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Perrotta AM, Rotondi S, Mazzaferro S, Bosi L, Letizia C, Muscaritoli M, Gigante A, Salciccia S, Pasculli P, Ciardi MR, Tinti F, Galani A, Errigo F, Menè P, Cianci R, Mitterhofer AP, Mastroianni CM, Palange P, Lai S. COVID-19 and kidney: role of SARS-CoV-2 infection in the induction of renal damage. Eur Rev Med Pharmacol Sci 2023; 27:7861-7867. [PMID: 37667963 DOI: 10.26355/eurrev_202308_33441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE SARS-CoV-2 causes acute respiratory disease, interstitial and alveolar pneumonia, and involves numerous organs and systems such as the kidney, heart, digestive tract, blood, and nervous system. We aimed to evaluate the incidence of renal manifestations in patients diagnosed with COVID-19 infection. PATIENTS AND METHODS We performed a monocentric, cross-sectional, observational study, conducted on 114 patients with SARS-CoV-2. Clinical and laboratory parameters [renal function, serum electrolytes, inflammatory state, blood gas analysis, Interleukin 6 (IL-6) and urinalysis] were evaluated. The same values were checked out after two months (T1), however after negativization. RESULTS We enrolled 114 patients (59 males) with a mean age of 63.8 ± 13.9 years. We found hematuria in 48 patients (55.8%), proteinuria in 33 patients (38.4%), leukocyturia in 61 patients (70.9%), acute kidney injury (AKI) in 28 patients (24.6%), AKI in chronic kidney disease (CKD) in 24 patients (21.1%). Moreover, we found a significant increase of inflammatory indexes as C Reactive Protein (CRP), lactic dehydrogenase (LDH), alpha 1 and alpha 2 globulins with a subsequent reduction at T1 (p = 0.016, p < 0.001, p = 0.005, p = 0.007; respectively). Hemoglobin and erythrocyte values significantly decreased (p < 0.001, p = 0.003, respectively), and we found lymphopenia (p < 0.001). Also, we found elevated levels of the D-Dimer (p < 0.001) and a significant increase in the International Normalized Ratio (INR) (p = 0.038). We also showed a significant improvement after negativization in oxygen partial pressure (p = 0.001) and oxygen saturation (p < 0.001) and a significant increase in pH (p = 0.018) and bicarbonate concentration (p = 0.042). Moreover, we found a significant increase in IL-6 (p = 0.004). Also, we reported mild hyponatremia and hypokalemia with subsequent significant recovery (p < 0.001, p < 0.001, respectively) and mild hypochloremia with a recovery to the limits of statistical significance (p = 0.053). At the entrance, we found an increase in serum glucose with a significant reduction during recovery (p < 0.001). CONCLUSIONS The prevalence of AKI and/or CKD and/or abnormal urinalysis in patients diagnosed with COVID-19 on admission seems to be high and appears as a negative prognostic factor. Urinalysis appears to be very useful in unveiling the potential kidney impairment of COVID-19 patients; therefore, urinalysis could be used to reflect and predict the disease severity. We also recommend a careful evaluation of metabolic alterations, inflammatory states, and electrolytic disorders in COVID-19 patients.
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Affiliation(s)
- A M Perrotta
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy.
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Pham T, Heunks L, Bellani G, Madotto F, Aragao I, Beduneau G, Goligher EC, Grasselli G, Laake JH, Mancebo J, Peñuelas O, Piquilloud L, Pesenti A, Wunsch H, van Haren F, Brochard L, Laffey JG, Acharya SP, Amin P, Arabi Y, Aragao I, Bauer P, Beduneau G, Beitler J, Berkius J, Bugedo G, Camporota L, Cerny V, Cho YJ, Clarkson K, Estenssoro E, Goligher E, Grasselli G, Gritsan A, Hashemian SM, Hermans G, Heunks LM, Jovanovic B, Kurahashi K, Laake JH, Matamis D, Moerer O, Molnar Z, Ozyilmaz E, Panka B, Papali A, Peñuelas Ó, Perbet S, Piquilloud L, Qiu H, Razek AA, Rittayamai N, Roldan R, Serpa Neto A, Szuldrzynski K, Talmor D, Tomescu D, Van Haren F, Villagomez A, Zeggwagh AA, Abe T, Aboshady A, Acampo-de Jong M, Acharya S, Adderley J, Adiguzel N, Agrawal VK, Aguilar G, Aguirre G, Aguirre-Bermeo H, Ahlström B, Akbas T, Akker M, Al Sadeh G, Alamri S, Algaba A, Ali M, Aliberti A, Allegue JM, Alvarez D, Amador J, Andersen FH, Ansari S, Apichatbutr Y, Apostolopoulou O, Arabi Y, Arellano D, Arica M, Arikan H, Arinaga K, Arnal JM, Asano K, Asín-Corrochano M, Avalos Cabrera JM, Avila Fuentes S, Aydemir S, Aygencel G, Azevedo L, Bacakoglu F, Badie J, Baedorf Kassis E, Bai G, Balaraj G, Ballico B, Banner-Goodspeed V, Banwarie P, Barbieri R, Baronia A, Barrett J, Barrot L, Barrueco-Francioni JE, Barry J, Bauer P, Bawangade H, Beavis S, Beck E, Beehre N, Belenguer Muncharaz A, Bellani G, Belliato M, Bellissima A, Beltramelli R, Ben Souissi A, Benitez-Cano A, Benlamin M, Benslama A, Bento L, Benvenuti D, Berkius J, Bernabe L, Bersten A, Berta G, Bertini P, Bertram-Ralph E, Besbes M, Bettini LR, Beuret P, Bewley J, Bezzi M, Bhakhtiani L, Bhandary R, Bhowmick K, Bihari S, Bissett B, Blythe D, Bocher S, Boedjawan N, Bojanowski CM, Boni E, Boraso S, Borelli M, Borello S, Borislavova M, Bosma KJ, Bottiroli M, Boyd O, Bozbay S, Briva A, Brochard L, Bruel C, Bruni A, Buehner U, Bugedo G, Bulpa P, Burt K, Buscot M, Buttera S, Cabrera J, Caccese R, Caironi P, Canchos Gutierrez I, Canedo N, Cani A, Cappellini I, Carazo J, Cardonnet LP, Carpio D, Carriedo D, Carrillo R, Carvalho J, Caser E, Castelli A, Castillo Quintero M, Castro H, Catorze N, Cengiz M, Cereijo E, Ceunen H, Chaintoutis C, Chang Y, Chaparro G, Chapman C, Chau S, Chavez CE, Chelazzi C, Chelly J, Chemouni F, Chen K, Chena A, Chiarandini P, Chilton P, Chiumello D, Cho YJ, Chou-Lie Y, Chudeau N, Cinel I, Cinnella G, Clark M, Clark T, Clarkson K, Clementi S, Coaguila L, Codecido AJ, Collins A, Colombo R, Conde J, Consales G, Cook T, Coppadoro A, Cornejo R, Cortegiani A, Coxo C, Cracchiolo AN, Crespo Ramirez M, Crova P, Cruz J, Cubattoli L, Çukurova Z, Curto F, Czempik P, D'Andrea R, da Silva Ramos F, Dangers L, Danguy des Déserts M, Danin PE, Dantas F, Daubin C, Dawei W, de Haro C, de Jesus Montelongo F, De Mendoza D, de Pablo R, De Pascale G, De Rosa S, Decavèle M, Declercq PL, Deicas A, del Carmen Campos Moreno M, Dellamonica J, Delmas B, Demirkiran O, Demirkiran H, Dendane T, di Mussi R, Diakaki C, Diaz A, Diaz W, Dikmen Y, Dimoula A, Doble P, Doha N, Domingos G, Dres M, Dries D, Duggal A, Duke G, Dunts P, Dybwik K, Dykyy M, Eckert P, Efe S, Elatrous S, Elay G, Elmaryul AS, Elsaadany M, Elsayed H, Elsayed S, Emery M, Ena S, Eng K, Englert JA, Erdogan E, Ergin Ozcan P, Eroglu E, Escobar M, Esen F, Esen Tekeli A, Esquivel A, Esquivel Gallegos H, Ezzouine H, Facchini A, Faheem M, Fanelli V, Farina MF, Fartoukh M, Fehrle L, Feng F, Feng Y, Fernandez I, Fernandez B, Fernandez-Rodriguez ML, Ferrando C, Ferreira da Silva MJ, Ferreruela M, Ferrier J, Flamm Zamorano MJ, Flood L, Floris L, Fluckiger M, Forteza C, Fortunato A, Frans E, Frattari A, Fredes S, Frenzel T, Fumagalli R, Furche MA, Fusari M, Fysh E, Galeas-Lopez JL, Galerneau LM, Garcia A, Garcia MF, Garcia E, Garcia Olivares P, Garlicki J, Garnero A, Garofalo E, Gautam P, Gazenkampf A, Gelinotte S, Gelormini D, Ghrenassia E, Giacomucci A, Giannoni R, Gigante A, Glober N, Gnesin P, Gollo Y, Gomaa D, Gomero Paredes R, Gomes R, Gomez RA, Gomez O, Gomez A, Gondim L, Gonzalez M, Gonzalez I, Gonzalez-Castro A, Gordillo Romero O, Gordo F, Gouin P, Graf Santos J, Grainne R, Grando M, Granov Grabovica S, Grasselli G, Grasso S, Grasso R, Grimmer L, Grissom C, Gritsan A, Gu Q, Guan XD, Guarracino F, Guasch N, Guatteri L, Gueret R, Guérin C, Guerot E, Guitard PG, Gül F, Gumus A, Gurjar M, Gutierrez P, Hachimi A, Hadzibegovic A, Hagan S, Hammel C, Han Song J, Hanlon G, Hashemian SM, Heines S, Henriksson J, Herbrecht JE, Heredia Orbegoso GO, Hermans G, Hermon A, Hernandez R, Hernandez C, Herrera L, Herrera-Gutierrez M, Heunks L, Hidalgo J, Hill D, Holmquist D, Homez M, Hongtao X, Hormis A, Horner D, Hornos MC, Hou M, House S, Housni B, Hugill K, Humphreys S, Humbert L, Hunter S, Hwa Young L, Iezzi N, Ilutovich S, Inal V, Innes R, Ioannides P, Iotti GA, Ippolito M, Irie H, Iriyama H, Itagaki T, Izura J, Izza S, Jabeen R, Jamaati H, Jamadarkhana S, Jamoussi A, Jankowski M, Jaramillo LA, Jeon K, Jeong Lee S, Jeswani D, Jha S, Jiang L, Jing C, Jochmans S, Johnstad BA, Jongmin L, Joret A, Jovanovic B, Junhasavasdikul D, Jurado MT, Kam E, Kamohara H, Kane C, Kara I, Karakurt S, Karnjanarachata C, Kataoka J, Katayama S, Kaushik S, Kelebek Girgin N, Kerr K, Kerslake I, Khairnar P, Khalid A, Khan A, Khanna AK, Khorasanee R, Kienhorst D, Kirakli C, Knafelj R, Kol MK, Kongpolprom N, Kopitko C, Korkmaz Ekren P, Kubisz-Pudelko A, Kulcsar Z, Kumasawa J, Kurahashi K, Kuriyama A, Kutchak F, Laake JH, Labarca E, Labat F, Laborda C, Laca Barrera MA, Lagache L, Landaverde Lopez A, Lanspa M, Lascari V, Le Meur M, Lee SH, Lee YJ, Lee J, Lee WY, Lee J, Legernaes T, Leiner T, Lemiale V, Leonor T, Lepper PM, Li D, Li H, Li O, Lima AR, Lind D, Litton E, Liu N, Liu L, Liu J, Llitjos JF, Llorente B, Lopez R, Lopez CE, Lopez Nava C, Lovazzano P, Lu M, Lucchese F, Lugano M, Lugo Goytia G, Luo H, Lynch C, Macheda S, Madrigal Robles VH, Maggiore SM, Magret Iglesias M, Malaga P, Mallapura Maheswarappa H, Malpartida G, Malyarchikov A, Mansson H, Manzano A, Marey I, Marin N, Marin MDC, Markman E, Martin F, Martin A, Martin Dal Gesso C, Martinez F, Martínez-Fidalgo C, Martin-Loeches I, Mas A, Masaaki S, Maseda E, Massa E, Mattsson A, Maugeri J, McCredie V, McCullough J, McGuinness S, McKown A, Medve L, Mei C, Mellado Artigas R, Mendes V, Mervat MKE, Michaux I, Mikhaeil M, Milagros O, Milet I, Millan MT, Minwei Z, Mirabella L, Mishra S, Mistraletti G, Mochizuki K, Moerer O, Moghal A, Mojoli F, Molin A, Molnar Z, Montiel R, Montini L, Monza G, Mora Aznar M, Morakul S, Morales M, Moreno Torres D, Morocho Tutillo DR, Motherway C, Mouhssine D, Mouloudi E, Muñoz T, Munoz de Cabo C, Mustafa M, Muthuchellappan R, Muthukrishnan M, Muttini S, Nagata I, Nahar D, Nakanishi M, Nakayama I, Namendys-Silva SA, Nanchal R, Nandakumar S, Nasi A, Nasir K, Navalesi P, Naz Aslam T, Nga Phan T, Nichol A, Niiyama S, Nikolakopoulou S, Nikolic E, Nitta K, Noc M, Nonas S, Nseir S, Nur Soyturk A, Obata Y, Oeckler R, Oguchi M, Ohshimo S, Oikonomou M, Ojados A, Oliveira MT, Oliveira Filho W, Oliveri C, Olmos A, Omura K, Orlandi MC, Orsenigo F, Ortiz-Ruiz De Gordoa L, Ota K, Ovalle Olmos R, Öveges N, Oziemski P, Ozkan Kuscu O, Özyilmaz E, Pachas Alvarado F, Pagella G, Palaniswamy V, Palazon Sanchez EL, Palmese S, Pan G, Pan W, Panka B, Papanikolaou M, Papavasilopoulou T, Parekh A, Parke R, Parrilla FJ, Parrilla D, Pasha T, Pasin L, Patão L, Patel M, Patel G, Pati BK, Patil J, Pattnaik S, Paul D, Pavesi M, Pavlotsky VA, Paz G, Paz E, Pecci E, Pellegrini C, Peña Padilla AG, Perchiazzi G, Pereira T, Pereira V, Perez M, Perez Calvo C, Perez Cheng M, Perez Maita R, Pérez-Araos R, Perez-Teran P, Perez-Torres D, Perkins G, Persona P, Petnak T, Petrova M, Pham T, Philippart F, Picetti E, Pierucci E, Piervincenzi E, Pinciroli R, Pintado MC, Piquilloud L, Piraino T, Piras S, Piras C, Pirompanich P, Pisani L, Platas E, Plotnikow G, Porras W, Porta V, Portilla M, Portugal J, Povoa P, Prat G, Pratto R, Preda G, Prieto I, Prol-Silva E, Pugh R, Qi Y, Qian C, Qin T, Qiu H, Qu H, Quintana T, Quispe Sierra R, Quispe Soto R, Rabbani R, Rabee M, Rabie A, Rahe Pereira MA, Rai A, Raj Ashok S, Rajab M, Ramdhani N, Ramey E, Ranieri M, Rathod D, Ray B, Redwanul Huq SM, Regli A, Reina R, Resano Sarmiento N, Reynaud F, Rialp G, Ricart P, Rice T, Richardson A, Rieder M, Rinket M, Rios F, Rios F, Risso Vazquez A, Rittayamai N, Riva I, Rivette M, Roca O, Roche-Campo F, Rodriguez C, Rodriguez G, Rodriguez Gonzalez D, Rodriguez Tucto XY, Rogers A, Romano ME, Rørtveit L, Rose A, Roux D, Rouze A, Rubatto Birri PN, Ruilan W, Ruiz Robledo A, Ruiz-Aguilar AL, Sadahiro T, Saez I, Sagardia J, Saha R, Saha R, Saiphoklang N, Saito S, Salem M, Sales G, Salgado P, Samavedam S, Sami Mebazaa M, Samuelsson L, San Juan Roman N, Sanchez P, Sanchez-Ballesteros J, Sandoval Y, Sani E, Santos M, Santos C, Sanui M, Saravanabavan L, Sari S, Sarkany A, Sauneuf B, Savioli M, Sazak H, Scano R, Schneider F, Schortgen F, Schultz MJ, Schwarz GL, Seçkin Yücesoy F, Seely A, Seiler F, Seker Tekdos Y, Seok Chan K, Serano L, Serednicki W, Serpa Neto A, Setten M, Shah A, Shah B, Shang Y, Shanmugasundaram P, Shapovalov K, Shebl E, Shiga T, Shime N, Shin P, Short J, Shuhua C, Siddiqui S, Silesky Jimenez JI, Silva D, Silva Sales B, Simons K, Sjøbø BÅ, Slessor D, Smiechowicz J, Smischney N, Smith P, Smith T, Smith M, Snape S, Snyman L, Soetens F, Sook Hong K, Sosa Medellin MÁ, Soto G, Souloy X, Sousa E, Sovatzis S, Sozutek D, Spadaro S, Spagnoli M, Spångfors M, Spittle N, Spivey M, Stapleton A, Stefanovic B, Stephenson L, Stevenson E, Strand K, Strano MT, Straus S, Sun C, Sun R, Sundaram V, SunPark T, Surlemont E, Sutherasan Y, Szabo Z, Szuldrzynski K, Tainter C, Takaba A, Tallott M, Tamasato T, Tang Z, Tangsujaritvijit V, Taniguchi L, Taniguchi D, Tarantino F, Teerapuncharoen K, Temprano S, Terragni P, Terzi N, Thakur A, Theerawit P, Thille AW, Thomas M, Thungtitigul P, Thyrault M, Tilouch N, Timenetsky K, Tirapu J, Todeschini M, Tomas R, Tomaszewski C, Tonetti T, Tonnelier A, Trinder J, Trongtrakul K, Truwit J, Tsuei B, Tulaimat A, Turan S, Turkoglu M, Tyagi S, Ubeda A, Vagginelli F, Valenti MF, Vallverdu I, Van Axel A, van den Hul I, van der Hoeven H, Van Der Meer N, Van Haren F, Vanhoof M, Vargas-Ordoñez M, Vaschetto R, Vascotto E, Vatsik M, Vaz A, Vazquez-Sanchez A, Ventura S, Vermeijden JW, Vidal A, Vieira J, Vilela Costa Pinto B, Villagomez A, Villagra A, Villegas Succar C, Vinorum OG, Vitale G, Vj R, Vochin A, Voiriot G, Volta CA, von Seth M, Wajdi M, Walsh D, Wang S, Wardi G, Ween-Velken NC, Wei BL, Weller D, Welsh D, Welters I, Wert M, Whiteley S, Wilby E, Williams E, Williams K, Wilson A, Wojtas J, Won Huh J, Wrathall D, Wright C, Wu JF, Xi G, Xing ZJ, Xu H, Yamamoto K, Yan J, Yáñez J, Yang X, Yates E, Yazicioglu Mocin O, Ye Z, Yildirim F, Yoshida N, Yoshido HHL, Young Lee B, Yu R, Yu G, Yu T, Yuan B, Yuangtrakul N, Yumoto T, Yun X, Zakalik G, Zaki A, Zalba-Etayo B, Zambon M, Zang B, Zani G, Zarka J, Zerbi SM, Zerman A, Zetterquist H, Zhang J, Zhang H, Zhang W, Zhang G, Zhang W, Zhao H, Zheng J, Zhu B, Zumaran R. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study. Lancet Respir Med 2023; 11:465-476. [PMID: 36693401 DOI: 10.1016/s2213-2600(22)00449-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. METHODS WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. FINDINGS Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. INTERPRETATION In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. FUNDING European Society of Intensive Care Medicine, European Respiratory Society.
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Affiliation(s)
- Tài Pham
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de Recherche CARMAS, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France
| | - Leo Heunks
- Department of Intensive Care Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - Fabiana Madotto
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Aragao
- Department of Intensive Care Medicine, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Gaëtan Beduneau
- Normandie University, UNIROUEN, UR 3830, CHU Rouen, Department of Medical Intensive Care, F-76000 Rouen, France
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute University Health Network, Toronto, Canada
| | - Giacomo Grasselli
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Jon Henrik Laake
- Department of Anaesthesiology and Department of Research and Development, Division of Critical Care and Emergencies, Oslo University Hospital, Oslo, Norway
| | - Jordi Mancebo
- Department of Intensive Care Medicine, Hospital Universitari Sant Pau, Barcelona, Spain
| | - Oscar Peñuelas
- Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain; Centro de Investigación Biomédica en Red, CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - Lise Piquilloud
- Adult Intensive Care Unit, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonio Pesenti
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Hannah Wunsch
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frank van Haren
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Intensive Care Unit, St George Hospital, Sydney, NSW, Australia
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - John G Laffey
- Anaesthesia and Intensive Care Medicine, School of Medicine, Clinical Sciences Institute, Galway University Hospitals, Galway, Ireland; School of Medicine, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
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Lai S, Gigante A, Pellicano C, Mariani I, Iannazzo F, Concistrè A, Letizia C, Muscaritoli M. Kidney dysfunction is associated with adverse outcomes in internal medicine COVID-19 hospitalized patients. Eur Rev Med Pharmacol Sci 2023; 27:2706-2714. [PMID: 37013790 DOI: 10.26355/eurrev_202303_31809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
OBJECTIVE In this study, we aimed to evaluate the kidney involvement assessed by estimated glomerular filtration rate (eGFR), the associations with specific clinical disease variables and laboratory findings, and the predictive role of eGFR on clinical outcomes of patients admitted with COVID-19 in Internal Medicine ward in the first wave. PATIENTS AND METHODS Clinical data of 162 consecutive patients hospitalized in the University Hospital Policlinico Umberto I in Rome, Italy, between December 2020 to May 2021 were collected and retrospectively analyzed. RESULTS The median eGFR was significantly lower in patients with worse outcomes than in patients with favorable outcomes [56.64 ml/min/1.73 m2 (IQR 32.27-89.73) vs. 83.39 ml/min/1.73 m2 (IQR 69.59-97.08), p<0.001]. Patients with eGFR < 60 ml/min/1.73 m2 (n=38) were significantly older compared to patients with normal eGFR [82 years (IQR 74-90) vs. 61 years (IQR 53-74), p<0.001] and they had fever less frequently [39.5% vs. 64.2%, p<0.01]. Kaplan-Meier curves demonstrated that overall survival was significantly shorter in patients with eGFR < 60 ml/min/1.73 m2 (p<0.001). In multivariate analysis, only eGFR < 60 ml/min/1.73 m2 [HR=2.915 (95% CI=1.110-7.659), p<0.05] and platelet to lymphocyte ratio [HR=1.004 (95% CI=1.002-1.007), p<0.01] showed a significant predictive value for death or transfer to intensive care unit (ICU). CONCLUSIONS Kidney involvement on admission was an independent predictor for death or transfer to ICU among hospitalized COVID-19 patients. The presence of chronic kidney disease could be regarded as a relevant factor in risk stratification for COVID-19.
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Affiliation(s)
- S Lai
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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Pellegrino G, Colasanti T, Bisconti I, Cadar M, DI Ciommo FR, Reza Beigi DM, Stefanantoni K, Gigante A, Rosato E, Conti F, Riccieri V. POS0475 ROLE OF IL-33/ST2 AXIS IN SYSTEMIC SCLEROSIS PATIENTS WITH ELECTROCARDIOGRAPHIC ABNORMALITIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundElectrocardiographic (EKG) abnormalities are described in 25-75% Systemic Sclerosis (SSc) patients and they are associated with other systemic manifestations1 as well as with a worse prognosis.2 There is an increasing need for clinical and laboratory biomarkers to ameliorate the diagnostic approaches to patients with EKG abnormalities.3In the last decade, many studies focused on the components of the interleukin (IL)-33/ST2 axis. Under physiological conditions, IL-33 is released by apoptotic cardiac cells, promoting a protective mechanism of cell survival, thanks to the binding with its transmembrane receptor ST2.4 During pathological cardiovascular events, an abnormal secretion of the IL-33 soluble receptor (sST2) by Th2 cells occurs. It binds IL-33 not allowing the physiological mechanism driven by the IL-33/ST2 binding previously described.4 For these reasons, sST2 has been proposed as a biomarker of cardiac injury in a variety of diseases.5ObjectivesAim of this study was to analyse clinical and demographical parameters in a group of SSc patients, trying to define any possible feature associated with EKG abnormalities. Furthermore, the role of IL-33/ST2 axis components as biomarkers of cardiac injury in patients with SSc-related EKG abnormalities was evaluated, also assessing the possible correlation with serum concentration of NT-pro-BNP, a well-known cardiac injury biomarker in SSc.MethodsData from 277 SSc patients, fulfilling the 2013 ACR/EULAR classification criteria,6 attending our Scleroderma Clinic were retrospectively analysed. We selected patients with EKG trace and a blood sample available, collected after the SSc diagnosis. The sera levels of sST2 (ELISA Kit, Abcam), IL-33 (ELISA kit, RayBiotech) and NT-pro-BNP (ELISA Kit, Abcam) were measured. Patients with a history of heart diseases occurring before the diagnosis of SSc or features of secondary cardiac involvement (pulmonary arterial hypertension, severe interstitial lung disease or renal disease) were excluded.ResultsForty-six SSc patients showed significant EKG abnormalities (rhythm and conduction disorders). Thirty-one SSc patients without pathologic finding at EKG traces were recruited as the control group.From the analysis of the clinical characteristic of the disease at the moment of serum collection, patients with EKG anomalies have more frequently both a diffuse form of disease (n°-%: 23-50 vs 7-23; p 0.01), with a mean value of mRSS higher than controls (11±9 vs 6±6; p 0.01), and a scleroderma “late” pattern at the nailfold capillaroscopy (n°-% 23-50 vs 6-19; p 0.027).Significantly higher median values of serum levels of sST2 in SSc patients with EKG disorders compared to the control group (4289pg/mL, IQR 2383 vs 2560 pg/mL, IQR 1455; p 0.0002) were detected, while opposite results were found analyzing serum levels of IL-33 (2.89 pg/mL IQR 101 vs 9 pg/mL IQR 277; p 0.032) (Graph 1). Serum NT-pro-BNP median values were significantly higher in the group of patients with EKG abnormalities than in the control group (149 pg/mL, IQR 354 vs 26 pg/mL, IQR 62; p 0.0007). These values correlated with sST2 serum levels (rho Spearman correlation 0.37; p 0.0006).ConclusionSSc patients with EKG abnormalities showed an increased skin and vascular involvement with respect to the control group. These associations could help clinicians in clinically stratifying SSc patients at risk of EKG abnormalities. To our knowledge, this is the first report evaluating the serum concentration of sST2 in SSc patients. Based on these results, we can speculate on the role of this molecule as potential biomarkers of early cardiac injury during SSc, although further studies involving a larger cohort of patients are needed.References[1]Vacca et al. Rheumatol 2014[2]Tyndall et al. Ann Rheum Dis 2010[3]Muresan et al. Clin Rheumatol 2018[4]Vianello et al. Int J Biochem Cell Biol 2019[5]Dudek et al. Adv Clin Exp Med 2020[6]van den Hoogen et al. Arthritis Rheum 2013Figure 1:Graph 1. Serum sST2 (a) and IL-33 (b) concentrations in patients with EKG abnormalities (EKG+) vs control group (EKG)Disclosure of InterestsNone declared.
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Luciani P, Procaccini R, Rotini M, Pettinari F, Gigante A. Angular stable plate versus reverse shoulder arthroplasty for proximal humeral fractures in elderly patient. Musculoskelet Surg 2022; 106:43-48. [PMID: 32504451 DOI: 10.1007/s12306-020-00669-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Treatment of complex proximal humeral fractures in the elderly is a challenge and reverse shoulder arthroplasty (RTSA) is now an important alternative to open reduction internal fixation (ORIF) with angular stable plate. The purpose of this study is to compare clinical and radiological outcomes of RTSA and ORIF in the elderly. METHODS We retrospectively analyzed patients treated for three- or four-part displaced fractures of the proximal humerus. Range of motion, disabilities of the arm, shoulder and hand (DASH) and Constant scores were recorded. X-ray exam in three projections completed the clinical observation at follow-up. RESULTS Forty-eight patients were enrolled after a mean follow-up of 37 months: 22 RTSA and 26 ORIF. Mean age at trauma was 74 years. Compared with RTSA patients, ORIF patients had significantly higher mean external rotation (28° vs. 14°) and better results in modal internal rotation (hand at D7 vs. hand at L5-S1). No significant differences were seen in DASH and Constant scores. Avascular necrosis and loss of reduction with varus dislocation of the humeral head were the most frequent causes of revision surgery in ORIF (34.6%) while the revision rate of the RTSA was 9.1%. CONCLUSION In this study, both treatments showed good clinical outcomes, but RTSA resulted in lower revision rate than ORIF. Even if external and internal rotation in RTSA patients were worse than ORIF, they did not affect the patient's quality of life. So, the reverse arthroplasty seems to be a more reliable treatment.
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Affiliation(s)
- P Luciani
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy.
| | - R Procaccini
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy
| | - M Rotini
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy
| | - F Pettinari
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy
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Auci E, Vendramin I, Barbariol F, Riccardi I, Gigante A, Baroselli A, Bove T, Bassi F, Vetrugno L, Livi U. Platelet Dysfunction in Cardiac Surgery: When is the Best Time to Assess It? An Observational Single Center Study. Semin Cardiothorac Vasc Anesth 2022; 26:8-14. [PMID: 35156440 DOI: 10.1177/10892532211064041] [Citation(s) in RCA: 1] [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] [Indexed: 11/15/2022]
Abstract
Purpose. Cardiac surgery is characterized by a high risk of complications related to perioperative bleeding. Guidelines suggest the use of local algorithms based on perioperative point-of-care tests to assess and manage potential coagulation abnormalities. We investigated whether heparin reversal administration affects the adenosine-5-diphosphate (ADP) test values, thus identifying the earliest time point following cardio-pulmonary bypass that permits the promptest detection and treatment of potential platelet dysfunctions. Methods. This was a retrospective, single-center, observational study enrolling cardiac surgery patients requiring cardiac bypass. ADP-tests at 4 different time-points during surgery (T0: baseline, T1: at aortic de-clamping, T2: 10 minutes after protamine administration, and T3: at the end of surgery) were performed. Results. 63 patients undergoing elective cardiac surgery were studied. Baseline ADP-test values were almost constantly greater than intraoperative values, and end of surgery values were often greater than previous intraoperative values. The only difference that proved to be not statistically significant was between T1 and T2, with a clinically insignificant mean difference of -.2 U (95%CI of difference: -6.9 - 6.5 U). There was no correlation between the variation in ADP-test values pre- and post-protamine administration and the protamine-to-heparin ratio. Conclusion. The results of the present study support the hypothesis that the ADP-test could be performed early, at aortic de-clamping before protamine administration. This approach allows for the promptest assessment of a potential impairment in platelet function, and its timely correction.
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Affiliation(s)
| | | | | | | | | | | | - Tiziana Bove
- ASUFC University Hospital of Udine, Udine, Italy.,Department of Medicine, 9316University of Udine, Udine, Italy
| | - Flavio Bassi
- ASUFC University Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- ASUFC University Hospital of Udine, Udine, Italy.,Department of Medicine, 9316University of Udine, Udine, Italy
| | - Ugolino Livi
- ASUFC University Hospital of Udine, Udine, Italy.,Department of Medicine, 9316University of Udine, Udine, Italy
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Farinelli L, Aquili A, Mattioli-Belmonte M, Manzotti S, D'Angelo F, Ciccullo C, Gigante A. Synovial mast cells from knee and hip osteoarthritis: histological study and clinical correlations. J Exp Orthop 2022; 9:13. [PMID: 35079910 PMCID: PMC8789998 DOI: 10.1186/s40634-022-00446-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/07/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the presence of synovial mast cells (MCs) in hip and knee tissue from osteoarthritis (OA) patients and to correlate them with clinical and radiological data. METHODS Synovial tissue was obtained during arthroplasty from 60 patients, 30 with knee OA and 30 with hip OA. Control synovial tissue was obtained from 30 patients without OA, 15 undergoing above-knee amputation and 15 receiving a hip replacement for fracture. Before surgery, the radiographic findings were graded according to the Kellgren-Lawrence system and clinical data including pain (VAS) and functional information (KOOS and HOOS) was collected. The tissue was stained with hematoxylin-eosin and toluidine blue for histochemistry and incubated with CD117 and CD31 antibodies for immunohistochemistry. MC and vessel number and synovitis score were determined in all samples. RESULTS Mean MC number, synovitis score and vessel number were significantly higher in the OA samples (p < 0.05) than in control tissue. MC number correlated with the synovitis score and disease severity in both patient groups. CONCLUSIONS The prevalence of MCs in synovium from OA patients and their association with synovial inflammation and pain suggest a role for them in OA pathophysiology.
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Affiliation(s)
- L Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, Università Politecnica Delle Marche, Ancona, Italy
| | - A Aquili
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, Università Politecnica Delle Marche, Ancona, Italy
| | - M Mattioli-Belmonte
- Department of Clinical and Molecular Science DISCLIMO, Università Politecnica Delle Marche, Ancona, Italy
| | - S Manzotti
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, Università Politecnica Delle Marche, Ancona, Italy
| | - F D'Angelo
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, Università Politecnica Delle Marche, Ancona, Italy
| | - C Ciccullo
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, Università Politecnica Delle Marche, Ancona, Italy
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, Università Politecnica Delle Marche, Ancona, Italy.
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Gigante A, Rosato E. Reduced glomerular filtrate rate, end-stage renal disease, scleroderma renal crisis, and risk of mortality in patients with systemic sclerosis. Scand J Rheumatol 2021; 51:246-247. [PMID: 34788189 DOI: 10.1080/03009742.2021.1995983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - E Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Lai S, Perrotta AM, Bagordo D, Mazzaferro S, Menè P, Gigante A, Tinti F, Galani A, Cianci R. Screening of QTc interval and global autonomic activity in autosomal dominant polycystic kidney disease and atherosclerotic renal artery stenosis hypertensive patients. Eur Rev Med Pharmacol Sci 2021; 25:6333-6338. [PMID: 34730214 DOI: 10.26355/eurrev_202110_27005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Arterial hypertension (AH) represents a major risk factor for cardiovascular disease and is associated to several complications, such as prolonged corrected QT (QTc) interval and impaired heart rate variability (HRV). Secondary causes of AH include autosomal dominant polycystic kidney disease (ADPKD) and atherosclerotic renal artery stenosis (ARAS), both known to be related to arrhythmic risk and autonomic imbalance. The aim of the study is to evaluate whether global autonomic activity and QTc interval differently affect ADPKD and ARAS hypertensive patients. PATIENTS AND METHODS An observational study was performed on 59 patients: 16 ADPKD patients and 19 diagnosed with ARAS, compared to 24 healthy controls (HC). All patients underwent clinical evaluation, biochemical lab tests, 24-hour electrocardiogram (ECG) and renal Doppler ultrasound. HRV was assessed through the analysis of 24-hour ECG to detect standard deviation of normal-to-normal RR intervals (SDNN). QTc interval was defined as prolonged when > 440 msec. RESULTS SDNN was significantly lower in ADPKD and ARAS patients than HC (p < 0.0001) and no significant differences were found between ADPKD and ARAS patients (p > 0.05). QTc was found significantly higher in ARAS patients than HC (p = 0.001) and in ARAS patients than ADPKD patients (p = 0.004). CONCLUSIONS The pathogenesis of hypertension in ADPKD and ARAS patients is related to the activation of the renin angiotensin aldosterone system (RAAS). In ADPKD, cyst enlargement leads to kidney ischemia and renin release, associated to endothelial dysfunction, low nitric oxide and sympathetic tone activation. Differently, reduction in renal perfusion pressure activates RAAS and renal adrenergic nerves in ARAS patients. We can speculate that prolonged QTc interval is more present in ARAS vs. ADPKD hypertensive patients due to a greater activation of RAAS. We suggest adding 24-hour HRV evaluation in association with traditional risk factors in course of ADPKD and ARAS hypertension to better stratify cardiovascular risk in these groups of patients.
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Affiliation(s)
- S Lai
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy.
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Moretti B, Spinarelli A, Varrassi G, Massari L, Gigante A, Iolascon G, Benedetti MG, Moretti AM. Influence of sex and gender on the management of late-stage knee osteoarthritis. Musculoskelet Surg 2021; 106:457-467. [PMID: 34363604 DOI: 10.1007/s12306-021-00725-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The exact nature of sex and gender differences in knee osteoarthritis (OA) among patient candidates for total knee arthroplasty (TKA) remains unclear and requires better elucidation to guide clinical practice. The purpose of this investigation was to survey physician practices and perceptions about the influence of sex and gender on knee OA presentation, care, and outcomes after TKA. METHODS The survey questions were elaborated by a multidisciplinary scientific board composed of 1 pain specialist, 4 orthopedic specialists, 2 physiatrists, and 1 expert in gender medicine. The survey included 5 demographic questions and 20 topic questions. Eligible physician respondents were those who treat patients during all phases of care (pain specialists, orthopedic specialists, and physiatrists). All survey responses were anonymized and handled via remote dispersed geographic participation. RESULTS Fifty-six physicians (71% male) accepted the invitation to complete the survey. In general, healthcare professionals expressed that women presented worse symptomology, higher pain intensity, and lower pain tolerance and necessitated a different pharmacological approach compared to men. Pain and orthopedic specialists were more likely to indicate sex and gender differences in knee OA than physiatrists. Physicians expressed that the absence of sex and gender-specific instruments and indications is an important limitation on available studies. CONCLUSIONS Healthcare professionals perceive multiple sex and gender-related differences in patients with knee OA, especially in the pre- and perioperative phases of TKA. Sex and gender bias sensitivity training for physicians can potentially improve the objectivity of care for knee OA among TKA candidates.
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Affiliation(s)
- B Moretti
- Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, General Hospital, Faculty of Medicine and Surgery, University of Study of Bari, Bari, Italy
| | - A Spinarelli
- Department of Orthopedic and Trauma Unit, AOU Policlinico Consorziale Hospital, P.zza G. Cesare 11, 70124, Bari, BA, Italy.
| | | | - L Massari
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - A Gigante
- Clinical Orthopedics, Department of Clinical and Molecular Science, Università Politecnica Delle Marche and Ospedali Riuniti Ancona, Ancona, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M G Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A M Moretti
- Italian Group for Health and Gender, Bari, Italy
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Iacono V, Farinelli L, Natali S, Piovan G, Screpis D, Gigante A, Zorzi C. The use of augmented reality for limb and component alignment in total knee arthroplasty: systematic review of the literature and clinical pilot study. J Exp Orthop 2021; 8:52. [PMID: 34287721 PMCID: PMC8295423 DOI: 10.1186/s40634-021-00374-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/16/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE A systematic review of the literature has been carried out to assess the actual evidence of the use of augmented reality in total knee arthroplasty (TKA). We then conducted a pilot clinical study to examine the accuracy of the Knee + augmented reality navigation in performing TKA. The present augmented reality (AR) system allows the surgeon to view the tibial and femur axis superimposed on the surgical field through the smart glasses. It provides real-time information during surgery and intraoperative feedback. METHODS A systematic review of the PubMed, MEDLINE, and Embase databases up to May 2021 using the keywords "augmented reality", "knee arthroplasty", "computer assisted surgery", "navigation knee arthroplasty" was performed by two independent reviewers. We performed five TKAs using the Knee + system. Patients were 4 females, with mean age of 76.4 years old (range 73-79) and mean Body Max Index (BMI) of 31.9 kg/m2 (range 27-35). The axial alignment of the limb and the orientation of the components were evaluated on standardized pre and postoperative full leg length weight-bearing radiographs, anteroposterior radiographs, and lateral radiographs of the knee. The time of tourniquet was recorded. The perception of motion sickness was assessed by Virtual Reality Sickness Questionnaire (VRSQ) subjected to surgeon immediately after surgery. RESULTS After duplicate removal, a total of 31 abstracts were found. However, only two studies concerned knee arthroplasty. Unfortunately, both were preclinical studies. Knee + system is able to perform a cutting error of less than 1° of difference about coronal alignment of femur and tibia and less than 2° about flexion/extension of femur and posterior tibial slope. The absolute differences between the values obtained during surgery and the measurement of varus femur, varus tibia, posterior slope, and femur flexion angle on post-operative radiographs were 0.6° ± 1.34°, 0.8° ± 0.84°, 0.8° ± 1.79°, and 0.4 mm ± 0.55 mm, respectively. CONCLUSIONS On light of our preliminary results, the Knee + system is accurate and effective to perform TKA. The translation from pilot study to high-level prospective studies is warranted to assess accuracy and cost-effective analysis compared to conventional techniques. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- V Iacono
- Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - L Farinelli
- Clinical Ortopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - S Natali
- Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy.
| | - G Piovan
- Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - D Screpis
- Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - A Gigante
- Clinical Ortopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - C Zorzi
- Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
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Setaro N, Gigante A. Conservative treatment of partial rotator cuff tears, comparison between infiltrative treatment with corticosteroids, medium molecular weight hyaluronic acid and high molecular weight hyaluronic acid: a prospective study. J BIOL REG HOMEOS AG 2021; 35:1073-1080. [PMID: 34155877 DOI: 10.23812/21-132-l] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N Setaro
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - A Gigante
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
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13
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Lai S, Bagordo D, Perrotta AM, Gigante A, Gasperini ML, Muscaritoli M, Mazzaferro S, Cianci R. Autonomic dysfunction in kidney diseases. Eur Rev Med Pharmacol Sci 2021; 24:8458-8468. [PMID: 32894552 DOI: 10.26355/eurrev_202008_22643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Kidney diseases are associated with many cardiovascular risk factors, such as anaemia, inflammation and chronic volume overload. Changes in the sympathovagal balance are common findings in patients with end-stage renal disease (ESRD). In particular, sympathetic hyperactivity is linked with an increase in resting heart rate leading to myocardial hypertrophy and fibrosis. The latter increases the risk of sudden cardiac death from fatal arrythmias and therefore assessment of both sympathetic and parasympathetic tones could be clinically relevant in ESRD patients. Heart rate variability and other indices are currently used to evaluate the functionality of the autonomic nervous system. Some of these have emerged as potential diagnostic tools that can support clinical decision-making processes and therapeutic strategies in patients with renal disease, including those who are on dialysis replacement therapy. In this review, we summarize the impact and the relationships between sympathovagal disturbances and kidney diseases, replacement therapies and transplantation.
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Affiliation(s)
- S Lai
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy.
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14
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Cianforlini M, Grassi M, Coppa V, Manzotti S, Orlando F, Mattioli-Belmonte M, Gigante A. Skeletal muscle repair in a rat muscle injury model: the role of growth hormone (GH) injection. Eur Rev Med Pharmacol Sci 2021; 24:8566-8572. [PMID: 32894561 DOI: 10.26355/eurrev_202008_22652] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Muscle injury tends to heal with incomplete functional recovery. Among the growth factors released in the physio-pathological response of muscle lesion, the Insulin-like Growth-Factor-1 (IGF-1) results in an engine factor of the reparation program. The therapeutic use of growth factors has been exploited to improve healing. As IGF-1 is a primary mediator of the effects of growth hormone (GH), we exploited its systemic administration to muscle recovery in a rat model of muscle injury. MATERIALS AND METHODS Monolateral lesion of the longissimus dorsi muscle of rats was performed. Animals were divided into 5 groups: four groups for histological studies and serum hormone dosage, whilst the fifth group represented the uninjured control. Rat GH was intraperitoneally administered after 24h from the surgical lesion at three different concentrations (0.1, 0.2, 0.4 mg/kg). At 3 days from surgery, immunohistochemical and histological analyses evaluated the expression of MyoD and Myogenin, and the presence of neovascularization and inflammation, respectively. After 2 months, we analyzed the presence of muscle regeneration and fibrosis. RESULTS The treatment with GH resulted in a significant increase in neovascularization and Myogenin expression at 24h from injury in comparison with the control. This suggested speed up biological recovery times. After two-months, a dose-dependent increase of the connective component was observed. CONCLUSIONS The potential effect of GH on muscle repair and regeneration, through the activation of satellite cells already demonstrated in vitro, was confirmed in this in vivo experimental approach. This study sheds light on the role of growth factors in damage repair mechanisms to find an appropriate biological treatment for muscle injury.
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Affiliation(s)
- M Cianforlini
- Orthopedic Division, Ospedale Carlo Urbani Jesi (AN), Italy.
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15
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Cianci R, Simeoni M, Zingaretti V, Bagordo D, Barbano B, Granatelli A, Gigante A, Lai S. Resistant hypertension: drug-eluting balloon for revascularization of bilateral renal fibromuscular dysplasia. QJM 2021; 114:119-121. [PMID: 33098416 DOI: 10.1093/qjmed/hcaa295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Cianci
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - M Simeoni
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - V Zingaretti
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - D Bagordo
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - B Barbano
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - A Granatelli
- Department of Cardiology, Tivoli Hospital, Lazio, Italy
| | - A Gigante
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - S Lai
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
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Setaro N, Amico S, Gigante A. Peripheral longitudinal acute meniscal lesion: conservative treatment based on medium molecular weight hyaluronic acid. J BIOL REG HOMEOS AG 2021; 35:391-395. [PMID: 33605571 DOI: 10.23812/20-654-l] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N Setaro
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - S Amico
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - A Gigante
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
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Gigante A, Rosato E, Muscaritoli M. Body composition and microvascular damage in systemic sclerosis patients. J Endocrinol Invest 2021; 44:205-206. [PMID: 32683616 DOI: 10.1007/s40618-020-01364-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- A Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy.
| | - E Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
| | - M Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
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18
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Rosato E, Gigante A, Villa A, Iannazzo F, Muscaritoli M. Gastrointestinal involvement and low muscularity in systemic sclerosis. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Setaro N, Rotini M, Luciani P, Facco G, Gigante A. Surgical management of 2- or 3-part proximal humeral fractures: comparison of plate, nail and K-wires. Musculoskelet Surg 2020; 106:163-167. [PMID: 33257999 PMCID: PMC9130153 DOI: 10.1007/s12306-020-00686-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022]
Abstract
Background Proximal humeral fractures (PHFs) are fairly common injuries, and their treatment is a challenge. The aim of this study is to compare clinical and functional outcomes of different osteosynthesis techniques. Materials and methods We retrospectively reviewed patients’ files and the hospital’s digital database between March 2002 and April 2018. We treated surgically 148 patients with 2- and 3-part PHFs: 64 with plate and screws, 53 with intramedullary nailing and 31 with retrograde K-wires. We constituted three groups according to the type of treatment and two subgroups for each according to the number of fragments (Neer II or Neer III). Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-12 (SF-12) scores were recorded. Results Mean DASH and SF-12 scores both from the group treated with plate (Group I) and the one subjected to intramedullary nailing (Group II) were statistically superior to results from the patients treated by retrograde K-wires (Group III), while nails showed better functional results than the locking plates. In the first two groups, no difference was found between Neer II and III subgroups, while in Group III the DASH scores were significantly better in Neer II subgroup than those in Neer III subgroup. Avascular necrosis was the most frequent cause of revision surgery in Group I (4 cases) where we had 8 cases of reintervention (12.5%). In Group II, the subacromial impingement was the only cause for revision surgery with 3 cases (5.6%). Conclusions Intramedullary nails showed better functional results and a lower complication rate than the locking plates. Both techniques showed superior results compared to those available with retrograde K-wires. So the nail seems to be a more reliable and adequate method for treating 2- and 3-part proximal humeral fractures.
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Affiliation(s)
- N Setaro
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy
| | - M Rotini
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy
| | - P Luciani
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy.
| | - G Facco
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy
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20
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Setaro N, Luciani P, Farinelli L, Gigante A. Conservative treatment of hip osteoarthritis; comparison between three medium/high molecular weight hyaluronic acid injections and two injections of HYADD®4: a randomized controlled double-blind study. J BIOL REG HOMEOS AG 2020; 34:2401-2405. [PMID: 33307600 DOI: 10.23812/20-575-l] [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] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- N Setaro
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - P Luciani
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - L Farinelli
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - A Gigante
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
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21
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Baldini M, Farinelli L, Luciani P, Manzotti S, Salaffi F, Gigante A. Synovial and serum levels of NGF in osteoarthritis and rheumatic diseases: a systematic review. J BIOL REG HOMEOS AG 2020; 34:25-32. IORS Special Issue on Orthopedics. [PMID: 33739001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
NGF has raised interest as a target molecule in the treatment of OA, after the clinical evidences that antagonization of NGF axis provides symptoms relief in OA. Thus, we conducted a systematic review of the literature to investigate the evidence of NGF being overexpressed during OA. We conducted a database search on Medline using keywords including NGF, serum, synovial fluid, AND osteoarthritis or arthritis. We included study conducted on human, with serum or synovial specimens and an OA cohort. Nine studies met the inclusion criteria. Serum levels ranged from non-detectable to 153.5±28.6 pg/ml. Synovial fluid levels ranged from non-detectable to nearly 210±82 pg/ml. One study supported the evidence of an increased level of NGF in SF and serum of OA patients. The concentration of NGF reported in these studies is controversial and evidence of overexpression of NGF is low.
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Affiliation(s)
- M Baldini
- Clinica Ortopedica, Dipartimento di Scienze Cliniche e Molecolari (DISCLIMO), Università Politecnica delle Marche (UNIVPM)
| | - L Farinelli
- Clinica Ortopedica, Dipartimento di Scienze Cliniche e Molecolari (DISCLIMO), Università Politecnica delle Marche (UNIVPM)
| | - P Luciani
- Clinica Ortopedica, Dipartimento di Scienze Cliniche e Molecolari (DISCLIMO), Università Politecnica delle Marche (UNIVPM)
| | - S Manzotti
- Clinica Ortopedica, Dipartimento di Scienze Cliniche e Molecolari (DISCLIMO), Università Politecnica delle Marche (UNIVPM)
| | - F Salaffi
- Department of Rheumatology, University of Ancona, Ospedale A. Murri, Jesi (Ancona), Italy
| | - A Gigante
- Clinica Ortopedica, Dipartimento di Scienze Cliniche e Molecolari (DISCLIMO), Università Politecnica delle Marche (UNIVPM)
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22
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Luciani P, Bottegoni C, Manzotti S, Solfanelli G, Farinelli L, Gigante A. The metabolic effects of quinolones and steroids on human ligament cells: an in vitro study. J BIOL REG HOMEOS AG 2020; 34:93-99. IORS Special Issue on Orthopedics. [PMID: 33739012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The toxic effects of fluoroquinolones and steroid on tendon cells have been well established, but their role on human ligamentocytes remain unclear. We have investigated the effects of ciprofloxacin and methylprednisolone on human anterior cruciate ligamentocytes after 7 and 14 days of culture. We evaluated cell viability, Annexin V-FITC/PI assay, senescence-associated β-galactosidase staining, and collagen type I detection. Regarding quinolones administration, we observed that ligament cells treated with ciprofloxacin have characterized by a significantly decrease of cell viability and collagen type I expression and an increase of apoptotic cells. In cells treated with high dose of steroid we observed a significantly decrease of cell viability and collagen type I expression and the presence of senescent cells. Therefore, ciprofloxacin and methylprednisolone might have cytotoxic effects on ligamentocytes by two distinct mechanisms. Quinolones seem to induce cell apoptosis, while steroids might be able to induce cellular senescence. Hence their use should be avoided in athletes and in orthopedic surgery.
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Affiliation(s)
- P Luciani
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Ancona, Italia
| | - C Bottegoni
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Ancona, Italia
| | - S Manzotti
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Ancona, Italia
| | - G Solfanelli
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Ancona, Italia
| | - L Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Ancona, Italia
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Ancona, Italia
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Farinelli L, Baldini M, Bucci A, Ulisse S, Carle F, Gigante A. Axial and rotational alignment of lower limb in a Caucasian aged non-arthritic cohort. Eur J Orthop Surg Traumatol 2020; 31:221-228. [PMID: 32785786 PMCID: PMC7875943 DOI: 10.1007/s00590-020-02763-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/04/2020] [Indexed: 01/17/2023]
Abstract
Background The alignment of human lower limb has been an area of ongoing study for decades. The purpose of this study was to analyze the axial and rotational alignment from hip to ankle in a Caucasian aged non-arthritic cohort. Methods A non-arthritic cohort of aged patients was retrospectively analyzed by computer tomography. Anatomical–mechanical angle of femur (AMA), femur inclination (FI), femoral anteversion (FA), posterior condylar angle (PCA), proximal tibial torsion (TEAs-PTC and TEAs-PTT) and tibial fibular torsion (PTC-TFA) were measured. Results The median age of the patients was 76 years (range 67 to 91 years). Regarding axial alignment, the AMA was 5 (2.94; 6.80). No significance differences were reported by side and age. AMA was significantly lower in men. The FI was 125.3 (120.0; 134.8) with no differences in terms of side, age or gender. Regarding torsion alignment, the median values of FA, PTC-TFA and TEAs-PTT were, respectively, 16.8, 28.5 and − 1.4. No differences were reported by age. Right tibia was externally rotated by 1.5 degrees as compared to the left side (P 0.035). Conclusion The broad variability of the parameters analyzed highlights the necessity for a more anatomical and individualized approach during surgery of lower limb. The present study offers the fundament to understand and treat lower limb deformities. Hence, these data can constitute the normal reference values useful to investigate lower limb malalignment. Moreover, it helps to assess the possible changes of axial and rotational alignment in idiopathic OA of lower limb. Level of evidence III Retrospective cohort study
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Affiliation(s)
- L Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - M Baldini
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - A Bucci
- Centre of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica Delle Marche, Ancona, Italy
| | - S Ulisse
- Department of Radiological Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - F Carle
- Centre of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica Delle Marche, Ancona, Italy
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy.
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Gigante A, Coppa V, Marinelli M, Giampaolini N, Falcioni D, Specchia N. Acute osteomyelitis and septic arthritis in children: a systematic review of systematic reviews. Eur Rev Med Pharmacol Sci 2020; 23:145-158. [PMID: 30977881 DOI: 10.26355/eurrev_201904_17484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Septic arthritis and osteomyelitis are rare in children, but they are difficult to treat and are associated with a high rate of sequelae. This paper addresses the main clinical issues related to septic arthritis and osteomyelitis by means of a systematic review of systematic reviews. MATERIALS AND METHODS The major electronic databases were searched for systematic reviews/meta-analyses septic arthritis and osteomyelitis. The papers that fulfilled the inclusion/exclusion criteria were selected. RESULTS There were four systematic reviews on septic arthritis and four on osteomyelitis. Independent assessment of their methodological quality by two reviewers using AMSTAR 2 indicated that its criteria were not consistently followed. CONCLUSIONS Collectively, these works provide strong evidence regarding a large number of issues including classification, epidemiology and risk factors, causative organisms, clinical presentation, laboratory markers, imaging, diagnostic needle aspiration, antibiotic therapy, surgical therapy, and prognosis. A clinical summary based on the best evidence is supplied.
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Affiliation(s)
- A Gigante
- Orthopaedics and Traumatology, Polytechnic University of Marche, Ancona, Italy.
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Auci E, Vetrugno L, Riccardi I, Brussa A, Orso D, Baroselli A, Gigante A, Cecotti R, Bassi F, Livi U, Bove T. Multiple Electrode Aggregometry After Cardiopulmonary Bypass to Assess Platelet (Dys)-Function and Transfusion Threshold: A Concordance Study. J Cardiothorac Vasc Anesth 2020; 34:3306-3313. [PMID: 32684430 DOI: 10.1053/j.jvca.2020.06.060] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/31/2020] [Accepted: 06/17/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Cardiac surgery patients have a high risk of postoperative bleeding. Historically, the platelet count has been one of the main parameters used to establish the need for platelet transfusions, and the recent introduction of point-of-care tests for platelet function has allowed clinicians to rationalize platelet transfusion needs by assessing the platelet (dys-)function of the patient. For the present study, the authors evaluated how the introduction of one of these systems-the adenosine diphosphate (ADP) test, performed using a Multiplate electrode analyzer (Roche Diagnostics, Basel, Switzerland)-into their clinical practice had modified their platelet transfusion practice. The relationship between the platelet count and the functional evaluation of platelet aggregation (via the ADP test) also was examined. DESIGN This was a retrospective, single-center, observational study. SETTING Cardiac surgery department of a tertiary care center in North-east Italy. PARTICIPANTS Cardiac surgery patients requiring cardiac bypass in 2017 and 2019. INTERVENTIONS The primary outcome was to compare platelet transfusion practice before and after the implementation of a platelet function test (the ADP test) into the institution's transfusion algorithm, which replaced the platelet count as the trigger. Secondary outcomes were assessing whether the incorporation of the ADP test into their transfusion algorithm brought about a reduction in the frequency of platelet transfusions compared with previous rates (when only platelets counts were used); assessing patient blood loss in the first 12 postoperative hours; and ascertaining the percentage of patients requiring surgical reexplorations. MEASUREMENTS AND MAIN RESULTS The study comprised 110 patients undergoing cardiac surgery from the platelet count period (2017) and 110 patients from the ADP test period (2019). Agreement between platelet counts versus ADP tests in determining the need for platelet transfusion was moderate (κ = 0.483; 95% confidence interval [CI] 0.239-0.728), and the general linear regression relationship between platelet counts and the ADP test (Akaike information criterion = 2536; p < 0.001) was determined. Since the introduction of ADP testing, a highly significant reduction in platelet transfusions has occurred: 41.82% (platelet count period) versus 13.64% (ADP test period) (p < 0.001); average blood loss in the 12 hours postsurgery also was less in the ADP test period (p < 0.001) at 300 mL (95% CI 150-730) compared with 440 mL in the platelet count period (95% CI 135-900). Furthermore, a decreasing trend was observed in the number of patients requiring reexploration to optimize hemostasis in the first 12 hours postsurgery (6.36% v 2.73%); however, this trend did not achieve statistical significance (p = 0.195). CONCLUSION The application of new Multiplate analyzer technologies, like the ADP test, have the potential to reduce platelet transfusion rates in cardiac surgery patients compared with the use of platelet counts alone; this point-of-care test may constitute an important strategy to help spare the use of allogeneic blood products. Additional studies are needed to confirm this trend and establish the best cutoff values to apply.
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Affiliation(s)
- Elisabetta Auci
- Department of Anesthesia and Intensive Care Medicine, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Clinic, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy; Department of Medicine, University of Udine, Udine, Italy.
| | - Ilaria Riccardi
- Department of Anesthesia and Intensive Care Clinic, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Alessandro Brussa
- Department of Anesthesia and Intensive Care Clinic, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy
| | - Antonio Baroselli
- Department of Anesthesia and Intensive Care Medicine, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Andrea Gigante
- Department of Anesthesia and Intensive Care Medicine, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Roberta Cecotti
- Department of Anesthesia and Intensive Care Medicine, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care Medicine, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Ugolino Livi
- Department of Cardiothoracic Surgery, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy; Department of Medicine, University of Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care Clinic, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy; Department of Medicine, University of Udine, Udine, Italy
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Farinelli L, Barba M, Beltrami B, Baranzini M, Milani D, Lattanzi W, Manzotti S, Gigante A. Effects of NGF and BDNF on chondrocytes: a microarray analysis. J BIOL REG HOMEOS AG 2020; 34:83-89. Congress of the Italian Orthopaedic Research Society. [PMID: 33261260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Osteoarthritis (OA) represents an inflammation-driven injury of articular tissues, progressively leading to structural and functional joint impairment. The main symptom of OA is pain. Although it has been well established that OA represents a whole joint disease, the source of pain remains to be clarified. Nowadays, it has been well established that neurotrophines expression is evident in joints affected by OA. In addition, elevated NGF levels are found in the synovial fluid of patients with inflammatory or degenerative rheumatic diseases, including OA, rheumatoid arthritis and spondylarthritis. Growing evidences indicate that blocking NGF signaling using an anti NGF agent (i.e. tanezumab) provides effective pain relief. This study analyzed the effects of NGF and BDNF on cultured human chondrocytes by evaluating and their effects on chondrogenesis, chondrocyte differentiation and cartilage degeneration through a microarray analysis. The whole transcriptome analysis performed in this study highlighted how NGF and BDNF could be able to induce a proinflammatory response in human chondrocytes. Moreover, NGF and BDNF treatments seems to be able to induce the activation of several genes involved in the OA pathogenesis as IL17AR, HLA-DRB1, GDF-15, NR1D1, MCF2L and TGF-Beta.
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Affiliation(s)
- L Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona
| | - M Barba
- Istituto di Anatomia Umana e Biologia Cellulare, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - B Beltrami
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IRCCS) Milan, Italy
| | - M Baranzini
- Istituto di Anatomia Umana e Biologia Cellulare, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - D Milani
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IRCCS) Milan, Italy
| | - W Lattanzi
- Istituto di Anatomia Umana e Biologia Cellulare, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - S Manzotti
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona
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Pellegrino G, Stefanantoni K, Facioni F, Angelelli C, Gigante A, Badagliacca R, Vizza CD, Morelli S, Rosato E, Riccieri V. SAT0296 SERUM LEPTIN LEVELS IN SYSTEMIC SCLEROSIS PATIENTS WITH ELECTROCARDIOGRAPHIC ABNORMALITIES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Electrocardiographic (ECG) abnormalities are described in 25-75% Systemic Sclerosis (SSc) cases and they are associated with other systemic manifestations as well as with a worse prognosis. There is an increasing need for clinical and laboratory biomarkers to ameliorate the diagnostic and therapeutic approaches to patients with ECG abnormalities, due to their actual low sensitivity and specificity. Adipokines are circulating proteins that appear dysregulated in SSc and leptin in particular is synthesized in response to inflammatory conditions and seems to play a proinflammatory and pro-fibrotic action in SSc. Interesting, many studies in the last years have underlined its role in the cardiac remodeling mechanisms and in the development of cardiac fibrosis in other chronic diseases.Objectives:Aim of our study is to evaluate the role of leptin in the development of cardiac rhythm disorders (CRD) during SSc. Furthermore, by the analysis of the clinical and demographical parameters of our SSc patients, we tried to define other possible features associated with increased serum leptin concentration.Methods:We included eighty-five SSc patients, fulfilling the 2013 ACR/EULAR classification criteria, attending the Regional Rare Disease Center of Policlinico Umberto I of Rome. Fifty presented significant CRD at non-invasive diagnostic techniques (12 Lead ECG, 24-hour Holter ECG). Demographic, clinical, conventional cardiovascular risk factors were examined; instrumental and laboratory assessments were obtained, together with ECG recordings. Thirty-five SSc patients without pathologic finding at ECG traces, matched for demographic and clinical features, were recruited as the control group. In all cases, after obtaining written informed consent, blood samples were taken to measure serum levels of leptin using an ELISA assay (Life Technologies-Italia).Results:The fifty SSc patients with CRD (mean age 51±15 years; F:M 41:9) had pulmonary fibrosis (PF) in 32 cases (64%) and a BMI >25Kg/m2in 22 (44%) while in the control group of thirty-five SSc patients (mean age 49±16 years; F:M 33:2) PF was found in 15 (43%) and a BMI >25Kg/m2in 9 (35%); We detected significantly higher median values of serum leptin in SSc patients with CRD compared to the control group (12027 pg/ml IQR 12314 versus 6392 pg/ml IQR 7103;p 0,0009). Additionally, SSc patients with a BMI> 25 kg/m2(31 cases) as well as those with PF (47 cases) showed a significantly higher median serum leptin levels compared to those with BMI <25 kg/m2(13161 pg/ml IQR 13610 versus 8187 pg/ml IQR 8255;p 0,0008) and those without PF (11740 pg/ml IQR 11940 versus 7616 pg/ml IQR 7855;p 0,0079).Conclusion:To our knowledge this is the first report on high serum levels of leptin in SSc patients with CRD that also confirms its increase in those cases with a BMI >25 kg/m2and with PF, according to scientific literature data. The role of leptin in the pathogenesis of SSc remains unclear although it is already known its involvement in the development of cardiac fibrosis during other chronic diseases. On the basis of these results we speculate on leptin involvement in the pathogenesis of CRD during SSc, although further studies are needed with larger cohort of patients.References:[1]Vacca A et al. Rheumatology, 2014[2]Tyndall AJ et al. Ann Rheum Dis, 2010[3]Muresan L et al. Iran J Pub Health, 2017[4]Sanna T et al. Indian Pacing Electrophysiol J, 2009[5]Riccieri V et al. Clin Exp Rheumatol, 2011[6]Żółkiewicz J et al. Arch Dermatol Res, 2019[7]Huby AC et al. Circulation, 2015[8]Shulze PC et al. Clin Chim Acta, 2005[9]Van de Hoogen F et al. Arthritis Rheum, 2013[10]Gui X et al. Biochem Biophys Res Commun, 2018Disclosure of Interests:Greta Pellegrino: None declared, Katia Stefanantoni Consultant of: ItalfarmacoBoehringer Ingelheim, Fausta Facioni: None declared, Carlotta Angelelli: None declared, Antonietta Gigante: None declared, Roberto Badagliacca: None declared, Carmine Dario Vizza: None declared, Sergio Morelli: None declared, Edoardo Rosato: None declared, Valeria Riccieri: None declared
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Luciani P, Farinelli L, Procaccini R, Verducci C, Gigante A. Primary reverse shoulder arthroplasty for acute proximal humerus fractures: A 5-year long term retrospective study of elderly patients. Injury 2019; 50:1974-1977. [PMID: 31540798 DOI: 10.1016/j.injury.2019.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/22/2019] [Accepted: 09/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) in complex shoulder fractures is ever more frequently. This study compares clinical and radiologic results of patients with comminuted proximal humeral fractures (PHFs) treated with RSA, with and without tuberosities grafting. METHODS Between January 2009 and June 2014, 55 patients aged ≥65 years with 3- and 4-part PHFs were treated surgically. Patients' files and the hospital's digital database were reviewed retrospectively with at least 5-year of follow up. We constituted three groups according to the tuberosity consolidation: patients in whom the tuberosities showed anatomic consolidation (Group I) and patients either with secondary displacement of the tuberosities (Group II) or without tuberosity repair (Group III). RESULTS The 74% of the repaired tuberosities consolidated in anatomic position. Among range of motion (ROM), we reported that forward elevation, abduction and external rotation were significantly better in Group I than those in Group II-III. Furthermore, quick Dash score and Constant score showed more satisfied results in Group I. Regarding complications, not infection or instability were found in group I. On the other hand, in group II, we reported one patient with deep infection, leading to two steps surgery. In group III, we recorded two patients with instability required implant revision and one with deep infection treated by revision. CONCLUSION RSA showed satisfied results even at 5 year follow up. Preservation of the tuberosities in anatomic position improves active forward elevation and external rotation as well as patient satisfaction with less complications.
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Affiliation(s)
- Pierfrancesco Luciani
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
| | - L Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - R Procaccini
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - C Verducci
- Department of Orthopedics and Traumatology, Civitanova Marche, Italy
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
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Gigante A, Li M, Junghänel S, Hirschhäuser C, Knauer S, Schmuck C. Non-viral transfection vectors: are hybrid materials the way forward? Medchemcomm 2019; 10:1692-1718. [PMID: 32180915 PMCID: PMC7053704 DOI: 10.1039/c9md00275h] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/12/2019] [Indexed: 12/18/2022]
Abstract
Transfection is a process by which oligonucleotides (DNA or RNA) are delivered into living cells. This allows the synthesis of target proteins as well as their inhibition (gene silencing). However, oligonucleotides cannot cross the plasma membrane by themselves; therefore, efficient carriers are needed for successful gene delivery. Recombinant viruses are among the earliest described vectors. Unfortunately, they have severe drawbacks such as toxicity and immunogenicity. In this regard, the development of non-viral transfection vectors has attracted increasing interests, and has become an important field of research. In the first part of this review we start with a tutorial introduction into the biological backgrounds of gene transfection followed by the classical non-viral vectors (cationic organic carriers and inorganic nanoparticles). In the second part we highlight selected recent reports, which demonstrate that hybrid vectors that combine key features of classical carriers are a remarkable strategy to address the current challenges in gene delivery.
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Affiliation(s)
- A Gigante
- Institute of Organic Chemistry , University of Duisburg-Essen , 45141 Essen , Germany .
| | - M Li
- Institute of Organic Chemistry , University of Duisburg-Essen , 45141 Essen , Germany .
| | - S Junghänel
- Institute of Organic Chemistry , University of Duisburg-Essen , 45141 Essen , Germany .
- Biomedical Technology Center of the Medical Faculty , University of Muenster , Muenster , Germany
| | - C Hirschhäuser
- Institute of Organic Chemistry , University of Duisburg-Essen , 45141 Essen , Germany .
| | - S Knauer
- Faculty of Biology , University of Duisburg-Essen , 45141 Essen , Germany
| | - C Schmuck
- Institute of Organic Chemistry , University of Duisburg-Essen , 45141 Essen , Germany .
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Molfino A, Gasperini M, Gigante A, Rosato E, Muscaritoli M. SUN-PO183: Correlation Between Left Ventricular Mass and Fat Free Mass Index in Patients with Systemic Sclerosis without Cardiovascular Disease. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gigante A, Gasperini M, Iacolare A, Molfino A, Proietti L, Margiotta D, Navarini L, Afeltra A, Rosato E, Muscaritoli M. MON-PO498: Phase Angle as a Marker of Microvascular Damage in Systemic Sclerosis. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gigante A, Gasperini M, Iacolare A, Molfino A, Proietti L, Rosato E, Muscaritoli M. GM01: Comparison of ESPEN 2015 and GLIM Criteria for Assessing Malnutrition in Systemic Sclerosis. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Aquili A, Farinelli L, Gigante A. Hyaluronic acid versus hyaluronic acid and Dolatrox®: a prospective, double-blind randomized controlled pilot study for the treatment of knee osteoarthritis. J BIOL REG HOMEOS AG 2019; 33:1303-1308. [PMID: 31298018] [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] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- A Aquili
- Clinical Orthopaedics, Università Politecnica delle Marche, Ancona, Italy
| | - L Farinelli
- Clinical Orthopaedics, Università Politecnica delle Marche, Ancona, Italy
| | - A Gigante
- Clinical Orthopaedics, Università Politecnica delle Marche, Ancona, Italy
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Farinelli L, Aquili A, Manzotti S, Graciotti L, Messi MM, Gigante A. Characterization of human costal cartilage: is it an adapt tissue as graft for articular cartilage repair? J BIOL REG HOMEOS AG 2019; 33:69-77. XIX Congresso Nazionale S.I.C.O.O.P. Societa' Italiana Chirurghi Ortopedici Dell'ospedalita' Privata Accreditata. [PMID: 31169006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Several techniques and different biological or artificial tissues have been proposed as graft to restore articular defects. However, among the numerous and heterogeneous procedures proposed over time, the current literature findings are not conclusive. The aim of the current study is to evaluate if human costal cartilage can be suitable as graft for restoring articular cartilage defects. Knee articular cartilage and costal cartilage samples were obtained respectively from patients that underwent anterior cruciate ligament reconstruction (samples from notch plasty) or knee joint replacement and ear reconstruction or rhinoplasty through rib graft. The samples were stained with hematoxylin eosin, safranine-O, Gomori paraldehyde-fuchsin and Von Kossa for light microscopy. Immunohistochemistry was performed using anti-collagen I, II, IV and anti-SOX9 antibodies. Furthermore, samples were analyzed by transmission electron microcopy (TEM). In both cartilage, the cells are arranged in quite similar layers and the matrix show the same hyaline appearance: presence of type II collagen and solphated glycosaminoglycans, and absence of type I collagen and SOX-9. The bigger difference between the two hyaline tissues is the presence of perichondrium that surrounds all the specimens of costal cartilage. It consists of two separate layers where the inner one seems to get thinner with aging. The results show that rib cartilage seems to be an adapt tissue as graft for articular cartilage repair from a histological point of view. However, to date its therapeutic potential remains to be clearly defined by animal and clinical studies.
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Affiliation(s)
- L Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy
| | - A Aquili
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy
| | - S Manzotti
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy
| | - L Graciotti
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - M M Messi
- Maxillofacial Surgery Unit, University Hospital "Ospedali Riuniti" Umberto I, Ancona, Italy
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy
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Gigante A, Grad JN, Briels J, Bartel M, Hoffmann D, Ottmann C, Schmuck C. A new class of supramolecular ligands stabilizes 14-3-3 protein-protein interactions by up to two orders of magnitude. Chem Commun (Camb) 2019; 55:111-114. [PMID: 30515494 DOI: 10.1039/c8cc07946c] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report the first supramolecular stabilizers of the interaction between 14-3-3ζ and two of its effectors, Tau and C-Raf, which are involved in neurodegenerative diseases and proliferative signal transduction, respectively. These supramolecular ligands open up an opportunity to modulate functions of 14-3-3 with these effectors.
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Affiliation(s)
- A Gigante
- Institute of Organic Chemistry, University of Duisburg Essen, Universitätstr. 7, 45141, Essen, Germany.
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Cesari E, Castagna A, Garofalo R, Gigante A, Conti M, Markopoulos N, Maffulli N. Tendon cell ciliary length as a biomarker of in situ cytoskeletal tensional homeostasis. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2013.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- E. Cesari
- Shoulder and Elbow Surgery Unit: Istituto Clinico Humanitas Rozzano, Milan, Italy
| | - A. Castagna
- Shoulder and Elbow Surgery Unit: Istituto Clinico Humanitas Rozzano, Milan, Italy
| | - R. Garofalo
- Department of Orthopedic and Traumatology, F. Miulli Hospital. Acquaviva delle Fonti, Bari, Italy
| | - A. Gigante
- Orthopaedics Clinic, School of Medicine, Marche Polytechnic University, Ancona, Italy
- Department of Molecular Pathology and Innovative Therapies, School of Medicine, Marche Polytechnic University, Ancona, Italy
| | - M. Conti
- Shoulder and Elbow Surgery Unit: Istituto Clinico Humanitas Rozzano, Milan, Italy
| | - N. Markopoulos
- Shoulder and Elbow Surgery Unit: Istituto Clinico Humanitas Rozzano, Milan, Italy
| | - N. Maffulli
- Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
- Department of Physical and Rehabilitation Medicine, University of Salerno, Italy
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Fusini F, Bisicchia S, Bottegoni C, Gigante A, Zanchini F, Busilacchi A. Nutraceutical supplement in the management of tendinopathies: a systematic review. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2016.06] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- F. Fusini
- Clinical Orthopaedics, Department of Orthopaedics, Traumatology, Plastic Surgery and Rehabilitation, Second University of Naples, Naples, Italy
| | - S. Bisicchia
- Department of Orthopaedic Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - C. Bottegoni
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - A. Gigante
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - F. Zanchini
- Clinical Orthopaedics, Department of Orthopaedics, Traumatology, Plastic Surgery and Rehabilitation, Second University of Naples, Naples, Italy
| | - A. Busilacchi
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
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Fusini F, Langella F, Busilacchi A, Tudisco C, Gigante A, Massé A, Bisicchia S. Real-time sonoelastography: principles and clinical applications in tendon disorders. A systematic review. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2017.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- F. Fusini
- University of Turin, School of Orthopaedic and Traumatology, Turin, Italy
| | - F. Langella
- Clinical Orthopedics, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - A. Busilacchi
- Clinical Orthopedics, Department of Molecular Pathology and Innovative Therapies, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - C. Tudisco
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - A. Gigante
- Clinical Orthopedics, Department of Molecular Pathology and Innovative Therapies, School of Medicine, Università
| | - A. Massé
- University of Turin, School of Orthopaedic and Traumatology, Turin, Italy
| | - S. Bisicchia
- Orthopaedics and Traumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy
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Senesi L, Farinelli L, Manzotti S, Fravisini M, Gigante A. Nerve growth factor administration on cultured human ligamentocytes: an in vitro pilot study. J BIOL REG HOMEOS AG 2018; 32:1-7. [PMID: 30644274] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Nerve growth factor (NGF) is involved in several joint pathologies. It has been demonstrated that its concentration increases in synovial fluid and tissue from arthritis. However, its role in joint homeostasis and pathophysiology still remain to be clarified. This study analyzed the effect of 200 ng/ml on cultured human ligamentocytes by evaluating cell proliferation, cell phenotype and gene expression. The MTT test excluded an influence on cell viability at 7 and 14 days. Regarding cell phenotype, we observed that NGF might promote the synthesis of COL1A1. On the other hand, real time PCR showed that NGF did not influence gene expression of COL3A1, FGF-BETA, IGF1, MMP2, MMP3, MMP9 and MMP13. However, COL1A1 gene was significantly upregulated in treated cell at 14 days. Our results suggest that NGF may have an anabolic effect on ligament. Additional investigations are necessary to determine how NGF may influence ligamentocytes..
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Affiliation(s)
- L Senesi
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona
| | - L Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona
| | - S Manzotti
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona
| | - M Fravisini
- Department of Orthopaedic, "Sol et Salus" Hospital, Torre Pedrera, Italy
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona
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Gigante A, Setaro N, Rotini M, Finzi SS, Marinelli M. Intercondylar eminence fracture treated by resorbable magnesium screws osteosynthesis: A case series. Injury 2018; 49 Suppl 3:S48-S53. [PMID: 30415669 DOI: 10.1016/j.injury.2018.09.055] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 07/03/2018] [Revised: 09/13/2018] [Accepted: 09/29/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tibial spine avulsion fractures are mostly a paediatric injury which appropriate treatment is currently debated in literature. The choice between conservative and surgical treatment is based on the radiographic classification of Meyers-McKeever. The most diffused surgical techniques involve either internal fixation devices (screws) or bone tunnels fixation with resorbable sutures. Today, a third option is represented by resorbable magnesium screws which could combine the best features of the two classical systems. Objective of this study is to investigate the efficacy of these new devices in the surgical treatment of tibial spine avulsions. MATERIALS AND METHODS Since 2014 we have seen seven patients with tibial eminence fracture. Patients underwent clinical and radiological examination (MRI, CT scan) before surgery. Only 3 patients that presented with a grade III or IV lesion were treated surgically with internal fixation with magnesium resorbable screws. In post-operative follow-up, functional recovery was evaluated at 1, 2, 4, 6 and 12 months, clinically and by X-ray. Lysholm and IKDC scores were submitted at 1, 2, 6 and 12 months. MRI was repeated at 6 and 12 months. RESULTS All three surgical patients showed progressive clinical and functional improvement during the follow-up period. The first case showed a quicker overall recovery rate, which might be due to the lower grade of the lesion. Radiographs and MRI evaluation showed regular healing of the injury. The devices appeared completely resorbed at the 6 months follow-up and replaced by newly formed bone at the 12 months follow-up. CONCLUSIONS The treatment of tibial spine avulsion fractures with arthroscopic reduction and internal fixation (ARIF) technique by magnesium resorbable screws seems to result in an excellent functional recovery without complications related to fixation devices, which were completely resorbed after 6 months and replaced by newly formed bone after 12 months. This new method could be considered as an alternative option to classic techniques by non resorbable fixation devices or bone tunnel fixation. Further studies are needed in order to evaluate the efficacy of these new devices in a wider group of patients.
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Affiliation(s)
- A Gigante
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy.
| | - N Setaro
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy.
| | - M Rotini
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy
| | - S S Finzi
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy
| | - M Marinelli
- Clinic of Adult and Paediatric Orthopaedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
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Ferrazzano G, Conte A, Gigante A, Defazio G, Berardelli A, Fabbrini G. Disease progression in blepharospasm: a 5-year longitudinal study. Eur J Neurol 2018; 26:268-273. [PMID: 30308706 DOI: 10.1111/ene.13832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The clinical manifestation of dystonic spasms in blepharospasm (BSP) patients may be heterogeneous. Whether the varying phenomenology of eyelid spasms becomes manifest sequentially during the course of the disease or aggregates in separate clusters according to different disease courses is still unclear. For this purpose, the clinical features in BSP patients were evaluated longitudinally over a 5-year period and also the blink reflex recovery cycle was tested in a subgroup of BSP patients. METHODS Sixty BSP patients were videotaped at time 0 and after approximately 5 years of follow-up. Two experts in movement disorders, who were blinded to the video order, reviewed the videotapes and scored the severity of BSP using the Blepharospasm Severity Rating Scale. Changes in the R2 recovery index were also evaluated in 18 patients twice, i.e. upon enrolment and at the follow-up. RESULTS The severity of BSP worsened significantly over the 5-year follow-up period owing to the appearance or the increased duration and frequency of prolonged spasms. It was also found that the blink reflex recovery cycle worsened at follow-up in comparison with the baseline. CONCLUSIONS This study shows that the disease progression of BSP is characterized by the appearance or worsening of prolonged spasms. Prolonged spasms are accompanied by changes in the excitability of brainstem interneurons. Aging-related effects may exacerbate the pathophysiological mechanisms underlying spasms.
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Affiliation(s)
| | - A Conte
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - A Gigante
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, 'Aldo Moro', University of Bari, Bari, Italy
| | - G Defazio
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, 'Aldo Moro', University of Bari, Bari, Italy.,Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - A Berardelli
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - G Fabbrini
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Mario FD, Pofi R, Gigante A, Rivoli L, Rosato E, Isidori AM, Cianci R, Barbano B. Hypothyroidism and Nephrotic Syndrome: Why, When and How to Treat. Curr Vasc Pharmacol 2018; 15:398-403. [PMID: 28176633 DOI: 10.2174/1570161115999170207114706] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hypothyroidism, characterised by low/normal free thyroxine (FT4) and free triiodothyronine (FT3) with elevated thyroid-stimulating hormone (TSH), is a well-known complication of nephrotic syndrome (NS). This is a common feature of primary and secondary glomerular diseases and comprises loss of protein in the urine and increased urinary excretion of thyroid hormones and thyroxine- binding globulin. With a normal thyroid reserve, this scenario is associated with the development of subclinical hypothyroidism, with a slight increase in TSH and normal free fractions. However, with a low thyroid reserve the transition toward overt hypothyroidism is almost inevitable, affecting morbidity and mortality. As T4 replacement is a cheap and well-established treatment to achieve a stable hormone status in different types of thyroid deficiency, it is essential to recognise and appropriately treat this condition. CONCLUSION In this article we summarise the evidence on this nephro-endocrine disorder in humans and focus on diagnostic and therapeutic strategies.
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Affiliation(s)
- F Di Mario
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome. Italy
| | - R Pofi
- Department of Experimental Medicine, Sapienza University of Rome, Rome. Italy
| | - A Gigante
- Department of Clinical Medicine, Sapienza, University of Rome, Viale dell'Università, 37, 00185 Rome. Italy
| | - L Rivoli
- Nephrology and Dialysis Unit, Magna Graecia University, Catanzaro. Italy
| | - E Rosato
- Department of Clinical Medicine, Sapienza University of Rome, Rome. Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome. Italy
| | - R Cianci
- Department of Clinical Medicine, Sapienza University of Rome, Rome. Italy
| | - B Barbano
- Department of Clinical Medicine, Sapienza University of Rome, Rome. Italy
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Gigante A, Rosato E, Barbano B, Di Mario F, Di Lazzaro-Giraldi G, Gasperini ML, Pofi R, Laviano A. Malnutrition is prevalent in patients with cardiorenal syndrome and negatively influences clinical outcome. J BIOL REG HOMEOS AG 2018; 32:163-166. [PMID: 29504382] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cardiorenal syndrome (CRS) describes the concurrent failure of cardiac and renal function, each influencing the other. Malnutrition and cachexia frequently develop in patients with heart failure or kidney failure. However, no information is currently available on the prevalence of malnutrition in CRS patients. We studied CRS patients admitted to an internal medicine ward during a 5-month period and evaluated their clinical characteristics and nutritional status. Malnutrition risk was assessed by using the validated screening tool NRS-2002 whilst body composition was assessed by bioimpedance analysis and muscle function was measured by handgrip (HG) strength. Cardiac mass was also recorded. Length of stay, hospital readmission and 6-month mortality were registered. During the study period, 22 CRS patients were studied. Twenty patients were diagnosed with either CRS type 1 or CRS type 5. In CRS patients, fat-free mass showed a trend toward representing a protective factor for 6-month mortality (OR=0.904; p=0.06). Also, fat-free mass correlated with HG strength and cardiac ejection fraction. Malnutrition risk was diagnosed in 45% of the patients, whereas 8 patients met the definition of cachexia. Even without statistical significance, CRS patients with malnutrition had lower BMI (Body Mass Index) (p=0.038) and fat-free mass (p= n.s.). However, CRS malnutrition was associated to higher 6-month mortality (p= 0.05), and appears to negatively influence the outcome in CRS (OR= 9; p= 0.06). Our results show that malnutrition is prevalent in CRS patients and influences the clinical outcome. The assessment of nutritional status, and particularly body composition, should be implemented in daily practice of patients with CRS.
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Affiliation(s)
- A Gigante
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - E Rosato
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - B Barbano
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - F Di Mario
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | | | - M L Gasperini
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - R Pofi
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - A Laviano
- Department of Clinical Medicine, Sapienza University, Rome, Italy
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Rosato E, Gigante A, Liberatori M, Gasperini ML, Barbano B, Amoroso A, Tubani L, Laviano A. Altered diurnal cardiac sympathovagal balance correlates with nutritional status indexes in systemic sclerosis patients. J BIOL REG HOMEOS AG 2017; 31:1133-1138. [PMID: 29254326] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Autonomic nervous system is involved in body weight regulation. Gastrointestinal manifestations of systemic sclerosis (SSc) can influence patients nutritional status and facilitate the development of proteinenergy malnutrition. The aim of the study is to assess the nutritional status of SSc patients and to explore its possible correlation with autonomic dysfunction using heart rate variability (HRV). We enrolled 19 SSc subjects and 19 healthy subjects as controls. Body mass index (BMI) and body surface area (BSA) were collected and recorded in all patients. HRV was measured and the domains of low frequencies (LF, index of the sympathetic modulation) and high frequencies (HF, index of the parasympathetic modulation) were recorded. As assessed by the LF/HF RATIO, sympathovagal balance is altered in SSc patients because of increased sympathetic modulation and reduced parasympathetic activity. BMI positively correlates with LF (r=0.57; p less than 0.01) and LF/HF RATIO during daytime (r= 0.46; p less than 0.05). Similarly, BSA positively correlates with LF (r= 0.51; p less than 0.05), LF day time (r= 0.53; p less than 0.05) and LF/HF RATIO night time (r=-0.51; p less than 0.05). In SSc patients the autonomic dysfunction is characterized by increased sympathetic modulation. We observed a correlation between autonomic dysfunction and nutritional status in SSc patients.
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Affiliation(s)
- E Rosato
- Department of Clinical Medicine, Scleroderma Unit, Sapienza University of Rome, Italy
| | - A Gigante
- Department of Clinical Medicine, Scleroderma Unit, Sapienza University of Rome, Italy
| | - M Liberatori
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - M L Gasperini
- Department of Clinical Medicine, Scleroderma Unit, Sapienza University of Rome, Italy
| | - B Barbano
- Department of Clinical Medicine, Scleroderma Unit, Sapienza University of Rome, Italy
| | - A Amoroso
- Department of Clinical Medicine, Scleroderma Unit, Sapienza University of Rome, Italy
| | - L Tubani
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - A Laviano
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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Aquili A, Farinelli L, Bottegoni C, Antonicelli L, Gigante A. The effect of anti-IgE therapy in knee osteoarthritis: a pilot observational study. J BIOL REG HOMEOS AG 2017; 31:1-5. [PMID: 29172299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Osteoarthritis is a whole-joint disease and its pathogenesis remains poorly understood. Recent evidence proposed the importance of the innate immune system as trigger of synovium inflammation following the degeneration of cartilage. Moreover, synovial mast cells (MCs) might be correlated with pain and disability reported by patients. Anti IgE therapy represents a new class of MCs stabilizing agent, licensed for people with asthma and chronic urticaria. Therefore, we studied if the stabilizing effect of anti IgE would improve the pain and disability in patients affected by knee osteoarthritis and atopic disease. This pilot study provides the first evidence that anti IgE treatment induces a short-term clinical improvement supporting the role of MCs in osteoarthritis.
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Affiliation(s)
- A Aquili
- Clinical Orthopaedics, Università Politecnica delle Marche, Ancona, Italy
| | - L Farinelli
- Clinical Orthopaedics, Università Politecnica delle Marche, Ancona, Italy
| | - C Bottegoni
- Clinical Orthopaedics, Università Politecnica delle Marche, Ancona, Italy
| | - L Antonicelli
- Allergy Unit, Department of Internal Medicine, Ospedali Riuniti, Ancona, Italy
| | - A Gigante
- Clinical Orthopaedics, Università Politecnica delle Marche, Ancona, Italy
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Affiliation(s)
- E Rosato
- Department of Clinical Medicine, Clinical Immunology Unit, Scleroderma Center, Sapienza University of Rome, Italy
| | - L Tubani
- Department of Clinical Medicine, Clinical Immunology Unit, Scleroderma Center, Sapienza University of Rome, Italy
| | - A Gigante
- Department of Clinical Medicine, Clinical Immunology Unit, Scleroderma Center, Sapienza University of Rome, Italy.
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Gigante A, Di Mario F, Pierucci A, Amoroso A, Pignataro FS, Napoleone L, Basili S, Raparelli V. Kidney disease and venous thromboembolism: Does being woman make the difference? Eur J Intern Med 2017; 39:18-23. [PMID: 28258791 DOI: 10.1016/j.ejim.2017.02.012] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/20/2016] [Accepted: 02/16/2017] [Indexed: 01/05/2023]
Abstract
The risk of venous thromboembolism (VTE) is increased across the spectrum of chronic kidney disease (CKD), from mild to more advanced CKD, and typically characterizes nephrotic syndrome (NS). VTE risk in patients with kidney disease may be due to underlying hemostatic abnormalities, including activation of pro-thrombotic factors, inhibition of endogenous anticoagulation systems, enhanced platelet activation and aggregation, and decreased fibrinolytic activity. The mechanisms involved differ depending on the cause of the kidney impairment (i.e. presence of NS or CKD stage). Sex and gender differences, as well as, environmental factors or comorbidities may play a modulating role; however, specific sex and gender data on this topic are still rare. The aim of the present review is to discuss the VTE risk associated with impairment of kidney function, the potential mechanism accounting for it and the impact of sex differences in this clinical setting.
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Affiliation(s)
- A Gigante
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
| | - F Di Mario
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - A Pierucci
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - A Amoroso
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - F S Pignataro
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - L Napoleone
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Basili
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; Research Center on Gender and Evaluation and Promotion of Quality in Medicine, (CEQUAM), Sapienza University of Rome, Rome, Italy
| | - V Raparelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Gigante A, Di Mario F, Barbano B, Rosato E, Di Lazzaro Giraldi G, Pofi R, Gasperini ML, Amoroso D, Cianci R, Laviano A. Nutritional status and intrarenal arterial stiffness in cardiorenal syndrome: a pilot study. Eur Rev Med Pharmacol Sci 2017; 21:313-316. [PMID: 28165555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Cardio-Renal Syndrome (CRS) is a condition, which is more frequently observed in clinical practice. The aim of this study is to explore nutritional status and intrarenal arterial stiffness in patients affected by CRS. PATIENTS AND METHODS 14 consecutive CRS patients, screened for anthropometry, biochemistry, nutritional and metabolic status underwent renal Doppler ultrasound and whole-body bioimpedance spectroscopy (BIS). RESULTS We found a positive correlation between phase angle (PA) and CKD-EPI and MDRD (p=0.011 and p=0.007), and between body mass index and renal resistive index (RRI) (p=0.002). Finally, we found a negative correlation between fat-free mass and RRI (p=0.024). CONCLUSIONS Body composition assessment may improve the care of patients with chronic kidney disease (CKD). Also, BIS may help identify changes in hydration status in CKD patients resulting as a significant predictor of mortality.
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Affiliation(s)
- A Gigante
- Department of Clinical Medicine, Sapienza University, Rome, Italy.
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Gigante A, Senesi L, Manzotti S, Palmieri A, Skrami E, Sollazzo V. Effect of nerve growth factor on cultured human chondrocytes. J BIOL REG HOMEOS AG 2016; 30:1-6. [PMID: 28002894] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Nerve growth factor (NGF) is involved in several joint diseases. It participates in nociception and neurogenic inflammation and its concentrations increase in synovial fluid and tissue from arthritis. However, data about its role in articular cartilage are scant and conflicting. This study analysed effects of different NGF concentrations on cultured human chondrocytes by evaluating cell proliferation, cell phenotype, and gene expression. The MTT test excluded an influence on cell viability. Alcian blue and S100 staining demonstrated that NGF may induce de-differentiation of the chondrocyte phenotype. Real-time PCR showed that NGF did not influence gene expression of type I, II and XI collagen, TGF-β, IGF-1 and metalloproteinase (MMP)-13, while it reduced the expression of MMP-3. These findings show that NGF may have uncertain effects in human chondrocytes. Further investigations by wider gene expression and protein synthesis analyses are required to determine how chondrocytes may be influenced by NGF.
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Affiliation(s)
- A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Polytechnic University
| | - L Senesi
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Polytechnic University
| | - S Manzotti
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Polytechnic University
| | - A Palmieri
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - E Skrami
- Center of Epidemiology, Biostatistics and Medical Information Technology, Polytechnic University of Marche, Italy
| | - V Sollazzo
- MD, Maxillofacial and Orthopaedic Basic Science Lab, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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Bottegoni C, Farinelli L, Aquili A, Chiurazzi E, Gigante A. Homologous platelet-rich plasma for the treatment of knee involvement in primary Sjögrens syndrome. J BIOL REG HOMEOS AG 2016; 30:63-67. [PMID: 28002901] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Primary Sjögrens syndrome (pSS) is a chronic autoimmune disease characterized by dry eyes, dry mouth, and other clinical manifestations. The most common extraglandular manifestation of pSS is articular involvement and to date their management is unclear. The aims of the current pilot study were to assess the safety and the outcomes of homologous platelet-rich plasma (HPRP) injections in pSS cohort affected by knee arthralgia/arthritis at short-term follow up. This pilot study provides the first evidence that HPRP injections are a safe treatment and induce a short-term clinical improvement. Although the lack of a control group, randomization and long-term follow up prevents the assessment of the real effectiveness of this treatment, further studies are needed to confirm these findings and to determine the mechanism of action, biological changes and disease-modifying properties of PRP.
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Affiliation(s)
- C Bottegoni
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - L Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - A Aquili
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - E Chiurazzi
- Intercompany Regional Department of Transfusion Medicine, Ospedali Riuniti, Ancona, Italy
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
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