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Malferrari G, Merli N, Inchingolo V, Siniscalchi A, Laterza D, Monaco D, Arnone G, Zini A, Prada F, Azzini C, Pugliatti M. Role of Advanced Hemodynamic Ultrasound Evaluation in the Differential Diagnosis of Middle Cerebral Artery Stenosis: Introducing Morphological Criteria. Ultrasound Med Biol 2023; 49:2428-2435. [PMID: 37550172 DOI: 10.1016/j.ultrasmedbio.2023.07.004] [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] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/28/2023] [Accepted: 07/09/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE The aim of the work described here was to determine the possible impact of the new technique advanced hemodynamic ultrasound evaluation (AHUSE) in identification of severe intracranial stenosis. Transcranial Doppler (TCD) and transcranial color-coded Doppler (TCCD) provide reliable velocimetric data, the indirect analysis of which allows us to obtain information on the patency of vessels and assumed stenosis range. However, very tight stenoses (>95%) cannot be detected with velocimetric criteria because of spectrum drops and the absence of high velocities, so that the right curve of the Spencer equation cannot be solved. Likewise, high velocities are not detected when analyzing morphologically long stenosis. Furthermore, the current classifications based on velocimetric criteria do not provide any categorization on stenoses with multiple acceleration points (MAPs). METHODS With this Technical Note we aim to introduce, in addition to velocimetric criteria, more morphological criteria based on TCCD with the algorithm of AHUSE to optimize the characterization of intracranial stenosis (IS). TCCD-AHUSE relies on intensity-based next-generation techniques and can be used to identify IS with MAPs and simultaneously perform a morphological assessment of the stenosis length. RESULTS We introduce a new technical ultrasound (U) approach that we tested in a sample of four different types of stenoses combining velocimetric data and AHUSE using Esaote Microvascularization (MicroV) technique to the M1 tract of the middle cerebral artery (MCA). CONCLUSION The authors believe that a multiparametric evaluation is more sensitive and supports the clinician by introducing the morphological concept, not just the velocimetric concept, to differentiate the IS pattern of MCA. The potential for developing a diagnostic/prognostic algorithm is discussed.
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Affiliation(s)
- Giovanni Malferrari
- Stroke Unit and Neurology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy.
| | - Nicola Merli
- Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Vincenzo Inchingolo
- Neurology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonio Siniscalchi
- Department of Neurology and Stroke Unit, Annunziata Hospital, Cosenza, Italy
| | - Domenico Laterza
- Neurology and Stroke Unit, Nuovo Ospedale degli Infermi, Biella (BI), Italy
| | - Daniela Monaco
- Department of Emergency Neurology and Stroke Unit, "S. Spirito" Hospital, Pescara, Italy
| | - Giorgia Arnone
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Francesco Prada
- Acoustic Neuroimaging and Therapy Lab, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy; Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA; Focused Ultrasound Foundation, Charlottesville, VA, USA
| | - Cristiano Azzini
- Stroke Unit and Neurology Unit, S. Anna University Hospital, Ferrara Italy
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Italy; S. Anna University Hospital, Ferrara Italy
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Siniscalchi A, Malferrari G, Lochner P, Sanguigni S. Transcranial Doppler Ultrasonography in Pre-hospital Management of Stroke: Can it make a Difference? Curr Med Imaging 2021; 17:850-853. [PMID: 33602098 DOI: 10.2174/1573405617666210218094002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/18/2020] [Accepted: 01/18/2021] [Indexed: 11/22/2022]
Abstract
The aim of this paper is to discuss the use of transcranial doppler in the pre-hospital management of stroke. In the pre-hospital organization, neurological defect scales are used, but they are often indicative of the occlusions of anterior circulation and not of the posterior circulation. Patients with posterior circulation stroke are sometimes not diagnosed and clinically treated. In the pre-hospital phase, the transcranial doppler may identify an occlusion of the large cerebral vessels and be useful for stroke patients, in particular those with posterior occlusions, for a more precise diagnosis and consequently for adequate treatment in the excellence centers for stroke.
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Affiliation(s)
- Antonio Siniscalchi
- Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Giovanni Malferrari
- Stroke Unit, Neurology Unit, Azienda Unita Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Sandro Sanguigni
- Department of Neurology, Madonna del Soccorso Hospital, S Benedetto del Tronto, Italy
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Siniscalchi A, Gray C, Malferrari G. Ultrasound Diagnostic Method in Vascular Dementia: Current Concepts. Curr Med Imaging 2021; 17:507-512. [PMID: 33032514 DOI: 10.2174/1573405616999201008145106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasing interest in identifying cerebral hemodynamics alterations as a cause of possible onset or worsening of cognitive impairment in elderly patients with vascular risk factors. INTRODUCTION Intracranial ultrasound is a non-invasive, repeatable inexpensive method for recording variation of the cerebral vascular tree in physiological and pathological conditions and the diagnosis of vascular dementia (VaD). METHODS PubMed, Embase, Cochrane library and reference lists have been searched for articles published until March 30, 2020. RESULTS Clinical studies reported different Transcranial Doppler (TCD) parameters and subsequently transcranial duplex with color code (TCCD) in patients affected by vascular dementia. The number of studies using TCCD remains limited and most of the available data are still based on TCD. However, the use of transcranial Doppler could better stratify elderly patients with initial signs of cognitive impairment. CONCLUSION Intracranial ultrasound employment to detect cerebral hemodynamic changes in VaD patients has been briefly discussed in this review.
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Affiliation(s)
- Antonio Siniscalchi
- Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Cleona Gray
- Vascular and Endovascular Surgery Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Giovanni Malferrari
- Stroke Unit, Neurology Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
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Siniscalchi A, Malferrari G. The role of transcranial Doppler ultrasonography in differential diagnosis of vertigo in the Emergency Department. Emerg Care J 2019. [DOI: 10.4081/ecj.2019.8341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Vertigo represents about 4% of access to the Emergency Department (ED). Several conditions, such as general medical illnesses, otovestibular diseases and neurological diseases (including posterior circulation stroke) cause acute vertigo. The incidence of cerebrovascular disease in patients with vertigo in ED varies from 3 to 5%. Although neurosonology studies on acute vestibular syndrome are scarce, the use of transcranial Doppler (TCD) and transcranial color Doppler (TCCD) in the management of vertigo patients has several advantages: it can be performed at the patient's bedside and repeated and, furthermore, its use is low-cost. In an acute stroke, with an experienced doctor, it can help distinguish an ischemic stroke from a hemorrhagic stroke. In acute central vertigo induced by posterior circulation stroke, the TCD or TCCD can be a screening test before angiographic neuroradiological studies for stenosis of vertebral or basal arteries. As a matter of fact, the clinical outcome, particularly in the posterior circulation stroke, is mainly related to a rapid diagnosis and subsequent treatment that will be able to quickly restore the blood flow. In conclusion, TCD and TCCD are useful in the differential diagnosis of vertigo in the ED, although we recognize the indisputable importance of clinical examination as a first step in vertigo management. In the evaluation of patients with acute central vertigo due to suspected posterior circulation stroke, the use of TCD or TCCD can rapidly reveal steno-occlusive disease of the posterior circulation, arterial dissections and give indirect signs of vertebra-basilar insufficiency.
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Monaco D, Berg D, Thomas A, Di Stefano V, Barbone F, Vitale M, Ferrante C, Bonanni L, Di Nicola M, Garzarella T, Marchionno LP, Malferrari G, Di Mascio R, Onofrj M, Franciotti R. The predictive power of transcranial sonography in movement disorders: a longitudinal cohort study. Neurol Sci 2018; 39:1887-1894. [DOI: 10.1007/s10072-018-3514-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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Malferrari G, Pulito G, Pizzini AM, Carraro N, Meneghetti G, Sanzaro E, Prati P, Siniscalchi A, Monaco D. MicroV Technology to Improve Transcranial Color Coded Doppler Examinations. J Neuroimaging 2018; 28:350-358. [DOI: 10.1111/jon.12517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/06/2018] [Accepted: 04/11/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Giovanni Malferrari
- Stroke Unit, Neurology Unit; Azienda Unità Sanitaria Locale - IRCCS; Reggio Emilia Italy
| | - Giuseppe Pulito
- Department of Anaesthesia and Resuscitation Service - Vito Fazzi Hospital; Lecce Italy
| | | | - Nicola Carraro
- Neurology Clinic; Department of Head and Neck - Integrated University Healthcare Company; Trieste Italy
| | - Giorgio Meneghetti
- Department of Neurosciences; University of Padua School of Medicine; Padova Italy
| | - Enzo Sanzaro
- Stroke Unit; Department of Medicine - Umberto I Hospital; Siracusa Italy
| | | | | | - Daniela Monaco
- Stroke Unit; Department of Medicine - Spirito Santo Hospital; Pescara Italy
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Cattaneo M, Orlandi R, Ronchini C, Granelli P, Malferrari G, Menard S, Biunno I. The Expression of Sel1L and Tan-1 in Normal and Neoplastic Cells. Int J Biol Markers 2018; 15:26-32. [PMID: 10763137 DOI: 10.1177/172460080001500105] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We have previously reported on the isolation and chromosomal mapping of a novel human gene (SEL1L), which shows sequence similarity to sel-1, an extragenic suppressor of C. elegans. sel-1 functions as a negative regulator of lin-12 activity, the latter being implicated in the control of diverse cellular differentiation events. In the present study we compare the expression patterns of SEL1L and TAN-1, the human ortholog of lin-12 in normal and neoplastic cells. We found that, whereas both genes are expressed in fetal tissues at similar levels, they are differentially expressed in normal adult and neoplastic cells. In normal adult cells SEL1L is generally present at very low levels; only in the cells of the pancreas does it show maximum expression. By contrast, SEL1L is generally well represented in most neoplastic cells but not in those of pancreatic and gastric carcinomas, where transcription is either downregulated or completely repressed. TAN-1 on the other hand is well represented in almost all normal and neoplastic cells, with very few exceptions. Our observations suggest that SEL1L is presumably implicated in pancreatic and gastric carcinogenesis and that, along with TAN-1, it is very important for normal cell function. Alterations in the expression of SEL1L may be used as a prognostic marker for gastric and pancreatic cancers.
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Affiliation(s)
- M Cattaneo
- Institute of Advanced Biomedical Technologies, National Research Council, Milan, Italy
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Poli L, Grassi M, Zedde M, Marcheselli S, Silvestrelli G, Sessa M, Zini A, Paciaroni M, Azzini C, Gamba M, Toriello A, Tassi R, Giorli E, Calabrò R, Ritelli M, De Vito A, Pugliese N, Martini G, Lanari A, Lodigiani C, Padroni M, De Giuli V, Caria F, Morotti A, Costa P, Strambo D, Corato M, Pascarella R, Del Sette M, Malferrari G, Colombi M, Padovani A, Pezzini A. Anticoagulants Resumption after Warfarin-Related Intracerebral Haemorrhage: The Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy). Thromb Haemost 2018; 118:572-580. [DOI: 10.1055/s-0038-1627454] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractWhether to resume antithrombotic treatment after oral anticoagulant–related intracerebral haemorrhage (OAC-ICH) is debatable. In this study, we aimed at investigating long-term outcome associated with OAC resumption after warfarin-related ICH, in comparison with secondary prevention strategies with platelet inhibitors or antithrombotic discontinuation. Participants were patients who sustained an incident ICH during warfarin treatment (2002–2014) included in the Multicenter Study on Cerebral Hemorrhage in Italy. Primary end-point was a composite of ischemic stroke/systemic embolism (SE) and all-cause mortality. Secondary end-points were ischemic stroke/SE, all-cause mortality and major recurrent bleeding. We computed individual propensity score (PS) as the probability that a patient resumes OACs or other agents given his pre-treatment variables, and performed Cox multivariable analysis using Inverse Probability of Treatment Weighting (IPTW) procedure. A total of 244 patients qualified for the analysis. Unlike antiplatelet agents, OAC resumption was associated with a lower rate of the primary end-point (weighted hazard ratio [HR], 0.21; 95% confidence interval [CI], 0.09–0.45), as well as of overall mortality (weighted HR, 0.17; 95% CI, 0.06–0.45) and ischemic stroke/SE (weighted HR, 0.19; 95% CI, 0.06–0.60) with no significant increase of major bleeding in comparison with patients receiving no antithrombotics. In the subgroup of patients with atrial fibrillation, OACs resumption was also associated with a reduction of the primary end-point (weighted HR, 0.22; 95% CI, 0.09–0.54), and the secondary end-point ischemic stroke/SE (weighted HR, 0.09; 95% CI, 0.02–0.40). In conclusion, in patients who have an ICH while receiving warfarin, resuming anticoagulation results in a favorable trade-off between bleeding susceptibility and thromboembolic risk.
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Denti L, Caminiti C, Scoditti U, Zini A, Malferrari G, Zedde ML, Guidetti D, Baratti M, Vaghi L, Montanari E, Marcomini B, Riva S, Iezzi E, Castellini P, Olivato S, Barbi F, Perticaroli E, Monaco D, Iafelice I, Bigliardi G, Vandelli L, Guareschi A, Artoni A, Zanferrari C, Schulz PJ. Impact on Prehospital Delay of a Stroke Preparedness Campaign: A SW-RCT (Stepped-Wedge Cluster Randomized Controlled Trial). Stroke 2017; 48:3316-3322. [PMID: 29101258 DOI: 10.1161/strokeaha.117.018135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/20/2017] [Accepted: 09/18/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Public campaigns to increase stroke preparedness have been tested in different contexts, showing contradictory results. We evaluated the effectiveness of a stroke campaign, designed specifically for the Italian population in reducing prehospital delay. METHODS According to an SW-RCT (Stepped-Wedge Cluster Randomized Controlled Trial) design, the campaign was launched in 4 provinces in the northern part of the region Emilia Romagna at 3-month intervals in randomized sequence. The units of analysis were the patients admitted to hospital, with stroke and transient ischemic attack, over a time period of 15 months, beginning 3 months before the intervention was launched in the first province to allow for baseline data collection. The proportion of early arrivals (within 2 hours of symptom onset) was the primary outcome. Thrombolysis rate and some behavioral end points were the secondary outcomes. Data were analyzed using a fixed-effect model, adjusting for cluster and time trends. RESULTS We enrolled 1622 patients, 912 exposed and 710 nonexposed to the campaign. The proportion of early access was nonsignificantly lower in exposed patients (354 [38.8%] versus 315 [44.4%]; adjusted odds ratio, 0.81; 95% confidence interval, 0.60-1.08; P=0.15). As for secondary end points, an increase was found for stroke recognition, which approximated but did not reach statistical significance (P=0.07). CONCLUSIONS Our campaign was not effective in reducing prehospital delay. Even if some limitations of the intervention, mainly in terms of duration, are taken into account, our study demonstrates that new communication strategies should be tested before large-scale implementation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01881152.
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Affiliation(s)
- Licia Denti
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.).
| | - Caterina Caminiti
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Umberto Scoditti
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Andrea Zini
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Giovanni Malferrari
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Maria Luisa Zedde
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Donata Guidetti
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Mario Baratti
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Luca Vaghi
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Enrico Montanari
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Barbara Marcomini
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Silvia Riva
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Elisa Iezzi
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Paola Castellini
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Silvia Olivato
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Filippo Barbi
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Eva Perticaroli
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Daniela Monaco
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Ilaria Iafelice
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Guido Bigliardi
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Laura Vandelli
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Angelica Guareschi
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Andrea Artoni
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Carla Zanferrari
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
| | - Peter J Schulz
- From the Geriatrics Ward-Stroke Care Section, (L.D., A.A.), Research and Innovation Unit (C.C., B.M., E.I.), and Stroke Care Program (U.S., P.C., C.Z.), University Hospital of Parma, Italy; Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Italy (A.Z., M.B., L. Vaghi, S.O., F.B., G.B., L. Vandelli); Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy (G.M., M.L.Z., E.P., D.M.); Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy (D.G., I.I.); Neurology Unit, Vaio Fidenza Hospital, Italy (E.M., A.G.); Department of Oncology and Hemato-oncology, University of Milan, Italy (S.R.); and Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland (P.J.S.)
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De Giuli V, Grassi M, Lodigiani C, Patella R, Zedde M, Gandolfo C, Zini A, DeLodovici ML, Paciaroni M, Del Sette M, Azzini C, Toriello A, Musolino R, Calabrò RS, Bovi P, Sessa M, Adami A, Silvestrelli G, Cavallini A, Marcheselli S, Bonifati DM, Checcarelli N, Tancredi L, Chiti A, Lotti EM, Del Zotto E, Tomelleri G, Spalloni A, Giorli E, Costa P, Poli L, Morotti A, Caria F, Lanari A, Giacalone G, Ferrazzi P, Giossi A, Piras V, Massucco D, D'Amore C, Di Lisi F, Casetta I, Cucurachi L, Cotroneo M, De Vito A, Coloberti E, Rasura M, Simone AM, Gamba M, Cerrato P, Micieli G, Malferrari G, Melis M, Iacoviello L, Padovani A, Pezzini A. Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults. JAMA Neurol 2017; 74:512-518. [PMID: 28264095 DOI: 10.1001/jamaneurol.2016.5704] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Although sparse observational studies have suggested a link between migraine and cervical artery dissection (CEAD), any association between the 2 disorders is still unconfirmed. This lack of a definitive conclusion might have implications in understanding the pathogenesis of both conditions and the complex relationship between migraine and ischemic stroke (IS). Objective To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD. Design, Setting, and Participants A prospective cohort study of consecutive patients aged 18 to 45 years with first-ever acute ischemic stroke enrolled in the multicenter Italian Project on Stroke in Young Adults was conducted between January 1, 2000, and June 30, 2015. In a case-control design, the study assessed whether the frequency of migraine and its subtypes (presence or absence of an aura) differs between patients whose IS was due to CEAD (CEAD IS) and those whose IS was due to a cause other than CEAD (non-CEAD IS) and compared the characteristics of patients with CEAD IS with and without migraine. Main Outcomes and Measures Frequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS. Results Of the 2485 patients (mean [SD] age, 36.8 [7.1] years; women, 1163 [46.8%]) included in the registry, 334 (13.4%) had CEAD IS and 2151 (86.6%) had non-CEAD IS. Migraine was more common in the CEAD IS group (103 [30.8%] vs 525 [24.4%], P = .01), and the difference was mainly due to migraine without aura (80 [24.0%] vs 335 [15.6%], P < .001). Compared with migraine with aura, migraine without aura was independently associated with CEAD IS (OR, 1.74; 95% CI, 1.30-2.33). The strength of this association was higher in men (OR, 1.99; 95% CI, 1.31-3.04) and in patients 39.0 years or younger (OR, 1.82; 95% CI, 1.22-2.71). The risk factor profile was similar in migrainous and non-migrainous patients with CEAD IS (eg, hypertension, 20 [19.4%] vs 57 [24.7%], P = .29; diabetes, 1 [1.0%] vs 3 [1.3%], P > .99). Conclusions and Relevance In patients with IS aged 18 to 45 years, migraine, especially migraine without aura, is consistently associated with CEAD. This finding suggests common features and warrants further analyses to elucidate the underlying biologic mechanisms.
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Affiliation(s)
- Valeria De Giuli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Mario Grassi
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italia
| | - Corrado Lodigiani
- Centro Trombosi, Istituto di Ricerca e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano-Milano, Italia
| | - Rosalba Patella
- Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università "La Sapienza," Roma, Italia
| | - Marialuisa Zedde
- Unità di Neurologia, Arcispedale Santa Maria Nuova-Istituto di Ricerca e Cura a Carattere Scientifico, Reggio Emilia, Italia
| | - Carlo Gandolfo
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genova, Italia
| | - Andrea Zini
- Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile "S. Agostino Estense," Azienda Unità Sanitaria Locale, Modena, Italia
| | | | - Maurizio Paciaroni
- Stroke Unit, Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italia
| | | | - Cristiano Azzini
- Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara, Italia
| | - Antonella Toriello
- Unità Operativa Complessa Neurologia, Azienda Ospedaliera Universitaria "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italia
| | - Rossella Musolino
- Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche, Clinica Neurologica, Università di Messina, Messina, Italia
| | - Rocco Salvatore Calabrò
- Istituto di Ricerca e Cura a Carattere Scientifico, Centro Neurolesi Bonino-Pulejo, Policlinico Universitario, Messina, Italia
| | - Paolo Bovi
- Unità Operativa Neurologia, Azienda Ospedaliera-Universitaria Borgo Trento, Verona, Italia
| | - Maria Sessa
- Unità Operativa Neurologia, Istituti Ospitalieri, Cremona, Italia
| | - Alessandro Adami
- Stroke Center, Dipartimento di Neurologia, Ospedale Sacro Cuore Negrar, Verona, Italia
| | - Giorgio Silvestrelli
- Stroke Unit, Unità Operativa Neurologia, Azienda Ospedaliera "Carlo Poma," Mantova, Italia
| | - Anna Cavallini
- Stroke Unit, Istituto di Ricerca e Cura a Carattere Scientifico Fondazione Istituto "C. Mondino," Pavia, Italia
| | - Simona Marcheselli
- Neurologia d'Urgenza e Stroke Unit, Istituto di Ricerca e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano-Milano, Italia
| | - Domenico Marco Bonifati
- Unità Operativa Complessa Neurologia, Ospedale Cà Foncello, Unità Locale Socio Sanitaria 9, Treviso, Italia
| | | | - Lucia Tancredi
- Unità Operativa Neurologia, Azienda Ospedaliera Ospedale Sant'Anna, Como, Italia
| | - Alberto Chiti
- Neurologia, Azienda Ospedaliera Universitaria Pisana, Pisa, Italia
| | | | - Elisabetta Del Zotto
- Unità Operativa Recupero e Rieducazione Funzionale, Istituto di Ricerca e Cura a Carattere Scientifico Fondazione Don Gnocchi, Rovato, Italia
| | - Giampaolo Tomelleri
- Unità Operativa Neurologia, Azienda Ospedaliera-Universitaria Borgo Trento, Verona, Italia
| | - Alessandra Spalloni
- Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università "La Sapienza," Roma, Italia
| | - Elisa Giorli
- Unità di Neurologia, Ospedale S. Andrea, La Spezia, Italia
| | - Paolo Costa
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Loris Poli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Andrea Morotti
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Filomena Caria
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Alessia Lanari
- Stroke Unit, Unità Operativa Neurologia, Azienda Ospedaliera "Carlo Poma," Mantova, Italia
| | - Giacomo Giacalone
- Stroke Unit, Unità Operativa Clinica Neurologia, Istituto di Ricerca e Cura a Carattere Scientifico S. Raffaele, Milano, Italia
| | - Paola Ferrazzi
- Centro Trombosi, Istituto di Ricerca e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano-Milano, Italia
| | - Alessia Giossi
- Unità Operativa Neurologia, Istituti Ospitalieri, Cremona, Italia
| | - Valeria Piras
- Stroke Unit, Azienda Ospedaliera "G. Brotzu," Cagliari, Italia
| | - Davide Massucco
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genova, Italia
| | - Cataldo D'Amore
- Stroke Unit, Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italia
| | - Filomena Di Lisi
- Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università "La Sapienza," Roma, Italia
| | - Ilaria Casetta
- Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara, Italia
| | - Laura Cucurachi
- Stroke Unit, Unità Operativa Neurologia, Ospedale "S. Chiara," Trento, Italia
| | - Masina Cotroneo
- Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche, Clinica Neurologica, Università di Messina, Messina, Italia
| | - Alessandro De Vito
- Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara, Italia
| | - Elisa Coloberti
- Neurologia d'Urgenza e Stroke Unit, Istituto di Ricerca e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano-Milano, Italia
| | - Maurizia Rasura
- Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università "La Sapienza," Roma, Italia
| | - Anna Maria Simone
- Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile "S. Agostino Estense," Azienda Unità Sanitaria Locale, Modena, Italia
| | - Massimo Gamba
- Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia
| | - Paolo Cerrato
- Dipartimento di Neuroscienze, Stroke Unit, Università di Torino, Torino, Italia
| | - Giuseppe Micieli
- Neurologia d'Urgenza, Istituto di Ricerca e Cura a Carattere Scientifico Fondazione Istituto "C. Mondino," Pavia, Italia
| | - Giovanni Malferrari
- Unità di Neurologia, Arcispedale Santa Maria Nuova-Istituto di Ricerca e Cura a Carattere Scientifico, Reggio Emilia, Italia
| | - Maurizio Melis
- Stroke Unit, Azienda Ospedaliera "G. Brotzu," Cagliari, Italia
| | - Licia Iacoviello
- Laboratorio di Epidemiologia Molecolare e Nutrizionale, Dipartimento di Epidemiologia e Prevenzione, Istituto di Ricerca e Cura a Carattere Scientifico Istituto Neurologico Mediterraneo, Neuromed, Pozzilli, Italia
| | - Alessandro Padovani
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Alessandro Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
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Caminiti C, Schulz P, Marcomini B, Iezzi E, Riva S, Scoditti U, Zini A, Malferrari G, Zedde ML, Guidetti D, Montanari E, Baratti M, Denti L. Development of an education campaign to reduce delays in pre-hospital response to stroke. BMC Emerg Med 2017. [PMID: 28646851 PMCID: PMC5483310 DOI: 10.1186/s12873-017-0130-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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] [Indexed: 11/18/2022] Open
Abstract
Background Systematic reviews call for well-designed trials with clearly described intervention components to support the effectiveness of educational campaigns to reduce patient delay in stroke presentation. We herein describe the systematic development process of a campaign aimed to increase stroke awareness and preparedness. Methods Campaign development followed Intervention Mapping (IM), a theory- and evidence-based tool, and was articulated in two phases: needs assessment and intervention development. In phase 1, two cross-sectional surveys were performed, one aiming to measure stroke awareness in the target population and the other to analyze the behavioral determinants of prehospital delay. In phase 2, a matrix of proximal program objectives was developed, theory-based intervention methods and practical strategies were selected and program components and materials produced. Results In phase 1, the survey on 202 citizens highlighted underestimation of symptom severity, as in only 44% of stroke situations respondents would choose to call the emergency service (EMS). In the survey on 393 consecutive patients, 55% presented over 2 hours after symptom onset; major determinants were deciding to call the general practitioner first and the reaction of the first person the patient called. In phase 2, adult individuals were identified as the target of the intervention, both as potential “patients” and witnesses of stroke. The low educational level found in the patient survey called for a narrative approach in cartoon form. The family setting was chosen for the message because 42% of patients who presented within 2 hours had been advised by a family member to call EMS. To act on people’s tendency to view stroke as an untreatable disease, it was decided to avoid fear-arousal appeals and use a positive message providing instructions and hope. Focus groups were used to test educational products and identify the most suitable sites for message dissemination. Conclusions The IM approach allowed to develop a stroke campaign integrating theories, scientific evidence and information collected from the target population, and enabled to provide clear explanations for the reasons behind key decisions during the intervention development process. Trial registration NCT01881152. Retrospectively registered June 7 2013 Electronic supplementary material The online version of this article (doi:10.1186/s12873-017-0130-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Peter Schulz
- Institute of Communication and Health, Università della Svizzera italiana, Via Buffi 6, CH 6900, Lugano, Switzerland
| | - Barbara Marcomini
- Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Elisa Iezzi
- Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Silvia Riva
- Department of Oncology and Hematology, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Umberto Scoditti
- Stroke Care Program, Neurology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Andrea Zini
- Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, Via Pietro Giardini 1355, 41126, Baggiovara, Modena, Italy
| | - Giovanni Malferrari
- Department of Neuromotor Physiol, Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Umberto I 50, 42123, Reggio Emilia, Italy
| | - Maria Luisa Zedde
- Department of Neuromotor Physiol, Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Umberto I 50, 42123, Reggio Emilia, Italy
| | - Donata Guidetti
- Department of Neurology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29100, Piacenza, Italy
| | - Enrico Montanari
- Neurology Unit, Vaio Fidenza Hospital, Via Don Tincati 5, 43036, Fidenza, Parma, Italy
| | - Mario Baratti
- Division of Neurology, B Ramazzini Hospital, Via Guido Molinari 2, 41012, Carpi, Modena, Italy
| | - Licia Denti
- Clinical Geriatrics Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
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Siniscalchi A, Sztajzel R, Malferrari G, Gallelli L. The National Institutes of Health Stroke Scale: Its Role in Patients with Posterior Circulation Stroke. Hosp Top 2017; 95:79-81. [PMID: 28535100 DOI: 10.1080/00185868.2017.1322888] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The National Institutes of Health Stroke Scale (NIHSS) is indispensable for both prognosis and treatment in patients with acute ischemic stroke. However, there is subtype of acute ischemic stroke (i.e., posterior circulation stroke) that is difficult to diagnose using the NIHSS. The authors report the limits of NIHSS in this stroke subtype, suggesting thereby the need to modify and render it more appropriate for the evaluation of the neurological signs occurring in posterior circulation stroke.
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Affiliation(s)
| | - Roman Sztajzel
- b Department of Neurology , University Hospital of Geneva , Geneva , Switzerland
| | - Giovanni Malferrari
- c Stroke Unit, Department of Neurology , Santa Maria Nuova Hospital , Reggio Emilia , Italy
| | - Luca Gallelli
- d Department of Health Science, School of Medicine , University of Catanzaro, Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital , Catanzaro , Italy
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13
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Poli L, Zedde M, Zini A, Del Sette M, Lodigiani C, Spalloni A, Di Lisi F, Toriello A, Piras V, Stilo C, Tomelleri G, Tancredi L, Paciaroni M, Silvestrelli G, Adami A, Costa P, Morotti A, De Giuli V, Caria F, Gamba M, Malferrari G, Simone AM, Musolino R, Giorli E, Banfi E, Marcheselli S, Rasura M, Pugliese N, Melis M, Bovi P, Padovani A, Burlina A, Pezzini A. Screening for Fabry disease in patients with ischaemic stroke at young age: the Italian Project on Stroke in Young Adults. Eur J Neurol 2017; 24:e12-e14. [DOI: 10.1111/ene.13254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 01/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- L. Poli
- Dipartimento di Scienze Cliniche e Sperimentali; Clinica Neurologica; Università degli Studi di Brescia; Brescia
| | - M. Zedde
- S.C. Neurologia; Arcispedale ‘Santa Maria Nuova - IRCCS’; Reggio Emilia
| | - A. Zini
- Stroke Unit; Clinica Neurologica; Nuovo Ospedale Civile ‘S. Agostino Estense’, AUSL; Modena
| | | | - C. Lodigiani
- Centro Trombosi; IRCCS Humanitas Research Hospital; Rozzano-Milano
| | - A. Spalloni
- Stroke Unit; Azienda Ospedaliera Sant'Andrea; Università ‘La Sapienza’; Roma
| | - F. Di Lisi
- Stroke Unit; Azienda Ospedaliera Sant'Andrea; Università ‘La Sapienza’; Roma
| | - A. Toriello
- U.O.C. Neurologia; A.O. Universitaria ‘San Giovanni di Dio e Ruggi d'Aragona’; Salerno
| | - V. Piras
- Stroke Unit; Azienda Ospedaliera ‘G. Brotzu’; Cagliari
| | - C. Stilo
- Dipartimento di Neuroscienze; Scienze Psichiatriche e Anestesiologiche; Clinica Neurologica; Università di Messina; Messina
| | - G. Tomelleri
- UO Neurologia; Azienda Ospedaliera-Universitaria Borgo Trento; Verona
| | - L. Tancredi
- U.O. Neurologia; ASST Lariana - Ospedale Sant'Anna; Como
| | - M. Paciaroni
- Stroke Unit; Divisione di Medicina Cardiovascolare; Università di Perugia; Perugia
| | - G. Silvestrelli
- Stroke Unit; Dipartimento di Neuroscienze; Azienda Ospedaliera Carlo Poma; Mantova
| | - A. Adami
- Stroke Center; Dipartimento di Neurologia; Ospedale Sacro Cuore Negrar; Verona
| | - P. Costa
- Dipartimento di Scienze Cliniche e Sperimentali; Clinica Neurologica; Università degli Studi di Brescia; Brescia
| | - A. Morotti
- Dipartimento di Scienze Cliniche e Sperimentali; Clinica Neurologica; Università degli Studi di Brescia; Brescia
| | - V. De Giuli
- Dipartimento di Scienze Cliniche e Sperimentali; Clinica Neurologica; Università degli Studi di Brescia; Brescia
| | - F. Caria
- Dipartimento di Scienze Cliniche e Sperimentali; Clinica Neurologica; Università degli Studi di Brescia; Brescia
| | - M. Gamba
- Stroke Unit; Neurologia Vascolare; Spedali Civili di Brescia; Brescia
| | - G. Malferrari
- S.C. Neurologia; Arcispedale ‘Santa Maria Nuova - IRCCS’; Reggio Emilia
| | - A. M. Simone
- Stroke Unit; Clinica Neurologica; Nuovo Ospedale Civile ‘S. Agostino Estense’, AUSL; Modena
| | - R. Musolino
- Dipartimento di Neuroscienze; Scienze Psichiatriche e Anestesiologiche; Clinica Neurologica; Università di Messina; Messina
| | - E. Giorli
- Unità di Neurologia; Ospedale S. Andrea; La Spezia
| | - E. Banfi
- Centro Trombosi; IRCCS Humanitas Research Hospital; Rozzano-Milano
| | - S. Marcheselli
- Neurologia d'Urgenza and Stroke Unit; IRCCS Humanitas Research Hospital; Rozzano-Milano
| | - M. Rasura
- Stroke Unit; Azienda Ospedaliera Sant'Andrea; Università ‘La Sapienza’; Roma
| | - N. Pugliese
- U.O.C. Neurologia; A.O. Universitaria ‘San Giovanni di Dio e Ruggi d'Aragona’; Salerno
| | - M. Melis
- Stroke Unit; Azienda Ospedaliera ‘G. Brotzu’; Cagliari
| | - P. Bovi
- UO Neurologia; Azienda Ospedaliera-Universitaria Borgo Trento; Verona
| | - A. Padovani
- Dipartimento di Scienze Cliniche e Sperimentali; Clinica Neurologica; Università degli Studi di Brescia; Brescia
| | - A. Burlina
- Neurologia; Dipartimento di Medicina Interna; Ospedale San Bassiano; Bassano del Grappa Italy
| | - A. Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali; Clinica Neurologica; Università degli Studi di Brescia; Brescia
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Siniscalchi A, Sztajzel R, Bonci A, Malferrari G, De Sarro G, Gallelli L. Editorial: Cocaine and Cerebral Small Vessel: Is it a Negative Factor for Intravenous Thrombolysis? Curr Vasc Pharmacol 2016; 14:304-6. [PMID: 26845684 DOI: 10.2174/1570161114999160204151620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Antonio Siniscalchi
- Department of Neurology, Annunziata Hospital Via F. Migliori, 1; 87100 Cosenza, Italy.
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15
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Manzoni GC, Micieli G, Granella F, Martignoni E, Malferrari G, Nappi G. Daily Chronic Headache: Classification And Clinical Features. Observation On 250 Patients. Cephalalgia 2016. [DOI: 10.1177/03331024870070s654] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- GC Manzoni
- Headache Centers, Departments of Neurology, Universities of Parma and Pavia, Italy
| | - G Micieli
- Headache Centers, Departments of Neurology, Universities of Parma and Pavia, Italy
| | - F Granella
- Headache Centers, Departments of Neurology, Universities of Parma and Pavia, Italy
| | - E Martignoni
- Headache Centers, Departments of Neurology, Universities of Parma and Pavia, Italy
| | - G Malferrari
- Headache Centers, Departments of Neurology, Universities of Parma and Pavia, Italy
| | - G Nappi
- Headache Centers, Departments of Neurology, Universities of Parma and Pavia, Italy
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16
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Siniscalchi A, Sztajzel R, Malferrari G, De Sarro G, Saletti A, Gallelli L. Editorial: Cocaine and Acute Basilar Artery Occlusion: What we Know to Date? Curr Vasc Pharmacol 2016; 15:3-4. [PMID: 27633287 DOI: 10.2174/1570161114666160909162205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Antonio Siniscalchi
- Department of Neurology, "Annunziata Hospital", Via F. Migliori, 1 87100, Cosenza, Italy.
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17
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Pezzini A, Grassi M, Iacoviello L, Zedde M, Marcheselli S, Silvestrelli G, DeLodovici ML, Sessa M, Zini A, Paciaroni M, Azzini C, Gamba M, Del Sette M, Toriello A, Gandolfo C, Bonifati DM, Tassi R, Cavallini A, Chiti A, Calabrò RS, Musolino R, Bovi P, Tomelleri G, Di Castelnuovo A, Vandelli L, Ritelli M, Agnelli G, De Vito A, Pugliese N, Martini G, Lanari A, Ciccone A, Lodigiani C, Malferrari G, Del Zotto E, Morotti A, Costa P, Poli L, De Giuli V, Bonaiti S, La Spina P, Marcello N, Micieli G, de Gaetano G, Colombi M, Padovani A. Serum cholesterol levels, HMG-CoA reductase inhibitors and the risk of intracerebral haemorrhage. The Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy). J Neurol Neurosurg Psychiatry 2016; 87:924-9. [PMID: 27003275 DOI: 10.1136/jnnp-2015-312736] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/04/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Although a concern exists that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) might increase the risk of intracerebral haemorrhage (ICH), the contribution of these agents to the relationship between serum cholesterol and disease occurrence has been poorly investigated. METHODS We compared consecutive patients having ICH with age and sex-matched stroke-free control subjects in a case-control analysis, as part of the Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy), and tested the presence of interaction effects between total serum cholesterol levels and statins on the risk of ICH. RESULTS A total of 3492 cases (mean age, 73.0±12.7 years; males, 56.6%) and 3492 control subjects were enrolled. Increasing total serum cholesterol levels were confirmed to be inversely associated with ICH. We observed a statistical interaction between total serum cholesterol levels and statin use for the risk of haemorrhage (Interaction OR (IOR), 1.09; 95% CI 1.05 to 1.12). Increasing levels of total serum cholesterol were associated with a decreased risk of ICH within statin strata (average OR, 0.87; 95% CI 0.86 to 0.88 for every increase of 0.26 mmol/l of total serum cholesterol concentrations), while statin use was associated with an increased risk (OR, 1.54; 95% CI 1.31 to 1.81 of the average level of total serum cholesterol). The protective effect of serum cholesterol against ICH was reduced by statins in strictly lobar brain regions more than in non-lobar ones. CONCLUSIONS Statin therapy and total serum cholesterol levels exhibit interaction effects towards the risk of ICH. The magnitude of such effects appears higher in lobar brain regions.
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Affiliation(s)
- Alessandro Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Mario Grassi
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italia
| | - Licia Iacoviello
- Laboratorio di Epidemiologia Molecolare e Nutrizionale, Dipartimento di Epidemiologia e Prevenzione, IRCCS Istituto Neurologico Mediterraneo, NEUROMED, Pozzilli, Italia
| | - Marialuisa Zedde
- SC Neurologia, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italia
| | - Simona Marcheselli
- Neurologia d'Urgenza and Stroke Unit, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italia
| | - Giorgio Silvestrelli
- Stroke Unit, Dipartimento di Neuroscienze, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italia
| | | | | | - Andrea Zini
- Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile "S Agostino Estense", AUSL, Modena, Italia
| | - Maurizio Paciaroni
- Stroke Unit and Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italia
| | - Cristiano Azzini
- Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara, Italia
| | - Massimo Gamba
- Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia
| | | | - Antonella Toriello
- U.O.C Neurologia ad Indirizzo Riabilitativo, AO Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italia
| | - Carlo Gandolfo
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Italia
| | | | | | - Anna Cavallini
- U.C Malattie Cerebrovascolari e Stroke Unit and U.C Neurologia d'Urgenza, IRCCS Fondazione Istituto Neurologico Nazionale "C Mondino", Pavia, Italia
| | - Alberto Chiti
- U.O Neurologia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italia
| | - Rocco Salvatore Calabrò
- Istituto di Ricovero e Cura a Carattere Scientifico, Centro Neurolesi Bonino-Pulejo, Messina, Italia
| | - Rossella Musolino
- Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche Clinica Neurologica, Università di Messina, Italia
| | - Paolo Bovi
- USD Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Italia
| | - Giampaolo Tomelleri
- USD Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Italia
| | - Augusto Di Castelnuovo
- Laboratorio di Epidemiologia Molecolare e Nutrizionale, Dipartimento di Epidemiologia e Prevenzione, IRCCS Istituto Neurologico Mediterraneo, NEUROMED, Pozzilli, Italia
| | - Laura Vandelli
- Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile "S Agostino Estense", AUSL, Modena, Italia
| | - Marco Ritelli
- Divisione di Biologia e Genetica, Dipartimento di Medicina Molecolare e Traslazionale, Università degli Studi di Brescia, Italia
| | - Giancarlo Agnelli
- Stroke Unit and Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italia
| | - Alessandro De Vito
- Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara, Italia
| | - Nicola Pugliese
- U.O.C Neurologia ad Indirizzo Riabilitativo, AO Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italia
| | | | - Alessia Lanari
- Stroke Unit, Dipartimento di Neuroscienze, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italia
| | - Alfonso Ciccone
- Stroke Unit, Dipartimento di Neuroscienze, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italia
| | - Corrado Lodigiani
- Centro Trombosi, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italia
| | | | - Elisabetta Del Zotto
- UO di Recupero e Rieducazione Funzionale, IRCCS Fondazione Don Gnocchi, Rovato, Italia
| | - Andrea Morotti
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Paolo Costa
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Loris Poli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Valeria De Giuli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Silvia Bonaiti
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
| | - Paolo La Spina
- Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche Clinica Neurologica, Università di Messina, Italia
| | - Norina Marcello
- SC Neurologia, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italia
| | - Giuseppe Micieli
- U.C Malattie Cerebrovascolari e Stroke Unit and U.C Neurologia d'Urgenza, IRCCS Fondazione Istituto Neurologico Nazionale "C Mondino", Pavia, Italia
| | - Giovanni de Gaetano
- Laboratorio di Epidemiologia Molecolare e Nutrizionale, Dipartimento di Epidemiologia e Prevenzione, IRCCS Istituto Neurologico Mediterraneo, NEUROMED, Pozzilli, Italia
| | - Marina Colombi
- Divisione di Biologia e Genetica, Dipartimento di Medicina Molecolare e Traslazionale, Università degli Studi di Brescia, Italia
| | - Alessandro Padovani
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
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Siniscalchi A, Sanguigni S, Lochner P, De Sarro G, Malferrari G, Gallelli L. Editorial: Statins and Tissue Plasminogen Activator for Stroke: A Beneficial Combination? Curr Vasc Pharmacol 2016; 14:302-3. [DOI: 10.2174/1570161114999160229142909] [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: 11/22/2022]
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Siniscalchi A, Bonci A, Mercuri NB, De Siena A, De Sarro G, Malferrari G, Diana M, Gallelli L. Cocaine dependence and stroke: pathogenesis and management. Curr Neurovasc Res 2015; 12:163-72. [PMID: 25742568 DOI: 10.2174/1567202612666150305110144] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/14/2015] [Accepted: 02/15/2015] [Indexed: 11/22/2022]
Abstract
Cocaine abuse remains a devastating medical problem for our society. Current concepts suggest that both hemorrhagic and ischemic stroke, particularly in young people, can result as a consequence of cocaine exposure. We provide an analysis of mechanisms of injury and a discussion of the pharmacological management of stroke following cocaine use. Preclinical research suggests that the cause of cocaine-mediated stroke is multifactorial and involves vasospasm, changes in cerebral vasculature, and platelet aggregation. We suggest that drugs able to induce vasospastic, thrombogenic, or neurotoxic effects of cocaine could be suitable as therapeutic agents. In contrast caution should be exerted when using anti-platelet and thrombolytic agents in cocaine users with stroke.
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Affiliation(s)
- Antonio Siniscalchi
- Clinical Specialist (Neurologist), Department of Neurology, Annunziata Hospital, Via F. Migliori, 1 - 87100 Cosenza, Italy.
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Consoli D, Paciaroni M, Aguggia M, Melis M, Malferrari G, Vidale S, Cerrato P, Sacco S, Gandolfo C, Bovi P, Serrati C, Del Sette M, Cavallini A, Diomedi M, Postorino P, Ricci S. Erratum to: Prevalence of patent foramen ovale in ischemic stroke in Italy: the SISIFO Study. Neurol Sci 2015; 36:1973. [DOI: 10.1007/s10072-015-2209-y] [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: 11/24/2022]
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Consoli D, Paciaroni M, Galati F, Aguggia M, Melis M, Malferrari G, Consoli A, Vidale S, Bosco D, Cerrato P, Sacco S, Gandolfo C, Bovi P, Serrati C, Del Sette M, Cavallini A, Diomedi M, Postorino P, Reboldi P, Ricci S. Prevalence of Patent Foramen Ovale in Ischaemic Stroke in Italy: Results of SISIFO Study. Cerebrovasc Dis 2015; 39:162-9. [PMID: 25720306 DOI: 10.1159/000375152] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 01/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although several authors have studied the association between patent foramen ovale (PFO) and ischaemic stroke, the matter is still controversial; few have suggested an association between cryptogenetic stroke and PFO, while others have denied this association. The aim of this study was to evaluate PFO prevalence in the whole ischaemic stroke population, independently from age and stroke subtypes and to identify the characteristics associated with the presence of PFO. METHODS SISIFO study was a multicenter, prospective, single-wave, cross-sectional survey conducted on consecutive patients with acute ischemic stroke admitted to selected clinical centres. Data regarding vascular risk factors were registered for each patient; all patients underwent computed tomography scan and/or magnetic resonance imaging of the brain; an electrocardiogram and standard laboratory blood tests were performed. A Doppler ultrasound study of extra-cranial arteries was performed too. The cases were classified according to TOAST and OCSP criteria. Each patient underwent transcranial Doppler or transcranial color-coded duplex sonography with bubble test as diagnostic tool for right-to-left-shunt. Where right-to-left shunt was detected, PFO presence was confirmed by echocardiography. FINDINGS 1,130 consecutive patients were included. We found a PFO in 247 (21.9%; 95% CI, 19.5-24.3%) patients; PFO was present in 23.5% of patients with cryptogenic stroke and in 21.3% of patients with stroke of known causes; this difference was not statistically significant. At the univariate analysis, decreasing age, hypertension, diabetes mellitus, and atrial fibrillation, and stroke characteristics such as NIHSS, OCSP and TOAST were predictors of PFO presence. At the multivariate analysis, we found a significant interaction between age and OCSP syndrome. Being LACI the reference category, the prevalence of PFO in PACI and POCI decreased significantly along with age, whereas there was no change in TACI. CONCLUSION If any relationship exists between stroke and PFO, this is more likely in PACI and POCI at a younger age. Our results are consistent with recent findings that underline PFO alone must not be considered a significant independent predictor for stroke; so the presence of PFO alone doesn't permit rushed causal correlations or 'therapeutic aggressiveness'.
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Siniscalchi A, Gallelli L, Malferrari G, Pirritano D, Serra R, Santangelo E, De Sarro G. Cerebral stroke injury: the role of cytokines and brain inflammation. J Basic Clin Physiol Pharmacol 2014; 25:131-7. [PMID: 24515999 DOI: 10.1515/jbcpp-2013-0121] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 01/10/2014] [Indexed: 12/31/2022]
Abstract
Stroke represents the most frequent cause of permanent disability in adults worldwide. Cerebral ischemia triggers the pathological pathways of the ischemic cascade and causes irreversible neuronal injury in the ischemic core within minutes of the onset. Elements of the immune system are involved in all stages of ischemic cascade from acute intravascular events triggered by the interruption of blood supply, to the parenchymal processes leading to brain damage and to the ensuing tissue repair. In this review, we will provide a brief overview of current understanding of the role of cytokines and brain inflammation during acute ischemic stroke.
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Sanzaro E, Iemolo F, Duro G, Malferrari G. A new assessment tool for Parkinson disease: the nigral lesion load obtained by transcranial sonography. J Ultrasound Med 2014; 33:1635-1640. [PMID: 25154946 DOI: 10.7863/ultra.33.9.1635] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES A sonographic method that provides for the measurement of a single frozen image and ignores the remaining portions of the midbrain has been used recently as a biological marker of Parkinson disease. We propose a new approach to evaluating the midbrain: obtaining the nigral lesion load, with which it is possible to acquire an estimate of the real damage to the substantia nigra. METHODS We studied 60 patients with Parkinson disease and classified them according to the Hoehn and Yahr scale (Neurology 1967; 17:427-442). Magnetic resonance imaging of the brain, ioflupane-labeled single-photon emission computed tomography, and technetium Tc 99m-labeled single-photon emission computed tomography were performed. Assessment of the midbrain parenchyma was performed with transcranial sonography to quantify the extent of hyperechoic signals on 2 different scans (upper and lower substantia nigra). RESULTS In 90% of patients (54), we found pathologic hyperechoic substantia nigra signals (>0.25 cm(2)). These data were similar to those described previously by other authors. However, the sum of the values obtained from each measurement (total of 4 per patient) showed that patients with severe disease had larger nigral lesion loads. In most cases, the study showed impairment of the nigrostriatal dopaminergic system when the hyperechoic pattern was more pronounced. CONCLUSIONS Transcranial sonography is a useful tool for Parkinson disease workup. A single measurement of substantia nigra echogenicity may be insufficient for an optimal definition of the stage of the disease. A study of the entire midbrain may deliver more information than a single measurement.
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Affiliation(s)
- Enzo Sanzaro
- Department of Neurology, Hospital of Vittoria, Ragusa, Italy (E.S., F.I.); National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy (F.I., G.D.); and Department of Neurology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (G.M.).
| | - Francesco Iemolo
- Department of Neurology, Hospital of Vittoria, Ragusa, Italy (E.S., F.I.); National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy (F.I., G.D.); and Department of Neurology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (G.M.)
| | - Giovanni Duro
- Department of Neurology, Hospital of Vittoria, Ragusa, Italy (E.S., F.I.); National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy (F.I., G.D.); and Department of Neurology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (G.M.)
| | - Giovanni Malferrari
- Department of Neurology, Hospital of Vittoria, Ragusa, Italy (E.S., F.I.); National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy (F.I., G.D.); and Department of Neurology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (G.M.)
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Ghadirpour R, Nasi D, Benedetti B, Zedde M, Iaccarino C, Malferrari G, Servadei F. Delayed cervical epidural hematoma after intravenous thrombolysis for acute ischemic stroke: Case report and review of literature. Clin Neurol Neurosurg 2014; 122:50-3. [DOI: 10.1016/j.clineuro.2014.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/13/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
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Lochner P, Mader C, Nardone R, Tezzon F, Zedde ML, Malferrari G, Brigo F. Sonography of the optic nerve sheath beyond the hyperacute stage of intracerebral hemorrhage. J Ultrasound 2014; 17:225-8. [PMID: 25177397 DOI: 10.1007/s40477-014-0069-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/05/2013] [Accepted: 01/15/2014] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the feasibility and utility of serial measuring of the optic nerve sheath diameter beyond the hyperacute and acute stage of intracerebral hemorrhage (ICH). METHODS Four patients with extensive ICH in the left basal ganglia were followed using ultrasound (US) and cerebral CT scans. RESULTS Optic nerve sheath diameter values assessed beyond the acute stage of ICH showed a high correlation (ρ = 0.84, p = 0.0022) with midline shift of the third ventricle seen on CT scans. CONCLUSIONS Optic nerve sonography can be useful to evaluate patients with extensive ICH beyond the acute stage and help monitoring clinical evolution in these patients, when ICP monitoring is not feasible.
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Affiliation(s)
- Piergiorgio Lochner
- Department of Neurology, Franz Tappeiner Hospital, Rossini Street 5, 39012 Merano, BZ Italy
| | - Cornelia Mader
- Department of Neurology, Franz Tappeiner Hospital, Rossini Street 5, 39012 Merano, BZ Italy
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Rossini Street 5, 39012 Merano, BZ Italy ; Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Frediano Tezzon
- Department of Neurology, Franz Tappeiner Hospital, Rossini Street 5, 39012 Merano, BZ Italy
| | | | | | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Rossini Street 5, 39012 Merano, BZ Italy ; Section of Clinical Neurology, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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Comi G, Battaglia MA, Bertolotto A, Del Sette M, Ghezzi A, Malferrari G, Salvetti M, Sormani MP, Tesio L, Stolz E, Zaratin P, Mancardi G. Observational case-control study of the prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: results from the CoSMo study. Mult Scler 2013; 19:1508-17. [PMID: 24014572 DOI: 10.1177/1352458513501231] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a possible cause of multiple sclerosis (MS). OBJECTIVES The CoSMo study evaluated the association between CCSVI and MS. METHODS The primary end-point of this multicentric, case-control study was to compare the prevalence of CCSVI between patients with MS, patients with other neurodegenerative diseases (ONDs) and healthy controls (HCs). Color-coded duplex sonography was performed by a sonologist and the images were sent to one of three central sonologists for a second reading. Agreement between local and central sonologists or, in case of disagreement, the predominant judgment among the three central readers, was required for a diagnosis of CCSVI. All readings, data collection and analysis were blinded. RESULTS The study involved 35 MS centers across Italy and included 1874 subjects aged 18-55. 1767 (94%) were evaluable: 1165 MS patients, 226 patients with ONDs and 376 HCs. CCSVI prevalence was 3.26%, 3.10% and 2.13% for the MS, OND and HC groups, respectively. No significant difference in CCSVI prevalence was found amongst the three cohorts (MS versus HC, OR = 1.55, 95%CI = 0.72-3.36, p = 0.30; OND versus HC, OR = 1.47, 95%CI = 0.53-4.11, p = 0.46; MS versus OND, OR = 1.05, 95%CI = 0.47-2.39, p = 0.99). High negative and low positive agreement was found between the local and centralized readers. CONCLUSIONS CCSVI is not associated with MS.
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Affiliation(s)
- G Comi
- Department of Neurology, Università Vita Salute San Raffaele, Milan, Italy
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Comi G, Battaglia MA, Bertolotto A, Del Sette M, Ghezzi A, Malferrari G, Salvetti M, Sormani MP, Tesio L, Stolz E, Mancardi G. Italian multicentre observational study of the prevalence of CCSVI in multiple sclerosis (CoSMo study): rationale, design, and methodology. Neurol Sci 2013; 34:1297-307. [PMID: 23344741 PMCID: PMC3747324 DOI: 10.1007/s10072-012-1269-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 12/05/2012] [Indexed: 11/29/2022]
Abstract
Chronic cerebro-spinal venous insufficiency (CCSVI) has been proposed as a “congenital malformation” implicated in the pathogenesis of multiple sclerosis (MS). However, numerous studies failed to confirm its presence in MS patients. This paper presents the rationale, design, and methodology adopted in the CoSMo study, conducted with the aim of verifying whether or not CCSVI is linked to MS. The primary endpoint of the CoSMo study is to compare the prevalence of CCSVI in patients with MS versus patients affected by other neurodegenerative diseases (OND) and healthy volunteers. CoSMo is a multicenter, blinded, prevalence study recruiting 2,000 adult subjects, involving 43 MS centers across Italy. Assessment of the presence or absence of CCSVI is performed by color-coded duplex (CCD) sonography and two out of the five criteria according to Zamboni are necessary for the diagnosis of CCSVI. Local CCD examination carried out by a certified sonologist and the central image readings performed by experts in the field are blinded. An advanced protocol is also described in this paper. The application of a rigorous methodological design will definitively confirm whether an association exists between CCSVI and MS. Should an association be observed, this study also further examines the link between CCSVI and the severity of MS. The addition of subgroups without MS and OND also provides information on whether CCSVI is specific to MS only. Results from the CoSMo study will play a crucial role in the possible studies concerning the potential treatment of CCSVI in MS.
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Affiliation(s)
- Giancarlo Comi
- Division of Neurology and Neurophysiology Service, Ospedale "San Raffaele", Milan, Italy
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Siniscalchi A, Gallelli L, Labate A, Malferrari G, Palleria C, Sarro GD. Post-stroke Movement Disorders: Clinical Manifestations and Pharmacological Management. Curr Neuropharmacol 2012; 10:254-62. [PMID: 23449883 PMCID: PMC3468879 DOI: 10.2174/157015912803217341] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 04/30/2012] [Accepted: 06/04/2012] [Indexed: 12/12/2022] Open
Abstract
Involuntary abnormal movements have been reported after ischaemic and haemorrhagic stroke. Post stroke movement disorders can appear as acute or delayed sequel. At the moment, for many of these disorders the knowledge of pharmacological treatment is still inadequate. Dopaminergic and GABAergic systems may be mainly involved in post-stroke movement disorders. This article provides a review on drugs commonly used in post-stroke movement disorders, given that some post-stroke movement disorders have shown a partial benefit with pharmacological approach.
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Affiliation(s)
- Antonio Siniscalchi
- Department of Neuroscience, Neurology Division, “Annunziata” Hospital, Cosenza, Italy
| | - Luca Gallelli
- Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Angelo Labate
- Institute of Neurology, University of Catanzaro, Catanzaro, Italy
| | | | - Caterina Palleria
- Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Giovambattista De Sarro
- Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
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Siniscalchi A, Gallelli L, Malferrari G, De Sarro G. Limb-shaking transient ischemic attack associated with focal electroencephalography slowing: case report. J Vasc Interv Neurol 2012; 5:3-5. [PMID: 22737258 PMCID: PMC3379906] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Limb shaking is a rare form of transient ischemic attack (TIA) that can easily be confused with focal motor seizures. CASE We report a case of a 61-year-old man with rhythmic jerky movements of his left limb, without loss of awareness, that have occurred about once per month for the past four months, precipitated by standing up and extending the neck. The electroencephalography test showed right temporal slow activity, without epileptiform features. No evidence of a noteworthy structural lesion was found on magnetic resonance imaging of the brain. Doppler ultrasound and magnetic resonance angiography of the neck disclosed an 80% stenosis of the right internal carotid artery. The patient underwent an endarterectomy of the right internal carotid artery and remained asymptomatic in the 12-month follow-up period. DISCUSSION Both hypoperfusion and reduction of vasomotor reactivity to hypercapnia of corresponding cerebral territories, without the structural lesions of the brain, were observed in patients with limb-shaking syndrome (LSS). Electroencephalographic studies have failed to show epileptiform activity associated with LSS, although some patients have controlateral slow activity. In our patient, we observed a resolution of the attacks after endarterectomy of controlateral internal carotid artery, suggesting that a quick diagnosis of this form of TIA is important both to abolish the attacks and to reduce the risk of major stroke.
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Affiliation(s)
- Antonio Siniscalchi
- Department of Neuroscience, Neurology Division, “Annunziata” Hospital, Cosenza, Italy ‡ Regional delegate SINV
| | - Luca Gallelli
- Department of Experimental and Clinical Medicine, University Magna Grecia of Catanzaro, Clinical Pharmacology Operative Unit, Mater Domini University Hospital, Catanzaro, Italy
| | | | - Giovambattista De Sarro
- Department of Experimental and Clinical Medicine, University Magna Grecia of Catanzaro, Clinical Pharmacology Operative Unit, Mater Domini University Hospital, Catanzaro, Italy
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Malferrari G, Zedde M, De Berti G, Maggi M, Marcello N. An unexpected evolution of symptomatic mild middle cerebral artery (MCA) stenosis: asymptomatic occlusion. BMC Neurol 2011; 11:154. [PMID: 22165899 PMCID: PMC3270006 DOI: 10.1186/1471-2377-11-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 12/13/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The intracranial localization of large artery disease is recognized as the main cause of ischemic stroke in the world, considering all countries, although its global burden is widely underestimated. Indeed it has been reported more frequently in Asians and African-American people, but the finding of intracranial stenosis as a cause of ischemic stroke is relatively common also in Caucasians. The prognosis of patients with stroke due to intracranial steno-occlusion is strictly dependent on the time of recanalization. Moreover, the course of the vessel involvement is highly dynamic in both directions, improvement or worsening, although several data are derived from the atherosclerotic subtype, compared to other causes. CASE DESCRIPTION We report the clinical, neurosonological and neuroradiological findings of a young woman, who came to our Stroke Unit because of the abrupt onset of aphasia during her work. An urgent neurosonological examination showed a left M1 MCA stenosis, congruent with the presenting symptoms; magnetic resonance imaging confirmed this finding and identified an acute ischemic lesion on the left MCA territory. The past history of the patient was significant only for a hyperinsulinemic condition, treated with metformine, and a mild overweight. At this time a selective cerebral angiography was not performed because of the patient refusal and she was discharged on antiplatelet and lipid-lowering therapy, having failed to identify autoimmune or inflammatory diseases. Within 1 month, she went back to our attention because of the recurrence of aphasia, lasting about ten minutes. Neuroimaging findings were unchanged, but the patient accepted to undergo a selective cerebral angiography, which showed a mild left distal M1 MCA stenosis.During the follow-up the patient did not experienced any recurrence, but a routine neurosonological examination found an unexpected evolution of the known MCA stenosis, i.e. left M1 MCA occlusion. Neuroradiological imaging did not identify new lesions of the brain parenchyma and a repeated selective cerebral angiography confirmed the left M1 MCA occlusion. CONCLUSIONS Regardless of the role of metabolic and/or inflammatory factors on the aetiology of the intracranial stenosis in this case, the course of the vessel disease was unexpected and previously unreported in the literature at our knowledge.
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Affiliation(s)
- Giovanni Malferrari
- Neurology Unit, Department of Neuromotor Physiology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42100 Reggio Emilia, Italy
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Siniscalchi A, Gallelli L, De Sarro G, Malferrari G, Santangelo E. Antiepileptic drugs for central post-stroke pain management. Pharmacol Res 2011; 65:171-5. [PMID: 21925602 DOI: 10.1016/j.phrs.2011.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 08/28/2011] [Accepted: 09/05/2011] [Indexed: 12/14/2022]
Abstract
Antiepileptic drugs (AEDs) are commonly prescribed for a wide range of disorders other than epilepsy, including both neurological and psychiatric disorders. AEDs play also a role in pharmacological management of neuropathic pain. Central post-stroke pain (CPSP) is a disabling morbidity occurring in 35% of patients with stroke. The pathophysiology of CPSP is not well known but central disinhibition with increased neuronal excitability has been suggested. AEDs include many different drugs acting on pain through several mechanisms, such as reduction of neuronal hyperexcitability. To our knowledge conclusive evidence has not been published yet. The aim of this review is to delineate efficacy and safety of AEDs in CPSP.
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Affiliation(s)
- A Siniscalchi
- Department of Neuroscience, Neurology Division, Annunziata Hospital, Cosenza, Italy
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Nicoletti G, Albano G, Sanguigni S, Tardi S, Malferrari G, Del Sette M, Bruno F, Nicolai A. Transient basilar artery occlusion monitored by transcranial color Doppler presenting with a spectacular shrinking deficit: a case report. J Med Case Rep 2010; 4:13. [PMID: 20205759 PMCID: PMC2822791 DOI: 10.1186/1752-1947-4-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 01/19/2010] [Indexed: 11/10/2022] Open
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Nedelmann M, Stolz E, Gerriets T, Baumgartner RW, Malferrari G, Seidel G, Kaps M. Consensus recommendations for transcranial color-coded duplex sonography for the assessment of intracranial arteries in clinical trials on acute stroke. Stroke 2009; 40:3238-44. [PMID: 19661474 DOI: 10.1161/strokeaha.109.555169] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Transcranial color-coded duplex sonography has become a standard diagnostic technique to assess the intracranial arterial status in acute stroke. It is increasingly used for the evaluation of prognosis and the success of revascularization in multicenter trials. The aim of this international consensus procedure was to develop recommendations on the methodology and documentation to be used for assessment of intracranial occlusion and for monitoring of recanalization. METHODS Thirty-five experts participated in the consensus process. The presented recommendations were approved during a meeting of the consensus group in October 2008 in Giessen, Germany. The project was an initiative of the German Competence Network Stroke and performed under the auspices of the Neurosonology Research Group of the World Federation of Neurology. RESULTS Recommendations are given on how examinations should be performed in the time-limited situation of acute stroke, including criteria to assess the quality of the acoustic bone window, the use of echo contrast agents, and the evaluation of intracranial vessel status. The important issues of the examiners' training and experience, the documentation, and analysis of study results are addressed. One central aspect was the development of standardized criteria for diagnosis of arterial occlusion. A transcranial color-coded duplex sonography recanalization score based on objective hemodynamic criteria is introduced (consensus on grading intracranial flow obstruction [COGIF] score). CONCLUSIONS This work presents consensus statements in an attempt to standardize the application of transcranial color-coded duplex sonography in the setting of acute stroke research, aiming to improve the reliability and reproducibility of the results of future stroke studies.
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Affiliation(s)
- Max Nedelmann
- Department of Neurology, Justus Liebig University, Giessen, Germany.
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Toni D, Lorenzano S, Agnelli G, Guidetti D, Orlandi G, Semplicini A, Toso V, Caso V, Malferrari G, Fanucchi S, Bartolomei L, Prencipe M. Intravenous Thrombolysis with rt-PA in Acute Ischemic Stroke Patients Aged Older than 80 Years in Italy. Cerebrovasc Dis 2007; 25:129-35. [DOI: 10.1159/000112323] [Citation(s) in RCA: 48] [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: 01/22/2007] [Accepted: 08/14/2007] [Indexed: 11/19/2022] Open
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Malferrari G, Bertolino C, Casoni F, Zini A, Sarra VM, Sanguigni S, Pratesi M, Lochner P, Coppo L, Brusa G, Guidetti D, Cavuto S, Marcello N. The Eligible study: ultrasound assessment in acute ischemic stroke within 3 hours. Cerebrovasc Dis 2007; 24:469-76. [PMID: 17895622 DOI: 10.1159/000108922] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Accepted: 06/04/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AIMS OF THE STUDY to identify with echo color Doppler ultrasound of the supra-aortic vessels and transcranial color-coded duplex sonography (TCCD) various patterns of vessel occlusion within 3 h from stroke onset, to compare each group defined at the admission with clinical findings and outcome, and to study the recanalization process, independent of therapy. METHODS We enrolled 89 consecutive patients (mean age 68.9 years). Ultrasound evaluation was done within 3 h from stroke onset, and was repeated at 3-6 and 24-36 h, at day 5, and at 3 months. At admission, patients were divided into the following groups: internal carotid artery occlusions and stenoses (<50%, 50-69%, > or =70%, near occlusion), middle cerebral artery stenoses and occlusions, tandem occlusions and T occlusions. Vascular recanalization in each group was evaluated. Subgroups were compared for NIH Stroke Scale (NIHSS) and the outcome measures mortality, Barthel index (BI) and modified Rankin scale (mRS). Favorable outcome was defined as mRS < or =2 and BI > or =90. RESULTS Each subgroup differed significantly for baseline NIHSS (p < 0.0001), 3-month mortality (p = 0.0235), BI at day 5 (p = 0.0458) and mRS at 3 months (p = 0.0028), even after adjustment for treatment. T and tandem occlusions were the subgroups with the highest NIHSS scores and the poorest outcomes, and the same subgroups had the worst recanalization rates. CONCLUSIONS TCCD in the acute setting of stroke patients allows identification of the presence and site of clots, prediction of outcome and study of the dynamic process of vessel recanalization, in both the acute phase and follow-up.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Aged, 80 and over
- Brain Ischemia/complications
- Brain Ischemia/diagnostic imaging
- Brain Ischemia/etiology
- Brain Ischemia/physiopathology
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/physiopathology
- Carotid Stenosis/complications
- Carotid Stenosis/diagnostic imaging
- Carotid Stenosis/physiopathology
- Female
- Follow-Up Studies
- Humans
- Infarction, Middle Cerebral Artery/complications
- Infarction, Middle Cerebral Artery/diagnostic imaging
- Infarction, Middle Cerebral Artery/physiopathology
- Italy
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Recovery of Function
- Severity of Illness Index
- Stroke/diagnostic imaging
- Stroke/etiology
- Stroke/physiopathology
- Time Factors
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Transcranial
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36
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Cremonesi P, Castiglioni B, Malferrari G, Biunno I, Vimercati C, Moroni P, Morandi S, Luzzana M. Technical Note: Improved Method for Rapid DNA Extraction of Mastitis Pathogens Directly from Milk. J Dairy Sci 2006; 89:163-9. [PMID: 16357279 DOI: 10.3168/jds.s0022-0302(06)72080-x] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Efficient control against bovine mastitis requires sensitive, rapid, and specific tests to detect and identify the main bacteria that cause heavy losses to the dairy industry. Molecular detection of pathogenic microorganisms is based on DNA amplification of the target pathogen. Therefore, efficient extraction of DNA from pathogenic bacteria is a major step. In this study, we aimed to develop a specific, sensitive, and rapid method to extract DNA directly from the main gram-positive bacteria known to cause bovine mastitis (Staphylococcus aureus, Streptococcus agalactiae, Streptococcus dysgalactiae, and Streptococcus uberis) found in milk samples. The DNA extraction method is based on the lysing and nuclease-inactivating properties of the chaotropic agent, guanidinium thiocyanate, together with the nucleic acid-binding properties of the silica particles. An efficient protocol consisting of 6 basic steps (3 of which were done twice) was developed and applied directly to milk samples. Absence of PCR inhibitors and DNA quality were evaluated by PCR amplification of the species-specific DNA sequences of the target bacteria. The level of sensitivity achieved in our experiments is applicable to milk sample analysis without sample enrichment.
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Affiliation(s)
- P Cremonesi
- Department of Biomedical Sciences and Technologies, University of Milan, Segrate, Milan, Italy.
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37
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Ferrarini G, Malferrari G, Zucco R, Gaddi O, Norina M, Pini LA. High prevalence of patent foramen ovale in migraine with aura. J Headache Pain 2005; 6:71-6. [PMID: 16362645 PMCID: PMC3452317 DOI: 10.1007/s10194-005-0154-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Accepted: 02/07/2005] [Indexed: 01/10/2023] Open
Abstract
In this study we evaluated the presence of patent foramen ovale (PFO) in a cohort of 25 consecutive patients suffering from migraine with aura (MA) during an attack presenting to the emergency ward of an Italian hospital. Patients underwent brain magnetic resonance imaging (MRI) with contrast medium, routine coagulation tests, contrast transcranial echocolour-coded sonography (c-TCCS) and transoesophageal echocardiography (TEE). Of the enrolled patients, 88.7% showed a PFO according to the c-TCCS test, whereas only in 72% TEE confirmed the presence of PFO. This discordance could be due to the fact that c-TCCS is more sensitive even with shunts with minimal capacity also located in the pulmonary vasculature. After surgical treatment of the PFO, MA disappeared within two months. Also, the treatment with warfarin as well as with acetylsalicylic acid and flunarizine was able to dramatically reduce the frequency of migraine attacks. These data indicate a higher prevalence of PFO in MA vs. normal population (OR=2.92) and could suggest that the presence of arteriovenous (AV) shunts could represent a trigger for MA attacks as well as for stroke, but more studies are needed to confirm this preliminary hypothesis.
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Affiliation(s)
- G. Ferrarini
- Centro Cefalee Alta Specialità, Dipartimento Area Critica, Reggio Emilia, Italy
| | - G. Malferrari
- Laboratorio di Neurosonologia, Dipartimento Area Critica, Reggio Emilia, Italy
| | - R. Zucco
- Centro Cefalee Alta Specialità, Dipartimento Area Critica, Reggio Emilia, Italy
| | - O. Gaddi
- Struttura Semplice Servizio Ambulatoriale di Cardiologia, Reggio Emilia, Italy
| | - M. Norina
- Azienda Ospedaliera S. Maria Nuova di Reggio Emilia, Dipartimento Area Medica 2 U.O. di Neurologia, Reggio Emilia, Italy
| | - L. A. Pini
- Centro Cefalee, Università di Modena e Reggio Emilia, Via del Pozzo 71, I-41100 Modena, Italy
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38
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Malferrari G, Stella A, Monferini E, Saltini G, Proverbio MC, Grimaldi LM, Rossi-Bernardi L, Biunno I. Ctla4 and multiple sclerosis in the Italian population. Exp Mol Pathol 2005; 78:55-7. [PMID: 15596061 DOI: 10.1016/j.yexmp.2004.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Indexed: 11/23/2022]
Abstract
CTLA4 protein is a receptor molecule that plays a critical role as a negative regulator of the immune response. Therefore, genetic variations in CTLA4 may confer susceptibility to autoimmune diseases such as multiple sclerosis (MS). In order to investigate the association of two CTLA4 polymorphisms (+49 A/G and -318 C/T) with multiple sclerosis, sporadic MS patients and healthy controls from Italy were genotyped through direct DNA sequencing. Considering single-loci variations, no differences in the allelic and genotypic frequencies between patients and controls were found. However, considering a putative interaction at the two loci, the T/G combination was more frequently observed in patients than in controls. This result suggests that this allelic combination of the CTLA4 polymorphisms may be involved in the susceptibility to MS in the Italian population.
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Affiliation(s)
- G Malferrari
- Centre for Bio-Molecular Interdisciplinary Studies and Industrial Applications, University of Milan, Milan, Italy
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39
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Saltini G, Proverbio MC, Malferrari G, Biagiotti L, Boettcher P, Dominici R, Monferini E, Lorenzini E, Cattaneo M, Antonello D, Moore PS, Zamproni I, Viscardi M, Chiumello G, Biunno I. Identification of a novel polymorphism in the fibronectin type II domain of the SEL1L gene and possible relation to the persistent hyperinsulinemic hypoglycemia of infancy. Mutat Res 2004; 554:159-63. [PMID: 15450414 DOI: 10.1016/j.mrfmmm.2004.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2004] [Revised: 04/22/2004] [Accepted: 04/22/2004] [Indexed: 04/30/2023]
Abstract
SEL1L, a human gene located on chromosome 14q24.3-q31, is highly expressed in adult pancreas. It is proximal to D14S67 (IDDM11) a proposed type I diabetes susceptibility locus. Considering the organ specific expression of SEL1L, a fundamental role of SEL1L in pancreatic growth can be hypothesized. While screening for mutations in young diabetic patients, in children affected by persistent hyperinsulinemic hypoglycemia of infancy (PHHI), in patients with non-functional endocrine tumours and in over 100 control subjects, we identified a novel polymorphism (D162G) residing on the fourth exon of the gene. This exon encodes for the fibronectin type II domain and the nucleotide change involves a highly conserved amino acid. The D162G polymorphism induces a major change in the amino acid composition producing a possible disruptive role in collagen binding.
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Affiliation(s)
- G Saltini
- Centre for Bio-molecular Interdisciplinary Studies and Industrial applications, University of Milan, Italy
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40
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Crimi M, Galbiati S, Perini MP, Bordoni A, Malferrari G, Sciacco M, Biunno I, Strazzer S, Moggio M, Bresolin N, Comi GP. A mitochondrial tRNA(His) gene mutation causing pigmentary retinopathy and neurosensorial deafness. Neurology 2003; 60:1200-3. [PMID: 12682337 DOI: 10.1212/01.wnl.0000055865.30580.39] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We have identified a heteroplasmic G to A mutation at position 12,183 of the mitochondrial transfer RNA Histidine (tRNA(His)) gene in three related patients. These phenotypes varied according to mutation heteroplasmy: one had severe pigmentary retinopathy, neurosensorial deafness, testicular dysfunction, muscle hypotrophy, and ataxia; the other two had only retinal and inner ear involvement. The mutation is in a highly conserved region of the T(psi)C stem of the tRNA(His) gene and may alter secondary structure formation. This is the first described pathogenic, maternally inherited mutation of the mitochondrial tRNA(His) gene.
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Affiliation(s)
- M Crimi
- Centro Dino Ferrari, Dipartimento di Scienze Neurologiche, Università degli Studi di Milano, I.R.C.C.S. Ospedale Maggiore Policlinico and Centro di Eccellenza per le Malattie Neurodegenerative, Italy.
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41
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Malferrari G, Monferini E, DeBlasio P, Diaferia G, Saltini G, Del Vecchio E, Rossi-Bernardi L, Biunno I. High-quality genomic DNA from human whole blood and mononuclear cells. Biotechniques 2002; 33:1228-30. [PMID: 12503304 DOI: 10.2144/02336bm09] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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42
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Nicolini A, Ghirarduzzi A, Iorio A, Silingardi M, Malferrari G, Baldi G. Intracranial bleeding: epidemiology and relationships with antithrombotic treatment in 241 cerebral hemorrhages in Reggio Emilia. Haematologica 2002; 87:948-56. [PMID: 12217807] [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: 02/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Anticoagulant (AC) and antiplatelet (AP) drugs are effectively used in the prevention of thromboembolic events, with the trade-off of bleeding side effects, particularly intracranial. The aim of this study was to determine the incidence of intracranial bleeding in the population of Reggio Emilia and to investigate the potential effect of AC and AP drugs. DESIGN AND METHODS We reviewed all the patients admitted for cerebral hemorrhages to our hospital between April 1998 and September 2000. Data were collected with a standardized form. All the patients were followed-up to estimate long-term mortality. Chi(2) and t-tests were used as appropriate. Logistic regression analysis was performed to test predictors of mortality. Pharmaceutical department data were employed to estimate the total number of patients receiving AC and AP drugs. RESULTS We found 241 cases (107/134 female/male, mean age 61 years, 133/107 spontaneous/traumatic events, 0.32/1,000/year overall). Twenty-nine and 47 of these patients were being given AC or AP drugs, respectively (4.9/1,000/year and 3.7/1,000/year). The relative risk of intracranial bleeding was 11.5 in AP and 15.3 in AC treated patients. Two patients (one underwent neurosurgery and one thrombolytic treatment) were excluded from mortality and risk factors analysis. Six patients were lost from follow-up and excluded from mortality analysis. Overall mortality was 100/233 (42.9%); mortality in traumatic events was 25/103 (24.2%) versus 75/130 (57.7%) in spontaneous events. Mortality was 19/29 (65.5%), 26/47 (55.3%) and 55/157 (35%) in AC recipients, AP recipients, and untreated patients, respectively. This increased risk was mainly confined to traumatic events (p = 0.06), without difference between AC and AP recipients. At the time of the event, the mean duration of oral AC treatment was 26.3 months (range 1-120). Mean INR was = 3.1 (range 1.6-8.8). Mortality was significantly predicted by the Glasgow Coma Scale Score (GCS) at admission (p < 0.0001), by the type of bleeding (spontaneous versus traumatic) (p = 0.0026), and by age (p < 0.0001). INTERPRETATION AND CONCLUSIONS Careful selection of patients and prevention of traumatic events are the main candidate mechanisms to reduce intracranial bleeding in patients being treated with AC and AP drugs.
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Affiliation(s)
- Alberto Nicolini
- Unità Tromboembolismo Venoso, Centro Emostasi e Trombosi, Dipartimento Area Medica 1, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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43
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Cattaneo M, Zollo M, Malferrari G, Orlandi R, D'Angelo A, Menard S, Biunno I. Allelic polymorphisms in the transcriptional regulatory region of human SEL1L. Mutat Res 2001; 458:71-6. [PMID: 11691638 DOI: 10.1016/s0027-5107(01)00241-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this work, we explored the existence of genetic variants within the SEL1L transcriptional regulatory region by direct sequencing of the basal promoter. SEL1L is the human ortholog of the Caenorhabditis elegans gene sel-1, a negative regulator of LIN-12/NOTCH receptor proteins. To understand the relation in SEL1L transcription pattern observed in different epithelial cells, we analysed its promoter activity. We found it to be considerably higher only in pancreatic cells. We then looked for the presence of genetic variability within this region by sequencing the minimal promoter of 63 individuals (126 alleles); two new and associated polymorphic variants were found only in few lung carcinoma bearing patients. The functional effects of this polymorphism was analysed by transient transfection assay which resulted in a significant increase in the transcriptional activity of the gene.
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Affiliation(s)
- M Cattaneo
- Institute of Advanced Biomedical Technologies, National Research Council, Via Fratelli Cervi 93, Segrate, 20090, Milan, Italy
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44
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Malferrari G, Mirabella M, D'Alessandra Y, Servidei S, Biunno I. Deletion polymorphism of DNASE1L1, an X-linked DNase I-like gene, in acid maltase deficiency disorders. Exp Mol Pathol 2001; 70:173-4. [PMID: 11263960 DOI: 10.1006/exmp.2001.2374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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45
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Cattaneo M, Sorio C, Malferrari G, Rogozin IB, Bernard L, Scarpa A, Zollo M, Biunno I. Cloning and functional analysis of SEL1L promoter region, a pancreas-specific gene. DNA Cell Biol 2001; 20:1-9. [PMID: 11242538 DOI: 10.1089/10445490150504648] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We examined the promoter activity of SEL1L, the human ortholog of the C. elegans gene sel-1, a negative regulator of LIN-12/NOTCH receptor proteins. To understand the relation in SEL1L transcription pattern observed in different epithelial cells, we determined the transcription start site and sequenced the 5' flanking region. Sequence analysis revealed the presence of consensus promoter elements--GC boxes and a CAAT box--but the absence of a TATA motif. Potential binding sites for transcription factors that are involved in tissue-specific gene expression were identified, including: activator protein-2 (AP-2), hepatocyte nuclear factor-3 (HNF3 beta), homeobox Nkx2-5 and GATA-1. Transcription activity of the TATA-less SEL1L promoter was analyzed by transient transfection using luciferase reporter gene constructs. A core basal promoter of 302 bp was sufficient for constitutive promoter activity in all the cell types studied. This genomic fragment contains a CAAT and several GC boxes. The activity of the SEL1L promoter was considerably higher in mouse pancreatic beta cells (beta TC3) than in several human pancreatic neoplastic cell lines; an even greater reduction of its activity was observed in cells of nonpancreatic origin. These results suggest that SEL1L promoter may be a useful tool in gene therapy applications for pancreatic pathologies.
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Affiliation(s)
- M Cattaneo
- Istituto di Tecnologie Biomediche Avanzate-CNR, Milan, Italy
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46
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Granelli P, Siardi C, Zennaro F, Cattaneo M, Malferrari G, Buffa R, Fociani P, Fregoni F, De Ruberto F, Fichera G, Peracchia A, Biunno I. Melanoma antigen genes 1 and 2 are differentially expressed in human gastric and cardial carcinomas. Scand J Gastroenterol 2000; 35:528-33. [PMID: 10868457 DOI: 10.1080/003655200750023804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND MAGE genes encode for tumor-rejection antigens and are expressed in tumors of different histologic types but not in normal tissues, with the exception of testis and placenta. The aim of this study was to evaluate the frequency of MAGE-1 and -2 expression in gastric and in cardial carcinomas; these conditions have been described as two distinct diseases, having different etiologies, epidemiologic patterns, and gene mutations. METHODS Two groups of patients were studied: patients with distal gastric carcinoma and patients with carcinoma of the cardia. A group of patients with intestinal metaplasia in the gastric mucosa and controls were also included. All of them underwent upper GI endoscopy. Paired biopsy specimens were taken for routine histology and for RNA extraction, to study the expression of MAGE-1 and -2 genes. RESULTS None of the intestinal metaplastic samples or controls expressed MAGE-1 and -2 at detectable levels. Whereas 40% of the gastric cancer patients expressed either MAGE-1 or -2, 26.6% transcribed both. In the cardial cancer group, 20% of the cases expressed at least one MAGE, and only 6.6% expressed both genes. These results might reinforce the concept that cancer of the cardia is a distinct neoplastic disease with regard to esophageal and gastric (distal) carcinomas. CONCLUSIONS Here we show that MAGE gene expression occurs in advanced stages of gastric and cardial cancer and therefore appears to be a late event. This might point to a reconsideration of their potential role in cancer immunotherapy.
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Affiliation(s)
- P Granelli
- Dept. of General Surgery and Surgical Oncology, Ospedale Maggiore I.R.C.C.S., University of Milan, Italy
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47
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Malferrari G, Mazza U, Tresoldi C, Rovida E, Nissim M, Mirabella M, Servidei S, Biunno I. Molecular characterization of a novel endonuclease (Xib) and possible involvement in lysosomal glycogen storage disorders. Exp Mol Pathol 1999; 66:123-30. [PMID: 10409440 DOI: 10.1006/exmp.1999.2254] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We cloned and partially characterized a human endonuclease (Xib) which shows sequence homologies to pancreatic DNase I but an enzymatic activity closer to DNase II. We report on the structural differences found between Xib and other recently cloned human DNases. Fluores cence microscopy analysis of transiently transfected cells with Xib::pEGFP constructs indicate that the protein is located in the cytoplasm and possibly anchored to a membrane, as deduced from a hydrophobic amino acid stretch present at the C-terminal end. Xib is overexpressed in muscle and cardiac tissues and is alternately spliced in several normal and neoplastic cells. In situ hybridization studies using human cardiac and muscle biopsies indicate accumulation of Xib transcript in the vacuoles of muscle cells from patients affected by vacuolar myopathy as acid maltase deficiency; however, no point mutations were detected in their DNA.
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Affiliation(s)
- G Malferrari
- Istituto Tecnologie Biomediche Avanzate-Consiglio Nazionale delle Ricerche, Via Fratelli Cervi 93, Segrate Milano, 20090, Italy
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48
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Malferrari G, Borioni D, Negri E, Bondi M. Early treatment of ischemic-stroke. Pharmacol Res 1992. [DOI: 10.1016/1043-6618(92)90363-g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Ferrari A, Bertolotti M, Malferrari G, Pini LA, Trenti T, Sternieri E. Interactions between Chronic Headache and Analgesic Drugs Overuse: Clinical and Toxicological Aspects. Cephalalgia 1991. [DOI: 10.1177/0333102491011s11115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anna Ferrari
- Headache Study Center, c/o Clinical Pharmacology and Toxicology Dept., University of Modena, Italy
| | - Marco Bertolotti
- Headache Study Center, c/o Clinical Pharmacology and Toxicology Dept., University of Modena, Italy
| | - Giovanni Malferrari
- Headache Study Center, c/o Clinical Pharmacology and Toxicology Dept., University of Modena, Italy
| | - Luigi A. Pini
- Headache Study Center, c/o Clinical Pharmacology and Toxicology Dept., University of Modena, Italy
| | - Tommaso Trenti
- Headache Study Center, c/o Clinical Pharmacology and Toxicology Dept., University of Modena, Italy
| | - Emilio Sternieri
- Headache Study Center, c/o Clinical Pharmacology and Toxicology Dept., University of Modena, Italy
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50
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Granella F, Malferrari G, Farina S, Manzoni GC. [Rebound headache. Clinical and epidemiologic study]. Minerva Med 1987; 78:997-1000. [PMID: 3601176] [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: 01/06/2023]
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