1
|
Franceschi P, Balducci A, Nardi E, Niro F, Attinà D, Russo V, Donti A, Angeli E, Gargiulo GD, Lovato L. Predictive value of Cardiac Magnetic Resonance: new and old parameters in the natural history of repaired Tetralogy of Fallot. BMC Cardiovasc Disord 2024; 24:15. [PMID: 38172687 PMCID: PMC10765701 DOI: 10.1186/s12872-023-03671-4] [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] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Patients with repaired Tetralogy of Fallot (rTOF) often develop pulmonary regurgitation (PR) and right ventricle (RV) dysfunction, experiencing increased mortality and morbidity rates in adulthood. Pulmonary valve replacement (PVR) timing to address PR is controversial. Cardiac Magnetic Resonance (CMR) is the gold standard for morpho-functional evaluation of complex cardiopathies. This study aims to identify CMR parameters predictive of adverse outcomes to help defining the best therapeutic management of rTOF patients. METHODS 130 rTOF patients who underwent CMR (2006-2019) were enrolled in this retrospective single-center study. CMR, clinical, ECG and exercise data were analyzed. Univariate and multivariate analyses identified clinical and CMR parameters predictive of adverse outcomes both individually (e.g., death, arrhythmias, heart failure (HF), pharmacological therapy, QRS ≥ 160ms) and as composite outcome. RESULTS Univariate analysis confirmed RV volumes and RV ejection fraction corrected for PR as adverse outcome predictors and identified interesting correlations: pulmonary artery bifurcation geometry and abnormal interventricular septum (IVS) motion with arrhythmias (p < .001; p = .037), HF (p = .049; p = .005), composite outcome (p = .039; p = .009); right atrium (RA) dimensions with the composite outcome and the outcomes individually (p < .001). The best predictive models by multivariate analysis included sex (male), RV and RA dilation for QRS ≥ 160ms, time form repair to CMR, age at TOF repair and IVS fibrosis for pharmacological therapy. CONCLUSIONS Besides RV volumes, new adverse prognostic factors could guide rTOF therapeutic management: pulmonary arteries morphology, abnormal IVS motion, RV dysfunction, RA dilation. Perspective multicentric evaluation is needed to specify their effective role.
Collapse
Affiliation(s)
- Paola Franceschi
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy.
| | - A Balducci
- Pediatric Cardiology, Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - E Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - F Niro
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - D Attinà
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - V Russo
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - A Donti
- Pediatric Cardiology, Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - E Angeli
- Pediatric Cardiology, Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| | - G D Gargiulo
- Pediatric Cardiology, Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - L Lovato
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via G. Massarenti, 9, Bologna, 40138, Italy
| |
Collapse
|
2
|
Parisi V, Baldassarre R, Ferrara V, Ditaranto R, Barlocco F, Lillo R, Re F, Marchi G, Chiti C, Di Nicola F, Catalano C, Barile L, Schiavo MA, Ponziani A, Saturi G, Caponetti AG, Berardini A, Graziosi M, Pasquale F, Salamon I, Ferracin M, Nardi E, Capelli I, Girelli D, Gimeno Blanes JR, Biffi M, Galiè N, Olivotto I, Graziani F, Biagini E. Electrocardiogram analysis in Anderson-Fabry disease: a valuable tool for progressive phenotypic expression tracking. Front Cardiovasc Med 2023; 10:1184361. [PMID: 37416917 PMCID: PMC10320218 DOI: 10.3389/fcvm.2023.1184361] [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: 03/11/2023] [Accepted: 06/09/2023] [Indexed: 07/08/2023] Open
Abstract
Background Electrocardiogram (ECG) has proven to be useful for early detection of cardiac involvement in Anderson-Fabry disease (AFD); however, little evidence is available on the association between ECG alterations and the progression of the disease. Aim and Methods To perform a cross sectional comparison of ECG abnormalities throughout different left ventricular hypertrophy (LVH) severity subgroups, providing ECG patterns specific of the progressive AFD stages. 189 AFD patients from a multicenter cohort underwent comprehensive ECG analysis, echocardiography, and clinical evaluation. Results The study cohort (39% males, median age 47 years, 68% classical AFD) was divided into 4 groups according to different degree of left ventricular (LV) thickness: group A ≤ 9 mm (n = 52, 28%); group B 10-14 mm (n = 76, 40%); group C 15-19 mm (n = 46, 24%); group D ≥ 20 mm (n = 15, 8%). The most frequent conduction delay was right bundle branch block (RBBB), incomplete in groups B and C (20%,22%) and complete RBBB in group D (54%, p < 0.001); none of the patients had left bundle branch block (LBBB). Left anterior fascicular block, LVH criteria, negative T waves, ST depression were more common in the advanced stages of the disease (p < 0.001). Summarizing our results, we suggested ECG patterns representative of the different AFD stages as assessed by the increases in LV thickness over time (Central Figure). Patients from group A showed mostly a normal ECG (77%) or minor anomalies like LVH criteria (8%) and delta wave/slurred QR onset + borderline PR (8%). Differently, patients from groups B and C exhibited more heterogeneous ECG patterns: LVH (17%; 7% respectively); LVH + LV strain (9%; 17%); incomplete RBBB + repolarization abnormalities (8%; 9%), more frequently associated with LVH criteria in group C than B (8%; 15%). Finally, patients from group D showed very peculiar ECG patterns, represented by complete RBBB + LVH and repolarization abnormalities (40%), sometimes associated with QRS fragmentation (13%). Conclusions ECG is a sensitive tool for early identification and long-term monitoring of cardiac involvement in patients with AFD, providing "instantaneous pictures" along the natural history of AFD. Whether ECG changes may be associated with clinical events remains to be determined.
Collapse
Affiliation(s)
- V. Parisi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - R. Baldassarre
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - V. Ferrara
- Unità Ospedaliera Cardiologia, Azienda Sanitaria Territoriale Pesaro Urbino, Fano, Italy
| | - R. Ditaranto
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - F. Barlocco
- Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - R. Lillo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F. Re
- Cardiology Department, San Camillo-Forlanini Hospital, Rome, Italy
| | - G. Marchi
- Internal Medicine Unit and MetabERN Health Care Provider, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - C. Chiti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - F. Di Nicola
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - C. Catalano
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - L. Barile
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - M. A. Schiavo
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - A. Ponziani
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - G. Saturi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - A. G. Caponetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - A. Berardini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
| | - M. Graziosi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
| | - F. Pasquale
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
| | - I. Salamon
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - M. Ferracin
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - E. Nardi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - I. Capelli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Rare Kidney Disease Reference Network-ERKNet, Bologna, Italy
| | - D. Girelli
- Internal Medicine Unit and MetabERN Health Care Provider, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - J. R. Gimeno Blanes
- Inherited Cardiac Disease Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - M. Biffi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
| | - N. Galiè
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
| | - I. Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer University Children Hospital and Careggi University Hospital, Florence, Italy
| | - F. Graziani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E. Biagini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
| |
Collapse
|
3
|
Garofalo M, Corsini A, Potena L, Schinzari M, Nardi E, Barberini F, Gargiulo C, Malaguti M, Sabatino M, Semprini F, Galie N, Nanni S. Clinical profile and in-hospital outcome of patients supported by intra-aortic balloon pump in the clinical setting of cardiogenic shock according to aetiology. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1101] [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: 11/14/2022] Open
Abstract
Abstract
Background
Despite controversial evidence, intra-aortic balloon pump (IABP) is still the most used temporary mechanical support in cardiogenic shock (CS), as a bridge to recovery or to more advanced mechanical support and/or heart transplantation [1]. Indeed, the available evidence, which is mainly restricted to the context of acute coronary syndromes (ACS) and is limited by the variability of CS definitions, shows no benefit in terms of mortality [2]. Randomized controlled trials on IABP in the setting of non-ACS CS are still missing. As a result, European guidelines do not recommend the routine use of IABP, which may be considered in refractory CS [3].
Purpose
The aim of our study was to analyse the use of IABP in the context of CS, providing insights into its indications, outcomes, and complications in relation to the aetiology (ACS vs non-ACS) of CS.
Methods
We retrospectively enrolled all consecutive adult patients receiving IABP for refractory CS at our tertiary referral Hospital between 2009 and 2018, and analysed data focusing on in-hospital outcomes, including death, recovery, heart transplantation, and escalation to more advanced mechanical support such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) or left ventricular assist device (LVAD), and on IABP-related complications.
Results
403 patients received IABP, 75.2% (n=303) for ACS CS and 24.8% (n=100) for non-ACS CS. With respect to ACS patients, non-ACS patients were younger (age 59±18.3 vs 73.1±12.6 years old, p<0.001), had a lower left ventricular ejection fraction (LVEF) [25% (IR 18–35%) vs 38% (IR 25–45%), p<0.001], were supported by IABP for longer time [6 (IR 2–18) vs 2 (IR 1–4) days, p<0.001], required more use of inotropes/vasoconstrictors [80.0% (n=80) vs 33.8% (n=102), p<0.001], and needed more often escalation to VA-ECMO [23.0% (n=23) vs 1.3% (n=4), p<0.001]. Non-ACS patients showed higher in-hospital mortality than ACS patients [46.0% (n=46) vs 33.9% (n=103), p=0.042]. Non-ACS patients were more frequently bridged to heart transplantation [20.0% (n=20) vs 0.3% (n=1), p<0.001] or LVAD [4.0% (n=4) vs 0.6% (n=2), p=0.055] than ACS patients; mortality after transplantation/LVAD did not significantly differ between the two groups [12.5% (n=3/24) vs 66.7% (n=2/3), p>0.05]. The incidence of IABP-related overall and major complications (including ischemic stroke, major bleeding, and peripheral or visceral ischemia) was not different with respect to the non-ACS vs ACS aetiology [major complications: 8.0% (n=8) vs 5.0% (n=15), p>0.05].
Conclusions
In our experience, in the clinical setting of CS treated with IABP, non-ACS patients show a worse clinical profile and prognosis than ACS patients, and more often require escalation to more advanced mechanical support and/or heart transplantation, while the incidence of IABP-related complications appears similar independently of the aetiology.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- M Garofalo
- Policlinico IRCCS Sant'Orsola-Malpighi - Alma Mater Studiorum Università di Bologna, Dipartimento Cardio-Toraco-Vascolare - Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - A Corsini
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
| | - L Potena
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
| | - M Schinzari
- Policlinico IRCCS Sant'Orsola-Malpighi - Alma Mater Studiorum Università di Bologna, Dipartimento Cardio-Toraco-Vascolare - Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - E Nardi
- Policlinico IRCCS Sant'Orsola-Malpighi - Alma Mater Studiorum Università di Bologna, Dipartimento Cardio-Toraco-Vascolare - Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - F Barberini
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
| | - C Gargiulo
- Policlinico IRCCS Sant'Orsola-Malpighi - Alma Mater Studiorum Università di Bologna, Dipartimento Cardio-Toraco-Vascolare - Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - M Malaguti
- Alma Mater Studiorum Università di Bologna, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - M Sabatino
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
| | - F Semprini
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
| | - N Galie
- Policlinico IRCCS Sant'Orsola-Malpighi - Alma Mater Studiorum Università di Bologna, Dipartimento Cardio-Toraco-Vascolare - Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - S Nanni
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
| |
Collapse
|
4
|
Giammanco A, Mattina A, Cefalù A, Geraci G, Noto D, Nardi E, Barbagallo C, Fayer F, Spina R, D'Ignoto F, Cardella A, La Grutta L, Smeraldi T, Midiri M, Averna M. Coronary artery calcium is strongly associated with pulse wave velocity and LDL-cholesterol burden in patients with familial hypercholesterolemia. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.123] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
5
|
Giammanco A, Mattina A, Geraci G, Zammuto M, Maida C, Nardi E, Tuzzolino F, Averna M, Cottone S, Mulè G. Newly imaging biomarker of hypertension-related vascular and kidney damage: The ophthalmic artery index. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.984] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Brandimarte G, Frajese GV, Bargiggia S, Castellani D, Cocco A, Colucci R, Evangelista E, Gravina AG, Napoletano D, Nardi E, Maisto T, Morabito A, Pianese G, Romano A, Sacco R, Sediar I L, Sinnona N, Tifi L, Davino A, Elisei W, Tursi A. Performance of a multi-compounds nutraceutical formulation in patients with symptomatic uncomplicated diverticular disease. Minerva Gastroenterol (Torino) 2022; 68:216-222. [PMID: 35262307 DOI: 10.23736/s2724-5985.22.03132-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/08/2022]
Abstract
BACKGROUND Symptomatic uncomplicated diverticular disease (SUDD) is a recognized clinical condition characterized by abdominal pain and changes in bowel habits, attributed to diverticula but without macroscopic signs of diverticulitis. There is no consensus about the management of these patients. Enteroflegin®, an association of natural active ingredients, could be effective in the treatment of those patients. METHODS We conducted a retrospective observational study to evaluate the performances of Enteroflegin® in patients with SUDD. Patients were treated with Enteroflegin® 2 cp/day for 10 days per month for 6 months. Primary endpoint was the clinical remission rate, defined as the absence of any symptoms; secondary endpoints were the impact of the treatment on reduction of symptoms, on fecal calprotectin (FC) expression, and the prevention of acute diverticulitis. RESULTS Three hundred and fifty patients were retrospectively enrolled (183 males, median age 64 yrs, IQR 54-70). Enteroflegin® was effective in inducing remission in 9.34% and 17.64% of patients at 3 and 6 months respectively (p<0.001). Reduction of symptoms occurred in 92.3% and in 85.3% of patients at 3 and 6 months respectively (p<0.001), and symptoms' recurrence or worsening was recorded in only 1.71% of patients during the follow-up. FC expression dropped from 181,3 μg/g at baseline to 100,2 μg/g (p<0.001) and to 67,9 μg/g (p<0.001) at 3 and 6 months of follow-up respectively. No adverse event was recorded during the follow-up. Finally, acute diverticulitis occurred in just 2% of patients during the follow-up. CONCLUSIONS Enteroflegin® seems to be an effective nutraceutical compound in obtaining remission and symptom relief in SUDD patients. Further randomized, placebo-controlled clinical trials are needed to confirm these preliminary data.
Collapse
Affiliation(s)
- Giovanni Brandimarte
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Giovanni V Frajese
- Section of Human Health, Department of Human Health and Exercise Sciences, Foro Italico University, Rome, Italy
| | - Stefano Bargiggia
- Division of Gastroenterology and Digestive Endoscopy, San Carlo Nursing Home, Paderno Dugnano, Milan, Italy
| | - Danilo Castellani
- Gastroenterology and Hepatology Unit, Department of Medicine and Surgery, Santa Maria della Misericordia University Hospital, University of Perugia, Perugia, Italy
| | - Andrea Cocco
- Division of Gastroenterology, S. Pertini Hospital, Rome, Italy
| | - Raffaele Colucci
- Digestive Endoscopy Unit, San Matteo degli Infermi Hospital, Spoleto, Perugia, Italy
| | | | | | - Domenico Napoletano
- Service of Digestive Endoscopy, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Elisabetta Nardi
- Gastroenterology and Hepatology Unit, Department of Medicine and Surgery, Santa Maria della Misericordia University Hospital, University of Perugia, Perugia, Italy
| | - Tammaro Maisto
- Gastroenterology and Digestive Endoscopy Unit, San Giovanni di Dio Hospital, Frattamaggiore, Naples, Italy
| | - Antonino Morabito
- Service of Digestive Endoscopy, Villa dei Gerani Nursing Home, Vibo Valentia, Italy
| | - Giuseppe Pianese
- Digestive Endoscopy Unit, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Rodolfo Sacco
- Division of Gastroenterology, Ospedali Riuniti Hospital, Foggia, Italy
| | - Luca Sediar I
- Gastroenterology and Hepatology Unit, Department of Medicine and Surgery, Santa Maria della Misericordia University Hospital, University of Perugia, Perugia, Italy
| | - Nicola Sinnona
- Service of Digestive Endoscopy, San Marco Nursing Home, Latina, Italy
| | - Lorenza Tifi
- Division of Gastroenterology and Digestive Endoscopy, Città di Castello Hospital, Città di Castello, Perugia, Italy
| | - Alessandro Davino
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Walter Elisei
- Division of Gastroenterology, S. Camillo Hospital, Rome, Italy
| | - Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria, Italy - .,Department of Medical and Surgical Sciences, Catholic University, Rome, Italy
| |
Collapse
|
7
|
Donati C, Nardi E, Galietta E, Alfieri M, Siepe G, Zamagni A, Buwenge M, Macchia G, Deodato F, Cilla S, Ferro M, Strigari L, Cammelli S, Cellini F, Morganti A, Morganti A. PD-0884 Educational intervention to improve the rate of single fraction radiotherapy prescriptions. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07163-2] [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: 11/17/2022]
|
8
|
Oriolo C, Fanelli F, Castelli S, Mezzullo M, Altieri P, Corzani F, Pelusi C, Repaci A, Di Dalmazi G, Vicennati V, Baldazzi L, Menabò S, Dormi A, Nardi E, Brillanti G, Pasquali R, Pagotto U, Gambineri A. Steroid biomarkers for identifying non-classic adrenal hyperplasia due to 21-hydroxylase deficiency in a population of PCOS with suspicious levels of 17OH-progesterone. J Endocrinol Invest 2020; 43:1499-1509. [PMID: 32236851 DOI: 10.1007/s40618-020-01235-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/20/2019] [Accepted: 03/20/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed at defining the most effective routine immunoassay- or liquid chromatography-tandem mass spectrometry (LC-MS/MS)-determined steroid biomarkers for identifying non-classic adrenal hyperplasia due to 21-hydroxylase deficiency (21-NCAH) in a PCOS-like population before genotyping. METHODS Seventy PCOS-like patients in reproductive age with immunoassay-determined follicular 17OH-progesterone (17OHP) ≥ 2.00 ng/mL underwent CYP21A2 gene analysis and 1-24ACTH test. Serum steroids were measured by immunoassays at baseline and 60 min after ACTH stimulation; basal steroid profile was measured by LC-MS/MS. RESULTS Genotyping revealed 23 21-NCAH, 15 single allele heterozygous CYP21A2 mutations (21-HTZ) and 32 PCOS patients displaying similar clinical and metabolic features. Immunoassays revealed higher baseline 17OHP and testosterone, and after ACTH stimulation, higher 17OHP (17OHP60) and lower cortisol, whereas LC-MS/MS revealed higher 17OHP (17OHPLC-MS/MS), progesterone and 21-deoxycortisol and lower corticosterone in 21-NCAH compared with both 21-HTZ and PCOS patients. Steroid thresholds best discriminating 21-NCAH from 21-HTZ and PCOS were estimated, and their diagnostic accuracy in identifying 21-NCAH from PCOS was established by ROC analysis. The highest accuracy was observed for 21-deoxycortisol ≥ 0.087 ng/mL, showing 100% sensitivity, while the combination of 17OHPLC-MS/MS ≥ 1.79 ng/mL and corticosterone ≤ 8.76 ng/mL, as well as the combination of ACTH-stimulated 17OHP ≥ 6.77 ng/mL and cortisol ≤ 240 ng/mL by immunoassay, showed 100% specificity. CONCLUSIONS LC-MS/MS measurement of basal follicular 21-deoxycortisol, 17OHP and corticosterone seems the most convenient method for diagnosing 21-NCAH in a population of PCOS with a positive first level screening, providing high accuracy and reducing the need for ACTH stimulation test.
Collapse
Affiliation(s)
- C Oriolo
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - F Fanelli
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - S Castelli
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - M Mezzullo
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - P Altieri
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - F Corzani
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - C Pelusi
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - A Repaci
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - G Di Dalmazi
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - V Vicennati
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - L Baldazzi
- Medical Genetic Unit, Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - S Menabò
- Medical Genetic Unit, Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - A Dormi
- Biostatistics Laboratory, Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - E Nardi
- Biostatistics Laboratory, Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - G Brillanti
- Biostatistics Laboratory, Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - R Pasquali
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - U Pagotto
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - A Gambineri
- Endocrinology Unit and Centre for Applied Biomedical Research (CRBA), Department of Medical and Surgical Sciences, St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| |
Collapse
|
9
|
Parmegiani L, Beilby KH, Arnone A, Bernardi S, Maccarini AM, Nardi E, Cognigni GE, Filicori M. Testing the efficacy and efficiency of a single "universal warming protocol" for vitrified human embryos: prospective randomized controlled trial and retrospective longitudinal cohort study. J Assist Reprod Genet 2018; 35:1887-1895. [PMID: 30074129 PMCID: PMC6150888 DOI: 10.1007/s10815-018-1276-4] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/20/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose To study the efficacy and efficiency of a “universal warming protocol” for vitrified human embryos, based on subsequent steps with 1 and 0.5 M concentration of extracellular cryoprotectant (ECCP). Method Two studies on patients undergoing fertility treatments via ICSI: a prospective randomized controlled trial (RCT) and a retrospective cohort study (CS). Setting: Private assisted reproductive (AR) center. RCT: duration 01/03/2017–01/10/2017; 315 embryos at blastocyst stage obtained from 169 patients. Each patient’s embryos were first randomized for vitrification with two different kits: Vitrification Kit (Kitazato, Japan) and Sage Vitrification Kit (Origio, Denmark). The embryos were randomly warmed with either Kitazato (K) or Sage (S) warming kits, specifically: group A (KK), group B (KS), group C (SK), and group D (SS). Primary outcome measure: survival rate (number of embryos surviving per number of embryos warmed). Secondary: implantation rate (number of embryos implanted per number of embryos transferred). CS: duration 01/01/2013–31/12/2015 embryos from patients’ own oocytes; 10/04/2015–31/07/2017 embryos from donors’ oocytes. A total of 1055 embryos vitrified at cleavage stage obtained from 631 warming cycles: 847 of these obtained from patients’ own oocytes, 208 egg-donation-derived embryos. Each patient’s embryos were vitrified and warmed in various combinations of three different vitrification/warming kits: Kitazato (K), Sage (S), or made in-house in our laboratory (H). Vitrification/warming kits from different manufacturers are routinely used in our AR center, and the warming procedures are randomly performed with any available kit on a “first-in-first-out” basis, irrespective of the kit used for vitrification. Group names: KK, KS, SK, SS, SH, HK, HS, HH (embryos from patients’ own oocytes); eKK, eKS, eSK, eSS (egg-donation-derived embryos). Results Cryo-survival rates were comparable in all study groups. RCT. Group A 99.0% (96/97), group B 98.8% (83/84), group C 98.4% (61/62), and group D 98.6% (71/72). CS. Embryos from patients’ own oocytes: KK 96.4% (54/56), KS 100.0% (13/13), SK 98.8% (80/81), SS 97.2% (174/179), SH 97.6% (40/41), HK 95.2% (20/21), HS 99.5% (187/188), and HH 97.4% (261/268). Egg-donation-derived embryos: eKK 100.0% (91/91), eKS 98.4% (60/61), eSK 100.0% (26/26), and eSS 96.7 (29/30). Implantation was generally comparable in all study groups—exceptions were in CS: KS vs. SK (P = 0.049), SS (P = 0.012), HS (P = 0.010), HH (P = 0.025); and SH vs. SS (P = 0.042), HS (P = 0.035). Conclusion Worldwide, millions of embryos have been cryopreserved using different vitrification kits; these studies establish that it is possible to combine different kits for vitrification and warming using a universal warming protocol. This can optimize costs, simplify lab routines, and favor embryo exchange between IVF centers. RCT registration number ISRCTN12342851.
Collapse
Affiliation(s)
- L Parmegiani
- Reproductive Medicine Unit- GynePro Medical Centers GynePro Medical, Via T. Cremona, 8-40137, Bologna, Italy.
| | - K H Beilby
- Department of Obstetrics & Gynaecology, Monash University - Melbourne, Melbourne, Australia
| | - A Arnone
- Reproductive Medicine Unit- GynePro Medical Centers GynePro Medical, Via T. Cremona, 8-40137, Bologna, Italy
| | - S Bernardi
- Reproductive Medicine Unit- GynePro Medical Centers GynePro Medical, Via T. Cremona, 8-40137, Bologna, Italy
| | - A M Maccarini
- Reproductive Medicine Unit- GynePro Medical Centers GynePro Medical, Via T. Cremona, 8-40137, Bologna, Italy
| | - E Nardi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - G E Cognigni
- Reproductive Medicine Unit- GynePro Medical Centers GynePro Medical, Via T. Cremona, 8-40137, Bologna, Italy
| | - M Filicori
- Reproductive Medicine Unit- GynePro Medical Centers GynePro Medical, Via T. Cremona, 8-40137, Bologna, Italy
| |
Collapse
|
10
|
Marsicano L, Battaglieri M, Bondí M, Carvajal CDR, Celentano A, De Napoli M, De Vita R, Nardi E, Raggi M, Valente P. Novel Way to Search for Light Dark Matter in Lepton Beam-Dump Experiments. Phys Rev Lett 2018; 121:041802. [PMID: 30095943 DOI: 10.1103/physrevlett.121.041802] [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] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/13/2018] [Indexed: 06/08/2023]
Abstract
A novel mechanism to produce and detect light dark matter in experiments making use of GeV electrons (and positrons) impinging on a thick target (beam dump) is proposed. The positron-rich environment produced by the electromagnetic shower allows us to produce an A^{'} via nonresonant (e^{+}+e^{-}→γ+A^{'}) and resonant (e^{+}+e^{-}→A^{'}) annihilation on atomic electrons. The latter mechanism, for some selected kinematics, results in a larger sensitivity with respect to limits derived by the commonly used A^{'}-strahlung. This idea, applied to beam-dump experiments and active beam-dump experiments, pushes down the current limits by an order of magnitude.
Collapse
Affiliation(s)
- L Marsicano
- Istituto Nazionale di Fisica Nucleare, Sezione di Genova, 16146 Genova, Italy
- Universitá degli studi di Genova, 16126 Genova, Italy
| | - M Battaglieri
- Istituto Nazionale di Fisica Nucleare, Sezione di Genova, 16146 Genova, Italy
| | - M Bondí
- Istituto Nazionale di Fisica Nucleare, Sezione di Catania, 95125 Catania, Italy
| | - C D R Carvajal
- Universidad de Antioquia, Instituto de Física, Calle 70 No. 52-21, Medellín, Colombia
| | - A Celentano
- Istituto Nazionale di Fisica Nucleare, Sezione di Genova, 16146 Genova, Italy
| | - M De Napoli
- Istituto Nazionale di Fisica Nucleare, Sezione di Catania, 95125 Catania, Italy
| | - R De Vita
- Istituto Nazionale di Fisica Nucleare, Sezione di Genova, 16146 Genova, Italy
| | - E Nardi
- Istituto Nazionale di Fisica Nucleare, Laboratori Nazionali di Frascati, C.P. 13, 00044 Frascati, Italy
| | - M Raggi
- Universitá degli studi Roma La Sapienza, 00185 Roma, Italy
| | - P Valente
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, 00185 Roma, Italy
| |
Collapse
|
11
|
Carlson R, Nardi E, Bacigalupo J, Darlow S, McClure J, Pfister D. Resource-stratification of national comprehensive cancer network (NCCN®) head and neck cancers guideline. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.048] [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
|
12
|
Affiliation(s)
- G. Ben-David
- Israel Atomic Energy Commission, Soreq Research Establishment, Yavne, Israe
| | - E. Nardi
- Israel Atomic Energy Commission, Soreq Research Establishment, Yavne, Israe
| | - M. Pasternak
- Israel Atomic Energy Commission, Soreq Research Establishment, Yavne, Israe
| |
Collapse
|
13
|
Manta R, Nardi E, Pagano N, Ricci C, Sica M, Castellani D, Bertani H, Piccoli M, Mullineris B, Tringali A, Marini F, Germani U, Villanacci V, Casadei R, Mutignani M, Conigliaro R, Bassotti G, Zullo A. Pre-operative Diagnosis of Pancreatic Neuroendocrine Tumors with Endoscopic Ultrasonography and Computed Tomography in a Large Series. J Gastrointestin Liver Dis 2017; 25:317-21. [PMID: 27689195 DOI: 10.15403/jgld.2014.1121.253.ned] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS Diagnosis of pancreatic neuroendocrine tumors (p-NETs) is frequently challenging. We describe a large series of patients with p-NETs in whom both pre-operative Computed Tomography (CT) and Endoscopic Ultrasonography (EUS) were performed. METHODS This was a retrospective analysis of prospectively collected sporadic p-NET cases. All patients underwent both standard multidetector CT study and EUS with fine-needle aspiration (FNA). The final histological diagnosis was achieved on a post-surgical specimen. Chromogranin A (CgA) levels were measured. RESULTS A total of 80 patients (mean age: 58 +/- 14.2 years; males: 42) were enrolled. The diameter of functioning was significantly lower than that of non-functioning p-NETs (11.2 +/- 8.5 mm vs 19.8 +/- 12.2 mm; P = 0.0004). The CgA levels were more frequently elevated in non-functioning than functioning pNET patients (71.4% vs 46.9%; P = 0.049). Overall, the CT study detected the lesion in 51 (63.7%) cases, being negative in 26 (68.4%) patients with a tumor </=10 mm, and in a further 3 (15%) cases with a tumor diameter </=20 mm. CT overlooked the pancreatic lesion more frequently in patients with functioning than non-functioning p-NETs (46.5% vs 24.3%; P = 0.002). EUS allowed a more precise pre-operative tumor measurement, with an overall incorrect dimension in only 9 (11.2%) patients. Of note, the EUS-guided FNA suspected the neuroendocrine nature of tumor in all cases. CONCLUSIONS Data of this large case series would suggest that the EUS should be included in the diagnostic work-up in all patients with a suspected p-NET, even when the CT study was negative for a primary lesion in the pancreas.
Collapse
Affiliation(s)
- Raffaele Manta
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy.
| | - Elisabetta Nardi
- Gastroenterology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - Nico Pagano
- Department of Internal Medicine and Surgery (DIMEC), University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Ricci
- Department of Internal Medicine and Surgery (DIMEC), University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Mariano Sica
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy
| | - Danilo Castellani
- Gastroenterology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy
| | - Micaela Piccoli
- Department of General Surgery, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy
| | - Barbara Mullineris
- Department of General Surgery, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy
| | | | | | - Ugo Germani
- Gastroenterology Unit, Ospedali Riuniti Ancona, Italy
| | | | - Riccardo Casadei
- Department of Internal Medicine and Surgery (DIMEC), University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy
| | - Gabrio Bassotti
- Gastroenterology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| |
Collapse
|
14
|
Zanasi A, Lecchi M, Mazzolini M, Mastroroberto M, Nardi E, Morselli-Labate A. Observational prospective study comparing mucoactive and antibiotic treament in the management of acute cough from upper respiratory tract infections. Minerva Med 2015; 106:239-246. [PMID: 26495821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Since the efficacy of antibiotics in the management of cough from upper respiratory tract infections (URTI) is unclear, we conducted an observational study to evaluate the efficacy of antibiotic compared to symptomatic treatment in adults with productive cough from URTI in a real life setting. METHODS One-hundred and 50 subjects presenting to five general practice ambulatories with productive cough due to URTI were included in the study. According to the physician judgment, patients were treated with either oral antibiotics (group A, 50 patients), a mucoactive syrup (sobrerol: group S, 50 patients) as symptomatic treatment, or both sobrerol and oral antibiotics (group SA, 50 patients). Cough severity was assessed daily with a diary, by means of a validated verbal category-descriptive (VCD) Scale. RESULTS In every treatment group cough severity decreased over time (P<0.001); however, during the first week of treatment patients in groups S and SA experienced significantly lower VCD score values in comparison to Group A (P=0.045 and P=0.010, respectively). On the other hand, the VCD score was never significantly different between the two groups that received symptomatic treatment at any of the 4 weeks of the study, suggesting that the effect observed was due to the action of the mucoactive syrup. CONCLUSION Our data confirm the lack of efficacy of antibiotics in the management of productive cough in URTI and suggest that symptomatic treatment should be preferred to antibiotics in acute cough from URTI.
Collapse
Affiliation(s)
- A Zanasi
- Italian Association for Cough Study, Bologna, Italy -
| | | | | | | | | | | |
Collapse
|
15
|
Cerasola G, Cottone S, Mulé G, Nardi E, Mangano MT, Andronico G, Contorno A, Galione P, LaMilia D, Renda F, Piazza G, Volpe V, Lisi A, Ferrara L, Panepinto N. Relationship between microalbuminuria, blood pressure and cardiovascular changes in essential hypertension. Contrib Nephrol 2015; 119:130-34. [PMID: 8925655 DOI: 10.1159/000425462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- G Cerasola
- Internal Medicine and Hypertension Center, University of Palermo, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Mulè G, Riccobene R, Castiglia A, D'Ignoto F, Ajello E, Geraci G, Guarino L, Nardi E, Vaccaro F, Cerasola G, Cottone S. Relationships between mild hyperuricaemia and aortic stiffness in untreated hypertensive patients. Nutr Metab Cardiovasc Dis 2014; 24:744-750. [PMID: 24675008 DOI: 10.1016/j.numecd.2014.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 08/25/2013] [Revised: 01/02/2014] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Clinical studies exploring the relationship between serum uric acid (SUA) and arterial stiffness yielded conflicting results. Only in a few of these studies, arterial distensibility was examined by measuring aortic pulse wave velocity (PWV), which is considered the gold standard for evaluating arterial stiffness. In none of the previous investigations was the influence of SUA on aortic distensibility assessed, taking into account the effect of albuminuria. The purpose of our study was to comprehensively analyse the relationships between SUA and aortic PWV in a group of essential hypertensive patients. METHODS AND RESULTS We enrolled 222 untreated and uncomplicated hypertensive subjects (mean age: 44 ± 10 years; 60% males), without gout. In all patients, SUA and urinary albumin excretion rate (AER) were determined. Moreover, carotid-femoral (c-f) PWV was measured. C-f PWV was significantly higher in hypertensive patients belonging to the uppermost tertile of SUA distribution, compared to subjects of the lowest tertiles (10.9 ± 2.2 vs. 10 ± 1.8 vs. 9.9 ± 1.7 m s(-1); p = 0.001). In univariate analysis, SUA correlated with c-f PWV (r = 0.24; p < 0.001). This association disappeared when AER was added in a multiple regression model, including SUA, age, mean arterial pressure, gender, metabolic syndrome components and glomerular filtration rate. CONCLUSION The results of our study showed that, in essential hypertensive subjects, there is a positive relationship between mild hyperuricaemia and aortic stiffness. This association weakened after adjustment for covariates and lost statistical significance after further correction for albuminuria.
Collapse
Affiliation(s)
- G Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy.
| | - R Riccobene
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - A Castiglia
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - F D'Ignoto
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - E Ajello
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - G Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - L Guarino
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - E Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - F Vaccaro
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - G Cerasola
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - S Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| |
Collapse
|
17
|
Mulè G, Riccobene R, Castiglia A, D'Ignoto F, Ajello E, Geraci G, Guarino L, Nardi E, Vaccaro F, Cerasola G, Cottone S. Relationships between mild hyperuricaemia and aortic stiffness in untreated hypertensive patients. Nutr Metab Cardiovasc Dis 2014. [PMID: 24675008 DOI: 10.1016/j.numecd.2014.01.014]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Clinical studies exploring the relationship between serum uric acid (SUA) and arterial stiffness yielded conflicting results. Only in a few of these studies, arterial distensibility was examined by measuring aortic pulse wave velocity (PWV), which is considered the gold standard for evaluating arterial stiffness. In none of the previous investigations was the influence of SUA on aortic distensibility assessed, taking into account the effect of albuminuria. The purpose of our study was to comprehensively analyse the relationships between SUA and aortic PWV in a group of essential hypertensive patients. METHODS AND RESULTS We enrolled 222 untreated and uncomplicated hypertensive subjects (mean age: 44 ± 10 years; 60% males), without gout. In all patients, SUA and urinary albumin excretion rate (AER) were determined. Moreover, carotid-femoral (c-f) PWV was measured. C-f PWV was significantly higher in hypertensive patients belonging to the uppermost tertile of SUA distribution, compared to subjects of the lowest tertiles (10.9 ± 2.2 vs. 10 ± 1.8 vs. 9.9 ± 1.7 m s(-1); p = 0.001). In univariate analysis, SUA correlated with c-f PWV (r = 0.24; p < 0.001). This association disappeared when AER was added in a multiple regression model, including SUA, age, mean arterial pressure, gender, metabolic syndrome components and glomerular filtration rate. CONCLUSION The results of our study showed that, in essential hypertensive subjects, there is a positive relationship between mild hyperuricaemia and aortic stiffness. This association weakened after adjustment for covariates and lost statistical significance after further correction for albuminuria.
Collapse
Affiliation(s)
- G Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy.
| | - R Riccobene
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - A Castiglia
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - F D'Ignoto
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - E Ajello
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - G Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - L Guarino
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - E Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - F Vaccaro
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - G Cerasola
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - S Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| |
Collapse
|
18
|
Setchell KDR, Nardi E, Battezzati PM, Asciutti S, Castellani D, Perriello G, Clerici C. Novel soy germ pasta enriched in isoflavones ameliorates gastroparesis in type 2 diabetes: a pilot study. Diabetes Care 2013; 36:3495-7. [PMID: 23835688 PMCID: PMC3816848 DOI: 10.2337/dc12-1615] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 05/06/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the effect of soy germ pasta enriched in biologically active isoflavone aglycons on gastric emptying in type 2 diabetic patients with gastroparesis. RESEARCH DESIGN AND METHODS This randomized double-blind, placebo-controlled study compared soy germ pasta with conventional pasta for effects on gastric emptying. Patients (n = 10) with delayed gastric emptying consumed one serving per day of each pasta for 8 weeks, with a 4-week washout. Gastric emptying time (t1/2) was measured using the [(13)C]octanoic acid breath test at baseline and after each period, and blood glucose and insulin concentrations were determined after oral glucose load. RESULTS Soy germ pasta significantly accelerated the t1/2 in these patients (161.2 ± 17.5 min at baseline vs. 112.6 ± 11.2 min after treatment, P = 0.009). Such change differed significantly (P = 0.009) from that for conventional pasta (153.6 ± 24.2 vs. 156.2 ± 27.4 min), without affecting glucose or insulin concentrations. CONCLUSIONS These findings suggest that soy germ pasta may offer a simple dietary approach to managing diabetic gastropathy.
Collapse
|
19
|
Mulè G, Nardi E, Costanzo M, Mogavero M, Guarino L, Viola T, Vario MG, Cacciatore V, Andronico G, Cerasola G, Cottone S. Absence of an independent association between serum uric acid and left ventricular mass in Caucasian hypertensive women and men. Nutr Metab Cardiovasc Dis 2013; 23:715-722. [PMID: 22494808 DOI: 10.1016/j.numecd.2012.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 09/04/2011] [Revised: 12/09/2011] [Accepted: 01/18/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Experimentally uric acid may induce cardiomyocyte growth and interstitial fibrosis of the heart. However, clinical studies exploring the relationship between serum uric acid (SUA) and left ventricular (LV) mass yielded conflicting results. The aim of our study was to evaluate the relationships between SUA and LV mass in a large group of Caucasian essential hypertensive subjects. METHODS AND RESULTS We enrolled 534 hypertensive patients free of cardiovascular complications and without severe renal insufficiency. In all subjects routine blood chemistry, including SUA determination, echocardiographic examination and 24 h ambulatory blood pressure (BP) monitoring were obtained. In the overall population we observed no significant correlation of SUA with LV mass indexed for height(2.7) (LVMH(2.7)) (r = 0.074). When the same relationship was analysed separately in men and women, we found a statistically significant correlation in female gender (r = 0.27; p < 0.001), but not in males (r = -0.042; p = NS). When we grouped the study population in sex-specific tertiles of SUA, an increase in LVMH(2.7) was observed in the highest tertiles in women (44.5 ± 15.6 vs 47.5 ± 16 vs 55.9 ± 22.2 g/m(2.7); p < 0.001), but not in men. The association between SUA and LVMH(2.7) in women lost statistical significance in multiple regression analyses, after adjustment for age, 24 h systolic BP, body mass index, serum creatinine and other potential confounders. CONCLUSIONS Our findings do not support an independent association between SUA and LV mass in Caucasian men and women with arterial hypertension.
Collapse
Affiliation(s)
- G Mulè
- Dipartimento di Medicina Interna e Specialistica, Cattedra di Medicina Interna e Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Via del Vespro 129, 90127 Palermo, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Alezra D, Nardi E, Koren S, Bragilovski D, Orion I. SU-E-T-279: A Novel Electron-Beam Combined with Magnetic Field Application for Radiotherapy. Med Phys 2012; 39:3767-3768. [PMID: 28517301 DOI: 10.1118/1.4735347] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The new beam and delivery system consists of an electron accelerator and a system of magnets (one or more). Introducing a transverse magnetic field in and near the tumor, causes the electrons to spiral in this region, thereby producing an effective peak in the depth dose distribution, within the tumor volume. Although the basic idea is not new, we suggest here for the first time, a viable as well as a workable, magnetic field configuration, which in addition to focusing the beam does not interfere with its propagation to the target. METHODS The electron accelerator: can be a linear accelerator or any other type electron accelerator, capable of producing different electron energies for different depths and dose absorption accumulation. The Field size can be as small as a pencil beam and as big as any of the other standard field sizes that are used in radiotherapy. The scatter filter can be used or removed. The dose rate accumulation can be as higher as possible.The magnets are able to produce magnetic fields. The order, direction, width, place, shape and number of the magnetic fields define the shape and the Percentage Depth Dose (PDD) curve of the electron beam. Prototypes were successfully tested by means of computer simulation, using:COMSOL-Multiphsics for magnetic fields calculations. FLUKA package, for electron beam MC simulation. RESULTS Our results suggest that by using an electron beam at different energies, combined with magnetic fields, we could modify the delivered dose. This is caused by manipulating the electron motion via the Lorentz force. The applied magnetic field, will focus the electron beam at a given depth and deposit the energy in a given volume and depth, where otherwise the electron energy will have spread deeper. The direction and magnitude of the magnetic fields will prevent the scattering of the electron beam and its absorption in remote volumes. In practice, we get a pseudo Bragg peak depth dose distribution, applying a relatively low cost system. The therapeutic efficiency induced by the system is of similar efficiency as the ion beam therapy techniques. CONCLUSIONS Our novel concept demonstrates treatment that is almost similar to proton therapy and in some parameters even better performance.Unlike the current high-energy electron therapy, our system's beam deposit almost all of its energy on its target, with a low amount of radiation deposited in tissues from the surface of the skin to the front of tumor, and almost no "exit dose" beyond the tumor. This property will enables to hit tumors with higher, potentially more effective radiation doses, while being considerably less expensive.
Collapse
Affiliation(s)
- D Alezra
- Sheba Medical Center, Tel Hashomer.,Nuclear Engineering Dept, Ben Gurion University, Beer Sheva
| | - E Nardi
- Sheba Medical Center, Tel Hashomer.,Nuclear Engineering Dept, Ben Gurion University, Beer Sheva
| | - S Koren
- Sheba Medical Center, Tel Hashomer.,Nuclear Engineering Dept, Ben Gurion University, Beer Sheva
| | - D Bragilovski
- Sheba Medical Center, Tel Hashomer.,Nuclear Engineering Dept, Ben Gurion University, Beer Sheva
| | - I Orion
- Sheba Medical Center, Tel Hashomer.,Nuclear Engineering Dept, Ben Gurion University, Beer Sheva
| |
Collapse
|
21
|
Clerici C, Nardi E, Battezzati PM, Asciutti S, Castellani D, Corazzi N, Giuliano V, Gizzi S, Perriello G, Di Matteo G, Galli F, Setchell KD. Novel soy germ pasta improves endothelial function, blood pressure, and oxidative stress in patients with type 2 diabetes. Diabetes Care 2011; 34:1946-8. [PMID: 21788625 PMCID: PMC3161297 DOI: 10.2337/dc11-0495] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 05/27/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the effects of a novel soy germ-enriched pasta, containing isoflavone aglycons, with conventional pasta on endothelial function and cardiovascular risk markers in patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS This randomized controlled double-blind crossover study compared one serving/day of soy germ pasta and conventional pasta for 8 weeks for effects on brachial artery flow-mediated vasodilation, blood pressure, plasma lipids, oxidized LDL cholesterol, 8-iso-PGF2α, total antioxidant capacity (TAC), glutathione (GSH), and homocysteine. RESULTS Isoflavone-enriched pasta significantly improved arterial stiffness (P = 0.005) and reduced systolic (P = 0.026) and diastolic (P = 0.017) blood pressures. Plasma TAC increased (P = 0.0002), oxidized LDL cholesterol decreased (P = 0.009), 8-iso-PGF2α decreased (P = 0.001), GSH levels increased (P = 0.0003), and homocysteine decreased (P = 0.009) consistent with a reduction in oxidative stress. No significant changes were observed with conventional pasta. CONCLUSIONS Pasta enriched with biologically active isoflavone aglycons improved endothelial function and had beneficial effects on cardiovascular risk markers in patients with T2D.
Collapse
Affiliation(s)
- Carlo Clerici
- Clinic of Gastroenterology and Hepatology, University of Perugia, Perugia, Italy
| | - Elisabetta Nardi
- Clinic of Gastroenterology and Hepatology, University of Perugia, Perugia, Italy
| | - Pier Maria Battezzati
- Division of Internal Medicine VI, Department of Medicine, Surgery, and Dentistry, San Paolo School of Medicine, University of Milan, Milan, Italy
| | - Stefania Asciutti
- Clinic of Gastroenterology and Hepatology, University of Perugia, Perugia, Italy
| | - Danilo Castellani
- Clinic of Gastroenterology and Hepatology, University of Perugia, Perugia, Italy
| | - Nadia Corazzi
- Clinic of Gastroenterology and Hepatology, University of Perugia, Perugia, Italy
| | - Vittorio Giuliano
- Clinic of Gastroenterology and Hepatology, University of Perugia, Perugia, Italy
| | - Stefania Gizzi
- Clinic of Gastroenterology and Hepatology, University of Perugia, Perugia, Italy
| | - Gabriele Perriello
- Department of Internal Medicine and Endocrine and Metabolic Sciences (DIMISEM), University of Perugia, Perugia, Italy
| | - Giorgio Di Matteo
- Department of Internal Medicine and Endocrine and Metabolic Sciences (DIMISEM), University of Perugia, Perugia, Italy
| | - Francesco Galli
- Institute of Biochemistry, University of Perugia, Perugia, Italy
| | - Kenneth D.R. Setchell
- Department of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
22
|
Castellani D, Nardi E, Baldoni M, Bassotti G. Duodenal submucosal tunnelization by fishbone. Dig Liver Dis 2011; 43:e7. [PMID: 20708985 DOI: 10.1016/j.dld.2010.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 06/23/2010] [Accepted: 07/12/2010] [Indexed: 12/11/2022]
Affiliation(s)
- Danilo Castellani
- Gastroenterology & Hepatology Section, Department of Clinical & Experimental Medicine, University of Perugia Medical School, Perugia, Italy
| | | | | | | |
Collapse
|
23
|
Nardi E, Palermo A, Cusimano P, Mule G, Cerasola G. Electrocardiography plus limited echocardiography in young, newly identified, hypertensives: some considerations. Am J Hypertens 2010; 23:1050. [PMID: 20852598 DOI: 10.1038/ajh.2010.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
24
|
Asciutti S, Kanninen TT, Clerici G, Nardi E, Castellani D, DI Renzo GC, Clerici C. Acute pancreatitis with a mucinous cystoadenoma of the pancreas in pregnancy. Anticancer Res 2010; 30:1025-1028. [PMID: 20393031] [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: 05/29/2023]
Abstract
Pregnancy complicated by pancreatitis is a rare and difficultly managed clinical situation. Gallstones are the most frequent cause of pancreatitis in pregnancy. Non-gallstone pancreatitis in pregnancy has been shown to be significantly more prone to premature delivery and pseudocyst formation. Cystic lesions as a cause of pancreatitis in pregnancy have not, to our knowledge, been observed. Pancreatic cystic lesions in general are rare, but are difficult to treat given problems in clarifying their malignancy. Mucinous cystic neoplasms are considered premalignant lesions and resection is recommended. Receptors for estrogen and progesterone receptors in these cysts may cause cystic growth during pregnancy. Treatment recommendations for pancreatitis in pregnancy are not well defined; this applies as well to treatment protocols for cystic lesions. In this case report we describe a new potential cause of acute pancreatitis in pregnancy due to compression of the principal pancreatic duct by a mucinous cystoadenoma.
Collapse
Affiliation(s)
- Stefania Asciutti
- Clinica di Gastroenterologia ed Epatologia, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia 06100, Italy.
| | | | | | | | | | | | | |
Collapse
|
25
|
Cerasola G, Mulè G, Nardi E, Cusimano P, Palermo A, Arsena R, Guarneri M, Geraci C, Cottone S. Clinical correlates of renal dysfunction in hypertensive patients without cardiovascular complications: the REDHY study. J Hum Hypertens 2010; 24:44-50. [PMID: 19440210 PMCID: PMC3017309 DOI: 10.1038/jhh.2009.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Revised: 04/16/2009] [Accepted: 04/16/2009] [Indexed: 01/23/2023]
Abstract
Our study was aimed to assess the clinical correlates of different degrees of renal dysfunction in a wide group of non-diabetic hypertensive patients, free from cardiovascular (CV) complications and known renal diseases, participating to the REDHY (REnal Dysfunction in HYpertension) study. A total of 1856 hypertensive subjects (mean age: 47+/-14 years), attending our hypertension centre, were evaluated. The glomerular filtration rate (GFR) was estimated by the simplified Modification of Diet in Renal Disease Study prediction equation. A 24-h urine sample was collected to determine albumin excretion rate (AER). Albuminuria was defined as an AER greater than 20 microg min(-1). We used the classification proposed by the US National Kidney Foundation's guidelines for chronic kidney disease (CKD) to define the stages of renal function impairment. In multiple logistic regression analysis, the probability of having stage 1 and stage 2 CKD was significantly higher in subjects with greater values of systolic blood pressure (SBP) and with larger waist circumference. SBP was also positively related to stage 3 CKD. Stage 3 and stages 4-5 CKD were inversely associated with waist circumference and directly associated with serum uric acid. Age was inversely related to stage 1 CKD and directly related to stage 3 CKD. The factors associated with milder forms of kidney dysfunction are, in part, different from those associated with more advanced stages of renal function impairment.
Collapse
Affiliation(s)
- G Cerasola
- Cattedra di Medicina Interna, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - G Mulè
- Cattedra di Medicina Interna, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - E Nardi
- Cattedra di Medicina Interna, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - P Cusimano
- Cattedra di Medicina Interna, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - A Palermo
- Cattedra di Medicina Interna, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - R Arsena
- Cattedra di Medicina Interna, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - M Guarneri
- Cattedra di Medicina Interna, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - C Geraci
- Cattedra di Medicina Interna, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - S Cottone
- Cattedra di Nefrologia, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| |
Collapse
|
26
|
Asciutti S, Castellani D, Nardi E, Morelli O, Clementi M, Chistolini F, Gentili G, Setchell KDR, O'Connell N, Pellicciari R, Clerici C. A new amino acid derivative of ursodeoxycholate, (N-L-Glutamyl)-UDCA (UDCA-Glu), to selectively release UDCA in the colon. Anticancer Res 2009; 29:4971-4979. [PMID: 20044604] [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: 05/28/2023]
Abstract
BACKGROUND Ursodeoxycholic acid (UDCA) is chemoprotective in animal models of colon cancer but results from clinical trials have been less impressive probably because UDCA is rapidly absorbed in the small intestine and little reaches the colon. UDCA-glutamate (Glu), a novel bile acid, was synthesized with the objective of utilizing peptide bond cleavage by brush border enzymes to enhance delivery of UDCA to the colon. MATERIALS AND METHODS Qualitative and quantitative intestinal intraluminal and fecal bile acid composition measured by mass spectrometry was determined in Fisher rats after intragastric administration of UDCA, or UDCA-Glu for 5 days. The effect of UDCA and UDCA-Glu on bile flow was studied after bile duct canulation. RESULTS In the small intestine, UDCA was found in higher amounts when UDCA was administered compared with UDCA-Glu (1.50 + or - 0.32 vs. 0.75 + or - 0.12 mg). By contrast, UDCA-Glu administration resulted in a greater delivery of UDCA to the colon. The fecal bile acid composition resembled that of the intraluminal colonic composition and a higher mass of UDCA (unconjugated 3.39 + or - 0.30 mg; conjugated 6.40 + or - 1.03 mg) was found in rats treated with UDCA-Glu compared to those treated with UDCA (2.27 + or - 0.11 and. 0.04 + or - 0.01 mg, respectively), establishing increased delivery of UDCA to the colon. Both bile acids similarly increased bile flow but the initial effect of UDCA was greater than that of UDCA-Glu. CONCLUSION Conjugation of UDCA to glutamic acid reduces its intestinal absorption and biotransformation resulting in increased colonic delivery of UDCA. UDCA-Glu may have potential application as a pro-drug for enhancing the action of UDCA in the treatment of colonic diseases.
Collapse
Affiliation(s)
- Stefania Asciutti
- Clinica di Gastroenterologia ed Epatologia dell'Università degli Studi di Perugia, Ospedale S.Maria della Misericordia, S.Andrea delle Fratte, 06156 Perugia, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Geraci C, Mulè G, Cottone S, Arsena R, Guarneri M, Cusimano P, Palermo A, Nardi E, Cerasola G. Aneurysm of the superior thyroid artery in a 80-year-old man: case report. Minerva Cardioangiol 2008; 56:707-708. [PMID: 19092749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
28
|
Mulè G, Cusimano P, Nardi E, Cottone S, Geraci C, Palermo A, Costanzo M, Foraci AC, Cerasola G. Relationships between metabolic syndrome and left ventricular mass in hypertensive patients: does sex matter? J Hum Hypertens 2008; 22:788-95. [PMID: 18596721 DOI: 10.1038/jhh.2008.69] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Several studies documented an association between metabolic syndrome (MetS) and left ventricular (LV) hypertrophy. However, only in a few of these studies the impact of MetS on left ventricular mass (LVM) was separately analysed by gender, with conflicting results. The aim of our study was to verify, in a wide sample of essential hypertensive patients, the influence of gender, if any, on the relationship between MetS and LVM. We enrolled 475 non-diabetic subjects (mean age: 46 +/- 11 years), with mild-to-moderate essential hypertension, of whom 40% had MetS, defined on the basis of Adult Treatment Panel III (ATPIII) criteria. All the patients underwent a 24-h ambulatory blood pressure monitoring and an echocardiogram. LVM indexed for height (2.7) (LVMH (2.7)) was significantly (P < 0.001) higher in women with MetS (n=83) than in those without it (n=97; 54+/-17 vs 42+/-11 g m(-2.7)). An equally significant difference in LVMH (2.7) was documented also in male gender between the two groups with (n=105) and without MetS (n=190; 51+/-14 vs 43+/-11 g m(-2.7); P < 0.001). The relationship between MetS and LVMH (2.7) remained statistically significant (P < 0.001) in both sexes, in multiple regression analyses, even after adjustment for potential confounding factors. Our results seem to suggest that the relationship between MetS and LVM is not significantly affected by gender, being LVM increased in both hypertensive women and men with MetS.
Collapse
Affiliation(s)
- G Mulè
- Cattedra di Medicina Interna, Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Cottone S, Guarneri M, Mulè G, Riccobene R, Lorito MC, Nardi E, Arsena R, Palermo A, Cusimano P, Vaccaro F, Tornese F, Canale C, Vadalà A, Cerasola G. 12.8 Endotelin-1 and 8-Isoprostanes Predict Estimated Glomerular Filtration Rate in Arterial Hypertension. High Blood Press Cardiovasc Prev 2008. [DOI: 10.1007/bf03263729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
30
|
Nardi E, Palermo A, Mulè G, Cusimano P, Cottone S, Re A, Bellavia T, Cerasola G. 5.16 Left Ventricular Geometry In Chronic Kidney Disease. High Blood Press Cardiovasc Prev 2008. [DOI: 10.1007/bf03263636] [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: 11/27/2022] Open
|
31
|
Mule G, Cottone S, Cusimano P, Incalcaterra F, Giandalia M, Costanzo M, Nardi E, Palermo A, Geraci C, Costa R, Cerasola G. Inverse relationship between ambulatory arterial stiffness index and glomerular filtration rate in arterial hypertension. Am J Hypertens 2008; 21:35-40. [PMID: 18091742 DOI: 10.1038/ajh.2007.10] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Arterial stiffness and mild-to-moderate renal dysfunction are predictors of cardiovascular (CV) morbidity and mortality. Recently, the ambulatory arterial stiffness index (AASI) has been proposed as a surrogate index of arterial stiffness. It has been associated with an enhanced risk of stroke. The aim of our study was to assess the relationship between AASI and glomerular filtration rate (GFR) in a group of hypertensive patients with no CV complications. METHODS A total of 143 untreated hypertensive subjects (mean age: 44 +/- 12 years; men 57%), with serum creatinine <1.5 mg/dl, were enrolled. AASI was calculated as one minus the regression slope of diastolic on systolic blood pressure (BP) obtained by individual 24-h BP recordings. GFR was computed from the scintigraphic determination of the technetium-99m diethylenetriaminepentaacetic acid uptake within the kidneys, by the Gates' method. RESULTS Hypertensive patients with AASI above the median value (n = 71) had lower GFR than those with AASI below the median (n = 72) (98.3 +/- 31 vs. 122.4 +/- 32 ml/min/1.73 m(2); P < 0.001). This difference held even after adjustment for age and gender. The linear regression analysis disclosed a significant inverse correlation between GFR and AASI (r = -0.30; P < 0.001), that was replicated (beta = -0.19; P = 0.02) in a multiple regression model including, as independent variables (besides AASI), age, gender, high-density lipoprotein cholesterol, body mass index, 24-h pulse pressure (PP) and nocturnal reduction in BP. CONCLUSIONS AASI is inversely related to GFR in arterial hypertension. This may help to explain the increased CV risk associated with mild-to-moderate renal dysfunction.
Collapse
|
32
|
Nardi E, Marioni L, Forfori F, Licitra G, Del Turco M, Giunta F. Therapy with teicoplanin in the ICU: continuous intravenous infusion or intermittent intravenous administration? Crit Care 2008. [PMCID: PMC4088402 DOI: 10.1186/cc6252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
33
|
Battaglia A, Calace N, Nardi E, Petronio BM, Pietroletti M. Reduction of Pb and Zn bioavailable forms in metal polluted soils due to paper mill sludge addition. Effects on Pb and Zn transferability to barley. Bioresour Technol 2007; 98:2993-9. [PMID: 17126014 DOI: 10.1016/j.biortech.2006.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Revised: 10/11/2006] [Accepted: 10/12/2006] [Indexed: 05/12/2023]
Abstract
In the last few years solidification/stabilisation of acidic soils polluted by heavy metals with low-cost sorbents has been investigated. Paper mill sludges are produced in large amounts and their disposal is a serious environmental problem. The possibility was therefore studied of using paper mill sludge as a stabilizer to reduce the bioavailable metal forms in polluted soils and thus the transferability of metals to plants (barley). We first investigated the sorbing properties of paper mill sludge for Zn(II) and Pb(II) and then their fractionation both in a polluted soil and in the same soil amended with paper mill sludge in order to check the decrease in mobile forms. Finally in both soils we tested the uptake of two metals by common barley in order to assess the performance of soil remediation from an ecological point of view. The addition of paper mill sludge to a soil contaminated by lead and zinc induces a decrease in the mobile forms of both metals, probably due to the presence in sludge of organic matter and kaolinite, which are able to bind the metals very strongly. The decrease in the mobile forms, which are the most readily available for uptake by plants, corresponds to a decrease in plant uptake.
Collapse
Affiliation(s)
- A Battaglia
- Department of Chemistry, University La Sapienza, Rome, Italy
| | | | | | | | | |
Collapse
|
34
|
Clerici C, Setchell KDR, Battezzati PM, Pirro M, Giuliano V, Asciutti S, Castellani D, Nardi E, Sabatino G, Orlandi S, Baldoni M, Morelli O, Mannarino E, Morelli A. Pasta naturally enriched with isoflavone aglycons from soy germ reduces serum lipids and improves markers of cardiovascular risk. J Nutr 2007; 137:2270-8. [PMID: 17885010 DOI: 10.1093/jn/137.10.2270] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [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: 11/14/2022] Open
Abstract
Most studies of soy and cholesterol have tested foods made from purified soy proteins containing mainly isoflavone glycosides. Fermented soy foods have mainly isoflavone aglycons and account for a high proportion of the soy protein source in Asia, where there is an inverse relationship between soy intake and serum cholesterol. The aim of this study was to compare a novel soy germ pasta, naturally enriched in isoflavone aglycons as a result of the manufacturing process, with conventional pasta for effects on serum lipids and other cardiovascular risk markers. In this randomized, controlled, parallel study design of 62 adults with hypercholesterolemia who consumed a Step II diet that included one 80-g serving/d of pasta, we measured serum lipids, high sensitivity C-reactive protein (hsCRP), urinary isoprostanes, and brachial artery flow-mediated vasodilatation at baseline and after 4 and 8 wk. The pasta delivered 33 mg of isoflavones and negligible soy protein and led to a serum isoflavone concentration of 222 +/- 21 nmol/L; 69% of subjects were equol producers. Soy germ pasta reduced serum total and LDL cholesterol by 0.47 +/- 0.13 mmol/L (P = 0.001) and 0.36 +/- 0.10 mmol/L (P = 0.002) more than conventional pasta, representing reductions from baseline of 7.3% (P = 0.001) and 8.6% (P = 0.002), respectively. Arterial stiffness (P = 0.003) and hsCRP (P = 0.03) decreased and improvements in all the above risk markers were greatest in equol producers. All measures returned to baseline when patients were switched to conventional pasta. In conclusion, pasta naturally enriched with isoflavone aglycons and lacking soy protein had a significant hypocholesterolemic effect beyond a Step II diet and improved other cardiovascular risk markers.
Collapse
Affiliation(s)
- Carlo Clerici
- Clinica di Gastroenterologia ed Epatologia, Università degli Studi di Perugia, Perugia, Italy 06100
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Cottone S, Nardi E, Mulè G, Vadalà A, Lorito MC, Riccobene R, Palermo A, Arsena R, Guarneri M, Cerasola G. Association between biomarkers of inflammation and left ventricular hypertrophy in moderate chronic kidney disease. Clin Nephrol 2007; 67:209-16. [PMID: 17474556 DOI: 10.5414/cnp67209] [Citation(s) in RCA: 43] [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: 11/18/2022] Open
Abstract
AIMS Left ventricular hypertrophy (LVH) is a predictor for cardiovascular mortality, and it is considered to be a surrogate marker of preclinical cardiovascular disease. This study aimed at evaluating whether fetuin-A plasma levels are decreased in patients with moderate chronic kidney disease (CKD) and their linkage to plasma concentrations of hs-C-reactive protein (CRP), cardiotrophyn-1 (CT-1), tumor necrosis factor-ac (TNF-alpha), propeptide of collagen Type I (PIP) and to LVH. MATERIAL AND METHODS We enrolled 64 moderate CKD and 55 essential hypertensives (EH) with normal renal function as controls. All the patients underwent an echocardiographic examination; plasma samples were obtained to measure routine clinical parameters and the molecules listed above (measured by ELISA). RESULTS Among CKD there were 30/64 patients with LVH, and in EH group 14/55 subjects had LVH. Fetuin A was reduced in CKD when compared with EH (p < 0.0001). The comparison between CKD having LVH with those without LVH showed significant differences in plasma levels of fetuin-A (p < 0.002), TNF-alpha (p < 0.01) and hs-CRP (p < 0.001), CT-1 and PIP (p < 0.002). CKD with LVH had lower values of fetuin-A (p < 0.001), and higher values of hs-CRP (p < 0.001) TNF-alpha (p < 0.001), CT-1 (p < 0.001) and PIP (p < 0.001) than EH with LVH. The multivariate analysis of correlation demonstrated that in CKD patients hs-CRP (beta 0.42, p < 0.00006), and systolic blood pressure (beta 0.29, p < 0.02) were independent predictors of LV mass index. The relationship between LV mass index and fetuin-A did not reach statistical significance. CONCLUSIONS For the first time in moderate CKD patients, we demonstrate that fetuin-A is decreased and relates to LVH depending on C-reactive protein.
Collapse
Affiliation(s)
- S Cottone
- Dipartimento di Medicina Interna, Malattie Cardiovascolari e NefroUrologiche, Divisione di Medicina Interna, Nefrologia ed Ipertensione ed Unità Operativa semplice di Malattie Renali ed Ipertensione, Università di Palermo, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Mulè G, Nardi E, Cottone S, Cusimano P, Incalcaterra F, Palermo A, Giandalia M, Geraci C, Buscemi S, Cerasola G. Metabolic syndrome in subjects with white-coat hypertension: impact on left ventricular structure and function. J Hum Hypertens 2007; 21:854-60. [PMID: 17541385 DOI: 10.1038/sj.jhh.1002238] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 12/25/2022]
Abstract
Some reports have suggested that white-coat hypertension (WCH) is associated with some features of the metabolic syndrome (MetS). These metabolic disturbances, instead of WCH per se, may potentially explain the greater extent of end-organ damage sometimes observed in WCH subjects (WCHs) when compared to normotensive individuals (NTs). The aim of the present cross-sectional study was to compare left ventricular (LV) structure and function in three groups of subjects: WCHs with MetS, WCHs without MetS and NTs. A total of 145 WCHs, 35% of whom had MetS, were enrolled. As controls, 35 NTs were also studied. In all subjects, routine blood chemistry, echocardiographic examination and 24-h ambulatory blood pressure monitoring were performed. When compared with WCHs without MetS, those with MetS showed higher LV mass indexed by height elevated by a power of 2.7 (LVMH(2.7)) (49.6+/-14.8 vs 38.9+/-9.8 g/m(2.7); P<0.0001). The same parameter was greater in WCHs without MetS than in NTs (32+/-8 g/m(2.7); P=0.004). Moreover, the E-wave deceleration time was longer in WCHs with MetS than in those without it (236.2+/-66.4 vs 200.5+/-30.8 ms; P<0.0001). The relationship of MetS with LVMH(2.7) was confirmed in multivariate regression models. Our results seem to suggest that MetS may have a deleterious influence on LV structure and function in WCH. However, WCH, being associated with an increased LV mass, also in subjects without MetS, may not be considered as an innocuous phenomenon.
Collapse
Affiliation(s)
- G Mulè
- Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Cattedra di Medicina Interna e Unità Operativa di Medicina Interna, Nefrologia ed Ipertensione Università di Palermo, Palermo, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Cerasola G, Cottone S, Mule G, Nardi E, Cusimano P, Guarneri M, Arsena R, Briolotta C, Tornese D. The REDHY Study: Prevalence of Decreased Renal Function in Uncomplicated Essential Hypertension. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00112] [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: 11/02/2022] Open
|
38
|
Nardi E, Mulè G, Cottone S, Palermo A, Cusimano P, Cerasola G. Patterns of Left Ventricular Hypertrophy in Hypertensives with Chronic Renal Insufficiency. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00062] [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: 11/02/2022] Open
|
39
|
Muleʼ G, Cottone S, Cusimano P, Incalcaterra F, Giandalia M, Costanzo M, Palermo A, Nardi E, Geraci C, Costa R, Cerasola G. Relationship Between Ambulatory Artery Stiffness Index and Glomerular Filtration Rate in Essential Hypertension. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00011] [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: 11/02/2022] Open
|
40
|
Cerasola G, Nardi E, Mule G, Cottone S, Cusimano P, Palermo A, Mezzatesta G, Incalcaterra F, Rallo D, Geraci C. Inverse Relationships between Glomerular Filtration Rate and Left Ventricular Mass in Uncomplicated Arterial Hypertension. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00063] [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: 11/02/2022] Open
|
41
|
Cerasola G, Mule G, Cottone S, Nardi E, Cusimano P, Lo Cicero A, Buscemi B, Giammaresi G, Tamburello S. Influence of Different Methods to Estimate the Glomerular Filtration Rate on the Prevalence of Decreased Renal Function in Arterial Hypertension. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00111] [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: 11/02/2022] Open
|
42
|
Cottone S, Mulè G, Nardi E, Lorito MC, Guarneri M, Arsena R, Briolotta C, Vadalà A, Cerasola G. Microalbuminuria and early endothelial activation in essential hypertension. J Hum Hypertens 2006; 21:167-72. [PMID: 17051235 DOI: 10.1038/sj.jhh.1002109] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We hypothesized that in essential hypertensive patients (EHs), plasma levels of pro-atherogenic adhesion molecules would be increased and related with urine albumin excretion (UAE). Thus, this study was aimed at evaluating biochemical markers of endothelial activation and their relationship with UAE in a group of patients with uncomplicated EH. In basal condition soluble forms of adhesion molecules intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1, as well as 24-h UAE were assayed. One hundred patients with essential hypertension and no diabetes or ultrasonographic evidence of atherosclerosis were included in the study. Seventy normotensive healthy subjects served as controls. EHs were first studied overall, than were divided into two subgroups: those with UAE > or =20 mcg/min MAUs and those with UAE <20 mcg/min (non-MAUs). ICAM-1 (P<0.001) and VCAM-1 (P<0.0001) plasma concentrations were higher in EHs than in controls. Microalbuminuric EHs had greater levels of adhesion molecules than non-MAUs (ICAM-1 P=0.04; VCAM-1 P=0.02, respectively). In EHs UAE was correlated with ICAM-1 (r=0.29, P=0.003), and VCAM-1 (r=0.30, P=0.002). These associations were confirmed in multiple regression models (P=0.02 for both ICAM-1 and VCAM-1) including, along with adhesion molecules, age, body mass index and blood pressures. Our findings show that in essential hypertension there is a very early activation of endothelial adhesion molecules favouring atherosclerosis.
Collapse
Affiliation(s)
- S Cottone
- Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Cattedra di Medicina Interna ed Unità Operativa di Medicina Interna, Nefrologia ed Ipertensione, Università di Palermo, Palermo, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Morelli O, Castellani D, Asciutti S, Baldoni M, Familiari L, Nardi E, Morelli A, Clerici C. Colon and gastric metastases from a primary signet-ring cell carcinoma of the urinary bladder. Dig Liver Dis 2006; 38:609-11. [PMID: 16551516 DOI: 10.1016/j.dld.2005.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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] [Received: 06/15/2005] [Revised: 11/04/2005] [Accepted: 11/30/2005] [Indexed: 12/11/2022]
Abstract
Signet-ring cell carcinoma is a relatively rare neoplasm that rarely occurs in the urinary bladder. We report a case of a 60-year-old man who presented with gross haematuria. Cystoscopy revealed a white sessile tumour of the anterior bladder wall. The histological diagnosis showed a primary signet-ring cell carcinoma of the bladder (T3bN0M0). Eighteen months after radical cystectomy, the patient developed colon and stomach metastases. This case represents the first description of a primary signet-ring cell carcinoma of the urinary bladder with gastrointestinal metastases.
Collapse
Affiliation(s)
- O Morelli
- Department of Clinical and Experimental Medicine, Clinic of Gastroenterology and Hepatology, University of Perugia, Perugia, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Clerici C, Castellani D, Asciutti S, Pellicciari R, Setchell KDR, O'Connell NC, Sadeghpour B, Camaioni E, Fiorucci S, Renga B, Nardi E, Sabatino G, Clementi M, Giuliano V, Baldoni M, Orlandi S, Mazzocchi A, Morelli A, Morelli O. 3α-6α-Dihydroxy-7α-fluoro-5β-cholanoate (UPF-680), physicochemical and physiological properties of a new fluorinated bile acid that prevents 17α-ethynyl-estradiol-induced cholestasis in rats. Toxicol Appl Pharmacol 2006; 214:199-208. [PMID: 16487557 DOI: 10.1016/j.taap.2005.12.017] [Citation(s) in RCA: 6] [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] [Received: 11/09/2005] [Revised: 12/13/2005] [Accepted: 12/14/2005] [Indexed: 01/06/2023]
Abstract
3alpha-6alpha-Dihydroxy-7alpha-fluoro-5beta-cholanoate (UPF-680), the 7alpha-fluorine analog of hyodeoxycholic acid (HDCA), was synthesized to improve bioavailability and stability of ursodeoxycholic acid (UDCA). Acute rat biliary fistula and chronic cholestasis induced by 17alpha-ethynyl-estradiol (17EE) models were used to study and compare the effects of UPF-680 (dose range 0.6-6.0 micromol/kg min) with UDCA on bile flow, biliary bicarbonate (HCO(3)(-)), lipid output, biliary bile acid composition, hepatic enzymes and organic anion pumps. In acute infusion, UPF-680 increased bile flow in a dose-related manner, by up to 40.9%. Biliary HCO(3)(-) output was similarly increased. Changes were observed in phospholipid secretion only at the highest doses. Treatment with UDCA and UPF-680 reversed chronic cholestasis induced by 17EE; in this model, UDCA had no effect on bile flow in contrast to UPF-680, which significantly increased bile flow. With acute administration of UPF-680, the biliary bile acid pool became enriched with unconjugated and conjugated UPF-680 (71.7%) at the expense of endogenous cholic acid and muricholic isomers. With chronic administration of UPF-680 or UDCA, the main biliary bile acids were tauro conjugates, but modification of biliary bile acid pool was greater with UPF-680. UPF-680 increased the mRNA for cytochrome P450 7A1 (CYP7A1) and cytochrome P450 8B (CYP8B). Both UDCA and UPF-680 increased the mRNA for Na(+) taurocholate co-transporting polypeptide (NCTP). In conclusion, UPF-680 prevented 17EE-induced cholestasis and enriched the biliary bile acid pool with less detergent and cytotoxic bile acids. This novel fluorinated bile acid may have potential in the treatment of cholestatic liver disease.
Collapse
Affiliation(s)
- Carlo Clerici
- Clinica di Gastroenterologia ed Epatologia, Dipartimento di Medicina Clinica e Sperimentale Università degli Studi di Perugia, 06122 Perugia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Mulé G, Cottone S, Nardi E, Andronico G, Cerasola G. Metabolic syndrome in subjects with essential hypertension: relationships with subclinical cardiovascular and renal damage. Minerva Cardioangiol 2006; 54:173-94. [PMID: 16778751] [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: 05/10/2023]
Abstract
It has long been recognized that arterial hypertension is often a part of a larger constellation of anthropometric and metabolic abnormalities that includes abdominal (or visceral) obesity, a characteristic dyslipidemia (low high-density lipoprotein cholesterol and high triglycerides), glucose intolerance, insulin-resistance and hyperuricemia. These traits occur simultaneously to a greater degree than would be expected by chance alone, supporting the existence of a discrete disorder that, over the years, has been defined by a variety of terms, including plurimetabolic syndrome, the deadly quartet, dysmetabolic syndrome, insulin resistance syndrome, cardiometabolic syndrome and more recently metabolic syndrome (MS). In last years some scientific organizations proposed working definitions for MS. Among these definitions, the one suggested by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATPIII) is the simplest and the most commonly applied. The MS is extremely common worldwide. This high prevalence is of considerable concern because accumulating evidences suggest that the MS, even without type 2 diabetes, carries an increased risk for cardiovascular and renal events. Recently it has been demonstrated that the adverse prognostic impact of MS may also be extended to hypertensive patients. Some recent studies reported an increased prevalence of left ventricular hypertrophy, diastolic dysfunction, early carotid atherosclerosis, impaired aortic distensibility, hypertensive retinopathy and microalbuminuria in hypertensive patients with MS when compared to those without it. The increased occurrence of these early signs of subclinical target organ damage, most of which are recognized as significant independent predictors of adverse cardiovascular and renal outcomes, may partially explain the association of the MS with a higher cardiovascular and renal risk.
Collapse
Affiliation(s)
- G Mulé
- Unit of Internal Medicine, Department of Internal Medicine, Cardiovascular and Nephro-Urological Diseases, University of Palermo, Palermo, Italy.
| | | | | | | | | |
Collapse
|
46
|
Mulè G, Nardi E, Cottone S, Cusimano P, Volpe V, Piazza G, Mongiovì R, Mezzatesta G, Andronico G, Cerasola G. Influence of metabolic syndrome on hypertension-related target organ damage. J Intern Med 2005; 257:503-13. [PMID: 15910554 DOI: 10.1111/j.1365-2796.2005.01493.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [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: 12/13/2022]
Abstract
OBJECTIVES The aim of our study was to analyse, in a wide group of essential hypertensive patients without diabetes mellitus, the influence of metabolic syndrome (MS) (defined according to the criteria laid down in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) on markers of preclinical cardiac, renal and retinal damage. DESIGN Cross-sectional study. SETTING Outpatient hypertension clinic. SUBJECTS AND METHODS A total of 353 young and middle-aged hypertensives, free from cardiovascular and renal diseases (and 37% of whom had MS), underwent echocardiographic examination, microalbuminuria determination and non-mydriatic retinography. RESULTS When compared with subjects without MS, hypertensive patients with MS exhibited more elevated left ventricular (LV) mass (either normalized by body surface area or by height elevated by a power of 2.7), higher myocardial relative wall thickness, albumin excretion rate (AER) and a greater prevalence of LV hypertrophy (57.7% vs. 25.1%; P < 0.00001), of microalbuminuria (36.2% vs. 19.3%; P = 0.002) and of hypertensive retinopathy (87.7% vs. 48.4%; P < 0.00001). These results held even after correction for age, 24-h blood pressures, duration of hypertension, previous antihypertensive therapy, and gender distribution. The independent relationships between LV mass and MS, and between AER and MS, were confirmed in multivariate regression models including MS together with its individual components. CONCLUSIONS MS may amplify hypertension-related cardiac and renal changes, over and above the potential contribution of each single component of this syndrome. As these markers of target organ damage are well-known predictors of cardiovascular events, our results may partly explain the enhanced cardiovascular risk associated with MS.
Collapse
Affiliation(s)
- G Mulè
- Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Università di Palermo, Palermo, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Mulè G, Cottone S, Vadalà A, Volpe V, Mezzatesta G, Mongiovì R, Piazza G, Nardi E, Andronico G, Cerasola G. Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients. J Intern Med 2004; 256:22-9. [PMID: 15189362 DOI: 10.1111/j.1365-2796.2004.01338.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [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: 11/28/2022]
Abstract
OBJECTIVES To evaluate, in a group of nondiabetic essential hypertensive patients with normal renal function, the relationship between albumin excretion rate (AER) and carotid-femoral pulse wave velocity (PWV), as an index of aortic stiffness. DESIGN Cross-sectional study. SETTING Outpatient hypertension clinic. SUBJECTS Seventy patients with mild-to-moderate essential hypertension, aged 42 +/- 8 years, never pharmacologically treated. All subjects underwent routine laboratory tests, 24-h ambulatory blood pressure (BP) monitoring, measurement of carotid-femoral PWV, by means of a computerized method, and AER. RESULTS Microalbuminuric patients (AER > or = 20 microg min(-1); n = 19), when compared with normoalbuminuric subjects, showed more elevated 24-h BP (136/88 +/- 10/10 vs. 128/83 +/- 7/6 mmHg; P < 0.001 and P = 0.013, for systolic and diastolic BP respectively) and higher values of carotid-femoral PWV (10.4 +/- 2 m s(-1) vs. 9.2 +/- 1.3; P = 0.006). This latter difference remained statistically significant, even after correction by ancova for 24-h systolic and diastolic BP, and body mass index (BMI, P = 0.016). Univariate regression analysis disclosed a tight correlation between AER and carotid-femoral PWV (r = 0.42; P = 0.0003). This association was confirmed in a multiple regression model (beta = 0.35; P = 0.009) in which, as independent variables, besides PWV, 24-h BP, age, serum glucose values, smoking status, gender and BMI, were added. CONCLUSIONS Our results seem to confirm that microalbuminuria may represent the early renal manifestation of a widespread vascular dysfunction, and therefore it is an integrated marker of cardiovascular risk.
Collapse
Affiliation(s)
- G Mulè
- Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Cattedra di Medicina Interna e Centro Ipertensione, Università di Palermo, Palermo, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Chromatographic columns packed with paper mill sludge are employed for metal ion recovery from water. The breakthrough curves show that cadmium, copper, lead and silver are removed from acid solutions (pH 2, 4); the affinity series is Pb(II)>Cu(II)>Ag(I)>Cd(II). Both the amount of metal retained and the metal-matrix interaction are pH dependent; the sorptive capacity increases with increasing pH. When the metals are present together at the same initial concentrations a competition among the different ions occurs although the affinity order remains unchanged. In metal recovery from the paper mill sludge column, the total amount of the cadmium and copper is displaced by HCl 1.0 M, 65% of the lead by HCl 0.1 M and 75% of the silver by HNO(3) 0.1 M. More than 95% of copper and lead and less than 20% of cadmium were recovered with HCl 0.1 M when the metals were present at the same time.
Collapse
Affiliation(s)
- N Calace
- Department of Chemistry, University "La Sapienza", ple A. Moro 5, 00185, Rome, Italy
| | | | | | | | | |
Collapse
|
49
|
Mulè G, Nardi E, Andronico G, Cottone S, Federico MR, Piazza G, Volpe V, Ferrara D, Cerasola G. Pulsatile and steady 24-h blood pressure components as determinants of left ventricular mass in young and middle-aged essential hypertensives. J Hum Hypertens 2003; 17:231-8. [PMID: 12692567 DOI: 10.1038/sj.jhh.1001542] [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] [Indexed: 11/08/2022]
Abstract
In order to explore the relations between left ventricular mass (LVM) and the pulsatile (pulse pressure) and steady (mean pressure) components of the blood pressure (BP) curve, 304 young and middle-aged essential hypertensive patients were studied by means of 24-h ambulatory BP monitoring and echocardiography. In the overall study population, both the BP components showed significant correlations with LVM. These correlations were unevenly distributed in the subgroups of subjects younger and in those older than 50 years. While in this latter subgroup, in multivariate analysis, both 24-h mean BP (24-MBP) (beta = 0.27; P = 0.008) and 24-h pulse pressure (24-h PP) (beta = 0.23; P = 0.02) were associated with LVM, in the subset of younger hypertensives only 24-h MBP (beta = 0.21; P = 0.009) was related to LVM, independent of other covariates. The relations observed between 24-h PP and LVM in the entire study population and in the patients older than 50 years lost statistical significance when the effect of 24-h systolic blood pressure (24-h SBP) was taken into account, in a multiple regression model in which 24-h MBP was replaced by 24-h SBP. Our findings seem to suggest that the association of PP with LVM in middle-aged hypertensives may partially explain the increased cardiovascular risk, documented in subjects with high PP. However, this relation is not independent, but is mediated by SBP.
Collapse
Affiliation(s)
- G Mulè
- Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Cattedra di Medicina Interna e Centro Ipertensione, University of Palermo, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
|