1
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Fisher AD, Marconi M, Castellini G, Safer JD, D'Arienzo S, Levi M, Brogonzoli L, Iardino R, Cocchetti C, Romani A, Mazzoli F, Matarrese P, Ricca V, Vignozzi L, Maggi M, Pierdominici M, Ristori J. Estimate and needs of the transgender adult population: the SPoT study. J Endocrinol Invest 2024:10.1007/s40618-023-02251-9. [PMID: 38372939 DOI: 10.1007/s40618-023-02251-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/17/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Despite the increasing interest in transgender health research, to date little is known about the size of the transgender and gender diverse (TGD) population. METHODS A web-based questionnaire survey was developed, including a collection of socio-demographic characteristics and disseminated online through social media. Gender incongruence was evaluated by using a 2-item approach assessing gender recorded at birth and gender identity. The primary objective of the present population-based study was to estimate the proportion of TGD people across ages among a large sample of people who answered a web-based survey. The secondary endpoints were to identify gender-affirming needs and possible barriers to healthcare access. RESULTS A total of 19,572 individuals participated in the survey, of whom 7.7% reported a gender identity different from the sex recorded at birth. A significantly higher proportion of TGD people was observed in the youngest group of participants compared with older ones. Among TGD people who participated in the study, 58.4% were nonbinary, and 49.1% experienced discrimination in accessing health care services. Nonbinary TGD participants reported both the need for legal name and gender change, along with hormonal and surgical interventions less frequently compared to binary persons. CONCLUSIONS Being TGD is not a marginal condition In Italy. A large proportion of TGD persons may not need medical and surgical treatments. TGD people often experience barriers to healthcare access relating to gender identity.
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Affiliation(s)
- A D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, University of Florence, Florence, Italy.
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy.
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
| | - M Marconi
- Reference Centre for Gender Medicine, Italian National Institute of Health, Rome, Italy
| | - G Castellini
- Psychiatric Unit, University of Florence, Florence, Italy
| | - J D Safer
- Mount Sinai Center for Transgender Medicine and Surgery, New York City, NY, USA
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - S D'Arienzo
- Azienda USL Toscana Centro SOC Monitoraggio e Programmazione Performance Clinico-Assistenziale Pistoia, Prato ed Empoli e Relazioni con Agenzie Esterne, Florence, Italy
| | - M Levi
- UFC Epidemiologia, Dipartimento di Prevenzione Azienda USL Toscana Centro, Florence, Italy
| | | | | | - C Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, University of Florence, Florence, Italy
| | - A Romani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, University of Florence, Florence, Italy
| | - F Mazzoli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, University of Florence, Florence, Italy
| | - P Matarrese
- Reference Centre for Gender Medicine, Italian National Institute of Health, Rome, Italy
| | - V Ricca
- Psychiatric Unit, University of Florence, Florence, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, University of Florence, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - M Maggi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - M Pierdominici
- Reference Centre for Gender Medicine, Italian National Institute of Health, Rome, Italy
| | - J Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, University of Florence, Florence, Italy
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2
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Portal L, Polishchuk I, Zilberberg R, Levi M, Koifman-Khristosov M, Katsman A, Pokroy B. Deformation twin traces on gold surfaces: A pathway to tailored epitaxial growth of 1D semiconductors. Proc Natl Acad Sci U S A 2023; 120:e2314192120. [PMID: 38048465 PMCID: PMC10723047 DOI: 10.1073/pnas.2314192120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023] Open
Abstract
The field of one-dimensional semiconducting materials holds a wide variety of captivating applications, such as photovoltaic cells, electronic devices, catalysis cells, lasers, and more. The tunability of electrical, mechanical, or optical attributes of a semiconductor crystal relies on the ability to control and pattern the crystal's growth direction, orientation, and dimensions. In this study, we harvest the unique properties of crystallographic defects in Au substrates, specifically twin boundaries, to fabricate selective epitaxial growth of semiconducting nanocrystals. Different crystallographic defects were previously shown to enhance materials properties, such as, screw dislocations providing spiral crystal growth, dislocation outcrops, and vacancies increasing their catalytic activity, dislocation strengthening, and atomic doping changing the crystal's electrical properties. Here, we present a unique phenomenon of directed growth of semiconductor crystals of gold(I)-cyanide (AuCN) on the surface of thin Au layers, using traces of deformation twins on the surface. We show that emergence of deformation twins to the {111} Au surface leads to the formation of ledges, exposing new {001} and {111} facets on the surface. We propose that this phenomenon leads to epitaxial growth of AuCN on the freshly exposed {111} facets of the twin boundary trace ledges. Specific orientations of the twin boundaries with respect to the Au surface allow for patterned growth of AuCN in the <110> orientations. Nano-scale patterning of AuCN semiconductors may provide an avenue for property tuning, particularly the band gap acquired.
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Affiliation(s)
- Lotan Portal
- Department of Materials Science and Engineering, Technion–Israel Institute of Technology, Haifa32000, Israel
| | - Iryna Polishchuk
- Department of Materials Science and Engineering, Technion–Israel Institute of Technology, Haifa32000, Israel
| | - Rotem Zilberberg
- Department of Materials Science and Engineering, Technion–Israel Institute of Technology, Haifa32000, Israel
| | - Mor Levi
- Department of Materials Science and Engineering, Technion–Israel Institute of Technology, Haifa32000, Israel
| | - Maria Koifman-Khristosov
- Department of Materials Science and Engineering, Technion–Israel Institute of Technology, Haifa32000, Israel
| | - Alexander Katsman
- Department of Materials Science and Engineering, Technion–Israel Institute of Technology, Haifa32000, Israel
| | - Boaz Pokroy
- Department of Materials Science and Engineering, Technion–Israel Institute of Technology, Haifa32000, Israel
- The Nancy and Stephen Grand Technion Energy Program, Technion − Israel Institute of Technology, Haifa3200003, Israel
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3
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Grimes M, Pauwels K, Schülli TU, Martin T, Fajardo P, Douissard PA, Kocsis M, Nishino H, Ozaki K, Honjo Y, Nishiyama Hiraki T, Joti Y, Hatsui T, Levi M, Rabkin E, Leake SJ, Richard MI. Bragg coherent diffraction imaging with the CITIUS charge-integrating detector. J Appl Crystallogr 2023; 56:1032-1037. [PMID: 37555222 PMCID: PMC10405578 DOI: 10.1107/s1600576723004314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/17/2023] [Indexed: 08/10/2023] Open
Abstract
The CITIUS detector is a next-generation high-speed X-ray imaging detector. It has integrating-type pixels and is designed to show a consistent linear response at a frame rate of 17.4 kHz, which results in a saturation count rate of over 30 Mcps pixel-1 when operating at an acquisition duty cycle close to 100%, and up to 20 times higher with special extended acquisition modes. Here, its application for Bragg coherent diffraction imaging is demonstrated by taking advantage of the fourth-generation Extremely Brilliant Source of the European Synchrotron (ESRF-EBS, Grenoble, France). The CITIUS detector outperformed a photon-counting detector, similar spatial resolution being achieved (20 ± 6 nm versus 22 ± 9 nm) with greatly reduced acquisition times (23 s versus 200 s). It is also shown how the CITIUS detector can be expected to perform during dynamic Bragg coherent diffraction imaging measurements. Finally, the current limitations of the CITIUS detector and further optimizations for coherent imaging techniques are discussed.
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Affiliation(s)
- Michael Grimes
- Université Grenoble Alpes, CEA Grenoble, IRIG, MEM, NRS, 17 rue des Martyrs, F-38000 Grenoble, France
- ESRF – The European Synchrotron, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Kristof Pauwels
- ESRF – The European Synchrotron, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Tobias U. Schülli
- ESRF – The European Synchrotron, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Thierry Martin
- ESRF – The European Synchrotron, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Pablo Fajardo
- ESRF – The European Synchrotron, 71 avenue des Martyrs, F-38000 Grenoble, France
| | | | - Menyhert Kocsis
- ESRF – The European Synchrotron, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Haruki Nishino
- RIKEN SPring-8 Center, RIKEN, 1-1-1 Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5148, Japan
- Japan Synchrotron Radiation Research Institute, 1-1-1 Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5198, Japan
| | - Kyosuke Ozaki
- RIKEN SPring-8 Center, RIKEN, 1-1-1 Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5148, Japan
| | - Yoshiaki Honjo
- RIKEN SPring-8 Center, RIKEN, 1-1-1 Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5148, Japan
| | | | - Yasumasa Joti
- RIKEN SPring-8 Center, RIKEN, 1-1-1 Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5148, Japan
- Japan Synchrotron Radiation Research Institute, 1-1-1 Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5198, Japan
| | - Takaki Hatsui
- RIKEN SPring-8 Center, RIKEN, 1-1-1 Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5148, Japan
| | - Mor Levi
- Department of Materials Science and Engineering, Technion – Israel Institute of Technology, Haifa, Israel
| | - Eugen Rabkin
- Department of Materials Science and Engineering, Technion – Israel Institute of Technology, Haifa, Israel
| | - Steven J. Leake
- ESRF – The European Synchrotron, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Marie-Ingrid Richard
- Université Grenoble Alpes, CEA Grenoble, IRIG, MEM, NRS, 17 rue des Martyrs, F-38000 Grenoble, France
- ESRF – The European Synchrotron, 71 avenue des Martyrs, F-38000 Grenoble, France
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4
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van Mens TE, Klok FA, Levi M. Searching the literature to explain unexpected clinical observations: all that glitters is not gold. Eur J Intern Med 2023; 112:17-18. [PMID: 37059603 DOI: 10.1016/j.ejim.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Affiliation(s)
- T E van Mens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, the Netherlands.
| | - F A Klok
- Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M Levi
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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5
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Levi M, Melamed R, Shany E, Marks K, Landau D, Shashar S, Golan A. The impact of the early onset neonatal sepsis calculator on antibiotic initiation: a single center study in Israel. Eur J Pediatr 2023:10.1007/s00431-023-04993-3. [PMID: 37119298 DOI: 10.1007/s00431-023-04993-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023]
Abstract
To evaluate the effect of implementation of the Kaiser Permanente (KP) early onset sepsis (EOS) calculator in infants born at 34 week's gestation or more on antibiotic utilization and length of hospitalization. A single center, retrospective cohort study included all neonates born in Soroka Medical Center at 34 weeks gestation or more between January 1st, 2015, and January 1st, 2019, with a predefined maternal risk factor for EOS. Two cohorts of neonates were compared during two time periods, before and after the implementation of the KP calculator. Multivariable logistic and linear regressions were performed to assess the effect of the KP calculator on antibiotic treatment and length of hospitalization. Also, an interrupted time series (ITS) analysis was used to assess the time trends of the two periods. The study included 3858 neonates in the pre-implementation period and 3081 neonates in the post-implementation cohort. The use of the calculator resulted in a significant reduction (46%) in antibiotics treatment for suspected EOS (5.1 vs. 9.4%, P < 0.001). The ITS analysis demonstrated a sharp decline in the slope of antibiotic treatment in the post intervention period: (b = -0.14, p-value = 0.08). The length of hospitalization was significantly reduced in the post-implementation cohort from 62 to 60 h (p-value < 0.001) with no clinical significance. The incidence of EOS was similar in both groups. Conclusion: A significant reduction in antibiotic treatment was demonstrated after the implementation of the KP calculator without an increase incidence of EOS. The calculator is a powerful accessory decision-making tool that can be used safely in combination with, but not replacing, thorough clinical assessment. What is Known: • The EOS calculator is a useful tool that leads to a significant reduction in preemptive antibiotic utilization. What is New: • The EOS calculator is sensitive when applied to the whole-nursery. • The calculator is useful in different populations, also when women are not routinely screened for GBS.
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Affiliation(s)
- Mor Levi
- Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Rimma Melamed
- Department of Pediatrics, Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eilon Shany
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Kyla Marks
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Danielle Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Sagi Shashar
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Agneta Golan
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
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6
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Richard MI, Labat S, Dupraz M, Carnis J, Gao L, Texier M, Li N, Wu L, Hofmann JP, Levi M, Leake SJ, Lazarev S, Sprung M, Hensen EJM, Rabkin E, Thomas O. Anomalous Glide Plane in Platinum Nano- and Microcrystals. ACS Nano 2023; 17:6113-6120. [PMID: 36926832 DOI: 10.1021/acsnano.3c01306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
At the nanoscale, the properties of materials depend critically on the presence of crystal defects. However, imaging and characterizing the structure of defects in three dimensions inside a crystal remain a challenge. Here, by using Bragg coherent diffraction imaging, we observe an unexpected anomalous {110} glide plane in two Pt submicrometer crystals grown by very different processes and having very different morphologies. The structure of the defects (type, associated glide plane, and lattice displacement) is imaged in these faceted Pt crystals. Using this noninvasive technique, both plasticity and unusual defect behavior can be probed at the nanoscale.
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Affiliation(s)
- Marie-Ingrid Richard
- Univ. Grenoble Alpes, CEA Grenoble, IRIG/MEM/NRX, Grenoble 38054, France
- ESRF - The European Synchrotron, 71 Avenue des Martyrs, Grenoble 38000, France
| | - Stéphane Labat
- Aix Marseille Université, CNRS, Université de Toulon, IM2NP UMR 7334, 13397 Marseille, France
| | - Maxime Dupraz
- ESRF - The European Synchrotron, 71 Avenue des Martyrs, Grenoble 38000, France
- Univ. Grenoble Alpes, CEA Grenoble, NRX, 17 Avenue des Martyrs 38000 Grenoble, France
| | - Jérôme Carnis
- Univ. Grenoble Alpes, CEA Grenoble, IRIG/MEM/NRX, Grenoble 38054, France
| | - Lu Gao
- Laboratory for Inorganic Materials and Catalysis, Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - Michaël Texier
- Aix Marseille Université, CNRS, Université de Toulon, IM2NP UMR 7334, 13397 Marseille, France
| | - Ni Li
- Univ. Grenoble Alpes, CEA Grenoble, NRX, 17 Avenue des Martyrs 38000 Grenoble, France
| | - Longfei Wu
- Laboratory for Inorganic Materials and Catalysis, Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - Jan P Hofmann
- Surface Science Laboratory, Department of Materials and Earth Sciences, Technical University of Darmstadt, Otto-Berndt-Strasse 3, 64287 Darmstadt, Germany
| | - Mor Levi
- Department of Materials Science and Engineering, Technion-Israel Institute of Technology, 3200003, Haifa, Israel
| | - Steven J Leake
- ESRF - The European Synchrotron, 71 Avenue des Martyrs, Grenoble 38000, France
| | - Sergey Lazarev
- Deutsches Elektronen-Synchrotron (DESY), D-22607 Hamburg, Germany
| | - Michael Sprung
- Deutsches Elektronen-Synchrotron (DESY), D-22607 Hamburg, Germany
| | - Emiel J M Hensen
- Laboratory for Inorganic Materials and Catalysis, Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - Eugen Rabkin
- Department of Materials Science and Engineering, Technion-Israel Institute of Technology, 3200003, Haifa, Israel
| | - Olivier Thomas
- Aix Marseille Université, CNRS, Université de Toulon, IM2NP UMR 7334, 13397 Marseille, France
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Bronstein Y, Gat R, Levi S, Cohen YC, Luttwak E, Benyamini N, Shragai T, Vitkon R, Neaman M, Eilaty N, Levi M, Trestman S, Perry C, Herishanu Y, Avivi I. COVID-19 in patients with lymphoproliferative diseases during the Omicron variant surge. Cancer Cell 2022; 40:578-580. [PMID: 35477028 PMCID: PMC9021039 DOI: 10.1016/j.ccell.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Yotam Bronstein
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Roi Gat
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shai Levi
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael C Cohen
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Luttwak
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noam Benyamini
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamir Shragai
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Roy Vitkon
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miriam Neaman
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nili Eilaty
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mor Levi
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Svetlana Trestman
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Chava Perry
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Avivi
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Levi M, Cipriani F, Balzi D. All-cause mortality during the influenza season 2019- 2020: comparison with previous influenza seasons in the territory of the local health authority "Central Tuscany", Italy. Ann Ig 2021; 34:150-155. [PMID: 34328497 DOI: 10.7416/ai.2021.2465] [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: 11/03/2022]
Abstract
Materials and Methods Age- and sex-adjusted mortality rates for 2019-2020 influenza season were compared with those of influenza seasons 2009-2010 to 2016-2017. Results No all-cause mortality excess was observed in the 2019-2020 influenza season, which, on the contrary, was characterized by the lowest all-cause mortality rate. Introduction Because of the 24 months latency in the release of official data on causes of death, and in consideration of the limited testing capacity during the first pandemic wave, to estimate the COVID-19- related mortality in 2020, the evaluation of all-cause mortality excess is often used instead. Our study aimed at assessing whether in Central Tuscany, Italy, an excess all-cause mortality occurred in the 2019-2020 influenza season, which partly overlapped with the months of the first pandemic wave in which the impact of COVID-19 was the highest. Conclusion Our finding can be explained by the imposition, in early March 2020, of a national lockdown, which came into effect in an early epidemic phase in Tuscany, and thus limited the transmission of SARSCoV- 2 infection, as well as influenza, in the territory. In March and April, by causing the death of vulnerable elderly patients who had been spared by the mild seasonal flu in the prior months, COVID-19 acted with a harvesting effect.
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Affiliation(s)
- M Levi
- Epidemiology Unit, Department of Prevention, Central Tuscany Local Health Authority, Florence, Italy
| | - F Cipriani
- Epidemiology Unit, Department of Prevention, Central Tuscany Local Health Authority, Florence, Italy
| | - D Balzi
- Epidemiology Unit, Department of Prevention, Central Tuscany Local Health Authority, Florence, Italy
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9
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Glazer R, Gao S, Yuan H, Ranjit S, Lu J, Xiang H, Bhattacharya A, Brandish P, Levi M. Targeting immune tolerance and stromal fibrosis with an LXR agonist in a conditional transgenic model of mammary fibrosis. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ariani F, Baldasseroni A, Rondinone B, Ferrante P, Levi M, Balzi D, Romeo G, Biffino M, Cipriani F. Burden of occupational injuries occurred in Italy, 1900-2017. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The GBD study allows comparison of health conditions among different societies and cultures. This permits also to estimate health variations over a long time in a single nation, overcoming the difficulties deriving from social and economic changes. INAIL, the National Institute for Insurance against Accidents at Work, provides since 1884, detailed data about the number of events and their consequences, age and sex of injured workers, and the total number of insured workers. Such data allow us to estimate DALYs in terms of incidence and prevalence, and under different mortality models.
Methods
1.8 mln. individual injury records occurred in 1990-2015 were transcoded into GBD injury categories. YLLs and YLDs were calculated considering life expectancy, DWs and duration, then distributed by compensation category. The YLLs and YLDs of permanent disabilities have been assessed with reference both to the life expectancy of the GBD 2017 and, in a competitive mortality model, to mean values at the time of the accident. Estimated DALYs were assessed both in terms of incidence and prevalence.
Results
Around 1900, an industrial worker suffered on average 0.087 incident DALY/year for occupational injuries, or 0.058 in a competitive mortality model. These values remained almost stationary until WWII when they showed a peak around 0.11, then declined to about a third in the 1970s, and to about a twentieth in 2017. The YLL / DALY ratio was 0.82 around 1900, then slowly decreased to less than 0.5 in the late 1930s, rose to a new peak around 0.8 in WWII, then diminished again to 0.32 in 2017. Considering prevalence, variations are much slower, due to the expected average durations of permanent disabilities, between 32.5 and 52 years. Risk breakdown by main industry sectors is ongoing.
Conclusions
DALY rate and YLL/DALY injuries declined largely along time. Nevertheless, such events continue to leave a very long-term legacy of disabilities.
Key messages
INAIL data permit to estimate burden for occupational injuries occurred in Italy along over a century. Injury burden declined over time, but continues to leave a legacy of long-term disabilities.
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Affiliation(s)
- F Ariani
- CeRIMP, Azienda USL Toscana Centro, Firenze, Italy
| | - A Baldasseroni
- CeRIMP ext. collabborator, Azienda USL Toscana Centro, Firenze, Italy
| | - B Rondinone
- Department Occupational Medicine and Epidemiology, INAIL, Rome, Italy
| | - P Ferrante
- Department Occupational Medicine and Epidemiology, INAIL, Rome, Italy
| | - M Levi
- UFS Epidemiology, Azienda USL Toscana Centro, Firenze, Italy
| | - D Balzi
- UFS Epidemiology, Azienda USL Toscana Centro, Firenze, Italy
| | - G Romeo
- CeRIMP, Azienda USL Toscana Centro, Firenze, Italy
| | - M Biffino
- CeRIMP, Azienda USL Toscana Centro, Firenze, Italy
| | - F Cipriani
- UFS Epidemiology, Azienda USL Toscana Centro, Firenze, Italy
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11
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Iba T, Levy JH, Wada H, Thachil J, Warkentin TE, Levi M. Differential diagnoses for sepsis-induced disseminated intravascular coagulation: communication from the SSC of the ISTH. J Thromb Haemost 2019; 17:415-419. [PMID: 30618150 DOI: 10.1111/jth.14354] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Indexed: 01/04/2023]
Affiliation(s)
- T Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - J H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA
| | - H Wada
- Department of Molecular and Laboratory Medicine, Mie University School of Medicine, Tsu, Japan
| | - J Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - T E Warkentin
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - M Levi
- Department of Medicine, University College London Hospitals NHS Foundation Trust, London, UK
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12
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Abstract
Several clinical conditions, in particular those associated with a systemic inflammatory response, can cause some degree of activation of coagulation but when the procoagulant stimulus is sufficiently severe and overcomes the natural anticoagulant mechanisms of coagulation, disseminated intravascular coagulation (DIC) may occur. The clinical manifestations of DIC encompass multiorgan dysfunction caused by fibrin-platelet clots in the microcirculation, and bleeding caused by consumption of platelets and coagulation factors. Molecular mechanisms that play a role in inflammation-induced effects on coagulation have been recognized in much detail. Exposure of blood to tissue factor is the most common trigger, whereas the intravascular coagulation is propagated due to loss of function of physiological anticoagulants and impaired fibrinolysis. In patients with DIC, various abnormalities in routine coagulation parameters may be observed, including thrombocytopenia, prolonged global coagulation assays, or high levels of fibrin split products. In addition, more sophisticated tests for activation of individual factors or pathways of coagulation may point to specific involvement of these components in the pathogenesis of the disorder. A combination of readily available tests is usually sufficient in establishing the diagnosis of DIC, and for this purpose, several scoring algorithms have been developed. Some specific clinical situations may elicit coagulation responses that can be distinguished from DIC or may occur in combination with DIC, including dilutional coagulopathy, liver failure-related coagulation derangement, and thrombotic microangiopathies.
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Affiliation(s)
- M Levi
- Department of Medicine, University College London Hospitals NHS Foundation Trust, London, UK.,Cardiometabolic Programme-NIHR UCLH/UCL BRC, London, UK
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13
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Abstract
SummaryInterferons (IFNs) are used for a variety of disorders. It has been postulated that part of the effects of IFN may be mediated by IFN-induced modulation of endothelial cells. Since the principal activating and inhibiting factors of the fibrinolytic system are synthesized and stored in endothelial cells, we have studied the effects on fibrinolysis and coagulation of the administration of recombinant IFN-α (5 × 106U/m2) to healthy human subjects (n = 8) in a randomized controlled cross-over study. IFN-α significantly increased plasma levels of tissue-type plasminogen activator (t-PA) and urokinase-type plasminogen activator (u-PA). Simultaneously, plasma levels of the inhibitor of plasminogen activation, PAI-1, sharply increased. The net effect on plasma plasminogen activator activity (PA-activity) was a modest increase to 116% of baseline, however without a significant effect on plasmin generation, as reflected by plasma levels of plasmin-α2-antiplasmin complexes. IFN-α had no effect on the plasma levels of thrombin-antithrombin III (TAT) complexes.We conclude that despite considerable effects on endothelial cells, IFN-α does not significantly alter the coagulant-fibrinolytic balance, although the occurrence of such changes under pathological circumstances is not excluded.
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Affiliation(s)
- E P M Corssmit
- The Department of Internal Medicine, University of Amsterdam, The Netherlands
| | - M Levi
- The Department of Internal Medicine, University of Amsterdam, The Netherlands
- The Center for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, University of Amsterdam, The Netherlands
| | - C E Hack
- The Department of Autoimmune Diseases and Inflammation, Central Laboratory of the Netherlands Red Cross Blood Transfusion Service (CLB), Amsterdam, The Netherlands
| | - J W ten Cate
- The Center for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, University of Amsterdam, The Netherlands
| | - H P Sauerwein
- The Department of Internal Medicine, University of Amsterdam, The Netherlands
| | - J A Romijn
- The Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands
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14
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Turunen T, Levi M, Díez-Domingo J, Simondon F. A tool for evaluating scientific independence, integrity and transparency in observational studies of vaccine effectiveness. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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15
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Abstract
The interaction between platelets and the vessel wall is mediated by various receptors and adhesive proteins, of which von Willebrand factor (VWF) is the most prominent. The multimeric size of VWF is an important determinant of a more intense platelet-vessel wall interaction, and is regulated by the VWF-cleaving protease ADAMTS-13. A deficiency in ADAMTS-13 leads to higher concentrations of ultralarge VWF multimers and pathological platelet-vessel wall interactions, in its most typical and extreme form leading to thrombocytopenic thrombotic purpura, a thrombotic microangiopathy characterized by thrombocytopenia, non-immune hemolysis, and organ dysfunction. Thrombotic microangiopathy associated with low levels of ADAMTS-13 may be a component of the coagulopathy observed in patients with sepsis. Here, we review the potential role of ADAMTS-13 deficiency and ultralarge VWF multimers in sepsis, and their relationship with sepsis severity and prognosis. In addition, we discuss the possible benefit of restoring ADAMTS-13 levels or reducing the effect of ultralarge VWF as an adjunctive treatment in patients with sepsis.
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Affiliation(s)
- M Levi
- Department of Medicine, University College London Hospitals NHS Foundation Trust, London, UK
- Cardiometabolic Programme-NIHR UCLH/UCL BRC, London, UK
| | - M Scully
- Cardiometabolic Programme-NIHR UCLH/UCL BRC, London, UK
- Department of Haematology, Bloomsbury Institute of Intensive Care Medicine, London, UK
| | - M Singer
- Cardiometabolic Programme-NIHR UCLH/UCL BRC, London, UK
- University College London, Bloomsbury Institute of Intensive Care Medicine, London, UK
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16
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Alonso-Díez A, Levi M, Caceres S, Barreno L, Sarli G, Benazzi C, Illera J, Peña L. P-glycoprotein is Overexpressed in Human and Canine Inflammatory Breast Cancer Cell Lines But Not in Xenotransplanted Mouse Tumours. J Comp Pathol 2018. [DOI: 10.1016/j.jcpa.2017.10.089] [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: 11/29/2022]
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17
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Brunetti B, Levi M, Martini O, Zambelli D, Laddaga E, Muscatello L. Canine Vulvar Fibromatosis: A Rare Lesion. J Comp Pathol 2018. [DOI: 10.1016/j.jcpa.2017.10.067] [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: 11/15/2022]
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18
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Levi M, Peña L, Brunetti B, Alonso-Díez A, Muscatello L, Pérez-Alenza M, Benazzi C, Sarli G. Chemoresistance Markers Pgp and Bcrp in Canine Inflammatory and Grade 3 Mammary Carcinoma. J Comp Pathol 2018. [DOI: 10.1016/j.jcpa.2017.10.028] [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: 11/26/2022]
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19
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Abstract
SummaryRecombinant activated factor VII (rFVIIa) is a pro-haemo -static agent that can be used for patients with haemophilia and inhibiting antibodies towards a coagulation factor. Recombinant factor VIIa is, however, increasingly used for several other indications, including patients who experience serious and life-threatening bleeding. In addition, rFVIIa has been evaluated for the prevention of major blood loss in patients undergoing surgical procedures that are known to be associated with major blood loss. In this manuscript we review the data on efficacy and safety of rFVIIa in the prevention of excessive blood loss and trans-fusion requirements in the perioperative period.We conclude that recombinant factor VIIa is a promising agent for perioperative prevention of major blood loss but that its efficacy will probably vary between specific clinical settings. Its exact place in surgery warrants further clinical trials in various situations that will also more precisely determine the safety of this intervention.
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20
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Abstract
SummaryCritically ill patients often have systemic activation of both inflammation and coagulation. Increasing evidence points to an extensive cross-talk between these two systems, whereby inflammation not only leads to activation of coagulation, but coagulation also considerably affects inflammatory activity. The intricate relationship between inflammation and coagulation may have major consequences for the pathogenesis of microvascular failure and subsequent multiple organ failure, as a result of severe infection and the associated systemic inflammatory response. Molecular pathways that contribute to inflammation-induced activation of coagulation have been precisely identified. Activation of the coagulation system and ensuing thrombin generation is dependent on an inter-leukin-6-induced expression of tissue factor on activated mononuclear cells and endothelial cells and is insufficiently counteracted by tissue factor pathway inhibitor. Simultaneously, endothelial-bound anticoagulant mechanisms, in particular the protein C system and the antithrombin system, are shut-off by pro-inflammatory cytokines. Modulation of inflammatory activity by activation of coagulation also occurs by various mechanisms. Activated coagulation proteases, such as the tissue factor-factor VIIa complex, factor Xa and thrombin can bind to protease-activated receptors on various cells and the ensuing intracellular signaling leads to increased production of pro-inflammatory cytokines and chemo kines. Physiological anticoagulants can modulate inflammatory activity as well. Increasing knowledge on the various mechanisms underlying activation of inflammation and coagulation may lead to better (adjunctive) management strategies in critically ill patients.
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21
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Abstract
SummaryAnticoagulants are effective in the prevention and treatment of a variety of arterial and venous thrombotic disorders but are associated with an increased risk of serious bleeding complications. Based on well documented studies of patients using vitamin K antagonists the incidence of major bleeding is 0.5%/year and the incidence of intracranial bleeding is 0.2%/year, however, in real life practice this incidence may be even higher. Risk factors for bleeding are the intensity of anticoagulation, the management strategy to keep the anticoagulant effect in the desired range, and patient characteristics. Recently, a new generation of anticoagulants have been developed and is currently evaluated in clinical trials. Initial results show a similar or superior efficacy over conventional anticoagulant agents with a good safety profile. In case of serious bleeding complications in a patient who uses vitamin K antagonists, this anticoagulant treatment can be quickly reversed by administration of vitamin K or coagulation factor concentrates. For the newer anticoagulants, quick reversal strategies are more cumbersome, although some interventions, including prothrombin complex concentrates, show promising results in initial experimental studies.
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22
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Levi M, Berends F, Ende AEVD, Cate JWT, Stoutenbeek CP, Jonge ED. Impaired Haemostasis by Intravenous Administration of a Gelatin-based Plasma Expander in Human Subjects. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614979] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThe aim of this study was to investigate the effects of a gelatin-based plasma expander on blood coagulation and haemostasis in human subjects.Six healthy men were studied in a randomised, controlled cross-over study to investigate the effects of a 60 min intravenous infusion of either 1 l gelatin-based plasma substitute (Gelofusine) or 0.9% NaCl (control). The infusion of gelatin resulted in a 1.7 fold increase in bleeding time at 60 min and a 1.4 fold increase at 120 min, while saline had no effect (p <0.05). Aggregation studies revealed a significant impairment of ristocetin-induced platelet aggregation (p <0.05), associated with a substantial decrease of vWF:ag (–32% vs. –5%, p <0.05) and ristocetin co-factor (–29% vs. +1%, p <0.05) and without in vitro impairment of the platelet glycoprotein 1b receptor. Gelatin caused a decrease in thrombin-antithrombin complexes (–45% vs. –4%, p <0.05) and F1+2 (–40% vs. +1%, p <0.05). The decrease in circulating levels of vWF:ag, vWF R:Co, thrombin-antithrombin complexes and F1+ 2 was more than could be expected by the calculated plasma-dilution generated by Gelofusine.Our results demonstrated that the administration of a gelatin-based plasma substitute results in a significant impairment of primary haemostasis and thrombin generation. The defect in primary haemostasis appears to be related to a gelatin-induced reduction in von Willebrand factor, whereas the decreased thrombin generation may be due to the dilution of coagulation factors induced by Gelofusine.
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Levendowski D, Oksenberg A, Vicini C, Dawson D, Levi M, Westbrook P. Validation of a new criterion for characterization of positional obstructive sleep apnea. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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25
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Masykura N, Kwang D, Zaini J, Andarini S, Hudoyo A, Syahruddin E, Levi M, Widjajahakim G, Utomo A. P3.01-053 Detection of Common EGFR Mutation in Cytological Smears Using Reversed Dot Blot (RDB) Hybridization Method. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Gilhooly M, Dalley G, Gilhooly K, Harries P, Sullivan M, Levi M. FINANCIAL EXPLOITATION: LESSONS LEARNED FROM A STUDY OF PEOPLE HOLDING LASTING POWERS OF ATTORNEY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1331] [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: 11/14/2022] Open
Affiliation(s)
- M.L. Gilhooly
- Department of Clinical Sciences, Brunel University London, Uxbridge, England, United Kingdom,
| | - G. Dalley
- Department of Clinical Sciences, Brunel University London, Uxbridge, England, United Kingdom,
| | - K.J. Gilhooly
- Department of Clinical Sciences, Brunel University London, Uxbridge, England, United Kingdom,
- University of Hertfordshire, Hatfield, England, United Kingdom
| | - P. Harries
- Department of Clinical Sciences, Brunel University London, Uxbridge, England, United Kingdom,
| | - M. Sullivan
- Department of Clinical Sciences, Brunel University London, Uxbridge, England, United Kingdom,
| | - M. Levi
- Cardiff University, Cardiff, Wales, United Kingdom,
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27
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Pérez-Díaz I, Hayes J, Medina E, Anekella K, Daughtry K, Dieck S, Levi M, Price R, Butz N, Lu Z, Azcarate-Peril M. Reassessment of the succession of lactic acid bacteria in commercial cucumber fermentations and physiological and genomic features associated with their dominance. Food Microbiol 2017; 63:217-227. [DOI: 10.1016/j.fm.2016.11.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/04/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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28
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Postiglione G, Alberini M, Leigh S, Levi M, Turri S. Effect of 3D-Printed Microvascular Network Design on the Self-Healing Behavior of Cross-Linked Polymers. ACS Appl Mater Interfaces 2017; 9:14371-14378. [PMID: 28387500 DOI: 10.1021/acsami.7b01830] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article describes the manufacturing procedure and the characterization of self-healing polymers based on embedded microvascular networks. The samples were realized by resin casting into water-soluble PVA molds, fabricated via 3D printing. This technology allowed us to exploit the 3D printers' ability to produce complex structures with high resolution for the creation of independent microchannels networks. The two reacting components of a two-part resin could be stored separately within the microstructure. The materials' self-healing ability resulted from their reaction when severe damage caused the healing liquids to leak out, wetting the sample cross section and diffusing one into the other. The mechanical properties of healed samples were investigated by means of uniaxial tensile tests and compared to those of undamaged samples. The effect of microchannel density and different network designs on self-healing efficiency was determined. The different microstructures used were characterized using computerized X-ray microtomography. The versatility of the fabrication technique presented in this work allows conversion of any water-resistant resin into a fully functional self-healing polymeric composite.
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Affiliation(s)
- G Postiglione
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano , Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - M Alberini
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano , Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - S Leigh
- School of Engineering, University of Warwick , Coventry CV4 7 AL, U.K
| | - M Levi
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano , Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - S Turri
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano , Piazza Leonardo da Vinci 32, 20133 Milan, Italy
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29
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Abstract
Lameness related to growth plate lesions is an important problem in the beef industry. This article describes the macroscopic and microscopic lesions in the distal metatarsal physis of bulls from an association of farmers in northeastern Italy. The metatarsal bones of 62 bulls (12 with severe lameness and 50 without lameness), average age 16.44 ± 1.72 months, were examined at the abattoir. The animals came from the same geographic area and shared intensive husbandry practices and a diet based on maize starch. A total of 124 metatarsal bones were sectioned, and the distal metaphyseal growth plate was grossly examined. Twenty-three cases, including 12 lame and 9 nonlame animals with visible lesions on macroscopic examination, and 2 controls (a total of 46 physes) were examined microscopically. Eight of 12 bulls with severe lameness had a chronic purulent physitis in at least 1 limb. Segmental thickening of the hypertrophic zone, consistent with osteochondrosis (OC), was present contralaterally ( n = 3 cases) and bilaterally ( n = 3 cases) in 6 of these animals. In the group of nonlame bulls, 19 of 50 (38%) had similar segmental thickening of the physis consistent with OC. In the remaining bulls, minor findings included partial closure of the physis and a variable degree of metaphyseal hyperemia. A high incidence of OC was found in both lame and nonlame fattening bulls. It is likely that lame animals were clinically more severe due to secondary hematogenous implantation of bacteria, resulting in a purulent physitis and severe lameness that required emergency slaughter in some cases.
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Affiliation(s)
- M Levi
- 1 Department of Veterinary Medical Sciences, University of Bologna, Italy
| | - K E Dittmer
- 2 Institute of Veterinary, Animal and Biomedical Sciences, Massey University, New Zealand
| | - A Gentile
- 1 Department of Veterinary Medical Sciences, University of Bologna, Italy
| | - A Beltrame
- 1 Department of Veterinary Medical Sciences, University of Bologna, Italy
| | - M Bolcato
- 1 Department of Veterinary Medical Sciences, University of Bologna, Italy
| | - M Morgante
- 3 Department of Animal Medicine, Production and Health, University of Padua, Italy
| | - E Fiore
- 3 Department of Animal Medicine, Production and Health, University of Padua, Italy
| | - C Benazzi
- 1 Department of Veterinary Medical Sciences, University of Bologna, Italy
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30
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Levi M, Bellini I, Sinisgalli E, Sala A, Indiani L, Bonanni P. The burden of hospitalization due to HPV infections in Tuscany, Central Italy. Public Health 2016; 141:194-197. [PMID: 27932000 DOI: 10.1016/j.puhe.2016.09.031] [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] [Received: 04/26/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 11/17/2022]
Affiliation(s)
- M Levi
- Department of Health Sciences, University of Florence, Florence, Italy.
| | - I Bellini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - E Sinisgalli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - A Sala
- Department of Health Sciences, University of Florence, Florence, Italy
| | - L Indiani
- Department of Health Sciences, University of Florence, Florence, Italy
| | - P Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
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31
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Levi M, Brunetti B, Sarli G, Benazzi C. Immunohistochemical Expression of P-glycoprotein and Breast Cancer Resistance Protein in Canine Mammary Hyperplasia, Neoplasia and Supporting Stroma. J Comp Pathol 2016; 155:277-285. [PMID: 27528038 DOI: 10.1016/j.jcpa.2016.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/01/2016] [Accepted: 07/13/2016] [Indexed: 12/25/2022]
Abstract
The ability of a tumour to become simultaneously resistant to different drugs is known as multidrug resistance and is often due to the expression of ATP-dependent binding cassette transporters (ABC-transporters) such as P-glycoprotein (PGP) and breast cancer resistance protein (BCRP). In this study, the expression of PGP and BCRP was determined in the components of hyperplastic and neoplastic canine mammary glands, including the supporting stroma. The variation of expression of these molecules in carcinomas was evaluated between lesions of different histological stage and grade of malignancy. Samples included 47 hyperplastic tissues and 10 benign and 46 malignant neoplasms. Tumours were classified into histological subtype, histological stage and grade. Immunohistochemical evaluation of PGP and BCRP expression showed that both markers are potentially expressed by epithelial cells, myoepithelial cells in complex tumours and mesenchymal cells in mixed tumours, but expression of both proteins was significantly higher in malignant epithelial cells versus hyperplastic epithelium or the epithelium of benign tumours. BCRP showed significantly higher expression in epithelial cells of simple carcinomas versus those of complex and mixed carcinomas. Grade II and III carcinomas had higher epithelial PGP expression than grade I tumours. The positivity of stromal fibroblasts was higher in histological stage II versus I carcinomas, and in histological grade II versus I carcinomas. Malignant and invasive tumours were more likely to express PGP and/or BCRP in luminal and stromal components and evaluation of these markers could provide valuable information for the identification of tumours characterized by an aggressive and chemoresistant phenotype.
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Affiliation(s)
- M Levi
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - B Brunetti
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy.
| | - G Sarli
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - C Benazzi
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
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32
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Montin E, Migliori S, Chiastra C, Credi C, Fedele R, Aurigemma C, Levi M, Burzotta F, Migliavacca F, Mainardi LT. A method for coronary bifurcation centerline reconstruction from angiographic images based on focalization optimization. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2016:4165-4168. [PMID: 28269200 DOI: 10.1109/embc.2016.7591644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A method for the reconstruction of a vessel centerline from angiographic images is outlined in this work. A typical coronary artery segment with bifurcations was emulated with a 3D printed static phantom and several angiograms were acquired at various angular positions on the C-Arm. The effectiveness of the reconstruction turned out to be largely influenced by the intrinsic parameters of the angiographic system, particularly the homogeneous coordinates system scaling factor λ. Therefore, recourse was made to a heuristic optimization method to estimate the optimal value of λ for each view. We measured the reliability of the reconstruction method by varying the fitness function of the optimization step and measuring the distances of 8 test points in comparison to the corresponding points identified in the μCT centerline. Preliminary results showed that, with an adequate number of views, the adoption of the optimal fitness function allowed the median distance error to be decreased below the acceptance threshold of 10%. As expected, the reliability of the method is improved by increasing the number of processed views.
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33
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Abstract
Plasmin-antiplasmin complex (PAP) has been reported previously as elevated in sepsis syndrome and infection. To assess the value of PAP complex and the thrombin-antithrombin (TAT)/PAP ratio in thermal injury, sixty patients were studied within the first 36 h, at 5-7 days following injury, and at time of infection. The patient population was categorized by percent burn (2° + 3°): <20%, n = 22; 20-40%, n = 18; >40%, n = 20. PAP increased significantly between days 1 and 5 in the <20% and 20-40% burn groups ( p < 0.01) and in the >40% group ( p < 0.002). The TAT/PAP ratio was elevated on day 1 in the 20-40% group ( p < 0.04) and the >40% group ( p < 0.001), and decreased to near normal limits on day 5 in both groups. These data revealed a proportionately greater incidence of coagulation activation than fibrinolysis on day 1. Of 16 episodes of sepsis syndrome or severe infection, PAP was elevated, average 14.6 nM (normal < 8 n M), in 10 (63%) patients. PAP was significantly elevated on day 5 during the clinically stabilized phase regardless of percent burn ( p = 0.01). In individuals who had a burn wound surface area of >40%, the PAP values were significantly higher for those who did not survive ( p < 0.03). PAP did not appear to correlate with the type of burn or with inhalation. Although PAP complex levels were elevated in thermal injury patients with sepsis syndrome or severe infection, they were not a specific predictor of infection. In conclusion, PAP complex and the TAT/PAP ratio provided useful information as to the fibrinolytic status of thermally injured patients with correlation to survival, but without correlation to sepsis and infection.
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Affiliation(s)
- A. Kowal-Vern
- Hemostasis Research Laboratory, Department of Pathology, Loyola University Medical Center, Maywood Illinois, U.S.A
| | - J.M. Walenga
- Hemostasis Research Laboratory, Department of Pathology, Loyola University Medical Center, Maywood Illinois, U.S.A
| | - M. Levi
- Center for Haemostasis, Thrombosis, Atherosclerosis, and Inflammation Research, Academic Medical Center, Amsterdam, The Netherlands
| | - M.M. Sharp-Pucci
- Department of Surgery and Shock Trauma Institute, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - R.L. Gamelli
- Department of Surgery and Shock Trauma Institute, Loyola University Medical Center, Maywood, Illinois, U.S.A
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34
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Bechini A, Levi M, Falla A, Ahmad A, Veldhuijzen I, Tiscione E, Bonanni P. The role of the general practitioner in the screening and clinical management of chronic viral hepatitis in six EU countries. J Prev Med Hyg 2016; 57:E51-60. [PMID: 27582629 PMCID: PMC4996040] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Chronic viral hepatitis is still a major public health concern in the EU. In order to halt the progression of the disease and to prevent onward transmission, timely recognition and accurate clinical management are crucial. The aim of the present study was to investigate the role of the general practitioner (GP) in the screening of persons at risk and in the clinical management of chronic viral hepatitis patients in six EU countries. METHODS An online survey among GPs and secondary-care specialists was conducted in the UK, Germany, the Netherlands, Hungary, Italy and Spain. In the GP survey, we used a four-point Likert scale to find out how commonly risk groups are screened. In both surveys, we measured GPs involvement in monitoring clinical indicators in patients undergoing antiviral treatment, and explored whether patients in four clinical scenarios are referred back to primary care. RESULTS Between five and 10 experts per professional group were surveyed, except for Spain (GPs: n = 2; Specialists: n = 4) and, in the case of the GP survey, Hungary (GPs: n = 1) and Germany (GPs: n = 4). Migrants are variably or not routinely screened for hepatitis B/C in the majority of cases. The majority of GPs reported that hepatitis B/C screening was routinely offered to people who inject drugs. In Hungary, Italy and in the Netherlands, screening sex workers is not a regular practice. As to whether GPs offer screening to men who have sex with men, responses varied; in Germany, the Netherlands and Italy, screening was "variably" or "commonly" implemented, while in Hungary the practice seems to be sporadic. In the UK, screening for hepatitis B seems to be common practice among GPs, while hepatitis C testing is only occasionally offered to this risk group. Most GPs (> 44%) in all countries except Hungary reported that hepatitis B/C screening was very commonly offered to HIV patients. The role of GPs in monitoring hepatitis cases and the referral of cases back to GPs by specialists varied both within and between countries. GPs are unlikely to monitor clinical outcomes other than side effects in patients undergoing treatment. Patients who have had a sustained virological response are usually referred back to GPs, whereas patients undergoing antiviral treatment and those who do not respond to treatment are rarely referred back. CONCLUSIONS The GP's decision to offer screening to risk groups often seems to be an individual choice of the healthcare professional. Raising GPs' awareness of the disease, for example through the adoption of effective strategies for the dissemination and implementation of the existing guidelines for general practice, is strongly needed. The role of GPs and specialists involved in the management of chronically infected patients should also be clarified, as opinions sometimes differ markedly even within each professional group.
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Affiliation(s)
- A. Bechini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - M. Levi
- Department of Health Sciences, University of Florence, Florence, Italy;,Correspondence: Miriam Levi, Department of Health Sciences, University of Florence, viale G.B. Morgagni 48, 50134 Florence, Italy - E-mail:
| | - A. Falla
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - A. Ahmad
- Department of Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - I. Veldhuijzen
- Division of Infectious Disease Control, Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - E. Tiscione
- Department of Health Sciences, University of Florence, Florence, Italy
| | - P. Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
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Abstract
Severe burn injury is associated with systemic coagulopathy. The changes in coagulation described in patients with severe burns resemble those found patients with sepsis or major trauma. Coagulopathy in patients with severe burns is characterized by procoagulant changes, and impaired fibrinolytic and natural anticoagulation systems. Both the timing of onset and the severity of hemostatic derangements are related to the severity of the burn. The exact pathophysiology and time course of coagulopathy are uncertain, but, at least in part, result from hemodilution and hypothermia. As the occurrence of coagulopathy in patients with severe burns is associated with increased comorbidity and mortality, coagulopathy could be seen as a potential therapeutic target. Clear guidelines for the treatment of coagulopathy in patients with severe burns are lacking, but supportive measures and targeted treatments have been proposed. Supportive measures are aimed at avoiding preventable triggers such as tissue hypoperfusion caused by shock, or hemodilution and hypothermia following the usually aggressive fluid resuscitation in these patients. Suggested targeted treatments that could benefit patients with severe burns include systemic treatment with anticoagulants, but sufficient randomized controlled trial evidence is lacking.
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Affiliation(s)
- G J Glas
- Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, the Netherlands
| | - M Levi
- Department of Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - M J Schultz
- Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, the Netherlands
- Department of Intensive Care, Academic Medical Center, Amsterdam, the Netherlands
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Lapi F, Cassano N, Pegoraro V, Cataldo N, Heiman F, Cricelli I, Levi M, Colombo D, Zagni E, Cricelli C, Vena GA. Epidemiology of chronic spontaneous urticaria: results from a nationwide, population-based study in Italy. Br J Dermatol 2016; 174:996-1004. [PMID: 26872037 DOI: 10.1111/bjd.14470] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a common skin disease, but there is a paucity of precise epidemiological data on this disease. OBJECTIVES To obtain information on the epidemiology of CSU in Italy. METHODS The data source was the Health Search IMS Health Longitudinal Patient Database. The study population was formed by patients aged ≥ 15 years, registered with a total of 700 general practitioners, homogeneously distributed across Italy. An algorithm based on the International Classification of Diseases, ninth revision, Clinical Modification was used for the identification of patients with CSU. The annual prevalence and incidence rates of CSU over a 12-year period (2002-2013) were estimated, along with demographic and clinical determinants. RESULTS The annual prevalence of CSU ranged from 0·02% in 2002 to 0·38% in 2013. The incidence was 0·10-1·50 per 1000 person-years. For both prevalence and incidence rates, female patients outnumbered male. The risk of CSU was statistically significantly higher in the presence of the following variables: obesity; anxiety, dissociative and somatoform disorders; malignancies; use of immunosuppressive drugs; and chronic use of systemic corticosteroids. History of autoimmune thyroiditis showed a trend towards an increased risk of CSU, though it was not statistically significant. Smoking was associated with a significantly reduced risk of CSU. CONCLUSIONS Our findings on CSU prevalence are consistent with those obtained in previous studies. Furthermore, this large population-based study provides important information regarding the association of CSU with demographic and clinical determinants, which have been examined in the primary-care setting.
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Affiliation(s)
- F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - N Cassano
- Dermatology and Venereology Private Practice, Bari/Barletta, Italy
| | - V Pegoraro
- IMS Health Information Solutions Srl, Milan, Italy
| | - N Cataldo
- IMS Health Information Solutions Srl, Milan, Italy
| | - F Heiman
- IMS Health Information Solutions Srl, Milan, Italy
| | - I Cricelli
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Levi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - D Colombo
- Novartis Farma S.p.A., Origgio, Varese, Italy
| | - E Zagni
- Novartis Farma S.p.A., Origgio, Varese, Italy
| | - C Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - G A Vena
- Dermatology and Venereology Private Practice, Bari/Barletta, Italy
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Lapi F, Levi M, Simonetti M, Cancian M, Parretti D, Cricelli I, Sobrero A, Cricelli C. Risk of prostate cancer in low-dose aspirin users: A retrospective cohort study. Int J Cancer 2016; 139:205-11. [PMID: 26915905 DOI: 10.1002/ijc.30061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/16/2016] [Accepted: 02/19/2016] [Indexed: 11/06/2022]
Abstract
A growing body of evidence indicates that use of low-dose aspirin (LDA) reduces the risk of certain adenocarcinomas. While there are several and consistent findings on the protective effect of LDA on colorectal and other cancers, few and conflicting evidence is available on prostate cancer (PCa). The aim of this study was to assess whether LDA reduces the incidence rate of PCa. We conducted a nationwide, population-based, retrospective cohort study by using Health Search IMS Health Longitudinal Patient Database (HSD). Patients with ischemic cardio- or cerebrovascular disease (index date) were identified. Time-dependent multivariable Cox proportional hazard models were adopted to estimate Hazard Ratios (HRs) and related 95% confidence intervals (95% CI) of PCa associated with use of LDA. The exposure was lagged by one year to consider the latency of drug effect on the outcome onset. Within a cohort 13,453 patients, the overall incidence rate of PCa was 2.5 per 1,000 person-years. Use of LDA was associated with a decreased incidence rate of PCa (HR = 0.64; 95% CI: 0.48-0.86), which was primarily driven by a frequency of LDA use equal to or higher than twice per week (HR = 0.60; 95% CI: 0.43-0.83). Such an association was more pronounced (HR = 0.43; 95% CI: 0.21-0.91) when LDA was used for five or more years. Our findings indicate that LDA use might be associated with a reduction of risk of PCa in patients with cardio- or cerebrovascular diseases.
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Affiliation(s)
- F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Levi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - M Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Cancian
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - D Parretti
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - I Cricelli
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - A Sobrero
- Medical Oncology, IRCCS Ospedale San Martino IST, Genova, Italy
| | - C Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Levi M, Hunt BJ. A critical appraisal of point-of-care coagulation testing in critically ill patients. J Thromb Haemost 2015; 13:1960-7. [PMID: 26333113 DOI: 10.1111/jth.13126] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/22/2015] [Indexed: 12/16/2022]
Abstract
Derangement of the coagulation system is a common phenomenon in critically ill patients, who may present with severe bleeding and/or conditions associated with a prothrombotic state. Monitoring of this coagulopathy can be performed with conventional coagulation assays; however, point-of-care tests have become increasingly attractive, because not only do they yield a more rapid result than clinical laboratory testing, but they may also provide a more complete picture of the condition of the hemostatic system. There are many potential areas of study and applications of point-of-care hemostatic testing in critical care, including patients who present with massive blood loss, patients with a hypercoagulable state (such as in disseminated intravascular coagulation), and monitoring of antiplatelet treatment for acute arterial thrombosis, mostly acute coronary syndromes. However, the limitations of near-patient hemostatic testing has not been fully appreciated, and are discussed here. The currently available evidence indicates that point-of-care tests may be applied to guide appropriate blood product transfusion and the use of hemostatic agents to correct the hemostatic defect or to ameliorate antithrombotic treatment. Disappointingly, however, only in cardiac surgery is there adequate evidence to show that application of near-patient thromboelastography leads to an improvement in clinically relevant outcomes, such as reductions in bleeding-related morbidity and mortality, and cost-effectiveness. More research is required to validate the utility and cost-effectiveness of near-patient hemostatic testing in other areas, especially in traumatic bleeding and postpartum hemorrhage.
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Affiliation(s)
- M Levi
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - B J Hunt
- Thrombosis & Haemostasis, Kings College University & Consultant in Haematology, Lupus & Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Litaor M, Meir-Dinar N, Castro B, Azaizeh H, Rytwo G, Levi N, Levi M, MarChaim U. Treatment of winery wastewater with aerated cells mobile system. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.enmm.2015.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bechini A, Chellini M, Indiani L, Levi M, Bonanni P, Boccalini S. Developing a training course on risk assessment of infectious diseases for travelling students. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.058] [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: 11/14/2022] Open
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Eerenberg ES, Middeldorp S, Levi M, Lensing AW, Büller HR. Clinical impact and course of major bleeding with rivaroxaban and vitamin K antagonists. J Thromb Haemost 2015; 13:1590-6. [PMID: 26179293 DOI: 10.1111/jth.13051] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 06/28/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rivaroxaban is a new oral anticoagulant (NOAC) that can be prescribed in a fixed dose, making regular monitoring and dose adjustments unnecessary. It has been proven to be safe and effective in comparison with enoxaparin/vitamin K antagonists (LMWH/VKA) for the (extended) treatment of venous thromboembolism in the EINSTEIN studies. Nevertheless, there is a need for information regarding the clinical impact of (major) bleeding events with NOACs such as rivaroxaban. OBJECTIVES A post-hoc analysis was performed to compare the severity of clinical presentation and subsequent clinical course of major bleeding with rivaroxaban vs. LMWH/VKA. METHODS Two investigators performed a blinded classification of major bleeding using a priori defined criteria. During the EINSTEIN studies, data concerning the clinical course and measures applied were prospectively collected for each major bleed. RESULTS Treatment with LMWH/VKA caused more major bleeding events (1.7%) than rivaroxaban (1.0%; hazard ratio, 0.54; 95% confidence interval [CI], 0.37-0.79). Major bleeding events during rivaroxaban therapy had a milder presentation (23% were adjudicated to the worst categories vs. 38% for LMWH/VKA; hazard ratio or HR, 0.35; 95% CI, 0.17-0.74; P = 0.0062). The clinical course was severe in 25% of all major bleeding events associated with rivaroxaban, compared with 33% of LMWH/VKA-associated bleeds (HR, 0.46; 95% CI, 0.22-0.96; P = 0.040). CONCLUSIONS Rivaroxaban-associated major bleeding events occurred less frequently, had a milder presentation and appeared to take a less severe clinical course compared with major bleeding with LMWH/VKA.
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Affiliation(s)
- E S Eerenberg
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - S Middeldorp
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - M Levi
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | | | - H R Büller
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
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Thachil J, Falanga A, Levi M, Liebman H, Di Nisio M. Management of cancer-associated disseminated intravascular coagulation: guidance from the SSC of the ISTH: reply. J Thromb Haemost 2015; 13:1352-3. [PMID: 25854143 DOI: 10.1111/jth.12962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- J Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Falanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - M Levi
- Faculty of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - H Liebman
- Division of Hematology, USC Norris Cancer Hospital, Los Angeles, CA, USA
| | - M Di Nisio
- Department of Medical, Oral and Biotechnological Sciences, University 'G. D'Annunzio' of Chieti-Pescara, Chieti, Italy
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
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Levi M, Bonenfant F, Brouwers FM, Farand P, Corbin F, Nguyen M. Impact of hemodialysis on the level of high-sensitivity cardiac troponins T in patients with end-stage renal disease. Minerva Cardioangiol 2015; 63:179-186. [PMID: 25389561] [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: 06/04/2023]
Abstract
AIM The majority of patients with end-stage renal disease have chronically elevated concentrations of troponins, thus obscuring the diagnosis of myocardial infarction. We conducted a prospective study to examine the impact of hemodialysis on the level of high-sensitivity cardiac troponins T in asymptomatic patients with end-stage renal disease. METHODS High-sensitivity cardiac troponins T were measured in 43 patients, before and after three dialysis sessions, over a one week period. RESULTS Following dialysis, an average decrease of 7.6 pg/mL in high-sensitivity cardiac troponin T levels was observed which represents a 10.3% drop from baseline. Mutlivariable mixed linear regression models taking into account dialysis session (session 1, 2 or 3), sampling moment (before and after dialysis) and repeated measures on individuals revealed that the presence of coronary artery disease and elevated body mass index were associated with higher high-sensitivity cardiac troponin T levels when the other variables were held constant (CAD: β [fixed effect estimate]=31.13 pg/mL, P=0.022, 95%CI 4.46-57.80; body mass index: β=2.57 kg/m2, P=0.008, 95%CI 0.68-4.46). The significant fixed effect estimate for the interaction between gender and sampling moment indicated that the drop in high-sensitivity cardiac troponin T levels following dialysis was greater for women than for men (β=5.75, P=0.049, 95% CI 0.02-11.47). When controlling for the variables mentioned above, this analysis confirmed that hemodialysis accounted for an 11.31 pg/mL decrease in high-sensitivity cardiac troponin T levels (P<0.001, 95%CI -15.99 - -6.62) and that the values were higher in the first dialysis session than in the third (P=0.007; 95%CI 1.62-9.79). Ten patients (23%) were found to have no decrease or an increase in troponin levels after hemodialysis. CONCLUSION In stable asymptomatic patients with end-stage renal disease, we have shown that hemodialysis reduces the blood concentration of high-sensitivity cardiac troponins T by at least 10%. Further studies are needed to confirm these results and determine their prognostic significance.
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Affiliation(s)
- M Levi
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center, Sherbrooke, Quebec, Canada -
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Affiliation(s)
- M Levi
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Proietti R, Porto I, Levi M, Leo A, Russo V, Kalfon E, Biondi-Zoccai G, Roux JF, Birnie DH, Essebag V. Risk of pocket hematoma in patients on chronic anticoagulation with warfarin undergoing electrophysiological device implantation: a comparison of different peri-operative management strategies. Eur Rev Med Pharmacol Sci 2015; 19:1461-79. [PMID: 25967723 DOI: pmid/25967723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Periprocedural management of warfarin remains challenging in patients requiring electrophysiological device surgery. For patients at high risk of thromboembolic events, guidelines recommend bridging therapy with heparin; however, this strategy is associated with a high risk of pocket hematoma. This paper systematically reviews studies appraising the risk of pocket hematoma with different perioperative anticoagulation strategies. METHODS All relevant studies identified in MEDLINE/PubMed, The Cochrane Collaboration CENTRAL, clinicaltrials.org and in bibliographies of key articles. Estimates were combined using a fixed effects model. Heterogeneity was assessed by p values of χ2 statistics and I2. Publication bias was assessed by visual examination of funnel plots and by Egger test. Fifteen studies enrolling 5911 patients met all inclusion criteria and were included in this review. RESULTS Heparin bridging compared with no heparin was associated with increased risk of pocket hematoma (OR = 4.47, 95% CI 3.21-6.23, p < 0.00001), and prolonged hospital stay (9.13 ± 1.9 days vs. 5.11 ± 1 .39 days, p < 0.00001). Warfarin continuation was not associated with increased pocket hematoma compared to warfarin discontinuation (p = 0.38), but was associated with reduced risk of pocket hematoma compared with heparin bridging (OR = 0.37, 95% CI 0.2-0.69, p = 0.002). Thromboembolic complications were reduced with heparin bridging vs. no heparin (0.50% vs.1.07%, p = 0.02), and no significant differences were reported between heparin bridging vs. warfarin continuation (p = 0.83). CONCLUSIONS Heparin bridging is associated with a higher risk of pocket hematoma and a prolonged hospital stay. Perioperative continuation of warfarin reduces the occurrence of pocket hematoma compared with heparin bridging without any significant differences in thromboembolic complications.
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Affiliation(s)
- R Proietti
- Cardiology Department, Luigi Sacco Hospital, Milan, Italy.
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Wahren B, Brytting MM, Engström G, Hinkula J, Levi M, Ståhle EL, Ohlsson S, Rudén U, Schwartz S. Immune responses to the HIV rev regulatory gene. Antibiot Chemother (1971) 2015; 48:105-12. [PMID: 8726512 DOI: 10.1159/000425164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- B Wahren
- Microbiology and Tumor Biology Center, Karolinska Institute, Stockholm, Sweden
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Levi M. Recombinant soluble thrombomodulin: coagulation takes another chance to reduce sepsis mortality. J Thromb Haemost 2015; 13:505-7. [PMID: 25650725 DOI: 10.1111/jth.12868] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/23/2015] [Indexed: 12/25/2022]
Affiliation(s)
- M Levi
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Thachil J, Falanga A, Levi M, Liebman H, Di Nisio M. Management of cancer-associated disseminated intravascular coagulation: guidance from the SSC of the ISTH. J Thromb Haemost 2015; 13:671-5. [PMID: 25556711 DOI: 10.1111/jth.12838] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Indexed: 01/13/2023]
Affiliation(s)
- J Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
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Abstract
Disseminated intravascular coagulation (DIC) is a condition in which systemic activation of coagulation without a specific localization occurs, resulting in extensive formation of intravascular fibrin, particularly in small and midsize vessels. Disseminated intravascular coagulation may lead to several altered coagulation parameters, including a low platelet count, abnormal global clotting assays, low levels of physiological anticoagulant proteases, or increased fibrin degradation products. Also, more complex assays for activation of coagulation factors or pathways may indicate involvement of these molecules in DIC. None of these tests alone, however, can accurately ascertain or rebuff a diagnosis of DIC. Nonetheless, a combination of readily available routine assays may be instrumental in establishing a diagnosis of DIC and can also be useful to point to a subset of patients with DIC that may need definite, often costly, interventions in the hemostatic system. Current insights on relevant etiological pathways that may contribute to the occurrence of DIC have led to innovative therapeutic and adjunctive approaches to patient with DIC. Management options directed at the amelioration of hemostatic activation may tentatively be indicated and were found to be advantageous in experimental and clinical investigations. These treatments encompass elimination of tissue factor-mediated thrombin generation or restitution of normal anticoagulant function.
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Affiliation(s)
- M Levi
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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