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Gauna C, Romeo F, Scatena A, Miranda C, Uccioli L, Vermigli C, Volpe A, Bordieri C, Tramonta R, Ragghianti B, Bandini G, Monami M, Monge L. Offloading systems for the treatment of neuropathic foot ulcers in patients with diabetes mellitus: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome. Acta Diabetol 2024; 61:693-703. [PMID: 38489054 DOI: 10.1007/s00592-024-02262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/17/2024] [Indexed: 03/17/2024]
Abstract
AIM To compare the effectiveness of commonly used offloading devices for the treatment of neuropathic foot ulcers in patients with diabetes mellitus. This meta-analysis (MA) has been performed for giving an answer to clinical questions on this topic of the Italian guideline on diabetic foot syndrome. METHODS The present MA includes randomized controlled studies (duration > 12 weeks) comparing, in patients with diabetes mellitus and non-infected neuropathic foot ulcer: any offloading device vs either no offloading device or conventional footwear; removable versus non-removable offloading devices; surgical procedure vs other offloading approaches. The primary endpoint was ulcer healing. RESULTS A total of 184 studies were identified, and 18 were considered eligible for the analysis. We found that: any plantar off-loading, when compared to the absence of plantar offloading device, is associated with a higher ulcer healing (MH-OR: 3.13 [1.08, 9.11], p = 0.04, I2 = 0%); total contact cast or nonremovable knee-high walker, compared to other offloading devices, had a higher ulcer healing rate (MH-OR: 2.64 [1.43, 4.89], p = 0.002, I2 = 51%); surgical offloading for active ulcers in combination with post-surgery offloading achieves higher ulcer healing rate when compared to offloading devices alone (MH-OR: 6.77 [1.64, 27.93], p = 0.008, I2 = 0%). CONCLUSIONS Any plantar offloading, compared to the absence of plantar offloading device, is associated with a higher ulcer healing rate. Total contact cast or nonremovable knee-high walker, compared to other offloading devices, is preferable. Surgical offloading for active ulcers, in combination with post-surgery offloading devices, achieves a higher ulcer healing rate when compared to other offloading devices alone. Further studies with a larger cohort of patients with diabetic neuropathic foot ulcers and extended follow-up periods are necessary.
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Affiliation(s)
- Carlotta Gauna
- Endocrinology and Metabolism, Azienda Sanitaria Locale Città di Torino, Turin, Italy.
| | - Francesco Romeo
- SC Territorial Diabetology, Azienda Sanitaria Locale Torino 5, Turin, Italy
| | | | | | | | - Cristiana Vermigli
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | | | | | | | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Giulia Bandini
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Matteo Monami
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Luca Monge
- AMD-Italian Association of Clinical Diabetologists, Rome, Italy
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Monami M, Scatena A, Miranda C, Monge L, De Cassai A, Volpe A, Tramonta R, Medea G, Bordieri C, Falcone M, Stefanon L, Bernetti A, Cappella C, Gargiulo M, Lorenzoni V, Scevola G, Stabile E, Ragghianti B, Silverii GA, da Ros R, Meloni M, Giurato L, Murdolo G, Bianchini E, Gaggia F, Gauna C, Romeo F, Apicella M, Mantuano M, Uccioli L, Vermigli C. Correction to: Development of the Italian clinical practice guidelines for the treatment of diabetic foot syndrome: design and methodological aspects. Acta Diabetol 2024; 61:807-808. [PMID: 38565687 DOI: 10.1007/s00592-024-02263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Matteo Monami
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy.
- University of Florence, Florence, Italy.
| | | | | | - Luca Monge
- AMD-Italian Association of Clinical Diabetologists, Milan, Italy
| | | | | | | | - Gerardo Medea
- SIMG-Italian Society of General Medicine, Florence, Italy
| | | | - Marco Falcone
- Cisanello Hospital and University of Pisa, Pisa, Italy
| | | | | | - Cristina Cappella
- Associazione di Volontariato Piede Diabetico Umbria ODV, Perugia, Italy
| | - Mauro Gargiulo
- University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy
| | | | - Roberto da Ros
- Azienda Sanitaria Universitaria Giuliana Isontina, Monfalcone, Italy
| | - Marco Meloni
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Laura Giurato
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Giuseppe Murdolo
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | - Eleonora Bianchini
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | - Francesco Gaggia
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | | | | | | | | | - Luigi Uccioli
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Cristiana Vermigli
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
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Meloni M, Giurato L, Monge L, Miranda C, Scatena A, Ragghianti B, Silverii GA, Vermigli C, De Cassai A, Volpe A, Tramonta R, Medea G, Bordieri C, Falcone M, Stefanon L, Bernetti A, Cappella C, Gargiulo M, Lorenzoni V, Scevola G, Stabile E, Da Ros R, Murdolo G, Bianchini E, Gaggia F, Gauna C, Romeo F, Apicella M, Mantuano M, Monami M, Uccioli L. Effect of a multidisciplinary team approach in patients with diabetic foot ulcers on major adverse limb events (MALEs): systematic review and meta-analysis for the development of the Italian guidelines for the treatment of diabetic foot syndrome. Acta Diabetol 2024; 61:543-553. [PMID: 38461443 DOI: 10.1007/s00592-024-02246-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024]
Abstract
The treatment of patients with diabetic foot ulcers (DFUs) is extremely complex, requiring a comprehensive approach that involves a variety of different healthcare professionals. Several studies have shown that a multidisciplinary team (MDT) approach is useful to achieve good clinical outcomes, reducing major and minor amputation and increasing the chance of healing. Despite this, the multidisciplinary approach is not always a recognized treatment strategy. The aim of this meta-analysis was to assess the effects of an MDT approach on major adverse limb events, healing, time-to-heal, all-cause mortality, and other clinical outcomes in patients with active DFUs. The present meta-analysis was performed for the purpose of developing Italian guidelines for the treatment of diabetic foot with the support of the Italian Society of Diabetology (Società Italiana di Diabetologia, SID) and the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD). The study was performed using the Grading of Recommendations Assessment, Development, and Evaluation approach. All randomized clinical trials and observational studies, with a duration of at least 26 weeks, which compared the MDT approach with any other organizational strategy in the management of patients with DFUs were considered. Animal studies were excluded. A search of Medline and Embase databases was performed up until the May 1st, 2023. Patients managed by an MDT were reported to have better outcomes in terms of healing, minor and major amputation, and survival in comparison with those managed using other approaches. No data were found on quality of life, returning-to-walking, and emergency admission. Authors concluded that the MDT may be effective in improving outcomes in patients with DFUs.
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Affiliation(s)
- Marco Meloni
- Department of Systems of Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | - Laura Giurato
- Department of Endocrinology and Diabetology, CTO Hospital, 00145, Rome, Italy
| | - Luca Monge
- AMD-Italian Association of Clinical Diabetologists, Milan, Italy
| | | | | | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy
| | | | - Cristiana Vermigli
- Azienda Ospedaliera Santa Maria Della Misericordia, Ospedale Di Perugia, Perugia, Italy
| | | | | | | | - Gerardo Medea
- SIMG- Italian Society of General Medicine, Florence, Italy
| | | | - Marco Falcone
- Cisanello Hospital and University of Pisa, Pisa, Italy
| | | | | | - Cristina Cappella
- Associazione Di Volontariato Piede Diabetico Umbria ODV, Perugia, Italy
| | - Mauro Gargiulo
- University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Roberto Da Ros
- Azienda Sanitaria Universitaria Giuliana Isontina, Monfalcone, Italy
| | - Giuseppe Murdolo
- Azienda Ospedaliera Santa Maria Della Misericordia, Ospedale Di Perugia, Perugia, Italy
| | - Eleonora Bianchini
- Azienda Ospedaliera Santa Maria Della Misericordia, Ospedale Di Perugia, Perugia, Italy
| | - Francesco Gaggia
- Azienda Ospedaliera Santa Maria Della Misericordia, Ospedale Di Perugia, Perugia, Italy
| | | | | | | | | | - Matteo Monami
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy
| | - Luigi Uccioli
- Department of Systems of Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
- Department of Endocrinology and Diabetology, CTO Hospital, 00145, Rome, Italy
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Fadini GP, Buzzetti R, Pitocco D, Tortato E, Scatena A, Lamacchia O, Lastoria G, Simoni L, Consoli A. IDegLira for the real-world treatment of type 2 diabetes in Italy. Final results from the REX observational study. Diabetes Obes Metab 2024; 26:1746-1756. [PMID: 38327240 DOI: 10.1111/dom.15486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
AIM The study was designed to generate real-world evidence on IDegLira in the Italian clinical practice in two groups of patients with type 2 diabetes (T2D), switching to IDegLira either from a basal only (basal group) or basal-bolus insulin regimen (BB group). MATERIALS AND METHODS This was a non-interventional, multicentre, single-cohort, prospective study assessing the long-term glycaemic control in patients with T2D, who switched to IDegLira from a basal insulin ± glucose-lowering medication regimen with or without a bolus insulin component for approximately 18 months, conducted in 28 Italian diabetes centres. The primary endpoint was the change in glycated haemoglobin (HbA1c) levels from baseline to 6 months after IDegLira initiation. RESULTS The study included 358 patients with a mean age 67.2 years and diabetes duration of 15.7 years. HbA1c significantly decreased from IDegLira start to all study time points in the overall population (basal group -1.19%; BB group -0.60% at the end of observation). Patients achieving HbA1c <7% levels increased from 12.9% (n = 43) to 40.3% (n = 110) at 18 months. Fasting blood glucose and body weight also significantly decreased in both groups, although more in the BB group. Overall, 14.3% of completed patients had an intensification of treatment (mainly in the basal group) and 48.6% had a simplification of treatment (mainly in the BB group). CONCLUSIONS Switching to IDegLira in a real-world clinical setting is a valid therapeutic option for patients with T2D with inadequate glycaemic control on basal or BB insulin regimen and/or need to simplify their insulin therapy, with specific reasons and therapeutic goals according to different T2D management trajectories.
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Affiliation(s)
- Gian Paolo Fadini
- Department of Medicine, University of Padova, Padua, Italy
- Division of Metabolic Diseases, Padova Hospital, Padua, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Dario Pitocco
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Tortato
- Metabolic Diseases and Diabetology Department, IRCCS INRCA, Ancona, Italy
| | | | - Olga Lamacchia
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giusi Lastoria
- Clinical Medical & Regulatory Department, Novo Nordisk SpA, Rome, Italy
| | - Lucia Simoni
- Medineos Observational Research, an IQVIA Company, Modena, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences (DMSI) and Center for Advanced Studies and Technology (CAST), University G. D'Annunzio, Chieti, Italy
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Monami M, Silverii A, Miranda C, Monge L, Uccioli L, Scevola G, Stabile E, Gargiulo M, Scatena A, Ragghianti B, Vermigli C. Prostanoids in patients with diabetes and chronic limb-threatening ischemia: a meta-analysis of randomized clinical trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome. Acta Diabetol 2024:10.1007/s00592-024-02260-x. [PMID: 38563995 DOI: 10.1007/s00592-024-02260-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/11/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Matteo Monami
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy.
- Diabetology, Careggi Hospital, Largo Brambilla 3, 50141, Florence, Italy.
| | - Antonio Silverii
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | | | - Luca Monge
- AMD - Italian Association of Clinical Diabetologists, Rome, Italy
| | - Luigi Uccioli
- Diabetes Section CTO Hospital and Dept of Biomedicine and Prevention Tor Vergata, University of Rome, Rome, Italy
| | | | | | - Mauro Gargiulo
- Vascular Surgery, University of Bologna - DIMEC, Bologna, Italy
- Vascular Surgery Unit, IRCCS, University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Alessia Scatena
- San Donato Hospital, Health Authorities South East Tuscany, Arezzo, Italy
| | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
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Scatena A, Apicella M, Mantuano M, Liistro F, Ventoruzzo G, Petruzzi P, Miranda C, Monge L, Ragghianti B, Silverii A, Ferraro I, Uccioli L, Vermigli C, Mannucci E, Scevola G, Stabile E, Gargiulo M, Monami M. Bypass surgery versus endovascular revascularization for occlusive infrainguinal peripheral artery disease: a meta-analysis of randomized controlled trials for the development of the Italian Guidelines for the treatment of diabetic foot syndrome. Acta Diabetol 2024; 61:19-28. [PMID: 37792028 DOI: 10.1007/s00592-023-02185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/11/2023] [Indexed: 10/05/2023]
Abstract
To report a review and meta-analysis of all randomized controlled trials (RCTs) comparing bypass surgery (BS) and endovascular treatment (ET) in infrainguinal peripheral arterial disease (PAD) for several endpoints, such as major and minor amputation, major adverse limb events (MALEs), ulcer healing, time to healing, and all-cause mortality to support the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome (DFS). A MEDLINE and EMBASE search was performed to identify RCTs, published since 1991 up to June 21, 2023, enrolling patients with lower limb ischemia due to atherosclerotic disease (Rutherford I-VI). Any surgical BS or ET was allowed, irrespective of the approach, route, or graft employed, from iliac to below-the-knee district. Primary endpoint was major amputation rate. Secondary endpoints were amputation-free survival major adverse limb events (MALEs), minor amputation rate, all-cause mortality, ulcer healing rate, time to healing, pain, transcutaneous oxygen pressure (TcPO2) or ankle-brachial index (ABI), quality of life, need for a new procedure, periprocedural serious adverse events (SAE; within 30 days from the procedure), hospital lenght of stay, and operative time. Twelve RCTs were included, one enrolled two separate cohorts of patients, and therefore, the studies included in the analyses were 13. Participants treated with ET had a similar rate of major amputations to participants treated with BS (MH-OR 0.85 [0.60, 1.20], p = 0.36); only one trial reported separately data on patients with diabetes (N = 1), showing no significant difference between ET and BS (MH-OR: 0.67 [0.09, 5.13], p = 0.70). For minor amputation, no between-group significant differences were reported: MH-OR for ET vs BS: 0.83 [0.21, 3.30], p = 0.80). No significant difference in amputation-free survival between the two treatment modalities was identified (MH-OR 0.94 [0.59, 1.49], p = 0.80); only one study reported subgroup analyses on diabetes, with a non-statistical trend toward reduction in favor of ET (MH-OR 0.62 [0.37, 1.04], p = 0.07). No significant difference between treatments was found for all-cause mortality (MH-OR for ET vs BS: 0.98 [0.80, 1.21], p = 0.88). A significantly higher rate of MALE was reported in participants treated with ET (MH-OR: 1.44 [1.05, 1.98], p = 0.03); in diabetes subgroup analysis showed no differences between-group for this outcome (MH-OR: 1.34 [0.76, 2.37], p = 0.30). Operative duration and length of hospital stay were significantly shorter for ET (WMD: - 101.53 [- 127.71, - 75.35] min, p < 0.001, and, - 4.15 [- 5.73, - 2.57] days, p < 0.001 =, respectively). ET was associated with a significantly lower risk of any SAE within 30 days in comparison with BS (MH-OR: 0.60 [0.42, 0.86], p = 0.006). ET was associated with a significantly higher risk of reintervention (MH-OR: 1.57 [1.10, 2.24], p = 0.01). No significant between-group differences were reported for ulcer healing (MH-OR: 1.19 [0.53, 2.69], p = 0.67), although time to healing was shorter (- 1.00 [0.18, 1.82] months, p = 0.02) with BS. No differences were found in terms of quality of life and pain. ABI at the end of the study was reported by 7 studies showing a significant superiority of BS in comparison with ET (WMD: 0.09[0.02; 0.15] points, p = 0.01). The results of this meta-analysis showed no clear superiority of either ET or BS for the treatment of infrainguinal PAD also in diabetic patients. Further high-quality studies are needed, focusing on clinical outcomes, including pre-planned subgroup analyses on specific categories of patients, such as those with diabetes and detailing multidisciplinary team approach and structured follow-up.
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Affiliation(s)
- Alessia Scatena
- San Donato Hospital, Arezzo, Health Authorities South East Tuscany, Italy, Via Pietro Nenni, 20, 52100, Arezzo, Italy.
| | - Matteo Apicella
- San Donato Hospital, Arezzo, Health Authorities South East Tuscany, Italy, Via Pietro Nenni, 20, 52100, Arezzo, Italy
| | - Michele Mantuano
- San Donato Hospital, Arezzo, Health Authorities South East Tuscany, Italy, Via Pietro Nenni, 20, 52100, Arezzo, Italy
| | - Francesco Liistro
- San Donato Hospital, Arezzo, Health Authorities South East Tuscany, Italy, Via Pietro Nenni, 20, 52100, Arezzo, Italy
| | - Giorgio Ventoruzzo
- San Donato Hospital, Arezzo, Health Authorities South East Tuscany, Italy, Via Pietro Nenni, 20, 52100, Arezzo, Italy
| | - Pasquale Petruzzi
- San Donato Hospital, Arezzo, Health Authorities South East Tuscany, Italy, Via Pietro Nenni, 20, 52100, Arezzo, Italy
| | | | - Luca Monge
- AMD - Italian Association of Clinical Diabetologists, Rome, Italy
| | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Antonio Silverii
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | | | - Luigi Uccioli
- Diabetes Section CTO Hospital and Dept of Biomedicine and Prevention Tor Vergata, University of Rome, Rome, Italy
| | | | - Edoardo Mannucci
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | | | | | - Mauro Gargiulo
- Vascular Surgery, University of Bologna - DIMEC, Bologna, Italy
- Vascular Surgery Unit, IRCCS, University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Matteo Monami
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
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Monami M, Scatena A, Miranda C, Monge L, De Cassai A, Volpe A, Tramonta R, Medea G, Bordieri C, Falcone M, Stefanon L, Bernetti A, Cappella C, Gargiulo M, Lorenzoni V, Scevola G, Stabile E, Ragghianti B, Silverii GA, da Ros R, Meloni M, Giurato L, Murdolo G, Bianchini E, Gaggia F, Gauna C, Romeo F, Apicella M, Mantuano M, Uccioli L, Vermigli C. Development of the Italian clinical practice guidelines for the treatment of diabetic foot syndrome: design and methodological aspects. Acta Diabetol 2023; 60:1449-1469. [PMID: 37491605 DOI: 10.1007/s00592-023-02150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 07/27/2023]
Abstract
AIMS Diabetic foot syndrome (DFS) and its complications are a growing public health concern. The Italian Society of Diabetology (SID) and the Italian Association of Clinical Diabetologists (AMD), in collaboration with other scientific societies, will develop the first Italian guidelines for the treatment of DFS. METHODS The creation of SID/AMD Guidelines is based on an extended work made by 19 panelists and 12 members of the Evidence Review Team. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology has been used to decide aims, reference population, and target health professionals. Clinical questions have been created using PICO (Patient, Intervention, Comparison, Outcome) conceptual framework. The definition of questions has been performed using a two-step web-based Delphi methodology, a structured technique aimed at obtaining by repeated rounds of questionnaires a consensus opinion from a panel of experts in areas wherein evidence is scarce or conflicting, and opinion is important. RESULTS The mean age of panelists (26.3% women) was 53.7 ± 10.6 years. The panel proposed 34 questions. A consensus was immediately reached for all the proposed questions, 32 were approved and 2 were rejected. CONCLUSIONS The areas covered by clinical questions included diagnosis of ischemia and infection, treatment of ischemic, neuropathic, and infected ulcers, prevention of foot ulceration, organization and education issues, and surgical management. The PICO presented in this paper are designed to provide indications for healthcare professionals in charge of diabetic foot treatment and prevention, primarily based on clinical needs of people with diabetic foot syndrome and considering the existing organization of health care.
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Affiliation(s)
- Matteo Monami
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy.
- University of Florence, Florence, Italy.
| | | | | | - Luca Monge
- AMD-Italian Association of Clinical Diabetologists, Milan, Italy
| | | | | | | | - Gerardo Medea
- SIMG-Italian Society of General Medicine, Florence, Italy
| | | | - Marco Falcone
- Cisanello Hospital and University of Pisa, Pisa, Italy
| | | | | | - Cristina Cappella
- Associazione di Volontariato Piede Diabetico Umbria ODV, Perugia, Italy
| | - Mauro Gargiulo
- University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy
| | | | - Roberto da Ros
- Azienda Sanitaria Universitaria Giuliana Isontina, Monfalcone, Italy
| | - Marco Meloni
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Laura Giurato
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Giuseppe Murdolo
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | - Eleonora Bianchini
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | - Francesco Gaggia
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | | | | | | | | | - Luigi Uccioli
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Cristiana Vermigli
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
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Ventoruzzo G, Mazzitelli G, Ruzzi U, Liistro F, Scatena A, Martelli E. Limb Salvage and Survival in Chronic Limb-Threatening Ischemia: The Need for a Fast-Track Team-Based Approach. J Clin Med 2023; 12:6081. [PMID: 37763021 PMCID: PMC10531516 DOI: 10.3390/jcm12186081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Chronic limb-threatening ischemia (CLTI) represents the end-stage form of peripheral arterial disease (PAD) and is associated with a very poor prognosis and high risk of limb loss and mortality. It can be considered very similar to a terminal cancer disease, reflecting a large impact on quality of life and healthcare costs. The aim of this study is to offer an overview of the relationship between CLTI, limb salvage, and mortality, with a focus on the need of a fast-track team-based management that is a driver to achieve better survival results. This review can be useful to improve management of this growing impact disease, and to promote the standardisation of care and communication between specialist and non-specialist healthcare professionals.
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Affiliation(s)
- Giorgio Ventoruzzo
- Vascular and Endovascular Surgery Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy; (G.M.); (U.R.)
| | - Giulia Mazzitelli
- Vascular and Endovascular Surgery Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy; (G.M.); (U.R.)
| | - Umberto Ruzzi
- Vascular and Endovascular Surgery Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy; (G.M.); (U.R.)
| | - Francesco Liistro
- Interventional Cardiology Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy;
| | - Alessia Scatena
- Diabetology Unit, San Donato Hospital Arezzo, Local Health Authorities South East Tuscany, 52100 Arezzo, Italy;
| | - Eugenio Martelli
- Department of General and Specialist Surgery, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 155 Viale del Policlinico, 00161 Rome, Italy;
- Medicine and Surgery School of Medicine, Saint Camillus International University of Health Sciences, 8 Via di Sant’Alessandro, 00131 Rome, Italy
- Division of Vascular Surgery, Department of Cardiovascular Sciences, S. Anna and S. Sebastiano Hospital, Via F. Palasciano, 81100 Caserta, Italy
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9
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Di Lullo L, Lavalle C, Scatena A, Mariani MV, Ronco C, Bellasi A. Finerenone: Questions and Answers-The Four Fundamental Arguments on the New-Born Promising Non-Steroidal Mineralocorticoid Receptor Antagonist. J Clin Med 2023; 12:3992. [PMID: 37373685 PMCID: PMC10299719 DOI: 10.3390/jcm12123992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/03/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic kidney disease (CKD) is one of the most common complications of diabetes mellitus and an independent risk factor for cardiovascular disease. Despite guideline-directed therapy of CKD in patients with type 2 diabetes, the risk of renal failure and cardiovascular events still remains high, and diabetes remains the leading cause of end-stage kidney disease in affected patients. To date, current medications for CKD and type 2 diabetes mellitus have not reset residual risk in patients due to a high grade of inflammation and fibrosis contributing to kidney and heart disease. This question-and-answer-based review will discuss the pharmacological and clinical differences between finerenone and other mineralocorticoid receptor antagonists and then move on to the main evidence in the cardiovascular and renal fields, closing, finally, on the potential role of therapeutic combination with sodium-glucose cotransporter 2 inhibitors (SGLT2is).
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Affiliation(s)
- Luca Di Lullo
- Department of Nephrology and Dialysis, L. Parodi—Delfino Hospital, 00034 Colleferro, Italy
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (M.V.M.)
| | | | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.L.); (M.V.M.)
| | - Claudio Ronco
- International Renal Research Institute (IRRIV), S. Bortolo Hospital, 36100 Vicenza, Italy
| | - Antonio Bellasi
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland;
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10
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Lazzari J, Scatena A, Milone V, Ferrara M. The evolution of the autopsy over the years. Clin Ter 2022; 173:301-303. [PMID: 35857045 DOI: 10.7417/ct.2022.2437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Autopsy has played an extremely important role in both the forensic and clinical fields for many years. In recent years, clinical autopsy has become less important, but today, thanks to the pandemic, this importance has been rediscovered. Conversely, forensic autopsy has never lost its importance, but it would need to be updated.
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Affiliation(s)
- J Lazzari
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - A Scatena
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - V Milone
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - M Ferrara
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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11
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Costantino A, Manetti AC, Baronti A, Scatena A, Visi G, Mezzetti E, David MC, De Matteis A, Maiese A. Abuse and misuse of prescription opioids: is it only an Ameri- can problem? An observational study on an Italian casuistry. Clin Ter 2022; 173:56-63. [PMID: 35147655 DOI: 10.7417/ct.2022.2393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Medical use of prescription opioids has steadily increased since the 1990s, particularly in the U.S.A. and Canada, along with abuse of these substances and significant increases in rates of addiction and death related to prescription opioids. The American authorities speak of an "addiction epidemic" and are launching a series of countermeasures to better address the problem. In Europe, there is an increasing use of prescription opioids and related problems, but the European context is much less dramatic than the American and Canadian ones. Never-theless, based on the data, it cannot be ruled out that a similar crisis will occur on the Old Continent. The aim of this study is to analyze the Italian context to better understand whether there is a possibility of an addiction epidemic. Twenty-four cases of death of people under treatment with pre-scription opioids have been retrospectively analyzed. Toxicological samples were collected with routine methods during the autopsy, followed by systematic screening for substances by diverse methods. Volatile compounds were identified using gas chromatography-flame ionization detection (GC-FID). Medical drugs and drugs of abuse were identified via the use of gas chromatography-mass spectrome-try (GC-MS) and liquid chromatography-tandem mass spectrometry (LC-MS-MS). Of a total of 24 subjects, 14 died due to an overdose of Tramadol, while 7 died due to an overdose of Buprenorphine and 3 dues to a Fentanyl overdose. The most used drug was Tramadol. Histological examination was performed with hematoxylin/eosin staining, though no significant findings emerged apart from widespread edema and focal sclerosis of the myocardium, and interstitial and alveolar edema of the lungs. Our data show that attention must be paid to prescription opioids. European institutions, as soon as possible, must implement preventive measures that avoid the recurrence of the North American situation.
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Affiliation(s)
- A Costantino
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| | - A C Manetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| | - A Baronti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| | - A Scatena
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| | - G Visi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| | - E Mezzetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
| | | | - A De Matteis
- Department of Anatomical, Histological, Forensic and OrthopedicSciences, Sapienza University of Rome, Rome (RM), Italy
| | - A Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa (PI), Italy
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12
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Pintaudi B, Scatena A, Piscitelli G, Frison V, Corrao S, Manicardi V, Graziano G, Chiara Rossi M, Gallo M, Mannino D, Nicolucci A, Di Bartolo P. Clinical profiles and quality of care of adults with type 1 diabetes according to their cardiovascular Risk: A Multicenter, Observational, retrospective study. Diabetes Res Clin Pract 2021; 182:109131. [PMID: 34762997 DOI: 10.1016/j.diabres.2021.109131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
AIMS The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 1 diabetes (T1D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care. METHODS The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD (Associazione Medici Diabetologi) Annals initiative. Patients with T1D were stratified by cardiovascular risk. Measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment, and overall quality of care were evaluated. RESULTS Overall, 29.368 subjects with type 1 diabetes (64.7% at very high cardiovascular risk, 28.5% at high risk and 6.8% at moderate risk) were evaluated. A lack of use of drugs in case of high values and an inadequate control despite the antihypertensive and lipid-lowering treatment was recognized. The overall quality of care tended to be lower as the level of cardiovascular risk increased. CONCLUSION A large proportion of subjects with T1D is at high or very high risk. Antihypertensive and lipid-lowering treatment seem not adequately used. Several actions are necessary to improve the quality of care.
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Affiliation(s)
| | | | | | - Vera Frison
- Internal Medicine and Diabetology Service, ULSS6, Cittadella, Italy
| | - Salvatore Corrao
- Department of Internal Medicine, ARNAS Civico Benfratelli Hospital, University of Palermo, Palermo, Italy
| | - Valeria Manicardi
- Diabetes Clinic, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Giusi Graziano
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Pescara, Italy
| | - Maria Chiara Rossi
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Pescara, Italy
| | - Marco Gallo
- AOU Città Della Salute E Della Scienza, Molinette Hospital, Torino, Italy
| | | | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Pescara, Italy.
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13
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Liistro F, Angioli P, Reccia MR, Ducci K, Falsini G, Pieroni M, Ventoruzzo G, Scatena A, Bolognese L. Long-term mortality in patients undergoing lower-limb revascularization with Paclitaxel eluting devices. Int J Cardiol 2021; 339:150-157. [PMID: 34216710 DOI: 10.1016/j.ijcard.2021.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/13/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Paclitaxel-eluting devices (PED) reduce restenosis and target lesion revascularization (TLR) in femoropopliteal intervention. Recent data suggest a two-fold increased long-term mortality in patients treated with PED. The aim of our study is to evaluate if endovascular therapy (EVT) with PED increases mortality risk in patients with symptomatic lower limb peripheral artery disease (PAD) compared to non-eluting devices (NED). METHODS The study is a retrospective, single-center registry on patients undergoing EVT for PAD from January 2009 to June 2018. Propensity score analysis on logistic regression model for independent predictors of long-term mortality was used to match PED and NED patients. Mortality was assessed at 2, 5 and 7 years in the entired matched population and in a sub-group of patients ≤75 years. RESULTS During the study period, 1294 patients, 718 NED and 576 PED, met the inclusion/exclusion criteria and entered in the study. Propensity score matching analysis identified 854 matched patients, 414 PED and 440 NED. The population was mainly characterized by diabetic patients with CLI (80%) and high prevalence of CAD (30%), heart failure (15%) and renal insufficiency (20%). Mean follow-up length was 58 ± 34 months, (median 52.5). Mortality was 18% in NED vs 12% in PED patients at two years (p = 0.01), 36% vs 30% at 5 years (p = 0.03) and 41% vs 39% at seven years (p = 0.2) respectively. In patients ≤75 years, mortality at 7-year was 28% in PED vs 36% in NED, p = 0.07. CONCLUSION These results suggest a reduced mortality at 2 and 5 years with PED as compare to NED treatment in a real-world CLI scenario. At 7-year follow-up, the advantage was numerically evident only in patients ≤75 years.
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Affiliation(s)
- Francesco Liistro
- Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy.
| | - Paolo Angioli
- Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy
| | - Matteo Rocco Reccia
- Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy
| | - Kenneth Ducci
- Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy
| | - Giovanni Falsini
- Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy
| | - Maurizio Pieroni
- Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy
| | - Giorgio Ventoruzzo
- Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy
| | - Alessia Scatena
- Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy
| | - Leonardo Bolognese
- Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy
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14
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Dell'Aquila M, De Matteis A, Scatena A, Costantino A, Camporeale MC, De Filippis A. Estimation of the time of death: where we are now? Clin Ter 2021; 172:109-112. [PMID: 33763669 DOI: 10.7417/ct.2021.2294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
ABSTRACT One of the increasingly discussed topics in forensic pathology is that concerning the quantification of the postmortem interval (PMI). The estimation of the time interval between the death of a person and the discovery of the body is extremely complicated, as it is affected by the influence of many factors, both endogenous and exogenous. With the advancement of knowledge in the field of molecular biology, several studies have been performed, for more than 30 years, on the degradation pattern of macromolecules, such as proteins, DNA, RNA, and the relationship with PMI. Despite initial enthusiasm, studies have shown different kind of limitations in determining PMI in the forensic field. In the last years, consequently, researchers focused their attention on the potential of microRNAs as housekeeping genes, due to their postmortem stability and resistance to degradation. MiRNAs are small, endogenous, single stranded, non-coding RNA molecules identified in plants, animals and DNA virus transcriptome. Various and growing are the fields of application: to establish time of death, to evaluate vitality of skin lesions, in cases of head trauma, and cases of acute myocardial infarction. Their use could also be particularly useful in determining late PMI (beyond 24 hours after death), as no additional markers are available in this scenario. At the moment, scientific research is still at an early stage as it is mainly based on animal models. However, the promising properties of miRNAs and their low cost may make this field of research very interesting for an increasingly precise determination of PMI in the future.
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Affiliation(s)
- M Dell'Aquila
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome
| | - A De Matteis
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome
| | - A Scatena
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa
| | - A Costantino
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa
| | - M C Camporeale
- Dipartimento di Medicina Clinica e Sperimentale Università degli Studi di Foggia
| | - A De Filippis
- Fetal Medicine Unit, Di Venere Hospital, Bari, Italy
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15
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Pintaudi B, Scatena A, Piscitelli G, Frison V, Corrao S, Manicardi V, Graziano G, Rossi MC, Gallo M, Mannino D, Di Bartolo P, Nicolucci A. Clinical profiles and quality of care of subjects with type 2 diabetes according to their cardiovascular risk: an observational, retrospective study. Cardiovasc Diabetol 2021; 20:59. [PMID: 33676499 PMCID: PMC7936493 DOI: 10.1186/s12933-021-01251-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/22/2021] [Indexed: 01/10/2023] Open
Abstract
Background The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. Methods The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. Results Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate risk) were evaluated. Among people with T2D at very high risk: 26.4% had retinopathy, 39.5% had albuminuria, 18.7% had a previous major cardiovascular event, 39.0% had organ damage, 89.1% had three or more risk factors. The use of DPP4-i markedly increased as cardiovascular risk increased. The prescription of secretagogues also increased and that of GLP1-RAs tended to increase. The use of SGLT2-i was still limited, and only slightly higher in subjects with very high cardiovascular risk. The overall quality of care, as summarized by the Q score, tended to be lower as the level of cardiovascular risk increased. Conclusions A large proportion of subjects with T2D is at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to their potential advantages in terms of cardiovascular risk reduction. Several actions are necessary to improve the quality of care.
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Affiliation(s)
| | | | | | - Vera Frison
- Internal Medicine and Diabetology Service, ULSS6, Cittadella, Italy
| | - Salvatore Corrao
- Department of Internal Medicine, ARNAS Civico Benfratelli Hospital, University of Palermo, Palermo, Italy
| | - Valeria Manicardi
- Diabetes Clinic, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Giusi Graziano
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Corso Umberto I, 65122, Pescara, Italy
| | - Maria Chiara Rossi
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Corso Umberto I, 65122, Pescara, Italy
| | - Marco Gallo
- AOU Città Della Salute E Della Scienza, Presidio Ospedaliero Molinette, Torino, Italy
| | | | | | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Corso Umberto I, 65122, Pescara, Italy.
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Lorenzoni V, Chiavetta A, Curci V, Pepa GD, Licciardello C, Pantò F, Scatena A, Turchetti G. New Perspective to Improve Care of Patients with Infected Diabetic Foot Ulcer: Early Economic Impact of the Use of Photodynamic Therapy with RLP068 (Based) System. Clinicoecon Outcomes Res 2021; 13:135-144. [PMID: 33664581 PMCID: PMC7924247 DOI: 10.2147/ceor.s274897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To perform an early economic evaluation of a system based on photodynamic advanced adjuvant therapy with photosensitizer RLP068/CI to facilitate the healing process of foot/leg skin lesions/ulcers with an excellent safety profile. Design An early short-term (10 weeks) cost-effectiveness and a budget impact analysis (over 5 years) comparing photodynamic therapy with photosensitizer RLP068/CI based (PDT-RLP068) system added to Standard of Care (SoC) vs SoC alone. Setting The Italian National Healthcare System perspective considering both the outpatient and the day-hospital regimen. Participants Hypothetical patients with diabetic foot infection (DFI) grades I/IIB. Interventions The PDT-RLP068 system as an add-on to Standard of Care (SoC) vs SoC alone as the first-line treatment for the management of DFIs. Main Outcomes Days within which the clinical target was achieved and direct health costs for patients' management. Results Additional costs generated by the use of the PDT-RLP068 system progressively decreased as time to reach the target induced by the novel system decreased. In the outpatient regimen, when time to reach clinical target decreased in the range 7-28 days, ICERs varied from about 1€ to 70€ for each additional day gained with clinical target achieved. The system was dominant when halving time to reach the target in the outpatient regimen and even for modest reduction of time in day-hospital regimen. In terms of budget impact, when considering day-hospital regimen, if the PDT-RLP068 based system allowed a shortened duration to reach the clinical target of between 7-28 days, BI was 8,100,000€ to 700,000€, with saving less than 2,000,000€ with 50% reduction of time. Considering the inpatient setting, the use of the PDT-RLP068 system would result in saving even with the modest impact on the time needed to activate the healing process. Conclusion The early economic evaluation performed suggested that, if the claimed effectiveness of the technology demonstrated in case reports and in preliminary clinical studies can be confirmed in larger population studies, and allowing for shortening of the time needed to activate the healing process, the PDT-RLP068 system could offer the chance to improve care for DFI patients without compromising the sustainability of the system.
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Affiliation(s)
| | | | - Vincenzo Curci
- Centro per La Cura del Piede Diabetico, Ospedale Costantino Cantù di Abbiategrasso, Milan, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Carmelo Licciardello
- Unit of Metabolic and Endocrine Diseases, Centro Catanese di Medicina e Chirurgia, Catania, Italy
| | - Felicia Pantò
- Section of Endocrinology, Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Alessia Scatena
- Diabetology Unit, Cardioneurovascular Department, San Donato Hospital Arezzo Local Health Authorities South East Tuscany, Arezzo, Italy
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Monami M, Ragghianti B, Silverii A, Scatena A, Landi L, Cosentino C, Vitale V, Mannucci E. Retrospective Matched Case-Control Study on the Use of CO 2 Laser for the Treatment of Nonhealing Diabetic Foot Ulcers: The DULCIS-2 (Diabetic ULcer, CO 2 Laser, and Infections) Study. INT J LOW EXTR WOUND 2020; 21:471-476. [PMID: 33225783 DOI: 10.1177/1534734620960298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Infection, which is one of the possible complications of diabetic foot ulcers (DFUs), makes the treatment of ulcers challenging because of its negative impact on healing processes and the high prevalence of multiresistant germs. This study is aimed at verifying the effect of a surgical CO2 laser (which reduces the bacterial load and allows a more accurate debridement), as compared with the traditional lancets, on the healing rate of DFU. METHODS The present case-control retrospective analysis was performed on patients with chronic (>6 months) DFU with Texas grade >1, treated with 80 W surgical CO2 laser (DEKA SmartXide2 C80, El.En. Group) and compared with a matched sample of patients with similar characteristics, who were treated with a traditional surgical approach. The debridement was performed trying to achieve the complete removal of nonviable tissues. The principal endpoint was the proportion of patients healed at 6 months. All analyses were carried out with SPSS 25.0. The study protocol was approved by the local ethical committee. RESULTS This study included 118 patients (59 cases and 59 controls). At 6 months, the proportion of healing patients was 35% and 18% in cases and controls, respectively (P = .034). The corresponding figure at 1 year was 62% and 38% (P = .009), whereas no difference was observed at 1, 2, and 3 months. No serious adverse event was observed. CONCLUSIONS In this article, we show for the first time that CO2 laser treatment, in comparison with traditional surgical approaches, can be associated with an increased healing rate in patients with DFU.
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Affiliation(s)
- Matteo Monami
- Careggi Hospital and University of Florence, Florence, Italy
| | | | | | | | - Letizia Landi
- Careggi Hospital and University of Florence, Florence, Italy
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18
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Liistro F, Angioli P, Ventoruzzo G, Ducci K, Reccia MR, Ricci L, Falsini G, Scatena A, Pieroni M, Bolognese L. Randomized Controlled Trial of Acotec Drug-Eluting Balloon Versus Plain Balloon for Below-the-Knee Angioplasty. JACC Cardiovasc Interv 2020; 13:2277-2286. [DOI: 10.1016/j.jcin.2020.06.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/19/2020] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
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Monami M, Scatena A, Schlecht M, Lobmann R, Landi L, Ricci L, Mannucci E. Antimicrobial Photodynamic Therapy in Infected Diabetic Foot Ulcers: A Multicenter Preliminary Experience. J Am Podiatr Med Assoc 2020; 110:Article5. [PMID: 32073323 DOI: 10.7547/18-069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The increasing resistance of bacteria to antibiotics and the frequency of comorbid conditions of patients make the treatment of diabetic foot infections problematic. In this context, photodynamic therapy could be a useful tool to treat infected wounds. The aim of this study was to evaluate the effect of repeated applications of a phthalocyanine derivative (RLP068) on the bacterial load and on the healing process. METHODS The present analysis was performed on patients with clinically infected ulcers who had been treated with RLP068. A sample for microbiological culture was collected at the first visit before and immediately after the application of RLP068 on the ulcer surface, and the area was illuminated for 8 minutes with a red light. The whole procedure was repeated three times per week at two centers (Florence and Arezzo, Italy) (sample A), and two times per week at the third center (Stuttgart, Germany) (sample B) for 2 weeks. RESULTS Sample A and sample B were composed of 55 and nine patients, respectively. In sample A, bacterial load decreased significantly after a single treatment, and the benefit persisted for 2 weeks. Similar effects of the first treatment were observed in sample B. In both samples, the ulcer area showed a significant reduction during follow-up, even in patients with ulcers infected with gram-negative germs or with exposed bone. CONCLUSIONS RLP068 seems to be a promising topical wound management procedure for the treatment of infected diabetic foot ulcers.
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Affiliation(s)
- Matteo Monami
- Diabetology, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Michael Schlecht
- Clinic for Endocrinology, Diabetology and Geriatric Medicine, Klinikum Stuttgart-Krankenhaus Bad Cannstatt, Stuttgart, Germany
| | - Ralf Lobmann
- Clinic for Endocrinology, Diabetology and Geriatric Medicine, Klinikum Stuttgart-Krankenhaus Bad Cannstatt, Stuttgart, Germany
| | - Letizia Landi
- Diabetology, Careggi Hospital and University of Florence, Florence, Italy
| | - Lucia Ricci
- Diabetology Unit, San Donato Hospital, Arezzo, Italy
| | - Edoardo Mannucci
- Diabetology, Careggi Hospital and University of Florence, Florence, Italy
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Monami M, Liistro F, Scatena A, Nreu B, Mannucci E. Short and medium-term efficacy of sodium glucose co-transporter-2 (SGLT-2) inhibitors: A meta-analysis of randomized clinical trials. Diabetes Obes Metab 2018; 20:1213-1222. [PMID: 29327406 DOI: 10.1111/dom.13221] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/15/2022]
Abstract
AIMS Sodium glucose co-transport-2 (SGLT-2) inhibitors reduce tubular glucose reabsorption, producing a reduction of blood glucose without stimulating insulin release. The aim of this meta-analysis was the systematic collection of available data from randomized trials, in order to establish the durability of the efficacy of SGLT-2 inhibitors on glycaemic control and body mass index. METHODS A meta-analysis was performed, including all trials with a duration of at least 12 weeks, comparing SGLT-2 inhibitors with non-SGLT-2 inhibitor agents in type 2 diabetes. The principal outcome was the effect of SGLT-2 inhibitors on hemoglobin A1c (HbA1c) at 12, 24, 52 and 104 weeks. Data on body mass index at the same time points were also collected. RESULTS Among 66 randomized trials, HbA1c reduction at 12, 24, 52 and 104 weeks was 0.63% (0.57; 0.68, 0.63% (0.57; 0.70), 0.66% (0.57; 0.74) and 0.60% (0.40; 0.81), respectively. SGLT-2 inhibitors showed a greater efficacy than dipeptidyl-peptidase-4 inhibitors (DPP-4i). Sulfonylureas appeared to be superior to SGLT-2 inhibitors at 12 weeks, but not at 24 and 52 weeks; SGLT-2 inhibitors produced a greater reduction in HbA1c than did sulfonylureas at 104 weeks. SGLT-2 inhibitor-induced weight loss in placebo-controlled trials appeared to increase progressively with the duration of treatment. CONCLUSIONS SGLT-2 inhibitors showed a good persistence of efficacy, at least up to 2 years, with a small but significant superiority over DPP-4i. Sulfonylureas are more effective in the very short term, but less effective in the longer term.
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Affiliation(s)
- Matteo Monami
- Department of Diabetology, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Alessia Scatena
- Department of Diabetology, Ospedale San Donato, Arezzo, Italy
| | - Besmir Nreu
- Department of Diabetology, Careggi Hospital and University of Florence, Florence, Italy
| | - Edoardo Mannucci
- Department of Diabetology, Careggi Hospital and University of Florence, Florence, Italy
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Lepore G, Bonfanti R, Bozzetto L, Di Blasi V, Girelli A, Grassi G, Iafusco D, Laviola L, Rabbone I, Schiaffini R, Bruttomesso D, Mammì F, Bruzzese M, Schettino M, Nuzzo M, Di Blasi V, Fresa R, Lambiase C, Iafusco D, Zanfardino A, Confetto S, Bozzetto L, Annuzzi G, Alderisio A, Riccardi G, Gentile S, Marino G, Guarino G, Zucchini S, Maltoni G, Suprani T, Graziani V, Nizzoli M, Acquati S, Cavani R, Romano S, Michelini M, Manicardi E, Bonadonna R, Dei Cas A, Dall'aglio E, Papi M, Riboni S, Manicardi V, Manicardi E, Manicardi E, Pugni V, Lasagni A, Street M, Pagliani U, Rossi C, Assaloni R, Brunato B, Tortul C, Zanette G, Li Volsi P, Zanatta M, Tonutti L, Agus S, Pellegrini M, Ceccano P, Pozzilli G, Anguissola B, Buzzetti R, Moretti C C, Leto G, Pozzilli P, Manfrini S, Maurizi A, Leotta S, Altomare M, Abbruzzese S, Carletti S, Suraci C, Filetti S, Manca Bitti M, Arcano S, Cavallo M, De Bernardinis M, Pitocco D, Caputo S, Rizzi A, Manto A, Schiaffini R, Cappa M, Benevento D, Frontoni S, Malandrucco I, Morano S, Filardi T, Lauro D, Marini M, Castaldo E, Sabato D, Tuccinardi F, Forte E, Viterbori P, Arnaldi C, Minuto N, d'Annunzio G, Corsi A, Rota R, Scaranna C, Trevisan R, Valentini U, Girelli A, Bonfadini S, Zarra E, Plebani A, Prandi E, Felappi B, Rocca A, Meneghini E, Galli P, Ruggeri P, Carrai E, Fugazza L, Baggi V, Conti D, Bosi E, Laurenzi A, Caretto A, Molinari C, Orsi E, Grancini V, Resi V, Bonfanti R, Favalli V, Bonura C, Rigamonti A, Bonomo M, Bertuzzi F, Pintaudi B, Disoteo O, Perseghin G, Perra S, Chiovato L, De Cata P, Zerbini F, Lovati E, Laneri M, Guerraggio L, Bossi A, De Mori V, Galetta M, Meloncelli I, Aiello A A, Di Vincenzo S, Nuzzi A, Fraticelli E, Ansaldi E, Battezzati M, Lombardi M, Balbo M, Lera R, Secco A, De Donno V, Cadario F, Savastio S, Ponzani C, Aimaretti G, Rabbone I, Ignaccolo G, Tinti D, Cerutti F, Bari F, Giorgino F, Piccinno E, Zecchino O, Cignarelli M, Lamacchia O, Picca G, De Cosmo S, Rauseo A, Tomaselli L, Tumminia A, Egiziano C, Scarpitta A, Maggio F, Cardella F, Roppolo R, Provenzano V, Fleres M, Scorsone A, Scatena A, Gregori G, Lucchesi S, Gadducci F, Di Cianni S, Pancani S, Del Prato S, Aragona M, Crisci I, Calianno A, Fattor B, Crazzolara D, Reinstadler P, Longhi S, Incelli G, Rauch S, Romanelli T, Orrasch M, Cauvin V, Franceschi R, Lalli C, Pianta A, Marangoni A, Aricò C, Marin N, Nogara N, Simioni N, Filippi A, Gidoni Guarneri G, Contin M.L M, Decata A, Bondesan L, Confortin L, Coracina A, Lombardi S, Costa Padova S, Cipponeri E, Scotton R, Galasso S, Boscari F, Zanon M, Vinci C, Lisato G, Gottardo L, Bonora E, Trombetta M, Negri C, Brangani C, Maffeis C, Sabbion A, Marigliano M. Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion. Nutr Metab Cardiovasc Dis 2018; 28:335-342. [PMID: 29428572 DOI: 10.1016/j.numecd.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/31/2017] [Accepted: 12/02/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII). METHODS AND RESULTS Questionnaires investigating the organisation of diabetes care centres, individuals' clinical and metabolic features and pump technology and its management were sent to adult and paediatric diabetes centres that use CSII for treatment in Italy. Information on standard clinical variables, demographic data and acute and chronic diabetic complications was derived from local clinical management systems. The sample consisted of 6623 people with diabetes, which was obtained from 93 centres. Of them, 98.8% had type 1 diabetes mellitus, 57.2% were female, 64% used a conventional insulin pump and 36% used a sensor-augmented insulin pump. The median glycated haemoglobin (HbA1c) level was 60 mmol/mol (7.6%). The HbA1c target (i.e. <58 mmol/mol for age <18 years and <53 mmol/mol for age >18 years) was achieved in 43.4% of paediatric and 23% of adult participants. Factors such as advanced pump functions, higher rate of sensor use, pregnancy in the year before the study and longer duration of diabetes were associated with lower HbA1c levels. The most common chronic complications occurring in diabetes were retinopathy, microalbuminuria and hypertension. In the year before the study, 5% of participants reported ≥1 episode of severe hypoglycaemic (SH) episodes (SH) and 2.6% reported ≥1 episode of ketoacidosis. CONCLUSIONS Advanced personal skills and use of sensor-based pump are associated with better metabolic control outcomes in Italian people with diabetes who were treated with CSII. The reduction in SH episodes confirms the positive effect of CSII on hypoglycaemia. CLINICAL TRIAL REGISTRATION NUMBER NCT 02620917 (ClinicalTrials.gov).
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Dicembrini I, Nreu B, Scatena A, Andreozzi F, Sesti G, Mannucci E, Monami M. Erratum to: Microvascular effects of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized controlled trials. Acta Diabetol 2017; 54:1069-1071. [PMID: 28924916 DOI: 10.1007/s00592-017-1049-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the manuscript, the events of nephropathy and retinopathy recorded for the LEADER trial (Marso et al. 2016) were erroneously imputed; the numbers reported in Table 1 for that trial refer to serious adverse events, and not to total events, as stated in Methods. The correct figures are 268 and 416 cases of nephropathy, and 106 and 92 cases of retinopathy in liraglutide and control arms, respectively. As a consequence, the overall risk (MH-OR [95% CI]) of nephropathy and retinopathy with GLP-1RA (vs all comparators) is 0.77 [0.67-0.88], p < 0.001, and 0.99 [0.80-1.21], p = 0.90, respectively. The analyses reported in Figs. 1 and 2 were also corrected and reported below, together with supplementary figures 3 and 5. Please note that liraglutide is associated with a significant reduction in the incidence of nephropathy, whereas for retinopathy the difference from placebo is no longer statistically significant.
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Affiliation(s)
- Ilaria Dicembrini
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy
| | - Besmir Nreu
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy
| | | | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Edoardo Mannucci
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy
| | - Matteo Monami
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy.
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Monami M, Nreu B, Scatena A, Giannini S, Andreozzi F, Sesti G, Mannucci E. Glucagon-like peptide-1 receptor agonists and atrial fibrillation: a systematic review and meta-analysis of randomised controlled trials. J Endocrinol Invest 2017; 40:1251-1258. [PMID: 28569363 DOI: 10.1007/s40618-017-0698-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/24/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND The pharmacological stimulation of GLP-1 receptors is associated with an increase in heart rate. A pooled analysis of patient-level data from phase III trials with albiglutide revealed a significant increase in the risk of atrial fibrillation. Aim of the present meta-analysis is to summarize all available evidence on the effects of individual GLP-1 receptor agonists (RA), and of the whole class, on the incidence of atrial fibrillation. METHODS A Medline search for GLP-1 RA (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration ≥12 weeks, enrolling patients with type 2 diabetes and comparing a GLP-1 RA with placebo or any other non-GLP-1 RA drug. RESULTS Of the 113 trials fulfilling the inclusion criteria, 19 did not report information on atrial fibrillation, whereas 63 reported zero events in all treatment groups. In the remaining trials (enrolling 17,966 and 15,305 patients in GLP-1 RA and comparator arms, respectively, 55.3% women, with a mean age of 57.0 ± 3.8 years), treatment with GLP-1 RA was not associated with a significant increase in the incidence of atrial fibrillation [Mantel-Haenszel OR (95% CI) 0.87 (0.71-1.05), p = 0.15]. CONCLUSIONS In conclusion, available data suggest that GLP-1 RA is not associated with atrial fibrillation, with the only possible exception of albiglutide. Newly onset atrial fibrillation deserves to be investigated as an event of special interest in future trials with GLP-1 RA.
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Affiliation(s)
- M Monami
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy.
| | - B Nreu
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy
| | - A Scatena
- Diabetology Unit, Ospedale San Donato Arezzo, Arezzo, Italy
| | - S Giannini
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy
| | - F Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - G Sesti
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - E Mannucci
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy
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Dicembrini I, Nreu B, Scatena A, Andreozzi F, Sesti G, Mannucci E, Monami M. Microvascular effects of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized controlled trials. Acta Diabetol 2017; 54:933-941. [PMID: 28748377 DOI: 10.1007/s00592-017-1031-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/16/2017] [Indexed: 01/22/2023]
Abstract
AIMS Results with GLP1-receptor agonists (GLP-1RA) on microvascular complications of diabetes are contrasting. In trials designed for cardiovascular outcomes, both liraglutide and semaglutide were associated with a relevant reduction in the incidence and progression of nephropathy. On the other hand, in the same trials, semaglutide was associated with an increased progression of retinopathy, and a similar trend was observed for liraglutide. This meta-analysis is aimed at assessing the effects of GLP-1RA on retinopathy and nephropathy. METHODS A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration >11 weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. RESULTS Of the 113 trials fulfilling the inclusion criteria, 78 and 62 did not report information on retinopathy and nephropathy, respectively. Treatment with GLP1-RA was not associated with a significant increase in the incidence of retinopathy (MH-OR [95% CI] 0.92 [0.74-1.16]. p = 0.49). In subgroup analyses, GLP1-RA were associated with a lower risk of retinopathy in comparison with sulfonylureas. Cases of macular edema were reported only in nine trials with no sign of increased risk. GLP1-RA reduced the incidence of nephropathy with respect to comparators (MH-OR [95% CI] 0.74 [0.60-0.92]. p = 0.005). This difference was significant versus placebo, but not versus any class of active comparators. CONCLUSIONS GLP1-RA appear to reduce the incidence and/or progression of nephropathy and to have no specific effect on retinopathy-with the notable exception of semaglutide, which could have a negative impact on the retina.
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Affiliation(s)
- Ilaria Dicembrini
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy
| | - Besmir Nreu
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy
| | | | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Edoardo Mannucci
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy
| | - Matteo Monami
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy.
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Monami M, Nreu B, Scatena A, Cresci B, Andreozzi F, Sesti G, Mannucci E. Safety issues with glucagon-like peptide-1 receptor agonists (pancreatitis, pancreatic cancer and cholelithiasis): Data from randomized controlled trials. Diabetes Obes Metab 2017; 19:1233-1241. [PMID: 28244632 DOI: 10.1111/dom.12926] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 01/01/2023]
Abstract
AIM Glucagon-like peptide 1 receptor agonists (GLP1-RA) have been associated with an increased risk of pancreatitis and pancreatic cancer. Prior meta-analyses of randomized controlled trials failed to show any significant increase of risk; however, those meta-analyses did not include the recently published cardiovascular outcome trials (CVOT) with GLP1-RA, which provide a substantial additional body of data. The aim of the present meta-analysis is to assess the effect of GLP1-RA on pancreatitis, pancreatic cancers and cholelithiasis. MATERIALS AND METHODS A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide or semaglutide) was performed, collecting all randomized clinical trials with a duration >11 weeks, enrolling patients with type 2 diabetes and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. RESULTS Of the 113 trials fulfilling inclusion criteria, 13 did not report information on pancreatitis, whereas 72 reported no events in all treatment groups. The incidence of pancreatitis and pancreatic cancer with GLP1-RA was not significantly different from that observed in comparator arms (MH-OR [95% CI] 0.93 [0.65-1.34], P = .71, and 0.94 [0.52-1.70], P = .84, respectively), whereas, a significantly increased risk of cholelithiasis (MH-OR [95% CI] 1.30 [1.01-1.68], P = .041) was detected. CONCLUSIONS Presently available data confirm the safety of GLP-1 receptor agonists for pancreatitis. Conversely, therapy with those drugs is associated with an increased risk of cholelithiasis, which deserves further investigation.
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Affiliation(s)
- Matteo Monami
- Department of Diabetology, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Besmir Nreu
- Department of Diabetology, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Alessia Scatena
- Diabetology Unit, Osperdale San Donato Arezzo, Arezzo, Italy
| | - Barbara Cresci
- Department of Diabetology, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Francesco Andreozzi
- Diabetology Unit, Osperdale San Donato Arezzo, Arezzo, Italy
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Sesti
- Diabetology Unit, Osperdale San Donato Arezzo, Arezzo, Italy
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Edoardo Mannucci
- Department of Diabetology, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
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Monami M, Scatena A, Zannoni S, Aleffi S, Mirabella C, Giannoni L, Mannucci E. A randomized, open-label, controlled trial to evaluate the antimicrobial and surgical effect of CO 2 laser treatment in diabetic infected foot ulcers: DULCIS (diabetic ulcer, CO 2 laser, and infections) study. J Endocrinol Invest 2017; 40:985-989. [PMID: 28378156 DOI: 10.1007/s40618-017-0666-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/26/2017] [Indexed: 11/28/2022]
Abstract
AIM Debridement of fibrin and necrotic tissue from the ulcer surface is an important component of the treatment of diabetic ulcers. A possible alternative to standard lancets is represented by CO2 laser, which vaporizes necrotic tissues together with any pathogen. The present trial is aimed at verifying the effect of a CO2 laser on bacterial load in the debridement of infected diabetic foot ulcers. METHODS In this open-label randomized controlled trial (NCT02677779), patients with diabetes and an infected foot ulcers were randomized to either CO2 laser or traditional debridement. RESULTS The reduction (%) of bacterial load with CO2 laser was significantly greater than in control group [-99.9 (-100.0; -90.0) vs. -50.0 (-96.0; -75.0), p = 0.049]. Similarly, a significantly greater reduction (%) of the fraction of ulcer area covered by fibrin was obtained in the intervention group [-84.1 (-95.0; -72.2) vs. -46.9 (-69.5; -40.8), p = 0.038]. CONCLUSIONS Debridement of ulcers with CO2 laser significantly reduces bacterial load and fibrin-covered areas, and could be of help in the treatment of diabetic foot ulcer.
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Affiliation(s)
- M Monami
- Diabetic Foot Unit, SOD Diabetologia-Azienda Ospedaliero Universitaria Careggi, Via delle Oblate n. 4, 50141, Florence, Italy.
| | - A Scatena
- Diabetology Unit, San Donato Hospital, Arezzo, Italy
| | - S Zannoni
- Diabetic Foot Unit, SOD Diabetologia-Azienda Ospedaliero Universitaria Careggi, Via delle Oblate n. 4, 50141, Florence, Italy
| | - S Aleffi
- Diabetic Foot Unit, SOD Diabetologia-Azienda Ospedaliero Universitaria Careggi, Via delle Oblate n. 4, 50141, Florence, Italy
| | - C Mirabella
- Department of Immunohematology and Transfusion Medicine, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - L Giannoni
- Diabetic Foot Unit, SOD Diabetologia-Azienda Ospedaliero Universitaria Careggi, Via delle Oblate n. 4, 50141, Florence, Italy
| | - E Mannucci
- Diabetic Foot Unit, SOD Diabetologia-Azienda Ospedaliero Universitaria Careggi, Via delle Oblate n. 4, 50141, Florence, Italy
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Ricci L, Scatena A, Tacconi D, Ventoruzzo G, Liistro F, Bolognese L, Monami M, Mannucci E. All-cause and cardiovascular mortality in a consecutive series of patients with diabetic foot osteomyelitis. Diabetes Res Clin Pract 2017; 131:12-17. [PMID: 28668718 DOI: 10.1016/j.diabres.2017.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/26/2017] [Accepted: 06/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mortality in patients with type 2 diabetes and diabetic foot osteomyelitis (DFO) have been explored in few small studies with a short follow-up. Aim of the present study is to assess all-cause and cardiovascular mortality and predictors of mortality in a consecutive series of patients with DFO. RESEARCH DESIGN AND METHODS Patients with a diagnosis of DFO, attending the Diabetic Foot Unit of San Donato Hospital in Arezzo between January 1st, 2012 and December 31st, 2013, were included in this retrospective study. Information on all-cause mortality up to December 1st, 2016, was obtained from the registry of the Local Health Unit of Arezzo, which contains updated records of all persons living in Tuscany. RESULTS One hundred ninety-four patients were included in the study. During a mean period of observation of 2.8±1.4years, 73 (37.6%) died, with a yearly rate of 13.2%. Of the 73 deaths, 59 were attributable to cardiovascular causes. After adjusting for possible confounders in a Cox analysis, site of osteomyelitis (hindfoot vs mid/forefoot) was associated with a higher mortality, and surgical treatment with a lower mortality. CONCLUSIONS Mortality in patients with DFO appears to be much higher than that reported in clinical series of patients with diabetic foot ulcers, particularly when hindfoot is affected.
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Affiliation(s)
- Lucia Ricci
- Diabetology Unit - Ospedale San Donato Arezzo, Italy
| | | | - Danilo Tacconi
- Infective Disease Unit - Ospedale San Donato Arezzo, Italy
| | | | | | | | - Matteo Monami
- Diabetology - Azienda Ospedaliero Universitaria Careggi, Italy
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Monami M, Mirabella C, Scatena A, Nreu B, Zannoni S, Aleffi S, Giannoni L, Mannucci E. CO 2 laser for the treatment of diabetic foot ulcers with exposed bone. A consecutive series of type 2 diabetic patients. J Endocrinol Invest 2017; 40:819-822. [PMID: 28260184 DOI: 10.1007/s40618-017-0642-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/13/2017] [Indexed: 11/30/2022]
Abstract
AIM The treatment of foot ulcers with exposed bone is challenging, because of the risk of infection and of difficulties in the development of granulation tissue. A CO2 laser beam could be used to produce discontinuities in periosteum, allowing the exposure of blood containing multipotent stem cells, capable of initiating the healing process. The local application of platelet-rich plasma (PRP) has been proposed as a therapeutic tool for accelerating healing in foot ulcers, including those in patients with diabetes. Aim of the present pilot, proof-of-concept study is the assessment of the therapeutic potential of CO2 laser treatment, either alone or combined with PRP, in the treatment of diabetic foot ulcers with exposed bone. METHODS We performed a pilot, uncontrolled 3-month observation study on a consecutive series of 9 type two diabetic patients and foot ulcers with exposed bone. A CO2-laser was used for producing nine discontinuities on periosteum for each cm2, by directing the focused laser beam on the bone until bleeding. The procedure was repeated up to 6 times, at a distance of 1 week and ulcers assessed weekly until the end of the study (3 months). In the last 5 of the 14 patients, the treatment described above was associated with PRP. RESULTS Of the nine patients treated, four healed, and one more patient developed granulation tissue covering entirely bone surface. Out of the four patients who did not heal, one underwent minor amputation. Among the five patients treated with a combination of CO2 laser and PRP, two healed within 3 months, and two more patients developed granulation tissue covering entirely bone surface; the fifth patient did not show any improvement and underwent amputation. CONCLUSIONS The present pilot experience represents a novelty in this field showing a possible use of CO2-laser in the treatment of diabetic foot ulcers.
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Affiliation(s)
- M Monami
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, SOD Diabetologia - AOU Careggi, Via delle Oblate n. 4, 50141, Florence, Italy.
| | - C Mirabella
- Immunohematology and Transfusion Medicine, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - A Scatena
- Diabetology Unit, Ospedale San Donato Arezzo, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - B Nreu
- Geriatric Medicine, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - S Zannoni
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, SOD Diabetologia - AOU Careggi, Via delle Oblate n. 4, 50141, Florence, Italy
| | - S Aleffi
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, SOD Diabetologia - AOU Careggi, Via delle Oblate n. 4, 50141, Florence, Italy
| | - L Giannoni
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, SOD Diabetologia - AOU Careggi, Via delle Oblate n. 4, 50141, Florence, Italy
| | - E Mannucci
- Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, SOD Diabetologia - AOU Careggi, Via delle Oblate n. 4, 50141, Florence, Italy
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Panichi V, Rocchetti MT, Scatena A, Rosati A, Migliori M, Pizzarelli F, Gesualdo L. Long term variation of serum levels of uremic toxins in patients treated by post-dilution high volume on-line hemodiafiltration in comparison to standard low-flux bicarbonate dialysis: results from the REDERT study. J Nephrol 2017; 30:583-591. [PMID: 28337716 DOI: 10.1007/s40620-017-0381-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/02/2016] [Accepted: 02/06/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE OF THE STUDY Little information have been provided till now regarding the effect of high volume HDF (hv-OL-HDF) in respect to standard bicarbonate dialysis (BHD) in medium-long term protein-bound toxins removal. PROCEDURES A randomised cross-over multicentre study (REDERT study) was designed to compare the effects of hv-OL-HDF and low-flux BHD on uremic toxins serum levels in 36 chronic dialysis patients followed for 13 months. Group 1 patients were treated with BHD (Treatment A) for 6 months, and afterwards, they were transferred to hv-OL-HDF for a further 6 months (Treatment B). Group 2 patients were treated with Treatment B for 6 months, and afterwards, they were transferred to Treatment A for a further 6 months. Total and free pre-dialysis indoxyl-sulfate (IS) and p-cresyl-sulfate (pCS) were determined starting a midweek dialysis session at baseline and after six months of hv-OL-HDF or BHD. IS and pCS, were simultaneously measured, by liquid chromatography/electrospray ionization-tandem mass spectrometry, Kt/v and pre and post-dialysis b-2microglobulin (b2MG) levels were measured every three months. RESULTS Kt/V was significantly increased in hv-OL-HDF (from 1.47 ± 0.24 to 1.49 ± 0.16; p < 0.01) and was reduced in BHD (from 1.51 ± 0.2 to 1.36 ± 0.21; p < 0.001). The mean infusion volume in HDF was 20.9 ± 2.1 L with a mean total convective volume of 23.8 ± 2.3 L and a significant removal of b2MG was obtained in hv-OL-HDF at month 3 and month 6. Both free and total levels of IS and pCS were significantly reduced in hv-OL-HDF at month 6 in respect to BHD. CONCLUSIONS In the present study we confirm the assumption that post-HDF is an effective technique in small and protein-bound uremic toxins removal. INTRODUCTION
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Affiliation(s)
- Vincenzo Panichi
- Nephrology and Dialysis USL Nord Ovest Toscana, Versilia Hospital, Toscana, Italy.
| | - Maria Teresa Rocchetti
- Department of Emergency and Organ Transplantation, Section of Nephrology, University of Bari 'Aldo Moro', Bari, Italy
| | - Alessia Scatena
- Nephrology and Dialysis USL Nord Ovest Toscana, Versilia Hospital, Toscana, Italy
| | - Alberto Rosati
- Nephrology and Dialysis USL Centro Toscana, Toscana, Italy
| | | | | | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation, Section of Nephrology, University of Bari 'Aldo Moro', Bari, Italy
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Goretti C, Mazzurco S, Nobili LA, Macchiarini S, Tedeschi A, Palumbo F, Scatena A, Rizzo L, Piaggesi A. Clinical Outcomes of Wide Postsurgical Lesions in the Infected Diabetic Foot Managed With 2 Different Local Treatment Regimes Compared Using a Quasi-Experimental Study Design: A Preliminary Communication. INT J LOW EXTR WOUND 2016; 6:22-7. [PMID: 17344198 DOI: 10.1177/1534734606298543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The safety and efficacy of a novel superoxidized solution (Dermacyn™ Wound Care [DWC], Oculus Innovative Sciences, Petaluma, Calif) was evaluated for the treatment of wide postsurgical infected ulcers of the diabetic foot. A group (group A,n = 18) of patients with diabetes mellitus who had postsurgical lesions>5 cm2 without ischemia or infection were recruited consecutively and treated with DWC-saturated dressings. These dressings were renewed once daily and were compared with a group of patients that had been previously treated with diluted povidone iodine (group B,n = 15) using a quasi-experimental study design. Both sets of patients also received standard systemic antibiotic therapy, as per the practice in this center, and local surgical debridement. Patients had weekly assessments until wounds had re-epithelialized completely. Patients in group A had statistically significant shorter healing time and duration of antibiotic therapy and a higher healing rate at 6 months compared with those in group B (p < .01). Recurrence of infection, requirement for debridement procedures, and requirement for minor amputations were significantly less frequent during follow-up in group A patients (p < .05) when compared with those in group B. These preliminary data suggest that DWC used as a wound dressing together with other local and systemic therapies may have a role in reducing healing time as well as complications in patients with diabetes who have postsurgical lesions of the diabetic foot. These data propose the need for a robust controlled study of DWC-saturated dressings to explore its full potential.
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Affiliation(s)
- Chiara Goretti
- Diabetic Foot Section, Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
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Panichi V, Ricchiuti G, Scatena A, Del Vecchio L, Locatelli F. Pure red cell aplasia induced by epoetin zeta. Clin Kidney J 2016; 9:599-602. [PMID: 27478604 PMCID: PMC4957714 DOI: 10.1093/ckj/sfw030] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/04/2016] [Indexed: 01/08/2023] Open
Abstract
Pure red cell aplasia (PRCA) may develop in patients with chronic kidney disease receiving erythropoiesis-stimulating agents (ESA). We report on a 72-year-old patient who developed hypo-proliferative anaemia unresponsive to ESA following the administration of epoetin zeta subcutaneously for 7 months. On the basis of severe isolated hypoplasia of the erythroid line in the bone marrow and high-titre neutralizing anti-erythropoietin antibodies (Ab), a diagnosis of Ab-mediated PRCA was made. Epoetin zeta was discontinued and the patient was given steroids. This was associated with anaemia recovery. To our knowledge this is the first PRCA case related to epoetin zeta.
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Affiliation(s)
- Vincenzo Panichi
- Department of Nephrology and Dialysis , Versilia Hospital , Lido di Camaiore (LU) , Italy
| | - Guido Ricchiuti
- Department of Nephrology and Dialysis , Versilia Hospital , Lido di Camaiore (LU) , Italy
| | - Alessia Scatena
- Department of Nephrology and Dialysis , Versilia Hospital , Lido di Camaiore (LU) , Italy
| | - Lucia Del Vecchio
- Department of Nephrology and Dialysis , A. Manzoni Hospital , Lecco , Italy
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Abstract
A 72-year-old male was referred to our hospital for a plantar ulceration that had occurred many years earlier. The lesion, with exuberant granulation and large areas of necrosis and fibrin, had long been treated by plastic surgeons with no positive evolution. At admission in our hospital no ischemia was detected, and foot radiograph was negative for bone involvement. The patient underwent a foot magnetic resonance imaging, which showed high vascularization in the plantar region and early capture of the contrast medium. We then performed multiple biopsies of the ulceration that revealed a moderately differentiated squamous cell carcinoma. The total body computed tomography exam raised a systemic involvement. A lymph node biopsy and immunohistochemistry assay on the pleural cytological sample proved the presence of a primary squamous cell carcinoma of the foot with systemic dissemination. Although rare, squamous cell carcinoma could be associated with chronic nonhealing ulcers; therefore, when a lesion does not heal, despite adequate standard treatment, its etiopathogenesis should be challenged.
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Affiliation(s)
- Alessia Scatena
- Diabetic Foot Section, Department of Medicine, Pisa University Hospital
| | - Virna Zampa
- Imaging Department, Pisa University Hospital
| | | | - Elisabetta Iacopi
- Diabetic Foot Section, Department of Medicine, Pisa University Hospital
| | - Alberto Piaggesi
- Diabetic Foot Section, Department of Medicine, Pisa University Hospital
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Curcio M, Sciarrino R, Biagini C, Marchetti L, Gobbo F, Scatena A, Presciuttini S. Characterization of a novel HLA-B allele (HLA-B*18:108) by intron-exon sequencing of the HLA-B locus. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/tan.12623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M. Curcio
- Laboratorio di Immunogenetica; U.O. Medicina Trasfusionale e Biologia dei Trapianti, AOUP; Pisa Italy
| | - R. Sciarrino
- Laboratorio di Immunogenetica; U.O. Medicina Trasfusionale e Biologia dei Trapianti, AOUP; Pisa Italy
| | - C. Biagini
- Laboratorio di Immunogenetica; U.O. Medicina Trasfusionale e Biologia dei Trapianti, AOUP; Pisa Italy
| | - L. Marchetti
- NEST; Scuola Normale Superiore and Istituto Nanoscienze - CNR; Pisa Italy
| | - F. Gobbo
- NEST; Scuola Normale Superiore and Istituto Nanoscienze - CNR; Pisa Italy
| | - A. Scatena
- Dipartimento di Medicina Traslazionale; Università di Pisa; Pisa Italy
| | - S. Presciuttini
- Dipartimento di Medicina Traslazionale; Università di Pisa; Pisa Italy
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De Pietro S, Ferrandello PF, Migliori M, Scatena A, Cipollini I, Fumagalli G, Aloisi M, Panichi V. SP595THE VERSILIA EXPERIENCE OF HEMODIALYSIS VASCULAR ACCESS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv198.18] [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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Migliori M, Rosati A, Di Giorgio A, Scatena A, Bigazzi R, Grazi G, Paoletti S, Manca Rizza G, Casani A, Panichi V. FP759A PHARMACOECONOMIC ANALYSIS OF PHOSPHATE BINDERS COST-EFFECTIVENESS IN THE RISCAVID STUDY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv183.77] [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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Migliori M, Panichi V, Bertelli A, Scatena A, Paoletti S, Ronco C. SP422ANTI-INFLAMMATORY EFFECT OF WHITE WINE IN CKD PATIENTS AND HEALTHY VOLUNTEERS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv193.30] [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: 11/12/2022] Open
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Migliori M, Cantaluppi V, Mannari C, Bertelli AAE, Medica D, Quercia AD, Navarro V, Scatena A, Giovannini L, Biancone L, Panichi V. Caffeic acid, a phenol found in white wine, modulates endothelial nitric oxide production and protects from oxidative stress-associated endothelial cell injury. PLoS One 2015; 10:e0117530. [PMID: 25853700 PMCID: PMC4390339 DOI: 10.1371/journal.pone.0117530] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/02/2014] [Indexed: 02/07/2023] Open
Abstract
Introduction Several studies demonstrated that endothelium dependent vasodilatation is impaired in cardiovascular and chronic kidney diseases because of oxidant stress-induced nitric oxide availability reduction. The Mediterranean diet, which is characterized by food containing phenols, was correlated with a reduced incidence of cardiovascular diseases and delayed progression toward end stage chronic renal failure. Previous studies demonstrated that both red and white wine exert cardioprotective effects. In particular, wine contains Caffeic acid (CAF), an active component with known antioxidant activities. Aim of the study The aim of the present study was to investigate the protective effect of low doses of CAF on oxidative stress-induced endothelial injury. Results CAF increased basal as well as acetylcholine—induced NO release by a mechanism independent from eNOS expression and phosphorylation. In addition, low doses of CAF (100 nM and 1 μM) increased proliferation and angiogenesis and inhibited leukocyte adhesion and endothelial cell apoptosis induced by hypoxia or by the uremic toxins ADMA, p-cresyl sulfate and indoxyl sulfate. The biological effects exerted by CAF on endothelial cells may be at least in part ascribed to modulation of NO release and by decreased ROS production. In an experimental model of kidney ischemia-reperfusion injury in mice, CAF significantly decreased tubular cell apoptosis, intraluminal cast deposition and leukocyte infiltration. Conclusion The results of the present study suggest that CAF, at very low dosages similar to those observed after moderate white wine consumption, may exert a protective effect on endothelial cell function by modulating NO release independently from eNOS expression and phosphorylation. CAF-induced NO modulation may limit cardiovascular and kidney disease progression associated with oxidative stress-mediated endothelial injury.
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Affiliation(s)
| | - Vincenzo Cantaluppi
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Claudio Mannari
- Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy
| | | | - Davide Medica
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alessandro Domenico Quercia
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Victor Navarro
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alessia Scatena
- Nephrology and Dialysis Unit, Versilia Hospital, Lido di Camaiore, Italy
| | - Luca Giovannini
- Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy
| | - Luigi Biancone
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Vincenzo Panichi
- Nephrology and Dialysis Unit, Versilia Hospital, Lido di Camaiore, Italy
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Panichi V, Scatena A, Rosati A, Giusti R, Ferro G, Malagnino E, Capitanini A, Piluso A, Conti P, Bernabini G, Migliori M, Caiani D, Tetta C, Casani A, Betti G, Pizzarelli F. High-volume online haemodiafiltration improves erythropoiesis-stimulating agent (ESA) resistance in comparison with low-flux bicarbonate dialysis: results of the REDERT study. Nephrol Dial Transplant 2015; 30:682-689. [DOI: 10.1093/ndt/gfu345] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Migliori M, Panichi V, de la Torre R, Fitó M, Covas M, Bertelli A, Muñoz-Aguayo D, Scatena A, Paoletti S, Ronco C. Anti-Inflammatory Effect of White Wine in CKD Patients and Healthy Volunteers. Blood Purif 2015; 39:218-223. [DOI: 10.1159/000371570] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/14/2014] [Indexed: 11/19/2022]
Abstract
Background: Mediterranean-style diet has been considered for its important beneficial effects on the progression of CV disease. Wine is an important component of the Mediterranean diet, and moderate wine drinkers have lower mortality rates than nondrinkers and heavy drinkers in epidemiologic studies. The beneficial effects of red wine are thought to be dependent on the polyphenol compounds such as resveratrol that exhibit potent antioxidant activity. However, white wine, although lacking polyphenols, contains simple phenols, such as tyrosol (Tyr) and hydroxytyrosol (OH-Tyr), characteristic also of extra-virgin olive oil, which may share similar antioxidant and inflammatory properties. Patients and Methods: The effect of white wine and extra-virgin olive oil on inflammatory markers was evaluated in 10 healthy volunteers and in 10 patients with CKD (chronic kidney disease) K-DOQI stage III-IV in a prospective, single blind, randomized, cross-over trial. After two weeks of wash-out from alcoholic beverages, subjects were randomized to a cross-over design A-B or B-A of a 2-week treatment with white wine (4 ml/kg body weight, 0.48 g/kg of alcohol 12%, corresponding to 2-3 glasses/daily) and extra-virgin olive oil (treatment A) or extra-virgin olive oil alone (treatment B). The two study periods were separated by a two-week wash-out period. At baseline and at the end of each treatment, plasma levels of inflammatory markers C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and interleukin-8 (IL-8) concentration were determined. Urinary levels of Tyr, OH-Tyr, and their metabolites were measured at the same time. Results: During combined consumption of white wine and extra-virgin olive oil (treatment A), plasma levels of CRP and IL-6 decreased from 4.1 ± 1.8 to 2.4 ± 1.9 mg/l (p < 0.05) and from 5.3 ± 3.2 to 3.4 ± 2.3 mg/l (p < 0.05) in CKD patients. CRP decreased from 2.6 ± 1.2 to 1.9 ± 0.9 mg/l (p < 0.05), and IL-6 decreased from 2.2 ± 1.8 to 1.7 ± 1.3 mg/l (p = ns) in healthy volunteers. No significant variation versus baseline was observed during treatment B. A significant increase in urinary Tyr and OH-Tyr was observed during treatment A (white wine and extra-virgin olive oil). Conclusions: Plasma markers of chronic inflammation were significantly reduced in CKD patients during the combined consumption of white wine and olive oil, suggesting a possible anti-inflammatory effect of this nutritional intervention.
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Panichi V, Rosati A, Di Giorgio A, Scatena A, Bigazzi R, Grazi G, Migliori M, Paoletti S, Manca Rizza G, Casani A, Sgambato A, Ruggeri M. A pharmacoeconomic analysis of phosphate binders cost-effectiveness in the RISCAVID study. Blood Purif 2015; 39:174-180. [PMID: 25765293 DOI: 10.1159/000369957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND A pharmacoeconomic analysis of the RISCAVID database aimed at assessing the cost effectiveness of phosphate binders in preventing CV mortality and morbidity over 7 years was performed. METHODS Morbid or fatal events occurring in 750 chronic HD patients were recorded. Statistical analysis evaluated the distribution of variables and the effect of sevelamer on survival. A cost-effectiveness evaluation was performed using a probabilistic model based on a Markov chain. RESULTS Multivariate analysis showed that treatment with sevelamer was associated with a reduced stroke incidence by 52% (p = 0.04) and reduced levels of C-reactive protein (p < 0.01). Cost-effectiveness evaluation evidenced a 33% decrease in hospital-days for patients treated with sevelamer, with and without comorbidities compared to patients undergoing calcium binders treatment. CONCLUSION Treatment with sevelamer was associated with a reduced risk of stroke in HD patients, with a clear saving on disease-related costs for the Italian National Healthcare System.
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Faglia E, Clerici G, Scatena A, Caminiti M, Curci V, Prisco M, Prisco V, Greco R, Cetta F, Morabito A. Severity of Demographic and Clinical Characteristics, Revascularization Feasibility, Major Amputation, and Mortality Rate in Diabetic Patients Admitted to a Tertiary Diabetic Foot Center for Critical Limb Ischemia: Comparison of 2 Cohorts Recruited at a 10-year Distance. Ann Vasc Surg 2014; 28:1729-36. [DOI: 10.1016/j.avsg.2014.06.004] [Citation(s) in RCA: 2] [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] [Received: 02/04/2014] [Revised: 04/28/2014] [Accepted: 06/01/2014] [Indexed: 10/25/2022]
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Lemoine S, Fournier T, Kocevar G, Belloi A, Ibarrola D, Sappey-Marinier D, Juillard L, Kaysen G, Usvyat L, Grassmann A, Marcelli D, Pecoits-Filho R, Marelli C, Kooman J, Van Der Sande F, Haviv Y, Power A, Kotanko P, Migliori M, Cantaluppi V, Medica D, Paoletti S, Panichi V, Kuragano T, Yahiro M, Kida A, Nagasawa Y, Hasuike Y, Nanami M, Nakanishi T, Garneata L, Slusanschi O, Dragomir DR, Corbu-Stancu A, Barbulescu C, Mircescu G, Minutolo R, Borrelli S, De Nicola L, Conte G, Basic-Jukic N, Katalinic L, Ivandic E, Kes P, Jelakovic B, Beberashvili I, Sinuani I, Azar A, Shapiro G, Feldman L, Stav K, Sandbank J, Averbukh Z, Bruschetta E, Righetti M, Colombo F, Palmieri N, Prencipe M, Bracchi O, Stefani F, Amar K, Scalia A, Conte F, Rosenberger J, Majernikova M, Kissova V, Straussova Z, Boldizsar J, Cobo G, Di Gioia C, Camacho R, Garcia Lacalle C, Ortega O, Rodriguez I, Mon C, Ortiz M, Herrero J, Oliet A, Vigil A, Gallar P, Kyriazis J, Markaki A, Kourtesi K, Kalymniou M, Vougazianos S, Kyriazis P, Stylianou K, Tanaka H, Tsuneyoshi S, Sawa M, Fujisaki K, Daijo Y, Hristea D, Paris A, Lefrancois G, Volteau C, Savoiu C, Ozenne S, Testa A, Coupel S, Bertho I, Legall MC, Magnard J, Deschamps T, Capusa C, Stoian I, Barbulescu C, Santimbrean C, Dumitru D, Mircescu G, Kato S, Lindholm B, Yuzawa Y, Shiels PG, Hwang JC, Jiang MY, Lu YH, Wang CT, Chiou TTY, Lee YT, Ng HY, Lee CT, Kaminska D, Koscielska-Kasprzak K, Chudoba P, Mazanowska O, Zabinska M, Banasik M, Boratynska M, Lepiesza A, Korta K, Klinger M, Struijk-Wielinga T, Neelemaat F, Slieker T, Koolen M, Ter Wee PM, Weijs PJ\, Tsuchida K, Hirose D, Minakuchi J, Kawashima S, Tomo T, Lee JE, Yun GY, Choi HY, Lee S, Kim W, Jo IY, Ha SK, Kim HJ, Park HC, Migliori M, Scatena A, Cantaluppi V, Rosati A, Pizzarelli F, Panichi V, Shin BC, Kim HL, Chung JH, Malgorzewicz S, Chmmielewski M, Debska-Slizien A, Rutkowski B, Kolesnyk M, Stepanova N, Korol L, Kulizkyi M, Ablogina O, Migal L, Takahashi T, Kitajima Y, Hirano S, Naka A, Ogawa H, Aono M, Sato Y, Hoppe K, Schwermer K, K Ysz P, Kaczmarek J, Baum E, Sikorska D, Radziszewska D, Szkudlarek M, Olejniczak P, Pawlaczyk K, Lindholm B, Oko A, Severova Andreevska G, Trajceska L, Gelev S, Dzekova P, Selim G, Sikole A, Trajceska L, Severova Andreevska G, Rambabova Busletik I, Gelev S, Pavleska Kuzmanovska S, Dzekova Vidimiski P, Selim G, Sikole A, Borrelli S, De Simone E, Laurino S, De Simone W, Ahbap E, Kara E, Basturk T, Sakaci T, Koc Y, Sahutoglu T, Akgol C, Sevinc M, Atan Ucar Z, Unsal A, Girndt M, Fiedler R, Martus P, Pawlak M, Storr M, Boehler T, Templin M, Trojanowicz B, Ulrich C, Glomb M, Liehr K, Werner K, Zickler D, Schindler R, Vishnevskii KA, Gerasimchuk RP, Zemchenkov AY, Moura A, Madureira J, Alija P, Fernandes JC, Oliveira JG, Lopez M, Filgueiras M, Amado L, Sameiro-Faria M, Miranda V, Vieira M, Santos-Silva A, Costa E, Zaluska W, Kotlinska-Hasiec EKH, Zaluska A, Rzecki Z, Zadora P, Dabrowski W, Sikole A, Trajceska L, Amitov V, Busletik IR, Dzekova P, Selim G, Severova Andreevska G, Gelev S, Aicardi Spalloni V, La Milia V, Longhi S, Volo L, Del Vecchio L, Pontoriero G, Locatelli F, Martino F, Scalzotto E, Corradi V, Nalesso F, Zanella M, Brandolan A, Perez De Jose A, Abad S, Vega A, Reque J, Quiroga B, Lopez-Gomez JM, Esteve Simo V, Duarte Gallego V, Moreno Guzman F, Fulquet Nicolas M, Pou Potau M, Saurina Sole A, Carneiro Oliveira J, Ramirez De Arellano Serna M, Ahbap E, Kara E, Basturk T, Koc Y, Sakaci T, Sahutoglu T, Sevinc M, Atan Ucar Z, Unsal A, Van Diepen AT, Hoekstra T, De Mutsert R, Rotmans JI, De Boer M, Suttorp MM, Struijk DG, Boeschoten EW, Krediet RT, Dekker FW, Trigka K, Chouchoulis K, Musso CG, Kaza M, Mpimpi A, Pipili C, Kyritsis I, Douzdampanis P, Streja E, Rezakhani S, Rhee CM, Kalantar-Zadeh K, Streja E, Doshi M, Rhee C, Kovesdy C, Moradi H, Kalantar-Zadeh K, Dantas MA, Resende LL, Silva LF, Matos CM, Lopes GB, Lopes AA, Knap B, Arnol M, Buturovic J, Ponikvar R, Bren A, Codognotto M, Piasentin P, Conte F, Righetti M, Limido A, Tsuchida K, Michiwaki H, Minakuchi J, Kawashima S, Tomo T, Mutsaers HA, Jansen J, Van Den Broek PH, Verweij VG, Van Den Heuvel LP, Hoenderop JG, Masereeuw R, Clari R, Mongilardi E, Vigotti FN, Scognamiglio S, Consiglio V, Nazha M, Avagnina P, Piccoli G, Costelloe SJ, Freeman J, Keane DF, Lindley EJ, Thompson D, Kang GW, Lee IH, Ahn KS. DIALYSIS. PROTEIN-ENERGY WASTING, INFLAMMATION AND OXIDATIVE STRESS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Faglia E, Clerici G, Scatena A, Caminiti M, Curci V, Morabito A, Prisco V, Greco R, Edmonds M. Effectiveness of combined therapy with angiotensin-converting enzyme inhibitors and statins in reducing mortality in diabetic patients with critical limb ischemia: an observational study. Diabetes Res Clin Pract 2014; 103:292-7. [PMID: 24492022 DOI: 10.1016/j.diabres.2013.12.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/23/2013] [Accepted: 12/30/2013] [Indexed: 10/25/2022]
Abstract
AIMS To investigate the effect of combined treatment with angiotensin-converting enzyme inhibitors (ACE) and statins on mortality in diabetic patients with critical limb ischemia (CLI). METHODS Prospective observational study of 553 consecutive diabetic patients admitted because of CLI followed for a mean of 2.2 years. All patients underwent peripheral revascularization and antithrombotic therapy was prescribed or continued and therapy with statin and ACE was recorded. Mortality from any cause was assessed and Kaplan-Meier analyses were performed to compare the relationship between survival and recorded variables. RESULTS One hundred thirty-nine patients did not have therapy with statin or an ACE, 78 had therapy with statin without ACE, 164 had therapy with ACE without statin and 172 patients had therapy with both statin and ACE. One hundred thirty-six patients died, 45/139 with neither statin nor ACE, 40/164 with ACE only, 26/78 with statin only, and 25/172 with both statin and ACE. Multivariate analysis confirmed the independent role of age, history of stroke, renal insufficiency and dialysis. Combined treatment with ACE and statin appeared to have a protective role. CONCLUSIONS In patients with diabetes and CLI mortality after two years is high. Life expectancy was better in patients receiving combined therapy with ACE and statin but not with therapy with only a statin or an ACE.
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Affiliation(s)
- Ezio Faglia
- Diabetic Foot Centre, IRCCS Policlinico Multimedica, Va Milanese 300, Sesto San Giovanni 20099, Milan, Italy
| | - Giacomo Clerici
- Diabetic Foot Centre, IRCCS Policlinico Multimedica, Va Milanese 300, Sesto San Giovanni 20099, Milan, Italy.
| | - Alessia Scatena
- Diabetic Foot Centre, IRCCS Policlinico Multimedica, Va Milanese 300, Sesto San Giovanni 20099, Milan, Italy
| | - Maurizio Caminiti
- Diabetic Foot Centre, IRCCS Policlinico Multimedica, Va Milanese 300, Sesto San Giovanni 20099, Milan, Italy
| | - Vincenzo Curci
- Diabetic Foot Centre, IRCCS Policlinico Multimedica, Va Milanese 300, Sesto San Giovanni 20099, Milan, Italy
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Panichi V, Cupisti A, Rosati A, Di Giorgio A, Scatena A, Menconi O, Bozzoli L, Bottai A. Geriatric nutritional risk index is a strong predictor of mortality in hemodialysis patients: data from the Riscavid cohort. J Nephrol 2014; 27:193-201. [PMID: 24430765 DOI: 10.1007/s40620-013-0033-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/01/2013] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Malnutrition is a common complication in hemodialysis (HD) patients and it is related to morbidity and mortality. Although a gold standard method for diagnosis of malnutrition is not available, serum albumin, body weight and height are commonly used and are included in the calculation of the Geriatric nutritional risk index (GNRI). Recently the association between GNRI and mortality in chronic HD patients has been documented in Asian populations. Our aim was to examine the relative reliability of the GNRI as a mortality and morbidity predictor in an Italian HD cohort. METHODS We prospectively examined the GNRI of 753 maintenance HD patients aged 65.7 ± 14.1 years, 457 males, included in the Riscavid cohort, and followed them up for 84 months. Predictors for all-cause death were examined using Kaplan-Meier and Cox proportional-hazards analyses. RESULTS Low GNRI was significantly associated with signs of wasting, i.e. low Body mass index, hypoalbuminemia, low normalized protein catabolic rate. Patients within the lowest GNRI quartile had a significantly lower survival rate than those in the 2nd to 4th quartile (p < 0.001). Multivariate Cox proportional-hazards analysis demonstrated that the lowest quartile of GNRI was a significant predictor of case mix adjusted all-cause mortality (HR 1.72; CI 1.35-2.18, p < 0.001). CONCLUSIONS These results demonstrate that low GNRI (<92) is associated with malnutrition and is a strong predictor of overall mortality in HD patients. However, cardiovascular events did not differ among the GNRI quartiles. A low GNRI score can be considered a simple and reliable marker of malnutrition and predictor for mortality risk in Caucasian HD patients.
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Affiliation(s)
- Vincenzo Panichi
- Nephrology and Dialysis Unit, Versilia Hospital, Lido di Camaiore, Italy,
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Kohlova M, Ribeiro S, do Sameiro-Faria M, Rocha-Pereira P, Fernandes J, Reis F, Miranda V, Quintanilha A, Bronze-da-Rocha E, Belo L, Costa E, Santos-Silva A, Arias-Guillen M, Maduell F, Masso E, Fontsere N, Carrera M, Ojeda R, Vera M, Cases A, Campistol J, Di Benedetto A, Ciotola A, Stuard S, Marcelli D, Canaud B, Kim MJ, Lee SW, Kweon SH, Song JH, Rosales LM, Abbas S, Zhu F, Flores C, Carter M, Apruzzese R, Kotanko P, Levin NW, Mann H, Seyffart G, Ensminger A, Goksel T, Stiller S, Zaluska W, Kotlinska-Hasiec E, Rzecki Z, Rybojad B, Zaluska A, Da'browski W, Ponce P, Chung T, Kreuzberg U, Pedrini L, Francois K, Wissing KM, Jacobs R, Boone D, Jacobs K, Tielemans C, Agar BU, Culleton BF, Fluck R, Leypoldt JK, Lentini P, Zanoli L, Granata A, Contestabile A, Basso A, Berlingo G, Pellanda V, de Cal M, Clementi A, Insalaco M, Dell'Aquila R, Panichi V, Rosati A, Casani A, Conti P, Capitanini A, Migliori M, Scatena A, Giusti R, Malagnino E, Betti G, Bernabini G, Gabbrielli C, Rollo S, Caiani D, Pizzarelli F, Cantaluppi V, Medica D, Quercia AD, Gai M, Leonardi G, Anania P, Guarena C, Giovinazzo G, Ferraresi M, Merlo I, Deambrosis I, Giaretta F, Biancone L, Segoloni GP, Surace A, Pieri M, Rovatti P, Steckiph D, Mambelli E, Mancini E, Santoro A, Devine E, Krieter D, Lemke HD, Frasca GM, Sagripanti S, Boggi R, Del Rosso G, Gattiani A, Mosconi G, Oliva S, Rigotti A, Sopranzi F, Tetta C, Cavallari C, Fonsato V, Maffei S, Collino F, Camussi G, Ksiazek A, Waniewski J, Debowska M, Wojcik-Zaluska A, Zaluska W, Maduell F, Wieneke P, Arias-Guillen M, Fontsere N, Vera M, Ojeda R, Carrera M, Cases A, Campistol J, Bunia J, Ziebig R, Wolf H, Ahrenholz P, Donadio C, Kanaki A, Sami N, Tognotti D, Goubella A, Gankam-Kengne F, Baudoux T, Fagnoul D, Husson C, Ghisdal L, Broeders NE, Nortier JL, von Albertini B, Mathieu C, Cherpillod A, Boesch A, Romo M, Zhou J, Tang L, Kong D, Zhang L, Shi S, Lv Y, Chen X, Sakurai K, Saito T, Ishii D, Fievet P, Delpierre A, Faucher J, Ghazali A, Soltani ON, Lefevre M, Stephan R, Demontis R, Hougardy JM, Husson C, Gastaldello K, Nortier JL, Mishkin GJ, McLean A, Palant C, Fievet P, Faucher J, Delpierre A, Ghazali A, Demontis R, Glorieux G, Hulko M, Speidel R, Brodbeck K, Krause B, Vanholder R, Rovatti P, Grandi E, Stefani D, Ruffo M, Solem K, Olde B, Santoro A, Sterner G, Lee YK, Lee HW, Choi KH, Kim BS, Sakurai K, Saito T, Wakabayasi Y, Djuric P, Bulatovic A, Jankovic A, Tosic J, Popovic J, Djuric Z, Bajcetic S, Dimkovic N, Golubev RV, Soltysiak J, Malke A, Warzywoda A, Blumczynski A, Silska-Dittmar M, Musielak A, Ostalska-Nowicka D, Zachwieja J, Ashcroft R, Williams G, Brown C, Chess J, Mikhail A, Steckiph D, Bertucci A, Petrarulo M, Baldini C, Calabrese G, Gonella M. Extracorporeal dialysis: techniques and adequacy II. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft144] [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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Panichi V, Scatena A, Migliori M, Marchetti V, Paoletti S, Beati S. Biomarkers of chronic inflammatory state in uremia and cardiovascular disease. Int J Inflam 2012; 2012:360147. [PMID: 22701810 PMCID: PMC3373120 DOI: 10.1155/2012/360147] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 04/05/2012] [Accepted: 04/17/2012] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular disease is the leading cause of death in the general population; traditional risk factors seem inadequate to explain completely the remarkable prevalence of cardiovascular mortality and morbidity observed in the uremic population. A role for chronic inflammation has been well established in the development of atherosclerotic disease, and, on the basis of these observations, atherosclerosis might be considered an inflammatory disease. Inflammation has been implicated in the etiology of coronary artery disease in the general population, and traditional inflammatory biomarkers such as C-reactive protein (CRP) and interleukin-6 (IL-6) have been shown to predict cardiovascular events in both symptomatic and asymptomatic individuals as well as those in the uremic population. Later on, new nontraditional markers were related to the risk of cardiovascular morbidity and mortality in general and in uremic population. As a consequence of the expanding research base and availability of assays, the number of inflammatory marker tests ordered by clinicians for cardiovascular disease (CVD) risk prediction has grown rapidly and several commercial assays have become available. So, up to now we can consider that several new nontraditional markers as CD40-CD40 ligand system and pentraxin-3 seem to be significant features of cardiovascular disease in general and in ESRD population.
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Affiliation(s)
- Vincenzo Panichi
- Nephrology and Dialysis Unit, Versilia Hospital, Via Aurelia 335, 55034 Lido di Camaiore, Italy
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Scatena A, Petruzzi P, Ferrari M, Rizzo L, Cicorelli A, Berchiolli R, Goretti C, Bargellini I, Adami D, Iacopi E, Del Corso A, Cioni R, Piaggesi A. Outcomes of three years of teamwork on critical limb ischemia in patients with diabetes and foot lesions. INT J LOW EXTR WOUND 2012; 11:113-9. [PMID: 22665920 DOI: 10.1177/1534734612448384] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate the outcomes of a multidisciplinary team working on diabetic foot (DF) patients with critical limb ischemia (CLI) in a specialized center, the authors retrospectively traced all the patients admitted in their department in 3 consecutive years with a diagnosis of CLI. From January 2006 to December 2008, 245 consecutive DF patients with CLI according the TransAtlantic interSociety Consensus II criteria were included in the study. Treatment strategy was decided by a team of diabetologists, inteventional radiologists, and vascular surgeons. Technical and clinical success, mortality, and ulcer recurrence were evaluated at 6 months and at a mean follow-up of 19.5 ± 13.4 months. Percutaneous transluminal angioplasty (PTA) was performed in 189 (77%) patients, whereas medical treatment, open surgical revascularization (OSR), and primary amputation were performed in 44 (18.3%), 11 (4.3%), and 1 (0.5%) patients, respectively. Revascularization was successful in 227/233 (97.4%) patients. At follow-up, the overall clinical success rate was 60.4%; it was significantly (P = .001) higher after revascularization (75.9%) compared with medical treatment (48.3%). During follow-up, surgical interventions in the foot were 1.5 ± 0.4 in those treated with PTA, 1.6 ± 0.5 in those treated with OSR, and 0.3 ± 0.8 in those receiving medical therapy (P < .05 compared with the others). Ulcer recurrence occurred in 29 (11.8%) patients: 4 (1.6%) in PTA, 2 (0.8%) in OSR, and 23 (9.4%) in the medical therapy group (P < .05). Major amputation rate was 9.3%, being significantly (P = .04) lower after revascularization (5.2%) compared with medical therapy alone (13.8%). Cumulative mortality rate was 10.6%. In conclusion, this study confirms the positive role of a PTA-first approach for revascularizing the complex cases of DF with CLI in a teamwork management strategy.
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Affiliation(s)
- Alessia Scatena
- Diabetic Foot Section, Department of Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Takasawa K, Takaeda C, Higuchi M, Maeda T, Tomosugi N, Ueda N, Sasaki Y, Ikezoe M, Hagiwara M, Furuhata S, Murakami M, Shimonaka Y, Yamazaki S, Hamahata S, Hamahata S, Oue M, Kuragano T, Furuta M, Yahiro M, Kida A, Otaki Y, Hasuike Y, Nonoguchi H, Nakanishi T, Sarafidis P, Rumjon A, Ackland D, Maclaughlin H, Bansal SS, Macdougall IC, Panichi V, Rosati A, Malagnino E, Giusti R, Casani A, Betti G, Conti P, Bernabini G, Bernabini G, Gabrielli C, Caiani D, Scatena A, Migliori M, Pizzarelli F, Mitsopoulos E, Tsiatsiou M, Minasidis I, Kousoula V, Intzevidou E, Passadakis P, Vargemezis V, Tsakiris D, Yahiro M, Kida A, Otaki Y, Hasuike Y, Nonoguchi H, Nakanishi T, Kuragano T, Lines SW, Carter AM, Dunn EJ, Wright MJ, Aoyagi R, Miura T, De Paola L, Lombardi G, Coppolino G, Lombardi L, Hasuike Y, Fukumoto H, Kaibe S, Tokuyama M, Kida A, Otaki Y, Kuragano T, Nonoguchi H, Hiwasa M, Miyamoto T, Ohue H, Matsumoto A, Toyoda K, Nakanishi T, Rottembourg J, Emery C, Lafuma A, Wernli J, Zakin L, Mahi L, Borzych-Duzalka D, Bilginer Y, Pape L, Ha IS, Bak M, Chua A, Rees L, Pesle S, Cano F, Urzykowska A, Emre S, Russcasso J, Ramela V, Printza N, White C, Kuzmanovska D, Andrea V, Muller-Wiefel D, Warady B, Schaefer F, Chung JH, Park MK, Kim HL, Shin BC, Fujikawa T, Kuji T, Kakimoto M, Shibata K, Satta H, Nishihara M, Kawata S, Koguchi N, Toya Y, Umemura S, David V, Michel G, Maxime H, Paul L, Sebastien K, Francois V, Kuntsevich V, Dou Y, Thijssen S, Levin NW, Kotanko P, Kim BS, Kim BS, Park WD, Song HC, Kim HG, Kim YO, Woodburn K, Fong KL, Moriya Y, Tagawa Y, Maeda T, Kanda F, Morita N, Tomosugi N, London G, London G, Zaoui P, Covic A, Dellanna F, Goldsmith D, Gesualdo L, Mann J, Combe C, Turner M, Meunzberg M, Macdonald K, Abraham I, Gesualdo L, Combe C, Covic A, Dellanna F, Goldsmith D, London G, Mann J, Zaoui P, Turner M, Meunzberg M, Macdonald K, Abraham I, Rottembourg J, Guerin A, Diaconita M, Apruzzese R, Dou Y, Thijssen S, Kruse A, Ouellet G, Levin NW, Kotanko P, Bond C, Jensen D, Wang S, Pham E, Rubin J, Sika M, Niecestro R, Woodburn K, Fong KL, Sloneker S, Strzemienski P, Solon E, Moriya Y, Tagawa Y, Stamopoulos D, Mpakirtzi N, Grapsa E, Gogola B, Manios E, Afentakis N, Ewer J, Macdougall IC. Renal anaemia - CKD 5D. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs244] [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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Scatena A, Fornai F, Trincavelli ML, Taliani S, Daniele S, Pugliesi I, Cosconati S, Martini C, Da Settimo F. 3-(Fur-2-yl)-10-(2-phenylethyl)-[1,2,4]triazino[4,3-a]benzimidazol-4(10H)-one, a novel adenosine receptor antagonist with A(2A)-mediated neuroprotective effects. ACS Chem Neurosci 2011; 2:526-35. [PMID: 22860174 DOI: 10.1021/cn200036s] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/10/2011] [Indexed: 12/20/2022] Open
Abstract
In this study, compound FTBI (3-(2-furyl)-10-(2-phenylethyl)[1,2,4]triazino[4,3-a]benzimidazol-4(10H)-one) was selected from a small library of triazinobenzimidazole derivatives as a potent A(2A) adenosine receptor (AR) antagonist and tested for its neuroprotective effects against two different kinds of dopaminergic neurotoxins, 1-methyl-4-phenylpyridinium (MPP+) and methamphetamine (METH), in rat PC12 and in human neuroblastoma SH-SY5Y cell lines. FTBI, in a concentration range corresponding to its affinity for A(2A) AR subtype, significantly increased the number of viable PC12 cells after their exposure to METH and, to a similar extent, to MPP+, as demonstrated in both trypan blue exclusion assay and in cytological staining. These neuroprotective effects were also observed with a classical A(2A) AR antagonist, ZM241385, and appeared to be completely counteracted by the AR agonist, NECA, supporting A(2A) ARs are directly involved in FTBI-mediated effects. Similarly, in human SH-SY5Y cells, FTBI was able to prevent cell toxicity induced by MPP+ and METH, showing that this A(2A) AR antagonist has a neuroprotective effect independently by the specific cell model. Altogether these results demonstrate that the A(2A) AR blockade mediates cell protection against neurotoxicity induced by dopaminergic neurotoxins in dopamine containing cells, supporting the potential use of A(2A) AR antagonists in dopaminergic degenerative diseases including Parkinson's disease.
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Affiliation(s)
- Alessia Scatena
- Dipartimento di Morfologia Umana e Biologia Applicata, Università di Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Francesco Fornai
- Dipartimento di Morfologia Umana e Biologia Applicata, Università di Pisa, Via Roma 55, 56126 Pisa, Italy
- Neurobiologia dei disturbi del movimento, IRCCS INM Neuromed, Via Atinense 18, 86077 Pozzilli, Isernia, Italy
| | - Maria Letizia Trincavelli
- Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, Università di Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Sabrina Taliani
- Dipartimento di Scienze Farmaceutiche, Università di Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Simona Daniele
- Department of Drug Discovery and Development, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genova, Italy
| | - Isabella Pugliesi
- Dipartimento di Scienze Farmaceutiche, Università di Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Sandro Cosconati
- Dipartimento di Scienze Ambientali, Seconda Università di Napoli, Via Vivaldi 43, 81100 Caserta, Italy
| | - Claudia Martini
- Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, Università di Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Federico Da Settimo
- Dipartimento di Scienze Farmaceutiche, Università di Pisa, Via Bonanno 6, 56126 Pisa, Italy
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Piaggesi A, Vallini V, Iacopi E, Tedeschi A, Scatena A, Goretti C, Rizzo L. Iloprost in the management of peripheral arterial disease in patients with diabetes mellitus. Minerva Cardioangiol 2011; 59:101-108. [PMID: 21285935] [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: 05/30/2023]
Abstract
Diabetic complications in the lower extremities, especially those secondary to diabetic macroangiopathy, have increasingly become a clinical emergency, given the high prevalence and progression of the disease. Until recently, the only approach to treating advanced stage disease was medical therapy and major amputation; however, the advent of revascularization procedures has radically improved the prognosis of patients with critical lower limb ischemia. In this setting, iloprost holds a dual position: as first-choice therapy in patients ineligible for revascularization and as complementary therapy in candidates for surgical or endovascular revascularization.
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Affiliation(s)
- A Piaggesi
- Sezione Piede Diabetico, Unità Operativa Malattie del Metabolismo e Diabetologia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italia.
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