1
|
Metal(loid)s and Rare Earth Elements in Posidonia oceanica (L.) Delile (1813) banquettes. MARINE POLLUTION BULLETIN 2024; 203:116435. [PMID: 38772171 DOI: 10.1016/j.marpolbul.2024.116435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/23/2024]
Abstract
The Posidonia oceanica (L.) Delile 1813 banquette provides precious ecosystem services for Mediterranean beach nourishment and protection, representing an important way of energy transfer through marine-coastal habitats. It is surprising to note how it is poorly investigated, especially concerning its double role as potential sink and source of chemicals. In particular, few studies exist about the metal (loid)s occurrence and no data are available on emerging contaminants, such as Rare Earth Elements (REEs). The present research investigated for the first time the concentrations of twenty-eight metal(loid)s and fifteen REEs in a well-structured banquette along the Italian coast (Central Tyrrhenian Sea) showing that (i) metal(loid)s and REEs occur in banquettes, with higher relative concentrations of some metal(loid)s (B, Sr, Mn, Fe, Al, Zn) and REEs (Ce, Y, La, Nd) with no statistically significant seasonal variations; (ii) Posidonia banquettes may represent an interesting biological model for chemicals monitoring.
Collapse
|
2
|
The favourable alliance between CardioMEMS and levosimendan in patients with advanced heart failure. ESC Heart Fail 2024. [PMID: 38761030 DOI: 10.1002/ehf2.14838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/07/2024] [Accepted: 04/17/2024] [Indexed: 05/20/2024] Open
Abstract
AIMS We report the results of a real-world study based on heart failure (HF) patients' continuous remote monitoring strategy using the CardioMEMS system to assess the impact of this device on healthcare outcomes, costs, and patients' management and quality of life. METHODS AND RESULTS We enrolled seven patients (69.00 ± 4.88 years; 71.43% men) with HF, implanted with CardioMEMS, and daily remote monitored to optimize both tailored adjustments of home therapy and/or hospital infusions of levosimendan. We recorded clinical, pharmacological, biochemical, and echocardiographic parameters and data on hospitalizations, emergency room access, visits, and costs. Following the implantation of CardioMEMS, we observed a 50% reduction in the total number of hospitalizations and a 68.7% reduction in the number of days in the hospital. Accordingly, improved patient quality of life was recorded with EQ-5D (pre 58.57 ± 10.29 vs. 1 year post 84.29 ± 19.02, P = 0.008). Echocardiographic data show a statistically significant improvement in both systolic pulmonary artery pressure (47.86 ± 8.67 vs. 35.14 ± 9.34, P = 0.022) and E/e' (19.33 ± 5.04 vs. 12.58 ± 3.53, P = 0.023). The Quantikine® HS High-Sensitivity Kit determined elevated interleukin-6 values at enrolment in all patients, with a statistically significant reduction after 6 months (P = 0.0211). From an economic point of view, the net savings, including the cost of CardioMEMS, were on average €1580 per patient during the entire period of observation, while the analysis performed 12 months after the implant vs. 12 months before showed a net saving of €860 per patient. The ad hoc analysis performed on the levosimendan infusions resulted in 315 days of hospital avoidance and a saving of €205 158 for the seven patients enrolled during the observation period. CONCLUSIONS This innovative strategy prevents unplanned access to the hospital and contributes to the efficient use of healthcare facilities, human resources, and costs.
Collapse
|
3
|
Incidental and anticipated arrhythmic diagnoses in patients with an implantable cardiac monitor. J Cardiovasc Med (Hagerstown) 2024:01244665-990000000-00204. [PMID: 38625830 DOI: 10.2459/jcm.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
AIMS In this study, we investigated a cohort of unselected patients with various indications for an implantable cardiac monitor (ICM). Our main objectives were to determine the incidence of arrhythmic diagnoses, both anticipated and incidental in relation to the ICM indication, and to assess their clinical relevance. METHODS We examined remote monitoring transmissions from patients with an ICM at four Italian sites to identify occurrences of cardiac arrhythmias. Concurrently, we collected data on medical actions taken in response to arrhythmic findings. RESULTS The study included 119 patients, with a median follow-up period of 371 days. ICM indications were syncope/presyncope (46.2%), atrial fibrillation management (31.1%), and cryptogenic stroke (22.7%). In the atrial fibrillation management group, atrial fibrillation was the most common finding, with an incidence of 36% [95% confidence interval (CI) 22-55%] at 18 months. Rates of atrial fibrillation were not significantly different between patients with cryptogenic stroke and syncope/presyncope [17% (95% CI 7-40%) vs. 8% (95% CI 3-19%), P = 0.229].For patients with cryptogenic stroke, the incidence of asystole and bradyarrhythmias at 18 months was 23% (95% CI 11-45%) and 42% (95% CI 24-65%), respectively, similar to estimates obtained for patients implanted for syncope/presyncope (P = 0.277 vs. P = 0.836).Overall, 30 patients (25.2%) required medical intervention following ICM-detected arrhythmias, predominantly involving atrial fibrillation ablation (10.9%) and medication therapy changes (10.1%). CONCLUSION In a real-life population with heterogeneous insertion indications, approximately 25% of patients received ICM-guided medical interventions within a short timeframe, including treatments for incidental findings. Common incidental arrhythmic diagnoses were bradyarrhythmias in patients with cryptogenic stroke and atrial fibrillation in patients with unexplained syncope.
Collapse
|
4
|
[Implantable cardioverter-defibrillator explosion after gunshot: when the device protects not only from arrhythmic death]. GIORNALE ITALIANO DI CARDIOLOGIA (2006) 2023; 24:318-322. [PMID: 36971176 DOI: 10.1714/4004.39823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A 70-year-old man presented to the emergency department with accidental gunshot wound at left hemithorax and left shoulder/arm. Initial clinical assessment showed stable vital signs and an implantable cardioverter-defibrillator (ICD) protruding outside from large wound in the infraclavicular region. The ICD, previously implanted for secondary prevention of ventricular tachycardia, appeared burned and the battery was exploded. Urgent chest computed tomography scan was performed with evidence of left humeral fracture without significant arterial injury. The ICD generator was disconnected from passive fixation leads and removed. The patient was stabilized and the humeral fracture was fixed. Then lead extraction was successfully performed in a hybrid operating room with cardiac surgery standby. The patient was discharged in good clinical conditions after reimplantation of a novel ICD in the right infraclavicular region.Emerging technologies are promising in making lead extraction safer and more accessible for patients worldwide. This case report provides the most up-to-date indications and procedural approaches for lead extraction and insights on the future trends in this field.
Collapse
|
5
|
High frame-rate contrast enhanced ultrasound (HIFR-CEUS) in the characterization of small hepatic lesions in cirrhotic patients. J Ultrasound 2023; 26:71-79. [PMID: 36227456 PMCID: PMC10063709 DOI: 10.1007/s40477-022-00724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To show the effectiveness of plane wave HighFrame-Rate CEUS (HiFR-CEUS) compared with "conventional" (plane wave) CEUS (C-CEUS) in the characterization of small (< 2 cm) focal liver lesions (FLLs) not easily detected by CT in cirrhotic patients. HiFR-CEUS exploit an ultra-wideband nonlinear process to combine fundamental, second and higher-order harmonic signals generated by ultrasound contrast agents to increase the frame rate. C-CEUS is limited by the transmission principle, and its frame-rate is around 10 FPS. With HiFR-CEUS (Shenzhen Mindray Bio-Medical Electronics Co., China), the frame-rate reached 60 FPS. MATERIAL AND METHODS Ultrasound detected small FLLs (< 2 cm) in 63 cirrhotic patients during follow-up (June 2019-February 2020); (7 nodules < 1 cm and were not evaluable by spiral CT). Final diagnosis was obtained with MRI (47) or fine needle aspiration (16 cases) C-CEUS was performed and HiFR-CEUS was repeated after 5 min; 0.8-1.2 ml of contrast media (SonoVue, Bracco, Italy) was used. 57 nodules were better evaluable with HiFR-CEUS; 6 nodules were equally evaluable by both techniques; final diagnosis was: 44 benign lesions (29 hemangiomas, 1 amartoma, 2 hepatic cysts; 2 focal nodular hyperplasias, 3 regenerative macronodules, 3 AV-shunts, 3 hepatic sparing areas and 1 focal steatosis) and 19 malignant one (17 HCCs, 1 cholangioca, 1 metastasis); statistical evaluation for better diagnosis with X2 test (SPSS vers. 26); we used LI-RADS classification for evaluating sensitivity, specificity PPV, NPV and diagnostic accuracy of C- and HFR-CEUS. Corrispective AU-ROC were calculated. RESULTS C-CEUS and HiFR-CEUS reached the same diagnosis in 29 nodules (13 nodules > 1 < 1.5 cm; 16 nodules > 1.5 < 2 cm); HiFR-CEUS reached a correct diagnosis in 32 nodules where C-CEUS was not diagnostic (6 nodules < 1 cm; 17 nodules > 1 < 1.5 cm; 9 nodules > 1.5 < 2 cm); C-CEUS was better in 2 nodules (1 < 1 cm and 1 > 1 < 1.5 cm). Some patient's (sex, BMI, age) and nodule's characteristics (liver segment, type of diagnosis, nodule's dimensions (p = 0.65)) were not correlated with better diagnosis (p ns); only better visualization (p 0.004) was correlated; C-CEUS obtained the following LI-RADS: type-1: 18 Nodules, type-2: 21; type-3: 7, type-4: 7; type-5: 8; type-M: 2; HiFR-CEUS: type-1: 38 Nodules, type-2: 2; type-3:4, type-4: 2; type-5: 15; type-M: 2; In comparison with final diagnosis: C-CEUS: TP: 17; TN: 39; FP: 5; FN:2; HIFR-CEUS: TP: 18; TN: 41; FP: 3; FN:1; C-CEUS: sens: 89.5%; Spec: 88.6%, PPV: 77.3%; NPV: 95.1%; Diagn Acc: 88.6% (AU-ROC: 0.994 ± SEAUC: 0.127; CI: 0.969-1.019); HiHFR CEUS: sens: 94.7%; Spec: 93.2%, PPV: 85.7%; NPV: 97.6%; Diagn Acc: 93.2% (AU-ROC: 0.9958 ± SEAUC: 0.106; CI: 0.975-1.017) FLL vascularization in the arterial phase was more visible with HiFR-CEUS than with C-CEUS, capturing the perfusion details in the arterial phase due to a better temporal resolution. With a better temporal resolution, the late phase could be evaluated longer with HiFR-CEUS (4 min C-CEUS vs. 5 min HiFR-CEUS). CONCLUSION Both C-CEUS and HIFR-CEUS are good non invasive imaging system for the characterization of small lesions detected during follow up of cirrhotic patients. HiFR-CEUS allowed better FLL characterization in cirrhotic patients with better temporal and spatial resolution capturing the perfusion details that cannot be easily observed with C-CEUS.
Collapse
|
6
|
360 CARDIOMEMS HF SYSTEM: CONTINUOUS REMOTE MONITORING FOR OPTIMIZE HF PATIENTS' MANAGEMENT AND RESOURCES CONSUMPTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Heart failure (HF) alternates phases of stability and phases of exacerbation, with a progressive decline in the patient's functional capacity and quality of life; the need to anticipate and improve the effectiveness of management of HF exacerbation has led to the development of several remote monitoring tools.
We report our experience with CardioMEMS HF system (implantable device to monitor changes in pulmonary artery diastolic pressure (PAPd) as early indicator of the onset of worsening HF) in order to optimize the pharmaceutical treatments strategy (e.g. Levosimendan infusion) and to assess the impact on hospital resources consumption and costs.
Methods
We enrolled 7 patients (69.00±4.88 years; 30% female) with end-stage HF, implanted with CardioMEMS and daily monitored remotely, in order to optimize both tailored adjustment of home therapy and infusions of Levosimendan. More in detail, if the cardiologist detected a tendency for PAPd to rise, patients were contacted for home therapeutic changes. If no further changes were possible, the patient was hospitalized for the infusion of Levosimendan.
In order to calculate the impact of this remote monitoring strategy on resources consumption, we collected data on hospitalizations (e.g. causes, numbers, length, high-cost drugs and costs) taking into account the same number of months pre and post-CardioMEMS implant for each patient.
Results
Following the implantation of CardioMEMS we observed a 45% reduction in the total number of hospitalizations and a 62% reduction in the days of hospitalization (from a total of 421 days before implantation to a total of 159 days post implantation in the observation period).
From an economic point of view, a significant hospital cost reduction was recorded in terms of both hospitalization costs (HF related re-hospitalization and CardioMEMS's implant related cost) and drugs infusion costs (hospital stay and drug costs); more specifically, the total savings for the 7 patients are around € 236,000 and total days of hospitalization avoided are around 500 days including the hospitalizations avoided for drugs infusion.
Accordingly, was recorded an improvement in patients’ quality of life measured with EQ5D (pre-implantation 75.17±2.06 vs post-implantation 108.60±8.70, p 0.0078).
Conclusions
Our preliminary results support the usefulness of this system in the remote management of the HF patients and in the re-hospitalization reduction both for exacerbation and drug management. In fact, the parameters’ monitoring through the CardioMEMS device allows a personalized management of drug therapy; more precisely, considering the drug Levosimendan, instead of a periodic standard timing for infusion, a patient-tailored timing of infusion was applied.
In conclusion, our innovative strategy contributes to achieve the organizational efficiency of the healthcare facilities, as well as to the adequate use and allocation of financial and human resources with a better outcome for HF patients.
Collapse
|
7
|
23 IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD) EXPLOSION AFTER GUNSHOT: WHEN DEVICE PROTECTS TWICE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
A 70 years old man presented to the emergency department with “accidental” gunshot wound at left hemithorax and left shoulder/arm. Initial clinical assessment showed stable vital signs and implantable cardioverter defibrillator(ICD) protruding outside from large wound in the infraclavicular region. The ICD, previously implanted for secondary prevention of ventricular tachycardia, appeared burned and the battery was exploded. Urgent chest computed tomography scan was performed with evidence of left omeral displaced fracture, large hematoma without arterial injury and many shotgun pellets in left shoulder/arm. The ICD generator was disconnected from passive fixation leads and removed. Patient was stabilized and omeral fracture was fixed. Following leads extraction was successfully performed in hybrid operating room with cardiac surgery standby considering the difficulty of the procedure, the type of leads (double coil, passive fixation) and the risk of complications. The patient was discharged home in good clinical conditions after re-implantation of novel ICD in right infraclavicular region.
Emerging technologies are promising in making lead extractions safer and more accessible for patients worldwide. This clinicl case report will provide the most up-to-date indications and procedural approaches for lead extractions and insight on the future trends in this field.
Collapse
|
8
|
Efficacy of a food supplement based on S-adenosyl methionine and probiotic strains in subjects with subthreshold depression and mild-to-moderate depression: A monocentric, randomized, cross-over, double-blind, placebo-controlled clinical trial. Biomed Pharmacother 2022; 156:113930. [DOI: 10.1016/j.biopha.2022.113930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/02/2022] Open
|
9
|
242 Palliative care needs in cystic fibrosis: Baseline data from the Improving Life with Cystic Fibrosis Multi-site Implementation Trial for Primary Palliative Care Intervention. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
Device-detected sleep-disordered breathing predicts implantable defibrillator therapy in patients with heart failure. Europace 2022. [DOI: 10.1093/europace/euac053.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Sleep-disordered breathing is highly prevalent in heart failure (HF) and it has been suggested as a risk factor for malignant ventricular arrhythmias. The Respiratory Disturbance Index (RDI) algorithm computed by select implantable cardioverter defibrillators (ICDs) can identify severe sleep apnea (SA).
Purpose
In the present analysis we evaluated the association between ICD-detected SA and the incidence of appropriate ICD therapy in patients with HF.
Methods
We enrolled 411 HF patients (age 69±10years, 77% male, ejection fraction 32±8%), implanted with an ICD endowed with an algorithm (ApneaScan, Boston Scientific) that calculates the RDI each night. In this analysis the weekly mean RDI value was considered. The endpoint was the first appropriate ICD shock. The median follow-up was 26 months [25th–75th percentile: 16-35].
Results
During follow-up, one or more ICD shocks were documented in 58 (14%) patients.
Patients with shocks were younger (66±13years versus 70±10years, p=0.038), and more frequently implanted for secondary prevention (21% versus 10%, p=0.026). The maximum RDI value calculated during the entire follow-up period did not differ between patients with and without shocks (55±15episodes/h versus 54±14episodes/h, p=0.539). However, the ICD-detected RDI showed a considerable variability during follow-up. The overall median of the weekly RDI was 33episodes/h [25th–75th percentile: 24-45]. Using a time-dependent Cox regression model, the continuously measured weekly mean RDI≥45episodes/h was independently associated with shock occurrence (HR:4.63, 95%CI:2.54-8.43, p<0.001), after correction for baseline confounders (age, secondary prevention).
Conclusions
In HF patients, patients were more likely to receive appropriate ICD shocks during periods of time when they exhibited more sleep-disordered breathing.
Collapse
|
11
|
A Multistep Approach to Deal With Advanced Heart Failure: A Case Report on the Positive Effect of Cardiac Contractility Modulation Therapy on Pulmonary Pressure Measured by CardioMEMS. Front Cardiovasc Med 2022; 9:874433. [PMID: 35445087 PMCID: PMC9013826 DOI: 10.3389/fcvm.2022.874433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/08/2022] [Indexed: 01/04/2023] Open
Abstract
During the last years, the management of heart failure (HF) made substantial progress, focusing on device-based therapies to meet the demands of this complex syndrome. In this case report, we present a multistep approach to deal with HF. Specifically, we report the first patient subjected to the implantation of both Optimizer Smart® (Impulse Dynamics Inc., Marlton, NJ, USA) and CardioMEMS devices. A 72-year-old male patient with HF and reduced ejection fraction (HFrEF) was admitted to our cardiology department in January 2021, following a progressive shortening of the time between hospitalizations for levosimendan infusions. Specifically, the patient was monitored daily by CardioMEMS, and a strategy of levosimendan infusions guided by the device had been adopted. He was also a carrier of MitraClips and cardiac resynchronization therapy defibrillator (CRT-D) and had optimized HF medical therapy. In January 2021, the patient implanted Optimizer Smart® device for cardiac contractility modulation (CCM) therapy because of poor response to therapy and elevated pulmonary artery pressure (PAP). CCM significantly reduced PAP values following discharge (systolic PAP 33.67 ± 2.92 vs. 40.6 ± 3.37 mmHg, diastolic PAP 14.5 ± 2.01 vs. 22.5 ± 2.53 mmHg, mean PAP 22.87 ± 2.20 vs. 30.9 ± 2.99 mmHg, HR 60.93 ± 1.53 vs. 80.83 ± 3.66 bpm; p < 0.0001), with persisting effect at 9 months. The usefulness of CCM is objectively demonstrated for the first time by continuous invasive monitoring of PAP by CardioMEMS, which can suggest the correct timing for CCM implantation.
Collapse
|
12
|
58 Effects of sodium–glucose co-transporter 2 (SGLT2) inhibitors on major cardiovascular events in Type 2 diabetic patients: a meta-analysis of randomized controlled trials. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab136.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Sodium–glucose co-transporter-2 inhibitors (SGLT2i) reduce cardiovascular (CV) events in diabetic patients, with a consistent effect on heart failure (HF) related outcomes. However, the effects on ischaemic CV events appear less certain, in particular in patients with history of HF. The aim of this meta-analysis is to investigate CV benefit of SGLT2i and to assess the effects in patients with and without established atherosclerotic cardiovascular disease (ASCVD), with and without HF, and with estimated glomerular filtration rate < or ≥ 60 mL/min.
Methods
We searched PubMed, Embase, Cochrane, ISI Web of Science, SCOPUS, and clinicaltrial.gov databases. We performed a systematic review and meta-analysis of randomized, placebo-controlled, cardiovascular outcome trials (CVOT) of SGLT2i in diabetic patients, assessing the effects of SGLT2i on 3-point MACE [CV death, non-fatal myocardial infarction (MI), non-fatal stroke] and composite of HF hospitalization or CV death.
Results
Of 205 articles, 7 CVOTs were included in the meta-analysis. Compared to placebo, SGLT2i significantly reduced by 10% the risk of 3-point MACE (HR 0.90; P = 0.025) (Figure panel A) and the risk of CV death or HF hospitalization by 24% (HR 0.76; P < 0.001) (Figure panel B). SGLT2i significantly reduced HF hospitalization by 30% (HR 0.70; P < 0.001), with consistent effects in all subgroups analysed, CV death by 17% (HR 0.83; P = 0.035) and all-cause mortality by 18% (HR 0.82; P = 0.024). No significant effects were observed on MI and stroke.
Conclusions
SGLT2i significantly reduce CV outcome in diabetic patients. SGLT2i remarkably and consistently reduce HF hospitalization, in patients with and without HF at baseline and independently on the presence of ASCVD.
Collapse
|
13
|
C-reactive protein but not procalcitonin may predict antibiotic response and outcome in infections following major abdominal surgery. Updates Surg 2021; 74:765-771. [PMID: 34699035 PMCID: PMC8546392 DOI: 10.1007/s13304-021-01172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/16/2021] [Indexed: 02/05/2023]
Abstract
We aimed to evaluate the usefulness of C-reactive protein (CRP) and procalcitonin (PCT) as markers of infection, sepsis and as predictors of antibiotic response after non-emergency major abdominal surgery. We enrolled, from June 2015 to June 2019, all patients who underwent surgery due to abdominal infection (peritoneal abscess, peritonitis) or having sepsis episode after surgical procedures (i.e. hepatectomy, bowel perforation, pancreaticoduodenectomy (PD), segmental resection of the duodenum (SRD) or biliary reconstruction in a Tertiary Care Hospital. Serum CRP (cut-off value < 5 mg/L) and PCT (cut-off value < 0.1mcg/L) were measured in the day when fever was present or within 24 h after abdominal surgery. Both markers were assessed every 48 h to follow-up antibiotic response and disease evolution up to disease resolution. We enrolled a total of 260 patients underwent non-emergency major abdominal surgery and being infected or developing infection after surgical procedure with one or more microbes (55% mixed Gram-negative infection including Klebsiella KPC, 35% Gram-positive infection, 10% with Candida infection), 58% of patients had ICU admission for at least 96 h, 42% of patients had fast track ICU (48 h). In our group of patients, we found that PCT had a trend to increase after surgical procedure; particularly, those undergoing liver surgery had higher PCT than those underwent different abdominal surgery (U Mann–Whitney p < 0.05). CRP rapidly increase after surgery in those developing infection and showed a statistical significant decrease within 48 h in those subject being responsive to antibiotic treatment and having a clinical response within 10 days independently form the pathogens (bacterial or fungal). Further we found that those having CRP higher than 250 mg/L had a reduced percentage of success treatment at 10 days compared to those < 250 mg/mL (U Mann–Whitney p < 0.05). PCT did not show any variation according to treatment response. CRP in our cohort seems to be a useful marker to predict antibiotic response in those undergoing non-emergency abdominal surgery, while PCT seem to be increased in those having major liver surgery, probably due to hepatic production of cytokines.
Collapse
|
14
|
Safety and efficacy of alpha-lipoic acid oral supplementation in the reduction of pain with unknown etiology: A monocentric, randomized, double-blind, placebo-controlled clinical trial. Biomed Pharmacother 2021; 144:112308. [PMID: 34649217 DOI: 10.1016/j.biopha.2021.112308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Extensive evidence suggests that alpha-lipoic acid (ALA) is effective in diabetic neuropathy pain management. However, little is known on its safety and efficacy in reducing idiopathic pain in normoglycemic subjects. The aim of this study was to evaluate ALA food supplement safety and efficacy in the reduction of different forms of idiopathic pain. METHODS Two-hundred and ten normoglycemic adults suffering from idiopathic pain (i.e. 57 subjects with primitive neuropathic pain, 141 subjects with arthralgia with unknown etiology, and 12 subjects with idiopathic myalgia) were randomized to receive placebo, 400 mg/day, or 800 mg/day of ALA. Participants underwent two visits (at baseline = t0, and after 2 months = t1) in which two validated questionaries for pain (numerical rating scale [NRS] and visual analogue scale [VAS]) were collected; fasting blood glucose assessment, adverse effects, and renal and hepatic toxicity were also monitored. RESULTS At t1, none of subjects treated with ALA reported a decreased glycemia or adverse effects. The treated subjects showed a significant reduction in NRS (p < 0.001) while the placebo group did not show any NRS reduction (p = 0.86). Similar results were also obtained for VAS. Statistical analysis aimed at detecting possible differences in NRS and VAS scores among treatment groups based on the source of pain did not reveal any significant effect. CONCLUSIONS Since the management of idiopathic pain is challenging for physicians, the use of ALA food supplements could be a feasible option, based on its safety and efficacy compared to commonly-used analgesic drugs.
Collapse
|
15
|
Epilobium angustifolium L. extract with high content in oenothein B on benign prostatic hyperplasia: A monocentric, randomized, double-blind, placebo-controlled clinical trial. Biomed Pharmacother 2021; 138:111414. [PMID: 33765581 DOI: 10.1016/j.biopha.2021.111414] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common condition in adult men. Especially in Europe, increasing attention has been focused on E. angustifolium extracts (EAEs), which are widely used for their positive effects on the symptoms of BPH, although human clinical trials are limited. The aim of this monocentric, randomized, double-blind, placebo-controlled clinical trial is to evaluate if a daily intake of hard, gastric-resistant capsules containing a chemically characterized EAE (500 mg) for 6 months may allow a significant improvement in symptoms in subjects with BPH. This study was conducted in 128 adult men, randomly assigned to receive either EAE food supplement (N = 70) or placebo (N = 58), who underwent four visits (baseline = t0, after 15 days = t1, after 2 months = t2 and after 6 months = t3) in an outpatient setting to evaluate post-void residual (PVR) and prostate volume (PV) by means of prostate ultrasound, prostate-specific antigen (PSA) and neutrofile/lymphocyte ratio (N/L), nocturia before the clinical visits and International Prostate Specific Score (IPSS) registered by the physicians. EAE food supplement induced a significant decrease in the PVR and consequently nocturia improving the quality of life as suggested by the decrease of IPSS. No subjects reported adverse effects related to oral intake of EAE food supplement. Moreover, EAE food supplement did not show hepatic or renal toxicity. In conclusion, EAE food supplements can be used in subjects with BPH, to improve their quality of life and general renal function.
Collapse
|
16
|
A standardized polyphenol mixture extracted from poplar-type propolis for remission of symptoms of uncomplicated upper respiratory tract infection (URTI): A monocentric, randomized, double-blind, placebo-controlled clinical trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 80:153368. [PMID: 33091857 DOI: 10.1016/j.phymed.2020.153368] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The most common symptoms of mild upper respiratory tract infections (URTIs) are sore throat, muffled dysphonia, and swelling and redness of the throat, which result from the inflammation process following acute bacterial or viral infection. HYPOTHESIS/PURPOSE As propolis is a natural resinous substance traditionally used to maintain oral cavity and upper respiratory tract health due to its antimicrobial and anti-inflammatory properties, the aim of this study is to evaluate the efficacy of an oral spray based on poplar-type propolis extract with a known and standardized polyphenol content, on the remission of the symptoms associated with mild uncomplicated URTIs. STUDY DESIGN A monocentric, randomized, double-blind, placebo-controlled clinical trial was performed. METHODS This study was conducted in 122 healthy adults who had perceived mild upper respiratory tract infections. Participants, randomly assigned to receive either propolis oral spray (N = 58) or placebo (N = 64), underwent four visits (baseline = t0, after 3 days = t1 and after 5 days = t2 and after a follow-up of 15 days = t3) in an outpatient setting. Propolis oral spray total polyphenol content was 15 mg/ml. The dosage was 2-4 sprays three times/day (corresponding to 12-24 mg of polyphenols/day), for five days. The duration of the study was 8 weeks. RESULTS After 3 days of treatment, 83% of subjects treated with propolis oral spray had remission of symptoms, while 72% of subjects in the placebo group had at least one remaining symptom. After five days, all subjects had recovered from all symptoms. This means that resolution from mild uncomplicated URTIs took place two days earlier, instead of taking place in five days as recorded in the control group. There was no relationship between the ingestion of propolis oral spray or placebo and adverse reactions. CONCLUSION Propolis oral spray can be used to improve both bacterial and viral uncomplicated URTI symptoms in a smaller number of days without the use of pharmacological treatment, leading to a prompt symptom resolution.
Collapse
|
17
|
It is easy to see, but it is better to foresee: a case report on the favourable alliance between CardioMEMS and levosimendan. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32974431 DOI: 10.1093/ehjcr/ytaa205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/12/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022]
Abstract
Background In the past years, different devices have been investigated to help in identifying early decompensation events in patients with heart failure (HF) and reduced ejection fraction (EF), reducing hospital admissions. In this report, we present the first patient experience with levosimendan infusion led by CardioMEMS. Case summary A 68-year-old man with HF and reduced EF with more than 20 hospitalizations for exacerbation of HF was enrolled in our HF Clinic from October 2017. Echocardiogram showed a dilated left ventricle with severely reduced EF (29%) and increased pulmonary artery systolic pressure (40 mmHg). From October 2017 to May 2019, the patient went through numerous hospitalizations, despite optimal medical therapy; subsequently, was adopted a strategy of levosimendan infusions guided by CardioMEMS. Levosimendan infusions improved haemodynamic and pressure profiles. The patient was monitored daily by CardioMEMS, and from June to December 2019, he had only two hospitalizations scheduled for levosimendan infusion and none for HF exacerbation. Discussion Our case supports the combination of CardioMEMS and levosimendan for the optimal management of patients with advanced HF. These results further strengthen the development of a randomized clinical trial to demonstrate the clinical usefulness of this device in combination with the levosimendan infusion programme in advanced HF patients.
Collapse
|
18
|
Characterization of Local Products for Their Industrial Use: The Case of Italian Potato Cultivars Analyzed by Untargeted and Targeted Methodologies. Foods 2020; 9:foods9091216. [PMID: 32887216 PMCID: PMC7555304 DOI: 10.3390/foods9091216] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/03/2022] Open
Abstract
The chemical characterization of local Italian potato cultivars is reported to promote their preservation and use as high quality raw material in food industries. Twenty potato (Solanum tuberosum L.) cultivars from Piedmont and Liguria Italian regions were investigated using NMR (Nuclear Magnetic Resonance) and RP-HPLC-PDA-ESI-MSn (Reversed Phase High-Performance Liquid Chromatography with Photodiode Array Detector and Electrospray Ionization Mass Detector) methodologies. Water soluble and lipophilic metabolites were identified and quantified. With respect to literature data, a more complete 1H (protonic) spectral assignment of the aqueous potato extracts was reported, whereas the 1H NMR assignment of potato organic extracts was reported here for the first time. Phenolics resulted to be in high concentrations in the purple–blue colored Rouge des Flandres, Bergerac, Fleur Bleu, and Blue Star cultivars. Servane, Piatlina, and Malou showed the highest amount of galacturonic acid, a marker of pectin presence, whereas Jelly cultivar was characterized by high levels of monosaccharides. Roseval and Rubra Spes contained high levels of citric acid involved in the inhibition of the enzymatic browning in fresh-cut potato. High levels of the amino acids involved in the formation of pleasant-smell volatile compounds during potato cooking were detected in Rouge des Flandres, Blue Star, Bergerac, Roseval, and Ratte cultivars. These results suggest that each local cultivar is characterized by a proper chemical profile related to specific proprieties that can be useful to obtain high quality industrial products.
Collapse
|
19
|
Advances in management of periprosthetic joint infections: an historical prospective study. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2020; 23:129-138. [PMID: 30977879 DOI: 10.26355/eurrev_201904_17482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of our study is to assess the incidence of prosthetic joint infection (PJI) after total Knee arthroplasty (TKA), total Hip arthroplasty (THA) and total Shoulder arthroplasty (TSA), to identify risk factors, determine the microbial spectrum and management's outcome. PATIENTS AND METHODS A case-control, retrospective observational study was performed analyzing patients who developed a PJI after TKA, THA, and TSA from 2000 to 2017 at our hospital. The patient's risk profile was defined extracting from clinical records the following data: sex, age, BMI, type of implant, comorbidity, year of surgery, year of infection, previous intra-articular injection, microbial isolation, medical and surgical management outcome. We include in the "control group" for each "case" at least 3 patients who didn't have a PJI after TJA. RESULTS 28 patients met all inclusion and exclusion criteria. Comparing the "cases" with "controls" demographics parameters, medical comorbidities and previous intra-articular injection were not associated with an increased risk of PJI. Comparing the "early/delayed group" with "late group", BMI was associated with an increased risk of early/delayed PJI, while demographics parameters, medical comorbidities, and previous intra-articular injection did not significantly increase the risk of PJI. Logistic regression showed that for each BMI unit there was a 20-fold increased risk of early prosthetic infection (OR 1.19, IC 1.03-1.38, p=0.01). Staphylococci were isolated most frequently from pre-operative and intra-operative cultures. Two-stage arthroplasty exchange and surgical debridement resulted in the most performed surgical treatment with a success rate of 88 and 87%. CONCLUSIONS Obesity is a risk factor for "early/delayed infection" of TJA. Two-stage arthroplasty exchange, debridement, antibiotics, and implant retention in patients are treatments with a high rate of success in terms of reinfection.
Collapse
|
20
|
Gastrointestinal Disorders and Metabolic Syndrome: Dysbiosis as a Key Link and Common Bioactive Dietary Components Useful for their Treatment. Int J Mol Sci 2020; 21:E4929. [PMID: 32668581 PMCID: PMC7404341 DOI: 10.3390/ijms21144929] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/05/2020] [Accepted: 07/10/2020] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal (GI) diseases, which include gastrointestinal reflux disease, gastric ulceration, inflammatory bowel disease, and other functional GI disorders, have become prevalent in a large part of the world population. Metabolic syndrome (MS) is cluster of disorders including obesity, hyperglycemia, hyperlipidemia, and hypertension, and is associated with high rate of morbidity and mortality. Gut dysbiosis is one of the contributing factors to the pathogenesis of both GI disorder and MS, and restoration of normal flora can provide a potential protective approach in both these conditions. Bioactive dietary components are known to play a significant role in the maintenance of health and wellness, as they have the potential to modify risk factors for a large number of serious disorders. Different classes of functional dietary components, such as dietary fibers, probiotics, prebiotics, polyunsaturated fatty acids, polyphenols, and spices, possess positive impacts on human health and can be useful as alternative treatments for GI disorders and metabolic dysregulation, as they can modify the risk factors associated with these pathologies. Their regular intake in sufficient amounts also aids in the restoration of normal intestinal flora, resulting in positive regulation of insulin signaling, metabolic pathways and immune responses, and reduction of low-grade chronic inflammation. This review is designed to focus on the health benefits of bioactive dietary components, with the aim of preventing the development or halting the progression of GI disorders and MS through an improvement of the most important risk factors including gut dysbiosis.
Collapse
|
21
|
Chemical and mechanical characterization of hyaluronic acid hydrogel cross‐linked with polyethylen glycol and its use in dermatology. Dermatol Ther 2020; 33:e13747. [DOI: 10.1111/dth.13747] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/05/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
|
22
|
The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. Anaesthesia 2020; 75:724-732. [PMID: 32221973 DOI: 10.1111/anae.15049] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
Abstract
Novel coronavirus 2019 is a single-stranded, ribonucleic acid virus that has led to an international pandemic of coronavirus disease 2019. Clinical data from the Chinese outbreak have been reported, but experiences and recommendations from clinical practice during the Italian outbreak have not. We report the impact of the coronavirus disease 2019 outbreak on regional and national healthcare infrastructure. We also report on recommendations based on clinical experiences of managing patients throughout Italy. In particular, we describe key elements of clinical management, including: safe oxygen therapy; airway management; personal protective equipment; and non-technical aspects of caring for patients diagnosed with coronavirus disease 2019. Only through planning, training and team working will clinicians and healthcare systems be best placed to deal with the many complex implications of this new pandemic.
Collapse
|
23
|
Distal hypospadias repair using the needle point bipolar cutting-coagulation forceps. J Pediatr Urol 2020; 16:69.e1-69.e5. [PMID: 31740147 DOI: 10.1016/j.jpurol.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To determine the outcome of distal hypospadias repairs performed using bipolar diathermy (BD) for all the dissection. METHODS Retrospective review of 310 patients undergoing distal hypospadias (264 subcoronal/distal penile and 46 coronal/glanular) over a 11-year period. Median age at surgery was 2.0 years (range 9 months-15 years). Caudal anesthesia was performed in all patients. All children underwent an in situ tubularization of the urethral plate, which was combined with midline incision of the plate in 30 (10%). Preputial reconstruction was performed in 303 (98%) patients. BD forceps was used for coagulation and for all the dissection including skin incision, elevation of glans wings, separation of the corpus spongiosum from the corpora cavernosa, and urethral plate incision, when deemed appropriate. The authors assessed surgical complications and cosmetic results. The latter using the hypospadias objective score (HOSE), with a score ≥ 14 considered as acceptable. RESULTS The average operative time was 70 min. There was no postoperative bleeding or hematomas that required surgical intervention. There were no wound infections or necrosis. Complications occurred in 37 patients (11.9%). Urethral fistula formation was the commonest (n = 18). Postoperative persistent preputial swelling occurred in 3.5% of cases. Two hundred twelve patients (90.6%) had a HOSE score ≥ 14, and no patient required revision surgery for skin problems after a median follow-up of 8.1 (range 1.2-13.1) years. DISCUSSION The study is limited by its retrospective nature and by the fact that a number of other pre-operative, intra-operative, and postoperative variables can affect outcome. CONCLUSIONS Bipolar diathermy can be safely used for distal hypospadias repairs. It allowed careful control of intra-operative bleeding and also clear visualization of tissue planes. Complication rate overall compares favorably with the literature, and cosmetic results were satisfactory.
Collapse
|
24
|
Pegylated hyaluronic acid filler enriched with calcium hydroxyapatite treatment of human skin: collagen renewal demonstrated through morphometric computerized analysis. J BIOL REG HOMEOS AG 2020; 33:1967-1971. [PMID: 31920061 DOI: 10.23812/19-250-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
25
|
P268 Epicardial cyst in a three months old baby: a challenging decision. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
We report a case of a three months old baby, with no history of heart disease, referred to our center for cardiological screening. EKG was normal and a physiologic 1/6 systolic murmur was present. Conversely, echocardiography revealed a thin-walled, echo-free cystic intrapericardic structure adjacent to the posterior wall of the left ventricle; no signs of compression on cardiac structures were evident. CAT scan confirmed the presence of echo-free cystic over-diaphragmatic structure at the crux cordis level. The cyst was described as located between visceral pericardial layer and muscolar ventricular wall and appeared to cause compression on the midbasal wall of the left ventricle, of the interventricular septum and less extensively on the right ventricle. The dimension of the cyst was 2.7x2.5x1.8 cm. Worthy of note, posterior interventricular and posterolateral coronary arteries were very close to the cyst and partially pushed apart one from the other by the mass. Eight months after the diagnosis we detected an increase in mass size, confirmed also by cardiac MRI showing a mass of 4.5x3.4x3 cm with an extimated volume of 23 cm2. Because of significant increase of dimension of the cyst we decided for surgical excision of the mass. The cyst contained clear and translucent fluid and was successfully removed. Pleuropericardial window was created to prevent pericardial effusion. Histopathological report suggested the diagnosis of bronchogenic cyst because of the presence of smooth muscle.
Bronchogenic cyst are closed epithelial-lined sacs developed from the respiratory system as the result of an abnormal budding process during the early development of the foregut. These congenital malformations are usually located in the mediastinum or in the lung parenchyma, but atypical locations such as neck, intramedullary part of the spine, diaphragm or intraabdominal region have been reported. Only a few cases occurring in the heart have been described, but their location in the left ventricle is extremely rare. Bronchogenic cyst are usually asymptomatic: symptoms are related to the interaction with the adjacent structures and therefore depend on the dimensions and the localization of the mass. Surgical approach is mandatory if a complication occurs. Conversely there is not a unique approach for asymptomatic mass as in our case.
The young age of the baby and the absence of symptoms argued in favor of a "watchful waiting" strategy. Nevertheless, the particular localization of the cyst at the crux cordis level, its relatively rapid growth and above all the evidence of a close relationship with the coronary arteries, suggesting a concrete risk of compression with further enlargement, were determinant for the final decision for surgical excision.
Abstract P268 Figure 1
Collapse
|
26
|
P1542 Reference values for multilayer longitudinal strain in children: preliminary findings from healthy individuals. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Strain echocardiography is a reliable echocardiographic modality to measure myocardial mechanical deformation and evaluate regional and global myocardial systolic function, and has been demonstrated to be a useful tool for the evaluation of cardiac function in children with acquired and congenital heart diseases. Recent advancements in echocardiographic technology allow to analyze myocardial strain in multiple layers. To our knowledge, there are no published reference values for echocardiographic multilayer-specific strain measurement.
AIM OF THE STUDY
Aim of our study was to establish normal reference values for left ventricular (LV) and right ventricular (RV) longitudinal strain (LS) in a wide population of Italian children and to provide normal reference values of layer-specific LS in a healthy pediatric population.
METHODS AND RESULT
At present we have analyzed data from two-hundred (target: n = 500) healthy, consecutive subjects (age <18 years, mean age 7.5 ± 4yrs; range from 1 month to 17,5 years). All subjects underwent a clinical cardiological evaluation including ECG and physical examination. Subsequently, a complete echo Doppler examination including LS evaluation using speckle-tracking echocardiography was performed. Individuals were excluded if any significant abnormality was found at echocardiography (e.g. valvular regurgitation more than trivial, any structural abnormalities including small ASDs or VSDs; patients with isolated PFO were included). Subendocardial, midwall, subepicardial LS, and strain gradient (LSsubepi - LSsubendo) were also determined. LS% analysis was considered acceptable if missing data were present in no more than one segment per echocardiographic view, according to current consensus. Echocardiographic yield for LS analysis was 98.5 % for 4-chamber views, 82.5% for 2-chamber views and 84.5% for 3-chamber views. Accordingly Global Longitudinal Strain (GLS) was available overall in 82% of the population analyzed so far (n= 164 children) on all layers, with a total of 8,872 echocardiographic available segments analyzed. Normal distribution was found for global subendocardial, midwall and subepicardial LS. As displayed in figure 1 (panels A-B-C), means ± SD were -20.8 ± 1.9% for LSsubendo, -19.2 ± 1.8% for LSsubepi and -19.9 ± 1.8% for LSmidwall. Accordingly higher value (95ile) for normal LS were -17.9%, -16.4% and -17.1% for LSsubepi, LSsubendo and LSmidwall, respectively. A significant subepicardial to subendocardial gradient was found in all children with higher absolute values found at the endocardial level, with a mean difference of 1.6 ± 0.9% (Panel D).
CONCLUSIONS
We provide preliminary data on 200 children to establish normal reference values for echocardiographic multilayer-specific strain measurement in a wide population of healthy italian children.
Abstract P1542 Figure.
Collapse
|
27
|
Viscoelastic properties and thermodynamic balance improvement of a hyaluronic acid hydrogel enriched with proline and glycyne. J BIOL REG HOMEOS AG 2019; 33:1955-1959. [PMID: 31793281 DOI: 10.23812/19-252-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
28
|
Genitourinary syndrome of menopause and the role of biostimulation with non-cross-linked injectable hyaluronic acid plus calcium hydroxyapatite. J BIOL REG HOMEOS AG 2019. [PMID: 31782291 DOI: 10.23812/19-251-l.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
29
|
Genitourinary syndrome of menopause and the role of biostimulation with non-cross-linked injectable hyaluronic acid plus calcium hydroxyapatite. J BIOL REG HOMEOS AG 2019; 33:1961-1966. [PMID: 31782291 DOI: 10.23812/19-251-l] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
|
30
|
Ureteroscopic lithotripsy for ureteral stones in children using holmium: yag laser energy: results of a multicentric survey. J Pediatr Urol 2019; 15:391.e1-391.e7. [PMID: 31182399 DOI: 10.1016/j.jpurol.2019.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Holmium:YAG (Ho:YAG) laser lithotripsy has broadened the indications for ureteroscopic stone managements in adults, but few evidence are currently available in the pediatric population. OBJECTIVE This article aimed to assess the outcome of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral stones in different locations in children. STUDY DESIGN The medical records of 149 patients (71 boys and 78 girls; median age 9.2 years) treated with Ho:YAG laser ureteroscopic lithotripsy in five international pediatric urology units over the last 5 years were retrospectively reviewed. Exclusion criteria included patients with renal calculi and/or with a history of ipsilateral stricture, renal failure, active urinary tract infection, or coagulation disorder. RESULTS Stones were treated with dusting technique in all cases. The median stone size was 10.3 mm (range 5-17). Stones were located in the distal ureter in 77 cases (51.7%), in the middle ureter in 23 cases (15.4%), and in the proximal ureter in 49 cases (32.9%). The median operative time was 29.8 min (range 20-95). Intra-operative complications included five bleedings (3.3%) and seven stone retropulsions (4.7%). Overall stone-free rate was 97.3%. Overall postoperative complications rate was 4.0% and included two cases of stent migration (1.3%) (Clavien II) and four residual stone fragments (2.7%) that were successfully treated using the same technique (Clavien IIIb). On multivariate analysis, re-operation rate was significantly dependent on the proximal stone location and presence of residual fragments >2 mm (P = 0.001). DISCUSSION This study is one of the largest pediatric series among those published until now. The study series reported a shorter operative time, a higher success rate, and a lower postoperative complications rate compared with previous series. A limitation of this study is that stone-free rates may be somewhat inaccurate using ultrasonography and plain X-ray compared with computed tomography (CT); the study's 97.3% success rate may be overestimated because no CT scan was done postoperatively to check the stone-free rate. Other limitations of this article include its retrospective nature, the multi-institutional participation, and the heterogeneous patient collective. CONCLUSION The Ho:YAG laser ureteroscopic lithotripsy seems to be an excellent first-line treatment for children with ureteral stones, independently from primary location and size. However, patients with proximal ureteral stones and residual fragments >2 mm reported a higher risk to require a secondary procedure to become stone-free. Combination of techniques as well as appropriate endourologic tools are key points for the success of the procedure regardless of stones' size and location.
Collapse
|
31
|
Consecutive episodes of heart and kidney failure in an "otherwise" healthy young man. BMC Nephrol 2019; 20:229. [PMID: 31221126 PMCID: PMC6587250 DOI: 10.1186/s12882-019-1414-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 06/06/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Acute renal failure is a rare occurrence in a patient with an unremarkable past medical history and should always lead to an in depth clinical study. The occurrence in the same healthy young subject, of consecutive episodes of heart failure and of acute renal failure is an even rarer event and should prompt diagnostic tests and restrict the diagnostic hypotheses. CASE PRESENTATION We present the case of a 28 year-old man who, while waiting to undergo assessment for a mild chronic kidney disease, was diagnosed with decompensated dilated cardiomyopathy and placed on diuretics and β-blockers. After few weeks he developed a non oligoanuric acute renal failure with a slight elevation of serum calcium. Renal biopsy proved suggestive for renal sarcoidosis; thus the hypothesis of systemic sarcoidosis with cardiac and renal involvement was possible avoiding further delay in initiation of therapy. CONCLUSIONS Cardiac sarcoidosis is usually silent but the majority of cases are diagnosed when cardiac symptoms are present in a patient with systemic sarcoidosis. Renal involvement with granulomatous interstitial nephritis is also quite rare and can be an unexpected finding at kidney biopsy. This case highlights the need to evaluate thoroughly clinical problems that do not fit in a specific scenario and emphasizes the importance of performing a kidney biopsy in case of kidney failure of unknown etiology.
Collapse
|
32
|
In Vitro Evaluation of the Biological Availability of Hyaluronic Acid Polyethylene Glycols-Cross-Linked Hydrogels to Bovine Testes Hyaluronidase. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3196723. [PMID: 31309104 PMCID: PMC6594335 DOI: 10.1155/2019/3196723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/14/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022]
Abstract
During last years, hyaluronic acid- (HA-) based dermal fillers have grown rapidly and continuously, as reported by the American Society of Aesthetic Plastic Surgery (ASAPS). In fact, HA fillers are considered the gold standard technique for soft tissue augmentation, deep skin hydration, and facial recontouring, playing a key role as an alternative to plastic surgery. HA fillers are less invasive, more biocompatible, and safer and with a more natural and immediate result if compared to plastic surgery. Hence, the safety of HA-based dermal fillers plays a crucial role, mostly in terms of biocompatibility and adjustability in case of unpleasant results and side effects such as, tyndall effect, edema, or granulomas. Hyaluronidase is a naturally occurring enzyme, present in the human body, and can degrade HA fillers avoiding more severe complications. In this article, we analyzed the bioavailability of hyaluronidase degradation of five fillers of Neauvia® hydrogels line (MatexLab SA, Lugano, CH), composed of pure hyaluronic acid and based on PEGDE cross-linking (polyethylene glycol) technology that guarantees a higher biocompatibility and an optimal biointegration and rheological characteristics. The performed in vitro testing is based on the colorimetric determination of the N-acetyl-D-glucosamine (NAG) present in solution after incubation with hyaluronidase, determined at different time points in order to assess the kinetic of each product degradation (1h, 3h, 6h, 24h, 48h, 72h, 120h, and 168h). The aim of this study was to assess, in vitro, how the difference in HA content and PEGDE concentration of the analyzed fillers can influence the product biocompatibility, intended as product enzymatic clearance and duration in time. The results demonstrated that the method was reproducible and easy to perform and that all the analyzed fillers are naturally immediately available for hyaluronidase-mediated degradation.
Collapse
|
33
|
Is there long-term value of pathology scoring in immunoglobulin A nephropathy? A validation study of the Oxford Classification for IgA Nephropathy (VALIGA) update. Nephrol Dial Transplant 2018; 35:1002-1009. [DOI: 10.1093/ndt/gfy302] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
It is unknown whether renal pathology lesions in immunoglobulin A nephropathy (IgAN) correlate with renal outcomes over decades of follow-up.
Methods
In 1130 patients of the original Validation Study of the Oxford Classification for IgA Nephropathy (VALIGA) cohort, we studied the relationship between the MEST score (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T), crescents (C) and other histological lesions with both a combined renal endpoint [50% estimated glomerular filtration rate (eGFR) loss or kidney failure] and the rate of eGFR decline over a follow-up period extending to 35 years [median 7 years (interquartile range 4.1–10.8)].
Results
In this extended analysis, M1, S1 and T1–T2 lesions as well as the whole MEST score were independently related with the combined endpoint (P < 0.01), and there was no effect modification by age for these associations, suggesting that they may be valid in children and in adults as well. Only T lesions were associated with the rate of eGFR loss in the whole cohort, whereas C showed this association only in patients not treated with immunosuppression. In separate prognostic analyses, the whole set of pathology lesions provided a gain in discrimination power over the clinical variables alone, which was similar at 5 years (+2.0%) and for the whole follow-up (+1.8%). A similar benefit was observed for risk reclassification analyses (+2.7% and +2.4%).
Conclusion
Long-term follow-up analyses of the VALIGA cohort showed that the independent relationship between kidney biopsy findings and the risk of progression towards kidney failure in IgAN remains unchanged across all age groups and decades after the renal biopsy.
Collapse
|
34
|
|
35
|
P4235Telemedicine cardiovascular screening program in low-income settings by smartphone based technology. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
36
|
Abstract
Ultrastructural findings in an unusual case of chondromyxoid fibroma are reported. The tumor was located in the iliac bone of a 42-year-old woman with left hip pain of 5 years duration.
Collapse
|
37
|
|
38
|
Advanced Parameters of Cardiac Function Out Perform Traditional Echocardiographic Indices in the Identification of Pediatric Patients with Acute Antibody-Mediated Cardiac Transplant Rejection. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
39
|
A Lupus Hepatitis Case and its Association with Igm Antibodies against Cytomegalovirus, Herpes Simplex and Herpes Zoster Viruses. EUR J INFLAMM 2017. [DOI: 10.1177/1721727x0900700106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The hypothesis for a role of viral infections on the pathogenesis of systemic lupus erythematosus has been discussed in many works, particularly that of cytomegalovirus and Epstein Barr virus infections as trigger of autoimmune processes. Here, we describe the case of a young woman affected by systemic lupus erythematosus with marked hepatic involvement presenting IgM antibodies against cytomegalovirus, herpesvirus and herpes zoster virus in the absence of virus. The meaning of these laboratory findings is discussed.
Collapse
|
40
|
Antifungal prophylaxis with liposomal amphotericin B and caspofungin in high-risk patients after liver transplantation: impact on fungal infections and immune system. Infect Dis (Lond) 2016; 48:161-6. [PMID: 26513601 DOI: 10.3109/23744235.2015.1100322] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Antifungal prophylaxis may be required in high-risk patients undergoing liver transplantation and for that reason we aimed to verify its role and its related impact on the graft. From January 2006 throughout 2012, 250 liver transplants were evaluated and 54 patients identified as being at higher risk were randomly selected to undergo the following schedule: 28 patients received liposomal amphotericin B and 26 received caspofungin. We evaluated, throughout 12 months, renal and liver function tests, bacterial and fungal infection episodes, and intensive care unit (ICU) stay, as well as the Th1 and Th2 cytokine network. Differences were analyzed according to non-parametric tests (two-tailed p values). Neither of the groups showed episodes of invasive fungal infection during the 12 months follow-up; however, patients receiving prophylaxis with liposomal amphotericin B had reduced episodes of bacterial infections coupled with an improved immune system response compared with those receiving caspofungin. Finally, a reduced stay in the ICU was also observed. In conclusion, even if the results of liposomal amphotericin B and caspofungin prophylaxis strategies did not differ in terms of invasive fungal infection rate, patients receiving prophylaxis with liposomal amphotericin B had a reduced ICU stay and an improved Th2 status, as well as a reduced number of post-transplant bacterial infections. Further studies are required to better address and evaluate these findings.
Collapse
|
41
|
Spontaneous thrombosis of the ductus arteriosus in a newborn, complicated by thrombus migration and massive pulmonary embolism. Eur Heart J Cardiovasc Imaging 2016; 17:1026. [DOI: 10.1093/ehjci/jew108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
42
|
The MEST score provides earlier risk prediction in lgA nephropathy. Kidney Int 2016; 89:167-75. [DOI: 10.1038/ki.2015.322] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 01/12/2023]
|
43
|
Laparoscopy or retroperitoneoscopy for pediatric patients with adrenal masses? Minerva Pediatr 2015; 67:525-528. [PMID: 26530494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Minimally invasive approach to the adrenal gland was first reported in 1992. Since then, the experience with the laparoscopic technique for adrenal disease in children has been limited. We report our experience with minimally invasive adrenal surgery in children. Two young girls (2 and 4 years old) with a left adrenal mass were operated using minimally invasive surgery (MIS) in our Unit. Ultrasonography and MRI showed in the oldest a 2 x 3 cm adrenal mass, while in the youngest a 5.5 x 5 cm adrenal tumor was found. According to the pre-existing literature, we approached the smallest lesion via retroperitoneoscopy, and the largest one laparoscopically. The operating time was 110 minutes for retroperitoneoscopy and 75 minutes for laparoscopy. No major intra or postoperative complications occurred. There were no conversions to open surgery. Postoperative hospital stay was 5 days for both patients. In both cases, the anatomo-pathological result was an adenoma. Minimally invasive adrenalectomy is a safe and feasible procedure in children with good results. For lesions smaller than 3-4 cm retroperitonescopy is feasible, while for tumors larger than 5 cm, due to malignancy risk, the laparoscopic approach is indicated. To keep oncologic criteria it is important to avoid tumor rupture and to extract the specimen in an endobag.
Collapse
|
44
|
Poster session 2THE IMAGING EXAMINATIONP536Appropriate use criteria of transthoracic echocardiography and its clinical impact: a continuous challengeP537Implementation of proprietary plug-ins in the DICOM-based computerized echo reporting system fuels the use of 3D echo and deformation imaging in the clinical routine of a multivendor laboratoryP538Exercise stress echocardiography appropriate use criteria: real-life cases classification ease and agreement among cardiologistsANATOMY AND PHYSIOLOGY OF THE HEART AND GREAT VESSELSP539Functional capacity in older people with normal ejection fraction correlates with left ventricular functional reserve and carotid-femoral pulse wave velocity but not with E/e and augmentation indexP540Survey of competency of practitioners for diagnosis of acute cardiopulmonary diseases manifest on chest x-rayASSESSMENT OF DIAMETERS, VOLUMES AND MASSP541Left atrium remodeling in dialysis patients with normal ejection fractionP542The prediction of postinfarction left ventricular remodeling and the role of of leptin and MCP-1 in regard to the presence of metabolic syndromeP543Ascending aorta and common carotid artery: diameters and stiffness in a group of 584 healthy subjectsAssessments of haemodynamicsP544Alternate echo parameters in patients without estimable RVSPAssessment of systolic functionP545Reduced contractile performance in heart failure with preserved ejection fraction: determination using novel preload-adjusted maximal left ventricular ejection forceP546Left ventricular dimensions and prognosis in acute coronary syndromesP547Time course of myocardial alterations in a murine model of high fat diet: A strain rate imaging studyP548Subclinical left ventricular systolic dysfunction in patients with premature ventricular contractionsP549Global myocardial strain by CMR-based feature tracking (FT) and tagging to predict development of severe left ventricular systolic dysfunction after acute st-elevation myocardial infarctionP550Echocardiographic analysis of left and right ventricular function in patients after mitral valve reconstructionP551The role of regional longitudinal strain assessment in predicting response to cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and left bundle branch blockP552Speckle tracking automatic border detection improves echocardiographic evaluation of right ventricular systolic function in repaired tetralogy of fallot patients: comparison with MRI findingsP553Echocardiography: a reproducible and relevant tool in pah? intermediate results of the multicentric efort echogardiographic substudy (evaluation of prognostic factors and therapeutic targets in pah)Assessment of diastolic functionP554Relationship between left ventricular filling pressures and myocardial fibrosis in patients with uncomplicated arterial hypertensionP555Cardiac rehabilitation improves echocardiographic parameters of diastolic function in patients with ischemic heart diseaseP556Diastolic parameters in the calcified mitral annulusP557Biomarkers and echocardiography - combined weapon to diagnose and prognose heart failure with and without preserved ejection fractionP558Diastolic function changes of the maternal heart in twin and singleton pregnancyIschemic heart diseaseP559Syntax score as predictor for the correlation between epicardial adipose tissue and the severity of coronary lesions in patients with significant coronary diseaseP560Impact of strain analysis in ergonovine stress echocardiography for diagnosis vasospastic anginaP561Cardiac magnetic resonance tissue tracking: a novel method to predict infarct transmurality in acute myocardial infarctionP562Infarct size is correlated to global longitudinal strain but not left ventricular ejection fraction in the early stage of acute myocardial infarctionP563Magnetic resonance myocardial deformation assessment with tissue tracking and risk stratification in acute myocardial infarction patientsP564Increase in regional end-diastolic wall thickness by transthoracic echocardiography as a biomarker of successful reperfusion in anterior ST elevation acute myocardial infarctionP565Mitral regurgitation is associated with worse long-term prognosis in ST-segment elevation myocardial infarction treated with primary percutaneous coronary interventionP566Statistical significance of 3D motion and deformation indexes for the analysis of LAD infarctionHeart valve DiseasesP567Paradoxical low gradient aortic stenosis: echocardiographic progression from moderate to severe diseaseP568The beneficial effects of TAVI in mitral insufficiencyP569Impact of thoracic aortic calcification on the left ventricular hypertrophy and its regression after aortic valve replacement in patients with severe aortic stenosisP570Additional value of exercise-stress echocardiography in asymptomatic patients with aortic valve stenosisP571Valvulo-arterial impedance in severe aortic stenosis: a dual imaging modalities studyP572Left ventricular mechanics: novel tools to evaluate left ventricular performance in patients with aortic stenosisP573Comparison of long-term outcome after percutaneous mitral valvuloplasty versus mitral valve replacement in moderate to severe mitral stenosis with left ventricular dysfunctionP574Incidence of de novo left ventricular dysfunction in patient treated with aortic valve replacement for severe aortic regurgitationP575Transforming growth factor-beta dependant progression of the mitral valve prolapseP576Quantification of mitral regurgitation with multiple jets: in vitro validation of three-dimensional PISA techniqueP577Impaired pre-systolic contraction and saddle-shape deepening of mitral annulus contributes to atrial functional regurgitation: a three-dimensional echocardiographic studyP578Incidence and determinants of left ventricular (lv) reverse remodeling after MitraClip implantation in patients with moderate-to severe or severe mitral regurgitation and reduced lv ejection fractionP579Severe functional tricuspid regurgitation in rheumatic heart valve disease. New insights from 3D transthoracic echocardiographyP58015 years of evolution of the etiologic profile for prosthetic heart valve replacement through an echocardiography laboratoryP581The role of echocardiography in the differential diagnosis of prolonged fever of unknown originP582Predictive value for paravalvular regurgitation of 3-dimensional anatomic aortic annulus shape assessed by multidetector computed tomography post-transcatheter aortic valve replacementP583The significance and advantages of echo and CT imaging & measurement at transcatherter aortic valve implantation through the left common carotid accessP584Comparison of the self-expandable Medtronic CoreValve versus the balloon-expandable Edwards SAPIEN bioprostheses in high-risk patients undergoing transfemoral aortic valve implantationP585The impact of transcatheter aortic valve implantation on mitral regurgitation severityP586Echocardiographic follow up of children with valvular lesions secondary to rheumatic heart disease: Data from a prospective registryP587Valvular heart disease and different circadian blood pressure profilesCardiomyopathiesP588Comparison of transthoracic echocardiography versus cardiac magnetic for implantable cardioverter defibrillator therapy in primary prevention strategy dilated cardiomyopathy patientsP589Incidence and prognostic significance of left ventricle reverse remodeling in a cohort of patients with idiopathic dilated cardiomyopathyP590Early evaluation of diastolic function in fabry diseaseP591Echocardiographic predictors of atrial fibrillation development in hypertrophic cardiomyopathyP592Altered Torsion mechanics in patients with hypertrophic cardiomyopathy: LVOT-obstruction is the topdog?P593Prevention of sudden cardiac death in hypertrophic cardiomyopathy: what has changed in the guidelines?P594Coronary microcirculatory function as determinator of longitudinal systolic left ventricular function in hypertrophic cardiomyopathyP595Detection of subclinical myocardial dysfunction by tissue Doppler ehocardiography in patients with muscular dystrophiesP596Speckle tracking myocardial deformation analysis and three dimensional echocardiography for early detection of chemotherapy induced cardiac dysfunction in bone marrow transplantation patientsP597Left ventricular non compaction or hypertrabeculation: distinguishing between physiology and pathology in top-level athletesP598Role of multi modality imaging in familiar screening of Danon diseaseP599Early impairment of global longitudinal left ventricular systolic function independently predicts incident atrial fibrillation in type 2 diabetes mellitusP600Fetal cardiovascular programming in maternal diabetes mellitus and obesity: insights from deformation imagingP601Longitudinal strain stress echo evaluation of aged marginal donor hearts: feasibility in the Adonhers project.P602Echocardiographic evaluation of left ventricular size and function following heart transplantation - Gender mattersSystemic diseases and other conditionsP603The impact of septal kinetics on adverse ventricular-ventricular interactions in pulmonary stenosis and pulmonary arterial hypertensionP604Improvement in right ventricular mechanics after inhalation of iloprost in pulmonary hypertensionP605Does the treatment of patients with metabolic syndrome correct the right ventricular diastolic dysfunction?P606Predictors of altered cardiac function in breast cancer survivors who were treated with anthracycline-based therapyP607Prevalence and factors related to left ventricular systolic dysfunction in asymptomatic patients with rheumatoid arthritis: a prospective tissue-doppler echocardiography studyP608Diastolic and systolic left ventricle dysfunction presenting different prognostic implications in cardiac amyloidosisP609Diagnostic accuracy of Bedside Lung Ultrasonography in Emergency (BLUE) protocol for the diagnosis of pulmonary embolismP610Right ventricular systolic dysfunction and its incidence in breast cancer patients submitted to anthracycline therapyP611Right ventricular dysfunction is an independent predictor of survival among cirrhotic patients undergoing liver transplantCongenital heart diseaseP612Hypoplasia or absence of posterior leaflet: a rare congenital anomaly of the mitral valveP613ECHO screening for Barlow disease in proband's relativesDiseases of the aortaP614Aortic size distribution and prognosis in an unselected population of patients referred for standard transthoracic echocardiographyP615Abdominal aorta aneurysm ultrasonographic screening in a large cohort of asympromatic volounteers in an Italian urban settingP616Thoracic aortic aneurysm and left ventricular systolic functionStress echocardiographyP617Wall motion score index, systolic mitral annulus velocity and left ventricular mass predicted global longitudinal systolic strain in 238 patients examined by stress echocardiographyP618Prognostic parameters of exercise-induced severe mitral valve regurgitation and exercise-induced systolic pulmonary hypertensionP619Risk stratification after myocardial infarction: prognostic value of dobutamine stress echocardiographyP620relationship between LV and RV myocardial contractile reserve and metabolic parameters during incremental exercise and recovery in healthy children using 2-D strain analysisP621Increased peripheral extraction as a mechanism compensatory to reduced cardiac output in high risk heart failure patients with group 2 pulmonary hypertension and exercise oscillatory ventilationP622Can exercise induced changes in cardiac synchrony predict response to CRT?Transesophageal echocardiographyP623Fully-automated software for mitral valve assessment in chronic mitral regurgitation by three-dimensional transesophageal echocardiographyP624Real-time 3D transesophageal echocardiography provides more accurate orifice measurement in percutaneous transcatheter left atrial appendage closureP625Percutaneous closure of left atrial appendage: experience of 36 casesReal-time three-dimensional TEEP626Real-time three-dimensional transesophageal echocardiography during pulmonary vein cryoballoon ablation for atrial fibrilationP627Three dimensional ultrasound anatomy of intact mitral valve and in the case of type 2 disfunctionTissue Doppler and speckle trackingP629Left ventricle wall motion tracking from echocardiographic images by a non-rigid image registrationP630The first experience with the new prototype of a robotic system for remote echocardiographyP631Non-invasive PCWP influence on a loop diuretics regimen monitoring model in ADHF patients.P632Normal range of left ventricular strain, dimensions and ejection fraction using three-dimensional speckle-tracking echocardiography in neonatesP633Circumferential ascending aortic strain: new parameter in the assessment of arterial stiffness in systemic hypertensionP634Aortic vascular properties in pediatric osteogenesis imperfecta: a two-dimensional echocardiography derived aortic strain studyP635Assessment of cardiac functions in children with sickle cell anemia: doppler tissue imaging studyP636Assessment of left ventricular function in type 1 diabetes mellitus patients by two-dimensional speckle tracking echocardiography: relation to duration and control of diabetesP637A study of left ventricular torsion in l-loop ventricles using speckle-tracking echocardiographyP638Despite No-Reflow, global and regional longitudinal strains assessed by two-dimensional speckle tracking echocardiography are predictive indexes of left ventricular remodeling in patients with STEMIP639The function of reservoir of the left atrium in patients with medicaly treated arterial hypertensionP640The usefulness of speckle tracking analysis for predicting the recovery of regional systolic function after myocardial infarctionP641Two dimensional speckle tracking echocardiography in assessment of left ventricular systolic function in patients with rheumatic severe mitral regurgitation and normal ejection fractionP642The prediction of left-main and tripple vessel coronary artery disease by tissue doppler based longitudinal strain and strain rate imagingP643Role of speckle tracking in predicting arrhythmic risk and occurrence of appropriate implantable defibrillator Intervention in patients with ischemic and non-ischemic cardiomyopathyComputed Tomography & Nuclear CardiologyP644Cardiac adrenergic activity in patients with nonischemic dilated cardiomyopathy. Correlation with echocardiographyP645Different vascular territories and myocardial ischemia, there is a gradient of association? Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
45
|
Poster session 5The imaging examinationP1097Correlation between visual and quantitative assessment of left ventricle: intra- and inter-observer agreementP1099Incremental prognostic value of late gadolinium-enhanced by cardiac magnetic resonance in patients with heart failureAnatomy and physiology of the heart and great vesselsP1100Left ventricular geometry and diastolic performance in erectile dysfunction patients; a topic of differential arterial stiffness influenceAssessment of diameters, volumes and massP1101Impact of the percutaneous closure of atrial septal defect on the right heart "remodeling"P1102Left Ventricular Mass Indexation in Infants, Children and Adolescents: a Simplified Approach for the Identification of Left Ventricular Hypertrophy in Clinical PracticeP1103Impact of trabecules while quantifying cardiac magnetic resonance exams in patients with systemic right ventricleP1104Detection of subclinical atherosclerosis by carotid intima-media thickness: correlation with leukocytes telomere shorteningAssessments of haemodynamicsP1105Flow redirection towards the left ventricular outflow tract: vortex formation is not affected by variations in atrio-ventricular delayAssessment of systolic functionP1106Reproducibility and feasibility of cardiac MRI feature tracking in Fabry diseaseP1107Normal left ventricular strain values by two-dimensional strain echocardiography; result of normal (normal echocardiographic dimensions and functions in korean people) studyP1108Test-retest repeatability of global strain following st-elevation myocardial infarction - a comparison of tagging and feature trackingP1109Cardiotoxicity induced by tyrosine kinase inhibitors in patients with gastrointestinal stromal tumors (GIST)P1110Finite strain ellipses for the analysis of left ventricular principal strain directions using 3d speckle tracking echocardiographyP1111Antihypertensive therapy reduces time to peak longitudinal strainP1112Right ventricular systolic function as a marker of prognosis after inferior myocardial infarction - 5-year follow-upP1113Is artery pulmonary dilatation related with right but also early left ventricle dysfunction in pulmonary artery hypertension?P1114Right ventricular mechanics changes according to pressure overload increasing, a 2D-speckle tracking echocardiographic evaluationAssessment of diastolic functionP1115Paired comparison of left atrial strain from P-wave to P-wave and R-wave to R-waveP1116Diagnostic role of Tissue Doppler Imaging echocardiographic criteria in obese heart failure with preserved ejection fraction patientsP1117Evaluation of diastolic function of right ventricle in idiopathic pulmonary arterial hypertensionP1118Severity and predictors of diastolic dysfunction in a non-hypertensive non-ischemic cohort of Egyptian patients with documented systemic autoimmune disease; pilot reportP1119correlation between ST segment shift and cardiac diastolic function in patients with acute myocardial infarctionIschemic heart diseaseP1120Computed tomography coronary angiography verSus sTRess cArdiac magneTic rEsonance for the manaGement of sYmptomatic revascularized patients: a cost effectiveness study (STRATEGY study)P1121Utility of transmural myocardial mechanic for early infarct size prediction after primary percutaneous coronary intervention in STEMI patientsP1122Progressive Improvements of the echocardiographic deformation parameters in ST Elevation Myocardial Infarction after five years follow-upP1123Long-term prognostic value of left ventricular dyssynchrony as assessed by cardiac magnetic resonance feature-tracking imaging after a first st-segment elevation myocardial infarctionP1124Differences in mitral annulus remodeling in acute anterior ST elevation and acute inferior ST elevation myocardial infarctionP1125Reduction of microvascular injury using a novel theragnostic ultrasound strategy: a first in men feasibility and safety studyP1126Impact of focused echocardiography in clinical decision of patient presented with st elevation myocardial infarction underwent primary angioplastyHeart valve DiseasesP1127Aortic valve area calculation in aortic stenosis: a comparison among conventional and 3D-transesophageal echocardiography and computed tomographyP1128Myocardial fibrosis and microRNA-21 expression in patients with severe aortic valve stenosis and preserved ejection fraction: a 2D speckle tracking echocardiography, tissutal and plasmatic studyP1129Quantification of calcium amount in a new experimental model: a comparison between calibrated integrated backscatter of ultrasound and computed tomographyP1130Altered diffusion capacity in aortic stenosis: role of the right heartP1131Osteoprotegerin predicts all-cause mortality in calcific aortic stenosis patients with preserved left ventricle ejection fraction in long term observationP1132Mitral regurgitation as a risk factor for pulmonary hypertension in patients with aortic stenosisP1133The relationship between the level of plasma B-type natriuretic peptide and mitral stenosisP1134Aortic regurgitation, left ventricle mechanics and vascular load: a single centre 2d derived-speckle tracking studyP1135Feasibility and reproducibility issues limit the usefulness of quantitative colour Doppler parameters in the assessment of chronic aortic and mitral regurgitation severityP1136Predictors of postoperative outcome in degenerative mitral regurgitationP1137Left ventricular mechanical dyssynchrony in patients with severe mitral regurgitation of rheumatic etiology; three dimensional echocardiography studyP1138Functional mitral regurgitation and left atrial dysfunction concur in determining pulmonary hypertension and functional status in subjects with left ventricular systolic dysfunctionP11393D echocardiography allows more effective quantitative assessment of the severity of functional tricuspid regurgitation than conventional 2D/Doppler echocardiographyP1140Prosthetic valve thrombosis: still a severe disease? 10-years experience in a university hospitalP1141Validity of echocardiography in the hospital course of patients with feverP1142Do baseline 3DTEE characteristics of mitral valve apparatus predict long term result in patients undergoing percutaneous valve repair for degenerative regurgitation?P1143Influence of baseline aortic regurgitation on mitral regurgitation change after transcatheter aortic valve replacement for aortic stenosisP1144Prevalence of echocardiography detected significant valvular regurge in subclinical rheumatic carditis in assiut childrenCardiomyopathiesP1145Can we early detect left ventricular systolic dysfunction in patients with Duchenne muscular dystrophy using global longitudinal strain assessment?P1146Prevalence of isolated papillary muscle hypertrophy in young competitive athletesP1147Troponin release after exercise in patients with hypertrophic cardiomyopathy: associations with clinical and mr imaging characteristicsP1148Atrial fibrillation in hypertrophic cardiomyopathy: can we score the risk?P1149Impact of hypertrophy on multiple layer longitudinal deformation in hypertrophy cardiomyopathy and cardiac amyloidosis compared to controlsP1150Functional evaluation in hypertrophic cardiomyopathy combining cardiopulmonary exercise testing combined with exercise-echocardiographyP1151Refinement of the old diagnostic criteria of left ventricular noncompaction cardiomyopathy (LVNC) based on cardiac magnetic resonance (CMR)P1152Differences of clinical characteristics and outcomes between acute myocarditis with preserved and reduced left ventricular systolic functionP1153Value of longitudinal strain for distinguishing left ventricular non-compaction from idiopathic dilated cardiomyopathyP1154Speed of recovery of left ventricular function is not related to the prognosis of Takotsubo cardiomyopathy. A Portuguese multicentre studyP1155Predictors of in-hospital left ventricular systolic function recovery after admission with takotsubo cardiomyopathy. Portuguese multicentre studyP1156Mid-ventricular takotsubo detected by initial echocardiogram associates with recurrence of takotsubo cardiomyopathy - a portuguese multicentre studySystemic diseases and other conditionsP1157Relations between left ventricle remodelling and expression of angiotensin 2 AT2R1 geneP1158Impact of renal denervation on long-term blood pressure variability and surrogate markers of target organ damage in individuals with drug-resistant arterial hypertensionP1159Greater improvement of coronary artery function, left ventricular deformation and twisting by IL12/23 compared to TNF-a inhibition in psoriasisP1160Advanced glycation end products play a role in adverse LV remodeling following MIP1161Incidence of subclinical myocardial dysfunction in patients with systemic sclerosis and normal left ventricular systolic and diastolic functionP1162Left atrial remodeling and dysfunction occur early in patients with systemic sclerosis and normal left ventricular functionP1163Intrinsic vortex formation : a unique performance indicatorP1164P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletesP1165Usefulness of transthoracic echocardiography in diagnosis of young patients with ischemic strokeP1166Primary cardiac lymphoma: role of echocardiography in the clinical managementP1167Abnormal echocardiographic findings in cancer patients before chemotherapyMasses, tumors and sources of embolismP1168Three-dimensional transesophageal echocardiography of the left atrial appendage reduces rate of postpone electrical cardioversionP1169Detection of ventricular thrombus by cmr after reperfused st-segment elevation myocardial infarction correlated with echocardiographyP1170Clinical and transthoracic echocardiographic predictors of left atrial appendage thrombus in patients with atrial fibrillationStress echocardiographyP1171Pharmacological stress echocardiography complications: a 4-year single center experienceP1172Myocardial functional and perfusion reserve in type I diabetesP1173Feasibility of incorporating 3D Dobutamine stress echocardiography into routine clinical practiceP1174Right ventricular isovolumic acceleration at rest and during exercise in children after heart transplantP1175Right ventricular systolic and diastolic response to exercise in children after heart transplant -a bicycle exercise studyP1176Determinants of functional capacity in heart failure patients with reduced ejection fractionP1177Handgrip stress echocardiography with emotional component compared to conventional isometric exercise in coronary artery disease diagnosisP1178The relationship between resting transthoracic echocardiography and exercise capacity in patients with paroxysmal atrial fibrillationP1179Correlation between NT-proBNP and selected echocardiography parameters at rest and after exercise in patients with functional ischemic mitral regurgitation qualified for cardiosurgical treatmentReal-time three-dimensional TEEP1180Vena contracta area for severity grading in functional and degenerative mitral regurgitation: A study based on transesophageal 3D colour Doppler in 419 patientsP1181Proximal flow convergence by 3D echocardiography in the evaluation of mitral valve area in rheumatic mitral stenosisP1182Quantification of valve dimensions by transesophageal 3D echocardiography in patients with functional and degenerative mitral regurgitationTissue Doppler and speckle trackingP1183Automatic calculation of left ventricular volume changes over a cardiac cycle from echocardiography images by nonlinear dimensionality reductionP1184Effect of the mitral valve repairs on the left ventricular blood flow formationP1185Quantification of left atrial strain using cardiovascular magnetic resonance. a comparison between hypertrophic cardiomyopathy and healthy controlsP1186The role of early systolic lengthening in patients with non-ST elevation acute coronary syndrome and its relation to syntax scoreP1187Different standard two dimensional strain methods to quantity left ventricular mechanicsP1188Atrial function and electrocardiography caracteristics in sportsmen with or without paroxysmal atrial fibrillationP1189Right ventricular outflow premature contractions induce regional left ventricular dysfunctionP1190Ultrasound guided venous access for pacemaker and defibrillators. Randomized TrialP1191Atrial function analysis correlates with symptoms and quality of life of heart failure patientsP1192The use of tissue doppler echocardiography in myocardial iron overload in patients with thalassaemia majorP1193Independent association between pulse pressure and left ventricular global longitudinal strainP1194Global and regional longitudinal strain identifies the presence of coronary artery disease in patients with suspected reduction of coronary flow reserve and absence of wall motion abnormalitiesP1195Prognostic value of invasive and noninvasive parameters of right ventricular function in patients with pulmonary arterial hypertension receiving specific vasodilator therapyP1196Myocardial deformation analysis to improve arrhythmic risk stratificationP1197Quantitative assessment of regional systolic and diastolic function parameters for detecting prior transient ischemia in normokinetic segmentsP1198Left atrial function in patients with corrected tetralogy of Fallot - a three-dimensional speckle-tracking echocardiographic studyP1199Left atrial ejection force correlates with left atrial strain and volume-based functional properties as assessed by three-dimensional speckle tracking echocardiographyP1200Acute angulation of the aortic arch late after the arterial switch operation for transposition of the great arteries: impact on cardiac mechanicsP1201Circumferential deformation of the ascending thoracic aorta in hypertensive patients by three-dimensional speckle tracking echocardiographyCardiac Magnetic ResonanceP1202The incremental value of cardiac magnetic resonance on diagnosis myocardial infarction and non-obstructed coronary arteriesP1204Reference ranges of global and regional myocardial T1 values derived from MOLLI and shMOLLI at 3TComputed Tomography & Nuclear CardiologyP1205Deformation of the left atrial appendage after percutaneous closure with the Amplatzer cardiac plugP1206Prognostic impact of non-obstructive coronary artery disease on coronary computed tomographic angiography: A single-center study. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
46
|
4-Nonylphenol reduces cell viability and induces apoptosis and ER-stress in a human epithelial intestinal cell line. Toxicol In Vitro 2015; 29:1436-44. [DOI: 10.1016/j.tiv.2015.04.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 11/25/2022]
|
47
|
A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2015; 50:1441-56. [PMID: 25783403 DOI: 10.1016/j.jpedsurg.2015.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Our study aims at disclosing epidemiology and most relevant clinical features of esophageal atresia (EA) pointing to a model of multicentre collaboration. METHODS A detailed questionnaire was sent to all Italian Units of pediatric surgery in order to collect data of patients born with EA between January and December 2012. The results were crosschecked by matching date and place of birth of the patients with those of diagnosis-related group provided by the Italian Ministry of Health (MOH). RESULTS A total of 146 questionnaires were returned plus a further 32 patients reported in the MOH database. Basing on a total of 178 patients with EA born in Italy in 2012, the incidence of EA was calculated in 3.33 per 10,000 live births. Antenatal diagnosis was suspected in 29.5% patients. 55.5% showed associated anomalies. The most common type of EA was Gross type C (89%). Postoperative complications occurred in 37% of type C EA and 100% of type A EA. A 9.5% mortality rate was reported. CONCLUSIONS This is the first Italian cross-sectional nationwide survey on EA. We can now develop shared guidelines and provide more reliable prognostic expectations for our patients.
Collapse
|
48
|
Effects of hypertension on renal function in pregnant rats. CONTRIBUTIONS TO NEPHROLOGY 2015; 37:179-81. [PMID: 6713871 DOI: 10.1159/000408568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
49
|
Involvement of synthesis and degradation pathways of collagen type IV in human glomerulosclerosis: molecular analysis by in situ reverse transcription and competitive polymerase chain reaction. CONTRIBUTIONS TO NEPHROLOGY 2015; 118:12-6. [PMID: 8744034 DOI: 10.1159/000425070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
50
|
Heterogeneity of KRAS, NRAS, BRAF and PIK3CA mutations in metastatic colorectal cancer and potential effects on therapy in the CAPRI GOIM trial. Ann Oncol 2015; 26:1710-4. [PMID: 25851630 DOI: 10.1093/annonc/mdv176] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/13/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evidence suggests that metastatic colorectal carcinoma (mCRC) has a high level of intratumor heterogeneity. We carried out a quantitative assessment of tumor heterogeneity for KRAS, NRAS, BRAF and PIK3CA mutations, in order to assess potential clinical implications. PATIENTS AND METHODS Tumor samples (n = 182) from the CAPRI-GOIM trial of first-line cetuximab + FOLFIRI in KRAS exon-2 wild-type mCRC patients were assessed by next-generation sequencing that allows quantitative assessment of mutant genes. Mutant allelic frequency was normalized for the neoplastic cell content and, assuming that somatic mutations usually affect one allele, the Heterogeneity Score (HS) was calculated by multiplying by 2 the frequency of mutant alleles in neoplastic cells. Therefore, HS virtually corresponds to the fraction of neoplastic cells carrying a specific mutation. RESULTS The KRAS HS ranged between 12 and 260 with mean value of 87.1 and median value of 84.4, suggesting that in most CRC, the majority of neoplastic cells carry mutant KRAS. Similar findings were observed for NRAS (HS range 35.5-146.7; mean 102.8; median 117.1). In contrast, in BRAF (HS range 17.1-120; mean 54.8; median 54.3) and PIK3CA (HS range 14.3-120; mean 59.5; median 47.3) mutant cases, only a fraction of neoplastic cells seem to carry the mutant allele. The response rate was 70% in KRAS mutant patients with an HS <33 (low KRAS; n = 10) and 45.7% in KRAS HS >33 patients (high KRAS; n = 35); median progression-free survival were 7.97 and 8.37 months, respectively. Low-KRAS tumors had a higher frequency of additional mutations in PIK3CA when compared with high-KRAS (6/10 versus 8/35). CONCLUSIONS KRAS and NRAS mutations are usually present in the majority of neoplastic cells, whereas BRAF and PIK3CA mutations often affect a limited fraction of transformed cells. Resistance to cetuximab in low-KRAS patients might be driven by the complex mutational profile rather than KRAS mutation load.
Collapse
|