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Bonetti G, Michelini S, Donato K, Dhuli K, Medori MC, Micheletti C, Marceddu G, Herbst KL, Cristoni S, Fulcheri E, Buffelli F, Bertelli M. Targeting Mast Cells: Sodium Cromoglycate as a Possible Treatment of Lipedema. Clin Ter 2023; 174:256-262. [PMID: 37994773 DOI: 10.7417/ct.2023.2496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Mast cells are immune cells that mediate hypersensi-tivity and allergic reactions in the body, secreting histamine and other inflammatory molecules. They have been associated with different inflammatory conditions such as obesity and other adipose tissue di-sorders. Lipedema is a chronic disease characterized by an abnormal accumulation of adipose tissue on the legs and arms, pain, and other symptoms. Mast cells may play a role in the pathology of lipedema. Objective Pilot study to determine levels of histamine and its metabolites in lipedema subcutaneous adipose tissue (SAT) biopsy samples, and to test sodium cromoglycate for the treatment of mast cells in women with lipedema. Methods Biopsies from lipedema and control SAT were collected and analyzed histologically for the presence of mast cells. Mass spec-trometry was used to measure the levels of histamine, a key marker of mast cells, and its metabolites in SAT in women with lipedema and controls, and after a group of women with lipedema were administered oral and topical doses of sodium cromoglycate for two weeks. Results Histological examination of biopsies from lipedema patients confirmed the presence of mast cells. Metabolomic analysis revealed high levels of histamine and its metabolites in samples from women with lipedema compared to controls. Following a two-week treatment period, lipedema tissue samples exhibited reduced levels of histamine, suggesting a reduction of mast cell activity. Conclusion Sodium cromoglycate has the ability to stabilize mast cells and reduce histamine levels in lipedema patients, which could be useful in lowering the symptoms of lipedema.
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Affiliation(s)
- G Bonetti
- MAGI'S LAB, Rovereto (TN), Italy
- Department of Pharmaceutical Sciences, University of Perugia, Italy
| | - S Michelini
- Vascular Diagnostics and Rehabilitation Service, Marino Hospital, ASL Roma 6, Marino, Italy
| | - K Donato
- MAGI EUREGIO, Bolzano, Italy
- MAGISNAT, Atlanta Tech Park, Peachtree Corners, GA, USA
| | - K Dhuli
- MAGI'S LAB, Rovereto (TN), Italy
| | | | | | - G Marceddu
- Vascular Diagnostics and Rehabilitation Service, Marino Hospital, ASL Roma 6, Marino, Italy
| | - K L Herbst
- Total Lipedema Care, Beverly Hills, California, and Tucson, Arizona, USA
| | - S Cristoni
- ISB Ion Source & Biotechnologies srl, Italy, Bresso, Milano, Italy
| | - E Fulcheri
- Division of Anatomic Pathology. Department of Surgical and Diagnostic Sciences (DISC), University of Genova, Italy
| | - F Buffelli
- Fetal-Perinatal Pathology Unit, IRCCS Istituto Giannina Gaslini, Italy
| | - M Bertelli
- MAGI'S LAB, Rovereto (TN), Italy
- MAGI EUREGIO, Bolzano, Italy
- MAGISNAT, Atlanta Tech Park, Peachtree Corners, GA, USA
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Bonsignore A, Buffelli F, Monari F, Fulcheri E. Answers by phone to 15 common questions concerning perinatal foetal autopsy in the Italian legislative framework. Pathologica 2023; 115:193-198. [PMID: 37711035 PMCID: PMC10688245 DOI: 10.32074/1591-951x-869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- Alessandro Bonsignore
- Section of Legal and Forensic Medicine, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
- IRCCS-Policlinico San Martino Teaching Hospital, Genova, Italy
| | - Francesca Buffelli
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena
| | - Francesca Monari
- Fetal-Perinatal Pathology Unit, IRCCS-Istituto Giannina Gaslini, Genova, Italy
| | - Ezio Fulcheri
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena
- Section of Pathology, Department of Surgical and Diagnostic Sciences (DISC), University of Genova, Genova, Italy
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3
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Bottelli L, Franzè V, Tuo G, Buffelli F, Paladini D. Prenatal detection of congenital heart disease at 12-13 gestational weeks: detailed analysis of false-negative cases. Ultrasound Obstet Gynecol 2023; 61:577-586. [PMID: 36240512 DOI: 10.1002/uog.26094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/28/2022] [Accepted: 09/08/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To report on the early detection of congenital heart disease (CHD) in low- and high-risk populations managed at our hospital; and perform a detailed analysis of false-negative diagnoses, in order to derive possible recommendations on how to reduce their incidence. METHODS This was a retrospective observational study analyzing cases which underwent an ultrasound examination at the end of the first trimester at the Fetal Medicine and Surgery Unit of Gaslini Children's Hospital, Genoa, Italy, in the period January 2015 to December 2021. The study population included both low-risk pregnancies that underwent standard first-trimester combined screening and high-risk ones referred to our unit because of a positive combined test or suspicion of fetal anomalies raised in a regional community hospital. For each case, the following variables were retrieved and analyzed: number of fetuses, maternal body mass index, gestational age at first-trimester screening, whether the pregnancy was low or high risk, nuchal translucency thickness (normal or > 99th centile), type of CHD, associated extracardiac anomalies, karyotype and pregnancy outcome. For low-risk pregnancies, suspicion of CHD was also recorded. In low-risk cases, sonographic cardiac screening comprised evaluation of the four-chamber view (grayscale and color/power Doppler) and three-vessel-and-trachea view (color/power Doppler). High-risk cases underwent early fetal echocardiography. False-negative cases were categorized according to likely cause of the missed diagnosis, as follows: human factor; technical factor; acoustic-window factor. RESULTS Gestational age at ultrasound ranged from 12 + 0 to 13 + 6 weeks (crown-rump length (CRL), 50.1-84.0 mm) in the low-risk group and from 11 + 5 to 13 + 6 weeks (CRL, 45.1-84.0 mm) in the high-risk group. Over the 7-year study period, 7080 pregnancies were evaluated in the first trimester. Of these, 6879 (7167 fetuses) were low-risk and 201 were high-risk cases. In the low-risk group, there were 30 fetuses with CHD (including 15 major and 15 minor CHD), yielding a prevalence of 4.2/1000 (2.1/1000 for major CHD). Nine of the 30 CHD cases were suspected at screening ultrasound (7/15 major CHD). Excluding cases in which the CHD would not be expected to be associated with a modification of the screening views and would therefore not be detectable on screening ultrasound, 7/12 cases of major CHD were detected, corresponding to a sensitivity of 58.3%. Among the 201 high-risk cases, there were 46 fetuses with CHD (including 44 major and two minor CHD), of which 43 were detected, corresponding to a sensitivity for early fetal echocardiography of 93.5%, or 97.7% if the two cases that were unlikely to be detectable on first-trimester screening were excluded. Analysis of the 11 (of 24) false-negative cases that would be expected to be picked up on screening views revealed that human error (image interpretation and/or scanning approach) was involved in all 11 cases and technical factors (excessive color priority (color-balance function) and/or incorrect plane alignment) were present in two. There was impairment of the acoustic window (associated with maternal obesity and/or twin gestation) as a cofactor in five of the 11 cases. CONCLUSIONS The sensitivity for detection of major CHD of early cardiac screening in low-risk pregnancy is under 60%, partly due to the natural history of CHD and, it seems, partly relating to human error and technical issues with image quality. Factors associated with false-negative diagnoses may be categorized into three types: human error, technical factors and acoustic-window impairment. We recommend: appropriate assessment with fetal posterior spine; that sufficient time is spent on assessment of the fetal situs; and that color/power Doppler settings are adapted to the individual case. A lower threshold for referring doubtful cases for early fetal echocardiography should be adopted in cases of maternal obesity and in twin gestation. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Bottelli
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - V Franzè
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Tuo
- Pediatric Cardiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - F Buffelli
- Fetopathology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - D Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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4
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Bonsignore A, Drommi M, Frigiolini F, Roncallo A, Ventura F, Buffelli F, Fulcheri E. A Rare Case of Fatal Thyroid Hemorrhage After Fine-Needle Aspiration: Case Report and Review of the Literature. Am J Forensic Med Pathol 2022; 43:291-295. [PMID: 35960205 PMCID: PMC9390222 DOI: 10.1097/paf.0000000000000761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Sudden death due to massive hemorrhage after a mini-invasive ambulatory diagnostic procedure is extremely rare. Fine-needle aspiration (FNA) of thyroid nodules is very safe, displaying a low rate of complications, all of which mild and often self-limiting. In few cases do these complications necessitate surgical decompression, and rarely does FNA of a thyroid nodule lead to the death of the patient.We report a case of sudden death caused by respiratory insufficiency after compression of the vascular and nervous structures of the neck and obstruction of the upper airways by hemorrhages dissecting the thyroidal and perithyroidal tissues in a 78-year-old woman. These hemorrhages were the result of vascular lacerations caused during diagnostic FNA of a nodule suspected of malignancy. In such cases, it is important to conduct a complete autopsy and histological analysis to ascertain the origin of massive hemorrhage involving the structures of the neck and to attribute the cause of death to the aforementioned procedure. The forensic pathologist must bear in mind that even extremely small damage, such as that produced by a fine needle, may cause a fatal hemorrhage in subjects with a subverted anatomo-pathological picture (such as, for example, the massive fibrosis of an organ).
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Affiliation(s)
- Alessandro Bonsignore
- From the Department of Legal and Forensic Medicine, University of Genova
- IRCCS—Ospedale Policlinico San Martino
| | - Martina Drommi
- From the Department of Legal and Forensic Medicine, University of Genova
| | | | - Anna Roncallo
- From the Department of Legal and Forensic Medicine, University of Genova
| | - Francesco Ventura
- From the Department of Legal and Forensic Medicine, University of Genova
- IRCCS—Ospedale Policlinico San Martino
| | | | - Ezio Fulcheri
- Clinical Pathology Unit, IRCCS—Istituto Giannina Gaslini
- Department of Pathology, San Martino Hospital, University of Genova, Genova, Italy
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Ruscitti F, Cerminara M, Iascone M, Pezzoli L, Rosti G, Romano F, Ronchetto P, Martucciello G, Buratti S, Buffelli F, Bocciardi R, Puliti A, Divizia MT. An example of parenchymal renal sparing in the context of complex malformations due to a novel mutation in the PBX1 gene. Birth Defects Res 2022; 114:674-681. [PMID: 35751431 DOI: 10.1002/bdr2.2065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION PBX1 encodes the pre-B cell leukemia factor 1, a Three Amino acid Loop Extension (TALE) transcription factor crucial to regulate basic developmental processes. PBX1 loss-of-function variants have been initially described in association with renal malformations in both isolated and syndromic forms. CASE REPORT Herein, we report a male infant presenting multiple organ malformations (cleidosternal dysostosis, micrognathia, left lung hypoplasia, wide interatrial defect, pulmonary hypertension, total anomalous pulmonary venous return, intestinal malrotation) and carrying the heterozygous de novo c.868C > T (p.Arg290Trp) variant in PBX1. This novel variant affects the highly conserved homeodomain of the protein, leading to a non-conservative substitution and consequently altering its tridimensional structure and DNA-binding capacity. CONCLUSION So far, PBX1 has been reported in association with a broad spectrum of renal anomalies. However, given the role of this gene in many different developing processes, whole-exome sequencing can detect mutations in PBX1 even in patients with different phenotypes, not necessarily involving the renal primordium. This report presents a novel PBX1 variant with a predicted strong deleterious effect. The mutation leads to a non-conservative substitution in a very highly conserved domain of the protein, thus altering its tertiary structure and DNA-binding capacity.
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Affiliation(s)
| | - Maria Cerminara
- DINOGMI, University of Genoa, Genoa, Italy
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Iascone
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Pezzoli
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giulia Rosti
- DINOGMI, University of Genoa, Genoa, Italy
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Patrizia Ronchetto
- UOC Laboratorio di Genetica Umana, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppe Martucciello
- DINOGMI, University of Genoa, Genoa, Italy
- UOC Chirurgia Pediatrica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Silvia Buratti
- UOC Terapia Intensiva Neonatale e Pediatrica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Buffelli
- Fetal-Perinatal Pathology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Renata Bocciardi
- DINOGMI, University of Genoa, Genoa, Italy
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Aldamaria Puliti
- DINOGMI, University of Genoa, Genoa, Italy
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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6
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Fulcheri E, Buffelli F, Fiore C, Izzotti A, Piccardo MT, Chiozza MB, Petralia P, Ciliberti R, Bonsignore A. Considerations about the burial of foetuses of less than 20-weeks gestational age. Pathologica 2022; 114:238-240. [PMID: 35775710 PMCID: PMC9248242 DOI: 10.32074/1591-951x-773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ezio Fulcheri
- Section of Pathology, Department of Surgical and Diagnostic Sciences (DISC), University of Genova, Genova, Italy.,Fetal and Perinatal Pathology Unit, IRCCS - Istituto Giannina Gaslini, Genova, Italy
| | - Francesca Buffelli
- Fetal and Perinatal Pathology Unit, IRCCS - Istituto Giannina Gaslini, Genova, Italy
| | | | - Alberto Izzotti
- Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy.,Mutagenesis & Cancer Prevention Unit, IRCCS Policlinico San Martino, Teaching Hospital, Genova, Italy
| | - Maria Teresa Piccardo
- Mutagenesis & Cancer Prevention Unit, IRCCS Policlinico San Martino, Teaching Hospital, Genova, Italy
| | | | - Paolo Petralia
- General Direction of the Local Health Authority ASL4, Liguria Region, Italy
| | - Rosagemma Ciliberti
- Section of Bioethics and History of Medicine, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Alessandro Bonsignore
- Section of Legal and Forensic Medicine, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy.,IRCCS Policlinico San Martino, Teaching Hospital, Genova, Italy
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7
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Buffoni I, Buratti S, Mallamaci MF, Pezzato S, Lampugnani E, Buffelli F, Fulcheri E, Moscatelli A. Sudden Onset of Severe Pulmonary Hypertension in a Preterm Infant: A Case Report on the Role of Maternal Use of Serotonin Re-Uptake Inhibitors During Pregnancy and Concurrent Risk Factors. Front Pediatr 2022; 10:855419. [PMID: 35757139 PMCID: PMC9227662 DOI: 10.3389/fped.2022.855419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Persistent pulmonary hypertension of the newborn (PPHN) is a severe condition caused by failed circulatory adaptation at birth. Pulmonary hypertension is most common in full-term infants and rare in preterms, although it is increasingly diagnosed also in extremely preterm infants. Previous studies demonstrated the association between maternal use of selective serotonin re-uptake inhibitors during gestation and pulmonary hypertension. This brief report describes the complex physiopathological correlations that were identified in a case of severe pulmonary hypertension in a fetal growth restricted (FGR) preterm infant, with a history of maternal use of antidepressants during pregnancy. Perinatal factors, triggers and aggravating mechanisms caused a dramatic clinical course. Maternal history of escitalopram therapy throughout pregnancy was noted. Uteroplacental insufficiency, fetal hypoxia, FGR, preeclampsia, preterm delivery, antenatal steroids, and cesarean section were documented as concurrent risk factors. Myocardial immaturity and dysfunction, secondary to FGR and prematurity aggravated the hemodynamic compromise. The short time gap between pharmacological ductal closure and the onset of PPHN may suggest a cause-effect relationship, as observed in previous reports. Placental histopathologic findings are reported.
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Affiliation(s)
- Isabella Buffoni
- Division of Neonatal and Pediatric Intensive Care, Emergency Department, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Silvia Buratti
- Division of Neonatal and Pediatric Intensive Care, Emergency Department, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Marisa F Mallamaci
- Division of Neonatal and Pediatric Intensive Care, Emergency Department, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Stefano Pezzato
- Division of Neonatal and Pediatric Intensive Care, Emergency Department, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Elisabetta Lampugnani
- Division of Neonatal and Pediatric Intensive Care, Emergency Department, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Francesca Buffelli
- Fetal and Perinatal Pathology Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Ezio Fulcheri
- Fetal and Perinatal Pathology Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Andrea Moscatelli
- Division of Neonatal and Pediatric Intensive Care, Emergency Department, IRCCS Giannina Gaslini Institute, Genoa, Italy
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8
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Kiani AK, Mor M, Bernini A, Fulcheri E, Michelini S, Herbst KL, Buffelli F, Belgrado JP, Kaftalli J, Stuppia L, Dautaj A, Dhuli K, Guda T, Manara E, Maltese PE, Michelini S, Chiurazzi P, Paolacci S, Ceccarini MR, Beccari T, Bertelli M. Steroid-converting enzymes in human adipose tissues and fat deposition with a focus on AKR1C enzymes. Eur Rev Med Pharmacol Sci 2021; 25:23-32. [PMID: 34890031 DOI: 10.26355/eurrev_202112_27330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Adipocytes express various enzymes, such as aldo-keto reductases (AKR1C), 11β-hydroxysteroid dehydrogenase (11β-HSD), aromatase, 5α-reductases, 3β-HSD, and 17β-HSDs involved in steroid hormone metabolism in adipose tissues. Increased activity of AKR1C enzymes and their expression in mature adipocytes might indicate the association of these enzymes with subcutaneous adipose tissue deposition. The inactivation of androgens by AKR1C enzymes increases adipogenesis and fat mass, particularly subcutaneous fat. AKR1C also causes reduction of estrone, a weak estrogen, to produce 17β-estradiol, a potent estrogen and, in addition, it plays a role in progesterone metabolism. Functional impairments of adipose tissue and imbalance of steroid biosynthesis could lead to metabolic disturbances. In this review, we will focus on the enzymes involved in steroid metabolism and fat tissue deposition.
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9
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Kiani AK, Paolacci S, Scanzano P, Michelini S, Capodicasa N, D'Agruma L, Notarangelo A, Tonini G, Piccinelli D, Farshid KR, Petralia P, Fulcheri E, Buffelli F, Chiurazzi P, Terranova C, Plotti F, Angioli R, Castori M, Pös O, Szemes T, Bertelli M. Prenatal genetic diagnosis: Fetal therapy as a possible solution to a positive test. Acta Biomed 2020; 91:e2020021. [PMID: 33170180 PMCID: PMC8023142 DOI: 10.23750/abm.v91i13-s.10534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fetal abnormalities cause 20% of perinatal deaths. Advances in prenatal genetic and other types of screening offer great opportunities for identifying high risk pregnancies. METHODS Through a literature search, here we summarise what are the prenatal diagnostic technique that are being used and how those techniques may allow for prenatal interventions. RESULTS Next generation sequencing and non-invasive prenatal testing are fundamental for clinical diagnostics because of their sensitivity and accuracy in identifying point mutations, aneuploidies, and microdeletions, respectively. Timely identification of genetic disorders and other fetal abnormalities enables early intervention, such as in-utero gene therapy, fetal drug therapy and prenatal surgery. CONCLUSION Prenatal intervention is mainly focused on conditions that may cause death or lifelong disabilities, like spina bifida, congenital diaphragm hernia and sacrococcygeal teratoma; and may be an alternative therapeutic option to termination of pregnancy. However, it is not yet widely available, due to lack of specialized centers.
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Affiliation(s)
| | | | | | - Sandro Michelini
- Department of Rehabilitation, San Giovanni Battista Hospital, Rome, Italy.
| | | | - Leonardo D'Agruma
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy.
| | - Angelantonio Notarangelo
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy.
| | - Gerolamo Tonini
- Surgical Department, Unit of Urology, Poliambulanza Foundation, Brescia, Italy.
| | - Daniela Piccinelli
- Department of Mother and Child Health, Unit of Obstetrics and Gynecology, Poliambulanza Foundation, Brescia, Italy.
| | | | | | - Ezio Fulcheri
- UOSD Fetal and Perinatal Pathology, Department of Translational Research, Laboratory Medicine, Diagnostics and Services, IRCCS Giannina Gaslini Institute, Genoa, Italy.
| | - Francesca Buffelli
- UOSD Fetal and Perinatal Pathology, Department of Translational Research, Laboratory Medicine, Diagnostics and Services, IRCCS Giannina Gaslini Institute, Genoa, Italy.
| | - Pietro Chiurazzi
- Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, Rome, Italy; UOC Genetica Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy.
| | - Corrado Terranova
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Rome, Italy.
| | - Francesco Plotti
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Rome, Italy.
| | - Roberto Angioli
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Rome, Italy.
| | - Marco Castori
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy.
| | - Ondrej Pös
- Department of Molecular Biology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovakia; Geneton Ltd., Bratislava, Slovakia.
| | - Tomas Szemes
- 14 Department of Molecular Biology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovakia; Geneton Ltd., Bratislava, Slovakia; Comenius University Science Park, Bratislava, Slovakia.
| | - Matteo Bertelli
- MAGI EUREGIO, Bolzano, Italy; MAGI'S LAB, Rovereto (TN), Italy; EBTNA-LAB, Rovereto (TN), Italy.
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10
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Geraldo AF, Parodi A, Bertamino M, Buffelli F, Uccella S, Tortora D, Moretti P, Ramenghi L, Fulcheri E, Rossi A, Severino M. Perinatal Arterial Ischemic Stroke in Fetal Vascular Malperfusion: A Case Series and Literature Review. AJNR Am J Neuroradiol 2020; 41:2377-2383. [PMID: 33122209 DOI: 10.3174/ajnr.a6857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/17/2020] [Indexed: 11/07/2022]
Abstract
Fetal vascular malperfusion includes a continuum of placental histologic abnormalities increasingly associated with perinatal brain injury, namely arterial ischemic stroke. Here, we describe the clinical-neuroimaging features of 5 neonates with arterial ischemic stroke and histologically proved fetal vascular malperfusion. All infarcts involved the anterior territories and were multiple in 2 patients. In 2 neonates, there were additional signs of marked dural sinus congestion, thrombosis, or both. A mixed pattern of chronic hypoxic-ischemic encephalopathy and acute infarcts was noted in 1 patient at birth. Systemic cardiac or thrombotic complications were present in 2 patients. These peculiar clinical-radiologic patterns may suggest fetal vascular malperfusion and should raise the suspicion of this rare, underdiagnosed condition carrying important implications in patient management, medicolegal actions, and future pregnancy counseling.
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Affiliation(s)
- A F Geraldo
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.).,Diagnostic Neuroradiology Unit (A.F.G.), Imaging Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - A Parodi
- Neonatal Intensive Care (A.P., L.R.)
| | - M Bertamino
- Physical Medicine and Rehabilitation (M.B., P.M.)
| | - F Buffelli
- Gynaecologic and Fetal-Perinatal Pathology (F.B., E.F.)
| | - S Uccella
- Child Neuropsychiatry (S.U.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - D Tortora
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.)
| | - P Moretti
- Physical Medicine and Rehabilitation (M.B., P.M.)
| | - L Ramenghi
- Neonatal Intensive Care (A.P., L.R.).,Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (L.R.)
| | - E Fulcheri
- Gynaecologic and Fetal-Perinatal Pathology (F.B., E.F.).,Surgical Sciences and Integrated Diagnostics, Pathology Division of Anatomic Pathology (E.F.)
| | - A Rossi
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.).,Health Sciences (DISSAL) (A.R.), University of Genoa, Genoa, Italy
| | - M Severino
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.)
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11
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Paolacci S, Precone V, Acquaviva F, Chiurazzi P, Fulcheri E, Pinelli M, Buffelli F, Michelini S, Herbst KL, Unfer V, Bertelli M. Genetics of lipedema: new perspectives on genetic research and molecular diagnoses. Eur Rev Med Pharmacol Sci 2020; 23:5581-5594. [PMID: 31298310 DOI: 10.26355/eurrev_201907_18292] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this qualitative review is to provide an update on the current understanding of the genetic determinants of lipedema and to develop a genetic test to differentiate lipedema from other diagnoses. MATERIALS AND METHODS An electronic search was conducted in MEDLINE, PubMed, and Scopus for articles published in English up to March 2019. Lipedema and similar disorders included in the differential diagnosis of lipedema were searched in the clinical synopsis section of OMIM, in GeneCards, Orphanet, and MalaCards. RESULTS The search identified several genetic factors related to the onset of lipedema and highlighted the utility of developing genetic diagnostic testing to help differentiate lipedema from other diagnoses. CONCLUSIONS No genetic tests or guidelines for molecular diagnosis of lipedema are currently available, despite the fact that genetic testing is fundamental for the differential diagnosis of lipedema against Mendelian genetic obesity, primary lymphedema, and lipodystrophies.
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12
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Parodi A, De Angelis LC, Re M, Raffa S, Malova M, Rossi A, Severino M, Tortora D, Morana G, Calevo MG, Brisigotti MP, Buffelli F, Fulcheri E, Ramenghi LA. Placental Pathology Findings and the Risk of Intraventricular and Cerebellar Hemorrhage in Preterm Neonates. Front Neurol 2020; 11:761. [PMID: 32922347 PMCID: PMC7456995 DOI: 10.3389/fneur.2020.00761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
Placental pathology as a predisposing factor to intraventricular hemorrhage remains a matter of debate, and its contribution to cerebellar hemorrhage development is still largely unexplored. Our study aimed to assess placental and perinatal risk factors for intraventricular and cerebellar hemorrhages in preterm infants. This retrospective cohort study included very low-birth weight infants born at the Gaslini Children's Hospital between January 2012 and October 2016 who underwent brain magnetic resonance with susceptibility-weighted imaging at term-equivalent age and whose placenta was analyzed according to the Amsterdam Placental Workshop Group Consensus Statement. Of the 286 neonates included, 68 (23.8%) had intraventricular hemorrhage (all grades) and 48 (16.8%) had a cerebellar hemorrhage (all grades). After correction for gestational age, chorioamnionitis involving the maternal side of the placenta was found to be an independent risk factor for developing intraventricular hemorrhage, whereas there was no association between maternal and fetal inflammatory response and cerebellar hemorrhage. Among perinatal factors, we found that intraventricular hemorrhage was significantly associated with cerebellar hemorrhage (odds ratio [OR], 8.14), mechanical ventilation within the first 72 h (OR, 2.67), and patent ductus arteriosus requiring treatment (OR, 2.6), whereas cesarean section emerged as a protective factor (OR, 0.26). Inotropic support within 72 h after birth (OR, 5.24) and intraventricular hemorrhage (OR, 6.38) were independent risk factors for cerebellar hemorrhage, whereas higher gestational age was a protective factor (OR, 0.76). Assessing placental pathology may help in understanding mechanisms leading to intraventricular hemorrhage, although its possible role in predicting cerebellar bleeding needs further evaluation.
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Affiliation(s)
- Alessandro Parodi
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Laura Costanza De Angelis
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martina Re
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sarah Raffa
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Mariya Malova
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Morana
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Pia Brisigotti
- Gynaecologic and Fetal-Perinatal Pathology Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Buffelli
- Gynaecologic and Fetal-Perinatal Pathology Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ezio Fulcheri
- Gynaecologic and Fetal-Perinatal Pathology Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Division of Pathology, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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13
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De Angelis LC, Fulcheri E, Turchiano M, Buffelli F, Ramenghi LA, Bellini C. Placental pathology is rarely performed in sick neonates transferred soon after birth. Acta Paediatr 2020; 109:1522-1524. [PMID: 31997386 DOI: 10.1111/apa.15203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/15/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Laura C. De Angelis
- Department Mother and Child Neonatal Intensive Care Unit Gaslini Institute Genoa Italy
| | - Ezio Fulcheri
- Gynaecologic and Fetal‐Perinatal Pathology Centre Gaslini Institute Genoa Italy
| | - Maria Turchiano
- Department Mother and Child Neonatal Intensive Care Unit Gaslini Institute Genoa Italy
| | - Francesca Buffelli
- Gynaecologic and Fetal‐Perinatal Pathology Centre Gaslini Institute Genoa Italy
| | - Luca A. Ramenghi
- Department Mother and Child Neonatal Intensive Care Unit Gaslini Institute Genoa Italy
| | - Carlo Bellini
- Department Mother and Child Neonatal Intensive Care Unit Gaslini Institute Genoa Italy
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14
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Iacomino M, Baldassari S, Tochigi Y, Kośla K, Buffelli F, Torella A, Severino M, Paladini D, Mandarà L, Riva A, Scala M, Balagura G, Accogli A, Nigro V, Minetti C, Fulcheri E, Zara F, Bednarek AK, Striano P, Suzuki H, Salpietro V. Loss of Wwox Perturbs Neuronal Migration and Impairs Early Cortical Development. Front Neurosci 2020; 14:644. [PMID: 32581702 PMCID: PMC7300205 DOI: 10.3389/fnins.2020.00644] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022] Open
Abstract
Mutations in the WWOX gene cause a broad range of ultra-rare neurodevelopmental and brain degenerative disorders, associated with a high likelihood of premature death in animal models as well as in humans. The encoded Wwox protein is a WW domain-containing oxidoreductase that participates in crucial biological processes including tumor suppression, cell growth/differentiation and regulation of steroid metabolism, while its role in neural development is less understood. We analyzed the exomes of a family affected with multiple pre- and postnatal anomalies, including cerebellar vermis hypoplasia, severe neurodevelopmental impairment and refractory epilepsy, and identified a segregating homozygous WWOX mutation leading to a premature stop codon. Abnormal cerebral cortex development due to a defective architecture of granular and molecular cell layers was found in the developing brain of a WWOX-deficient human fetus from this family. A similar disorganization of cortical layers was identified in lde/lde rats (carrying a homozygous truncating mutation which disrupts the active Wwox C-terminal domain) investigated at perinatal stages. Transcriptomic analyses of Wwox-depleted human neural progenitor cells showed an impaired expression of a number of neuronal migration-related genes encoding for tubulins, kinesins and associated proteins. These findings indicate that loss of Wwox may affect different cytoskeleton components and alter prenatal cortical development, highlighting a regulatory role of the WWOX gene in migrating neurons across different species.
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Affiliation(s)
- Michele Iacomino
- Unit of Medical Genetics, IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Simona Baldassari
- Unit of Medical Genetics, IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Yuki Tochigi
- Laboratory of Veterinary Physiology, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Musashinoi, Japan
| | - Katarzyna Kośla
- Department of Molecular Carcinogenesis, Medical University of Łódź, Łódź, Poland
| | - Francesca Buffelli
- Fetal and Perinatal Pathology Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Annalaura Torella
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Telethon Institute of Genetics and Medicine (TIGEM), Naples, Italy
| | | | - Dario Paladini
- Fetal Medicine and Surgery Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Luana Mandarà
- Medical Genetics Unit, Maria Paternò Arezzo Hospital, Ragusa, Italy
| | - Antonella Riva
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Marcello Scala
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Ganna Balagura
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Andrea Accogli
- Unit of Medical Genetics, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Telethon Institute of Genetics and Medicine (TIGEM), Naples, Italy
| | - Carlo Minetti
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Ezio Fulcheri
- Fetal and Perinatal Pathology Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), Pathology Division of Anatomic Pathology, University of Genoa, Genoa, Italy
| | - Federico Zara
- Unit of Medical Genetics, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Andrzej K Bednarek
- Department of Molecular Carcinogenesis, Medical University of Łódź, Łódź, Poland
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Hiroetsu Suzuki
- Laboratory of Veterinary Physiology, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Musashinoi, Japan
| | - Vincenzo Salpietro
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, United Kingdom
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15
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Ventura F, Barranco R, Smith A, Ceccherini I, Bandettini R, Coviello D, Morando A, Nozza P, Buffelli F, Fulcheri E, Palmieri A. Multidisciplinary study of sudden unexpected infant death in Liguria (Italy): a nine-year report. Minerva Pediatr (Torino) 2020; 73:435-443. [PMID: 32241102 DOI: 10.23736/s2724-5276.20.05599-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION We conducted a retrospective analysis of cases of sudden unexpected infant death (SUID) referred to the SIDS-ALTE Center of the Liguria Region (Italy) from 2010 to 2018. In all cases, the death scene was inspected, and a multidisciplinary post-mortem evaluation was conducted. Our aim was to analyze the epidemiological data and etiological distribution. EVIDENCE ACQUISITION We examined 15 cases initially classified as sudden infant death. EVIDENCE SYNTHESIS In all cases, the death was initially unexplained. Seven cases involved males and eight involved females. Their mean age was 67.47 days; the youngest victim was 2 days old, while the oldest was 8.5 months (253 days). In 7 cases, the post-mortem analysis showed an infection of lung. In 4 cases, the prone position of the infant during sleep was identified as a risk factor. Only in one case the cause of death remains unexplained, and it was classified as sudden infant death syndrome II according to San Diego Classification. CONCLUSIONS In the forensic approach to cases of SUID, it is always important to conduct a thorough multidisciplinary investigation. In order to avoid procedural errors that might compromise the post-mortem investigation, it is necessary to consider the medical and social history of both mother and child, in addition to the circumstances of the death. Moreover, a complete pediatric post-mortem examination and multidisciplinary discussion are required in order to identify potentially important causative or contributory factors.
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Affiliation(s)
- Francesco Ventura
- Department of Forensic and Legal Medicine, University of Genoa, Genoa, Italy -
| | - Rosario Barranco
- Department of Forensic and Legal Medicine, University of Genoa, Genoa, Italy
| | - Anna Smith
- Department of Forensic and Legal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Domenico Coviello
- Laboratory of Human Genetics, Giannina Gaslini Institute, Genoa, Italy
| | - Anna Morando
- Section of Analytic Toxicology, La Colletta Hospital, ASL 3 Genovese, Arenzano, Genoa, Italy
| | - Paolo Nozza
- Section of Clinical Pathology, Galliera Hospital, Genoa, Italy
| | - Francesca Buffelli
- Unit of Fetal and Perinatal Pathology, Giannina Gaslini Institute, Genoa, Italy
| | - Ezio Fulcheri
- Unit of Fetal and Perinatal Pathology, Giannina Gaslini Institute, Genoa, Italy.,School of Medicine, University of Genoa, Genoa, Italy
| | - Antonella Palmieri
- Department of Pediatric Emergency, Sudden Infant Death Syndrome Liguria Center, Giannina Gaslini Institute, Genoa, Italy
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16
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Ventura F, Barranco R, Smith A, Ceccherini I, Bandettini R, Coviello D, Morando A, Nozza P, Buffelli F, Fulcheri E, Palmieri A. Multidisciplinary study of sudden unexpected infant death in Liguria (Italy): an nine-year report. Minerva Pediatr 2020. [PMID: 32241102 DOI: 10.23736/s0026-4946.20.05599-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We conducted a retrospective analysis of cases of SUID referred to the SIDS-ALTE Center of the Liguria Region (Italy) from 2010 to 2018. In all cases, the death scene was inspected and a multidisciplinary post-mortem evaluation was conducted. Our aim was to analyze the epidemiological data and etiological distribution. We examined 15 cases initially classified as sudden infant death. In all cases, the death was initially unexplained. Seven cases involved males and eight involved females. Their mean age was 67,47 days; the youngest victim was 2 days old, while the oldest was 8.5 months (253 days). In 7 cases, the post-mortem analysis showed an infection of lung. In 4 cases, the prone position of the infant during sleep was identified as a risk factor. In only one case did the cause of death remain unexplained and it was classified as sudden infant death syndrome II according to San Diego classification. In the forensic approach to cases of SUID, it is always important to conduct a thorough multidisciplinary investigation. In order to avoid procedural errors that might compromise the post- mortem investigation, it is necessary to consider the medical and social history of both mother and child, in addition to the circumstances of the death. Moreover, a complete pediatric post-mortem examination and multidisciplinary discussion are required in order to identify potentially important causative or contributory factors.
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Affiliation(s)
- Francesco Ventura
- Department of Forensic and Legal Medicine, University of Genoa, Genoa, Italy -
| | - Rosario Barranco
- Department of Forensic and Legal Medicine, University of Genoa, Genoa, Italy
| | - Anna Smith
- Department of Forensic and Legal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Domenico Coviello
- Laboratory of Human Genetics, Istituto Giannina Gaslini, Genoa, Italy
| | - Anna Morando
- S.C. of Analytic Toxicology, La Colletta Hospital - ASL 3 Genovese, Arenzano, Genoa, Italy
| | - Paolo Nozza
- S.C. of Clinical Pathology, Galliera Hospital, Genoa, Italy
| | - Francesca Buffelli
- U.O.S.D. of Fetal and Perinatal Pathology, Istituto Giannina Gaslini, Genoa, Italy
| | - Ezio Fulcheri
- U.O.S.D. of Fetal and Perinatal Pathology, Istituto Giannina Gaslini, Genoa, Italy.,School of Medicine, University of Genoa, Italy
| | - Antonella Palmieri
- Department of Pediatric Emergency - Sudden Infant Death Syndrome Liguria Centre, Istituto Giannina Gaslini, Genoa, Italy
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17
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Vellone VG, Peñuela L, Paudice M, Todeschini F, Buffelli F, Biggi G, Felis S, Ferrero S, Fulcheri E. What can we learn from the histopathology of retained placenta? A 15-year experience at a regional referral center. Gazz Med Ital - Arch Sci Med 2019. [DOI: 10.23736/s0393-3660.18.03879-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Paudice M, Peñuela LA, Torielli F, Spina B, Remorgida V, Buffelli F, Fulcheri E, Arioni C, Vellone VG. Giant Hepatic Hemangioma and Placental Chorangiosis: A Unique Case of Stillbirth? Fetal Pediatr Pathol 2019; 38:175-181. [PMID: 30676122 DOI: 10.1080/15513815.2018.1564159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Hepatic hemangiomas (HH) are benign vascular tumors, and when large, may contribute to fetal morbidity/mortality. Chorangiosis is placental villus capillary hypervascularity, probably linked with fetal hypoxia. CASE REPORT We present a macrosomic stillbirth at 39 + 3 weeks of gestation with congestive heart failure (CHF) and myocardial infarction. A giant right hepatic lobe HH was present, along with placental chorangiosis. CONCLUSION A common pathogenetic pathway between congenital HH and placental chorangiosis has not been reported. Our case suggests that the effects of HH and chorangiosis increase the risk of late fetal loss due to the high-output CHF.
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Affiliation(s)
| | | | - Flaminia Torielli
- c Neonatology Unit , University of Genoa, Azienda Ospedaliera San Martino IRCCS - IST National Institute on Cancer Research , Genoa , Italy
| | - Bruno Spina
- d Pathology Unit , San Martino Hospital , Genoa , Italy
| | - Valentino Remorgida
- e Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health , University of Genoa , Genoa , Italy
| | - Francesca Buffelli
- b Fetal and Placental Pathology Unit , G. Gaslini Institute , Genoa , Italy
| | - Ezio Fulcheri
- a Pathology, DISC , University of Genoa , Genoa , Italy.,b Fetal and Placental Pathology Unit , G. Gaslini Institute , Genoa , Italy
| | - Cesare Arioni
- c Neonatology Unit , University of Genoa, Azienda Ospedaliera San Martino IRCCS - IST National Institute on Cancer Research , Genoa , Italy
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19
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Bonsignore A, Buffelli F, Ciliberti R, Ventura F, Molinelli A, Fulcheri E. Medico-legal considerations on "Lotus Birth" in the Italian legislative framework. Ital J Pediatr 2019; 45:39. [PMID: 30885231 PMCID: PMC6423792 DOI: 10.1186/s13052-019-0632-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/13/2019] [Indexed: 12/26/2022] Open
Abstract
The term “Lotus Birth” identifies the practice of not cutting the umbilical cord and of leaving the placenta attached to the newborn after its expulsion until it detaches spontaneously, which generally occurs 3–10 days after birth. The first reported cases of Lotus Birth date back to 2004 in Australia. Supporters of such a procedure claim that the newborn is better perfused, endowed with a more robust immune system and “less stressed”. However, it should be pointed out that histopathological study of the placenta is increasingly being requested in order to investigate problems of an infective nature or dysmaturity affecting the foetus, and situations of risk affecting the mother. Moreover, from the legal standpoint, there is no uniform position on the question of whether the placenta belongs to the mother or to the newborn. Lastly, a proper conservation of the embryonic adnexa is very difficult and includes problems of a hygiene/health, infectivological and medico-legal nature. The authors analyzed all these aspect in the Italian legislative framework, reaching the conclusion that Lotus Birth is inadvisable from both the scientific and logical/rational points of view.
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Affiliation(s)
- Alessandro Bonsignore
- Department of Health Sciences (DISSAL) - Section of Legal and Forensic Medicine and Bioethics, University of Genova, Via De Toni 12, 16132, Genoa, Italy.
| | - Francesca Buffelli
- Ph.D Course in Paediatric Science, Fetal-Perinatal and Paediatric Pathology, University of Genova, Genoa, Italy.,Fetal and Perinatal Pathology Unit, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini, 16147, Genoa, Italy
| | - Rosagemma Ciliberti
- Department of Health Sciences (DISSAL) - Section of Legal and Forensic Medicine and Bioethics, University of Genova, Via De Toni 12, 16132, Genoa, Italy
| | - Francesco Ventura
- Department of Health Sciences (DISSAL) - Section of Legal and Forensic Medicine and Bioethics, University of Genova, Via De Toni 12, 16132, Genoa, Italy
| | - Andrea Molinelli
- Department of Health Sciences (DISSAL) - Section of Legal and Forensic Medicine and Bioethics, University of Genova, Via De Toni 12, 16132, Genoa, Italy
| | - Ezio Fulcheri
- Fetal and Perinatal Pathology Unit, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini, 16147, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC) - Pathology Division of Anatomic Pathology, University of Genova, Largo Rosanna Benzi 10, 16132, Genoa, Italy
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20
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Bonsignore A, Palmiere C, Buffelli F, Maselli E, Marzullo A, Fraternali Orcioni G, Ventura F, De Stefano F, Dell'Erba A. When is myocarditis indeed the cause of death? Forensic Sci Int 2018; 285:72-76. [PMID: 29453007 DOI: 10.1016/j.forsciint.2018.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/07/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
Attribution of death to myocarditis continues to be a controversial issue in forensic pathology, despite the existence of established histopathological criteria as well as complementary investigations. The aim of the study was two-fold: (a) to retrospectively analyse the data obtained from a series of clinical and forensic autopsies in order to assess the number of cases with death attributed to myocarditis, and (b) to reevaluate these cases in order to assess how properly the histopathological diagnosis of myocarditis conformed to established criteria and therefore how accurately these were used on the basis of all postmortem investigation findings to conclude the cause of death. 2474 clinical and forensic autopsies were taken into consideration. Myocarditis was recorded as the official, underlying cause of death in 48 cases. Of those, 8 cases were considered to accurately conform to the histopathological Dallas criteria for the presence of myocarditis and could therefore be classified as cases of fatal myocarditis. In 19 out of 48 cases, description of focal myocarditis was considered to accurately fulfill the histopathological Dallas criteria for the presence of myocarditis. However, data provided by histological analysis and virology testing result reevaluation allowed alternative causes of death to be speculated. In another 21 out of 48 cases, description of focal myocardial inflammation was considered to inaccurately meet the histopathological Dallas criteria for the presence of myocarditis. The findings of our own study appear to be in agreement with previous observations in similar study groups and highlight that since myocarditis may occur in association with many diseases, a great deal of evidence is required before settling on categorical conclusions.
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Affiliation(s)
- Alessandro Bonsignore
- Department of Health Sciences (DISSAL) - Section of Legal and Forensic Medicine, University of Genova, Italy.
| | - Cristian Palmiere
- CURML, University Center of Legal Medicine, Lausanne University Hospital, Switzerland
| | - Francesca Buffelli
- Fetal and Perinatal Pathology Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Eloisa Maselli
- Department of Interdisciplinary Medicine (DIM) - Section of Legal and Forensic Medicine, University of Bari, Italy
| | - Andrea Marzullo
- Department of Emergency and Organ Transplantation (DETO) - Section of Pathology, University of Bari, Italy
| | - Giulio Fraternali Orcioni
- Department of Pathology - Anatomic Pathology Division, IRCCS-AOU San Martino-IST Teaching Hospital, Genova, Italy
| | - Francesco Ventura
- Department of Health Sciences (DISSAL) - Section of Legal and Forensic Medicine, University of Genova, Italy
| | - Francesco De Stefano
- Department of Health Sciences (DISSAL) - Section of Legal and Forensic Medicine, University of Genova, Italy
| | - Alessandro Dell'Erba
- Department of Interdisciplinary Medicine (DIM) - Section of Legal and Forensic Medicine, University of Bari, Italy
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Paladini D, Donarini G, Buffelli F, Fulcheri E. Sonographic visualization of in-vivo formation of intervillous (Kline's) hemorrhage. Ultrasound Obstet Gynecol 2017; 50:131-132. [PMID: 27790780 DOI: 10.1002/uog.17336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/04/2016] [Accepted: 10/16/2016] [Indexed: 06/06/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Via Gerolamo Gaslini 5, Genoa, 16147, Italy
| | - G Donarini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Via Gerolamo Gaslini 5, Genoa, 16147, Italy
| | - F Buffelli
- Fetal and Perinatal Pathology Unit, Istituto G. Gaslini, Genoa, Italy
| | - E Fulcheri
- Fetal and Perinatal Pathology Unit, Istituto G. Gaslini, Genoa, Italy
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Losurdo G, Piscitelli D, Giangaspero A, Principi M, Buffelli F, Giorgio F, Montenegro L, Sorrentino C, Amoruso A, Ierardi E, Di Leo A. Evolution of nonspecific duodenal lymphocytosis over 2 years of follow-up. World J Gastroenterol 2015; 21:7545-52. [PMID: 26140001 PMCID: PMC4481450 DOI: 10.3748/wjg.v21.i24.7545] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/31/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the evolution of duodenal lymphocytosis (DL), a condition characterized by increased intraepithelial lymphocytes (IELs), over 2 years of follow-up. METHODS Consecutive patients undergoing upper endoscopy/histology for abdominal pain, diarrhea, weight loss, weakness or other extraintestinal features compatible with celiac disease (CD) were included. Evaluation of IELs infiltrate in duodenal biopsy samples was carried out by CD3-immunohistochemistry and expressed as number of positive cells/100 enterocytes. Diagnostic agreement on the IELs count was tested by calculating the weighted k coefficient. All patients underwent serological detection of autoantibodies associated with CD: IgG and IgA anti-tissue transglutaminase and endomysium. Each patient underwent further investigations to clarify the origin of DL at baseline and/or in the course of 2 years of follow-up every six months. Autoimmune thyroiditis, intestinal infections, parasitic diseases, bacterial intestinal overgrowth, hypolactasia and wheat allergy were detected. Colonoscopy and enteric magnetic resonance imaging were performed when necessary. Risk factors affecting the final diagnosis were detected by multinomial logistic regression and expressed as OR. RESULTS Eighty-five patients (16 males, 69 females, aged 34.1 ± 12.5 years) were followed up for a mean period of 21.7 ± 11.7 mo. At baseline, endoscopy/duodenal biopsy, CD3 immunohistochemistry revealed: > 25 IELs/100 enterocytes in 22 subjects, 15-25 IELs in 37 and < 15 IELs in 26. They all had negative serum anti-transglutaminase and anti-endomysium, whilst 5 showed IgG anti-gliadin positivity. In the course of follow-up, 23 developed CD seropositivity and gluten sensitivity (GS) was identified in 19. Other diagnoses were: 5 Helicobacter pylori infections, 4 jejunal Crohn's disease, 1 lymphocytic colitis and 1 systemic sclerosis. The disease in the remaining 32 patients was classified as irritable bowel syndrome because of the lack of diagnostic evidence. At multivariate analysis, the evolution towards CD was associated with an IELs infiltrate > 25 (OR = 1640.4) or 15-25 (OR = 16.95), human leukocyte antigen (HLA) DQ2/8 (OR = 140.85) or DQA1*0501 (OR = 15.36), diarrhea (OR = 5.56) and weakness (OR = 11.57). GS was associated with IELs 15-25 (OR = 28.59), autoimmune thyroiditis (OR = 87.63), folate deficiency (OR = 48.53) and diarrhea (OR = 54.87). CONCLUSION DL may have a multifactorial origin but the IELs infiltrate and HLA are strong predictive factors for CD development and a clinical diagnosis of GS.
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Ierardi E, Amoruso A, Giorgio F, Principi M, Losurdo G, Piscitelli D, Buffelli F, Fiore MG, Mongelli A, Castellaneta NM, Giangaspero A, De Francesco V, Montenegro L, Di Leo A. Mucosal molecular pattern of tissue transglutaminase and interferon gamma in suspected seronegative celiac disease at marsh 1 and 0 stages. Saudi J Gastroenterol 2015; 21:379-85. [PMID: 26655133 PMCID: PMC4707806 DOI: 10.4103/1319-3767.167189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIM In celiac disease (CD), there is increased mRNA coding for tissue transglutaminase (tTG) and interferon gamma (IFNα). In seronegative celiac patients, the mucosal immune complexes anti-tTG IgA/tTG are found. We assayed tTG- and IFNα-mRNA in the mucosa of patients with a clinical suspicion of seronegative CD and correlated the values with intraepithelial CD3 lymphocytes (IELs). MATERIALS AND METHODS Distal duodenum specimens from 67 patients were retrieved and re-evaluated for immunohistochemically proven CD3 IELs. Five 10 μm sections were used for the extraction and assay of tTG and IFNα coding mRNA levels using reverse transcriptase real-time polymerase chain reaction (RT-PCR). Samples from 15 seropositive CD patients and 15 healthy subjects were used as positive and negative controls. Results were expressed as fold-change. RESULTS Our series was divided into three groups based on IEL count: >25 (14 patients: group A), 15-25 (26 patients: group B), and 0-15 (27 patients: Group C). tTG-mRNA levels were (mean ± SD): CD = 9.8 ± 2.6; group A = 10.04 ± 4.7; group B = 4.99 ± 2.3; group C = 2.26 ± 0.8, controls = 1.04 ± 0.2 (CD = group A > group B > group C = controls). IFNα-mRNA levels were: CD = 13.4 ± 3.6; group A = 7.28 ± 3.6; group B = 4.45 ± 2.9; group C = 2.06 ± 1.21, controls = 1.04 ± 0.4. CONCLUSIONS Our results suggest that tTG- and IFNγmRNA levels are increased in both seropositive and potential seronegative patients with CD, showing a strong correlation with the CD3 IEL count at stage Marsh 1. An increase in both molecules is found even when IELs are in the range 15-25 (Marsh 0), suggesting the possibility of a "gray zone" inhabited by patients which should be closely followed up in gluten-related disorders.
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Affiliation(s)
- Enzo Ierardi
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy,Address for correspondence: Prof. Enzo Ierardi, Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Piazza G, Cesare, Bari - 70124, Italy. E-mail:
| | - Annacinzia Amoruso
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Floriana Giorgio
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Giuseppe Losurdo
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | | | | | - Maria G. Fiore
- Department of Pathology Section, University of Bari, Bari, Italy
| | - Antonio Mongelli
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Nicola M. Castellaneta
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Antonio Giangaspero
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Vincenzo De Francesco
- Department of Gastroenterology Department of Medical Sciences Unit, Ospedali Riuniti, Foggia, Italy
| | - Lucia Montenegro
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
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