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Arenare L, Porta C, Barberio D, Terzolo S, Zagonel V, Pisconti S, Del Mastro L, Pinto C, Bilancia D, Cinieri S, Rizzo M, Migliaccio G, Montesarchio V, Del Campo L, De Lorenzo F, Iannelli E, Traclò F, Gitto L, Vaccaro MC, Frontini L, Giannarelli D, Bryce J, Piccirillo MC, Jommi C, Efficace F, Riva S, Di Maio M, Gallo C, Perrone F. Confirmatory validation analysis of the PROFFIT questionnaire to assess financial toxicity in cancer patients. ESMO Open 2023; 8:102192. [PMID: 38052104 PMCID: PMC10774953 DOI: 10.1016/j.esmoop.2023.102192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The Patient Reported Outcome for Fighting FInancial Toxicity (PROFFIT) questionnaire was developed to measure financial toxicity (FT) and identify its determinants. The aim of the present study was to confirm its validity in a prospective cohort of patients receiving anticancer treatment. PATIENTS AND METHODS From March 2021 to July 2022, 221 patients were enrolled at 10 Italian centres. Selected items of the EORTC-QLQ-C30 questionnaire represented the anchors, specifically, question 28 (Q-28) on financial difficulties, and questions 29-30 measuring global health status/quality of life (HR-QOL). The study had 80% power to detect a 0.20 correlation coefficient (r) between anchors and PROFFIT-score (items 1-7, range 0-100, 100 indicating maximum FT) with bilateral alpha 0.05 and 80% power. Confirmatory factor analysis was conducted. FT determinants (items 8-16) were described. RESULTS Median age of patients was 65 years, 116 (52.5%) were females, 96 (43.4%) had low education level. Confirmatory factor analysis confirmed goodness of fit of the PROFFIT-score. Significant partial correlation of PROFFIT-score was found with Q-28 (r = 0.51) and HR-QOL (r = -0.23). Mean (SD) PROFFIT-score at baseline was 36.5 (24.9); it was statistically significantly higher for patients living in South Italy, those with lower education level, those who were freelancer/unemployed at diagnosis and those who reported significant economic impact from the COVID-19 pandemic. Mean (SD) scores of determinants ranged from 17.6 (27.1) for item 14 (support from medical staff) to 49.0 (36.3) for item 10 (expenses for medicines or supplements). PROFFIT-score significantly increased with worsening response to determinants. CONCLUSIONS External validation of PROFFIT-score in an independent sample of patients was successful. The instrument is now being used in clinical studies.
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Affiliation(s)
- L Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - C Porta
- Interdisciplinary Department of Medicine, Università degli Studi 'A. Moro', Bari, Italy; Polyclinic Consortium University Hospital, Bari, Italy
| | - D Barberio
- Departmental Structure of Clinical Psycho-oncology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - S Terzolo
- Department of Oncology, Università di Torino, AO Ordine Mauriziano, Torino, Italy
| | - V Zagonel
- Oncology Unit 1, Istituto Oncologico Veneto, IOV, IRCCS, Padova, Italy
| | - S Pisconti
- Oncology Unit, Ospedale S. G. Moscati, Statte TA, Italy
| | - L Del Mastro
- Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genova, Italy
| | - C Pinto
- Medical Oncology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - D Bilancia
- Medical Oncology, Azienda Ospedaliera San Carlo, Potenza, Italy
| | - S Cinieri
- Medical Oncologiy, Ospedale Perrino, Brindisi, Italy
| | - M Rizzo
- Polyclinic Consortium University Hospital, Bari, Italy
| | - G Migliaccio
- Departmental Structure of Clinical Psycho-oncology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - V Montesarchio
- Medical Oncology, Azienda Ospedaliera Specialistica dei Colli, Napoli, Italy
| | - L Del Campo
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO), Rome, Italy
| | - F De Lorenzo
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO), Rome, Italy; European Cancer Patient Coalition (ECPC), Brussels, Italy
| | - E Iannelli
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO), Rome, Italy; Associazione Italiana Malati di Cancro (AIMAC), Roma, Italy
| | - F Traclò
- Associazione Italiana Malati di Cancro (AIMAC), Roma, Italy
| | - L Gitto
- Department of Economy, Università degli Studi di Messina, Messina, Italy
| | - M C Vaccaro
- Welfare and Health Department, Centro Studi Investimenti Sociali (CENSIS), Roma, Italy
| | - L Frontini
- Federation of Italian Cooperative Oncology Groups (FICOG), Milano, Italy
| | - D Giannarelli
- Epidemiology and Biostatistics, GSTeP, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - J Bryce
- Ascension St. John Clinical Research Institute, Tulsa, USA
| | - M C Piccirillo
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - C Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - F Efficace
- Gruppo Italiano per le Malattie Ematologiche dell'Adulto (GIMEMA) Health Outcomes Research Unit, Roma, Italy
| | - S Riva
- St Mary's University, Twickenham, London, UK
| | - M Di Maio
- Department of Oncology, Università di Torino, AO Ordine Mauriziano, Torino, Italy
| | - C Gallo
- Professor Emeritus Medical Statistics, Università degli Studi della Campania 'Luigi Vanvitelli', Napoli, Italy
| | - F Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy.
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2
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Riva S, Kabir Z, Biscoe N, O'Sullivan G, Soriano G, Penalvo J. Research ethics with real-world data (RWD) on COVID-19 infections: the unCoVer study. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue
The aim of the Horizon 2020 unCoVer project (Unravelling Data for Rapid Evidence-Based Response to COVID-19) is to coordinate research expertise in utilising Real World Data (RWD) to investigate the underlying risk factors for COVID-19 infection and severity, the effectiveness of treatments and the impact on health systems. RWD is particularly useful in a dynamic health context as it is relevant, timely, and more ecologically valid. Pooling clinical databases and integrating epidemiological principles and powerful biostatistical tools optimises resources and fully exploits routinely-collected data.
Description of the problem
RWD sharing poses new practical and ethical challenges to research. The unCoVer network has developed a federated data platform to access diverse databases for advanced analytics. This data access process entails GDPR, and regulatory and ethical nuances. The use of large-scale data from heterogeneous sources across multiple jurisdictions for research purposes presents a complex systems challenge.
Effects & Lessons
A dedicated team of unCoVer network members is responsible for addressing these challenges. Here, we describe the ethical and regulatory aspects of RWD sources, the role of the Data Protection Authorities and the Data Protection External Authority Board (DP-EAB) of the Uncover project, and the documentation involved, including a data processing agreement and a data transfer agreement. We provide an overview of the main principles for sharing RWD whilst maintaining integrity and security and how this translates into procedures to protect the rights, security, and well-being of human research participants. This represents a practical framework for researchers.
Key messages
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Affiliation(s)
- S Riva
- St. Mary's University, Twickenham , London, UK
| | - Z Kabir
- University College of Cork , Cork, Ireland
| | - N Biscoe
- St. Mary's University, Twickenham , London, UK
| | | | - G Soriano
- Institute of Tropical Medicine , Antwerp, Belgium
| | - J Penalvo
- Institute of Tropical Medicine , Antwerp, Belgium
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3
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Fassini GM, De Simone A, Iacopino S, Bianchi S, Bencardino G, Pecora D, Iuliano A, Moltrasio M, Rossi P, Perna F, La Greca C, Placentino F, Riva S, Tondo C, Stabile G. Novel cryo-balloon technology for a successful pulmonary vein isolation: acute outcome and follow-up from a large multicenter Italian clinical setting. Europace 2022. [DOI: 10.1093/europace/euac053.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Complete electrical pulmonary vein isolation (PVI) by cryo-balloon approach is a well-established ablation strategy of atrial fibrillation (AF). Recently, a new cryoablation system (POLARx) with unique features has been made available for clinical use. To date, limited data exist on acute and follow-up outcome of this system in a multicentric clinical practice.
Purpose
We reported the preliminary experience of this novel technology in a multicenter Italian registry.
Methods
Consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 6 Italian centres were included. Protocol-directed cryoablation was delivered for 180 sec or 240 sec according to operator’s preference for isolation achieved in ≤60 sec, or 240 sec if isolation occurred >60 sec or when time to isolation (TTI) was not available. The ablation endpoint was PV isolation as assessed by entrance and exit block. Rhythm monitoring during the follow-up examinations was performed via the clinical assessment of AF recurrence, ECG and Holter monitoring, according to the clinical practice of each center. All patients were followed-up for at least 6 months after the procedure. Arrhythmia recurrences within the first 3 months (blanking period) were classified as early recurrences and were not considered procedural failures
Results
Six-hundred twenty-four cryoapplications from 112 pts (439 PVs) were analyzed (n=89, 79.5% paroxysmal AF, n=23, 20.5% persistent AF, mean age 61.5±9 years, 76% male, 22% with an history of AT, mean LVEF 49±10%). PVI was achieved in all pts using only cryoablation. The mean number of freeze applications per pt was 5.6±2.1 (1.4±1.2 for LSPV, 1.5±1.1 for LIPV, 1.3±0.8 for RSPV and 1.3±0.8 for RIPV), with 318 (72.4%) PVs treated with a single cryoablation (92, 21% with 2 cryoablation; 29, 6.6% with more than 2 cryoablations). Fourty-four (39.3%) pts were treated with a single application to each of the PVs. Over a median of 296[245 to 382] days of follow-up, five (4.5%) patients experienced an early recurrence of AF/AT during the 90-day blanking period. Overall, 12 patients (10.7%) suffered an AF/AT recurrence after the 90-day blanking period (median time to recurrence 200[124 to 297] days). Specifically, 8 (7.1%) patients had AF recurrence only, 3 (2.7%) had AT recurrence only and 1 (0.9%) experienced both events. One (0.9%) patient underwent a repeated ablation procedure. The proportion of patients exhibiting AF/AT recurrences was similar between AF types (10 out 89, 11.2% for paroxysmal AF vs 2 out 23, 8.7% for persistent AF, p=1.00) with a hazard ratio of 0.9 (95%CI: 0.2 to 3.9, log-rank p=0.8894). One transient phrenic nerve palsy was observed, with full recovery in the 48-h post procedure; no major procedure-related adverse events were reported.
Conclusion
In this first multicentric experience, the novel cryo-balloon system proved to be safe and effective and resulted in a very low rate of AF/AT recurrence during follow-up.
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Affiliation(s)
- GM Fassini
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - G Bencardino
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - A Iuliano
- San Michele Clinic, Maddaloni, Italy
| | - M Moltrasio
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | - P Rossi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - F Perna
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | - S Riva
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | - C Tondo
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | - G Stabile
- San Michele Clinic, Maddaloni, Italy
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4
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Marcon L, Zannoni J, Tundo F, Moltrasio M, Majocchi B, Fassini G, Riva S, Casella M, Tondo C, Ribatti V. P377 CHALLENGING RISK STRATIFICATION IN BRUGADA SYNDROME: A CASE OF VENTRICULAR TACHYCARDIA IN A LOW–RISK PATIENT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A 22–year–old healthy athlete was referred to our hospital for electrocardiographic findings consistent with intermittent type–1 Brugada pattern. A routine electrocardiogram (ECG) performed during a check–up showed sinus rhythm, normal PR interval and QRS duration, rSR’ with a coved type ST–segment elevation in V2 lead (Figure 1).The patients denied history of syncope or palpitations and his family history did not show sudden cardiac death or Brugada syndrome (BrS). Transthoracic echocardiography was normal and a 12–lead Holter monitoring revealed the intermittence of the type–1 Brugada pattern. The patient was hospitalized for further investigation. On admission, ECG showed a type–2 Brugada pattern; therefore, Ajmaline challenge test (1 mg/kg injection in 10 minutes) was performed and resulted positive. Subsequently, the patient underwent an electrophysiological study (EPS) which was negative for induction of sustained arrhythmias. The protocol adopted consisted of double extrastimuli programmed electrical stimulation until refractoriness (drive 600/220 ms and 400/210 ms), at double sites (right ventricle apex and right ventricular outflow tract). Furthermore a genetic test was performed using next–generation sequencing, showing a heterozygous mutation in the SCN5A gene, encoding for sodium channel alpha subunit (variant c.5363delA), not previously described in the literature. Since the low arrhythmic risk, the patient was implanted with a loop recorder (ILR, Medtronic Reveal LINQ), entering a program of home monitoring. After a 15–months follow–up, an episode of ventricular polymorphic tachycardia lasting 2 minutes and 11 seconds, associated with lightheadedness and palpitations, was detected by the remote monitoring (Figure 2). The patient was therefore hospitalized. During the in–hospital stay a cardiac magnetic resonance was performed to exclude other underlying diseases, identifying an enlarged right ventricle (EDVi 114 ml/m2) and abnormal free wall motion (Figure 3), thus reaching one major criteria of arrhythmogenic cardiomyopathy (however not sufficient for the diagnosis). The patient was then implanted with a subcutaneous implantable cardiac defibrillator (Boston Scientific EMBLEM MRI S–ICD). We presented a case of complex arrhythmic risk stratification in a possible overlap of an arrhythmogenic cardiomyopathy and a Brugada Syndrome in a young athlete who experienced a sustained ventricular tachycardia during loop–recorder monitoring.
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Affiliation(s)
- L Marcon
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - J Zannoni
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - F Tundo
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - M Moltrasio
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - B Majocchi
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - G Fassini
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - S Riva
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - M Casella
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - C Tondo
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - V Ribatti
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
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5
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Mambretti F, Martinelli M, Civillini F, Bertoletti M, Riva S, Manini N, Galli DE, Pini D. Low-temperature ordering of the dimer phase of a two-dimensional model of core-softened particles. Phys Rev E 2021; 104:044602. [PMID: 34781531 DOI: 10.1103/physreve.104.044602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/17/2021] [Indexed: 11/07/2022]
Abstract
Purely pairwise interactions of the core-softened type, i.e., featuring a soft repulsion followed by a hard-core interaction at shorter distance, give rise to nontrivial equilibrium structures entirely different from the standard close packing of spheres. In particular, in a suitable low-temperature region of their phase diagram, such interactions are well known to favor a transition from a fluid to a cluster crystal. The residual mutual interaction between individual clusters can lead to the formation of patterns of their reciprocal orientations. In this work, we investigate two examples of such models in two dimensions, at the density most appropriate to the dimer phase, whereby clusters consist of just two particles, studying them with optimization techniques and Monte Carlo simulations. We focus on the dimer crystal, and unveil a second phase transition at extremely low temperature. This transition leads from a triangular dimer lattice with randomly disordered dimer orientations at high temperature to a reduced-symmetry ground state with nematic orientational order and a slightly distorted structure characterized by a centered-rectangular lattice at low temperature.
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Affiliation(s)
- F Mambretti
- Università degli Studi di Milano, Dipartimento di Fisica "Aldo Pontremoli," via Celoria 16, 20133 Milan, Italy.,Università degli Studi di Padova, Dipartimento di Fisica e Astronomia, via Marzolo 8, 35131 Padua, Italy
| | - M Martinelli
- Università degli Studi di Milano, Dipartimento di Fisica "Aldo Pontremoli," via Celoria 16, 20133 Milan, Italy
| | - F Civillini
- Università degli Studi di Milano, Dipartimento di Fisica "Aldo Pontremoli," via Celoria 16, 20133 Milan, Italy
| | - M Bertoletti
- Università degli Studi di Milano, Dipartimento di Fisica "Aldo Pontremoli," via Celoria 16, 20133 Milan, Italy
| | - S Riva
- Università degli Studi di Milano, Dipartimento di Fisica "Aldo Pontremoli," via Celoria 16, 20133 Milan, Italy
| | - N Manini
- Università degli Studi di Milano, Dipartimento di Fisica "Aldo Pontremoli," via Celoria 16, 20133 Milan, Italy
| | - D E Galli
- Università degli Studi di Milano, Dipartimento di Fisica "Aldo Pontremoli," via Celoria 16, 20133 Milan, Italy
| | - D Pini
- Università degli Studi di Milano, Dipartimento di Fisica "Aldo Pontremoli," via Celoria 16, 20133 Milan, Italy
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6
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Compagnucci P, Casella M, Guerra F, Gasperetti A, Volpato G, Belfioretti L, Riva S, Dessanai M, Pizzamiglio F, Natale A, Di Biase L, Capucci A, Zeppilli P, Tondo C, Dello Russo A. Role of an extensive diagnostic work-up in the detection of concealed cardiomyopathies in athletes with premature ventricular complexes and implications for sports' eligibility assessment. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Premature ventricular complexes (PVCs) are a common clinical problem and a critical issue with regard to sports eligibility in sportsmen. Although PVCs can be considered a benign feature of the athlete's heart adaptive phenotype, they may also be the only clinical manifestation of a concealed cardiomyopathy, potentially heralding sudden cardiac death (SCD) during sports activity. The optimal diagnostic evaluation of athletes with PVCs is currently uncertain.
Purpose
To evaluate the diagnostic contribution and the implications for sports eligibility assessment of a thorough non-invasive and invasive work-up including electroanatomical mapping (EAM) and endomyocardial biopsy (EMB) in athletes with PVCs.
Methods
We conducted a prospective, single-arm, open-label double center study. All consecutive athletes presenting for evaluation at our institution after being disqualified from participating in sports due to PVCs were included in our study. These athletes underwent a baseline non-invasive diagnostic protocol with transthoracic echocardiogram and gadolinium enhanced cardiac magnetic resonance imaging (cMRI). Subsequently, an invasive diagnostic work-up was performed, including EPS with programmed electrical stimulation, EAM and EAM-guided EMB if deemed necessary. When clinically indicated, catheter ablation was performed. Sports eligibility status was re-assessed at six months' follow-up according to Italian sports medicine guidelines.
Results
After diagnostic evaluation, 20 subjects out of 107 (19%) had a diagnosis of heart disease, most commonly myocarditis (n=8), arrhythmogenic right ventricular cardiomyopathy (ARVC, n=7) or dilated cardiomyopathy (DCM, n=2). On multivariate logistic-regression analysis, QRS complex/T wave abnormalities on ECG (OR 23), non left bundle branch block and inferior axis PVC morphology (OR 13), echocardiogram abnormalities (OR 24) and low-voltage areas on EAM (OR 33) were significantly associated with diagnosis of a concealed cardiac disease. Nondiagnostic abnormalities on cMRI were common in this population of athletes, prevalently involving the right ventricle. EAM-guided EMB was performed in 12 subjects (11%) and catheter ablation in 56 (52.3%). After six months, 63 athletes (59%) were judged eligible to participate in competitive sports and 23 subjects (21%) were deemed eligible to participate in non-competitive sports.
Conclusions
Almost one fifth of sportsmen presenting with PVCs have a concealed heart disease, most commonly myocarditis or ARVC. Non-outflow tract PVCs' morphology and abnormalities on ECG, echocardiogram and EAM are predictive of structural heart disease's detection, whereas nondiagnostic findings on cMRI can be misleading in athletes. Invasive diagnostic tests, including EAM and EAM-guided EMB, play a critical role in case of diagnostic uncertainty. More than ¾ of subjects were judged eligible to participate in sports at 6 months' follow-up.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Compagnucci
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - M Casella
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - F Guerra
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - A Gasperetti
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - G Volpato
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - L Belfioretti
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - S Riva
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - M.A Dessanai
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - F Pizzamiglio
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - A Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| | - L Di Biase
- Montefiore Medical Center (Bronx), Department of Medicine (Cardiology), New York, United States of America
| | - A Capucci
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - P Zeppilli
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Istituto di Cardiologia; Istituto di Medicina Dello Sport, Rome, Italy
| | - C Tondo
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - A Dello Russo
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
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7
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Dello Russo A, Casella M, Guerra F, Compagnucci P, Gasperetti A, Belfioretti L, Volpato G, Riva S, Dessanai MA, Pizzamiglio F, Grifoni G, Fiorentini C, Capucci A, Zeppilli P, Tondo C. P1110Role of an extensive diagnostic work-up in the detection of concealed cardiomyopathies in athletes with complex ventricular arrhythmias and implications for sports" eligibility assessment. Europace 2020. [DOI: 10.1093/europace/euaa162.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
ventricular Arrhythmias (VAs) are a common clinical problem and a critical issue with regards to sports" eligibility in athletes. Although VAs can be considered a benign feature of the athlete’s heart adaptive phenotype, they may also be the only clinical manifestation of a concealed cardiomyopathy, potentially heralding sudden cardiac death (SCD) during sports activity.
Purpose
to evaluate the diagnostic contribution and the implications for sports eligibility assessment of a thorough non-invasive and invasive work-up including electrophysiology study (EPS), electroanatomical mapping (EAM) and endomyocardial biopsy (EMB) in athletes with complex VAs and to derive a multiparametric risk score in order to easily predict structural heart diseases’ diagnosis.
Methods
we conducted a prospective, single-arm, open-label single center, observational study. All consecutive athletes presenting for evaluation at our institution after being disqualified from participating in sports due to complex VAs were enrolled. The athletes underwent a baseline non-invasive diagnostic protocol with transthoracic echocardiogram and gadolinium enhanced cardiac magnetic resonance imaging (cMRI). Subsequently EPS, EAM and EAM-guided EMB were performed if deemed necessary. Sports eligibility status was re-assessed at 6 months’ follow-up. A multivariable logistic regression model was built, considering cMRI as the gold standard exam.
Results
after diagnostic evaluation, 55 subjects (26.4%) had a diagnosis of heart disease, most commonly myocarditis (n = 27) and arrhythmogenic right ventricular cardiomyopathy (ARVC, n = 16). After 6 months, 100 athletes (48.1%) were judged eligible to participate in competitive sports and 46 subjects (22.1%) were deemed eligible to participate in non-competitive sports. On multivariable logistic-regression analysis, abnormalities on ECG (OR 5.3) or on echocardiogram (OR 3.7), sustained VA inducibility on EPS (OR 17.7) and low-voltage areas on EAM (OR 7.7) proved all predictive of concealed structural heart diseases’ diagnosis. We derived two simple risk scores: a 40-points risk score and an 8-points risk score (obtained by weighing each variable according to the regression model’s ORs). Both these risk scores’ performance proved very good (AUC = 0.856 for the 40-points score and AUC = 0.852 for the 8-points score, figure 1).
Conclusions
approximately 1/4 of athletes presenting with complex VAs have a concealed heart disease, most commonly myocarditis or ARVC. ECG, echocardiogram and EAM abnormalities and sustained VAs inducibility on EPS are predictive of structural heart diseases’ detection. Therefore, these diagnostic tests should be routinely included in the evaluation of athletes with complex VAs. A risk score including the results of these tests can greatly help in the prediction of concealed structural heart diseases’ diagnosis. More than 2/3 of subjects were judged eligible to participate in sports at 6 months’ follow-up.
Abstract Figure 1. ROC curves for diagnosis
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Affiliation(s)
- A Dello Russo
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - M Casella
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - F Guerra
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - P Compagnucci
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - A Gasperetti
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - L Belfioretti
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - G Volpato
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - S Riva
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - M A Dessanai
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - F Pizzamiglio
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - G Grifoni
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - C Fiorentini
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
| | - A Capucci
- University Hospital “Ospedali Riuniti”, Marche Polytechnic University, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - P Zeppilli
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Istituto di Cardiologia; Istituto di Medicina Dello Sport, Rome, Italy
| | - C Tondo
- Centro Cardiologico Monzino IRCCS, Heart Rhythm Center, Milan, Italy
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8
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Grimaldi M, Tondo C, Riva S, Neuzil P, Ghaly N, Bishara M, Schilling R, Reddy V. P1033Impact of workflow modifications in atrial fibrillation ablation for reducing the incidence of silent cerebral lesions with a new multi-electrode radiofrequency balloon catheter. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0624] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Silent cerebral lesions (SCL) often occur after invasive cardiac procedures. Reported SCL incidence with AF ablation varies (incidence, up to 50%), depending on technology used, procedural workflow, and detection method.
Objective
To evaluate the impact of ablation workflow modifications on SCL incidence following pulmonary vein isolation radiofrequency (RF) ablation with a novel multi-electrode RF balloon catheter in patients with symptomatic paroxysmal AF (PAF).
Methods
In the RADIANCE feasibility study of the balloon catheter, all enrolled patients who underwent ablation were screened for SCL using pre- and post-procedural diffusion-weighted MRI. Several modifications were made to the ablation workflow in a subsequent European registration study (SHINE) of the same catheter: eliminating dual transseptal access, using an over-the-wire mini lasso, continuously irrigating all side ports, bolus dosing with heparin before transseptal puncture, maintaining activated clotting time (ACT) at 350–400 sec, and setting a maximum temperature limit of 55°C (previously, 60–65°C). Interim data are presented for SHINE (data cutoff, 22 Oct 2018).
Results
In the neurological assessment evaluable (NAE) populations of RADIANCE (n=38) and SHINE (n=30), respectively, mean ages were 60.8±10.04 and 59.7±7.83 years, and 57.9% and 70.0% were male. One patient in each study had a history of TIAs. SCL incidences were 23.7% (10 lesions in 9 patients) in RADIANCE and 7.1% (2 lesions in 2 patients) in SHINE (excluding 1 SCL that occurred in a patient who failed to meet inclusion criteria [age>75] and 1 SCL that occurred after data cut-off). SHINE NAE enrollment has since completed with no further SCL occurrences. Overall, mean ACTs were 344.3±24.55 sec in RADIANCE and 381.6±73.31 sec in SHINE (p=0.01); in patients with SCL, mean ACTs were 349.3±25.65 and 417.8±87.33 sec, respectively.
Conclusion(s)
Modifications to the workflow led to a decrease in the SCL incidence for PAF ablation using the novel RF balloon catheter.
Acknowledgement/Funding
These studies were sponsored by Biosense Webster, Inc.
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Affiliation(s)
- M Grimaldi
- Regional General Hospital F. Miulli, Acquaviva Delle Fonti, Italy
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Riva
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Neuzil
- Na Homolce Hospital, Prague, Czechia
| | - N Ghaly
- Johnson & Johnson Medical Devices, Irvine, United States of America
| | - M Bishara
- Johnson & Johnson Medical Devices, Irvine, United States of America
| | - R Schilling
- St Bartholomew's Hospital, London, United Kingdom
| | - V Reddy
- Mount Sinai School of Medicine, New York, United States of America
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9
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Dello Russo A, Della Rocca D, Gasperetti A, Casella M, Basso C, Bianchini L, Fassini G, Riva S, Moltrasio M, Ribatti V, Tundo F, Zucchetti M, Carbucicchio C, Natale A, Tondo C. P3682Myocardial structural abnormalities in nonischemic patients presenting with ventricular arrhythmias. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The diagnosis of concealed cardiomyopathies in patients with ventricular arrhythmias (VAs) is one of the major challenging issues faced by physicians.
Purpose
We aimed at reporting the cardiomyopathic substrate in patients with recurrent arrhythmias of ventricular origin.
Methods
Consecutive patients with unexplained VAs underwent a complete diagnostic work-out, including endomyocardial biopsy (EMB).
Results
Ninety-seven patients were enrolled (76.3% male, age 39.7±13.3 yrs). The presenting arrhythmic manifestation was aborted cardiac arrest in 30 (30.9%) patients, sustained ventricular tachycardia (VT) in 9 (9.3%), nonsustained VT in 15 (15.5%) and frequent premature ventricular complexes in 43 (44.3%). Overall, 350 biopsies were collected (3.6/patient). The incidence of procedure-related complications was 5.1% (n=5): 4 major complications (1 rupture of a tricuspid chorda tendinea w/o hemodynamic impairment, 1 dissection of right external iliac artery treated with stent, 1 thrombotic occlusion of left superficial femoral artery which required surgical treatment, 1 TIA) and 1 minor complication (groin hematoma) occurred. The final diagnosis was arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) (n=41; 42.3%), followed by myocarditis (n=20; 20.6%), dilated cardiomyopathy (n=6; 6.2%), cardiac sarcoidosis (n=6; 6.2%), and myocarditis in ARVD/C (n=5; 5.1%). Among the 25 patients whose final diagnosis was consistent with myocarditis, an acute stage of the disease was documented in 7 (7.2%), while a chronic myocarditis in 18 (18.5%). Additionally, according to medical history and diagnostic workout, in 2 of the 6 patients the dilated cardiomyopathy had a likely post-inflammatory etiology. Absence of myocardial abnormalities was documented in 15 (15.5%) patients: this group included 1 case of methadone-induced torsade de pointes. The remaining 4 (4.1%) patients were diagnosed with a cardiac hypertrophy (n=2, 2.1%, secondary to exercise or Fabry disease), a dilated mitochondrial cardiomyopathy (n=1, 1.0%), a dilated cardiomyopathy in Emery-Dreifuss muscular dystrophy (n=1; 1.0%).
Conclusion
In our series, approximately 45% of patients with unexplained VAs had a final diagnosis of ARVD/C.
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Affiliation(s)
| | - D Della Rocca
- St. David's Medical Center, Austin, United States of America
| | | | - M Casella
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - C Basso
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - L Bianchini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Fassini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Riva
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Moltrasio
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Ribatti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - F Tundo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Zucchetti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - A Natale
- St. Davids Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
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10
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Pizzamiglio F, Casella M, Dessanai MA, Chihade F, Riva S, Pontone G, Andreini D, Basso CM, Tondo C, Delo Russo A, Zeppilli P. P4422Myocarditis: a deceitful but not infrequent athletes' enemy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Myocarditis represents a not negligible cause of sudden death (SD) in athletes, representing the cause of 4%-14% cardiac arrests and deaths in athletes. Preparticipation screening including 12-leads basal electrocardiogram could drastically reduce SD in athletes and screening programs are therefore now recommended by most medical and sport association. At the moment, no data in literature are available about incidence of concealed myocarditis in athletes but there is general consensus about disqualification from competitive sport in the presence of myocardial fibrosis (MF).
Purpose
Purpose of our study was to quantify incidence of MF consistent with past myocarditis in athletes that referred to our Sport Cardiology Center for ventricular arrhythmias (VA) +/− repolarization abnormalities (RA) detected at preparticipation screening.
Methods
In our study we retrospectively evaluated all athletes with VA +/− RA and we quantified how many were found to have MF consistent with myocarditis at cardiac MRI. Furthermore, we evaluated characteristics of presentation in terms of clinical symptoms of myocarditis and frequency and morphology of VA. Finally, we analyzed findings of invasive diagnostic workout when performed.
Results
In the last two years we evaluated 111 athletes for VA +/− RA and we found MF consistent with myocarditis in 18 (16%) of them. Only 2/18 referred past febrile status probably correlated with myocarditis and 1 had symptoms consistent with acute myocarditis. Number of VA was not correlated with MF fibrosis, while polymorphic VA and exercise-correlated VA were the most frequent finding. 5/18 (28%) had also rest and/or exercise induced RA. 10/18 (55%) athletes underwent electrophysiological study without any induction of arrhythmias. 7/18 (39%) underwent also electroanatomical mapping (EAM) with pathological findings in 5/7 (71%). All of these 5 underwent endomyocardial biopsy guided by EAM and in 2 cases bioptic findings were consistent with arrhythmogenic cardyomyopahty (ACM). All 18 athletes were disqualified from competitive sport as for Italian Sport Medicine protocols.
Conclusion
MF consistent with past myocarditis is a not infrequent finding in athletes with VA with or without RA. Morphology and exercise behavior of VA are the most important “alarm bell”, while VA number is not correlated with MRI pathological findings. Sometimes MF interpreted as consistent with past myocarditis is actually the manifestation of ACM. Identification of these diseases is of extreme importance for athletes' safety.
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Affiliation(s)
| | - M Casella
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - F Chihade
- Federico II University Hospital, Naples, Italy
| | - S Riva
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Pontone
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - D Andreini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - C M Basso
- University Hospital of Padova, Padua, Italy
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - P Zeppilli
- Catholic University of the Sacred Heart, Rome, Italy
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11
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Casella M, Gasperetti A, Dello Russo A, Sicuso R, Basso C, Della Rocca D, Catto V, Fassini G, Riva S, Natale A, Tondo C. P3687Abnormal voltage recordings in patients with ventricular arrhythmias: comparison between right and left cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Arrhythmogenic Cardio-Myopathy (ACM) is characterized by epi-endocardial fibro-fatty replacement. Depending on the most affected ventricle, right dominant (RDACM) or left dominant (LDACM) phenotypes can be defined. RDACM voltage mapping characteristics have already been described, with late potentials strongly correlating with arrhythmia recurrence risk; LDACM voltage features have not been described yet.
Purpose
To analyze voltage map characteristics in LDACM patients (pts) and compare them with RDACM; to assess if there is any correlation between late potentials and recurrence rate in LDACM as well.
Methods
We retrospectively enrolled all consecutive ACM patients treated c/o our center and diagnosed according to the 2010 Task Force Criteria. Procedural and follow up data were collected. Patient were sorted by ventricular involvement lateralization. Recurrence rates were evaluated and linearly regressed for the presence of late potentials.
Results
89 ACM patients were enrolled (67 RDACM, 22 LDACM; 76% males, 69±4 y.o.) in our study. All patients underwent endocardial voltage mapping; procedurally, 43 (48%) pts underwent catheter ablation, while 46 (52%) were managed conservatively with anti-arrhythmic drugs.
Bipolar pathological potentials were found in 43 (64%) and 13 (59%), unipolar pathological potentials in 45 (67%) and 14 (63%), while late potentials in 19 (31%) and 8 (36%) in the RDACM and LDACM group respectively [p = 0.66, p=0.63, and p=0.33].
The average follow-up was 18 months [14–48]; 15 (22%) in the RDACM and 9 (40%) in LDACM arrhythmic recurrences were respectively encountered; recurrences in both groups were regressed for the presence of late potentials. Results were as follows: the presence of late potentials correlated with recurrences with an 4,3 [1.15–16.1; p=0.03] OR and with an 11 [0.4–85; p=0.022] OR in the RDACM and LDACM group respectively.
Conclusion
Pathologically low unipolar, bipolar and late potentials can be found in comparable % both in RDACM and LDACM; like in RDACM, late potentials represent an important risk factor for arrhythmic recurrence in LDACM as well.
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Affiliation(s)
- M Casella
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | | | - R Sicuso
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - C Basso
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - D Della Rocca
- St. Davids Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| | - V Catto
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Fassini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Riva
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - A Natale
- St. Davids Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
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12
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Della Rocca DG, Casella M, Dello Russo A, Gasperetti A, Fassini G, Catto V, Tundo F, Riva S, Ribatti V, Dessanai MA, Pizzamiglio F, Moltrasio M, Carbucicchio C, Natale A, Tondo C. P993Diagnostic accuracy of cardiac magnetic resonance and endomyocardial biopsy for arrhythmogenic right ventricular dysplasia/cardiomyopathy and myocarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Patients with myocarditis may fulfill the cardiac magnetic resonance (CMR) criteria set forth by the 2010 Task Force for arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), thereby increasing the risk of misdiagnosis.
Purpose
We sought to evaluate the role of CMR and endomyocardial biopsy (EMB) in the differential diagnosis between myocarditis and ARVD/C.
Methods
Consecutive patients presenting with ventricular arrhythmias, underwent a complete diagnostic work-out, which included CMR and EMB. The final diagnosis served as the gold standard to assess the diagnostic accuracy of CMR and EMB.
Results
Overall, 74 consecutive patients presenting with VAs underwent a complete diagnostic workout at our institution. The cohort was 70.3% male, with a mean age of 38.9±12.1 years. A final diagnosis of ARVD/C was made in 30 (40.5%) patients, whereas 19 (25.7%) had a diagnosis of myocarditis.
The McNemar's test showed significant differences in the diagnostic performance of EMB and cardiac MRI (p=0.003 for ARVD/C, p=0.04 for myocarditis).
At receiver operating characteristic (ROC) analyses, the area under the curve (AUC) to discriminate between controls and ARVD/C patients was 0.711 (95% CI: 0.59–0.83) for MRI and 0.944 (95% CI: 0.88–1.00) for biopsy (p<0.001). The AUC to discriminate between controls and patients with myocarditis was 0.656 (95% CI: 0.51–0.80) for MRI and 0.893 (95% CI: 0.80–0.99) for biopsy (p=0.006).
Diagnostic performance of CMR and EMB
Conclusion
Even though CMR has good diagnostic performances as single technique, a complete diagnostic work-out including EMB may frequently reduce the risk of misdiagnoses.
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Affiliation(s)
- D G Della Rocca
- St. David's Medical Center, Austin, United States of America
| | - M Casella
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - A Gasperetti
- St. David's Medical Center, Austin, United States of America
| | - G Fassini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Catto
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - F Tundo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Riva
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Ribatti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | | | - M Moltrasio
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - A Natale
- St. David's Medical Center, Austin, United States of America
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
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13
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Dello Russo A, Gasperetti A, Riva S, Dessanai M, Pizzamiglio F, Casella M, Chihade F, Catto V, Majocchi B, Zucchetti M, Ribatti V, Andreini D, Basso C, Zeppilli P, Tondo C. P307Magnetic resonance, electroanatomical mapping, and endomyocardial biopsy to solve the diagnostic and sport eligibility dilemma in a cohort of competitive athletes with ventricular arrhythmias. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Ventricular arrhythmias (VAs) are a frequent finding in agonist athletes (athl) at routine sport medicine visits. VAs impact on sport eligibility, their management, and the sudden arrhythmic death risk evaluation in athletes currently represents one of the greatest challenges across both the cardiology and sport medicine field.
Purpose
To describe how an advanced multi-methodical evaluation allowed diagnosis, risk stratification, targeted therapy and sport eligibility reassessment in a competitive athl cohort with ventricular arrhythmias and pathological findings at magnetic resonance (MR).
Methods
All consecutive competitive athl with denied sport eligibility due to ventricular arrhythmias that underwent an advanced invasive evaluation at our institute were enrolled.
A baseline and stress ECG, and late gadolinium enhanced evaluation (LGE) at MR were performed prior to invasive evaluation in all athl.
Invasive evaluation performed in all athl comprised of an electrophysiological study (EPS) to assess arrhythmic inducibility, an endo-cavitary electro-anatomical mapping (EAM), and a EAM and MR guided endo-myocardial biopsy (EMB). A defined diagnosis was postulated in all cases, specific therapeutic interventions were started and sport eligibility status reassessed after 6 months from discharge.
Results
Thirty-two competitive athl were enrolled in our study (32±6 y.o.; 77% male; 4±1 1h-training session/week); 26 (81%) athl practiced a mixed aerobic-anaerobic, 5 (16%) a pure-aerobic, while only 1 (3%) a pure anaerobic sport.
Arrhythmic presentation leading to sport eligibility revoke was: in 13 (40%) athl frequent (>2000/day) premature ventricular contractions (PVCs) at rest, in 2 (6%) PVCs during stress ECG, in 6 (18%) non-sustained ventricular tachycardia (VT), in 8 (25%) sustained VT, and in 3 (11%) ventricular fibrillation/cardiac arrest during sport practice.
MR alterations were described in all cases, and LGE at MR was found in 31 (87%) athl; a definite radiological diagnosis was obtained in 13 (40%) athl.
A normal myocardium at EMB was found only in 3 (8%) pts; in 15 (45%) a leukocyte infiltrate pattern compatible with myocarditis, in 11 (39%) fibro-fatty replacement, in 2 (5%) a mitochondrial disease and in 1 (3%) a sarcoidosis were proven, and diagnosis were consequently postulated.
EPS showed complex VAs inducibility in 8 (25%) cases, while a trans catheter ablation was performed in 10 (31%) athl. A total of 9 (28%) implantable cardioverter devices (ICDs) were implanted, for primary or secondary prevention.
According to invasive diagnostic findings and sport medicine guidelines, 8 (25%) athl had their sport eligibility statuts re-instated.
Conclusion
An invasive multi-methodical assessment allowed in all cases to reach a diagnosis and to start a targeted therapy in a cohort of competitive athl with VA and a pathological MR, granting in a significant (25%) percentage sport eligibility status re-instatement.
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Affiliation(s)
| | | | - S Riva
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Dessanai
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - M Casella
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - F Chihade
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Catto
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - B Majocchi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Zucchetti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Ribatti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - D Andreini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - C Basso
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - P Zeppilli
- Catholic University of the Sacred Heart, Sports Medicine Unit, Orthopedics, Aging and Rehabilitation Area, Rome, Italy
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
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14
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Riva S, Maio MD, Efficace F, Frontini L, Gallo C, Giannarelli D, Montesarchio V, De Lorenzo F, Del Campo L, Iannelli E, Traclò F, Gitto L, Jommi C, Vaccaro C, Bryce J, Gimigliano A, Sparavigna L, Perrone F. Measuring financial toxicity of cancer in the Italian health care system: Initial results of the patient reported outcome for fighting financial toxicity of cancer project (proFFiT). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz263.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Damanti S, Azzolino D, Riva S, Cano A, Marcucci M. PoliFIT-INFOcus: A pilot study exploring how to promote physical activity in older people. Eur J Intern Med 2018; 57:e41-e42. [PMID: 30268575 DOI: 10.1016/j.ejim.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 11/27/2022]
Affiliation(s)
- S Damanti
- Department of Clinical and Community Sciences, University of Milan, Italy; Geriatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - D Azzolino
- Geriatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Riva
- University of Wolverhampton, West Midlands, UK
| | - A Cano
- Department of Paediatrics, Obstetrics and Gynaecology, Universitat de Valência, Spain
| | - M Marcucci
- Geriatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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16
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Casella M, Dello Russo A, Della Rocca D, Gianni C, Santangeli P, Gasperetti A, Carbucicchio C, Tundo F, Moltrasio M, Riva S, Sommariva E, Catto V, Di Biase L, Natale A, Tondo C. P2918Comparing long term outcomes of anti-arrhythmic therapy and catheter ablation in arrhythmogenic cardiomyopathy patients with ventricular arrhythmias. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Casella
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - D Della Rocca
- St. David's Medical Center, Austin, United States of America
| | - C Gianni
- St. David's Medical Center, Austin, United States of America
| | - P Santangeli
- Hospital of the University of Pennsylvania, Philadelphia, United States of America
| | | | | | - F Tundo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Moltrasio
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Riva
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - E Sommariva
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Catto
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - L Di Biase
- Montefiore Hospital, Bronx, United States of America
| | - A Natale
- St. David's Medical Center, Austin, United States of America
| | - C Tondo
- Cardiology Center Monzino IRCCS, Milan, Italy
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17
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Bert F, Frigerio F, Clari M, Di Fine G, Riva S, Bergese I, Diouf SG, Alvaro R, Buonomo E, D'Ambrosio A. Knowledge, Attitudes and Practices related to Schistosomiasis among children in Northern Senegal. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- F Bert
- Department of Public Health Sciences, Turin, Italy
| | - F Frigerio
- Department of Biomedicine and Prevention, University of Rome, Rome, Italy
| | - M Clari
- Department of Biomedicine and Prevention, University of Rome, Rome, Italy
| | | | - S Riva
- ASL TO4, Chivasso, Turin, Italy
| | - I Bergese
- Department of Pediatric Emergency, Città della Salute e della Scienza of Turin, Turin, Italy
| | - SG Diouf
- École Primaire, Kassack North, Senegal
| | - R Alvaro
- Department of Biomedicine and Prevention, University of Rome, Rome, Italy
| | - E Buonomo
- Department of Biomedicine and Prevention, University of Rome, Rome, Italy
| | - A D'Ambrosio
- Department of Public Health Sciences, Turin, Italy
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18
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Boccalandro E, Mancuso ME, Riva S, Pisaniello DM, Ronchetti F, Santagostino E, Peyvandi F, Solimeno LP, Mannucci PM, Pasta G. Ageing successfully with haemophilia: A multidisciplinary programme. Haemophilia 2017; 24:57-62. [DOI: 10.1111/hae.13308] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2017] [Indexed: 12/15/2022]
Affiliation(s)
- E. Boccalandro
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - M. E. Mancuso
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - S. Riva
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
- Department of Oncology and Hematology; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - D. M. Pisaniello
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - F. Ronchetti
- Geriatric Unit; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico University of Milan; Milan Italy
| | - E. Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - F. Peyvandi
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - L. P. Solimeno
- Division of Orthopaedic Surgery and Traumatology; Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - P. M. Mannucci
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; University of Milan; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - G. Pasta
- Division of Orthopaedic Surgery and Traumatology; Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico; Milan Italy
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19
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Dello Russo A, Riva S, Catto V, Dessanai M, Pizzamiglio F, Casella M, Majocchi B, Cellucci S, Vettor G, Basso C, Thiene G, Zeppilli P, Tondo C. 302Ventricular arrhythmias in athletes: useful of invasive electrophysiological approach to resolve a dilemma for sport eligibility. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Dello Russo A, Riva S, Catto V, Casella M, Dessanai M, Pizzamiglio F, Majocchi B, Cellucci S, Vettor G, Fassini G, Basso C, Thiene G, Carbucicchio C, Zeppilli P, Tondo C. P1533Prevalence of lymphocytic myocarditis mimicking arrhythmogenic right ventricular cardiomyopathy in competitive athlethes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Casella M, Ribatti V, Dello Russo A, Russo E, Riva S, Catto V, Lumia G, Vettor G, Vignati C, Moltrasio M, Tundo F, Fassini G, Carbucicchio C, Natale A, Tondo C. P769X-ray exposure in cardiac electrophysiology. a retrospective analysis over 6 years of activity in a modern, large volume laboratory. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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22
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Riva S, Del Sordo S, Genovese U, Pravettoni G. Medical decision making and risky choices: psychological and medicolegal consequences of HIV and HCV contamination of blood products. HIV AIDS (Auckl) 2017; 9:161-165. [PMID: 28883743 PMCID: PMC5576709 DOI: 10.2147/hiv.s137419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aims The overall goal of this article is to make a scientific comment about the psycho-social consequences of hemophilia patients affected by human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) and to point out the related medicolegal issues. Methods This commentary takes into account some published evidences about the current scenario of hemophilia patients infected by HIV and/or HCV who received contaminated blood products in the late 1970s through 1985. Results Several psychological and medicolegal consequences are related with HIV and HCV contamination of blood products. A multidisciplinary approach is needed to treat all the difficulties experienced by these patients and to ensure good clinical decisions in medical practice. Conclusion The literature on the psychosocial functioning of hemophilia patients with human HIV and HCV infection offers a number of implications, including medicolegal issues, that can be discussed for guaranteeing a good level of care and safeguard of this group of patients.
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Affiliation(s)
- S Riva
- Department of Oncology and Hemato-oncology, University of Milan, Italy
- Correspondence: Silvia Riva, Department of Oncology and Hemato-Oncology, Faculty of Medicine, University of Milan, Via Festa del Perdono, 720122 Milan, Italy, Tel +39 025 032 1240, Email
| | - S Del Sordo
- FOLSATEC (Foundations & Ethics of the Life Sciences) PhD School, University of Milan, Milan, Italy
- Healthcare Accountability Lab, University of Milan, Milan, Italy
| | - U Genovese
- Department of Oncology and Hemato-oncology, University of Milan, Italy
- Healthcare Accountability Lab, University of Milan, Milan, Italy
| | - G Pravettoni
- Department of Oncology and Hemato-oncology, University of Milan, Italy
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23
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Moltrasio M, Fassini G, Riva S, Tundo F, Dello Russo A, Casella M, Romanelli E, Pala S, Tondo C. P1413A new improved 3D mapping system for left atrial ablation procedures: initial evaluation. Europace 2017. [DOI: 10.1093/ehjci/eux158.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Dello Russo A, Romanelli E, Casella M, Pala S, Fassini G, Moltrasio M, Riva S, Tundo F, Catto V, Ribatti V, Lumia G, Tondo C. P355Lesion index, a novel marker of ablation lesion efficacy: a promising tool to decrease the pulmonary vein reconnection. Europace 2017. [DOI: 10.1093/ehjci/eux141.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Riva S, Mancuso ME, Cortesi L, Nobili A, Santagostino E, Peyvandi F, Mannucci PM. Polypharmacy in older adults with severe haemophilia. Haemophilia 2017; 24:e1-e3. [DOI: 10.1111/hae.13262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 01/05/2023]
Affiliation(s)
- S. Riva
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation and University of Milan; Milan Italy
- Department of Oncology and Hematology; University of Milan; Milan Italy
| | - M. E. Mancuso
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation and University of Milan; Milan Italy
| | - L. Cortesi
- IRCCS Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milan Italy
| | - A. Nobili
- IRCCS Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milan Italy
| | - E. Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation and University of Milan; Milan Italy
| | - F. Peyvandi
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation and University of Milan; Milan Italy
| | - P. M. Mannucci
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation and University of Milan; Milan Italy
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26
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Riva S, Caminiti C, Iannelli E, Bryce J, Bagnalasta M, Arpinelli F, Bassi M, Betteto P, Del Mastro L, De Persis D, Nicelli A, Passalacqua R, Porta C, Sparavigna L, Diodati F, Piparo C, Novello S, Castro K, Mitchell S, Perrone F. Cross-cultural adaptation of the US National Cancer Institute's PRO-CTCAE instrument into Italian for adult cancer patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw345.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Kollerov VV, Lobastova TG, Monti D, Deshcherevskaya NO, Ferrandi EE, Fronza G, Riva S, Donova MV. Deoxycholic acid transformations catalyzed by selected filamentous fungi. Steroids 2016; 107:20-9. [PMID: 26718089 DOI: 10.1016/j.steroids.2015.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 07/24/2015] [Revised: 12/08/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
More than 100 filamentous fungi strains, mostly ascomycetes and zygomycetes from different phyla, were screened for the ability to convert deoxycholic acid (DCA) to valuable bile acid derivatives. Along with 11 molds which fully degraded DCA, several strains were revealed capable of producing cholic acid, ursocholic acid, 12-keto-lithocholic acid (12-keto-LCA), 3-keto-DCA, 15β-hydroxy-DCA and 15β-hydroxy-12-oxo-LCA as major products from DCA. The last metabolite was found to be a new compound. The ability to catalyze the introduction of a hydroxyl group at the 7(α/β)-positions of the DCA molecule was shown for 32 strains with the highest 7β-hydroxylase activity level for Fusarium merismoides VKM F-2310. Curvularia lunata VKM F-644 exhibited 12α-hydroxysteroid dehydrogenase activity and formed 12-keto-LCA from DCA. Acremonium rutilum VKM F-2853 and Neurospora crassa VKM F-875 produced 15β-hydroxy-DCA and 15β-hydroxy-12-oxo-LCA, respectively, as major products from DCA, as confirmed by MS and NMR analyses. For most of the positive strains, the described DCA-transforming activity was unreported to date. The presented results expand the knowledge on bile acid metabolism by filamentous fungi, and might be suitable for preparative-scale exploitation aimed at the production of marketed bile acids.
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Affiliation(s)
- V V Kollerov
- G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms, Russian Academy of Sciences, Prospekt Nauki, 5, 142290 Pushchino, Moscow Region, Russia
| | - T G Lobastova
- G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms, Russian Academy of Sciences, Prospekt Nauki, 5, 142290 Pushchino, Moscow Region, Russia
| | - D Monti
- Istituto di Chimica del Riconoscimento Molecolare - C.N.R., Via Mario Bianco 9, 20131 Milano, Italy.
| | - N O Deshcherevskaya
- G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms, Russian Academy of Sciences, Prospekt Nauki, 5, 142290 Pushchino, Moscow Region, Russia
| | - E E Ferrandi
- Istituto di Chimica del Riconoscimento Molecolare - C.N.R., Via Mario Bianco 9, 20131 Milano, Italy
| | - G Fronza
- Istituto di Chimica del Riconoscimento Molecolare - C.N.R., UOS-Milano Politecnico, Via Mancinelli 7, 20131 Milano, Italy
| | - S Riva
- Istituto di Chimica del Riconoscimento Molecolare - C.N.R., Via Mario Bianco 9, 20131 Milano, Italy
| | - M V Donova
- G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms, Russian Academy of Sciences, Prospekt Nauki, 5, 142290 Pushchino, Moscow Region, Russia.
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Cozzani E, Agnoletti AF, Riva S, Parodi A. Minocycline: a new molecule inducing subacute cutaneous lupus erythematosus? GIORN ITAL DERMAT V 2015; 150:261-265. [PMID: 25876148] [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: 06/04/2023]
Affiliation(s)
- E Cozzani
- DISSAL Section of Dermatology, IRCCS Azienda Universitaria Ospedaliera San Martino-IST, Genoa, Italy -
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29
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Rongioletti F, Merlo V, Riva S, Cozzani E, Cinotti E, Ghigliotti G, Parodi A, Kanitakis J. Reticular erythematous mucinosis: a review of patients' characteristics, associated conditions, therapy and outcome in 25 cases. Br J Dermatol 2014; 169:1207-11. [PMID: 23937648 DOI: 10.1111/bjd.12577] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reticular erythematous mucinosis (REM) is an uncommon disease, the nosology and specific characteristics of which are controversial because most reports deal with single cases or small series. OBJECTIVES To describe the characteristics of patients with REM regarding demographics, clinical and pathological features, comorbidities, treatment and course. METHODS A retrospective and prospective study was conducted on 25 patients diagnosed with REM in the setting of university-affiliated dermatology departments and dermatopathology centres. RESULTS Of the 25 patients with REM, 16 were women (sex ratio 2 : 1) and the mean age was 46 years. The roles of sun exposure and oral contraceptives were ambiguous. Associated diseases included hypertension (n = 4), malignancies (n = 3), autoimmune diseases (n = 3) and Borrelia infection (n = 1). Immunological studies (including serology and direct immunofluorescence) were noncontributory. The response to antimalarial treatment was good in > 80% of cases. Worsening or recurrence of the lesion after treatment discontinuation, or in the course of the disease, occurred in 31% of patients. CONCLUSIONS We present the largest REM case series to date. The reticular pattern with involvement of the midline of the chest and back, the predilection for middle-aged women, the controversial relationship with photosensitivity and the possible association with other conditions such as malignancies and thyroid dysfunctions are the main characteristics that makes REM a recognizable disease.
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Affiliation(s)
- F Rongioletti
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Viale Benedetto XV, 16132, Genoa, Italy
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30
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Gringeri A, Leissinger C, Cortesi PA, Jo H, Fusco F, Riva S, Antmen B, Berntorp E, Biasoli C, Carpenter S, Kavakli K, Morfini M, Négrier C, Rocino A, Schramm W, Windyga J, Zülfikar B, Mantovani LG. Health-related quality of life in patients with haemophilia and inhibitors on prophylaxis with anti-inhibitor complex concentrate: results from the Pro-FEIBA study. Haemophilia 2013; 19:736-43. [DOI: 10.1111/hae.12178] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A. Gringeri
- Department of Clinical Sciences and Community Health; Università degli Studi di Milano; Milan; Italy
| | - C. Leissinger
- Louisiana Center for Bleeding and Clotting Disorders; Tulane University Medical Center; New Orleans; LA; USA
| | - P. A. Cortesi
- Research Centre on Public Health; University of Milano-Bicocca; Monza; Italy
| | - H. Jo
- Quintiles; Rockville; MD; USA
| | | | - S. Riva
- IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy and Institute of Communication and Health; University of Svizzera Italiana; Lugano; Switzerland
| | | | - E. Berntorp
- Malmö University Hospital, Malmö Center for Thrombosis and Hemostasis; Lund University; Malmö; Sweden
| | - C. Biasoli
- Hemophilia Center; Bufalini Hospital; Cesena; Italy
| | - S. Carpenter
- University of Missouri-Kansas City School of Medicine; Kansas City; MO; USA
| | - K. Kavakli
- University of Ege; Children's Hospital; Izmir; Turkey
| | - M. Morfini
- Azienda University Hospital Careggi; Florence; Italy
| | - C. Négrier
- Hemophilia Treatment Center; Edouard Herriot Hospital; University Claude Bernard; Lyon; France
| | - A. Rocino
- Hemophilia and Thrombosis Center; San Giovanni Bosco Hospital; Naples; Italy
| | - W. Schramm
- Ludwig-Maximilians University; Munich; Germany
| | - J. Windyga
- Institute of Hematology and Transfusion Medicine; Warsaw; Poland
| | | | - L. G. Mantovani
- CIRFF/Center of Pharmacoeconomics; Federico II University of Naples; Naples; Italy
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Kollerov VV, Monti D, Deshcherevskaya NO, Lobastova TG, Ferrandi EE, Larovere A, Gulevskaya SA, Riva S, Donova MV. Hydroxylation of lithocholic acid by selected actinobacteria and filamentous fungi. Steroids 2013; 78:370-8. [PMID: 23333587 DOI: 10.1016/j.steroids.2012.12.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/03/2012] [Accepted: 12/15/2012] [Indexed: 11/23/2022]
Abstract
Selected actinobacteria and filamentous fungi of different taxonomy were screened for the ability to carry out regio- and stereospecific hydroxylation of lithocholic acid (LCA) at position 7β. The production of ursodeoxycholic acid (UDCA) was for the first time shown for the fungal strains of Bipolaris, Gibberella, Cunninghamella and Curvularia, as well as for isolated actinobacterial strains of Pseudonocardia, Saccharothrix, Amycolatopsis, Lentzea, Saccharopolyspora and Nocardia genera. Along with UDCA, chenodeoxycholic (CDCA), deoxycholic (DCA), cholic (CA), 7-ketodeoxycholic and 3-ketodeoxycholic acids were detected amongst the metabolites by some strains. A strain of Gibberella zeae VKM F-2600 expressed high level of 7β-hydroxylating activity towards LCA. Under optimized conditions, the yield of UDCA reached 90% at 1g/L of LCA and up to 60% at a 8-fold increased substrate loading. The accumulation of the major by-product, 3-keto UDCA, was limited by using selected biotransformation media.
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Affiliation(s)
- V V Kollerov
- G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms, Russian Academy of Sciences, Prospekt Nauki 5, 142290 Pushchino, Moscow Region, Russia
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Tufano M, Liccardo D, Riva S, Candusso M, Torre G, Iorio R. Efficacy of combined antiviral therapy with lamivudine and tenofovir in a liver transplanted girl with de novo hepatitis B virus infection. Transpl Infect Dis 2013; 15:E81-4. [PMID: 23387823 DOI: 10.1111/tid.12057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/29/2012] [Accepted: 12/02/2012] [Indexed: 12/01/2022]
Abstract
The management of de novo hepatitis B (HBV) infection in children after liver transplantation is not well defined. Because this infection may induce severe liver disease in the graft liver, an efficient antiviral therapy is desirable. Here, we describe the favorable viral outcome observed in a liver transplanted girl with de novo HBV infection following combination therapy with lamivudine and tenofovir.
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Affiliation(s)
- M Tufano
- Department of Pediatric Hepatology, University of Naples, Federico II, Naples, Italy
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Pagano D, Cintorino D, Li Petri S, di Francesco F, Ricotta C, Argento J, Echeverri GJ, Bertani T, Riva S, Gridelli BG, Spada M. Laparoscopic approach for an intra-abdominal kidney allograft nephrectomy after pediatric transplantation: a case report. Transplant Proc 2013; 44:2036-7. [PMID: 22974901 DOI: 10.1016/j.transproceed.2012.06.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report a case of minimally invasive nephrectomy of a kidney transplanted into the abdominal cavity in a child. A 15-year-old girl underwent transplantation with a cadaveric donor kidney due to congenital pyelonephritis, vesicoureteral reflux, and secondary bladder atrophy. The transplant was complicated by hyperacute rejection, cytomegalovirus infection, and anastomotic stenosis of the Bricker neobladder. After recurrent urinary tract infections, the patient was reintroduced to hemodialysis in 2010. After pneumo-peritoneum, we placed 2 10-mm trocars in the hypochondrium and left side and 2 5-mm in the left iliac fossa and right upper quadrant. The transplanted kidney was skeletonized, the artery and vein were cut to the end-to-side anastomoses to the juxta-renal aorta and cava using an automatic 35-mm, stapler, and the ureter was dissected and closed with clips. Via a Pfannestiel minilaparotomy we extracted the allograft. The patient was discharged on the third postoperative day. After 4 months of follow-up, she is alive an on dialysis. Laparoscopic nephrectomy of a kidney transplanted into the abdominal cavity is feasible and safe in centers with skilled minimally invasive techniques.
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Affiliation(s)
- D Pagano
- Department of Abdominal and Transplantation Surgery, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, University of Pittsburgh Medical Center in Italy, Palermo, Italy
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Cagliani R, Guerini FR, Fumagalli M, Riva S, Agliardi C, Galimberti D, Pozzoli U, Goris A, Dubois B, Fenoglio C, Forni D, Sanna S, Zara I, Pitzalis M, Zoledziewska M, Cucca F, Marini F, Comi GP, Scarpini E, Bresolin N, Clerici M, Sironi M. A trans-specific polymorphism in ZC3HAV1 is maintained by long-standing balancing selection and may confer susceptibility to multiple sclerosis. Mol Biol Evol 2012; 29:1599-613. [PMID: 22319148 PMCID: PMC7187542 DOI: 10.1093/molbev/mss002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The human ZC3HAV1 gene encodes an antiviral protein. The longest splicing isoform of ZC3HAV1 contains a C-terminal PARP-like domain, which has evolved under positive selection in primates. We analyzed the evolutionary history of this same domain in humans and in Pan troglodytes. We identified two variants that segregate in both humans and chimpanzees; one of them (rs3735007) does not occur at a hypermutable site and accounts for a nonsynonymous substitution (Thr851Ile). The probability that the two trans-specific polymorphisms have occurred independently in the two lineages was estimated to be low (P = 0.0054), suggesting that at least one of them has arisen before speciation and has been maintained by selection. Population genetic analyses in humans indicated that the region surrounding the shared variants displays strong evidences of long-standing balancing selection. Selection signatures were also observed in a chimpanzee population sample. Inspection of 1000 Genomes data confirmed these findings but indicated that search for selection signatures using low-coverage whole-genome data may need masking of repetitive sequences. A case–control study of more than 1,000 individuals from mainland Italy indicated that the Thr851Ile SNP is significantly associated with susceptibility to multiple sclerosis (MS) (odds ratio [OR] = 1.47, 95% confidence intervals [CI]: 1.08–1.99, P = 0.011). This finding was confirmed in a larger sample of 4,416 Sardinians cases/controls (OR = 1.18, 95% CI: 1.037–1.344, P = 0.011), but not in a population from Belgium. We provide one of the first instances of human/chimpanzee trans-specific coding variant located outside the major histocompatibility complex region. The selective pressure is likely to be virus driven; in modern populations, this variant associates with susceptibility to MS, possibly via the interaction with environmental factors.
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Affiliation(s)
- R Cagliani
- Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
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Nastasio S, Sciveres M, De Tata R, Riva S, Palla G, Maggiore G. CO30 CYCLOSPORIN TREATMENT FOR AUTOIMMUNE LIVER DISEASES IS SAFE AND EFFICACIOUS IN THE LONG TERM. Dig Liver Dis 2011. [DOI: 10.1016/s1590-8658(11)60638-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Spada M, Corno V, Colledan M, Segalin A, Lucianetti A, Torre G, Riva S, Sonzogni A, Petz W, Gridelli B. Rejection and tacrolimus conversion therapy in paediatric liver transplantation. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02056.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gridelli B, Spada M, Riva S, Colledan M, Segalin A, Lucianetti A, Sonzogni A, Furione M, Baldanti F, Torre G. Circulating Epstein-Barr virus DNA to monitor lymphoproliferative disease following pediatric liver transplantation. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02069.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Navarra C, Caufin S, Monti D, Danieli B, Riva S. Laccase-Catalyzed Oxydation of Phenolic Derivatives. J Biotechnol 2010. [DOI: 10.1016/j.jbiotec.2010.09.551] [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: 11/17/2022]
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Cagliani R, Fumagalli M, Biasin M, Piacentini L, Riva S, Pozzoli U, Bonaglia MC, Bresolin N, Clerici M, Sironi M. Long-term balancing selection maintains trans-specific polymorphisms in the human TRIM5 gene. Hum Genet 2010; 128:577-88. [PMID: 20811909 DOI: 10.1007/s00439-010-0884-6] [Citation(s) in RCA: 45] [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] [Received: 06/04/2010] [Accepted: 08/25/2010] [Indexed: 01/09/2023]
Abstract
The human TRIM5 genes encodes a retroviral restriction factor (TRIM5α). Evolutionary analyses of this gene in mammals have revealed a complex and multifaceted scenario, suggesting that TRIM5 has been the target of exceptionally strong selective pressures, possibly exerted by recurrent waves of retroviral infections. TRIM5 displays inter-individual expression variability in humans and high levels of TRIM5 mRNA have been associated with a reduced risk of HIV-1 infection. We resequenced TRIM5 in chimpanzees and identified two polymorphisms in intron 1 that are shared with humans. Analysis of the gene region encompassing the two trans-specific variants in human populations identified exceptional nucleotide diversity levels and an excess of polymorphism compared to fixed divergence. Most tests rejected the null hypothesis of neutral evolution for this region and haplotype analysis revealed the presence of two deeply separated clades. Calculation of the time to the most recent common ancestor (TMRCA) for TRIM5 haplotypes yielded estimates ranging between 4 and 7 million years. Overall, these data indicate that long-term balancing selection, an extremely rare process outside MHC genes, has maintained trans-specific polymorphisms in the first intron of TRIM5. Bioinformatic analyses indicated that variants in intron 1 may affect transcription factor-binding sites and, therefore, TRIM5 transcriptional activity. Data herein confirm an extremely complex evolutionary history of TRIM5 genes in primates and open the possibility that regulatory variants in the gene modulate the susceptibility to HIV-1.
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Affiliation(s)
- R Cagliani
- Scientific Institute IRCCS E. Medea, Via don L. Monza 20, 23842, Bosisio Parini, LC, Italy
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Dello Russo A, Casella M, Pelargonio G, Bonelli F, Santangeli P, Fassini G, Riva S, Carbucicchio C, Giraldi F, De Iuliis P, Bartoletti S, Pintus F, Di Biase L, Pepi M, Natale A, Fiorentini C, Tondo C. Intracardiac echocardiography in electrophysiology. Minerva Cardioangiol 2010; 58:333-342. [PMID: 20485239] [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
Intracardiac echocardiography (ICE) is a recent, invaluable tool which can provide real-time anatomical guidance in electrophysiological procedures. By inserting intravenously an ultrasound probe and advancing it into the heart, various different views can be obtained which allow to better visualize patient anatomy, to guide the placement of electrophysiological catheters, and to detect immediately procedural complications as they occur. In atrial fibrillation ablation, ICE proves particularly useful to achieve a safer trans-septal puncture (especially in the presence of anatomical anomalies of the interatrial septum) and to help to monitor the visualization of the mapping catheters (circular, high density), or the monitoring of the balloons catheter (Cryo, Laser) position. In ventricular tachycardia ablation, on the other hand, ICE allows for continuous correlation between electrophysiological and structural findings (such as wall motion anomalies or changes in echodensity), and helps to ensure correct catheter contact and to position it, particularly around delicate structures such as the aortic cusps. In any procedure, ICE is also useful to immediately detect procedural complications, such as thrombus formation along catheters, or pericardial effusion. Thanks to its real-time morphological information, ICE provides an ideal complement to simple fluoroscopy or to more complex electroanatomic mapping techniques and is set to gain a wider role in a broad range of electrophysiological procedures.
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Affiliation(s)
- A Dello Russo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, Department of Cardiovascular Research, University of Milan, Milan, Italy.
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Cagliani R, Fumagalli M, Riva S, Pozzoli U, Fracassetti M, Bresolin N, Comi GP, Sironi M. Polymorphisms in the CPB2 Gene Are Maintained by Balancing Selection and Result in Haplotype-Preferential Splicing of Exon 7. Mol Biol Evol 2010; 27:1945-54. [DOI: 10.1093/molbev/msq082] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Fumagalli M, Cagliani R, Pozzoli U, Riva S, Comi GP, Menozzi G, Bresolin N, Sironi M. A population genetics study of the Familial Mediterranean Fever gene: evidence of balancing selection under an overdominance regime. Genes Immun 2009; 10:678-86. [DOI: 10.1038/gene.2009.59] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Maggiore G, Riva S, Sciveres M. Autoimmune diseases of the liver and biliary tract and overlap syndromes in childhood. MINERVA GASTROENTERO 2009; 55:53-70. [PMID: 19212308] [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
Autoimmune liver diseases in childhood includes Autoimmune Hepatitis (AIH) and Primary (Autoimmune) Sclerosing Cholangitis (P(A)SC). Both diseases are characterized by a chronic, immune-mediated liver inflammation involving mainly hepatocytes in AIH and bile ducts in PSC. Both diseases, if untreated, lead to liver cirrhosis. AIH could be classified, according to the autoantibodies pattern, into two subtypes: AIH type 1 presents at any age as a chronic liver disease with recurrent flares occasionally leading to liver cirrhosis and liver failure. Characterizing autoantibodies are anti-nuclear (ANA) and anti-smooth muscle (SMA), usually at high titer (>1:100). These autoantibodies are not specific and probably do not play a pathogenic role. AIH type 2 shows a peak of incidence in younger children, however with a fluctuating course. The onset is often as an acute liver failure. Anti-liver kidney microsome autoantibodies type 1 (LKM1) and/or anti-liver cytosol autoantibody (LC1) are typically found in AIH type 2 and these autoantibodies are accounted to have a potential pathogenic role. Diagnosis of AIH is supported by the histological finding of interface hepatitis with massive portal infiltration of mononuclear cells and plasmocytes. Inflammatory bile duct lesions are not unusual and may suggest features of ''overlap'' with P(A)SC. A diagnostic scoring system has been developed mainly for scientific purposes, but his diagnostic role in pediatric age is debated. Conventional treatment with steroids and azathioprine is the milestone of therapy and it is proved effective. Treatment withdrawal however should be attempted only after several years. Cyclosporin A is the alternative drug currently used for AIH and it is effective as steroids. P(A)SC exhibit a peak of incidence in the older child, typically in pre-pubertal age with a slight predominance of male gender. Small bile ducts are always concerned and the histological picture shows either acute cholangitis (bile duct infiltration and destruction) and/or lesions suggesting chronic cholangitis as well (bile duct paucity and/or proliferation, periductal sclerosis). Small bile ducts damage may be associated, at onset or in the following years, with lesions of larger bile ducts with duct wall irregularities, strictures, dilations, and beading resulting in the characteristic ''bead-on-a-string'' appearance. The ''small duct'' (autoimmune) sclerosing cholangitis is also called autoimmune cholangitis. PSC is strictly associated to a particular form of inflammatory bowel disease (IBD) which shows features not typical of ulcerative colitis neither of Crohn's disease. Symptoms related to IBD often are present at onset (abdominal pain, weight loss, bloody stools) but the liver disease is frequently asymptomatic and it may be discovered fortuitously. Treatment of PSC is particularly challenging. In case of ''small duct'' SC or in case of evidence active inflammation on liver biopsy, immunosuppressive treatment is probably useful while in case of large bile ducts non inflammatory sclerosis, immunosuppression is probably uneffective. Ursodeoxycholic acid, however, may leads to an improvement of liver biochemistry even if there's no evidence that it may alter the course of disease. Thus, liver transplantation, is often necessary in the long term follow-up, even with a risk of disease recurrence. In adjunction to these two main disorders, many patients show an''overlap'' disease with features of both AIH and PSC. In such disorders the immune-mediated damage concerns both the hepatocyte and the cholangiocyte with a continuous clinical spectrum from AIH with minimal bile ducts lesions and PSC with portal inflammation and active inflammatory liver damage.
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Affiliation(s)
- G Maggiore
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Azienda Ospedaliera, Universitaria Pisana, Pisa, Italy.
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Riva S, Spada M, Sciveres M, Minervini M, Cintorino D, Maggiore G, Gridelli B. Hepatocarcinoma in a child with cholesterol ester storage disease. Dig Liver Dis 2008; 40:784. [PMID: 18339594 DOI: 10.1016/j.dld.2008.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 01/29/2008] [Indexed: 12/11/2022]
Affiliation(s)
- S Riva
- Pediatric Liver Transplantation, Pediatric Hepatology, ISMETT, Palermo, Italy
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Spada M, Petz W, Bertani A, Riva S, Sonzogni A, Giovannelli M, Torri E, Torre G, Colledan M, Gridelli B. Randomized trial of basiliximab induction versus steroid therapy in pediatric liver allograft recipients under tacrolimus immunosuppression. Am J Transplant 2006; 6:1913-21. [PMID: 16771811 DOI: 10.1111/j.1600-6143.2006.01406.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Avoidance of corticosteroids could be beneficial after pediatric liver transplantation (LTx). To test this hypothesis, we performed a randomized prospective study to compare immunosuppression with tacrolimus (TAC) and steroids versus TAC and basiliximab (BAS) after pediatric LTx. Seventy-two patients were recruited, 36 receiving TAC and steroids and 36 TAC and BAS. The primary endpoint was the occurrence of the first rejection episode. Secondary endpoints were the cumulative incidence and severity of rejection, patient and graft survival, and incidence of adverse events. Overall 1-year patient and graft survival rates were 91.4% and 85.5% in the steroid group, and 88.6% and 80% in the BAS group (p = NS). Patients free from rejection were 87.7% in the BAS group and 67.7% in the steroid group (p = 0.036). The use of BAS was associated with a 63.6% reduction in incidence of acute rejection episodes. Overall incidence of infection was 72.3% in the steroid group and 50% in the BAS group (p = 0.035). We conclude that the combination of TAC with BAS is an alternative to TAC and steroid immunosuppression in pediatric LTx, which allows for a significant reduction in the incidence of acute rejection and infectious complications.
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Affiliation(s)
- M Spada
- Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione, IsMeTT, University of Pittsburgh Medical Center, Italy.
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46
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Cintorino D, Riva S, Spada M, Minervini M, Sonzogni A, Foglieni CS, Gruttadauria S, Verzaro R, Henderson K, Aricò M, Gridelli B. Corticosteroid-Free Immunosuppression in Pediatric Liver Transplantation: Safety and Efficacy After a Short-Term Follow-up. Transplant Proc 2006; 38:1099-100. [PMID: 16757276 DOI: 10.1016/j.transproceed.2006.02.147] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND We report our results with the use of corticosteroid-free immunosuppression after pediatric liver transplantation, evaluating the efficiency and safety of this protocol in the early posttransplantation period. PATIENTS AND METHODS From July 2003 to October 2005, 34 liver transplantations were performed in 32 pediatric patients (19 boys, 13 girls) at our institution. Recipient median age was 5 years (range, 0.2-14 years), and median body weight was 10 kg (range, 4-49 kg). Twenty-seven patients received a graft from in situ split liver transplantation, 5 a whole graft. Twenty-nine children (90%) received an immunosuppressive therapy based on methylprednisolone IV bolus at reperfusion (10 mg/kg) plus tacrolimus given at an initial dose of 0.08 mg/kg/d and then adjusted to obtain whole blood trough levels of 10 to 15 ng/mL during the first 3 months and 5 to 10 ng/mL after the 3rd month; basiliximab was given on postoperative days 0 and 4. Biopsy-proven acute rejection episodes were treated by methylprednisone IV boluses. RESULTS After a median follow-up of 9 months (range, 1-27 months), the overall patient survival rate was 84% and graft survival rate was 79%. Three children (9%) died after their transplantations. Three (9%) experienced episodes of biopsy-proven acute rejection, always treated with IV steroid boluses. Mean RAI score was 4. One patient experienced PTLD that resolved with temporary reduction of immunosuppression. Cytomegalovirus infection rate was 14%. Sepsis occurred in 2 cases (6%). CONCLUSIONS Initial results with a steroid-free immunosuppressive protocol are encouraging, with low rates of acute rejection and infectious complications as in steroid-based protocols.
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Affiliation(s)
- D Cintorino
- Liver Transplantation Unit, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (IsMeTT), UPMC Italy, Palermo
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Cintorino D, Spada M, Gruttadauria S, Riva S, Luca A, Volpes R, Vizzini G, Arcadipane A, Henderson K, Verzaro R, Foglieni CS, Gridelli B. In Situ Split Liver Transplantation for Adult and Pediatric Recipients: An Answer to Organ Shortage. Transplant Proc 2006; 38:1096-8. [PMID: 16757275 DOI: 10.1016/j.transproceed.2006.02.146] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 10/24/2022]
Abstract
BACKGROUND We report our initial experience with in situ split liver transplantation (SLT) for adult and pediatric patients. PATIENTS AND METHODS From June 2003 to August 2005, 177 liver transplantations in 165 patients, 133 adults (81%) and 32 children (19%), were performed at our institution. Over this period, 45 liver transplantations (25%) were performed with an in situ split liver technique in 44 patients: 17 (39%) were adults and 27 (61%) children. All of the adult split liver recipients were transplanted with an extended right graft (ERG; segments I + IV-VIII), while pediatric recipients received in 23 cases a left lateral segment (LLS; segments II-III) and in 4 cases an ERG from a pediatric donor. The 45 split liver grafts (21 ERGs and 24 LLSs) were generated from 35 donors. In 10 cases we used both grafts generated with an in situ split procedure to transplant our patients, while in 25 cases the procurement procedure was performed in collaboration with other transplant centers. RESULTS After a median follow-up of 9 months (range, 1-27 months), the overall patient survival rate was 88% for adult patients and 82% for pediatric patients. Graft survivals were 88% and 79%, respectively. Two adult patients (12%) died from sepsis in the early postoperative period. Five children (18%) died after their transplantations. Only one pediatric recipient (2%) of primary SLT underwent retransplantation. Vascular complications were absent in adult recipients, whereas 4 arterial (14%) and 4 venous (14%) complications developed in the pediatric population. The incidence of biliary complications was 23% in adult and 18% in pediatric recipients. CONCLUSIONS The use of in situ SLT for adult and pediatric populations allowed us to expand the cadaveric donor pool, significantly eliminating pediatric waiting list mortality without penalizing the adult population.
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Affiliation(s)
- D Cintorino
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (IsMeTT), University of Pittsburgh Medical Center, Palermo, Italy
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Fecarotta S, Parenti G, Vajro P, Zuppaldi A, Della Casa R, Carbone MT, Correra A, Torre G, Riva S, Dionisi-Vici C, Santorelli FM, Andria G. HHH syndrome (hyperornithinaemia, hyperammonaemia, homocitrullinuria), with fulminant hepatitis-like presentation. J Inherit Metab Dis 2006; 29:186-9. [PMID: 16601889 DOI: 10.1007/s10545-006-0120-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 06/07/2005] [Indexed: 01/10/2023]
Abstract
We report a 3-year-old Italian patient with the hyperornithinaemia, hyperammonaemia, homocitrullinuria (HHH) syndrome who presented with neurological deterioration after an intercurrent infection. Hyperammonaemia, coagulopathy and moderate hypertransaminasaemia were detected on hospital admission. Severe hepatocellular necrosis with hypertransaminasaemia (aspartate aminotransferase 20,000 UI/L, alanine aminotransferase 18,400 UI/L) and coagulopathy (PT < 5%) rapidly developed within few days, prompting evaluation for liver transplantation. A protein-restricted diet and arginine supplementation were immediately started, with a rapid improvement of the patient's neurological conditions and normalization of liver function tests and blood ammonia. The diagnosis of HHH syndrome was based on the presence of the typical metabolic abnormalities. Molecular analysis of the SLC25A15 gene showed that the patient was heterozygous for two novel mutations (G113C and M273K). The diagnosis of HHH syndrome should be considered in patients with fulminant hepatitis-like presentations. Early identification and treatment of these patients can be life-saving and can avoid liver transplantation.
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Affiliation(s)
- S Fecarotta
- Department of Pediatrics, Federico II University, Via S Pansini 5, 80131 Naples, Italy
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Ghetta A, Prosperi D, Mantegazza F, Panza L, Riva S, Bellini T. Light scattered by model phantom bacteria reveals molecular interactions at their surface. Proc Natl Acad Sci U S A 2005; 102:15866-70. [PMID: 16243972 PMCID: PMC1276067 DOI: 10.1073/pnas.0505877102] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Testing molecular interactions is an ubiquitous need in modern biology and molecular medicine. Here, we present a qualitative and quantitative method rooted in the basic properties of the scattering of light, enabling detailed measurement of ligand-receptor interactions occurring on the surface of colloids. The key factor is the use of receptor-coated nanospheres matched in refractive index with water and therefore optically undetectable ("phantom") when not involved in adhesion processes. At the occurrence of ligand binding at the receptor sites, optically unmatched material adsorbs on the nanoparticle surface, giving rise to an increment in their scattering cross section up to a maximum corresponding to saturated binding sites. The analysis of the scattering growth pattern enables extracting the binding affinity. This label-free method has been assessed through the determination of the binding constant of the antibiotic vancomycin with the tripeptide l-Lys-d-Ala-d-Ala and of the vancomycin dimerization constant. We shed light on the role of chelate effect and molecular hindrance in the activity of this glycopeptide.
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Affiliation(s)
- A Ghetta
- Dipartimento di Chimica, Biochimica e Biotecnologie per la Medicina, Università di Milano, Via Fratelli Cervi 93, 20090 Segrate, Italy
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Pinelli D, Spada M, Lucianetti A, Riva S, Guizzetti M, Giovanelli M, Maldini G, Corno V, Sonzogni V, Vedovati S, Bertani A, Zambelli M, Gridelli B, Colledan M. Transplantation for acute liver failure in children. Transplant Proc 2005; 37:1146-8. [PMID: 15848651 DOI: 10.1016/j.transproceed.2004.12.302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We reviewed the clinical data of 30 children-hospitalized for acute liver failure in the last 6 years. Ten patients were not listed for liver transplantation OLTX. Their clinical conditions gradually improved and they are all alive without deficit. Among 20 patients listed, 15 underwent urgent OLTX. Two children died on the waiting list and three were suspended from waiting list after few days because of improvement. Survival according to age class was analyzed dividing the patients into two groups: A, age 1 year or less versus B, age between 1 and 16 years. The patient survival was 86% at 6 months and 61% both at 1 and 2 years. Survival at 6 months and 1 and 2 years was 88%, 67%, and 45% for the patients in group A and 83%, 83%, and 83% for the patients in group B (P = NS). Observing graft-to-recipient weight ratio and donor-to-recipient weight ratio most patients received an optimal sized graft. The split-liver technique is considered the preferred method of liver transplantation even in the pediatric patients with acute liver failure; especially in the setting of a cooperative system in which all livers that are suitable for split-liver transplantation are shared between centers. In order to have the best chance for survival, children with acute liver failure should be referred as soon as possible to an highly specialized pediatric liver transplantation center that can offer all the treatment modalities that are currently available.
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Affiliation(s)
- D Pinelli
- Ospedali Riuniti di Bergamo Bergamo, Italy.
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