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Ruggiero M, Conforti A, Culcasi A, Mazzanti C, Sibahi G, Rani N, Sartini S. A focus on melorheostosis disease: a literature review and case report of femoral-acetabular impingement due to melorheostosis treated with surgical hip osteoplasty. Reumatismo 2024; 76. [PMID: 38523583 DOI: 10.4081/reumatismo.2024.1621] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/25/2023] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE Melorheostosis is a rare, non-hereditary, benign bone disease characterized by abnormal bone growth. Generally, melorheostosis develops during childhood or adolescence and progresses gradually over time. This disease represents a true challenge to the physician because of its variability due to location, extension of the affected bone, and involvement of associated soft tissue. Pain management, physical therapy, and surgery may be recommended, depending on the individual case. This review aims to get an overview of the latest evidence relating to epidemiology, clinical and radiographic characteristics, diagnosis, and possible therapeutic strategies for melorheostosis and describe our experience through a clinical case. METHODS We designed a comprehensive literature search on melorheostosis in MEDLINE (via Pubmed) up to April 2023 and reviewed reports published in international journals. RESULTS The purpose is to highlight the importance of a multidisciplinary approach in the management of a rare disease such as melorheostosis. We discuss the role of different physicians, including genetists, rheumatologists, physiatrists, physical therapists, and orthopedic surgeons, in providing accurate diagnoses and effective treatments. We conducted a comprehensive review of the literature on the treatment of melorheostosis to support these findings. In addition, the article presents a case study of a patient suffering from melorheostosis, focusing on difficulties in reaching a correct diagnosis and attempts towards conservative and surgical interventions. The patient underwent hip arthroplasty, and the final result was an improvement in function and a reduction in pain. CONCLUSIONS Managing melorheostosis can be challenging, and there is no standardized treatment for this condition at the moment.
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Affiliation(s)
- M Ruggiero
- Physical and Rehabilitation Medicine 2, Rizzoli Orthopedic Institute, Bologna.
| | - A Conforti
- Local Health Unit Roma 4, Civitavecchia, Rome.
| | - A Culcasi
- Technical and Rehabilitation Nursing Service, Rizzoli Orthopedic Institute, Bologna.
| | - C Mazzanti
- Physical and Rehabilitation Medicine 2, Rizzoli Orthopedic Institute, Bologna.
| | - G Sibahi
- Physical and Rehabilitation Medicine 2, Rizzoli Orthopedic Institute, Bologna.
| | - N Rani
- Conservative Orthopaedic Surgery and Innovative Techniques, Rizzoli Orthopedic Institute, Bologna.
| | - S Sartini
- Physical and Rehabilitation Medicine 2, Rizzoli Orthopedic Institute, Bologna.
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2
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Bernetti A, Ruggiero M, Ruiu P, Napoli M, D’Urzo R, Mancuso A, Mariani F, Tota L, Agostini F, Mangone M, Paoloni M. Analysis and Report of the Physical and Rehabilitation Medicine Evaluation Activity in Patients Admitted to Acute Care Setting: An Observational Retrospective Study. Int J Environ Res Public Health 2023; 20:6039. [PMID: 37297646 PMCID: PMC10252334 DOI: 10.3390/ijerph20116039] [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: 01/24/2023] [Revised: 05/01/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Disability (both temporary and transitory, or definitive) might occur for the first time in a given patient after an acute clinical event. It is essential, whenever indicated, to undergo a Physical Medicine and Rehabilitation assessment to detect disability and any need for rehabilitation early. Although access to rehabilitation services varies from country to country, it should always be governed by a PRM prescription. OBJECTIVE The aim of the present observational retrospective study is to describe consultancy activity performed by PRM specialists in a university hospital in terms of requests' typology, clinical questions, and rehabilitation setting assignment. METHODS Multiple parameters were analyzed (clinical condition, patient's socio-family background, and rehabilitation assessment scale scores) and a correlation analysis was performed between the analyzed characteristics and both the different clinical conditions and the assigned rehabilitation setting. RESULTS PRM evaluations of 583 patients from 1 May 2021 to 30 June 2022 were examined. Almost half of the total sample (47%) presented disability due to musculoskeletal conditions with a mean age of 76 years. The most frequently prescribed settings were home rehabilitation care, followed by intensive rehabilitation and long-term care rehabilitation. CONCLUSIONS Our results suggest the high public health impact of musculoskeletal disorders, followed by neurological disorders. This is, however, without forgetting the importance of early rehabilitation to prevent other types of clinical conditions such as cardiovascular, respiratory, or internal diseases from leading to motor disability and increasing costs.
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Affiliation(s)
- Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Marco Ruggiero
- Physical and Rehabilitation Medicine, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Pierangela Ruiu
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Martina Napoli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Rossella D’Urzo
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Annalisa Mancuso
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Flavio Mariani
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Luigi Tota
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
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Ruggiero M, Pinar U, Popelin M, Rod X, Denys P, Chartier-Kastler E. Single centre experience and long-term outcomes of implantable devices ACT and Pro- ACT (Uromedica, Irvin, CA, USA) - adjustable continence therapy for treatment of stress urinary incontinence. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00928-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Ruggiero M, Pinar U, Popelin MB, Rod X, Denys P, Bazinet A, Chartier-Kastler E. Single center experience and long-term outcomes of implantable devices ACT and Pro-ACT (Uromedica, Irvin, CA, USA) - Adjustable continence Therapy for treatment of stress urinary incontinence. Prog Urol 2023; 33:96-102. [PMID: 36572628 DOI: 10.1016/j.purol.2022.12.004] [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: 08/15/2022] [Revised: 11/27/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE In this study, we aimed at evaluating the long-term adjustable peri-urethral balloons (PUB) durability in both male and female with neurogenic or non-neurogenic stress urinary incontinence. MATERIAL AND METHODS Each consecutive patient who underwent surgery for PUB placement before 2008 was included in this study. A PUB was proposed for patients with refractory to perineal reeducation stress urinary incontinence (SUI) caused by intrinsic sphincter deficiency. There were no exclusion criteria. Demographic, clinical and perioperative data were collected retrospectively from our clinical follow-up notes. RESULTS A total of 177 patients were included in the study. Median [IQR] follow-up was 5 years [1.8-11.2]. The 3 main causes of SUI were radical prostatectomy (n=82, 46.3%), idiopathic intrinsic sphincter deficiency (n=55, 31.1%) and neurogenic sphincter deficiency (n=32, 18.1%). Complete continence (no pad necessary) was achieved for 109 patients (61.6%). At the end of the follow-up, the PUB global survival rate was 47.5% (Fig. 1). Median [IQR] PUB survival without removal was 57.8 months [42.3-81.7]. PUB survival without failure rate was 68.4% accounting for a median [IQR] survival duration of 116.9 months [86.2-176.9] CONCLUSION: In this study, we evidenced acceptable long-term efficiency and survival of PUB in the management of SUI in both neurogenic and non-neurogenic population. Given those results it could be a good alternative to AUS on unfit or unwilling population. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- M Ruggiero
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - U Pinar
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - M-B Popelin
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - X Rod
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - P Denys
- Université Paris Saclay, hôpital R.-Poincaré, AP-HP, neurourology department, Garches, France
| | - A Bazinet
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - E Chartier-Kastler
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France.
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de Sire A, Agostini F, Bernetti A, Mangone M, Ruggiero M, Dinatale S, Chiappetta A, Paoloni M, Ammendolia A, Paolucci T. Non-Surgical and Rehabilitative Interventions in Patients with Frozen Shoulder: Umbrella Review of Systematic Reviews. J Pain Res 2022; 15:2449-2464. [PMID: 36016536 PMCID: PMC9397530 DOI: 10.2147/jpr.s371513] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Frozen shoulder (FS) is a painful condition characterized by progressive loss of shoulder function with passive and active range of motion reduction. To date, there is still no consensus regarding its rehabilitative treatment for pain management. Purpose The aim of this umbrella review of systematic reviews was to analyze the literature, investigating the effects of non-surgical and rehabilitative interventions in patients suffering from FS. Patients and Methods A review of the scientific literature was carried out from 2010 until April 2020 using the following search databases: PubMed, Medline, PEDro, Scopus and Cochrane Library of Systematic Reviews. A combination of terms was used for the search: frozen shoulder OR adhesive capsulitis AND systematic review OR meta-analysis AND rehabilitation NOT surgery NOT surgical intervention. We included systematic reviews that specifically dealt with adults with FS, treated with non-surgical approaches. All the systematic reviews and meta-analyses included in the study that met the inclusion criteria were assessed using the Assessment of Multiple Systematic Reviews as a quality assessment tool. Results Out of 49 studies, only 14 systematic reviews respected the eligibility criteria and were included in this study. Their results showed an important heterogeneity of the studies and all of them agree on the lack of high-quality scientific work to prove unequivocally which rehabilitative treatment is better than the other. Due to this lack of gold standard criteria, there may be also a heterogeneity in the diagnosis of the reviews analyzed. Conclusion Non-surgical and rehabilitative interventions are undoubtedly effective in treating FS, but there is no evidence that one approach is more effective than the other regarding the methods reported. Future high-quality RCTs are needed to standardize the treatment modalities of each physiotherapy intervention to provide strong recommendations in favor.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Marco Ruggiero
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Stefano Dinatale
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Alessandro Chiappetta
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Teresa Paolucci
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
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Mokhtari N, Bazinet A, Pinar U, Ruggiero M, Robain G, Chartier-Kastler E. Neurogenic stress urinary incontinence management. From past to recent techniques: What have we learnt? Prog Urol 2022; 32:809-812. [PMID: 35840454 DOI: 10.1016/j.purol.2022.06.004] [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: 03/23/2022] [Revised: 05/10/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Urinary prostheses for the treatment of male stress urinary incontinence ranged from simple to adjustable bulbourethral compressing devices to complex artificial urinary sphincter. Those devices have remarkably evolved since the 1950s. In this article, we review the story of a patient who experienced this device evolution. His history provides us with the opportunity to retrieve the historical transformation of the incontinence prostheses around time. Moreover, this patient story challenges us on those devices past and present limitations.
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Affiliation(s)
- N Mokhtari
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
| | - A Bazinet
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France; Department of Urology, University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Canada.
| | - U Pinar
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
| | - M Ruggiero
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
| | - G Robain
- Médecine physique et réadaptation, Sorbonne université, hôpital Rotschild, Paris, France
| | - E Chartier-Kastler
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
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Baloche P, Szabla N, Freton L, Hutin M, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayotopoulos P, Betari R, Matillon X, Chebbi A, Caes T, Patard P, Brichart N, Dariane C, Lebacle C, Gondran-Tellier B, Pradere B, Peyronnet B. Y a-t-il un effet centre dans la prise en charge des traumatismes du rein ? Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.055] [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: 11/30/2022]
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8
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Guillot-Tantay C, Chartier-Kastler E, Ruggiero M, Cancrini F, Vaessen C, Phé V. Résultats fonctionnels de l’implantation laparoscopique robot-assistée du sphincter urinaire artificiel dans le traitement de l’incontinence urinaire d’effort masculine d’origine neurologique. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.233] [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: 11/30/2022]
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9
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Toscano M, Viganò A, Jannini TB, Ruggiero M, Comanducci A, Di Piero V. Intensity-Dependence of Auditory Evoked Potentials (IDAP) as a Neurophysiological Parameter to Predict Anti-Aggressive Responsiveness to SSRI Treatment. Front Pharmacol 2021; 12:716338. [PMID: 34456730 PMCID: PMC8397375 DOI: 10.3389/fphar.2021.716338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/31/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Massimiliano Toscano
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | | | - Tommaso B Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marco Ruggiero
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | | | - Vittorio Di Piero
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
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Pinar U, Clerget A, Perrot O, Beaud N, Akakpo W, Ruggiero M, Parra J, Vaessen C, Guillot-Tantay C, Conort P, Campedel L, Girault J, Simon J, Maingon P, Renard-Penna R, Mozer P, Chartier-Kastler E, Roupret M, Seisen T. Assessment of physicians’ satisfaction with a virtual tumour board in a French academic centre during the COVID-19 pandemic. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01362-2] [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: 10/20/2022]
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Guillot-Tantay C, Chartier-Kastler E, Ruggiero M, Cancrini F, Vaessen C, Phé V. Functional outcomes of robot-assisted laparoscopic artificial urinary sphincter implantation for the treatment of adult male neurogenic stress urinary incontinence. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
ABSTRACT In 2020 the World Health Organization declared the Covid-19 to be a pandemic. Governments around the world are facing a tough challenge that could jeopardise the national healthcare systems. Safeguarding the rights of Covid patients and all citizens - especially those who are now even more vulnerable than they were before - is part of this challenge. This work aims to examine the issues arising from the current emergency in terms of how individuals' constitutional rights have been balanced and how much people at the highest risk amid this pandemic - the homeless, the inmates in prison, geriatric and psychiatric patients, and doctors on the Covid frontline - have been protected. This analysis focuses mostly on one of the worst-hit countries by the SARS-CoV-2: Italy.
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Affiliation(s)
- A Cioffi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome
| | | | - R Rinaldi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome
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Alexandre AM, Valente I, Consoli A, Piano M, Renieri L, Gabrieli JD, Russo R, Caragliano AA, Ruggiero M, Saletti A, Lazzarotti GA, Pileggi M, Limbucci N, Cosottini M, Cervo A, Viaro F, Vinci SL, Commodaro C, Pilato F, Pedicelli A. Posterior Circulation Endovascular Thrombectomy for Large-Vessel Occlusion: Predictors of Favorable Clinical Outcome and Analysis of First-Pass Effect. AJNR Am J Neuroradiol 2021; 42:896-903. [PMID: 33664106 DOI: 10.3174/ajnr.a7023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/19/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Successful vessel recanalization in posterior circulation large-vessel occlusion is considered crucial, though the evidence of clinical usefulness, compared with the anterior circulation, is not still determined. The aim of this study was to evaluate predictors of favorable clinical outcome and to analyze the effect of first-pass thrombectomy. MATERIALS AND METHODS A retrospective, multicenter, observational study was conducted in 10 high-volume stroke centers in Europe, including the period from January 2016 to July 2019. Only patients with an acute basilar artery occlusion or a single, dominant vertebral artery occlusion ("functional" basilar artery occlusion) who had a 3-month mRS were included. Clinical, procedural, and radiologic data were evaluated, and the association between these parameters and both the functional outcome and the first-pass effect was assessed. RESULTS A total of 191 patients were included. A lower baseline NIHSS score (adjusted OR, 0.77; 95% CI, 0.61-0.96; P = .025) and higher baseline MR imaging posterior circulation ASPECTS (adjusted OR, 3.01; 95% CI, 1.03-8.76; P = .043) were predictors of better outcomes. The use of large-bore catheters (adjusted OR, 2.25; 95% CI, 1.08-4.67; P = .030) was a positive predictor of successful reperfusion at first-pass, while the use of a combined technique was a negative predictor (adjusted OR, 0.26; 95% CI, 0.09-0.76; P = .014). CONCLUSIONS The analysis of our retrospective series demonstrates that a lower baseline NIHSS score and a higher MR imaging posterior circulation ASPECTS were predictors of good clinical outcome. The use of large-bore catheters was a positive predictor of first-pass modified TICI 2b/3; the use of a combined technique was a negative predictor.
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Affiliation(s)
- A M Alexandre
- From the Unità Operativa Complessa Radiologia e Neuroradiologia (A.M.A., I.V., A.P.), Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia. Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico, Roma, Italia
| | - I Valente
- From the Unità Operativa Complessa Radiologia e Neuroradiologia (A.M.A., I.V., A.P.), Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia. Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico, Roma, Italia
| | - A Consoli
- Diagnostic and Interventional Neuroradiology (A.Consoli, R.R.), Foch Hospital, Suresnes, France
| | - M Piano
- Neuroradiologia (M.Piano, A.Cervo), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - L Renieri
- UOC Interventistica Neurovascolare (L.R., N.L.), Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - J D Gabrieli
- Neuroradiology Unit (J.D.G.), Policlinico Universitario di Padova, Padua, Italy
| | - R Russo
- Diagnostic and Interventional Neuroradiology (A.Consoli, R.R.), Foch Hospital, Suresnes, France
| | - A A Caragliano
- Neuroradiology Unit, Biomedical Sciences and Morphologic and Functional Images (A.A.C., S.L.V.), Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - M Ruggiero
- Neuroradiology Unit (M.R., C.C.), Azienda Unità Sanitaria Locale Romagna, Cesena, Italy
| | - A Saletti
- Interventional Neuroradiology (A.S.), S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - G A Lazzarotti
- Department of Neuroradiology (G.A.L., M.C.), Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - M Pileggi
- Department of Neuroradiology (M.Pileggi), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - N Limbucci
- UOC Interventistica Neurovascolare (L.R., N.L.), Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - M Cosottini
- Department of Neuroradiology (G.A.L., M.C.), Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Cervo
- Neuroradiologia (M.Piano, A.Cervo), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - F Viaro
- UOC Neurologia (F.V.), Policlinico Universitario di Padova, Padua, Italy
| | - S L Vinci
- Neuroradiology Unit, Biomedical Sciences and Morphologic and Functional Images (A.A.C., S.L.V.), Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - C Commodaro
- Neuroradiology Unit (M.R., C.C.), Azienda Unità Sanitaria Locale Romagna, Cesena, Italy
| | - F Pilato
- UOC Neurologia (F.P.), Fondazione Policlinico Universitario A. Gemelli, Istituto Di Ricovero e Cura a Carattere Scientifico, Roma, Italy
| | - A Pedicelli
- From the Unità Operativa Complessa Radiologia e Neuroradiologia (A.M.A., I.V., A.P.), Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia. Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico, Roma, Italia
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Bai AV, Agostini F, Bernetti A, Mangone M, Fidenzi G, D'Urzo R, Ruggiero M, Murgia M, Santilli V, Paoloni M, Ruoppolo G, Masiero S. State of the evidence about rehabilitation interventions in patients with dysphagia. Eur J Phys Rehabil Med 2021; 57:900-911. [PMID: 33541045 DOI: 10.23736/s1973-9087.21.06716-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Rather than a separate nosological entity, dysphagia must be considered as a symptom of other pathological conditions, which afflicts patients admitted to numerous medical departments (rehabilitation, neurology, geriatrics, internal medicine, etc.) These disorders share the need for timely access to quality care and multidisciplinary treatment, including rehabilitation. The purpose of this study was to conduct a review of the current guidelines' recommendations in the literature and provide recommendations on the rehabilitative management of the patient with dysphagia. EVIDENCE ACQUISITION The search was carried out through the main databases (Medline, PEDro, Cochrane Database and Google Scholar). All the articles concerning rehabilitation management of dysphagia, published in the last 10 years, have been included. EVIDENCE SYNTHESIS Bibliographic research has provided thirteen guidelines. The literature analysed focuses mainly on the screening, the evaluation and the planning of multidisciplinary treatment. The literature agrees in recommending as cornerstones in the treatment of the dysphagic patient dietary changes, rehabilitation training (particularly muscle strengthening exercises and coordination) and early use of alternative nutrition in patients severely compromised. CONCLUSIONS The dysphagic patient requires the deployment of a range of skills by a multiprofessional and multi-disciplinary team. Speech and language pathologists in cooperation with specialists of rehabilitation have the task of managing the various stages, ranging from the early identification of the symptom to the setting of the treatment plan. Due to the lack of standardized protocols, it is necessary to implement the research path, especially regarding rehabilitation intervention.
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Affiliation(s)
- Arianna V Bai
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy -
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Gabriele Fidenzi
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Rossella D'Urzo
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Marco Ruggiero
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Murgia
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Valter Santilli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Giovanni Ruoppolo
- Department of Sensorial Organs, Sapienza University of Rome, Rome, Italy
| | - Stefano Masiero
- Department of Neuroscience, University of Padua, Padua, Italy
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Toscano M, Ricci M, Celletti C, Paoloni M, Ruggiero M, Viganò A, Jannini TB, Altarocca A, Liberatore M, Camerota F, Di Piero V. Motor Recovery After Stroke: From a Vespa Scooter Ride Over the Roman Sampietrini to Focal Muscle Vibration (fMV) Treatment. A 99mTc-HMPAO SPECT and Neurophysiological Case Study. Front Neurol 2020; 11:567833. [PMID: 33281704 PMCID: PMC7705992 DOI: 10.3389/fneur.2020.567833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/19/2020] [Indexed: 01/19/2023] Open
Abstract
Focal repetitive muscle vibration (fMV) is a safe and well-tolerated non-invasive brain and peripheral stimulation (NIBS) technique, easy to perform at the bedside, and able to promote the post-stroke motor recovery through conditioning the stroke-related dysfunctional structures and pathways. Here we describe the concurrent cortical and spinal plasticity induced by fMV in a chronic stroke survivor, as assessed with 99mTc-HMPAO SPECT, peripheral nerve stimulation, and gait analysis. A 72-years-old patient was referred to our stroke clinic for a right leg hemiparesis and spasticity resulting from a previous (4 years before) hemorrhagic stroke. He reported a subjective improvement of his right leg's spasticity and dysesthesia that occurred after a30-min ride on a Vespa scooter as a passenger over the Roman Sampietrini (i.e., cubic-shaped cobblestones). Taking into account both the patient's anecdote and the current guidelines that recommend fMV for the treatment of post-stroke spasticity, we then decided to start fMV treatment. 12 fMV sessions (frequency 100 Hz; amplitude range 0.2–0.5 mm, three 10-min daily sessions per week for 4 consecutive weeks) were applied over the quadriceps femoris, triceps surae, and hamstring muscles through a specific commercial device (Cro®System, NEMOCOsrl). A standardized clinical and instrumental evaluation was performed before (T0) the first fMV session and after (T1) the last one. After fMV treatment, we observed a clinically relevant motor and functional improvement, as assessed by comparing the post-treatment changes in the score of the Fugl-Meyer assessment, the Motricity Index score, the gait analysis, and the Ashworth modified scale, with the respective minimal detectable change at the 95% confidence level (MDC95). Data from SPECT and peripheral nerve stimulation supported the evidence of a concurrent brain and spinal plasticity promoted by fMV treatment trough activity-dependent changes in cortical perfusion and motoneuron excitability, respectively. In conclusion, the substrate of post-stroke motor recovery induced by fMV involves a concurrently acting multisite plasticity (i.e., cortical and spinal plasticity). In our patient, operant conditioning of both cortical perfusion and motoneuron excitability throughout a month of fMV treatment was related to a clinically relevant improvement in his strength, step symmetry (with reduced limping), and spasticity.
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Affiliation(s)
- Massimiliano Toscano
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Maria Ricci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Claudia Celletti
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, "Sapienza" University of Rome, Rome, Italy
| | - Marco Ruggiero
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | | | - Tommaso B Jannini
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Altarocca
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | - Mauro Liberatore
- Department of Radiological, oncological and pathological Sciences - Radiometabolic Division, Umberto I Hospital, Rome, Italy
| | - Filippo Camerota
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
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16
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Taylor J, Ruggiero M, Maity A, Ko K, Greenberger B, Donofree D, Sherif K, Lazar M, Jaslow R, Richard S, Mitchell E, Anne P, Trabulsi E, Leader A, Simone N. Sexual Health Toxicity in Cancer Survivors: Is There a Gender Disparity in Physician Evaluation and Intervention? Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Cappellari M, Saia V, Pracucci G, Sallustio F, Gandini R, Nappini S, Nencini P, Vallone S, Zini A, Bigliardi G, Granata F, Grillo F, Cioni S, Tassi R, Bergui M, Cerrato P, Saletti A, De Vito A, Gasparotti R, Magoni M, Taglialatela F, Ruggiero M, Longoni M, Castellan L, Malfatto L, Menozzi R, Castellini P, Cosottini M, Mancuso M, Comai A, Franchini E, Lozupone E, Della Marca G, Ciceri EFM, Bonetti B, Zampieri P, Inzitari D, Mangiafico S, Toni D. Functional and radiological outcomes after bridging therapy versus direct thrombectomy in stroke patients with unknown onset: Bridging therapy versus direct thrombectomy in unknown onset stroke patients with 10-point ASPECTS. Eur J Neurol 2020; 28:209-219. [PMID: 32924246 DOI: 10.1111/ene.14529] [Citation(s) in RCA: 5] [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: 08/07/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to assess functional and radiological outcomes after bridging therapy (intravenous thrombolysis plus mechanical thrombectomy) versus direct mechanical thrombectomy (MT) in unknown onset stroke patients. METHODS A cohort study was conducted on prospectively collected data from unknown onset stroke patients who received endovascular procedures at ≤6 h from symptom recognition or awakening time. RESULTS Of the 349 patients with a 10-point Alberta Stroke Program Early Computed Tomography Score (ASPECTS), 248 received bridging and 101 received direct MT. Of the 134 patients with 6-9-point ASPECTS, 123 received bridging and 111 received direct MT. Each patient treated with bridging was propensity score matched with a patient treated with direct MT for age, sex, study period, pre-stroke disability, stroke severity, type of stroke onset, symptom recognition to groin time (or awakening to groin time), ASPECTS and procedure time. In the two matched groups with 10-point ASPECTS (n = 73 vs. n = 73), bridging was associated with higher rates of excellent outcome (46.6% vs. 28.8%; odds ratio 2.302, 95% confidence interval 1.010-5.244) and successful recanalization (83.6% vs. 63%; odds ratio 3.028, 95% confidence interval 1.369-6.693) compared with direct MT; no significant association was found between bridging and direct MT with regard to rate of symptomatic intracerebral hemorrhage (0% vs. 1.4%). In the two matched groups with 6-9-point ASPECTS (n = 45 vs. n = 45), no significant associations were found between bridging and direct MT with regard to rates of excellent functional outcome (44.4% vs. 31.1%), successful recanalization (73.3% vs. 76.5%) and symptomatic intracerebral hemorrhage (0% vs. 0%). CONCLUSIONS Bridging at ≤ 6 h of symptom recognition or awakening time was associated with better functional and radiological outcomes in unknown onset stroke patients with 10-point ASPECTS.
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Affiliation(s)
- M Cappellari
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - V Saia
- Santa Corona Hospital, Pietra Ligure, Italy
| | | | | | - R Gandini
- Policlinico Tor Vergata, Roma, Italy
| | - S Nappini
- Careggi University Hospital, Firenze, Italy
| | - P Nencini
- Careggi University Hospital, Firenze, Italy
| | - S Vallone
- Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy
| | - A Zini
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - G Bigliardi
- Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy
| | - F Granata
- Policlinico G. Martino, Messina, Italy
| | - F Grillo
- Policlinico G. Martino, Messina, Italy
| | - S Cioni
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - R Tassi
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - M Bergui
- Città della Salute e della Scienza-Molinette, Torino, Italy
| | - P Cerrato
- Città della Salute e della Scienza-Molinette, Torino, Italy
| | - A Saletti
- Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - A De Vito
- Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | | | | | - F Taglialatela
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | | | | | | | - R Menozzi
- Ospedale Universitario, Parma, Italy
| | | | | | | | - A Comai
- Ospedale Provinciale, Bolzano, Italy
| | | | | | | | - E F M Ciceri
- Fondazione IRCSS-Istituto Neurologico Carlo Besta, Milano, Italy
| | - B Bonetti
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - P Zampieri
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - D Toni
- Sapienza University Hospital, Roma, Italy
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18
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Da Ros V, Scaggiante J, Sallustio F, Lattanzi S, Bandettini M, Sgreccia A, Rolla-Bigliani C, Lafe E, Sanfilippo G, Diomedi M, Ruggiero M, Haznedari N, Giannoni M, Finocchi C, Floris R. Carotid Stenting and Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Tandem Occlusions: Antithrombotic Treatment and Functional Outcome. AJNR Am J Neuroradiol 2020; 41:2088-2093. [PMID: 32972953 DOI: 10.3174/ajnr.a6768] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is no consensus on the optimal antithrombotic medication for patients with acute ischemic stroke with anterior circulation tandem occlusions treated with emergent carotid stent placement and mechanical thrombectomy. The identification of factors influencing hemorrhagic risks can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to investigate the impact of medical therapy on functional and safety outcomes in patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions. MATERIALS AND METHODS A multicenter retrospective study on prospectively collected data was conducted. Only patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions of the anterior circulation were included. Univariate and multivariate analyses were performed on preprocedural, procedural, and postprocedural variables to assess factors influencing clinical outcome, symptomatic intracranial hemorrhage, stent patency, and successful intracranial vessel recanalization. RESULTS Ninety-five patients with acute ischemic stroke and tandem occlusions were included. Good clinical outcome (mRS ≤ 2) at 3 months was reached by 33 (39.3%) patients and was associated with baseline ASPECTS ≥ 8 (OR = 1.53; 95% CI, 1.16-2.00), ≤2 mechanical thrombectomy attempts (OR = 0.71; 95% CI, 0.55-0.99), and the absence of symptomatic intracranial hemorrhage (OR = 0.13; 95% CI , 0.03-0.51). Symptomatic intracranial hemorrhage was associated with a higher amount of intraprocedural heparin, ASPECTS ≤ 7, and ≥3 mechanical thrombectomy attempts. No relationships among types of acute antiplatelet regimen, intravenous thrombolysis, and symptomatic intracranial hemorrhage were observed. Patients receiving dual-antiplatelet therapy after hemorrhagic transformation had been ruled out on 24-hour CT were more likely to achieve functional independence and had a lower risk of symptomatic intracranial hemorrhage. CONCLUSIONS During carotid stent placement and mechanical thrombectomy for tandem occlusion treatment, higher intraprocedural heparin dosage (≥3000 IU) increased symptomatic intracranial hemorrhage risk when the initial ASPECTS was ≤7, and mechanical thrombectomy needs more than one passage for complete recanalization. Antiplatelets antiplatelets use were safe, and dual-antiaggregation therapy was related to better functional outcomes.
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Affiliation(s)
- V Da Ros
- From the Department of Biomedicine and Prevention (V.D.R., J.S., R.F.), Interventional Neuroradiology Unit
| | - J Scaggiante
- From the Department of Biomedicine and Prevention (V.D.R., J.S., R.F.), Interventional Neuroradiology Unit
| | - F Sallustio
- Comprehensive Stroke Center (F.S., M.D.), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - S Lattanzi
- Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | | | - A Sgreccia
- Department of Neurosciences and Interventional Neuroradiology Unit (A.S., E.L., G.S.), IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Rolla-Bigliani
- Department of Diagnostic and Interventional Neuroradiology (C.R.-B.), Policlinico Universitario, San Martino, Italy
| | - E Lafe
- Department of Neurosciences and Interventional Neuroradiology Unit (A.S., E.L., G.S.), IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Sanfilippo
- Department of Neurosciences and Interventional Neuroradiology Unit (A.S., E.L., G.S.), IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Diomedi
- Comprehensive Stroke Center (F.S., M.D.), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - M Ruggiero
- Neuroradiology Unit (M.R., N.H.), AUSL Romagna, Cesena, Italy
| | - N Haznedari
- Neuroradiology Unit (M.R., N.H.), AUSL Romagna, Cesena, Italy
| | - M Giannoni
- Neuroradiological Clinic (M.G.), Department of Radiological Sciences, AOU Ospedali Riuniti, Ancona, Italy
| | | | - R Floris
- From the Department of Biomedicine and Prevention (V.D.R., J.S., R.F.), Interventional Neuroradiology Unit
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Lo Torto F, Kaciulyte J, Marcasciano M, Casella D, Bernetti A, Mangone M, Agostini F, Ciudad P, Fioramonti P, Ruggiero M, Ribuffo D, Carlesimo B. Peroneus Brevis flap in Achilles tendon reconstruction. Clinical, radiological and functional analysis. Foot Ankle Surg 2020; 26:218-223. [PMID: 30837207 DOI: 10.1016/j.fas.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/06/2018] [Revised: 02/01/2019] [Accepted: 02/15/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND We would like to describe our experience with Peroneus Brevis flap in complicated Achilles tendon re-ruptures with fringed stumps. METHODS Eight patients with monolateral re-rupture of Achilles tendon were selected as eligible for surgical repair with Peroneus Brevis flap. Patients' outcome was evaluated clinically (ATRS and ROM), functionally (Gait analysis) and MRI was performed before and after surgery. RESULTS Effective coverage of tissue defect was reached in all patients. Functional assessment evaluation results were registered in a follow-up time that ranged from 12 to 18 months. ATRS and ROM tests' results showed good functional recovery without functional limitations or subjective reports pain. Post-operative MRI showed no signs of inflammation or tissue gaps. Gait analysis showed a partial reduction of performance in the affected side that did not affect patients' quality of life. CONCLUSIONS In the presence of fringed stumps in Achilles tendon re-rupture, tendon flaps have the benefits of autologous tissues transfers and present less risks of failure than free flaps. Among them, Peroneus Brevis flap is easy to perform and leads to donor site's low morbidity. Our preliminary experience provides support for this technique to be potentially validated in larger more controlled trial.
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Affiliation(s)
- Federico Lo Torto
- Sapienza Università di Roma, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Juste Kaciulyte
- Sapienza Università di Roma, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic Reconstructive and Aesthetic Surgery, Rome, Italy.
| | - Marco Marcasciano
- Sapienza Università di Roma, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Donato Casella
- Department of Oncologic and Reconstructive Breast Surgery, "Breast Unit Integrata di Livorno, Cecina, Piombino, Elba, Azienda USL Toscana nord ovest", Italy
| | - Andrea Bernetti
- Sapienza Università di Roma, Policlinico Umberto I, Department of Physical Medicine and Rehabilitation, Rome, Italy
| | - Massimiliano Mangone
- Sapienza Università di Roma, Policlinico Umberto I, Department of Physical Medicine and Rehabilitation, Rome, Italy
| | - Francesco Agostini
- Sapienza Università di Roma, Policlinico Umberto I, Department of Physical Medicine and Rehabilitation, Rome, Italy
| | - Pedro Ciudad
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Paolo Fioramonti
- Sapienza Università di Roma, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Marco Ruggiero
- Policlinico Luigi Di Liegro, Via dei Badoer, Rome, Italy
| | - Diego Ribuffo
- Sapienza Università di Roma, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Bruno Carlesimo
- Department of Plastic Surgery, Clinica Mater Dei, Rome, Italy
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Freton L, Pradere B, Fiard G, Chebbi A, Caes T, Hutin M, Olivier J, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayatopoulos P, Betari R, Patard PM, Szabla N, Brichart N, Sabourin L, Guleryuz K, Dariane C, Lebacle C, Rizk J, Gryn A, Madec FX, Rod X, Nouhaud FX, Matillon X, Peyronnet B. [Renal Trauma]. Prog Urol 2019; 29:936-942. [PMID: 31668829 DOI: 10.1016/j.purol.2019.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Renal traumas are common, observed in 10% of patients with abdominal trauma. Most renal traumas are blunt, resulting from a direct hit or from an abrupt deceleration. MATERIAL AND METHODS We realized a synthesis of renal trauma management for nurses. RESULTS Clinical presentation often encompasses gross hematuria and lumbar pain. The best diagnostic tool is computed tomography (CT) urogram. Based on CT urogram images, renal traumas are classified according to the American Association for the Surgery of Trauma (AAST) classification in five grades of increasing severity. The management is conservative in the vast majority of cases and has been largely simplified over the past few years, being now mostly based on observation. Radiological interventional and endoscopic procedures are used only in very selected cases and surgical exploration has become extremely rare. CONCLUSION The prognosis has also considerably improved and renal trauma rarely result in death or loss of the kidney nowadays.
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Affiliation(s)
- L Freton
- Service d'urologie, université de Rennes, 35000 Rennes, France.
| | - B Pradere
- Service d'urologie, PRES Centre Val-de-Loire, CHRU de Tours et université François-Rabelais de Tours, 37000 Tours, France
| | - G Fiard
- Service d'urologie, université de Grenoble, 38700 Grenoble, France
| | - A Chebbi
- Service d'urologie, université de Rouen, 76000 Rouen, France
| | - T Caes
- Service d'urologie, université de Lille, 59000 Lille, France
| | - M Hutin
- Service d'urologie, université de Montpellier, 34000 Montpellier, France
| | - J Olivier
- Service d'urologie, université de Lille, 59000 Lille, France
| | - M Ruggiero
- Service d'urologie, université de Paris Sud, CHU de Bicêtre, 94270 Paris, France
| | - I Dominique
- Service d'urologie, université de Lyon, 69002 Lyon, France
| | - C Millet
- Service d'urologie, université de Clermont-Ferrand, 63100 Clermont-Ferrand, France
| | - S Bergerat
- Service d'urologie, université de Strasbourg, 67000 Strasbourg, France
| | | | - R Betari
- Service d'urologie, université de Brest, 29200 Brest, France
| | - P-M Patard
- Service d'urologie, université de Toulouse, 31300 Toulouse, France
| | - N Szabla
- Service d'urologie, université de Caen, 14033 Caen, France
| | - N Brichart
- Service d'urologie, CHR d'Orléans, 45100 Orléans, France
| | - L Sabourin
- Service d'urologie, université de Clermont-Ferrand, 63100 Clermont-Ferrand, France
| | - K Guleryuz
- Service d'urologie, université de Caen, 14033 Caen, France
| | - C Dariane
- Service d'urologie, université de Paris-Descartes, 75006 Paris, France
| | - C Lebacle
- Service d'urologie, université de Paris Sud, CHU de Bicêtre, 94270 Paris, France
| | - J Rizk
- Service d'urologie, université de Lille, 59000 Lille, France
| | - A Gryn
- Service d'urologie, université de Toulouse, 31300 Toulouse, France
| | - F-X Madec
- Service d'urologie, hôpital Saint-Joseph, 75014 Paris, France
| | - X Rod
- Service d'urologie, université de Nantes, 44000 Nantes, France
| | - F-X Nouhaud
- Service d'urologie, université de Rouen, 76000 Rouen, France
| | - X Matillon
- Service d'urologie, université de Lyon, 69002 Lyon, France
| | - B Peyronnet
- Service d'urologie, université de Rennes, 35000 Rennes, France
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Toscano M, Celletti C, Viganò A, Altarocca A, Giuliani G, Jannini TB, Mastria G, Ruggiero M, Maestrini I, Vicenzini E, Altieri M, Camerota F, Di Piero V. Short-Term Effects of Focal Muscle Vibration on Motor Recovery After Acute Stroke: A Pilot Randomized Sham-Controlled Study. Front Neurol 2019; 10:115. [PMID: 30873102 PMCID: PMC6401608 DOI: 10.3389/fneur.2019.00115] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/29/2019] [Indexed: 12/01/2022] Open
Abstract
Repetitive focal muscle vibration (rMV) is known to promote neural plasticity and long-lasting motor recovery in chronic stroke patients. Those structural and functional changes within the motor network underlying motor recovery occur in the very first hours after stroke. Nonetheless, to our knowledge, no rMV-based studies have been carried out in acute stroke patients so far, and the clinical benefit of rMV in this phase of stroke is yet to be determined. The aim of this randomized double-blind sham-controlled study is to investigate the short-term effect of rMV on motor recovery in acute stroke patients. Out of 22 acute stroke patients, 10 were treated with the rMV (vibration group-VG), while 12 underwent the sham treatment (control group-CG). Both treatments were carried out for 3 consecutive days, starting within 72 h of stroke onset; each daily session consisted of three 10-min treatments (for each treated limb), interspersed with a 1-min interval. rMV was delivered using a specific device (Cro®System, NEMOCO srl, Italy). The transducer was applied perpendicular to the target muscle's belly, near its distal tendon insertion, generating a 0.2-0.5 mm peak-to-peak sinusoidal displacement at a frequency of 100 Hz. All participants also underwent a daily standard rehabilitation program. The study protocol underwent local ethics committee approval (ClinicalTrial.gov NCT03697525) and written informed consent was obtained from all of the participants. With regard to the different pre-treatment clinical statuses, VG patients showed significant clinical improvement with respect to CG-treated patients among the NIHSS (p < 0.001), Fugl-Meyer (p = 0.001), and Motricity Index (p < 0.001) scores. In addition, when the upper and lower limb scales scores were compared between the two groups, VG patients were found to have a better clinical improvement at all the clinical end points. This study provides the first evidence that rMV is able to improve the motor outcome in a cohort of acute stroke patients, regardless of the pretreatment clinical status. Being a safe and well-tolerated intervention, which is easy to perform at the bedside, rMV may represent a valid complementary non-pharmacological therapy to promote motor recovery in acute stroke patients.
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Affiliation(s)
- Massimiliano Toscano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Neurology, Fatebenefratelli Hospital, Rome, Italy
| | - Claudia Celletti
- Physical Medicine and Rehabilitation Division, Umberto I University Hospital, Rome, Italy
| | - Alessandro Viganò
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Alberto Altarocca
- Physical Medicine and Rehabilitation Division, Umberto I University Hospital, Rome, Italy
| | - Giada Giuliani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Tommaso B. Jannini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giulio Mastria
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Ruggiero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Ilaria Maestrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Edoardo Vicenzini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marta Altieri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Filippo Camerota
- Physical Medicine and Rehabilitation Division, Umberto I University Hospital, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Branca JJV, Pacini S, Morucci G, Bocchi L, Cosentino A, Boni E, Ruggiero M. Effects of ultrasound and selenium on human neurons in vitro. Arch Ital Biol 2018; 156:153-163. [PMID: 30796759 DOI: 10.12871/00039829201842] [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: 11/03/2022]
Abstract
As the effects of ultrasound on human brain functions might bear therapeutic potential, in this study, we examined the effects of diagnostic, i.e. non-thermal, ultrasound, on morphology, networking, and metabolic activity of SH- SY5Y human neurons in culture, as well as on the expression of GAP-43, Hsp90 and VEGF proteins, with and without selenium in the culture medium. The rationale for studying selenium lays in the observation that selenium improves functional neurologic outcome in traumatic brain injury and, therefore, analysis of the interactions between ultrasound and selenium may be of clinical interest. In the presence of selenium, ultrasound increased the overall number and length of elongations arising from the neuron bodies, thus reflecting an increase in the complexity of neuronal networks and circuits. The expression of GAP-43, Hsp90 and VEGF and metabolic activity of SH-SY5Y neurons, studied as markers of cell damage, were not affected by ultrasound or selenium. This study suggests that ultrasound may modulate neuronal networking in vitro without inducing cellular or molecular damage and highlights the potential role of selenium in the ultrasound-elicited cellular responses.
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Affiliation(s)
| | - S Pacini
- Department of Experimental and Clinical Medicine,University of Firenze,Largo Brambilla 3, 50134 Firenze, Italy -
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Toscano M, Viganò A, Rea A, Verzina A, Sasso D'Elia T, Puledda F, Longo L, Mancini V, Ruggiero M, Jannini TB, Giuliani G, Albino F, Altieri M, Vicenzini E, Fattapposta F, Pauri F, Giacomini P, Ruoppolo G, Di Piero V. Sapienza Global Bedside Evaluation of Swallowing after Stroke: the GLOBE-3S study. Eur J Neurol 2018; 26:596-602. [PMID: 30414300 DOI: 10.1111/ene.13862] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Dysphagia occurs in up to 50% of all patients with acute stroke. There is debate regarding which is the most effective screening tool in identifying aspiration in patients with acute stroke. We assessed the accuracy of the Sapienza Global Bedside Evaluation of Swallowing after Stroke (GLOBE-3S), which combines the Toronto Bedside Swallowing Screening Test (TOR-BSST©) with oxygen desaturation and laryngeal elevation measurement during swallowing. METHODS We prospectively enrolled consecutive patients with stroke within 72 h of symptom onset. All patients with stroke firstly underwent a standard neurological examination, then the GLOBE-3S evaluation and finally the fiberoptic endoscopic evaluation of swallowing (FEES). Two different assessors, a neurologist and a speech pathologist, blind to both the clinical data and each other's evaluation, administered the GLOBE-3S and FEES examination. We assessed the accuracy of the GLOBE-3S in detecting post-stroke swallow impairment with aspiration using the FEES as the standard. RESULTS We enrolled 50 patients with acute stroke, 28 of whom (56%) had swallowing impairment with aspiration at FEES evaluation. A total of 33 patients (66%) failed the GLOBE-3S evaluation. The GLOBE-3S reached a sensitivity of 100% and a specificity of 77.3% (negative predictive value, 100%; positive likelihood ratio, 4.34). The median time required for the GLOBE-3S to be performed was 297 s. CONCLUSIONS GLOBE-3S is quick to perform at the bedside and can accurately identify aspiration in patients with acute stroke. By including the measurement of laryngeal elevation and monitoring of oxygen desaturation, it could represent a highly sensitive instrument to avoid the misdiagnosis of silent aspirators.
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Affiliation(s)
- M Toscano
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - A Viganò
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy.,Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, 'Sapienza' University of Rome, Rome, Italy
| | - A Rea
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - A Verzina
- Neurology Clinic, University of Perugia - Perugia General Hospital, Perugia, Italy
| | - T Sasso D'Elia
- Physical Medicine and Rehabilitation Division, 'Sapienza' University of Rome, Rome, Italy
| | - F Puledda
- Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, UK
| | - L Longo
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - V Mancini
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - M Ruggiero
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - T B Jannini
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - G Giuliani
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - F Albino
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - M Altieri
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - E Vicenzini
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - F Fattapposta
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - F Pauri
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - P Giacomini
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - G Ruoppolo
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - V Di Piero
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
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Freton L, Scailteux L, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayotopoulos P, Lebacle C, Rizk J, Matillon X, Gryn A, Madec F, Nouhaud F, Rod X, Hutin M, Fiard G, Pradere B, Peyronnet B. Traumatisme rénal de bas grade et durée de séjour : vers une prise en charge ambulatoire ? Résultats de l’étude multicentrique traumAFUf avec analyse par score de propension. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Novel aspects of cytokine receptor signal transduction are discussed and cytokine receptors classified based on ligand-dependent signalling. An introductory section presents an overview of the role of cytokines in hematopoiesis. A brief explanation of basic concepts, such as redundancy, pleiotropy, synergism, etc., important for the understanding of cell response to cytokines, is also included. Three of five classes of receptors show the involvement of tyrosine kinase activity as the key step in signal transduction. The importance of tyrosine phosphorylation in cellular response to cytokines is pointed out.
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Affiliation(s)
- V Chiarugi
- Laboratory of Molecular Biology, University of Florence
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Pacini S, Milano F, Pinzani P, Pazzagli M, Gulisano M, Ruggiero M, Casamassima F. Effects of Gemcitabine in Normaland Transformed Human Lung Cell Cultures: Cytotoxicity and Increase in Radiation Sensitivity. Tumori 2018; 85:503-7. [PMID: 10774574 DOI: 10.1177/030089169908500615] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background Several anticancer drugs increase cell sensitivity to irradiation. Gemcitabine (2′, 2′ difluorodeoxycytidine) decreases the cellular dNTP pools and thus significantly increases the sensitivity to the DNA damaging effects of low-dose radiation. In this study we have investigated whether gemcitabine may play a role as radiosensitizer also in lung adenocarcinoma treatment. Methods & Study Design We studied this nucleoside analogue in normal and transformed human cell lines (fetal lung and lung adenocarcinoma). After drug treatment, cell lines were irradiated with different doses. Cell damage following drug treatment and/or irradiation was assessed by measuring intracellular ATP level and by the colony forming assay. Results The two cell lines significantly differed in their sensitivity to the toxic effects of the drug; the normal cell line was much more resistant than its transformed counterpart. This difference was observed in both assays, although it was more evident in the colony forming assay. A low radiation dose (50-100 cGy) did not cause any significant damage to transformed cells; normal cells were more resistant and doses up to 500 cGy caused little damage. However, when transformed cells were pretreated for three hours with gemcitabine, even a nontoxic concentration of the drug (1-10 nM) caused a marked sensitization of the cells to irradiation (50-100 cGy). The radiosensitizing effect of gemcitabine could be observed also in normal cells, although these cells were more resistant to the damaging effects of both anticancer treatments. Conclusions This study demonstrates that gemcitabine, a chemotherapeutic agent already used in the clinic, could be proposed as a radiosensitizer for radiation therapy of lung adenocarcinoma, having a clearly potentiating effect on low-dose radiation.
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Affiliation(s)
- S Pacini
- Department of Anatomy, Histology and Forensic Medicine, University of Florence, Policlinico di Careggi, Italy.
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Chiarugi VP, Fibbi G, Del Rosso M, Ruggiero M, Pasquali F, Viti M, Vannucchi S. Cooperative Effect of Exogenous Heparin-Like Compounds and Secreted Glucocorticoid-Induced Inhibitor on Plasminogen Activator in 3T3 Cell Cultures. Tumori 2018; 70:301-6. [PMID: 6433523 DOI: 10.1177/030089168407000401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Balb/c 3T3 cultures grown in the absence of serum release both plasminogen activator and plasminogen activator inhibitor in the culture medium. Cellular transformation with SV-40 virus increased the level of the activator, whereas dexamethasone increased the level of the inhibitor. Heparin added to the medium potentiated the glucocorticoid-induced inhibitory activity, strongly decreasing or completely abolishing the activity of plasminogen activator. Heparin sulfate showed similar effects to heparin, although at higher concentrations. It is suggested that heparin-like compounds are involved in the regulation of plasminogen activator, acting as inhibitory cofactors.
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Caës T, Rizk J, Olivier J, Hutin M, Bergerat S, Betari R, Freton L, Ruggiero M, Panayatopoulos P, Patard P, Dariane C, Fiard G, Peyronnet B, Pradere B, Nouhaud FX, Langouet Q, Dominique I, Matillon X, Chebbi A, Szabla N, Brichart N, Sabourin L, Guleryuz K, Bohem A, Millet C, Rod X, Lebacle C, Gryn A, Madec FX. Facteurs de risque d’échec du traitement conservateur des traumatismes du rein : une étude multicentrique (TRAUMAFUF). Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Patard P, Abbo O, Gryn A, Bergerat S, Matillon X, Betari R, Ruggiero M, Dominique I, Freton L, Rod X, Dariane C, Lebacle C, Pradere B, Fiard G, Peyronnet B, Panayatopoulos P, Olivier J, Langouet Q, Millet C, Hutin M, Chebbi A, Caes T, Szabla N, Brichart N, Sabourin L, Guleryuz K, Rizk J, Madec FX, Nouhaud FX. Comparaison des caractéristiques et de la prise en charge des traumatismes rénaux entre la population adulte et pédiatrique. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.056] [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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Panayotopoulos P, Peyronnet B, Bergerat S, Betari R, Freton L, Olivier J, Ruggiero M, Langouet Q, Dominique I, Matillon X, Chebbi A, Caes T, Patard P, Szabla N, Brichart N. Quelle est la place de la radio-embolisation en urgence dans la prise en charge de patients traumatisés rénaux en instabilité hémodynamique ? Résultats de l’étude multicentrique nationale TRAUMAFUF. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.058] [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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Adriani E, Moio M, Di Paola B, Salustri W, Alfieri A, Parisi P, Ruggiero M, Borab Z, Carlesimo B. Percutaneous Fat Transfer to Treat Knee Osteoarthritis Symptoms: Preliminary Results. Joints 2017; 5:89-92. [PMID: 29114637 PMCID: PMC5672865 DOI: 10.1055/s-0037-1603672] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Indexed: 01/08/2023]
Abstract
Purpose This study aims to evaluate the safety and efficacy of autologous aspirated and purified fat tissue injected percutaneously into the knee joint for the treatment of symptomatic osteoarthritis (OA). Methods We reviewed 30 patients, who received an autologous percutaneous fat injection for the treatment of knee OA, from January 2012 to March 2015. Mean patients' age was 63.3 ± 5.3 years (range, 50-80 years). Body mass index was 25.1 ± 1.7. Clinical evaluation was based on pain visual analog scale (VAS) and WOMAC score for functional and subjective assessment. We also noted the adverse reactions and the consumption of nonsteroidal anti-inflammatory drugs in the posttreatment period. Results All patients reported improvements with respect to pain: average VAS was 7.7 ± 1.2 at baseline, 5.2 ± 0.2 at 1-month follow-up, and 4.3 ± 1 at 3-month follow-up. A slight deterioration (5.0 ± 1.1) was evidenced at 1 year. Total WOMAC score was 89.9 ± 1.7 at baseline, 66.3 ± 1 at 1 month, 68.6 ± 1.7 at 3 months, and 73.2 ± 1.8 at 12 months of follow-up. Conclusion Our preliminary findings suggest that autologous percutaneous fat injections are a valid treatment option for knee OA. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Ezio Adriani
- Department of Orthopedics and Traumatology, Sport Clinique, Rome, Italy
| | - Mariagrazia Moio
- Department of Plastic Surgery, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | | | - Walter Salustri
- Department of Orthopedics and Traumatology, Sport Clinique, Rome, Italy
| | - Andrea Alfieri
- Department of Orthopedics and Traumatology, Sport Clinique, Rome, Italy
| | - Paola Parisi
- Department of Plastic Surgery, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Marco Ruggiero
- Department of Plastic Surgery, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Zack Borab
- Department of Plastic Surgery, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Bruno Carlesimo
- Department of Plastic Surgery, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
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Lo Torto F, Ruggiero M, Parisi P, Borab Z, Sergi M, Carlesimo B. The effectiveness of negative pressure therapy on infected wounds: preliminary results. Int Wound J 2017; 14:909-914. [PMID: 28198150 DOI: 10.1111/iwj.12725] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 01/25/2017] [Indexed: 01/14/2023] Open
Abstract
Vacuum-assisted closure (VAC) therapy is a sophisticated system that maintains a closed, humid, sterile and isolated environment. Wound infection is considered a relative contraindication. The objective of this study is to extend the indications for VAC therapy to include infected wounds by demonstrating its ability to increase the antibiotic concentration in the damaged and infected tissues. Patients who presented with ulcers infected with daptomycin-sensitive bacteria were eligible to be enrolled in this prospective study. They were given antibiotic therapy with daptomycin with a specific protocol. A biopsy of the lesion was carried out to detect tissue concentration of the drug at time 0. Afterwards, the patients were subjected to VAC therapy. At the end of VAC therapy, a second lesion biopsy was performed and analysed to detect tissue concentration of the drug at time 1. A control group was enrolled in which patients followed the same protocol, but they were treated with traditional dressings. Fisher's exact test was used to compare the two groups. The results highlighted a significant increase in the concentration of antibiotics in the study group tissue; the improvement was sensibly lower in the control group. Statistical differences were not found between the two groups. The preliminary analysis of the data showed an important increase of antibiotic concentration in the tissue after VAC therapy. Despite the encouraging data, it is necessary to broaden the sample of patients and perform the same study with other antibiotics.
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Affiliation(s)
- Federico Lo Torto
- 'P. Valdoni' Department of Surgery, U.O. of Plastic Reconstructive Surgery, 'Sapienza' University of Rome, Rome, Italy
| | - Marco Ruggiero
- Policlinico Luigi Di Liegro, Via dei Badoer, Rome, Italy
| | - Paola Parisi
- 'P. Valdoni' Department of Surgery, U.O. of Plastic Reconstructive Surgery, 'Sapienza' University of Rome, Rome, Italy
| | - Zachary Borab
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Manuel Sergi
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - Bruno Carlesimo
- 'P. Valdoni' Department of Surgery, U.O. of Plastic Reconstructive Surgery, 'Sapienza' University of Rome, Rome, Italy
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Freton L, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayatopoulos P, Betari R, Matillon X, Chebbi A, Caes T, Patard P, Szabla N, Brichart N, Sabourin L, Guleryuz K, Dariane C, Lebacle C, Rizk J, Gryn A, Madec F, Nouhaud F, Pradere B, Bensalah K, Fiard G, Peyronnet B. Traumatismes du rein de bas grade : vers une prise en charge en ambulatoire ? Résultats de l’étude multicentrique nationale Traumafuf. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.256] [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: 11/28/2022]
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Pradere B, Freton L, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayotopoulos P, Betari R, Matillon X, Chebbi A, Caes T, Boehm A, Patard P, Szabla N, Brichart N, Sabourin L, Guleryuz K, Lebacle C, Rizk J, Gryn A, Nouhaud F, Madec F, Dariane C, Bensalah K, Fiard G, Peyronnet B. Incidence et facteur prédictifs des pseudo-anévrysmes au cours des traumatismes du rein : résultats de l’étude multicentrique nationale Traumafuf. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Peyronnet B, Bergerat S, Betari R, Freton L, Olivier J, Ruggiero M, Panayatopoulos P, Langouet Q, Dominique I, Matillon X, Chebbi A, Caes T, Patard P, Szabla N, Brichart N, Bohem A, Sabourin L, Guleryuz K, Millet C, Dariane C, Lebacle C, Rizk J, Gryn A, Madec F, Nouhaud F, Pradère B, Bensalah K, Fiard G. Faut-il maintenir les patients en décubitus dorsal après un traumatisme du rein ? Résultats de l’étude multicentrique nationale Traumafuf. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dominique I, Ruffion A, Matillon X, Freton L, Betari R, Dariane C, Millet C, Ruggiero M, Chebbi A, Olivier J, Langouet Q, Bergerat S, Panayotopoulos P, Caes T, Patard P, Szabla N, Brichart N, Sabourin L, Guleryuz K, Lebacle C, Rizk J, Madec F, Nouhaud F, Pradere B, Saint F, Fiard G, Peyronnet B. Complications rénales à long terme des traumatismes rénaux : résultats de l’étude multicentrique nationale Traumafuf. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.260] [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: 11/16/2022]
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Ruggiero M, Reinwald H, Pacini S. Is chondroitin sulfate responsible for the biological effects attributed to the GC protein-derived Macrophage Activating Factor (GcMAF)? Med Hypotheses 2016; 94:126-31. [PMID: 27515218 DOI: 10.1016/j.mehy.2016.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/29/2016] [Accepted: 07/17/2016] [Indexed: 12/15/2022]
Abstract
We hypothesize that a plasma glycosaminoglycan, chondroitin sulfate, may be responsible for the biological and clinical effects attributed to the Gc protein-derived Macrophage Activating Factor (GcMAF), a protein that is extracted from human blood. Thus, Gc protein binds chondroitin sulfate on the cell surface and such an interaction may occur also in blood, colostrum and milk. This interpretation would solve the inconsistencies encountered in explaining the effects of GcMAF in vitro and in vivo. According to our model, the Gc protein or the GcMAF bind to chondroitin sulfate both on the cell surface and in bodily fluids, and the resulting multimolecular complexes, under the form of oligomers trigger a transmembrane signal or, alternatively, are internalized and convey the signal directly to the nucleus thus eliciting the diverse biological effects observed for both GcMAF and chondroitin sulfate.
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Affiliation(s)
- Marco Ruggiero
- dr. reinwald healthcare gmbh + co kg, Friedrich-Luber-Straße 29, D-90592 Schwarzenbruck, Germany
| | - Heinz Reinwald
- dr. reinwald healthcare gmbh + co kg, Friedrich-Luber-Straße 29, D-90592 Schwarzenbruck, Germany
| | - Stefania Pacini
- dr. reinwald healthcare gmbh + co kg, Friedrich-Luber-Straße 29, D-90592 Schwarzenbruck, Germany.
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Bradstreet JJ, Ruggiero M, Pacini S. Commentary: Structural and functional features of central nervous system lymphatic vessels. Front Neurosci 2015; 9:485. [PMID: 26733797 PMCID: PMC4686591 DOI: 10.3389/fnins.2015.00485] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/07/2015] [Indexed: 01/09/2023] Open
Affiliation(s)
- James J Bradstreet
- The Brain Treatment CenterBuford, GA, USA; Faculty for Autism Collaboration & Education, Western University of Health SciencesPomona, CA, USA
| | | | - Stefania Pacini
- Department of Experimental and Clinical Medicine, University of Florence Firenze, Italy
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Peyronnet B, Vaessen C, Grassano Y, Benoit T, Carrouget J, Fardoun T, Masson-lecomte A, Khene Z, Pradère B, Girwec A, Ruggiero M, Beauval J, Nouhaud F, Brichart N, Baumert H, Bigot P, Droupy S, Bruyère F, De la taille A, Doumerc N, Bernhard J, Roupret M, Mejean A, Bensalah K. Comparaison de 1800 néphrectomies partielles ouvertes et robot-assistées pour tumeur rénale unique. Prog Urol 2015; 25:822. [DOI: 10.1016/j.purol.2015.08.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pradère B, Peyronnet B, Ruggiero M, Khene Z, Seisen T, Parra J, Verhoest G, Vaessen C, Rouprêt M, Bensalah K. Étude multicentrique sur l’impact des anticoagulants et antiagrégants sur la morbidité de la néphrectomie partielle robotique. Prog Urol 2015; 25:824. [DOI: 10.1016/j.purol.2015.08.216] [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: 10/22/2022]
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Branca JJV, Pacini S, Ruggiero M. Effects of Pre-surgical Vitamin D Supplementation and Ketogenic Diet in a Patient with Recurrent Breast Cancer. Anticancer Res 2015; 35:5525-5532. [PMID: 26408720] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND A woman, mother of one at the age of 19 years, was diagnosed with mammary adenocarcinoma in the right breast in 1985 at the age of 37 years. The patient underwent surgery (quadrantectomy), lymphadenectomy and radiotherapy. In 1999, an adenocarcinoma was diagnosed in the left breast, followed by adequate resection, radiotherapy and anti-oestrogen receptor treatment for 6 years. In March 2014, an infiltrating adenocarcinoma was diagnosed in the remaining part of the right breast that had been operated on and irradiated in 1985. CASE REPORT The pre-surgical biopsy, showed weak positivity for progesterone receptor (PgR) (<1%), high positivity for oestrogen receptor (ER) (90%), high positivity for human epidermal growth factor receptor (HER2) (>10%, score 2+), and high positivity for the nuclear protein Ki67 (30%). In the three weeks between diagnosis and operation, when no other treatment had been planned, the patient decided to self-administer high doses of oral vitamin D3 (10,000 IU/day), and to follow a strict ketogenic diet. RESULTS Following right mastectomy, analysis of the surgical specimen showed no positivity for HER2 expression (negative, score 0), and significant increase in positivity of PgR (20%). Positivity for ER and Ki67 were unaltered. CONCLUSION This observation indicates that a combination of high-dose vitamin D3 and ketogenic diet leads to changes in some biological markers of breast cancer, i.e. negativization of HER2 expression and increased expression of PgR.
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Affiliation(s)
- Jacopo J V Branca
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Stefania Pacini
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Marco Ruggiero
- Department of Experimental and Clinical Biomedical Sciences, University of Firenze, Florence, Italy
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Cosentino A, Boni E, Pacini S, Branca J, Morucci G, Ruggiero M, Bocchi L. Morphological analysis of neurons: Automatic identification of elongations. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2015:8131-8134. [PMID: 26738181 DOI: 10.1109/embc.2015.7320281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Our study is focused on the development of a new method for the automatic analysis of cell images. We focused on neurons (cells line SH-SY5Y) treated/untreated with ultrasound and stained with Haematoxylin-Eosin. The aim of the algorithm is the automatic detection of the cell body as well as the determination of the number and the length of neuron elongations. Starting point of the algorithm was the convolution of an image with a bank of rotating Gaussian kernels and the construction of a module map. Then several strategies were implemented to detect cell bodies and to detect and extract data about cell elongations. We have also realized a graphical user interface allowing the loading, saving and processing of images. Results show that this method is able to properly and efficiently detect cell contours and elongations. The automated evaluation is in strong agreement with manual evaluation performed by an expert operator, with an average error of 11% with most parameter combinations. This tool constitutes an important support in biological research activities, where operators need to analyze a large number of images to investigate about cell morphology before and after a treatment.
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Branca JJV, Morucci G, Malentacchi F, Gelmini S, Ruggiero M, Pacini S. Effects of oxaliplatin and oleic acid Gc-protein-derived macrophage-activating factor on murine and human microglia. J Neurosci Res 2015; 93:1364-77. [PMID: 25782915 DOI: 10.1002/jnr.23588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/11/2015] [Accepted: 02/26/2015] [Indexed: 11/11/2022]
Abstract
The biological properties and characteristics of microglia in rodents have been widely described, but little is known about these features in human microglia. Several murine microglial cell lines are used to investigate neurodegenerative and neuroinflammatory conditions; however, the extrapolation of the results to human conditions is frequently met with criticism because of the possibility of species-specific differences. This study compares the effects of oxaliplatin and of oleic acid Gc-protein-derived macrophage-activating factor (OA-GcMAF) on two microglial cell lines, murine BV-2 cells and human C13NJ cells. Cell viability, cAMP levels, microglial activation, and vascular endothelial growth factor (VEGF) expression were evaluated. Our data demonstrate that oxaliplatin induced a significant decrease in cell viability in BV-2 and in C13NJ cells and that this effect was not reversed with OA-GcMAF treatment. The signal transduction pathway involving cAMP/VEGF was activated after treatment with oxaliplatin and/or OA-GcMAF in both cell lines. OA-GcMAF induced a significant increase in microglia activation, as evidenced by the expression of the B7-2 protein, in BV-2 as well as in C13NJ cells that was not associated with a concomitant increase in cell number. Furthermore, the effects of oxaliplatin and OA-GcMAF on coculture morphology and apoptosis were evaluated. Oxaliplatin-induced cell damage and apoptosis were nearly completely reversed by OA-GcMAF treatment in both BV-2/SH-SY5Y and C13NJ/SH-SY5Y cocultures. Our data show that murine and human microglia share common signal transduction pathways and activation mechanisms, suggesting that the murine BV-2 cell line may represent an excellent model for studying human microglia.
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Affiliation(s)
- Jacopo J V Branca
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Gabriele Morucci
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Francesca Malentacchi
- Department of Experimental and Clinical Biomedical Sciences, University of Firenze, Firenze, Italy
| | - Stefania Gelmini
- Department of Experimental and Clinical Biomedical Sciences, University of Firenze, Firenze, Italy
| | - Marco Ruggiero
- Department of Experimental and Clinical Biomedical Sciences, University of Firenze, Firenze, Italy.,Immuno Biotech Ltd, St. Peter Port, Guernsey, Channel Islands
| | - Stefania Pacini
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
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Magherini S, Fiore MG, Chiarelli B, Serrao A, Paternostro F, Morucci G, Branca JJV, Ruggiero M, Pacini S. Metopic suture and RUNX2, a key transcription factor in osseous morphogenesis with possible important implications for human brain evolution. Ital J Anat Embryol 2015; 120:5-20. [PMID: 26738254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Overall, the comparative data available on the timing of metopic suture closure in present-day and fossil members of human lineage, as well as great apes, seem to indicate that human brain evolution occurred within a complex network of fetopelvic constraints, which required modification of frontal neurocranial ossification patterns, involving delayed fusion of the metopic suture. It is very interesting that the recent sequencing of the Neanderthal genome has revealed signs of positive selection in the modern human variant of the RUNX2 gene, which is known to affect metopic suture fusion in addition to being essential for osteoblast development and proper bone formation. It is possible that an evolutionary change in RUNX2, affecting aspects of the morphology of the upper body and cranium, was of importance in the origin of modern humans. Thus, to contribute to a better understanding of the molecular evolution of this gene probably implicated in human evolution, we performed a comparative bioinformatic analysis of the coding sequences of RUNX2 in Homo sapiens and other non-human Primates. RESULTS We found amino-acid sequence differences between RUNX2 protein isoforms of Homo sapiens and the other Primates examined, that might have important implications for the timing of metopic suture closure. CONCLUSIONS Further studies are needed to clear the potential distinct developmental roles of different species-specific RUNX2 N-terminal isoforms. Meantime, our bioinformatic analysis, regarding expression of the RUNX2 gene in Homo sapiens and other non-human Primates, has provided a contribution to this important issue of human evolution.
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Beltramello A, Casartelli Liviero M, Bernardi B, Causin F, Di Paola F, Muto M, Ruggiero M, Procaccio F. Computed tomography angiography: a double step methodology in brain death confirmation. Minerva Anestesiol 2014; 80:862-863. [PMID: 24463944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- A Beltramello
- Dipartimento di Neuroradiologia, AOUI Verona, Verona, Italia -
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Ruggiero M, Ward E, Smith R, Branca JJV, Noakes D, Morucci G, Taubmann M, Thyer L, Pacini S. Oleic Acid, deglycosylated vitamin D-binding protein, nitric oxide: a molecular triad made lethal to cancer. Anticancer Res 2014; 34:3569-3578. [PMID: 24982371] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Oleic Acid (OA) has been shown to have anticancer properties mediated by interaction with proteins such as α-lactalbumin and lactoferrins. Therefore, we synthesized complexes of OA and Gc protein-derived macrophage activating factor (GcMAF) that inhibits per se cancer cell proliferation and metastatic potential. We hypothesised that OA-GcMAF complexes could exploit the anticancer properties of both OA and GcMAF in a synergistic manner. We postulated that the stimulating effects of GcMAF on macrophages might lead to release of nitric oxide (NO). PATIENTS AND METHODS Patients with advanced cancer were treated at the Immuno Biotech Treatment Centre with OA-GcMAF-based integrative immunotherapy in combination with a low-carbohydrate, high-protein diet, fermented milk products containing naturally-produced GcMAF, Vitamin D3, omega-3 fatty acids and low-dose acetylsalicylic acid. RESULTS Measuring the tumour by ultrasonographic techniques, we observed a decrease of tumour volume of about 25%. CONCLUSION These observations demonstrate that OA, GcMAF and NO can be properly combined and specifically delivered to advanced cancer patients with significant effects on immune system stimulation and tumour volume reduction avoiding harmful side-effects.
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Affiliation(s)
- Marco Ruggiero
- Department of Experimental and Clinical Biomedical Sciences, University of Firenze, Firenze, Italy Immuno Biotech Ltd, Guernsey, Channel Islands, UK
| | - Emma Ward
- Macro Innovations Ltd, Cambridge, UK
| | | | - Jacopo J V Branca
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - David Noakes
- Immuno Biotech Ltd, Guernsey, Channel Islands, UK
| | - Gabriele Morucci
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | | | | | - Stefania Pacini
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
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Bradstreet JJ, Pacini S, Ruggiero M. A New Methodology of Viewing Extra-Axial Fluid and Cortical Abnormalities in Children with Autism via Transcranial Ultrasonography. Front Hum Neurosci 2014; 7:934. [PMID: 24459462 PMCID: PMC3892177 DOI: 10.3389/fnhum.2013.00934] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/24/2013] [Indexed: 11/17/2022] Open
Abstract
Background: Autism spectrum disorders (ASDs) are developmental conditions of uncertain etiology which have now affected more than 1% of the school-age population of children in many developed nations. Transcranial ultrasonography (TUS) via the temporal bone appeared to be a potential window of investigation to determine the presence of both cortical abnormalities and increased extra-axial fluid (EAF). Methods: TUS was accomplished using a linear probe (10–5 MHz). Parents volunteered ASD subjects (N = 23; males 18, females 5) for evaluations (mean = 7.46 years ± 3.97 years), and 15 neurotypical siblings were also examined (mean = 7.15 years ± 4.49 years). Childhood Autism Rating Scale (CARS2®) scores were obtained and the ASD score mean was 48.08 + 6.79 (Severe). Results: Comparisons of the extra-axial spaces indicated increases in the ASD subjects. For EAF we scored based on the gyral summit distances between the arachnoid membrane and the cortical pia layer (subarachnoid space): (1) <0.05 cm, (2) 0.05–0.07 cm, (3) 0.08–0.10 cm, (4) >0.10 cm. All of the neurotypical siblings scored 1, whereas the ASD mean score was 3.41 ± 0.67. We also defined cortical dysplasia as the following: hypoechoic lesions within the substance of the cortex, or disturbed layering within the gray matter. For cortical dysplasia we scored: (1) none observed, (2) rare hypoechogenic lesions and/or mildly atypical cortical layering patterns, (3) more common, but separated areas of cortical hypoechogenic lesions, (4) very common or confluent areas of cortical hypoechogenicity. Again all of the neurotypical siblings scored 1, while the ASD subjects’ mean score was 2.79 ± 0.93. Conclusion: TUS may be a useful screening technique for children at potential risk of ASDs which, if confirmed with repeated studies and high resolution MRI, provides rapid, non-invasive qualification of EAF, and cortical lesions.
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Affiliation(s)
- James Jeffrey Bradstreet
- Newport Brain Research Laboratory , Newport Beach, CA , USA ; Brain Treatment Center , Newport Beach, CA , USA ; Brain Treatment Center , Buford, GA , USA
| | - Stefania Pacini
- Department of Experimental and Clinical Medicine, University of Florence , Florence , Italy
| | - Marco Ruggiero
- Department of Experimental and Clinical Biomedical Sciences, University of Florence , Florence , Italy ; Immuno Biotech Ltd., Saint Peter Port , Guernsey
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Carlesimo B, Lo Torto F, Rossi A, Marcasciano M, Ruggiero M. Long-term result of bilateral pectoralis major muscle advancement flap in median sternotomy wound infections. Eur Rev Med Pharmacol Sci 2014; 18:3767-3772. [PMID: 25555865] [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: 06/04/2023]
Abstract
OBJECTIVE Deep sternal wound infection (DSWI) is an uncommon but serious complication of open heart surgery being characterized by a high mortality rate and a considerable economic weight. Repair of sternal defects, compromised with infection, can be achieved in several ways. The aim of our study is to report our case load in the management of sternal wound infection. PATIENTS AND METHODS In this study, we will report our twelve-year case load with bilateral pectoralis major advancement flap as the sole treatment modality for deep sternal wound infection. RESULTS This surgical approach has given excellent results in terms of resolution of the infection of the sternum, with few complications and a good cosmetic result. CONCLUSIONS We propose bilateral pectoralis major advancement flap as the first choice treatment for deep sternal wound infection.
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Affiliation(s)
- B Carlesimo
- Department of Plastic and Reconstructive and Aesthetic Surgery, Sapienza University of Rome, Rome, Italy.
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