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Cortés-Téllez AA, D'ors A, Sánchez-Fortún A, Fajardo C, Mengs G, Nande M, Martín C, Costa G, Martín M, Bartolomé-Camacho MC, Sánchez-Fortún S. Using single-species and algal communities to determine long-term adverse effects of silver nanoparticles on freshwater phytoplankton. Sci Total Environ 2024; 928:172500. [PMID: 38631630 DOI: 10.1016/j.scitotenv.2024.172500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024]
Abstract
The physical and chemical properties of silver nanoparticles (AgNPs) have led to their increasing use in various fields such as medicine, food, and industry. Evidence has proven that AgNPs cause adverse effects in aquatic ecosystems, especially when the release of Ag is prolonged in time. Several studies have shown short-term adverse effects of AgNPs on freshwater phytoplankton, but few studies have analysed the impact of long-term exposures on these populations. Our studies were carried out to assess the effects of AgNPs on growth rate, photosynthesis activity, and reactive oxygen species (ROS) generation on the freshwater green algae Scenedesmus armatus and the cyanobacteria Microcystis aeruginosa, and additionally on microcystin (MC-LR) generation from these cyanobacteria. The tests were conducted both in single-species cultures and in phytoplanktonic communities exposed to 1 ngL-1 AgNPs for 28 days. The results showed that cell growth rate of both single-species cultures decreased significantly at the beginning and progressively reached control-like values at 28 days post-exposure. This effect was similar for the community-cultured cyanobacteria, but not for the green algae, which maintained a sustained decrease in growth rate. While gross photosynthesis (Pg) increased in both strains exposed in single cultures, dark respiration (R) and net photosynthesis (Pn) decreased in S. armatus and M. aeruginosa, respectively. These effects were mitigated when both strains were exposed under community culture conditions. Similarly, the ROS generation shown by both strains exposed in single-species cultures was mitigated when exposure occurred in community cultures. MC-LR production and release were significantly decreased in both single-species and community exposures. These results can supply helpful information to further investigate the potential risks of AgNPs and ultimately help policymakers make better-informed decisions about their utilization for environmental restoration.
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Affiliation(s)
- A A Cortés-Téllez
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St., 58000 Morelia, Michoacán, Mexico
| | - A D'ors
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - A Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - C Fajardo
- Dpt. of Biomedicine and Biotechnology, Universidad de Alcalá (UAH), w/n San Diego Sq., 28801 Alcalá de Henares, Spain
| | - G Mengs
- Techincal and R&D Department, Ecotoxilab SL. 10 Juan XXIII., 28550 Tielmes, Spain
| | - M Nande
- Dpt. of Biochemistry and Molecular Biology, Complutense University. w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - C Martín
- Dpt. of Biotechnology-Plant Biology, Universidad Politécnica de Madrid (UPM), 3 Complutense Ave., 28040 Madrid, Spain
| | - G Costa
- Department of Animal Physiology, Faculty of Veterinary Sciences, Complutense University. w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - M Martín
- Dpt. of Biochemistry and Molecular Biology, Complutense University. w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - M C Bartolomé-Camacho
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St., 58000 Morelia, Michoacán, Mexico
| | - S Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave., 28040 Madrid, Spain.
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Fazio F, Costa A, Capparucci F, Costa G, Parrino V, Arfuso F. Automated Hematological Approach and Protein Electrophoretic Pattern in Tilapia ( Oreochromis niloticus): An Innovative and Experimental Model for Aquaculture. Animals (Basel) 2024; 14:392. [PMID: 38338035 PMCID: PMC10854657 DOI: 10.3390/ani14030392] [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] [Received: 12/20/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
This study aimed to assess the usefulness of two innovative automated methods (automated blood count counters and flow cytometry) for hematological investigation in Tilapia to make a contribution to the clinical diagnostics of this farmed species. Moreover, serum total proteins and their electrophoretic fractions (prealbumin, albumin, α-, β-, and γ-fraction), as health condition indicators, were assessed. The analysis of serum total proteins and electrophoretic fraction showed a normal and typical electrophoretic pattern of healthy fish (serum total proteins, 3.70 ± 0.62 g/dL; prealbumin, 0.44 ± 0.20 g/dL; albumin, 1.17 ± 0.66 g/dL; α-fraction, 1.49 ± 0.64 g/dL; β-fraction, 0.32 ± 0.16 g/dL; and γ-fraction, 0.29 ± 0.13 g/dL). The relationships between the values of red blood cells (RBCs), white blood cells (WBCs), and thrombocytes (TCs) obtained with the two automated methods were determined using Pearson correlation analysis. The results showed a significant positive correlation between automatic blood cell counting and flow cytometry analysis for RBCs (r = 0.97, p < 0.0001) and WBCs (r = 0.91, p < 0.0001), whereas no correlation was found for TCs (r = -0.11, p = 0.66). The preliminary results gathered in this study seem to highlight the usefulness of the new analytical techniques herein investigated in tilapia, suggesting their application in the hematological investigation of farmed fish species and their usefulness for monitoring the health and well-being of fish reared in aquaculture.
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Affiliation(s)
- Francesco Fazio
- Department of Veterinary Sciences, University of Messina, Via Palatucci, 98168 Messina, Italy;
| | | | - Fabiano Capparucci
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (F.C.); (V.P.)
| | - Gregorio Costa
- Department of Human Pathology in Adult and Developmental Age, University of Messina, 98125 Messina, Italy;
| | - Vincenzo Parrino
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (F.C.); (V.P.)
| | - Francesca Arfuso
- Department of Veterinary Sciences, University of Messina, Via Palatucci, 98168 Messina, Italy;
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3
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Molonia MS, Muscarà C, Speciale A, Salamone FL, Costa G, Vento G, Saija A, Cimino F. Low concentrations of antimony impair adipogenesis and endoplasmic reticulum homeostasis during 3T3-L1 cells differentiation. Food Chem Toxicol 2023; 181:114107. [PMID: 37858840 DOI: 10.1016/j.fct.2023.114107] [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: 05/02/2023] [Revised: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
Antimony (Sb) is a metalloid widely present in plastics used for food contact packaging, toys and other household items. Since Sb can be released by these plastics and come into contact with humans, health concerns have been highlighted. The effect of Sb on human tissues is yet controversial, and biochemical mechanisms of toxicity are lacking. In the present study, the effect of very low nanomolar concentrations of Sb(III), able to mimicking chronic human exposure, was evaluated in 3T3-L1 murine cells during the differentiation process. Low nanomolar Sb exposure (from 0.05 to 5 nM) induced lipid accumulation and a marked increase in C/EBP-β and PPAR-γ levels, the master regulators of adipogenesis. The Sb-induced PPAR-γ was reverted by the estrogen receptor antagonist ICI 182,780. Additionally, Sb stimulated preadipocytes proliferation inducing G2/M phase of cell cycle and this effect was associated to reduced cell-cycle inhibitor p21 levels. In addition to these metabolic dysfunctions, Sb activated the proinflammatory NF-κB pathway and altered endoplasmic reticulum (ER) homeostasis inducing ROS increase, ER stress markers XBP-1s and pEIF2a and downstream genes, such as Grp78 and CHOP. This study, for the first time, supports obesogenic effects of low concentrations exposure of Sb during preadipocytes differentiation.
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Affiliation(s)
- Maria Sofia Molonia
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale F. Stagno D'Alcontres 31, 98166, Messina, Italy; "Prof. Antonio Imbesi" Foundation, University of Messina, 98100, Messina, Italy.
| | - Claudia Muscarà
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale F. Stagno D'Alcontres 31, 98166, Messina, Italy.
| | - Antonio Speciale
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale F. Stagno D'Alcontres 31, 98166, Messina, Italy.
| | - Federica Lina Salamone
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale F. Stagno D'Alcontres 31, 98166, Messina, Italy.
| | - Gregorio Costa
- Department of Human Pathology in Adult and Developmental Age, University of Messina, 98125, Messina, Italy.
| | - Grazia Vento
- Department of Experimental Medicine (DIMES), University of Genova, 16132, Genoa, Italy.
| | - Antonella Saija
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale F. Stagno D'Alcontres 31, 98166, Messina, Italy.
| | - Francesco Cimino
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale F. Stagno D'Alcontres 31, 98166, Messina, Italy.
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D'ors A, Sánchez-Fortún A, Cortés-Téllez AA, Fajardo C, Mengs G, Nande M, Martín C, Costa G, Martín M, Bartolomé MC, Sánchez-Fortún S. Adverse effects of iron-based nanoparticles on freshwater phytoplankton Scenedesmus armatus and Microcystis aeruginosa strains. Chemosphere 2023; 339:139710. [PMID: 37532199 DOI: 10.1016/j.chemosphere.2023.139710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
Zero-valent nano-iron particles (nZVI) are increasingly present in freshwater aquatic environments due to their numerous applications in environmental remediation. However, despite the broad benefits associated with the use and development of nZVI nanoparticles, the potential risks of introducing them into the aquatic environment need to be considered. Special attention should be focused on primary producer organisms, the basal trophic level, whose impact affects the rest of the food web. Although there are numerous acute studies on the acute effects of these nanoparticles on photosynthetic primary producers, few studies focus on long-term exposures. The present study aimed at assessing the effects of nZVI on growth rate, photosynthesis activity, and reactive oxygen activity (ROS) on the freshwater green algae Scenedesmus armatus and the cyanobacteria Microcystis aeruginosa. Moreover, microcystin production was also evaluated. These parameters were assessed on both organisms singly exposed to 72 h-effective nZVI concentration for 10% maximal response for 28 days. The results showed that the cell growth rate of S. armatus was initially significantly altered and progressively reached control-like values at 28 days post-exposure, while M. aeruginosa did not show any significant difference concerning control values at any time. In both strains dark respiration (R) increased, unlike net photosynthesis (Pn), while gross photosynthesis (Pg) only slightly increased at 7 days of exposure and then became equal to control values at 28 days of exposure. The nZVI nanoparticles generated ROS progressively during the 28 days of exposure in both strains, although their formation was significantly higher on green algae than on cyanobacteria. These data can provide additional information to further investigate the potential risks of nZVI and ultimately help decision-makers make better informed decisions regarding the use of nZVI for environmental remediation.
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Affiliation(s)
- A D'ors
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - A Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - A A Cortés-Téllez
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St, 58000, Morelia, (Michoacán), Mexico
| | - C Fajardo
- Dpt. of Biomedicine and Biotechnology, Universidad de Alcalá (UAH), w/n San Diego Sq, 28801, Alcalá de Henares, Spain
| | - G Mengs
- Technical and R&D Department, Ecotoxilab SL, 10 Juan XXIII, 28550, Tielmes, Spain
| | - M Nande
- Dpt. of Biochemistry and Molecular Biology, Complutense University, w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - C Martín
- Dpt. of Biotechnology-Plant Biology, Universidad Politécnica de Madrid (UPM), 3 Complutense Ave, 28040, Madrid, Spain
| | - G Costa
- Department of Animal Physiology, Faculty of Veterinary Sciences, Complutense University, w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - M Martín
- Dpt. of Biochemistry and Molecular Biology, Complutense University, w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - M C Bartolomé
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St, 58000, Morelia, (Michoacán), Mexico.
| | - S Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave, 28040, Madrid, Spain.
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5
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Molonia MS, Salamone FL, Muscarà C, Costa G, Vento G, Saija A, Speciale A, Cimino F. Regulation of mitotic clonal expansion and thermogenic pathway are involved in the antiadipogenic effects of cyanidin-3-O-glucoside. Front Pharmacol 2023; 14:1225586. [PMID: 37614314 PMCID: PMC10442822 DOI: 10.3389/fphar.2023.1225586] [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: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction: Obesity is a metabolic disease with an increase both in cell size (hypertrophy) and in cell number (hyperplasia) following differentiation of new adipocytes. Adipogenesis is a well-orchestrated program in which mitotic clonal expansion (MCE) occurs in the early step followed by the late terminal differentiation one. Methods: Aim of the study was to evaluate the in vitro effects of cyanidin-3-O-glucoside (C3G), an anthocyanin present in many fruits and vegetables, in the early or late phase of 3T3-L1 preadipocytes differentiation. Results: C3G exposure in the early phase of adipogenesis process induced a more marked reduction of CCAAT/enhancer-binding protein-β (C/EBPβ), peroxisome proliferator-activated receptor γ (PPAR-ɣ) and fatty acid synthase (Fasn) expression than late phase exposure and these effects were associated to a reduced MCE with cell cycle arrest at G0/G1 phase via p21 expression. Furthermore, C3G exposure during the early phase activated AMP-activated protein kinase (AMPK) pathway better than in the late phase promoting the enhancement of beige-like adipocytes. In fact, C3G induced thermogenic biomarkers uncoupling protein-1 (Ucp1) and peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (Pgc1) and these effects were more evident during early phase exposure. Conclusion: Our data demonstrate that C3G reduces the terminal adipogenic process affecting the early phase of differentiation and inducing a thermogenic program.
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Affiliation(s)
- Maria Sofia Molonia
- Department of Chemical Biological Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
- “Prof Antonio Imbesi” Foundation, University of Messina, Messina, Italy
| | - Federica Lina Salamone
- Department of Chemical Biological Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Claudia Muscarà
- Department of Chemical Biological Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Gregorio Costa
- Department of Human and Pediatric Pathology “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Grazia Vento
- Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
| | - Antonella Saija
- Department of Chemical Biological Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Antonio Speciale
- Department of Chemical Biological Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Francesco Cimino
- Department of Chemical Biological Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
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6
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D'Andrea R, Corona C, Poszwa A, Belingard C, Domínguez-Delmás M, Stoffel M, Crivellaro A, Crouzevialle R, Cerbelaud F, Costa G, Paradis-Grenouillet S. Combining conventional tree-ring measurements with wood anatomy and strontium isotope analyses enables dendroprovenancing at the local scale. Sci Total Environ 2023; 858:159887. [PMID: 36351500 DOI: 10.1016/j.scitotenv.2022.159887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Dendroprovenancing provides critical information regarding the origin of wood, allowing further insights into economic exploitation strategies and source regions of timber products. Traditionally, dendroprovenancing relies on pattern-matching of tree rings, but its spatial resolution is limited by the geographical coverage of species-specific chronologies available for crossdating and, in the case of short-distance trades, by scarce environmental variability. Here, we present an approach to provenance timber with high spatial resolution from forested areas that have been exploited intensively throughout history, with the aim to understand the sustainability of the various woodland management practices used to supply timber products. To this end, we combined tree-ring width (TRW), wood anatomical and geochemical analyses in addition to multivariate statistical validation procedures to trace the origin of living oak trees (Quercus robur) sampled in four stands located within a 30-km radius around the city of Limoges (Haute-Vienne, France). We demonstrate that TRW and wood anatomical variables (and in particular cell density) robustly discriminate the eastern from the western site, while failing to trace the origin of trees from the northern and southern sites. Here, strontium isotopic ratios (87Sr/86Sr) and Ca concentrations identify clusters of trees which could not be identified with TRW or wood anatomy. Ultimately, our study demonstrates that the coupling of wood anatomy with geochemical signatures allows to correctly pinpoint the origin of trees. Given the small geographic scale of our study and the limited differences in elevation and climate between study sites, our results are particularly promising for future dendroprovenancing studies. We thus conclude that the combination of multiple approaches will not only increase the accuracy of dendroprovenancing studies at local scales, but could also be implemented at much larger scales to identify trends in historic timber supply throughout Europe.
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Affiliation(s)
- R D'Andrea
- GEOLAB, Université de Limoges, Limoges, France.
| | - C Corona
- GEOLAB, UMR 6042 CNRS, Université Clermont Auvergne, Clermont-Ferrand, France; Climate Change Impacts and Risks in the Anthropocene, Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland; Department F.A. Forel for Environmental and Aquatic Sciences, University of Geneva, Geneva, Switzerland
| | - A Poszwa
- Laboratoire Interdisciplinaire des Environnements Continentaux, Université de Lorraine, Nancy, France
| | - C Belingard
- GEOLAB, Université de Limoges, Limoges, France
| | - M Domínguez-Delmás
- Amsterdam School for Heritage and Memory Studies, University of Amsterdam, Amsterdam, the Netherlands
| | - M Stoffel
- Climate Change Impacts and Risks in the Anthropocene, Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland; Department F.A. Forel for Environmental and Aquatic Sciences, University of Geneva, Geneva, Switzerland; Department of Earth Sciences, University of Geneva, Geneva, Switzerland
| | - A Crivellaro
- Forest Biometrics Laboratory, Faculty of Forestry, University of Suceava, Suceava, Ukraine; Éveha, Bureau d'étude archéologique, Limoges, France
| | | | - F Cerbelaud
- GEOLAB, Université de Limoges, Limoges, France
| | - G Costa
- Laboratoire PEIRENE, Université de Limoges, Limoges, France
| | - S Paradis-Grenouillet
- GEOLAB, Université de Limoges, Limoges, France; Éveha, Bureau d'étude archéologique, Limoges, France
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7
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Costa G, Oprandi A, Bavestrello G, Castellano M, Bertolino M. Biogenic silica in the Posidonia oceanica “matte”, a tool to discover past dynamics of the sponge community. The European Zoological Journal 2022. [DOI: 10.1080/24750263.2022.2140851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- G. Costa
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Milan, Italy
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
| | - A. Oprandi
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
| | - G. Bavestrello
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
- NBFC, National Biodiversity Future Center, Palermo, Italy
| | - M. Castellano
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
| | - M. Bertolino
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
- NBFC, National Biodiversity Future Center, Palermo, Italy
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8
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Galletti M, Alesini D, Anania MP, Arjmand S, Behtouei M, Bellaveglia M, Biagioni A, Buonomo B, Cardelli F, Carpanese M, Chiadroni E, Cianchi A, Costa G, Del Dotto A, Del Giorno M, Dipace F, Doria A, Filippi F, Franzini G, Giannessi L, Giribono A, Iovine P, Lollo V, Mostacci A, Nguyen F, Opromolla M, Pellegrino L, Petralia A, Petrillo V, Piersanti L, Di Pirro G, Pompili R, Romeo S, Rossi AR, Selce A, Shpakov V, Stella A, Vaccarezza C, Villa F, Zigler A, Ferrario M. Stable Operation of a Free-Electron Laser Driven by a Plasma Accelerator. Phys Rev Lett 2022; 129:234801. [PMID: 36563228 DOI: 10.1103/physrevlett.129.234801] [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] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 06/17/2023]
Abstract
The breakthrough provided by plasma-based accelerators enabled unprecedented accelerating fields by boosting electron beams to gigaelectronvolt energies within a few centimeters [1-4]. This, in turn, allows the realization of ultracompact light sources based on free-electron lasers (FELs) [5], as demonstrated by two pioneering experiments that reported the observation of self-amplified spontaneous emission (SASE) driven by plasma-accelerated beams [6,7]. However, the lack of stability and reproducibility due to the intrinsic nature of the SASE process (whose amplification starts from the shot noise of the electron beam) may hinder their effective implementation for user purposes. Here, we report a proof-of-principle experiment using plasma-accelerated beams to generate stable and reproducible FEL light seeded by an external laser. FEL radiation is emitted in the infrared range, showing the typical exponential growth of its energy over six consecutive undulators. Compared to SASE, the seeded FEL pulses have energies 2 orders of magnitude larger and stability that is 3 times higher.
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Affiliation(s)
- M Galletti
- Department of Physics, Università di Roma Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- INFN-Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- NAST Center, Via Ricerca Scientifica 1, 00133 Rome, Italy
| | - D Alesini
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M P Anania
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - S Arjmand
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Behtouei
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Bellaveglia
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Biagioni
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - B Buonomo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Cardelli
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Carpanese
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - E Chiadroni
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
- Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - A Cianchi
- Department of Physics, Università di Roma Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- INFN-Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- NAST Center, Via Ricerca Scientifica 1, 00133 Rome, Italy
| | - G Costa
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Del Dotto
- ENEA, C.R. Brasimone, 40032, Camugnano, Bologna, Italy
| | - M Del Giorno
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Dipace
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Doria
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - F Filippi
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - G Franzini
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - L Giannessi
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Giribono
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - P Iovine
- INFN-Napoli, Via Cintia, 80126 Naples, Italy
| | - V Lollo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Mostacci
- Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - F Nguyen
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - M Opromolla
- Università degli Studi di Milano, Via Celoria 16 20133 Milano Italy
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - L Pellegrino
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Petralia
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - V Petrillo
- Università degli Studi di Milano, Via Celoria 16 20133 Milano Italy
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - L Piersanti
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - G Di Pirro
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - R Pompili
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - S Romeo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A R Rossi
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - A Selce
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
- INFN-Roma Tre, Via della Vasca Navale 84, 00146 Roma RM, Italy
| | - V Shpakov
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Stella
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - C Vaccarezza
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Villa
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Zigler
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
- Racah Institute of Physics, Hebrew University, 91904 Jerusalem, Israel
| | - M Ferrario
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
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9
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Costa G. Short introduction to JAHEE and Actions. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Reducing health inequalities is on the agenda of many countries. Despite an increasing concern and awareness on health inequalities a wide gap exists in Europe in terms of political response. The main objective of JAHEE was to strengthen a cooperative approach among participating countries and implement concrete actions to reduce health inequalities. The partnership was composed of 24 countries including many strategically most relevant public health institutions in the European Union, which contributed with different backgrounds, skills and know-how to the achievement of the project objectives. The main results will be presented.
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Affiliation(s)
- G Costa
- Piemonte Region , Turin, Italy
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10
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Strippoli E, Zengarini N, Di Girolamo C, Bartolini L, Aversa C, Costa G. Impact of COVID-19 pandemic on inequalities in mortality: an analysis in Piedmont and Emilia-Romagna. Eur J Public Health 2022. [PMCID: PMC9593877 DOI: 10.1093/eurpub/ckac130.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Italy was heavily hit by the COVID-19 pandemic. According to official statistics, during 2020 there were more than 75,000 excess deaths compared to the average expected mortality in 2015-2019. General mortality (GM) is a good measure of both the direct and indirect effects of the pandemic because it's exempt from potential bias due to misclassification of events. Evidence shows a greater burden of disease and mortality attributable to COVID-19 among disadvantaged populations, with the risk of an exacerbation of existing health inequalities. We aim to analyse the trend of social inequalities in mortality during the first pandemic year in two Italian regions (Piedmont and Emilia-Romagna) using data from Administrative Population Registries (APR) and statistical databases. Methods Data on deaths occurred between Jan 2015 and Jan 2021 in subjects ≥65, stratified by educational level, were obtained from Regional APR and the Census. Using a time series approach, we computed Standardized Mortality Rates (SMR), Relative Index of Inequalities (RII) and Slope Index of Inequalities (SII), adjusted by age, gender, month and region. SMR, RII and SII from March 2020 were forecasted using Holt-Winters method and compared to the observed values in the same period. Results SMRs were higher than expected during the two 2020 epidemic waves (Mar-Apr, Oct-Dec) in both regions. RII didn't increase significantly. Absolute inequalities instead rose in Piedmont during both pandemic waves, mostly among women, and in Emilia-Romagna in March among men. Conclusions The impact of the pandemic on inequalities in GM has been at least of the same size of the impact of other mechanisms of unequal mortality. APR coupled with sociodemographic data are a quick and reliable source for assessing the unequal impact of the COVID-19 pandemic on health. Further research is needed to explore mechanisms underlying these effects e.g. inequalities in cause-specific mortality and access to health services. Key messages
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Affiliation(s)
- E Strippoli
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
| | - N Zengarini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
| | - C Di Girolamo
- Health and Social Care Agency, Emilia-Romagna Region , Bologna, Italy
| | - L Bartolini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - C Aversa
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
| | - G Costa
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
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11
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De Lucia R, Giannini C, Parollo M, Costa G, Barletta V, Giannotti Santoro M, Primerano C, De Carlo M, Angelillis M, Zucchelli G, Petronio AS. Cardiac arrhythmias and conduction disorders monitoring after transcatheter aortic valve replacement procedure, using a mobile electrocardiogram 6 lead device. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2109] [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: 11/12/2022] Open
Abstract
Abstract
Background
In the early post transcatheter aortic valve replacement (TAVR) discharge era, rate of readmission for permanent pacemaker implantation (PPM-I) due to delayed conduction disturbances (CDs) has significantly increased. This issue has powered post procedural ambulatory electrocardiogram (AECG) monitoring by using implantable cardiac monitors or mobile cardiac telemetry devices, despite several disadvantages as frequent electrode changes and costs.
Purpose
In this scenario we aimed to evaluate the incidence of post-TAVR new onset arrhythmias and delayed CDs, performing an AECG monitoring through a 30s spot digital ECG (AeECG), by using a mobile electrocardiogram 6 lead (ME6L) device in a 30 days period after a TAVR procedure.
Methods
Between March 2021 and February 2022 we consecutively enrolled all patients undergoing a TAVR at the University Hospital of Pisa, excepting who already had a PM. At discharge, all patients received ME6L device and were asked to record a spot eECG for 1 month: 1 eECG per day during the first week and then 1 eECG per week. Clinical and follow-up data were collected and analyzed, and eECG scheduling compliance and quality recordings were explored.
Results
Among 185 consecutive TAVR patients, 12 were excluded due to pre-existing pacing device and 33 due to PPM-I <2 days post TAVR; 3 died before enrollment and 10 refused the enrollment; 18 were excluded because failed the ME6L training phase, 6 for severe postprocedural complications and the last 3 because affected by isolated aortic regurgitation.The remaining ones (100) had 30-day AeECG data. Delayed CDs with a Class I/IIa indications for PPM-Ioccurred in 8 patients with a median of 6 days (range 4–8 days) post-TAVR. New onset documented arrhythmias were AT/AF in 3 patients, isolated PVCs in 10 patients, and competitive transitory junctional rhythm in 2 patients. Delayed PPM-I versus non-delayed PPM-Ipatients were more likely to have a non-self-expandable valve (3 vs 69; p=0.02) and longer PR and QRS intervals at discharge (250.00±53,29 ms vs 179.17±39.17 ms; p=0,003; 125±33.38 ms vs 102.55±30.48 ms; p=0,04). The overall eECG schedule level compliance was 96.5%. Out of a total of 965 sent eECGs, 950 (98,4%) have been correctly recorded and transmitted.
Conclusion
Delayed CDs requiring PPM-I are the most important drawback of TAVR procedure. In our study, AeECG was seen to be safe and helpful in the identification and treatment of delayed CDs requiring PPM-I, with a very high eECG schedule level of compliance and quality. Further prospective studies are needed to better identify patient selection for outpatient monitoring, making safer and safer the early post TAVR discharge approach.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R De Lucia
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - C Giannini
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M Parollo
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - G Costa
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - V Barletta
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - M Giannotti Santoro
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - C Primerano
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M De Carlo
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M Angelillis
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - G Zucchelli
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - A S Petronio
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
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12
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes R, Rosa J, Campos G, Baptista R, Monteiro P, Monteiro S, Goncalves F, Madeira M, Goncalves L. Comparing the long-term prognosis of myocardial infarction with non-obstructive coronary arteries to myocardial infarction with obstructive coronary artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The long-term survival rates of myocardial infarction with non-obstructive coronary arteries (MINOCA) patients is lower than in the general population. Nevertheless, there are conflicting results regarding the prognosis of MINOCA patients in comparison to myocardial infarction with obstructive coronary artery disease (MI-CAD) patients.
Purpose
The aim of this study was to assess the long-term all-cause mortality of MINOCA patients and compare it to MI-CAD patients.
Methods
Retrospective analysis of 2443 consecutively admitted patients for acute myocardial infarction (AMI), in a single coronary intensive care unit. Only patients with 5 years of follow-up and those who died before the 5-year mark were considered. Patients were divided into two groups according to the presence or absence of obstructive coronary artery disease on angiography (≥50% stenosis). Demographic characteristics, symptoms at presentation, past medical history, laboratory characteristics and medication at discharge were compared using the Mann-Whitney U or χ2 test (according to variable type) to ensure comparability between groups. Five-year all-cause mortality was the target endpoint. Five-year survival was modelled through the Cox proportional hazard regression model. The variable of interest (MINOCA vs MI-CAD) and possible confounders that displayed statistically significant differences in the initial demographic analysis were included in univariable Cox regressions, and those with statistically significant associations were included in a multivariable model. Those that displayed non-significant associations in the multivariable model were subsequently removed until we were left with significant associations only, giving us an adjusted hazard ratio.
Results
Comparison between groups is presented in table 1. MINOCA patients were younger and more often women. They were less likely to have smoking habits, diabetes, or a previous history of AMI. They had a lower Killip class, as well as lower troponin I, serum creatinine and low-density lipoprotein cholesterol at admission. On the other hand, they had higher left ventricular ejection fractions. They were also less likely to have beta-blockers or aspirin prescribed at discharge.
All-cause mortality at 5 years was 13.1% among MINOCA patients and 28.3% among MI-CAD patients, with an unadjusted hazard ratio (HR) of 0.421 (95% CI 0.322–0.550), p<0.001. Adjusting for known confounders, the HR was 0.461 (95% CI 0.261–0.816), p=0.008.
Conclusions
Compared with MI-CAD patients, those with MINOCA were slightly younger and had fewer comorbidities. In spite of having a worse long-term prognosis when compared to the general population, MINOCA patients have a significantly higher 5-year survival rate than MI-CAD patients, even after adjustment of confounding factors.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto , Porto , Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Gomes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Rosa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Campos
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Baptista
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - P Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - S Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - F Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
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13
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Costa G, Cardoso J, Goncalves L, Teixeira R. Early aortic valve replacement in asymptomatic severe aortic stenosis with preserved ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) is the most common valvular disease in developed countries. Specific timing of intervention for asymptomatic patients with severe aortic stenosis and preserved ejection fraction remains controversial.
Purpose
To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in asymptomatic AS patients with preserved ejection.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in November 2021, for both interventional or observational studies comparing early-AVR with WW in the treatment of asymptomatic severeAS with preserved ejection fraction criteria. Random-effects meta-analysis was performed.
Results
Eight studies were included in which two were randomized clinical trials. A total of 2672 patients were included, providing a 642 pooled death events (327 in early-AVR and 941 in watchful waiting). In our meta-analysis, early-AVR revealed a significant lower all-cause mortality (pooled OR, 0.39; 95% CI [0.30, 0.51], P<0.01; I2=47%). Additionally, the early-AVR group presented a lower rate of cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P<0.01; I2=64%). Both strategies had similar rate of stroke (pooled OR, 1.30; 95% CI [0.39, 4.27], P=0.67; I2=0%) and myocardial infarction (pooled OR, 0.49; 95% CI [0.14, 1.78], P=0.28; I2=0%). Heart Failure hospitalizations presented a lower trend early-AVR group (pooled OR, 0.22; 95% CI [0.05, 1.08], P=0.36; I2=36%).
Conclusion
Our pooled data suggests that early-AVR strategy is preferable for asymptomatic severe AS patients with preserved ejection fraction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - J Cardoso
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic Surgery , Vila Nova de Gaia , Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research , Coimbra , Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
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14
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Costa G, Cardoso J, Goncalves L, Teixeira R. Early intervention versus conservative management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) is the most common valvular disease in developed countries. However, the specific timing of intervention for asymptomatic patients with severe AS remains controversial.
Purpose
To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in asymptomatic patients with AS.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in December 2021, for both interventional or observational studies comparing early AVR with WW in the treatment of asymptomatic severe AS. Random-effects meta-analysis was performed.
Results
Thirteen studies were included in which two were randomised clinical trials. A total of 4,679 patients were included, providing a 1,268 pooled death events (327 in early AVR and 941 in WW). Our meta-analysis showed a significantly lower all-cause mortality for the early-AVR compared with WW group, although with a moderate amount of heterogeneity between studies in the magnitude of the effect (pooled odds ratio [OR], 0.41; 95% confidence interval [CI] 0.34, 0.50, P<0.01; I2=60%). An early surgery strategy displayed a significantly lower cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P<0.01; I 2=64%) and heart failure hospitalisations (pooled OR 0.19; 95% CI [0.10, 0.39], P<0.01, I2=7%). However, both groups had similar rates of stroke (pooled OR 1.30; 95% CI [0.73, 2.29], P=0.36, I2=0%) and myocardial infarction (pooled OR 0.49; 95% CI [0.19, 1.27], P=0.14, I2=0%).
Conclusions
Our pooled data suggest that an early-AVR strategy is preferable for asymptomatic patients with severe AS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - J Cardoso
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic Surgery , Vila Nova de Gaia , Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research , Coimbra , Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
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15
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Costa G, Marinho V, Costa M, Goncalves L, Teixeira R. Meta-analysis comparing outcomes in patients undergoing transcatheter aortic valve implantation with versus without percutaneous coronary intervention. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1590] [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: 11/15/2022] Open
Abstract
Abstract
Background
Patients having transcatheter aortic valve implantation (TAVI) routinely undergo coronary angiography before the procedure to define the coronary anatomy and to evaluate the extend of coronary artery disease (CAD). Whether percutaneous coronary intervention (PCI) prior/concomitant with TAVI confers any additional clinical benefit in patients with CAD remains unclear.
Purpose
To compare the outcomes of PCI prior to TAVI in patients with significant coronary artery disease and severe aortic stenosis.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in November 2021, for both retrospective and prospective studies comparing TAVI with PCI versus TAVI alone. Random-effects meta-analysis was performed.
Results
Eleven studies were included in which one was a randomized clinical trial. A total of 2530 patients were included, providing a 145 pooled death events (64 in TAVI with PCI and 81 in TAVI only). In terms of 30-day clinical outcomes, our pooled analysis revealed a similar all-cause mortality (pooled OR, 1.24; 95% CI [0.80, 1.93], P=0.34; I2=27% - Figure), cardiovascular mortality (pooled OR, 1.44; 95% CI [0.56, 3.75], P=0.45; I2=57%) and stroke (pooled OR, 1.07; 95% CI [0.53, 2.13], P=0.86; I2=0%). However, our analysis revealed a higher rate of myocardial infarction (pooled OR, 4.28; 95% CI [1.56, 11.69], P<0.01; I2=0%) and major bleeding events (pooled OR, 1.40; 95% CI [1.02, 1.93], P=0.04; I2=0%) in the TAVI with PCI group. A 1-year clinical outcomes analysis revealed a trend for lower all-cause mortality in TAVI only group (pooled OR, 1.37; 95% CI [0.98, 1.91], P=0.06; I2=0%), similar cardiovascular death rate (pooled OR, 1.15; 95% CI [0.70, 1.89], P=0.59; I2=6%) and major bleeding events (pooled OR, 1.62; 95% CI [0.95, 2.76], P=0.07; I2=0%).
Conclusion
Our pooled data suggests that PCI with TAVI in patients with severe aortic stenosis and concomitant CAD grants no additional clinical advantage.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - V Marinho
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - M Costa
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - R Teixeira
- Centro hospitalar de Coimbra , Coimbra , Portugal
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16
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes R, Rosa J, Campos G, Costa S, Baptista R, Franco F, Madeira M, Goncalves L. Maximum dose sacubitril/valsartan in heart failure with reduced ejection fraction: does atrial fibrillation compromise the benefits? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.953] [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
In the PARADIGM-HF trial, sacubitril/valsartan (SV) was shown to be superior to enalapril in reducing hospitalizations for worsening heart failure (HF), cardiovascular mortality, and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). The 2021 ESC Guidelines recommends SV as a replacement for angiotensin-converting-enzyme inhibitors to reduce the risk of HF hospitalization and death. There is little information regarding the effects of SV according to atrial fibrillation (AF) status.
Purpose
The aim of this study was to compare the effects of maximum dose SV regarding symptomatic improvement, change in natriuretic peptides levels (NP) and left ventricular ejection fraction (LVEF) in patients with HFrEF with and without AF.
Methods
Retrospective analysis of 137 patients with HFrEF on maximum dose SV (97/103mg twice daily). Patients were divided into two groups according to AF status. Age, gender, relevant comorbidities, usual medication, baseline symptomatic status, NP levels and LVEF were assessed using the Mann-Whitney U or χ2 test (according to variable type) to ensure comparability between groups. Variation in NYHA class, NP levels and LVEF between baseline and 6-month follow-up was evaluated and compared between groups.
Results
Comparison between groups is presented in Table 1. In our studied population, ischemic aetiology was more common in the sinus rhythm group (49.5% vs 30.4%; p 0.034). There were no significant differences between groups regarding age, gender, hypertension, diabetes, and beta-blocker and mineralocorticoid receptor antagonist usage. At baseline, the AF group had higher NT-proBNP levels [median 1421 mg/dL (IQR 743–3087) vs 467 mg/dL (IQR 140–797); p<0.001]. There were no significant differences regarding baseline NYHA class or LVEF. After 6 months of follow-up, reductions in NYHA class [−1 (IQR −2, −1) for AF; −1 (IQR −1, 0) for SR; p=0.437] and NT-proBNP levels [−358 mg/dL (IQR −2275, −47) for AF; −162 mg/dL (IQR −364, 27) for SR; p=0.156], as well as LVEF improvement [11% (IQR 3–15) for AF; 12% (IQR 7–21) for SR; p=0.201], displayed no statistically significant differences between the two groups.
Conclusions
Our study shows that the beneficial effects of SV on symptomatic status, NP levels and LVEF were not compromised by the presence of AF at baseline.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto , Porto , Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Gomes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Rosa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Campos
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - S Costa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Baptista
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - F Franco
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
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17
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Costa G, Cardoso J, Donato H, Goncalves L, Teixeira R. Concomitant tricuspid repair in mitral regurgitation surgery: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Tricuspid Regurgitation (TR) is common in patients with severe mitral disease. However, the evidence is insufficient to inform a decision about whether to perform prophylactic tricuspid-valve repair during mitral-valve surgery in patients who have moderate TR or less-than-moderate regurgitation.
Purpose
To compare the outcomes of concomitant tricuspid repair in mitral valve surgery versus no concomitant tricuspid repair in less-than-severe TR patients.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in December 2021, for interventional studies comparing concomitant tricuspid repair in mitral valve surgery versus no tricuspid intervention. Random-effects meta-analysis was performed.
Results
Four randomised trials were included, providing a total of 651 patients (323 in prophylactic tricuspid intervention group and 328 patients in conservative group). Our meta-analysis showed a similar all-cause mortality for concomitant prophylactic tricuspid repair compared with no tricuspid intervention (pooled OR, 0.54; 95% CI [0.25, 1.15], P=0.11; I2=0%). Additionally, there is a similar New York Heart Association (NYHA) III–IV classes in both groups, despite a lower trend in the tricuspid intervention group (pooled OR, 0.63; 95% CI [0.38, 1.06], P=0.08; I2=0%) (Figure 3). However, there was a significant lower progression of TR (pooled OR, 0.06; 95% CI [0.02, 0.24], P<0.01; I2=0%) and moderate-severe TR (pooled OR, 0.23; 95% CI [0.11, 0.46], P<0.01; I2=27%).
Conclusions
Our pooled analysis suggests that a tricuspid-valve repair at the time of mitral-valve surgery in patients with moderate or less-than-moderate TR does not impact perioperative or postoperative all-cause mortality, despite reducing TR severity and progression of TR following intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - J Cardoso
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic Surgery , Vila Nova de Gaia , Portugal
| | - H Donato
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research , Coimbra , Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
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18
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de Oliveira V, Santos D, Sinisgalli R, Vancini R, Costa G, Nikolaidis PT, Knechtle B, Weiss K, Andrade M, de Lira C. Factors associated with perceived performance drops and musculoskeletal injuries in Brazilian recreational triathletes. Eur Rev Med Pharmacol Sci 2022; 26:5651-5659. [PMID: 36066136 DOI: 10.26355/eurrev_202208_29498] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of the study was to investigate sleep characteristics, use of supplements, and training volume of recreational triathletes, and to verify possible associations with perceived performance drops and occurrence of injuries. MATERIALS AND METHODS Recreational triathletes (n=942) answered a questionnaire inquiring about their demographic characteristics, performance, injuries and training volume. RESULTS When comparing athletes who slept more (9-10 hours) with those who slept less, less sleep was associated with a higher prevalence of perceived performance drops. Regarding difficulties in initiating sleep, the absence of initiating difficulties (p<0.001) was a protective factor against perceived performance drops. Regarding weekly training volume, compared to those who trained more than 20 hours, training less than 3 hours (p<0.001), 3-5 hours (p<0.001), or 12-14 hours (p<0.001) were protective factors against perceived performance drops. Concerning training volume and injuries, we found that compared to those who trained more than 20 hours, training 18-20 hours (p<0.001), 15-17 hours (p<0.001), 12-14 hours (p<0.001), 6-8 hours (p<0.001), or 3-5 hours (p<0.001) were protective factors against injuries. CONCLUSIONS Triathletes with a lower sleep quantity and those who have difficulties initiating sleep frequently experience drops in performance. Training volumes can influence both performance and the likelihood of injuries.
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Affiliation(s)
- V de Oliveira
- Human and Exercise Physiology Division, Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil.
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19
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Savino MS, Cavinato L, Costa G, Fiz F, Torzilli G, Vigano L, Ieva F. Distant supervision for imaging-based cancer sub-typing in Intrahepatic Cholangiocarcinoma. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:1032-1035. [PMID: 36086172 DOI: 10.1109/embc48229.2022.9871262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Finding effective ways to perform cancer sub-typing is currently a trending research topic for therapy opti-mization and personalized medicine. Stemming from genomic field, several algorithms have been proposed. In the context of texture analysis, limited efforts have been attempted, yet imaging information is known to entail useful knowledge for clinical practice. We propose a distant supervision model for imaging-based cancer sub-typing in Intrahepatic Cholangiocar-cinoma patients. A clinically informed stratification of patients is built and homogeneous groups of patients are characterized in terms of survival probabilities, qualitative cancer variables and radiomic feature description. Moreover, the contributions of the information derived from the ICC area and from the peri tumoral area are evaluated. The findings suggest the reliability of the proposed model in the context of cancer research and testify the importance of accounting for data coming from both the tumour and the tumour-tissue interface. Clinical relevance - In order to accurately predict cancer prognosis for patients affected by ICC, radiomic variables of both core cancer and surrounding area should be exploited and employed in a model able to manage complex information.
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20
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Viganò L, Branciforte B, Laurenti V, Costa G, Procopio F, Cimino M, Del Fabbro D, Di Tommaso L, Torzilli G. The Histopathological Growth Pattern of Colorectal Liver Metastases Impacts Local Recurrence Risk and the Adequate Width of the Surgical Margin. Ann Surg Oncol 2022; 29:5515-5524. [PMID: 35687176 DOI: 10.1245/s10434-022-11717-8] [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] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The histopathological growth pattern (HGP) of colorectal liver metastases (CLM) has been associated with prognosis. This study was designed to elucidate if the HGP is associated with local recurrence risk and impacts the adequate width of surgical margin. METHODS All consecutive patients resected for CLM in 2018-2019 were considered. HGP was prospectively classified as follows: desmoplastic, pushing, and replacement. Surgical margin was classified as follows: R0 (margin ≥ 1 mm), R1vasc (0-mm margin, tumor detachment from intrahepatic vessels), and R1par (tumor exposure along transection plane). R0 resections were further distinguished in R0min (1-mm margin) and R0wide (> 1-mm margin). RESULTS A total of 340 resection areas in 136 patients were analyzed (70 R0min, 143 R0wide, 31 R1vasc, 96 R1par). HGP was desmoplastic in 26 cases, pushing in 221, and replacement in 93. Thirty-six local recurrences occurred (11%, median follow-up 21 months): 1 after R0wide, 4 after R0min, 3 after R1vasc, and 28 after R1par resection. In R1par group, local recurrence rate was high independently of HGP (29%). In R1vasc and R0min groups, local recurrence risk was higher in the replacement group (R1vasc: 29% vs. 4% if pushing/desmoplastic; R0min: 11% vs. 4%). In R0wide group, local recurrence risk was low for all HGP ( < 1%). Independent predictors of local recurrence were replacement HGP (odds ratio = 1.654, P = 0.036), and R1par resection (odds ratio = 57.209, P < 0.001 vs. R0). CONCLUSIONS Replacement HGP is associated with an increased risk of local recurrence. In these patients, a wide surgical margin should be pursued, because R1vasc and R0min resections could be insufficient. R1par resection is inadequate, independently of the HGP.
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Affiliation(s)
- L Viganò
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - B Branciforte
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - V Laurenti
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - G Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - F Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - M Cimino
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - D Del Fabbro
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - L Di Tommaso
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy.,Pathology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - G Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy. .,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy.
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21
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Viganò L, Branciforte B, Laurenti V, Costa G, Procopio F, Cimino M, Del Fabbro D, Di Tommaso L, Torzilli G. ASO Visual Abstract: The Histopathological Growth Pattern of Colorectal Liver Metastases Impacts Local Recurrence Risk and the Adequate Width of the Surgical Margin. Ann Surg Oncol 2022. [PMID: 35639291 DOI: 10.1245/s10434-022-11854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- L Viganò
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - B Branciforte
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - V Laurenti
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - M Cimino
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - D Del Fabbro
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - L Di Tommaso
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Pathology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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22
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Pompili R, Alesini D, Anania MP, Arjmand S, Behtouei M, Bellaveglia M, Biagioni A, Buonomo B, Cardelli F, Carpanese M, Chiadroni E, Cianchi A, Costa G, Del Dotto A, Del Giorno M, Dipace F, Doria A, Filippi F, Galletti M, Giannessi L, Giribono A, Iovine P, Lollo V, Mostacci A, Nguyen F, Opromolla M, Di Palma E, Pellegrino L, Petralia A, Petrillo V, Piersanti L, Di Pirro G, Romeo S, Rossi AR, Scifo J, Selce A, Shpakov V, Stella A, Vaccarezza C, Villa F, Zigler A, Ferrario M. Free-electron lasing with compact beam-driven plasma wakefield accelerator. Nature 2022; 605:659-662. [PMID: 35614244 DOI: 10.1038/s41586-022-04589-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/25/2022] [Indexed: 11/09/2022]
Abstract
The possibility to accelerate electron beams to ultra-relativistic velocities over short distances by using plasma-based technology holds the potential for a revolution in the field of particle accelerators1-4. The compact nature of plasma-based accelerators would allow the realization of table-top machines capable of driving a free-electron laser (FEL)5, a formidable tool to investigate matter at the sub-atomic level by generating coherent light pulses with sub-ångström wavelengths and sub-femtosecond durations6,7. So far, however, the high-energy electron beams required to operate FELs had to be obtained through the use of conventional large-size radio-frequency (RF) accelerators, bound to a sizeable footprint as a result of their limited accelerating fields. Here we report the experimental evidence of FEL lasing by a compact (3-cm) particle-beam-driven plasma accelerator. The accelerated beams are completely characterized in the six-dimensional phase space and have high quality, comparable with state-of-the-art accelerators8. This allowed the observation of narrow-band amplified radiation in the infrared range with typical exponential growth of its intensity over six consecutive undulators. This proof-of-principle experiment represents a fundamental milestone in the use of plasma-based accelerators, contributing to the development of next-generation compact facilities for user-oriented applications9.
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Affiliation(s)
- R Pompili
- Laboratori Nazionali di Frascati, Frascati, Italy.
| | - D Alesini
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M P Anania
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - S Arjmand
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Behtouei
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - A Biagioni
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - B Buonomo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Cardelli
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Carpanese
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - E Chiadroni
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Cianchi
- University of Rome Tor Vergata, Rome, Italy.,INFN Tor Vergata, Rome, Italy.,NAST Center, Rome, Italy
| | - G Costa
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Del Dotto
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Del Giorno
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Dipace
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Doria
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - F Filippi
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - M Galletti
- University of Rome Tor Vergata, Rome, Italy.,INFN Tor Vergata, Rome, Italy.,NAST Center, Rome, Italy
| | - L Giannessi
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Giribono
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - V Lollo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - F Nguyen
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | | | - E Di Palma
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - L Pellegrino
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Petralia
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | | | - L Piersanti
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - G Di Pirro
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - S Romeo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - J Scifo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Selce
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - V Shpakov
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Stella
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - C Vaccarezza
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Villa
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Zigler
- Laboratori Nazionali di Frascati, Frascati, Italy.,Racah Institute of Physics, Hebrew University, Jerusalem, Israel
| | - M Ferrario
- Laboratori Nazionali di Frascati, Frascati, Italy
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23
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De Almeida Fernandes D, Guimaraes J, Monteiro E, Costa G, Antonio N, Goncalves L. Tachydysrhythmias in patients admitted with COVID-19 pneumonia: prevalence and impact on in-hospital mortality. Europace 2022. [PMCID: PMC9384055 DOI: 10.1093/europace/euac053.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The COVID-19 pandemic has shifted tremendously the paradigm of hospital care and treatment of cardiovascular (CV) patients. According to most recent evidence, due to its multisystemic impact, COVID-19 may lead to an increased risk of cardiac arrhythmias with subsequently increased morbimortality.
Purpose
Determine the prevalence of tachyarrhythmias in patients admitted with COVID-19, possible predictors and impact on in-hospital mortality.
Methods
A retrospective study of 3475 consecutive patients with COVID-19 pneumonia admitted to our hospital between February 2020 and November 2021 were included. The main outcome was tachyarrhythmias (high ventricular rate (HVR) or new-onset atrial fibrillation (AF), HVR or new-onset atrial flutter (AFL), other supraventricular tachycardias (SVT), ventricular tachycardia (VT) and ventricular fibrillation (VF)). Secondary outcome was in-hospital mortality. Sociodemographic variables and clinical data were recorded. Statistical comparison was made between groups, including logistic regression to determine odds ratios (OR).
Results
A total of 215 patients presented HVR AF (6.31%), 79 of which with new-onset AF (36.74%). 8 patients had HVR AFL (0.23%), 5 VT (0.15%), 4 VF (0.12%) and only 3 patients had a SVT identified (0.09%). Patients with tachyarrhythmias were significantly older (77. 74 ± 11.25 68.94 ± 17.51 years, p <0.001) and had more hypertension (p 0.034), heart failure (HF) (p <0.001), severe valvular heart disease (VHD) (p 0.007), coronary artery disease (CAD) (p 0.031), chronic kidney disease (CKD) (p 0.048) and paroxysmal AF (if previously diagnosed (p 0.001). There were no significant differences regarding gender, dyslipidemia, diabetes, cerebrovascular disease and obstructive sleep apnoea (OSA).
Patients with HF had the highest risk of tachyarrhythmia (OR 3.539; 95% CI 2.666-4.698; p <0.001), followed by severe VHD (OR 1.990; 95% CI 1.192-3.365; p 0.009) and CAD (OR 1.575; 95% CI 1.040-2.386; p 0.032). Older patients or patients with hypertension or CKD were also at an increased risk. Also of note, patients previously diagnosed with paroxysmal AF were more likely to have episodes of HVR AF than the ones with persistent or permanent AF (OR 1.819; 95% CI 1.272-2.602; p 0.001)
Regarding the secondary outcome, patients with tachyarrhythmias during hospital stay had an odd almost 3 times higher of death (OR 2.820; 95% CI 2.151-3.695; p <0.001).
Conclusions
Tachyarrhythmias is a common complication in COVID-19 patients during hospital stay that is significantly linked to higher in-hospital mortality. Patients presenting with high CV disease burden are at particularly significant risk and should be carefully managed.
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Affiliation(s)
| | - J Guimaraes
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - E Monteiro
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - G Costa
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - N Antonio
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - L Goncalves
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
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24
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De Almeida Fernandes D, Guimaraes J, Costa P, Monteiro E, Costa G, Antonio N, Martins P, Goncalves L. Prevalence and impact of dysrhythmias in COVID-19 intensive care patients. Europace 2022. [PMCID: PMC9384148 DOI: 10.1093/europace/euac053.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Background The COVID-19 pandemic has had a dramatic impact on clinical practice, amounting to more emergency department and intensive care unit (ICU) admissions. Due to their frequent multiple comorbidities, management in the ICU is challenging. Early studies suggest that cardiac injury is frequent in hospitalized patients with COVID-19, and it is plausible that these patients have a higher risk of cardiac dysrhythmias. Purpose To determine the prevalence of dysrhythmias in ICU patients with COVID-19 pneumonia, identify major predictors and determine the impact on in-hospital mortality. Methods A retrospective study of 98 consecutive patients with COVID-19 Pneumonia admitted to the ICU of a tertiary hospital in 2020. The main outcome was dysrhythmias (including significant bradycardia, high/slow ventricular rate or new-onset atrial fibrillation (AF) or atrial flutter, other supraventricular tachycardias, ventricular tachycardia and ventricular fibrillation). Significant bradycardia was defined as heart rate lower than 40 or need of treatment. Sociodemographic variables and clinical data were retrieved for each patient, severity scores at admission (Apache II, SOFA and SAPS II), number of days on mechanical ventilation or high-flow oxygen and placement on Venovenous Extracorporeal Membrane Oxygenation (ECMO) or prone position were recorded. Statistical comparison was made between groups, including logistic regression adjusting for confounding variables. Results The most frequent arrhythmia was significant sinus bradycardia (28, 28.5%) followed by high ventricular rate AF (14, 14.2%). Patients who had dysrhythmias were older (66.24 ± 10.13 vs 60.85 ± 12.69 years, p 0.024), more severe (SAPS II score 42.55 ± 11.08 vs 35.98 ± 11.26, p 0.006), had more atrial fibrillation (AF) (p 0.022), had higher maximum C-reactive protein (mCRP) (6.56 ± 2.68 vs 6.24 vs 2.86, p 0.009), were mechanically ventilated for a longer time (15.64 ± 13.18 vs 8.92 ± 8.85 days, p 0.004), had longer intubation time (14.52 ± 9.39 vs 8.70 ± 8.21 days, p 0.002) and had higher usage of dexamethasone (p 0.042) and prone position (p 0.016). When adjusted for confounding variables, prone was the most significant predictor (OR 2.800; 95% CI 1.203-6.516) followed by use of dexamethasone (OR 2.484; 95% CI 1.020-6.050). Days intubated, days on mechanical ventilation, age, mCRP and SAPS II on admission were also predictors of dysrhythmia. Regarding mortality, patients with arrhythmic events had a tendency for greater in-hospital death (OR 2.440; 95% CI 0.950-6.310; p 0.065). Conclusions COVID-19 ICU patients are a subset of patients at risk of cardiac arrhythmias. Use of prone position was the main contributor to these events, but clinical history, severity and treatment may also play an important role. Efforts must be made to optimize ventilatory support and treatment in order to reduce the risk of dysrhythmias.
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Affiliation(s)
| | - J Guimaraes
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - P Costa
- Coimbra Hospital and University Center, Intensive Care Medicine, Coimbra, Portugal
| | - E Monteiro
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - G Costa
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - N Antonio
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - P Martins
- Coimbra Hospital and University Center, Intensive Care Medicine, Coimbra, Portugal
| | - L Goncalves
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
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25
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Rosato S, Biancari F, D‘errigo P, Tarantini G, Costa G, Baglio G, Seccareccia F, Tamburino C. P326 SURGICAL VERSUS TRANSCATHETER AORTIC VALVE REPLACEMENT WITH NEWER GENERATION DEVICES IN REAL–WORLD PRACTICE: ONE–YEAR OUTCOMES FROM THE ITALIAN OBSERVANT STUDIES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
To compare the early and 1–year outcomes after transcatheter aortic valve replacement (TAVR) with new–generation devices over surgical replacement (SAVR) among patients with severe aortic stenosis (AS).
Background
TAVR is gaining acceptance for the treatment of lower risk patients with AS after several randomized and observational studies confirmed comparable early results to SAVR. On the other hand, clinical studies have shown that SAVR is still widely used in intermediate and high risk patients. There is need of data from large clinical registries to demonstrate the efficacy and safety of TAVR in the real–world setting, particularly after the introduction of new TAVR technology.
Methods
A total of 5706 AS patients who underwent SAVR and 2989 AS patients who underwent TAVR enrolled in the national, prospective OBSERVANT and OBSERVANT II studies, respectively in 2010–2012 and 2016–2018, were analyzed. Outcomes were adjusted using the propensity score matching. The primary outcomes of interest were all–cause mortality, major adverse cardiac and cerebrovascular events (MACCEs) and hospital readmission due to heart failure at 1–year. Secondary outcomes were major adverse events occurring during the index hospitalization.
Results
Among 1008 propensity score matched pairs, TAVR was associated with significantly lower 30–day mortality (1.8 vs. 3.5%, p = 0.020), stroke (0.8 vs. 2.3%, p = 0.005), acute kidney injury (0.6 vs. 8.2%, p < 0.001), infectious complications (3.8 vs. 6.5%, p = 0.006) and cardiogenic shock (1.4 vs. 5.1%, p < 0.001) compared to SAVR. Moderate–to–severe paravalvular regurgitation (5.9 vs. 2.0%, p < 0.001), major vascular complications requiring invasive treatment (2.2 vs. 0.1%, p < 0.001) and permanent pacemaker implantation (during the index hospitalization, 13.8 vs. 3.3%, p < 0.001) were more frequent after TAVR. At 1–year, TAVR was associated with lower risk of all–cause death (7.9 vs. 11.5%, p = 0.006), MACCE (12.0 vs. 15.8%, p = 0.011), readmission due to heart failure (10.8 vs. 15.9%, p < 0.001) and stroke (3.2 vs. 5.1%, p = 0.033) compared to SAVR.
Conclusions
In a real–world setting, patients with intermediate operative risk treated with newer generation TAVR devices had a low risk of major adverse events during the index–hospitalization and at 1–year follow–up. TAVR could become the treatment of choice for AS in the elderly provided that its durability is proved by long–term follow–up studies.
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Affiliation(s)
- S Rosato
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - F Biancari
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - P D‘errigo
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - G Tarantini
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - G Costa
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - G Baglio
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - F Seccareccia
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - C Tamburino
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes A, Saleiro C, Campos D, Sousa J, Lopes J, Puga L, Teixeira R, Lourenco C, Madeira M, Goncalves L. Inflammation in acute coronary syndrome: prognostic significance. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In patients with acute coronary syndrome (ACS) the acute phase reactant, C-reactive protein (CRP), might be significantly elevated. Several reports suggest that CRP may play a direct pathophysiological role on the development and progression of atherosclerosis, and CRP values correlate with infarct size when measured by magnetic resonance imaging.
Purpose
The aim of the present study was to evaluate the prognostic value of CRP in patients presenting with an ACS.
Methods
Retrospective analysis of 635 consecutively admitted patients due to ACS in a single coronary intensive care unit. CRP levels were measured at admission. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether CRP was an independent predictor of outcome.
Results
In the studied sample, 75% were male. Median age was 69 [interquartile range (IQR) 57–78]. ST-elevation myocardial infarction (STEMI) occurred in 39.6%, non-ST segment elevation myocardial infarction in 44.9% and unstable angina in 15.5% of the patients. Median left ventricular ejection fraction (LVEF) was 48% (IQR 40–55%) and median CRP level at admission 0.7 mg/dL (IQR 0.5–1.9 mg/dL). Regarding important comorbidities and past medical history, 75.9% had hypertension (HTN), 34.0% diabetes, 20.3% chronic kidney disease (CKD), 68.6% dyslipidaemia and 17.3% heart failure (HF). The median follow-up was 34 months (IQR 22–72). In univariate analysis, CRP was significantly associated with all-cause mortality (HR 1.06 per 1 mg/dL increase, 95% CI 1.04–1.08, p<0.001), as was gender, age, LVEF, STEMI and previous history of diabetes, HTN, CKD or HF. In multivariate analysis, CRP remained significantly associated with the primary endpoint (HR 1.02, 95% CI 1.00–1.05, p=0.033), as did age, LVEF and previous history of HF.
Conclusions
In our study, CRP at admission was an independent risk factor for all-cause mortality following an ACS. This finding indicates that inflammation associated with the acute event has a significant impact in the long-term prognosis. More evidence is needed to determine if treating inflammation (and when, in the course of the disease) could result in better outcomes.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto, Porto, Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - A Gomes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - D Campos
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - L Puga
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - R Teixeira
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
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Forresi B, Michelini G, Sapuppo W, Costa G, Castellini G, Livellara S, Gregori Grgič R. Anger, personality traits and psychopathological symptoms in subjects exposed to negative interpersonal actions in workplaces: an observational study in a large sample attending a Center for Occupational Stress. Int Arch Occup Environ Health 2022; 95:1763-1773. [PMID: 35511292 DOI: 10.1007/s00420-022-01868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The association between adverse working conditions and mental disorders is well established. In addition to psychopathological symptoms, this study aimed at investigating anger and personality traits in a clinical sample of subjects referring negative interpersonal experiences in workplaces. METHODS 1676 workers attending a Centre for Occupational Stress in Milan (from 2014 to 2016) were administered an assessment protocol including SCL-90 for general psychopathology, STAXI for anger intensity and expression, and MMPI-2 for personality traits. A qualitative checklist was used to collect negative experiences in workplaces. RESULTS Patients reported they were exposed to "threats to the task or the professional career" more than to "attacks to the person". Over 80% scored above the cutoff in all the subscales of the SCL-90, with highest scores in Depression, Obsessive-Compulsive Disorder, Anxiety, Somatization and Paranoia. 60% scored above the 90th percentile in the AX/in subscale, showing intense anger feelings that they mostly suppress. Abnormal elevations at the MMPI scales of Hypochondria, Depression, Hysteria, and Paranoia were found in over 50% of the sample. Women reported higher psychological difficulties and internalized anger than men. Anger towards objects and people, instead, was more common in males. No differences were observed by work sector or employment status. CONCLUSIONS In addition to severe psychological difficulties, individuals reporting negative interpersonal experiences in workplaces have high levels of internalized anger and a distinctive profile of personality traits. While a deeper investigation is needed, anger expression should be considered in future treatment programs.
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Affiliation(s)
- Barbara Forresi
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy.
| | - G Michelini
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy
| | - W Sapuppo
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy.,London South Bank University, London, UK
| | - G Costa
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - G Castellini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Livellara
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy
| | - R Gregori Grgič
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy
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28
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Fransvea P, Costa G, Pepe G, La Greca A, Magalini S, Puccioni C, d'Agostino L, Altieri G, Borello A, Cozza V, Sganga G. Acute intestinal ischemia in patients with COVID-19: single-centre experience and literature review. Eur Rev Med Pharmacol Sci 2022; 26:1414-1429. [PMID: 35253199 DOI: 10.26355/eurrev_202202_28135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Acute Intestinal ischemia (AII) may involve the small and/or large bowel after any process affecting intestinal blood flow. COVID-19-related gastrointestinal manifestations, including AII, have been attributed to pharmacologic effects, metabolic disorders in ICU patients and other opportunistic colonic pathogens. AII in COVID-19 patients may be due also to "viral enteropathy" and SARS-CoV-2-induced small vessel thrombosis. A critical appraisal of personal experience regarding COVID-19 and AII was carried out comparing this with a systematic literature review of published series. PATIENTS AND METHODS A retrospective observational clinical cohort study and a systematic literature review including only COVID-19 positive patients with acute arterial or venous intestinal ischemia were performed. The primary endpoint of the study was the mortality rate. Secondary endpoints were occurrence of major complications and length of hospital stay. RESULTS Patient mean age was 62.9±14.9, with a prevalence of male gender (23 male, 72% vs. 9 female, 28%). The mean Charlson Comorbidity Index was 3.1±2.7. Surgery was performed in 24/32 patients (75.0%), with a mean delay time from admission to surgery of 6.0 ±5.6 days. Small bowel ischemia was confirmed to be the most common finding at surgical exploration (22/24, 91.7%). Acute abdomen at admission to the ED (Group 1) was observed in 10 (31.2%) cases, while 16 (50%) patients developed an acute abdomen condition during hospitalization (Group 2) for SARS-CoV-2 infection. CONCLUSIONS Our literature review showed how intestinal ischemia in patients with SARS-CoV-2 has been reported all over the world. The majority of the patients have a high CCI with multiple comorbidities, above all hypertension and cardiovascular disease. GI symptoms were not always present at the admission. A high level of suspicion for intestinal ischemia should be maintained in COVID-19 patients presenting with GI symptoms or with incremental abdominal pain. Nevertheless, a prompt thromboelastogram and laboratory test may confirm the need of improving and fastening the use of anticoagulants and trigger an extended indication for early abdominal CECT in patients with suggestive symptoms or biochemical markers of intestinal ischemia.
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Affiliation(s)
- P Fransvea
- Emergency Surgery and Trauma - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
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Mazzon G, Ferretti S, Acquati P, Nazzani S, Campobasso D, Germinale F, Filippi B, Micali S, Pavan N, De Marco G, Vismara Fugini A, Morena T, Peroni A, Celentano G, Creta M, Serafin E, Costa G, Rocco B, Maestrani U, Vaccaro C, Carmignani L, Trombetta C, Cerruto M, Antonelli A, Celia A. The effect of COVID-19 outbreak on endourological treatments for urinary stones: A retrospective multicentric study. Eur Urol 2022. [PMCID: PMC9155269 DOI: 10.1016/s0302-2838(22)00335-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ceresoli M, Carissimi F, Nigro A, Fransvea P, Lepre L, Braga M, Costa G. Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry. Hernia 2022; 26:165-175. [PMID: 32737706 PMCID: PMC8881429 DOI: 10.1007/s10029-020-02269-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. METHODS This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson's comorbidity index, P-POSSUM and CR-POSSUM were assessed. RESULTS 259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson's comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality CONCLUSION: Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson's comorbidity index could be adopted to select patients for elective operation.
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Affiliation(s)
- M Ceresoli
- General and Emergency Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, via Pergolesi 33, 20900, Monza, Italy.
| | - F Carissimi
- General and Emergency Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | - A Nigro
- General and Emergency Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | - P Fransvea
- UOC Chirurgia D'Urgenza E del Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - L Lepre
- UOC Chirurgia Generale, Ospedale Santo Spirito in Sassia, ASL Roma 1, Roma, Italy
| | - M Braga
- General and Emergency Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | - G Costa
- Surgical and Medical Department of Translational Medicine, Sant'Andrea Teaching Hospital, Sapienza University of Roma, Roma, Italy
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31
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Parrino V, Costa G, Giannetto A, De Marco G, Cammilleri G, Acar Ü, Piccione G, Fazio F. Trace elements (Al, Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn) in Mytilus galloprovincialis and Tapes decussatus from Faro and Ganzirri Lakes (Sicily, Italy): Flow cytometry applied for hemocytes analysis. J Trace Elem Med Biol 2021; 68:126870. [PMID: 34601281 DOI: 10.1016/j.jtemb.2021.126870] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Trace elements present in sessile molluscs, are important because they are used in human consumption and it has significantly increased in recent years. While their filtering of the water can lead to their build-up of organic and inorganic materials that can be sampled and analyzed, this can also lead to bioaccumulation of harmful substances, such as essential and non-essential elements, that can harm the human health if in taken in high concentrations or for a long period of time. METHODS In the present study, the trace metal content (Al, Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn) of two sessile crustaceans, 20 Mytilus galloprovincialis (mussel) and 20 Tapes decussatus (clam) in Faro and Ganzirri Lakes (Messina, Sicily, Italy) were analyzed. Haemolymph samples were taken on both molluscs in order to analyze the haemocyte population by flow cytometric analysis. Unpaired t-tests were used to determine significant differences for the essential and non-essential metallic elements concentrations in the lake waters and in the tissues of M. galloprovincialis and T. decussatus and for hemocyte populations R1 (halinocytes) and R2 (granulocytes). RESULTS The results suggested that that in Faro Lake, the tissue Al, Cr and Pb levels in M. galloprovincialis were higher than those for T. decussatus, in contrast to Mn, Fe, Ni, Cu, Zn and Cd, which were higher in T. decussatus. Unpaired t-tests showed that there were significantly higher proportions of halinocytes in M. galloprovincialis versus T. decussatus for both Faro Lake (41.8 % vs. 24.3 %; P < 0.001) and Ganzirri Lake (43.0 % vs. 22.4 %; P < 0.001). In contrast, while there were significantly higher proportions of granulocytes in Faro Lake (21.2 % vs. 9.1 %; P < 0.001), this difference was not seen for the granulocytes of M. galloprovincialis versus T. decussatus in Ganzirri Lake (9.6 % vs. 13.0 %). CONCLUSION This study shows that M. galloprovincialis and T. decussatus can indeed bioaccumulate some of these metal, such that activation of the immune responses is specific to certain cell types. Future research must focus on the balance of trace elements in the consumption of these shellfish, and analyzes with more sophisticated tools can be used to diagnose the increased concentration of trace elements and the quantification of trace metals from shellfish to clams.
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Affiliation(s)
- Vincenzo Parrino
- Department of Chemical, Biological, Pharmaceutical, and Environmental Sciences, University of Messina, 98166, Messina, Italy.
| | - Gregorio Costa
- Department of Human Pathology in Adult and Developmental Age, University of Messina, 98125, Messina, Italy
| | - Alessia Giannetto
- Department of Chemical, Biological, Pharmaceutical, and Environmental Sciences, University of Messina, 98166, Messina, Italy
| | - Giuseppe De Marco
- Department of Chemical, Biological, Pharmaceutical, and Environmental Sciences, University of Messina, 98166, Messina, Italy
| | - Gaetano Cammilleri
- Experimental Zooprophylactic Institute of Sicily "A. Mirri", Palermo, Italy
| | - Ümit Acar
- Bayramiç Vocational School, Çanakkale Onsekiz Mart University, Çanakkale, 17100, Turkey
| | - Giuseppe Piccione
- Department of Veterinary Sciences, Polo Universitario dell'Annunziata, 98168, Messina, Italy
| | - Francesco Fazio
- Department of Veterinary Sciences, Polo Universitario dell'Annunziata, 98168, Messina, Italy
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Pereira D, Costa G, Catarino R, Pina-Vaz T, Silva J. Testicular disorders’ awareness and knowledge among Portuguese high-school students. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03175-x] [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: 10/19/2022] Open
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Catarino R, Alves L, Pereira J, Pereira D, Costa G, Cardoso A, Braga I, Freitas R, Correia T, Cerqueira M, Carmo Reis F, Lobo F, Morais A, Silva V, Magalhães S, Prisco R. Neoadjuvant chemotherapy in patients with urothelial bladder cancer. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03227-4] [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] Open
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Cigliano F, Boccuzzi A, Basile V, Ferraro A, Macciotta A, Catalano A, Costa G, Vineis P, Sacerdote C, Caramello V. Are antigen tests useful as screening for the identification of SARS-CoV-2 in emergency rooms? Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A quick and accurate case identification in the Emergency Department (ED) during the SARS-CoV-2 pandemic is crucial for clinical management and to prevent spread of infections. The gold standard for diagnosing SARS-CoV-2 infection is the real-time reverse transcription polymerase chain reaction (RT-PCR) test in upper airways swabs. However, the procedure is available in few specialized laboratories and requires an average sample processing time of about 6 hours from its inception. The development of reliable but cheaper and faster point-of-care tests was expected to be useful either for population-screening or as first aid tests in the ED. Rapid antigenic diagnostic tests (Ag-RDTs), directly detect SARS-CoV-2 proteins produced by the replicating virus in respiratory specimens, were proved to be candidates in both cases. However, data on their effectiveness are still few and controversial. The aim of the study is to establish the accuracy of antigen tests to identify SARS-CoV-2 in a high prevalence setting.
Methods
Results of 324 patients, consecutively admitted to the ED of San Luigi Gonzaga University Hospital in Orbassano (Turin, Italy) between 26 October and 10 November 2020 and subjected to both molecular and antigen tests, were compared.
Results
Using RT-PCR as gold standard, specificity and sensitivity of Ag-RDT were 0.94 (95%CI: 0.90-0.98) and 0.80 (95%CI: 0.75-0.85), respectively. The Ag-RDT positive predictive value was 0.96 (95%CI 0.93- 0.99), and the negative predictive value was 0.72 (95% CI: 0.65-0.79). Patients that tested negative to Ag-RDT but presented with fever and cough or had pneumonia at imaging were more likely to be false negatives. Ag-RDTs best performance occurs in the first days after symptom onset.
Conclusions
These results confirm the limits of antigenic tests as first line screening tests and suggest that the antigenic test should be integrated with clinical judgement, based on physical and instrumental examinations.
Key messages
Antigenic tests have a limited effectiveness as first line screening tests. In a high-prevalence setting these tests incorrectly judge as negative many COVID-19 symptomatic patients, making necessary to integrate their results with clinical judgement.
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Affiliation(s)
- F Cigliano
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - A Boccuzzi
- Emergency Department and High Dependency Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - V Basile
- Emergency Department and High Dependency Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - A Ferraro
- Emergency Department and High Dependency Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - A Macciotta
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - A Catalano
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - G Costa
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Epidemiology Unit, Regional Health Service ASLTO3, Grugliasco, Italy
| | - P Vineis
- MRC Centre for Environment and Health, Imperial College, London, UK
| | - C Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy
| | - V Caramello
- Emergency Department and High Dependency Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
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Favaro E, Saugo C, Sandu B, DeMaria M, Gnavi R, Lefevre C, Costa G. Estimation of Excess Deaths in Turin from COVID-19 and other causes, October to November 2020. Eur J Public Health 2021. [PMCID: PMC8574562 DOI: 10.1093/eurpub/ckab164.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Understanding the effect of COVID-19 on mortality during this emergency and evaluating unexplained increases in deaths due to nonspecific outcomes can provide a more complete picture of this period and give better instrument to deal with the pandemy in the future.
Objective
The aim is to evaluate in the city of Turin the excess in the number of deaths from October to November 2020.
Methods
The number of excess deaths was defined as the difference between the deaths observed in the pandemic period of 2020 and the deaths expected for the years 2014-2019.
Results
There were approximately 2047 total all causes deaths in Turin October 1 to November 30 2020, representing 630 more deaths than would typically be expected at that time of year. This excess was higher between men than in women. The number of excess all cause death was higher in 80 years old, less evident between 60-79 years old and very few between under 60 years old. Regarding the place of death, the number of excess all cause death was higher in hospital or in some health institutions for old people. Regarding the causes of deaths the explanation of these excess of deaths was COVID-19 infection only for a part of deaths and there are some excess of deaths not caused by COVID-19. The cause of excess of death not COVID-19 seems to be due to cardiovascular diseases, respiratory diseases, psychiatric disorders, neurological diseases, diabetes or nephrological diseases and to other undefinited causes.
Conclusions
The results showed during pandemic an increase of mortality respect to the expected mortality. Only a part of this excess deaths is due to COVID-19 but there is a relevant percentage of excess of deaths apparentely not due to COVID-19 but probably due to other causes. A better knowledge of these phenomena could help to improve any gaps in territorial assistance and provide indications for the future management of the pandemic in Europe.
Key messages
Increase of mortality in pandemic respect to the expected mortality. There is an excess of deaths apparentely not due to COVID-19.
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Affiliation(s)
- E Favaro
- University of Turin, Turin, Italy
| | - C Saugo
- University of Turin, Turin, Italy
| | - B Sandu
- University of Turin, Turin, Italy
| | - M DeMaria
- Servizio Epidemiologia Piemonte, Turin, Italy
| | - R Gnavi
- Servizio Epidemiologia Piemonte, Turin, Italy
| | - C Lefevre
- Servizio Epidemiologia Piemonte, Turin, Italy
| | - G Costa
- University of Turin, Turin, Italy
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Costa G. Impact of the COVID-19 pandemic on emotional status of the adult and older population in Italy. Data from the behavioural risk factor surveillance systems PASSI and PASSI d’Argento, 2020-2021. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
PASSI and PASSI d'Argento are two nationwide ongoing population-based surveillance systems in Italy which targeting, respectively, adults aged 18-69 and over-65, aim at monitoring people health profile, as per health behaviours and their determinants. The Italian National Institute of Health is in charge of the central coordination, but the Local Health Units (LHUs) develop these surveillances. Specifically trained LHUs personnel conduct phone-interviews on gender and age-representative monthly samples of residents in Italy by using a standardised questionnaire. Within both systems, depressive symptoms are under investigation through the Patient Health Questionnaire-2. Since August 2020 to date, PASSI and PASSI d'Argento annexed a specific COVID module in addition to the standard questionnaires' sections. In this way, we have been studying the impact of the COVID-19 pandemic on economic and working conditions, emotional status and other health-related aspects, as well as those concerning contagion risk perception and its outcomes or citizens compliance with pandemic control measures. In detail, two questions detect the impact of the pandemic on emotional status: ‘intrusive thinking' as dimension of psychological stress associated to experiencing COVID-19 emergency, and ‘degree of concern' about the current situation as a dimension of anxiety. Even if the two items are not precise tools to assess mental health symptoms, they are in the condition to give hints for an estimation of the pandemic impact on the psychological well-being in the general population. Preliminary findings, from the analysis of 5,000 interviews, show quite direct experience of COVID (bereavements in family or COVID-positive friends), worsened economic resources among the working-age individuals, and social isolation in the elderly, as the main determinants of intrusive thinking. Being worried about pandemic also correlates with experience of COVID, showing significant differences by gender.
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Affiliation(s)
- G Costa
- Epidemiologia Piemonte, Grugliasco, Italy
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Monteiro E, Pedro Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes A, Saleiro C, Campos D, Sousa J, Lopes J, Puga L, Teixeira R, Lourenco C, Madeira M, Goncalves L. Prognostic significance of percutaneous coronary intervention associated blood loss in acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1241] [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: 11/15/2022] Open
Abstract
Abstract
Background
Antiplatelet and anticoagulants are one of the mainstay treatment of acute coronary syndrome (ACS), however they are associated with a significant increase of bleeding risk. While anaemia is a recognized predictor of adverse outcomes, it is unknown if a variation of haemoglobin (HB) levels, even without associated anaemia, has the same impact.
Purpose
The aim of this study was to determine the prognostic impact of HB variation after percutaneous coronary intervention (PCI) in ACS patients.
Methods
Retrospective analysis of 822 consecutive patients admitted due to ACS and treated with PCI, in a single coronary intensive care unit. Delta HB – ΔHB – (HB at admission – HB 24 hours after PCI) was calculated. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether ΔHB was independent from other known factors in predicting the outcome.
Results
In the studied sample, 75.4% were male. Mean age was 66.4±13.1. ST-elevation myocardial infarction (STEMI) occurred in 45.5%, non-ST segment elevation myocardial infarction in 42.6% and unstable angina in 11 9% of the studied population. Moderate to severe systolic dysfunction was present in 23.5% of the cases. Regarding comorbidities and past medical history, 76% had hypertension (HTN), 30.3% diabetes, 16.4% chronic kidney disease (CKD), 62.2% dyslipidaemia and 10.5% heart failure (HF). Mean HB at admission was 13.8±1.8 g/dL, mean HB after PCI was 12.9±1.9 g/dL and mean ΔHB was 0.9±1.1 g/dL. The mean follow-up was 51.6±30.6 months. In univariate analysis, ΔHB was significantly associated with all-cause mortality (HR 1.15 per 1 g/dL loss, 95% CI 1.01–1.30, p=0.04), as was HB at admission, HB after PCI, age, sex, diabetes, HTN, dyslipidaemia, CKD and moderate to severe systolic dysfunction. In multivariate analysis, ΔHB remained significantly associated with the endpoint and gained even more statistical power (HR 1.25, 95% CI 1.10–1.43, p<0.01). HB at admission and after PCI, age, CKD and moderate to severe systolic dysfunction were also independent predictors of this outcome.
Conclusions
In our study, irrespective of the admission and discharge HB, ΔHB was associated with more adverse outcomes in patients submitted to PCI. Hence, even patients with a normal HB after PCI have a worse long-term prognosis if a negative variation of HB occurs. This highlights the importance of identifying and optimising all the correctable factors that might lead to an increased bleeding risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Monteiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | | | - J Guimaraes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Fernandes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - G Costa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - A Gomes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Puga
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - R Teixeira
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - M Madeira
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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Costa G, Goncalves L, Teixeira R. Efficacy and safety of direct oral anticoagulants with diabetes and nonvalvular atrial fibrillation: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2988] [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
Diabetes Mellitus (DM) is an independent risk factor for stroke and atrial fibrillation (AF). Therefore, the risk/benefit profile of the direct oral anticoagulants (DOAC) is of clinical interest.
Purpose
To compare efficacy and safety outcomes of DOAC for nonvalvular AF in patients with DM versus without DM.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in January 2020, for interventional studies comparing DOAC efficacy and safety in patients with AF and diabetes versus without diabetes.
Results
Four randomized clinical trials were included, providing a total of 63987 patients, 18860 with DM and 45127 without DM. In terms of efficacy, our meta-analysis revealed a similar rate of stroke/systemic embolism (pooled OR 1.02 [0.79, 1.31], P=0.87, I2=83%), stroke (pooled OR 1.98 [0.68, 1.40], P=0.90, I2=90%) and all-cause mortality (pooled OR 1.18 [0.97, 1.43], P=0.10, I2=87%), albeit with a significant heterogeneity. However, in direct factor Xa inhibitors sub analysis, diabetic patients had a lower trend of systemic embolism/stroke (pooled OR 0.90 [0.79, 1.02], P=0.09, I2=18%), significantly lower stroke rate (pooled OR 0.82 [0.73, 0.93], P<0.01, I2=0%), but a higher all-cause mortality (pooled OR 1.08 [1.00, 1.16], P<0.01, I2=0%). In terms of safety, the diabetic patients receiving DOAC had higher rates of major bleeding events (pooled OR 1.28 [1.14, 1.45], P<0.01, I2=50%), although with significant heterogeneity. Direct factor Xa inhibitors sub analysis also revealed a higher rate of major bleeding events (pooled OR 1.22 [1.08, 1.38], P<0.01, I2=24%), but a similar intracranial bleeding events (pooled OR 1.03 [0.86, 1.24], P=0.72, I2=0%).
Conclusion
Our pooled analysis suggests that diabetic patients on DOAC have an higher bleeding risk on DOAC, although with a superior embolic protection.
Funding Acknowledgement
Type of funding sources: None. Systemic Embolism/Stroke in DM vs. NonDM
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Affiliation(s)
- G Costa
- Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research, Coimbra, Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
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De Almeida Fernandes D, Cadete R, Guimaraes J, Monteiro E, Costa G, Antonio N, Goncalves L. Impact of the COVID-19 pandemic on emergent pacemaker implantation during lockdown and its aftermath. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
COVID-19 was first considered a pandemic on the 11th of March of 2020 by the World Health Organization. Its impact comprised not only the direct consequences of the disease but a decrease in the follow-up and interventions of patients with cardiovascular (CV) disease. In Portugal and the World, the consequences of this complex paradigm shift on emergent pacemaker implantation rates during and after this pandemic is largely unknown.
Purpose
We sought to analyse the impact of COVID-19 pandemic on emergent pacemaker implantation rate and patient profile in a tertiary hospital during the first Portuguese lockdown and subsequent post-lockdown period.
Methods
We retrospectively reviewed the clinical profile of patients who had pacemakers implanted in our hospital in an urgent/emergent setting from March 18, 2020 to May 17, 2020 (lockdown) and May 19 to July 17, 2020 (post-lockdown). This data was then directly compared to the homologous periods from the year before (H1 and H2, respectively).
Results
A total of 180 patients submitted to emergent pacemaker implantation were included.
The cohort was comprised of 29 patients who had a pacemaker implanted during lockdown, 60 post-lockdown, 38 in H1 (+31% vs lockdown) and 53 in H2. Average age and gender proportion were similar for all groups.
When comparing lockdown and post-lockdown periods, the number of cases significantly increased in the second period (+106.9%) and there was a tendency for a higher number of temporary pacemaker use (3.4% vs 16.7%; p=0.076). Patients admitted during lockdown were 7.57 times more likely to present with hypotension/shock (odds ratio (OR) 7.57; p=0.013).
Regarding lockdown and its homologous 2019 period, there was a decrease in the number of patients admitted (−23.7%). Again, there was a higher tendency for hypotension on presentation during lockdown (p=0.054).
In comparison to its homologous 2019 period, post-lockdown saw a slight increase in the number of patients (+13.2%) and more patients presented with bradycardia (16.7% vs 3.8%; p=0.026).
Also of note, no patients were admitted to the emergency department during lockdown for anomalies detected on ambulatory tests (Holter, electrocardiogram or implanted loop recorder).
Conclusion
During lockdown, clinical presentation was generally more severe, with a greater number of patients presenting with hypotension/shock. In addition, there appears to be a lockdown effect on emergent bradyarrhtmias admissions in the post-lockdown period with a profound impact: higher admission rates and more severe presentations including a higher need of temporary pacemaker. Patients with symptoms suggestive of bradyarrhythmias should be advised to present promptly regardless of the pandemic.
Funding Acknowledgement
Type of funding sources: None. Pacemakers during lockdown/post-lockdownPacemakers implanted by diagnosis
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Affiliation(s)
| | - R Cadete
- University of Coimbra, Faculty of Medicine, Coimbra, Portugal
| | - J Guimaraes
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - E Monteiro
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - G Costa
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - N Antonio
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - L Goncalves
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
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Costa G, Saleiro C, Neto V, Goncalves L, Teixeira R. Direct oral anticoagulants compared with vitamin K antagonists for left ventricular thrombi systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2986] [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: 11/12/2022] Open
Abstract
Abstract
Background
Left ventricular thrombus (LVT) is a serious complication primarily occurring in patients with LV dysfunction following large myocardial infarction. The role of direct oral anticoagulants in this clinical setting remains controversial.
Purpose
To compare DOACs versus vitamin K antagonists (VKA) in LVT treatment.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in February 2020, for interventional or observational studies comparing DOAC with VKA on LVT treatment.
Results
Fourteen publications were included, nine published studies and five conference abstracts, providing 1899 patients, 490 patients on DOACs and 1409 subjects on VKA. In terms of efficacy, DOAC had a lower LVT resolution for all studies included which reported LVT resolution (pooled OR, 0.73; 95% CI, 0.55–0.98; P=0.04; I2=52%), but sensitivity analysis revealed no difference between anticoagulant strategy (pooled OR, 0.78; 95% CI, 0.57–1.05; P=0.10; I2=59%). In terms of systemic embolism or stroke, DOAC had a similar efficacy (pooled OR, 1.06; 95% CI, 0.69–1.63; P=0.78; I2=30%) compared to VKA. In clinically relevant bleeding events analysis, the anticoagulation strategy did not differ in the odds of bleeding (pooled OR, 0.65; 95% CI, 0.37–1.15 P=0.14; I2=0%), with similar findings in net adverse clinical events analysis (pooled OR, 0.66; 95% CI, 0.35–1.25; I2=54%; P=0.20).
Conclusion
Our pooled data suggests DOACs as a safe approach to LVT, despite inconsistent efficacy on LVT resolution.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - V Neto
- Hospital Center Tondela Viseu, Viseu, Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research, Coimbra, Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
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Catarino R, Alves L, Costa G, Pereira D, Pereira J, Cardoso A, Braga I, Freitas R, Correia T, Cerqueira M, Carmo Reis F, Lobo F, Morais A, Prisco R. Neoadjuvant chemotherapy outcomes in muscle-invasive bladder cancer. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)01229-5] [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: 10/20/2022] Open
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De Gobbi A, Aiello G, Pozzi E, Agostini A, Andrisano A, Fulcoli V, Guttilla A, Invidiato F, Massari D, Costa G, Fiorello M. Self-removal double J stent proposal after endourological procedures during Sars-Cov-2 emergency. EUR UROL SUPPL 2021. [PMCID: PMC8487691 DOI: 10.1016/s2666-1683(21)00739-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Borges-Rosa J, Oliveira-Santos M, Silva R, Lopes De Almeida J, Goncalves L, Costa G, Ferreira MJ. The prevalence of cardiac sarcoidosis is underestimated: [18F]FDG-PET is the answer. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.071] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Overt cardiac involvement is reported in 5% of patients with sarcoidosis, although autopsy and imaging studies suggest higher prevalence, worldwide variation. The role of 18F-fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) in non-invasive diagnosis and follow-up has increased in the last decade.
Purpose
Our goal is to describe the prevalence, clinical manifestations and outcomes of cardiac sarcoidosis (CS), diagnosed through [18F]FDG-PET, in a southern European population.
Methods
We included all patients with histological diagnosis of extracardiac sarcoidosis screened with [18F]FDG-PET between 2009 and 2020. We collected data on clinical manifestations, cardiac magnetic resonance (CMR) results, and mortality outcomes and compared those with and without cardiac involvement. We applied the criteria for the diagnosis of CS from Heart Rhythm Society.
Results
Of the 400 patients screened with [18F]FDG-PET, 128 had a histological diagnosis of extracardiac sarcoidosis (54.7% females, mean age 51.0 ± 14.2 years). None underwent endomyocardial biopsy. Ten patients had a pattern of [18F]FDG uptake consistent with CS defined as diffuse (n = 5), focal (n = 3), and focal on diffuse (n = 2). Of the 128 patients, 14 also underwent CMR, which identified 2 subjects with positive findings in both modalities and 3 additional patients: focal (n = 1), multifocal mid-wall (n = 2), focal mid-wall (n = 2), and multifocal subepicardial (n = 1) delayed gadolinium enhancement. Overall, 13 patients (10.2%) fulfilled the criteria for probable CS (53.8% female, mean age 56.2 ± 12.6 years), all with multiorgan involvement, mostly lung and lymph nodes (each 92%), followed by skin and central nervous system (each 15%). Median left ventricle ejection fraction was 62% [55-65] and there were cardiac manifestations of CS in 6 patients (46%): sick sinus syndrome (n = 2), complete heart block (n = 1), frequent premature ventricular complexes (n = 1), ventricular tachycardia plus heart failure (n = 1), and bifascicular block plus heart failure (n = 1). Eleven patients (85%) with probable CS were medicated with immunosuppressant drugs: corticosteroids (n = 9), methotrexate (n = 4), and azathioprine (n = 2). Four patients with previous [18F]FDG screening were revaluated after treatment, each showing no cardiac uptake. After a mean follow-up of 4.0 ± 1.0 years, mortality was three-fold higher in patients with cardiac involvement, despite the absence of statistical significance (15% vs. 5%, P = 0.151).
Conclusions
In a southern European population with histological extracardiac sarcoidosis, the prevalence of cardiac involvement was 10.2%, most asymptomatic. [18F]FDG-PET improves the diagnostic yield and plays an important role in monitoring response to therapy. The higher mortality trend in those with CS needs to be ascertained in longer follow-up.
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Affiliation(s)
| | | | - R Silva
- University Hospitals of Coimbra, Coimbra, Portugal
| | | | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - G Costa
- University Hospitals of Coimbra, Coimbra, Portugal
| | - MJ Ferreira
- University Hospitals of Coimbra, Coimbra, Portugal
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Genovese C, Squeri R, Alessi V, Conti A, D'Amato S, Mazzitelli F, Costa G, Squeri A. Adherence to the three Italian screening in a sample of women (and men) in the Southern Italy. Clin Ter 2021; 171:e75-e79. [PMID: 33346333 DOI: 10.7417/ct.2021.2287] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although scientific evidence shows the numerous benefits of screening programs, in Italy. There is a great disparity between the regional coverage of the North and South despite the screening programs have been activated for several years in all regions even with territorial differences. OBJECTIVE The aim of our study was to evaluate the knowledge and adherence to different screenings in the population, the influence exercised by the local health authority the role of the general practitioner in advising and referring patients to screening tests and the main causes of refuse. MATERIAL AND METHODS The study was carried out, from December 2019 to May 2020, through the administration of anonymous self-filled "ad hoc" questionnaires to women and men over 26 years old. RESULTS in our sample 36% have never performed a breast check and 39% of the interviewees never had a mammogram; for cervical cancer 25% did not ever perform screening and 65% did not have an indication by GP. The worst result was found for colorectal cancer (only 27% of the sample performed the screening). The role of GP was fundamental for and similar to other studies, was fundamental in fact,similar to other studies the most frequent reported reasons for the non-execution of screening were the lack of physicians' advice, follwed by lack of time, the most frequent reported reasons for the non-execution of screening were the lack of physicians' advice, a lack of time, fear of cancer and embarrassment at visiting a gynaecologist. DISCUSSION AND CONCLUSIONS the study carried out found that despite the knowledge of the oncological disease and the possibilities of prevention is fairly rooted in the population, adherence to the screening is quite inadequate, especially as regards colorectal cancer.
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Affiliation(s)
- C Genovese
- PhD students in Translational Molecular Medicine and Surgery, XXXV cycle, University of Messina - Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina
| | - R Squeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina
| | - V Alessi
- Postgraduate Medical School in Hygiene and Preventive Medicine, University of Messina, Messina
| | - A Conti
- Health Management, Lentini Hospital, Sicily
| | - S D'Amato
- Postgraduate Medical School in Hygiene and Preventive Medicine, University of Messina, Messina
| | - F Mazzitelli
- Postgraduate Medical School in Hygiene and Preventive Medicine, University of Messina, Messina
| | - G Costa
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina
| | - A Squeri
- Department of Human Pathology of the adult and developmental age "Gaetano Barresi", University of Messina, Italy
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Fransvea P, Costa G, D'Agostino L, Sganga G, Serao A. Redo-laparoscopy in the management of complications after laparoscopic colorectal surgery: a systematic review and meta-analysis of surgical outcomes. Tech Coloproctol 2020; 25:371-383. [PMID: 33230649 DOI: 10.1007/s10151-020-02374-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The laparoscopic approach for colorectal surgery has gradually become widely accepted for the treatment of both benign and malignant diseases thanks to its several advantages over the open approach. However, it is associated with the same potential postoperative complications. Some recent studies have analyzed the potential role of laparoscopy in early diagnosis and management of complications following laparoscopic colorectal surgery. The aim of this systematic review was to investigate the outcomes of redo-laparoscopy (RL) for the management of early postoperative complications following laparoscopic colorectal surgery, focusing on length of stay, morbidity and mortality. METHODS A systematic review of the literature was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines through MEDLINE (PubMed), Embase and Google Scholar from January 1990 to December 2019. The main outcomes examined were conversion rate, length of hospital stay, postoperative morbidity and mortality rates. A meta-analysis of all eligible studies was then conducted and forest plots were generated. RESULTS A total of 19 studies involving 1394 patients who required reoperation after laparoscopic colorectal resection were included. In 539 (38.2%) of these patients, a laparoscopic approach was adopted. The most common indication for returning to the operating theater was anastomotic leakage (64.4% of all redo-surgeries, 67.7% of RL) and the most common type of intervention performed in RL was diverting stoma with or without anastomotic repair/redo (47.1%). Nine studies were included in the pooled analysis. The mean length of stay was significantly shorter in the RL group than in the redo-open one (WMD = - 0.90; 95% CI - 1.04 to - 0.76; Z = - 12,6; p < 0.001). A significantly lower risk of mortality was observed in the RL cohort (OR = - 0.91; 95% CI - 1.58 to - 0.23; Z = - 2.62; p = 0.009). CONCLUSIONS Laparoscopy is a valid and effective approach for the treatment of complications following laparoscopic primary colorectal surgery thanks to it is well-established advantages over the open approach, which remain noticeable even in redo-surgeries.
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Affiliation(s)
- P Fransvea
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - G Costa
- Department of Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - L D'Agostino
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - G Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - A Serao
- General Surgery Department, Ospedale Dei Castelli, ASL RM 6, Rome, Italy
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De Almeida J, Marinho V, Silva R, Goncalves F, Costa G, Goncalves L, Ferreira M. Infectious endocarditis: improving diagnostic performance in native and prosthetic valve infectious with 18F-FDG PET/CT. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0296] [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
The diagnosis of infective endocarditis (IE) remains a clinical challenge. Diagnostic accuracy of the modified Duke criteria is suboptimal for native valve endocarditis (NVE) and even worse in the presence of prosthetic material-related infection (PVE). We aim to evaluate the diagnostic performance of 18F-FDG PET in patients with suspected IE referred to perform PET/CT.
Methods
Consecutive patients with suspected IE, referred to perform PET/CT between May 2016 and June 2019 were included. Diagnostic performance of modified Duke criteria (mDC) and PET/ CT for IE for NVE and PVE was determined.
Results
In total, 82 patients (mean age of 61±19 years, 62% of male gender) were enrolled. There were 67 18F-FDG PET/CT concordant results with final diagnosis, corresponding to a 96% of agreement, k=0.91 (p=0.04). A SUVmax cutoff value of ≥3.1 identified positive cases with 88.9% sensitivity and 70.0% specificity. In patients with NVE, the addition of PET/CT to the mDC resulted in a reduction of the number of possible IE cases (from 58% to 4.3%). In patients with PVE/intracardiac devices, PET/CT allowed reclassification of 67.4% of possible cases to 4.2%. An alternative diagnosis was provided in 55.6% of the negative IE cases.
Conclusions
18F-FDG PET/CT proved to be a useful diagnostic tool in patients with both suspected NVE and PVE with good sensitivity and specificity, resulting in a significant decrease of the number of possible endocarditis. Furthermore, it allowed the identification of the cause of clinical scenario in more than 50% of patients in which the diagnosis was excluded.
18F-FDG PET SUV max ROC for IE diagnosis
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - V Marinho
- University Hospitals of Coimbra, Coimbra, Portugal
| | - R Silva
- University Hospitals of Coimbra, Coimbra, Portugal
| | - F Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - G Costa
- University Hospitals of Coimbra, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - M.J Ferreira
- University Hospitals of Coimbra, Coimbra, Portugal
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Costa G, Oliveiros B, Goncalves L, Teixeira R. Meta-analysis and meta-regression of early aortic valve replacement versus watchful waiting in asymptomatic severe aortic stenosis: a 2020 boost of evidence. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1975] [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: 11/15/2022] Open
Abstract
Abstract
Background
Current guidelines recommend aortic-valve replacement (AVR) as the only effective therapy for severe symptomatic aortic stenosis (AS) patients. Nevertheless, management and timing of intervention in asymptomatic AS remains a controversial topic, with sparse evidence to support the recommendations (level C).
Purpose
To assess an early-AVR strategy in asymptomatic severe AS, comparing it with a watchful waiting (WW) strategy
Methods
We systematically searched PubMed, Embase and Cochrane databases, in February 2020, for both interventional or observational studies comparing early-AVR with WW in the treatment of asymptomatic severe AS. Random-effects meta-analysis for early-AVR and WW were performed. Meta-regression was used to assess the influence of study characteristics on the outcome.
Results
Eight studies were included (seven registry-based or unrandomized studies and one randomized clinical trial) providing a total of 3985 patients, and 1232 pooled all-cause deaths (172 in early-AVR and 1060 in watchful waiting). Meta-analysis showed a significantly lower all-cause mortality for the early-AVR compared with WW group (pooled OR 0.24 [0.17, 0.32], P<0.01) although with a moderate amount of heterogeneity between studies in the magnitude of effect (I2=57%, P=0.02). The early-AVR patients also displayed a lower cardiovascular mortality (pooled OR 0.27 [0.15, 0.48], P<0.01) plus a lower heart failure hospitalization rate (pooled OR 0.27 [0.06, 0.65], P<0.007). No difference in clinical thromboembolic event rate (stroke or myocardial infarction) was noted.
The meta-regression for all cause mortality based on possible confounders such as time of follow-up, age, gender, diabetes mellitus, coronary artery disease, left ventricular ejection fraction, and mean peak aortic jet velocity showed that effect sizes reported by the individual studies seem to be independent from the covariates considered (P>0.05).
Conclusions
Our 2020 pooled data reinforces the previous evidence suggesting the benefit of early-AVR in asymptomatic patients with severe AS.
Early AVR vs WW, All-cause death
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Costa
- Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - B Oliveiros
- Coimbra Institute for Clinical and Biomedical Research, Coimbra, Portugal
| | - L Goncalves
- Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
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Bisesto FG, Galletti M, Anania MP, Costa G, Ferrario M, Pompili R, Poyé A, Consoli F, Salvadori M, Cipriani M, Verona C, Zigler A. Ultrafast electron and proton bunches correlation in laser-solid matter experiments. Opt Lett 2020; 45:5575-5578. [PMID: 33001957 DOI: 10.1364/ol.402938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
The interaction of an ultra-intense laser with a solid state target allows the production of multi-MeV proton and ion beams. This process is explained by the target normal sheath acceleration (TNSA) model, predicting the creation of an electric field on the target rear side, due to an unbalanced positive charge. This process is related to the emission of relativistic ultrafast electrons, occurring at an earlier time. In this work, we highlight the correlations between the ultrafast electron component and the protons by their simultaneous detection by means of an electro-optical sampling and a time-of-flight diagnostics, respectively, supported by numerical simulations showing an excellent agreement.
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Costa G, Zengarini N, Marra M. Towards a national health equity monitoring strategy. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The 2017 Italian Review on health inequalities identified two main needs with regards to Italian health equity monitoring. (1) The need to collect a social covariate at individual level in each health information system at local, regional and national level. Such a social covariate is fundamental for monitoring if any avoidable inequality in access, use, quality of care and health outcome is occurring at local, regional, national level. (2) The need to re-engineer and frame the different health equity monitoring surveys already established into an explicit health inequalities monitoring strategy (HIMS). Both challenges are accounted for by Italy in the Joint Action Health Equity Europe workplan.
As for the social covariate, a pilot project is conducted. Data from 2011 census (education and area deprivation) and the national identification code used to link individual data on health and services utilization in four representative regions is linked. This will allow monitoring the social variation in selected performance indicators by region, across regions and through time.
As for HIMS, previous research projects have designed and successfully piloted different models of low-cost data linkage for already established longitudinal studies. Now these pilot results will evolve into a national HIMS. As a first step, a special project of consensus building will be implemented among institutional partners responsible for the following national longitudinal studies based on record linkage: a) Work Histories Italian Panel followed up prospectively for health outcomes; b) Italian Longitudinal Study: 2000, 2015, 2013 Health Interview Surveys followed up prospectively for health outcomes; c) differential mortality 2011-2017 in the 2011 censused Italian population; d) the network of the metropolitan and regional census based longitudinal studies followed up prospectively for mortality disease registries and health care utilization. Experiences gained will be shared and discussed.
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Affiliation(s)
- G Costa
- Regional Health Observatory, ASL TO3 Piedmont, Turin, Italy
| | - N Zengarini
- Regional Health Observatory, ASL TO3 Piedmont, Turin, Italy
| | - M Marra
- Regional Health Observatory, ASL TO3 Piedmont, Turin, Italy
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Ardito C, D'Errico A, Leombruni R, Ricceri F, Costa G. Life expectancy inequalities and their evolution in Italy. How these impact on the equity of the pension system? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The article aims to present the most recent evidence on the life-expectancy differentials across socio-economic groups in Italy and discuss their implications in terms of equity and fairness of the pension systems. In fact, Italian pension rules are set according to average life expectancy, ignoring the shorter life expectancy at retirement observed in more disadvantaged socioeconomic groups, as well as in many occupations and economic sectors. This produces unintended consequences in terms of redistribution, which reinforce and exacerbate inequalities present in the labour market.
This article will present updated evidence on the evolution of life expectancy inequalities across job titles, sectors and occupational class in Italy to assess whether the social gap, already highlighted by previous scholars, has been widening or narrowing. Only a few studies are available in the literature on this subject, almost exclusively from the US, which suggest that the gap in terms of life expectancy at ages approaching retirement is increasing, mainly driven by a faster improvement in longevity across most advantaged groups. It is crucial to examine the trend in a country like Italy where retirement age has been strongly tightened and linked automatically to average life expectancy in the population. These results may be important in order to inform the public debate about future reforms on retirement rules and in particular for the definition of the so called “arduous and hazardous jobs” (in Italian: lavori gravosi), that could be exempted from the postponement of pension age.
In order to estimate life expectancy differentials among different occupations, three of the largest Italian longitudinal studies will be used: the Turin Longitudinal Study (SLT), the Italian Longitudinal Study (SLI) and WHIP-Health Study, all studies where it is possible to conduct mortality follow-up through administrative record linkage with archives of mortality of large cohorts until recent years.
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Affiliation(s)
- C Ardito
- Department of Economics and Statistics, University of Turin, Turin, Italy
| | - A D'Errico
- Unit of Epidemiology, Regional Health Service of ASL TO3, Turin, Italy
| | - R Leombruni
- Department of Economics and Statistics, University of Turin, Turin, Italy
| | - F Ricceri
- Unit of Epidemiology, Regional Health Service of ASL TO3, Turin, Italy
| | - G Costa
- Unit of Epidemiology, Regional Health Service of ASL TO3, Turin, Italy
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