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Noviello TMR, Di Giacomo AM, Caruso FP, Covre A, Mortarini R, Scala G, Costa MC, Coral S, Fridman WH, Sautès-Fridman C, Brich S, Pruneri G, Simonetti E, Lofiego MF, Tufano R, Bedognetti D, Anichini A, Maio M, Ceccarelli M. Guadecitabine plus ipilimumab in unresectable melanoma: five-year follow-up and integrated multi-omic analysis in the phase 1b NIBIT-M4 trial. Nat Commun 2023; 14:5914. [PMID: 37739939 PMCID: PMC10516894 DOI: 10.1038/s41467-023-40994-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/18/2023] [Indexed: 09/24/2023] Open
Abstract
Association with hypomethylating agents is a promising strategy to improve the efficacy of immune checkpoint inhibitors-based therapy. The NIBIT-M4 was a phase Ib, dose-escalation trial in patients with advanced melanoma of the hypomethylating agent guadecitabine combined with the anti-CTLA-4 antibody ipilimumab that followed a traditional 3 + 3 design (NCT02608437). Patients received guadecitabine 30, 45 or 60 mg/m2/day subcutaneously on days 1 to 5 every 3 weeks starting on week 0 for a total of four cycles, and ipilimumab 3 mg/kg intravenously starting on day 1 of week 1 every 3 weeks for a total of four cycles. Primary outcomes of safety, tolerability, and maximum tolerated dose of treatment were previously reported. Here we report the 5-year clinical outcome for the secondary endpoints of overall survival, progression free survival, and duration of response, and an exploratory integrated multi-omics analysis on pre- and on-treatment tumor biopsies. With a minimum follow-up of 45 months, the 5-year overall survival rate was 28.9% and the median duration of response was 20.6 months. Re-expression of immuno-modulatory endogenous retroviruses and of other repetitive elements, and a mechanistic signature of guadecitabine are associated with response. Integration of a genetic immunoediting index with an adaptive immunity signature stratifies patients/lesions into four distinct subsets and discriminates 5-year overall survival and progression free survival. These results suggest that coupling genetic immunoediting with activation of adaptive immunity is a relevant requisite for achieving long term clinical benefit by epigenetic immunomodulation in advanced melanoma patients.
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Affiliation(s)
- Teresa Maria Rosaria Noviello
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
- BIOGEM Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
| | - Anna Maria Di Giacomo
- University of Siena, Siena, Italy
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
- NIBIT Foundation Onlus, Siena, Italy
| | - Francesca Pia Caruso
- BIOGEM Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
- Department of Electrical Engineering and Information Technology (DIETI), University of Naples "Federico II", Naples, Italy
| | | | - Roberta Mortarini
- Human Tumors Immunobiology Unit, Dept. of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Scala
- Department of Biology, University of Naples "Federico II", Naples, Italy
| | - Maria Claudia Costa
- BIOGEM Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
- Department of Electrical Engineering and Information Technology (DIETI), University of Naples "Federico II", Naples, Italy
| | | | - Wolf H Fridman
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Team Cancer, Immune Control and Escape, Paris, France
- University Paris Descartes Paris 5, Sorbonne Paris Cite, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Sorbonne University, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Catherine Sautès-Fridman
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Team Cancer, Immune Control and Escape, Paris, France
- University Paris Descartes Paris 5, Sorbonne Paris Cite, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Sorbonne University, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Silvia Brich
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Simonetti
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | | | - Rossella Tufano
- BIOGEM Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
- Department of Science and Technology, University of Sannio, Benevento, Italy
| | - Davide Bedognetti
- Cancer Program, Human Immunology Department, Research Branch, Sidra Medicine, Doha, Qatar
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Andrea Anichini
- Human Tumors Immunobiology Unit, Dept. of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Maio
- University of Siena, Siena, Italy.
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy.
- NIBIT Foundation Onlus, Siena, Italy.
| | - Michele Ceccarelli
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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Toscano E, Sepe L, del Giudice G, Tufano R, Paolella G. A three component model for superdiffusive motion effectively describes migration of eukaryotic cells moving freely or under a directional stimulus. PLoS One 2022; 17:e0272259. [PMID: 35917375 PMCID: PMC9345344 DOI: 10.1371/journal.pone.0272259] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 07/15/2022] [Indexed: 11/25/2022] Open
Abstract
Although the simple diffusion model can effectively describe the movement of eukaryotic cells on a culture surface observed at relatively low sampling frequency, at higher sampling rates more complex models are often necessary to better fit the experimental data. Currently available models can describe motion paths by involving additional parameters, such as linearity or directional persistence in time. However sometimes difficulties arise as it is not easy to effectively evaluate persistence in presence of a directional bias. Here we present a procedure which helps solve this problem, based on a model which describes displacement as the vectorial sum of three components: diffusion, persistence and directional bias. The described model has been tested by analysing the migratory behaviour of simulated cell populations and used to analyse a collection of experimental datasets, obtained by observing cell cultures in time lapse microscopy. Overall, the method produces a good description of migration behaviour as it appears to capture the expected increase in the directional bias in presence of wound without a large concomitant increase in the persistence module, allowing it to remain as a physically meaningful quantity in the presence of a directional stimulus.
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Affiliation(s)
- Elvira Toscano
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli studi di Napoli “Federico II”, Napoli, Italy
- Ceinge Biotecnologie Avanzate, Napoli, Italy
| | - Leandra Sepe
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli studi di Napoli “Federico II”, Napoli, Italy
- Ceinge Biotecnologie Avanzate, Napoli, Italy
| | - Giusy del Giudice
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli studi di Napoli “Federico II”, Napoli, Italy
| | | | - Giovanni Paolella
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli studi di Napoli “Federico II”, Napoli, Italy
- Ceinge Biotecnologie Avanzate, Napoli, Italy
- * E-mail:
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Malapelle U, Buono M, Pisapia P, Russo G, Tufano R, Pepe F, Rolfo C, Troncone G. Circulating tumor DNA in cancer: Predictive molecular pathology meets mathematics. Crit Rev Oncol Hematol 2021; 163:103394. [PMID: 34119656 DOI: 10.1016/j.critrevonc.2021.103394] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/28/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 12/11/2022] Open
Abstract
The cancer secretome is a valuable reservoir of cancer biomarkers. Besides containing circulating tumor cells, extracellular vesicles, and proteins, it is also rich in circulating tumor DNA (ctDNA)-a subpopulation of cell free DNA. The most efficient technology to capture ctDNA is next generation sequencing (NGS). Indeed, this analysis enables the identification of both quantitative (e.g., mutant allelic fraction - MAF) and qualitative (e.g., the variant type) information. Strikingly, by calculating these data in relation to time, cytopathologists can decodify and graphically report the ctDNA "message", which may help to diagnose cancer, define treatment, and monitor disease evolution. In this paper, we report the most compelling evidence steadily accumulating on the successful application of NGS-based ctDNA analysis in cancer diagnosis, treatment decision, and monitoring of cancer progression. We also propose a mathematical model that calculates MAF evolution in relation to time.
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Affiliation(s)
- Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Mauro Buono
- School of Specialization in Medical Physics, University of Naples Federico II, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Gianluca Russo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Francesco Pepe
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cancer Institute, Mount Sinai Medical System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy.
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4
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Discepolo V, Lania G, Ten Eikelder MLG, Nanayakkara M, Sepe L, Tufano R, Troncone R, Auricchio S, Auricchio R, Paolella G, Barone MV. Pediatric Celiac Disease Patients Show Alterations of Dendritic Cell Shape and Actin Rearrangement. Int J Mol Sci 2021; 22:ijms22052708. [PMID: 33800150 PMCID: PMC7962447 DOI: 10.3390/ijms22052708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 12/26/2022] Open
Abstract
Celiac disease (CD) is a frequent intestinal inflammatory disease occurring in genetically susceptible individuals upon gluten ingestion. Recent studies point to a role in CD for genes involved in cell shape, adhesion and actin rearrangements, including a Rho family regulator, Rho GTPase-activating protein 31 (ARHGAP31). In this study, we investigated the morphology and actin cytoskeletons of peripheral monocyte-derived dendritic cells (DCs) from children with CD and controls when in contact with a physiological substrate, fibronectin. DCs were generated from peripheral blood monocytes of pediatric CD patients and controls. After adhesion on fibronectin, DCs showed a higher number of protrusions and a more elongated shape in CD patients compared with controls, as assessed by immunofluorescence actin staining, transmitted light staining and video time-lapse microscopy. These alterations did not depend on active intestinal inflammation associated with gluten consumption and were specific to CD, since they were not found in subjects affected by other intestinal inflammatory conditions. The elongated morphology was not a result of differences in DC activation or maturation status, and did not depend on the human leukocyte antigen (HLA)-DQ2 haplotype. Notably, we found that ARH-GAP31 mRNA levels were decreased while RhoA-GTP activity was increased in CD DCs, pointing to an impairment of the Rho pathway in CD cells. Accordingly, Rho inhibition was able to prevent the cytoskeleton rearrangements leading to the elongated morphology of celiac DCs upon adhesion on fibronectin, confirming the role of this pathway in the observed phenotype. In conclusion, adhesion on fibronectin discriminated CD from the controls' DCs, revealing a gluten-independent CD-specific cellular phenotype related to DC shape and regulated by RhoA activity.
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Affiliation(s)
- Valentina Discepolo
- European Laboratory for the Investigation of Food Induced Diseases, Department of Translational Medical Science, Section of Pediatrics, and ELFID, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.D.); (G.L.); (M.N.); (R.T.); (S.A.); (R.A.); (G.P.)
| | - Giuliana Lania
- European Laboratory for the Investigation of Food Induced Diseases, Department of Translational Medical Science, Section of Pediatrics, and ELFID, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.D.); (G.L.); (M.N.); (R.T.); (S.A.); (R.A.); (G.P.)
| | | | - Merlin Nanayakkara
- European Laboratory for the Investigation of Food Induced Diseases, Department of Translational Medical Science, Section of Pediatrics, and ELFID, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.D.); (G.L.); (M.N.); (R.T.); (S.A.); (R.A.); (G.P.)
| | - Leandra Sepe
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (L.S.); (R.T.)
| | - Rossella Tufano
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (L.S.); (R.T.)
| | - Riccardo Troncone
- European Laboratory for the Investigation of Food Induced Diseases, Department of Translational Medical Science, Section of Pediatrics, and ELFID, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.D.); (G.L.); (M.N.); (R.T.); (S.A.); (R.A.); (G.P.)
| | - Salvatore Auricchio
- European Laboratory for the Investigation of Food Induced Diseases, Department of Translational Medical Science, Section of Pediatrics, and ELFID, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.D.); (G.L.); (M.N.); (R.T.); (S.A.); (R.A.); (G.P.)
| | - Renata Auricchio
- European Laboratory for the Investigation of Food Induced Diseases, Department of Translational Medical Science, Section of Pediatrics, and ELFID, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.D.); (G.L.); (M.N.); (R.T.); (S.A.); (R.A.); (G.P.)
| | - Giovanni Paolella
- European Laboratory for the Investigation of Food Induced Diseases, Department of Translational Medical Science, Section of Pediatrics, and ELFID, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.D.); (G.L.); (M.N.); (R.T.); (S.A.); (R.A.); (G.P.)
| | - Maria Vittoria Barone
- European Laboratory for the Investigation of Food Induced Diseases, Department of Translational Medical Science, Section of Pediatrics, and ELFID, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.D.); (G.L.); (M.N.); (R.T.); (S.A.); (R.A.); (G.P.)
- Correspondence:
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5
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Pisapia P, Pepe F, Iaccarino A, Sgariglia R, Nacchio M, Conticelli F, Salatiello M, Tufano R, Russo G, Gragnano G, Girolami I, Eccher A, Malapelle U, Troncone G. Next Generation Sequencing in Cytopathology: Focus on Non-Small Cell Lung Cancer. Front Med (Lausanne) 2021; 8:633923. [PMID: 33644101 PMCID: PMC7904874 DOI: 10.3389/fmed.2021.633923] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
Molecular cytopathology is a rapidly evolving field embracing both conventional microscopy and molecular pathology. Its growing popularity stems from the fact that in many types of advanced cancers, including non small cell lung cancer (NSCLC), cytological samples often constitute the only available specimens for morphomolecular analysis. Indeed, non formalin fixed and paraffin embedded (FFPE) cytological samples feature a higher quality of extracted nucleic acids than histological specimens. However, because of the growing complexity of molecular testing, several efforts should be made to validate the analytical performance of the wide array of currently available molecular technologies, including next generation sequencing (NGS). This technology has the terrific advantage of allowing simultaneous detection of scores of predictive biomarkers even in low-input DNA/RNA specimens. Here, we briefly review the role of the modern cytopathologist in the morphomolecular diagnosing of advanced stage NSCLC and the adoption of NGS in conventional cytopreparations (cell blocks, direct smears, and liquid-based cytology) and supernatants.
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Affiliation(s)
- Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Francesco Pepe
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Roberta Sgariglia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Mariantonia Nacchio
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Floriana Conticelli
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Maria Salatiello
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Gianluca Russo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Gianluca Gragnano
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ilaria Girolami
- Division of Pathology, Central Hospital Bolzano, Bolzano, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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6
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De Luca C, Pepe F, Iaccarino A, Pisapia P, Righi L, Listì A, Greco L, Gragnano G, Campione S, De Dominicis G, Pagni F, Sgariglia R, Nacchio M, Tufano R, Conticelli F, Vigliar E, Bellevicine C, Cortinovis DL, Novello S, Molina-Vila MA, Rosell R, Troncone G, Malapelle U. RNA-Based Assay for Next-Generation Sequencing of Clinically Relevant Gene Fusions in Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13010139. [PMID: 33406752 PMCID: PMC7796105 DOI: 10.3390/cancers13010139] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 12/10/2020] [Revised: 12/28/2020] [Accepted: 01/02/2021] [Indexed: 02/07/2023] Open
Abstract
Gene fusions represent novel predictive biomarkers for advanced non-small cell lung cancer (NSCLC). In this study, we validated a narrow NGS gene panel able to cover therapeutically-relevant gene fusions and splicing events in advanced-stage NSCLC patients. To this aim, we first assessed minimal complementary DNA (cDNA) input and the limit of detection (LoD) in different cell lines. Then, to evaluate the feasibility of applying our panel to routine clinical samples, we retrospectively selected archived lung adenocarcinoma histological and cytological (cell blocks) samples. Overall, our SiRe RNA fusion panel was able to detect all fusions and a splicing event harbored in a RNA pool diluted up to 2 ng/µL. It also successfully analyzed 46 (95.8%) out of 48 samples. Among these, 43 (93.5%) out of 46 samples reproduced the same results as those obtained with conventional techniques. Intriguingly, the three discordant results were confirmed by a CE-IVD automated real-time polymerase chain reaction (RT-PCR) analysis (Easy PGX platform, Diatech Pharmacogenetics, Jesi, Italy). Based on these findings, we conclude that our new SiRe RNA fusion panel is a valid and robust tool for the detection of clinically relevant gene fusions and splicing events in advanced NSCLC.
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Affiliation(s)
- Caterina De Luca
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
| | - Francesco Pepe
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
| | - Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
| | - Luisella Righi
- Department of Oncology, San Luigi University Hospital, University of Turin, 10043 Orbassano, Italy; (L.R.); (A.L.)
| | - Angela Listì
- Department of Oncology, San Luigi University Hospital, University of Turin, 10043 Orbassano, Italy; (L.R.); (A.L.)
| | - Lorenza Greco
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
| | - Gianluca Gragnano
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
| | - Severo Campione
- Anatomic Pathology, A.O.R.N. Antonio Cardarelli, 80131 Naples, Italy; (S.C.); (G.D.D.); (S.N.)
| | - Gianfranco De Dominicis
- Anatomic Pathology, A.O.R.N. Antonio Cardarelli, 80131 Naples, Italy; (S.C.); (G.D.D.); (S.N.)
| | - Fabio Pagni
- Department of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy; (F.P.); (D.L.C.)
| | - Roberta Sgariglia
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
| | - Mariantonia Nacchio
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
| | - Rossella Tufano
- CEINGE Biotecnologie Avanzate, Via Gaetano Salvatore 486, 80131 Naples, Italy;
| | - Floriana Conticelli
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
| | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
| | - Diego Luigi Cortinovis
- Department of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy; (F.P.); (D.L.C.)
| | - Silvia Novello
- Anatomic Pathology, A.O.R.N. Antonio Cardarelli, 80131 Naples, Italy; (S.C.); (G.D.D.); (S.N.)
| | | | - Rafael Rosell
- Cancer Biology and Precision Medicine Program Catalan Institute of Oncology, Germans Trias i Pujol Health Sciences Institute and Hospital Badalona, 08916 Barcelona, Spain;
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
- Correspondence: ; Fax: +39-(011)-0817-463-679
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (C.D.L.); (F.P.); (A.I.); (P.P.); (L.G.); (G.G.); (R.S.); (M.N.); (F.C.); (E.V.); (C.B.); (U.M.)
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7
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Pepe F, Pisapia P, Gristina V, Rocco D, Micheli M, Micheli P, Iaccarino A, Tufano R, Gragnano G, Russo G, De Luca C, Sgariglia R, Nacchio M, Girolami I, Eccher A, Russo A, Troncone G, Malapelle U. Tumor mutational burden on cytological samples: A pilot study. Cancer Cytopathol 2020; 129:460-467. [PMID: 33378102 DOI: 10.1002/cncy.22400] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 10/26/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Immune-checkpoint inhibitors (ICIs) represent an important treatment option for patients who have advanced stage non-small cell lung cancer (NSCLC). Currently, evaluation of the expression level of programmed death-ligand 1 (PD-L1) has proven highly successful as a positive predictive biomarker for ICIs. In addition to PD-L1, other promising predictive biomarkers are emerging, including high tumor mutational burden (TMB-H). However, measuring TMB-H remains challenging for several reasons, among which is the difficulty in obtaining adequate tissue material from NSCLC patients. There are no data in the current literature regarding the possibility of adopting cell blocks (CBs) for TMB evaluation; therefore, our goal was to evaluate the feasibility of analyzing TMB on CBs. METHODS For evaluation of differences in run metric parameters, 8 pairs of histological and CB samples from patients with NSCLC were analyzed using the Oncomine Tumor Mutational Load Assay on Ion Torrent S5 GS next-generation sequencing (NGS) platform. RESULTS Most CBs (6/8, 75.0%) were successfully analyzed by adopting the broad NGS panel approach. CBs provided results similar to those obtained on histological matched specimens in terms of median total reads (7207048.80 vs 7558817.80), median mapped reads (7075753.83 vs 7513822.00), median read lengths (115.50 vs. 113.00), median percentage of reads on-target (97.49% vs. 98.45%), median average reads per amplicon (454.67 vs 476.14), and median uniformity of amplicon coverage (83.52% vs 84.13%). CONCLUSION In this pilot study, we demonstrated the technical feasibility of assessing TMB on CBs.
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Affiliation(s)
- Francesco Pepe
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Valerio Gristina
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Danilo Rocco
- Department of Oncology, A.O.R.N. Azienda Ospedaliera dei Colli, Naples, Italy
| | | | - Pietro Micheli
- Department of Pathology, A.O.R.N. Azienda Ospedaliera dei Colli, Naples, Italy
| | - Antonino Iaccarino
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | | | - Gianluca Gragnano
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Gianluca Russo
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Caterina De Luca
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Roberta Sgariglia
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Mariantonia Nacchio
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Ilaria Girolami
- Division of Pathology, Central Hospital Bolzano, Bolzano, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giancarlo Troncone
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, University Federico II of Naples, Naples, Italy
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Zhang D, Caruso E, Sun H, Anuwong A, Tufano R, Materazzi G, Dionigi G, Kim HY. Classifying pain in transoral endoscopic thyroidectomy. J Endocrinol Invest 2019; 42:1345-1351. [PMID: 31187465 DOI: 10.1007/s40618-019-01071-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 05/10/2019] [Accepted: 06/05/2019] [Indexed: 11/28/2022]
Abstract
PURPOSES Knowledge of visual analog scale (VAS) pain assessment for transoral endoscopic thyroidectomy vestibular approach (TOETVA) is limited. The purpose of this analysis was to classify the postoperative discomfort scores in patients undergoing TOETVA compared to open thyroidectomy. METHODS Observational clinical study of patients who underwent thyroidectomy by VAS pain assessment from September 2016 to March 2017. Patients were stratified into two groups: patients eligible for TOETVA (Group TOETVA) and non-candidates for endoscopic intervention (open thyroidectomy approach-OTA). VAS was recorded in the recovery room, at 24 h, + 2, + 5, + 15, + 30, + 90 days, and 6 months after surgery. Pain assessment was stratified in VAS-lower lip, VAS-chin, VAS-jaw, VAS-anterior neck, VAS-cervical/back, VAS-swallowing, VAS-brushing, VAS-speaking, and VAS-shaving. Secondary outcome assessed were analgesic rescue dose, morbidity, operative notes, hospital stay, and histopathology. RESULTS 41 TOETVA and 45 OTA constituted the analysis. There were differences between the TOETVA and OTA for age, gland volume, mean nodule diameter, coexistence thyroiditis, bilateral procedures, and use of drain. Operative time was longer in TOETVA. Results indicated that TOETVA was associated with reduced neck, cervical back, and swallowing VAS scores in the 24 h after surgery. Conversely, jaw and brushing teeth resulted in higher VAS score in TOETVA group. OTA patients never experienced lower lip or chin pain. The use of rescue analgesics did not differ between the two groups. CONCLUSIONS VAS was used to measure treatment outcome in TOETVA. VAS scores achieved overall a minimal clinical importance difference from the two procedures. There appears to be both a short- and long-term different range of interpretations of pain between TOETVA and OTA.
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Affiliation(s)
- D Zhang
- Division of thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin Provincial Key Laboratory Of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun, Jilin, P.R. China
| | - E Caruso
- Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Via C. Valeria 1, 98125, Messina, Italy.
| | - H Sun
- Division of thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin Provincial Key Laboratory Of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun, Jilin, P.R. China
| | - A Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - R Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - G Dionigi
- Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Via C. Valeria 1, 98125, Messina, Italy
| | - H Y Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, South Korea
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Cirillo V, Zito Marinosci G, De Robertis E, Iacono C, Romano GM, Desantis O, Piazza O, Servillo G, Tufano R. Navigator® and SmartPilot® View are helpful in guiding anesthesia and reducing anesthetic drug dosing. Minerva Anestesiol 2015; 81:1163-1169. [PMID: 25598294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The recently introduced Navigator® (GE Healthcare, Helsinki, Finland) and SmartPilot® View (Dräger Medical, Lübeck, Germany) show the concentrations and predicted effects of combined anesthetic drugs, and should facilitate more precisely their titration. Our aim was to evaluate if Navigator® or SmartPilot® View guided anesthesia was associated with a good quality of analgesia, depth of hypnosis and may reduce anesthetic requirements. METHODS We performed a prospective non-randomized study. Sixty ASA I-II patients undergoing balanced general anesthesia for abdominal and plastic surgery were enrolled. Patients were divided in 4 groups. Group 1 (N. 15) and group 3 (N. 15) were cases in whom anesthesia was performed with standard monitoring plus the aid of Navigator® (Nav) or SmartPilot® View (SPV) display. Group 2 (N. 15) and group 4 (N. 15) were controls in whom anesthesia was performed with standard monitoring (heart rate, NIBP, SpO2, end-tidal CO2, end-expired sevoflurane concentration, train of four, Bispectral Index [Aspect Medical Systems, Natick, MA, USA] or Entropy [GE Healthcare]). Patients' vital parameters and end-expired sevoflurane concentration were recorded during anesthesia. RESULTS All patients recovered uneventfully and showed hemodynamic stability. End-tidal sevoflurane concentrations values [median (min-max)], during maintenance of anesthesia, were significantly (P<0.05) lower in SPV [1.1% (0.8-1.5)] and Nav [1%(0.8-1.8)] groups compared to SPV-control group [1.5%(1-2.5)] and Nav-control group [1.5%(0.8-2)]. BIS and entropy values were respectively higher in the SPV group [53 (46-57)] compared to the control group [43 (37-51)] (P<0.05) and Nav group [53 (43-60)] compared to the control group [41 (35-51)] (P<0.05). No significant differences in Remifentanil dosing were observed in the four groups. CONCLUSION Navigator® and SmartPilot® View may be of clinical use in monitoring adequacy of anesthesia. Both displays can optimize the administration and monitoring of anesthetic drugs during general anesthesia and may reduce the consumption of volatile anesthetic agents.
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Affiliation(s)
- V Cirillo
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University Federico II, Naples, Italy -
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Partanen A, Ellens N, Noureldine S, Burdette E, Tufano R, Farahani K. WE-EF-BRA-12: Magnetic Resonance- Guided High-Intensity Focused Ultrasound for Localized Ablation of Head and Neck Tissue Structures: A Feasibility Study in An Animal Model. Med Phys 2015. [DOI: 10.1118/1.4925991] [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: 11/07/2022] Open
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De Robertis E, Kozek-Langenecker SA, Tufano R, Romano GM, Piazza O, Zito Marinosci G. Coagulopathy induced by acidosis, hypothermia and hypocalcaemia in severe bleeding. Minerva Anestesiol 2015; 81:65-75. [PMID: 24608516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Acidosis, hypothermia and hypocalcaemia are determinants for morbidity and mortality during massive hemorrhages. However, precise pathological mechanisms of these environmental factors and their potential additive or synergistic anticoagulant and/or antiplatelet effects are not fully elucidated and are at least in part controversial. Best available evidences from experimental trials indicate that acidosis and hypothermia progressively impair platelet aggregability and clot formation. Considering the cell-based model of coagulation physiology, hypothermia predominantly prolongs the initiation phase, while acidosis prolongs the propagation phase of thrombin generation. Acidosis increases fibrinogen breakdown while hypothermia impairs its synthesis. Acidosis and hypothermia have additive effects. The effect of hypocalcaemia on coagulopathy is less investigated but it appears that below the cut-off of 0.9 mmol/L, several enzymatic steps in the plasmatic coagulation system are blocked while above that cut-off effects remain without clinical sequalae. The impact of environmental factor on hemostasis is underestimated in clinical practice due to our current practice of using routine coagulation laboratory tests such as partial thromboplastin time or prothrombin time, which are performed at standardized test temperature, after pH correction, and upon recalcification. Temperature-adjustments are feasible in viscoelastic point-of-care tests such as thrombelastography and thromboelastometry which may permit quantification of hypothermia-induced coagulopathy. Rewarming hypothermic bleeding patients is highly recommended because it improves patient outcome. Despite the absence of high-quality evidence, calcium supplementation is clinical routine in bleeding management. Buffer administration may not reverse acidosis-induced coagulopathy but may be essential for the efficacy of coagulation factor concentrates such as recombinant activated factor VII.
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Affiliation(s)
- E De Robertis
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Federico II University of Naples, Naples, Italy -
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Piazza O, Leggiero E, De Benedictis G, Pastore L, Salvatore F, Tufano R, De Robertis E. S100B induces the release of pro-inflammatory cytokines in alveolar type I-like cells. Int J Immunopathol Pharmacol 2013; 26:383-91. [PMID: 23755753 DOI: 10.1177/039463201302600211] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
S100B, a 21kDa cytosolic calcium-binding protein of the EF-hand type, present in high abundance in the brain, stimulates inflammatory responses in different cellular types inside and outside the central nervous system. Most of extracellular S100B effects are mediated by Receptor for Advanced Glycation End-products (RAGE). RAGE is highly expressed in lung by Alveolar Type-I (AT-I) cells and its activation contributes to ALI/ARDS pathogenesis. In this in-vitro study, we tested the hypothesis that S100B stimulates an ATI-derived cell line (R3/1) to secrete inflammatory mediators involved in lung inflammation. Our main result is that S100B stimulates R3/1 cells to secrete TNF-alpha and IL-6 (well-known pro-inflammatory cytokines in lung inflammation and neurogenic pulmonary edema), but not sICAM-1, CINC-1 or CINC-3. Soluble RAGE (sRAGE) reduced S100B-dependent secretion of TNF-alpha but did not decrease S100B-dependent secretion of IL-6. Moreover, in absence of S100B, sRAGE enhanced IL-6 release. This study demonstrates that in vitro S100B dose-dependently stimulated R3/1 cells, to enhance the secretion of TNF-alpha and IL-6; S100B pro-inflammatory activity might be mediated at least in part by RAGE. Besides acting as decoy receptor, sRAGE could have pro-inflammatory properties.
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Affiliation(s)
- O Piazza
- Dipartimento di Medicina, Anestesiologia e Rianimazione, University of Salerno, Salerno, Italy
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Piazza O, Pulcrano G, Fiori PL, Tufano R, Lonardo M, Rossano F, Catania MR. Toll-like receptor kinetics in septic shock patients: a preliminary study. Int J Immunopathol Pharmacol 2012; 25:425-33. [PMID: 22697074 DOI: 10.1177/039463201202500212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study is to evaluate some inflammatory parameter changes in septic shock patients and their possible correlation with clinical outcome, in particular when continuous veno-venous hemofiltration (CVVH) treatment is required. Considering the objective difficulty in enrolling this kind of patient, a preliminary study was initiated on seventeen septic shock patients admitted to a medical and surgical ICU. The mRNA expression of Toll-like receptor (TLR)-1, TLR-2, TLR-4, TLR-5, TLR-9, TNFα, IL-8 and IL-1β was assessed, the plasmatic concentrations of IL-18, IL-2, IL-10 and TNFα were measured on the day of sepsis diagnosis and after 72 h. In those patients who developed acute renal failure unresponsive to medical treatment and who underwent CVVH treatment the same parameters were measured every 24 h during CVVH and after completion of the treatment. On sepsis diagnosis, gene expression of TLRs was up-regulated compared to the housekeeping gene in all the patients. After 72 h, in 35% of the patients a down-regulation of these genes was found compared to day 1, but it was not associated with a reduction of cytokine serum levels or improved clinical signs, better outcome or reduced mortality. After high volume hemofiltration treatment, cytokine serum levels and TLR expression were not significantly modified. In conclusion, considering the not numerous number of cases, from our preliminary study, we cannot certainly correlate TLR over-expression in septic shock patients with severity or outcome scores.
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Affiliation(s)
- O Piazza
- Department of Medicine and Surgery, University of Salerno, Italy
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Tufano R, Puntillo F, Draisci G, Pasetto A, Pietropaoli P, Pinto G, Catarci S, Cardone A, Varrassi G. ITalian Observational Study of the management of mild-to-moderate Post-Operative Pain (ITOSPOP). Minerva Anestesiol 2012; 78:15-25. [PMID: 21720283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The multicenter observational ITalian Observational Study on the management of mild-to-moderate PostOperative Pain (ITOSPOP) was carried out in 24 hospitals to describe current postoperative pain management in Italy and the intensity of pain experienced by patients during the first 48 hours after surgery. METHODS Adult patients, after surgery expected to result in mild-moderate postoperative pain, underwent six evaluations. The primary endpoint was the level of organization and standardization of postoperative pain management. Secondary objectives included the intensity of postoperative pain, and an assessment of incident pain, postoperative analgesic and concomitant treatment administration. RESULTS Only 16.7% hospitals had an acute pain service and 41.7% hospitals applied a standardized protocol for postoperative pain management. The majority (>60%) of the 1952 patients monitored underwent all six assessments, >70% of which were performed by a physician. The proportion of patients with moderate pain decreased during the study period, but almost 10% of patients still experienced moderate pain at study end. Mild pain was reported by 50% of the patients for the entire study duration. At the final assessment, 5% of patients still presented with incident pain frequently interfering with daily activities. Most patients were treated with analgesics, but 20% of patients did not receive any pain medications despite experiencing pain. CONCLUSION The level of organization and standardization of postoperative pain management in Italian hospitals remains low. Postoperative analgesic treatment remained suboptimal and almost two-thirds of patients continued to experience pain.
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Affiliation(s)
- R Tufano
- Department of Anesthesia and Intensive Care, Federico II University, Naples, Italy
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Piazza O, Venditto A, Tufano R. Neurogenic pulmonary edema in subarachnoid hemorrage. Panminerva Med 2011; 53:203-210. [PMID: 21775947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Aneurysmal subarachnoid hemorrhage (SAH), in addition to the direct effects of the initial hemorrhage and secondary neurological complications, predisposes to medical complications. The proportion of deaths caused by non-neurological medical complications (cardiac, pulmonary, gastrointestinal, renal, hematological) equals that from neurological complications. In particular, pulmonary complications are responsible for 50% of all deaths from medical complications. Neurogenic pulmonary edema (NPE) is an increase of interstitial and alveolar fluid occurring as direct consequence of any acute central nervous system injury. Two different pathogenetic mechanisms of NPE have been hypothesized: i) hemodynamic (an increase of pulmonary vascular pressure due to an α-adrenergic response produces hydrostatic edema) and ii) inflammatory mechanism (brain cytokines and chemokines determinates an increase in the permeability of pulmonary capillaries causing exudative edema). Recent studies postulate that both mechanisms may be implicated in the pathogenesis of NPE. Brain injury is known to determine increased levels of S100B, a Ca- binding protein, in cerebrospinal fluid and in blood. Moreover, amine precursor uptake and decarboxylation (APUD) cells located in the respiratory tract produce and release S100B. This protein may contribute to the pathogenesis of NPE binding RAGE receptors in alveolar epithelial type I pneumocytes and amplifying the immune and inflammatory response causing lung injury. S100B can be the link between the brain and the lung and may be among the multiple pathological pathways that determine the development of pulmonary edema after bleeding.
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Affiliation(s)
- O Piazza
- Department of Anesthesiology and Resuscitation, Federico II University of Naples, Naples, Italy.
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Rispoli F, Iannuzzi M, De Robertis E, Piazza O, Tufano R. An unusual airway device obstruction. Minerva Anestesiol 2011; 77:96. [PMID: 21273970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Piazza O, De Robertis E, Caranci F, Quarantelli M, Tufano R. Riedel's thyroiditis and cerebral venous sinuses thrombosis: a case report. Panminerva Med 2010; 52:362-364. [PMID: 21183898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Iannuzzi M, De Sio A, De Robertis E, Piazza O, Servillo G, Tufano R. Different patterns of lung recruitment maneuvers in primary acute respiratory distress syndrome: effects on oxygenation and central hemodynamics. Minerva Anestesiol 2010; 76:692-698. [PMID: 20820146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND The aim of this study was to test if different recruitment maneuver (RM) patterns, that achieve the same maximum pressure for the same length of time in humans, have a similar efficacy on alveolar recruitment, intrathoracic vascular pressures and flows, and on cardiac function and ventricular filling. METHODS Forty patients were randomly allocated to undergo different RM patterns: sustained inflation (SI) or pressure controlled ventilation (PCV). The RM methods tested are as follows: SI was achieved by raising peak inspiratory pressure to 45 cmH(2)O and sustaining it for 40 seconds. The PCV was set to obtain a 45 cmH(2)O peak inspiratory pressure for 2 minutes, I:E 1:2, PEEP 16 RR 8/min. During the study period, patients were mechanically ventilated to obtain a volume of 6 mL/kg, FiO(2) 0.7, PEEP 14, RR 14, Pplateau < or =30 cmH(2)O according to the ARDSnet trial. All patients were sedated and paralyzed during the study period. All patients were given i.v. norepinephrine. Heart rate, pulse oxymetry, blood pressure, pulmonary artery catheter data (C.I., PVRI, MPAP, PAOP, SvO(2), CVP), and arterial and right heart side venous blood gas analysis data (ph, PaO(2), PaCO(2), SatO(2), HCO(3)(-), SvO(2)) were recorded before and immediately after the lung recruitment maneuver. The static compliance of the respiratory system (CRS) was recorded. Echocardiographic spot evaluations before and after RM were obtained in all cases. RESULTS Central venous pressure increased during RM. Mean pulmonary artery pressure, pulmonary capillary wedge pressure and pulmonary vascular resistance index were reduced during PCV RM compared to SI RM (P<0.05). The right ventricle stroke work index decreased to a major extent during PCV RM (P<0.05). The P/F ratio was significantly increased after PCV RM compared to SI RM (P<0.05). PaCO(2) levels were similar in the two groups. Compared to baseline, the Qs/Qt decreased significantly after the PCV recruitment maneuver. Ventricular end-diastolic and end-systolic areas decreased during both RM protocols, but they were decreased to a greater extent after SI RM than after PCV RM (P<0.05). The eccentricity index increased from baseline after the SI RM (P<0.05). CONCLUSION Given its comparable, or even superior, performance over the SI RM, we favor the PCV technique over the time-honored SI maneuver.
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Affiliation(s)
- M Iannuzzi
- Intensive Care Unit, Department of Anesthesia and Resuscitation, Federico II University Hospital, Naples, Italy.
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Iannuzzi E, Iannuzzi M, Mora B, Sidro L, Berrino L, Chiefari M, Tufano R. Relationship between A-line Autoregressive Index, Spectral Entropy and steady state predicted site-effect effective concentrations at 05-50-95 of propofol at different clinical endpoints. Minerva Anestesiol 2009; 75:692-697. [PMID: 19940821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM Target controlled infusion intravenous anesthesia is a growing phenomenon. Nowadays, many anesthesiologists feel the need to monitor depth of anesthesia during total intravenous anesthesia, even though it is not a standard technique worldwide. Spectral Entropy (SE) is a relatively new depth of anesthesia index. The aim of this study was to investigate whether predicted site-effect propofol concentrations, A-line Autoregressive Index (AAI) and SE values are useful for predicting loss of verbal contact (LVC) and loss of consciousness (LOC) during steady-state conditions. METHODS Forty-four patients scheduled for elective major abdominal surgery were recruited. All patients were unpremedicated. A target controlled infusion of propofol was administered using Schnider's pharmacokinetic model. The initial propofol infusion provided a site-effect concentration of 1.0 mcg mL-1, and was increased stepwise by 1.0 mcg mL-1 every 4 minutes until the concentration reached 6.0 mcg mL-1. A 4 minute interval was chosen to assure that steady state site-effect concentrations were obtained. AAI, SE and propofol site-effect concentrations were recorded when LVC occurred and also when LOC occurred. Population values for predicted site-effect concentrations at the clinical endpoints were estimated and correlated with AAI and SE values. RESULTS In our study for LOC the effect-site concentration to include 90% of patients was 5.85 ?mcg mL-1 (5.70-5.90) and 3.4 mcg mL-1 (3.24-3.60) for LVC. In this study, 90% of patients lost verbal contact at an AAI value of 68 (64.6-71.4) and an SE value of 68.2 (66.2-70.2). LOC occurred in 90% of patients at an AAI value of 39.2 (37.2-41.1) and an SE value of 40.2 (38.1-41.3). CONCLUSIONS LOC and LVC occur within a defined range of predicted site-effect concentrations. More emphasis should be given to site-effect concentrations. SE and AAI have similar values at different endpoints and similar correlation with Ceprop. AAI and SE are both useful tools in predicting both LVC and LOC.
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Affiliation(s)
- E Iannuzzi
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy.
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Piazza T, Piazza O, De Robertis E, Tufano R. Do you think my ICU will benefit from an electronic medical record system? Panminerva Med 2008; 50:339-345. [PMID: 19078874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In many Hospitals, Intensive Care Units (ICUs) are the most technologically advanced areas since the Intensive Care physicians deal with a massive quantity of data and information, because of the critical status of their patients each day. An electronic medical record (EMR) is a computer-base patient record optimized to support ambulatory settings and ward activities. An EMR may provide the physician with all the necessary information clearly gathered and stored and satisfy the need for more direct integration of the different information. Even if the installation of an EMR is a positive signal of modernity, it may represent a useless investment with minor effects on the clinical staff improvement and on the risk reduction, because of mayor failures in the installation planning, integration in the hospital system, personnel education. Definitions, advantages and limitation, implementation strategies and objectives of an ICU EMR system are reviewed.
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Affiliation(s)
- T Piazza
- Mediterranean Institute for Transplantations and High Specialized Therapies, Palermo, Italy.
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Sanguineti G, Califano J, Zhou J, Stafford E, Koch W, Tufano R, Gourin C, Sormani M, Marur S, Forastiere A. Defining the Risk of Involvement for each Neck Nodal Level in Patients with Early T-stage/Node-positive Oropharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.506] [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: 10/21/2022]
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Cotena S, Piazza O, Tufano R. The use of erythtropoietin in cerebral diseases. Panminerva Med 2008; 50:185-192. [PMID: 18607342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Global and focal cerebral ischemia is followed by a secondary damage characterized by oxidative stress, excitotoxicity, inflammation and apoptosis. Erythropoietin (EPO) exerts antiapoptotic, anti-inflammatory, antioxidative, angiogenetic and neurotrophic properties. Its potential therapeutic role has been demonstrated in several animal models of cerebral ischemia and also in a clinical trial of ischemic stroke, so it could be considered an ideal compound for neuroprotection in ischemic stroke and in cardiac arrest. Intracerebral hemorrhage (ICH) is the least treatable form of stroke; the mechanisms involved in the secondary brain injury include hematoma mass effect, neuronal apoptosis and necrosis, inflammation. It has been demonstrated in an experimental ICH that EPO intervenes in the inflammatory process, reduces brain water content, hemorrhage volume and hemispheric atrophy, promotes cell survival, preserves cerebral blood flow, has antiapoptotic protective function against oxidative stress and excitotoxic damage. EPO can attenuate acute vasoconstriction and prevent brain ischemic damage in subarachnoid hemorrhage. The neuroprotective function of EPO has been studied also in traumatic brain injury: it reduces the inflammation and improves cognitive and motor deficits. The authors review some of the physiological actions of EPO in the physiopathology of ischemic and hemorrhagic stroke, subarachnoid hemorrhage and brain trauma, and its potential usefulness in the brain injured patient management.
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Affiliation(s)
- S Cotena
- Department of Anesthesiology and Resuscitation, ''Federico II'' University of Naples, Naples, Italy.
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Zhou J, Goenka A, Garg R, Richardson M, Forastiere A, Califano J, Koch W, Farrag T, Tufano R, Bajaj G. Optimal Management of the Neck in Patients With Locoregionally Advanced Oropharyngeal Carcinoma: Comparison of Pre-Radiotherapy Neck Dissection, Post-Radiotherapy Neck Dissection or Observation. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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D'Amato L, Piazza O, Alliata L, Sabia G, Zito G, Frassanito L, Della Corte F, Tufano R. Prognosis of isolated acute post-traumatic subdural haematoma. J Neurosurg Sci 2007; 51:107-11. [PMID: 17641575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
AIM Acute subdural haematoma (ASDH) is seldom an isolated lesion and it is difficult to understand the mechanisms which determine the poor prognosis associated to this occurrence. Aim of this study was estimating the outcome of patients with ASDH without any companion lesions by analysing the haematoma volume, its thickness and midline shift. METHODS Twenty-eight severely head injured patients (Glasgow Coma Scale, GCS =/<8) with isolated unilateral ASDH admitted in intensive care unit (ICU) were retrospectively studied. The haematoma thickness, the midline shift, the ASDH volume were obtained from the first emergency computerized tomography (CT) scan and analysed by a computer assisted programme (Osiris). Patients' outcome was scored according to the Glasgow Outcome Scale (GOS) 6 months after the event. According to their GOS the patients were further divided in 2 groups (favourable outcome: GOS 4-5, poor outcome: GOS 1-2-3). RESULTS Midline shift ranged from 0 to 19.2 mm; we found a larger midline shift in those patients who died and in patients with severe disability or vegetative state 6 months after the trauma. CONCLUSION The presence and size of midline shift was a more important determinant of outcome than ASDH volume or its thickness.
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Affiliation(s)
- L D'Amato
- Department of Anaesthesia and Intensive Care, University of Naples Federico II, Naples, Italy
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Lonardo M, Piazza O, De Marco G, De Robertis E, Servillo G, Tufano R. Intra-abdominal hypertension is not reliable as an early predictor of mortality in the intensive care unit. Minerva Anestesiol 2007; 73:447-50. [PMID: 17660736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
AIM The aim of this study was to assess the prevalence of intra-abdominal hypertension and its prognostic value in critical patients. METHODS In an observational study, 56 patients of a multidisciplinary intensive care unit (ICU) of a university hospital, with either surgical (44.6%) or medical (55.4%) diagnoses, were studied. Intra-abdominal pressure was quantified daily by bladder pressure method from the first to the eighth day of hospitalization. RESULTS The mean intra-abdominal pressure at admission was 9.97+/-5.26 mmHg; 41% of patients suffered moderate intra-abdominal hypertension (defined as intra-abdominal pressure greater than 11 mmHg) at admission. On day 1 mean intra-abdominal pressure was not significantly different between the patients who died and those who survived (9.69+/-5.06 mmHg vs 10.12+/-5.57 mmHg respectively), but by measuring IAP until day 8 it was possible to distinguish a subgroup of patients who showed a persistently elevated intra-abdominal pressure, developed further complications, later died (12.5+/-4.37 mmHg vs 7.17+/-2.02 mmHg, P=0.022). CONCLUSION Intra-abdominal pressure does not have prognostic value at ICU admission, but may predict bad outcomes later during the ICU stay. Intra-abdominal hypertension is a frequent and rarely recognized event in the ICU which can be monitored by the bladder pressure method throughout the period of hospitalization.
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Affiliation(s)
- M Lonardo
- Department of Surgical Sciences, Anesthesiology and Critical Care, University Federico II, Naples, Italy
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Piazza O, Russo E, Cotena S, Esposito G, Tufano R. Elevated S100B levels do not correlate with the severity of encephalopathy during sepsis. Br J Anaesth 2007; 99:518-21. [PMID: 17650519 DOI: 10.1093/bja/aem201] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sepsis-associated encephalopathy (SAE) is defined as a diffuse cerebral dysfunction induced by the systemic response to infection without any clinical or laboratory evidence of direct infectious involvement of the central nervous system. The astroglial protein S100B has been used as a marker of severity of brain injury and as a prognostic index in trauma patients and cardiac arrest survivors. We measured S100B serum levels in patients with severe sepsis to investigate if the severity of SAE correlated with an increase in S100B levels. METHODS Twenty-one patients, with a diagnosis of severe sepsis, were included in this study. S100B levels were measured at intensive care unit (ICU) admission, 72 h and 7 days after admission. Their association with markers of brain dysfunction such as Glasgow coma scale (GCS), and EEG, and with sepsis-related organ failure assessment score (SOFA) and ICU mortality was investigated. RESULTS Fourteen patients had elevated S100B levels. The levels did not correlate with GCS at admission, EEG pattern, or SOFA scores. Also, S100B levels did not differ between patients who recovered neurologically and those who did not (P = 0.62). CONCLUSIONS In severe sepsis, an increase in S100B does not allow the physicians to distinguish patients with severe impairment of consciousness from those with milder derangements or to prognosticate neurological recovery.
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Affiliation(s)
- O Piazza
- Anestesia e Rianimazione, Università degli Studi di Napoli Federico II, via Pansini 5 (Ed 8), 80131 Napoli, Italy.
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Piazza O, Storti MP, Cotena S, Stoppa F, Perrotta D, Esposito G, Pirozzi N, Tufano R. S100B is not a reliable prognostic index in paediatric TBI. Pediatr Neurosurg 2007; 43:258-64. [PMID: 17627141 DOI: 10.1159/000103304] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [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: 11/16/2005] [Accepted: 09/19/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND As far as paediatric traumatic brain injury is concerned, it is difficult to quantify the extent of the primary insult, to monitor secondary changes and to predict neurological outcomes by means of the currently used diagnostic tools: physical examination, Glasgow Coma Scale (GCS) score and computed tomography. For this reason, several papers focused on the use of biochemical markers (S100B, neuron-specific enolase) to detect and define the severity of brain damage and predict outcome after traumatic head injury or cardiac arrest. OBJECTIVE The aim of this paper is measuring the range of S100B serum concentrations in children affected by traumatic brain injury and describing the possible roles of this protein in the reaction to trauma. METHODS Fifteen children aged 1-15 years were included in the study. Traumatic brain injury severity was defined by paediatric GCS score as mild (9 patients), moderate (2 patients) or severe (4 patients). Blood samples for S100B serum measurement were taken at emergency department admission and after 48 h. RESULTS The serum S100B concentration was higher in the group of severe trauma patients, who scored the lowest on the GCS at admission, and among them, the highest values were reported by the children with concomitant peripheral lesions. CONCLUSIONS The role of S100B in paediatric traumatic brain injury has not been clarified yet, and the interpretation of its increase when the head trauma is associated with other injuries needs the understanding of the physiopathological mechanisms that rule its release in the systemic circulation. The levels of S100B in serum after a brain injury could be related to the mechanical discharge from a destroyed blood-brain barrier, or they could be due to the active expression by the brain, as a part of its involvement in the systemic inflammatory reaction. Early increase of this protein is not a reliable prognostic index of neurological outcome after pediatric traumatic brain injury, since even very elevated values are compatible with a complete neurological recovery.
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Affiliation(s)
- O Piazza
- Department of Anaesthesia and Intensive Care, University of Naples Federico II, Naples, Italy
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Ambrosio F, Finco G, Mattia C, Mediati R, Paoletti F, Coluzzi F, Piacevoli Q, Savoia G, Amantea B, Aurilio C, Bonezzi C, Camaioni D, Chiefari M, Costantini A, Evangelista M, Ischia S, Mondello E, Polati E, Raffaeli W, Sabato AF, Varrassi G, Visentin M, Tufano R. SIAARTI recommendations for chronic noncancer pain. Minerva Anestesiol 2006; 72:859-80. [PMID: 17095986] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- F Ambrosio
- Department of Pharmacology and Anaesthesia, Padoa University, Padoa, Italy.
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Levati A, Bevilacqua L, Torri G, Tufano R. Error in medicine. Minerva Anestesiol 2006; 72:881-90. [PMID: 17095987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Mattia C, Savoia G, Paoletti F, Piazza O, Albanese D, Amantea B, Ambrosio F, Belfiore B, Berti M, Bertini L, Bruno F, Carassiti M, Celleno D, Coluzzi F, Consales G, Costantini A, Cuppini F, De Gaudio RA, Farnia A, Finco G, Gravino E, Guberti A, Laurenzi L, Mangione S, Marano M, Mariconda G, Martorano PP, Mediati R, Mercieri M, Mondello E, Oggioni R, Paolicchi A, Pelagalli L, Perrotta D, Petrini F, Piacevoli Q, Pirozzi N, Santangelo E, Siliotti R, Stoppa F, Tulli G, Tufano R. SIAARTI recommendations for analgo-sedation in intensive care unit. Minerva Anestesiol 2006; 72:769-805. [PMID: 17006417] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- C Mattia
- Unit of Anaesthesia, Resuscitation, Pain Therapy, Hyperbaric Therapy ICOT, Polo Pontino, La Sapienza University, Rome, Italy
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Bertini L, Savoia G, De Nicola A, Ivani G, Gravino E, Albani A, Alemanno F, Barbati A, Borghi B, Borrometi F, Casati A, Celleno D, Ciaschi A, Corcione A, De Negri P, Di Benedetto P, Evangelista M, Fanelli G, Grossi P, Loreto M, Margaria E, Mastronardi P, Mattia C, Nicosia F, Nolli M, Rutili A, Santangelo E, Sucre J, Tagariello V, Varrassi G, Paoletti F, Tufano R. SIAARTI guidelines for safety in locoregional anaesthesia. Minerva Anestesiol 2006; 72:689-722. [PMID: 16871153] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- L Bertini
- Anaesthesiology in Trauma Surgery and Pain Therapy Unit, CTO Hospital, ASL RMC, Rome, Italy
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Frova G, Guarino A, Petrini F, Merli G, Sorbello M, Baroncini S, Agrò F, Giusti F, Ivani G, Lombardo G, Messeri A, Mirabile L, Pigna A, Ripamonti D, Salvo I, Sarti A, Serafini G, Villani A, Accorsi A, Adrario E, Amicucci G, Antonelli M, Azzeri F, Bettelli G, Cafaggi C, Cattano D, Chinelli E, Corbanese U, Corso R, Di Filippo A, Facco E, Favaro R, Giunta F, Giurati G, Iannuzzi E, Mazzon D, Menarini M, Mondello E, Muttini S, Nardi G, Pittoni G, Rosa G, Rosi R, Servadio G, Sgandurra A, Tana F, Tufano R, Vesconi S, Zauli M. Recommendations for airway control and difficult airway management in paediatric patients. Minerva Anestesiol 2006; 72:723-48. [PMID: 16871154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Montanini S, Danelli G, Nuzzi M, Mentegazzi F, Torri G, Martani C, Spreafico E, Fierro G, Pugliese F, De Cosmo G, Aceto P, Servillo G, Monaco F. Monitoring cerebral oxygen saturation in elderly patients undergoing general abdominal surgery: a prospective cohort study. Eur J Anaesthesiol 2006; 24:59-65. [PMID: 16824246 DOI: 10.1017/s0265021506001025] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this prospective, observational study was to evaluate changes in regional cerebral oxygen saturation (rSO2) and incidence of intraoperative cerebral desaturation in a cohort of elderly patients undergoing major abdominal surgery. METHODS rSO2 was continuously monitored on the left and right sides of the forehead in 60 patients older than 65 yr (35 males and 25 females; ASA II-III; age: 72 +/- 5 yr; without pre-existing cerebral pathology, and baseline Mini Mental State Examination (MMSE) score >23) undergoing sevoflurane anaesthesia for major abdominal, non-vascular surgery >2 h. RESULTS Baseline rSO2 was 63 +/- 8%; cerebral desaturation (rSO2 decrease <75% of baseline or <80% in case of baseline rSO2 <50%) occurred in 16 patients (26%). The MMSE decreased from 28 +/- 1 before surgery to 27 +/- 2 on 7th postoperative day (P = 0.05). A decline in cognitive function (decrease in MMSE score > or = 2 points one week after surgery as compared to baseline value) was observed in six patients without intraoperative cerebral desaturation (13.6%) and six patients who had intraoperative cerebral desaturation (40%) (P = 0.057) (odds ratio: 4.22; CI95%: 1.1-16). Median (range) hospital stay was 14 (5-41) days in patients with an area under the curve of rSO2 <50% (AUCrSO2<50%) >10 min%, and 10 (4-30) days in those with an AUCrSO2<50% <10 min% (P = 0.0005). CONCLUSIONS In a population of healthy elderly patients, undergoing non-vascular abdominal surgery cerebral desaturation can occur in up to one in every four patients, and the occurrence of cerebral desaturation is associated with a higher incidence of early postoperative cognitive decline and longer hospital stay.
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Affiliation(s)
- A Casati
- Università degli Studi di Parma, Department of Anaesthesiology, Parma, Italy.
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Palumbo D, Servillo G, D'Amato L, Volpe ML, Capogrosso G, De Robertis E, Piazza O, Tufano R. The effects of hydroxyethyl starch solution in critically ill patients. Minerva Anestesiol 2006; 72:655-64. [PMID: 16865084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
AIM In the treatment of the critically ill patients an adequate fluid therapy appears to be essential to optimize hemodynamics and to get a suitable tissue perfusion. In this study we have evaluated the effects of volume replacement, carried out with 2 different solutions: hydroxyethyl starch 6% (HAES) and albumin 20% (HA). METHODS Twenty patients suffering from sepsis were recruited and randomized into 2 groups. The first group was treated with hydroxyethyl starch 6% ( HAES treated group), and the second with albumin 20% (HA treated group). The volume of colloids was given to maintain pulmonary capillary wedge pressure (PCWP) between 15 and 18 mmHg. Daily, both hemodynamic parameters and blood gas analyses were monitored. RESULTS Groups were homogeneous for age, sex and pathology. During the treatment we observed that cardiac index (CI), right ventricular ejection fraction (RVEF), oxygen consumption index (VO(2)I), oxygen delivery index (DO(2)I), and rate between arterial oxygen pressure and fraction of inspired oxygen (PaO(2)/FiO(2)) were increased significantly only in HAES treated group (P<0.05). APACHE II score decreased significantly only in HAES treated group (P<0.05), contrarily to the HA treated group, in which we observed a non significant increase. CONCLUSIONS Since hydroxyethyl starch induced a hemodynamic and clinical improvement, these effects translated into an improvement of sensorium and a reduction of APACHE II score, without causing pulmonary edema, we can conclude that hydroxyethyl starch 6% ws 130,000 dalton ms 0.4 (Voluven) is an effective fluid for resuscitation of hypovolemic patients and represent an attractive alternative to albumin.
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Affiliation(s)
- D Palumbo
- Department of Surgical, Anesthesiological Intensive Care and Emergency Sciences, Federico II University of Naples, Naples, Italy
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Volpe ML, Piazza O, Palumbo D, Griffo S, Romano M, Servillo G, De Robertis E, Tufano R. Conscious analgosedation for radiofrequency ablation of lung neoplasm. Minerva Anestesiol 2006; 72:111-5. [PMID: 16493387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
AIM Radiofrequency ablation (RFA) is a minimally invasive therapy for pulmonary malignant cancers in patients with medical co-morbidities or refusal of surgery. The aim of this study was to evaluate a conscious analgosedation protocol for RFA of lung neoplasm. METHODS Ten RFAs were performed. Following analgesic premedication patients underwent local anesthesia (lidocaine 2%) and propofol infusion. RESULTS The procedures were always uneventful. Postoperative severe pain was not reported; a deep sedation was required to allow the quick and safe management of RFA. CONCLUSIONS Spontaneous breathing sedation is safe in monitored and well-oxygenated patients and may limit the incidence of tension pneumothorax. Postoperative period needs a proper pain control for the first 24 h. Data on the long-term efficacy of lung tumor RFA are not yet available.
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Affiliation(s)
- M L Volpe
- Department of Surgical, Anesthesiological Intenstive Care and Emergency Sciences, Federico II University, Naples, Italy
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Gullo A, Tufano R. Of anesthesia standards in ambulatory surgery: questions and controversies, certainties and prospects. Minerva Anestesiol 2006; 72:1-11. [PMID: 16407802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Piazza O, Cotena S, Esposito G, De Robertis E, Tufano R. S100B is a sensitive but not specific prognostic index in comatose patients after cardiac arrest. MINERVA CHIR 2005; 60:477-80. [PMID: 16402001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
AIM The aim of this study was to compare serum S100B levels and EEG findings as prognostic indexes in comatose (GCS<8) patients after cardiac arrest. METHODS S100B serum levels were assessed 12 h after the event and EEG findings were recorded within 24 h in comatose cardiac arrest survivors. At hospital discharge, patients were divided into groups according the Glasgow-outcome scale (GOS): group 1 with bad neurological outcome and group 2 with good neurological outcome (GOS 4-5). S100B levels and EEG findings were retrospectively tested about their predictive value. RESULTS S100B has a very low specificity (37.5%) while S100B sensitivity is 100%. EEG findings specificity is 75% and sensitivity 50%. S100B was not significantly lower in patients who recovered consciousness (10 patients) and there was no significant difference in EEGs findings between group 1 and 2. CONCLUSIONS The association of serum S100B levels with EEG might be helpful when used together to formulate outcome in comatose patients within 24 h after cardiac arrest. However, increased levels of S100B 12 h after a cardiac arrest might be expression of a still amendable brain damage.
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Affiliation(s)
- O Piazza
- Anesthesiology and Resuscitation Unit, University of Naples II, Naples, Italy.
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Piazza O, Iasiello A, PapaIanni C, De Robertis E, Servillo G, Rossano F, Tufano R. Incidence of antimicrobial-resistant ventilator associated pneumonia: an eighteen-month survey. Panminerva Med 2005; 47:265-7. [PMID: 16489325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
AIM Microbes commonly involved in ventilator associated pneumonia (VAP) are difficult to eradicate: Pseudomonas aeruginosa and Acinetobacter baumannii are often resistant to piperacillin, aztreonam and ceftazidim while Klebsiella pneumoniae and other Enterobacteriaceae are resistant to third generation cephalosporins. Physicians need to tailor their therapeutic approach depending on individual patients and clinical setting, firmly based on local epidemiology. The aim of this study was to assess the incidence of VAP caused by multidrug-resistant bacteria in our ICU. METHODS We conducted a retrospective review of all patients mechanically ventilated for longer than 72 h, who developed pneumonia over an eighteen-month period for whom final culture data were available. One-hundred and forty-three patients admitted to a University Hospital medical surgical ICU were included in this survey. VAP was diagnosed by Centers for Disease Control and Prevention criteria and confirmed by mini- bronchoalveolar lavage. RESULTS In this study, the incidence of VAP in the period January 1, 2002-June 31, 2003 was very high, accounting for about 20% of all at-risk cases. Multiresistant agents were involved in about 57% of VAP occurring within 7 days of mechanical ventilation, and in 80% of late VAP. CONCLUSIONS This study revealed differences in VAP incidence and features among our ICU and literature data, indicating a need for caution when using hospital infection surveillance data for comparisons and choice of therapy. In our setting, with high levels of antibiotic resistance, combined approaches of non-antibiotic using strategies and education programs might be beneficial.
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Affiliation(s)
- O Piazza
- Intensive Care Unit, Federico II University, Naples, Italy.
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Petrini F, Accorsi A, Adrario E, Agrò F, Amicucci G, Antonelli M, Azzeri F, Baroncini S, Bettelli G, Cafaggi C, Cattano D, Chinelli E, Corbanese U, Corso R, Della Puppa A, Di Filippo A, Facco E, Favaro R, Favero R, Frova G, Giunta F, Giurati G, Giusti F, Guarino A, Iannuzzi E, Ivani G, Mazzon D, Menarini M, Merli G, Mondello E, Muttini S, Nardi G, Pigna A, Pittoni G, Ripamonti D, Rosa G, Rosi R, Salvo I, Sarti A, Serafini G, Servadio G, Sgandurra A, Sorbello M, Tana F, Tufano R, Vesconi S, Villani A, Zauli M. Recommendations for airway control and difficult airway management. Minerva Anestesiol 2005; 71:617-57. [PMID: 16278626] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- F Petrini
- Anestesia e Rianimazione, Università degli Studi Gabriele D'Annunzio Chieti-Pescara, Chieti.
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Gullo A, Iscra F, Di Capua G, Berlot G, Lucangelo U, Chierego ML, Ristagno G, Peratoner A, Fasiolo S, Consales C, De Martino G, Tufano R. Sepsis and organ dysfunction: an ongoing challenge. Minerva Anestesiol 2005; 71:671-99. [PMID: 16278628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In recent years the problem of infection has become increasingly significant, especially in intensive care hospital wards such as Intensive Care Units (ICU), emergency medicine, surgery and critically ill patient care departments. Sepsis is a complex, multifactorial syndrome that can develop into conditions of different severity, described as severe sepsis or septic shock. In these conditions the triggering event may coincide with the functional impairment of one or more vital organs or systems, thus leading to poorer prognosis in patients with overt signs of sepsis or systemic inflammation syndromes. The available data are quite alarming, as most prevention and treatment is performed empirically and requires considerable human and technological resources. Clinical signs are often misleading and, in some circumstances, it may be difficult or even impossible to identify the source of the infection which might otherwise be removed relatively simply, using proper antimicrobial treatment or a less invasive surgical removal of the area from which the infection originates based on needle-guided radiology. In addition, the complex pathophysiological mechanisms involved can be an obstacle to gaining a full understanding of the various biohumoral interactions or mediators action mechanisms. It may not be easy to enroll patients belonging to homogeneous groups in terms of age, underlining disease, immune profile or genetic predisposition, although the use of specific severity indexes has proved helpful also to establish the prognosis. Although the interpretation of generalised inflammation as a warning sign also in the absence of clear signs of infection or a state of overt inflammation has to rely largely on simple intuition, it has helped to drive experimental and clinical research work towards the investigation of interaction between different factors such as infection and sepsis, or inflammation and coagulation. An additional useful tool is the possibility of modulating the endothelial response which may support the process of disseminated thrombosis typical of sepsis evolution. In this context the improvement of standards of care can shed light on the efficacy of different treatments.
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Affiliation(s)
- A Gullo
- Department of Perioperative Medicine, Intensive Care and Emergency, Postgraduate School of Anaesthesia and Resuscitation, University of Trieste, Azienda Mista Ospedaliero Universitaria, Ospedali Riuniti di Trieste, Trieste, Italy.
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Lonardo M, Piazza O, De Robertis E, Tufano R. Nosocomial fungal infection in intensive care units. Panminerva Med 2005; 47:195-6. [PMID: 16462728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Piazza O, De Robertis E, Servillo G, Tufano R. The demonstration that I am sick is the fact that I have not recovered. Panminerva Med 2005; 47:131. [PMID: 16210998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Tufano R. When plans backfire: telling the difference between the pain physician and the palliative care physician. Minerva Anestesiol 2005; 71:111-5. [PMID: 15756152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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De Robertis E, Caliendo D, Varriale A, Bilancio F, Tufano R. Infection in ICU: a burden without solution? Panminerva Med 2005; 47:65-6. [PMID: 15985979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Tufano R. The traps of scientific literature. Minerva Anestesiol 2004; 70:789-92. [PMID: 15702059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Tufano R, Vesconi S. Safe sedation in pediatric neuroradiology: an impossible objective? Minerva Anestesiol 2004; 70:671-2; 672-3. [PMID: 15516881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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De Robertis E, Viscidi D, Servillo G, Pezza M, Piazza O, Giuliano CA, Tufano R. Use of quinupristin/dalfopristin in a critical patient with a methicillin-resistant Staphilococcus aureus infection. Minerva Anestesiol 2004; 70:747-9; 749-51. [PMID: 15516886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The growing incidence of infections due to Gram-positive multiresistant germs has stimulated research into new drugs endowed with broader activity, that are useful in case of infections unresponsive to common antibiotics. The case of a 28-year-old man infected with a methicillin resistant Staphylococcus aureus non responder to therapy with glycopeptide antibiotics is reported. At admission the patient presented a septic condition and required mechanical ventilation. Antibiotic therapy was immediately started with teicoplanin+meropenem. Blood culture and bronchial aspirate evidenced a methicillin resistant Staphylococcus aureus with high sensibility to glycopeptide antibiotics. Although this therapy produced a slight improvement in clinical condition and the patient was extubated, fever and leucocytosis associated with a BAL positive to methicillin resistant Staphylococcus aureus, in vitro susceptible to glycopeptides, persisted. Considering the possibility of a non-responder condition of the patient to glycopeptide antibiotics, quinupristin/dalfopristin was added. The streptogramin produced a quick improvement in clinical condition with resolution of sepsis and culture sterilization. The patient improved progressively and was discharged. In conclusion, in our experience the association quinupristin/dalfopristin was effective in the resolution of a critical methicillin resistant Staphylococcus aureus infection non responder to classical treatment with glycopeptide antibiotics that showed a high sensibility in vitro.
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Affiliation(s)
- E De Robertis
- Department of Anesthesia and Intensive Care, Federico II University, Naples, Italy.
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Piazza O, Pellegrini C, Rossano F, Servillo G, Tufano R, Piazza T. Individual perception of stress in the ICU. Eur J Anaesthesiol 2004; 21:749-51. [PMID: 15595592 DOI: 10.1017/s0265021504249134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Tufano R, Di Rocco C. Severely head-injured children: treatment and dilemma. Minerva Anestesiol 2004; 70:545-7. [PMID: 15252370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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