebo (n = 68) for a 12-mo period in powder form as sprinkles. At the end of the intervention period, FAs in the range of 16 to 24 C were determined in blood drops absorbed on a strip collected from 182 subjects, and values among the 3 intervention subgroups and those of 21 Italian 18-mo-old, normal-growing infants as the reference group were compared. RESULTS At the end of the supplementation trial, higher levels of the 2 essential FAs (EFAs) (linoleic acid, 18:2n-6, and alpha-linolenic acid, 18:3n-3) were found in the MMN group. No differences occurred for the major longer chain derivatives of both EFAs arachidonic acid (20:4n-6) and docosahexaenoic acid (22:6n-3). In MMN supplemented Cambodians, blood levels of linoleic acid approached those of Italian infants, and in addition their alpha-linolenic acid levels were improved. Cambodian infants, mostly still breast-fed through the second year of life, showed significantly higher levels of long-chain derivatives of both the n-6 and the n-3 series compared with Italians. CONCLUSIONS Supplementation with iron, folic acid, zinc and vitamins was associated with an increase of linoleic acid and alpha-linolenic acid levels in Cambodian infants versus placebo, without significant changes in the concentrations of their longer chain derivatives, resulting in a FA status closer to Italian counterparts for the essential polyunsaturated FA levels. The iron/folate-treated infants showed no differences compared with the other 2 groups. Studies are needed to differentiate the potential effects of the supplemented micronutrients on the FA status.
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Affiliation(s)
- Carlo Agostoni
- Department of Pediatrics, San Paolo Hospital, University of Milan, Italy.
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Lluch A, Chirivella I, Insa A, Martinez-Ruiz F, Santaballa A, Herranz C, Ibañez J, Miranda J, Pons C, Sala D. Impact of mammographic screening in staging, treatment and prognosis of breast cancer: Early assessment. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10537] [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: 11/20/2022] Open
Abstract
10537 Background: The use of breast cancer mammographic screening (MS) leads to early detection and has been shown to reduce the mortality rate and to increase the proportion of breast-conserving surgery. The aim of this study is to analyze the impact of mammography in the staging, treatment and prognosis of breast carcinoma. Methods: In 1993, a population-based mammographic screening among women aged from 45 to 70 years was introduced in the community of Valencia. We examined the effects of this MS program by the comparison of two populations. The first one included all the women with screen-detected invasive breast carcinoma between 1993 and 2002 in the community of Valencia. The second one was comprised of all the women with invasive breast carcinoma, diagnosed in the same period, aged 45–70, not attending the MS and treated at H. Clinico of Valencia. Results: Between January, 1993 and December, 2002, 2313 new invasive breast cancer patients were detected by the MS program in the community of Valencia, and 1349 women aged 45–70, not attending de MS were diagnosed with invasive breast carcinoma in H.Clinico of Valencia. The median follow-up period was 45.5 months for the screen-detected breast cancer and 51.9 months for not screen-detected patients. The screen-detected tumors had smaller pathological size (pT1 tumors 70.2% vs 40.5%, p < 0.0001), were more likely to have pathologically confirmed negative nodal status (66.4% vs 52.2%, p < 0.0001) and stage I disease (55.3% vs 26.1%, p < 0.0001). Breast-conserving surgery was performed in 50.4% of patients with screen-detected tumors and in 31.9% of women who had not undergone MS (p < 0.0001). The 5-year estimated survival was 95.5% (SE 0.57) for women with screen-detected breast cancer and 85.5% (SE 1.17) for those with not screen-detected tumors (p < 0.0001). Conclusions: Our data demonstrate a better prognosis in terms of 5-year survival in screen-detected breast cancer patients that may explain why breast carcinoma mortality rates have decreased in recent decades. These patients have also been found to have smaller tumors, a more favorable tumor stage and a higher proportion of breast-conserving surgery. No significant financial relationships to disclose.
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Affiliation(s)
- A. Lluch
- Universitary Clinic Hospital, Valencia, Spain; Breast Cancer Screening Group of Valencia, Valencia, Spain
| | - I. Chirivella
- Universitary Clinic Hospital, Valencia, Spain; Breast Cancer Screening Group of Valencia, Valencia, Spain
| | - A. Insa
- Universitary Clinic Hospital, Valencia, Spain; Breast Cancer Screening Group of Valencia, Valencia, Spain
| | - F. Martinez-Ruiz
- Universitary Clinic Hospital, Valencia, Spain; Breast Cancer Screening Group of Valencia, Valencia, Spain
| | - A. Santaballa
- Universitary Clinic Hospital, Valencia, Spain; Breast Cancer Screening Group of Valencia, Valencia, Spain
| | - C. Herranz
- Universitary Clinic Hospital, Valencia, Spain; Breast Cancer Screening Group of Valencia, Valencia, Spain
| | - J. Ibañez
- Universitary Clinic Hospital, Valencia, Spain; Breast Cancer Screening Group of Valencia, Valencia, Spain
| | - J. Miranda
- Universitary Clinic Hospital, Valencia, Spain; Breast Cancer Screening Group of Valencia, Valencia, Spain
| | - C. Pons
- Universitary Clinic Hospital, Valencia, Spain; Breast Cancer Screening Group of Valencia, Valencia, Spain
| | - D. Sala
- Universitary Clinic Hospital, Valencia, Spain; Breast Cancer Screening Group of Valencia, Valencia, Spain
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Giovannini M, Sala D, Usuelli M, Livio L, Francescato G, Braga M, Radaelli G, Riva E. Double-blind, placebo-controlled trial comparing effects of supplementation with two different combinations of micronutrients delivered as sprinkles on growth, anemia, and iron deficiency in cambodian infants. J Pediatr Gastroenterol Nutr 2006; 42:306-12. [PMID: 16540800 DOI: 10.1097/01.mpg.0000189363.07040.4b] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To assess and compare efficacy of two micronutrient sprinkle supplementation on growth, anemia, and iron deficiency in Cambodian infants. METHODS A total of 204 infants aged 6 months and living in Kompong Chhnang Province, Cambodia were randomly assigned to receive daily supplements of either iron (12.5 mg) plus folic acid (150 mug) plus zinc (5 mg) (MMN, n = 68), or iron (12.5 mg) plus folic acid (150 microg) alone (FFA, n = 68), or placebo (n = 68) for a 12 month period in powder form as sprinkles. Anthropometrics was evaluated bimonthly. Biochemical assessment was performed at baseline and at the end of intervention period. RESULTS At baseline, the overall mean (SD) of hemoglobin concentration was 101 g/L. No difference among groups was found for growth pattern. Significant decline was observed for weight-for-age and height-for-age z-scores in any group (P < 0.0001). The rate of recovery from anemia was significant (P < 0.001) and comparable between MMN (54%) and FFA (53%) groups and higher than in the placebo group (22%, P < 0.0001). Through the study period, no significant change in the rate of iron deficiency was found in MMN and FFA groups, whereas it increased in the placebo group (31%, baseline vs. 52%, end of study; P < 0.0001). CONCLUSION Both MMN and FFA supplements were effective for preventing or treating anemia in Cambodian infants and stabilizing plasma levels of ferritin. Use of micronutrients in a controlled home setting, as sprinkled daily supplements, may be promising in preventing and treating anemia in developing countries.
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Bettini R, Sala D, Gorini M. [Essential thrombocythemia]. Clin Ter 2005; 156:125-9. [PMID: 16048033] [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: 05/03/2023]
Abstract
New diagnostic and therapeutic aspects of the essential thrombocythemia are summarized. A series of 14 patients with essential thrombocythemia is reported.
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Affiliation(s)
- R Bettini
- Università dell'Insubria Patologia Medica Ospedale di Circolo Varese, Italia
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Zuccotti GV, Zenga A, Durando P, Massone L, Bruzzone B, Sala D, Riva E. Immunogenicity and tolerability of a trivalent virosomal influenza vaccine in a cohort of HIV-infected children. J Int Med Res 2004; 32:492-9. [PMID: 15458281 DOI: 10.1177/147323000403200506] [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] [Indexed: 11/15/2022] Open
Abstract
Twenty-three children infected with the human immunodeficiency virus (HIV) were vaccinated with a trivalent inactivated virosomal influenza vaccine. Serum haemagglutinin inhibition antibody titres were determined for the three viral strains at the time of vaccination and 1 month later. CD4 cell counts and HIV viral loads were measured to evaluate the effect of vaccination on HIV status. Adverse reactions were monitored during the first hour following vaccination by an investigator and then on a continuous basis by the parents. Seroconversion rates against the three viral strains A/H3N2, A/H1N1 and B were 73.9%, 56.5% and 52.2%, respectively. Geometric mean antibody titres increased after 1 month compared with baseline values (A/H3N2: 70.9 versus 13.5; A/H1N1: 24.7 versus 5.8; B: 34.4 versus 9.1). No significant changes were observed in either HIV viral load or CD4 cell count following vaccination. Vaccination was well tolerated with only a few mild, transient symptoms.
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Affiliation(s)
- G V Zuccotti
- Department of Paediatrics, San Paolo Hospital, University of Milan, Italy.
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Zuccotti GV, Cucchi C, Torcoletti M, Gemmellaro L, Sala D, Salvini F, Riva E. Proposal of a step-wise follow-up for hepatitis C seropositive mothers and their infants. Pediatr Med Chir 2003; 25:6-11. [PMID: 12920971] [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: 03/04/2023] Open
Abstract
Mother-to-child transmission of hepatitis C virus can take place in utero, during labour or after birth. Rate of vertical transmission varies widely between surveys but is around 5-6%. Maternal risk factors which may condition perinatal transmission risk are HIV/HCV coinfection, drug use, viral load, viral genotype, type of delivery and breastfeeding. On the basis of recent data, we propose a step-wise follow-up for HCV seropositive mothers and their infants. This proposal might represent an important occasion to unify behaviors in different Obstetrics-Gynecology and Neonatology Units.
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Affiliation(s)
- G V Zuccotti
- Clinica Pediatrica dell'Università di Milano, Ospedale San Paolo, Milano.
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Guynot ME, Ramos AJ, Sala D, Sanchis V, Marín S. Combined effects of weak acid preservatives, pH and water activity on growth of Eurotium species on a sponge cake. Int J Food Microbiol 2002; 76:39-46. [PMID: 12038576 DOI: 10.1016/s0168-1605(01)00751-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [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: 11/30/2022]
Abstract
The combined effects of weak acid preservatives (sorbate, benzoate and propionate), pH (6.0, 7.5) and water activity (a(w)) levels (0.80, 0.85, 0.90) on growth of four Eurotium species isolated from bakery products on a sponge cake analogue were studied. Even though it is universally known that these preservatives are much more effective at lower pH values, we chose a 6-7.5 level to correlate with the pH of the Spanish cake product studied. In general, 0.3% doses of all three preservatives were effective only when they were applied at pH 6.0 and at 0.80-0.85 a(w). Potassium sorbate was clearly the most effective in inhibiting growth of all isolates. Under the conditions tested, application of all three preservatives added at 0.03% acted as growth promoter of all isolates rather than having a preservative effect.
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Affiliation(s)
- M E Guynot
- Food Technology Department, Lleida University, UTPV-CeRTA, Spain
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25
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Zuccotti GV, Gracchi V, Sala D, Salvini F. [Nosocomial infections at a pediatric age]. Pediatr Med Chir 2002; 24:177-85. [PMID: 12236029] [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: 02/26/2023] Open
Abstract
The overall incidence of nosocomial infections in children ranges from 2.3% to 12.6%. Even if there are great variations among data in literature, most authors agree that nosocomial infections are less frequent in children than in adults. Differences between these two populations concern anatomical sites of infection and microrganisms: in children, most frequent are gastrointestinal infections (10-35%), respiratory infections (5-30%) and bacteremia (10-23%); Gram positive bacteria account for 31-50% of infections, Gram negative for 23-35% and viruses for 22-27%. All these percentages change enormously depending on the type of department and child age. Because of increasing rates of resistance to antimicrobial agents, it is important to identify the main infectious agents and their sensibility, considering carefully when to give antibiotic therapy and what drug should be chosen.
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Affiliation(s)
- G V Zuccotti
- Clinica Pediatrica Ospedale San Paolo, Università degli Studi, Milano, Via A. di Rudinì 8, 20142 Milano.
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26
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Frenkel SR, Jaffe WL, Valle CD, Jazrawi L, Maurer S, Baitner A, Wright K, Sala D, Hawkins M, Di Cesare PE. The effect of alendronate (Fosamax) and implant surface on bone integration and remodeling in a canine model. J Biomed Mater Res 2002; 58:645-50. [PMID: 11745516 DOI: 10.1002/jbm.1064] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients at high risk for osteoporosis and its associated morbidity, including postmenopausal women, are being pharmacologically managed to stabilize and improve bone mass. Alendronate sodium (Fosamax) is a commonly used antiresorptive agent effective in osteopenic women for reducing bone resorption, increasing bone density, and decreasing fracture incidence. With the increased incidence of alendronate-treated women who are undergoing hip replacement or fracture repair by prosthesis placement, data are needed to predict how alendronate affects host bone integration with uncemented surfaces. The aim of this study was to determine the effect of alendronate on new bone formation and attachment to implant surfaces in a normal and simulated estrogen-deficient, calcium-deficient canine model, using an implantable bone growth chamber. Alendronate did not affect host bone integration to surfaces commonly used in uncemented total joint arthroplasty, but there were significant differences dependent solely on the type of surface.
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Affiliation(s)
- S R Frenkel
- Musculoskeletal Research Center and Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York 10003, USA.
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27
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Crespo E, Sala D, Crespo R, Silvestre A. Transient osteoporosis. Acta Orthop Belg 2001; 67:330-7. [PMID: 11725563] [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: 02/22/2023]
Abstract
Transient osteoporosis (TO) is an uncommon entity whose principal characteristic is to be a self-limited syndrome. Diagnosis is made upon clinical presentation and x-ray evidence of diffuse osteopenia around the affected joint followed by spontaneous healing after several months. When recurrent episodes occur at different times and locations it is called regional migratory osteoporosis. Magnetic resonance imaging and technetium-99 bone scan may be helpful in diagnosis during the early phase. Good results may be achieved with nonsteroidal antiinflammatory medication, protected weight bearing and physical therapy.
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Affiliation(s)
- E Crespo
- Department of Orthopedics and Trauma Surgery, University Clinic Hospital, Valencia, Spain.
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28
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Kopell BH, Sala D, Doyle WK, Feldman DS, Wisoff JH, Weiner HL. Subfascial implantation of intrathecal baclofen pumps in children: technical note. Neurosurgery 2001; 49:753-6; discussion 756-7. [PMID: 11523691 DOI: 10.1097/00006123-200109000-00045] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [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: 11/25/2022] Open
Abstract
OBJECTIVE Indwelling intrathecal drug delivery systems are becoming increasingly important as a method of neuromodulation within the nervous system. In particular, intrathecal baclofen therapy has shown efficacy and safety in the management of spasticity and dystonia in children. The most common complications leading to explantation of the pumps are skin breakdown and infection at the pump implantation site. The pediatric population poses particular challenges with regard to these complications because appropriate candidates for intrathecal baclofen therapy are often undernourished and thus have a dearth of soft tissue mass to cover a subcutaneously implanted baclofen pump. We report a technique of subfascial implantation that provides greater soft tissue coverage of the pump, thereby reducing the potential for skin breakdown and improving the cosmetic appearance of the implantation site. METHODS Eighteen consecutively treated children (average age, 8 yr, 7 mo) with spasticity and/or dystonia underwent subfascial implantation of a baclofen pump. These children's mean weight of 42.9 lb is less than the expected weight for a group of children in this age group, ranging from 4 years, 8 months, to 15 years, 7 months. In all patients, the pump was inserted into a pocket surgically constructed between the rectus abdominus and the external oblique muscles and the respective anterior fascial layers. RESULTS At an average follow-up of 13.7 months, no infection or skin breakdown had occurred at the pump surgical site in any of the 18 patients. CONCLUSION At this early follow-up, the subfascial implantation technique was associated with a reduced rate of local wound and pump infections and provided optimal cosmetic results as compared with that observed in retrospective cases.
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Affiliation(s)
- B H Kopell
- Department of Neurosurgery, New York University School of Medicine, New York 10016, USA
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29
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Abstract
BACKGROUND/PURPOSE Trauma is still the most frequent cause of mortality and disability in childhood and adolescence. An epidemiologic prospective study on children under 16 years of age with multiple trauma (MT) was conducted in a large Spanish urban university hospital over a 6-year period. METHODS Of 1,937 children admitted at the pediatric trauma unit for musculoskeletal injuries from March 1988 until March 1994, 56 patients including 37 boys and 19 girls had MT. MT was considered when at least 2 long bones were fractured or there was a fracture of 1 long bone combined with an injury of 4 other major anatomic regions (face and neck, thorax, abdomen, or neural system). The severity of injuries was evaluated according to the modified injury severity score (MISS). RESULTS Injury to pedestrians was the most frequent cause of MT (54%). The overall mortality rate of the series, including those children dying during transport to the hospital was 11.5%. The average MISS for the whole group was 15 (range, 5 to 59). Head trauma was the most frequent associated injury (52%), two thirds of which were considered minor injuries (Glasgow Coma Scale >15). Seventy-seven fractures were registered, 10% of which were open fractures. External fixation was the most common surgical technique among operated fractures. The average hospitalization period was 16 (median, 13; range, 1 to 150) days. Children with a MISS above 18 points showed a significant longer hospitalization period (mean, 31 +/- 45 days) as compared with those with MISS below 18 points (mean, 10 +/- 7 days; P < .05). There was a strong correlation between the MISS and both the period of hospitalization at the pediatric intensive care unit and the total length of hospital stay. CONCLUSIONS Pedestrian accidents caused by motor vehicles in children playing at the street contributed most significantly to MT in the urban pediatric population. Special care for prevention must be taken in the age group of 6 to 10 years. Head injury was the main cause of death in children with multiple trauma. MISS was found to be a good predictor of survival and duration of hospital stay in pediatric MT.
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Affiliation(s)
- D Sala
- Department of Surgery, Valencia University Medical School, Spain
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30
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Biagini G, Sala D, Zini I. Diethyldithiocarbamate, a superoxide dismutase inhibitor, counteracts the maturation of ischemic-like lesions caused by endothelin-1 intrastriatal injection. Neurosci Lett 1995; 190:212-6. [PMID: 7637895 DOI: 10.1016/0304-3940(95)11529-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.5] [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: 01/26/2023]
Abstract
The effects of a focal lesion induced by endothelin-1 (ET-1, 0.8 microgram/0.8 microliter) on superoxide dismutase (SOD) were studied in the neostriatum of male rats. SOD activity was analyzed at several time intervals (5, 20, 60 min, 4, 24 h and 7 days) after the lesion. No significant changes were observed early after the injection, but SOD activity started to rise significantly at the 60-min time interval reaching a peak 24 h after the injection. In a second experiment the volume of ET-1-induced lesion was evaluated following treatments which induce variations of SOD activity. ET-1 caused a large lesion (9.20 +/- 1.32 mm3) in the neostriatum 24 h after the injection that was 3-fold greater than that observed 1 h after. Rats treated with the SOD inhibitor diethyldithiocarbamate showed a lesion equivalent to that observed 1 h after ET-1 injection, suggesting that SOD may be involved in the maturation of ET-1-induced neuronal damage.
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Affiliation(s)
- G Biagini
- Department of Biomedical Sciences, University of Modena, Italy
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31
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Abstract
A prospective study was performed on 30 patients who underwent an anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allograft. An arthroscopic technique alone was used in 10 patients, and in the other 20 patients this was combined with a miniarthrotomy. After a mean follow up of 35 months, the overall functional results were satisfactory in 85%. There were no cases of infection, disease transmission or tissue rejection. Fresh-frozen patellar tendon allografts are a good method of anterior cruciate reconstruction.
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Affiliation(s)
- J R Valenti
- Department of Orthopaedic Surgery and Traumatology, School of Medicine, University of Navarra, Pamplona, Spain
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