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Giroletti L, Brembilla V, Graniero A, Albano G, Villari N, Roscitano C, Parrinello M, Grazioli V, Lanzarone E, Agnino A. Learning Curve Analysis of Robotic-Assisted Mitral Valve Repair with COVID-19 Exogenous Factor: A Single Center Experience. Medicina (Kaunas) 2023; 59:1568. [PMID: 37763687 PMCID: PMC10536190 DOI: 10.3390/medicina59091568] [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] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/14/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background and objective Renewed interest in robot-assisted cardiac procedures has been demonstrated by several studies. However, concerns have been raised about the need for a long and complex learning curve. In addition, the COVID-19 pandemic in 2020 might have affected the learning curve of these procedures. In this study, we investigated the impact of COVID-19 on the learning curve of robotic-assisted mitral valve surgery (RAMVS). The aim was to understand whether or not the benefits of RAMVS are compromised by its learning curve. Materials and Methods Between May 2019 and March 2023, 149 patients underwent RAMVS using the Da Vinci® X Surgical System at the Humanitas Gavazzeni Hospital, Bergamo, Italy. The selection of patients enrolled in the study was not influenced by case complexity. Regression models were used to formalize the learning curves, where preoperative data along with date of surgery and presence of COVID-19 were treated as the input covariates, while intraoperative and postoperative data were analyzed as output variables. Results The age of patients was 59.1 ± 13.3 years, and 70.5% were male. In total, 38.2% of the patients were operated on during the COVID-19 pandemic. The statistical analysis showed the positive impact of the learning curve on the trend of postoperative parameters, progressively reducing times and other key indicators. Focusing on the COVID-19 pandemic, statistical analysis did not recognize an impact on postoperative outcomes, although it became clear that variables not directly related to the intervention, especially ICU hours, were strongly influenced by hospital logistics during COVID-19. Conclusions Understanding the learning curve of robotic surgical procedures is essential to ensure their effectiveness and benefits. The learning curve involves not only surgeons but also other health care providers, and establishing a stable team in the early stage, as in our case, is important to shorten the duration. In fact, an exogenous factor such as the COVID-19 pandemic did not affect the robotic program despite the fact that the pandemic occurred early in the program.
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Affiliation(s)
- Laura Giroletti
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
| | - Valentina Brembilla
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine (Bg), Italy; (V.B.); (E.L.)
| | - Ascanio Graniero
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
| | - Giovanni Albano
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Nicola Villari
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Claudio Roscitano
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Matteo Parrinello
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Valentina Grazioli
- Cardiovascular Surgery Department, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy;
| | - Ettore Lanzarone
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine (Bg), Italy; (V.B.); (E.L.)
| | - Alfonso Agnino
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
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Peluso L, Baccanelli F, Grazioli V, Panisi P, Taccone FS, Albano G. Pupillary dysfunction during hypothermic circulatory arrest: insights from automated pupillometry. Crit Care 2023; 27:197. [PMID: 37217944 DOI: 10.1186/s13054-023-04490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023] Open
Affiliation(s)
- Lorenzo Peluso
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072, Pieve Emanuele, Milan, Italy.
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy.
| | - Federica Baccanelli
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy
| | - Valentina Grazioli
- Department of Cardiac Surgery, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy
| | - Paolo Panisi
- Department of Cardiac Surgery, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hopital Erasme - Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Giovanni Albano
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy
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3
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Grazioli V, Giroletti L, Graniero A, Albano G, Mazzoni M, Panisi PG, Gerometta P, Anselmi A, Agnino A. Comparative myocardial protection of endoaortic balloon versus external clamp in minimally invasive mitral valve surgery. J Cardiovasc Med (Hagerstown) 2023; 24:184-190. [PMID: 36409631 DOI: 10.2459/jcm.0000000000001404] [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] [Indexed: 11/22/2022]
Abstract
AIMS Minimally invasive mitral valve surgery leads to shorter postoperative recovery time, cosmetic advantages and significant pain reduction compared with the standard sternotomy approach. Both an external aortic clamp and an endoaortic balloon occlusion can be used to manage the ascending aorta and the myocardial protection. In this study, we aimed to compare these two strategies in terms of effectiveness of myocardial protection and associated early postoperative outcomes. METHODS We investigated the retrospective records of prospectively collected data of patients treated by minimally invasive mitral valve surgery from March 2014 to June 2019. A total of 180 cases (78 in the external aortic clamp group and 102 in the endoaortic balloon clamp group) were collected. A propensity weighting analysis was adopted to adjust for baseline variables. RESULTS The endoaortic balloon clamp presented higher EuroSCORE II (higher reoperative surgery rate). The intra- and postoperative data were similar between the two groups: the postoperative troponin-I levels, peak of serum lactates and rate of myocardial infarction were also comparable. The endoaortic clamp group recorded longer operative, cardiopulmonary bypass and cross-clamp times. The external clamp group showed a higher rate of postoperative atrial fibrillation and conduction block. CONCLUSIONS In experienced centers, the use of the endoaortic balloon clamp is safe, reproducible and comparable to the external aortic clamp regarding the effectiveness of myocardial protection: its employment might facilitate minimally invasive mitral valve surgery.
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Affiliation(s)
| | - Laura Giroletti
- Cardiovascular Surgery Department
- Division of Robotic and Minimally Invasive Cardiac Surgery
| | - Ascanio Graniero
- Cardiovascular Surgery Department
- Division of Robotic and Minimally Invasive Cardiac Surgery
| | - Giovanni Albano
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Maurizio Mazzoni
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | | | | | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Alfonso Agnino
- Cardiovascular Surgery Department
- Division of Robotic and Minimally Invasive Cardiac Surgery
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Schmutz E, Graells M, Moullin J, Kasztura M, Chastonay O, Allen MC, Hugli O, Daeppen JB, Grazioli V, Bodenmann P. Implementation of Case Management in emergency departments: the view of the involved staff. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.009] [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: 11/15/2022] Open
Abstract
Abstract
Introduction
Frequent users of emergency departments (FUED; ≥ 5 ED visits in the previous 12 months) often present with somatic, psychological and substance use problems. Providing a Case Management (CM) intervention may reduce their number ED visits and improve their quality of life. However, there is limited knowledge about the implementation process of CM.
Methods
This study aimed to introduce CM into the EDs in the French-speaking part of Switzerland and to identify the facilitators, barriers and needs encountered in this process. Semi-structured interviews were conducted with ED involved staff. An inductive content analysis was conducted.
Results
Among 13 invited hospitals, 8 implemented CM (62%); 23 ED staff were sampled from all participating ED: 17 nurses (74%), 5 physicians (22%) and 1 healthcare manager (4%). The average age was 48,48 years (SD = 8,64) and 74% were female. Four main facilitators emerged from the analysis: 1) Direct hierarchy support and flexibility (e.g. time management, supplemental paid hours); 2) Exchange with colleagues (e.g. debriefing, support); 3) Supervision by the research team (training and toolkit consisting of a binder and USB stick containing the study presentation and implementation procedures); and 4) Motivation (pleasure to work on an innovative project, benefit for patients and caregivers). Lack of resources was an unanimously mentioned barrier (e. g., time to identify and contact FUED medical and social support). Finally, participants identified the following needs to enable CM implementation: official and protected time for the project, a dedicated room for CM, at least two team members involved in the project since its initiation with complementary skills (e.g.: somatic, psychiatric and social).
Conclusions
Our study suggests that successful CM implementation is a complex process that, in addition to motivated ED staff, requires significant dedicated resources, such as protected time and a devoted support team.
Key messages
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Affiliation(s)
- E Schmutz
- Department of Vulnerabilities and Social Medicine, University of Lausanne , Lausanne, Switzerland
| | - M Graells
- Department of Vulnerabilities and Social Medicine, University of Lausanne , Lausanne, Switzerland
| | - J Moullin
- Faculty Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University , Perth, Australia
| | - M Kasztura
- Department of Vulnerabilities and Social Medicine, University of Lausanne , Lausanne, Switzerland
| | - O Chastonay
- Department of Vulnerabilities and Social Medicine, University of Lausanne , Lausanne, Switzerland
| | - M Canepa Allen
- Department of Vulnerabilities and Social Medicine, University of Lausanne , Lausanne, Switzerland
| | - O Hugli
- Emergency Department, Lausanne University Hospital , Lausanne, Switzerland
| | - JB Daeppen
- Addiction Medicine, Department of Psychiatry, University of Lausanne , Lausanne, Switzerland
| | - V Grazioli
- Department of Vulnerabilities and Social Medicine, University of Lausanne , Lausanne, Switzerland
| | - P Bodenmann
- Department of Vulnerabilities and Social Medicine, University of Lausanne , Lausanne, Switzerland
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5
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Bonalumi G, Pilozzi Casado A, Barbone A, Garatti A, Colli A, Giambuzzi I, Torracca L, Ravenni G, Folesani G, Murara G, Pantaleo A, Picichè M, Villa E, Ferraro F, Vendramin I, Livi U, Montalto A, Musumeci F, Tarzia V, Trumello C, De Bonis M, Margari V, Paparella D, Salsano A, Santini F, Nicolardi S, Patanè F, Mammana L, Cura Stura E, Rinaldi M, Massi F, Triggiani M, Grazioli V, Giroletti L, Rubino A, De Feo M, Audo A, Regesta T, Barili F, Gerosa G, Di Mauro M, Parolari A. Prognostic value of SARS-CoV-2 on patients undergoing cardiac surgery. J Card Surg 2021; 37:165-173. [PMID: 34717007 PMCID: PMC8661587 DOI: 10.1111/jocs.16106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/28/2021] [Accepted: 09/24/2021] [Indexed: 01/01/2023]
Abstract
Objective To analyze Italian Cardiac Surgery experience during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) identifying risk factors for overall mortality according to coronavirus disease 2019 (COVID‐19) status. Methods From February 20 to May 31, 2020, 1354 consecutive adult patients underwent cardiac surgery at 22 Italian Centers; 589 (43.5%), patients came from the red zone. Based on COVID‐19 status, 1306 (96.5%) were negative to SARS‐CoV‐2 (COVID‐N), and 48 (3.5%) were positive to SARS‐CoV‐2 (COVID‐P); among the COVID‐P 11 (22.9%) and 37 (77.1%) become positive, before and after surgery, respectively. Surgical procedures were as follows: 396 (29.2%) isolated coronary artery bypass grafting (CABG), 714 (52.7%) isolated non‐CABG procedures, 207 (15.3%) two associate procedures, and three or more procedures in 37 (2.7%). Heart failure was significantly predominant in group COVID‐N (10.4% vs. 2.5%, p = .01). Results Overall in‐hospital mortality was 1.6% (22 cases), being significantly higher in COVID‐P group (10 cases, 20.8% vs. 12, 0.9%, p < .001). Multivariable analysis identified COVID‐P condition as a predictor of in‐hospital mortality together with emergency status. In the COVID‐P subgroup, the multivariable analysis identified increasing age and low oxygen saturation at admission as risk factors for in‐hospital mortality. Conclusion As expected, SARS‐CoV‐2 infection, either before or soon after cardiac surgery significantly increases in‐hospital mortality. Moreover, among COVID‐19‐positive patients, older age and poor oxygenation upon admission seem to be associated with worse outcomes.
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Affiliation(s)
- Giorgia Bonalumi
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | | | - Alessandro Barbone
- Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Andrea Garatti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Andrea Colli
- Department of Cardiac, Thoracic, and Vascular, Cardiac Surgery Unit, University of Pisa, Pisa, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy.,Dipartimento di Scienze Cliniche e Comunità, DISCCO- UNIMI, Milan, Italy
| | - Lucia Torracca
- Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Giacomo Ravenni
- Department of Cardiac, Thoracic, and Vascular, Cardiac Surgery Unit, University of Pisa, Pisa, Italy
| | - Gianluca Folesani
- Departments of Cardiac Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giacomo Murara
- Departments of Cardiac Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Pantaleo
- Department of Cardiac Surgery, Azienda ULSS2 Ca' Foncello Hospital, Treviso, Italy
| | - Marco Picichè
- Department of Cardiac Surgery, AULSS 8 Berica, San Bortolo Hospital, Vicenza, Italy
| | - Emmanuel Villa
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Francesco Ferraro
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy.,Departments of Cardiac Surgery, Catholic University of The Sacred Heart, Brescia, Italy
| | - Igor Vendramin
- Department of Cardiothoracic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Ugolino Livi
- Department of Cardiothoracic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Andrea Montalto
- Department of Cardiac Surgery, Ospedale San Camillo, Roma, Italy
| | | | - Vincenzo Tarzia
- Department of Cardiac Surgery, University of Padua, Padua, Italy
| | - Cinzia Trumello
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute" San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute" San Raffaele University, Milan, Italy
| | - Vito Margari
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Domenico Paparella
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy.,Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Antonio Salsano
- Division of Cardiac Surgery, Department of DISC, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Francesco Santini
- Division of Cardiac Surgery, Department of DISC, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Francesco Patanè
- Department of Cardiac Surgery, Azienda Ospedaliera Papardo, Messina, Italy
| | - Liborio Mammana
- Department of Cardiac Surgery, Azienda Ospedaliera Papardo, Messina, Italy
| | - Erik Cura Stura
- Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Massi
- Department of Cardiac Surgery, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Michele Triggiani
- Department of Cardiac Surgery, Giuseppe Mazzini Hospital, Teramo, Italy
| | | | | | - Antonino Rubino
- Department of Translational Medical Sciences, AORN dei Colli/Monaldi Hospital, University of Campania "L. Vanvitelli", Naples, Italy
| | - Marisa De Feo
- Department of Translational Medical Sciences, AORN dei Colli/Monaldi Hospital, University of Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Audo
- Department of Cardiac Surgery, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Tommaso Regesta
- Department of Cardiac Surgery, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Gino Gerosa
- Department of Cardiac Surgery, University of Padua, Padua, Italy
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute, Maastricht (CARIM), Maastricht, Netherlands
| | - Alessandro Parolari
- Department of Universitary Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, Milan, Italy.,Deparment of Biomedical Sciences for Health, Università di Milano, Milan, Italy
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6
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Morisod K, Durand M, Selby K, Le Pogam M, Grazioli V, Sanchis Zozaya J, Bodenmann P, Van Plessen C. Asylum seekers’ and refugees’ understanding of government restrictions during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574750 DOI: 10.1093/eurpub/ckab164.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Asylum seekers and refugees risk poorer public health information and difficulties to follow measures during the COVID-19 pandemic because of language, cultural, administrative barriers and social insecurity. We investigate their attitudes and knowledge about COVID-19 measures.
Methods
A cross-sectional survey conducted between August and October 2020 in the canton of Vaud, Switzerland. The 24 questions covered health literacy, perception of the pandemic, understanding of health measures and adherence to conspiracy theories. The questionnaire was translated into the ten most common languages. It was distributed online through social networks of charitable and public organisations and in paper in asylum centres. Associations between participants responses and their characteristics were studied using multivariable logistic regressions.
Results
The 242 respondents had a mean age of 33 years, 63% were men and 42% had low health literacy. They were 16% asylum seekers, 45% temporarily admitted persons, 12% refugees and 26% rejected asylum seekers. All languages were used.
Self-reported adherence to recommendations was 82%. Respectively, 39% and 31% of participants reported sleep disorders or fear of dying. Adjusted for age, gender, health literacy and French language skills, rejected asylum seekers were less worried about the pandemic (aOR 0.37, p = 0.007) and more sensitive to conspiracy theories (aOR 3.47, p = 0.006) than other respondents. They also reported lower adherence to recommendations (aOR 0.45, p = 0.034).
Conclusions
We contribute new knowledge about a varied group of vulnerable persons under precarious conditions during the COVID-19 pandemic. The network based multi-language survey combining online and center based distribution was useful but also tedious. Our results highlight the low health literacy of asylum seekers and refugees and their deep concerns about the pandemic. Public health messages should be adapted to rejected asylum seekers.
Key messages
Asylum seekers and refugees have deep concerns about the Covid-19 pandemic (including sleep disorders and fear of dying) but a low health literacy. Public health messages should be adapted to socially vulnerable groups, especially rejected asylum seekers.
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Affiliation(s)
- K Morisod
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - M Durand
- Geisel School of Medicine, The Dartmouth Institute, Lebanon, USA
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - K Selby
- Department Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - M Le Pogam
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - V Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - J Sanchis Zozaya
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - P Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - C Van Plessen
- Department of Polyclinics, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Direction Générale de la Santé, Lausanne, Switzerland
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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7
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Morisod K, Grazioli V, Schlüter V, Bochud M, Gonseth Nusslé S, D'Acremont V, Felappi A, Bühler N, Bodenmann P. Prevalence of SARS-CoV-2 and associated risk factors among asylum seekers living in centres. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.250] [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: 11/12/2022] Open
Abstract
Abstract
Background
Understanding the factors influencing SARS-CoV-2 transmission in asylum seekers and refugees living in centres is crucial to determine targeted public health policies protecting these populations. We explored the pandemic's spread into asylum centres during the first wave of the pandemic (May-June 2020) in Switzerland and factors associated with the presence of SARS-CoV-2 antibodies.
Methods
This research is part of SérocoVID, a seroepidemiologic study of SARS-CoV-2 infection conducted in Canton of Vaud, Switzerland. All migrants living in two asylum centres were invited to participate. Anti-Spike IgG and IgA antibodies were measured in all participants. Each participant completed a questionnaire measuring socio-demographic characteristics, medical history, health literacy, public health recommendations, behaviours and exposures. The association of independent variables with serologic test result were estimated using a multivariable logistic regression model.
Results
The mean (SD) age of the 124 participants (23% women) was 33.7 (11.6) years (Centre 1, n = 82; Centre 2, n = 42). The mean participation rate was 37%. The seroprevalence in Centres 1 and 2 were 13% [95% CI 3-14%] and 50 [34-65%], respectively. Next, 41% of SARS-CoV-2 positive people never developed symptoms, and no one had developed severe Covid-19 disease. After adjusting for individual characteristics and centre, seropositivity was higher among people with low health literacy (aOR 6.2, p = 0.010 [1.6, 24.8]) and non-smokers (aOR 5.4, p = 0.013 [1.4- 20.3]). No other significant associations were found.
Conclusions
Findings suggest that developing targeted public health measures, especially for low health literacy people, would be necessary to limit the risk of outbreaks in asylum centres and improve this population's safety. Further investigations are required to understand better the negative association between tobacco consumption and SARS-CoV-2 infection.
Key messages
Asylum centres require specific public health measures to guarantee their population's safety and limit the virus spread. Asylum seekers and refugees with low health literacy seem particularly vulnerable during the Covid-19 pandemic.
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Affiliation(s)
- K Morisod
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - V Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - V Schlüter
- Department of Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - M Bochud
- Department of Epidemiology and Health systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - S Gonseth Nusslé
- Department of Epidemiology and Health systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - V D'Acremont
- Department of Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - A Felappi
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - N Bühler
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - P Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
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8
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Morisod K, Malebranche M, Marti J, Spycher J, Grazioli V, Bodenmann P. Interventions aimed at improving health care equity for d/Deaf patients: a systematic review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
d/Deaf people suffer from inequitable access to care and health information, which results in worse health literacy and poorer mental and physical health compared to hearing populations. Various interventions aimed at improving health equity for d/Deaf people exist in the scientific literature but have to be systematically analysed. The purpose of this systematic literature review was to obtain a global overview of what we know about these interventions.
Methods
Medline Ovid SP, Embase, CINAHL EBSCO, PsycINFO Ovid SP, Central - Cochrane Library Wiley and Web of Science were searched for relevant studies on access to health care, interventions and health education for d/Deaf people following PRISMA-equity guidelines. The outcomes of interest were interventions aimed at achieving equitable care access to health information for d/Deaf people.
Results
Forty-eight studies were analysed. Four main categories of interventions emerged: 1) interventions addressing direct clinical care, 2) health technology-based interventions, 3) interventions focused on patient education, and 4) interventions focused on health care provider education. Among them, access to sign language interpretation or to culturally and linguistically adapted means of communication, use of communication media such as sign language video for the dissemination of medical information, and increasing use of technology (telemedicine, videoconferencing) were effective to strengthen equity in the care of d/Deaf people. Moreover, involving d/Deaf individuals in the conceptualization, creation, implementation and evaluation of interventions seemed to be imperative.
Conclusions
A multi-pronged approach, using a combination of interventions that improve health literacy among d/Deaf patients and promote health care providers' awareness of communication barriers and cultural sensitivity show promise in achieving more equitable care for d/Deaf patients, but more widespread research is needed.
Key messages
The scientific literature has identified and analysed many tools for improving health care equity for d/Deaf people, but their implementation is lacking. The involvement of d/Deaf people in research and implementation processes is crucial for the development of appropriate interventions.
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Affiliation(s)
- K Morisod
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - M Malebranche
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Department of Medicine, University of Calgary, Calgary, Canada
| | - J Marti
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - J Spycher
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - V Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - P Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
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9
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Schaad L, Graells M, Moullin J, Kasztura M, Schmutz E, Hugli O, Daeppen JB, Grazioli V, Bodenmann P. Frequent users of ED’s perspectives about a case management intervention in Western Switzerland. Eur J Public Health 2021. [PMCID: PMC8574553 DOI: 10.1093/eurpub/ckab165.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Management of frequent users of the emergency department (FUED; ≥5 visits/year) is a known challenge. Studies show that case management (CM) improves FUEDs' quality of life while reducing their number of emergency department visits and associated costs. However, little is known about FUEDs' own perspectives on CM. Methods This qualitative study was part of a larger study aiming to implement CM for FUED in French-speaking Switzerland. Participants were FUEDs included in the parent study, who had either completed the CM intervention or were still enrolled. Semi-structured qualitative interviews were conducted with 20 participants (75% female; mean age=40.55, SD = 12.84), randomly drawn from the parent study sample. Content analysis was performed by two researchers to assess participants' perceptions on the CM intervention. Results Most participants endorsed general positive perceptions of CM. CM differed from their usual treatment by two characteristics: its holistic approach and the quality of the relationship with the case manager. Also, moral support was perceived as a main benefit. FUEDs perceived four outcomes: an increase in motivation (e.g., day-to-day life or health-related), better orientation in and interaction with the healthcare system and improved health literacy. Finally, FUEDs identified two negative aspects to the CM: few perceived benefits (e.g., not enough concrete outcomes) and negative consequences (e.g., feeling ashamed to come back to ED). Three obstacles were identified: case manager's lack of time, COVID-19's influence (e.g., less personal contact) and uncertainty around the program (e.g., organization, aims). The personal relationship with their case manager was perceived as the main driver to positive outcomes. Conclusions FUED perceived the program as useful and considered the relationship with the case manager as key for positive outcomes. Our findings also suggest ways to improve CM, such as clarifying its organization and aims. Key messages In FUEDs’ opinion, the CM intervention had many positive outcomes, often relying on the relationship with the case manager. However, the CM intervention had also some negatives.
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Affiliation(s)
- L Schaad
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - M Graells
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - J Moullin
- Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia
| | - M Kasztura
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - E Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - O Hugli
- Emergency Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - J-B Daeppen
- Addiction Medicine, Psychiatry Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - V Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - P Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
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10
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Grazioli V, Ghio S, Pin M, Sciortino A, Celentano A, Silvaggio G, Monterosso C, Turco A, Klersy C, Merli VN, Vanini B, D'Armini AM. Pulmonary endarterectomy in the octogenarian population: safety and outcomes. J Cardiovasc Med (Hagerstown) 2021; 22:567-571. [PMID: 33186233 DOI: 10.2459/jcm.0000000000001138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Aim of the study was to verify the feasibility, safety and efficacy of pulmonary endarterectomy (PEA) in octogenarian patients with chronic thromboembolic pulmonary hypertension. METHODS We retrospectively analyzed 635 chronic thromboembolic pulmonary hypertension patients who underwent PEA at our center and were followed-up for at least 1 year. The end-points of the study were in-hospital mortality, hemodynamic results at 1 year and long-term survival. RESULTS In-hospital mortality was 4, 10 and 17%, respectively, for 259 patients under the age of 60 years, 352 aged between 60 and 79 years and 24 octogenarians (P = 0.006 octogenarians vs. <60 years). At multivariable analysis, age and pulmonary vascular resistances were independent risk factors for mortality (P = 0.021 and P < 0.001, respectively). At 1 year, the improvement in cardiac index was lower and the distance walked in 6 min was poorer for octogenarians than for the other two groups (both P = 0.001). Survival after hospital discharge was similar over a median follow-up period of 59 months (P = 0.113). Although in-hospital mortality and long-term survival are similar in octogenarians as compared with patients aged between 60 and 79, the improvement in cardiac index and in functional capacity at 1 year are lower in this very elderly population. CONCLUSION Age over 80 years should not be a contraindication to PEA surgery in selected patients operated on in referral centers.
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Affiliation(s)
- Valentina Grazioli
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation I.R.C.C.S. Policlinico San Matteo
| | - Stefano Ghio
- Division of Cardiology, Foundation I.R.C.C.S. Policlinico San Matteo, University of Pavia School of Medicine
| | - Maurizio Pin
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation I.R.C.C.S. Policlinico San Matteo
| | - Antonio Sciortino
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation I.R.C.C.S. Policlinico San Matteo
| | - Anna Celentano
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation I.R.C.C.S. Policlinico San Matteo
| | - Giuseppe Silvaggio
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation I.R.C.C.S. Policlinico San Matteo
| | - Cristian Monterosso
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation I.R.C.C.S. Policlinico San Matteo
| | - Annalisa Turco
- Division of Cardiology, Foundation I.R.C.C.S. Policlinico San Matteo, University of Pavia School of Medicine
| | - Catherine Klersy
- Service of Clinical Epidemiology and Biometry, Foundation 'I.R.C.C.S. Policlinico San Matteo'
| | - Vera N Merli
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation I.R.C.C.S. Policlinico San Matteo
| | - Benedetta Vanini
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation I.R.C.C.S. Policlinico San Matteo.,Section of Psychiatry, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Andrea M D'Armini
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation I.R.C.C.S. Policlinico San Matteo
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11
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Rosati F, Muneretto C, Baudo M, D'Ancona G, Bichi S, Merlo M, Cuko B, Gerometta P, Grazioli V, Giroletti L, Di Bacco L, Repossini A, Benussi S. A multicentre roadmap to restart elective cardiac surgery after COVID-19 peak in an Italian epicenter. J Card Surg 2021; 36:3308-3316. [PMID: 34173273 PMCID: PMC9292840 DOI: 10.1111/jocs.15776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND During the Italian Phase-2 of the coronavirus pandemic, it was possible to restart elective surgeries. Because hospitals were still burdened with coronavirus disease 2019 (COVID-19) patients, it was focal to design a separate "clean path" for the surgical candidates and determine the possible effects of major surgery on previously infected patients. METHODS From May to July 2020 (postpandemic peak), 259 consecutive patients were scheduled for elective cardiac surgery in three different centers. Our original roadmap with four screening steps included: a short item questionnaire (STEP-1), nasopharyngeal swab (NP) (STEP-2), computed tomography (CT)-scan using COVID-19 reporting and data system (CO-RADS) scoring (STEP-3), and final NP swab before discharge (STEP-4). RESULTS Two patients (0.8%) resulted positive at STEP-2: one patient was discharged home for quarantine, the other performed a CT-scan (CO-RADS: <2), and underwent surgery for unstable angina. Chest-CT was positive in 6.3% (15/237) with mean CO-RADS of 2.93 ± 0.8. Mild-moderate lung inflammation (CO-RADS: 2-4) did not delay surgery. Perioperative mortality was 1.15% (3/259), and cumulative incidence of pulmonary complications was 14.6%. At multivariable analysis, only age and cardiopulmonary bypass (CPB) time were independently related to pulmonary complications composite outcome (age >75 years: odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.25-5.57; p = 0.011; CPB >90 min. OR: 4.3; 95% CI: 1.84-10.16; p = 0.001). At 30 days, no periprocedural contagion and rehospitalization for COVID-19 infections were reported. CONCLUSIONS Our structured roadmap supports the safe restarting of an elective cardiac surgery list after a peak of a still ongoing COVID-19 pandemic in an epicenter area. Mild to moderate CT residuals of coronavirus pneumonia do not justify elective cardiac surgery procrastination.
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Affiliation(s)
- Fabrizio Rosati
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Massimo Baudo
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Giuseppe D'Ancona
- Department of Cardiovascular Research, Vivantes Klinikum Urban, Berlin, Germany
| | - Samuele Bichi
- Division of Cardiac Surgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maurizio Merlo
- Division of Cardiac Surgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Besart Cuko
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | | | - Laura Giroletti
- Division of Cardiac Surgery, Humanitas Gavazzeni, Bergamo, Italy
| | - Lorenzo Di Bacco
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alberto Repossini
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Stefano Benussi
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
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12
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Marzouk M, Kalavrouziotis D, Grazioli V, Meneas C, Nader J, Simard S, Mohammadi S. Long-term outcome of the in situ versus free internal thoracic artery as the second arterial graft. J Thorac Cardiovasc Surg 2020; 162:1744-1752.e7. [DOI: 10.1016/j.jtcvs.2020.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/21/2020] [Accepted: 03/02/2020] [Indexed: 11/15/2022]
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13
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Lorusso R, Moscarelli M, Di Franco A, Grazioli V, Nicolini F, Gherli T, De Bonis M, Taramasso M, Villa E, Troise G, Scrofani R, Antona C, Mariscalco G, Beghi C, Miceli A, Glauber M, Ranucci M, De Vincentiis C, Gaudino M. Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke. J Am Heart Assoc 2019; 8:e013650. [PMID: 31830873 PMCID: PMC6951073 DOI: 10.1161/jaha.119.013650] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The impact of the coronary artery bypass grafting (CABG) technique (on- versus off-pump, single versus multiple aortic clamping) on postoperative neurological outcome remains a matter of controversy. The aim of this study was to assess the association between the incidence of postoperative stroke and the degree of aortic manipulation in one of the largest contemporary CABG series. Methods and Results A retrospective, multicenter, international study was conducted in 25 388 patients undergoing isolated CABG procedures with on-pump CABG (ONCAB) or off-pump CABG (OPCAB) technique including single or multiple aortic clamping. Postoperative stroke was defined as a postoperative neurological deficit lasting more than 24 hours and associated with evidence of a brain lesion on computed tomography. The degree of aortic manipulation was assumed to be higher for on-pump versus off-pump surgery and for multiple versus single or no aortic clamping. Logistic regression and propensity matching were used. ONCAB procedures were performed in 17 231 cases and OPCAB in 8157. The incidence of postoperative stroke was significantly lower in the OPCAB group even after propensity matching (0.4% OPCAB versus 1.2% ONCAB, P=0.02). In the ONCAB group (but not in the OPCAB arm) the use of single aortic clamping was associated with significantly reduced postoperative stroke rate (odds ratio, 0.05; 95% CI, 0.008 to 0.07 [P<0.001]). Conclusions OPCAB and the use of single aortic clamping in the ONCAB arm were associated with a reduced incidence of postoperative stroke. Our data confirm a strong association between aortic manipulation and neurological outcome after CABG surgery.
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Affiliation(s)
- Roberto Lorusso
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre Maastricht University Medical Centre (MUMC) Cardiovascular Research Institute Maastricht (CARIM) Maastricht The Netherlands.,Cardiac Surgery Unit Community Hospital Brescia Italy
| | - Marco Moscarelli
- Cardiothoracic and Vascular Department Maria Cecilia Hospital GVM Care & Research Cotignola (RA) Italy
| | - Antonino Di Franco
- Department of Cardio-Thoracic Surgery Weill Cornell Medicine New York NY
| | | | | | - Tiziano Gherli
- Cardiac Surgery Unit Ospedale Maggiore University of Parma Italy
| | - Michele De Bonis
- Cardiac Surgery Unit San Raffaele Hospital University of Milan Italy
| | | | - Emmanuel Villa
- Cardiac Surgery Unit Poliambulanza Hospital Fondazione Poliambulanza Brescia Italy
| | - Giovanni Troise
- Cardiac Surgery Unit Poliambulanza Hospital Fondazione Poliambulanza Brescia Italy
| | | | - Carlo Antona
- Cardiac Surgery Unit Ospedale Sacco University of Milan Italy
| | | | - Cesare Beghi
- Cardiac Surgery Unit Ospedale di Circolo University of Varese Italy
| | | | | | - Marco Ranucci
- Cardiac Surgery and Intensive Care Units S. Donato Hospital IRCCS University of Milan Italy
| | - Carlo De Vincentiis
- Cardiac Surgery and Intensive Care Units S. Donato Hospital IRCCS University of Milan Italy
| | - Mario Gaudino
- Department of Cardio-Thoracic Surgery Weill Cornell Medicine New York NY
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14
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von Allmen M, Grazioli V, Kasztura M, Lemoine M, Chastonay O, Hugli O, Daeppen JB, Bodenmann P. Does case management provides support for staff facing frequent users of emergency departments? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Frequent users of emergency departments (FUED; 5 ED visits during the preceding 12 months) account for a disproportionate part of ED visits, causing a wide range of work difficulties to ED staff potentially leading to FUED discrimination. Whereas case management (CM) tailored to FUED leads to a reduction in ED visits, CM impact on ED staff has not been explored yet. This study aimed to compare ED staff perceptions of FUED with and without dedicated CM support.
Methods
Participants (N = 253) were ED staff (81 physicians; 172 nurses/assistant nurses) of two Swiss university hospitals, one with CM and one without CM support. Perceptions regarding FUED (i.e., knowledge and awareness of the issue extent; related work difficulties; FUEDs’ legitimate use of ED resources) were measured with a 25-item online survey (4 to 10-level Likert scales). Multivariable regression analyses were conducted to 1) explore the associations between CM implementation and FUED perceptions, and 2) test the moderating effect of profession (physician or nurse/nurse assistant) on these associations. All analyses were adjusted by gender and years of practical experience.
Results
Physicians with CM considered FUED as a less important problem (=.375, R2=.11, p <.05) and rated their knowledge of FUED issue higher (=.245, R2=.077, p <.05) compared to those without CM. In contrast, nurses without CM perceived fewer FUED-related work difficulties (i.e., feeling of failure and helplessness) than nurses with CM. (=-1.01, R2=.06, p <.05) No significant difference was found regarding ED staff’s perceptions of FUEDs’ legitimate use of ED resources and frequentation, nor on nurses’ knowledge of the issue.
Conclusions
These results suggest that CM intervention for FUED is a potential source of support for ED physicians working with FUED. Further qualitative research is needed to explore why nurses without CM support reported feeling less failure and helplessness regarding FUED.
Key messages
By highlighting a different impact of CM on nurses’ perception, this study illustrates where CM intervention might be improved. This study supports CM as a promising intervention for FUED by potentially having a positive impact on ED physicians’ perception besides the one previously proved on FUEDs’ number of visits and QOL.
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Affiliation(s)
- M von Allmen
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
| | - V Grazioli
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
- Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - M Kasztura
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
| | - M Lemoine
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
| | - O Chastonay
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
| | - O Hugli
- Emergency Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - J B Daeppen
- Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - P Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
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15
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Grazioli V, Kasztura M, Chastonay O, Graells M, Schmutz E, von Allmen M, Lemoine M, Daeppen JB, Hugli O, Bodenmann P. Healthcare providers’ perceptions of difficulties related to frequent users of emergency departments. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Frequent users of emergency department (FUEDs; ≥ 5 ED visits/ year) are often vulnerable individuals cumulating medical, social and substance use problems. FUEDs often require complex and sustained care coordination generally unavailable in ED and are commonly considered contributing to ED crowding. In view of supporting ED health-care providers through specific training and interventions tailored to FUEDs, this study aimed to explore ED healthcare providers’ perceptions of difficulties related to FUEDs.
Methods
Participants (N = 208) were ED healthcare providers (i.e., nurses, physicians) from 75 university and community hospitals in Switzerland (71% of all EDs) who answered a questionnaire on FUEDs. They were asked to indicate the extent to which FUEDs represent a problem in their ED. Perceived difficulties related to FUEDs were elicited by an open-ended question. Conventional content analysis was used to extract common categories and themes.
Results
Among the 208 participants, 134 (64%) reported that FUEDs represent a problem. Of those, 132 provided 1 to 5 answers to the open-ended question. Twenty-eight categories were identified and organized in 4 themes. First, participants reported difficulties related to FUEDs’ characteristics themselves (e.g., problem’s chronicity; behavioural difficulties) leading to healthcare complexity. Second, participants perceived negative consequences related to the presence of FUEDs in the ED (e.g., work overload, staff helplessness and fatigue). Third, ED healthcare offer was considered inappropriate and inefficient to respond to FUEDs needs and fourth collaborating with FUEDs’ existing healthcare network was perceived as difficult.
Conclusions
ED healthcare providers experience a wide range of difficulties related to the management of FUEDs. Providing training and implementing a case management intervention tailored to FUEDs might support ED health-care providers and contribute to address FUEDs’ complex needs.
Key messages
ED healthcare providers perceive FUEDs to represent a problem. Perceived difficulties might decrease through training and case management support might contribute to better address FUEDs complex needs.
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Affiliation(s)
- V Grazioli
- Center for General Medicine and Public Health, Department of Vulnerabilities and Social Medicine, Lausanne, Switzerland
- Addiction Medicine, Department of Psychiatry, Lausanne, Switzerland
| | - M Kasztura
- Center for General Medicine and Public Health, Department of Vulnerabilities and Social Medicine, Lausanne, Switzerland
| | - O Chastonay
- Center for General Medicine and Public Health, Department of Vulnerabilities and Social Medicine, Lausanne, Switzerland
| | - M Graells
- Center for General Medicine and Public Health, Department of Vulnerabilities and Social Medicine, Lausanne, Switzerland
| | - E Schmutz
- Center for General Medicine and Public Health, Department of Vulnerabilities and Social Medicine, Lausanne, Switzerland
| | - M von Allmen
- Center for General Medicine and Public Health, Department of Vulnerabilities and Social Medicine, Lausanne, Switzerland
| | - M Lemoine
- Center for General Medicine and Public Health, Department of Vulnerabilities and Social Medicine, Lausanne, Switzerland
| | - J-B Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne, Switzerland
| | - O Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - P Bodenmann
- Center for General Medicine and Public Health, Department of Vulnerabilities and Social Medicine, Lausanne, Switzerland
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16
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Corsico AG, D'Armini AM, Conio V, Sciortino A, Pin M, Grazioli V, Di Vincenzo G, Di Domenica R, Celentano A, Vanini B, Grosso A, Gini E, Albicini F, Merli VN, Ronzoni V, Ghio S, Klersy C, Cerveri I. Persistent exercise limitation after successful pulmonary endoarterectomy: frequency and determinants. Respir Res 2019; 20:34. [PMID: 30764853 PMCID: PMC6376724 DOI: 10.1186/s12931-019-1002-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/23/2018] [Accepted: 02/06/2019] [Indexed: 11/21/2022] Open
Abstract
Background After successful pulmonary endoarterectomy (PEA), patients may still suffer from exercise limitation, despite normal pulmonary vascular resistance. We sought to assess the proportion of these patients after the extension of PEA to frail patients, and the determinants of exercise limitation. Methods Out of 553 patients treated with PEA from 2008 to 2016 at our institution, a cohort of 261 patients was followed up at 12 months. They underwent clinical, haemodynamic, echocardiographic, respiratory function tests and treadmill exercise testing. A reduced exercise capacity was defined as Bruce test distance < 400 m. Results Eighty patients did not had exercise testing because of inability to walk on treadmill and/or ECG abnormalities Exercise limitation 12 months after PEA was present in 74/181 patients (41, 95%CI 34 to 48%). The presence of COPD was more than double in patients with exercise limitation than in the others. Patients with persistent exercise limitation had significantly higher mPAP, PVR, HR and significantly lower RVEF, PCa, CI, VC, TLC, FEV1, FEV1/VC, DLCO, HbSaO2 than patients without. The multivariable model shows that PCa at rest and TAPSE are important predictors of exercise capacity. Age, COPD, respiratory function parameters and unilateral surgery were also retained. Conclusions After successful PEA, most of the patients recovered good exercise tolerance. However, about 40% continues to suffer from limitation to a moderate intensity exercise. Besides parameters of right ventricular function, useful information are provided by respiratory function parameters and COPD diagnosis. This could be useful to better address the appropriate therapeutic approach. Electronic supplementary material The online version of this article (10.1186/s12931-019-1002-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Angelo G Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Viale Golgi 19, 27100, Pavia, Italy. .,Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
| | - Andrea M D'Armini
- Department of Cardio-Thoracic and Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Valentina Conio
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Viale Golgi 19, 27100, Pavia, Italy
| | - Antonio Sciortino
- Department of Cardio-Thoracic and Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Maurizio Pin
- Department of Cardio-Thoracic and Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Valentina Grazioli
- Department of Cardio-Thoracic and Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giulia Di Vincenzo
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Viale Golgi 19, 27100, Pavia, Italy
| | - Rita Di Domenica
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Viale Golgi 19, 27100, Pavia, Italy
| | - Anna Celentano
- Department of Cardio-Thoracic and Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Benedetta Vanini
- Department of Cardio-Thoracic and Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Viale Golgi 19, 27100, Pavia, Italy
| | - Erica Gini
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Viale Golgi 19, 27100, Pavia, Italy
| | - Federica Albicini
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Viale Golgi 19, 27100, Pavia, Italy
| | - Vera N Merli
- Department of Cardio-Thoracic and Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Vanessa Ronzoni
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Viale Golgi 19, 27100, Pavia, Italy
| | - Stefano Ghio
- Division of Cardiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Catherine Klersy
- Service of Biometrics and Statistics, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Isa Cerveri
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Viale Golgi 19, 27100, Pavia, Italy
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Marzouk M, Grazioli V, Mohammadi S, Dagenais F. Minimizing Atheromatous Emboli During Arch Surgery With a Sequential Debranching Procedure. Semin Thorac Cardiovasc Surg 2018; 31:66-68. [PMID: 30415027 DOI: 10.1053/j.semtcvs.2018.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/30/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Mohamed Marzouk
- Division of Cardiac Surgery, Quebec Heart & Lung University Institute, Quebec City, Quebec, Canada
| | - Valentina Grazioli
- Division of Cardiac Surgery, Quebec Heart & Lung University Institute, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Division of Cardiac Surgery, Quebec Heart & Lung University Institute, Quebec City, Quebec, Canada
| | - François Dagenais
- Division of Cardiac Surgery, Quebec Heart & Lung University Institute, Quebec City, Quebec, Canada.
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Merli VN, Dell'Oglio S, Grazioli V, Monterosso C, Vanini B, Gori M, Quarta G, D'Armini AM. Surgical Treatment for Pulmonary Embolization of a Right Atrial Myxoma. Ann Thorac Surg 2018; 107:e245-e246. [PMID: 30315803 DOI: 10.1016/j.athoracsur.2018.07.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
We report the case of a woman with pulmonary embolism due to a cardiac mass. Echocardiography, computed tomography scan, and cardiac magnetic resonance raised the suspicion of right atrial myxoma and confirmed the presence of pulmonary embolism. The patient was sent to the University of Pavia School of Medicine, where the atrial myxoma was excised, and, using interrupted periods of circulatory arrest, extraction of the myxoma emboli from the pulmonary arteries was performed. No adjuvant chemotherapy was required as surgical treatment is an effective therapy in cases of pulmonary embolism of a benign neoplastic mass.
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Affiliation(s)
- Vera N Merli
- Department of Cardiothoracic and Vascular Surgery, Foundation "I.R.C.C.S. Policlinico San Matteo," University of Pavia, School of Medicine, Pavia, Italy.
| | - Sonia Dell'Oglio
- Cardiovascular Department, A.S.S.T. Papa Giovanni XXIII, Bergamo, Italy
| | - Valentina Grazioli
- Department of Cardiothoracic and Vascular Surgery, Foundation "I.R.C.C.S. Policlinico San Matteo," University of Pavia, School of Medicine, Pavia, Italy
| | - Cristian Monterosso
- Department of Cardiothoracic and Vascular Surgery, Foundation "I.R.C.C.S. Policlinico San Matteo," University of Pavia, School of Medicine, Pavia, Italy
| | - Benedetta Vanini
- Department of Cardiothoracic and Vascular Surgery, Foundation "I.R.C.C.S. Policlinico San Matteo," University of Pavia, School of Medicine, Pavia, Italy
| | - Mauro Gori
- Cardiovascular Department, A.S.S.T. Papa Giovanni XXIII, Bergamo, Italy
| | - Giovanni Quarta
- Cardiovascular Department, A.S.S.T. Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea M D'Armini
- Department of Cardiothoracic and Vascular Surgery, Foundation "I.R.C.C.S. Policlinico San Matteo," University of Pavia, School of Medicine, Pavia, Italy
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19
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Pin M, Vanini B, Sciortino A, Grazioli V, Merli V, Celentano A, Parisi I, Klersy C, Silvaggio G, Monterosso C, Salati M, Pellegrini C, Cattadori B, D'Armini A. Pulmonary Endarterectomy: Relationship Between Total Reopened Branches and Outcomes. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Vanini B, Grazioli V, Sciortino A, Pin M, Merli VN, Celentano A, Parisi I, Klersy C, Petrucci L, Salati M, Politi P, D'Armini AM. Neuropsychological outcomes after pulmonary endarterectomy using moderate hypothermia and periodic circulatory arrest. J Heart Lung Transplant 2018; 37:860-864. [PMID: 29550147 DOI: 10.1016/j.healun.2018.02.007] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/10/2018] [Accepted: 02/14/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In this prospective, single-center, observational study, we investigated the association between repeated short periods of circulatory arrest with moderate hypothermia during pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and different neuropsychological dimensions. METHODS We examined 70 patients with CTEPH, >18 to 80 years of age, who had been treated with PEA. Neuropsychological testing was performed. RESULTS Learning ability and delayed memory remained well within the normal range for patients' age. We found a statistically significant post-surgical improvement in motor speed, which was accompanied by a better quality of life and reduced symptoms of depression and anxiety. CONCLUSION PEA with repeated short periods of circulatory arrest in CTEPH did not result in any neuropsychological complications and may even lead to post-surgical psychological improvements.
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Affiliation(s)
- Benedetta Vanini
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation IRCCS Policlinico San Matteo, Pavia, Italy; Department of Brain and Behavioral Sciences, Section of Psychiatry, University of Pavia, Pavia, Italy.
| | - Valentina Grazioli
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Sciortino
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Pin
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vera N Merli
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Celentano
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Parisi
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Service of Biometrics and Statistics, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lucia Petrucci
- Rehabilitation Unit, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Salati
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, Section of Psychiatry, University of Pavia, Pavia, Italy
| | - Andrea M D'Armini
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
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21
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D'Agostino C, Zonzin P, Enea I, Gulizia MM, Ageno W, Agostoni P, Azzarito M, Becattini C, Bongarzoni A, Bux F, Casazza F, Corrieri N, D'Alto M, D'Amato N, D'Armini AM, De Natale MG, Di Minno G, Favretto G, Filippi L, Grazioli V, Palareti G, Pesavento R, Roncon L, Scelsi L, Tufano A. ANMCO Position Paper: long-term follow-up of patients with pulmonary thromboembolism. Eur Heart J Suppl 2017; 19:D309-D332. [PMID: 28751848 PMCID: PMC5520763 DOI: 10.1093/eurheartj/sux030] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Venous thromboembolism (VTE), including pulmonary embolism and deep venous thrombosis, is the third most common cause of cardiovascular death. The management of the acute phase of VTE has already been described in several guidelines. However, the management of the follow-up (FU) of these patients has been poorly defined. This consensus document, created by the Italian cardiologists, wants to clarify this issue using the currently available evidence in VTE. Clinical and instrumental data acquired during the acute phase of the disease are the cornerstone for planning the FU. Acquired or congenital thrombophilic disorders could be identified in apparently unprovoked VTE during the FU. In other cases, an occult cancer could be discovered after a VTE. The main targets of the post-acute management are to prevent recurrence of VTE and to identify the patients who can develop a chronic thromboembolic pulmonary hypertension. Knowledge of pathophysiology and therapeutic approaches is fundamental to decide the most appropriate long-term treatment. Moreover, prognostic stratification during the FU should be constantly updated on the basis of the new evidence acquired. Currently, the cornerstone of VTE treatment is represented by both the oral and the parenteral anticoagulation. Novel oral anticoagulants should be an interesting alternative in the long-term treatment.
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Affiliation(s)
- Carlo D'Agostino
- Department of Cardiology, Cardiologia Ospedaliera, University General Hospital, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Pietro Zonzin
- Department of Cardiology, Presidio Ospedaliero, Rovigo, Italy
| | - Iolanda Enea
- Emergency Care Department, Anna e S. Sebastiano Hospital, Caserta, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Garibaldi Nesima Hospital, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy
| | - Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | | | | | - Cecilia Becattini
- Department of Internal and Vascular Medicine, Perugia General Hospital, Perugia, Italy
| | | | - Francesca Bux
- Coronary Care Unit, Department of Cardiology, Di Venere ASL Hospital, Bari, Italy
| | | | - Nicoletta Corrieri
- Department of Clinical Sciences and Community, University of Milan, Milan, Italy
| | - Michele D'Alto
- Cardiology SUN Department, Colli and Monaldi Hospital, Naples, Italy
| | - Nicola D'Amato
- Coronary Care Unit, Department of Cardiology, Di Venere ASL Hospital, Bari, Italy
| | - Andrea Maria D'Armini
- Cardio-Thoracic Surgery Department, University of Pavia, IRCCS Foundation San Matteo General Hospital, Pavia, Italy
| | | | | | - Giuseppe Favretto
- Cardiac Rehabilitation and Preventive Unit, High Specialization Rehabilitation Hospital, Motta di Livenza, Treviso, Italy
| | - Lucia Filippi
- Thoracic and Vascular Department, University of Padova, Cardiological Sciences, Padova, Italy
| | - Valentina Grazioli
- Cardio-Thoracic Surgery Department, University of Pavia, IRCCS Foundation San Matteo General Hospital, Pavia, Italy
| | - Gualtiero Palareti
- Angiology and Blood Coagulation Unit, S. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy
| | - Raffaele Pesavento
- Thoracic and Vascular Department, University of Padova, Cardiological Sciences, Padova, Italy
| | - Loris Roncon
- Cardiology Department, S. Maria della Misericordia Hospital, Rovigo, Italy
| | - Laura Scelsi
- Department of Cardiology, University of Pavia, IRCCS Foundation San Matteo General Hospital, Pavia, Italy
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Merli VN, Vistarini N, Grazioli V, Sciortino A, Pin M, Parisi I, D'Armini AM. Pavia Experience in Reoperative Pulmonary Endarterectomy. Semin Thorac Cardiovasc Surg 2017; 29:464-468. [DOI: 10.1053/j.semtcvs.2017.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2017] [Indexed: 11/11/2022]
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23
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Vistarini N, Morsolini M, Klersy C, Mattiucci G, Grazioli V, Pin M, Ghio S, D'Armini AM. Pulmonary endarterectomy in the elderly: safety, efficacy and risk factors. J Cardiovasc Med (Hagerstown) 2016; 17:144-51. [PMID: 26702594 DOI: 10.2459/jcm.0000000000000327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension, but there are few data in the literature about the results of this procedure in the elderly. In this study, we aimed to assess whether this type of surgery is effective and well tolerated for the elderly. METHODS A total of 264 consecutive patients who underwent PEA between January 2008 and December 2012 were reviewed. PEA was performed under cardiopulmonary bypass and hypothermic ventricular fibrillation, with the aorta left unclamped. The population was dichotomized according to age into the following two groups: below 70 years (n = 176, younger patients) and at least 70-year-olds (n = 88, elderly patients). Regression models were used to identify predictors of hospital mortality and postoperative adverse events, and their interaction with age was tested. RESULTS Hospital mortality was slightly, but not significantly higher in elderly patients (9.1 vs. 5.1%; P = 0.22). Effect modification by history of smoking and preoperative O2 therapy was present. The cumulative survival at 1, 2, and 4 years was 93, 92, and 91% among younger patients; and 88, 86, and 86% among older patients (P = 0.19). Clinical and hemodynamic improvement was similar in the two groups. CONCLUSION Despite a slightly higher short-term mortality, PEA is feasible and well tolerated for the vast majority of the elderly patients. Clinical and hemodynamic improvements are outstanding, with satisfactory long-term survival rates.
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Affiliation(s)
- Nicola Vistarini
- aDivision of Cardiac Surgery, Foundation 'I.R.C.C.S. Policlinico San Matteo', Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia School of MedicinebService of Biometrics & StatisticscDivision of Cardiology, Foundation 'I.R.C.C.S. Policlinico San Matteo', Pavia, Italy
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Secondino S, Grazioli V, Dore R, Callegari G, Paulli M, Pedrazzoli P, D'Armini A. Multimodal approach of pulmonary artery sarcoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw343.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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D'Agostino C, Zonzin P, Enea I, Gulizia MM, Ageno W, Agostoni P, Azzarito M, Becattini C, Bongarzoni A, Bux F, Casazza F, Corrieri N, D'Alto M, D'Amato N, D'Armini AM, De Natale MG, Di Minno G, Favretto G, Filippi L, Grazioli V, Palareti G, Pesavento R, Roncon L, Scelsi L, Tufano A. [ANMCO Position paper: Recommendations for the follow-up of patients with pulmonary thromboembolism]. G Ital Cardiol (Rome) 2016; 17:68S-109. [PMID: 27869893 DOI: 10.1714/2450.25670] [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: 06/06/2023]
Abstract
Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, is the third most common cause of cardiovascular death. The management of the acute phase of VTE is well described in several papers and guidelines, whereas the management of the follow-up of the patients affected from VTE is less defined. This position paper of the Italian Association of Hospital Cardiologists (ANMCO) tries to fill the gap using currently available evidence and the opinion of the experts to suggest the most useful way to manage patients in the chronic phase.The clinical and laboratory tests acquired during the acute phase of the disease drives the decision of the following period. Acquired or congenital thrombophilic factors may be identified to explain an apparently not provoked VTE. In some patients, a not yet clinically evident cancer could be the trigger of VTE and this could lead to a different strategy. The main target of the post-acute management is to prevent relapse of the disease and to identify those patients who could worsen or develop chronic thromboembolic pulmonary hypertension. The knowledge of the etiopathogenetic ground is important to address the therapeutic approach, choosing the best antithrombotic strategy and deciding how long therapy should last. During the follow-up period, prognostic stratification should be updated on the basis of new evidences eventually acquired.Treatment of VTE is mainly based on oral or parenteral anticoagulation. Oral direct inhibitors of coagulation represent an interesting new therapy for the acute and extended period of treatment.
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Affiliation(s)
- Carlo D'Agostino
- U.O.C. Cardiologia Ospedaliera, Azienda Ospedaliero-Universitaria Policlinico, Bari
| | | | - Iolanda Enea
- U.O.C. Medicina d'Urgenza, A.O.R.N. S. Anna e S. Sebastiano, Caserta
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Walter Ageno
- Dipartimento di Medicina Clinica e Sperimentale, Università dell'Insubria, Varese
| | | | | | - Cecilia Becattini
- Medicina Interna e Vascolare, Azienda Ospedaliera di Perugia, Perugia
| | | | - Francesca Bux
- U.O.C. Cardiologia-UTIC, Ospedale Di Venere ASL, Bari
| | | | - Nicoletta Corrieri
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi, Milano
| | - Michele D'Alto
- U.O.C. Cardiologia-SUN, A.O.R.N. dei Colli-A.O. Monaldi, Napoli
| | | | - Andrea Maria D'Armini
- Chirurgia Cardio-Toracica, Università degli Studi, Fondazione IRCSS Policlinico San Matteo, Pavia
| | | | - Giovanni Di Minno
- Centro per le Coagulopatie, Università degli Studi "Federico II", Napoli
| | - Giuseppe Favretto
- U.O. Cardiologia Riabilitativa e Preventiva, Ospedale Riabilitativo Alta Specializzazione, Motta di Livenza (TV)
| | - Lucia Filippi
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Università degli Studi, Padova
| | - Valentina Grazioli
- Chirurgia Cardio-Toracica, Università degli Studi, Fondazione IRCSS Policlinico San Matteo, Pavia
| | - Gualtiero Palareti
- Divisione di Angiologia e Malattie della Coagulazione, Policlinico S. Orsola-Malpighi, Università degli Studi, Bologna
| | - Raffaele Pesavento
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Università degli Studi, Padova
| | - Loris Roncon
- U.O.C. Cardiologia, Ospedale S. Maria della Misericordia, Rovigo
| | - Laura Scelsi
- S.C. Cardiologia, Fondazione IRCSS Policlinico San Matteo, Pavia
| | - Antonella Tufano
- Centro per le Coagulopatie, Università degli Studi "Federico II", Napoli
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Lencioni V, Grazioli V, Rossaro B, Bernabò P. Transcriptional profiling induced by pesticides employed in organic agriculture in a wild population of Chironomus riparius under laboratory conditions. Sci Total Environ 2016; 557-558:183-191. [PMID: 26994805 DOI: 10.1016/j.scitotenv.2016.03.062] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 06/05/2023]
Abstract
Copper (Cu) and azadirachtin (AZA-A+B) are pesticides allowed in organic agriculture whose environmental risk and toxicity for aquatic wildlife is only partially known. Reverse Transcription Polymerase Chain Reaction was used to assess the molecular effect of acute and short-term exposure (3, 24h) of Cu (0.01, 0.05, 1, 10, 25mgl(-1)) and AZA-A+B (0.2, 0.3, 0.4, 0.5, 1mgl(-1)) on the expression of five candidate genes (hsp70, hsc70, hsp40, hsp10 and cyP450) in a non-target species, Chironomus riparius. Fourth-instar larvae were collected from a mountain stream polluted by agricultural land run-off. All genes were responsive to both pesticides but each gene had a specific response to the different experimental concentrations and exposure times. A few similarities in transcriptional profiling were observed, such as a linear concentration-dependent response of hsp70 after 24h of exposure (at ≥1mgl(-1) of Cu and ≥0.2mgl(-1) of AZA-A+B) and an up-regulation regardless of the concentration of hsc70 after 24h of exposure (at ≥0mgl(-1) of Cu and ≥0.2mgl(-1) of AZA-A+B and the up-regulation of hsp70 after 3h of exposure at ~LC50 (Cu-LC50=26.1±2.5mgl(-1), AZA-A+B-LC50=1.1±0.2mgl(-1)). According to the results, hsp40, hsp10 and cyP450 may be defined as pesticide-dependent (i.e., hsp40 and hsp10 seemed to responded mainly to AZA-A+B and cyP450 to Cu), while hsc70 as time-dependent regardless of the pesticide (i.e., hsc70 responded only after 24h of treatment with Cu and AZA-A+B). This study gives new insights on the potential role of the C. riparius's hsps and cyP450 genes as sensitive biomarkers for freshwater monitoring.
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Affiliation(s)
- Valeria Lencioni
- Section of Invertebrate Zoology and Hydrobiology, MUSE-Museo delle Scienze, Corso del Lavoro e della Scienza 3, 38123 Trento, Italy.
| | - Valentina Grazioli
- Section of Invertebrate Zoology and Hydrobiology, MUSE-Museo delle Scienze, Corso del Lavoro e della Scienza 3, 38123 Trento, Italy; Department of Agrifood and Urban Systems Protection and Biodiversity Enhancement (DiPSA), University of Milan, Via Celoria 1, 20133 Milano, Italy
| | - Bruno Rossaro
- Department of Agrifood and Urban Systems Protection and Biodiversity Enhancement (DiPSA), University of Milan, Via Celoria 1, 20133 Milano, Italy
| | - Paola Bernabò
- Section of Invertebrate Zoology and Hydrobiology, MUSE-Museo delle Scienze, Corso del Lavoro e della Scienza 3, 38123 Trento, Italy; CNR-Institute of Biophysics, Via Sommarive 18, 38123 Povo (Trento), Italy.
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D’Armini AM, Morsolini M, Mattiucci G, Grazioli V, Pin M, Sciortino A, Arbustini E, Goggi C, Viganò M. Chronic thromboembolic pulmonary hypertension: From transplantation to distal pulmonary endarterectomy. J Heart Lung Transplant 2016; 35:827-31. [DOI: 10.1016/j.healun.2015.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 11/13/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022] Open
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Ghio S, Turco A, Klersy C, Scelsi L, Raineri C, Crescio V, Viscardi A, Grazioli V, Sciortino A, Oltrona Visconti L, D'Armini AM. Changes in surface electrocardiogram in patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy. Correlations with hemodynamic and echocardiographic improvements after surgery. J Electrocardiol 2016; 49:223-30. [PMID: 26850496 DOI: 10.1016/j.jelectrocard.2015.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 09/20/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the changes of electrocardiographic (ECG) markers of right ventricular (RV) hypertrophy/overload in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary endarterectomy (PEA). METHODS AND RESULTS We evaluated 99 CTEPH patients who underwent PEA. P wave amplitude in DII, R wave amplitude in V1 and the number of patients with negative T wave in V1-V3 decreased significantly at 1month after surgery with no further change at 1year, in parallel with the rapid improvement in right heart hemodynamics. S wave amplitude in V1, R:S wave ratio in lead V6 and prevalence of SIQIII pattern improved significantly at 1year, in parallel with the progressive reverse remodeling of the right ventricle at echocardiography. CONCLUSIONS The study shows that some of the ECG markers of RV hypertrophy/overload better reflect RV hemodynamic overload while others better reflect the pathologic remodeling of the right ventricle.
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Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
| | - Annalisa Turco
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Service of Biometrics & Statistics, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Claudia Raineri
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Valeria Crescio
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Arianna Viscardi
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Valentina Grazioli
- Unit of Cardiac Surgery, Cardiothoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Pavia, Italy
| | - Antonio Sciortino
- Unit of Cardiac Surgery, Cardiothoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Pavia, Italy
| | | | - Andrea Maria D'Armini
- Unit of Cardiac Surgery, Cardiothoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Pavia, Italy
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Pedrazzoli P, Secondino S, Grazioli V, Dore R, Pin M, Callegari G, Paulli M, D'Armini A. Treatment of pulmonary artery sarcoma (PAS): a single center experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv338.09] [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: 11/13/2022] Open
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Secondino S, Grazioli V, Dore R, Valentino F, Pin M, Callegari GC, Paulli M, Pedrazzoli P, D'Armini A. Multimodal treatment of pulmonary artery sarcoma: A single center experience. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.10552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Simona Secondino
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Grazioli
- Cardiothoracic Surgery, Fondazione IRCCS Policlinico San Matteo and Pavia University School of Medicine, Pavia, Italy
| | - Roberto Dore
- Division of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Maurizio Pin
- Cardiothoracic Surgery, Fondazione IRCCS Policlinico San Matteo and Pavia University School of Medicine, Pavia, Italy
| | | | - Marco Paulli
- Unit of Pathology, Fondazione IRCCS Policlinico San Matteo and Pavia University School of Medicine, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea D'Armini
- Cardiothoracic Surgery, Fondazione IRCCS Policlinico San Matteo and Pavia University School of Medicine, Pavia, Italy
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D'Armini AM, Morsolini M, Mattiucci G, Grazioli V, Pin M, Valentini A, Silvaggio G, Klersy C, Dore R. Pulmonary endarterectomy for distal chronic thromboembolic pulmonary hypertension. J Thorac Cardiovasc Surg 2014; 148:1005-11; 1012.e1-2; discussion 1011-2. [DOI: 10.1016/j.jtcvs.2014.06.052] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/17/2014] [Accepted: 06/27/2014] [Indexed: 11/27/2022]
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D’Armini A, Morsolini M, Mattiucci G, Grazioli V, Pin M, Valentini A, Goggi C, Dore R. Surgical Treatment of Chronic Thromboembolic Pulmonary Hypertension: from Transplantation to Endarterectomy. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Grazioli V, Vistarini N, Morsolini M, Klersy C, Orlandoni G, Dore R, D'Armini AM. Surgical treatment of primary pulmonary artery sarcoma. J Thorac Cardiovasc Surg 2013; 148:113-8. [PMID: 24075471 DOI: 10.1016/j.jtcvs.2013.07.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/16/2013] [Accepted: 07/26/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Primary pulmonary artery sarcoma is a severe and underdiagnosed disease, with the clinical and surgical approach not clearly established. Only a few individual case reports or small series on this topic have been published. The aim of the present study was to report our surgical experience in this field. METHODS From March 2004 to December 2012, 13 patients underwent surgery for pulmonary artery sarcoma at our institution. In 7 patients, the sarcoma was unilateral (53.8%), and in 6 (46.2%), the tumor had already extended to both lungs. The surgical strategy evolved over the years, but the 2 techniques used were always the same: pneumonectomy in 5 patients and pulmonary endarterectomy in 8. RESULTS Two patients died in-hospital, both in the pneumonectomy group. The median length of the intensive care unit and hospital stay was 1 day (range, 1-10) and 14 days (range, 11-17) for the pneumonectomy group and 6 days (range, 3-23) and 19 days (range, 10-32) fort the pulmonary endarterectomy group, respectively. The median survival was 26.8 months after pneumonectomy and 6.6 months after pulmonary endarterectomy. CONCLUSIONS Primary pulmonary artery sarcoma has a poor prognosis. The surgical strategy at our institution included pneumonectomy, for possible radical resection, and palliative endarterectomy, to reduce symptoms and increase the life expectancy. The correct surgical approach must be evaluated individually, according to the tumor presentation, the presence of pulmonary hypertension, and the patient's clinical condition.
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Affiliation(s)
- Valentina Grazioli
- Division of Cardiothoracic Surgery, IRCCS Policlinico San Matteo and Pavia University School of Medicine, Pavia, Italy
| | - Nicola Vistarini
- Division of Cardiothoracic Surgery, IRCCS Policlinico San Matteo and Pavia University School of Medicine, Pavia, Italy
| | - Marco Morsolini
- Division of Cardiothoracic Surgery, IRCCS Policlinico San Matteo and Pavia University School of Medicine, Pavia, Italy
| | - Catherine Klersy
- Service of Biometrics and Statistics, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulio Orlandoni
- Division of Cardiothoracic Surgery, IRCCS Policlinico San Matteo and Pavia University School of Medicine, Pavia, Italy
| | - Roberto Dore
- Division of Radiology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Maria D'Armini
- Division of Cardiothoracic Surgery, IRCCS Policlinico San Matteo and Pavia University School of Medicine, Pavia, Italy.
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Lodolo L, Bonfrate N, Canale C, Franzin L, Grazioli V, Mondino V, Rossi C. YERSINIA ENTEROCOLITICA: CASO DI BATTERIEMIA IN PAZIENTE TALASSEMICO. Microbiol Med 2006. [DOI: 10.4081/mm.2006.3153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Dalla Vestra M, Pozza G, Mosca A, Grazioli V, Lapolla A, Fioretto P, Crepaldi G. Effect of lercanidipine compared with ramipril on albumin excretion rate in hypertensive Type 2 diabetic patients with microalbuminuria: DIAL study (diabete, ipertensione, albuminuria, lercanidipina). Diabetes Nutr Metab 2004; 17:259-66. [PMID: 16295047] [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: 05/05/2023]
Abstract
Microalbuminuria and hypertension are risk factors for diabetic nephropathy in Type 2 diabetic patients. Recent data suggest that blockade of the renin-angiotensin system slows the progression of diabetic nephropathy; in contrast, the results on the renoprotective effect of calcium channel antagonists are conflicting. We evaluated the effectiveness of lercanidipine, in comparison with ramipril, on the reduction in albumin excretion rate (AER) and blood pressure in mild-to-moderate hypertensive patients with Type 2 diabetes and persistent microalbuminuria. A total of 277 patients were enrolled in a multicentric, randomized, double-blind, active-controlled, parallel-group trial; 180 were randomized to receive 10-20 mg/day of lercanidipine or 5-10 mg/day of ramipril and followed up for 9-12 months. The primary outcome was the change in AER from baseline. After 9-12 months of follow-up, a reduction in AER of -17.4+/-65 microg/min (p<0.05) and -19.7+/-52.5 (p<0.05) in the lercanidipine and ramipril group, respectively, was observed, without differences between the groups. A significant reduction in systolic and diastolic blood pressure was observed in both the lercanidipine and ramipril-based treatment groups (p<0.0001 for both). This study demonstrated that treatment with lercanidipine 10-20 mg/day does not worsen albuminuria in microalbuminuric Type 2 diabetic patients with hypertension. Indeed, both lercanidipine and ramipril treatments resulted in a significant reduction in AER without a statistically significant difference between the two groups.
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Affiliation(s)
- M Dalla Vestra
- Dipartimento di Scienze Mediche e Chirurgiche, Clinica Medica I, Università di Padova, Italy.
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Casari E, Ferrario A, Cristiano A, Grazioli V. RIVALUTAZIONE DELLA PREVALENZA DI GARDNERELLA,TRICHOMONAS VAGINALIS E CANDIDA NELL’ESSUDATO VAGINALE CON SONDE MOLECOLARI. Microbiol Med 2003. [DOI: 10.4081/mm.2003.4392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Gaetani P, Rodriguez y Baena R, Riva C, Messina AL, Tancioni F, Grazioli V. Collagenase-1 and stromelysin distribution in fresh human herniated intervertebral disc: a possible link to the in vivo inflammatory reactions. Neurol Res 1999; 21:677-81. [PMID: 10555191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Chondrocytes may play an important role in the inflammatory reactions involving intervertebral discs: the role of metalloproteases (MMP) and the imbalance between proteases and their inhibitors seems to play a crucial role in the disc degenerative process. In the present study we have analysed the production of collagenase-1 and stromelysin in different parts of herniated intervertebral discs. Ten samples of herniated lumbar discs were obtained from adult patients operated on for primary microdiscectomy because of persistent radicular symptoms and subdivided into three samples: 1. The nearest to the nerve root in close contact with it, 2. the sample obtained from the intervertebral space, and 3. the sample obtained from the vertebral plates. The DNA content of each specimen was measured in order to obtain the best estimate of the cell content as well as to normalise the content of collagenase-1 and stromelysin found in the same tissues with respect to the number of cells. In 9 out of the 10 cases the DNA content was significantly higher in samples obtained from the intervertebral plates than in samples obtained near the nerve root or the intervertebral space. DNA content did not show any significant difference considering disc samples contiguous to the nerve root and samples obtained from the intervertebral space. The production of collagenase-1 did not show a specific pattern, being produced in similar quantities in the three disc compartments. The production of stromelysin was significantly lower in disc samples obtained from the intervertebral plates. In conclusion the results of the present study suggest firstly that in the herniated lumbar disc the reactivity and the production of pro-inflammatory agents is independent of DNA content, i.e. the cellularity of the sample, and secondly that activated cells in the intervertebral space and in the part of the disc in contact with the nerve root, even if scarce in number, are able to synthesise a proportionally higher quantity of MMP than the high-cellular disc fragments from the intervertebral plates, potentially playing a specific role in the inflammatory reactions.
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Affiliation(s)
- P Gaetani
- Section of Neurosurgery, Istituto Clinico Humanitas, Rozzano, Milan, Italy
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Abstract
Recent studies have suggested that metalloproteinases (MMP) might be involved in the pathogenesis of cerebral aneurysm formation and rupture and that elevated serum levels of MMP may effectively be considered as possible markers of cerebrovascular malformations. The present study was planned in order to verify if serum levels of MMPs may be the mirror of the MMP activity in the wall of intracranial aneurysms, reflecting the predisposition to aneurysm development and/or rupture. A series of 84 patients operated for intracranial cerebrovascular lesions (63 aneurysms and 21 arterovenous malformations (AVM)) and 20 controls entered the study. Among the 63 cases of intracranial aneurysms, nine were discovered before rupture, while 54 patients were included after subarachnoid hemorrhage (SAH). Using radioimmunoassay, plasma elastase levels were measured in all cases, while in 25 cases, when aneurysmectomy was possible, the activity of elastase and collagenase were measured in aneurysm samples. Mean plasma elastase level in patients bearing both an intracranial aneurysm or an intracranial AVM was significantly higher than in controls, while there was no significant difference between plasmatic level of elastase in patients with aneurysms when compared with patients bearing an intracranial AVM; there was no significant difference between mean elastase level in patients who suffered SAH and patients bearing an intracranial unruptured aneurysm. The activity of elastase and collagenase measured in the aneurysm wall were significantly higher in cases of ruptured than in unruptured aneurysms. The present results show that plasmatic level of elastase does not reflect the activity of MMP as measured in the aneurysm wall and that the patterns of MMP activities measured in the aneurysm wall differ considerably at different stages of SAH. This suggests that local rather than systemic changes in metalloproteases activity might be involved in cerebral aneurysm formation and rupture.
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Affiliation(s)
- P Gaetani
- Section of Neurosurgery, Istituto Clinico Humanitas, Milan, Italy
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Gaetani P, Tartara F, Grazioli V, Tancioni F, Infuso L, Rodriguez y Baena R. Collagen cross-linkage, elastolytic and collagenolytic activities in cerebral aneurysms: a preliminary investigation. Life Sci 1998; 63:285-92. [PMID: 9698037 DOI: 10.1016/s0024-3205(98)00272-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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: 11/30/2022]
Abstract
The pathogenesis of aneurysms formation and rupture is not clearly understood and is undoubtedly a multifactorial event. It is generally accepted that the aneurysm arises from an interaction between structural weakness of arterial wall and hemodynamic factors. Previous studies suggested the possible role of collagenolytic and elastolytic activities in aneurysm development, leading to extracellular matrix alteration. The content of collagen 3-hydroxypiridinium cross-links and elastase and collagenase activities were measured in 12 samples of intracranial aneurysms and in control specimens obtained from temporal superficial arteries and from autoptic samples of Willis Circle. Collagen content is significantly lower in aneurysm than in autoptic control samples (p < 0.01). The total amount of cross-links is significantly lower in ruptured aneurysms than in unruptured and autoptic controls (p < 0.01). Collagenase and elastase activities are significantly increased in ruptured cerebral aneurysms versus unruptured aneurysms (p < 0.01). Linear regression shows that an inverse relationship exists between cross-links content and both elastolytic (p = 0.0032) and collagenolytic (p < 0.001) activities in aneurysmal samples. Multiple regression shows that collagenase has a more important statistic impact (p = 0.027) than elastase (p = 0.08). The results of the study supports the hypothesis that an imbalance of protease-antiprotease homeostasis with elevated collagenolytic and elastolytic activities may represent the predisposing condition leading to aneurysms rupture through collagen depauperation and reduced cross-linkage of collagen fibres.
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Affiliation(s)
- P Gaetani
- Section of Neurosurgery, Istituto Clinico Humanitas, Rozzano (Milan), Italy
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Grazioli V, Schiavo R, Casari E, Marzatico F, Rodriguez y Baena R, Gaetani P. Antioxidant enzymatic activities and lipid peroxidation in cultured human chondrocytes from vertebral plate cartilage. FEBS Lett 1998; 431:149-53. [PMID: 9708892 DOI: 10.1016/s0014-5793(98)00731-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In vitro models based on primary cultured human chondrocytes could be useful to study the ROS-mediated inflammatory processes that seem to involve chondrocytes in vivo. In this work, we studied the enzymatic antioxidative capability of human chondrocytes removed from vertebral plates during micro-discectomy and cultured 18 days, measuring total superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSHPx) activities. We also evaluated in the same cells the amount of malondialdehyde (MDA) in order to verify the effect of the variation of the cellular enzymatic antioxidative capability on the degree of membrane lipid peroxidation. Total SOD activity increased, even if not significantly, between the 12th and the 18th day. A significant variation of GSHPx (P<0.01) and of catalase (P<0.001) activity was observed between the 3rd and the 6th day with no further variation until the 18th day. A significant increase (P<0.001) of lipid peroxidation from the 3rd to the 18th day was also observed. These results seem to indicate that only fresh human cultured chondrocytes are suitable to study, through in vitro models, the in vivo behavior of the antioxidative status of these cells.
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Affiliation(s)
- V Grazioli
- Department of Laboratory Medicine, Istituto Clinico Humanitas, Rozzano, Italy.
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Gaetani P, Tartara F, Tancioni F, Rodriguez y Baena R, Casari E, Alfano M, Grazioli V. Deficiency of total collagen content and of deoxypyridinoline in intracranial aneurysm walls. FEBS Lett 1997; 404:303-6. [PMID: 9119084 DOI: 10.1016/s0014-5793(97)00149-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The tissue contents of total collagen and of 3-hydroxypyridinium cross-links, pyridinoline (PYD) and deoxypyridinoline (DPD), were measured in 15 samples of human aneurysms of Willis' Circle obtained at surgery and in 25 autopsy control samples of intracranial arteries of Willis' Circle obtained from 6 subjects who died of other causes than cerebral hemorrhage. PYD and DPD were detected fluorimetrically after HPLC separation. Total collagen content was significantly lower (P < 0.001) in aneurysm samples (mean +/- S.E.M. 2.50 +/- 0.33 nmol of alpha 1(I) collagen chain per mg of delipidated and dried material) than in controls (mean +/- S.E.M. 3.86 +/- 0.14). DPD, but not PYD, content appears to be lower in aneurysm walls. In the aneurysms, the tissue contents of PYD ranged from 212 to 587 pmol/nmol of alpha 1(I) collagen chain (mean +/- S.E.M. 430 +/- 31) while in control samples the values observed ranged from 292 to 642 (mean +/- S.E.M. 471 +/- 21). The tissue content of DPD was measurable only in 6 aneurysm samples (60%), ranging from 12 to 60 pmol/nmol of alpha 1(I) collagen chain (mean +/- S.E.M. 33 +/- 9), while in control samples, DPD content ranged from 30 to 123 (mean +/- S.E.M. 75 +/- 5).
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Affiliation(s)
- P Gaetani
- Department of Surgery, Neurosurgery Unit, IRCCS Policlinico S. Matteo, Pavia, Italy
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Gaetani P, Grazioli V, Tancioni F, Casari E, Tartara F, Rodriguez y Baena R. Abnormalities of collagen cross-linkage in posterior communicating artery aneurysms: a preliminary study. Neurol Res 1996; 18:541-5. [PMID: 8985955 DOI: 10.1080/01616412.1996.11740467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The collagen of tissues submitted to mechanical load (i.e. arterial wall) is characterised by the presence of intermolecular covalent cross-links (hydroxylysyl pyridinoline or pyridinoline: PYD; and lysyl-pyridinoline or deoxypyridinoline: DPD) which stabilise the molecular structure. In this preliminary study we look for quantitative or qualitative alterations of collagen cross-linkage in intracranial aneurysms of posterior communicating artery (PCoA) which may be considered a site of elective weakening in the intracranial arterial circulation, being one of the most frequent locations of intracranial aneurysms and of so called "infundibular widening'. We analysed the collagen cross-linkage in 6 autopsy samples of intracranial arterial segments of the Circle of Willis which were removed from patients whose cause of death was other than cerebral hemorrhage, and in 6 samples of intracranial PCoA aneurysms obtained at surgery. The analysis of cross-links showed that there was no significant difference in collagen and cross-link content between autopic and aneurysmatic samples except for PCoA. In autoptic nonaneurysmatic samples of PCoA a lower content of PYD than in internal carotid artery (ICA) and a lower content of DPD than in all other arterial segments has been demonstrated; moreover a lower content of cross-links (DPD + PYD/ Collagen) was evident in nonaneurysmatic PCoA samples when compared to other segments (ICA and Anterior Communicating Artery). On the other hand, the mean content of DPD was significantly lower in PCoA aneurysms than in nonaneurysmatic samples of the artery and moreover, a significantly low content of cross-links (DPD + PYD/Collagen) is overemphasised in PCoA aneurysms, suggesting that the peculiar lower content of DPD in PCoA arteries may be considered the expression of minor resistance of the arterial wall at this site, and may be related to the higher incidence of aneurysms or infundibular widening of this arterial segment.
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Affiliation(s)
- P Gaetani
- Department of Neurosurgery, IRCCS Policlinico S. Matteo, Pavia, Italy
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Grazioli V, Alfano M, Stenico A, Casari E. Urinary output of hydroxylysine glycosides and pyridinium cross-links in detecting rat bone collagen turnover rate. FEBS Lett 1996; 388:134-8. [PMID: 8690072 DOI: 10.1016/0014-5793(96)00505-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Glucosylgalactosylhydroxylysine (GGHYL), galactosylhydroxylysine (GHYL), pyridinoline (PYD) and deoxypyridinoline (DPD) were measured in the urine (6 h serial specimens over 96 and 24 h urine specimens for 4 days) collected from four adult Sprague Dawley rats and in the femoral and tibia] bone as well as in the dorsal skin of the same rats. No significant daily variations were found in the urine excretion of GGHYL, GHYL, PYD and DPD but significant diurnal variations. The GGHYL/GHYL ratio in rat urine (0.46 +/- 0.1) reflected neither the bone collagen ratio (1.9 to 2.4) nor the skin collagen ratio (1.22 +/- 1.07), a finding that may reflect GGHYL conversion into GHYL. The content of both pyridinolines was very low in the skin and high in the bone collagen and the urinary PYD/DPD ratio (1.46 +/- 0.15) reflected essentially the bone collagen ratio (0.8-3.0). These results suggest the usefulness of measuring GGHYL, GHYL, PYD and DPD in 24 h urine specimen and, based on the inter-animal variations, the necessity to consider each animal as its own control when bone turnover needs to be monitored.
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Affiliation(s)
- V Grazioli
- Istituto Scientifico H.S. Raffaele-DSNP, Laboratorio di Tecniche Separative Cromatografiche, Milan, Italy
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McSheehy PM, Coltro-Campi C, Grazioli V, Mena R, Soldini L, Zocchetti A, Clarke GD. Mitogenic stimulation of osteoblastic cells by IGF-I is increased by synchronisation of cells in G1-phase. Biochem Soc Trans 1995; 23:116S. [PMID: 7758678 DOI: 10.1042/bst023116s] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P M McSheehy
- Smithkline Beecham Farmaceutici SpA, Milan, Italy
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Alfano M, Casari E, Stenico A, Murone M, Grazioli V. Improved HPLC determination of urinary hydroxylysine glycosides to study turnover rate of bone in humans and rats. Clin Chem 1994; 40:2113-4. [PMID: 7955391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Alfano M, Casari E, Stenico A, Murone M, Grazioli V. Improved HPLC determination of urinary hydroxylysine glycosides to study turnover rate of bone in humans and rats. Clin Chem 1994. [DOI: 10.1093/clinchem/40.11.2113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Grazioli V, Casari E, Murone M, Bonini PA. High-performance liquid chromatographic method for measuring hydroxylysine glycosides and their ratio in urine as a possible marker of human bone collagen breakdown. J Chromatogr 1993; 615:59-66. [PMID: 8340463 DOI: 10.1016/0378-4347(93)80290-k] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Glucosyl-galactosyl-hydroxylysine (GGHYL) and galactosyl-hydroxylysine (GHYL) are constituents of collagen protein. The ratio of the two hydroxylysine glycosides varies with the collagen type and, moreover, for a given collagen type, it also varies according to the connective tissue. For example, in type I collagen (the most abundant in the body), the GGHYL/GHYL ratio tends to be greater in soft connective tissues and lower in bone. The hydroxylysine glycosides are not recycled during collagen turnover and are excreted in the urine. Therefore, the urinary GGHYL/GHYL ratio, which reflects the proportion of the two metabolites in the various collagens, may indicate the type of connective tissue affected by pathological turnover, and may thus be a promising marker of bone metabolism. In this paper a method is described for the measurement of urinary hydroxylysine glycosides by reversed-phase liquid chromatography after purification of the sample by solid-phase extraction. The method presented is analytically reliable and suitable for routine use in a clinical laboratory.
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Affiliation(s)
- V Grazioli
- Istituto Scientifico H. S. Raffaele-DSNP, Laboratorio di Tecniche Separative Cromatografiche, Milan, Italy
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Casari E, Ferrero CA, Grazioli V, Murone M. Performance of a modified HPLC method to determine total hydroxyprolinuria in 2-h urine samples. Clin Chem 1992; 38:2337-8. [PMID: 1424135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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