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Anceschi A, Patrucco A, Bhavsar P, Zoccola M, Tessari M, Erbazzi L, Zamboni P. Keratose Self-Cross-Linked Wound Dressing for Iron Sequestration in Chronic Wounds. ACS Omega 2023; 8:30118-30128. [PMID: 37636950 PMCID: PMC10448490 DOI: 10.1021/acsomega.3c02525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/06/2023] [Indexed: 08/29/2023]
Abstract
Chronic wound diseases affect a large part of the world population, and therefore, novel treatments are becoming fundamental. People with chronic wounds show high iron and protease levels due to genetic disorders or other comorbidities. Since it was demonstrated that iron plays an important role in chronic wounds, being responsible for oxidative processes (ROS generation), while metalloproteinases prevent wound healing by literally "eating" the growing skin, it is crucial to design an appropriate wound dressing. In this paper, a novel bioactive dressing for binding iron in chronic wounds has been produced. Wool-derived keratose wound dressing in the form of films has been prepared by casting an aqueous solution of keratoses. These films are water-soluble; therefore, in order to increase their stability, they have been made insoluble through a thermal cross-link treatment. Fourier transform infrared (FTIR), differential scanning calorimetry (DSC), and thermogravimetric analyzer (TGA) analyses clarified the structure and the properties of the keratose wound dressing films. The capability of this new biomaterial in iron sequestration has been investigated by testing the adsorption of Fe3+ by inductively coupled plasma-optical emission spectrometry (ICP-OES). The results suggest that the keratose cross-linked films can adsorb a large amount of iron (about 85% of the average amount usually present in chronic wounds) following pseudo-second-order kinetics and an intraparticle diffusion model, thus opening new perspectives in chronic wound care. Furthermore, the QSAR Toolbox was applied for conducting in silico tests and for predicting the chemical behavior of the C-Ker-film. All of the data suggest that the keratose bioactive dressing can significantly contribute to wound healing by mechanisms such as iron depletion, acting as a radical scavenger, diminishing the proteolytic damage, acting as a substrate in place of skin, and, finally, promoting tissue regeneration.
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Affiliation(s)
- Anastasia Anceschi
- CNR-STIIMA,
Italian National Research Council, Institute of Intelligent Industrial
Technologies and Systems for Advanced Manufacturing, Corso G. Pella 16, 13900 Biella, Italy
| | - Alessia Patrucco
- CNR-STIIMA,
Italian National Research Council, Institute of Intelligent Industrial
Technologies and Systems for Advanced Manufacturing, Corso G. Pella 16, 13900 Biella, Italy
| | - Parag Bhavsar
- CNR-STIIMA,
Italian National Research Council, Institute of Intelligent Industrial
Technologies and Systems for Advanced Manufacturing, Corso G. Pella 16, 13900 Biella, Italy
| | - Marina Zoccola
- CNR-STIIMA,
Italian National Research Council, Institute of Intelligent Industrial
Technologies and Systems for Advanced Manufacturing, Corso G. Pella 16, 13900 Biella, Italy
| | - Mirko Tessari
- Vascular
Diseases Center, University of Ferrara, 44121 Ferrara, Italy
| | - Luca Erbazzi
- Vascular
Diseases Center, University of Ferrara, 44121 Ferrara, Italy
| | - Paolo Zamboni
- Vascular
Diseases Center, University of Ferrara, 44121 Ferrara, Italy
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2
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Gianesini S, Vagnoni E, Cavicchi C, Chi YW, Pagani A, Tessari M, Zamboni P, Menegatti E. Randomized controlled trial on occupational graduated compression clinical and cost-effectiveness. INT ANGIOL 2023; 42:344-351. [PMID: 37458579 DOI: 10.23736/s0392-9590.23.05030-7] [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: 08/02/2023]
Abstract
BACKGROUND Subjects exposed to occupational standing are at risk of developing chronic venous disease. Graduated compression stockings (GCS) counteract venous hypertension. Aim of the present investigation was to assess GCS clinical and cost effectiveness in prolonged standing up workers. METHODS Randomized controlled trial involving 75 healthy healthcare professionals working in 6 hours standing up shifts without or with GCS (group A and B, respectively). Outcome measures were performed before and after the shift, at baseline (T0), at 1 (T1), 6 (T6) and 12 (T12) months and included lower limb volume, air plethysmography (APG), quality of life, and dedicated cost-effectiveness questionnaires. RESULTS Seventy-two subjects completed the data collection. Leg volume increased in group A and decreased in B at all assessment points (T0, 1, 6, 12) (P<0.0001). Venous filling index did not change within the 12 months, but, after every shift, its value was lower in B compared to A (P<0.0001). At 12 months, VVSymQ worsened in A and improved in B (P<0.0001) and CIVIQ significantly worsened in A (P<0.0001), while in B it significantly improved (P<0.0001). Perceived disability was higher in A at 12 months (P<0.001) and the cost calculation revealed a saving of 1510 euro per year in B. CONCLUSIONS GCS counteracted occupational oedema and positively influenced venous filling index, while improving vein specific quality of life measurements in addition to cost savings.
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Affiliation(s)
- Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy -
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA -
- Mini-invasive Venous Surgery Unit, S. Anna University Hospital, Ferrara, Italy -
| | - Emidia Vagnoni
- Department of Economics and Management, University of Ferrara, Ferrara, Italy
| | - Caterina Cavicchi
- Department of Economics and Management, University of Ferrara, Ferrara, Italy
| | - Yung-Wei Chi
- Division of Cardiovascular Medicine, Vascular Center, University of California, Davis, CA, USA
| | - Anselmo Pagani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Mirko Tessari
- Mini-invasive Venous Surgery Unit, S. Anna University Hospital, Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Mini-invasive Venous Surgery Unit, S. Anna University Hospital, Ferrara, Italy
| | - Erica Menegatti
- Department of Environmental Science and Prevention, University of Ferrara, Ferrara, Italy
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D'Oria M, Zlatanovic P, Anthony A, Dua A, Flores AM, Tanious A, Rodríguez Morata A, Scerrati A, Baccellieri D, Biscetti F, Baldazzi G, Mantovani G, Sen I, Peinado Cebrian J, Rocha-Neves J, Sousa J, Davidovic L, Juszynski M, Markovic M, Oller Grau M, Tessari M, Hynes N, Gloviczki P, Shaw P, Zamboni P, Hinchliffe R, Ricci R, Sultan S, Acharya Y, Troisi N, Antignani PL, Mansilha A, Komlos PP. International union of angiology consensus document on vascular compression syndromes. INT ANGIOL 2023:S0392-9590.23.05100-3. [PMID: 37498053 DOI: 10.23736/s0392-9590.23.05100-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Vascular compression syndromes (VCS) are rare diseases, but they may cause significant symptoms interfering with the quality of life (QoL) of patients who are often in their younger age. Given their infrequent occurrence, multiform clinical and anatomical presentation, and absence of dedicated guidelines from scientific societies, further knowledge of these conditions is required to investigate and treat them using modern imaging and surgical (open or endovascular) techniques. This consensus document will focus on known VCS, affecting the arterial and venous system. The position paper, written by members of International Union of Angiology (IUA) Youth Committee and senior experts, will show an overview of pathophysiology, diagnostic, and therapeutical approaches for patients with VCS. Furthermore, this document will provide also unresolved issues that require more research that need to be addressed in the future.
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Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Department of Medical Surgical Health Sciences, University of Trieste, Trieste, Italy
| | - Petar Zlatanovic
- Clinic of Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia -
| | - Anthony Anthony
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | - Anahita Dua
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alyssa M Flores
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam Tanious
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | - Alba Scerrati
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Domenico Baccellieri
- Vein Center, Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Biscetti
- Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Baldazzi
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy
| | - Giorgio Mantovani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Indrani Sen
- Vascular and Endovascular Surgery, Mayo Clinic Health Systems, Eau Claire, WI, USA
| | - Javier Peinado Cebrian
- Service of Angiology and Vascular Surgery, Virgen de la Salud de Toledo Hospital, Toledo, Spain
| | - Joao Rocha-Neves
- Biomedicine Department, Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joel Sousa
- Centro Hospitalar Universitário de S. João, Porto, Portugal
| | - Lazar Davidovic
- Clinic of Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Michal Juszynski
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Miroslav Markovic
- Clinic of Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Mar Oller Grau
- Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Mirko Tessari
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy
| | - Niamh Hynes
- CORRIB-CURAM-Vascular Group, University of Galway, Galway, Ireland
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Palma Shaw
- Division of Vascular and Endovascular Surgery, UPSTATE Medical University, Syracuse, NY, USA
| | - Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy
| | - Robert Hinchliffe
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
- Center for Surgical Research, University of Bristol, Bristol, UK
| | - Roberta Ricci
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy
| | - Sherif Sultan
- CORRIB-CURAM-Vascular Group, University of Galway, Galway, Ireland
- Department of Vascular and Endovascular Surgery, University Hospital Galway, University of Galway, Galway, Ireland
- Western Vascular Institute, Galway University Hospital, Galway, Ireland
| | - Yogesh Acharya
- Department of Vascular and Endovascular Surgery, University Hospital Galway, University of Galway, Galway, Ireland
- Western Vascular Institute, Galway University Hospital, Galway, Ireland
| | - Nicola Troisi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Armando Mansilha
- Department of Angiology and Vascular Surgery at Hospital CUF, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
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4
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Ciorba A, Tessari M, Natale E, Buzzi F, Baldazzi G, Cosacco A, Migliorelli A, Corazzi V, Bianchini C, Stomeo F, Pelucchi S, Zamboni P. Cerebral Outflow Discrepancies in Recurrent Benign Paroxysmal Positional Vertigo: Focus on Ultrasonographic Examination. Diagnostics (Basel) 2023; 13:diagnostics13111902. [PMID: 37296754 DOI: 10.3390/diagnostics13111902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
This prospective pilot study aimed to evaluate whether cerebral inflow and outflow abnormalities assessed by ultrasonographic examination could be associated with recurrent benign paroxysmal positional vertigo (BPPV). Twenty-four patients with recurrent BPPV, affected by at least two episodes, and diagnosed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, evaluated at our University Hospital, between 1 February 2020 and 30 November 2021, have been included. At the ultrasonographic examination, 22 of 24 patients (92%) reported one or more alterations of the extracranial venous circulation, among those considered for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI), although none of the studied patients were found to have alterations in the arterial circulation. The present study confirms the presence of alterations of the extracranial venous circulation in recurrent BPPV; these anomalies (such as stenosis, blockages or regurgitation of flow, or abnormal valves, as per the CCSVI) could cause a disruption in the venous inner ear drainage, hampering the inner ear microcirculation and then possibly causing recurrent otolith detachment.
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Affiliation(s)
- Andrea Ciorba
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Mirko Tessari
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Erennio Natale
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Fabio Buzzi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Giulia Baldazzi
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Alessio Cosacco
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Andrea Migliorelli
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Virginia Corazzi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Chiara Bianchini
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Francesco Stomeo
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
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5
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Kulkarni PG, Paudel N, Magar S, Santilli MF, Kashyap S, Baranwal AK, Zamboni P, Vasavada P, Katiyar A, Singh AV. Overcoming Challenges and Innovations in Orthopedic Prosthesis Design: An Interdisciplinary Perspective. Biomed Mater Devices 2023:1-12. [PMID: 37363137 PMCID: PMC10180679 DOI: 10.1007/s44174-023-00087-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/29/2023] [Indexed: 06/28/2023]
Abstract
Recent advances in the orthopedic prostheses design have significantly improved the quality of life for individuals with orthopedic disabilities. However, there are still critical challenges that need to be addressed to further enhance the functionality of orthopedic prostheses improving biocompatibility to promote better integration with natural tissues, enhancing durability to withstand the demands of daily use, and improving sensory feedback for better control of movement are the most pressing issues. To address these challenges, promising emerging solutions such as smart prosthetics, 3D printing, regenerative medicine, and artificial intelligence have been developed. These innovative technologies hold the potential to significantly enhance the functionality of orthopedic prostheses. Realizing the full potential of these next-generation orthopedic prostheses requires addressing several critical factors. These include interdisciplinary collaboration between experts in orthopedics, materials science, biology, and engineering, increased investment in research and development, standardization of components to ensure quality and reliability, and improved access to prosthetics. A comprehensive review of these challenges and considerations for future orthopedic prosthesis design is s provided in this paper addressing the further advances to the field. By addressing these issues, we can continue to improve the lives of individuals with orthopedic disabilities and further enhance the field of orthopedic prosthetics.
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Affiliation(s)
| | - Namuna Paudel
- Department of Chemistry, Amrit Campus, Institute of Science and Technology, Tribhuvan University, Lainchaur, Kathmandu, 44600 Nepal
| | - Shilpa Magar
- Seeta Nursing Home, Shivaji Nagar, Nashik, Maharashtra 422002 India
| | | | | | | | - Paolo Zamboni
- Chair Vascular Diseases Center, University of Ferrara, 44124 Ferrara, Italy
| | - Priyank Vasavada
- M.S. Ramaiah Medical College and Hospital, Bengaluru, 560054 India
| | - Aman Katiyar
- Jain University, Bengaluru, Karnataka 560069 India
| | - Ajay Vikram Singh
- Department of Chemical and Product Safety, German Federal Institute of Risk Assessment (BfR), Maxdohrnstrasse 8-10, 10589 Berlin, Germany
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6
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Zamboni P, Bizzarri S. Comment on: A randomized clinical trial of isolated ambulatory phlebectomy versus saphenous thermal ablation with concomitant phlebectomy (SAPTAP trial). Br J Surg 2023; 110:616. [PMID: 36806549 PMCID: PMC10364548 DOI: 10.1093/bjs/znad038] [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] [Received: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Paolo Zamboni
- Department of Translational Medicine and for Romagna, University of Ferrara, Italy.,School of Vascular Surgery, University of Ferrara, Italy
| | - Sofia Bizzarri
- School of Vascular Surgery, University of Ferrara, Italy
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7
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Traina L, Mucignat M, Rizzo R, Gafà R, Bortolotti D, Passaro A, Zamboni P. COVID-19 induced aorto duodenal fistula following evar in the so called "negative" patient. Vascular 2023; 31:189-195. [PMID: 34919005 DOI: 10.1177/17085381211053695] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Since October 2019, SARS-CoV-2 pandemic represents a challenge for the international healthcare system and for the treatment and survival of patients. We normally focus on symptomatic patients, and symptoms can range from the respiratory to the gastrointestinal system. In addition, we consider patients without fever and respiratory symptoms, with both a negative RT nasopharyngeal swab and lung CT, as a "Covid-19 negative patient." In this article, we present a so called Covid-19 "negative" patient, with an unsuspected vascular clinical onset of the viral infection. METHODS An 80 y.o. man, who previously underwent endovascular aortic repair for an infrarenal abdominal aortic aneurysm, presented to our department with an atypical presentation of an aorto-enteric fistula during the pandemic. While in hospital, weekly nasopharyngeal swab tests were always negative for SARS-CoV-2. However, the absence of aortic endograft complications, the gross anatomy of duodenal ischemic injury, and the recent history of the patient who lived the last months in Bergamo, the Italian city with the highest number of COVID-19 deaths, lead the senior Author to suspect an occult SARS-CoV-2 infection. The patient underwent to resection of the fourth portion of the duodenum and the first jejunal loop, with subsequent duodenum-jejunal latero-lateral anastomosis and the direct suture of the aortic wall. The intestinal specimen was investigated as suspected SARS-CoV-2 bowel infection by the means of immune-histochemistry (IHC). An ileum sample obtained in the pre-COVID-19 era was used as a control tissue. RESULTS The histological analysis of the bowel revealed sustained wall ischemia and liponecrosis of the duodenal wall, with intramural blood vessels thrombosis. Blood vessel endotheliitis and neo-angiogenesis were also observed. Finally, the IHC was strongly positive for SARS-CoV-2 RNA and for HLA-G presence, with a particular concentration both in blood vessels and in the intestinal villi. The control tissue sample was not positive for both SARS-CoV-2 and HLA-G. CONCLUSIONS Coronavirus pandemic continues to be an international challenge and more studies and trials must be done to learn its pathogenesis and its complications. As for thromboembolic events caused by SARS-COV-2, vascular surgeons are involved in treatment and prevention of the complications of this syndrome and must be ready with general surgeons to investigate atypical and particular cases such as the one discussed in this article.
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Affiliation(s)
- Luca Traina
- Unit of Vascular and Endovascular Surgery, 18560Azienda Ospedaliero Universitaria di Ferrara - Arcispedale S.Anna, Ferrara, Italy
| | - Marianna Mucignat
- Unit of Vascular and Endovascular Surgery, 18560Azienda Ospedaliero Universitaria di Ferrara - Arcispedale S.Anna, Ferrara, Italy.,Department of Translational Medicine for Romagna, and Vascular Diseases Center, University of Ferrara, Ferrara, Italy
| | - Roberta Rizzo
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Roberta Gafà
- Department of Translational Medicine for Romagna, and Vascular Diseases Center, University of Ferrara, Ferrara, Italy
| | - Daria Bortolotti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Angelina Passaro
- Department of Translational Medicine for Romagna, and Vascular Diseases Center, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine for Romagna, and Vascular Diseases Center, University of Ferrara, Ferrara, Italy
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8
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Mantovani G, Zangrossi P, Flacco ME, Di Domenico G, Nastro Siniscalchi E, De Ponte FS, Maugeri R, De Bonis P, Cavallo MA, Zamboni P, Scerrati A. Styloid Jugular Nutcracker: The Possible Role of the Styloid Process Spatial Orientation-A Preliminary Morphometric Computed Study. Diagnostics (Basel) 2023; 13:diagnostics13020298. [PMID: 36673108 PMCID: PMC9857444 DOI: 10.3390/diagnostics13020298] [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: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Styloid Jugular Nutcracker (SJN, also known as Eagle Jugular Syndrome EJS) derives from a jugular stenosis caused by an abnormal styloid process, compressing the vessel in its superior portion (J3) against the C1 anterior arch. It could be considered a venous vascular variant of Eagle Syndrome (ES). Main clinical features of this ES variant are headache, pulsatile tinnitus and dizziness, possibly related to venous hypertension and impaired cerebral parenchyma drainage. In our opinion, conceptually, it is not the absolute length of the styloid bone that defines its abnormality, but its spatial direction. An elongated bone pointing outward far away from the midline could not compress the vein; vice versa, a short styloid process tightly adherent to the cervical spine could be pathological. To prove this hypothesis, we developed a semi-automatic software that processes CT-Angio images, giving quantitative information about distance and direction of the styloid process in three-dimensional space. We compared eight patients with SJN to a sample of healthy subjects homogeneous for sex and age. Our results suggest that SJN patients have a more vertically directed styloid, and this feature is more important than the absolute distance between the two bony structures. More studies are needed to expand our sample, including patients with the classic and carotid variants of Eagle Syndrome.
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Affiliation(s)
- Giorgio Mantovani
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, University Hospital of Ferrara, 44121 Ferrara, Italy
- Correspondence:
| | - Pietro Zangrossi
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Maria Elena Flacco
- Department of Environmental and Preventive Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Giovanni Di Domenico
- Department of Physic and Earth Science, University of Ferrara, 44122 Ferrara, Italy
| | | | | | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP “Paolo Giaccone”, 90127 Palermo, Italy
| | - Pasquale De Bonis
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Michele Alessandro Cavallo
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Vascular Diseases Center, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Alba Scerrati
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, University Hospital of Ferrara, 44121 Ferrara, Italy
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Zamboni P, Massi I, Franceschi C. Regarding the review and commentary of the CHIVA method for the treatment of chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord 2023; 11:227-228. [PMID: 36526405 DOI: 10.1016/j.jvsv.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Paolo Zamboni
- Venous and Lymphatic Disease Center, School of Vascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Ilaria Massi
- School of Vascular Surgery, University Hospital of Ferrara, Ferrara, Italy
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10
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Mantovani G, De Bonis P, Cavallo MA, Zamboni P, Scerrati A. Eagle jugular syndrome: a morphometric computed study on styloid process orientation. Veins and Lymphatics 2022. [DOI: 10.4081/vl.2022.10955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Cerebral venous drainage impairment is related to a wide spectrum of pathologies, both acute or chronic. Among the most intriguing and less explained there are those caused by a long-lasting compression on internal jugular vein (IJV), mono or bilaterally. Recently, a jugular variant of the Eagle syndrome has been described,1,2 in which an elongated styloid process, coming from the mastoid tip down through the neck, compresses the IJV (more frequently J3) in its passage on the C1 anterior arch. Interestingly, those patients often complaint of typical symptoms of intracranial hypertension, such as headache (not frequent in classic Eagle syndrome), tinnitus, dizziness. They also seem to have an increased risk of perimesencephalic hemorrhages. Conceptually, it is not the styloid process length in itself to determine the compression, but rather its spatial orientation. We could therefore expect to find patients suffering from Eagle jugular syndrome who present normal or short styloid process, but in close proximity to C1. To test this hypothesis, we are developing a novel software to analyze 3-D spatial orientation of styloid process in patient with a previously diagnosed Eagle jugular syndrome compared to healthy controls. Methods We collected cervical computed tomography angiography (CTA) images from 8 patients with EJS confirmed by venous angiography at our institution, and a control group of 7 random patients, homogenous for sex and age. A blind operator created with a dedicated pre-existing software3, an editable 3-D model (.stl file) of the 3 main region of interest (ROI), namely: right styloid, left styloid, C1 anterior arch. Starting from this dataset, our software, written using the open-source package management system Anaconda4 ver. 2-2.4.0, compares all the possible couples of points between each styloid process and the C1 arch, detecting the minimum and maximum distance. Then, it provides the mean spatial orientation of the process respect the CT-axis: x-axis (from left to right), y-axis (from occiput to nose) and z-axis (cranio-caudal). Results By now we included 15 patients (8 cases, 7 controls), homogeneous for sex and age. Preliminary data (Table 1), although not statistically significant yet, seems to indicate that Eagle jugular patients effectively have a more vertical styloid process, meaning an angle between styloid and y-axis greater than controls, rather than a longer one. Conclusions Our preliminary results could confirm that spatial orientation is more important in Eagle jugular patients than styloid process length. This study is currently ongoing and we planned to enroll at least 20 subjects for each arm. At the same time, we are collecting data from patients with carotic variant of Eagle syndrome, to better characterize morphometric structure of styloid in various subset of this pathology.
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11
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Menegatti E, Mandini S, Pagani A, Mandini B, Zerbini V, Piva T, Raisi A, Fabbri M, Fogli M, Mazzoni G, Zamboni P, Gianesini S. The Effect of Active Stretching Training in Patients with Chronic Venous Insufficiency Monitored by Raster-Stereography. Sensors (Basel) 2022; 22:8509. [PMID: 36366206 PMCID: PMC9657419 DOI: 10.3390/s22218509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Musculoskeletal disorders can be associated with advanced clinical stages of chronic venous insufficiency (CVI). The aim of the study is to investigate the effect of active stretching (AS) training on lower limb venous function and quality of life in patients affected by CVI. (2) Methods: A prospective two-armed pilot randomized controlled was conducted. Twenty (20) CVI patients were randomly assigned to an AS training or to a control group (C) who did not receive any exercise indication. At baseline and after three months all the participants were tested for leg volumetry (LV), air plethysmography (APG), and quality of life (QoL) measured by a disease specific validated questionnaire (VVSymQ), ankle range of motion (ROM), and postural deformities using an optoelectronic body posture machine. (3) Results: At the end of the training in the AS group a significant leg volume reduction was detected (from 2340 ± 239 mL to 2239 ± 237 mL (4.3%); p < 0.0001), whereas in the C group no significant volume changes were found. The ejection fraction rate (EF%) increased significantly from 49.3 ± 9.3 to 61.1 ± 14.5, p < 0.005. A moderate-strong linear correlation with EF% and ankle ROM variation was found (R2 = 0.6790; p < 0.0034). Several postural outcomes such as pelvic tilt, pelvic torsion, and lordotic angle significantly improved in the AS group (p < 0.01, p < 0.04, p < 0.01 respectively). (4) Conclusion: The AS training impacts on the APG parameters related to the musculoskeletal pump efficiency, opening a further possibility in the management of CVI patients by means of an appropriate adapted physical exercise program.
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Affiliation(s)
- Erica Menegatti
- Department of Environmental and Prevention Sciences, University of Ferrara, 44123 Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Anselmo Pagani
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Beatrice Mandini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Valentina Zerbini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Andrea Raisi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Marinella Fabbri
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Marco Fogli
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Sergio Gianesini
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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12
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Menegatti E, Proto A, Paternò G, Gadda G, Gianesini S, Raisi A, Pagani A, Piva T, Zerbini V, Mazzoni G, Grazzi G, Taibi A, Zamboni P, Mandini S. The Effect of Submaximal Exercise on Jugular Venous Pulse Assessed by a Wearable Cervical Plethysmography System. Diagnostics (Basel) 2022; 12:diagnostics12102407. [PMID: 36292096 PMCID: PMC9600745 DOI: 10.3390/diagnostics12102407] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/18/2022] Open
Abstract
The jugular venous pulse (JVP) is a one of the crucial parameters of efficient cardiovascular function. Nowadays, limited data are available regarding the response of JVP to exercise because of its complex and/or invasive assessment procedure. The aim of the present work is to test the feasibility of a non-invasive JVP plethysmography system to monitor different submaximal exercise condition. Twenty (20) healthy subjects (13M/7F mean age 25 ± 3, BMI 21 ± 2) underwent cervical strain-gauge plethysmography, acquired synchronously with the electrocardiogram, while they were carrying out different activities: stand supine, upright, and during the execution of aerobic exercise (2 km walking test) and leg-press machine exercise (submaximal 6 RM test). Peaks a and x of the JVP waveform were investigated since they reflect the volume of cardiac filling. To this aim, the Δax parameter was introduced, representing the amplitude differences between a and x peaks. Significant differences in the values of a, x, and Δax were found between static and exercise conditions (p < 0.0001, p < 0.0001, p < 0.0001), respectively. Particularly, the Δax value for the leg press was approximately three times higher than the supine, and during walking was even nine times higher. The exercise monitoring by means of the novel JVP plethysmography system is feasible during submaximal exercise, and it provides additional parameters on cardiac filling and cerebral venous drainage to the widely used heartbeat rate value.
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Affiliation(s)
- Erica Menegatti
- Department of Environmental Science and Prevention, University of Ferrara, 44123 Ferrara, Italy
| | - Antonino Proto
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
- Correspondence: ; Tel.: +39-0532-974375
| | - Gianfranco Paternò
- Department of Physics and Earth Sciences, University of Ferrara, 44122 Ferrara, Italy
| | - Giacomo Gadda
- Department of Physics and Earth Sciences, University of Ferrara, 44122 Ferrara, Italy
| | - Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, 44123 Ferrara, Italy
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Andrea Raisi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Anselmo Pagani
- Department of Translational Medicine, University of Ferrara, 44123 Ferrara, Italy
| | - Tommaso Piva
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Valentina Zerbini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Gianni Mazzoni
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Giovanni Grazzi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL 60612, USA
| | - Angelo Taibi
- Department of Physics and Earth Sciences, University of Ferrara, 44122 Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine, University of Ferrara, 44123 Ferrara, Italy
| | - Simona Mandini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
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13
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Singh AV, Chandrasekar V, Laux P, Luch A, Dakua SP, Zamboni P, Shelar A, Yang Y, Pandit V, Tisato V, Gemmati D. Micropatterned Neurovascular Interface to Mimic the Blood–Brain Barrier’s Neurophysiology and Micromechanical Function: A BBB-on-CHIP Model. Cells 2022; 11:cells11182801. [PMID: 36139383 PMCID: PMC9497163 DOI: 10.3390/cells11182801] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 12/25/2022] Open
Abstract
A hybrid blood–brain barrier (BBB)-on-chip cell culture device is proposed in this study by integrating microcontact printing and perfusion co-culture to facilitate the study of BBB function under high biological fidelity. This is achieved by crosslinking brain extracellular matrix (ECM) proteins to the transwell membrane at the luminal surface and adapting inlet–outlet perfusion on the porous transwell wall. While investigating the anatomical hallmarks of the BBB, tight junction proteins revealed tortuous zonula occludens (ZO-1), and claudin expressions with increased interdigitation in the presence of astrocytes were recorded. Enhanced adherent junctions were also observed. This junctional phenotype reflects in-vivo-like features related to the jamming of cell borders to prevent paracellular transport. Biochemical regulation of BBB function by astrocytes was noted by the transient intracellular calcium effluxes induced into endothelial cells. Geometry-force control of astrocyte–endothelial cell interactions was studied utilizing traction force microscopy (TFM) with fluorescent beads incorporated into a micropatterned polyacrylamide gel (PAG). We observed the directionality and enhanced magnitude in the traction forces in the presence of astrocytes. In the future, we envisage studying transendothelial electrical resistance (TEER) and the effect of chemomechanical stimulations on drug/ligand permeability and transport. The BBB-on-chip model presented in this proposal should serve as an in vitro surrogate to recapitulate the complexities of the native BBB cellular milieus.
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Affiliation(s)
- Ajay Vikram Singh
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), 10589 Berlin, Germany
- Correspondence: (A.V.S.); (S.P.D.)
| | | | - Peter Laux
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), 10589 Berlin, Germany
| | - Andreas Luch
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), 10589 Berlin, Germany
| | - Sarada Prasad Dakua
- Department of Surgery, Hamad Medical Corporation (HMC), Doha 3050, Qatar
- Correspondence: (A.V.S.); (S.P.D.)
| | - Paolo Zamboni
- Department of Vascular Surgery, University of Ferrara, 44121 Ferrara, Italy
| | - Amruta Shelar
- Department of Technology, Savitribai Phule Pune University, Pune 411007, India
| | - Yin Yang
- College of Science and Engineering, Hamad Bin Khalifa University (HBKU), Doha 24404, Qatar
| | - Vaibhav Pandit
- Dynex Technologies, 14340 Sullyfield Circle, Chantilly, VA 20151, USA
| | - Veronica Tisato
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Centre Hemostasis & Thrombosis, University of Ferrara, 44121 Ferrara, Italy
| | - Donato Gemmati
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Centre Hemostasis & Thrombosis, University of Ferrara, 44121 Ferrara, Italy
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14
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Maharjan RS, Singh AV, Hanif J, Rosenkranz D, Haidar R, Shelar A, Singh SP, Dey A, Patil R, Zamboni P, Laux P, Luch A. Investigation of the Associations between a Nanomaterial's Microrheology and Toxicology. ACS Omega 2022; 7:13985-13997. [PMID: 35559161 PMCID: PMC9089358 DOI: 10.1021/acsomega.2c00472] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/25/2022] [Indexed: 05/10/2023]
Abstract
With the advent of Nanotechnology, the use of nanomaterials in consumer products is increasing on a daily basis, due to which a deep understanding and proper investigation regarding their safety and risk assessment should be a major priority. To date, there is no investigation regarding the microrheological properties of nanomaterials (NMs) in biological media. In our study, we utilized in silico models to select the suitable NMs based on their physicochemical properties such as solubility and lipophilicity. Then, we established a new method based on dynamic light scattering (DLS) microrheology to get the mean square displacement (MSD) and viscoelastic property of two model NMs that are dendrimers and cerium dioxide nanoparticles in Dulbecco's Modified Eagle Medium (DMEM) complete media at three different concentrations for both NMs. Subsequently, we established the cytotoxicological profiling using water-soluble tetrazolium salt-1 (WST-1) and a reactive oxygen species (ROS) assay. To take one step forward, we further looked into the tight junction properties of the cells using immunostaining with Zonula occluden-1 (ZO-1) antibodies and found that the tight junction function or transepithelial resistance (TEER) was affected in response to the microrheology and cytotoxicity. The quantitative polymerase chain reaction (q-PCR) results in the gene expression of ZO-1 after the 24 h treatment with NPs further validates the findings of immunostaining results. This new method that we established will be a reference point for other NM studies which are used in our day-to-day consumer products.
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Affiliation(s)
- Romi Singh Maharjan
- German
Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
| | - Ajay Vikram Singh
- German
Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
| | - Javaria Hanif
- University
of Potsdam, Department of Food
Chemistry, 14476 Potsdam, Germany
| | - Daniel Rosenkranz
- Klinikum
Oldenburg, University Medical Center Oldenburg,
Institute for Clinic Chemistry and Laboratory Medicine, 26133 Oldenburg, Germany
| | - Rashad Haidar
- German
Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
| | - Amruta Shelar
- Department
of Technology, Savitribai Phule Pune University, Pune 411007, MH, India
| | | | - Aditya Dey
- Faculty
of Informatics, Otto von Guericke University, Magdeburg 39106, Germany
| | - Rajendra Patil
- Department
of Biotechnology, Savitribai Phule Pune
University, Pune 411007, MH, India
| | - Paolo Zamboni
- Department
of Translational Medicine for Romagna, University
of Ferrara, 44121 Ferrara, Italy
| | - Peter Laux
- German
Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
| | - Andreas Luch
- German
Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
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15
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Zamboni P, Scerrati A, Sessa F, Pomara C, Mannucci PM. Vaccine-induced immune thrombotic thrombocytopenia with atypical vein thrombosis: Implications for clinical practice. Phlebology 2022; 37:180-187. [PMID: 35068258 DOI: 10.1177/02683555211068948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a new and rare syndrome resulting from the largest vaccination campaign against SARS-CoV-2 in the history of mankind. The aim of this review is to clarify underlying mechanisms, pathology, diagnosis, and therapy, with the related clinical implications. METHODS We performed a comprehensive literature review in order to collect the clinical and treatment data about patients suffering from VITT. PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened regarding patients who developed VITT. Last search was launched on June 30th 2021. RESULTS Abdominal and/or neurological symptoms develop between 5 and 20 days after vaccine administration and do not involve the lower extremities. VITT is suspected if the platelet count is lower than 100.000/mm3 and D-dimer is higher than the age-adjusted range. Medical treatment is mainly based on intravenous immunoglobulins, corticosteroids, and anticoagulant drugs with a short plasma half-life, but the complete avoidance of low molecular weight heparin is recommended. Endovascular treatment and/or decompressive craniectomy might be an option in a minority of cases. CONCLUSION Due to widespread vaccination concerns, the vascular specialist and phlebologist are increasingly consulted to prevent or diagnose VITT. The latter has peculiar and completely different localizations, symptoms, and treatment compared to the common pictures of venous thrombosis.
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Affiliation(s)
- Paolo Zamboni
- Hub Center for Venous and Lymphatic Diseases Regione Emilia-Romagna, Sant'Anna University Hospital of Ferrara, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, 9299University of Ferrara, Ferrara, Italy
| | - Alba Scerrati
- Department of Morphology, Surgery and Experimental Medicine, 9299University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, 18567University of Foggia, Foggia, Italy
| | - Cristoforo Pomara
- Institute of Legal Medicine, Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 9339IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
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16
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Manfredini F, Traina L, Gasbarro V, Straudi S, Caruso L, Fabbian F, Zamboni P, Manfredini R, Lamberti N. Structured pain-free exercise progressively improves ankle-brachial index and walking ability in patients with claudication and compressible arteries: an observational study. Intern Emerg Med 2022; 17:439-449. [PMID: 34499318 PMCID: PMC8964614 DOI: 10.1007/s11739-021-02827-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023]
Abstract
In patients with peripheral artery disease (PAD), supervised exercise at near-moderate pain improves walking ability but not ankle-brachial index (ABI) values. In a retrospective observational study, we determined vascular and functional effects of a 6-month structured pain-free exercise program in patients with claudication and compressible vessels. Four-hundred and fifty-nine consecutive patients were studied. Segmental limb pressures were measured and ABI calculated during circa-monthly hospital visits. The 6-min (6MWD) and the pain-free walking distance (PFWD) during the 6-min walking test were determined. Two daily 8-min sessions of slow-moderate in-home walking at increasing metronome-paced speed were prescribed. After excluding patients with unmeasurable ABI or incompletion of the program, 239 patients were studied. Safe and satisfactory (88%) execution of the prescribed training sessions was reported. During the visits, bilateral ABI improved (+ 0.07; p < 0.001) as well as the segmental pressures in the more impaired limb, with changes already significant after 5 weeks of slow walking. Both systolic and diastolic blood pressure decreased overtime (F = 46.52; p < 0.001; F = 5.52; p < 0.001, respectively). 6MWD and PFWD improved (41[0‒73]m p < 0.001 and 107[42‒190]m p < 0.001, respectively) with associated decrease of walking heart rate (F = 15.91; p < 0.001) and Physiological Cost Index (F = 235.93; p < 0.001). The variations of most parameters at different visits correlated to the training load calculated. In a regression model, the PFWD variations directly correlated with rate sessions completed, training load and ABI change and inversely with the baseline value (R2 = 0.27; p < 0.001). In the PAD population studied, moderate pain-free exercise improved ABI with associated progressive functional and cardiovascular changes occurring regardless of subjects characteristics.
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Affiliation(s)
- Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
- Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Luca Traina
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Sofia Straudi
- Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Lorenzo Caruso
- Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center, University Hospital of Ferrara, Ferrara, Italy
| | | | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
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17
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Zamboni P, Bortolotti D, Occhionorelli S, Traina L, Neri LM, Rizzo R, Gafà R, Passaro A. Bowel ischemia as onset of COVID-19 in otherwise asymptomatic patients with persistently negative swab. J Intern Med 2022; 291:224-231. [PMID: 34437741 PMCID: PMC8662187 DOI: 10.1111/joim.13385] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Asymptomatic patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can develop hypercoagulable conditions and acute vascular events. The objective of this study is to determine whether SARS-CoV-2 was present in resected specimens from patients with acute bowel ischemia, but asymptomatic for Coronavirus Disease 2019 (COVID-19) and with persistently real-time polymerase chain reaction negative pharyngeal swab. METHODS Three consecutive patients presented severe abdominal symptoms due to extensive ischemia and necrosis of the bowel, with co-existent thrombosis of abdominal blood vessels. None had the usual manifestations of COVID-19, and repeated pharyngeal swabs tested negative. They underwent emergency surgery with intestinal resection. Immunohistochemical testing for SARS-CoV-2 on resected tissue was performed. RESULTS All tested samples were strongly positive for SARS-CoV-2. CONCLUSIONS This is the first case report in which patients with severe intestinal symptoms presented a marked SARS-CoV-2 positivity in the resected tissues, without any usual clinical manifestations of COVID-19. These results suggest that the patients might be infected with SARS-CoV-2 presenting acute abdominal distress but without respiratory or constitutional symptoms.
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Affiliation(s)
- Paolo Zamboni
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Surgery, University Hospital of Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | - Daria Bortolotti
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Savino Occhionorelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Surgery, University Hospital of Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | - Luca Traina
- Department of Surgery, University Hospital of Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | - Luca Maria Neri
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Roberta Rizzo
- Department of Surgery, University Hospital of Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | - Roberta Gafà
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Oncological and Medical Department, University Hospital of Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | - Angelina Passaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Medical Department, University Hospital of Ferrara Arcispedale Sant'Anna, Ferrara, Italy
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18
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Scapoli C, Ziliotto N, Lunghi B, Menegatti E, Salvi F, Zamboni P, Baroni M, Mascoli F, Bernardi F, Marchetti G. Combination of Genomic and Transcriptomic Approaches Highlights Vascular and Circadian Clock Components in Multiple Sclerosis. Int J Mol Sci 2021; 23:ijms23010310. [PMID: 35008743 PMCID: PMC8745220 DOI: 10.3390/ijms23010310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 12/17/2022] Open
Abstract
Aiming at exploring vascular components in multiple sclerosis (MS) with brain outflow disturbance, we combined transcriptome analysis in MS internal jugular vein (IJV) wall with WES in MS families with vertical transmission of disease. Main results were the differential expression in IJV wall of 16 MS-GWAS genes and of seven genes (GRIN2A, GRIN2B, IL20RB, IL26, PER3, PITX2, and PPARGC1A) not previously indicated by GWAS but encoding for proteins functionally interacting with MS candidate gene products. Strikingly, 22/23 genes have been previously associated with vascular or neuronal traits/diseases, nine encoded for transcriptional factors/regulators and six (CAMK2G, GRIN2A, GRIN2B, N1RD1, PER3, PPARGC1A) for circadian entrainment/rhythm components. Among the WES low-frequency (MAF ≤ 0.04) SNPs (n = 7) filtered in the 16 genes, the NR1D1 rs17616365 showed significantly different MAF in the Network for Italian Genomes affected cohort than in the 1000 Genome Project Tuscany samples. This pattern was also detected in five nonintronic variants (GRIN2B rs1805482, PER3 rs2640909, PPARGC1A rs2970847, rs8192678, and rs3755863) in genes coding for functional partners. Overall, the study proposes specific markers and low-frequency variants that might help (i) to understand perturbed biological processes in vascular tissues contributing to MS disease, and (ii) to characterize MS susceptibility genes for functional association with disease-pathways.
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Affiliation(s)
- Chiara Scapoli
- Department of Life Science and Biotechnology, University of Ferrara, 44121 Ferrara, Italy; (C.S.); (B.L.); (M.B.)
| | - Nicole Ziliotto
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Barbara Lunghi
- Department of Life Science and Biotechnology, University of Ferrara, 44121 Ferrara, Italy; (C.S.); (B.L.); (M.B.)
| | - Erica Menegatti
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (P.Z.)
| | - Fabrizio Salvi
- Center for Immunological and Rare Neurological Diseases, IRCCS of Neurological Sciences, Bellaria Hospital, 40139 Bologna, Italy;
| | - Paolo Zamboni
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (P.Z.)
| | - Marcello Baroni
- Department of Life Science and Biotechnology, University of Ferrara, 44121 Ferrara, Italy; (C.S.); (B.L.); (M.B.)
| | - Francesco Mascoli
- Unit of Vascular and Endovascular Surgery, S. Anna University-Hospital, 44124 Ferrara, Italy;
| | - Francesco Bernardi
- Department of Life Science and Biotechnology, University of Ferrara, 44121 Ferrara, Italy; (C.S.); (B.L.); (M.B.)
- Correspondence: ; Tel.: +39-0532-974425
| | - Giovanna Marchetti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy;
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Sessa F, Salerno M, Esposito M, Di Nunno N, Zamboni P, Pomara C. Autopsy Findings and Causality Relationship between Death and COVID-19 Vaccination: A Systematic Review. J Clin Med 2021; 10:jcm10245876. [PMID: 34945172 PMCID: PMC8709364 DOI: 10.3390/jcm10245876] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 01/02/2023] Open
Abstract
The current challenge worldwide is the administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Considering that the COVID-19 vaccination represents the best possibility to resolve this pandemic, this systematic review aims to clarify the major aspects of fatal adverse effects related to COVID-19 vaccines, with the goal of advancing our knowledge, supporting decisions, or suggesting changes in policies at local, regional, and global levels. Moreover, this review aims to provide key recommendations to improve awareness of vaccine safety. All studies published up to 2 December 2021 were searched using the following keywords: “COVID-19 Vaccine”, “SARS-CoV-2 Vaccine”, “COVID-19 Vaccination”, “SARS-CoV-2 Vaccination”, and “Autopsy” or “Post-mortem”. We included 17 papers published with fatal cases with post-mortem investigations. A total of 38 cases were analyzed: 22 cases were related to ChAdOx1 nCoV-19 administration, 10 cases to BNT162b2, 4 cases to mRNA-1273, and 2 cases to Ad26.COV2.S. Based on these data, autopsy is very useful to define the main characteristics of the so-called vaccine-induced immune thrombotic thrombocytopenia (VITT) after ChAdOx1 nCoV-19 vaccination: recurrent findings were intracranial hemorrhage and diffused microthrombi located in multiple areas. Moreover, it is fundamental to provide evidence about myocarditis related to the BNT162B2 vaccine. Finally, based on the discussed data, we suggest several key recommendations to improve awareness of vaccine safety.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.S.); (M.E.)
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.S.); (M.E.)
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Paolo Zamboni
- Vascular Diseases Center, Hub Center for Venous and Lymphatic Diseases Regione Emilia-Romagna, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy;
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.S.); (M.E.)
- Correspondence: ; Tel.: +39-095-3782-153 or +39-333-2466-148
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20
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Scerrati A, Travaglini F, Gelmi CAE, Lombardo A, De Bonis P, Cavallo MA, Zamboni P. Patient specific Polymethyl methacrylate customised cranioplasty using 3D printed silicone moulds: Technical note. Int J Med Robot 2021; 18:e2353. [PMID: 34786816 PMCID: PMC9285906 DOI: 10.1002/rcs.2353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/12/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Cranioplasty after decompressive craniectomy can be performed with several techniques and materials. With the common use of 3D printing, custom cranioplasty can be produced at affordable cost. Aim of this technical note is to describe our technique for producing patient specific Polymethyl methacrylate (PMMA) cranioplasty using 3D printed silicone moulds. MATERIALS AND METHODS We enrolled seven patients from January 2020 to June 2021 who required surgery for cranioplasty. The 3D printing was used to produce silicone moulds for defining the exact shape of the PMMA cranioplasty, according to the CT scan of the patient. RESULTS We performed seven procedures. The mean time of the surgery was 80 min. All cranioplasties perfectly matched the patient specific anatomy. No complications occurred. CONCLUSIONS Using 3D printed patient specific silicone moulds and PMMA resulted to be effective, with affordable costs and ensuring a good cosmetic result.
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Affiliation(s)
- Alba Scerrati
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy.,3D Bioprinting Laboratory, University of Ferrara, Ferrara, Italy
| | - Francesco Travaglini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Clarissa Ann Elisabeth Gelmi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Andrea Lombardo
- 3D Bioprinting Laboratory, University of Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Michele Alessandro Cavallo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,3D Bioprinting Laboratory, University of Ferrara, Ferrara, Italy.,Hub Center for Venous and Lymphatic Diseases Regione Emilia-Romagna, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
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21
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Lamberti N, Caruso L, Piva G, Traina L, Ficarra V, Zamboni P, Gasbarro V, Manfredini F. Beyond the Patient's Report: Self-Reported, Subjective, Objective and Estimated Walking Disability in Patients with Peripheral Artery Disease. Diagnostics (Basel) 2021; 11:diagnostics11111991. [PMID: 34829337 PMCID: PMC8623461 DOI: 10.3390/diagnostics11111991] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/24/2022] Open
Abstract
Among patients with peripheral artery disease, an altered estimation of walking ability reported to the physician may influence the choice of treatment. We compared claudication distance (CD) values reported by patients or assessed by validated protocols to elaborate a formula capable of estimating more reliable values. Three hundred fifty-nine patients with claudication were measured at the time of entry into a rehabilitation program. Walking performance was obtained by patients' reports (self-reported claudication distance, SR-CD) and was directly assessed to determine the claudication and maximal walking distance by the 6-min test (6-CD and 6-MWD) and an incremental treadmill test (T-CD and T-MWD). The degree of muscle deoxygenation was objectively determined at the calf by near-infrared spectroscopy (NIRS) during the treadmill test. Among the 289 subjects analyzed, SR-CD exceeded both 6-CD and T-CD (+155 and +182 m, respectively). SR-CD was moderately correlated with T-CD (r = 0.30), 6-CD (r = 0.32), and 6-MWD (r = 0.29) but not with muscle deoxygenation per meter walked, unlike T-CD and 6-CD. A formula adjusted for the presence of diabetes reduced patient overestimation by 92%. The patient's reported claudication distance was generally overestimated compared to objective measures, and it was made more reliable through a corrective factor for easy use in a clinical setting.
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Affiliation(s)
- Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (L.C.)
| | - Lorenzo Caruso
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (L.C.)
| | - Giovanni Piva
- PhD Program in Environmental Sustainability and Wellbeing, University of Ferrara, Via Paradiso 12, 44121 Ferrara, Italy;
| | - Luca Traina
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (L.T.); (V.F.); (V.G.)
| | - Valentina Ficarra
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (L.T.); (V.F.); (V.G.)
| | - Paolo Zamboni
- Vascular Diseases Center, Department of Translational Medicine for Romagna, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy;
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (L.T.); (V.F.); (V.G.)
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64, 44121 Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (L.C.)
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
- Correspondence: ; Tel.: +39-053-223-6187
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22
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Scerrati A, De Bonis P, Zamboni P, Dones F, Fontanella M, Cenzato M, Visani J, Bianchi F, Zanin L, Cavallo MA, Sturiale CL. A New Insight in Nonaneurysmal Subarachnoid Hemorrhage: the Potential Role of the Internal Jugular Veins. J Neurol Surg A Cent Eur Neurosurg 2021; 83:344-350. [PMID: 34687035 DOI: 10.1055/s-0041-1733895] [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: 10/20/2022]
Abstract
BACKGROUND Causes of the nonaneurysmal subarachnoid hemorrhage (na-SAH) are still debated. Many studies confirmed the possible involvement of the intracranial venous system, in particular variants of the basal vein of Rosenthal. STUDY OBJECT The aim of this study is to investigate the role of extracranial venous system, in particular the jugular drainage, in the na-SAH pathophysiology. MATERIALS AND METHODS This is a multicenter retrospective study including patients suffering from na-SAH who were radiologically screened to exclude vascular malformations. The course of the internal jugular veins was evaluated to reveal any stenosis (caliber reduction >80%). Particular attention was paid at the passage between the styloid process and the arch of C1 to detect possible compression. As a control group, we enrolled patients who underwent CT angiograms and/or cerebral DSAs in the past 2 years. RESULTS We included 194 patients. The na-SAH group consisted of 94 patients, whereas the control group consisted of 100 patients. Fifty patients of the control group underwent a CT angiography for an ischemic cerebrovascular disease or trauma and 50 patients for an SAH due to a ruptured aneurysm. A significant jugular stenosis was found in 49 (52.1%) patients in the na-SAH group and in 18 (18%) patients in the control group. At univariate and multivariate analysis, the difference was statistically significant (p < 0.0001). CONCLUSIONS This is the first study investigating the correlation between jugular stenosis and the occurrence of na-SAH. The impaired venous outflow due to reduced venous caliber could result in an engorgement of the upstream intracranial veins with transient hypertensive phases facilitating ruptures. Further larger prospective studies are necessary to confirm these data.
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Affiliation(s)
- Alba Scerrati
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Paolo Zamboni
- Department of Vascular Surgery, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Flavia Dones
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Marco Fontanella
- Neurosurgery Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, Brescia, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Ospedale Niguarda Ca Granda, Milano, Lombardia, Italy
| | - Jacopo Visani
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Federico Bianchi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Zanin
- Department of Neurosurgery, University of Brescia, Brescia, Lombardia, Italy
| | - Michele Alessandro Cavallo
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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23
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Menegatti E, Mandini S, Chi YW, Mazzoni G, Pagani A, Malagoni AM, Tessari M, Costa AL, Avruscio G, Zamboni P, Gianesini S. Physical fitness changes induced by thermal aquatic standardized exercise in chronic venous disease patients. Phlebology 2021; 37:134-142. [PMID: 34633888 DOI: 10.1177/02683555211051962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lack of physical activity represents a risk factor for both cardiovascular and chronic venous diseases (CVD), nevertheless a specific exercise protocol for CVD patient is still missing. This investigation was aimed to assess the impact of a standardized exercise protocol in a thermal water environment on physical fitness and quality-of-life (QoL) in CVD patients. METHODS Sixteen (16) CVD patients performed 5 standardized exercise sessions in a thermal water pool. Before starting the exercise protocol, the cohort filled International Physical Activity Questionnaire (IPAQ) to determine their physical activity level. At baseline and at the end of the exercise program, leg volume, QoL, musculoskeletal and cardiovascular physical fitness were assessed by means of water plethysmography, validated questionnaire and functional test, blood pressure and heart rate at rest were also reported. RESULTS All the patients were categorized as physically inactive: average activity time 235.6 (155.2) MET-minutes per week. At the end of the study, a significant leg volume reduction was found (-16%; p < .002). Significant improvement in lower limb strength (p < .0001), endurance (p < .006), rapidity and balance (p < .05) together with decrease in resting heart rate (-1.8%, p < .0001) and systolic blood pressure (-1.1%, p < .04) were reported, significant improvement in bodily pain (p < .0005) and social function (p < .002) QoL items were observed. CONCLUSIONS The proposed exercise protocol in thermal aquatic environment demonstrated to be an effective treatment modality improving both cardiovascular and musculoskeletal outcomes and QoL in sedentary CVD patients. Aquatic environment investigations require proper analysis of the various factors involved, in a standardized and reproducible way. The herein report can be a reference for further studies on different health related conditions.
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Affiliation(s)
- Erica Menegatti
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Yung-Wei Chi
- Division of Cardiovascular Medicine, Vascular Center, University of California Davis, Davis, CA, USA
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Anselmo Pagani
- Mini-invasive Venous Surgery Unit, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Ferrara, Italy
| | - Anna Maria Malagoni
- Mini-invasive Venous Surgery Unit, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Ferrara, Italy
| | - Mirko Tessari
- Mini-invasive Venous Surgery Unit, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Ferrara, Italy
| | - Alfio Luca Costa
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Giampiero Avruscio
- Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Paolo Zamboni
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Mini-invasive Venous Surgery Unit, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Ferrara, Italy
| | - Sergio Gianesini
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Mini-invasive Venous Surgery Unit, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Ferrara, Italy.,Department of Surgery, 1685Uniformed Services University of the Health Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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24
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Ascanelli S, Zamboni P, Campioni D, Grazia Sibilla M, Chimisso L, Zollino I, Valpiani G, Carcoforo P. Efficacy and Safety of Treatment of Complex Idiopathic Fistula-in-Ano Using Autologous Centrifuged Adipose Tissue Containing Progenitor Cells: A Randomized Controlled Trial. Dis Colon Rectum 2021; 64:1276-1285. [PMID: 34016825 DOI: 10.1097/dcr.0000000000001924] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mesenchymal stem cells derived from adipose tissue have been successfully used to promote sphincter-saving anal fistula healing. OBJECTIVE The aim of this study was to evaluate the efficacy and safety of the use of autologous centrifuged adipose tissue in the healing process of cryptoglandular complex anal fistulas. DESIGN This is a randomized controlled trial. SETTINGS This study was conducted at a single center. PATIENTS Patients with complex perianal fistulas not associated with Crohn's disease were included. Rectovaginal fistulas were not included. INTERVENTIONS Patients were randomly allocated to receive treatment with centrifuged adipose tissue injection (experimental group) and without injection (control group) in combination with fistula surgery. MAIN OUTCOME MEASURES The primary outcome was defined as the proportion of patients with complete fistula closure at 4 weeks (short-term outcome) and 6 months after surgery (long-term outcome). Healing was defined as when the external opening was closed with no perianal discharge on clinical assessment. The secondary outcome was safety that was evaluated by the analysis of adverse events up to 3 months after surgery. Pelvic MRI was performed at 3 months to assure safety and the accuracy of the clinical determination of healing. Postoperative pain, return to work/daily activities, persistent closure at 6 months, fecal incontinence, and patient satisfaction were evaluated. RESULTS Fifty-eight patients who received centrifuged adipose tissue injection and 58 patients who did not receive centrifuged adipose tissue injection were included in the safety and efficacy analysis. After 4 weeks, the healing rate was 63.8% in the experimental group compared with 15.5% in the control group (p < 0.001). No major adverse events were recorded. Postoperative anal pain was significantly lower in the injection group. Time taken to return to work/daily activities was significantly shorter in the experimental group (3 days) than in the control group (17 days). At 6 months, persistent closure was similar in the 2 groups (86.2% vs 81%). Fecal Incontinence Score at 6 months after surgery was identical to the preoperative score. Patient satisfaction was high in both groups. LIMITATIONS The absence of blinding, the lack of correlation between stem cell content, and the clinical outcome were limitations of the study. CONCLUSIONS Autologous centrifuged adipose tissue injection may represent a safe, efficacious, and inexpensive option for the treatment of complex fistula-in-ano. See Video Abstract at http://links.lww.com/DCR/B607. CLINICAL TRIALS REGISTRATION URL: https://www.clinicaltrials.gov. Identifier: NCT04326907. EFICACIA Y SEGURIDAD DEL TRATAMIENTO DE LA FSTULA ANAL COMPLEJA IDIOPTICA UTILIZANDO TEJIDO ADIPOSO CENTRIFUGADO AUTLOGO QUE CONTIENE CLULAS PROGENITORAS UN ENSAYO CONTROLADO ALEATORIO ANTECEDENTES:Las células madre mesenquimales derivadas del tejido adiposo se han utilizado con éxito para promover la curación de la fístula anal con preservación de esfínter.OBJETIVO:El objetivo de este estudio fue evaluar la eficacia y seguridad del uso de tejido adiposo autólogo centrifugado en el proceso de cicatrización de fístulas anales complejas de origen criptoglandular.DISEÑO:Ensayo controlado aleatorio.ENTORNO CLÍNICO:Estudio unicéntrico.PACIENTES:Se incluyeron pacientes con fístulas perianales complejas no asociadas a Enfermedad de Crohn. No se incluyeron las fístulas rectovaginales.INTERVENCIONES:Los pacientes fueron asignados aleatoriamente para recibir tratamiento con inyección de tejido adiposo centrifugado (grupo experimental) y sin inyección (grupo de control) en combinación con cirugía de fístula.PRINCIPALES MEDIDAS DE VALORACIÓN:El resultado primario se definió como la proporción de pacientes con cierre completo de la fístula a las 4 semanas (resultado a corto plazo) y 6 meses después de la cirugía (resultado a largo plazo). La curación se definió cuando orificio externo se cerró sin secreción perianal en la valoración clínica. El resultado secundario fue la seguridad que se evaluó mediante el análisis de los eventos adversos (EA) hasta 3 meses después de la cirugía. La resonancia magnética pélvica se realizó a los 3 meses para garantizar la seguridad y la precisión clínica de la curación. Se evaluó el dolor postoperatorio, el regreso al trabajo / actividades diarias, el cierre persistente a los 6 meses, la incontinencia fecal y la satisfacción del paciente.RESULTADOS:Cincuenta y ocho pacientes que recibieron inyección de tejido adiposo centrifugado y 58 pacientes que no recibieron inyección de tejido adiposo centrifugado se incluyeron en el análisis de seguridad y eficacia. Después de 4 semanas, la tasa de curación fue del 63,8% en el grupo experimental en comparación con el 15,5% en el grupo de control (p <0,001). No se registraron eventos adversos importantes. El dolor anal posoperatorio fue significativamente menor en el grupo de inyección. El tiempo necesario para volver al trabajo / actividades diarias fue significativamente menor en el grupo experimental (3 días) con respecto al grupo de control (17 días). A los 6 meses, el cierre persistente fue similar en los dos grupos (86,2% vs 81%). La puntuación de incontinencia fecal a los 6 meses después de la cirugía fue idéntica a la puntuación preoperatoria. La satisfacción del paciente fue muy alta en ambos grupos.LIMITACIONES:Ausencia de cegamiento, falta de correlación entre el contenido de células madre y el resultado clínico.CONCLUSIONES:La inyección de tejido adiposo centrifugado autólogo puede representar una opción segura, eficaz y económica para el tratamiento de la fístula anal compleja.Registro de ensayos clínicos: www.clinicaltrials.gov, identificador NCT04326907; No patrocinado.Consulte Video Resumen en http://links.lww.com/DCR/B607.
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Affiliation(s)
- Simona Ascanelli
- Department of Morphology, Surgery and Experimental Medicine, Section General Surgery, University of Ferrara, Italy
| | - Paolo Zamboni
- Department of Morphology, Surgery and Experimental Medicine, Section of Translational of Medicine and Surgery, University of Ferrara, Italy
| | - Diana Campioni
- Provincial Unique Laboratory Department, University Hospital Ferrara, Italy
| | - Maria Grazia Sibilla
- Department of Morphology, Surgery and Experimental Medicine, Section General Surgery, University of Ferrara, Italy
| | - Laura Chimisso
- Department of Morphology, Surgery and Experimental Medicine, Section General Surgery, University of Ferrara, Italy
| | - Ilaria Zollino
- Department of Morphology, Surgery and Experimental Medicine, Section of Translational of Medicine and Surgery, University of Ferrara, Italy
| | - Giorgia Valpiani
- Research Innovation Quality and Accreditation Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Paolo Carcoforo
- Department of Morphology, Surgery and Experimental Medicine, Section General Surgery, University of Ferrara, Italy
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25
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Beggs C, Zamboni P. The investigation of the cerebral venous system in multiple sclerosis. Mult Scler Relat Disord 2021; 56:103234. [PMID: 34496325 DOI: 10.1016/j.msard.2021.103234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 08/29/2021] [Indexed: 11/15/2022]
Abstract
Bateman et al. (2021) shows that multiple sclerosis (MS) is strongly associated with raised pressure in the superior sagittal sinus (SSS) and increased jugular bulb height above the sigmoid sinus. These findings are consistent with an increased aqueductal CSF pulse, as previously described in MS. They reinforce the hypothesis that intracranial compliance is reduced in MS and that internal jugular vein abnormalities contribute to SSS hypertension. However, the contribution of this to the pathophysiology of MS has not been established. Further investigation is therefore needed to determine what role, if any, these changes play in the complex puzzle of MS.
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Affiliation(s)
- Clive Beggs
- School of Sport, Leeds Beckett University, Leeds, UK.
| | - Paolo Zamboni
- Department of Translational Medicine for Romagna, University of Ferrara, Ferrara, Italy
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26
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Menegatti E, Masiero S, Zamboni P, Avruscio G, Tessari M, Gianesini S. Reply. J Vasc Surg Venous Lymphat Disord 2021; 9:1348-1350. [PMID: 34399940 DOI: 10.1016/j.jvsv.2021.03.007] [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] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Erica Menegatti
- Vascular Diseases Center Unit, University of Ferrara, Ferrara, Italy
| | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Paolo Zamboni
- Vascular Diseases Center Unit, University of Ferrara, Ferrara, Italy
| | - Giampiero Avruscio
- Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua University Hospital, Padua, Italy
| | - Mirko Tessari
- Vascular Diseases Center Unit, University of Ferrara, Ferrara, Italy
| | - Sergio Gianesini
- Vascular Diseases Center Unit, University of Ferrara, Ferrara, Italy; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Italy
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Bressan M, Tessari M, Cosacco AM, Zamboni P. Mondor’s disease of the penis due to asymptomatic infective prostatitis provoking episodes of secondary sclerotizing lymphangitis. Veins and Lymphatics 2021. [DOI: 10.4081/vl.2021.9863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mondor’s disease of the penis is an under-reported condition caused by superficial thrombophlebitis of the dorsal vein or thrombosis of the deep venous network of the penis. This is a benign, self-limiting condition, characterized by a sudden, indurated swelling of the aforementioned veins. The possible causes comprise traumatism, neoplasms, excessive sexual activity, or coagulation inherited deficit. An accompanied lymphangitis is discussed, eventually as a distinct variety. The differential diagnosis must be established by the means of ultrasound, which is the imaging diagnostic technique of choice. We describe the case of Mondor’s sclerotizing lymphangitis secondary to recurrent episodes of genitourinary infection previously diagnosed as recurrent superficial Mondor thrombophlebitis of the penis.
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Lamberti N, Straudi S, Manfredini R, De Giorgi A, Gasbarro V, Zamboni P, Manfredini F. Don't stop walking: the in-home rehabilitation program for peripheral artery disease patients during the COVID-19 pandemic. Intern Emerg Med 2021; 16:1307-1315. [PMID: 33411263 PMCID: PMC7788170 DOI: 10.1007/s11739-020-02598-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
We studied the outcomes of peripheral artery disease (PAD) patients enrolled in a structured in-home walking program right before the lockdown due to the SARS-CoV-2 epidemic emergency, to determine whether this intervention ensured the maintenance of mobility even in the case of movement restrictions.We selectively studied 83 patients (age 72 ± 11, males n = 65) enrolled in the program within 9-month before the lockdown. The usual intervention was based on two daily 8-min sessions of slow intermittent in-home walking prescribed in circa-monthly hospital visits. During the lockdown, the program was updated by phone. Six-minute (6MWD) and pain-free walking distance (PFWD) were measured pre- and post-lockdown as well as body weight (BW), blood pressure (BP), and ankle-brachial index (ABI). Sixty-six patients were measured 117 ± 23 days after their previous visit. A safe, pain-free execution of the prescribed sessions was reported (median distance: 74 km). Overall, the 6MWD was stable, while PFWD improved (p < 0.001). The improvement was not related to age/gender, comorbidities, type of home but to the time of enrollment before lockdown. The new-entry subjects (≤ 3 months; n = 35) obtained significant improvements post-lockdown for 6MWD and PFWD, while those previously enrolled (> 3 months; n = 31) were stable. Decreased BW with stable BP and ABI values were also recorded, with better outcomes for new-entry subjects. In PAD patients, a structured walking program performed inside home and purposely guided by phone was adhered to by patients and favored mobility and risk factor control during the COVID-19 pandemic, regardless of walking ability, type of home and external conditions.
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Affiliation(s)
- Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Sofia Straudi
- Rehabilitation Medicine Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Roberto Manfredini
- Department of Medical Sciences, Clinical Medicine Unit, University Hospital of Ferrara, University of Ferrara, via Aldo Moro 8, 44123, Cona, Ferrara, Italy.
| | - Alfredo De Giorgi
- Department of Medical Sciences, Clinical Medicine Unit, University Hospital of Ferrara, University of Ferrara, via Aldo Moro 8, 44123, Cona, Ferrara, Italy
| | - Vincenzo Gasbarro
- Department of Medical Sciences, Vascular Surgery Unit, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Rehabilitation Medicine Unit, University Hospital of Ferrara, Ferrara, Italy
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29
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Pomara C, Sessa F, Ciaccio M, Dieli F, Esposito M, Garozzo SF, Giarratano A, Prati D, Rappa F, Salerno M, Tripodo C, Zamboni P, Mannucci PM. Post-mortem findings in vaccine-induced thrombotic thombocytopenia. Haematologica 2021; 106:2291-2293. [PMID: 34011138 PMCID: PMC8327725 DOI: 10.3324/haematol.2021.279075] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Indexed: 01/01/2023] Open
Affiliation(s)
- Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, University of Catania
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia
| | - Marcello Ciaccio
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Bio-medicine, Neurosciences and Advanced Diagnostics, University of Palermo, Italy; Department of Laboratory Medicine, AOUP "P. Giaccone", Palermo, 90127
| | - Francesco Dieli
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), University of Palermo
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, University of Catania
| | | | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy; Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo
| | - Daniele Prati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Blood Transfusion Center, Milan
| | - Francesca Rappa
- Department of Biomedicine and Neurosciences and Advanced Diagnostics, University of Palermo
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, University of Catania
| | - Claudio Tripodo
- Tumor Immunology Unit, Department of Health Sciences, University School of Medicine of Palermo
| | - Paolo Zamboni
- Vascular Diseases Center, Mini-invasive Venous Surgery Unit, University of Ferrara
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Blood Transfusion Center, Milan.
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Abstract
Historically, the stents used in the venous system were not dedicated scaffolds. They were largely adapted arterial stents. An essential feature of a venous stent is compliance, in order to adapt its crosssectional area to the vein. It should also be crush resistant, corrosion resistant and fatigue resistant. The material should be radiopaque, for follow-up. Another characteristic of the ideal venous stent is flexibility, to adapt its shape to the vein, not vice versa. The scaffold should be uncovered too, in order to avoid the occlusion of collaterals. The ideal venous stent should not migrate, so it is necessary a large diameter and a long length. The radial force is important to prevent migration. However, current stents derived from arterial use display high radial force, which could affect the patency of the thin venous wall. Alternatively, if the stent has an anchor point, that permits a passive anchoring, the radial force required to avoid migration will be lower. Dedicated venous stents were not available until very recently. Furthermore, there is a preclinical study about a new compliant nitinol stent, denominated Petalo CVS. Out of the commonest causes of large veins obstruction, dedicated venous stent could also treat other diseases described more recently, such as the jugular variant of the Eagle syndrome, JEDI syndrome and jugular lesions of the chronic cerebrospinal venous insufficiency that result unfavorable for angioplasty according to Giaquinta classification.
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Haacke EM, Ge Y, Sethi SK, Buch S, Zamboni P. An Overview of Venous Abnormalities Related to the Development of Lesions in Multiple Sclerosis. Front Neurol 2021; 12:561458. [PMID: 33981281 PMCID: PMC8107266 DOI: 10.3389/fneur.2021.561458] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 03/26/2021] [Indexed: 12/21/2022] Open
Abstract
The etiology of multiple sclerosis (MS) is currently understood to be autoimmune. However, there is a long history and growing evidence for disrupted vasculature and flow within the disease pathology. A broad review of the literature related to vascular effects in MS revealed a suggestive role for abnormal flow in the medullary vein system. Evidence for venous involvement in multiple sclerosis dates back to the early pathological work by Charcot and Bourneville, in the mid-nineteenth century. Pioneering work by Adams in the 1980s demonstrated vasculitis within the walls of veins and venules proximal to active MS lesions. And more recently, magnetic resonance imaging (MRI) has been used to show manifestations of the central vein as a precursor to the development of new MS lesions, and high-resolution MRI using Ferumoxytol has been used to reveal the microvasculature that has previously only been demonstrated in cadaver brains. Both approaches may shed new light into the structural changes occurring in MS lesions. The material covered in this review shows that multiple pathophysiological events may occur sequentially, in parallel, or in a vicious circle which include: endothelial damage, venous collagenosis and fibrin deposition, loss of vessel compliance, venous hypertension, perfusion reduction followed by ischemia, medullary vein dilation and local vascular remodeling. We come to the conclusion that a potential source of MS lesions is due to locally disrupted flow which in turn leads to remodeling of the medullary veins followed by endothelial damage with the subsequent escape of glial cells, cytokines, etc. These ultimately lead to the cascade of inflammatory and demyelinating events which ensue in the course of the disease.
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Affiliation(s)
- E. Mark Haacke
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Yulin Ge
- Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, New York, NY, United States
| | - Sean K. Sethi
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Sagar Buch
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy
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32
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Scerrati A, Norri N, Mongardi L, Dones F, Ricciardi L, Trevisi G, Menegatti E, Zamboni P, Cavallo MA, De Bonis P. Styloidogenic-cervical spondylotic internal jugular venous compression, a vascular disease related to several clinical neurological manifestations: diagnosis and treatment-a comprehensive literature review. Ann Transl Med 2021; 9:718. [PMID: 33987416 PMCID: PMC8106058 DOI: 10.21037/atm-20-7698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Internal jugular vein (IJV) stenosis is associated with several central nervous system disorders such as Ménière or Alzheimer’s disease. The extrinsic compression between the styloid process and the C1 transverse process, is an emerging biomarker related to several clinical manifestations. However, nowadays a limited number of cases are reported, and few information are available about treatment, outcome and complications. Our aim is to collect and identify clinical-radiological characteristics, diagnosis and treatment of the styloidogenic internal jugular venous compression. We performed a comprehensive literature review. Studies reporting patients suffering from extracranial jugular stenosis were searched. For every patient we collected: demography, clinical and radiological characteristics and outcome, type of treatment, complications. Thirteen articles reporting 149 patients were included. Clinical presentation was non-specific. Most frequent symptoms were headache (46.3%), tinnitus (43.6%), insomnia (39.6%). The stenosis was monolateral in 51 patients (45.9%) and bilateral in 60 (54.1%). Anticoagulants were the most common prescribed drug (57.4%). Endovascular treatment was performed in 50 patients (33.6%), surgery in 55 (36.9%), combined in 28 (18.8%). Improvement of general conditions was reported in 58/80 patients (72.5%). Complications were reported in 23% of cases. Jugular stenosis is a complex and often underestimated disease. Conservative medical treatment usually fails while surgical, endovascular or a combined treatment improves general conditions in more than 70% of patients.
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Affiliation(s)
- Alba Scerrati
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Nicoló Norri
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy
| | - Lorenzo Mongardi
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy
| | - Flavia Dones
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy
| | - Luca Ricciardi
- Neurosurgery, Azienda Ospedaliera Sant'Andrea, Sapienza, Rome, Italy
| | | | - Erica Menegatti
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.,HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.,HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Michele Alessandro Cavallo
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
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Zamboni P. Vascular Biomarkers: Physics Parameters and Circulating Molecules Can Be Two Faces of the Same Coin. Diagnostics (Basel) 2021; 11:diagnostics11020217. [PMID: 33540677 PMCID: PMC7912994 DOI: 10.3390/diagnostics11020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
The arterial, venous and lymphatic conduits of human circulation are a fascinating field of research [...].
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Affiliation(s)
- Paolo Zamboni
- Department of Surgery, Vascular Disease Centre University Hospital of Ferrara, 44124 Cona, Italy
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34
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Franceschi C, Cappelli M, Pinelli M, Zamboni P. Transmural pressure for conceptualisation of chronic venous insufficiency management. Phlebology 2020; 36:243-244. [PMID: 33270505 DOI: 10.1177/0268355520974865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Mauro Pinelli
- Service of Angiology, Avezzano Hospital, Avezzano, Italy
| | - Paolo Zamboni
- Vascular Diseases Center, Center of Excellence for Venous and Lymphatic Disorders, Regione Emilia-Romagna, University of Ferrara, Ferrara, Italy
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35
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Guarnera G, Zamboni P, Nelzen O, Mannello F, Andriessen A. Pending questions in venous ulcers management. Report from a Symposium of the World Union of Wound Healing Societies International Congress. Veins and Lymphatics 2020. [DOI: 10.4081/vl.2020.9206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Venous ulcers represent the most frequent ulcers and have a high clinical and socioeconomic significance. Nevertheless, pending questions remain on epidemiology, genetic and biomolecular mechanisms, contraindications and risk factors of compression therapy, role of pharmacological therapy. Overall prevalence in the range of 1-2% and point prevalence of 0.08-0.6% can be reduced if risk factors are identified and treated early. In this context, analysis of factor XIII and hemocromatosis gene polymorphisms, with the C282Y and H63D variants, may be of great importance. Also MMP12 gene polymorphism and the imbalance between matrix metalloproteinases and their tissue inhibitors are able to impair wound healing via deleterious degradation process of extra-cellular matrix. From a therapeutic point of view, conflicting recommendations exist on relative contraindications, risks and adverse events of compression therapy. Some studies showed that the administration of pentoxyphilline, Micronized purified flavonoid fraction (MPFF) and sulodexide was effective in accelerating ulcer healing, but there is no data on the duration of treatment, recurrence rates and cost-effectiveness relationship.
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36
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Zamboni P, Malagoni AM, Menegatti E, Ragazzi R, Tavoni V, Tessari M, Beggs CB. Central venous pressure estimation from ultrasound assessment of the jugular venous pulse. PLoS One 2020; 15:e0240057. [PMID: 33112871 PMCID: PMC7592775 DOI: 10.1371/journal.pone.0240057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/17/2020] [Indexed: 01/21/2023] Open
Abstract
Objectives Acquiring central venous pressure (CVP), an important clinical parameter, requires an invasive procedure, which poses risk to patients. The aim of the study was to develop a non-invasive methodology for determining mean-CVP from ultrasound assessment of the jugular venous pulse. Methods In thirty-four adult patients (age = 60 ± 12 years; 10 males), CVP was measured using a central venous catheter, with internal jugular vein (IJV) cross-sectional area (CSA) variation along the cardiac beat acquired using ultrasound. The resultant CVP and IJV-CSA signals were synchronized with electrocardiogram (ECG) signals acquired from the patients. Autocorrelation signals were derived from the IJV-CSA signals using algorithms in R (open-source statistical software). The correlation r-values for successive lag intervals were extracted and used to build a linear regression model in which mean-CVP was the response variable and the lagging autocorrelation r-values and mean IJV-CSA, were the predictor variables. The optimum model was identified using the minimum AIC value and validated using 10-fold cross-validation. Results While the CVP and IJV-CSA signals were poorly correlated (mean r = -0.018, SD = 0.357) due to the IJV-CSA signal lagging behind the CVP signal, their autocorrelation counterparts were highly positively correlated (mean r = 0.725, SD = 0.215). Using the lagging autocorrelation r-values as predictors, mean-CVP was predicted with reasonable accuracy (r2 = 0.612), with a mean-absolute-error of 1.455 cmH2O, which rose to 2.436 cmH2O when cross-validation was performed. Conclusions Mean-CVP can be estimated non-invasively by using the lagged autocorrelation r-values of the IJV-CSA signal. This new methodology may have considerable potential as a clinical monitoring and diagnostic tool.
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Affiliation(s)
- Paolo Zamboni
- HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Anna Maria Malagoni
- HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Erica Menegatti
- HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Valentina Tavoni
- HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Mirko Tessari
- HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Clive B. Beggs
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
- * E-mail:
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37
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Scerrati A, De Bonis P, Zamboni P. Letter to the Editor Regarding "Styloidectomy and Venous Stenting for Treatment of Styloid-Induced Internal Jugular Vein Stenosis: A Case Report and Literature Review". World Neurosurg 2020; 139:697. [PMID: 32689686 DOI: 10.1016/j.wneu.2020.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Alba Scerrati
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | - Pasquale De Bonis
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy; Vascular Diseases Center, Translational Surgery Unit, University of Ferrara, Ferrara, Italy
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38
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Scerrati A, Zamboni P, De Bonis P. Letter: C1 Transverse Process Resection for Management of Jugular Stenosis. Oper Neurosurg (Hagerstown) 2020; 19:E465. [PMID: 32629482 DOI: 10.1093/ons/opaa200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alba Scerrati
- Department of Neurosurgery S. Anna University Hospital Ferrara, Italy.,Department of Morphology Surgery and Experimental Medicine University of Ferrara Ferrara, Italy
| | - Paolo Zamboni
- Department of Morphology Surgery and Experimental Medicine University of Ferrara Ferrara, Italy.,Vascular Diseases Center Translational Surgery Unit University of Ferrara Ferrara, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery S. Anna University Hospital Ferrara, Italy.,Department of Morphology Surgery and Experimental Medicine University of Ferrara Ferrara, Italy
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39
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Zamboni P. Phlebology in art. Veins and Lymphatics 2020. [DOI: 10.4081/vl.2020.9254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper is part of the monographic issue: ‘Did the Masters of the past know the future? History and update of Italian Phlebolymphology’
Guest editor: Alberto Macciò (Phlebology - Part I edited by G. Agus; Phlebology - Part II edited by P. Bonadeo; Lymphology edited by F. Boccardo)
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40
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Gianesini S, Raffetto JD, Mosti G, Maietti E, Sibilla MG, Zamboni P, Menegatti E. Volume control of the lower limb with graduated compression during different muscle pump activation conditions and the relation to limb circumference variation. J Vasc Surg Venous Lymphat Disord 2020; 8:814-820. [DOI: 10.1016/j.jvsv.2019.12.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022]
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41
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Gianesini S, Menegatti E, Occhionorelli S, Grazia Sibilla M, Mucignat M, Zamboni P. Segmental saphenous ablation for chronic venous disease treatment. Phlebology 2020; 36:63-69. [PMID: 32746725 DOI: 10.1177/0268355520946238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovenous thermal ablation for chronic venous disease treatment is recommended over traditional surgery. The present investigation compares endovenous laser ablation (EVLA) with radiofrequency (RF) for segmental endovenous sapheno-femoral junction ablation. METHODS This is a retrospective study in which 79 patients underwent a 6 cm great saphenous vein ablation by RF or by EVLA.Primary outcome was occlusion rate. Secondary outcomes included Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ) score, peri-procedural pain, aesthetic satisfaction. RESULTS At 12 ± 1 months recanalization of shrunk tract was recorded in 5/85 (5.8%) cases (2 RF, 3 EVLA) [OR: 1.6; 95%CI: 0.2-10.4; P = 0.6689]. Two cases (1/44 RF group and 1/38 EVLA group) also showed reflux recurrence [OR: 1.0; 95%CI: 0.06-17.8; P = 1.0000]. No significant differences between groups were found in AVVQ, VCSS, peri-procedural pain, or aesthetic satisfaction. CONCLUSION Saphenous sparing is feasible and effective by means of both EVLA and RF, representing a possible alternative to surgery.
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Affiliation(s)
- Sergio Gianesini
- Vascular Diseases Center-Mini-invasive Venous Surgery Unit, University of Ferrara, Ferrara, Italy.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Erica Menegatti
- Vascular Diseases Center-Mini-invasive Venous Surgery Unit, University of Ferrara, Ferrara, Italy
| | - Savino Occhionorelli
- General and Emergency Surgery Unit, Sant'Anna University-Hospital, Ferrara, Italy
| | - Maria Grazia Sibilla
- Vascular Diseases Center-Mini-invasive Venous Surgery Unit, University of Ferrara, Ferrara, Italy.,General and Emergency Surgery Unit, Sant'Anna University-Hospital, Ferrara, Italy
| | - Marianna Mucignat
- Vascular Diseases Center-Mini-invasive Venous Surgery Unit, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center-Mini-invasive Venous Surgery Unit, University of Ferrara, Ferrara, Italy
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42
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Zamboni P. COVID-19 as a Vascular Disease: Lesson Learned from Imaging and Blood Biomarkers. Diagnostics (Basel) 2020; 10:E440. [PMID: 32610564 PMCID: PMC7399947 DOI: 10.3390/diagnostics10070440] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 02/08/2023] Open
Abstract
COVID-19, a disease initially thought to be prominently an interstitial pneumonia with varying degrees of severity, can be considered a vascular disease with regards to serious complications and causes of mortality. Quite recently, blood clots have emerged as the common factor unifying many of the symptoms initially attributed without an explanation to COVID-19. Cardiovascular biomarkers and particularly, D-dimer and troponin appear to be very powerful prognostic markers, signaling the need for earlier and more aggressive interventions and treatments in order to avoid and/or minimize arterial/venous thromboembolism and myocardial infarct. The ultrasound imaging patterns at both the lung and peripheral vascular level can also be very useful weapons that have the advantage of being able to monitor longitudinally the clinical picture, something that real-time PCR/nasopharyngeal swab is not able to do and that CT can only pursue with significant radiation exposure. A lesson learned in the early phase of the COVID-19 pandemic suggests quitting and starting again with targeted imaging and blood vascular biomarkers.
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Affiliation(s)
- Paolo Zamboni
- Department of Surgery, Vascular Disease Centre University Hospital of Ferrara, 44124 Cona (Fe), Italy
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43
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Abstract
The model of Rembrandt's Bathsheba, a celebrated painting of the Louvre Museum in Paris, was his lover Hendrickje Stoffels. The picture has periodically caught the attention of the medical community because Hendrickje appears to have a condition affecting her left breast. Generally breast cancer has been proposed. The past diagnoses have been reviewed and has been proposed a new one - Mondor's disease - based on colour, a critique of past diagnoses, and the depth of the disease to be perceivable by the painters' eye. Finally, the article shows a convincing comparison between Bathsheba disease and a case of Mondor's thrombophebites recently observed.
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Affiliation(s)
- Paolo Zamboni
- Vascular Diseases Centre, University of Ferrara, Ferrara, Italy
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44
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Manfredini F, Lamberti N, Ficarra V, Tsolaki E, Straudi S, Zamboni P, Basaglia N, Gasbarro V. Biomarkers of Muscle Metabolism in Peripheral Artery Disease: A Dynamic NIRS-Assisted Study to Detect Adaptations Following Revascularization and Exercise Training. Diagnostics (Basel) 2020; 10:diagnostics10050312. [PMID: 32429406 PMCID: PMC7277989 DOI: 10.3390/diagnostics10050312] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022] Open
Abstract
We assessed whether muscle metabolism biomarkers (MMb) identified by near-infrared spectroscopy (NIRS) are valid for determining adaptations following revascularization or exercise training in peripheral artery disease (PAD). Eighteen patients (males n = 13; 69 ± 7 years) were randomized to receive revascularization (Rev = 6) or pain-free home-based exercise (Ex = 12). MMb were safely collected via a NIRS-assisted treadmill test as area-under-curve for the spectra of oxygenated (-oxy), deoxygenated (-deoxy), differential (-diff) and total (-tot) hemoglobin traces. MMb, ankle–brachial index (ABI), pain-free (PFWD) and 6-min (6MWD) walking distances were assessed at baseline and after four months. MMb were correlated at baseline with ABI (MMb-oxy r = 0.46) and 6MWD (MMb-tot r = 0.51). After treatments, MMb-oxy showed an expected increase, which was more relevant for Rev group than the Ex (56% vs. 20%), with trends towards normalization for the other MMb. These changes were significantly correlated with variations in ABI (MMb-oxy r = 0.71; p = 0.002) and 6MWD (MMb-tot r = 0.58; p = 0.003). The MMb-diff in Rev group and MMb-deoxy in Ex group at baseline predicted clinical outcomes being correlated with PFWD improvements after 4-month (r = −0.94; p = 0.005 and r = −0.57; p = 0.05, respectively). A noninvasive NIRS-based test, feasible in a clinical setting, identified muscle metabolism biomarkers in PAD. The novel MMb were associated with validated outcome measures, selectively modified after different interventions and able to predict long-term functional improvements after surgery or exercise training.
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Affiliation(s)
- Fabio Manfredini
- Section of Sports Sciences, Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Italy–Via Luigi Borsari 46, 44121 Ferrara, Italy;
- Unit of Physical Medicine and Rehabilitation, Department of Neurosciences/Rehabilitation, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (S.S.); (N.B.)
- Correspondence: ; Tel.: +39-0532-236187
| | - Nicola Lamberti
- Section of Sports Sciences, Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Italy–Via Luigi Borsari 46, 44121 Ferrara, Italy;
| | - Valentina Ficarra
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (V.F.); (E.T.); (V.G.)
| | - Elpiniki Tsolaki
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (V.F.); (E.T.); (V.G.)
| | - Sofia Straudi
- Unit of Physical Medicine and Rehabilitation, Department of Neurosciences/Rehabilitation, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Italy–Via Aldo Moro 8, 44124 Ferrara, Italy;
| | - Nino Basaglia
- Unit of Physical Medicine and Rehabilitation, Department of Neurosciences/Rehabilitation, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (V.F.); (E.T.); (V.G.)
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45
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Abstract
Podoconiosis causes a painful massive swelling of the lower limbs, bilaterally and asymmetrically. It is caused by exposure to particles common in soils of volcanic origin and is second only to lymphatic filariasis as the leading cause of tropical lymphoedema. An estimated 4 million people live with podoconiosis globally in 32 potentially endemic countries. Podoconiosis is associated with positive family history of podoconiosis, bare foot, gender, poor housing condition, foot hygiene, income and educational status of the affected patients. There are also cultural barriers involved in maintaining a high epidemiology of the disease. Podoconiosis was never been prioritized either in intervention or research programmes. This may be due to the lack of resources for new health initiatives, which is a common problem in the low-income tropical countries in which this disease is present. Only Ethiopia, Cameroon, and Rwanda report podoconiosis within their routine health management information systems.We believe that comprehensive podoconiosis control strategies such as promotion of footwear and personal hygiene are urgently needed in endemic countries in the African Region. Mapping, active surveillance and a systematic approach to the monitoring of disease burden must accompany the implementation of podoconiosis control activities.
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46
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Lamberti N, López-Soto PJ, Guerzoni F, Napoli N, Gasbarro V, Zamboni P, Tsolaki E, Taddia MC, Rodríguez-Borrego MA, Manfredini R, Basaglia N, Manfredini F. Changes in exercise capacity and risk of all-cause mortality in patients with peripheral artery disease: a 10-year retrospective cohort study. Intern Emerg Med 2020; 15:289-298. [PMID: 31435898 DOI: 10.1007/s11739-019-02176-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/11/2019] [Indexed: 01/07/2023]
Abstract
We retrospectively studied the association between changes in exercise capacity at discharge from a home-based exercise program and the risk of all-cause mortality among patients with peripheral artery disease (PAD) and claudication. The records of 1076 consecutive PAD patients were assessed between 2003 and 2013. The exercise program was prescribed during a few visits and executed at home at symptom-free walking speed. Ankle-Brachial Index (ABI) and maximal speed (Smax) on an incremental treadmill test were recorded at baseline and discharge. The number and date of deaths and hospitalizations for a 10-year period were collected from the regional registry. A total of 865 PAD patients completed the program (completers), while 221 left the program for health reasons (n = 128, diseased) or for nonhealth reasons (n = 83, quitters). Among the completers, the mortality rate (27%) was significantly lower (p < 0.001) than that of both the diseased (49 deaths, 38%) and the quitters (45 deaths, 54%). The completers (71 ± 9 years; 88% exercise sessions completed) showed significant improvements in the lowest ABI (from 0.62 ± 0.18 to 0.67 ± 0.19) and Smax (from 3.3 ± 1.1 to 3.8 ± 1.1 km h-1) at discharge. The completers who reached the clinically important difference of Smax ≥ 0.4 km h-1 at follow-up showed a significantly lower mortality risk (25% vs. 30%; HR 0.72; 95% CI 0.55-0.93) as well a lower rate of hospitalizations (p < 0.001). In conclusion, in PAD patients, active participation in a home-based exercise program was associated with a lower rate of death and better long-term clinical outcomes, particularly for those who attained a moderate increase in exercise capacity.
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Affiliation(s)
- Nicola Lamberti
- Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Pablo Jesùs López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, 14004, Cordoba, Spain
| | - Franco Guerzoni
- Department of Medical Statistics, University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Nicola Napoli
- Department of Medical Statistics, University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Paolo Zamboni
- Unit of Translational Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Elpiniki Tsolaki
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Maria Cristina Taddia
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Maria Aurora Rodríguez-Borrego
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, 14004, Cordoba, Spain
| | - Roberto Manfredini
- Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Nino Basaglia
- Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
- Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy.
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47
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Zamboni P, Scerrati A, Menegatti E, Galeotti R, Lapparelli M, Traina L, Tessari M, Ciorba A, De Bonis P, Pelucchi S. The eagle jugular syndrome. BMC Neurol 2019; 19:333. [PMID: 31864313 PMCID: PMC6925502 DOI: 10.1186/s12883-019-1572-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 12/15/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The elongation of the styloid process is historically associated with two variants of the Eagle syndrome. The classic one, mainly characterized by pain and dysphagia, and the carotid variant characterized by pain and sometimes by cerebral ischemia. We observed a further variant characterized by a styloid elongation coursing adjacent to the transverse process of C1, causing significant compression of the internal jugular vein. METHODS We reviewed all the cases of Eagle syndrome, including the jugular variant, admitted in our Hospital in the last six years. We compared symptomatology, associated comorbidities and imaging. Data were statistically analyzed. RESULTS Overall 23 patients were admitted to the Hospital for symptomatic elongation of the styloid process, 11 male and 12 females. The jugular variant of the Eagle syndrome is clinically delineated by significant differences, as compared to the classic variant and carotid variants. Headache was the more prominent symptom (p < .009) as well as a documented peri-mesencephalic hemorrhage was the more significant comorbidity (p < .0003). The group classic-carotid variant was characterized by ipsilateral pain respect to the jugular variant (p < .0003). CT angiography with venous phase extended to the neck veins and imaging reconstruction is highly recommended as imaging technique, complemented by color-Doppler ultrasound. CONCLUSIONS The elongation of the styloid process may have different paths which creates compression on the surrounding anatomical structures. There may be a possible association of jugular impingement by an elongated styloid process with symptoms. TRIAL REGISTRATION Protocol n°45-2013.
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Affiliation(s)
- Paolo Zamboni
- Vascular Diseases Center, Ferrara University Hospital, Ferrara, Italy
| | - Alba Scerrati
- Neurosurgery Unit, Ferrara University Hospital, Ferrara, Italy.
| | - Erica Menegatti
- Vascular Diseases Center, Ferrara University Hospital, Ferrara, Italy
| | - Roberto Galeotti
- Interventional Radiology Unit, Ferrara University Hospital, Ferrara, Italy
| | | | - Luca Traina
- Vascular Surgery Unit, Ferrara University Hospital, Ferrara, Italy
| | - Mirko Tessari
- Vascular Diseases Center, Ferrara University Hospital, Ferrara, Italy
| | - Andrea Ciorba
- ENT Unit, Ferrara University Hospital, Ferrara, Italy
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48
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Sibilla MG, Zollino I, Campioni D, Tessari M, Malagoni AM, Zamboni P. Identification of Prognostic Biomarkers of Adipose-Derived Stem Cells Treatment in Non-healing Vascular Leg Ulcers. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.1049] [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: 10/25/2022]
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49
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Mohammed NY, Di Domenico G, Menegatti E, Sisini F, Vannini ME, Gambaccini M, Tessari M, Zamboni P. Mechanical Function of Internal Jugular Vein Valve: Post-analysis of M-Mode Imaging under Cardiac Monitoring. Ultrasound Med Biol 2019; 45:3087-3101. [PMID: 31540759 DOI: 10.1016/j.ultrasmedbio.2019.06.418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 05/31/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
Because the internal jugular vein (IJV) valve is the only protective valve between the brain and heart, recent studies have focused on the dynamic behaviour of the valve and its importance in regulating the cerebral blood outflow pathway. However, the mechanism underlying valve opening and closure, as well as the normal opening time, has not been investigated before. The aim of the study described here was to investigate IJV physiology in healthy young adults by means of ultrasound imaging. Twenty-four normal young adults (16 male, 8 female, 21.79 ± 0.79 y of age) were enrolled in this study. Each participant underwent IJV B- and M-mode ultrasound scans of the neck veins in supine position. Data on IJV leaflet movement and IJV blood velocity were extracted from images with the associated electrocardiogram traces to analyze the opening and closure cycles of IJV leaflets. The normal opening time calculated in this study includes 70% of the dynamic valve cycle. The normal opening time of the IJV valve could be a new physiologic metric and serves as a premise for further studies in the field of cerebral venous return.
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Affiliation(s)
- Nadiya Y Mohammed
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Di Domenico
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy.
| | - Erica Menegatti
- Vascular Diseases Center, University of Ferrara, Via Aldo Moro 8, 44124 Cona (FE), Italy
| | - Francesco Sisini
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Elena Vannini
- Vascular Diseases Center, University of Ferrara, Via Aldo Moro 8, 44124 Cona (FE), Italy
| | - Mauro Gambaccini
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Mirko Tessari
- Vascular Diseases Center, University of Ferrara, Via Aldo Moro 8, 44124 Cona (FE), Italy
| | - Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Via Aldo Moro 8, 44124 Cona (FE), Italy
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50
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Lamberti N, Tessari M, Spath P, Sibilla MG, Straudi S, Basaglia N, Manfredini F, Zamboni P. A NIRS-assisted Test Discriminates Patients with Peripheral Arterial Disease and Chronic Venous Insufficiency with Improved Foot Oxygenation Following Low Elastic Compression Therapy. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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