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Arnaldi D, Mattioli P, Pardini M, Morbelli S, Capriglia E, Rubino A, Rustioni V, Terzaghi M, Casaglia E, Serra A, Figorilli M, Liguori C, Fernandes M, Placidi F, Baldelli L, Provini F, Ferini-Strambi L, Marelli S, Plazzi G, Antelmi E, Brunetti V, Bonanni E, Puligheddu M. Clinical and dopaminergic imaging characteristics of the FARPRESTO cohort of trial-ready idiopathic rapid eye movement sleep behavior patients. Eur J Neurol 2023; 30:3703-3710. [PMID: 37498611 DOI: 10.1111/ene.16001] [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: 05/24/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Idiopathic/isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is considered the prodromal stage of alpha-synucleinopathies. Thus, iRBD patients are the ideal target for disease-modifying therapy. The risk FActoRs PREdictive of phenoconversion in iRBD Italian STudy (FARPRESTO) is an ongoing Italian database aimed at identifying risk factors of phenoconversion, and eventually to ease clinical trial enrollment of well-characterized subjects. METHODS Polysomnography-confirmed iRBD patients were retrospectively and prospectively enrolled. Baseline harmonized clinical and nigrostriatal functioning data were collected at baseline. Nigrostriatal functioning was evaluated by dopamine transporter-single-photon emission computed tomography (DaT-SPECT) and categorized with visual semi-quantification. Longitudinal data were evaluated to assess phenoconversion. Cox regressions were applied to calculate hazard ratios. RESULTS 365 patients were enrolled, and 289 patients with follow-up (age 67.7 ± 7.3 years, 237 males, mean follow-up 40 ± 37 months) were included in this study. At follow-up, 97 iRBD patients (33.6%) phenoconverted to an overt synucleinopathy. Older age, motor and cognitive impairment, constipation, urinary and sexual dysfunction, depression, and visual semi-quantification of nigrostriatal functioning predicted phenoconversion. The remaining 268 patients are in follow-up within the FARPRESTO project. CONCLUSIONS Clinical data (older age, motor and cognitive impairment, constipation, urinary and sexual dysfunction, depression) predicted phenoconversion in this multicenter, longitudinal, observational study. A standardized visual approach for semi-quantification of DaT-SPECT is proposed as a practical risk factor for phenoconversion in iRBD patients. Of note, non-converted and newly diagnosed iRBD patients, who represent a trial-ready cohort for upcoming disease-modification trials, are currently being enrolled and followed in the FARPRESTO study. New data are expected to allow better risk characterization.
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Affiliation(s)
- Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical Neurology, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Mattioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical Neurology, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical Neurology, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Elena Capriglia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Annalisa Rubino
- Unit of Sleep Medicine and Epilepsy, Mondino Foundation IRCCS, Pavia, Italy
| | - Valter Rustioni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Michele Terzaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Sleep Medicine and Epilepsy, Mondino Foundation IRCCS, Pavia, Italy
| | - Elisa Casaglia
- Department of Medical Science and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Alessandra Serra
- Nuclear Medicine Unit, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Michela Figorilli
- Department of Medical Science and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Claudio Liguori
- Sleep Medicine Center, University Hospital of Rome Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Placidi
- Sleep Medicine Center, University Hospital of Rome Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Division of Neuroscience, Università Vita-Salute San Raffaele, Milan, Italy
| | - Sara Marelli
- Sleep Disorders Center, Division of Neuroscience, Università Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Antelmi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Valerio Brunetti
- UOC di Neurologia - Dipartimento di Neuroscienze, Organi di Senso e Torace - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrica Bonanni
- Sleep Disorder Center, Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Monica Puligheddu
- Department of Medical Science and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
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Whittaker H, Nordon C, Rubino A, Morris T, Xu Y, De Nigris E, Müllerová H, Quint JK. Frequency and severity of respiratory infections prior to COPD diagnosis and risk of subsequent postdiagnosis COPD exacerbations and mortality: EXACOS-UK health care data study. Thorax 2023; 78:760-766. [PMID: 36316117 PMCID: PMC10359568 DOI: 10.1136/thorax-2022-219039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/12/2022] [Accepted: 09/10/2022] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Little is known about how lower respiratory tract infections (LRTIs) before chronic obstructive pulmonary disease (COPD) are associated with future exacerbations and mortality. We investigated this association in patients with COPD in England. METHODS Clinical Practice Research Datalink Aurum, Hospital Episode Statistics and Office of National Statistics data were used. Start of follow-up was patient's first ever COPD diagnosis date and a 1-year baseline period prior to start of follow-up was used to find mild LRTIs (general practice (GP) events/no antibiotics), moderate LRTIs (GP events+antibiotics) and severe LRTIs (hospitalised). Patients were categorised as having: none, 1 mild only, 2+ mild only, 1 moderate, 2+ moderate and 1+ severe. Negative binomial regression modelled the association between baseline LRTIs and subsequent COPD exacerbations and Cox proportional hazard regression was used to investigate mortality. RESULTS In 215 234 patients with COPD, increasing frequency and severity of mild and moderate LRTIs were associated with increased rates of subsequent exacerbations compared with no recorded LRTIs (1 mild adjusted IRR 1.16, 95% CI 1.14 to 1.18, 2+ mild IRR 1.51, 95% CI 1.46 to 1.55, 1 moderate IRR 1.81, 95% CI 1.78 to 1.85, 2+ moderate IRR 2.55, 95% CI 2.48 to 2.63). Patients with 1+ severe LRTI (vs no baseline LRTIs) also showed an increased rate of future exacerbations (adjusted IRR 1.75, 95% CI, 1.70 to 1.80). This pattern of association was similar for risk of all-cause and COPD-related mortality; however, patients with 1+ severe LRTIs had the highest risk of all-cause and COPD mortality. CONCLUSION Increasing frequency and severity of LRTIs prior to COPD diagnosis were associated with increasing rates of subsequent exacerbations, and increasing risk of all-cause and COPD-related mortality.
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Affiliation(s)
- Hannah Whittaker
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Tamsin Morris
- Medical and Scientific Affairs, AstraZeneca, Luton, UK
| | - Yang Xu
- Medical and Scientific Affairs, AstraZeneca, Luton, UK
| | | | | | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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Pascarella A, Mikulan E, Sciacchitano F, Sarasso S, Rubino A, Sartori I, Cardinale F, Zauli F, Avanzini P, Nobili L, Pigorini A, Sorrentino A. An in-vivo validation of ESI methods with focal sources. Neuroimage 2023:120219. [PMID: 37307867 DOI: 10.1016/j.neuroimage.2023.120219] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/15/2022] [Revised: 05/05/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023] Open
Abstract
Electrophysiological source imaging (ESI) aims at reconstructing the precise origin of brain activity from measurements of the electric field on the scalp. Across laboratories/research centers/hospitals, ESI is performed with different methods, partly due to the ill-posedness of the underlying mathematical problem. However, it is difficult to find systematic comparisons involving a wide variety of methods. Further, existing comparisons rarely take into account the variability of the results with respect to the input parameters. Finally, comparisons are typically performed using either synthetic data, or in-vivo data where the ground-truth is only roughly known. We use an in-vivo high-density EEG dataset recorded during intracranial single pulse electrical stimulation, in which the true sources are substantially dipolar and their locations are precisely known. We compare ten different ESI methods, using their implementation in the MNE-Python package: MNE, dSPM, LORETA, sLORETA, eLORETA, LCMV beamformers, irMxNE, Gamma Map, SESAME and dipole fitting. We perform comparisons under multiple choices of input parameters, to assess the accuracy of the best reconstruction, as well as the impact of such parameters on the localization performance. Best reconstructions often fall within 1 cm from the true source, with most accurate methods hitting an average localization error of 1.2 cm and outperforming least accurate ones erring by 2.5 cm. As expected, dipolar and sparsity-promoting methods tend to outperform distributed methods. For several distributed methods, the best regularization parameter turned out to be the one in principle associated with low SNR, despite the high SNR of the available dataset. Depth weighting played no role for two out of the six methods implementing it. Sensitivity to input parameters varied widely between methods. While one would expect high variability being associated with low localization error at the best solution, this is not always the case, with some methods producing highly variable results and high localization error, and other methods producing stable results with low localization error. In particular, recent dipolar and sparsity-promoting methods provide significantly better results than older distributed methods. As we repeated the tests with "conventional" (32 channels) and dense (64, 128, 256 channels) EEG recordings, we observed little impact of the number of channels on localization accuracy; however, for distributed methods denser montages provide smaller spatial dispersion. Overall findings confirm that EEG is a reliable technique for localization of point sources and therefore reinforce the importance that ESI may have in the clinical context, especially when applied to identify the surgical target in potential candidates for epilepsy surgery.
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Affiliation(s)
| | - Ezequiel Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco",Università degli Studi di Milano, Milan, Italy
| | | | - Simone Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco",Università degli Studi di Milano, Milan, Italy
| | - Annalisa Rubino
- Department of Neurosciences, Center for Epilepsy Surgery "C. Munari", Hospital Niguarda, Milan, Italy
| | - Ivana Sartori
- Department of Neurosciences, Center for Epilepsy Surgery "C. Munari", Hospital Niguarda, Milan, Italy
| | - Francesco Cardinale
- Department of Neurosciences, Center for Epilepsy Surgery "C. Munari", Hospital Niguarda, Milan, Italy
| | - Flavia Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco",Università degli Studi di Milano, Milan, Italy
| | | | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS "G. Gaslini" Institute, Genoa, Italy; DINOGMI, Università degli Studi di Genova, Genoa, Italy
| | - Andrea Pigorini
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Sorrentino
- Department of Mathematics, Università degli Studi di Genova, Genoa, Italy.
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Furregoni G, Russo S, Pigorini A, Mikulan E, Sarasso S, Rubino A, Zauli F, Parmigiani S, Piergiorgio d'Orio, Cattani A, Francione S, Tassi L, Bassetti C, Lo Russo G, Avanzini P, Nobili L, Sartori I, Massimini M. Focal brain lesions induce spontaneous and evoked sleep-like intracerebral activity in awake humans. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Pigorini A, Mikulan E, Russo S, Zauli F, Sarasso S, Comolatti R, Parmigiani S, Rubino A, Furregoni G, Casarotto S, Sartori I, Massimini M. Loss of differentiation and complexity in the sleeping human brain: a multi-scale analysis. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Proserpio P, Zambrelli E, Lanza A, Dominese A, Di Giacomo R, Quintas R, Tramacere I, Rubino A, Turner K, Colosio C, Cattaneo F, Canevini M, D'Agostino A, Agostoni E, Didato G. Sleep disorders and mental health in hospital workers during the COVID-19 pandemic: a cross-sectional multicenter study in Northern Italy. Sleep Med 2022. [PMCID: PMC9300242 DOI: 10.1016/j.sleep.2022.05.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rebordosa C, Plana E, Rubino A, Aguado J, Martinez D, Lei A, Daoud S, Saigi-Morgui N, Perez-Gutthann S, Rivero-Ferrer E. Risk Assessment of Acute Myocardial Infarction and Stroke Associated with Long-Acting Muscarinic Antagonists, Alone or in Combination, versus Long-Acting beta2-Agonists. Int J Chron Obstruct Pulmon Dis 2022; 17:1715-1733. [PMID: 35941901 PMCID: PMC9356604 DOI: 10.2147/copd.s363997] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background The long-acting muscarinic antagonist (LAMA) aclidinium was approved in Europe in 2012 to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). A post-authorization safety study was initiated to assess potential cardiovascular risks associated with LAMAs versus long-acting beta2-agonists. Purpose To estimate incidence rates and adjusted incidence rate ratios (IRRs) for acute myocardial infarction (AMI), stroke, and major adverse cardiac events (MACE) in new users of aclidinium, aclidinium/formoterol, tiotropium, other LAMA, long-acting beta-agonists/inhaled corticosteroids (LABA/ICS), and LAMA/LABA compared with initiators of LABA. Patients and Methods This population-based cohort study included patients with COPD aged ≥40 years initiating COPD medications in the UK Clinical Practice Research Datalink (CPRD) Aurum database from 2012 to 2019. Poisson regression models were used to estimate the IRR for AMI, stroke, and MACE in users of COPD medications versus LABA, adjusting for clinically relevant covariables. Results The study included 11,121 new users of aclidinium, 4804 of aclidinium/formoterol, 56,198 of tiotropium, 23,856 of other LAMA, 17,450 of LAMA/LABA, 70,289 of LABA/ICS, and 13,716 of LABA. During periods of continuous medication use after initiation (current use), crude incidence rates per 1000 person-years for AMI ranged from 8.7 (aclidinium/formoterol) to 12.4 (LAMA/LABA), for stroke ranged from 4.8 (aclidinium/formoterol) to 7.2 (LAMA/LABA), and for MACE ranged from 13.5 (aclidinium/formoterol) to 19.3 (LAMA/LABA). Using LABA as reference, adjusted IRRs [95% confidence intervals] were close to 1 for all study drugs for AMI (lowest for aclidinium/formoterol, 0.95 [0.60–1.52], and highest for LAMA/LABA, 1.23 [0.91–1.67]), stroke (lowest for aclidinium/formoterol, 0.64 [0.39–1.06], and highest for tiotropium, 1.02 [0.81–1.27] for tiotropium) and for MACE (lowest for aclidinium, 0.93 [0.75–1.16], and highest for LAMA/LABA, 1.24 [0.97–1.59]). Conclusion Risks of AMI, stroke, and MACE in current users of aclidinium, aclidinium/formoterol, tiotropium, other LAMA, LAMA/LABA, or LABA/ICS were similar to the risks among current users of LABA.
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Affiliation(s)
- Cristina Rebordosa
- Department of Epidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
- Correspondence: Cristina Rebordosa, RTI Health Solutions, Department of Epidemiology and Risk Management, Av. Diagonal, 605, 9-1, Barcelona, 08028, Spain, Tel +34.93.362.2807, Fax +34.93.760.8507, Email
| | - Estel Plana
- Department of Biometrics, RTI Health Solutions, Barcelona, Spain
| | - Annalisa Rubino
- Epidemiology, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | - Jaume Aguado
- Department of Biometrics, RTI Health Solutions, Barcelona, Spain
| | - David Martinez
- Department of Biometrics, RTI Health Solutions, Barcelona, Spain
| | | | - Sami Daoud
- BioPharmaceuticals Research and Development, Late-Stage Development Respiratory and Immunology, AstraZeneca, Gaithersburg, MD, USA
| | - Nuria Saigi-Morgui
- Department of Epidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Susana Perez-Gutthann
- Department of Epidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Elena Rivero-Ferrer
- Department of Epidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
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Parmigiani S, Mikulan EP, Russo S, Sarasso S, Zauli FM, Rubino A, Cattani A, Fecchio M, Giampiccolo D, Lanzone J, D'Orio P, Del Vecchio M, Avanzini P, Nobili L, Sartori I, Massimini M, Pigorini A. Simultaneous stereo-EEG and high-density scalp EEG recordings to study the effects of intracerebral stimulation parameters. Brain Stimul 2022; 15:664-675. [PMID: 35421585 DOI: 10.1016/j.brs.2022.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/17/2021] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cortico-cortical evoked potentials (CCEPs) recorded by stereo-electroencephalography (SEEG) are a valuable tool to investigate brain reactivity and effective connectivity. However, invasive recordings are spatially sparse since they depend on clinical needs. This sparsity hampers systematic comparisons across-subjects, the detection of the whole-brain effects of intracortical stimulation, as well as their relationships to the EEG responses evoked by non-invasive stimuli. OBJECTIVE To demonstrate that CCEPs recorded by high-density electroencephalography (hd-EEG) provide additional information with respect SEEG alone and to provide an open, curated dataset to allow for further exploration of their potential. METHODS The dataset encompasses SEEG and hd-EEG recordings simultaneously acquired during Single Pulse Electrical Stimulation (SPES) in drug-resistant epileptic patients (N = 36) in whom stimulations were delivered with different physical, geometrical, and topological parameters. Differences in CCEPs were assessed by amplitude, latency, and spectral measures. RESULTS While invasively and non-invasively recorded CCEPs were generally correlated, differences in pulse duration, angle and stimulated cortical area were better captured by hd-EEG. Further, intracranial stimulation evoked site-specific hd-EEG responses that reproduced the spectral features of EEG responses to transcranial magnetic stimulation (TMS). Notably, SPES, albeit unperceived by subjects, elicited scalp responses that were up to one order of magnitude larger than the responses typically evoked by sensory stimulation in awake humans. CONCLUSIONS CCEPs can be simultaneously recorded with SEEG and hd-EEG and the latter provides a reliable descriptor of the effects of SPES as well as a common reference to compare the whole-brain effects of intracortical stimulation to those of non-invasive transcranial or sensory stimulations in humans.
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Affiliation(s)
- S Parmigiani
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - E P Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - S Russo
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Philosophy "Piero Martinetti", Università degli Studi di Milano, Milan, Italy
| | - S Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - F M Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Philosophy "Piero Martinetti", Università degli Studi di Milano, Milan, Italy
| | - A Rubino
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - A Cattani
- Department of Mathematics & Statistics, Boston University, Boston, MA, USA
| | - M Fecchio
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - D Giampiccolo
- Department of Neurosurgery, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Institute of Neurosciences, Cleveland Clinic London, London, UK
| | - J Lanzone
- Department of Systems Medicine, Neuroscience, University of Rome Tor Vergata, Rome, Italy; Istituti Clinici Scientifici Maugeri, IRCCS, Neurorehabilitation Department of Milano Institute, Milan, Italy
| | - P D'Orio
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy; Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - M Del Vecchio
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - P Avanzini
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - L Nobili
- Child Neuropsychiatry, IRCCS Istituto G. Gaslini, Genova, Italy
| | - I Sartori
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - M Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy; Azrieli Program in Brain, Mind and Consciousness, Canadian Institute for Advanced Research, Toronto, Canada
| | - A Pigorini
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Biomedical, V, Università degli Studi di Milano, Milan, Italy.
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Griffiths H, Rubino A, Parmar J. Impact of Surgical Approach for Lung Transplantation on Clinical Outcomes Regarding Patient Recovery. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Berman M, Ali A, Macklam D, Garcia Saez D, Jothidasan A, Husain M, Stock U, Mehta V, Venkateswaran R, Curry P, Messer S, Mukadam M, Mascaro J, Clarke S, Baxter J, Tsui S, Large S, Osman M, Kaul P, Boda G, Jenkins D, Simmonds J, Quigley R, Whitney J, Gardiner D, Watson C, Rubino A, Currie I, Foley J, Macleod A, Slater C, Marley F, Downward L, Rushton S, Armstrong L, Ayton L, Ryan M, Parker M, Gibson S, Spence S, Quinn K, Watson S, Forsythe J. UK National DCD Heart Transplant Program - First Year Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Proserpio P, Zambrelli E, Lanza A, Dominese A, Di Giacomo R, Quintas R, Tramacere I, Rubino A, Turner K, Colosio C, Cattaneo F, Canevini MP, D'Agostino A, Agostoni EC, Didato G. Sleep disorders and mental health in hospital workers during the COVID-19 pandemic: a cross-sectional multicenter study in Northern Italy. Neurol Sci 2022; 43:2241-2251. [PMID: 35022932 PMCID: PMC8754520 DOI: 10.1007/s10072-021-05813-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION From the beginning of the COVID-19 pandemic, healthcare workers had to face unprecedented emergency needs associated with an extraordinary amount of psychological distress. In this cross-sectional multicenter study, we investigated sleep disturbances, and the level of anxiety and depression among the healthcare and non-healthcare staff of three hospitals in Milan (Italy) during the COVID-19 outbreak. Moreover, we explored potential predisposing factors for affective symptoms and poor sleep. METHODS Between June and July 2020, we administered an online questionnaire to evaluate the presence of sleep disorders (Pittsburgh Sleep Quality Index), insomnia (Sleep Condition Indicator), anxiety (State Trait Anxiety Inventory), and depression (Beck Depression Inventory-II). We used univariate and multivariate analysis to evaluate the association between the personal conditions and sleep and affective disorders. RESULTS The 964 participants reported high rates of sleep disorders (80.3%)-mainly insomnia (30.5%)-anxiety (69.7%), and depression (32.8%). The multivariate analysis showed a strong association of sleep disorders, especially insomnia, with female gender (p = 0.004), divorced marital status (p = 0.015), self-isolation (p = 0.037), and chronic diseases (p = 0.003). Anxiety was significantly associated with teleworking (p = 0.001), while depressive symptoms were associated with self-isolation (p = 0.028), modified work schedules (p = 0.03), and chronic diseases (p = 0.027). CONCLUSION In hospital workers, the high prevalence of sleep and psychiatric symptoms during the COVID-19 outbreak appears to be determined mainly by modifications of personal or work habits. Teleworking was associated with increased anxiety. An accurate planning of hospital activities and a psychological support are needed to prevent and manage sleep and mental disorders.
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Affiliation(s)
- Paola Proserpio
- Department of Neuroscience, Sleep Medicine Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 20162, Milan, Italy
| | - Elena Zambrelli
- Epilepsy Centre, Sleep Medicine Centre, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo E Carlo, San Paolo Hospital, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Andrea Lanza
- Department of Neuroscience, Sleep Medicine Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 20162, Milan, Italy
| | - Ambra Dominese
- Epilepsy Unit, Sleep Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Roberta Di Giacomo
- Epilepsy Unit, Sleep Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Rui Quintas
- Epilepsy Unit, Sleep Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Annalisa Rubino
- Department of Neuroscience, Sleep Medicine Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 20162, Milan, Italy
| | - Katherine Turner
- Epilepsy Centre, Sleep Medicine Centre, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo E Carlo, San Paolo Hospital, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Claudio Colosio
- Occupational Health Unit, ASST Santi Paolo E Carlo, San Paolo Hospital, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Federica Cattaneo
- Department of Neuroscience, Sleep Medicine Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 20162, Milan, Italy
| | - Maria Paola Canevini
- Epilepsy Centre, Sleep Medicine Centre, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo E Carlo, San Paolo Hospital, Via Antonio di Rudinì, 8, 20142, Milan, Italy.,Department of Health Sciences, Università Degli Studi, Milan, Italy
| | - Armando D'Agostino
- Department of Health Sciences, Università Degli Studi, Milan, Italy.,Department of Mental Health and Addiction, ASST Santi Paolo E Carlo, Milan, Italy
| | - Elio Clemente Agostoni
- Department of Neuroscience, Sleep Medicine Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 20162, Milan, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Sleep Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
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12
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Whittaker H, Rubino A, Müllerová H, Morris T, Varghese P, Xu Y, De Nigris E, Quint JK. Frequency and Severity of Exacerbations of COPD Associated with Future Risk of Exacerbations and Mortality: A UK Routine Health Care Data Study. Int J Chron Obstruct Pulmon Dis 2022; 17:427-437. [PMID: 35264849 PMCID: PMC8901192 DOI: 10.2147/copd.s346591] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/04/2022] [Indexed: 12/18/2022] Open
Abstract
Background Studies have shown that chronic obstructive pulmonary disease (COPD) exacerbation events are related to future events; however, previous literature typically reports frequent vs infrequent exacerbations per patient-year and no studies have investigated increasing number of severe exacerbations in relation to COPD outcomes. Objective To investigate the association between baseline frequency and severity of exacerbations and subsequent mortality and exacerbation risk in a COPD cohort. Methods Clinical Practice Research Datalink (CPRD) Aurum and Hospital Episode Statistics data were used to identify patients registered at general practices in the UK, who had a diagnosis of COPD, were over the age of 40 years, were smokers or ex-smokers and had data recorded from 2004 onwards. Frequency and severity of exacerbations in the baseline year were identified as moderate exacerbations (general practice events) and severe exacerbations (hospitalised events). Patients were categorised as having: none, 1 moderate only, 2 moderate only, 3+ moderate only, 1 severe (and any moderate), 2 severe (and any moderate), and 3+ severe (and any moderate exacerbations). Poisson regression was used to investigate the association between baseline exacerbation frequency/severity and exacerbation events and mortality over follow-up. Results Overall, 340,515 COPD patients were included. Patients had higher rates of future exacerbations with increasing frequency and severity of baseline exacerbations compared to no baseline exacerbations. Adjusted incidence rate ratios (IRR) for patients with 1, 2, and 3+ moderate exacerbations compared to 0 exacerbations were 1.70 (95% CI 1.66–1.74), 2.31 (95% CI 2.24–2.37), and 3.52 (95% CI 3.43–3.62), respectively. Patients with increased frequency of baseline exacerbations were more likely to die from all-cause, COPD-related, and cardiovascular-related mortality in a graduated fashion. Conclusion Increasing number and severity of exacerbations were associated with increasing risk of subsequent exacerbations, all-cause mortality and COPD-related mortality. Even a single moderate event increases the risk of future events, illustrating that every exacerbation counts.
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Affiliation(s)
- Hannah Whittaker
- National Heart and Lung Institute, Imperial College London, London, UK
- Correspondence: Hannah Whittaker, Email
| | | | | | - Tamsin Morris
- Medical and Scientific Affairs, AstraZeneca, Luton, UK
| | - Precil Varghese
- Biopharmaceuticals Medical, Respiratory and Immunology, AstraZeneca, Gaithersburg, MD, USA
| | - Yang Xu
- Medical and Scientific Affairs, AstraZeneca, Luton, UK
| | | | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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13
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Golino L, Caiazzo G, Calabrò P, Colombo A, Contarini M, Fedele F, Gabrielli G, Galassi AR, Golino P, Scotto di Uccio F, Tarantini G, Argentino V, Balbi M, Bernardi G, Boccalatte M, Bonmassari R, Bottiglieri G, Caramanno G, Cesaro F, Cigala E, Chizzola G, Di Lorenzo E, Intorcia A, Fattore L, Galli S, Gerosa G, Giannotta D, Grossi P, Monda V, Mucaj A, Napodano M, Nicosia A, Perrotta R, Pieri D, Prati F, Ramazzotti V, Romeo F, Rubino A, Russolillo E, Spedicato L, Tuccillo B, Tumscitz C, Vigna C, Bertinato L, Armigliato P, Ambrosini V. Excimer laser technology in percutaneous coronary interventions: Cardiovascular laser society's position paper. Int J Cardiol 2022; 350:19-26. [PMID: 34995700 DOI: 10.1016/j.ijcard.2021.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022]
Abstract
Excimer Laser Coronary Atherectomy (ELCA) is a well-established therapy that emerged for the treatment of peripheral vascular atherosclerosis in the late 1980s, at a time when catheters and materials were rudimentary and associated with the most serious complications. Refinements in catheter technology and the introduction of improved laser techniques have led to their effective use for the treatment of a wide spectrum of complex coronary lesions, such as thrombotic lesions, severe calcific lesions, non-crossable or non-expandable lesions, chronic occlusions, and stent under-expansion. The gradual introduction of high-energy strategies combined with the contrast infusion technique has enabled us to treat an increasing number of complex cases with a low rate of periprocedural complications. Currently, the use of the ELCA has also been demonstrated to be effective in acute coronary syndrome (ACS), especially in the context of large thrombotic lesions.
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Affiliation(s)
- L Golino
- UOC Cardiologia/UTIC, Laboratorio di Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero S. Giuseppe Moscati, Aversa, Caserta, Italy.
| | - G Caiazzo
- UOC Cardiologia/UTIC, Laboratorio di Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero S. Giuseppe Moscati, Aversa, Caserta, Italy
| | - P Calabrò
- Cattedra di Cardiologia, Dipartimento di Medicina Traslazionale, Università degli Studi della Campania "Luigi Vanvitelli" - U.O.C. di Cardiologia Clinica a Direzione Universitaria A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy
| | - A Colombo
- Cardiologia Interventistica, Centro Cuore Columbus, Milano, Italy
| | - M Contarini
- Cardiologia e Laboratorio di Emodinamica, Presidio Ospedaliero Umberto I° Siracusa, Italy
| | - F Fedele
- Cattedra di Cardiologia, Azienda Ospedaliero Universitaria Policlinico Umberto I°, Roma, Italy
| | - G Gabrielli
- Cardiologia Interventistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | - A R Galassi
- Cattedra di Cardiologia, Azienda Ospedaliera Universitaria, Policlinico "P. Giaccone", Palermo, Italy
| | - P Golino
- Cattedra di Cardiologia, Dipartimento di Scienze Medico-Translazionali, Università degli Studi della Campania "Luigi Vanvitelli", Sezione di Cardiologia, c/o Ospedale Monaldi, Napoli, Italy
| | | | - G Tarantini
- Unità Operativa Semplice Dipartimentale di "Emodinamica e Cardiologia Interventistica", Dipartimento Strutturale Aziendale Cardio-Toraco-Vascolare, Azienda Ospedaliera di Padova, Italy
| | - V Argentino
- Cardiologia Interventistica, Azienda Ospedaliera per l'Emergenza Cannizzaro, Catania, Italy
| | - M Balbi
- Cardiologia Interventistica, IRCCS Azienda Ospedaliera Universitaria S. Martino, Genova, Italy
| | - G Bernardi
- Associazione per la Ricerca in Cardiologia, Ospedale S. Maria degli Angeli, Pordenone, Italy
| | - M Boccalatte
- Laboratorio Emodinamica P.O. S. Maria delle Grazie ASL NA2, Pozzuoli, Napoli, Italy
| | - R Bonmassari
- Cardiologia Interventistica, Presidio Ospedaliero S. Chiara, Trento, Italy
| | - G Bottiglieri
- Cardiologia Interventistica, Ospedale "SS.Addolorata", Eboli, Salerno, Italy
| | - G Caramanno
- Cardiologia Interventistica, Presidio Ospedaliero S. Giovanni di Dio, Agrigento, Italy
| | - F Cesaro
- Cardiologia Università "Luigi Vanvitelli", Caserta, Italy
| | - E Cigala
- Cardiologia Interventistica, Azienda Ospedaliera dei Colli, Ospedale Monaldi, Napoli, Italy
| | - G Chizzola
- Cardiologia Interventistica, Azienda ospedaliera Universitaria Spedali Civili, Brescia, Italy
| | - E Di Lorenzo
- Cardiologia e Laboratorio di Emodinamica, AORN S. Giuseppe Moscati, Avellino, Italy
| | - A Intorcia
- Cardiologia e Laboratorio di Emodinamica, AORN S. Giuseppe Moscati, Avellino, Italy
| | - L Fattore
- UOC Cardiologia/UTIC, Laboratorio di Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero S. Giuseppe Moscati, Aversa, Caserta, Italy
| | - S Galli
- Cardiologia Interventistica, IRCCS Centro Cardiologico Monzino, Milano, Italy
| | - G Gerosa
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università di Padova, Italy
| | - D Giannotta
- Cardiologia, Presidio Ospedaliero Gravina e Santo Pietro, Caltagirone, Catania, Italy
| | - P Grossi
- Cardiologia e Laboratorio di Emodinamica, Presidio Ospedaliero Mazzoni, Ascoli Piceno, Italy
| | - V Monda
- Cardiologia Interventistica, Azienda Ospedaliera dei Colli, Ospedale Monaldi, Napoli, Italy
| | - A Mucaj
- Cardiologia Interventistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | - M Napodano
- Unità Operativa Semplice Dipartimentale di "Emodinamica e Cardiologia Interventistica", Dipartimento Strutturale Aziendale Cardio-Toraco-Vascolare, Azienda Ospedaliera di Padova, Italy
| | - A Nicosia
- Cardiologia Interventistica, Presidio Ospedaliero Giovanni Paolo II°, Ragusa, Italy
| | - R Perrotta
- Cardiologia Interventistica, Azienda Ospedaliera S. Anna e S. Sebastiano, Caserta, Italy
| | - D Pieri
- Cardiologia Interventistica, Presidio Ospedaliero G.F. Ingrassia, Palermo, Italy
| | - F Prati
- Cardiologia d'Urgenza ed Interventistica, Azienda Ospedaliera S. Giovanni Addolorata, Roma, Italy
| | - V Ramazzotti
- Cardiologia d'Urgenza ed Interventistica, Azienda Ospedaliera S. Giovanni Addolorata, Roma, Italy
| | - F Romeo
- UniCamillus International Medical University, Rome, Italy
| | - A Rubino
- Cardiologia Interventistica, Presidio Ospedaliero G.F. Ingrassia, Palermo, Italy
| | - E Russolillo
- Cardiologia Interventistica, Ospedale S. Giovanni Bosco, Napoli, Italy
| | - L Spedicato
- Cardiologia Interventistica, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - B Tuccillo
- Cardiologia Interventistica Ospedale del Mare, Napoli, Italy
| | - C Tumscitz
- Cattedra di Cardiologia, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - C Vigna
- Cardiologia Interventistica, IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | - L Bertinato
- Clinical Governance, Istituto Superiore di Sanità, Italy
| | - P Armigliato
- Scientific Board Cardiovascular Laser Society, Italy
| | - V Ambrosini
- Cardiologia e Laboratorio di Emodinamica, AORN S. Giuseppe Moscati, Avellino, Italy
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14
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Parmigiani S, Russo S, Mikulan E, Zauli F, Rubino A, Sartori I, Pergiorgio d'Orio, Cattani A, Fecchio M, Pigorini A. Waving together single pulse intracranial electrical stimulation with concurrent stereo EEG and scalp hd-EEG recording. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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15
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Liguori C, Spanetta M, Fernandes M, Placidi F, Massa R, Romigi A, Izzi F, Mauro L, Greco G, Frezza E, Cattaneo F, Rubino A, Agostoni EC, Nobili L, Mercuri NB, Sansone VA, Proserpio P. The actigraphic documentation of circadian sleep-wake rhythm dysregulation in myotonic dystrophy type 1. Sleep Med 2021; 88:134-139. [PMID: 34749272 DOI: 10.1016/j.sleep.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/16/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVES The present study aimed at identifying the sleep-wake rhythm in patients with myotonic dystrophy type 1 (DM1) compared to healthy controls. METHODS Patients with genetic diagnosis of DM1 and healthy controls underwent a 7-day actigraphic recording and filled out a daily sleep diary to evaluate the sleep-wake rhythm. All participants underwent a physical and neurological examination to exclude conditions interfering with the sleep-wake cycle. Daytime activity, nocturnal sleep, and non-parametric circadian rhythm activity (NPCRA) were analysed. RESULTS Twenty-nine patients affected by DM1 were included in the present study and were compared to 16 controls. Considering nocturnal actigraphic data, DM1 patients showed a longer time in bed, sleep period time, actual sleep time, and sleep latency compared to controls. Central phase measurement was significantly longer in DM1 patients than controls. At NPCRA analysis patients showed a lower degree of regularity in the activity-rest pattern compared to controls. Moreover, DM1 patients showed reduced motor activity during daytime and a lower synchronization of the rest-activity rhythm than controls. CONCLUSIONS This study documented that patients with DM1 not only present the impairment of nocturnal sleep, but also show a dysregulation of the sleep-wake circadian rhythm; moreover, reduced amplitude of the circadian rhythmicity was also evident in comparison to controls, probably in relation to the reduced diurnal motor activity of patients. These findings add further evidence to the already documented sleep impairment and excessive daytime sleepiness in DM1 patients.
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Affiliation(s)
- Claudio Liguori
- Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy.
| | - Matteo Spanetta
- Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mariana Fernandes
- Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Fabio Placidi
- Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Roberto Massa
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | | | - Francesca Izzi
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Luca Mauro
- The NEMO Clinical Center in Milan, Italy
| | - Giulia Greco
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Erica Frezza
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Federica Cattaneo
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - Annalisa Rubino
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | | | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy; Department of Neuroscience, DINOGMI, University of Genoa, Genoa, Italy
| | - Nicola Biagio Mercuri
- Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Valeria A Sansone
- The NEMO Clinical Center in Milan, Italy; Neurorehabilitation Unit, University of Milan, Milan, Italy
| | - Paola Proserpio
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Milan, Italy
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16
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Sansone VA, Proserpio P, Mauro L, Biost AL, Frezza E, Lanza A, Rogliani P, Pezzuto G, Falcier E, Aggradi CF, Pirola A, Rao F, Roma E, Galluzzi C, Spanetta M, Cattaneo F, Rubino A, Agostoni EC, Amico F, Zanolini A, Izzi F, Greco G, Romigi A, Liguori C, Nobili L, Placidi F, Massa R. Assessment of self-reported and objective daytime sleepiness in adult-onset myotonic dystrophy type 1. J Clin Sleep Med 2021; 17:2383-2391. [PMID: 34170223 DOI: 10.5664/jcsm.9438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES Excessive daytime sleepiness (EDS) in myotonic dystrophy type 1 (DM1) is mostly of central origin but it may coexist with sleep-related breathing disorders. However, there is no consensus on the sleep protocols to be used, assessments vary and only a minority of patients are regularly tested or are on treatment for EDS. Our study presents data on self-reported and objective EDS in adult-onset DM1. METHODS 63 adult-onset DM1 patients were subjected to EDS-sleep assessments (polysomnography, PSG; Multiple Sleep Latency Test, MSLT; Epworth Sleepiness Scale, ESS. Correlation coefficients were computed to assess the relationship between sleep and sleepiness test results, fatigue, quality of life. RESULTS 33% and 48% of patients had EDS based respectively on the ESS and the MSLT with a low concordance between these tests (k = 0.19). Thirteen patients (20%) displayed 2 or more sleep-onset REM periods on MSLT. Patients having EDS by MSLT had a shorter disease duration (p<0.05), higher total sleep time, sleep efficiency and lower WASO (Wake After Sleep Onset) on PSG. Patients with self-reported EDS reported significantly higher fatigue score compared to patients without EDS (p<0.05). No other difference was found in demographic, clinical and respiratory features. CONCLUSIONS EDS test results are contradictory making treatment options difficult. Combining quantitative tests and self-reported scales may facilitate physicians in planning EDS care with patients and families.
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Affiliation(s)
- Valeria A Sansone
- Neurorehabilitation Unit, University of Milan, Milan, Italy.,The NEMO Clinical Center in Milan, Italy
| | - Paola Proserpio
- Sleep Medicine Center, Dept. Neuroscience, Niguarda Hospital, Milan, Italy
| | - Luca Mauro
- The NEMO Clinical Center in Milan, Italy
| | | | - Erica Frezza
- Department of Neurology, Tor Vergata University of Rome, Rome, Italy
| | - Andrea Lanza
- Sleep Medicine Center, Dept. Neuroscience, Niguarda Hospital, Milan, Italy
| | - Paola Rogliani
- Department of Respiratory Diseases, Tor Vergata University of Rome, Rome, Italy
| | - Gabriella Pezzuto
- Department of Respiratory Diseases, Tor Vergata University of Rome, Rome, Italy
| | | | | | | | | | | | - Claudia Galluzzi
- Department of Neurology, Tor Vergata University of Rome, Rome, Italy
| | - Matteo Spanetta
- Department of Neurology, Tor Vergata University of Rome, Rome, Italy
| | - Federica Cattaneo
- Sleep Medicine Center, Dept. Neuroscience, Niguarda Hospital, Milan, Italy
| | - Annalisa Rubino
- Sleep Medicine Center, Dept. Neuroscience, Niguarda Hospital, Milan, Italy
| | | | - Federica Amico
- Sleep Medicine Center, Dept. Neuroscience, Niguarda Hospital, Milan, Italy
| | | | - Francesca Izzi
- Department of Neurology, Tor Vergata University of Rome, Rome, Italy
| | - Giulia Greco
- Department of Neurology, Tor Vergata University of Rome, Rome, Italy
| | - Andrea Romigi
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Pozzilli (IS), Rome, Italy
| | - Claudio Liguori
- Department of Neurology, Tor Vergata University of Rome, Rome, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy.,Department of Neuroscience, DINOGMI, University of Genoa, Genoa, Italy
| | - Fabio Placidi
- Department of Neurology, Tor Vergata University of Rome, Rome, Italy
| | - Roberto Massa
- Department of Neurology, Tor Vergata University of Rome, Rome, Italy
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Rebordosa C, Plana E, Rubino A, Aguado J, Lei A, Daoud S, Saigi-Morgui N, Perez-Gutthann S, Rivero-Ferrer E. A Cohort Study to Evaluate the Risk of Hospitalisation for Congestive Heart Failure Associated with the Use of Aclidinium and Other Chronic Obstructive Pulmonary Disease Medications in the UK Clinical Practice Research Datalink. Int J Chron Obstruct Pulmon Dis 2021; 16:1461-1475. [PMID: 34103906 PMCID: PMC8180309 DOI: 10.2147/copd.s301624] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The long-acting anticholinergic (LAMA) aclidinium was approved in Europe in 2012 to relieve symptoms in adults with chronic obstructive pulmonary disease (COPD). A Post-Authorisation Safety Study (PASS) was initiated to assess potential cardiovascular safety concerns for aclidinium. OBJECTIVE To estimate the adjusted incidence rate ratio (IRR) for hospitalisation for heart failure in patients with COPD who were new users of aclidinium, tiotropium, other LAMA, long-acting beta-agonists/inhaled corticosteroids (LABA/ICS), and LAMA/LABA were compared with initiators of LABA. METHODS This population-based cohort study included patients with COPD aged ≥40 years initiating COPD medications in the Clinical Practice Research Datalink (CPRD) GOLD in the United Kingdom from 2012 to 2017. Medications were identified via general practice prescriptions. The first-ever hospitalisations for heart failure were identified in the Hospital Episode Statistics, and general practitioner records from the CPRD. Poisson regression models were used to estimate the IRR for hospitalisation for heart failure in users of COPD medications versus LABA, adjusting for clinically relevant covariates. RESULTS The study included 4350 new users of aclidinium, 23,405 of tiotropium, 6977 of other LAMAs, 3122 of LAMA/LABA, 26,093 of LABA/ICS, and 5678 of LABA. Mean age was 69-70 years across medication groups. Aclidinium users had the highest proportion of severe COPD, and LABA users had the lowest (35% vs 19%, respectively). Crude incidence rates per 1000 person-years for the first-ever hospitalisation for heart failure ranged from 6.9 in LABA to 9.5 in aclidinium. Using LABA as reference, adjusted IRRs (95% confidence interval) for first-ever hospitalisation for heart failure were 0.90 (0.53-1.53) for aclidinium, 1.02 (0.69-1.51) for tiotropium, 0.86 (0.50-1.47) for other LAMAs, 1.09 (0.41-2.92) for LAMA/LABA, and 1.01 (0.69, 1.48) for LABA/ICS. CONCLUSION The study did not find increased risks of hospitalisations for heart failure in new users of aclidinium, tiotropium, other LAMAs, LAMA/LABA, and LABA/ICS compared with LABA.
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Affiliation(s)
| | | | - Annalisa Rubino
- Epidemiology, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | | | | | - Sami Daoud
- BioPharmaceuticals Research and Development, Late-Stage Development Research and Innovation, AstraZeneca, Gaithersburg, MD, USA
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Bertolini C, Rubinetti S, Umgiesser G, Witbaard R, Bouma TJ, Rubino A, Pastres R. How to cope in heterogeneous coastal environments: Spatio-temporally endogenous circadian rhythm of valve gaping by mussels. Sci Total Environ 2021; 768:145085. [PMID: 33736335 DOI: 10.1016/j.scitotenv.2021.145085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
Transitional coastal zones are subject to high degrees of temporal fluctuation in environmental conditions, with these patterns varying in space. Gaining an in depth understanding of how sessile organisms cope with and respond to such environmental changes at multiple scales is needed to i) advance fundamental knowledge, ii) predict how organisms may react to stressors and iii) support the management of halieutic resources in transitional coastal areas. We addressed this question using mussels (Mytilus galloprovincialis) as model system. Valve-gaping sensor were deployed at multiple sites within the southern Venice Lagoon over a period of 6 months, to investigate the existence of periodicity in valve-gaping and its relationship with environmental variables, such as temperature and chlorophyll-a. Gaping behaviour was found to have periodic rhythms, of ~12 h and ~ 24 h, which were most pronounced in the inner part of lagoon part and were strongest during summer months. In autumn, the dual periodicity became weaker and mostly the 12 h remained. Gaping was closely linked with tide, but the relationship in terms of phasing varied upon location. Surprisingly, no clear direct relationships were found with chlorophyll-a, but food delivery may be mediated by tide itself. The results highlight the heterogeneity of behaviour and the endogenic nature of circadian rhythms in space and time. These findings have important implications for management of transitional areas where tidal alteration may have impacts on key behaviours, and emphasize the importance of characterizing their rhythms before using these as stress indicator. Moreover, the described tidal relationships should be included in growth models of bivalves in these systems.
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Affiliation(s)
- C Bertolini
- DAIS, Ca' Foscari University of Venice, 30173 Venezia, Italy.
| | - S Rubinetti
- DAIS, Ca' Foscari University of Venice, 30173 Venezia, Italy
| | | | - R Witbaard
- EDS, Netherlands Institute for Sea Research, 4401, NT, Yerseke, the Netherlands
| | - T J Bouma
- EDS, Netherlands Institute for Sea Research, 4401, NT, Yerseke, the Netherlands
| | - A Rubino
- DAIS, Ca' Foscari University of Venice, 30173 Venezia, Italy
| | - R Pastres
- DAIS, Ca' Foscari University of Venice, 30173 Venezia, Italy
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Russo S, Pigorini A, Mikulan E, Sarasso S, Rubino A, Zauli FM, Parmigiani S, d'Orio P, Cattani A, Francione S, Tassi L, Bassetti CLA, Lo Russo G, Nobili L, Sartori I, Massimini M. Focal lesions induce large-scale percolation of sleep-like intracerebral activity in awake humans. Neuroimage 2021; 234:117964. [PMID: 33771696 DOI: 10.1016/j.neuroimage.2021.117964] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022] Open
Abstract
Focal cortical lesions are known to result in large-scale functional alterations involving distant areas; however, little is known about the electrophysiological mechanisms underlying these network effects. Here, we addressed this issue by analysing the short and long distance intracranial effects of controlled structural lesions in humans. The changes in Stereo-Electroencephalographic (SEEG) activity after Radiofrequency-Thermocoagulation (RFTC) recorded in 21 epileptic subjects were assessed with respect to baseline resting wakefulness and sleep activity. In addition, Cortico-Cortical Evoked Potentials (CCEPs) recorded before the lesion were employed to interpret these changes with respect to individual long-range connectivity patterns. We found that small structural ablations lead to the generation and large-scale propagation of sleep-like slow waves within the awake brain. These slow waves match those recorded in the same subjects during sleep, are prevalent in perilesional areas, but can percolate up to distances of 60 mm through specific long-range connections, as predicted by CCEPs. Given the known impact of slow waves on information processing and cortical plasticity, demonstrating their intrusion and percolation within the awake brain add key elements to our understanding of network dysfunction after cortical injuries.
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Affiliation(s)
- S Russo
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - A Pigorini
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - E Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - S Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - A Rubino
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - F M Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - S Parmigiani
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - P d'Orio
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy; Institute of Neuroscience, CNR, via Volturno 39E, 43125 Parma, Italy
| | - A Cattani
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, 53719, USA
| | - S Francione
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - L Tassi
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - C L A Bassetti
- Department of Neurology, Inselspital, University of Bern, Switzerland
| | - G Lo Russo
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - L Nobili
- Child Neuropsychiatry, IRCCS Istituto G. Gaslini, Genova 16147, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - I Sartori
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - M Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; IRCCS, Fondazione Don Carlo Gnocchi, Milan 20148, Italy; Azrieli Program in Brain, Mind and Consciousness, Canadian Institute for Advanced Research, Toronto, Canada.
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20
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Rebordosa C, Rubino A, Witzleb AJ, Olesen M, Plana E, Aguado J, Saigi N, Daoud SZ, Lei A, Perez-Gutthann S, Schink T, Kristiansen NS, Pottegard A, Rivero-Ferrer E. Characteristics of new users of aclidinium, aclidinium/formoterol, and other COPD medications in three European countries. Epidemiology 2020. [DOI: 10.1183/13993003.congress-2020.2072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Tran TN, MacLachlan S, Hicks W, Liu J, Chung Y, Zangrilli J, Rubino A, Ganz ML. Oral Corticosteroid Treatment Patterns of Patients in the United States with Persistent Asthma. J Allergy Clin Immunol Pract 2020; 9:338-346.e3. [PMID: 32569754 DOI: 10.1016/j.jaip.2020.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/14/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with poor asthma control may receive oral corticosteroid (OCS) therapy despite the risk for adverse effects. OBJECTIVE We assessed OCS use frequency and treatment patterns in patients with persistent asthma in the United States (US). METHODS We used the IBM MarketScan Commercial Claims and Encounters, Medicare Supplemental, and Medicaid Multistate Claims research databases to identify patients from January 1, 2012, to December 31, 2017, who were ≥12 years old, met the 2-year Healthcare Effectiveness Data and Information Set criteria for persistent asthma, and were continuously enrolled ≥6 months before (baseline) and ≥24 months after (follow-up) the persistent asthma index date. Patients were classified as high OCS use (defined as ≥450 mg of OCS prescribed within a 90-day period during follow-up), low use (use OCS but not meeting high use criteria), or no OCS use. RESULTS We identified 435,675 patients, of whom 65% used OCS and 19% were classified as high OCS users at some point during follow-up. The annual prevalence of high OCS use ranged from 5.3% in 2013 to 7.6% in 2017. During the entire follow-up, high and low OCS users filled an average of 2.2 and 0.8 OCS prescriptions and received an average daily dosage of 2.2 and 0.3 mg, respectively. Once the patients became high OCS users, the average daily OCS dosage was relatively stable (5.1-7.1 mg) over 3 years. CONCLUSIONS Patients with persistent asthma in the US have substantial exposure to OCS. OCS therapy should be considered carefully to avoid associated adverse effects.
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Affiliation(s)
- Trung N Tran
- Medical Affairs, Respiratory & Inflammation, AstraZeneca, Gaithersburg, Md.
| | | | - Wesley Hicks
- Global Product Development, PPD, Cambridge, United Kingdom
| | - Jieruo Liu
- Health Economics and Outcomes Research, Evidera, Waltham, Mass
| | - Yen Chung
- Medical Affairs, Respiratory & Inflammation, AstraZeneca, Wilmington, Del
| | - James Zangrilli
- Medical Affairs, Respiratory & Inflammation, AstraZeneca, Gaithersburg, Md
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Tran TN, King E, Sarkar R, Nan C, Rubino A, O'Leary C, Muzwidzwa R, Belton L, Quint JK. Oral corticosteroid prescription patterns for asthma in France, Germany, Italy and the UK. Eur Respir J 2020; 55:13993003.02363-2019. [PMID: 32165402 PMCID: PMC7270349 DOI: 10.1183/13993003.02363-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/27/2020] [Indexed: 01/01/2023]
Abstract
Oral corticosteroids (OCS) are used to manage asthma exacerbations and severe, uncontrolled asthma, but OCS use is associated with adverse effects. We aimed to describe the patterns of OCS use in the real-world management of patients with asthma in western Europe. We used electronic medical records from databases in France, Germany, Italy and the United Kingdom from July 2011 through February 2018. Patients aged ≥12 years with an asthma diagnosis, at least one non-OCS asthma medication within ±6 months of diagnosis, and available data ≥6 months prior to and ≥90 days after cohort entry were included. High OCS use was defined as OCS ≥450 mg prescribed in a 90-day window during follow-up. Baseline characteristics and OCS use during follow-up were described overall and by OCS use status. Of 702 685 patients with asthma, 14–44% were OCS users and 6–9% were high OCS users at some point during follow-up. Annual prevalence of high OCS use across all countries was ∼3%. High OCS users had a mean of between one and three annual OCS prescriptions, with an average daily OCS dosage of 1.3–2.2 mg. For patients who continued to meet the high-use definition, daily OCS exposure was generally stable at 5.5–7.5 mg for ≥2 years, increasing the risk of adverse effects. Our study demonstrates that OCS use is relatively common across the four studied European countries. Data from this study may provide decisive clinical insights to inform primary care physicians and specialists involved in the management of severe, uncontrolled asthma. This study gives a real-world snapshot of oral corticosteroid (OCS) use in western Europe, by highlighting an opportunity to shift towards corticosteroid-sparing therapies or safer alternatives that mitigate the risk of OCS-associated adverse effects http://bit.ly/3cB8kk8
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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23
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Rossi Sebastiano D, Tassi L, Duran D, Visani E, Gozzo F, Cardinale F, Nobili L, Del Sole A, Rubino A, Dotta S, Schiaffi E, Garbelli R, Franceschetti S, Spreafico R, Panzica F. Identifying the epileptogenic zone by four non-invasive imaging techniques versus stereo-EEG in MRI-negative pre-surgery epilepsy patients. Clin Neurophysiol 2020; 131:1815-1823. [PMID: 32544836 DOI: 10.1016/j.clinph.2020.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We evaluated four imaging techniques, i.e. Electroencephalography (EEG)-functional Magnetic Resonance Imaging (MRI) (EEG-fMRI), High-resolution EEG (HR-EEG), Magnetoencephalography (MEG) and 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (PET), for the identification of the epileptogenic zone (EZ) in 41 patients with negative MRI, candidate to neurosurgery. METHODS For each technique, results were compared to the Stereo-EEG. Diagnostic measures were calculated with respect to the post-surgical outcome, either for all the patients (39/41, two patients excluded) and for the subgroup of patients with the EZ involving more than one lobe (20/41). RESULTS When considered individually, each functional technique showed accuracy values ranging 54,6%-63,2%, having PET, MEG and HR-EEG higher sensitivity, and EEG-fMRI higher specificity. In patients with multilobar epileptogenic zone, functional techniques achieved the best accuracies (up to 80%) when three techniques, including EEG-fMRI, were considered together. CONCLUSIONS The study highlights the accuracy of a combination of functional imaging techniques in the identification of EZ in MRI negative focal epilepsy. The best diagnostic yield was obtained if the combination of PET, MEG (or HR-EEG as alternative), EEG-fMRI were considered together. SIGNIFICANCE The functional imaging techniques may improve the presurgical workup of MRI negative focal epilepsy, if epileptogenic zone involves more than one lobe.
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Affiliation(s)
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Dunja Duran
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Visani
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesca Gozzo
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | | | - Lino Nobili
- DINOGMI, University of Genoa, and Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Angelo Del Sole
- Department of Health Sciences, University of Milan and ASST Santi Paolo e Carlo, Milan, Italy
| | - Annalisa Rubino
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Sara Dotta
- Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Schiaffi
- Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Roberto Spreafico
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ferruccio Panzica
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Gardiner D, Charlesworth M, Rubino A, Madden S. The rise of organ donation after circulatory death: a narrative review. Anaesthesia 2020; 75:1215-1222. [PMID: 32430909 DOI: 10.1111/anae.15100] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Abstract
Solid organ transplantation saves and transforms lives. The original type of organ donation from deceased patients was controlled donation after circulatory death, previously referred to as non-heart beating organ donation. The rise of donation after circulatory death in the UK came about through advances in critical care and transplant medicine and support from several key organisations in developing a robust ethical, legal and professional framework. The transplant waiting list reached a historic peak in 2009-2010 of 8000 patients, but fell by 25% to 6000 in 2017-2018. There has also been a steady rise in the number of deceased donors and the number of donations after circulatory death. The contribution of donation after circulatory death to the total number of donations rose steadily between 2000 and 2012 and has remained about 40% since. Although the situation has improved for patients waiting for a transplant, deaths and long waits remain common. Changes to legislative, technical and peri-mortem procedures may greatly change future practices in donation after circulatory death in the UK.
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Affiliation(s)
- D Gardiner
- National Clinical Lead for Organ Donation, NHS Blood and Transplant, Nottingham, UK
| | - M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Rubino
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Royal Papworth Hospital, Cambridge, UK
| | - S Madden
- NHS Blood and Transplant, Bristol, UK
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Mikulan E, Russo S, Parmigiani S, Sarasso S, Zauli FM, Rubino A, Avanzini P, Cattani A, Sorrentino A, Gibbs S, Cardinale F, Sartori I, Nobili L, Massimini M, Pigorini A. Simultaneous human intracerebral stimulation and HD-EEG, ground-truth for source localization methods. Sci Data 2020; 7:127. [PMID: 32345974 PMCID: PMC7189230 DOI: 10.1038/s41597-020-0467-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/31/2020] [Indexed: 11/08/2022] Open
Abstract
Precisely localizing the sources of brain activity as recorded by EEG is a fundamental procedure and a major challenge for both research and clinical practice. Even though many methods and algorithms have been proposed, their relative advantages and limitations are still not well established. Moreover, these methods involve tuning multiple parameters, for which no principled way of selection exists yet. These uncertainties are emphasized due to the lack of ground-truth for their validation and testing. Here we present the Localize-MI dataset, which constitutes the first open dataset that comprises EEG recorded electrical activity originating from precisely known locations inside the brain of living humans. High-density EEG was recorded as single-pulse biphasic currents were delivered at intensities ranging from 0.1 to 5 mA through stereotactically implanted electrodes in diverse brain regions during pre-surgical evaluation of patients with drug-resistant epilepsy. The uses of this dataset range from the estimation of in vivo tissue conductivity to the development, validation and testing of forward and inverse solution methods.
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Affiliation(s)
- Ezequiel Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Simone Russo
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Sara Parmigiani
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Simone Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Flavia Maria Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Annalisa Rubino
- Centre of Epilepsy Surgery "C. Munari", Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - Pietro Avanzini
- Institute of Neuroscience, National Research Council of Italy, Parma, Italy
| | - Anna Cattani
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | | | - Steve Gibbs
- Centre of Epilepsy Surgery "C. Munari", Department of Neuroscience, Niguarda Hospital, Milan, Italy
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada
| | - Francesco Cardinale
- Centre of Epilepsy Surgery "C. Munari", Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - Ivana Sartori
- Centre of Epilepsy Surgery "C. Munari", Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS 'G. Gaslini' Institute, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
- IRCCS Fondazione Don Gnocchi, Milan, Italy
| | - Andrea Pigorini
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy.
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Rubino A, Sanon M, Ganz ML, Simpson A, Fenton MC, Verma S, Hartry A, Baker RA, Duffy RA, Gwin K, Fillit H. Association of the US Food and Drug Administration Antipsychotic Drug Boxed Warning With Medication Use and Health Outcomes in Elderly Patients With Dementia. JAMA Netw Open 2020; 3:e203630. [PMID: 32343351 PMCID: PMC7189225 DOI: 10.1001/jamanetworkopen.2020.3630] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Indexed: 01/19/2023] Open
Abstract
IMPORTANCE Atypical antipsychotics (AAPs) are often used off-label to manage dementia-associated neuropsychiatric symptoms. In 2005, the US Food and Drug Administration (FDA) issued a boxed warning for the use of AAPs in elderly patients. The long-term association of this warning with health outcomes is unknown to date. OBJECTIVE To assess the long-term association of the 2005 FDA boxed warning on AAPs with psychiatric medication and opioid use, health events, and quality of life among elderly individuals with dementia. DESIGN, SETTING, AND PARTICIPANTS For this cross-sectional study, data were analyzed from the household component of the Medical Expenditure Panel Survey (MEPS), the National Ambulatory Medical Care Survey (NAMCS), and the National Hospital Ambulatory Medical Care Survey (NHAMCS) fielded between January 1, 1996, and December 31, 2014. This interrupted time-series analysis applied to 3-year moving means derived from the 1996-2014 MEPS, NAMCS, and NHAMCS. All survey respondents included in this analysis were 65 years or older and had dementia. Data analysis was performed from December 1, 2017, to March 15, 2018. EXPOSURES The 2005 FDA boxed warning on AAPs. MAIN OUTCOMES AND MEASURES Use of psychiatric medications and opioids, prevalence of cerebrovascular and cardiovascular events, prevalence of falls and/or fractures, 2-year mortality, and health-related quality of life assessed by the Medical Outcomes Study 12-Item Short-Form Health Survey scores. RESULTS A total of 2430 (MEPS) and 5490 (NAMCS and NHAMCS) respondents were identified, corresponding to weighted populations of 22 996 526 (MEPS) and 65 502 344 (NAMCS and NHAMCS) noninstitutionalized elderly individuals with dementia (mean [SD] age, 81.06 [1.13] years; 63.1% female). In the MEPS sample, compared with before 2005, AAP use (from an annual slope of 0.99 to -0.18 percentage points), cerebrovascular events (0.75 to -0.50 percentage points), and falls and/or fractures (-1.72 to -0.40 percentage points) decreased and opioid use (0.04 to 1.29 percentage points), antiepileptic use (-0.42 to 1.21 percentage points), cardiovascular events (-0.13 to 1.30 percentage points), and 2-year mortality risk (-0.68 to 0.18 percentage points) increased. Health-related quality of life remained relatively unchanged. The NAMCS and NHAMCS sample yielded similar findings. CONCLUSIONS AND RELEVANCE These data suggest that the 2005 FDA boxed warning was associated with some unintended negative patient outcomes.
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Affiliation(s)
| | - Myrlene Sanon
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey
| | | | | | | | | | | | - Ross A. Baker
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey
| | - Ruth A. Duffy
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey
| | | | - Howard Fillit
- Mount Sinai Medical Center, New York City, New York
- Alzheimer’s Drug Discovery Foundation, New York, New York
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Alfonsi V, Palmizio R, Rubino A, Scarpelli S, Gorgoni M, D'Atri A, Pazzaglia M, Ferrara M, Giuliano S, De Gennaro L. The Association Between School Start Time and Sleep Duration, Sustained Attention, and Academic Performance. Nat Sci Sleep 2020; 12:1161-1172. [PMID: 33328774 PMCID: PMC7735793 DOI: 10.2147/nss.s273875] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/14/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE In adolescence, physiological (circadian and homeostatic regulation of sleep) and social habits contribute to delayed sleep onset, while social obligations impose early sleep offset. The effects of delayed school start time on the subjective/objective measures of sleep-wake patterns and academic achievement have not been established. METHODS This pre-, post-, and longitudinal non-randomized study included an early (8:00 am; ESC=30 students) and the late (9:00 am; LSC=21 students) start class. Multiple sleep data included a weekly sleep diary, Karolinska Sleepiness Scale, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. Sustained attention was measured using the Psychomotor Vigilance Task. Academic performance was evaluated by two different mathematical and scientific standard tests (entrance and final) and by school attendance indicators. Data were collected at monthly intervals from October 2018 to May 2019 and the beginning and end of the academic year (pre/post). RESULTS All students turned their lights off at similar times (LSC=11:21pm, ESC=11:11pm), but LSC students woke up later (7:23am) than ESC students (6:55am; F1,48=11.81, p=0.001) on school days. The groups did not differ in total sleep duration on non-school days. Longitudinal measures revealed a significant increase (8.9%, 34 min) in total sleep duration of LSC students across the academic year. ESC students maintained approximately the same sleep duration. Furthermore, changes in sleep duration had parallelled significant differences in sustained attention, with LSC students outperforming ESC students. Longitudinal changes of sleep and sustained attention were associated with a coherent pattern of changes in academic performance. CONCLUSION Findings indicate that a one-hour delay in school start time is associated with longer sleep, better diurnal sustained attention, attendance, and improved academic performance. Notably, sleep changes were limited to school days. A delay in school start time should be seriously considered to improve sleep and academic achievements of students.
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Affiliation(s)
- Valentina Alfonsi
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy
| | | | | | | | - Maurizio Gorgoni
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Aurora D'Atri
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mariella Pazzaglia
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy
| | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Luigi De Gennaro
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy
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Coelli S, Maggioni E, Rubino A, Campana C, Nobili L, Bianchi AM. Multiscale Functional Clustering Reveals Frequency Dependent Brain Organization in Type II Focal Cortical Dysplasia With Sleep Hypermotor Epilepsy. IEEE Trans Biomed Eng 2019; 66:2831-2839. [PMID: 30716026 DOI: 10.1109/tbme.2019.2896893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE A multiscale functional clustering approach is proposed to investigate the organization of the epileptic networks during different sleep stages and in relation with the occurrence of seizures. METHOD Stereo-electroencephalographic signals from seven pharmaco-resistant epileptic patients (focal cortical dysplasia type II) were analyzed. The discrete wavelet transform provided a multiscale framework on which a data-driven functional clustering procedure was applied, based on multivariate measures of integration and mutual information. The most interacting functional clusters (FCs) within the sampled brain areas were extracted. RESULTS FCs characterized by strongly integrated activity were observed mostly in the beta and alpha frequency bands, immediately before seizure onset and in deep sleep stages. These FCs generally included the electrodes from the epileptogenic zone. Furthermore, repeatable patterns were found across ictal events in the same patient. CONCLUSION In line with previous studies, our findings provide evidence of the important role of beta and alpha activity in seizures generation and support the relation between epileptic activity and sleep stages. SIGNIFICANCE Despite the small number of subjects included in the study, the present results suggest that the proposed multiscale functional clustering approach is a useful tool for the identification of the frequency-dependent mechanisms underlying seizure generation.
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Demal J, Reiter B, Reichart D, Dalen M, Ruggieri V, Gatti G, Onorati F, Rubino A, Maselli D, Gherli R, Salsano A, Saccocci M, Santarpino G, Francesco N, De Feo M, Perrotti A, Mariscalco G, Biancari F. Prevalence and Outcome of CABG in Patients with Severely Reduced Ejection Fraction. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J.T. Demal
- Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - B. Reiter
- Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - D. Reichart
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - M. Dalen
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - V. Ruggieri
- Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
| | - G. Gatti
- Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
| | - F. Onorati
- Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
| | - A. Rubino
- Centro Clinico-Diagnostico “G.B. Morgagni,” Centro Cuore, Pedara, Italy
| | - D. Maselli
- Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
| | - R. Gherli
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - A. Salsano
- Division of Cardiac Surgery, University of Genoa, Genoa, Italy
| | - M. Saccocci
- Department of Cardiac Surgery, University of Milan, Centro Cardiologico - Fondazione Monzino IRCCS, Milan, Italy
| | - G. Santarpino
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - N. Francesco
- Division of Cardiac Surgery, University of Parma, Parma, Italy
| | - M. De Feo
- Department of Cardiothoracic Sciences, University of Campania “Luigi Vanvitelli,” Caserta, Italy
| | - A. Perrotti
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - G. Mariscalco
- Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - F. Biancari
- Turku University Hospital and Department of Surgery, University of Turku, Heart Center, Turku, Finland
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Franzese I, Biagio LS, Gatti G, Perrotti A, Mariscalco G, Milano A, De Feo M, Rubino A, Santarpino G, Salsano A, Lucarelli C, Francica A, Beghi C, Mignosa C, Pappalardo A, D’Errigo P, Santini F, Onorati F, Faggian G. OC62 REDO MITRAL SURGERY AND HOSPITAL OUTCOME. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549859.74998.9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Franzese I, Biagio LS, Perrotti A, Mariscalco G, Francica A, Lucarelli C, De Feo M, Santarpino G, Salsano A, Rubino A, Gatti G, Beghi C, Mignosa C, Pappalardo A, Onorati F, Santini F, Faggian G. RF67 REDO MITRAL SURGERY AND HOSPITAL OUTCOME. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550012.26990.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Simpson A, Zakin L, Moore-Ramdin L, Vrouchou P, Rubino A. P3512Hyperkalemia in chronic kidney disease: incidence, prevalence and impact on RAAS inhibitors treatment in primary care in scotland. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3512] [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: 11/13/2022] Open
Affiliation(s)
- A Simpson
- Evidera Inc, Real-World Evidence, London, United Kingdom
| | - L Zakin
- Vifor Pharma, Zurich, Switzerland
| | | | | | - A Rubino
- Evidera Inc, Real-World Evidence, London, United Kingdom
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Heng HJ, Rubino A, Roscoe A. Impact of transoesophageal echocardiography on cardio-surgical plan. J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.08.069] [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: 11/11/2022]
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Ceccanti M, Onesti E, Rubino A, Cambieri C, Tartaglia G, Miscioscia A, Frasca V, Inghilleri M. Modulation of human corticospinal excitability by paired associative stimulation in patients with amyotrophic lateral sclerosis and effects of Riluzole. Brain Stimul 2018; 11:775-781. [DOI: 10.1016/j.brs.2018.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 12/13/2022] Open
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Di Battista ME, Cova I, Rubino A, Papi CP, Alampi G, Purcaro C, Vanacore N, Pascale E, Locuratolo N, Fattapposta F, Mariani C, Pomati S, Meco G. Intercepting Parkinson disease non-motor subtypes: A proof-of-principle study in a clinical setting. J Neurol Sci 2018; 388:186-191. [PMID: 29627019 DOI: 10.1016/j.jns.2018.03.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 11/06/2017] [Accepted: 03/14/2018] [Indexed: 01/05/2023]
Abstract
The construct of non-motor symptoms (NMS) subtyping in Parkinson Disease (PD) is emerging as a line of research in the light of its potential role in etiopathological interpretation of PD heterogeneity. Different approaches of NMS subtyping have been proposed: an anatomical model suggests that NMS aggregate according to the underpinning pathology; other researchers find aggregation of NMS according to the motor phenotype; the contribution of genetic background to NMS has also been assessed, primarily focusing on cognitive impairment. We have analyzed NMS burden assessed through an extensive clinical and neuropsychological battery in 137 consecutive non-demented PD patients genotyped for MAPT haplotypes (H1/H1 vs H2 carriers) in order to explore the applicability of the "anatomo-clinical", "motor" or "genetic" models for subtyping PD in a clinical setting; a subsequent independent analysis was conducted to verify a possible cluster distribution of NMS. No clear-cut NMS profiles according to the previously described models emerged: in our population, the autonomic dysfunctions and depressive symptoms represent the leading determinant of NMS clusters, which seems to better fit with the hypothesis of a "neurotransmitter-based" model. Selective preferential neurotransmitter network dysfunctions may account for heterogeneity of PD and could address translational research.
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Affiliation(s)
- M E Di Battista
- Parkinson's Centre [Research Centre of Social Diseases (CIMS)], "Sapienza" University of Rome, Italy; Cognitive Impairment Center, Local Health Authority 2 of Treviso, Treviso, Italy
| | - I Cova
- Neurology Unit, L. Sacco University Hospital, Milan, Italy.
| | - A Rubino
- Parkinson's Centre [Research Centre of Social Diseases (CIMS)], "Sapienza" University of Rome, Italy; Department of Neurology and Psychiatry (Parkinson's Centre), "Sapienza" University, Rome, Italy
| | - C P Papi
- Parkinson's Centre [Research Centre of Social Diseases (CIMS)], "Sapienza" University of Rome, Italy
| | - G Alampi
- Department of Neurology and Psychiatry (Parkinson's Centre), "Sapienza" University, Rome, Italy
| | - C Purcaro
- Department of Neurology and Psychiatry (Parkinson's Centre), "Sapienza" University, Rome, Italy
| | - N Vanacore
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - E Pascale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - N Locuratolo
- Department of Neurology and Psychiatry (Parkinson's Centre), "Sapienza" University, Rome, Italy
| | - F Fattapposta
- Department of Neurology and Psychiatry (Parkinson's Centre), "Sapienza" University, Rome, Italy
| | - C Mariani
- Neurology Unit, L. Sacco University Hospital, Milan, Italy
| | - S Pomati
- Neurology Unit, L. Sacco University Hospital, Milan, Italy
| | - G Meco
- Parkinson's Centre [Research Centre of Social Diseases (CIMS)], "Sapienza" University of Rome, Italy; Department of Neurology and Psychiatry (Parkinson's Centre), "Sapienza" University, Rome, Italy; Parkinson's Disease Clinical Trials Centre, Neurological Centre of Latium (NCL) Rome, NEUROMED IRCCS, Pozzilli, IS, Italy
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Lanza A, Mariani S, Sommariva M, Campana C, Rubino A, Nichelatti M, Proserpio P, Nobili L. Continuous positive airway pressure treatment with nasal pillows in obstructive sleep apnea: long-term effectiveness and adherence. Sleep Med 2018; 41:94-99. [DOI: 10.1016/j.sleep.2017.08.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/14/2017] [Accepted: 08/02/2017] [Indexed: 11/30/2022]
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Onesti E, Ceccanti M, Rubino A, Frasca V, Inghilleri M. Atypical case of diaphragmatic pseudo myoclonus. Parkinsonism Relat Disord 2017; 43:118-119. [DOI: 10.1016/j.parkreldis.2017.06.016] [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] [Received: 03/13/2017] [Revised: 06/20/2017] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
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Coelli S, Maggioni E, Cerutti S, Nobili L, Rubino A, Campana C, Bianchi AM. Functional Clustering approach for the analysis of Stereo-EEG activity patterns in correspondence of epileptic seizures. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:2806-2809. [PMID: 29060481 DOI: 10.1109/embc.2017.8037440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this study, a functional clustering approach is proposed and tested for the identification of brain functional networks emerging during sleep-related seizures. Stereo-EEG signals recorded in patients with Type II Focal Cortical Dysplasia (FCD type II), were analyzed. This novel approach is able to identify the network configuration changes in pre-ictal and early ictal periods, by grouping Stereo-EEG signals on the basis of the Cluster Index, after wavelet multiscale decomposition. Results showed that the proposed method is able to detect clusters of interacting leads, mainly overlapped on the Epileptogenic Zone (EZ) identified by a clinical expert, with distinctive configurations related to analyzed frequency ranges. This suggested the presence of coupling activities between the elements of the epileptic system at different frequency scales.
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Zubler F, Rubino A, Lo Russo G, Schindler K, Nobili L. Correlating Interictal Spikes with Sigma and Delta Dynamics during Non-Rapid-Eye-Movement-Sleep. Front Neurol 2017; 8:288. [PMID: 28690583 PMCID: PMC5479894 DOI: 10.3389/fneur.2017.00288] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/02/2017] [Indexed: 01/21/2023] Open
Abstract
Interictal spikes (IS) are one of the major hallmarks of epilepsy. Understanding the factors promoting or suppressing IS would increase our comprehension of epilepsy and possibly open new avenues for therapy. Sleep strongly influences epileptic activity, and the modulatory effects of the different sleep stages on IS have been studied for decades. However, several aspects are still disputed, in particular the role of sleep spindles and slow waves in the activation of IS during Non-REM sleep. Here, we correlate the rate of IS with quantitative measures derived from stereo-EEG during one Non-REM cycle in 10 patients suffering from drug-resistant epilepsy due to type 2 focal cortical dysplasia. We show that the IS rate (ISR) is positively correlated with sigma power (a surrogate for sleep-spindle density) but negatively correlated with delta power (surrogate for slow wave activity). In addition, we present two new indices for quantifying the spatial and temporal instability of sleep. We found that both instability indices are correlated with a high ISR. The main contribution of this study is to confirm the suppressive effect of stable deep sleep on IS. This result might influence future guidelines for therapy of patients suffering from epilepsy and sleep disorders.
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Affiliation(s)
- Frédéric Zubler
- "C. Munari" Center for Epilepsy Surgery, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - Annalisa Rubino
- "C. Munari" Center for Epilepsy Surgery, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - Giorgio Lo Russo
- "C. Munari" Center for Epilepsy Surgery, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - Kaspar Schindler
- Department of Neurology, Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lino Nobili
- "C. Munari" Center for Epilepsy Surgery, Department of Neuroscience, Niguarda Hospital, Milan, Italy
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Rubino A, Artime E. A descriptive review of additional risk minimisation measures applied to EU centrally authorised medicines 2006-2015. Expert Opin Drug Saf 2017; 16:877-884. [DOI: 10.1080/14740338.2017.1335303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Esther Artime
- Risk Management Epidemiology, OXON Epidemiology, Madrid, Spain
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Campana C, Zubler F, Gibbs S, de Carli F, Proserpio P, Rubino A, Cossu M, Tassi L, Schindler K, Nobili L. Suppression of interictal spikes during phasic rapid eye movement sleep: a quantitative stereo-electroencephalography study. J Sleep Res 2017; 26:606-613. [DOI: 10.1111/jsr.12533] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/01/2017] [Indexed: 12/20/2022]
Affiliation(s)
- C. Campana
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’; University of Milan; Milan Italy
| | - F. Zubler
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - S. Gibbs
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
- Center for Advanced Research in Sleep Medicine; University of Montreal; Montreal Canada
| | - F. de Carli
- Institute of Bioimaging and Molecular Physiology; Genoa Section; National Research Council; Genoa Italy
| | - P. Proserpio
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - A. Rubino
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’; University of Milan; Milan Italy
| | - M. Cossu
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - L. Tassi
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - K. Schindler
- Department of Neurology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - L. Nobili
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
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Cova I, Di Battista ME, Vanacore N, Papi CP, Alampi G, Rubino A, Valente M, Meco G, Contri P, Di Pucchio A, Lacorte E, Priori A, Mariani C, Pomati S. Adaptation and psychometric properties of the Italian version of the Non-Motor Symptoms Questionnaire for Parkinson's disease. Neurol Sci 2017; 38:673-678. [PMID: 28150102 DOI: 10.1007/s10072-017-2830-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Abstract
Although non-motor symptoms (NMS) of Parkinson's disease (PD) are very common also in early stages of the disease, they are still under-recognized. Screening tools for non-motor symptoms, such as non-motor symptoms questionnaire (NMSQuest), help clinicians to recognize NMS and to evaluate if patients could require further assessment or specific treatments. To validate an adapted Italian version of NMSQuest and study its psychometric properties, Italian PD patients self-completed Italian NMSQuest, and then underwent a standard clinical evaluation including motor assessment (by Hoehn and Yahr staging, unified Parkinson's disease rating scale part III) and non-motor assessment (by Montreal cognitive assessment, Beck depression inventory, neuropsychiatric inventory, Epworth sleepiness scale, scale for outcomes in Parkinson's disease-Autonomic and movement disorder society-sponsored revision of the unified Parkinson's disease rating scale part I). Somatic comorbidities were quantified using the modified cumulative illness rating scale (CIRS). Seventy-one subjects were assessed (mean age years 69.8 ± 9.6 SD; 31% women; mean duration of disease 6.3 ± 4.6 years; H&Y median 2). Italian NMSQuest showed adequate satisfactory clinimetrics in terms of data quality, precision, acceptability, internal consistency and reliability. A significant correlation was found between NMSQuest and most of non-motor assessment scales, while no significant correlation appeared with motor severity as well as with age of patients, disease duration, levodopa equivalent daily dose, L-DOPA/dopamine agonists assumption and CIRS total score. The Italian version of the NMSQuest resulted as a reliable instrument for screening NMS in Italian PD patients.
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Affiliation(s)
- I Cova
- Department of Clinical Sciences, Institute of Clinical Neurology, ASST Fatebenefratelli-Sacco, "Luigi Sacco" University Hospital, Milan, Italy. .,Neurology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, "San Paolo" University Hospital, Milan, Italy.
| | - M E Di Battista
- Department of Neurology and Psychiatry (Parkinson's Centre) and Research Centre of Social Diseases (CIMS), "Sapienza" University, Rome, Italy.,Cognitive Impairment Center, Local Health Authority 9 of Treviso, Treviso, Italy
| | - N Vanacore
- National Centre of Epidemiology, National Institute of Health, Rome, Italy
| | - C P Papi
- Department of Neurology and Psychiatry (Parkinson's Centre) and Research Centre of Social Diseases (CIMS), "Sapienza" University, Rome, Italy
| | - G Alampi
- Department of Neurology and Psychiatry (Parkinson's Centre) and Research Centre of Social Diseases (CIMS), "Sapienza" University, Rome, Italy
| | - A Rubino
- Department of Neurology and Psychiatry (Parkinson's Centre) and Research Centre of Social Diseases (CIMS), "Sapienza" University, Rome, Italy
| | - M Valente
- Department of Neurology and Psychiatry (Parkinson's Centre) and Research Centre of Social Diseases (CIMS), "Sapienza" University, Rome, Italy.,Parkinson's Clinical Trials Centre, Neurological Centre of Latium (NCL), Rome, Italy
| | - G Meco
- Department of Neurology and Psychiatry (Parkinson's Centre) and Research Centre of Social Diseases (CIMS), "Sapienza" University, Rome, Italy.,Parkinson's Clinical Trials Centre, Neurological Centre of Latium (NCL), Rome, Italy
| | - P Contri
- Department of Clinical Sciences, Institute of Clinical Neurology, ASST Fatebenefratelli-Sacco, "Luigi Sacco" University Hospital, Milan, Italy
| | - A Di Pucchio
- National Centre of Epidemiology, National Institute of Health, Rome, Italy
| | - E Lacorte
- National Centre of Epidemiology, National Institute of Health, Rome, Italy
| | - A Priori
- Neurology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, "San Paolo" University Hospital, Milan, Italy
| | - C Mariani
- Department of Clinical Sciences, Institute of Clinical Neurology, ASST Fatebenefratelli-Sacco, "Luigi Sacco" University Hospital, Milan, Italy
| | - S Pomati
- Department of Clinical Sciences, Institute of Clinical Neurology, ASST Fatebenefratelli-Sacco, "Luigi Sacco" University Hospital, Milan, Italy
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Cova I, Di Battista M, Vanacore N, Papi C, Alampi G, Rubino A, Valente M, Meco G, Contri P, Di Pucchio A, Lacorte E, Priori A, Mariani C, Pomati S. Validation of the Italian version of the Non Motor Symptoms Scale for Parkinson's disease. Parkinsonism Relat Disord 2017; 34:38-42. [DOI: 10.1016/j.parkreldis.2016.10.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/05/2016] [Accepted: 10/24/2016] [Indexed: 12/01/2022]
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Ceccanti M, Cambieri C, Onesti E, Tartaglia G, Frasca V, Rubino A, Inghilleri M. 67. Impact of Riluzole on the effects of paired associative stimulation (PAS) on cortical excitability in ALS patients. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Onorati F, Reichart D, Perrotti A, Mariscalo G, Della Ratta E, Santarpino G, Salsano A, Rubino A, Biancari F, Beghi C, De Feo M, Mignosa C, Fischlein T, Chocron S, Detter C, Santini F, Reichenspurner H, Faggian G. Risk Factors and Complications Affecting Hospital Outcome after Redo Mitral Surgery. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ortmann E, Rubino A, Altemimi B, Collier T, Besser MW, Klein AA. Validation of viscoelastic coagulation tests during cardiopulmonary bypass. J Thromb Haemost 2015; 13:1207-16. [PMID: 25903995 DOI: 10.1111/jth.12988] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 11/04/2014] [Accepted: 04/13/2015] [Indexed: 08/31/2023]
Abstract
BACKGROUND Viscoelastic point-of-care tests such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are increasingly used to guide hemostatic therapy after cardiac surgery. The aim of this study was to assess their clinical utility during cardiopulmonary bypass to predict postbypass coagulation status and to guide therapy. METHODS In this prospective study, TEG and ROTEM tests were performed in 52 adult patients undergoing elective cardiac surgery at two time points: near the end of cardiopulmonary bypass and after heparin reversal with protamine. The 95% confidence intervals of the mean difference were compared with a prespecified clinically relevant limit of ± 20% of the value after protamine. RESULTS Both viscoelastic fibrinogen assays were well within the prespecified clinically relevant limit (≥ 79% of patients). The laboratory Clauss fibrinogen was much lower during cardiopulmonary bypass than after protamine (mean difference 1.2 g L(-1) , 95% CI 1.03-1.4, which was outside a clinically acceptable difference. For intrinsically activated tests, clotting times (CT) were different and outside the prespecified limit on TEG (mean difference -1.2 min, 95% CI -1.8 to -0.6) but not on ROTEM (mean difference 2.3 sec, 95% CI -8.6 to 13.2), while clot strength was well within the clinical limit on both devices (≥ 94% of patients). For extrinsically activated tests, clot strength on both TEG and ROTEM was within the pre-specified limit in 98% of patients. CONCLUSIONS Results from TEG and ROTEM tests performed toward the end of cardiopulmonary bypass are similar to results after reversal of heparin. Amplitudes indicating clot strength were the most stable parameters across all tests, whereas CT showed more variability. In contrast, laboratory testing of fibrinogen using the Clauss assay was essentially invalid during cardiopulmonary bypass.
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Affiliation(s)
- E Ortmann
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
| | - A Rubino
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
| | - B Altemimi
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
| | - T Collier
- London School of Hygiene and Tropical Medicine, London, UK
| | - M W Besser
- Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals Foundation Trust, Cambridge, UK
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
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Sangalli F, Rubino A. Intraoperative transthoracic echocardiography: another arrow to the bow of perioperative medicine. Minerva Anestesiol 2015; 81:469-471. [PMID: 25220560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Santarpino G, Dalén M, Biancari F, Rubino A, De Praetere H, Kasama K, Deste W, Pollari F, Meuris B, Mignosa C, Gatti G, Pappalardo A, Sartipy U, Svenarud P, Fischlein T. Ministernotomy versus Full Sternotomy Aortic Valve Replacement with a Sutureless Aortic Bioprosthesis: An European Multicenter Registry. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Torrisi R, Garcia-Etienne CA, Losurdo A, Morenghi E, Di Tommaso L, Gatzemeier W, Sagona A, Fernandes B, Rossetti C, Eboli M, Rubino A, Barbieri E, Andreoli C, Orefice S, Gandini C, Rota S, Zuradelli M, Masci G, Santoro A, Tinterri C. Potential impact of the 70-gene signature in the choice of adjuvant systemic treatment for ER positive, HER2 negative tumors: a single institution experience. Breast 2013; 22:419-24. [PMID: 23643803 DOI: 10.1016/j.breast.2013.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 02/03/2013] [Accepted: 03/03/2013] [Indexed: 01/22/2023] Open
Abstract
PURPOSE We investigated in a single institution series of 124 women with operable breast cancer whether tumor clinicopathological features could predict the 70-gene signature (Mammaprint, MP) results, and whether MP results could help to make decisions for the use of chemotherapy (CT) in patients (pts) with ER positive breast cancer beyond recommendations of international guidelines. RESULTS Among the 68 ER/PgR positive, HER2 negative tumors, Ki-67 ≥ 20% was the only significant predictor of a high risk-MP among standard clinicopathological features. In candidates for endocrine therapy with undetermined benefit from CT according to international guidelines, MP results would have led to different treatment decisions in 13/46 (28%) and in 20/68 (29%) pts according to NCCN and St. Gallen recommendations, respectively. CONCLUSIONS Ki-67 independently predicted high risk-MP in ER/PgR positive, HER2 negative tumors. MP results would have led to discordant treatment recommendations in about 30% of cases, generally increasing indication rate for CT. The results of large randomized trials are warranted in order to understand whether we should rely on multigene assays rather than on standard clinicopathological features for treatment decisions.
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Affiliation(s)
- R Torrisi
- Division of Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, 20089 Milano, Italy.
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Rubino A, Marini E, Ferro B, Collareta M, Forfori F, Guarracino F, Giunta F. Haemodynamic changes during alveolar recruitment manoeuvre in patients with diastolic dysfunction. Crit Care 2013. [PMCID: PMC3642429 DOI: 10.1186/cc12046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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