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Vukotic R, Di Donato R, Bosch J, Andreone P. Reply to: "5-MTHF enhances the portal pressure reduction achieved with propranolol in patients with cirrhosis: A randomized placebo-controlled trial. Was an accurate statistical analysis performed?". J Hepatol 2024; 80:e162-e163. [PMID: 38097114 DOI: 10.1016/j.jhep.2023.11.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Ranka Vukotic
- Hepatology Unit, Pisa University Hospital, Pisa, Italy.
| | - Roberto Di Donato
- Internal Medicine Unit for the Treatment of the Severe Organ Failure, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jaime Bosch
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pietro Andreone
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, University of Modena and Reggio Emilia, Ospedale di Baggiovara, Modena, Italy
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Vukotic R, Di Donato R, Roncarati G, Simoni P, Renzulli M, Gitto S, Schepis F, Villa E, Berzigotti A, Bosch J, Andreone P. 5-MTHF enhances the portal pressure reduction achieved with propranolol in patients with cirrhosis: A randomized placebo-controlled trial. J Hepatol 2023; 79:977-988. [PMID: 37482222 DOI: 10.1016/j.jhep.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 05/12/2023] [Accepted: 06/02/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND & AIMS β-blockers reduce hepatic venous pressure gradient (HVPG) by decreasing portal inflow, with no reduction in intrahepatic vascular resistance. 5-Methyltetrahydrofolate (5-MTHF) can prevent oxidative loss of tetrahydrobiopterin (BH4), a cofactor for endothelial nitric oxide synthase coupling. It also converts homocysteine (tHcy) into methionine and enables the degradation of asymmetric dimethylarginine (ADMA), an inhibitor of endothelial nitric oxide synthase. The aim of this study was to evaluate the effects of 5-MTHF in combination with propranolol on HVPG and nitric oxide bioavailability markers in patients with cirrhosis and portal hypertension. METHOD Sixty patients with cirrhosis and HVPG ≥12 mmHg were randomized 1:1 to receive treatment with 5-MTHF+propranolol or placebo+propranolol for 90 days under double-blind conditions. HVPG and markers of nitric oxide bioavailability (BH4, ADMA and tHcy) were measured again at the end of treatment. RESULTS Groups were similar in terms of baseline clinical and hemodynamic data and nitric oxide bioavailability markers. HVPG decreased in both groups, but the magnitude of the change was significantly greater in the group treated with 5-MTHF+propranolol compared to placebo+propranolol (percentage decrease, 20 [29-9] vs. 12.5 [22-0], p = 0.028), without differences in hepatic blood flow. At the end of treatment, 5-MTHF+propranolol (vs. placebo+propranolol) was associated with higher BH4 (1,101.4 ± 1,413.3 vs. 517.1 ± 242.8 pg/ml, p <0.001), lower ADMA (109.3 ± 52.7 vs. 139.9 ± 46.7 μmol/L, p = 0.027) and lower tHcy (μmol/L, 11.0 ± 4.6 vs. 15.4 ± 7.2 μmol/L, p = 0.010) plasma levels. CONCLUSION In patients with cirrhosis and portal hypertension, 5-MTHF administration significantly enhanced the HVPG reduction achieved with propranolol. This effect appears to be mediated by improved nitric oxide bioavailability in the hepatic microcirculation. CLINICAL TRIAL EUDRACT NUMBER 2014-002018-21. IMPACT AND IMPLICATIONS Currently, the pharmacological prevention of cirrhosis complications due to portal hypertension, such as esophageal varices rupture, is based on the use of β-blockers, but some patients still present with acute variceal bleeding, mainly due to an insufficient reduction of portal pressure. In this study, we sought to demonstrate that the addition of folic acid to β-blockers is more effective in reducing portal pressure than β-blockers alone. This finding could represent the basis for validation studies in larger cohorts, which could impact the future prophylactic management of variceal bleeding in cirrhosis. Enhancing the benefit of β-blockers with a safe, accessible, cost-effective drug could improve clinical outcomes in cirrhosis, which in turn could translate into a reduction in the rates and costs of hospitalization, and ultimately into improved survival.
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Affiliation(s)
- Ranka Vukotic
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Roberto Di Donato
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Greta Roncarati
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Patrizia Simoni
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Gitto
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Filippo Schepis
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Villa
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jaume Bosch
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pietro Andreone
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Ferronato M, Molo CD, Bakken SM, Leoni FG, Vizioli L, Donato RD, Serra C, Dietrich CF. Porto-Sinusoidal Vascular Disorder, report of a novel association with POEMS syndrome. Future challenge for the hepatologist. Clin Res Hepatol Gastroenterol 2023; 47:102126. [PMID: 37068710 DOI: 10.1016/j.clinre.2023.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/19/2023]
Abstract
Porto-Sinusoidal Vascular Disorder (PSVD) is a recently introduced clinical entity. Since it is rare and often underrecognized, there is growing interest in identifying patients at increased risk. We present a case of a 59-year-old male with refractory ascites, pleural effusion, and high-risk varices meeting the diagnostic criteria for PSVD with a concomitant diagnosis of POEMS syndrome. The possible association between PSVD and POEMS syndrome has been described only in eight reports in literature, but it may be underrecognized due to the clinical manifestations overlap. To gain a wider comprehension of PSVD, it is fundamental to cooperate using international networks.
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Affiliation(s)
- Marco Ferronato
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Chiara De Molo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sofia M Bakken
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Luca Vizioli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Carla Serra
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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El Naofal M, Ramaswamy S, Alsarhan A, Nugud A, Sarfraz F, Janbaz H, Taylor A, Jain R, Halabi N, Yaslam S, Alfalasi R, Shenbagam S, Rabea F, Bitzan M, Yavuz L, Wafadari D, Abulhoul H, Shankar S, Al Maazmi M, Rizk R, Alloub Z, Elbashir H, Babiker MOE, Chencheri N, AlBanna A, Sultan M, El Bitar M, Kherani S, Thalange N, Alshryda S, Di Donato R, Tzivinikos C, Majid I, Freeman AF, Gonzalez C, Khan AO, Hamdan H, Abuhammour W, AlAwadhi M, AlKhayat A, Alsheikh-Ali A, Abou Tayoun AN. The genomic landscape of rare disorders in the Middle East. Genome Med 2023; 15:5. [PMID: 36703223 PMCID: PMC9881316 DOI: 10.1186/s13073-023-01157-8] [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: 09/02/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Rare diseases collectively impose a significant burden on healthcare systems, especially in underserved regions, like the Middle East, which lack access to genomic diagnostic services and the associated personalized management plans. METHODS We established a clinical genomics and genetic counseling facility, within a multidisciplinary tertiary pediatric center, in the United Arab Emirates to locally diagnose and manage patients with rare diseases. Clinical genomic investigations included exome-based sequencing, chromosomal microarrays, and/or targeted testing. We assessed the diagnostic yield and implications for clinical management among this population. Variables were compared using the Fisher exact test. Tests were 2-tailed, and P < .05 was considered statistically significant. RESULTS We present data on 1000 patients with rare diseases (46.2% females; average age, 4.6 years) representing 47 countries primarily from the Arabian Peninsula, the Levant, Africa, and Asia. The cumulative diagnostic yield was 32.5% (95% CI, 29.7-35.5%) and was higher for genomic sequencing-based testing than chromosomal microarrays (37.9% versus 17.2%, P = 0.0001) across all indications, consistent with the higher burden of single gene disorders. Of the 221 Mendelian disorders identified in this cohort, the majority (N = 184) were encountered only once, and those with recessive inheritance accounted for ~ 62% of sequencing diagnoses. Of patients with positive genetic findings (N = 325), 67.7% were less than 5 years of age, and 60% were offered modified management and/or intervention plans. Interestingly, 24% of patients with positive genetic findings received delayed diagnoses (average age, 12.4 years; range 7-37 years), most likely due to a lack of access to genomic investigations in this region. One such genetic finding ended a 15-year-long diagnostic odyssey, leading to a life-threatening diagnosis in one patient, who was then successfully treated using an experimental allogenic bone marrow transplant. Finally, we present cases with candidate genes within regions of homozygosity, likely underlying novel recessive disorders. CONCLUSIONS Early access to genomic diagnostics for patients with suspected rare disorders in the Middle East is likely to improve clinical outcomes while driving gene discovery in this genetically underrepresented population.
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Affiliation(s)
- Maha El Naofal
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Sathishkumar Ramaswamy
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ali Alsarhan
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ahmed Nugud
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Fatima Sarfraz
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Hiba Janbaz
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Alan Taylor
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ruchi Jain
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Nour Halabi
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Sawsan Yaslam
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Roudha Alfalasi
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Shruti Shenbagam
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Fatma Rabea
- grid.510259.a0000 0004 5950 6858College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Martin Bitzan
- Kidney Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Lemis Yavuz
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Deena Wafadari
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Hamda Abulhoul
- Department of Metabolic Medicine, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Shiva Shankar
- Critical Care Centre of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Munira Al Maazmi
- Critical Care Centre of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ruba Rizk
- Adolescent Medicine, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Zeinab Alloub
- Neurodevelopment Section, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Haitham Elbashir
- Neuroscience Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Mohamed O. E. Babiker
- Neurology Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Nidheesh Chencheri
- Neurology Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ammar AlBanna
- Mental Health Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Meshal Sultan
- Mental Health Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Mohamed El Bitar
- ENT Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Safeena Kherani
- ENT Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Nandu Thalange
- Endocrinology Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Sattar Alshryda
- Orthopedics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Roberto Di Donato
- Cardiology Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Christos Tzivinikos
- Gastroenterology Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ibrar Majid
- Orthopedics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Alexandra F. Freeman
- grid.419681.30000 0001 2164 9667National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD USA
| | - Corina Gonzalez
- grid.48336.3a0000 0004 1936 8075Immune Deficiency Cellular Therapy Program, National Cancer Institute, NIH, Bethesda, MD USA
| | - Arif O. Khan
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hisham Hamdan
- Pulmonology and Sleep Medicine Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Walid Abuhammour
- Infectious Diseases Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Mohamed AlAwadhi
- Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Abdulla AlKhayat
- Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Alawi Alsheikh-Ali
- grid.510259.a0000 0004 5950 6858College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates ,grid.414167.10000 0004 1757 0894Dubai Health Authority, Dubai, United Arab Emirates
| | - Ahmad N. Abou Tayoun
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates ,grid.510259.a0000 0004 5950 6858Center for Genomic Discovery, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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5
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Gitto S, Golfieri L, Mannelli N, Tamè MR, Lopez I, Ceccato R, Montanari S, Falcini M, Vitale G, De Maria N, Presti DL, Marzi L, Mega A, Valente G, Borghi A, Foschi FG, Grandi S, Forte P, Cescon M, Di Benedetto F, Andreone P, Arcangeli G, De Simone P, Bonacchi A, Sofi F, Morelli MC, Petranelli M, Lau C, Marra F, Chiesi F, Vizzutti F, Vero V, Di Donato R, Berardi S, Pianta P, D’Anzi S, Schepis F, Gualandi N, Miceli F, Villa E, Piai G, Valente M, Campani C, Lynch E, Magistri P, Cursaro C, Chiarelli A, Carrai P, Petruccelli S, Dinu M, Pagliai G. Quality of life in liver transplant recipients during the Corona virus disease 19 pandemic: A multicentre study. Liver Int 2022; 42:1618-1628. [PMID: 38009600 PMCID: PMC9115213 DOI: 10.1111/liv.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2023]
Abstract
BACKGROUND Liver transplant recipients require specific clinical and psychosocial attention given their frailty. Main aim of the study was to assess the quality of life after liver transplant during the current pandemic. METHODS This multicentre study was conducted in clinically stable, liver transplanted patients. Enrollment opened in June and finished in September 2021. Patients completed a survey including lifestyle data, quality of life (Short Form health survey), sport, employment, diet. To examine the correlations, we calculated Pearson coefficients while to compare subgroups, independent samples t-tests and ANOVAs. To detect the predictors of impaired quality of life, we used multivariable logistic regression analysis. RESULTS We analysed data from 511 patients observing significant associations between quality of life's physical score and both age and adherence to Mediterranean diet (p < .01). A significant negative correlation was observed between mental score and the sedentary activity (p < .05). Female patients scored significantly lower than males in physical and mental score. At multivariate analysis, females were 1.65 times more likely to report impaired physical score than males. Occupation and physical activity presented significant positive relation with quality of life. Adherence to Mediterranean diet was another relevant predictor. Regarding mental score, female patients were 1.78 times more likely to show impaired mental score in comparison with males. Sedentary activity and adherence to Mediterranean diet were further noteworthy predictors. CONCLUSIONS Females and subjects with sedentary lifestyle or work inactive seem to show the worst quality of life and both physical activity and Mediterranean diet might be helpful to improve it.
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Affiliation(s)
- Stefano Gitto
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Lucia Golfieri
- Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino‐metabolicheIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Nicolò Mannelli
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Maria Rosa Tamè
- Gastroenterology Division, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino‐metabolicheIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Ivo Lopez
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Roberta Ceccato
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Stanislao Montanari
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Margherita Falcini
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Giovanni Vitale
- Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino‐metabolicheIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Nicola De Maria
- Department of GastroenterologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Danilo Lo Presti
- Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino‐metabolicheIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Luca Marzi
- Division of GastroenterologyBolzano Regional HospitalBolzanoItaly
| | - Andrea Mega
- Division of GastroenterologyBolzano Regional HospitalBolzanoItaly
| | - Giovanna Valente
- Liver Unit for Transplant Management – SATTE, Department of Medical SciencesAORN Sant’Anna e San SebastianoCasertaItaly
| | | | | | - Silvana Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of PsychologyUniversity of BolognaBolognaItaly
| | - Paolo Forte
- Gastroenterology UnitUniversity Hospital CareggiFlorenceItaly
| | - Matteo Cescon
- General Surgery and Transplant UnitIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Fabrizio Di Benedetto
- Hepato‐Pancreato‐Biliary Surgery and Liver Transplantation UnitUniversity of Modena and Reggio EmiliaModenaItaly
| | - Pietro Andreone
- Internal and Metabolic MedicineAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Giulio Arcangeli
- Occupational Health Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceItaly
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver TransplantationUniversity of Pisa Medical School HospitalPisaItaly
| | - Andrea Bonacchi
- Centro Studi e Ricerca SynthesisAssociazione sul sentiero APSFlorenceItaly
| | - Francesco Sofi
- Unit of Clinical Nutrition, Careggi University Hospital, Department of Experimental and Clinical MedicineUniversity of FlorenceFirenzeItaly
| | - Maria Cristina Morelli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino‐metabolicheIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Marco Petranelli
- Department of Experimental and Clinical MedicineUniversity of FlorenceFirenzeItaly
| | - Chloe Lau
- Department of PsychologyUniversity of Western OntarioLondonOntarioCanada
| | - Fabio Marra
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Francesca Chiesi
- Department of Neuroscience, Psychology, Drug, and Child’s Health (NEUROFARBA), Section of PsychologyUniversity of FlorenceFirenzeItaly
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6
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Tambi R, Nandkishore S, Sharafat S, Kader F, Nassir N, Binte Ashraf Z, Mohamed N, Ahmed A, Abdel Hameid R, Taylor A, Abou Tayoun A, Alsheikh‐Ali A, Di Donato R, Uddin M, Berdiev B. Single‐Cell Reconstruction of Cellular Heterogeneity of Congenital Heart Disease. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Richa Tambi
- Mohammed Bin Rashid University of Medicine and Health SciencesDubai
| | | | - Shermin Sharafat
- Mohammed Bin Rashid University of Medicine and Health SciencesDubai
| | - Faiza Kader
- Mohammed Bin Rashid University of Medicine and Health SciencesDubai
| | - Nasna Nassir
- Mohammed Bin Rashid University of Medicine and Health SciencesDubai
| | | | - Nesrin Mohamed
- Mohammed Bin Rashid University of Medicine and Health SciencesDubai
| | - Awab Ahmed
- Mohammed Bin Rashid University of Medicine and Health SciencesDubai
| | | | | | - Ahmad Abou Tayoun
- Mohammed Bin Rashid University of Medicine and Health SciencesDubai
- Al Jalila Children's HospitalDubai
| | - Alawi Alsheikh‐Ali
- Mohammed Bin Rashid University of Medicine and Health SciencesDubai
- Dubai Health AuthorityDubai
| | | | - Mohammed Uddin
- Mohammed Bin Rashid University of Medicine and Health SciencesDubai
| | - Bakhrom Berdiev
- Mohammed Bin Rashid University of Medicine and Health SciencesDubai
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7
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Sciarrone SS, Ferrarese A, Bizzaro D, Volpato S, Donato FM, Invernizzi F, Trespidi L, Ramezzana IG, Avolio AW, Nure E, Pascale MM, Fagiuoli S, Pasulo L, Merli M, Lapenna L, Toniutto P, Lenci I, Di Donato R, De Maria N, Villa E, Galeota Lanza A, Marenco S, Bhoori S, Mameli L, Cillo U, Boccagni P, Russo FP, Bo P, Cosmi E, Burra P. Safe pregnancy after liver transplantation: Evidence from a multicenter Italian collaborative study. Dig Liver Dis 2022; 54:669-675. [PMID: 34497039 DOI: 10.1016/j.dld.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Women who have undergone liver transplantation (LT) enjoy better health, and possibility of childbearing. However, maternal and graft risks, optimal immunosuppression, and fetal outcome is still to clarify. AIM Aim of the study was to assess outcomes of pregnancy after LT at national level. METHODS In 2019, under the auspices of the Permanent Transplant Committee of the Italian Association for the Study of the Liver, a multicenter survey including 14 Italian LT-centers was conducted aiming at evaluating the outcomes of recipients and newborns, and graft injury/function parameters during pregnancy in LT-recipients. RESULTS Sixty-two pregnancies occurred in 60 LT-recipients between 1990 and 2018. Median age at the time of pregnancy was 31-years and median time from transplantation to conception was 8-years. During pregnancy, 4 recipients experienced maternal complications with hospital admission. Live-birth-rate was 100%. Prematurity occurred in 25/62 newborns, and 8/62 newborns had low-birth-weight. Cyclosporine was used in 16 and Tacrolimus in 37 pregnancies, with no different maternal or newborn outcomes. Low-birth-weight was correlated to high values of AST, ALT and GGT. CONCLUSION Pregnancy after LT has good outcome; however, maternal complications and prematurity may occur. Compliance with the immunosuppression is fundamental to ensure the stability of graft function and prevent graft-deterioration.
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Affiliation(s)
- Salvatore Stefano Sciarrone
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Debora Bizzaro
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Sofia Volpato
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, University of Padua, Via Giustianini 3, Padua 35128, Italy
| | - Francesca Maria Donato
- Division of Gastroenterology, Maggiore Hospital and IRCCS Foundation, Via Francesco Sforza 35, Milan 20122, Italy
| | - Federica Invernizzi
- Division of Gastroenterology, Maggiore Hospital and IRCCS Foundation, Via Francesco Sforza 35, Milan 20122, Italy
| | - Laura Trespidi
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, Fondazione Ospedale Maggiore, Via Francesco Sforza 35, Milan 20122, Italy
| | - Ilaria Giuditta Ramezzana
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, Fondazione Ospedale Maggiore, Via Francesco Sforza 35, Milan 20122, Italy
| | - Alfonso Wolfango Avolio
- Liver Unit, Department of Surgery, Agostino Gemelli Hospital, Catholic University, Largo Agostino Gemelli 8, Rome 00168, Italy
| | - Erida Nure
- Liver Unit, Department of Surgery, Agostino Gemelli Hospital, Catholic University, Largo Agostino Gemelli 8, Rome 00168, Italy
| | - Marco Maria Pascale
- Liver Unit, Department of Surgery, Agostino Gemelli Hospital, Catholic University, Largo Agostino Gemelli 8, Rome 00168, Italy
| | - Stefano Fagiuoli
- Gastroenterology, Hepatology and Liver Transplantation Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | - Luisa Pasulo
- Gastroenterology, Hepatology and Liver Transplantation Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | - Manuela Merli
- Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Via di Grottarossa 1015, Rome 00189, Italy
| | - Lucia Lapenna
- Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Via di Grottarossa 1015, Rome 00189, Italy
| | - Pierluigi Toniutto
- Internal Medicine, Department of Medical Area, University of Udine, via Palladio 8, Udine 33100, Italy
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, Department of Medicine, Policlinico Tor Vergata, Viale Oxford 81, Rome 00133, Italy
| | - Roberto Di Donato
- Department of Digestive Disease and Internal Medicine, Azienda Ospedaliero-Universitaria di Bologna Policlinico S.Orsola-Malpighi, Via Giuseppe Massarenti 11, Bologna 40138, Italy
| | - Nicola De Maria
- Department of Internal Medicine, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Largo del Pozzo 71, Modena 41124, Italy
| | - Erica Villa
- Department of Internal Medicine, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Largo del Pozzo 71, Modena 41124, Italy
| | | | - Simona Marenco
- Department of Internal Medicine, Gastroenterolgy Unit, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genova 16132, Italy
| | - Sherrie Bhoori
- Department of Surgery and Oncology, Istituto Nazionale Tumori IRCCS, Via Giacomo Venezian, 1, Milan 20133, Italy
| | - Laura Mameli
- Liver and Pancreas Transplant Center, Azienda Ospedaliera Brotzu Piazzale Ricchi 1, Cagliari 09134, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, Padua 35128, Italy
| | - Patrizia Boccagni
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, Padua 35128, Italy
| | - Francesco Paolo Russo
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Patrizio Bo
- Gynaecology and Obstetrics Unit, Cittadella Hospital, Via Riva dell'Ospedale, Cittadella 35013, Italy
| | - Erich Cosmi
- Gynaecology and Obstetrics Unit, Department of Women's and Children's Health, University of Padua, Via Giustianini 3, Padua 35128, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padua 35128, Italy.
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Rossetti B, Loggi E, Raffaelli CS, Mercinelli S, Gandolfo C, Savellini GG, Galli S, Vitale G, Di Donato R, Vukotic R, Grandini E, Margotti M, Guarneri V, Furlini G, Re MC, De Luca A, Andreone P, Galli C, Cusi MG. Hepatitis C Virus Core Antigen (HCVAg): an affordable assay to monitor the efficacy of treatment in DAAs era. New Microbiol 2021; 44:89-94. [PMID: 34151994] [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] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
Hepatitis C virus (HCV) Core Antigen (HCVAg) and HCV-RNA were tested in 962 plasma/serum samples from 180 patients during Direct Antiviral Agents (DAAs) treatment and at follow-up. One hundred and eighty individuals were included: 71% carried advanced fibrosis and 43% were treatment-experienced. A Sustained Virological Response (SVR) was achieved in 166/180 (92%) individuals: 96/102 (94.1%) na ve and 70/78 (89.7%) treatment-experienced (p=0.20). The baseline median levels of HCV-RNA and HCVAg were not significantly different between individuals achieving SVR (5.92 x 105 IU/mL, IQR 5.4-6.4, and 3,417 fmol/L, 2,900-3,795) and those without SVR (6.06 x 105 IU/mL, 5.63-6.57, and 3,391 fmol/L, 2,828-4,077). The HCV-RNA vs. HCVAg assays results showed a fair correlation with an overall moderate qualitative agreement (kappa=0.52). Among treatment-failed individuals, at failure 100% of the assays results were positive for both techniques, with HCV-RNA median value 3.09 x 105 IU/mL (2.10-29.09) and HCVAg median value 1570.28 fmol/L (360.15-9317.67). Undetectable HCV-RNA at EOT showed sensitivity 54%, specificity 100%, negative predictive value (NPV) 93% and positive predictive value (PPV) 100%. Undetectable HCVAg at EOT showed sensitivity 74%, specificity 100%, NPV 97% and PPV 100%. The operative and economic advantages of the HCVAg support the alternative use of HCVAg to monitor DAAs treatment outcome.
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Affiliation(s)
- Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Elisabetta Loggi
- Department of Medical and Surgical Sciences, Research Center for Hepatitis, Universit degli Studi di Bologna, Bologna, Italy
- Operational Unit of Clinical Pathology, ASUR4, Fermo, Italy
| | | | - Simona Mercinelli
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Claudia Gandolfo
- UOC Microbiologia e Virologia, Universit degli Studi di Siena, and Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Gianni Gori Savellini
- UOC Microbiologia e Virologia, Universit degli Studi di Siena, and Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Silvia Galli
- Microbiology Section, Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Italy
| | - Giovanni Vitale
- Department of Medical and Surgical Sciences, Research Center for Hepatitis, Universit degli Studi di Bologna, Bologna, Italy
- Department of Organ Failure and Transplantation, Internal Medicine, Universit degli Studi di Bologna, Bologna, Italy
| | - Roberto Di Donato
- Department of Medical and Surgical Sciences, Research Center for Hepatitis, Universit degli Studi di Bologna, Bologna, Italy
| | - Ranka Vukotic
- Department of Medical and Surgical Sciences, Research Center for Hepatitis, Universit degli Studi di Bologna, Bologna, Italy
| | - Elena Grandini
- Department of Medical and Surgical Sciences, Research Center for Hepatitis, Universit degli Studi di Bologna, Bologna, Italy
| | - Marzia Margotti
- Department of Medical and Surgical Sciences, Research Center for Hepatitis, Universit degli Studi di Bologna, Bologna, Italy
| | - Valeria Guarneri
- Department of Medical and Surgical Sciences, Research Center for Hepatitis, Universit degli Studi di Bologna, Bologna, Italy
| | - Giuliano Furlini
- Microbiology Section, Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Italy
| | - Maria Carla Re
- Microbiology Section, Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Italy
| | - Andrea De Luca
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
- Biotechnologies Department, Siena University, Siena, Italy
| | - Pietro Andreone
- Department of Medical and Surgical Sciences, Research Center for Hepatitis, Universit degli Studi di Bologna, Bologna, Italy
- UOC di Medicina Interna Metabolica, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Claudio Galli
- Global Medical Affairs, Abbott Diagnostics, Roma, Italy
| | - Maria Grazia Cusi
- UOC Microbiologia e Virologia, Universit degli Studi di Siena, and Azienda Ospedaliero-Universitaria Senese, Siena, Italy
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9
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A. Hawaelrasoul B, Sahari AA, Donato RD, Abdulhamed JM. Left ventricular aneurysm an unusual complication after muscular VSD device closure. Interv Cardiol 2019. [DOI: 10.4172/interventional-cardiology.1000621] [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: 11/09/2022] Open
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10
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Loggi E, Galli S, Vitale G, Di Donato R, Vukotic R, Grandini E, Margotti M, Guarneri V, Furlini G, Galli C, Re MC, Andreone P. Monitoring the treatment of hepatitis C with directly acting antivirals by serological and molecular methods. PLoS One 2017; 12:e0187755. [PMID: 29125869 PMCID: PMC5681287 DOI: 10.1371/journal.pone.0187755] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 07/13/2017] [Accepted: 10/25/2017] [Indexed: 12/16/2022] Open
Abstract
AIM To evaluate the potential value of using a serological assay to quantitate the hepatitis C virus core antigen (HCV-Ag) when monitoring patients with chronic hepatitis C being treated with direct-acting antivirals (DAAs). METHODS Ninety-six patients treated with DAAs, either alone (91) or in combination with PEG interferon (5), were tested for HCV-RNA and for HCV-Ag at baseline and at weeks 2, 4, 8 and 12 during treatment and 12 weeks after completion. The concordance and correlation between the viral parameters as well as the respective kinetics during and after treatment were evaluated. RESULTS A sustained viral response (SVR) was achieved in 82 patients (91%), whereas 11 relapsed (R) and 1 showed a virological breakthrough while receiving treatment. HCV-RNA and HCV-Ag showed good concordance (kappa = 0.62) and correlation. No significant differences between SVR and R was observed in either assay at 2 and 4 weeks after the start of treatment. At 8 weeks, HCV-Ag showed higher accuracy than HCV-RNA (AUC: 0.74 vs. 0.55) and there was a significantly greater decrease from baseline in SVR than in R (4.01 vs. 3.36 log10; p<0.05). CONCLUSIONS Monitoring during treatment with DAAs by using either HCV-RNA or HCV-Ag has only a limited predictive value for SVR. Since those assays are equivalent for identifying a virological relapse, HCV-Ag may be preferred from an economical and organizational perspective.
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Affiliation(s)
- Elisabetta Loggi
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca per lo Studio delle Epatiti, Università degli Studi di Bologna, Bologna, Italy
| | - Silvia Galli
- Unità di Microbiologia, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Giovanni Vitale
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca per lo Studio delle Epatiti, Università degli Studi di Bologna, Bologna, Italy
| | - Roberto Di Donato
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca per lo Studio delle Epatiti, Università degli Studi di Bologna, Bologna, Italy
| | - Ranka Vukotic
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca per lo Studio delle Epatiti, Università degli Studi di Bologna, Bologna, Italy
| | - Elena Grandini
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca per lo Studio delle Epatiti, Università degli Studi di Bologna, Bologna, Italy
| | - Marzia Margotti
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca per lo Studio delle Epatiti, Università degli Studi di Bologna, Bologna, Italy
| | - Valeria Guarneri
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca per lo Studio delle Epatiti, Università degli Studi di Bologna, Bologna, Italy
| | - Giuliano Furlini
- Unità di Microbiologia, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Claudio Galli
- Medical Scientific Liaison, Abbott Diagnostics, Roma, Italy
| | - Maria Carla Re
- Unità di Microbiologia, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Pietro Andreone
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca per lo Studio delle Epatiti, Università degli Studi di Bologna, Bologna, Italy
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11
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Piscaglia F, Salvatore V, Mulazzani L, Cantisani V, Colecchia A, Di Donato R, Felicani C, Ferrarini A, Gamal N, Grasso V, Marasco G, Mazzotta E, Ravaioli F, Ruggieri G, Serio I, Sitouok Nkamgho JF, Serra C, Festi D, Schiavone C, Bolondi L. Differences in liver stiffness values obtained with new ultrasound elastography machines and Fibroscan: A comparative study. Dig Liver Dis 2017; 49:802-808. [PMID: 28365330 DOI: 10.1016/j.dld.2017.03.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/17/2017] [Accepted: 03/02/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Whether Fibroscan thresholds can be immediately adopted for none, some or all other shear wave elastography techniques has not been tested. The aim of the present study was to test the concordance of the findings obtained from 7 of the most recent ultrasound elastography machines with respect to Fibroscan. METHODS Sixteen hepatitis C virus-related patients with fibrosis ≥2 and having reliable results at Fibroscan were investigated in two intercostal spaces using 7 different elastography machines. Coefficients of both precision (an index of data dispersion) and accuracy (an index of bias correction factors expressing different magnitudes of changes in comparison to the reference) were calculated. RESULTS Median stiffness values differed among the different machines as did coefficients of both precision (range 0.54-0.72) and accuracy (range 0.28-0.87). When the average of the measurements of two intercostal spaces was considered, coefficients of precision significantly increased with all machines (range 0.72-0.90) whereas of accuracy improved more scatteredly and by a smaller degree (range 0.40-0.99). CONCLUSIONS The present results showed only moderate concordance of the majority of elastography machines with the Fibroscan results, preventing the possibility of the immediate universal adoption of Fibroscan thresholds for defining liver fibrosis staging for all new machines.
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Affiliation(s)
- Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna, Italy.
| | - Veronica Salvatore
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Lorenzo Mulazzani
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Vito Cantisani
- Department of Radiological Sciences, Policlinico Umberto I, University La Sapienza, Rome, Italy
| | - Antonio Colecchia
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Roberto Di Donato
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Cristina Felicani
- Unit of Internal Medicine and Organ Insufficiency, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Alessia Ferrarini
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Nesrine Gamal
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Valentina Grasso
- Unit of Internal Medicine and Organ Insufficiency, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Elena Mazzotta
- Unit of Internal Medicine and Organ Insufficiency, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Giacomo Ruggieri
- Division of Infectious Disease, G. d'Annunzio University, Chieti, Italy
| | - Ilaria Serio
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | | | - Carla Serra
- Unit of Internal Medicine and Organ Insufficiency, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Cosima Schiavone
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Luigi Bolondi
- Department of Medical and Surgical Sciences, University of Bologna, Italy
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12
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Loggi E, Gitto S, Galli S, Minichiello M, Conti F, Grandini E, Scuteri A, Vitale G, Di Donato R, Cursaro C, Furlini G, Andreone P. Hepatitis B virus reactivation among hepatitis C patients treated with direct-acting antiviral therapies in routine clinical practice. J Clin Virol 2017; 93:66-70. [PMID: 28654775 DOI: 10.1016/j.jcv.2017.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/22/2017] [Accepted: 05/30/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis B (HBV) reactivation in chronic hepatitis C (CHC) patients treated with IFN-free direct acting antiviral (DAA) therapies has recently emerged as a potential risk. Given the potential burden of this issue, further data are needed to establish its actual clinical impact. OBJECTIVES The aim of the present study was to analyze the occurrence of HBV reactivation in a cohort of CHC patient treated with DAAs in routine clinical practice. STUDY DESIGN Consecutive CHC patients with different genotypes, treated with DAA between January 2015 and January 2016 were included in the study. Subjects had been tested for HBsAg and anti-HBc antibodies before antiviral therapy. HBV-DNA levels were examined in anti-HBc positive patients at baseline and 24 weeks after the end of treatment. Post-treatment HBsAg determination was performed in case of HBV-DNA positivity. Serum anti-HBs kinetics was analysed in anti-HBs and anti-HBc positive subjects. RESULTS A cohort of 137 consecutive HCV patients treated with IFN-free regimens in routine clinical practice was evaluated. From this cohort, plasma samples of 44 subjects with positive serology for HBV (anti-HBc positive) were tested for HBV-DNA levels at baseline and 24 weeks after the end of treatment. Two of them were HBsAg-positive, while the others had signs of a past HBV exposure (HBsAg-negative±HBsAb-positive). No reactivation was found in HBcAb-positive and HBsAg-negative subjects. In the two HBsAg-positive, one experienced an increase in HBV-DNA levels of ≥2 log10 IU/mL during treatment. However, the reactivation was without clinical impact and, most important, was followed by HBsAg loss. CONCLUSIONS Based on our experience, a past HBV infection seems not to be a condition predisposing to HBV reactivation. On the contrary, in HBsAg-positive subjects not in suppressive treatment with nucleos(t)ide analogs, regular monitoring of HBV-DNA during and after DAA treatment should be considered.
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Affiliation(s)
- Elisabetta Loggi
- Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy; Unità Operativa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Stefano Gitto
- Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy
| | - Silvia Galli
- Unità Operativa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Mario Minichiello
- Unità Operativa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Fabio Conti
- Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy
| | - Elena Grandini
- Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy
| | - Alessandra Scuteri
- Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy
| | - Giovanni Vitale
- Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy
| | - Roberto Di Donato
- Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy
| | - Carmela Cursaro
- Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy
| | - Giuliano Furlini
- Unità Operativa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Pietro Andreone
- Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy.
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Abstract
From its approval in 2008, sorafenib is the recommended treatment option for advanced-stage patients and its safety and efficacy has been confirmed by several studies. However, its mechanism of action is not completely understood and many efforts have been dedicated to investigating possible treatment response predictors. Dermatological adverse events occurring within the first 2 months of treatment are predictors of longer survival, while the same role for hypertension and diarrhea still needs a prospective confirmation. This association is opposite to the strategy of starting at a low dose as it may imply suboptimal drug exposure. In case of radiological progression, the appearance of new extrahepatic metastasis or vascular invasion significantly worsens life expectancy if compared to other patterns of progression. To date no genetic or biologic marker is available to predict response, even if some encouraging results have been reported by the study of polymorphism of VEGF and its receptor. Currently, data are conflicting about the possible predictive role of α-fetoprotein. Due to failure or the progression of therapies for earlier evolutionary stages (BCLC B) some patients in such a clinical profile may be treated with sorafenib. Indeed, almost 50% of the sorafenib-treated patients belong to this class. Patients with severely decompensated liver disease (jaundice, ascites in need of intense diuretic therapy/paracentesis) may not benefit from treatment. The use of sorafenib in the waiting list for liver transplantation is controversial, while its use at an advanced age requires careful evaluation of existing comorbidities that may increase the risk of adverse events. Many strides have been made in the field of hepatocellular carcinoma systemic therapy, and many remain to be realized. Considering the disappointing results of the trials conducted on new agents, a more dynamic interpretation of events together with the development of new strategies is key to enriching new and hopefully more successful trials.
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Affiliation(s)
- Alessia Gazzola
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
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14
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Gitto S, Belli LS, Vukotic R, Lorenzini S, Airoldi A, Cicero AFG, Vangeli M, Brodosi L, Panno AM, Di Donato R, Cescon M, Grazi GL, De Carlis L, Pinna AD, Bernardi M, Andreone P. Hepatitis C virus recurrence after liver transplantation: A 10-year evaluation. World J Gastroenterol 2015; 21:3912-3920. [PMID: 25852276 PMCID: PMC4385538 DOI: 10.3748/wjg.v21.i13.3912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/10/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the predictors of 10-year survival of patients with hepatitis C recurrence.
METHODS: Data from 358 patients transplanted between 1989 and 2010 in two Italian transplant centers and with evidence of hepatitis C recurrence were analyzed. A χ2, Fisher’s exact test and Kruskal Wallis’ test were used for categorical and continuous variables, respectively. Survival analysis was performed at 10 years after transplant using the Kaplan-Meier method, and a log-rank test was used to compare groups. A P level less than 0.05 was considered significant for all tests. Multivariate analysis of the predictive role of different variables on 10-year survival was performed by a stepwise Cox logistic regression.
RESULTS: The ten-year survival of the entire population was 61.2%. Five groups of patients were identified according to the virological response or lack of a response to antiviral treatment and, among those who were not treated, according to the clinical status (mild hepatitis C recurrence, “too sick to be treated” and patients with comorbidities contraindicating the treatment). While the 10-year survival of treated and untreated patients was not different (59.1% vs 64.7%, P = 0.192), patients with a sustained virological response had a higher 10-year survival rate than both the “non-responders” (84.7% vs 39.8%, P < 0.0001) and too sick to be treated (84.7% vs 0%, P < 0.0001). Sustained virological responders had a survival rate comparable to patients untreated with mild recurrence (84.7% vs 89.3%). A sustained virological response and young donor age were independent predictors of 10-year survival.
CONCLUSION: Sustained virological response significantly increased long-term survival. Awaiting the interferon-free regimen global availability, antiviral treatment might be questionable in selected subjects with mild hepatitis C recurrence.
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Alqathamy H, Ragheb A, Hussain W, Alfaraidi Y, Donato RD. Long term results of surgical management of anomalous origin of the left coronary artery from pulmonary artery (ALCAPA) and mitral incompetence. J Saudi Heart Assoc 2013. [DOI: 10.1016/j.jsha.2013.03.084] [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: 10/27/2022] Open
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16
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Salvatore V, Borghi A, Peri E, Colecchia A, Li Bassi S, Montrone L, Di Donato R, Conti F, Crespi C, Festi D, Bernardi M, Andreone P, Bolondi L. Relationship between hepatic haemodynamics assessed by Doppler ultrasound and liver stiffness. Dig Liver Dis 2012; 44:154-9. [PMID: 21958678 DOI: 10.1016/j.dld.2011.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 08/19/2011] [Accepted: 08/22/2011] [Indexed: 12/11/2022]
Abstract
AIM We tested the relationship between hepatic haemodynamics assessed by Doppler ultrasonography and liver stiffness assessed by Transient Elastography in hepatitis C related chronic liver disease. METHODS Three liver Doppler ultrasound parameters (hepatic artery resistance index, splenic artery resistance index and waveform pattern in hepatic veins) and liver stiffness measured by Transient Elastography were analysed in one hundred consecutive patients affected by hepatitis C related chronic liver disease. RESULTS Hepatic and splenic arteries resistance indexes correlate significantly (p<0.0001 for both) with liver stiffness. A hepatic artery resistance index cut-off value of 0.64 provided sensitivity and specificity respectively of 84.4% and 69.1% for predicting liver stiffness ≤or >13 kPa, whereas a splenic artery resistance index cut-off value of 0.56 provided sensitivity and specificity respectively of 81.3% and 48.5%. The coincidental finding of both resistance indexes above the respective cut-off values showed a good accuracy in identifying patients with liver stiffness values >13 kPa (accuracy=78%, +LR=2.90, -LR=0.31). A significant difference in liver stiffness values was evident between patients with triphasic and bi- or monophasic waveform pattern (p=0.005). CONCLUSIONS Hepatic and splenic arteries resistance indexes and the hepatic veins waveform pattern assessed by Doppler ultrasound may provide information similar to that of Transient Elastography in hepatitis C related chronic liver disease.
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Affiliation(s)
- Veronica Salvatore
- Department of Digestive Disease and Internal Medicine, Azienda Ospedaliero-Universitaria di Bologna Policlinico S.Orsola-Malpighi, Bologna, Italy
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17
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Buccione D, Fatti G, Gallotta A, Loggi E, Donato RD, Testa L, Saitta C, Santi V, Micoli AD, Erroi V, Frigerio M, Fazio V, Picciotto A, Biasiolo A, Degos F, Pontisso P, Raimondo G, Trevisani F. Serum SCCA-IgM as a predictor of hepatocellular carcinoma in patients with liver cirrhosis. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojgas.2012.22012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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18
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Grutter G, Guccione P, Mantione L, Giannico S, Parisi F, Di Donato R, Pongiglione G. A multiple combined treatment in an adult patient with Eisenmenger's syndrome. Int J Cardiol 2011; 151:372-3. [PMID: 21757244 DOI: 10.1016/j.ijcard.2011.06.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 06/21/2011] [Indexed: 10/17/2022]
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Biselli M, Gitto S, Gramenzi A, Di Donato R, Brodosi L, Ravaioli M, Grazi GL, Pinna AD, Andreone P, Bernardi M. Six score systems to evaluate candidates with advanced cirrhosis for orthotopic liver transplant: Which is the winner? Liver Transpl 2010; 16:964-73. [PMID: 20677287 DOI: 10.1002/lt.22093] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Many prognostic systems have been devised to predict the outcome of liver transplantation (LT) candidates. Today, the Model for End-Stage Liver Disease (MELD) is widely used for organ allocation, but it has shown some limitations. The aim of this study was to investigate the performance of MELD compared to 5 different score models. We evaluated the prognostic ability of MELD, modified Child-Turcotte-Pugh, MELD-sodium, United Kingdom MELD, updated MELD, and integrated MELD in 487 candidates with cirrhosis for LT at the Bologna Transplant Centre, Bologna, Italy, between 2003 and 2008. Calibration analysis by Hosmer-Lemeshow test, calibration curves, and concordance c-statistics (area under the receiver operating characteristic curve [AUC]) were calculated at 3, 6, and 12 months. Actual cumulative survival curves, taking into account the event of interest in the presence of competing risk, were obtained using the best cutoffs identified by AUC. For each score, the Hosmer-Lemeshow test revealed a good calibration. Integrated MELD showed calibration curves closer to the line of perfect predicting ability, followed by MELD-sodium at 3 months and modified Child-Turcotte-Pugh at 6 months. MELD-sodium AUCs at 3 and 6 months (0.798 and 0.765, respectively) and integrated MELD AUC at 6 months (0.792) were better than standard MELD (P < 0.05). Actual survival curves showed that these 2 scores were able to identify the patients with the highest drop-out risk. In conclusion, MELD-sodium and integrated MELD were the best prognostic models to predict drop-out rates among patients awaiting LT.
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Affiliation(s)
- Maurizio Biselli
- Department of Clinical Medicine, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
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20
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Vida VL, Speggiorin S, Padalino MA, Crupi G, Marcelletti C, Zannini L, Frigiola A, Varrica A, Di Carlo D, Di Donato R, Murzi B, Bernabei M, Boccuzzo G, Stellin G. The Scimitar Syndrome: An Italian Multicenter Study. Ann Thorac Surg 2009; 88:440-4. [DOI: 10.1016/j.athoracsur.2009.04.099] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/21/2009] [Accepted: 04/24/2009] [Indexed: 01/07/2023]
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21
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Del Pasqua A, Sanders SP, de Zorzi A, Toscano A, Iacobelli R, Pierli C, Pasquini L, Di Donato R, Rinelli G. Impact of three-dimensional echocardiography in complex congenital heart defect cases: the surgical view. Pediatr Cardiol 2009; 30:293-300. [PMID: 19083142 DOI: 10.1007/s00246-008-9348-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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] [Received: 01/24/2008] [Revised: 11/10/2008] [Accepted: 11/14/2008] [Indexed: 11/26/2022]
Abstract
Other authors have demonstrated the ability of three-dimensional (3D) echocardiography to produce "en face" views of anomalies such as atrioventricular valve disease and atrial and ventricular septal defects. Few data exist about the usefulness of 3D images for more complex congenital heart defects and the surgical impact of this relatively new technology. This study, covering a period of 8 months and including 43 young patients affected by complex congenital heart defects, demonstrated that the routine use of 3D echocardiography is feasible and valuable for some types of cardiac defects. In fact, 3D images have provided more detailed anatomic definition of interrelations between structures in about one-third (15/43) of our cases, yielding new insight into the anatomy analogous to what can be derived from examining a heart specimen. Our surgeons found the 3D images particularly helpful for providing a realistic and almost specimen-like preview of the surgical anatomy that facilitates planning of the surgical program.
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Iodice F, Brancaccio G, Lauri A, Di Donato R. Preventive ligation of the innominate artery in patients with neuromuscular disorders. Eur J Cardiothorac Surg 2007; 31:747-9. [PMID: 17236784 DOI: 10.1016/j.ejcts.2006.12.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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] [Received: 09/04/2006] [Revised: 11/27/2006] [Accepted: 12/04/2006] [Indexed: 10/23/2022] Open
Abstract
Tracheostomy, long-term mechanical ventilation, spinal deformaties are factors that contribute in patients with neuromuscular disorders to the development of an erosion of the tracheal wall and subsequent formation of a tracheo-innominate artery fistula. This condition is fatal unless promptly treated by exclusion of the innominate artery, which is often performed under desperate circumstances. We electively adopted a preventive ligation of the innominate artery in patients at risk for trachea-innominate artery fistula (TIF). We present seven patients with neuromuscular disorders who underwent preventive ligation of the innominate artery. All seven patients survived.
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Affiliation(s)
- Francesca Iodice
- Division of Anesthesia and Intensive Care, Ospedale Bambino Gesù-Palidoro, Rome, Italy.
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23
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Vida VL, Berggren H, Brawn WJ, Daenen W, Di Carlo D, Di Donato R, Lindberg HL, Corno AF, Fragata J, Elliott MJ, Hraska V, Kiraly L, Lacour-Gayet F, Maruszewski B, Rubay J, Sairanen H, Sarris G, Urban A, Van Doorn C, Ziemer G, Stellin G. Risk of Surgery for Congenital Heart Disease in the Adult: A Multicentered European Study. Ann Thorac Surg 2007; 83:161-8. [PMID: 17184653 DOI: 10.1016/j.athoracsur.2006.07.045] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [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] [Received: 03/09/2006] [Revised: 07/18/2006] [Accepted: 07/21/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgery for congenital heart disease (CHD) has changed considerably during the last three decades. The results of primary repair have steadily improved, to allow treating almost all patients within the pediatric age; nonetheless an increasing population of adult patients requires surgical treatment. The objective of this study is to present the early surgical results of patients who require surgery for CHD in the adult population within a multicentered European study population. METHODS Data relative to the hospital course of 2,012 adult patients (age > or = 18 years) who required surgical treatment for CHD from January 1, 1997 through December 31, 2004 were reviewed. Nineteen cardiothoracic centers from 13 European countries contributed to the data collection. RESULTS Mean age at surgery was 34.4 +/- 14.53 years. Most of the operations were corrective procedures (1,509 patients, 75%), followed by reoperations (464 patients, 23.1%) and palliative procedures (39 patients, 1.9%). Six hundred forty-nine patients (32.2%) required surgical closure of an isolated ostium secundum atrial septal defect. Overall hospital mortality was 2%. Preoperative cyanosis, arrhythmias, and NYHA class III-IV, proved significant risk factors for hospital mortality. Follow-up data were available in 1,342 of 1,972 patients (68%) who were discharged home. Late deaths occurred in 6 patients (0.5%). Overall survival probability was 97% at 60 months, which is higher for corrective procedures (98.2%) if compared with reoperations (94.1%) and palliations (86.1%). CONCLUSIONS Surgical treatment of CHD in adult patients, in specialized cardiac units, proved quite safe, beneficial, and low-risk.
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Affiliation(s)
- Vladimiro L Vida
- Pediatric Cardiac Surgery Unit, University of Padova, Padova, Italy
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Giannico S, Hammad F, Amodeo A, Michielon G, Drago F, Turchetta A, Di Donato R, Sanders SP. Clinical Outcome of 193 Extracardiac Fontan Patients. J Am Coll Cardiol 2006; 47:2065-73. [PMID: 16697327 DOI: 10.1016/j.jacc.2005.12.065] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [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] [Received: 08/03/2005] [Revised: 12/05/2005] [Accepted: 12/30/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circulation. BACKGROUND Few data exist about the mid-term and long-term results of the extracardiac Fontan operation. METHODS From November 1988 to November 2003, 221 patients underwent an extracardiac Fontan procedure as primary (9 patients) or secondary (212 patients) palliation, at a mean age of 72.2 months (range 13.1 to 131.3 months). A total of 165 of 193 early survivors underwent programmed noninvasive follow-up evaluations and at least one cardiac catheterization. RESULTS The overall survival, including operative deaths, was 85% at 15 years. Freedom from late failure among hospital survivors is 92% at 15 years. A total of 127 of 165 survivors (77%) were in New York Heart Association functional class I. The incidence of late major problems was 24% (42 major problems in 36 of 165 patients): 19 patients had arrhythmias (11%), 5 patients had obstruction of the extracardiac conduit (3%) and 6 of the left pulmonary artery (3.5%), and 5 patients experienced ventricular failure (3%), leading to heart transplantation in 3 patients. Protein-losing enteropathy was found in two patients (1%). The incidence of late re-interventions was 12.7% (21 of 165 patients, including 15 epicardial pacemaker implantations). Four patients died (2.3%), two after heart transplantation. CONCLUSIONS After 15 years of follow-up, the overall survival, the functional status, and the cardiopulmonary performance of survivors of the extracardiac Fontan procedure compare favorably with other series of patients who underwent the lateral tunnel approach. The incidence of late deaths, obstructions of the cavopulmonary pathway, re-interventions, and arrhythmias is lower than that reported late after other Fontan-type operations.
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Gagliardi MG, Adorisio R, Crea F, Versacci P, Di Donato R, Sanders SP. Abnormal Vasomotor Function of the Epicardial Coronary Arteries in Children Five to Eight Years After Arterial Switch Operation. J Am Coll Cardiol 2005; 46:1565-72. [PMID: 16226186 DOI: 10.1016/j.jacc.2005.06.065] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [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] [Received: 03/15/2005] [Revised: 05/30/2005] [Accepted: 06/20/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study sought to test the vasoreactivity of the translocated coronary arteries after arterial switch operation (ASO) using quantitative angiographic analysis and intracoronary Doppler flow wire velocimetry. BACKGROUND Late coronary artery events occur in 3% to 8% of patients after the ASO. Previous studies of coronary flow reserve have yielded disparate results. METHODS Nineteen children previously underwent ASO (13 boys, age 5.4 +/- 3.2 years, weight 22.3 +/- 10.6 kg), and six control patients were enrolled in the study. Each patient underwent quantitative angiographic assessment of the epicardial coronary arteries before and after administration of nitroglycerin and coronary blood flow volume assessment before and after administration of adenosine and acetylcholine. The results were compared between groups. RESULTS Epicardial coronary artery dilation in response to intracoronary nitroglycerin was significantly less in the ASO group than in the control group (left anterior descending [LAD], 5.0 +/- 0.05% vs. 18.0 +/- 4.5%, p = 0.0009; right coronary artery [RCA], 4.0 +/- 0.07% vs. 32.7 +/- 12.7%, p = 0.006). Moreover, the coronary blood flow volume reserve was reduced in ASO patients compared with control patients after intracoronary infusion of acetylcholine (2.3 +/- 0.9 vs. 4.9 +/- 1.7, p = 0.0003) or adenosine (2.7 +/- 1.5 vs. 5 +/- 0.5, p = 0.002). CONCLUSIONS Epicardial coronary arteries fail to dilate normally in children after ASO, and the calculated coronary flow volume reserve is consequently reduced.
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Affiliation(s)
- Maria Giulia Gagliardi
- Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Bambino Gesù, Rome, Italy.
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Anaclerio S, Di Ciommo V, Michielon G, Digilio MC, Formigari R, Picchio FM, Gargiulo G, Di Donato R, De Ioris MA, Marino B. Conotruncal heart defects: impact of genetic syndromes on immediate operative mortality. Ital Heart J 2004; 5:624-8. [PMID: 15554034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND The surgical outcome of conotruncal heart defects in patients with genetic syndromes has been poorly studied. The aim of this prospective 5-year multicenter study was to elucidate the post-surgical death rate of children with conotruncal heart defects in relation to the presence of associated genetic syndromes. METHODS Two institutions enrolled 350 consecutive inpatients with conotruncal heart defects, aged between 1 day and 60 months, who were submitted to surgery; all patients were evaluated by a clinical geneticist and had a standard metaphase chromosome analysis and a fluorescent in situ hybridization study searching for deletion of chromosome 22q11 (del22q11). RESULTS No genetic syndrome was diagnosed in 289 patients; among the other 61 patients, 27 had DiGeorge velocardiofacial syndrome (del22q11), 16 patients had Down syndrome, and 18 presented with other genetic syndromes. The overall post-surgical death rate was higher in syndromic patients (18%) than in non-syndromic ones (10.7%) with a relative risk of 1.9 (p = 0.06). However, children with del22q11 showed a higher risk for surgical mortality (25.9 vs 10.7%; relative risk 2.4, p = 0.03). Del22q11 was identified as a risk factor for immediate surgical mortality in patients with pulmonary atresia and ventricular septal defect and in patients with interrupted aortic arch. CONCLUSIONS Down syndrome is not a risk factor for surgery in children with conotruncal heart defects. The presence of a del22q11 may influence the surgical results in children with pulmonary atresia and ventricular septal defect and in those with interrupted aortic arch. Patients with genetic syndromes other than del22q11 and Down syndrome have a higher surgical mortality compared to that observed in non-syndromic patients. These data may be useful for preoperative counseling and for the elaboration of specific protocols of perioperative treatment.
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Affiliation(s)
- Silvia Anaclerio
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesu Pediatric Hospital, Rome, Italy
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Mazzera E, Brancaccio G, Feltri C, Michielon G, Capolupo I, Costa D, Di Donato R. [A new approach to the closure of patent ductus arteriosus in premature infants]. Ital Heart J Suppl 2004; 5:205-8. [PMID: 15116865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Minimally invasive surgical techniques have been employed successfully for a wide spectrum of cardiothoracic procedures. These approaches were proven to be as safe and effective as traditional surgical techniques. Unfortunately, it remains a lack of adequate instrumentations and anatomic features, particularly in the pediatric pool of patients. We have employed a new surgical approach for closing a patent ductus arteriosus in low weight newborn (< 2.5 kg), performing a superior extrapleuric approach. This report demonstrates that this technique is safe and reproducible, and is our opinion that it may substitute the medical management of patent ductus arteriosus.
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Affiliation(s)
- Ennio Mazzera
- Dipartimento di Cardiochirurgia Pediatrica, Ospedale Pediatrico Bambino Gesù, Roma
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Formigari R, Toscano A, Giardini A, Gargiulo G, Di Donato R, Picchio FM, Pasquini L. Prevalence and predictors of neoaortic regurgitation after arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 2003; 126:1753-9. [PMID: 14688683 DOI: 10.1016/s0022-5223(03)01325-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [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: 10/26/2022]
Abstract
BACKGROUND The fate of the native pulmonary valve after arterial switch operation is still unknown and may become a cause for a secondary aortic valve operation during adult life. We evaluated the prevalence and predictive factors associated with neoaortic valvular regurgitation by a retrospective study of children who underwent arterial switch operation for transposition of the great arteries. METHODS The onset of neoaortic valvular regurgitation was correlated with demographic data, cardiac anatomy, surgical technique, and postoperative ventricular function. The size of the neoaortic root and ascending aorta was measured in a selected subset of patients. RESULTS Among 253 survivors, 173 were eligible for the study. After a median follow-up time of 8.2 years, 61 patients showed echocardiographic or angiographic evidence of valvular incompetence, which was progressive in 14 cases; this led to surgical intervention in 2 patients, and there was 1 operative death. At multivariate analysis, the onset of valvular regurgitation was correlated with the trap-door technique for coronary reimplantation (P <.01). A smooth transition from the aortic sinus to the ascending aorta, with loss of the normal sinotubular junction geometry, may be associated with valvular incompetence. CONCLUSIONS After arterial switch operation, there is an increasing frequency of neoaortic regurgitation, which may lead to significant valvular dysfunction later in life. The trap-door type of coronary reimplantation is associated with an increased risk for valvular dysfunction, possibly because of a distortion of the sinotubular junction geometry. For this reason, we recommend the punch technique for repair in all but the most complicated coronary pattern.
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Affiliation(s)
- Roberto Formigari
- Pediatric Cardiology and Cardiac Surgery, University of Bologna, Italy.
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Marino B, Capolino R, Digilio MC, Di Donato R. Transposition of the great arteries in asplenia and polysplenia phenotypes. Am J Med Genet 2002; 110:292-4. [PMID: 12116241 DOI: 10.1002/ajmg.10376] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mazzera E, Brancaccio G, Feltri C, Michielon G, Di Donato R. Minimally invasive surgical closure of patent ductus arteriosus in premature infants: a novel approach. J Card Surg 2002; 17:292-4. [PMID: 12546075 DOI: 10.1111/j.1540-8191.2001.tb01143.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent advancement of minimally invasive cardiac surgical procedures have prompted the use of minimal incisions to perform operations on patients with congenital heart defects. In this report, we describe a new technique for closure of a patent ductus arteriosus, using an anterior extrapleural approach. We present our technique and results in five low-weight infants. This approach is safe and effective, shortens hospital stay, and is less invasive than classical approaches.
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Affiliation(s)
- Ennio Mazzera
- Department of Cardiac Pediatric Surgery, Hospital Bambino Gesu, Rome, Italy
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31
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Amodeo A, Donato RD, Dessanti A, Caccia G, Zaltron D, Alberti D, Callea F, Marcelletti C. Relief of membranous obstruction of the inferior vena cava in a 5-year-old child. J Thorac Cardiovasc Surg 1986. [DOI: 10.1016/s0022-5223(19)35828-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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