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Rando MM, Biscetti F, Masciocchi C, Savino M, Nicolazzi MA, Nardella E, Cecchini AL, Rossini E, Massetti M, Gasbarrini A, Flex A. Impact of COVID-19 pandemic on patients affected by peripheral arterial disease: an Italian single-center study. Eur Rev Med Pharmacol Sci 2023; 27:10144-10155. [PMID: 37916384 DOI: 10.26355/eurrev_202310_34194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) has evolved into a global pandemic, affecting a wide range of medical and surgical specialties. During COVID-19, we assisted in the reallocation of medical resources and services, as well as social distancing measures, and many patients with chronic diseases and comorbidities may have experienced difficulties in obtaining the correct medical care. The aim of the study was to investigate the impact of the COVID-19 pandemic on major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in patients with peripheral arterial disease (PAD) and chronic limb-threatening ischemia (CLTI), compared to previous years. PATIENTS AND METHODS We evaluated 1,335 hospital admissions of 877 patients with PAD admitted to Policlinico A. Gemelli Hospital between January 2017 and February 2020 and 368 hospital admissions of 272 patients with PAD admitted to the Policlinico A. Gemelli Hospital between March 2020 and March 2021. Data on demographic characteristics, comorbidities, symptoms, physical and radiological findings, laboratory tests, and routine visits before or after discharge were collected from electronic medical records. RESULTS Emergency room (ER) admissions among PAD patients during COVID-19 were higher than before the pandemic [190 (51.63%) vs. 579 (43.37%), p = 0.01]. A MACE was found in 78 (5.84%) pre-pandemic hospitalizations and 126 (34.24%) pandemic hospitalizations (p < 0.01). A MALE was identified in 942 (70.56%) pre-pandemic hospitalizations and 331 (89.95%) pandemic hospitalizations (p < 0.01). Amputation rates during the pandemic were higher than before the pandemic [80 (21.74%) vs. 191 (14.31%), p < 0.01]. The number of in-hospital deaths did not differ between the pandemic and pre-pandemic periods [11 (2.99%) vs. 51 (3.82%), p = 0.55]. CONCLUSIONS In patients with PAD and CLTI, the number of MACE, MALE, and amputations was higher during the COVID-19 period compared to the three years before the pandemic.
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Affiliation(s)
- M M Rando
- Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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2
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Rando MM, Biscetti F, Masciocchi C, Capocchiano ND, Nicolazzi MA, Nardella E, Cecchini AL, Pecorini G, Colosimo C, Sanguinetti M, Massetti M, Gasbarrini A, Flex A. Identification of early predictors of clinical outcomes of COVID-19 outbreak in an Italian single center using a machine-learning approach. Eur Rev Med Pharmacol Sci 2023; 27:9454-9469. [PMID: 37843358 DOI: 10.26355/eurrev_202310_33974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVE SARS-CoV-2 disease (COVID-19) has become a pandemic disease, determining a public health emergency. The use of artificial intelligence in identifying easily available biomarkers capable of predicting the risk for severe disease may be helpful in guiding clinical decisions. The aim of the study was to investigate the ability of interleukin (IL)-6, troponin I, and D-dimer to identify patients with COVID-19 at risk for intensive care unit (ICU)-admission and death by using a machine-learning predictive model. PATIENTS AND METHODS Data on demographic characteristics, underlying comorbidities, symptoms, physical and radiological findings, and laboratory tests have been retrospectively collected from electronic medical records of patients admitted to Policlinico A. Gemelli Foundation from March 1, 2020, to September 15, 2020, by using artificial intelligence techniques. RESULTS From an initial cohort of 425 patients, 146 met the inclusion criteria and were enrolled in the study. The in-hospital mortality rate was 15%, and the ICU admission rate was 41%. Patients who died had higher troponin I (p-value<0.01) and IL-6 values (p-value=0.04), compared to those who survived. Patients admitted to ICU had higher levels of troponin I (p-value<0.01) and IL-6 (p-value<0.01), compared to those not admitted to ICU. Threshold values to predict in-hospital mortality and ICU admission have been identified. IL-6 levels higher than 15.133 ng/L have been associated with a 22.91% risk of in-hospital mortality, and IL-6 levels higher than 25.65 ng/L have been associated with a 56.16% risk of ICU admission. Troponin I levels higher than 12 ng/L have been associated with a 26.76% risk of in-hospital mortality and troponin I levels higher than 12 ng/L have been associated with a 52.11% risk of ICU admission. CONCLUSIONS Levels of IL-6 and troponin I are associated with poor COVID-19 outcomes. Cut-off values capable of predicting in-hospital mortality and ICU admission have been identified. Building a predictive model using a machine-learning approach may be helpful in supporting clinical decisions in a more precise and personalized way.
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Affiliation(s)
- M M Rando
- Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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3
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Nardella E, Biscetti F, Rando MM, Cecchini AL, Nicolazzi MA, Rossini E, Angelini F, Iezzi R, Eraso LH, Dimuzio PJ, Pitocco D, Massetti M, Gasbarrini A, Flex A. Development of a biomarker panel for assessing cardiovascular risk in diabetic patients with chronic limb-threatening ischemia (CLTI): a prospective study. Cardiovasc Diabetol 2023; 22:136. [PMID: 37308885 DOI: 10.1186/s12933-023-01872-x] [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: 04/26/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Lower-extremity endovascular revascularization (LER) is often required for diabetic patients with chronic limb threatening ischemia (CLTI). During the post-revascularization period patients may unpredictably experience major adverse cardiac events (MACE) and major adverse limb events (MALE). Several families of cytokines are involved in the inflammatory process that underlies the progression of atherosclerosis. According to current evidence, we have identified a panel of possible biomarkers related with the risk of developing MACE and MALE after LER. The aim was to study the relationship between a panel of biomarkers - Interleukin-1 (IL-1) and 6 (IL-6), C-Reactive Protein (CRP), Tumor Necrosis Factor-α (TNF-α), High-Mobility Group Box-1 (HMGB-1), Osteoprotegerin (OPG), Sortilin and Omentin-1- at baseline, with cardiovascular outcomes (MACE and MALE) after LER in diabetic patients with CLTI. METHODS In this prospective non-randomized study, 264 diabetic patients with CLTI undergoing endovascular revascularization were enrolled. Serum levels of each biomarker were collected before revascularization and outcomes' incidence was evaluated after 1, 3, 6 and 12 months. RESULTS During the follow-up period, 42 cases of MACE and 81 cases of MALE occurred. There was a linear association for each biomarker at baseline and incident MACE and MALE, except Omentin-1 levels that were inversely related to the presence of MACE or MALE. After adjusting for traditional cardiovascular risk factors, the association between each biomarker baseline level and outcomes remained significant in multivariable analysis. Receiver operating characteristics (ROC) models were constructed using traditional clinical and laboratory risk factors and the inclusion of biomarkers significantly improved the prediction of incident events. CONCLUSIONS Elevated IL-1, IL-6, CRP, TNF-α, HMGB-1, OPG and Sortilin levels and low Omentin-1 levels at baseline correlate with worse vascular outcomes in diabetic patients with CLTI undergoing LER. Assessment of the inflammatory state with this panel of biomarkers may support physicians to identify a subset of patients more susceptible to the procedure failure and to develop cardiovascular adverse events after LER.
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Affiliation(s)
- Elisabetta Nardella
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | - Federico Biscetti
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy.
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy.
| | - Maria Margherita Rando
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | | | - Maria Anna Nicolazzi
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | - Enrica Rossini
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | - Flavia Angelini
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
| | - Roberto Iezzi
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Luis H Eraso
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul J Dimuzio
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dario Pitocco
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Massimo Massetti
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
- Department of Medical and Surgical sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | - Andrea Flex
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
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Nardella E, D'Addio S, Cipolla C, Manna R. Diabetic ketoacidosis during treatment with sodium-glucose cotransporter 2 inhibitors reveals a latent autoimmune diabetes in adult. Minerva Endocrinol (Torino) 2022; 47:475-476. [PMID: 33855387 DOI: 10.23736/s2724-6507.21.03432-5] [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: 01/20/2023]
Affiliation(s)
- Elisabetta Nardella
- Department of Internal Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Stefano D'Addio
- Department of Internal Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Clelia Cipolla
- Department of Life Sciences and Global Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Raffaele Manna
- Department of Internal Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Rare Diseases and Periodic Fevers Research Center, Sacred Heart Catholic University, Rome, Italy
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5
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Rando MM, Biscetti F, Cecchini AL, Nardella E, Nicolazzi MA, Angelini F, Iezzi R, Eraso LH, Dimuzio PJ, Pitocco D, Gasbarrini A, Massetti M, Flex A. Serum high mobility group box-1 levels associated with cardiovascular events after lower extremity revascularization: a prospective study of a diabetic population. Cardiovasc Diabetol 2022; 21:214. [PMID: 36244983 PMCID: PMC9571458 DOI: 10.1186/s12933-022-01650-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Peripheral arterial disease (PAD) is one of the most disabling cardiovascular complications of type 2 diabetes mellitus and is indeed associated with a high risk of cardiovascular and limb adverse events. High mobility group box-1 (HMGB-1) is a nuclear protein involved in the inflammatory response that acts as a pro-inflammatory cytokine when released into the extracellular space. HMBG-1 is associated with PAD in diabetic patients. The aim of this study was to evaluate the association between serum HMGB-1 levels and major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after lower-extremity endovascular revascularization (LER) in a group of diabetic patients with chronic limb-threatening ischemia (CLTI). Methods We conducted a prospective observational study of 201 diabetic patients with PAD and CLTI requiring LER. Baseline serum HMGB-1 levels were determined before endovascular procedure. Data on cardiovascular and limb outcomes were collected in a 12-month follow-up. Results During the follow-up period, 81 cases of MACE and 93 cases of MALE occurred. Patients who subsequently developed MACE and MALE had higher serum HMGB-1 levels. Specifically, 7.5 ng/mL vs 4.9 ng/mL (p < 0.01) for MACE and 7.2 ng/mL vs 4.8 ng/mL (p < 0.01) for MALE. After adjusting for traditional cardiovascular risk factors, the association between serum HMGB-1 levels and cardiovascular outcomes remained significant in multivariable analysis. In our receiver operating characteristic (ROC) curve analysis, serum HMGB-1 levels were a good predictor of MACE incidence (area under the curve [AUC] = 0.78) and MALE incidence (AUC = 0.75). Conclusions This study demonstrates that serum HMGB-1 levels are associated with the incidence of MACE and MALE after LER in diabetic populations with PAD and CLTI.
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Kajana V, Massaro G, Somaschini A, Cornara S, Demarchi A, Nardella E, Nicoletti A, Sangiorgi GM, Mandurino-Mirizzi A. Serum uric acid in patients with ST-segment elevation myocardial infarction: An innocent bystander or leading actor? Nutr Metab Cardiovasc Dis 2022; 32:1583-1589. [PMID: 35597708 DOI: 10.1016/j.numecd.2022.03.023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/02/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
Abstract
Elevated serum uric acid (SUA) levels have been associated with several cardiovascular risk factors and the progression of coronary artery disease. In the setting of acute myocardial infarction, increasing evidence suggests that high SUA levels could be related to adverse outcomes. Interestingly elevated SUA levels have been linked to endothelial dysfunction, inflammation and oxidative stress. The aim of this review is to discuss the potential negative effects of SUA in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, analyzing the possible underlying pathophysiological mechanisms.
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Affiliation(s)
- Vilma Kajana
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gianluca Massaro
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy
| | - Alberto Somaschini
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona, Italy
| | - Stefano Cornara
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona, Italy
| | | | - Elisabetta Nardella
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Nicoletti
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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7
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Biscetti F, Cecchini AL, Rando MM, Nardella E, Gasbarrini A, Massetti M, Flex A. Principal predictors of major adverse limb events in diabetic peripheral artery disease: A narrative review. Atheroscler Plus 2021; 46:1-14. [PMID: 36643723 PMCID: PMC9833249 DOI: 10.1016/j.athplu.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/10/2021] [Accepted: 10/28/2021] [Indexed: 01/18/2023]
Abstract
Background and aims The increasing prevalence of diabetes mellitus is causing a massive growth of peripheral artery disease incidences, a disabling complication of diabetic atherosclerosis, which leads often to the amputation of the affected limb. Critical limb ischemia is the terminal disease stage, which requires a prompt intervention to relieve pain and save limbs. However, patients undergoing revascularization often suffer from cardiovascular, cerebrovascular and major adverse limb events with poor outcomes. Furthermore, the same procedure performed in apparently similar patients has various outcomes and lack of an outcome predictive support causes a high lower limb arterial revascularization rate with disastrous effects for patients. We collected the main risk factors of major adverse limb events in a more readable and immediate format of the topic, to propose an overview of parameters to manage effectively peripheral artery disease patients and to propose basics of a new predictive tool to prevent from disabling vascular complications of the disease. Methods Most recent and updated literature about the prevalence of major adverse limb events in peripheral artery disease was reviewed to identify possible main predictors. Results In this article, we summarized major risk factors of limb revascularization failure and disabling vascular complications collecting those parameters principally responsible for major adverse limb events, which provides physio-pathological explanation of their role in peripheral artery disease. Conclusion We evaluated and listed a panel of possible predictors of MALE (Major Adverse Limb Event) in order to contribute to the development of a predictive score, based on a summary of the main risk factors reported in scientific articles, which could improve the management of peripheral artery disease by preventing vascular accidents.
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Affiliation(s)
- Federico Biscetti
- Internal and Cardiovascular Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy,Corresponding author. Internal and Cardiovascular Medicine Unit. Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, Rome, 00168, Italy.
| | | | - Maria Margherita Rando
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Elisabetta Nardella
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Universitá Cattolica del Sacro Cuore, Roma, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Andrea Flex
- Internal and Cardiovascular Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Department of Medical and Surgical Sciences, Universitá Cattolica del Sacro Cuore, Roma, Italy
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8
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Biscetti F, Tinelli G, Rando MM, Nardella E, Cecchini AL, Angelini F, Straface G, Filipponi M, Arena V, Pitocco D, Gasbarrini A, Massetti M, Flex A. Correction to: Association between carotid plaque vulnerability and high mobility group box‑1 serum levels in a diabetic population. Cardiovasc Diabetol 2021; 20:184. [PMID: 34503518 PMCID: PMC8431924 DOI: 10.1186/s12933-021-01376-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy. .,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy. .,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Giovanni Tinelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Vascular Surgery, Fondazione Policlinico Univer-Sitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Margherita Rando
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Elisabetta Nardella
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Flavia Angelini
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Straface
- Department of Internal Medicine, St. M. Goretti Hospital, Roma, Italy
| | | | - Vincenzo Arena
- Department of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Dario Pitocco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Massimo Massetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Cardiovascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy.,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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9
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Segala FV, Sgalla G, Salvati F, Berardini L, Negri M, Nardella E, Potenza A, Murri R, Fantoni M. Adjunctive corticosteroid treatment for organizing pneumonia in COVID-19 patients with persistent respiratory failure. Respir Med 2021; 187:106571. [PMID: 34388415 PMCID: PMC8352674 DOI: 10.1016/j.rmed.2021.106571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/06/2021] [Indexed: 12/28/2022]
Abstract
Since the beginning of COVID-19 pandemic, clinical, radiological and histopathological features consistent with viral-induced organizing pneumonia (OP) have been reported as hallmark characteristics of the disease. Here, we describe the case of ten patients with severe COVID-19 pneumonia treated with methylprednisolone 1mg/kg for showing clinical and radiological features suggestive of OP at least 20 days after symptom onset and despite standard treatment for COVID-19.
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Affiliation(s)
| | - Giacomo Sgalla
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Federica Salvati
- Infectious Diseases Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Ludovica Berardini
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Marcantonio Negri
- Istituto di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisabetta Nardella
- Istituto di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annalisa Potenza
- Istituto di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rita Murri
- Division of Infectious Diseases, Department of Laboratory Sciences and Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Fantoni
- Division of Infectious Diseases, Department of Laboratory Sciences and Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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10
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Biscetti F, Tinelli G, Rando MM, Nardella E, Cecchini AL, Angelini F, Straface G, Filipponi M, Arena V, Pitocco D, Gasbarrini A, Massetti M, Flex A. Association between carotid plaque vulnerability and high mobility group box-1 serum levels in a diabetic population. Cardiovasc Diabetol 2021; 20:114. [PMID: 34044825 PMCID: PMC8161555 DOI: 10.1186/s12933-021-01304-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background Carotid atherosclerosis represents one of the complications of diabetes mellitus. In particular, plaque instability contributes to disease progression and stroke incidence. High mobility group box-1 (HMGB1) is a nuclear protein involved in promotion and progression of atherosclerosis and cardiovascular diseases. The aim of this study was to analyze the relationship between HMGB1 serum levels, main inflammatory cytokines, the presence of internal carotid stenosis and unstable plaque in a diabetic population. Research design and methods We studied 873 diabetic patients, including 347 patients with internal carotid artery stenosis (ICAS) who underwent carotid endarterectomy and 526 diabetic patients without internal carotid artery stenosis (WICAS). At baseline, HMGB1 and the main inflammatory cytokines serum levels were evaluated. For ICAS patients, the histological features of carotid plaque were also collected to differentiate them in patients with stable or unstable atherosclerotic lesions. Results We found that HMGB1 serum levels, osteoprotegerin, high-sensitivity C-reactive protein, tumor necrosis factor-alpha and interleukin-6, were significantly higher in diabetic ICAS patients compared to diabetic WICAS patients. Among ICAS patients, individuals with unstable plaque had higher levels of these cytokines, compared to patients with stable plaque. A multivariable stepwise logistic regression analysis showed that HMGB1 and osteoprotegerin remained independently associated with unstable plaque in ICAS patients. Conclusions The present study demonstrated that HMGB1 is an independent risk factor for carotid plaque vulnerability in an Italian population with diabetes mellitus, representing a promising biomarker of carotid plaque instability and a possible molecular target to treat unstable carotid plaques and to prevent stroke.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy. .,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy. .,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Giovanni Tinelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Margherita Rando
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Elisabetta Nardella
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Flavia Angelini
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Straface
- Department of Internal Medicine, St. M. Goretti Hospital, Roma, Italy
| | | | - Vincenzo Arena
- Department of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Dario Pitocco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Massimo Massetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Cardiovascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy.,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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11
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Nicoletti A, Ponziani FR, Nardella E, Ianiro G, Gasbarrini A, Zileri Dal Verme L. Biliary tract microbiota: a new kid on the block of liver diseases? Eur Rev Med Pharmacol Sci 2021; 24:2750-2775. [PMID: 32196626 DOI: 10.26355/eurrev_202003_20548] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The microbiome plays a crucial role in maintaining the homeostasis of the organism. Recent evidence has provided novel insights for understanding the interaction between the microbiota and the host. However, the vast majority of such studies have analyzed the interactions taking place in the intestinal tract. The biliary tree has traditionally been considered sterile under normal conditions. However, the advent of metagenomic techniques has revealed an unexpectedly rich bacterial community in the biliary tract. Associations between specific microbiological patterns and inflammatory biliary diseases and cancer have been recently described. Hence, biliary dysbiosis may be a primary trigger in the pathogenesis of biliary diseases. In particular, recent studies have suggested that microorganisms could play a significant role in the development of gallstones, pathogenesis of autoimmune cholangiopathies and biliary carcinogenesis. Moreover, the intimate connection between the biliary tract, liver and pancreas, could reveal hidden influences on the development of diseases of these organs. Further studies are needed to deepen the comprehension of the influence of the biliary microbiota in human pathology. This knowledge could lead to the formulation of strategies for modulating the biliary microbiota in order to treat and prevent these pathological conditions.
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Affiliation(s)
- A Nicoletti
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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12
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Biscetti F, Nardella E, Rando MM, Cecchini AL, Gasbarrini A, Massetti M, Flex A. Outcomes of Lower Extremity Endovascular Revascularization: Potential Predictors and Prevention Strategies. Int J Mol Sci 2021; 22:2002. [PMID: 33670461 PMCID: PMC7922574 DOI: 10.3390/ijms22042002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 01/02/2023] Open
Abstract
Peripheral artery disease (PAD) is a manifestation of atherosclerosis, which may affect arteries of the lower extremities. The most dangerous PAD complication is chronic limb-threatening ischemia (CLTI). Without revascularization, CLTI often causes limb loss. However, neither open surgical revascularization nor endovascular treatment (EVT) ensure long-term success and freedom from restenosis and revascularization failure. In recent years, EVT has gained growing acceptance among all vascular specialties, becoming the primary approach of revascularization in patients with CLTI. In clinical practice, different clinical outcomes after EVT in patients with similar comorbidities undergoing the same procedure (in terms of revascularization technique and localization of the disease) cause unsolved issues that need to be addressed. Nowadays, risk management of revascularization failure is one of the major challenges in the vascular field. The aim of this literature review is to identify potential predictors for lower extremity endovascular revascularization outcomes and possible prevention strategies.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (M.M.R.); (A.G.); (M.M.); (A.F.)
- Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Elisabetta Nardella
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.N.); (A.L.C.)
| | - Maria Margherita Rando
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (M.M.R.); (A.G.); (M.M.); (A.F.)
- Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Andrea Leonardo Cecchini
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.N.); (A.L.C.)
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (M.M.R.); (A.G.); (M.M.); (A.F.)
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.N.); (A.L.C.)
| | - Massimo Massetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (M.M.R.); (A.G.); (M.M.); (A.F.)
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (M.M.R.); (A.G.); (M.M.); (A.F.)
- Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.N.); (A.L.C.)
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13
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Biscetti F, Rando MM, Nardella E, Cecchini AL, Bruno P, Landolfi R, Flex A. Cardiovascular Disease and SARS-CoV-2: the Role of Host Immune Response Versus Direct Viral Injury. Int J Mol Sci 2020; 21:ijms21218141. [PMID: 33143371 PMCID: PMC7663579 DOI: 10.3390/ijms21218141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/26/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
The 2019 novel coronavirus [2019-nCoV], which started to spread from December 2019 onwards, caused a global pandemic. Besides being responsible for the severe acute respiratory syndrome 2 [SARS-CoV-2], the virus can affect other organs causing various symptoms. A close relationship between SARS-CoV-2 and the cardiovascular system has been shown, demonstrating an epidemiological linkage between SARS-CoV-2 and cardiac injury. There are emerging data regarding possible direct myocardial damage by 2019-nCoV. In this review, the most important available evidences will be discussed to clarify the precise mechanisms of cardiovascular injury in SARS-CoV-2 patients, even if further researches are needed.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
- Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, 00168 Roma, Italy
- Correspondence: ; Tel.: +39-06-3015-4518
| | - Maria Margherita Rando
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | - Elisabetta Nardella
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | | | - Piergiorgio Bruno
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Cardiac Surgery Unit, 00168 Roma, Italy
| | - Raffaele Landolfi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
- Cardiac Surgery Unit, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
- Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, 00168 Roma, Italy
- Cardiac Surgery Unit, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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14
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Biscetti F, Nardella E, Rando MM, Cecchini AL, Angelini F, Cina A, Iezzi R, Filipponi M, Santoliquido A, Pitocco D, Landolfi R, Flex A. Association between omentin-1 and major cardiovascular events after lower extremity endovascular revascularization in diabetic patients: a prospective cohort study. Cardiovasc Diabetol 2020; 19:170. [PMID: 33028322 PMCID: PMC7542958 DOI: 10.1186/s12933-020-01151-z] [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: 05/22/2020] [Accepted: 10/01/2020] [Indexed: 12/24/2022] Open
Abstract
Background Cardiovascular complications represent the major cause of morbidity and mortality of type 2 diabetes mellitus (T2DM) patients. In particular, peripheral artery disease (PAD) represents a frequent T2DM vascular complication and a risk factor for the development of major adverse cardiovascular events (MACE). Among adipokines, omentin-1 serum levels are reduced in T2DM patients with PAD and are inversely related to disease severity. Objective To study the relationship between omentin-1 levels, at baseline, with outcomes after endovascular procedures in T2DM patients with PAD and chronic limb-threatening ischemia (CLTI). Research design and methods We enrolled for our prospective non-randomized study, 207 T2DM patients with PAD and CLTI, requiring revascularization. Omentin-1 serum levels were collected before revascularization and patients incidence outcomes were evaluated at 1, 3, 6 and 12 months. Results Omentin-1 was reduced in patients with more severe disease (27.24 ± 4.83 vs 30.82 ± 5.48 ng/mL, p < 0.001). Overall, 84 MACE and 96 major adverse limb events (MALE) occurred during the 12-month follow-up. We observed that omentin-1 levels were lower in patients with MACE (26.02 ± 4.05 vs 31.33 ± 5.29 ng/mL, p < 0.001) and MALE (26.67 ± 4.21 vs 31.34 ± 5.54 ng/mL, p < 0.001). The association between omentin-1, MACE and MALE remained significant after adjusting for major risk factors in a multivariate analysis. Receiver operating characteristics (ROC) curve using omentin-1 levels predicted incidence events (area under the curve = 0.80). Conclusions We demonstrated that reduced omentin-1 levels, at baseline, are related with worse vascular outcomes in T2DM patients with PAD and CLTI undergoing an endovascular procedure.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Internal Medicine and Vascular Diseases Unit, Rome, Italy. .,Department of Translational Medicine and Surgery, Laboratory of Vascular Biology and Genetics, Rome, Italy. .,Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | | | | | | | - Flavia Angelini
- Department of Translational Medicine and Surgery, Laboratory of Vascular Biology and Genetics, Rome, Italy
| | | | | | | | - Angelo Santoliquido
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.,Angiology Unit, Rome, Italy
| | - Dario Pitocco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.,Diabetology Unit, Rome, Italy
| | - Raffaele Landolfi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Internal Medicine and Vascular Diseases Unit, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Internal Medicine and Vascular Diseases Unit, Rome, Italy.,Department of Translational Medicine and Surgery, Laboratory of Vascular Biology and Genetics, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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15
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Biscetti F, Nardella E, Rando MM, Cecchini AL, Bonadia N, Bruno P, Angelini F, Di Stasi C, Contegiacomo A, Santoliquido A, Pitocco D, Landolfi R, Flex A. Sortilin levels correlate with major cardiovascular events of diabetic patients with peripheral artery disease following revascularization: a prospective study. Cardiovasc Diabetol 2020; 19:147. [PMID: 32977814 PMCID: PMC7519536 DOI: 10.1186/s12933-020-01123-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/12/2020] [Indexed: 12/24/2022] Open
Abstract
Background Peripheral artery disease (PAD) represents one of the most relevant vascular complications of type 2 diabetes mellitus (T2DM). Moreover, T2DM patients suffering from PAD have an increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Sortilin, a protein involved in apolipoproteins trafficking, is associated with lower limb PAD in T2DM patients. Objective To evaluate the relationship between baseline serum levels of sortilin, MACE and MALE occurrence after revascularization of T2DM patients with PAD and chronic limb-threatening ischemia (CLTI). Research design and methods We performed a prospective non-randomized study including 230 statin-free T2DM patients with PAD and CLTI. Sortilin levels were measured before the endovascular intervention and incident outcomes were assessed during a 12 month follow-up. Results Sortilin levels were significantly increased in individuals with more aggressive PAD (2.25 ± 0.51 ng/mL vs 1.44 ± 0.47 ng/mL, p < 0.001). During follow-up, 83 MACE and 116 MALE occurred. In patients, who then developed MACE and MALE, sortilin was higher. In particular, 2.46 ± 0.53 ng/mL vs 1.55 ± 0.42 ng/mL, p < 0.001 for MACE and 2.10 ± 0.54 ng/mL vs 1.65 ± 0.65 ng/mL, p < 0.001 for MALE. After adjusting for traditional atherosclerosis risk factors, the association between sortilin and vascular outcomes remained significant in a multivariate analysis. In our receiver operating characteristics (ROC) curve analysis using sortilin levels the prediction of MACE incidence improved (area under the curve [AUC] = 0.94) and MALE (AUC = 0.72). Conclusions This study demonstrates that sortilin correlates with incidence of MACE and MALE after endovascular revascularization in a diabetic population with PAD and CLTI.
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Affiliation(s)
- Federico Biscetti
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia. .,Internal Medicine and Vascular Diseases Unit, Roma, Italia. .,Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, Roma, Italia.
| | | | | | | | - Nicola Bonadia
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Emergency Medicine, Roma, Italia
| | - Piergiorgio Bruno
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Cardiac Surgery Unit, Roma, Italia
| | - Flavia Angelini
- Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, Roma, Italia
| | | | | | - Angelo Santoliquido
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia.,Angiology Unit, Roma, Italia
| | - Dario Pitocco
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia.,Diabetology Unit, Roma, Italia
| | - Raffaele Landolfi
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Internal Medicine and Vascular Diseases Unit, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Andrea Flex
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Internal Medicine and Vascular Diseases Unit, Roma, Italia.,Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
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16
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Biscetti F, Nardella E, Cecchini AL, Flex A, Landolfi R. Biomarkers of vascular disease in diabetes: the adipose-immune system cross talk. Intern Emerg Med 2020; 15:381-393. [PMID: 31919781 DOI: 10.1007/s11739-019-02270-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/21/2019] [Indexed: 12/21/2022]
Abstract
Experimental and clinical studies aimed at investigating the mechanism(s) underlying vascular complications of diabetes indicate that a great number of molecules are involved in the pathogenesis of these complications. Most of these molecules are inflammatory mediators or markers generated by immune or adipose tissue. Some of them, i.e. resistin and sortilin, have been shown to be involved in the cross talk between adipocytes and inflammatory cells. This interaction is an attractive area of research, particularly in type 2 diabetes and obesity. Other proteins, such as adiponectin and visfatin, appear to be more promising as possible vascular markers. In addition, some molecules involved in calcium/phosphorus metabolism, such as klotho and FGF23, have an involvement in the pathogenesis of diabetic vasculopathy, which appears to be dependent on the degree of vascular impairment. Inflammatory markers are a promising tool for treatment decisions while measuring plasma levels of adipokines, sortilin, Klotho and FGF23 in adequately sized longitudinal studies is expected to allow a more precise characterization of diabetic vascular disease and the optimal use of personalized treatment strategies.
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Affiliation(s)
- Federico Biscetti
- U.O.C. Clinica Medica e Malattie Vascolari, Catholic University School of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Nardella
- U.O.C. Clinica Medica e Malattie Vascolari, Catholic University School of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Andrea Leonardo Cecchini
- U.O.C. Clinica Medica e Malattie Vascolari, Catholic University School of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Andrea Flex
- U.O.C. Clinica Medica e Malattie Vascolari, Catholic University School of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- U.O.S.A Medicina delle Malattie Vascolari Periferiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Raffaele Landolfi
- U.O.C. Clinica Medica e Malattie Vascolari, Catholic University School of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
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Biscetti F, Rando MM, Nardella E, Cecchini AL, Pecorini G, Landolfi R, Flex A. High Mobility Group Box-1 and Diabetes Mellitus Complications: State of the Art and Future Perspectives. Int J Mol Sci 2019; 20:ijms20246258. [PMID: 31835864 PMCID: PMC6940913 DOI: 10.3390/ijms20246258] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/17/2022] Open
Abstract
Diabetes mellitus (DM) is an endemic disease, with growing health and social costs. The complications of diabetes can affect potentially all parts of the human body, from the heart to the kidneys, peripheral and central nervous system, and the vascular bed. Although many mechanisms have been studied, not all players responsible for these complications have been defined yet. High Mobility Group Box-1 (HMGB1) is a non-histone nuclear protein that has been implicated in many pathological processes, from sepsis to ischemia. The purpose of this review is to take stock of all the most recent data available on the role of HMGB1 in the complications of DM.
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Affiliation(s)
- Federico Biscetti
- U.O.C. Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (G.P.); (R.L.); (A.F.)
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Correspondence: ; Tel.: +39-06-3015-4335; Fax: +39-06-3550-7232
| | | | - Elisabetta Nardella
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | | | - Giovanni Pecorini
- U.O.C. Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (G.P.); (R.L.); (A.F.)
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | - Raffaele Landolfi
- U.O.C. Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (G.P.); (R.L.); (A.F.)
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | - Andrea Flex
- U.O.C. Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (G.P.); (R.L.); (A.F.)
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
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18
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Biscetti F, Ferraro PM, Hiatt WR, Angelini F, Nardella E, Cecchini AL, Santoliquido A, Pitocco D, Landolfi R, Flex A. Inflammatory Cytokines Associated With Failure of Lower-Extremity Endovascular Revascularization (LER): A Prospective Study of a Population With Diabetes. Diabetes Care 2019; 42:1939-1945. [PMID: 31371431 DOI: 10.2337/dc19-0408] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/11/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Peripheral artery disease (PAD) is one of the most relevant complications of diabetes. Although several pharmacological and revascularization approaches are available for treating patients with diabetes and PAD, an endovascular approach is often associated with postprocedural complications that can increase the risk for acute limb ischemia or amputation. However, no definitive molecular associations have been described that could explain the difference in outcomes after endovascular treatment in patients with diabetes, PAD, and chronic limb-threatening ischemia (CLTI). RESEARCH DESIGN AND METHODS We evaluated the relationship between the levels of the main cytokines associated with diabetic atherosclerosis and the outcomes after endovascular procedures in patients with diabetes, PAD, and CLTI. RESULTS A total of 299 patients with below-the-knee occlusive disease who were undergoing an angioplasty procedure were enrolled. The levels of key cytokines-osteoprotegerin (OPG), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP)-were measured, and major adverse limb events (MALE) and major adverse cardiovascular events (MACE) were assessed 1, 3, 6, and 12 months after the procedure. There was a linear trend from the lowest to the highest quartile for each cytokine at baseline and incident MALE. A linear association was also observed between increasing levels of each cytokine and incident MACE. Receiver operating characteristics models were constructed using clinical and laboratory risk factors, and the inclusion of cytokines significantly improved the prediction of incident events. CONCLUSIONS We demonstrated that elevated OPG, TNF-α, IL-6, and CRP levels at baseline correlate with worse vascular outcomes in patients with diabetes, PAD, and CLTI undergoing an endovascular procedure.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy .,UOC Clinica Medica e Malattie Vascolari, Rome, Italy.,Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Manuel Ferraro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,UOC Nefrologia, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - William R Hiatt
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, and CPC Clinical Research, Aurora, CO
| | - Flavia Angelini
- Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Nardella
- Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Angelo Santoliquido
- Università Cattolica del Sacro Cuore, Rome, Italy.,UOS Angiologia CIC, Rome, Italy
| | - Dario Pitocco
- Università Cattolica del Sacro Cuore, Rome, Italy.,UOSA Diabetologia, Rome, Italy
| | - Raffaele Landolfi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,UOC Clinica Medica e Malattie Vascolari, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Rome, Italy.,UOSA Medicina delle Malattie Vascolari Periferiche, Rome, Italy
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Biscetti F, Nardella E, Bonadia N, Angelini F, Pitocco D, Santoliquido A, Filipponi M, Landolfi R, Flex A. Association between plasma omentin-1 levels in type 2 diabetic patients and peripheral artery disease. Cardiovasc Diabetol 2019; 18:74. [PMID: 31167666 PMCID: PMC6549359 DOI: 10.1186/s12933-019-0880-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 03/29/2019] [Accepted: 05/30/2019] [Indexed: 01/06/2023] Open
Abstract
Background Type-2 diabetes mellitus is one of the major risk factors of atherosclerosis, particularly in peripheral artery disease (PAD). Several studies have documented a correlation between omentin-1 serum levels, atherosclerosis, and cardiovascular diseases. However, a clear link between circulating omentin-1 and PAD in diabetic patients has yet to be established. The aim of this study was to investigate the potential role of omentin-1 in PAD in type-2 diabetic patients. Methods In this cross-sectional study, we analyzed omentin-1 serum levels by ELISA in 600 type-2 diabetic patients with (n = 300) and without (n = 300) PAD at Fontaine’s stage II, III, or IV. Results We found that omentin-1 serum levels were significantly lower in diabetic patients with PAD than in diabetic controls (29.46 vs 49.24 ng/mL, P < 0.001) and that the levels gradually decreased in proportion to disease severity (P < 0.05). The association between omentin-1 levels and PAD remained significant after adjusting for major risk factors in a multivariate analysis. Conclusions Our results suggest that omentin-1 is reduced in type 2 diabetic patients with PAD and that omentin-1 levels are related to disease severity.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Roma, Italy. .,Clinica Medica e Malattie Vascolari, Roma, Italy. .,Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Elisabetta Nardella
- Clinica Medica e Malattie Vascolari, Roma, Italy.,Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Nicola Bonadia
- Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Roma, Italy.,Medicina d'Urgenza e Pronto Soccorso, Roma, Italy
| | - Flavia Angelini
- Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Dario Pitocco
- Diabetologia, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Angelo Santoliquido
- Università Cattolica del Sacro Cuore, Roma, Italy.,Angiologia Columbus, Roma, Italia
| | | | - Raffaele Landolfi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Roma, Italy.,Clinica Medica e Malattie Vascolari, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Roma, Italy.,Clinica Medica e Malattie Vascolari, Roma, Italy.,Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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20
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Biscetti F, Bonadia N, Santini F, Angelini F, Nardella E, Pitocco D, Santoliquido A, Filipponi M, Landolfi R, Flex A. Sortilin levels are associated with peripheral arterial disease in type 2 diabetic subjects. Cardiovasc Diabetol 2019; 18:5. [PMID: 30634965 PMCID: PMC6329108 DOI: 10.1186/s12933-019-0805-5] [Citation(s) in RCA: 25] [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: 11/07/2018] [Accepted: 01/03/2019] [Indexed: 02/07/2023] Open
Abstract
Background Sortilin is a 95-kDa protein which has recently been linked to circulating cholesterol concentration and lifetime risk of developing significant atherosclerotic disease. Sortilin is found inside different cell types and circulating in blood. Higher circulating sortilin concentration has been found in patients with coronary atherosclerosis compared to control subjects. Sortilin concentration is influenced by statin therapy. Methods We enrolled statin-naïve subjects with type 2 diabetes mellitus and we performed a cross-sectional study to evaluate the association between sortilin levels and the presence of clinically significant lower limb peripheral artery disease (PAD) in a population of statin-free diabetic subjects. Results Out of the 154 patients enrolled in our study, 80 patients were free from PAD, while 74 had clinically significant PAD. Sortilin concentration was significantly higher in the latter group compared to the former (1.61 ± 0.54 ng/mL versus 0.67 ± 0.30 ng/mL, P < 0.01) and there was a trend toward increased sortilin levels as disease severity increased. The association of sortilin levels with PAD remained after adjusting for major risk factors in a multivariate analysis. Conclusions We showed that sortilin is significantly and independently associated with the presence of lower limb PAD in a statin-free diabetic population and it may be a promising marker for clinically significant atherosclerosis of the lower limbs. Further studies are needed to confirm this finding and to evaluate its clinical usefulness.
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Affiliation(s)
- Federico Biscetti
- U.O.C. Clinica Medica e Malattie Vascolari, Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy. .,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Nicola Bonadia
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy.,U.O.C. Medicina d'Urgenza e Pronto Soccorso, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Santini
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavia Angelini
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Nardella
- U.O.C. Clinica Medica e Malattie Vascolari, Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Pitocco
- U.O.S.A. di Diabetologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Santoliquido
- Università Cattolica del Sacro Cuore, Rome, Italy.,U.O.S. Angiologia Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Raffaele Landolfi
- U.O.C. Clinica Medica e Malattie Vascolari, Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Flex
- U.O.C. Clinica Medica e Malattie Vascolari, Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Affiliation(s)
- V. Scavée
- Department of Thoracic and Vascular Surgery, Ottignies
| | - I. Pirlet
- Department of Thoracic and Vascular Surgery, Ottignies
| | - F. Terryn
- Department of Thoracic and Vascular Surgery, Ottignies
| | - E. Nardella
- Department of Anesthesiology, Clinique Saint-Pierre, Ottignies
| | - I. Michel
- Department of Anesthesiology, Clinique Saint-Pierre, Ottignies
| | - J.P. Haxhe
- Department of Thoracic and Vascular Surgery, Ottignies
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Giuliani M, Nardella E, Gatta G, De Caro A, Quitadamo M. PROCESSING TOMATO CULTIVATED UNDER WATER DEFICIT CONDITIONS: THE EFFECT OF AZOXYSTROBIN. ACTA ACUST UNITED AC 2011. [DOI: 10.17660/actahortic.2011.914.52] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ferrant T, Nardella E, Van Boven M. Office-based anesthesia in Belgium? Acta Anaesthesiol Belg 2008; 59:123-125. [PMID: 19051442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
For many years, office based anesthesia (OBA), has been considerably increasing in the US. This type of practice is starting to develop in Belgium. On the other side of the atlantic, legislation concerning this practice is becoming more and more precise, whereas the same isn't true in our country. It seems therefore opportune to try and define the different points of view. This article will define the position of the legislator, insurance companies and finally, of the professional organizations. OBA practice is developping insidiously here, and we should therefore ask ourselves serious questions regarding the legal repercussions that it could have. To conclude, we can say that if for a couple of years, the US have started to legislate and propose guidelines, as well as creating special accreditation organizations to inspect and advise the offices, the same is not the case in Belgium. The OBA phenomenon arrived much later here and is really at its very beginnings, but it seems however important to anticipate and clearly regulate this practice in our country.
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Affiliation(s)
- T Ferrant
- Saint-Luc Hospital, Catholic University of Louvain, Medical School, Hippocrate Avenue 10/1821, 1200 Brussels, Belgium.
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Scavée V, Pirlet I, Terryn E, Nardella E, Michel I, Haxhe JP. Varicose veins in ambulatory surgery : patients' perception. Acta Chir Belg 2007; 107:166-72. [PMID: 17515266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION It is mandatory to perform venous surgery in ambulatory surgery units. The aim of this study is to analyse the patient's perception concerning the period before hospital discharge. STUDY DESIGN This was a prospective observational study of 100 patients who underwent primary varicose vein surgery. Venous disease was assessed according to the CEAP classification and VCSS system. The perception of anxiety or psychological apprehension was documented by simple questions. Additionally, we recorded the daily postoperative pain, the return to normal activity and the patient's satisfaction score. RESULTS Four patients required unplanned admission from the ambulatory surgery floor to the hospital unit: two for medical reasons (urinary retention and haematomas) and two ladies who stayed overnight because of a severe anxious state. When questioned about the potential anxiety before hospital discharge, the majority of patients (87%) declared no psychological apprehension. Eleven patients decided to leave the hospital despite potential distress. Patients with distress were more frequently male (p = .75) with superficial phlebitis (p = .49), pre-operative painful varicose veins (p = .13) and a higher number of surgical incisions (p = .35). The only significant difference existing between patients with or without anxiety was regarding the complication rate in the recovery room (p = .04). CONCLUSION Despite careful patient selection, psychological distress could not be prevented or predicted. There is no doubt however that taking these emotional factors into consideration in outpatient surgical practice is essential.
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Affiliation(s)
- V Scavée
- Department of Thoracic and Vascular Surgery, Clinique Saint-Pierre, Ottignies.
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