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Transition from pediatric to adult care in patients with Turner syndrome in Italy: a consensus statement by the TRAMITI project. J Endocrinol Invest 2024:10.1007/s40618-024-02315-4. [PMID: 38376731 DOI: 10.1007/s40618-024-02315-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Transition from pediatric to adult care is associated with significant challenges in patients with Turner syndrome (TS). The objective of the TRansition Age Management In Turner syndrome in Italy (TRAMITI) project was to improve the care provided to patients with TS by harnessing the knowledge and expertise of various Italian centers through a Delphi-like consensus process. METHODS A panel of 15 physicians and 1 psychologist discussed 4 key domains: transition and referral, sexual and bone health and oncological risks, social and psychological aspects and systemic and metabolic disorders. RESULTS A total of 41 consensus statements were drafted. The transition from pediatric to adult care is a critical period for patients with TS, necessitating tailored approaches and early disclosure of the diagnosis to promote self-reliance and healthcare autonomy. Fertility preservation and bone health strategies are recommended to mitigate long-term complications, and psychiatric evaluations are recommended to address the increased prevalence of anxiety and depression. The consensus also addresses the heightened risk of metabolic, cardiovascular and autoimmune disorders in patients with TS; regular screenings and interventions are advised to manage these conditions effectively. In addition, cardiac abnormalities, including aortic dissections, require regular monitoring and early surgical intervention if certain criteria are met. CONCLUSIONS The TRAMITI consensus statement provides valuable insights and evidence-based recommendations to guide healthcare practitioners in delivering comprehensive and patient-centered care for patients with TS. By addressing the complex medical and psychosocial aspects of the condition, this consensus aims to enhance TS management and improve the overall well-being and long-term outcomes of these individuals.
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Predictive value of Cardiac Magnetic Resonance: new and old parameters in the natural history of repaired Tetralogy of Fallot. BMC Cardiovasc Disord 2024; 24:15. [PMID: 38172687 PMCID: PMC10765701 DOI: 10.1186/s12872-023-03671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Patients with repaired Tetralogy of Fallot (rTOF) often develop pulmonary regurgitation (PR) and right ventricle (RV) dysfunction, experiencing increased mortality and morbidity rates in adulthood. Pulmonary valve replacement (PVR) timing to address PR is controversial. Cardiac Magnetic Resonance (CMR) is the gold standard for morpho-functional evaluation of complex cardiopathies. This study aims to identify CMR parameters predictive of adverse outcomes to help defining the best therapeutic management of rTOF patients. METHODS 130 rTOF patients who underwent CMR (2006-2019) were enrolled in this retrospective single-center study. CMR, clinical, ECG and exercise data were analyzed. Univariate and multivariate analyses identified clinical and CMR parameters predictive of adverse outcomes both individually (e.g., death, arrhythmias, heart failure (HF), pharmacological therapy, QRS ≥ 160ms) and as composite outcome. RESULTS Univariate analysis confirmed RV volumes and RV ejection fraction corrected for PR as adverse outcome predictors and identified interesting correlations: pulmonary artery bifurcation geometry and abnormal interventricular septum (IVS) motion with arrhythmias (p < .001; p = .037), HF (p = .049; p = .005), composite outcome (p = .039; p = .009); right atrium (RA) dimensions with the composite outcome and the outcomes individually (p < .001). The best predictive models by multivariate analysis included sex (male), RV and RA dilation for QRS ≥ 160ms, time form repair to CMR, age at TOF repair and IVS fibrosis for pharmacological therapy. CONCLUSIONS Besides RV volumes, new adverse prognostic factors could guide rTOF therapeutic management: pulmonary arteries morphology, abnormal IVS motion, RV dysfunction, RA dilation. Perspective multicentric evaluation is needed to specify their effective role.
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3D-echocardiography for evaluation of the right ventricle in patients with repaired Tetralogy of Fallot: a comparison study with cardiac magnetic resonance. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with repaired Tetralogy of Fallot (ToF) need periodic instrumental assessments, due to complications they can meet during lifetime. Right ventricle (RV) dilation and dysfunction are some examples that explain why those patients regularly undergo Cardiac Magnetic Resonance (CMR), currently the gold standard method to detect these complications.
Purpose
3D-echocardiography is an emerging tool to study RV, but there is little data supporting its use in congenital heart diseases. This study aimed at evaluating its accuracy in assessing RV dimensions and systolic function in ToF patients, in comparison to CMR.
Methods
34 patients were prospectively enrolled after CMR performance. They all underwent standard 2D-echocardiography and Multi-Beat-ECG-triggered 3D Full-Volume acquisition.
RV End Diastolic Volume (RV-EDV), End Systolic Volume and Ejection Fraction (RV-EF) were defined both in 3D-echocardiography and CMR.
Results
Post-hoc analysis of 3D images was performed through a vendor-independent software in 30 patients, resulting in a feasibility of 88%.
A Bland-Altman analysis was performed, showing that 3D-echocardiography underestimates the RV-EDV/BSA of −27.39 mL/m2 on average (CI 95%: −29.46; −25.31, SD: 5.68 mL/m2), compared to CMR, as expected. However, when compared to normality reference, 3D-echocardiography identified RV dilatation with a significant correlation to CMR (V=0.66, p<0.001). Moreover, ROC curves showed that 3D-echo-RV-EDV/BSA is the echocardiographic measure that best correlates to CMR in detecting RV dilatation (AUC 1, CI 95%: 1.00; 1.00), followed by RVOT diameter in PLAX (AUC 0.89, CI 95%: 0.69; 0.99).
Youden analysis suggested 77 mL/m2 (Se 95%, Sp 100%; J 0,95) as optimal limit to define RV dilatation in 3D-echocardiography.
Regarding the RV-EF, the Bland-Altman analysis showed that 3D-echocardiography overestimates the RV-EF by 1,97% on average (CI 95%: 0.01; 3.95, SD: 5.43), compared to CMR.
Secondly, accuracy of different echocardiographic parameters (both 2D and 3D) in detecting a RV systolic impairment was analyzed: ROC curves showed that RV-EF in 3D echocardiography is the measurement that best correlates to CMR in detecting RV dysfunction (AUC 0.92, CI 95%: 0.79–1.00), followed by Fractional Area Change (FAC) (AUC 0.78, CI 95%: 0.60; 0.96).
Tricuspid Annular Plane Systolic Excursion (TAPSE) and tricuspid valve annular motion velocities in systole (S'-TDI), instead, showed very poor correlation.
Conclusions
3D-echocardiography showed good agreement with CMR in defining RV dimensions and systolic function in ToF patients, even more than the bidimensional measurements cardiologists are used to. This could lead to a wider use of this tool in daily clinical practice, involving a reduction in the execution of the numerous CMR patients usually undergo. Moreover, it could be a valid instrument in patients with contraindication to CMR.
Funding Acknowledgement
Type of funding sources: None.
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Kidney health for all: bridging the gap in kidney health education and literacy. Braz J Med Biol Res 2022; 55:e12161. [PMID: 35584454 PMCID: PMC9113529 DOI: 10.1590/1414-431x2022e12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022] Open
Abstract
The high burden of kidney disease, global disparities in kidney care, and the poor outcomes of kidney failure place a growing burden on affected individuals and their families, caregivers, and the community at large. Health literacy is the degree to which individuals and organizations have, or equitably enable individuals to have, the ability to find, understand, and use information and services to make informed health-related decisions and actions for themselves and others. Rather than viewing health literacy as a patient deficit, improving health literacy lies primarily with health care providers communicating and educating effectively in codesigned partnership with those with kidney disease. For kidney policy makers, health literacy is a prerequisite for organizations to transition to a culture that places the person at the center of health care. The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders. Advances in telecommunication, including social media platforms, can be leveraged to enhance persons’ and providers’ education. The World Kidney Day declares 2022 as the year of “Kidney Health for All” to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy. Kidney organizations should work toward shifting the patient-deficit health literacy narrative to that of being the responsibility of health care providers and health policy makers. By engaging in and supporting kidney health-centered policy making, community health planning, and health literacy approaches for all, the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.
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The influence of current density, rest time and electrolyte composition on the self-discharge of organic radical polymers. Electrochim Acta 2021. [DOI: 10.1016/j.electacta.2021.138070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Living well with kidney disease by patient and care partner empowerment: kidney health for everyone everywhere. Hong Kong Med J 2021; 27:97-98. [PMID: 33879627 DOI: 10.12809/hkmj209122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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The impact of the thermal stability of non-conventional electrolytes on the behavior of high voltage electrochemical capacitors operating at 60 °C. Electrochim Acta 2021. [DOI: 10.1016/j.electacta.2021.137919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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OC01.01: Foramen ovale morphology at fetal echocardiography may predict neonatal outcome in fetuses with complete transposition of the great arteries. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56 Suppl 1:1-378. [PMID: 33063402 DOI: 10.1002/uog.22195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/09/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
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P1599 Longue term outcome after surgical repair of complete atrioventricular septal defect: 2D versus 3D echocardiographic evaluation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
Assessment of longue term follow-up after surgical repair of Complete Atrioventricular Septal Defect (cAVSD). Evaluation of 3D versus standard 2D echocardiographic accuracy during the last follow-up.
Methods
43 patients were included in this study. Mean age at surgical repair was 7 months, 48.8% of patients were male; 67.4% had Down Syndrome. Mean time follow-up was 13 ± 6 years. During the last follow-up 2D and 3D echo evaluation were performed.
Results
All patients were alive and had a NYHA class I at the last follow-up. Survival free from new cardiac surgery at 13 years was 86%. During follow-up a progressive moderate to severe/severe mitral regurgitation (MR) was observed in 6 patients (16.3%) while 4 patients developed a progressive left ventricular outflow tract obstruction (LVOTO); overall 5 patients underwent new cardiac surgery (3 for MR and 2 for LVOTO). Echocardiographic evaluation showed: LV end diastolic volume 55.7 ± 13.0ml/m2, LV ejection fraction 64 ± 5%, left atrium volume 24.9 ± 13.9ml/m2, right ventricle systolic pression 21.0 ± 2.0 and a LVOT gradient 14.6 ± 16.4 mmHg. Mitral valve evaluation is evidenced in Table 1. Predictor factors of severe MR during follow-up were the cleft area and depth and the presence of anterior leaflet prolapse. Cohen’s kappa evidenced a good correlation between 2D and 3D VC evaluation with a higher sensibility of 3D evaluation to identify severe MR, data confirmed by the ROC curve analysis (Figure A and B).
Conclusions
Clinical outcome after cAVSD surgical repair is excellent with a low rate of reintervention. 3D echo evaluation is more sensitive to identify both predictors and severity of MR ì.
LAST Follow-up echocardiography 2D evaluation 3D evaluation Mitral Valve evaluation Vena contracta, mm 4.8 ± 2.5 5.3 ± 2.5 Regurgitant volume, ml 25 ± 20 ERO, cm2 0.17 ± 0.13 Mean gradient, mmHg 4 ± 2.4 Residual cleft, n(%) A1 A2 A3 30 (90.7) 4 (9.3) 33 (76.8) 6 (13.9) Cleft area,cm2 0.19 ± 0.21 Cleft depth, mm 5 .0 ± 2.9 Valve thickening, n(%) 14 (13.6) Leaflet Prolapse, n (%) Anterior Leaflet Prolapse, n (%) Posterior Leaflet Prolapse, n (%) 30 (69.7) 25 (58.1) 10 (23.2) Single papilary, n(%) 10 (23.2)
Abstract P1599 Figure.
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P642 Coronary arteriovenous fistulas. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Clinical case
A 53 years woman in good health and un uneventful clinical history except for a mild hypercholesteremia was evaluated for palpitations. At the clinical examination she had a systolic murmur 3/6 Levine, with no signs of heart failure.
The ECG showed normal sinus rhythm with a normal heart rate (62bpm), normal atrio-ventricular and intraventricular conduction and normal repolarisation, one supraventricular premature beat. The echocardiography showed normal biventricular dimension and function, no valvular heart diseases, no septal defects, regular aortic dimensions. A giant right coronary was evidenced (Figure, panel a) with an arteriovenous fistula originating from the right coronary artery and draining through the coronary sinus into the right atrium (Figure, panel b). The CT coronary angiogram evidenced an dilated right coronary artery communicating with the coronary sinus (arteriovenous fistula) draining into the right atrium. A smaller arteriovenous fistula was evidenced between the circumflex artery (slightly dilated) and the great cardiac vein. (Figure, panel c-e)
The Treadmill test didn’t evidence an induced ischemia; however the patient didn’t perform a maximal exercise (double product 20400mmHb*bpm). Moreover, during the first steps of recovery frequent supraventricular premature beats were registered with phases of bigeminies followed by a junctional rhythm phase. Thus, a Gated myocardial Perfusion SPECT was performed evidenced a mild stress induced ischemia of the inferolateral and apical left ventricle wall with normal rest perfusion and normal left ventricle volumes (125ml during exercise and 134ml at rest) with a normal ejection fraction ( > 65%). (Figure, panel f)An elective coronarography was planned. The patient is on therapy with beta-blockers and aspirin. The patient is asymptomatic for angina. Antibiotic prophylaxis was recommended for dental, gastrointestinal, or urologic procedures. Discussion: Coronary arteriovenous fistula (CAVF), first described in 1865 by Krausein (1), are a rare congenital heart disease representing less than 0.5% of all congenital heart diseases with an extremely rare prevalence 0.002% in the general population (2). Moreover, therapy of CAVF is still controversial with previous data showing a relatively high rate of myocardial infarction after surgical repair (3). The recent AHA/ACC guideline for the management of adults with Congenital heart disease recommend a review by a knowledgeable team that may include congenital or noncongenital cardiologists and surgeons to determine the role of medical therapy and/or percutaneous or surgical closure (4) Conclusion: CAVF is a very rare congenital heart defect and might be asymptomatic and evidenced by hazard in adults patients. Therapy strategy demands a multidisciplinary team evaluation and should be be individualized according to the clinic presentation, the presence or absence of myocardial ischemia or ventricular dysfunction.
Abstract P642 Figure.
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RF12 CLINICAL OUTCOME AND HEALTH RELATED QUALITY OF LIFE AFTER CRYOPRESERVED HOMOGRAFT IMPLANTATION FOR RIGHT VENTRICULAR OUTFLOW RECONSTRUCTION. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550047.73625.9a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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RF79 SURGERY OF GROWN UP CONGENITAL HEART DISEASE. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550020.65108.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Mixtures of glyme and aprotic-protic ionic liquids as electrolytes for energy storage devices. J Chem Phys 2018; 148:193825. [DOI: 10.1063/1.5013117] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Numerical Simulation of a Realistic Total Cavo-pulmonary Connection: Effect of Unbalanced Pulmonary Resistances on Hydrodynamic Performance. Int J Artif Organs 2018; 26:1005-14. [PMID: 14708830 DOI: 10.1177/039139880302601107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Total cavo pulmonary connection (TCPC) is one of the surgical techniques adopted to compensate the failure of the right heart in pediatric patients. The main goal of this procedure is the realization of a configuration for the caval veins and for the pulmonary arteries that can guarantee as low as possible pressure losses and appropriate lung perfusion. Starting from this point of view, a realistic TCPC with extracardiac conduit (TECPC) is investigated by means of Computational Fluid Dynamics (CFD) to evaluate the pressure loss under different pressure conditions, simulating different vessel resistances, on the pulmonary arteries. A total flow of 3 L/min, with a distribution between the inferior vena cava (IVC) and the superior vena cava (SVC) equal to 6/4, was investigated; three different boundary conditions for the pressure were imposed, resulting in three simulations in steady-state conditions, to the right pulmonary artery (RPA) and to the left pulmonary artery (LPA), simulating a balanced (deltaP(LPA-RPA) = 0 mmHg) and two unbalanced pulmonary resistances to blood flow (a pressure difference deltaP(LPA-RPA) = +/- 2 mmHg, respectively). The geometry for the TECPC was realized according to MRI derived physiological values for the vessels and for the configuration adopted for the anastomosis (the extra-cardiac conduit was inclined 22 degrees towards the left pulmonary artery with respect to the IVC axis). The computed power losses agree with previous in vitro Particle Image Velocimetry investigations. The results show that a higher resistance on the LPA causes the greater pressure loss for the TECPC under study, while the minimum pressure loss can be achieved balancing the pulmonary resistances, subsequently obtaining a balanced flow repartition towards the lungs.
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Abstract
The association between specific blood flow patterns and blood behaviour through medical devices suggests that a Lagrangian study may be a useful instrument for the evaluation of the thrombogenic and/or hemolytic potential of certain devices' geometries and biomaterials. In this study a description of blood particle trajectories in terms of their spiral contents is proposed; such a mathematical description for blood spiral flow, computed along several pathlines, is tested for a quantitative determination of the spiralled motion of blood flow into two three-dimensional numerical models, having different design characteristics, of venous cannula inserted in a vessel. As the influence of vortical flow conditions have been observed to have both beneficial and detrimental influence on blood behaviour in terms of blood-device interaction, of the degradation of its components, and of the efficiency of mass-exchange (in red cells oxygenation and plasma filtration, for example), the herein proposed method for the description of spiral laminar motion may be a helpful instrument to build up a tool to investigate, for example, the existence of correlations between level of spiral flow and geometry (as in the present investigated test case), rather than the effects of blood-surface contact. The results obtained in this test case investigation, confirm the effectiveness of the proposed function for a quantitative analysis of spiral flow in medical devices.
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Cardiac Calcium Evaluation in Hemodialysis Patients with Multisection Spiral Computed Tomography. Int J Artif Organs 2018; 27:759-65. [PMID: 15521215 DOI: 10.1177/039139880402700905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim The aim of this study is cardiac calcium content evaluation in hemodialysis patients by a new technique, based on ultrafast multisection CT (MTC). Methods The study was carried out on 30 HD patients, 14F and 16 M, average age 57.7±13.9 years, average HD age 57.3±47.4 months. The intact PTH levels were 625.4±571 pg/mL. Serum calcium, phosphate and CaxP product were 9.75±0.84 mg/mL, 6.21±1.01 mg/dL and 60.2±10.7 mg2/dL2, respectively. Results The values obtained with the MTC technique were reported in terms of Agatson scores. Score values frankly in the pathologic range (>100) were found in 24 patients (80%). Correlation analysis has shown positive and significant correlation coefficients of the score with patients’ age (p=0.003), serum calcium (p=0.012), CaxP (p=0.015), iPTH (=0.049), and borderline, to HD age (p=0.06). Conclusion Risk factors for cardiac calcification are mainly age, degree of hyperparathyroidism, increased CaxP and serum calcium levels. A control of calcium phosphate parameters in hemodialysis patients seems to be mandatory to avoid increased severity of coronary artery disease.
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The impact of mixtures of protic ionic liquids on the operative temperature range of use of battery systems. Electrochem commun 2017. [DOI: 10.1016/j.elecom.2017.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Mixtures of Azepanium Based Ionic Liquids and Propylene Carbonate as High Voltage Electrolytes for Supercapacitors. Electrochim Acta 2015. [DOI: 10.1016/j.electacta.2014.11.189] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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The synthesis and electrochemical characterization of bis(fluorosulfonyl)imide-based protic ionic liquids. Chem Commun (Camb) 2015; 51:3656-9. [DOI: 10.1039/c4cc09665g] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The use of PYRH4FSI represents a significant step towards the realization of high performance IL-based systems, which are able to fill the performance gap existing between these innovative electrolytes and the conventional ones.
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[Cardiac magnetic resonance and uremic cardiomyopathy]. GIORNALE ITALIANO DI NEFROLOGIA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI NEFROLOGIA 2014; 31:gin/00199.6. [PMID: 25504164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cardiovascular disease (CV) represents the main risk factor for morbidity and mortality in chronic kidney disease (CKD) patients. Large epidemiological studies have shown direct association between severity of CKD and CV event rates. Although patients with end-stage renal disease (ESRD), including dialysis ones, are at greater CV risk, cardiovascular involvement is already evident at the early stages of CKD. End-stage CKD is characterized conventional atherosclerotic risk factor but they cannot account for CV risk as reflected in high rates of sudden cardiac death, heart failure and myocardial infarction. Non-atherosclerotic processes, including left ventricular hypertrophy and fibrosis, mostly account for the excess risk of CV. Employment of cardiac magnetic resonance (CMR) in CKD has brought an improved understanding of the adverse CV changes, known as uremic cardiomyopathy. It is due to ability of cardiac magnetic resonance to provide a comprehensive non - invasive examination of cardiac structure and function, arterial function, myocardial tissue characterization (T1 mapping and inversion recovery imaging), and myocardial metabolic function (spectroscopy).
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Mixtures of protic ionic liquids and propylene carbonate as advanced electrolytes for lithium-ion batteries. Phys Chem Chem Phys 2014; 16:25014-23. [DOI: 10.1039/c4cp03830d] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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The influence of the electrochemical and thermal stability of mixtures of ionic liquid and organic carbonate on the performance of high power lithium-ion batteries. Electrochim Acta 2013. [DOI: 10.1016/j.electacta.2012.12.042] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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The influence of activated carbon on the performance of lithium iron phosphate based electrodes. Electrochim Acta 2012. [DOI: 10.1016/j.electacta.2012.04.152] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Natural and modified history of single-ventricle physiology in adult patients. Eur J Cardiothorac Surg 2012; 42:996-1002. [DOI: 10.1093/ejcts/ezs202] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Exercise training improves exercise capacity in adult patients with a systemic right ventricle: a randomized clinical trial. Eur Heart J 2011; 33:1378-85. [DOI: 10.1093/eurheartj/ehr396] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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High voltage electrochemical double layer capacitor containing mixtures of ionic liquids and organic carbonate as electrolytes. Electrochem commun 2011. [DOI: 10.1016/j.elecom.2011.05.010] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Mixtures of ionic liquid and organic carbonate as electrolyte with improved safety and performance for rechargeable lithium batteries. Electrochim Acta 2011. [DOI: 10.1016/j.electacta.2011.01.116] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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[SIN ECM activity 2007-2008 and program 2009]. GIORNALE ITALIANO DI NEFROLOGIA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI NEFROLOGIA 2009; 26:2-3. [PMID: 19255951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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High-dose calcitriol therapy and progression of cardiac vascular calcifications. J Nephrol 2008; 21:603-608. [PMID: 18651552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Dialysis patients show a very high prevalence of cardiovascular complications, affected as they are with abnormal and accelerated vascular calcifications and, eventually, calcium and phosphorous metabolism disorders. Multislice computed tomography (MSCT) provides a reproducible, high-resolution imaging of calcium contained in cardiac arteries, measured by Agatston score. The aim of the present study was to evaluate the influence of high-dose and low-dose calcitriol therapy on the progression of cardiac vascular calcifications in dialyzed patients. METHODS We enrolled 36 dialyzed patients in a prospective study, including an interventional period of 12 months and a follow-up period of 12 months. Eighteen protocol patients received intravenous pulses of high-doses calcitriol at the end of dialytic treatment and sevelamer hydrochloride therapy. Control patients received low-dose calcitriol and sevelamer hydrochloride as well. Two MSCT scans were performed: 1 at the start of the study and 1 at the end of follow-up, and Agatston score was calculated at both examinations. RESULTS At first examination, protocol patients showed almost the same level of cardiac vascular calcification as control patients. At the second MSCT, statistically significantly higher values of Agatston score were recorded for all patients. Indeed, patients who showed higher baseline values developed worse calcifications as recorded at the end of follow-up, both in the protocol and control group. CONCLUSIONS Our data show that baseline level is strongly predictive of vascular calcification progression, and, moreover, there is no association between calcitriol administered doses and the progression of cardiac vascular calcification.
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Conformational Preconditioning by Electrophoresis of DNA through a Finite Obstacle Array. Macromolecules 2008. [DOI: 10.1021/ma8010087] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Effect of sildenafil on haemodynamic response to exercise and exercise capacity in Fontan patients. Eur Heart J 2008; 29:1681-7. [DOI: 10.1093/eurheartj/ehn215] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pediatric heart failure. Minerva Cardioangiol 2008; 56:311-319. [PMID: 18509292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Heart failure is a clinical syndrome which presents similarities and differences between children and adults; in pediatric age the spectrum of causes of heart failure is wide and congenital heart defects are the most common etiology. Volume and pressure overload on a ''normal myocardium'' is the classical physiological pattern while myocardial contractile dysfunction of different etiology is much less observed in the pediatric population. However there are some peculiarities in clinical presentation of heart failure in infants and small children. The medical therapy cornerstones still remain loop diuretics, angiotensin-converting enzyme inhibitors, beta-blockers and digitalis. There are also some reported experiences with new inotropics drugs in acute heart failure. In pediatric cardiology there are few prospective studies on pharmacology of heart failure and the data are often extrapolated from adult large trials. Non pharmacological treatment with autonomic implantable cardioverter defibrillators and resynchronization therapy as well as the surgically implant of ventricular assist devices are increasingly employed in children. Cardiac transplantation is currently the treatment option with good outcome and long-term survival in pediatric patients with end-stage or refractory heart failure.
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[Gadolinium: a true problem for the nephrologists?]. GIORNALE ITALIANO DI NEFROLOGIA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI NEFROLOGIA 2008; 25:3-4. [PMID: 18264906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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36
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[World Kidney Day: a challenge for life]. GIORNALE ITALIANO DI NEFROLOGIA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI NEFROLOGIA 2008; 25:5-6. [PMID: 18264907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Relaxation of stretched DNA in slitlike confinement. PHYSICAL REVIEW LETTERS 2007; 99:238102. [PMID: 18233415 DOI: 10.1103/physrevlett.99.238102] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Indexed: 05/14/2023]
Abstract
We experimentally observe two separate time scales governing the entropic recoil in the linear force-extension regime of single double-stranded DNA in slit confinement. We demonstrate the existence of two distinct relaxation regimes at different extensions during relaxation. Contrary to bulk measurements, the true longest relaxation time may only be probed very close to equilibrium. A simple model of the relaxation mechanism leads to a scaling analysis that correctly predicts the extension at the crossover between the two regimes.
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Cardiac calcifications in hemodialysis patients assessed with spiral computed tomography. MINERVA UROL NEFROL 2006; 58:181-8. [PMID: 16767071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
AIM Cardiac disease is a major cause of mortality in uremic patients. The aim of this paper was to evaluate cardiac calcium content in uremic patients with multislice computed tomography (MSCT). METHODS The study has been carried out on 120 uremic and 28 nonuremic patients affected by cardiovascular disease. Serum calcium, phosphorus, calcium-phosphate product, intact PTH were assayed. Several lipidic and nutritional parameters were measured. Calcification values obtained with the MSCT were reported in terms of Agatson scores. RESULTS We found that the average score values in cohort on uremic was 10 times higher than in nonuremic patients (score values 3.389 vs 328). Cardiac calcification score was found to be correlated significantly to age (P=0.006), HD age (P=0.010), serum calcium (P=0.006), iPTH (P=0.004). Multiregression analysis (MRA) with the cardiac score as dependent variable selected the following variables (R(2) 0.612): age (P=0.002), HD age (P=0.010), serum cholesterol (P<0.000), triglycerides (P=0.001) and inversely HDL cholesterol (P=0.001) and non-HDL cholesterol (P=0.001) as predictive variables for cardiac score. By comparing patients with scores lower and higher than 400, the group with score <400 showed a significantly lower age (P=0.0001), HD vintage (P=0.01) and a significantly higher serum cholesterol (P=0.009), HDL cholesterol (P=0.05) and non-HDL cholesterol (P=0.05). CONCLUSIONS The MSCT could help in identifying and stratifying high-risk patients to implement preventive strategies. The control of mineral metabolism and of lipid levels is important in prevention of arterial calcification in uremic patients.
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Use of low-density foams as pressure amplifiers in equation-of-state experiments with laser-driven shock waves. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2001; 63:046410. [PMID: 11308959 DOI: 10.1103/physreve.63.046410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2000] [Indexed: 05/23/2023]
Abstract
The applicability of foams to equation of state experiments with laser-produced shocks has been studied. The pressure increase due to impedance mismatch at the payload-foam interface was measured experimentally using sub-ns laser pulses smoothed with phase zone plates. Foams of density in the range 5-900 mg/cm(3) and of thicknesses of 50-150 microm were used. A model has been developed to study pressure amplification and the conditions under which the shock is stationary. Two-step two-material targets, allowing simultaneous measurements of the shock velocities in the two materials, were then used to obtain relative equation of state data. Pressures higher than 100 Mbar were achieved in gold.
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Abstract
Several studies have suggested an inverse association between use of combined oral contraceptives (OC) and the risk of colorectal cancer and here we present a meta-analysis of published studies. Articles considered were epidemiological studies published as full papers in English up to June 2000 that included quantitative information on OC use. The pooled relative risks (RR) of colorectal cancer for ever OC use from the 8 case-control studies was 0.81 (95% confidence interval (CI): 0.69-0.94), and the pooled estimate from the 4 cohort studies was 0.84 (95% CI: 0.72-0.97). The pooled estimate from all studies combined was 0.82 (95% CI: 0.74-0.92), without apparent heterogeneity. Duration of use was not associated with a decrease in risk, but there was some indication that the apparent protection was stronger for women who had used OCs more recently (RR = 0.46; 95% CI: 0.30-0.71). A better understanding of this potential relation may help informed choice of contraception.
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Abstract
We observed a young patient with slight mental retardation, suffering from drug-resistant tonic-clonic seizures, who presented a status epilepticus (SE), in two separate periods when valproic acid (VPA) was added to the phenobarbital (PB) already being used in the patient's therapy. The VPA-induced SE was characterized by normal plasma levels of antiepileptic drugs (AEDs), normal ammonemia and normal liver function. The case we studied represents the first report on a VPA-induced SE. Furthermore the case confirms that VPA, as well as causing encephalopathy secondary to hyperammonemia, may also provoke a primary involvement of the central nervous system (CNS), specially when used in young epileptic, mentally retarded subjects. In an attempt to explain the paradoxical effect of VPA we hypothesise that the SE could be due to an increase in excitatory activity producing a consequent epileptogenic effect in those subjects with a predisposition for toxic reaction to VPA therapy due to congenital anomalies of neural networks.
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Recurrent cutaneous leiomyosarcoma. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 1998; 17:83-5. [PMID: 9646238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cutaneous leiomyosarcoma is a rare tumour, accounting for 2.3% to 6.5% of all soft tissue sarcomas. The case of a young patient with a cutaneous leiomyosarcoma on the right gluteal region is here presented. The lesion misdiagnosed as a keloid after primary excision of histiocytoma had a two-year history, had been excised twice. The tumour was widely excised, and the wound closed primarily. No recurrence or distant metastasis are reported 26 months after the initial presentation. Clinical, histological, immunohistochemical features and surgical strategies of the reported case are discussed and compared with literature.
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Tuberous sclerosis complex and early-onset autosomal dominant polycystic kidney disease as a 'contiguous gene' syndrome: report of a case. CONTRIBUTIONS TO NEPHROLOGY 1997; 122:96-7. [PMID: 9399047 DOI: 10.1159/000059874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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44
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Sweet's syndrome and chronic lymphocytic leukemia associated with scirrhous breast cancer. A case report. Haematologica 1990; 75:173-5. [PMID: 2162801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A 55-year-old woman developed Sweet's syndrome (acute febrile neutrophilic dermatosis, AFND) 5 years after a diagnosis of chronic lymphocytic leukemia (CLL). Two months later she developed a scirrhous carcinoma of the breast. The patient died 7 months later from sepsis. To our knowledge, this is the first case of an association among a cancer of the breast, CLL and Sweet's syndrome.
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Membranous nephropathy associated with giant lymph node hyperplasia. A case report with histological and ultrastructural studies. Am J Nephrol 1990; 10:323-8. [PMID: 2240060 DOI: 10.1159/000168127] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A young woman presented with nephrotic syndrome due to membranous nephropathy and a localized form of giant lymph node hyperplasia (Castleman's disease) occurring as a large intra-abdominal mass. Five months after surgical removal of the mass, only mild proteinuria persisted. Twenty months later a second kidney biopsy showed a near-normal morphology. Six years later the patient was free of symptoms and had normal urinalysis. Reviewing the pertinent literature, it seems to be the first case of a biopsy-proven cure of membranous nephropathy in a patient with membranous nephropathy and Castleman's disease.
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[Latero-ungual folds of the first toe in the newborn infant]. GIORN ITAL DERMAT V 1988; 123:551-2. [PMID: 3254324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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47
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[Total congenital leukonychia]. GIORN ITAL DERMAT V 1988; 123:547-9. [PMID: 2855424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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48
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[Sweet syndrome. Study of 6 cases]. GIORN ITAL DERMAT V 1988; 123:153-6. [PMID: 2846437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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49
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Abstract
The authors describe a case of Sweet's syndrome in a woman affected with chronic myeloid leukemia. They emphasize the association of the syndrome with a progression of the disease and the complete disappearance of it for 3 years until the present time after allogeneic bone marrow transplantation.
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A modified needle kidney biopsy: an open technique. Nephron Clin Pract 1985; 41:367-8. [PMID: 4069304 DOI: 10.1159/000183617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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