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Kiernan PA, Day CA, Berkowsky RS, Zaleski AL, Gao S, Taylor BA, Santos LP, Panza G, Kramarz M, McCormick K, Thompson PD, Fernandez AB, Chen MH, Pescatello LS. Reliability and Time Course of Postexercise Hypotension during Exercise Training among Adults with Hypertension. J Cardiovasc Dev Dis 2024; 11:42. [PMID: 38392256 PMCID: PMC10889392 DOI: 10.3390/jcdd11020042] [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: 12/28/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Postexercise hypotension (PEH), or the immediate decrease in blood pressure (BP) lasting for 24 h following an exercise bout, is well-established; however, the influence of exercise training on PEH dynamics is unknown. This study investigated the reliability and time course of change of PEH during exercise training among adults with hypertension. PEH responders (n = 10) underwent 12 weeks of aerobic exercise training, 40 min/session at moderate-to-vigorous intensity for 3 d/weeks. Self-measured BP was used to calculate PEH before and for 10 min after each session. The intraclass correlation coefficient (ICC) and Akaike Information Criterion (AIC) determined PEH reliability and goodness-of-fit for each week, respectively. Participants were obese (30.6 ± 4.3 kg∙m-2), middle-aged (57.2 ± 10.5 years), and mostly men (60%) with stage I hypertension (136.5 ± 12.1/83.4 ± 6.7 mmHg). Exercise training adherence was 90.6 ± 11.8% with 32.6 ± 4.2 sessions completed. PEH occurred in 89.7 ± 8.3% of these sessions with BP reductions of 9.3 ± 13.1/3.2 ± 6.8 mmHg. PEH reliability was moderate (ICC ~0.6). AIC analysis revealed a stabilization of maximal systolic and diastolic BP reductions at 3 weeks and 10 weeks, respectively. PEH persisted throughout exercise training at clinically meaningful levels, suggesting that the antihypertensive effects of exercise training may be largely due to PEH. Further studies in larger samples and under ambulatory conditions are needed to confirm these novel findings.
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Affiliation(s)
- Peter A Kiernan
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Christina A Day
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Rachel S Berkowsky
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | | | - Simiao Gao
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | | | - Lucas P Santos
- Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
| | | | - Melody Kramarz
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Kyle McCormick
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | | | | | - Ming-Hui Chen
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
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Bahl A, Clement V, DiLoreto E, Mielke N, Carr A, Panza G, Gibson SM. Evaluating the impact of external forces on peripheral intravenous catheter movement using ultrasound: A randomized pilot study. J Vasc Access 2024:11297298231222052. [PMID: 38183179 DOI: 10.1177/11297298231222052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND A major contributor to peripheral intravenous catheter (PIVC) failure may be related to PIVC movement within the vein which is associated with vein wall damage. The magnitude of PIVC movement against the vein wall has not previously been quantified. This study aimed to examine PIVC movement within the vein when minor forces were applied to the PIVC. METHODS This was a prospective, pilot trial including healthy volunteers in an outpatient research laboratory. The primary objective was to examine the in movement (millimeters) of the PIVC using ultrasound with external pull forces (4, 5, and 6 lbs; 1.8, 2.3, and 2.7 kg, respectively) applied to the PIVC in random order. RESULTS Participants (N = 11) were aged 40.36 ± 16.10 years with 54.55% being Male. Mean ± SD PIVC movement for 4, 5, and 6 lbs of force was 4.65 ± 1.88, 3.88 ± 2.28, and 5.25 ± 2.06 mm, respectively. There was substantial PIVC movement when a force was applied to the PIVC, but no statistically significant difference between 4, 5, and 6 lb forces (p > 0.05). CONCLUSION When external pull forces were applied to the PIVC, substantial PIVC movement within the vein occurred in a healthy population. Strategies that reduce PIVC movement and/or remove or limit external pull forces from the PIVC are needed. Future studies on hospitalized patients are warranted to quantify vein wall injury and PIVC failure due to PIVC movement from various pull forces.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | | | - Emily DiLoreto
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Nicholas Mielke
- Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | | | - Gregory Panza
- Department of Research, Hartford Healthcare, Hartford, CT, USA
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Ugurluer G, Schneiders FL, Corradini S, Boldrini L, Kotecha R, Kelly P, Portelance L, Camilleri P, Ben-David MA, Poiset SJ, Marschner S, Panza G, Kutuk T, Palacios M, Mustafayev TZ, Atalar B, Senan S, Ozyar E. Outcomes of MR-Guided Stereotactic Body Radiotherapy (MRgSBRT) for Adrenal Metastases: A Multi-Institutional Pooled Analysis. Int J Radiat Oncol Biol Phys 2023; 117:S111-S112. [PMID: 37784293 DOI: 10.1016/j.ijrobp.2023.06.439] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiotherapy (SBRT) is an effective treatment for adrenal metastases, but it is technically challenging and there are concerns about toxicity due to the proximity of organs at risk. We hypothesized that MR-guided SBRT (MRgSBRT) using a 0.35 T MR-Linac for adrenal metastases can achieve durable local control (LC) with a low probability of toxicity. MATERIALS/METHODS In an ethics-approved study, we analyzed clinical and dosimetric data of patients treated with MRgSBRT at 10 institutions between 2016-2022. LC, local progression-free survival (LPFS), distant progression-free survival (DPFS) and overall survival (OS) were estimated using Kaplan-Meier method and log-rank test. Responses were evaluated using RECIST criteria. Toxicity was graded according to CTCAE (v4.0). OS and DPFS were calculated on a per-patient basis, while LC and LPFS were calculated on a per-lesion basis. RESULTS A total of 249 patients (260 adrenal lesions) were included; median age was 65 years (range 28-91), 65.5% were male, 83.9% had ECOG PS 0-1. The most common primary tumor was lung cancer (69.1%). Adrenal metastases were synchronous, metachronous, oligoprogressive or oligopersistent in 20%, 41.5%, 35.8% and 2.7% of patients, respectively. Metastatic pattern was solitary in 26.9%, oligometastatic in 57.3% and polymetastatic in 15.8% of patients. Right-sided metastases comprised 40%, left-sided 51.5% and lesions were bilateral in 8.5%. Chemotherapy and immunotherapy were administered in 67.1% and 60.6% of patients, respectively. Median gross tumor volume was 21.8 cc (range 1.1-383.2) and median planning target volume was 36.9 cc (range 3.6-516.9). Median total dose was 45 Gy (range 16-60), median fraction number was 5 (range 1-8) and median fraction dose used was 10 Gy (range 5-24). Median BED10 was 100 Gy (range 37.5-132); 87.8% of fractions used adapted plans. At a median follow-up was 17.7 months (IQR 5.5-21.7), local responses were scored as complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD) in 36.9%, 28.2%, 25.7%, and 9.1%, respectively. Median OS was 30.4 months, with 1- and 2- year OS rates of 75.3% and 57.1%, respectively. On multivariate analysis, significantly higher OS rates were seen in patients achieving a CR (p = 0.007, HR 0.50) and with ECOG scores of 0-1 (p = 0.001, HR 0.43). One- and 2- year LPFS rates were 94.5% and 88.8%, respectively. No local recurrences were observed after treatment to a BED10>100 or with single fraction (range 16-24 Gy). Only 2 patients (0.8%) had ≥grade 3 chronic toxicity. CONCLUSION This multi-institutional study of MRgSBRT outcomes for adrenal metastases revealed a 2-year LPFS of 89%, with a <1% risk of ≥grade 3 toxicity. Daily adaptation was performed in 90% of plans, indicating a beneficial role for MR guidance.
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Affiliation(s)
- G Ugurluer
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - F L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - L Boldrini
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - R Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - P Kelly
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - L Portelance
- Department of Radiation Oncology, University of Miami, Miami, FL
| | - P Camilleri
- Radiation Oncology, GenesisCare, Oxford, United Kingdom
| | - M A Ben-David
- Department of Radiation Oncology, Assuta Medical Center, Tel Aviv, Israel
| | - S J Poiset
- Department of Radiation Oncology, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA
| | - S Marschner
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - G Panza
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - T Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - M Palacios
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - T Zoto Mustafayev
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - B Atalar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - S Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - E Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
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Shaik A, Patel N, Alvarez C, Panza G, Baker WL, McMahon S, Kluger J. Erroneous electrocardiographic interpretations and its clinical implications. J Cardiovasc Electrophysiol 2023. [PMID: 37272686 DOI: 10.1111/jce.15943] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The advancement of artificial intelligence (AI) has aided clinicians in the interpretation of electrocardiograms (ECGs) serving as an essential tool to provide rapid triage and care. However, in some cases, AI can misinterpret an ECG and may mislead the interpreting physician. Therefore, we aimed to describe the rate of ECG misinterpretation and its potential clinical impact in patient's management. METHODS We performed a retrospective descriptive analysis of misinterpreted ECGs and its clinical impact from May 28, 2020 to May 9, 2021. An electrophysiologist screened ECGs with confirmed diagnosis of atrial fibrillation (AF), sinus tachycardia (ST), sinus bradycardia (SB), intraventricular conduction delay (IVCD), and premature atrial contraction (PAC) that were performed in the emergency department. We then classified the misinterpreted ECGs as wrongly diagnosed AF, ST, SB, IVCD, or PAC into the correct diagnosis and reviewed the misinterpreted ECGs and medical records to evaluate inappropriate use of antiarrhythmic drugs (AAD), beta-blockers (BB), calcium channel blockers (CCB), anticoagulation, or resource utilization of cardiology and/or electrophysiology (EP) consultation. RESULTS A total of 4969 ECGs were screened with diagnoses of AF (2282), IVCD (296), PAC (972), SB (895), and ST (638). Among these, 101 ECGs (2.0%) were misinterpreted. Wrongly diagnosed AF (58.4%) was the most common followed by wrongly diagnosed PAC (14.9%), wrongly diagnosed ST (12.9%), wrongly diagnosed IVCD (7.9%), and wrongly diagnosed SB (6.0%). Patients with misinterpreted ECGs were aged 76.6 ± 11.6 years with male (52.5%) predominance and hypertension being the most prevalent (83.2%) comorbid condition. The misinterpretation of ECGs led to the inappropriate use of BB (19.8%), CCB (5.0%), AAD therapy (7.9%), anticoagulation (6.9%) in patients with wrongly diagnosed AF, as well as inappropriate resource utilization including cardiology (41.6%) and EP (8.9%) consultations. CONCLUSIONS Misinterpretation of ECGs may lead to inappropriate medical therapies and increased resource utilization. Therefore, it is essential to encourage physicians to carefully examine AI interpreted ECG's, especially those interpreted as having AF.
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Affiliation(s)
- Ayesha Shaik
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
- Division of Cardiology, University of Connecticut, Farmington, Connecticut, USA
| | - Nirav Patel
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
- Division of Cardiology, University of Connecticut, Farmington, Connecticut, USA
| | - Chikezie Alvarez
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
- Division of Cardiology, University of Connecticut, Farmington, Connecticut, USA
| | - Gregory Panza
- Research Administration, Hartford HealthCare, Hartford, Connecticut, USA
| | - William L Baker
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
| | - Sean McMahon
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
- Division of Cardiology, University of Connecticut, Farmington, Connecticut, USA
| | - Jeffrey Kluger
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
- Division of Cardiology, University of Connecticut, Farmington, Connecticut, USA
- Division of Electrophysiology, Hartford Hospital, Hartford, Connecticut, USA
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5
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Sutton TS, Bailey DL, Rizvi A, Al-Araji R, Kasliwala Q, Nero T, Scalzo M, Panza G, Mather JF, Orlando R, Hashim S, McKay RG. Racial and Ethnic Disparities in the Treatment and Outcomes for Witnessed Out-of-Hospital Cardiac Arrest in Connecticut. Resuscitation 2023:109850. [PMID: 37230326 DOI: 10.1016/j.resuscitation.2023.109850] [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: 02/28/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Racial and ethnic disparities in the treatment and outcomes for witnessed out-of-hospital cardiac arrest (OHCA) in the United States have been previously described. We sought to characterize disparities in pre-hospital care, overall survival, and survival with favorable neurological outcomes following witnessed OHCA in the state of Connecticut. METHODS We performed a cross-sectional study to compare pre-hospital treatment and outcomes for White versus Black and Hispanic (Minority) OHCA patients submitted from Connecticut to the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2021. Primary outcomes included bystander CPR use, bystander automated external defibrillator (AED) use with attempted defibrillation, overall survival, and survival with favorable cerebral function. RESULTS 2,809 patients with witnessed OHCA were analyzed (924 Black or Hispanic; 1885 White). Minorities had lower rates of bystander CPR (31.4% vs 39.1%, P=0.002) and bystander AED placement with attempted defibrillation (10.5% vs 14.4%, P=0.004), with lower rates of survival to hospital discharge (10.3% vs 14.8%, P=0.001) and survival with favorable cerebral function (65.3% vs 80.2%, P=0.003). Minorities were less likely to receive bystander CPR in communities with median annual household income >$80, 000 (OR, 0.56; 95% CI, 0.33 - 0.95; P=0.030) and in integrated neighborhoods (OR, 0.70; 95% CI, 0.52 - 0.95; P=0.020). CONCLUSIONS Black and Hispanic Connecticut patients with witnessed OHCA have lower rates of bystander CPR, attempted AED defibrillation, overall survival, and survival with favorable neurological outcomes compared to White patients. Minorities were less likely to receive bystander CPR in affluent and integrated communities.
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Affiliation(s)
| | | | - Asad Rizvi
- Department of Cardiology, Hartford Hospital
| | | | | | - Thomas Nero
- Department of Cardiology, St Vincent's Medical Center
| | | | - Gregory Panza
- Department of Research Administration, Hartford Hospital
| | - Jeff F Mather
- Department of Research Administration, Hartford Hospital
| | | | - Sabet Hashim
- Department of Cardiac Surgery, Hartford Hospital
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Patel NV, Zweibel SL, Friedman M, Panza G, Weissler-Snir A. Survey Study of the Real-World Outpatient Management of Postoperative Atrial Fibrillation. J Am Heart Assoc 2023; 12:e028396. [PMID: 37158098 DOI: 10.1161/jaha.122.028396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Nirav V Patel
- UCLA Division of Cardiology David Geffen School of Medicine Los Angeles CA USA
| | - Steven L Zweibel
- Department of Medicine Hartford HealthCare, Heart and Vascular Institute, Hartford, Connecticut, University of Connecticut Farmington CT USA
| | - Meir Friedman
- Department of Medicine Hartford HealthCare, Heart and Vascular Institute, Hartford, Connecticut, University of Connecticut Farmington CT USA
| | - Gregory Panza
- Department of Medicine Hartford HealthCare, Heart and Vascular Institute, Hartford, Connecticut, University of Connecticut Farmington CT USA
| | - Adaya Weissler-Snir
- Department of Medicine Hartford HealthCare, Heart and Vascular Institute, Hartford, Connecticut, University of Connecticut Farmington CT USA
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7
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Alvarez CK, Zweibel S, Stangle A, Panza G, May T, Marieb M. Anesthetic Considerations in the Electrophysiology Laboratory: A Comprehensive Review. J Cardiothorac Vasc Anesth 2023; 37:96-111. [PMID: 36357307 DOI: 10.1053/j.jvca.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Catheter ablation procedures for arrhythmias or implantation and/or extraction of cardiac pacemakers can present many clinical challenges. It is imperative that there is clear communication and understanding between the anesthesiologist and electrophysiologist during the perioperative period regarding the mode of ventilation, hemodynamic considerations, and various procedural complications. This article provides a comprehensive narrative review of the anesthetic techniques and considerations for catheter ablation procedures, ventilatory modes using techniques such as high-frequency jet ventilation, and strategies such as esophageal deviation and luminal temperature monitoring to decrease the risk of esophageal injury during catheter ablation. Various hemodynamic considerations, such as the intraprocedural triaging of cardiac tamponade and fluid administration during catheter ablation, also are discussed. Finally, this review briefly highlights the early research findings on pulse-field ablation, a new and evolving ablation modality.
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Affiliation(s)
- Chikezie K Alvarez
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT.
| | - Steven Zweibel
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT
| | - Alexander Stangle
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT
| | - Gregory Panza
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT
| | - Thomas May
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT
| | - Mark Marieb
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; Griffin Hospital, Derby, CT
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8
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Kiernan PA, Day CA, Berkowsky RS, Zaleski AL, Taylor BA, Santos LP, Panza G, Kramarz M, McCormick K, Thompson PD, Fernandez AB, Chen MH, Pescatello LS. The Reproducibility Of Postexercise Hypotension Over A 12-week Exercise Training Program Among Adults With Hypertension. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000880672.02200.81] [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: 11/21/2022]
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Panza G, Autorino R, Cusumano D, Boldrini L, Gui B, Russo L, Votta C, Dinapoli N, Ferrandina G, Nardangeli A, Campitelli M, Macchia G, Valentini V, Gambacorta M. PO-1343 Radiomic model to predict 2ysOS in Cervical Cancer patients underwent neoadjuvant chemoradiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kuruvilla DE, Mann JI, Tepper SJ, Starling AJ, Panza G, Johnson MAL. Phase 3 randomized, double-blind, sham-controlled Trial of e-TNS for the Acute treatment of Migraine (TEAM). Sci Rep 2022; 12:5110. [PMID: 35332216 PMCID: PMC8948251 DOI: 10.1038/s41598-022-09071-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/16/2022] [Indexed: 12/14/2022] Open
Abstract
Migraine is one of the most common and debilitating neurological disorders worldwide. External Trigeminal Nerve Stimulation (e-TNS) is a non-pharmacological, non-invasive therapeutic alternative for patients with migraine. The TEAM study was a prospective, multicenter, randomized, double-blind, sham-controlled, Phase 3 trial for 2-h, continuous, e-TNS treatment of a single moderate or severe migraine attack at home. A total of 538 adults meeting the International Classification of Headache Disorders 3rd edition criteria for 2–8 migraine headache days per month were recruited and randomized in a 1:1 ratio to 2-h active or sham stimulation. Migraine pain levels and most bothersome migraine-associated symptoms (MBS) were recorded at baseline, 2 h, and 24 h using a paper diary. The primary endpoints for the study were pain freedom at 2 h and freedom from the MBS at 2 h. The secondary endpoints were pain relief at 2 h, absence of most bothersome migraine-associated symptoms (MBSs) at 2 h, acute medication use within 24 h after treatment, sustained pain freedom at 24 h, and sustained pain relief at 24 h. Adverse event data was also collected and compared between groups. Five hundred thirty-eight patients were randomized to either the verum (n = 259) or sham (n = 279) group and were included in an intention-to-treat analysis. The percentage of patients with pain freedom at 2 h was 7.2% higher in verum (25.5%) compared to sham (18.3%; p = 0.043). Resolution of most bothersome migraine-associated symptom was 14.1% higher in verum (56.4%) compared to sham (42.3%; p = 0.001). With regards to secondary outcomes, pain relief at 2 h was 14.3% higher in verum (69.5%) than sham (55.2%; p = 0.001), absence of all migraine-associated symptoms at 2 h was 8.4% higher in verum (42.5%) than sham (34.1%; p = 0.044), sustained pain freedom and pain relief at 24 h was 7.0% and 11.5% higher in verum (22.8 and 45.9%) than sham (15.8 and 34.4%; p = 0.039 and .006, respectively). No serious adverse events were reported. Treatment with 2-h e-TNS is a safe and effective, non-invasive, and non-pharmacological alternative for the acute treatment of migraine attacks in an at-home setting. Trial registration Clinicaltrials.gov Identifier: NCT03465904. Registered 14/03/2018. https://www.clinicaltrials.gov/ct2/show/record/NCT03465904.
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Affiliation(s)
- Deena E Kuruvilla
- Department of Neurology, Westport Headache Institute, Westport, CT, USA
| | - Joseph I Mann
- Department of Neurology, Rochester Clinical Research, Rochester, NY, USA
| | - Stewart J Tepper
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Gregory Panza
- Department of Research, Hartford Healthcare, Hartford, CT, USA
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Beland DK, Panza G, Nouh A. Abstract WP33: Improving Activation Of The Inpatient Stroke Response Team - A Two Decade Experience. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp33] [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: 11/16/2022]
Abstract
Inpatient acute stroke may go unrecognized and missed treatment opportunities are often related to not activating an inpatient stroke response team (SRT). An inpatient stroke response protocol was implemented at our institution in 2001. Since implementation, several interventions have been tried to improve stroke recognition and increase the volume of SRT calls. Objective Describe the relationship between the interventions and change in stroke call volume aimed to support an inpatient SRT.
Methods:
We performed a retrospective review of all inpatient stroke calls at an urban university-affiliated Comprehensive Stroke Center. A descriptive analysis examined the change in call volume over 20 years as a result of various interventions to support inpatient stroke calls. Unit-based education, focused cardiology nursing unit education, all employee mandatory computer-based stroke education, addition of stroke unit nurses to the inpatient SRT, call process changes analogous to cardiac or respiratory alerts and treatment protocol updates were implemented. Previous interventions were continued as new ones were added.
Results:
A positive linear relationship between the interventions and call volume was noted. The average increase in annual call volume following an intervention was 47.95±42.39 calls. The average annual percent growth in call volume following an intervention was 134.79±134.58 percent. Continued nursing education led to the greatest increases in annual average call volume (Table).
Conclusions:
The results suggest that once implemented, supportive interventions positively impact the utilization of an inpatient SRT. Focused and frequent education regarding the inpatient stroke response protocols through annual education and activities related to program certification had the most impact on inpatient stroke team call volume at our center. These results may be beneficial to other stroke programs as they develop inpatient stroke protocols.
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12
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Patel SD, Topiwala K, Otite Oliver F, Saber H, Panza G, Mui G, Liebeskind DS, Saver JL, Alberts M, Ducros A. Outcomes Among Patients With Reversible Cerebral Vasoconstriction Syndrome: A Nationwide United States Analysis. Stroke 2021; 52:3970-3977. [PMID: 34470494 DOI: 10.1161/strokeaha.121.034424] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Reversible cerebral vasoconstriction syndrome (RCVS) is a well-established cause of stroke, but its demographics and outcomes have not been well delineated. METHODS Analysis of the United States Nationwide Inpatient Sample database (2016-2017) to characterize the frequency of hospitalizations for RCVS, demographic features, inpatient mortality, and discharge outcomes. RESULTS During the 2-year study period, 2020 patients with RCVS were admitted to Nationwide Inpatient Sample hospitals, representing 0.02 cases per 100 000 national hospitalizations. The mean age at admission was 47.6 years, with 85% under 65 years of age, and 75.5% women. Concomitant neurological diagnoses during hospitalization included ischemic stroke (17.1%), intracerebral hemorrhage (11.0%), subarachnoid hemorrhage (32.7%), seizure disorders (6.7%), and reversible brain edema (13.6%). Overall, 70% of patients were discharged home, 29.7% discharged to a rehabilitation facility or nursing home and 0.3% died before discharge. Patient features independently associated with the poor outcome of discharge to another facility or death were advanced age (odds ratio [OR], 1.04 [95% CI, 1.03-1.04]), being a woman (OR, 2.45 [1.82-3.34]), intracerebral hemorrhage (OR, 2.91 [1.96-4.31]), ischemic stroke (OR, 5.72 [4.32-7.58]), seizure disorders (OR, 2.61 [1.70-4.00]), reversible brain edema (OR, 6.26 [4.41-8.89]), atrial fibrillation (OR, 2.97 [1.83-4.81]), and chronic kidney disease (OR, 3.43 [2.19-5.36]). CONCLUSIONS Projected to the entire US population, >1000 patients with RCVS are hospitalized each year, with the majority being middle-aged women, and about 300 required at least some rehabilitation or nursing home care after discharge. RCVS-related inpatient mortality is rare.
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Affiliation(s)
- Smit D Patel
- Neurology Department, University of Connecticut/Hartford Hospital (S.D.P., G.M., M.A.)
| | - Karan Topiwala
- Neurology Department, University of Minnesota, Minneapolis (K.T.)
| | - Fadar Otite Oliver
- Neurology Department, State University of New York (SUNY) Upstate Medical University, Syracuse, NY (F.O.O.)
| | - Hamidreza Saber
- Neurology Department, University of California of Los Angelos (H.S., D.S.L., J.L.S.)
| | - Gregory Panza
- Department of Research, Hartford Hospital, CT (G.P.)
| | - Gracia Mui
- Neurology Department, University of Connecticut/Hartford Hospital (S.D.P., G.M., M.A.)
| | - David S Liebeskind
- Neurology Department, University of California of Los Angelos (H.S., D.S.L., J.L.S.)
| | - Jeffrey L Saver
- Neurology Department, University of California of Los Angelos (H.S., D.S.L., J.L.S.)
| | - Mark Alberts
- Neurology Department, University of Connecticut/Hartford Hospital (S.D.P., G.M., M.A.)
| | - Anne Ducros
- Neurology Department, Montpellier University Hospital, France (A.D.).,Laboratory Charles Coulomb UMR 5221 CNRS-UM, Montpellier University, France (A.D.)
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Beland DK, Panza G. Abstract P860: Is Now the Time to Wake Up? Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p860] [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: 11/16/2022]
Abstract
Thrombolytic treatment for patients who wake with acute ischemic stroke based on MRI DWI-FLAIR mismatch was added to AHA’s 2019 stroke guidelines. While changes were implemented to facilitate care in 2019, it was determined that managing each patient on a case-by-case basis would best use system resources. The spring of 2020 brought new challenges in delay to hospital arrival due to COVID-19.
Purpose:
Evaluate the current process of managing potential wake up treatment eligible patients.
Methods:
All ischemic stroke discharges during CT’s rise and peak of the pandemic were reviewed, January 1 - May 31, 2020. Records were reviewed to determine time of arrival, onset or last seen well, time found, NIHSS, treatment or hyperacute MRI done, and any contraindication based on wake up criteria. A chi-square of proportions or Fisher’s Exact test was used to examine the association between month of discharge and patient characteristics for categorical variables. A Kruskal-Wallis H test was used for the continuous NIHSS variable.
Results:
Since the first COVID-19 patients were admitted in early March, results from January and February were combined (Group 1 n=122) and compared to March, April and May (Group 2 n=143). There was a non-significant (p=0.48) increase from group 1 (62.3%) to group 2 (66.4%) in the percentage arriving more than 4.5 hours from onset or LSW. In addition, group 1 had higher NIHSSs than group 2 (median, IQR=6, 9 vs 3, 10, respectively), but this was not significant (p=0.27, H=1.21). This did however translate into fewer meeting wake up criteria for treatment during the rise and peak period (Group 1=6.6%, Group 2=2.8%; p=0.15). Use of hyperacute MRI was significantly higher in group 1 than group 2 (5.7% vs 0%, p=0.004) since no patients received a hyperacute MRI during peak pandemic.
Conclusions:
While more patients were expected to be eligible for acute thrombolytics using the wake up criteria due to delay in hospital arrival, this was not observed. Instead, patients arriving during the peak of the pandemic were less severe. Although a hyperacute MRI was still possible without confirmation of COVID-19 negative status, none were done. Enhancements to facilitate obtaining a hyperacute MRI are still needed regardless of reason for patient delay to hospital arrival.
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Zaleski AL, Vonk T, Taylor BA, Santos LP, Eijsvogels T, Panza G, Kramarz M, McCormick K, Thompson PD, Fernandez A, Chen MH, Pescatello LS. Relationship Between The Blood Pressure Responses To Acute And Chronic Aerobic Exercise Among Adults With Hypertension. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000682940.42254.cd] [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: 11/21/2022]
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Zaleski AL, Taylor BA, Park C, Santos LP, Panza G, Kramarz M, McCormick K, Thompson PD, Fernandez A, Hui-Chen M, Blissmer B, Deluca K, Pescatello LS. Using the Immediate Blood Pressure Benefits of Exercise to Improve Exercise Adherence. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563020.40146.56] [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: 11/21/2022]
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Taylor BA, Panza G, Ballard KD, White CM, Thompson PD. Creatine supplementation does not alter the creatine kinase response to eccentric exercise in healthy adults on atorvastatin. J Clin Lipidol 2018; 12:1305-1312. [PMID: 29945780 DOI: 10.1016/j.jacl.2018.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/17/2018] [Accepted: 05/23/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Serum creatine kinase (CK) levels are higher after eccentric, muscle-damaging exercise in statin-treated patients. This could contribute to the increased statin-associated muscle symptoms reported in physically active individuals. OBJECTIVE We tested the hypothesis in this pilot study that creatine (Cr) monohydrate supplementation would reduce the CK response to eccentric exercise in patients using statins to determine if Cr supplementation could be a strategy to mitigate statin-associated muscle symptoms in physically active individuals. METHODS Healthy, nonsmoking men (n = 5) and women (n = 14) were randomized to Cr monohydrate = atorvastatin 80 mg + 10 g Cr monohydrate (n = 10, age = 60 ± 7 years) or to placebo (PL) = atorvastatin 80 mg + PL (n = 9, age = 52 ± 6 years). After 4 weeks of treatment, subjects performed 45 minutes of eccentric exercise (downhill walking at a -15% grade). Serum CK levels, muscle soreness (visual analog scale after two squats), and muscle pain severity and interference (using the brief pain inventory) were measured before and after 4 weeks of treatment, and then for 4 consecutive days after downhill walking. Vitamin D, or serum 25(OH)D, was also measured at baseline. RESULTS The PL group was younger (P = .01) but not otherwise different in blood lipids, vitamin D, CK, muscle visual analog scale, and pain scores before (all P > .21) or after (all P > .12) treatment. CK increased in all subjects after downhill walking (P < .01), but neither the relative peak change (expressed as group mean difference with 95% confidence intervals: 43.52% [-196.41, 283.45]) nor the absolute peak change (67.38 U/L [-121.55, 256.31]) relative to baseline was different between groups (P = .46 and .71, respectively). A similar lack of treatment effect was observed for muscle soreness (11.03 mm [-9.49, 31.55]), pain severity (0.77 pts [-0.95, 2.50]), and pain interference (1.02 pts [-1.25, 3.29]) with P-values for group comparisons = 0.27, 0.36, and 0.35, respectively. However, subjects with "insufficient" Vitamin D < 30 ng/mL (n = 10) had an ∼2-fold greater CK increase with eccentric exercise (nominal P-value = .04) than subjects with higher vitamin D levels. CONCLUSION Cr monohydrate did not reduce CK increases after exercise in statin-treated subjects. We did observe that low vitamin D levels are associated with a greater CK response to eccentric exercise in statin-treated subjects.
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Affiliation(s)
- Beth A Taylor
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA; Department of Kinesiology, University of Connecticut, Storrs, CT, USA.
| | - Gregory Panza
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA; Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Kevin D Ballard
- Department of Kinesiology and Health, Miami University, Oxford, OH, USA
| | - C Michael White
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA; University of Connecticut School of Medicine, Farmington, CT, USA
| | - Paul D Thompson
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA; University of Connecticut School of Medicine, Farmington, CT, USA
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Zaleski AL, Pescatello LS, Panza G, Ballard K, Adams W, Hosokawa Y, Thompson PD, Taylor BA. Use of Compression Socks During a Marathon Does Not Mitigate Exercise-Associated Muscle Damage. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536004.67324.71] [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: 11/21/2022]
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Elsaid O, Taylor B, Zaleski A, Panza G, Thompson PD. Rationale for investigating metformin as a protectant against statin-associated muscle symptoms. J Clin Lipidol 2017; 11:1145-1151. [DOI: 10.1016/j.jacl.2017.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/23/2017] [Accepted: 06/29/2017] [Indexed: 11/30/2022]
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Abstract
Hydroxy-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors or statins are well tolerated, but associated with various statin-associated symptoms (SAS), including statin-associated muscle symptoms (SAMS), diabetes mellitus (DM), and central nervous system complaints. These are "statin-associated symptoms" because they are rare in clinical trials, making their causative relationship to statins unclear. SAS are, nevertheless, important because they prompt dose reduction or discontinuation of these life-saving mediations. SAMS is the most frequent SAS, and mild myalgia may affect 5% to 10% of statin users. Clinically important muscle symptoms, including rhabdomyolysis and statin-induced necrotizing autoimmune myopathy (SINAM), are rare. Antibodies against HMG-CoA reductase apparently provoke SINAM. Good evidence links statins to DM, but evidence linking statins to other SAS is largely anecdotal. Management of SAS requires making the possible diagnosis, altering or discontinuing the statin treatment, and using alternative lipid-lowering therapy.
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Affiliation(s)
- Paul D Thompson
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.
| | - Gregory Panza
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut; Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Amanda Zaleski
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut; Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Beth Taylor
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut; Department of Kinesiology, University of Connecticut, Storrs, Connecticut
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Taylor BA, Panza G, Thompson PD. Increased creatine kinase with statin treatment may identify statin-associated muscle symptoms. Int J Cardiol 2016; 209:12-3. [PMID: 26874453 DOI: 10.1016/j.ijcard.2016.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/01/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Beth A Taylor
- Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, CT, United States; Department of Kinesiology, University of Connecticut, Storrs, CT, United States; University of Connecticut School of Medicine, Farmington, CT, United States.
| | - Gregory Panza
- Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, CT, United States; Department of Kinesiology, University of Connecticut, Storrs, CT, United States
| | - Paul D Thompson
- Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, CT, United States; University of Connecticut School of Medicine, Farmington, CT, United States
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Melnyk J, Panza G, Zaleski A, Taylor B. Awareness and Knowledge of Cardiovascular Risk Through Blood Pressure and Cholesterol Testing in College Freshmen. American Journal of Health Education 2015. [DOI: 10.1080/19325037.2015.1023474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - G. Panza
- Henry Low Heart Center, Hartford Hospital
| | - A. Zaleski
- Henry Low Heart Center, Hartford Hospital
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Silvestrini Biavati A, Tecco S, Migliorati M, Festa F, Panza G, Marzo G, Gherlone E, Tetè S. Three-dimensional tomographic mapping related to primary stability and structural miniscrew characteristics. Orthod Craniofac Res 2011; 14:88-99. [PMID: 21457458 DOI: 10.1111/j.1601-6343.2011.01512.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the maxilla, mandible, and cortical plates on computerized tomographic (CT) scans to achieve accurate three-dimensional bone thickness measurements. SETTING AND SAMPLE POPULATION We selected the CT scans of 25 subjects (among 102), aged 18-58 years (10 men, 15 women), with nearly complete dentition. MATERIAL AND METHODS We performed interradicular and bucco-lingual (including cortical plate thickness) measurements in dental areas distal to the canines in both alveolar arches, at three levels (5, 8, and 11 mm) from the alveolar ridge. RESULTS The mean thicknesses of the cortical plates in the maxilla were 1.10 mm buccally and 1.27 mm on the palatal side (p < 0.05). In the mandible, cortical plates were 2.23 mm buccally and 2.02 mm lingually. Mandibular buccal and lingual cortical plates became thicker distally in the second and third molar areas. There was considerable variation in cortical thickness (from 0.25 to 5.50 mm). Based on interradicular distances, only 13% of measured sites in the maxilla were suitable for miniscrew insertion (≥3.3 mm), but 63% of sites were suitable in the mandible. CONCLUSION This study showed considerable individual variation in bone thickness. Our data suggested that the palatal/lingual side may provide greater primary stability for miniscrews. The palatal area, between the second upper bicuspid and the first molar, appeared to be the most suitable area for tapered 7- to 9-mm miniscrews, starting at 1.5-2 mm from the alveolar crest.
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Luers L, Panza G, Henke F, Agyenim T, Weiss J, Willbold D, Birkmann E. Amyloid formation: age-related mechanism in Creutzfeldt-Jakob disease? Rejuvenation Res 2010; 13:214-6. [PMID: 20017612 DOI: 10.1089/rej.2009.0932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Protein aggregation occurs in many age-related neurodegenerative diseases, where it can lead to deposits of naturally occurring proteins in the brain. In case of Creutzfeldt-Jakob disease (CJD), these deposits consist of prion protein (PrP). CJD has three etiologies: spontaneous, genetic, or caused by infection. A polymorphism within the PrP gene is associated with susceptibility of infection. The main event in prion diseases is the conversion of PrP from its naturally occurring isoform to its disease-associated isoform. Here, we present the adaption of a previously reported in vitro conversion system based on hamster recombinant PrP to analyze amyloid fibril formation of human recombinant PrP. We further compare the aggregation characteristics of the human PrP according to the polymorphism variants M129 and V129.
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Affiliation(s)
- L Luers
- Institut fuer Physikalische Biologie, Heinrich-Heine Universitaet Duesseldorf, Germany
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Coppola C, Panza G, Galano G, Romano N, Falco E, Smeraglia R. EPATITE DELTA: RICERCA DEL GENOMA VIRALE E CORRELAZIONE CON LA PRESENZA DI ANTICORPI NEL SIERO. Microbiol Med 2005. [DOI: 10.4081/mm.2005.3586] [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: 11/23/2022] Open
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Panza G, Coppola C, Romano N, Di Prisco G, Falco E, Scancariello G, Alterio A, Smeraglia R. VALUTAZIONE COMPARATIVA DI DUE TESTS DI QUARTA GENERAZIONE PER LA DIAGNOSI DI INFEZIONE DA HIV. DATI PRELIMINARI. Microbiol Med 2003. [DOI: 10.4081/mm.2003.4379] [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: 11/23/2022] Open
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Giannattasio A, Angeletti G, De Rosa M, Zarrilli S, Ambrosino M, Cimmino A, Coppola C, Panza G, Calafiore R, Colao A, Abete O, Lombardi G. RNA expression bcl-w, a new related protein Bcl-2 family, and caspase-3 in isolated sertoli cells from pre-pubertal rat testes. J Endocrinol Invest 2002; 25:RC23-5. [PMID: 12150348 DOI: 10.1007/bf03345074] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Apoptosis has a major role in molding the embryo, in the maintenance of tissue homeostasis, and in the defense against pathogens, while its disgregulation is strongly implicated in cancer as well as in autoimmune and degenerative diseases. The opposite action of anti-apoptotic proteins (Bcl-2 family) and pro-apoptotic proteins (p53, Bax, Bak) regulates the activation of caspases that are the effectors proteases of the cell suicide. Bcl-W is a pro-survival protein, recently discovered, related to the Bcl-2 family. The presence of Bcl-W is fundamental for spermatogenesis in rats. Caspases are cysteine-dependent aspartate-specific proteases, and their over-expression can result in apoptotic cell death. Normally, caspases exist in cells as inactive pro-enzymes and can be activated by 2 distinct mechanisms: the FADD/caspase 8 cascade, and the Apaf-1/caspase 9 cascade. These 2 mechanisms are used extensively by cells for the activation of the effectors caspases: caspase 3, caspase 6, and/or caspase 7. Bcl-W and caspases might have a pivotal role in maintenance of Sertoli cells integrity. In this study, we demonstrate that both Bcl-W mRNA and caspase 3 mRNA are expressed in isolated Sertoli cells of pre-puberal rat testes. This finding might be crucial in clarifying whether Sertoli cells die by an apoptotic mechanism. Further studies are required to understand whether the expression of Bcl-W and caspases is different before and after puberty in rat testis and/or in pathological conditions, that lead to an increased cell apoptosis.
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Affiliation(s)
- A Giannattasio
- Department of Virology, Ascalesi Hospital, Naples, Italy
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Mauri MC, Laini V, Scalvini ME, Volonteri LS, Ferrari MS, Panza G. Lithium safety in the prophylaxis of bipolar disorders: a study with plasma levels. Eur Rev Med Pharmacol Sci 1999; 3:63-9. [PMID: 10827806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
From many decades efficacy of lithium salts, as mood stabilizers, has been largely recognized, but their tolerability, in particular during intermediate or long-term treatments is still discussed. The most frequently described side effects can affect several organs. Aim of the study was to evaluate lithium carbonate tolerability after a "brief" (1 month-4 years), "intermediate" (5-9 years) and "longterm" (10-21 years) treatment of patients affected by Bipolar Disorders (BD). 27 patients (14 males, 13 females), aged from 20 to 78 years (mean 49.03 years +/- 14.61 SD), affected by BD, type I, according to DSM IV criteria were included into the study. Our data suggest a good tolerability of lithium salts without significant differences among the three different periods of treatment.
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Affiliation(s)
- M C Mauri
- Department of Clinical Psichiatry, University of Milan, IRCCS, Ospedale Maggiore, Italy
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Mauri MC, Rudelli R, Vanni S, Panza G, Sicaro A, Audisio D, Sacerdote P, Panerai AE. Cholecystokinin, beta-endorphin and vasoactive intestinal peptide in peripheral blood mononuclear cells of drug-naive schizophrenic patients treated with haloperidol compared to healthy controls. Psychiatry Res 1998; 78:45-50. [PMID: 9579701 DOI: 10.1016/s0165-1781(97)00145-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cholecystokinin (CCK), beta-endorphin (BE), and vasoactive intestinal peptide (VIP) in peripheral blood mononuclear cells from 30 drug-naive schizophrenics compared to 22 healthy controls were studied. Patients were evaluated with the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of the Negative Symptoms (SANS) at baseline (TO), and after four weeks (T4) in nine patients who were subsequently treated with haloperidol (HL). Neuropeptide concentrations in peripheral blood mononuclear cells (PBMC) were measured at TO and, for the treated patients, at T4. There was a negative correlation between CCK and SANS baseline scores and a trend for patients who responded poorly to HL (i.e. patients with a prevalence of negative symptomatology) to have lower CCK basal values.
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Affiliation(s)
- M C Mauri
- Department of Clinical Psychiatry, University of Milan, I.R.C.C.S., Ospedale Maggiore di Milano, Italy
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Affiliation(s)
- R Troncone
- Department of Paediatrics, University Federico II, Naples, Italy
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Panza G, Monzani E, Sacerdote P, Penati G, Panerai AE. Beta-endorphin, vasoactive intestinal peptide and cholecystokinin in peripheral blood mononuclear cells from healthy subjects and from drug-free and haloperidol-treated schizophrenic patients. Acta Psychiatr Scand 1992; 85:207-10. [PMID: 1561892 DOI: 10.1111/j.1600-0447.1992.tb08596.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Beta-endorphin, cholecystokinin and vasoactive intestinal peptide were measured in peripheral blood mononuclear cells of healthy controls, and schizophrenic patients at the first diagnosis before any treatment and after 2 or 15 d of treatment with haloperidol. Beta-endorphin concentrations were similar in controls and untreated patients, and increased with treatment. Cholecystokinin concentrations were higher in patients than in controls, and decreased during treatment. Vasoactive intestinal peptide was lower in patients and did not change with treatment. These observations are consistent with measurements of the same peptides in autopsy samples or cerebrospinal fluid. Peripheral blood mononuclear cells might be an useful tool for the study of some neuropeptides in brain.
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Affiliation(s)
- G Panza
- II Chair of Clinical Psychiatry, University of Milano, Italy
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Panza G, Grebb JA, Sanna E, Wright AG, Hanbauer I. Evidence for down-regulation of 3H-nitrendipine recognition sites in mouse brain after long-term treatment with nifedipine or verapamil. Neuropharmacology 1985; 24:1113-7. [PMID: 3001573 DOI: 10.1016/0028-3908(85)90200-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Mice were fed powdered food which contained nifedipine, verapamil or diltiazem for 28 days. Long lasting treatment with nifedipine (0.28 mg/g b.w./day) or verapamil (0.27 mg/g b.w./day), but not with diltiazem (0.38 mg/g b.w./day) reduced the number of 3H-nitrendipine recognition sites in membranes prepared from cerebral cortex, caudate nucleus, and hippocampus. In addition, the veratridine-elicited stimulation of 45Ca-uptake in slices of the same brain areas was decreased in mice which were fed nifedipine or verapamil for 28 days.
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Abstract
Glycosylated hemoglobin (HbA1c) levels are evaluated as a possible integrated measure parameter of chronic job stress. HbA1c and fasting blood glucose levels in 100 healthy male printing workers (pressmen) exposed to noise, rotating shifts, and overwork were compared with levels measured in 200 healthy male clerical workers not exposed to those stressors. While blood glucose levels and their variability were found to be approximately the same in both groups, HbA1c levels were found to be 8.64% higher among the pressmen and this difference was significant at p less than .001. These findings support the hypothesis, and further research to confirm the test is suggested.
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Panza G, Dughi D, Ferrario M, Cesana GC, Grieco A, Giavelli S, Caprioli R, Segalini AM, Previdi M. Excretion of urinary catecholamines and plasma cortisol levels in female nurses on short-rotating shift. Med Lav 1985; 76:30-4. [PMID: 4010611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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35
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Cesana GC, Zanettini R, Galli M, Ferrario M, Panza G, Grieco A. Stress and coronary risk in shiftworkers. Med Lav 1983; 74:351-60. [PMID: 6664329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Cesana GC, Panza G, Ferrario M, Grieco A, Sega R, Folcini V, Damiani E, Libretti A. Platelet MAO activity in shift workers exposed to noise. Med Lav 1983; 74:266-71. [PMID: 6664319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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37
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Cesana GC, Panza G, Ferrario M, Curti R, Zanettini R, Grieco A, Sega R, Palermo A, Mara G, Libretti A, Algeri S. Work-stress and urinary catecholamines excretion in shift workers exposed to noise. II: Dopamine (DA). Med Lav 1982; 73:110-7. [PMID: 7110039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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