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Marzola A, McGreevy KS, Mussa F, Volpe Y, Governi L. HyM3D: A hybrid method for the automatic 3D reconstruction of a defective cranial vault. Comput Methods Programs Biomed 2023; 234:107516. [PMID: 37023601 DOI: 10.1016/j.cmpb.2023.107516] [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: 12/21/2022] [Revised: 03/08/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND OBJECTIVE The ability to accomplish a consistent restoration of a missing or deformed anatomical area is a fundamental step for defining a custom implant, especially in the maxillofacial and cranial reconstruction where the aesthetical aspect is crucial for a successful surgical outcome. At the same time, this task is also the most difficult, time-consuming, and complicated across the whole reconstruction process. This is mostly due to the high geometric complexity of the anatomical structures, insufficient references, and significant interindividual anatomical heterogeneity. Numerous solutions, specifically for the neurocranium, have been put forward in the scientific literature to address the reconstruction issue, but none of them has yet been persuasive enough to guarantee an easily automatable approach with a consistent shape reconstruction. METHODS This work aims to present a novel reconstruction method (named HyM3D) for the automatic restoration of the exocranial surface by ensuring both the symmetry of the resulting skull and the continuity between the reconstructive patch and the surrounding bone. To achieve this goal, the strengths of the Template-based methods are exploited to provide knowledge of the missing or deformed region and to guide a subsequent Surface Interpolation-based algorithm. HyM3D is an improved version of a methodology presented by the authors in a previous publication for the restoration of unilateral defects. Differently from the first version, the novel procedure applies to all kinds of cranial defects, whether they are unilateral or not. RESULTS The presented method has been tested on several test cases, both synthetic and real, and the results show that it is reliable and trustworthy, providing a consistent outcome with no user intervention even when dealing with complex defects. CONCLUSIONS HyM3D method proved to be a valid alternative to the existing approaches for the digital reconstruction of a defective cranial vault; furthermore, with respect to the current alternatives, it demands less user interaction since the method is landmarks-independent and does not require any patch adaptation.
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Affiliation(s)
- Antonio Marzola
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, Firenze 50139, Italy.
| | | | - Federico Mussa
- Meyer Children's Hospital IRCCS, Viale Pieraccini 24, Florence 50141, Italy
| | - Yary Volpe
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, Firenze 50139, Italy
| | - Lapo Governi
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, Firenze 50139, Italy
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Lazzeri S, Talanti E, Basciano S, Barbato R, Fontanelli F, Uccheddu F, Servi M, Volpe Y, Vagnoli L, Amore E, Marzola A, McGreevy KS, Carfagni M. 3D-Printed Patient-Specific Casts for the Distal Radius in Children: Outcome and Pre-Market Survey. Materials (Basel) 2022; 15:ma15082863. [PMID: 35454555 PMCID: PMC9027121 DOI: 10.3390/ma15082863] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Background: Orthopaedic and Trauma surgery is expected to undergo profound transformation as a result of the adoption of 3D technology. Among the various applications, patient specific manufacturing of splints and casts would appear to be, particularly in children, an interesting implementation. This study aims to assess the safety of patient specific 3D casts obtained with a newly developed 3D-scanning devise in a small case series. We therefore conducted a clinical outcome and pre-marketing study in 10 consecutive patients with distal radius fractures treated at an Academic Level I Pediatric Trauma Center. After the application of the 3D cast, patients underwent three consecutive evaluations in the following 21 days. The main outcome measurements were: pain, skin lesions and general comfort, and acceptance of the cast. The three domains were measured with the Visual Analogue Scale (VAS), the NPUAP/EPUAP classification and the Positive affect-Negative affect Scale for Children (PANAS-C), the Self-Assessment Manikin (SAM) clinical psychology tests and a Likert-type five item questionnaire, respectively. A final mechanical analysis of the cast was carried out to confirm product integrity. Results: The results obtained were consistently positive in the investigated domains of general comfort, efficacy of contention and mechanical integrity of the 3D-printed cast as well as in the practicability of the supply chain. Conclusions: This study provides Level IV evidence that patient specific 3D printed casts obtained with a specifically designed software were safe in the management of “buckle” fractures of the distal radius in children. These results encourage to extend the technology to the treatment of more demanding fractures.
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Affiliation(s)
- Simone Lazzeri
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
- Correspondence:
| | - Emiliano Talanti
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Simone Basciano
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Raffaele Barbato
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Federico Fontanelli
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Francesca Uccheddu
- Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy; (F.U.); (M.S.); (Y.V.); (A.M.); (M.C.)
| | - Michaela Servi
- Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy; (F.U.); (M.S.); (Y.V.); (A.M.); (M.C.)
| | - Yary Volpe
- Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy; (F.U.); (M.S.); (Y.V.); (A.M.); (M.C.)
| | - Laura Vagnoli
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Elena Amore
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Antonio Marzola
- Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy; (F.U.); (M.S.); (Y.V.); (A.M.); (M.C.)
| | - Kathleen S. McGreevy
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Monica Carfagni
- Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy; (F.U.); (M.S.); (Y.V.); (A.M.); (M.C.)
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McIntosh J, McGreevy KS, Clark W, Bini G, Aquino F. A call to action: children's hospitals, child health, and the climate crisis. Lancet Child Adolesc Health 2021; 5:774-776. [PMID: 34592138 DOI: 10.1016/s2352-4642(21)00269-8] [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] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Jennifer McIntosh
- European Children's Hospitals Organisation, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain.
| | - Kathleen S McGreevy
- Meyer Children's Research Institute, Meyer Children's Hospital, Florence, Italy
| | - Will Clark
- Health Care Without Harm Europe, Brussels, Belgium
| | - Gemma Bini
- Youth Advisory Council, Meyer Children's Hospital, Florence, Italy
| | - Federica Aquino
- Youth Advisory Council, Meyer Children's Hospital, Florence, Italy
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Indolfi G, Stivala M, Lenge M, Diaz Naderi R, McIntosh J, Llandrich RC, Gannon J, McGreevy KS, Trapani S, Miettinen P, Lahdenne P, Desborough L, Pavare J, van Rossum A, Zyska D, Resti M, Zanobini A. Impact of SARS-CoV-2 Pandemic and Strategies for Resumption of Activities During the Second Wave of the Pandemic: A Report From Eight Paediatric Hospitals From the ECHO Network. Front Public Health 2021; 9:630168. [PMID: 33981662 PMCID: PMC8107357 DOI: 10.3389/fpubh.2021.630168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/26/2021] [Indexed: 12/24/2022] Open
Abstract
The Severe Acute Respiratory Syndrome CoronaVirus type 2 (SARS-CoV-2) pandemic impacted the organization of paediatric hospitals. This study aimed to evaluate the preparedness for the pandemic among a European network of children's hospitals and to explore the strategies to restart health care services. A cross-sectional, web-based survey was distributed in May 2020 to the 13 children's tertiary care hospitals belonging to the European Children's Hospitals Organisation. Responses were obtained from eight hospitals (62%). Significant reductions were observed in accesses to the emergency departments (41.7%), outpatient visits (35.7%), intensive and non-intensive care unit inpatient admissions (16.4 and 13%, respectively) between February 1 and April 30, 2020 as compared with the same period of 2019. Overall, 93 children with SARS CoV-2 infection were admitted to inpatient wards. All the hospitals created SARS-CoV-2 preparedness plans for the diagnosis and management of infected patients. Routine activities were re-scheduled. Four hospitals shared their own staff with adult units, two designated bed spaces for adults and only one admitted adults to inpatient wards. The three main components for the resumption of clinical activities were testing, source control, and reorganization of spaces and flows. Telemedicine and telehealth services were used before the SARS-CoV-2 pandemic by three hospitals and by all the hospitals during it. Conclusion: The present study provides a perspective on preparedness to SARS-CoV-2 pandemic among eight large European children's hospitals, on the impact of the pandemic on the hospital activities and on the strategies adopted to restart clinical activities.
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Affiliation(s)
- Giuseppe Indolfi
- Meyer Children's Hospital, Firenze, Italy.,Department Neurofarba, University of Florence, Firenze, Italy
| | | | | | - Ruben Diaz Naderi
- Sant Joan de Deu-Barcelona Children's Hospital, Esplugues de Llobregat, Spain.,European Children's Hospitals Organisation (ECHO), Esplugues de Llobregat, Spain
| | - Jennifer McIntosh
- Sant Joan de Deu-Barcelona Children's Hospital, Esplugues de Llobregat, Spain.,European Children's Hospitals Organisation (ECHO), Esplugues de Llobregat, Spain
| | | | - Joe Gannon
- Children's Health Ireland, Dublin, Ireland
| | | | | | | | | | | | - Jana Pavare
- Children's Clinical University Hospital, Riga, Latvia
| | | | - Dagmara Zyska
- The Children's Memorial Health Institute, Warsaw, Poland
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5
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McIntosh J, Aresté ME, Brierley J, Giugni C, McGreevy KS, Cambra FJ, Tibboel D, Diaz R, Zanobini A. Safeguarding children's right to health in hospital during COVID-19. Lancet Child Adolesc Health 2020; 4:800-802. [PMID: 32941785 PMCID: PMC7490005 DOI: 10.1016/s2352-4642(20)30300-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/25/2020] [Indexed: 10/31/2022]
Affiliation(s)
- Jennifer McIntosh
- European Children's Hospitals Organisation, Barcelona, Spain; International Department, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain.
| | | | - Joe Brierley
- Paediatric Bioethics Centre, Great Ormond Street Hospital, London, UK
| | | | - Kathleen S McGreevy
- Office of International Relations and the Promotion of Innovation, Florence, Italy
| | - Francisco José Cambra
- Paediatric Intensive Care Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain; Borja Bioethics Institute-URL, Barcelona, Spain
| | - Dick Tibboel
- Department of Paediatric Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ruben Diaz
- European Children's Hospitals Organisation, Barcelona, Spain; International Department, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
| | - Alberto Zanobini
- European Children's Hospitals Organisation, Barcelona, Spain; Meyer Children's Hospital, Florence, Italy
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Rosati A, Ilvento L, Lucenteforte E, Pugi A, Crescioli G, McGreevy KS, Virgili G, Mugelli A, De Masi S, Guerrini R. Comparative efficacy of antiepileptic drugs in children and adolescents: A network meta-analysis. Epilepsia 2017; 59:297-314. [PMID: 29270989 DOI: 10.1111/epi.13981] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To estimate the comparative efficacy among antiepileptic drugs in the pediatric population (0-18 years). METHODS Using the Embase and MEDLINE databases, we updated to February 2017 the search strategy of the National Institute for Health and Care Excellence guidelines for epilepsy. We only included randomized clinical trials conducted in children and mixed-age populations. According to the PRISMA network meta-analysis guideline, the study-level quality assessment was made with the Cochrane risk-of-bias tool. Three investigators independently selected articles. The efficacy outcome was considered to be seizure freedom or ≥50% seizure reduction. RESULTS We selected 46 randomized clinical trials. A total of 5652 individuals were randomized to 22 antiepileptic drugs and placebo. The point estimates of carbamazepine and lamotrigine efficacy showed their superiority with respect to all comparator antiepileptic drugs for the treatment of newly diagnosed focal epilepsy. In refractory focal epilepsy, levetiracetam (odds ratio [OR] = 3.3, 95% credible interval [CrI] = 1.3-7.6) and perampanel (OR = 2.5, 95% CrI = 1.1-5.8) were more effective compared to placebo. Ethosuximide and valproic acid were both superior to lamotrigine against absence seizures. The OR point estimate showed the superiority of adrenocorticotropic hormone over all comparators in infantile spasms. A wide heterogeneity in the length of follow-up was observed among the studies. SIGNIFICANCE This network meta-analysis suggests that the quality of studies should be improved through the use of comparative designs, relevant outcomes, appropriate follow-up length, and more reliable inclusion criteria.
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Affiliation(s)
- Anna Rosati
- Neuroscience Center of Excellence, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Lucrezia Ilvento
- Neuroscience Center of Excellence, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Ersilia Lucenteforte
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | - Alessandra Pugi
- Clinical Trial Office, Meyer Children's Hospital, Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | - Kathleen S McGreevy
- Research, Innovation, and International Relations Office, Meyer Children's Hospital, Florence, Italy
| | - Gianni Virgili
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | | | - Renzo Guerrini
- Neuroscience Center of Excellence, Meyer Children's Hospital, University of Florence, Florence, Italy
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Catastini P, Di Marco S, Furriolo M, Genovese C, Grande A, Iacinti E, Iusco DR, Nobili RMV, Pescini R, Ragni R, Randazzo R, Risso C, Tabarini P, Braggion C, De Masi S, McGreevy KS. The prevalence of anxiety and depression in Italian patients with cystic fibrosis and their caregivers. Pediatr Pulmonol 2016; 51:1311-1319. [PMID: 27759954 DOI: 10.1002/ppul.23566] [Citation(s) in RCA: 16] [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: 02/29/2016] [Revised: 08/11/2016] [Accepted: 08/19/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cystic fibrosis, like other chronic diseases, is a risk factor for the development of elevated symptoms of depression and anxiety. The objective of this study was to investigate the prevalence of anxiety and depression in Italian patients with CF and their parents. METHODS The Hospital Anxiety and Depression Scale (HADS) and Center for Epidemiologic Studies Depression Scale (CES-D) questionnaires were administered to a sample of patients and their parents recruited at the cystic fibrosis centers in Italy. RESULTS Elevated levels of anxiety were higher in mothers than in fathers, and also higher in female patients than in male patients. A correlation between elevated levels of anxiety/depression and geographical area also emerged. Patient anxiety (OR 2.33) and depression (OR 4.09) were significantly associated with forced expiratory volume in one second (FEV1) <40% and forced vital capacity (FVC) <80% (OR 1.60 and 1.61, respectively). CONCLUSIONS Cystic fibrosis increases the risk of developing anxiety and depression in female patients and in mothers. Geographical differences were observed, with higher anxiety and depression in southern Italy for parents, but not for patients. Anxiety and depression levels also depend on clinical status. Pediatr Pulmonol. 2016;51:1311-1319. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Paola Catastini
- Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Serena Di Marco
- Cystic Fibrosis Regional Center, Ospedale "Di Cristina" Arnas Civico, Palermo, Italy
| | - Maria Furriolo
- Cystic Fibrosis Regional Center, Presidio Ospedaliero Giovanni Paolo II, Lamezia Terme (CZ), Italy
| | - Carmela Genovese
- Cystic Fibrosis Regional Center, A.O.R. Ospedale San Carlo, Potenza, Italy
| | - Alessia Grande
- Cystic Fibrosis Adult Center, A.O.U. San Luigi Gonzaga, Orbassano (TO), Italy
| | | | - Danila Rosa Iusco
- Cystic Fibrosis Regional Center, A.O.U Policlinico Bari, Bari, Italy
| | | | - Rita Pescini
- Cystic Fibrosis Regional Center, Ospedale G.Gaslini, Genova, Italy
| | - Roberto Ragni
- Cystic Fibrosis Regional Center, A.O.U. Ancona, Italy
| | | | | | - Paola Tabarini
- Unit of Clinical Psychologist Unit of Cystic Fibrosis Center, Bambino Gesù Pediatric Hospital, Roma, Italy
| | - Cesare Braggion
- Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Salvatore De Masi
- Clinical Trial Office, Anna Meyer Children's Hospital, Florence, Italy
| | - Kathleen S McGreevy
- Research, Innovation and International Relations, Anna Meyer Children's Hospital, Florence, Italy
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Poggiali S, Ombrone D, Forni G, Malvagia S, Funghini S, Mura M, Pasquini E, Santoro L, Bellavia V, Granata OM, Castana C, McGreevy KS, Aronica TS, la Marca G. Reducing the False-Positive Rate for Isovalerylcarnitine in Expanded Newborn Screening. Journal of Inborn Errors of Metabolism and Screening 2016. [DOI: 10.1177/2326409816661355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sara Poggiali
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Pediatric Neurology Clinic and Laboratories, Meyer Children’s University Hospital, Florence, Italy
| | - Daniela Ombrone
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Pediatric Neurology Clinic and Laboratories, Meyer Children’s University Hospital, Florence, Italy
| | - Giulia Forni
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Pediatric Neurology Clinic and Laboratories, Meyer Children’s University Hospital, Florence, Italy
| | - Sabrina Malvagia
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Pediatric Neurology Clinic and Laboratories, Meyer Children’s University Hospital, Florence, Italy
| | - Silvia Funghini
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Pediatric Neurology Clinic and Laboratories, Meyer Children’s University Hospital, Florence, Italy
| | - Massimo Mura
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Pediatric Neurology Clinic and Laboratories, Meyer Children’s University Hospital, Florence, Italy
| | - Elisabetta Pasquini
- Metabolic and Muscular Unit, Pediatric Neurology Clinic, Meyer Children’s University Hospital, Florence, Italy
| | - Laura Santoro
- UOS Newborn Screening Center, UOC Pediatric Clinical Pathology, P.O.G. Di Cristina, Palermo, Italy
| | - Vincenzo Bellavia
- UOS Newborn Screening Center, UOC Pediatric Clinical Pathology, P.O.G. Di Cristina, Palermo, Italy
| | - Orazia Maria Granata
- UOS Newborn Screening Center, UOC Pediatric Clinical Pathology, P.O.G. Di Cristina, Palermo, Italy
| | - Cinzia Castana
- UOC Pediatric Clinic, P.O.G. Di Cristina, Palermo, Italy
| | - Kathleen S. McGreevy
- Research, Innovation and International Relations Office, Meyer Children’s University Hospital, Florence, Italy
| | - Tommaso Silvano Aronica
- UOS Newborn Screening Center, UOC Pediatric Clinical Pathology, P.O.G. Di Cristina, Palermo, Italy
| | - Giancarlo la Marca
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Pediatric Neurology Clinic and Laboratories, Meyer Children’s University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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9
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Rosati A, Ilvento L, L'Erario M, De Masi S, Biggeri A, Fabbro G, Bianchi R, Stoppa F, Fusco L, Pulitanò S, Battaglia D, Pettenazzo A, Sartori S, Biban P, Fontana E, Cesaroni E, Mora D, Costa P, Meleleo R, Vittorini R, Conio A, Wolfler A, Mastrangelo M, Mondardini MC, Franzoni E, McGreevy KS, Di Simone L, Pugi A, Mirabile L, Vigevano F, Guerrini R. Efficacy of ketamine in refractory convulsive status epilepticus in children: a protocol for a sequential design, multicentre, randomised, controlled, open-label, non-profit trial (KETASER01). BMJ Open 2016; 6:e011565. [PMID: 27311915 PMCID: PMC4916612 DOI: 10.1136/bmjopen-2016-011565] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Status epilepticus (SE) is a life-threatening neurological emergency. SE lasting longer than 120 min and not responding to first-line and second-line antiepileptic drugs is defined as 'refractory' (RCSE) and requires intensive care unit treatment. There is currently neither evidence nor consensus to guide either the optimal choice of therapy or treatment goals for RCSE, which is generally treated with coma induction using conventional anaesthetics (high dose midazolam, thiopental and/or propofol). Increasing evidence indicates that ketamine (KE), a strong N-methyl-d-aspartate glutamate receptor antagonist, may be effective in treating RCSE. We hypothesised that intravenous KE is more efficacious and safer than conventional anaesthetics in treating RCSE. METHODS AND ANALYSIS A multicentre, randomised, controlled, open-label, non-profit, sequentially designed study will be conducted to assess the efficacy of KE compared with conventional anaesthetics in the treatment of RCSE in children. 10 Italian centres/hospitals are involved in enrolling 57 patients aged 1 month to 18 years with RCSE. Primary outcome is the resolution of SE up to 24 hours after withdrawal of therapy and is updated for each patient treated according to the sequential method. ETHICS AND DISSEMINATION The study received ethical approval from the Tuscan Paediatric Ethics Committee (12/2015). The results of this study will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NCT02431663; Pre-results.
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Affiliation(s)
- Anna Rosati
- Paediatric Neurology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Lucrezia Ilvento
- Paediatric Neurology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | | | - Annibale Biggeri
- Department of Statistics, ‘G Parenti’, University of Florence, Florence, Italy
| | - Giancarlo Fabbro
- Department of Statistics, ‘G Parenti’, University of Florence, Florence, Italy
| | - Roberto Bianchi
- Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Stoppa
- DEA Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lucia Fusco
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Domenica Battaglia
- Department of Child Neurology and Psychiatry, Catholic University, Rome, Italy
| | - Andrea Pettenazzo
- Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Stefano Sartori
- Paediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Paolo Biban
- Department of Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elena Fontana
- Unit of Child Neuropsychiatry, University of Verona, Verona, Italy
| | - Elisabetta Cesaroni
- Child Neuropsychiatry Unit, Polytechnic University of the Marche, Ancona, Italy
| | - Donatella Mora
- Intensive Care Unit, Polytechnic University of the Marche, Ancona, Italy
| | - Paola Costa
- Intensive Care Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Rosanna Meleleo
- Department of Neuropsychiatry Ward, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Roberta Vittorini
- Department of Paediatric Neurology, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Alessandra Conio
- Paediatric Intensive Care Unit, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Andrea Wolfler
- Department of Anaesthesia and Intensive Care, Women and Children's Hospital Vittore Buzzi, ICP, Milan, Italy
| | - Massimo Mastrangelo
- Paediatric Neurology Unit, Women and Children's Hospital Vittore Buzzi, ICP, Milan, Italy
| | - Maria Cristina Mondardini
- Department of Paediatric Anaesthesia and Intensive Care, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Emilio Franzoni
- Child Neuropsychiatry Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Kathleen S McGreevy
- Research, Innovation and International Relations, Meyer Children's Hospital, Florence, Italy
| | | | - Alessandra Pugi
- Clinical Trial Office Meyer Children's Hospital, Florence, Italy
| | | | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Renzo Guerrini
- Paediatric Neurology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
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Donzelli G, McGreevy KS. Perinatal care at the confluence of narrative medicine and personalized medicine: what lies downstream? J Matern Fetal Neonatal Med 2016; 29:2807-9. [PMID: 26794262 DOI: 10.3109/14767058.2015.1105210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Gianpaolo Donzelli
- a Fetal-Neonatal Department , Meyer Children's Hospital, University of Florence , Florence , Italy and
| | - Kathleen S McGreevy
- b Research, Innovation and International Relations Office, Meyer Children's Hospital , Florence , Italy
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Donzelli G, Carnesecchi G, Amador C, di Tommaso M, Filippi L, Caporali R, Codullo V, Riccieri V, Valesini G, Gabrielli A, Bagnati R, McGreevy KS, De Masi S, Matucci Cerinic M. Fetal programming and systemic sclerosis. Am J Obstet Gynecol 2015; 213:839.e1-8. [PMID: 26232509 DOI: 10.1016/j.ajog.2015.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 06/16/2015] [Accepted: 07/21/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study investigated whether birthweight is linked to an increased risk of the development of systemic sclerosis. STUDY DESIGN This was a multicenter case-control study with perinatal data that were obtained from 332 cases with systemic sclerosis and 243 control subjects. Birthweight was treated as a dichotomous variable (<2500 g vs ≥2500 g); low birthweight was defined as a weight <2500 g; small for gestational age was defined as birthweight <10th percentile for gestational age adjusted for sex. The relationship between systemic sclerosis and both low birthweight and small for gestational age was expressed with the crude (univariate analysis) and adjusted (multivariate analysis) odds ratio (OR). RESULTS Significantly increased ORs were observed in the univariate analysis for low birthweight (OR, 2.59; 95% confidence interval [CI], 1.39-5.05) and small for gestational age (OR, 2.60; 95% CI, 1.34-5.32) subjects. Similarly increased risks were confirmed for both conditions in the multivariate analysis (OR, 3.93; 95% CI, 1.92-8.07; and OR, 2.58; 95% CI, 1.28-5.19), respectively. CONCLUSION Low birthweight and small for gestational age at birth are risk factors for the adult onset of systemic sclerosis.
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Affiliation(s)
- Gianpaolo Donzelli
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy.
| | - Giulia Carnesecchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carolina Amador
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Luca Filippi
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Roberto Caporali
- Department of Rheumatology, University and IRCCS Foundation, Policlinico San Matteo, Pavia, Italy
| | - Veronica Codullo
- Department of Rheumatology, University and IRCCS Foundation, Policlinico San Matteo, Pavia, Italy
| | - Valeria Riccieri
- Department of Internal Medicine and Clinical Specialties, Rheumatology Unit, "La Sapienza" University, Rome, Italy
| | - Guido Valesini
- Department of Internal Medicine and Clinical Specialties, Rheumatology Unit, "La Sapienza" University, Rome, Italy
| | - Armando Gabrielli
- Institute of General Clinical Medicine, Hematology, and Clinical Immunology, University of Ancona, Ancona, Italy
| | - Roberta Bagnati
- Institute of General Clinical Medicine, Hematology, and Clinical Immunology, University of Ancona, Ancona, Italy
| | - Kathleen S McGreevy
- Research, Innovation, and International Relations Office, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Salvatore De Masi
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Malvagia S, Haynes CA, Grisotto L, Ombrone D, Funghini S, Moretti E, McGreevy KS, Biggeri A, Guerrini R, Yahyaoui R, Garg U, Seeterlin M, Chace D, De Jesus VR, la Marca G. Heptadecanoylcarnitine (C17) a novel candidate biomarker for newborn screening of propionic and methylmalonic acidemias. Clin Chim Acta 2015; 450:342-8. [PMID: 26368264 DOI: 10.1016/j.cca.2015.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/10/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND 3-Hydroxypalmitoleoyl-carnitine (C16:1-OH) has recently been reported to be elevated in acylcarnitine profiles of patients with propionic acidemia (PA) or methylmalonic acidemia (MMA) during expanded newborn screening (NBS). High levels of C16:1-OH, combined with other hydroxylated long chain acylcarnitines are related to long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) and trifunctional protein (TFP) deficiency. METHODS The acylcarnitine profile of two LCHADD patients was evaluated using liquid chromatography-tandem mass spectrometric method. A specific retention time was determined for each hydroxylated long chain acylcarnitine. The same method was applied to some neonatal dried blood spots (DBSs) from PA and MMA patients presenting abnormal C16:1-OH concentrations. RESULTS The retention time of the peak corresponding to C16:1-OH in LCHADD patients differed from those in MMA and PA patients. Heptadecanoylcarnitine (C17) has been identified as the novel biomarker specific for PA and MMA patients through high resolution mass spectrometry (Orbitrap) experiments. We found that 21 out of 23 neonates (22 MMA, and 1PA) diagnosed through the Tuscany region NBS program exhibited significantly higher levels of C17 compared to controls. Twenty-three maternal deficiency (21 vitamin B12 deficiency, 1 homocystinuria and 1 gastrin deficiency) samples and 82 false positive for elevated propionylcarnitine (C3) were also analyzed. CONCLUSIONS We have characterized a novel biomarker able to detect propionate disorders during expanded newborn screening (NBS). The use of this new biomarker may improve the analytical performances of NBS programs especially in laboratories where second tier tests are not performed.
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Affiliation(s)
- Sabrina Malvagia
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Pediatric Neurology Unit and Laboratories, Meyer Children's University Hospital, Florence, Italy
| | - Christopher A Haynes
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Laura Grisotto
- Department of Statistics, Computer Science and Applications 'G. Parenti' University of Florence, Florence, Italy
| | - Daniela Ombrone
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Pediatric Neurology Unit and Laboratories, Meyer Children's University Hospital, Florence, Italy
| | - Silvia Funghini
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Pediatric Neurology Unit and Laboratories, Meyer Children's University Hospital, Florence, Italy
| | - Elisa Moretti
- Analytics and Early Formulations Department, Chiesi Farmaceutici S.P.A., Parma, Italy
| | - Kathleen S McGreevy
- Research, Innovation and International Relations Office, Meyer Children's University Hospital, Florence, Italy
| | - Annibale Biggeri
- Department of Statistics, Computer Science and Applications 'G. Parenti' University of Florence, Florence, Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit and Laboratories, Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Raquel Yahyaoui
- Newborn Screening and Clinical Laboratory, Málaga Regional Hospital, Málaga, Spain
| | - Uttam Garg
- Department of Pathology and laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA
| | - Mary Seeterlin
- Newborn Screening Section, Michigan Department of Community Health, Bureau of Laboratories, Chemistry and Toxicology, Lansing, MI, USA
| | - Donald Chace
- The Pediatrix Center for Research, Education and Quality Pediatrix Medical Group, Concord Terrace Sunrise, FL, USA
| | - Victor R De Jesus
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Giancarlo la Marca
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Pediatric Neurology Unit and Laboratories, Meyer Children's University Hospital, Florence, Italy.
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McGreevy KS, Hummel JP, Jiangang Z, Haines DE. Comparison of a Saline Irrigated Cooled-Tip Catheter to Large Electrode Catheters with Single and Multiple Temperature Sensors for Creation of Large Radiofrequency Lesions. J Interv Card Electrophysiol 2006; 14:139-45. [PMID: 16421689 DOI: 10.1007/s10840-006-5635-1] [Citation(s) in RCA: 9] [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] [Received: 06/10/2005] [Accepted: 10/20/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several catheter technologies for creating large radiofrequency (RF) lesions are used in clinical practice, but direct comparisons of the pathological lesions created by these technologies are unavailable. The purpose of this study was to compare the safety and efficacy of lesions created by three different large lesion RF ablation technologies. METHODS AND RESULTS RF lesions were created in all four chambers of 15 mongrel dogs using 10 mm-tip multiple temperature sensor catheters, 10 mm tip single temperature sensor catheters, and 4 mm cooled-tip catheters. Pathological lesions were bisected, and measured after viability staining. A total of 242 (79 large-tip single sensor, 82 large-tip multiple sensor, and 81 cooled-tip) lesions were created. All atrial lesions were transmural but tended to have larger surface areas with the single thermistor large-tip catheter (73.4 +/- 24.8 mm2) compared to either the multithermistor large-tip (60.9 +/- 28.3 mm2) or the cooled-tip (61.9 +/- 28.5 mm2) catheters (p = 0.07), especially those in the IVC-TA isthmus. Depths and volumes of ventricular lesions created by the multiple-thermistor catheter (5.0 +/- 1.5 mm; 260 +/- 168 mm3) were smaller than either the single thermistor (5.7 +/- 1.5 mm; 428 +/- 290 mm3) or cooled-tip (6.1 +/- 1.8 mm; 403 +/- 217 mm3) catheters (p < 0.05). The difference in the depth and volume of lesions made by large-tip single thermistor and cooled-tip catheters was not significant. Char formation occurred during 11% of ablation with the single thermistor catheter, 6% with multithermistor and 8% of cooled-tip catheter (p = NS). There were no complications of ablation. CONCLUSIONS All three catheters reliably created full thickness atrial lesions. For ventricular lesions, depths and volumes were similar for 10 mm-tip single thermistor and cooled-tip catheters. The multithermistor catheter lesions were smaller due to more precise temperature regulated power control. Safety was similar in all 3 groups.
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Affiliation(s)
- Kathleen S McGreevy
- The Cardiovascular Division, University of Virginia School of Medicine, Charlottesville, VA, USA
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