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Mokhtari A, Casale R, Salahuddin Z, Paquier Z, Guiot T, Woodruff HC, Lambin P, Van Laethem JL, Hendlisz A, Bali MA. Development of Clinical Radiomics-Based Models to Predict Survival Outcome in Pancreatic Ductal Adenocarcinoma: A Multicenter Retrospective Study. Diagnostics (Basel) 2024; 14:712. [PMID: 38611625 PMCID: PMC11011556 DOI: 10.3390/diagnostics14070712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE This multicenter retrospective study aims to identify reliable clinical and radiomic features to build machine learning models that predict progression-free survival (PFS) and overall survival (OS) in pancreatic ductal adenocarcinoma (PDAC) patients. METHODS Between 2010 and 2020 pre-treatment contrast-enhanced CT scans of 287 pathology-confirmed PDAC patients from two sites of the Hopital Universitaire de Bruxelles (HUB) and from 47 hospitals within the HUB network were retrospectively analysed. Demographic, clinical, and survival data were also collected. Gross tumour volume (GTV) and non-tumoral pancreas (RPV) were semi-manually segmented and radiomics features were extracted. Patients from two HUB sites comprised the training dataset, while those from the remaining 47 hospitals of the HUB network constituted the testing dataset. A three-step method was used for feature selection. Based on the GradientBoostingSurvivalAnalysis classifier, different machine learning models were trained and tested to predict OS and PFS. Model performances were assessed using the C-index and Kaplan-Meier curves. SHAP analysis was applied to allow for post hoc interpretability. RESULTS A total of 107 radiomics features were extracted from each of the GTV and RPV. Fourteen subgroups of features were selected: clinical, GTV, RPV, clinical & GTV, clinical & GTV & RPV, GTV-volume and RPV-volume both for OS and PFS. Subsequently, 14 Gradient Boosting Survival Analysis models were trained and tested. In the testing dataset, the clinical & GTV model demonstrated the highest performance for OS (C-index: 0.72) among all other models, while for PFS, the clinical model exhibited a superior performance (C-index: 0.70). CONCLUSIONS An integrated approach, combining clinical and radiomics features, excels in predicting OS, whereas clinical features demonstrate strong performance in PFS prediction.
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Affiliation(s)
- Ayoub Mokhtari
- Radiology Department, Institut Jules Bordet Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Roberto Casale
- Radiology Department, Institut Jules Bordet Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Zohaib Salahuddin
- Department of Precision Medicine, GROW—Research Institute for Oncology and Reproduction, Maastricht University, 6220MD Maastricht, The Netherlands
| | - Zelda Paquier
- Medical Physics Department, Institut Jules Bordet Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Thomas Guiot
- Medical Physics Department, Institut Jules Bordet Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Henry C. Woodruff
- Department of Precision Medicine, GROW—Research Institute for Oncology and Reproduction, Maastricht University, 6220MD Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, GROW—School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229HX Maastricht, The Netherlands
| | - Philippe Lambin
- Department of Precision Medicine, GROW—Research Institute for Oncology and Reproduction, Maastricht University, 6220MD Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, GROW—School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229HX Maastricht, The Netherlands
| | - Jean-Luc Van Laethem
- Department of Gastroenterology and Digestive Oncology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Alain Hendlisz
- Department of Gastroenterology and Digestive Oncology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Radiology Department, Institut Jules Bordet Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
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De Angelis R, Casale R, Coquelet N, Ikhlef S, Mokhtari A, Simoni P, Bali MA. The impact of radiomics in the management of soft tissue sarcoma. Discov Oncol 2024; 15:62. [PMID: 38441726 PMCID: PMC10914656 DOI: 10.1007/s12672-024-00908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Soft tissue sarcomas (STSs) are rare malignancies. Pre-therapeutic tumour grading and assessment are crucial in making treatment decisions. Radiomics is a high-throughput method for analysing imaging data, providing quantitative information beyond expert assessment. This review highlights the role of radiomic texture analysis in STSs evaluation. MATERIALS AND METHODS We conducted a systematic review according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in PubMed/MEDLINE and Scopus using the search terms: 'radiomics [All Fields] AND ("soft tissue sarcoma" [All Fields] OR "soft tissue sarcomas" [All Fields])'. Only original articles, referring to humans, were included. RESULTS A preliminary search conducted on PubMed/MEDLINE and Scopus provided 74 and 93 studies respectively. Based on the previously described criteria, 49 papers were selected, with a publication range from July 2015 to June 2023. The main domains of interest were risk stratification, histological grading prediction, technical feasibility/reproductive aspects, treatment response. CONCLUSIONS With an increasing interest over the last years, the use of radiomics appears to have potential for assessing STSs from initial diagnosis to predicting treatment response. However, additional and extensive research is necessary to validate the effectiveness of radiomics parameters and to integrate them into a comprehensive decision support system.
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Affiliation(s)
- Riccardo De Angelis
- Institut Jules Bordet, Anderlecht, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Roberto Casale
- Institut Jules Bordet, Anderlecht, Belgium.
- Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Samia Ikhlef
- Institut Jules Bordet, Anderlecht, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Ayoub Mokhtari
- Institut Jules Bordet, Anderlecht, Belgium.
- Université Libre de Bruxelles, Brussels, Belgium.
| | - Paolo Simoni
- Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Antonietta Bali
- Institut Jules Bordet, Anderlecht, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
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Casale R, Boattini M, Bianco G, Comini S, Corcione S, Garazzino S, Silvestro E, De Rosa FG, Cavallo R, Costa C. Bloodstream Infections by Pantoea Species: Clinical and Microbiological Findings from a Retrospective Study, Italy, 2018-2023. Antibiotics (Basel) 2023; 12:1723. [PMID: 38136757 PMCID: PMC10740582 DOI: 10.3390/antibiotics12121723] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: The widespread use of MALDI-TOF coupled to mass spectrometry has improved diagnostic accuracy by identifying uncommon bacteria. Among Enterobacterales, Pantoea species have been seen to be implicated in several human infections, but their clinical and microbiological framework is currently based on a few anecdotal reports. (2) Methods: We conducted this five-year (2018-2023) single-center study aimed at investigating the prevalence and clinical and microbiological findings of Pantoea species bloodstream infections. (3) Results: Among the 4996 bloodstream infection Gram-negative isolates collected during the study period, Pantoea species accounted for 0.4% (n = 19) of isolates from 19 different patients, 5 of them being pediatric cases. Among Pantoea species isolates, P. agglomerans was the most frequently detected (45%; n = 9) followed by P. eucrina (30%; n = 6) and P. septica (15%; n = 3). Malignancy (35.7%) in adults and malignancy (40%) and cerebrovascular disease following meconium aspiration (40%) in pediatric patients as comorbidities and shivering and/or fever following parenteral infusion (36.8%) as a symptom/sign of Pantoea species bloodstream infection onset were the most frequently observed clinical features. Among adults, primary bloodstream infection was the most frequent (50%), whereas among pediatric patients, the most commonly identified sources of infection were catheter-related (40%) and the respiratory tract (40%). Overall, Pantoea species bloodstream infection isolates displayed high susceptibility to all the antibiotics except for ampicillin (63.2%), fosfomycin (73.7%), and piperacillin/tazobactam (84.2%). Targeted antibiotic treatment was prescribed as monotherapy for adults (71.4%) and combination therapy for pediatric patients (60%). The most prescribed antibiotic regimens were piperacillin/tazobactam (21.4%) in adults and meropenem- (40%) and aminoglycoside-containing (40%) antibiotics in pediatric patients. The overall 28-day all-cause mortality rate was 5.3% (n = 1). (4) Conclusions: The prevalence and 28-day mortality rate of Pantoea species bloodstream infections were low. The prescription of targeted therapy including broad-spectrum antibiotics could indicate an underestimation of the specific involvement of the Pantoea species in the onset of the disease, warranting further studies defining their pathogenic potential.
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Affiliation(s)
- Roberto Casale
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
| | - Matteo Boattini
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
- Lisbon Academic Medical Centre, 1649-028 Lisbon, Portugal
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
| | - Sara Comini
- Operative Unit of Clinical Pathology, Carlo Urbani Hospital, 60035 Jesi, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatric and Public Health Sciences, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Erika Silvestro
- Infectious Diseases Unit, Department of Pediatric and Public Health Sciences, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy
- Unit of Infectious Diseases, Cardinal Massaia Hospital, 14100 Asti, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
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Casale R, De Angelis R, Coquelet N, Mokhtari A, Bali MA. The Impact of Edema on MRI Radiomics for the Prediction of Lung Metastasis in Soft Tissue Sarcoma. Diagnostics (Basel) 2023; 13:3134. [PMID: 37835878 PMCID: PMC10572878 DOI: 10.3390/diagnostics13193134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/03/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate whether radiomic features extracted solely from the edema of soft tissue sarcomas (STS) could predict the occurrence of lung metastasis in comparison with features extracted solely from the tumoral mass. MATERIALS AND METHODS We retrospectively analyzed magnetic resonance imaging (MRI) scans of 32 STSs, including 14 with lung metastasis and 18 without. A segmentation of the tumor mass and edema was assessed for each MRI examination. A total of 107 radiomic features were extracted for each mass segmentation and 107 radiomic features for each edema segmentation. A two-step feature selection process was applied. Two predictive features for the development of lung metastasis were selected from the mass-related features, as well as two predictive features from the edema-related features. Two Random Forest models were created based on these selected features; 100 random subsampling runs were performed. Key performance metrics, including accuracy and area under the ROC curve (AUC), were calculated, and the resulting accuracies were compared. RESULTS The model based on mass-related features achieved a median accuracy of 0.83 and a median AUC of 0.88, while the model based on edema-related features achieved a median accuracy of 0.75 and a median AUC of 0.79. A statistical analysis comparing the accuracies of the two models revealed no significant difference. CONCLUSION Both models showed promise in predicting the occurrence of lung metastasis in soft tissue sarcomas. These findings suggest that radiomic analysis of edema features can provide valuable insights into the prediction of lung metastasis in soft tissue sarcomas.
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Affiliation(s)
| | | | | | - Ayoub Mokhtari
- Institut Jules Bordet Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium; (R.C.); (R.D.A.); (N.C.); (M.A.B.)
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Casale R, Bianco G, Bastos P, Comini S, Corcione S, Boattini M, Cavallo R, Rosa FGD, Costa C. Prevalence and Impact on Mortality of Colonization and Super-Infection by Carbapenem-Resistant Gram-Negative Organisms in COVID-19 Hospitalized Patients. Viruses 2023; 15:1934. [PMID: 37766340 PMCID: PMC10534345 DOI: 10.3390/v15091934] [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: 09/04/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The relationship between superinfection by multidrug-resistant Gram-negative bacteria and mortality among SARS-CoV-2 hospitalized patients is still unclear. Carbapenem-resistant Acinetobacter baumannii and carbapenemase-producing Enterobacterales are among the most frequently isolated species when it comes to hospital-acquired superinfections among SARS-CoV-2 patients. METHODS Herein, a retrospective study was carried out using data from adult patients hospitalized for COVID-19. The interaction between in-hospital mortality and rectal carriage and superinfection by carbapenemase-producing Enterobacterales and/or carbapenem-resistant Acinetobacter baumannii was assessed. RESULTS The incidence of KPC-producing Klebsiella pneumoniae and/or carbapenem-resistant Acinetobacter baumannii rectal carriage was 30%. Bloodstream infection and/or pneumonia due to KPC-producing Klebsiella pneumoniae and/or carbapenem-resistant Acinetobacter baumannii occurred in 20% of patients. A higher Charlson comorbidity index (OR 1.41, 95% CI 1.24-1.59), being submitted to invasive mechanical ventilation/ECMO ≥ 96 h (OR 6.34, 95% CI 3.18-12.62), being treated with systemic corticosteroids (OR 4.67, 95% CI 2.43-9.05) and having lymphopenia at the time of admission (OR 0.54, 95% CI 0.40-0.72) were the features most strongly associated with in-hospital mortality. CONCLUSIONS Although KPC-producing Klebsiella pneumoniae and/or carbapenem-resistant Acinetobacter baumannii rectal carriage, and/or bloodstream infection/pneumonia were diagnosed in a remarkable percentage of COVID-19 patients, their impact on in-hospital mortality was not significant. Further studies are needed to assess the burden of antimicrobial resistance as a legacy of COVID-19 in order to identify future prevention opportunities.
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Affiliation(s)
- Roberto Casale
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (R.C.); (S.C.); (M.B.); (R.C.); (C.C.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (R.C.); (S.C.); (M.B.); (R.C.); (C.C.)
| | - Paulo Bastos
- Independent Researcher, 1169-056 Lisbon, Portugal;
| | - Sara Comini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (R.C.); (S.C.); (M.B.); (R.C.); (C.C.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (S.C.); (F.G.D.R.)
| | - Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (R.C.); (S.C.); (M.B.); (R.C.); (C.C.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
- Lisbon Academic Medical Centre, 1169-056 Lisbon, Portugal
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (R.C.); (S.C.); (M.B.); (R.C.); (C.C.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (S.C.); (F.G.D.R.)
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (R.C.); (S.C.); (M.B.); (R.C.); (C.C.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
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Casale R, Varriano G, Santone A, Messina C, Casale C, Gitto S, Sconfienza LM, Bali MA, Brunese L. Predicting risk of metastases and recurrence in soft-tissue sarcomas via Radiomics and Formal Methods. JAMIA Open 2023; 6:ooad025. [PMID: 37063407 PMCID: PMC10097456 DOI: 10.1093/jamiaopen/ooad025] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/20/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023] Open
Abstract
Objective Soft-tissue sarcomas (STSs) of the extremities are a group of malignancies arising from the mesenchymal cells that may develop distant metastases or local recurrence. In this article, we propose a novel methodology aimed to predict metastases and recurrence risk in patients with these malignancies by evaluating magnetic resonance radiomic features that will be formally verified through formal logic models. Materials and Methods This is a retrospective study based on a public dataset evaluating MRI scans T2-weighted fat-saturated or short tau inversion recovery and patients having "metastases/local recurrence" (group B) or "no metastases/no local recurrence" (group A) as clinical outcomes. Once radiomic features are extracted, they are included in formal models, on which is automatically verified the logic property written by a radiologist and his computer scientists coworkers. Results Evaluating the Formal Methods efficacy in predicting distant metastases/local recurrence in STSs (group A vs group B), our methodology showed a sensitivity and specificity of 0.81 and 0.67, respectively; this suggests that radiomics and formal verification may be useful in predicting future metastases or local recurrence development in soft tissue sarcoma. Discussion Authors discussed about the literature to consider Formal Methods as a valid alternative to other Artificial Intelligence techniques. Conclusions An innovative and noninvasive rigourous methodology can be significant in predicting local recurrence and metastases development in STSs. Future works can be the assessment on multicentric studies to extract objective disease information, enriching the connection between the radiomic quantitative analysis and the radiological clinical evidences.
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Affiliation(s)
| | - Giulia Varriano
- Corresponding author: Giulia Varriano, PhD Student, Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso 86100, Italy;
| | - Antonella Santone
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | | | - Chiara Casale
- Allergology Service, Dermatology Unit, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Salvatore Gitto
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Maria Antonietta Bali
- Department of Radiology, Institut Jules Bordet—Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Luca Brunese
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
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Boattini M, Comini S, Bianco G, Iannaccone M, Casale R, Cavallo R, Costa C. Activity of cefiderocol and synergy of novel β-lactam-β-lactamase inhibitor-based combinations against metallo-β-lactamase-producing gram-negative bacilli: insights from a two-year study (2019-2020). J Chemother 2023; 35:198-204. [PMID: 35731718 DOI: 10.1080/1120009x.2022.2090615] [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: 04/14/2022] [Revised: 05/25/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
This study was aimed at analyzing the prevalence of metallo-β-lactamase-producing Gram-negative bacilli (MBL-GNB) and evaluating both in vitro activity of cefiderocol and synergy of novel β-lactam-β-lactamase inhibitor-based combinations. Carbapenemase-producing Enterobacterales and meropenem-non-susceptible P. aeruginosa clinical strains were collected (2019-2020) and prevalence of MBL-producers investigated. Activity of cefiderocol was evaluated and synergistic effects of cefiderocol in combination with ceftazidime/avibactam vs aztreonam plus ceftazidime/avibactam vs meropenem/vaborbactam plus aztreonam were compared. Among carbapenemase-producing Enterobacterales, 87% (n = 307) produced KPC, 11.6% (n = 41) produced MBL, and 1.4% (n = 5) produced OXA-48-like. Among MBL-producing Enterobacterales, 78.1% (n = 32) and 21.9% (n = 9) were VIM- and NDM-producers, respectively. Among meropenem-non-susceptible P. aeruginosa, 1.9% (n = 8) produced VIM-type MBL. Cefiderocol resistance rate in VIM-producing Enterobacterales, VIM-producing P. aeruginosa, and NDM-producing Enterobacterales, was 6.2%, 12.5%, and 88.9%, respectively. Among MBL-producers tested, cefiderocol in combination with ceftazidime/avibactam showed a synergy rate of 20%, while for both aztreonam plus ceftazidime/avibactam and meropenem/vaborbactam plus aztreonam was 40%. Prevalence of MBL-producing Enterobacterales was remarkable. VIM-producing isolates were almost all susceptible to cefiderocol, while NDM-producers were often resistant. Meropenem/vaborbactam in combination with aztreonam showed similar synergistic activity to ceftazidime/avibactam plus aztreonam but the addition of aztreonam reduced MICs below the resistance breakpoint only for meropenem/vaborbactam.
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Affiliation(s)
- Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Sara Comini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberto Casale
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
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Rogers W, Keek SA, Beuque M, Lavrova E, Primakov S, Wu G, Yan C, Sanduleanu S, Gietema HA, Casale R, Occhipinti M, Woodruff HC, Jochems A, Lambin P. Towards texture accurate slice interpolation of medical images using PixelMiner. Comput Biol Med 2023; 161:106701. [PMID: 37244145 DOI: 10.1016/j.compbiomed.2023.106701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/06/2022] [Accepted: 11/23/2022] [Indexed: 05/29/2023]
Abstract
Quantitative image analysis models are used for medical imaging tasks such as registration, classification, object detection, and segmentation. For these models to be capable of making accurate predictions, they need valid and precise information. We propose PixelMiner, a convolution-based deep-learning model for interpolating computed tomography (CT) imaging slices. PixelMiner was designed to produce texture-accurate slice interpolations by trading off pixel accuracy for texture accuracy. PixelMiner was trained on a dataset of 7829 CT scans and validated using an external dataset. We demonstrated the model's effectiveness by using the structural similarity index (SSIM), peak signal to noise ratio (PSNR), and the root mean squared error (RMSE) of extracted texture features. Additionally, we developed and used a new metric, the mean squared mapped feature error (MSMFE). The performance of PixelMiner was compared to four other interpolation methods: (tri-)linear, (tri-)cubic, windowed sinc (WS), and nearest neighbor (NN). PixelMiner produced texture with a significantly lowest average texture error compared to all other methods with a normalized root mean squared error (NRMSE) of 0.11 (p < .01), and the significantly highest reproducibility with a concordance correlation coefficient (CCC) ≥ 0.85 (p < .01). PixelMiner was not only shown to better preserve features but was also validated using an ablation study by removing auto-regression from the model and was shown to improve segmentations on interpolated slices.
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Affiliation(s)
- W Rogers
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - S A Keek
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - M Beuque
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - E Lavrova
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; GIGA Cyclotron Research Centre in Vivo Imaging, University of Liège, Liège, Belgium
| | - S Primakov
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - G Wu
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - C Yan
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - S Sanduleanu
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - H A Gietema
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - R Casale
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M Occhipinti
- Radiomics, Clos Chanmurly 13, 4000, Liege, Belgium
| | - H C Woodruff
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - A Jochems
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - P Lambin
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
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Fundarò C, Casale R, Maestri R, Traversoni S, Colombo R, Salvini S, Ferretti C, Bartolo M, Buonocore M, Giardini A. Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q): development and implementation of an instrument to evaluate patients' perception during training. J Neuroeng Rehabil 2023; 20:35. [PMID: 36964543 PMCID: PMC10037786 DOI: 10.1186/s12984-023-01146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 01/27/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND The introduction of technology-assisted rehabilitation (TAR) uncovers promising challenges for the treatment of motor disorders, particularly if combined with exergaming. Patients with neurological diseases have proved to benefit from TAR, improving their performance in several activities. However, the subjective perception of the device has never been fully addressed, being a conditioning factor for its use. The aims of the study were: (a) to develop a questionnaire on patients' personal experience with TAR and exergames in a real-world clinical setting; (b) to administer the questionnaire to a pilot group of neurologic patients to assess its feasibility and statistical properties. METHODS A self-administrable and close-ended questionnaire, Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q), designed by a multidisciplinary team, was developed in Italian through a Delphi procedure. An English translation has been developed with consensus, for understandability purposes. The ultimate version of the questionnaire was constituted of 10 questions (5 with multiple answers), totalling 29 items, exploring the patient's performance and personal experience with TAR with Augmented Performance Feedback. TARPP-Q was then administered pre-post training in an observational, feasible, multi-centric study. The study involved in-patients aged between 18 and 85 with neurological diseases, admitted for rehabilitation with TAR (upper limb or gait). FIM scale was run to control functional performance. RESULTS Forty-four patients were included in the study. All patients answered the TARPP-Q autonomously. There were no unaccounted answers. Exploratory factor analyses identified 4 factors: Positive attitude, Usability, Hindrance perception, and Distress. Internal consistency was measured at T0. The values of Cronbach's alpha ranged from 0.72 (Distress) to 0.92 (Positive attitude). Functional Independence Measure (FIM®) scores and all TARPP-Q factors (Positive attitude, Usability, Hindrance perception, except for Distress (p = 0.11), significantly improved at the end of the treatment. A significant positive correlation between Positive attitude and Usability was also recorded. CONCLUSIONS The TARPP-Q highlights the importance of patients' personal experience with TAR and exergaming. Large-scale applications of this questionnaire may clarify the role of patients' perception of training effectiveness, helping to customize devices and interventions.
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Affiliation(s)
- Cira Fundarò
- Istituti Clinici Scientifici Maugeri Spa SB IRCCS Neurophysiopathology Unit of Montescano Institute, Pavia, PV, Italy.
| | - Roberto Casale
- OPUSMedica PC&R, Persons, Care & Research, Piacenza, Italy
| | - Roberto Maestri
- Istituti Clinici Scientifici Maugeri, IRCCS Department of Biomedical Engineering of Montescano Institute, Pavia, PV, Italy
| | - Silvia Traversoni
- Istituti Clinici Scientifici Maugeri IT Department, IRCCS Pavia, Pavia, PV, Italy
| | - Roberto Colombo
- Istituti Clinici Scientifici Maugeri IRCCS Veruno, Veruno, NO, Italy
| | - Silvana Salvini
- Istituti Clinici Scientifici Maugeri Spa SB IRCCS Neurophysiopathology Unit of Montescano Institute, Pavia, PV, Italy
| | - Chiara Ferretti
- Istituti Clinici Scientifici Maugeri IRCSS Neuromotor Rehabilitation Unit of Montescano Institute, Pavia, PV, Italy
| | - Michelangelo Bartolo
- Habilita Department of Rehabilitation, Neurorehabilitation Unit, HABILITA Zingonia, Ciserano, Bergamo, Italy
| | - Michelangelo Buonocore
- Istituti Clinici Scientifici Maugeri Spa SB IRCCS Neurophysiopathology Unit of Montescano Institute, Pavia, PV, Italy
| | - Anna Giardini
- Istituti Clinici Scientifici Maugeri IT Department, IRCCS Pavia, Pavia, PV, Italy
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10
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Leoni MLG, Vitali S, Micheli F, Mercieri M, Varrassi G, Casale R, Occhigrossi F, Giordano C. Radiation Exposure during Fluoroscopy-Guided Ozone Chemonucleolysis for Lumbar Disc Herniation. J Clin Med 2022; 11:jcm11247424. [PMID: 36556040 PMCID: PMC9781015 DOI: 10.3390/jcm11247424] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction: Radiation exposure is a frequent drawback of spinal surgery, even if X-ray guidance plays a pivotal role in improving the accuracy and safety of spinal procedures. Consequently, radiation protection is essential to reduce potential negative biological effects. The aim of this study was to evaluate patients’ radiation exposure, the radiation dose emission during fluoroscopy-guided ozone chemonucleolysis (OCN), and the potential role of patient characteristics. Methods: The radiation dose emission reports were retrospectively evaluated in patients who underwent single-level OCN for lumbar disc herniation. A generalized linear model (GLM) with a gamma distribution and log link function was used to assess the association between radiation emission and patients’ characteristics such as age, sex, BMI, level of disc herniation, disc height, and site of disc herniation. Results: Two hundred and forty OCN cases were analyzed. A safe and low level of radiation exposure was registered during OCN. The median fluoroscopy time for OCN was 26.3 (19.4−35.9) seconds, the median radiation emission dose was 19.3 (13.2−27.3) mGy, and he median kerma area product (KAP) was 0.46 (0.33−0.68) mGy ⋅ m2. The resulting KAP values were highly dependent on patient variables. In particular, sex, obesity, and residual disc height < 50% significantly increased the measured KAP, while levels of disc herniations other than L5-S1 reduced the KAP values. Conclusions: The radiation exposure during OCN is low and quite similar to a simple discography. However, patient characteristics are significantly related to radiation exposure and should be carefully evaluated before planning OCN.
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Affiliation(s)
- Matteo Luigi Giuseppe Leoni
- Unit of Interventional and Surgical Pain Management, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
- Correspondence:
| | - Sara Vitali
- Department of Medical Physics, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Fabrizio Micheli
- Unit of Interventional and Surgical Pain Management, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Marco Mercieri
- Department of Medical and Surgical Science and Translational Medicine, “La Sapienza” University, 00189 Rome, Italy
- Pain Therapy Unit, Sant’Andrea Hospital, 00189 Rome, Italy
| | | | - Roberto Casale
- Opusmedica Persons, Care & Research-PC&R, 29121 Piacenza, Italy
| | - Felice Occhigrossi
- Pain Therapy Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy
| | - Carlo Giordano
- Department of Medical Physics, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
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11
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Bianco G, Boattini M, Comini S, Iannaccone M, Casale R, Allizond V, Barbui AM, Banche G, Cavallo R, Costa C. Activity of ceftolozane-tazobactam, ceftazidime-avibactam, meropenem-vaborbactam, cefiderocol and comparators against Gram-negative organisms causing bloodstream infections in Northern Italy (2019-2021): emergence of complex resistance phenotypes. J Chemother 2022; 34:302-310. [PMID: 35098907 DOI: 10.1080/1120009x.2022.2031471] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/16/2021] [Accepted: 01/14/2022] [Indexed: 01/07/2023]
Abstract
Herein we assessed the frequency of Gram-negative organisms causing bloodstream infections and activity spectrum of ceftolozane-tazobactam (CTZ), ceftazidime-avibactam (CZA), meropenem-vaborbactam (MEV), cefiderocol (CFDC) and comparators. Overall, 1605 Gram-negative isolates were consecutively collected during 2019-2021. Enterobacterales represented more than 75% and exhibited >90% susceptibility to CZA (97%), amikacin (91.8%) and meropenem (90.6%). ESBL-producing Enterobacterales isolates showed high rates of susceptibility towards CZA (100%), carbapenems (89.1-100%) and CTZ (84.9-95.1%). MEV displayed the highest activity against KPC-producing Enterobacterales (MIC50/90, 0.75/4 mg/L; 92.9% susceptible) followed by CZA (MIC50/90, ≤2/>8 mg/L; 89.3% susceptible), CFDC (MIC50/90, 0.25/4 mg/L, 87.5% susceptible) and colistin (MIC50/90, ≤2/4 mg/L, 83.9% susceptible). High proportions of P. aeruginosa isolates were susceptible to colistin (97.8%), CZA (97.2%), CTZ (96.1%) and amikacin (94.5%). CFDC showed potent activity against Acinetobacter baumannii (MIC50/90, 0.5/1 mg/L; 97.2% susceptible), multi-drug resistant P. aeruginosa (MIC50/90, 0.25/1 mg/L; 96% susceptible), and Stenotrophomonas maltophilia (MIC50/90, 0.12/0.25 mg/L; 100% susceptible).
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Affiliation(s)
- Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Sara Comini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Marco Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberto Casale
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Valeria Allizond
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Anna Maria Barbui
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giuliana Banche
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
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12
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Giuliani F, Oros D, Gunier RB, Deantoni S, Rauch S, Casale R, Nieto R, Bertino E, Rego A, Menis C, Gravett MG, Candiani M, Deruelle P, García-May PK, Mhatre M, Usman MA, Abd-Elsalam S, Etuk S, Napolitano R, Liu B, Prefumo F, Savasi V, Do Vale MS, Baafi E, Ariff S, Maiz N, Aminu MB, Cardona-Perez JA, Craik R, Tavchioska G, Bako B, Benski C, Hassan-Hanga F, Savorani M, Sentilhes L, Carola Capelli M, Takahashi K, Vecchiarelli C, Ikenoue S, Thiruvengadam R, Soto Conti CP, Cetin I, Nachinab VB, Ernawati E, Duro EA, Kholin A, Teji JS, Easter SR, Salomon LJ, Ayede AI, Cerbo RM, Agyeman-Duah J, Roggero P, Eskenazi B, Langer A, Bhutta ZA, Kennedy SH, Papageorghiou AT, Villar J. Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study. Am J Obstet Gynecol 2022; 227:488.e1-488.e17. [PMID: 35452653 PMCID: PMC9017081 DOI: 10.1016/j.ajog.2022.04.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/30/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed. OBJECTIVE To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission. STUDY DESIGN In this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices. RESULTS A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P<.01) and pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (all with P<.001), than women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (P≤.001) and lower neonatal weight (P≤.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in utero exposure was significantly correlated to the risk of the neonate testing positive (odds ratio, 4.5; 95% confidence interval, 2.2-9.4 for length of in utero exposure >14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2-4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity. CONCLUSION In this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.
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Affiliation(s)
- Francesca Giuliani
- Neonatal Special Care Unit, Regina Margherita Children's Hospital, Turin, Italy.
| | - Daniel Oros
- Aragon Institute of Health Research, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Robert B. Gunier
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Sonia Deantoni
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom,Neonatal Care Unit, School of Medicine, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Stephen Rauch
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Roberto Casale
- Maternal and Child Department, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Ricardo Nieto
- Division Neonatología, Hospital Materno Infantil Ramón Sarda, Buenos Aires, Argentina
| | - Enrico Bertino
- Neonatal Unit of the University, City of Health and Science of Turin, Turin, Italy
| | - Albertina Rego
- Departamento de Pediatria, Faculdade Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Camilla Menis
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michael G. Gravett
- Departments of Obstetrics and Gynecology and of Global Health, University of Washington, Seattle, WA
| | - Massimo Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Mustapha Ado Usman
- Department of Obstetrics and Gynaecology, Muhammad Abdullahi Wase Teaching Hospital, Kano State, Nigeria
| | - Sherief Abd-Elsalam
- Faculty of Medicine, Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Saturday Etuk
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom,Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Becky Liu
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Valeria Savasi
- Ospedale Luigi Sacco University Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | | | - Shabina Ariff
- Department of Paediatrics & Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Nerea Maiz
- Department of Obstetrics, Hospital Universitari Vall d’Hebron, Barcelona Hospital Campus, Barcelona, Spain
| | - Muhammad Baffah Aminu
- Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | - Rachel Craik
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Gabriela Tavchioska
- Department of Pediatrics, General Hospital Borka Taleski, Prilep, Republic of North Macedonia
| | - Babagana Bako
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Caroline Benski
- Hôpitaux Universitaires de Genève, Département de la Femme, de l'Enfant et de l'Adolescent, Geneva, Switzerland
| | - Fatimah Hassan-Hanga
- Bayero University Kano, Nigeria,Aminu Kano Teaching Hospital, Kano State, Nigeria
| | | | - Loïc Sentilhes
- Department of Obstetrics and Gynecology Bordeaux University Hospital, Bordeaux, France
| | - Maria Carola Capelli
- Servicio de Neonatologia del Departamento Materno Infantil del Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Ken Takahashi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Irene Cetin
- Ospedale Vittore Buzzi Children's Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Ernawati Ernawati
- Department of Obstetrics & Gynecology, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia,Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eduardo A. Duro
- Universidad de Buenos Aires, Buenos Aires, Argentina,Universidad de Moron, Moron, Argentina
| | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology & Perinatology, Moscow, Russia
| | - Jagjit Singh Teji
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine and Division of Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Laurent J. Salomon
- Hôpital Universitaire Necker-Enfants Malades, Assistance Publique–Hôpitaux de Paris, Université de Paris, France
| | - Adejumoke Idowu Ayede
- College of Medicine, University of Ibadan, Ibadan, Nigeria,University College Hospital, Ibadan, Nigeria
| | - Rosa Maria Cerbo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Josephine Agyeman-Duah
- Nuffield Department of Women's & Reproductive Health, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Paola Roggero
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy,Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Zulfiqar A. Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Stephen H. Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Aris T. Papageorghiou
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom,St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jose Villar
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
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Boccia G, D’Emanuele S, Brustio PR, Beratto L, Tarperi C, Casale R, Sciarra T, Rainoldi A. Strength Asymmetries Are Muscle-Specific and Metric-Dependent. IJERPH 2022; 19:ijerph19148495. [PMID: 35886350 PMCID: PMC9319678 DOI: 10.3390/ijerph19148495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 12/10/2022]
Abstract
We investigated if dominance affected upper limbs muscle function, and we calculated the level of agreement in asymmetry direction across various muscle-function metrics of two heterologous muscle groups. We recorded elbow flexors and extensors isometric strength of the dominant and non-dominant limb of 55 healthy adults. Participants performed a series of explosive contractions of maximal and submaximal amplitudes to record three metrics of muscle performance: maximal voluntary force (MVF), rate of force development (RFDpeak), and RFD-Scaling Factor (RFD-SF). At the population level, the MVF was the only muscle function that showed a difference between the dominant and non-dominant sides, being on average slightly (3–6%) higher on the non-dominant side. At the individual level, the direction agreement among heterologous muscles was poor for all metrics (Kappa values ≤ 0.15). When considering the homologous muscles, the direction agreement was moderate between MVF and RFDpeak (Kappa = 0.37) and low between MVF and RFD-SF (Kappa = 0.01). The asymmetries are muscle-specific and rarely favour the same side across different muscle-performance metrics. At the individual level, no one side is more performative than the other: each limb is favoured depending on muscle group and performance metric. The present findings can be used by practitioners that want to decrease the asymmetry levels as they should prescribe specific exercise training for each muscle.
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Affiliation(s)
- Gennaro Boccia
- Department of Clinical and Biological Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (P.R.B.); (C.T.)
- NeuroMuscularFunction Research Group, School of Exercise and Sport Science, SUISM, University of Turin, 10126 Turin, Italy;
| | - Samuel D’Emanuele
- Department of Neuroscience, Biomedicine and Movement, University of Verona, 37129 Verona, Italy;
| | - Paolo Riccardo Brustio
- Department of Clinical and Biological Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (P.R.B.); (C.T.)
- NeuroMuscularFunction Research Group, School of Exercise and Sport Science, SUISM, University of Turin, 10126 Turin, Italy;
- Department of Neuroscience, Biomedicine and Movement, University of Verona, 37129 Verona, Italy;
| | - Luca Beratto
- NeuroMuscularFunction Research Group, School of Exercise and Sport Science, SUISM, University of Turin, 10126 Turin, Italy;
| | - Cantor Tarperi
- Department of Clinical and Biological Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (P.R.B.); (C.T.)
- Department of Neuroscience, Biomedicine and Movement, University of Verona, 37129 Verona, Italy;
| | - Roberto Casale
- Opusmedica Persons Care & Research, NPO, 29121 Piacenza, Italy;
| | - Tommaso Sciarra
- Joint Veterans Defence Center, Scientific Department, Army Medical Center, 00184 Rome, Italy;
| | - Alberto Rainoldi
- NeuroMuscularFunction Research Group, School of Exercise and Sport Science, SUISM, University of Turin, 10126 Turin, Italy;
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
- Correspondence:
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14
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Riedel R, Pérez-Pérez A, Jaime M, Parolini O, Casale R, Dueñas JL, Sánchez-Margalet V, Varone C, Maymó J. Human amniotic epithelial stem cells: Involvement of WNT/ΒETA-catenin signalling during their hepatic differentiation. Placenta 2022. [DOI: 10.1016/j.placenta.2022.03.115] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Szpilbarg N, Corominas A, Ferreiros A, Ruiz J, Casale R, Damiano A. AQP3 and AQP9 expression in extracellular microvesicle-enriched samples of plasma and supernatant of placental explants from healthy pregnant women at term. Placenta 2022. [DOI: 10.1016/j.placenta.2022.03.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
INTRODUCTION The analgesic action of localized vibration (LV), which is used in rehabilitation medicine to treat various clinical conditions, is usually attributed to spinal gate control, but is actually more complex. The aim of this review is: 1) to provide neurophysiological insights into the mechanisms underlying the ways in which afferent activity set up by LV induces analgesia through interactions with the nociceptive system throughout the nervous system; 2) to give a broader vision of the different effects induced by LV, some of them still related to basic science speculation. EVIDENCE ACQUISITION The Medline, EMBASE, AMED, Cochrane Library, CINAHL, Web of Science and ROAD databases were searched for animal and human neurophysiological and neurohormonal studies related to the direct effects of LV on nociceptive transmission and pain perception and were supplemented by published books and theses. EVIDENCE SYNTHESIS The spinal gate control mechanism through Aβ-fibers activation seems to be the most effective antinociceptive system activated by LV at frequencies between 100 and 250 Hz (high-frequency LV [HF-LV]) when applied in the same segment as the pain. A gating effect can be obtained also when it is applied contralaterally to the painful site or to adjacent dermatomes. Kinesthetic illusions of movement induced by HF-LV may induce a stronger analgesic effect. Activation of C-mechanoreceptors induced by a massage-like LV of low frequency and low intensity may interfere with pain through the activation of the limbic system. This action does not involve any gating mechanism. Frequency is more important than intensity as different frequencies induce activity in different cortical and cerebellar areas; these activations may be related to plastic cortical changes tentatively reversing pain-related maladaptive disorganization. Distraction/shift of attention or cortisol-mediated stress-induced analgesia are not involved in LV analgesic action in humans for both LF and HF. The release of opioidergic neuropeptides (analgesia not reversed by naloxone) as well as a reduction in substance P in the CSF does not seem to play a major role in the HF-LV action. Decrease in calcitonin and TRPV1 expression in the trigeminal ganglia in animals has been induced by HF-LV but the role of LF-LV is not completely deciphered. Both high and low LV induce the release of oxytocin, which may induce antinociceptive responses in animals and contribute to controlling pain in humans. CONCLUSIONS Although many aspects of LV-induced pain alleviation deserve more in-depth basic and translational studies, there are sound neurophysiological reasons for using LV in the therapeutic armamentarium of pain control. Laboratory animal and human data indicate that LV relieves pain not only by acting on the spinal gate, but also at higher levels of the nervous system.
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Affiliation(s)
| | - Per Hansson
- Department of Pain Management and Research, Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Bianco G, Boattini M, Comini S, Casale R, Iannaccone M, Cavallo R, Costa C. Occurrence of multi-carbapenemases producers among carbapenemase-producing Enterobacterales and in vitro activity of combinations including cefiderocol, ceftazidime-avibactam, meropenem-vaborbactam, and aztreonam in the COVID-19 era. Eur J Clin Microbiol Infect Dis 2022; 41:573-580. [PMID: 35061145 PMCID: PMC8780048 DOI: 10.1007/s10096-022-04408-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the prevalence of multi-carbapenemase-producing Enterobacterales (EB) and the activity of cefiderocol (CFDC), meropenem-vaborbactam (MEV), ceftazidime-avibactam (CZA), and combinations of CZA plus aztreonam (ATM), MEV plus ATM and CFDC plus CZA against them. METHODS A collection of carbapenemase-producing EB clinical isolates (n = 1242) was investigated by lateral flow immunoassay NG-Test CARBA-5 and molecular testing. Cefiderocol MICs were determined using broth microdilution SensititreTM panel. MICs of CZA and MEV were determined by the gradient diffusion method. Antimicrobial synergy testing was performed using gradient diffusion strip crossing. RESULTS KPC were the most frequent carbapenemases (83.2%), followed by VIM (9.2 %), OXA-48-like (4.3 %) and NDM enzymes (4.1%). Multi-carbapenemase producers were found in 10 (0.8%) isolates. Three combinations of two different carbapenemases were observed: KPC+VIM (n = 4), NDM+OXA-48-like (n = 4), and VIM+OXA-48-like (n = 2). CFDC showed potent activity against eight out of ten dual-carbapenemases producers, while resistance or reduced susceptibility was shown towards CZA and MEV. CFDC in combination with CZA showed no synergistic effects and only two additive effects on seven (87.5%) of the CFDC-susceptible strains. Conversely, CZA plus ATM and MEV plus ATM combinations were synergistic against all ATM-resistant strains regardless of dual-carbapenemases phenotype. CONCLUSIONS The occurrence of multi-carbapenemase producers is not uncommon in Northern Italy area. MEV in combination with ATM might be considered as a potential therapeutic option, alternative to CZA plus ATM. CFDC susceptibility testing and synergy evaluation of ATM-based combinations should be performed in the lab routine to evaluate the most in vitro active antimicrobial regimen.
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Affiliation(s)
- Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy.
| | - Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Sara Comini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Roberto Casale
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Marco Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
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Casale R, Ferriero G. Physical modalities and pain control in rehabilitation: lights and shadows to dispel. Eur J Phys Rehabil Med 2022; 58:280-281. [PMID: 35484664 PMCID: PMC9980484 DOI: 10.23736/s1973-9087.22.07535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Giorgio Ferriero
- Unit of Physical and Rehabilitation Medicine, IRCCS Scientific Institute of Tradate, Istituti Clinici Scientifici Maugeri, Tradate, Varese, Italy - .,Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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19
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Casale R, Bianco G, Cosma S, Micheletti L, Comini S, Iannaccone M, Boattini M, Cavallo R, Benedetto C, Costa C. Trueperella bernardiae bloodstream infection following onco-gynaecologic surgery and literature review. Infez Med 2022; 30:124-128. [PMID: 35350261 PMCID: PMC8929738 DOI: 10.53854/liim-3001-15] [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] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
Trueperella bernardiae is a Gram-positive commensal bacillus of the human skin and oropharynx. It is known as an opportunistic human pathogen causing surgical wound, skin, and soft tissue, osteoarticular, and bloodstream infections (BSIs) with severe complications. We report a case of surgical wound related T. bernardiae BSI following onco-gynaecologic surgery together with a comprehensive literature review of T. bernardiae infections to alert clinicians about this emerging pathogen.
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Affiliation(s)
- Roberto Casale
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Cosma
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Turin, Italy
| | - Leonardo Micheletti
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Turin, Italy
| | - Sara Comini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Marco Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
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20
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Corominas AI, Medina Y, Balconi S, Casale R, Farina M, Martínez N, Damiano AE. Assessing the Role of Uric Acid as a Predictor of Preeclampsia. Front Physiol 2022; 12:785219. [PMID: 35095555 PMCID: PMC8794766 DOI: 10.3389/fphys.2021.785219] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/13/2021] [Indexed: 12/31/2022] Open
Abstract
We assessed the diagnostic utility of uric acid for the prediction of preeclampsia. An observational prospective approach was carried out during 2014. Preeclamptic women were classified into 4 groups accordingly to the onset of preeclampsia and the presence of intrauterine growth restriction (IUGR). Serum uric acid levels, urea, and creatinine were measured. Receiver operating curves (ROC) of the uric acid levels ratio (UAr) between a dosage before and after the 20th week of gestation were performed. One thousand two hundred and ninety-third pregnant women were enrolled in this study. Eight hundred ten had non-complicated pregnancies, 40 preeclampsia, 33 gestational hypertension, and 20 IUGR without preeclampsia. Uric acid significantly raised after 20 weeks of gestation in women who develop preeclampsia before 34 weeks (Group A) or in those who develop preeclampsia after 37 weeks associated with IUGR (Group C). In women who develop preeclampsia after 34 weeks without IUGR (Groups B and D), uric acid increased after the 30th week of gestation. In all groups, UAr was greater than 1.5. In gestational hypertension, UAr was superior to 1.5 toward the end of gestation, while in IUGR without preeclampsia, the behavior of serum uric acid was similar to non-complicated pregnancies. In all cases, urea and creatinine showed normal values, confirming that patients had no renal compromise. ROC area was 0.918 [95% confidence interval (CI): 0.858–0.979) for the preeclampsia group and 0.955 (95% CI: 0.908–1.000) for Group A. UAr at a cut-off point ≥1.5 had a very low positive predictive value, but a high negative predictive value of 99.5% for preeclampsia and it reached 100% for Group A. Thus, a UAr less than 1.5 may be a helpful parameter with a strong exclusion value and high sensitivity for those women who are not expected to develop preeclampsia. Additionally, this low-cost test would allow for better use of resources in developing countries.
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Affiliation(s)
- Ana I. Corominas
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Yollyseth Medina
- Laboratorio de Biología de la Reproducción, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Silvia Balconi
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Roberto Casale
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Mariana Farina
- Laboratorio de Fisiopatología Placentaria, Centro de Estudios Farmacológicos y Botánicos (CEFyBO) - CONICET, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nora Martínez
- Laboratorio de Biología de la Reproducción, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alicia E. Damiano
- Laboratorio de Biología de la Reproducción, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Departamento de Ciencias Biológicas, Cátedra de Biología Celular y Molecular, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
- *Correspondence: Alicia E. Damiano,
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21
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Scalise ML, Garimano N, Sanz M, Padola NL, Leonino P, Pereyra A, Casale R, Amaral MM, Sacerdoti F, Ibarra C. Detection of Shiga Toxin-Producing Escherichia coli (STEC) in the Endocervix of Asymptomatic Pregnant Women. Can STEC Be a Risk Factor for Adverse Pregnancy Outcomes? Front Endocrinol (Lausanne) 2022; 13:945736. [PMID: 35957815 PMCID: PMC9358589 DOI: 10.3389/fendo.2022.945736] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
The presence of Escherichia coli in the vaginal microbiome has been associated with pregnancy complications. In previous works, we demonstrated that Shiga toxin-producing Escherichia coli (STEC) can produce abortion and premature delivery in rats and that Shiga toxin type 2 (Stx2) can impair human trophoblast cell lines. The hypothesis of this work was that STEC may colonize the lower female reproductive tract and be responsible for adverse pregnancy outcomes. Thus, the aim of this work was to evaluate the presence and prevalence of virulence factor genes from STEC in the endocervix of asymptomatic pregnant women. For that purpose, endocervical swabs were collected from pregnant women during their prenatal examination. Swab samples were enriched in a differential medium to select Enterobacteria. Then, positive samples were analyzed by PCR to detect genes characteristic of Escherichia sp. (such as uidA and yaiO), genes specific for portions of the rfb (O-antigen-encoding) regions of STEC O157 (rfbO157), and STEC virulence factor genes (such as stx1, stx2, eae, lpfAO113, hcpA, iha, sab, subAB). The cytotoxic effects of stx2-positive supernatants from E. coli recovered from the endocervix were evaluated in Vero cells. Our results showed that 11.7% of the endocervical samples were positive for E. coli. Additionally, we found samples positive for stx2 and other virulence factors for STEC. The bacterial supernatant from an isolate identified as E. coli O113:NT, carrying the stx2 gene, exhibited cytotoxic activity in Vero, Swan 71 and Hela cells. Our results open a new perspective regarding the presence of STEC during pregnancy.
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Affiliation(s)
- María Luján Scalise
- Laboratorio de Fisiopatogenia, Instituto de Fisiología y Biofísica, IFIBIO-Houssay (UBA-CONICET), Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nicolás Garimano
- Laboratorio de Fisiopatogenia, Instituto de Fisiología y Biofísica, IFIBIO-Houssay (UBA-CONICET), Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Sanz
- CIVETAN-Centro de Investigación Veterinaria Tandil (CONICET, CICPBA), Facultad de Ciencias Veterinarias, Tandil, Argentina
| | - Nora Lia Padola
- CIVETAN-Centro de Investigación Veterinaria Tandil (CONICET, CICPBA), Facultad de Ciencias Veterinarias, Tandil, Argentina
| | - Patricia Leonino
- Departamento de Obstetricia, Hospital Nacional “Prof. A. Posadas”, Buenos Aires, Argentina
| | - Adriana Pereyra
- Departamento de Obstetricia, Hospital Nacional “Prof. A. Posadas”, Buenos Aires, Argentina
| | - Roberto Casale
- Departamento de Obstetricia, Hospital Nacional “Prof. A. Posadas”, Buenos Aires, Argentina
| | - María Marta Amaral
- Laboratorio de Fisiopatogenia, Instituto de Fisiología y Biofísica, IFIBIO-Houssay (UBA-CONICET), Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Flavia Sacerdoti
- Laboratorio de Fisiopatogenia, Instituto de Fisiología y Biofísica, IFIBIO-Houssay (UBA-CONICET), Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- *Correspondence: Cristina Ibarra, ; Flavia Sacerdoti,
| | - Cristina Ibarra
- Laboratorio de Fisiopatogenia, Instituto de Fisiología y Biofísica, IFIBIO-Houssay (UBA-CONICET), Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- *Correspondence: Cristina Ibarra, ; Flavia Sacerdoti,
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22
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Boattini M, Bianco G, Comini S, Iannaccone M, Casale R, Charrier L, Cavallo R, Costa C. Changes in KPC-producing Klebsiella pneumoniae susceptibility from the pre- to ceftazidime-avibactam era. Infect Dis (Lond) 2021; 54:311-313. [PMID: 34871146 DOI: 10.1080/23744235.2021.2011957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Sara Comini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Marco Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberto Casale
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Lorena Charrier
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Public Health and Paediatrics, University of Torino, Turin, Italy
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23
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Comini S, Bianco G, Boattini M, Iannaccone M, Casale R, Banche G, Cavallo R, Costa C. Evaluation of the Amplex eazyplex SuperBug Acineto test for direct detection of multi-drug-resistant Acinetobacter baumannii bloodstream infections in high endemicity settings. J Hosp Infect 2021; 117:179-181. [PMID: 34562546 DOI: 10.1016/j.jhin.2021.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/24/2022]
Affiliation(s)
- S Comini
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.
| | - G Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - M Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - M Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - R Casale
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - G Banche
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - R Cavallo
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy; Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - C Costa
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy; Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
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Papageorghiou AT, Deruelle P, Gunier RB, Rauch S, García-May PK, Mhatre M, Usman MA, Abd-Elsalam S, Etuk S, Simmons LE, Napolitano R, Deantoni S, Liu B, Prefumo F, Savasi V, do Vale MS, Baafi E, Zainab G, Nieto R, Maiz N, Aminu MB, Cardona-Perez JA, Craik R, Winsey A, Tavchioska G, Bako B, Oros D, Rego A, Benski AC, Hassan-Hanga F, Savorani M, Giuliani F, Sentilhes L, Risso M, Takahashi K, Vecchiarelli C, Ikenoue S, Thiruvengadam R, Soto Conti CP, Ferrazzi E, Cetin I, Nachinab VB, Ernawati E, Duro EA, Kholin A, Firlit ML, Easter SR, Sichitiu J, Bowale A, Casale R, Cerbo RM, Cavoretto PI, Eskenazi B, Thornton JG, Bhutta ZA, Kennedy SH, Villar J. Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study. Am J Obstet Gynecol 2021; 225:289.e1-289.e17. [PMID: 34187688 PMCID: PMC8233533 DOI: 10.1016/j.ajog.2021.05.014] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [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] [Received: 03/18/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
Background It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study Design This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. Results We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2.77 (95% confidence interval, 1.66–4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios. Conclusion COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19.
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Affiliation(s)
- Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom; Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Robert B Gunier
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Stephen Rauch
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | | | | | - Mustapha Ado Usman
- Department of Obstetrics and Gynaecology, Muhammad Abdullahi Wase Teaching Hospital, Kano State, Nigeria
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Saturday Etuk
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Lavone E Simmons
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom; Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sonia Deantoni
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom; Neonatal Care Unit, Department of Public Health and Pediatrics, School of Medicine, University of Turin, Italy
| | - Becky Liu
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, zienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Valeria Savasi
- Department of BioMedical and Clinical Sciences, Ospedale Luigi Sacco University Hospital, University of Milan, Milan, Italy
| | | | | | - Ghulam Zainab
- Department of Obstetrics and Gynaecology, the Aga Khan University, Karachi, Pakistan
| | - Ricardo Nieto
- Division Neonatología, Hospital Materno Infantil Ramón Sarda, Buenos Aires Argentina
| | - Nerea Maiz
- Obstetrics Department, Hospital Universitari Vall d'Hebron, Barcelona Hospital Campus, Barcelona, Spain
| | - Muhammad Baffah Aminu
- Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | - Rachel Craik
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Adele Winsey
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Gabriela Tavchioska
- Department of Pediatrics, General Hospital Borka Taleski, Prilep, Republic of North Macedonia
| | - Babagana Bako
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Daniel Oros
- Obstetrics Department, Aragon Institute of Health Research, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Albertina Rego
- Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Anne Caroline Benski
- Département de la Femme, de l'Enfant et de l'Adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Fatimah Hassan-Hanga
- Bayero University Kano, Nigeria; Aminu Kano Teaching Hospital, Kano State, Nigeria
| | - Mónica Savorani
- Hospital de Moron, Moron, Provincia de Buenos Aires, Argentina
| | - Francesca Giuliani
- Neonatal Special Care Unit, Regina Margherita Children Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology Bordeaux University Hospital, Bordeaux, France
| | - Milagros Risso
- Servicio de Neonatologia del Departamento Materno Infantil del Hospital Universitario Austral, Pilar, Provincia de Buenos Aires, Argentina
| | - Ken Takahashi
- Department of Obstetrics and Gynecology, the Jikei University School of Medicine, Tokyo, Japan
| | | | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Cetin
- Department of BioMedical and Clinical Sciences, Ospedale Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | | | - Ernawati Ernawati
- Department of Obstetrics and Gynecology, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia; Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eduardo A Duro
- Universidad de Buenos Aires, Buenos Aires, Argentina; Universidad de Moron, Moron, Argentina
| | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology & Perinatology, Moscow, Russia
| | - Michelle L Firlit
- Department of Obstetrics and Gynecology, University of Illinois Hospital and Health Science System, Chicago, IL
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA; Division of Critical Care Medicine, Department of Anesthesia, Perioperative, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Joanna Sichitiu
- Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université de Paris, France
| | | | - Roberto Casale
- Maternal and Child Department, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Rosa Maria Cerbo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Ivo Cavoretto
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Jim G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistana
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - José Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
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Scalise ML, Garimano N, Porporato M, Leonino P, Pereyra A, Ferreiros J, Casale R, Amaral MM, Ibarra C, Sacerdoti F. Presence of Shiga toxin producing Escherichia coli in endocervix of asymptomatic pregnant women from Argentina. Placenta 2021. [DOI: 10.1016/j.placenta.2021.07.125] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Casale R. Capsaicin 179-mg cutaneous patch in the treatment of post-surgical neuropathic pain: a scoping review of current evidence and place in therapy. Expert Rev Neurother 2021; 21:1147-1158. [PMID: 34461799 DOI: 10.1080/14737175.2021.1974842] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The use of topical agents has been suggested for post-surgical neuropathic pain. A high-concentration capsaicin 179-mg cutaneous patch (Qutenza™) is licensed in adults for chronic neuropathic pain in the EU, and neuropathic pain with post-herpetic neuralgia and neuropathic pain with diabetic peripheral neuropathy in the USA. This article aims to describe the use of a topical capsaicin 179-mg cutaneous patch in the treatment of PSNP. AREA COVERED This narrative review presents the relevant clinical aspects of the use of a topical capsaicin 179-mg cutaneous patch for the treatment of post-surgical neuropathic pain (PSNP). Randomized control trials, observational studies, case series, and reports investigating the clinical use of the capsaicin patch were searched through MEDLINE, EMBASE, AMED, Cochrane Library, CINAHL, Web of Science, and ROAD databases. Trials from citation lists of reviewed articles and hand-searching were added. The search concluded in September 2020. 10/20 articles were considered. EXPERT OPINION Some clinical studies demonstrated the efficacy of the capsaicin 179-mg patch in PSNP as monotherapy and concomitant treatment with oral treatments. This topical treatment of PSNP is better tolerated and accepted compared with systemic treatments. To maximize the effectiveness of the treatment, correct administration recommendations should be followed.
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Affiliation(s)
- Roberto Casale
- Opusmedica Persons, Care & Research - PC&R, Piacenza, Italy
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Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, Roggero P, Prefumo F, do Vale MS, Cardona-Perez JA, Maiz N, Cetin I, Savasi V, Deruelle P, Easter SR, Sichitiu J, Soto Conti CP, Ernawati E, Mhatre M, Teji JS, Liu B, Capelli C, Oberto M, Salazar L, Gravett MG, Cavoretto PI, Nachinab VB, Galadanci H, Oros D, Ayede AI, Sentilhes L, Bako B, Savorani M, Cena H, García-May PK, Etuk S, Casale R, Abd-Elsalam S, Ikenoue S, Aminu MB, Vecciarelli C, Duro EA, Usman MA, John-Akinola Y, Nieto R, Ferrazi E, Bhutta ZA, Langer A, Kennedy SH, Papageorghiou AT. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr 2021; 175:817-826. [PMID: 33885740 PMCID: PMC8063132 DOI: 10.1001/jamapediatrics.2021.1050] [Citation(s) in RCA: 723] [Impact Index Per Article: 241.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
Importance Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed. Objective To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals. Design, Setting, and Participants In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. Exposures COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. Main Outcomes and Measures The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity. Results A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were at higher risk for preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43), severe infections (RR, 3.38; 95% CI, 1.63-7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13-8.10), maternal mortality (RR, 22.3; 95% CI, 2.88-172), preterm birth (RR, 1.59; 95% CI, 1.30-1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75). Fever and shortness of breath for any duration was associated with increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69). Asymptomatic women with COVID-19 diagnosis remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00-1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01-2.63). Among women who tested positive (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Cesarean delivery (RR, 2.15; 95% CI, 1.18-3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66-1.85) was associated with increased risk for neonatal test positivity. Conclusions and Relevance In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.
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Affiliation(s)
- José Villar
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Shabina Ariff
- Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Robert B. Gunier
- School of Public Health, University of California, Berkeley, Berkeley
| | | | - Stephen Rauch
- School of Public Health, University of California, Berkeley, Berkeley
| | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Paola Roggero
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Nerea Maiz
- Obstetrics Department, Hospital Universitari Vall d’Hebron, Barcelona Hospital Campus, Barcelona, Spain
| | - Irene Cetin
- Ospedale Vittore Buzzi Children’s Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Valeria Savasi
- Ospedale Luigi Sacco University Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joanna Sichitiu
- Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France
| | | | - Ernawati Ernawati
- Department of Obstetrics and Gynecology, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia
- Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | - Jagjit Singh Teji
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Becky Liu
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Carola Capelli
- Servicio de Neonatologia del Departamento Materno Infantil del Hospital Universitario Austral, Pilar, Provincia de Buenos Aires, Argentina
| | - Manuela Oberto
- S.C. Obstetrics 2U, Sant’Anna Hospital, AOU Città della Salute e della scienza di Torino, Turin, Italy
| | - Laura Salazar
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Michael G. Gravett
- Department of Obstetrics and Gynecology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - Paolo Ivo Cavoretto
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, Milan, Italy
| | | | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, Bayero University Kano, Kano, Nigeria
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Daniel Oros
- Aragon Institute of Health Research, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Adejumoke Idowu Ayede
- College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Babagana Bako
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Mónica Savorani
- Hospital de Moron, Moron, Provincia de Buenos Aires, Argentina
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, University of Pavia, Pavia, Italy
| | | | - Saturday Etuk
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Roberto Casale
- Maternal and Child Department, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Muhammad Baffah Aminu
- Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | - Eduardo A. Duro
- Universidad de Buenos Aires, Buenos Aires, Argentina
- Universidad de Moron, Moron, Argentina
| | - Mustapha Ado Usman
- Department of Obstetrics and Gynaecology, Muhammad Abdullahi Wase Teaching Hospital, Kano State, Nigeria
| | - Yetunde John-Akinola
- College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
| | - Ricardo Nieto
- Division Neonatología, Hospital Materno Infantil Ramón Sarda, Buenos Aires Argentina
| | - Enrico Ferrazi
- Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Zulfiqar A. Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ana Langer
- Women and Health Initiative, Global Health and Population Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stephen H. Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Aris T. Papageorghiou
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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Schanton M, Maymó J, Camisay MF, Pérez-Pérez A, Casale R, Sánchez-Margalet V, Erlejman A, Varone C. Crosstalk between estradiol and NFκB signaling pathways on placental leptin expression. Reproduction 2021; 160:591-602. [PMID: 32698160 DOI: 10.1530/rep-20-0142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/21/2020] [Indexed: 11/08/2022]
Abstract
Pregnancy success requires a proper fetal maternal interaction at the establishment of implantation. Leptin has been described as a multitasking cytokine in pregnancy, particularly in the placenta, where it acts as an autocrine hormone. The expression of leptin in normal trophoblastic cells is regulated by different endogenous signals. We have previously reported that 17β-estradiol upregulates placental leptin expression through genomic and non-genomic mechanisms. To improve the knowledge of estrogen receptor mechanisms in regulating leptin gene expression, we examined transcription nuclear factor kappa B (NFκB) effect on estradiol leptin induction in human BeWo cell line and human term placental explants. We demonstrated that estradiol induction effect on leptin expression is blocked by the inhibition of NFκB signaling. We also found that the overexpression of p65 subunit, the active form of NFκB, induces leptin expression. Moreover, downregulation of estrogen receptor alpha (ERα), through a specific siRNA, abolished NFκB effect on leptin expression. We also demonstrated that ERα enhanced NFκB signaling pathway activation in trophoblastic cells. Estradiol treatment significantly increased p65 expression and phosphorylation of the inhibitory protein κB alpha (IκBα). A reporter plasmid containing NFκB elements was also induced in response to estradiol stimulation. Localization experiments revealed that estradiol treatment induced nuclear localization of overexpressed p65. Moreover, the overexpression of ERα produced a complete displacement of p65 protein to the nucleus. Finally, immunoprecipitation experiments showed the presence of a complex containing ERα and NFκB. All these evidences suggest a cooperative behavior between ERα and NFκB transcription factors to induce leptin transcription.
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Affiliation(s)
- Malena Schanton
- Departamento de Química Biológica, Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina.,Universidad de Buenos Aires, CONICET, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, Argentina
| | - Julieta Maymó
- Departamento de Química Biológica, Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina.,Universidad de Buenos Aires, CONICET, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, Argentina
| | - María Fernanda Camisay
- Departamento de Química Biológica, Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina.,Universidad de Buenos Aires, CONICET, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, Argentina
| | - Antonio Pérez-Pérez
- Departamento de Bioquímica Médica y Biología Molecular, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - Roberto Casale
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Víctor Sánchez-Margalet
- Departamento de Bioquímica Médica y Biología Molecular, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - Alejandra Erlejman
- Departamento de Química Biológica, Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina.,Universidad de Buenos Aires, CONICET, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, Argentina
| | - Cecilia Varone
- Departamento de Química Biológica, Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina.,Universidad de Buenos Aires, CONICET, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, Argentina
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Fundaró C, Gazzoni M, Pinna GD, Dallocchio C, Rainoldi A, Casale R. Is fatigue a muscular phenomenon in Parkinson's disease? Implications for rehabilitation. Eur J Phys Rehabil Med 2021; 57:691-700. [PMID: 33947826 DOI: 10.23736/s1973-9087.21.06621-1] [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
BACKGROUND Fatigue in Parkinson's Disease (PD) compromises patients' physical activity and poses questions on how to plan correct rehabilitation training. In addition, the relationship between subjective perceived fatigue and fatigue in motor performance is not yet entirely understood. As a consequence, a conclusive interpretation of muscular mechanisms of fatigue in PD has not yet been achieved. Among the various instrumental evaluations for fatigue, multichannel surface electromyography (sEMG) is a recognized tool that permits the study of myoelectric manifestations of fatigue. AIM To assess if muscles in PD show a different myoelectric fatigue pattern compared to the muscles of healthy age-matched subjects. DESIGN Observational controlled study. POPULATION Idiopathic Parkinson's Disease, Hohen &Yahr II and III stage, Parkinsonian Fatigue Scale average score ≥ 2.95, no therapy modification in the 4 weeks preceding the study; exclusion criteria: Mini Mental State Examination ≤ 24, upper limb disease/symptoms that might interfere with sEMG analysis, presence of other fatiguerelated conditions. Twenty patients were selected according to these criteria. Twenty untrained healthy subjects were matched. METHODS All subjects underwent a muscle fatigue protocol and a sEMG analysis of the right biceps brachii muscle during electrically stimulated and voluntary contractions in order to obtain a myoelectric fatigue muscular pattern. The myoelectric pattern is characterized by the modifications of the following sEMG variables: reduction of mean frequency and muscle fibre conduction velocity, increase of average rectified value. RESULTS No statistical differences where observed between groups for sEMG variables and muscular electric behaviour in all contraction conditions (all p> .05). CONCLUSIONS Our results show that parkinsonian muscles does not differ from the muscles of healthy age-matched subjects in developing peripheral myoelectric fatigue. Nevertheless, the role of fatigue perception at rest and particularly during physical activity must be clearly understood in order to further target the rehabilitative approach for fatigued parkinsonian patients and to reduce hypomobility. CLINICAL REHABILITATION IMPACT In rehabilitative terms, these findings allow us to highlight the possibility of performing sustained training with isometric contractions in PD subjects; therefore, fatigue "per se" does not constitute a barrier for the execution of muscular exercises, likewise intensive.
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Affiliation(s)
- Cira Fundaró
- Neurophysiopathology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCSS, Pavia, Italy -
| | - Marco Gazzoni
- LISiN, Laboratory of Engineering of Neuromuscular System, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Gian Domenico Pinna
- Department of Biomedical Engineering of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCSS, Pavia, Italy
| | - Carlo Dallocchio
- Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, Pavia, Italy
| | - Alberto Rainoldi
- Department of Medical Sciences, NeuroMuscularFunction Research Group, School of Exercise & Sport Sciences, University of Turin, Turin, Italy
| | - Roberto Casale
- OPUSMedica PC&R, Persons, Care & Research, Piacenza, Italy
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Häuser W, Morlion B, Vowles KE, Bannister K, Buchser E, Casale R, Chenot JF, Chumbley G, Drewes AM, Dom G, Jutila L, O'Brien T, Pogatzki-Zahn E, Rakusa M, Suarez-Serrano C, Tölle T, Krčevski Škvarč N. European* clinical practice recommendations on opioids for chronic noncancer pain - Part 1: Role of opioids in the management of chronic noncancer pain. Eur J Pain 2021; 25:949-968. [PMID: 33655607 PMCID: PMC8248186 DOI: 10.1002/ejp.1736] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Opioid use for chronic non-cancer pain (CNCP) is complex. In the absence of pan-European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC). METHODS The clinical practice recommendations were developed by eight scientific societies and one patient self-help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence-based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case-series, case-control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment. RESULTS The key clinical practice recommendations suggest: (a) first optimizing established non-pharmacological treatments and non-opioid analgesics and (b) considering opioid treatment if established non-pharmacological treatments or non-opioid analgesics are not effective and/or not tolerated and/or contraindicated. Evidence- and clinical consensus-based potential indications and contraindications for opioid treatment are presented. Eighteen GCP recommendations give guidance regarding clinical evaluation, as well as opioid treatment assessment, monitoring, continuation and discontinuation. CONCLUSIONS Opioids remain a treatment option for some selected patients with CNCP under careful surveillance. SIGNIFICANCE In chronic pain, opioids are neither a universal cure nor a universally dangerous weapon. They should only be used for some selected chronic noncancer pain syndromes if established non-pharmacological and pharmacological treatment options have failed in supervised pain patients as part of a comprehensive, multi-modal, multi-disciplinary approach to treatment. In this context alone, opioid therapy can be a useful tool in achieving and maintaining an optimal level of pain control in some patients.
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Affiliation(s)
- Winfried Häuser
- Department Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
| | - Bart Morlion
- Center for Algology & Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Kevin E Vowles
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric Buchser
- Pain Management and Neuromodulation Centre EHC Hospital, Morges, Switzerland
| | - Roberto Casale
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
| | - Jean-François Chenot
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Gillian Chumbley
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Denmark
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerpen, Belgium
| | | | - Tony O'Brien
- College of Medicine & Health, University College Cork, Cork, Republic of Ireland
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster UKM, Munster, Germany
| | - Martin Rakusa
- Department of Neurology, University Medical Centre, Maribor, Slovenia
| | | | - Thomas Tölle
- Department of Neurology, Techhnische Universität München, München, Germany
| | - Nevenka Krčevski Škvarč
- Department of Anesthesiology, Intensive Care and Pain Treatment, Faculty of Medicine of University Maribor, Maribor, Slovenia
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Krčevski Škvarč N, Morlion B, Vowles KE, Bannister K, Buchsner E, Casale R, Chenot JF, Chumbley G, Drewes AM, Dom G, Jutila L, O'Brien T, Pogatzki-Zahn E, Rakusa M, Suarez-Serrano C, Tölle T, Häuser W. European clinical practice recommendations on opioids for chronic noncancer pain - Part 2: Special situations. Eur J Pain 2021; 25:969-985. [PMID: 33655678 DOI: 10.1002/ejp.1744] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Opioid use for chronic non-cancer pain (CNCP) is under debate. In the absence of pan-European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC). METHODS The clinical practice recommendations were developed by eight scientific societies and one patient self-help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence-based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case-series, case-control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment. RESULTS The European Clinical Practice Recommendations give guidance for combination with other medications, the management of frequent (e.g. nausea, constipation) and rare (e.g. hyperalgesia) side effects, for special clinical populations (e.g. children and adolescents, pregnancy) and for special situations (e.g. liver cirrhosis). CONCLUSION If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. SIGNIFICANCE If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. A collaboration of medical specialties and of all health care professionals is needed for some special populations and clinical situations.
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Affiliation(s)
- Nevenka Krčevski Škvarč
- Department of Anesthesiology, Intensive Care and Pain Treatment, Faculty of Medicine of University Maribor, Maribor, Slovenia
| | - Bart Morlion
- Center for Algology & Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Kevin E Vowles
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric Buchsner
- Pain Management and Neuromodulation Centre EHC Hospital, Morges, Switzerland
| | - Roberto Casale
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
| | - Jean-François Chenot
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Gillian Chumbley
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium
| | | | - Tony O'Brien
- College of Medicine & Health, University College Cork, Cork, Republic of Ireland
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster UKM, Munster, Germany
| | - Martin Rakusa
- Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | | | - Thomas Tölle
- Department of Neurology, Techhnische Universität München, München, Germany
| | - Winfried Häuser
- Department Internal Medicine 1, Saarbrücken, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
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Casale R, Lavrova E, Sanduleanu S, Woodruff HC, Lambin P. Development and external validation of a non-invasive molecular status predictor of chromosome 1p/19q co-deletion based on MRI radiomics analysis of Low Grade Glioma patients. Eur J Radiol 2021; 139:109678. [PMID: 33848780 DOI: 10.1016/j.ejrad.2021.109678] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/04/2021] [Accepted: 03/21/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The 1p/19q co-deletion status has been demonstrated to be a prognostic biomarker in lower grade glioma (LGG). The objective of this study was to build a magnetic resonance (MRI)-derived radiomics model to predict the 1p/19q co-deletion status. METHOD 209 pathology-confirmed LGG patients from 2 different datasets from The Cancer Imaging Archive were retrospectively reviewed; one dataset with 159 patients as the training and discovery dataset and the other one with 50 patients as validation dataset. Radiomics features were extracted from T2- and T1-weighted post-contrast MRI resampled data using linear and cubic interpolation methods. For each of the voxel resampling methods a three-step approach was used for feature selection and a random forest (RF) classifier was trained on the training dataset. Model performance was evaluated on training and validation datasets and clinical utility indexes (CUIs) were computed. The distributions and intercorrelation for selected features were analyzed. RESULTS Seven radiomics features were selected from the cubic interpolated features and five from the linear interpolated features on the training dataset. The RF classifier showed similar performance for cubic and linear interpolation methods in the training dataset with accuracies of 0.81 (0.75-0.86) and 0.76 (0.71-0.82) respectively; in the validation dataset the accuracy dropped to 0.72 (0.6-0.82) using cubic interpolation and 0.72 (0.6-0.84) using linear resampling. CUIs showed the model achieved satisfactory negative values (0.605 using cubic interpolation and 0.569 for linear interpolation). CONCLUSIONS MRI has the potential for predicting the 1p/19q status in LGGs. Both cubic and linear interpolation methods showed similar performance in external validation.
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Affiliation(s)
- Roberto Casale
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology, Maastricht University Maastricht, the Netherlands.
| | - Elizaveta Lavrova
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology, Maastricht University Maastricht, the Netherlands
| | - Sebastian Sanduleanu
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology, Maastricht University Maastricht, the Netherlands
| | - Henry C Woodruff
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology, Maastricht University Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology, Maastricht University Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Damiani C, Pournajaf S, Goffredo M, Proietti S, Denza G, Rosa B, Franceschini M, Casale R. Community ambulation in people with lower limb amputation: An observational cohort study. Medicine (Baltimore) 2021; 100:e24364. [PMID: 33546072 PMCID: PMC7837990 DOI: 10.1097/md.0000000000024364] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 12/20/2020] [Indexed: 11/26/2022] Open
Abstract
Lower limb amputation (LLA) is still a health issue requiring rehabilitation and long-term care even in industrial societies. Several studies on subjects with LLA have been focused on the efficacy of rehabilitation and factors influencing the use of prosthesis. However, literature data on the recovery of ability to walk outdoors, and thus to participate in social life in this population is limited.To investigate potential correlations between socio-demographic and clinical factors, and the use of the prosthesis for indoor and/or outdoor walking referred to as community ambulation (CA) in subjects with LLA.An observational cohort study on 687 LLA subjects was conducted. Socio-demographic and clinical characteristics of 302 subjects who received similar rehabilitative treatment with respect to the standard protocol were collected by a telephone survey with a structured questionnaire. The CA recovery, in terms of patient's autonomy and participation, assessed by Walking Handicap Scale, was considered as the main outcome.The univariate analysis demonstrated statistical significant positive correlation between CA and gender (χ2 = 3.901, P = .048); amputation level (χ2 = 24.657, P < .001); pre-LLA (χ2 = 6.338, P = .012) and current work activity (χ2 = 25.192, P < .001); prosthesis use (χ2 = 187.037, P < .01); and time from LLA (r = 0.183, P < .001); increasing age was negatively correlated with the outcome (r = -0.329, P < .001), while pain intensity was not significant. Being male (75.4%); trans-tibial (TT) amputation level (9.79%); working before (3.81%) and after LLA (7.68%); and the prosthesis use (24.63%) increased the probability of CA recovery. Multivariate binary logistic regression analysis confirmed that the prosthesis use (P < .001) and TT amputation level (P = .042) are predictors of a positive outcome (Walking Handicap Scale 4-6).These findings highlight the importance of the use of prosthesis in people with LLA for the restoration of a good capacity of participation (CA), especially in subjects with TT amputation level. The identification of predictive factors may help tailor-made rehabilitation approaches addressing an earlier reintegration to social life.
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Affiliation(s)
- Carlo Damiani
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome
| | - Sanaz Pournajaf
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome
| | - Michela Goffredo
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome
| | | | - Gabriele Denza
- ITOP S.p.A. Orthotic Prosthetic Centre, Palestrina, Rome
| | - Benedetta Rosa
- Opusmedica, Persons Care & Research, Non Profit Organization, Piacenza
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
| | - Roberto Casale
- Opusmedica, Persons Care & Research, Non Profit Organization, Piacenza
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Benincasa G, Schiano C, Infante T, Franzese M, Casale R, Della Mura N, Fiorito C, Mansueto G, Soricelli A, Nicoletti G, Salvatore M, Napoli C. Integrated analysis of DNA methylation profile in HLA-G gene and imaging in coronary heart disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Immune endothelial inflammation, underlie coronary heart disease (CHD) related phenotypes, could provide new insight into the pathobiology of the disease. We investigated DNA methylation level of the unique CpG island of HLA-G gene in CHD patients and evaluated the correlation with cardiac computed tomography angiography (CCTA) features.
Methods
Thirty-two patients that underwent CCTA for suspected CHD were enrolled for this study. Obstructive CHD group included fourteen patients, in which there was a stenosis greater than or equal to 50% in one or more of the major coronary arteries detected; whereas subjects with Calcium (Ca) Score=0, uninjured coronaries and with no obstructive CHD were considered as control subjects (Ctrls) (n=18). For both groups, DNA methylation profile of the whole 5'UTR-CpG island of HLA-G was measured. The plasma soluble HLA-G (sHLA-G) levels were detected in all subjects by specific ELISA assay. Statistical analysis was performed using R software.
Results
For the first time, our study reported that 1) a significant hypomethylation characterized three specific fragments (B, C and F) of the 5'UTR-CpG island (p=0.05) of HLA-G gene in CHD patients compared to Ctrl group; 2) hypomethylation level of one specific fragment positively correlated with coronary Ca score, a relevant parameter of CCTA (p<0.05) between two groups.
Conclusions
Our results showed that reduced levels of circulating HLA-G molecules could derive from epigenetic marks inducing hypomethylation of specific regions into 5'UTR-CpG island of HLA-G gene in CHD patients with obstructive coronary stenosis vs non critical stenosis group.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Italian Minister of Health
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Affiliation(s)
- G Benincasa
- University della Campania Luigi Vanvitelli, Naples, Italy
| | - C Schiano
- University della Campania Luigi Vanvitelli, Naples, Italy
| | - T Infante
- University della Campania Luigi Vanvitelli, Naples, Italy
| | | | | | | | - C Fiorito
- University della Campania Luigi Vanvitelli, Naples, Italy
| | - G Mansueto
- University della Campania Luigi Vanvitelli, Naples, Italy
| | - A Soricelli
- University of Naples “Parthenope”, Naples, Italy
| | - G.F Nicoletti
- University della Campania Luigi Vanvitelli, Naples, Italy
| | | | - C Napoli
- University della Campania Luigi Vanvitelli, Naples, Italy
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Guggino G, Schinocca C, Lo Pizzo M, Di Liberto D, Garbo D, Raimondo S, Alessandro R, Brighina F, Ruscitti P, Giacomelli R, Sireci G, Triolo G, Casale R, Sarzi-Puttini P, Dieli F. T helper 1 response is correlated with widespread pain, fatigue, sleeping disorders and the quality of life in patients with fibromyalgia and is modulated by hyperbaric oxygen therapy. Clin Exp Rheumatol 2020; 38:1275. [PMID: 33275092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Giuliana Guggino
- Dipartimento Biomedico di Medicina Interna e Specialistica, Sezione di Reumatologia, Università di Palermo, Italy.
| | - Claudia Schinocca
- Dipartimento Biomedico di Medicina Interna e Specialistica, Sezione di Reumatologia, Università di Palermo, Italy
| | - Marianna Lo Pizzo
- Dipartimento di Biopatologia e Biotecnologie Mediche, Università di Palermo, Italy
| | - Diana Di Liberto
- Dipartimento di Biopatologia e Biotecnologie Mediche, Università di Palermo, Italy
| | - Domenico Garbo
- Unità di Medicina Iperbarica, Policlinico P. Giaccone, Palermo, Italy
| | - Stefania Raimondo
- Dipartimento di Biopatologia e Biotecnologie Mediche, Università di Palermo, Italy
| | - Riccardo Alessandro
- Dipartimento di Biopatologia e Biotecnologie Mediche, Università di Palermo, Italy
| | - Filippo Brighina
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Italy
| | - Roberto Giacomelli
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Italy
| | - Guido Sireci
- Dipartimento di Biopatologia e Biotecnologie Mediche, Università di Palermo, Italy
| | - Giovanni Triolo
- Dipartimento Biomedico di Medicina Interna e Specialistica, Sezione di Reumatologia, Università di Palermo, Italy
| | - Roberto Casale
- OPUSmedica, PC & R, Persons, Care & Research Network, Piacenza, Italy
| | | | - Francesco Dieli
- Dipartimento di Biopatologia e Biotecnologie Mediche, Università di Palermo, Italy
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Avvantaggiato C, Casale R, Cinone N, Facciorusso S, Turitto A, Stuppiello L, Picelli A, Ranieri M, Intiso D, Fiore P, Ciritella C, Santamato A. Localized muscle vibration in the treatment of motor impairment and spasticity in post-stroke patients: a systematic review. Eur J Phys Rehabil Med 2020; 57:44-60. [PMID: 33111513 DOI: 10.23736/s1973-9087.20.06390-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION During the last decades, many studies have been carried out to understand the possible positive effects of vibration therapy in post-stroke rehabilitation. In particular, the use of localized muscle vibration (LMV) seems to have promising results. The aim of this systematic review was to describe the use of LMV in post-stroke patients to improve motor recovery, reducing spasticity and disability in both upper and lower limb. EVIDENCE ACQUISITION A search was conducted on PubMed, Scopus, Pedro and REHABDATA electronic database. Only randomized controlled trials have been included, excluding no-localized vibratory treatments and other pathological conditions. Fourteen studies met the inclusion criteria and were included in this review. EVIDENCE SYNTHESIS Collectively, the studies involved 425 stroke patients. Most studies included chronic stroke patients (ten) and treated only the upper limb (eleven). There is evidence that LMV therapy is effective in reducing spasticity and improving motor recovery, especially when associated with conventional physical therapy. CONCLUSIONS LMV may be a feasible and safe tool to be integrated into traditional and conventional neurorehabilitation programs for post-stroke patients to reduce spasticity. Analysis of the available clinical trials do not allow us to indicate vibration therapy as effective in functional motor recovery, despite some studies showed encouraging results. Further studies, with larger size of homogeneous patients and with a shared methodology are needed to produce more reliable data, especially on the lower limb.
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Affiliation(s)
- Christian Avvantaggiato
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy.,Istituti Clinici Scientifici Maugeri, IRCCS Institute of Bari, Bari, Italy
| | - Roberto Casale
- OPUS Medica Persons, Care and Research (PC&R), Piacenza, Italy
| | - Nicoletta Cinone
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy
| | - Salvatore Facciorusso
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy
| | - Antonio Turitto
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy
| | - Lucia Stuppiello
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
| | - Maurizio Ranieri
- Department of Basic Sciences, Neuroscience and Sense Organs, Aldo Moro University, Bari, Italy
| | - Domenico Intiso
- Department of Neuro-Rehabilitation IRCCS, Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Pietro Fiore
- Istituti Clinici Scientifici Maugeri, IRCCS Institute of Bari, Bari, Italy.,Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Chiara Ciritella
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy
| | - Andrea Santamato
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy -
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Hermans BCM, Sanduleanu S, Derks JL, Woodruff H, Hillen LM, Casale R, Hoesein FM, de Jong E, Berge DMHJT, Speel EJM, Lambin P, Gietema HA, Dingemans AMC. Exploring imaging features of molecular subtypes of large cell neuroendocrine carcinoma (LCNEC). Lung Cancer 2020; 148:94-99. [PMID: 32858338 DOI: 10.1016/j.lungcan.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Radiological characteristics and radiomics signatures can aid in differentiation between small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC). We investigated whether molecular subtypes of large cell neuroendocrine carcinoma (LCNEC), i.e. SCLC-like (with pRb loss) vs. NSCLC-like (with pRb expression), can be distinguished by imaging based on (1) imaging interpretation, (2) semantic features, and/or (3) a radiomics signature, designed to differentiate between SCLC and NSCLC. MATERIALS AND METHODS Pulmonary oncologists and chest radiologists assessed chest CT-scans of 44 LCNEC patients for 'small cell-like' or 'non-small cell-like' appearance. The radiologists also scored semantic features of 50 LCNEC scans. Finally, a radiomics signature was trained on a dataset containing 48 SCLC and 76 NSCLC scans and validated on an external set of 58 SCLC and 40 NSCLC scans. This signature was applied on scans of 28 SCLC-like and 8 NSCLC-like LCNEC patients. RESULTS Pulmonary oncologists and radiologists were unable to differentiate between molecular subtypes of LCNEC and no significant differences in semantic features were found. The area under the receiver operating characteristics curve of the radiomics signature in the validation set (SCLC vs. NSCLC) was 0.84 (95% confidence interval (CI) 0.77-0.92) and 0.58 (95% CI 0.29-0.86) in the LCNEC dataset (SCLC-like vs. NSCLC-like). CONCLUSION LCNEC appears to have radiological characteristics of both SCLC and NSCLC, irrespective of pRb loss, compatible with the SCLC-like subtype. Imaging interpretation, semantic features and our radiomics signature designed to differentiate between SCLC and NSCLC were unable to separate molecular LCNEC subtypes, which underscores that LCNEC is a unique disease.
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Affiliation(s)
- B C M Hermans
- Department of Pulmonary Diseases, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - S Sanduleanu
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - J L Derks
- Department of Pulmonary Diseases, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - H Woodruff
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - L M Hillen
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Pathology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - R Casale
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - F Mohamed Hoesein
- Department of Radiology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
| | - E de Jong
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - D M H J Ten Berge
- Department of Radiology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Pulmonology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - E J M Speel
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Pathology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - P Lambin
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - H A Gietema
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - A-M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Pulmonology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
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Digiacomo F, Tamburin S, Tebaldi S, Pezzani M, Tagliafierro M, Casale R, Bartolo M. Improvement of motor performance in children with cerebral palsy treated with exoskeleton robotic training: A retrospective explorative analysis. Restor Neurol Neurosci 2020; 38:185. [PMID: 32333565 DOI: 10.3233/rnn-200001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Picarelli A, Borghini R, Marino M, Casale R, Di Tola M, Lubrano C, Piermattei A, Gualdi G, Bella A, Donato G, Masselli G. Visceral and subcutaneous adipose tissue as markers of local and systemic inflammation: a comparison between celiac and obese patients using MRI. Tech Coloproctol 2020; 24:553-562. [PMID: 32112244 DOI: 10.1007/s10151-020-02173-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 02/08/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Celiac disease (CD) is a systemic inflammatory disease, which primarily affects the gastrointestinal tract. It has been recently demonstrated that adipose-tissue infiltration by proinflammatory immune cells causes a chronic low-grade inflammation in obese patients. Magnetic resonance imaging (MRI) has already proved to be useful in evaluation of inflammatory states. The aim of the present study was to determine whether alterations of visceral and subcutaneous adipose tissue, identified with MRI, could serve as markers of local and systemic inflammation in patients with CD. METHODS A pilot study was conducted comparing alterations in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in CD patients vs obese patients and healthy controls. Fifty patients were enrolled and assigned to one of the following groups: Group A: 11 active CD patients; Group B: 11 CD patients in remission; Group C: 16 obese patients; Group D: 12 healthy controls. A 3-T MRI unit was used and T2-weighted TSE images of VAT and SAT were obtained in specific regions of interest. Serum cytokine concentrations (TNF-α, IL-6, adiponectin, leptin, IL-2, IFN-γ) were determined. RESULTS There was a significant difference in VAT T2 relaxation time between Group A and B (p < 0.001), A and D (p < 0.01), B and C (p < 0.001). There was a statistically significant difference in SAT T2 relaxation time between Group A and B (p < 0.001), A and C (p < 0.05), A and D (p < 0.001), B and C (p < 0.01). In addition, VAT/SAT T2 relaxation time ratio showed a statistically significant difference between Group A and C (p < 0.05) and between Group B and C (p < 0.01). Only TNF-α and IL-6 significantly correlated with both VAT and VAT/SAT ratio in active CD. CONCLUSIONS MRI showed similar increased visceral inflammatory signals in patients with active CD and obese patients. However, subcutaneous inflammatory signals were higher in active CD than in all the other groups. These data show that there is a systemic inflammatory state in active CD, whereas chronic inflammation appears confined to VAT in obesity. These data were only partially confirmed by serological cytokine profiles, which showed less specificity than MRI.
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Affiliation(s)
- A Picarelli
- Department of Translational and Precision Medicine, Gastroenterology Unit, Policlinico Umberto I, Sapienza University, Viale del Policlinico, 155, 00161, Rome, Italy
| | - R Borghini
- Department of Translational and Precision Medicine, Gastroenterology Unit, Policlinico Umberto I, Sapienza University, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - M Marino
- Department of Translational and Precision Medicine, Gastroenterology Unit, Policlinico Umberto I, Sapienza University, Viale del Policlinico, 155, 00161, Rome, Italy
| | - R Casale
- Department of Translational and Precision Medicine, Gastroenterology Unit, Policlinico Umberto I, Sapienza University, Viale del Policlinico, 155, 00161, Rome, Italy
| | - M Di Tola
- Department of Translational and Precision Medicine, Gastroenterology Unit, Policlinico Umberto I, Sapienza University, Viale del Policlinico, 155, 00161, Rome, Italy
| | - C Lubrano
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Piermattei
- Department of Surgical Sciences, "F. Durante" Section, Sapienza University, Rome, Italy
| | - G Gualdi
- Department of Radiology, Sapienza University, Rome, Italy
| | - A Bella
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - G Donato
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - G Masselli
- Department of Radiology, Sapienza University, Rome, Italy
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Fundarò C, Cavalieri C, Pinna GD, Giardini A, Mancini F, Casale R. Upper Limb Interactive Weightless Technology-Aided Intervention and Assessment Picks Out Motor Skills Improvement in Parkinson's Disease: A Pilot Study. Front Neurol 2020; 11:40. [PMID: 32117009 PMCID: PMC7033477 DOI: 10.3389/fneur.2020.00040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/13/2020] [Indexed: 11/18/2022] Open
Abstract
Background: In Parkinson's disease, reaching movements are conditioned by motor planning and execution deficiency. Recently, rehabilitation, aided by high technological devices, was employed for Parkinson's disease. Objective: We aimed to (1) investigate the changes in the upper limb motor performances in a sample of a patient with Parkinson's disease after a weightless training, with a passive exoskeleton, in an augmented-feedback environment; (2) highlight differences by motor parameters (performance, speed, and movement accuracy) and by type of movement (simple or complex); and (3) evaluate movement improvements by UPDRS II–III. Methods: Observational pilot study. Twenty right-handed patients with Parkinson's disease, Hohen and Yahr 2, Mini Mental State Examination ≥24 were evaluated. All patients underwent 5 day/week sessions for 4 weeks, 30 min for each arm; the training was performed with 12 exercises (single and multi-joints, horizontal and vertical movements). All the patients were assessed by UPDRS II–III and the evaluation tests provided by the device's software: a simple movement, the vertical capture, and a complex movement, the horizontal capture. For each test, we analyzed reached target percentage, movement execution time, and accuracy. Results: After training, a significant improvement of accuracy and speed for simple movement on the dominant arm, of reached targets and speed for complex movement on both sides were shown. UPDRS II and III improved significantly after training. Conclusions: In our study, a motor training aided by a high technological device improves motor parameters and highlights differences between the type of movement (simple or complex) and movement parameters (speed and accuracy) in a sample of patients with Parkinson's disease.
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Affiliation(s)
- Cira Fundarò
- Neurophysiopathology Unit, Istituti Clinici Scientifici Maugeri, IRCSS, Montescano, Italy
| | - Carlo Cavalieri
- Neuromotory Rehabilitation Unit 1, Istituti Clinici Scientifici Maugeri, IRCSS, Montescano, Italy
| | - Gian Domenico Pinna
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri, IRCSS, Montescano, Italy
| | - Anna Giardini
- Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCSS, Montescano, Italy
| | - Francesca Mancini
- U. O. Neurologia-Stroke Unit e Laboratorio di Neuroscienze, Istituto Auxologico, IRCCS, Milan, Italy
| | - Roberto Casale
- OPUSMedica PC&R, Persons, Care and Research, Piacenza, Italy
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Miceli I, Borda ME, Casale R, Ferreirós A. [Maternal mortality. Hospital Profesor Alejandro Posadas, Buenos Aires. Evolution 2003-2015]. Medicina (B Aires) 2020; 80:117-126. [PMID: 32282316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
We reviewed the medical records of women with maternal death reported from August 2003 to December 2015 in the Posadas Hospital (Buenos Aires Province, Argentina), and calculated indexes, trends and years of potential life lost. A total of 52 cases fulfilled the criteria of maternal death. The information provided by death certificates was meager. Two deaths were incidental: one occurred post-caesarean section and was caused by fat embolism following liquid silicone breast injection, and the other was the consequence of femicide which involved also the 24-week fetus. Of the remaining 50 cases, 11 were late deaths (> 42 days postpartum). In 39 women, death occurred during pregnancy, childbirth, or puerperium up to 42 days: 20 were due to direct obstetric causes, and 18 to indirect, non-obstetric causes, the cause of the remaining death was not determined. The most frequent cause was septic abortion. Direct maternal deaths had had more than twice pregnancies, thrice caesarean sections, and orphaned twice as children as indirect deaths. Death caused by placenta accreta was directly related to the number of previous caesarean sections. Throughout the period, maternal mortality index varied between 25 y 150 (mean: 72) per 100 000 live births with ascending trend and 1576 years of potential life were lost. The study exposes the need to improve the death registration system and, most importantly, strengthen prevention and assistance measures to reduce maternal mortality in the area of influence of our hospital.
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Affiliation(s)
- Isabel Miceli
- Sector Epidemiología, área Programática, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Provincia de Buenos Aires, Argentina
| | - María Elena Borda
- Sector Epidemiología, área Programática, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Provincia de Buenos Aires, Argentina. E-mail:
| | - Roberto Casale
- Departamento de Maternidad e Infancia, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Provincia de Buenos Aires, Argentina
| | - Alberto Ferreirós
- Servicio de Obstetricia, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Provincia de Buenos Aires, Argentina
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Schanton M, Camisay MF, Pérez-Pérez A, Maskin B, Casale R, Margalet VS, Erlejman A, Varone C. Crosstalk between ERα and NFκB transcription factors on E2 induced leptin expression in placental cells. Placenta 2019. [DOI: 10.1016/j.placenta.2019.06.109] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Riedel R, Perez AP, Jaime M, Parolini O, Casale R, Dueñas J, Margalet VS, Varone C, Maymó J. Amniotic epithelial stem cells: Signalling pathways activated during their hepatic differentiation and proliferation. Placenta 2019. [DOI: 10.1016/j.placenta.2019.06.191] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Scalise M, Leonino P, Pereyra A, Casale R, Ferreiros JA, Sacerdoti F, Ibarra C. Cervico-vaginal carriage rate of Escherichia coli in pregnant women receiving antenatal control in a public hospital of Buenos Aires. Placenta 2019. [DOI: 10.1016/j.placenta.2019.06.288] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Colombo P, Taveggia G, Chiesa D, Penati R, Tiboni M, De Armas L, Casale R. Lower Tinetti scores can support an early diagnosis of spatial neglect in post-stroke patients. Eur J Phys Rehabil Med 2019; 55:722-727. [PMID: 31274273 DOI: 10.23736/s1973-9087.19.05448-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
BACKGROUND Neglect represents a severe complication of stroke, which impairs patients' daily activities. An early diagnosis of neglect is fundamental for management decisions. AIM The aim of this study is to evaluate the usefulness of the Tinetti Test as an outcome of spatial neglect in post-stroke patients. DESIGN Observational retrospective data analysis. SETTING Rehabilitation Hospital. POPULATION Cohort of post-stroke adults admitted in our Rehabilitation Unit. METHODS One hundred and sixty stroke patients were evaluated between the 1st of January 2015 and the 31st of December 2016 at our Department. Eighty-nine inpatients matched the inclusion criteria. Their scores of the Tinetti Test for balance condition and gait function were compared with Bells Test and line bisection task for spatial neglect. Global independence activity was also assessed using Barthel Index and global cognitive functioning by means of the Mini-Mental State Examination. RESULTS Twenty-two patients between the 89 patients included in this study were affected by spatial neglect at admission. A high statistical significant correlation was observed between lower Tinetti scores and neglect presence (mean Tinetti Score: 2.36 neglect; 7.82 non-neglect; P<0.001). CONCLUSIONS The Tinetti Test is a well-established assessment scale to measure balance ability and gait function in post-stroke patients. Results from this study suggest that Tinetti Test may be considered as an early ecological screening tool for the diagnosis of neglect in post-stroke patients. CLINICAL REHABILITATION IMPACT The alternative use of the Tinetti Test for the diagnosis of spatial neglect.
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Affiliation(s)
- Paola Colombo
- Unit of Rehabilitation, Faccanoni Hospital, Habilita Care&Research Hospitals, Sarnico, Bergamo, Italy
| | - Giovanni Taveggia
- Unit of Rehabilitation, Faccanoni Hospital, Habilita Care&Research Hospitals, Sarnico, Bergamo, Italy
| | - Deborah Chiesa
- Unit of Rehabilitation, Faccanoni Hospital, Habilita Care&Research Hospitals, Sarnico, Bergamo, Italy -
| | - Rachele Penati
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Monica Tiboni
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Liala De Armas
- Unit of Rehabilitation, Faccanoni Hospital, Habilita Care&Research Hospitals, Sarnico, Bergamo, Italy
| | - Roberto Casale
- Istituto di Neuroriabilitazione ad Alta Complessità, Habilita Care&Research Hospitals, Zingonia di Ciserano, Bergamo, Italy
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Fundarò C, Maestri R, Ferriero G, Chimento P, Taveggia G, Casale R. Self-selected speed gait training in Parkinson's disease: robot-assisted gait training with virtual reality versus gait training on the ground. Eur J Phys Rehabil Med 2019; 55:456-462. [DOI: 10.23736/s1973-9087.18.05368-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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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Casale R, Fundar C, Symeionidou Z, Furnari A, Taiocchi N, Galandra C. 100 Hz Localized vibration increases ipsilateral cerebellar areas activity during a motor task in healthy subjects: Three Cases Report. G Ital Med Lav Ergon 2019; 41:255-259. [PMID: 31242356] [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] [Received: 09/01/2017] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
Background and Purpose. The exact mechanism thought which Localized vibration (LV) acts on the motor system at the suprasegmental level is still poorly understood. In this paper we have reported three cases of healthy men exposed to 100 Hz localized vibration during a motor task. Case Description. This case report describes 3 healthy men (age 23 years). Outcomes. During fMRI participants were engaged in a right-hand self-paced finger tapping (FT) task, with and without a 100 Hz LV of the right hand. After standard images preprocessing and normalization, a fix-effect GLM analysis was used to test the effect of vibratory stimulation on motor network. A bilateral activation, greater in the left hemisphere than in the right one, in the frontal premotor and supplementary motor areas (SMA), central gyrus (M1), postcentral gyrus, was found without any statistical significance between conditions. Activation in the left lenticular nucleus and thalamus was also found without differences between conditions. When using the FT activation map as a mask, the analysis showed that only the right cerebellum correlate positively with the vibratory stimulation. Discussion. Using fMR a localized vibratory stimulus was found to significantly increase the activity in homo-lateral motor cerebellar areas during a motor task. This finding aims to trigger new studies on how a LV can influence motor recovery in neurorehabilitation and to (re) consider the role of cerebellum in the rehabilitation strategy.
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Affiliation(s)
- Roberto Casale
- Pain Rehabilitation Units, Habilita Care and Research Hospitals, Zingonia (BG), Italy
| | - Cira Fundar
- Neurophysiopatology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano (PV) Italy
| | - Zaira Symeionidou
- Pain Rehabilitation Units, Habilita Care and Research Hospitals, Zingonia (BG), Italy
- European Federation of Pain - EFIC Fellowship
| | - Anna Furnari
- Neurorehabilitation Unit, Habilita Care and Research Hospitals, Zingonia (BG), Italy
| | - Nicola Taiocchi
- Neurorehabilitation Unit, Habilita Care and Research Hospitals, Zingonia (BG), Italy
| | - Caterina Galandra
- Neuroradiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Pavia (PV), Italy
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Digiacomo F, Tamburin S, Tebaldi S, Pezzani M, Tagliafierro M, Casale R, Bartolo M. Improvement of motor performance in children with cerebral palsy treated with exoskeleton robotic training: A retrospective explorative analysis1. Restor Neurol Neurosci 2019; 37:239-244. [DOI: 10.3233/rnn-180897] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Fabio Digiacomo
- Department of Rehabilitation, Pediatric Neurorehabilitation Unit, Habilita, Zingonia (Bergamo), Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tebaldi
- Department of Rehabilitation, Pediatric Neurorehabilitation Unit, Habilita, Zingonia (Bergamo), Italy
| | - Marco Pezzani
- Department of Rehabilitation, Pediatric Neurorehabilitation Unit, Habilita, Zingonia (Bergamo), Italy
| | - Mario Tagliafierro
- Department of Rehabilitation, Pediatric Neurorehabilitation Unit, Habilita, Zingonia (Bergamo), Italy
| | - Roberto Casale
- Scientific Direction, Habilita, Zingonia (Bergamo), Italy
| | - Michelangelo Bartolo
- Department of Rehabilitation, Pediatric Neurorehabilitation Unit, Habilita, Zingonia (Bergamo), Italy
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Symeonidou Z, Theodoraki K, Chalkias A, Argyra E, Casale R. Critical Illness Polyneuropathy (CIP): a multicenter study on functional outcome. G Ital Med Lav Ergon 2019; 41:58-64. [PMID: 30946550] [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] [Received: 12/20/2016] [Accepted: 03/31/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To describe the functional recovery of consecutive inpatients with Critical Illness Polyneuropathy (CIP) at the time-point of the discharge from rehabilitation units according to Barthel Index scores. To examine whether age, gender, pre-ICU admission diagnosis, tracheostomy performance, heterotopic ossification development and duration of neuro-rehabilitation treatment are among the prognostic factors that can predict the functional outcome in studied patients. METHODS A retrospective observational clinical study from January 2010 to December 2014 in three rehabilitation units in Greece. RESULTS Sixteen subjects (57.1%) had >60 BI discharge scores, showing a prospect in gaining further independence. Females presented a tendency for better functional outcome vs males (73.8 ± 12.6 vs 58.6 ± 23.4, p=0.082). Respiratory, septic and neurologic patients demonstrated better rates of functional improvement after the rehabilitation process vs cardiac patients (p minor than 0.001, p=0.009 and p=0.019, respectively vs p=0,072). Heterotopic ossification development proved to be an adverse independent prognostic factor of functional outcome (47.8 ± 25.7 vs 68.8 ± 17.7, p=0.023). CONCLUSIONS A proportion of included patients experienced severe disability with poor prospect of further functional development and return to work at the discharge from the rehabilitation units. According to the present study, which is the first that focuses only on CIP and its outcome, specific prognostic factors can be defined. Our results can be used as pilot data for larger studies, so that firmer conclusions can be drawn.
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Affiliation(s)
- Zaira Symeonidou
- Department of Physical Medicine and Rehabilitation, General Hospital of Attica "KAT", 14561 Athens, Greece
- Department of High Technology Rehabilitation and Pain Rehabilitation Unit, Habilita Care and Research Hospitals, Zingonia di Ciserano (BG), Italy
| | - Kassiani Theodoraki
- Department of Anesthesiology, Pain Relief and Palliative Care, Aretaieion University Hospital, University of Athens, 11528 Athens, Greece
| | - Athanasios Chalkias
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | - Erifili Argyra
- Department of Anesthesiology, Pain Relief and Palliative Care, Aretaieion University Hospital, University of Athens, 11528 Athens, Greece
| | - Roberto Casale
- Department of High Technology Rehabilitation and Pain Rehabilitation Unit, Habilita Care and Research Hospitals, Zingonia di Ciserano (BG), Italy
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Atzeni F, Talotta R, Masala IF, Gerardi MC, Casale R, Sarzi-Puttini P. Central nervous system involvement in rheumatoid arthritis patients and the potential implications of using biological agents. Best Pract Res Clin Rheumatol 2019; 32:500-510. [PMID: 31174819 DOI: 10.1016/j.berh.2019.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Central nervous system (CNS) involvement is quite unusual in patients with rheumatoid arthritis (RA), although cerebral vasculitis, rheumatoid nodules and meningitis have all been reported, and patients with RA may also have CNS comorbidities such as stroke and neuro-degenerative and demyelinating syndromes. It has been found that biological drugs, especially anti-tumour necrosis factor-alpha (anti-TNF-α) drugs, slightly increase the risk of developing demyelinating diseases, and they are consequently discouraged in patients with multiple sclerosis and related disorders. Furthermore, the risk of opportunistic CNS infections is increased in immunosuppressed patients. To review the current literature concerning CNS involvement in patients with RA (including RA-related forms and comorbidities) and the incidence of new-onset CNS diseases in patients with RA undergoing biological treatment (anti-TNF or non-anti-TNF drugs), the Medline database was searched using the key words 'rheumatoid arthritis', 'central nervous system', 'anti-TNF', 'abatacept', 'tocilizumab', 'rituximab' and 'anakinra'. Abstracts not in English were excluded. We selected 76 articles published between 1989 and 2017, which were divided into four groups on the basis of whether CNS involvement was RA-related or not and according to the type of biological agent used (TNF inhibitors or other agents). The RA-related diseases included aseptic meningitis, vasculitis and cerebral rheumatoid nodules, which benefit from immunosuppressive treatments. CNS comorbidities included stroke, seizures, dementia and neuropsychiatric disorders, which have been frequently described in biological agent-naïve patients with RA, and other rarely reported neurological diseases, such as extra-pyramidal syndromes and demyelinating disorders. CNS comorbidities are relatively frequent among patients with RA and may be related to systemic inflammation or concomitant medications. The use of anti-TNF drugs is associated with the risk of developing demyelinating diseases, and CNS infections have been described in patients treated with anti-TNF and non-anti-TNF agents. Non-anti-TNF drugs may be preferred in the case of demyelinating diseases, cerebral vasculitis or neurolupus. Patients with RA may suffer from CNS involvement as a manifestation of RA or as a comorbidity. The treatment of such medical conditions should be guided on the basis of their etiopathogenesis: steroids and immunosuppressants are useful in the case of RA-related CNS diseases but are often detrimental in other situations. Similarly, the choice of biological agents in patients with RA with CNS complications should be guided by a correct diagnosis in order to prevent further complications.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Rossella Talotta
- Post-graduate School of Pharmacology and Clinical Toxicology, University of Milan, Piazza Ospedale Maggiore 3, 20152, Milano, Italy.
| | - Ignazio Francesco Masala
- Orthopedic and Trauma Unit, Santissima Trinità Hospital, Via Is Mirrionis 92, 09121, Cagliari, Italy.
| | - Maria Chiara Gerardi
- Rheumatology Unit, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Roberto Casale
- Habilita Hospitals & Research Rehabilitation Unit, Bergamo, Zingonia, Italy.
| | - Piercarlo Sarzi-Puttini
- Department of Rheumatology, University Hospital ASST-Fatebenefratelli-Sacco, Via GB Grassi 74, 20157, Milano, Italy.
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