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Mazzarini A, Fagioli I, Eken H, Livolsi C, Ciapetti T, Maselli A, Piazzini M, Macchi C, Davalli A, Gruppioni E, Trigili E, Crea S, Vitiello N. Improving Walking Energy Efficiency in Transtibial Amputees Through the Integration of a Low-Power Actuator in an ESAR Foot. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1397-1406. [PMID: 38507380 DOI: 10.1109/tnsre.2024.3379904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Reducing energy consumption during walking is a critical goal for transtibial amputees. The study presents the evaluation of a semi-active prosthesis with five transtibial amputees. The prosthesis has a low-power actuator integrated in parallel into an energy-storing-and-releasing foot. The actuator is controlled to compress the foot during the stance phase, supplementing the natural compression due to the user's dynamic interaction with the ground, particularly during the ankle dorsiflexion phase, and to release the energy stored in the foot during the push-off phase, to enhance propulsion. The control strategy is adaptive to the user's gait patterns and speed. The clinical protocol to evaluate the system included treadmill and overground walking tasks. The results showed that walking with the semi-active prosthesis reduced the Physiological Cost Index of transtibial amputees by up to 16% compared to walking using the subjects' proprietary prosthesis. No significant alterations were observed in the spatiotemporal gait parameters of the participants, indicating the module's compatibility with users' natural walking patterns. These findings highlight the potential of the mechatronic actuator in effectively reducing energy expenditure during walking for transtibial amputees. The proposed prosthesis may bring a positive impact on the quality of life, mobility, and functional performance of individuals with transtibial amputation.
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Lombardi G, Baccini M, Gualerzi A, Pancani S, Campagnini S, Doronzio S, Longo D, Maselli A, Cherubini G, Piazzini M, Ciapetti T, Polito C, Pinna S, De Santis C, Bedoni M, Macchi C, Ramat S, Cecchi F. Comparing the effects of augmented virtual reality treadmill training versus conventional treadmill training in patients with stage II-III Parkinson's disease: the VIRTREAD-PD randomized controlled trial protocol. Front Neurol 2024; 15:1338609. [PMID: 38327625 PMCID: PMC10847255 DOI: 10.3389/fneur.2024.1338609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024] Open
Abstract
Background Intensive treadmill training (TT) has been documented to improve gait parameters and functional independence in Parkinson's Disease (PD), but the optimal intervention protocol and the criteria for tailoring the intervention to patients' performances are lacking. TT may be integrated with augmented virtual reality (AVR), however, evidence of the effectiveness of this combined treatment is still limited. Moreover, prognostic biomarkers of rehabilitation, potentially useful to customize the treatment, are currently missing. The primary aim of this study is to compare the effects on gait performances of TT + AVR versus TT alone in II-III stage PD patients with gait disturbance. Secondary aims are to assess the effects on balance, gait parameters and other motor and non-motor symptoms, and patient's satisfaction and adherence to the treatment. As an exploratory aim, the study attempts to identify biomarkers of neuroplasticity detecting changes in Neurofilament Light Chain concentration T0-T1 and to identify prognostic biomarkers associated to blood-derived Extracellular Vesicles. Methods Single-center, randomized controlled single-blind trial comparing TT + AVR vs. TT in II-III stage PD patients with gait disturbances. Assessment will be performed at baseline (T0), end of training (T1), 3 (T2) and 6 months (T3, phone interview) from T1. The primary outcome is difference in gait performance assessed with the Tinetti Performance-Oriented Mobility Assessment gait scale at T1. Secondary outcomes are differences in gait performance at T2, in balance and spatial-temporal gait parameters at T1 and T2, patients' satisfaction and adherence. Changes in falls, functional mobility, functional autonomy, cognition, mood, and quality of life will be also assessed at different timepoints. The G*Power software was used to estimate a sample size of 20 subjects per group (power 0.95, α < 0.05), raised to 24 per group to compensate for potential drop-outs. Both interventions will be customized and progressive, based on the participant's performance, according to a predefined protocol. Conclusion This study will provide data on the possible superiority of AVR-associated TT over conventional TT in improving gait and other motor and non-motor symptoms in persons with PD and gait disturbances. Results of the exploratory analysis could add information in the field of biomarker research in PD rehabilitation.
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Affiliation(s)
- Gemma Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
| | - Marco Baccini
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
| | | | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
| | | | - Stefano Doronzio
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Diego Longo
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Maselli
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
- Department of Technical-Health Professions, Rehabilitation, and Prevention, Campostaggia Hospital, Poggibonsi (SI), USL Toscana Sudest, Italy
| | - Giulio Cherubini
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | | | - Samuele Pinna
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Chiara De Santis
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marzia Bedoni
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Silvia Ramat
- Parkinson Unit, Department of NeuroMuscular-Skeletal and Sensorial Organs, AOU Careggi, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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De Corso E, Pipolo C, Cantone E, Ottaviano G, Gallo S, Trimarchi M, Torretta S, Cavaliere C, Lucidi D, Seccia V, Settimi S, Canevari FRM, Pasquini E, La Mantia I, Garzaro M, Bellocchi G, De Benedetto M, Lombardo N, Macchi A, Malvezzi L, Motta G, Vicini C, Maselli A, Dell’Era V, Dragonetti A, Asprea F, Lupato V, Ghidini A, Masieri S, Mattavelli D, Salzano FA, Passali D, Galli J, Pagella F. Practical recommendations for managing severe chronic rhinosinusitis with nasal polyps in the era of biologics. Acta Otorhinolaryngol Ital 2023; 43:324-340. [PMID: 37224173 PMCID: PMC10551726 DOI: 10.14639/0392-100x-n2422] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/09/2023] [Indexed: 05/26/2023]
Abstract
Objective We conducted a national survey to understand how rhinology practice has changed with the advent of biologics and how this affected patients with uncontrolled, severe chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to analyse the results of the survey and infer practical recommendations for clinical practice. Methods A group of ear, nose, and throat specialists (ENTs) experienced in the management of CRSwNP developed a 74-question survey. ENTs from rhinology centres authorised to prescribe biologics in the context of the national health system were invited to answer it between 01/05/2022 and 31/07/2022. The responses underwent descriptive analyses, and the authors discussed the results and derived practical recommendations for clinical practice. Results ENTs working in rhinology centres changed their practices coinciding with the advent of biologics. CRSwNP evaluations have become more complex because they involve diagnostic confirmation, determining the patients' immunologic profile, and other factors. We observed heterogenous behaviours in practice that may be conditioned by the novelty of the topic. The results of the survey were used to develop practical recommendations for ENTs and are summarised herein. Conclusions Clinical practice in rhinology outpatient clinics has changed profoundly in the era of biologics. Our practical recommendations for clinicians working in rhinology centres are expected to help standardise practice and improve care.
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Affiliation(s)
- Eugenio De Corso
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, Head and Neck Department, Dipartimento di Scienze della Salute, Università degli Studi di Milano, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, “Federico II” University, Naples, Italy
| | - Giancarlo Ottaviano
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Stefania Gallo
- Otorhinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, Varese, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Cavaliere
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology – Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Pisa, Italy
| | | | - Frank Rikki Mauritz Canevari
- UOC di Otorinolaringoiatria IRCCS Policlinico San Martino Genova, Dipartimento DISC Università di Genova, Genoa, Italy
| | - Ernesto Pasquini
- ENT Unit “Bellaria” Hospital – Specialized Dep AUSL Bologna, Italy
| | | | | | | | | | - Nicola Lombardo
- ENT Unit Department of Medical and Surgical Sciences, University Magna Græcia Catanzaro, Italy
| | - Alberto Macchi
- ENT University of Insubria, ASST Settelaghi, Varese, Italy
| | - Luca Malvezzi
- IRCCS Humanitas Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Rozzano (MI), Italy
| | - Gaetano Motta
- Otorhinolaryngology – Head and Neck Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Alessandro Maselli
- Department Otorhinolaryngology, Hospital of Barletta, Barletta (BT), Italy
| | - Valeria Dell’Era
- ENT Division, Maggiore Hospital, Eastern Piedmont University – Novara, Italy
| | | | - Francesco Asprea
- Otorinolaringoiatria e audiologia. Università degli studi di Messina, Messina, Italy
| | - Valentina Lupato
- Division of Otolaryngology, Ospedale Civile di Pordenone, Azienda Sanitaria Friuli Occidentale (ASFO), Pordenone, Italy
| | - Angelo Ghidini
- Otorinolaringoiatria Azienda USL di Reggio Emilia/IRCCS, Italy
| | - Simonetta Masieri
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia – University of Brescia, Brescia, Italy
| | | | | | - Jacopo Galli
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Otorhinolaryngology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Gaggiano C, Bardelli M, Tarsia M, Gentileschi S, Maselli A, Grosso S, Cantarini L, Frediani B. Neridronate for transient osteoporosis of the hip in a child. Osteoporos Int 2022; 33:1619-1624. [PMID: 35106625 PMCID: PMC9187543 DOI: 10.1007/s00198-022-06324-y] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/24/2022] [Indexed: 12/05/2022]
Abstract
Transient osteoporosis of the hip (TOH) is usually reported in middle-aged men or during pregnancy as a benign self-limiting condition. Nevertheless, its impact on quality of life in terms of pain and disability is considerable. Also, it can lead to insufficiency fractures or, more rarely, evolve into osteonecrosis. This condition is anecdotally described in the pediatric age and very little is known about how it may affect the growing bone. We herein describe a case of TOH in a 10-year-old child treated at our pediatric rheumatology service and summarize the pediatric cases of TOH previously reported in literature. There are two points of interest in our case report, the first one being the unusual complication of TOH with a femoral physis fracture and the second the complete recovery after the off-label therapy with bisphosphonates. We suggest that interventional medical treatment could be considered in selected cases of juvenile TOH, to prevent any possible irreversible damage on the femoral physis. As far as we know, this is the first report of neridronate employment in children affected by TOH.
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Affiliation(s)
- C Gaggiano
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy.
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy.
| | - M Bardelli
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - M Tarsia
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - S Gentileschi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - A Maselli
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - S Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - L Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - B Frediani
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
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Goncalves S, Fonseca B, Barcellos D, Cavalcanti B, Silva T, Goncalves L, Esteves S, Maselli A. Mechanical, physicochemical and biological properties of experimental EGCG based adhesive. Dent Mater 2016. [DOI: 10.1016/j.dental.2016.08.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Spinelli F, Alessandri C, Pierdominici M, Ortona E, Maselli A, Vomero M, Ceccarelli F, Valesini G, Conti F. SAT0397 Estrogen and Estrogens Receptors as Biomarker of Systemic Lupus Erythematosus. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5103] [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: 11/04/2022]
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Abstract
The aim of this article is to show the use of the Balters' Bionator in pseudo-Class III treatment. The importance of differentiating between true Class III and pseudo-Class III is emphasized. The therapeutic results of a Balters' Bionator appliance are presented in three case reports of subjects in the mixed dentition. In this stage of development it is possible to correct an isolated problem. The use of the Bionator III in this kind of malocclusion enabled the correction of a dental malocclusion in a few months and therapeutic stability of a mesially-positioned mandible encouraging favourable skeletal growth.
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Affiliation(s)
- A Giancotti
- University of Rome Tor Vergata, Rome, Italy.
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Servoli L, Biasini M, Bissi L, Calandra A, Checcucci B, Chiocchini S, Cicioni R, Conti E, Di Lorenzo R, Dipilato A, Forini N, Magalotti D, Maselli A, Paolucci M, Passeri D, Pentiricci A, Placidi P, Scarpignato M, Scorzoni A. 179: Characterization of wireless personal dosimeter prototype for Interventional Radiology medical operators. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)34200-6] [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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Maselli A, Melandri A, Nava L, Mundell CG, Kawai N, Campana S, Covino S, Cummings JR, Cusumano G, Evans PA, Ghirlanda G, Ghisellini G, Guidorzi C, Kobayashi S, Kuin P, La Parola V, Mangano V, Oates S, Sakamoto T, Serino M, Virgili F, Zhang BB, Barthelmy S, Beardmore A, Bernardini MG, Bersier D, Burrows D, Calderone G, Capalbi M, Chiang J, D’Avanzo P, D’Elia V, De Pasquale M, Fugazza D, Gehrels N, Gomboc A, Harrison R, Hanayama H, Japelj J, Kennea J, Kopac D, Kouveliotou C, Kuroda D, Levan A, Malesani D, Marshall F, Nousek J, O’Brien P, Osborne JP, Pagani C, Page KL, Page M, Perri M, Pritchard T, Romano P, Saito Y, Sbarufatti B, Salvaterra R, Steele I, Tanvir N, Vianello G, Wiegand B, Wiersema K, Yatsu Y, Yoshii T, Tagliaferri G. GRB 130427A: A Nearby Ordinary Monster. Science 2014; 343:48-51. [DOI: 10.1126/science.1242279] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- A. Maselli
- Istituto Nazionale di Astrofisica (INAF)–Istituto di Astrofisica Spaziale e Fisica Cosmica (IASF) Palermo, Via Ugo La Malfa 153 I-90146 Palermo, Italy
| | - A. Melandri
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
| | - L. Nava
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
- AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, Commissariat à l'Energie Atomique et aux Energies Alternatives/Institut de Recherches sur les lois Fondamentales de l’Univers, Observatoire de Paris, Sorbonne Paris Cité, France
| | - C. G. Mundell
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool Science Park, 146 Brownlow Hill, Liverpool L3 5RF, UK
| | - N. Kawai
- Department of Physics, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo 152-8551, Japan
- Coordinated Space Observation and Experiment Research Group, RIKEN, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - S. Campana
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
| | - S. Covino
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
| | - J. R. Cummings
- University of Maryland, Baltimore County/Center for Research and Exploration in Space Science & Technology/NASA Goddard Space Flight Center, Code 661, Greenbelt, MD 20771, USA
| | - G. Cusumano
- Istituto Nazionale di Astrofisica (INAF)–Istituto di Astrofisica Spaziale e Fisica Cosmica (IASF) Palermo, Via Ugo La Malfa 153 I-90146 Palermo, Italy
| | - P. A. Evans
- Department of Physics and Astronomy, University of Leicester, Leicester, LE1 7RH, UK
| | - G. Ghirlanda
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
| | - G. Ghisellini
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
| | - C. Guidorzi
- Department of Physics, University of Ferrara, via Saragat 1, I-44122, Ferrara, Italy
| | - S. Kobayashi
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool Science Park, 146 Brownlow Hill, Liverpool L3 5RF, UK
| | - P. Kuin
- Mullard Space Science Laboratory, University College London, Holmbury St. Mary, Dorking, Surrey RH5 6NT, UK
| | - V. La Parola
- Istituto Nazionale di Astrofisica (INAF)–Istituto di Astrofisica Spaziale e Fisica Cosmica (IASF) Palermo, Via Ugo La Malfa 153 I-90146 Palermo, Italy
| | - V. Mangano
- Istituto Nazionale di Astrofisica (INAF)–Istituto di Astrofisica Spaziale e Fisica Cosmica (IASF) Palermo, Via Ugo La Malfa 153 I-90146 Palermo, Italy
- Department of Astronomy and Astrophysics, Pennsylvania State University, 525 Davey Lab, University Park, PA 16802, USA
| | - S. Oates
- Mullard Space Science Laboratory, University College London, Holmbury St. Mary, Dorking, Surrey RH5 6NT, UK
| | - T. Sakamoto
- Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5258, Japan
| | - M. Serino
- Coordinated Space Observation and Experiment Research Group, RIKEN, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - F. Virgili
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool Science Park, 146 Brownlow Hill, Liverpool L3 5RF, UK
| | - B.-B. Zhang
- Department of Astronomy and Astrophysics, Pennsylvania State University, 525 Davey Lab, University Park, PA 16802, USA
| | - S. Barthelmy
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - A. Beardmore
- Department of Physics and Astronomy, University of Leicester, Leicester, LE1 7RH, UK
| | - M. G. Bernardini
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
| | - D. Bersier
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool Science Park, 146 Brownlow Hill, Liverpool L3 5RF, UK
| | - D. Burrows
- Department of Astronomy and Astrophysics, Pennsylvania State University, 525 Davey Lab, University Park, PA 16802, USA
| | - G. Calderone
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
- Dipartimento di Fisica “G. Occhialini,” Università di Milano-Bicocca, Piazza della Scienza 3, I-20126 Milano, Italy
| | - M. Capalbi
- Istituto Nazionale di Astrofisica (INAF)–Istituto di Astrofisica Spaziale e Fisica Cosmica (IASF) Palermo, Via Ugo La Malfa 153 I-90146 Palermo, Italy
| | - J. Chiang
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics, and SLAC National Accelerator Laboratory, Stanford University, Stanford, CA 94305, USA
| | - P. D’Avanzo
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
| | - V. D’Elia
- INAF/Rome Astronomical Observatory, via Frascati 33, 00040 Monteporzio Catone (Roma), Italy
- Agenzia Spaziale Italiana (ASI) Science Data Centre, Via Galileo Galilei, 00044 Frascati (Roma), Italy
| | - M. De Pasquale
- Mullard Space Science Laboratory, University College London, Holmbury St. Mary, Dorking, Surrey RH5 6NT, UK
| | - D. Fugazza
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
| | - N. Gehrels
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - A. Gomboc
- Faculty of Mathematics and Physics, University of Ljubljana, Jadranska 19 1000, Ljubljana, Slovenia
- Centre of Excellence Space-si, Askerceva cesta 12, 1000 Ljubljana, Slovenia
| | - R. Harrison
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool Science Park, 146 Brownlow Hill, Liverpool L3 5RF, UK
| | - H. Hanayama
- Ishigakijima Astronomical Observatory, National Astronomical Observatory of Japan, 1024-1 Arakawa, Ishigaki, Okinawa 907-0024, Japan
| | - J. Japelj
- Faculty of Mathematics and Physics, University of Ljubljana, Jadranska 19 1000, Ljubljana, Slovenia
| | - J. Kennea
- Department of Astronomy and Astrophysics, Pennsylvania State University, 525 Davey Lab, University Park, PA 16802, USA
| | - D. Kopac
- Faculty of Mathematics and Physics, University of Ljubljana, Jadranska 19 1000, Ljubljana, Slovenia
| | - C. Kouveliotou
- Space Science Office, VP62, NASA/Marshall Space Flight Center, Huntsville, AL 35812, USA
| | - D. Kuroda
- Okayama Astrophysical Observatory, National Astronomical Observatory of Japan, 3037-5 Honjo, Kamogata, Asaguchi, Okayama 719-0232
| | - A. Levan
- Department of Physics, University of Warwick, Coventry CV4 7AL, UK
| | - D. Malesani
- Dark Cosmology Centre (DARK), Niels Bohr Institute, University of Copenhagen, Juliane Maries Vej 30, 2100 Copenhagen, Denmark
| | - F. Marshall
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - J. Nousek
- Department of Astronomy and Astrophysics, Pennsylvania State University, 525 Davey Lab, University Park, PA 16802, USA
| | - P. O’Brien
- Department of Physics and Astronomy, University of Leicester, Leicester, LE1 7RH, UK
| | - J. P. Osborne
- Department of Physics and Astronomy, University of Leicester, Leicester, LE1 7RH, UK
| | - C. Pagani
- Department of Physics and Astronomy, University of Leicester, Leicester, LE1 7RH, UK
| | - K. L. Page
- Department of Physics and Astronomy, University of Leicester, Leicester, LE1 7RH, UK
| | - M. Page
- Mullard Space Science Laboratory, University College London, Holmbury St. Mary, Dorking, Surrey RH5 6NT, UK
| | - M. Perri
- INAF/Rome Astronomical Observatory, via Frascati 33, 00040 Monteporzio Catone (Roma), Italy
- Agenzia Spaziale Italiana (ASI) Science Data Centre, Via Galileo Galilei, 00044 Frascati (Roma), Italy
| | - T. Pritchard
- Department of Astronomy and Astrophysics, Pennsylvania State University, 525 Davey Lab, University Park, PA 16802, USA
| | - P. Romano
- Istituto Nazionale di Astrofisica (INAF)–Istituto di Astrofisica Spaziale e Fisica Cosmica (IASF) Palermo, Via Ugo La Malfa 153 I-90146 Palermo, Italy
| | - Y. Saito
- Department of Physics, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo 152-8551, Japan
| | - B. Sbarufatti
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
- Department of Astronomy and Astrophysics, Pennsylvania State University, 525 Davey Lab, University Park, PA 16802, USA
| | - R. Salvaterra
- INAF-IASF Milano, via E. Bassini 15, I-20133 Milano, Italy
| | - I. Steele
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool Science Park, 146 Brownlow Hill, Liverpool L3 5RF, UK
| | - N. Tanvir
- Department of Physics and Astronomy, University of Leicester, Leicester, LE1 7RH, UK
| | - G. Vianello
- W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics, and SLAC National Accelerator Laboratory, Stanford University, Stanford, CA 94305, USA
| | - B. Wiegand
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - K. Wiersema
- Department of Physics and Astronomy, University of Leicester, Leicester, LE1 7RH, UK
| | - Y. Yatsu
- Department of Physics, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo 152-8551, Japan
| | - T. Yoshii
- Department of Physics, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo 152-8551, Japan
| | - G. Tagliaferri
- INAF–Osservatorio Astronomico di Brera, via E. Bianchi 46, I-23807 Merate, Italy
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12
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Alessandri C, Pierdominici M, Conti F, Truglia S, Barbati C, Pendolino M, Vacirca D, Piscopo P, Maselli A, Colasanti T, Perl A, Ortona E, Malorni W, Valesini G. SAT0163 Defective autophagy in T lymphocytes from patients with systemic lupus erythematosus: Potential role of anti-lymphocyte autoantibodies. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3110] [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: 11/04/2022]
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13
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Cassano M, Maselli A, Mora F, Cassano P. Rhinobronchial syndrome: pathogenesis and correlation with allergic rhinitis in children. Int J Pediatr Otorhinolaryngol 2008; 72:1053-8. [PMID: 18485492 DOI: 10.1016/j.ijporl.2008.03.017] [Citation(s) in RCA: 6] [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] [Received: 03/08/2008] [Accepted: 03/16/2008] [Indexed: 10/22/2022]
Abstract
AIM In the rhinobronchial syndrome a direct causal relationship exists between local nasal irritation and bronchopulmonary disease. Although allergic rhinitis has often been associated with lower airway hyperresponsiveness, no direct relationship between the two has been shown to date. The aim of this study was to determine the role of allergic rhinitis in the pathogenesis of the rhinobronchial syndrome in children by evaluating the effect of topical nasal treatment on lower airway hyperresponsiveness. MATERIALS AND METHODS A total of 168 children presenting with aeroallergy and nasal disease associated with bronchopulmonary disease (asthma, chronic cough, bronchopulmonary infection) were evaluated at baseline and at 1 year of follow-up. Nearly half (83) were noted to have signs of allergic rhinitis and were treated with topical nasal medications (cortisones and antihistamines). Changes in upper and lower airway diseases were evaluated and potential causal relationships established. RESULTS Allergic rhinitis treatment improved nasal disease symptoms in 67 (80.7%) patients; partial remission or lower healing rates were found in those with asthma (16.4%) and chronic cough (11.1%). CONCLUSIONS Although often associated with lower airway hyperresponsiveness, allergic rhinitis in children does not appear to be a pathogenetic factor, as confirmed by the scarce effect the nasal treatment had on the bronchopulmonary disease. Instead, the frequent co-existence of nasal and bronchial symptoms may come under the concept of global allergy of the airways.
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Affiliation(s)
- Michele Cassano
- Department of Otorhinolaryngology, University of Foggia, Foggia, Italy.
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14
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Pugliese F, Crusco F, Cardaioli G, Tambasco N, Boranga B, Scaroni R, Maselli A, Lupattelli L. CT angiography versus colour-Doppler US in acute dissection of the vertebral artery. Radiol Med 2007; 112:435-43. [PMID: 17440692 DOI: 10.1007/s11547-007-0152-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2006] [Accepted: 09/12/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE Conventional digital subtraction angiography (DSA) still represents the criterion standard for the diagnosis of vertebral artery dissection (VAD), but the main drawbacks of this technique include invasiveness, patient discomfort and risk of complications. We evaluated the potential of multidetector computed tomography angiography (CTA) as a noninvasive tool providing high-resolution images of the arterial lumen and wall by comparing the diagnostic accuracy of CTA and colour-Doppler ultrasonography (CDUS) in detecting acute VAD. MATERIALS AND METHODS We retrospectively reviewed 15 cases of VAD in 15 patients (five men and ten women, age range 28-58 years) who came to our attention between August 2001 and September 2005. The diagnosis was made on the basis of appropriate clinical presentation, absence of atherosclerotic disease in the cerebrovascular circulation and evidence of distinctive CT features, which were subsequently confirmed by conventional angiography used as reference standard. All patients with a clinical suspicion of VAD underwent CDUS of the neck vessels prior to CTA. Accuracy, sensitivity and specificity of CDUS and CTA were expressed as percentages of agreement with the reference angiographic procedure. Interreader concordance for detection of VAD by CTA was calculated with the Cohen K value. RESULTS The CDUS examinations revealed ten out of 15 VAD, with a sensitivity of 66%, a specificity of 60%, a positive predictive value of 55.5% and a negative predictive value of 70.5%. In five cases, CDUS revealed nonspecific wall and flow alterations; in eight patients, high resistance obstructive flow; and in two patients, intimal flap with demonstration of the true and false lumen. CTA enabled the correct identification of all 15 VAD. The reported sensitivity, specificity, positive predictive value and negative predictive value were 100%, 95%, 93.7% and 100%, respectively. With regard to localisation of VAD, CTA showed 100% correlation with DSA. The differences in CTA and CDUS sensitivity (100% vs 66%), specificity (95% vs 60%), and overall diagnostic accuracy (97% vs 62.8%), assessed by cross tabulations and compared by using the McNemar's two-sided test, were significant (p<0.05). CONCLUSIONS Multidetector CTA is a sensitive technique for the diagnosis of VAD. Used as a complement to unenhanced brain CT, it has the advantage of being readily available and easy to perform.
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Affiliation(s)
- F Pugliese
- Dipartimento Diagnostica per Immagini, AUSL 3 Umbria, Ospedale S. Giovanni Battista, Foligno, Italy
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15
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Giancotti A, Maselli A. Orthodontic correction of an ectopic mandibular first permanent molar: a case report. J Clin Pediatr Dent 2001; 25:119-21. [PMID: 11314209 DOI: 10.17796/jcpd.25.2.0125173672t7pm54] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ectopic eruption of mandibular first molar is a rare clinical problem. It is one result of an improper balance in the forces of growth and eruption. A case of ectopic eruption of the mandibular first permanent molar is described and the technique for repositioning it is showed.
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Affiliation(s)
- A Giancotti
- Department of Orthodontics, University of Rome Tor Vergata, Ospedale Fatebenefratelli, Isola Tiberina, Via Ponte Quattrocapi 34, 00184, Rome, Italy
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16
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Zannetti S, De Rango P, Parlani G, Verzini F, Maselli A, Cao P. Endovascular Abdominal Aortic Aneurysm Repair in High-risk Patients: a Single Centre Experience. Eur J Vasc Endovasc Surg 2001; 21:334-8. [PMID: 11359334 DOI: 10.1053/ejvs.2001.1345] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to evaluate the role of endovascular repair (ER) of abdominal aortic aneurysm (AAA) repair in American Society for Anaesthesiology [ASA] class IV patients. PATIENTS AND METHODS between April 1997 and March 2000, 266 consecutive patients underwent ER for AAA. There were 26 patients (10%) with ASA grade IV. The remaining 240 patients, ASA grade between I and III (ASA<IV group), were compared with the ASA IV group. Mean follow-up was 11.6 months (range 1-32 months). Increase in AAA diameter after ER or persisting graft-related endoleak were defined as failure of AAA exclusion. Regression analysis was performed to test the effect of five confounding variables on failure of AAA exclusion and perioperative mortality. RESULTS patients in the ASA IV group were significantly older than patients in ASA <IV group (mean age: 74 years vs 70 years p=0.005). AAA were larger (mean diameter: 56 mm vs 50 mm p =0.002) and more extensive (class E of EUROSTAR classification: 27% vs 5.8% p =0.002). There were two perioperative deaths in the ASA IV group and one in the ASA<IV group (8% vs 0.4%; RR 19; 95% CI 1.8-202 p=0.01). Major perioperative morbidity occurred in 8% of patients in the ASA IV group and in 3.3% in the ASA<IV group (n.s.). There were no conversions to open repair in the ASA IV group while six were performed in the ASA<IV group (n.s.). Length of hospitalisation was significantly longer for patients in the ASA IV group: 7.8 days vs 3.2 days (p =0.001). Operative times and blood loss were similar. Failure of AAA exclusion occurred in two patients (8%) in the ASA IV group and in four patients (1.6%) in the ASA<IV group (n.s.). On life table analysis, survival rates at 26 months were 76% in the ASA IV group and 89% in the ASA<IV group (p =0.004). Five variables were examined by regression analysis and no independent predictors of failure of AAA exclusion and operative mortality were found. CONCLUSIONS ER in ASA IV patients is feasible and effective with acceptable actuarial survival rates. However, the endovascular procedure in these patients is associated with higher major systemic morbidity, mortality, and prolonged hospitalisation rates.
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Affiliation(s)
- S Zannetti
- Unit of Vascular Surgery, Policlinico Monteluce, Perugia, Italy
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17
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Verzini F, Barzi F, Maselli A, Caporali S, Lenti M, Zannetti S, Cao P. Predictive factors for early success of endovascular abdominal aortic aneurysm repair. Ann Vasc Surg 2000; 14:318-23. [PMID: 10943781 DOI: 10.1007/s100169910063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/26/2022]
Abstract
To identify predictive factors for postoperative success and potential predictors for satisfactory outcome of endovascular grafting for abdominal aortic aneurysm (AAA), we collected data from our prospective database, which includes a series of consecutive patients undergoing endovascular repair at the Vascular Surgery Unit, Policlinico Monteluce, Perugia, Italy. From April 1997 to July 1998, 202 patients were referred to our Unit for elective AAA repair; 94 patients (47%) were selected for endografting. Placement of the graft using endovascular technique without conversion to open laparotomy, in addition to no mortality, major morbidity, or endoleak at 30-day follow-up, was defined as postoperative success. The influence of anatomical features on postoperative results was analyzed by univariate and multivariate analysis. Our experience shows that endoluminal repair of AAA is safe and effective in the short term and male patients with small aneurysms are optimal candidates for successful repair.
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Affiliation(s)
- F Verzini
- Division of Vascular Surgery, Policlinico Monteluce, Perugia, Italy
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18
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Zannetti S, De Rango P, Parente B, Parlani G, Verzini F, Maselli A, Nardelli L, Cao P. Role of duplex scan in endoleak detection after endoluminal abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2000; 19:531-5. [PMID: 10828236 DOI: 10.1053/ejvs.1999.1033] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to validate the role of duplex scan in endoleak detection in postoperative surveillance of endoluminal abdominal aneurysm repair (EAAR). PATIENTS AND METHODS between April 1997 and March 1999, 103 patients were eligible for duplex and computed tomography (CT) scan after EAAR. Mean follow-up was 8 months (range 1-24 months). The study protocol comprised concurrent examination with colour-duplex and CT scan at 1, 6, and 12 months after EAAR, for a total of 198 concurrent examinations. All duplex scan examinations were performed by two vascular surgeons with the same machine (ATL HDI 3000). Interobserver agreement in endoleak detection (kappa=1) and in type of endoleak (kappa=0.7) was evaluated in 50 random duplex examinations. Endoleak detection was examined comparatively in duplex and CT scan, the latter being the gold standard. Sensitivity and specificity tests together with negative- and positive-predictive values (NPV and PPV) were calculated. RESULTS duplex scan was not feasible in one patient. On CT scan the endoleak rate was 4% at one month, 3% at 6 months, and 4% at one year. Overall, CT scan detected 12 endoleaks. With respect to endoleak detection, duplex scan revealed a great ability in ruling out false-negative results (sensitivity 91.7%, NPV 99.4%), but overestimated the presence of endoleak (specificity 98.4%, PPV 78. 6%). Regarding type of endoleak, the ability of duplex scan to identify the source of endoleak was low (sensitivity 66.7%). CONCLUSIONS duplex scan, if validated, appears to be a reliable means for excluding the presence of endoleak after EAAR.
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Affiliation(s)
- S Zannetti
- Unità Operativa di Chirurgia Vascolare, Policlinico Monteluce, Perugia, Italy
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19
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Abstract
A technique which combines the use of rapid maxillary expansion and fixed appliance in growing patients, is presented. The treatment in three patients with Class II division 1 malocclusion and different skeletal patterns is described, and relative advantages highlighted.
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Affiliation(s)
- A Giancotti
- Department of Orthodontics, University of Rome Tor Vergata, Italy.
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20
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Nolthenius RP, Berg JC, Biasi GM, Piglionica MR, Meregaglia D, Ferrari SA, Coppi G, Pacchioni R, Gennai S, Cao P, Barzi F, Verzini F, Maselli A, Caporali S, Moll FL. Endoluminal repair of infrarenal abdominal aortic aneurysms using a modular stent-graft: one-year clinical results from a European multicentre trial. Cardiovasc Surg 1999; 7:503-7. [PMID: 10499892 DOI: 10.1016/s0967-2109(99)00018-6] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This is a report of a prospective study to evaluate the safety and efficacy of the Medtronic AneuRx stent-graft. Patients with an infrarenal aneurysm with a proximal neck length of greater than 10 mm and a neck diameter not greater than 26 mm and iliac artery diameters of at least 6 mm were accepted for endovascular repair using the Medtronic AneuRx modular stent-graft. A total of 104 patients were included in the study. Transfemoral placement of the bifurcated stent-graft was successful in 102 of 104 patients. Two conversions were performed. The mean operating time was 148 min (range 75-480) and the mean blood loss was 605 ml (range 100-2900). The mean follow-up was 15 months (range 12-21). Complications were rare and no kinking or migration occurred. At follow-up, four endoleaks persisted after 12 months. The Medtronic AneuRx stent-graft is a safe and efficacious alternative to open abdominal aortic aneurysm repair with excellent early results.
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Affiliation(s)
- R P Nolthenius
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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21
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Abstract
The purpose of this retrospective study was to evaluate the use of percutaneous transluminal angioplasty (PTA) and subsequent. Strecker stent implantation for the treatment of chronic iliac artery occlusions. A total of 39 patients were subjected to this procedure. The occluded vessels were catheterized, dilated and subjected to stenting in all patients: the length of occlusion varied from 4.5 to 10.5 cm (mean 5.9), lesions were located in common iliac arteries (25), external iliac arteries (10) and in combinations of both (4). Twenty-five patients presented stage II according to Fontaine classification, nine patients stage III and five patients stage IV. The stent was mounted on balloon catheter and introduced through a 9 French sheet (for 8-10 mm stent diameter). After this procedure, 37 out of 39 patients showed a statistically significant increase in the Doppler sonographic ankle-arm index (AAI) (P = 0.001) and improvement of clinical symptoms, while in two patients a complete occlusion resulted due to long dissection not covered by the stent in one case and to stent misplacement in the other case. After stenting, 27 patients improved to stage I, ten patients to stage IIa and two patients showed no changes. Two complications were observed: one groin hematoma and one distal embolization. At a 6-month follow-up, a 89.7% of patency was observed. This study shows that Strecker stent can be successfully employed in addition to PTA to treat occlusions of the iliac arteries.
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Affiliation(s)
- L Lupattelli
- Department of Radiology, University of Perugia, Policlinico Monteluce, Italy
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22
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Mosca S, Maselli A, Pozzilli P, Barzi F. [The cardiac migration of a caval filter]. Radiol Med 1994; 88:682-4. [PMID: 7824791] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- S Mosca
- Istituto di Radiologia, Università, Perugia
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23
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Barzi F, Panzarola P, Regi L, Corneli P, Mosca S, Maselli A, Pozzilli P, Lupattelli L, Cao PG, Lenti M. [The magnetic resonance imaging of abdominal aortic aneurysms]. Radiol Med 1994; 88:582-7. [PMID: 7824772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The diagnostic role of Magnetic Resonance Imaging (MRI) was investigated in the study of abdominal aortic aneurysms and compared with that of Computed Tomography (CT) and digital subtraction angiography (DSA). Magnetic Resonance angiography (MRA) was performed on 21 patients with radiologically proved abdominal aortic aneurysms, using a superconductive 1.5 T magnet (GE, Signa Advantage); the 2D TOF technique with gradient-echo sequences was used (SPGR: FA 45-60 degrees, TR/TE 33/7, ST 2 mm, 1 nex, 256 x 128 matrix, inferior presaturation and flow compensation). The images acquired on the axial plane were reconstructed according to MIP and rotated on the z-axis from +90 degrees to -90 degrees. In all cases SE 2D T1- and T2-weighted sequences were acquired on the axial plane. Twelve patients were examined with MRI, CT and DSA; 3 with MRI and CT; 2 with MRI and DSA and finally 4 with MRI only. The radiologic studies were then reviewed blind and the results of the different methods compared. In all cases MRI yielded similar information to CT and DSA as to aneurysm extent and size, vessel involvement, status of visceral, iliac and common femoral arteries and finally the conditions of perianeurysmatic tissues. The authors conclude that MRI is a useful and accurate technique for the preoperative examination of abdominal aortic aneurysm patients.
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Affiliation(s)
- F Barzi
- Istituto di Radiologia, Università di Perugia
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Mosca S, Maselli A, Pozzilli P, Pazzaglia G, Corneli P, Barzi F, Lupattelli L. [Comparison of Gunther, Filcard and LGM definitive caval filters. Our experience]. Radiol Med 1993; 85:224-34. [PMID: 8493371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The authors report their experience with 30 caval filters placed throughout 3 years, and compare it with the data from the literature. In 8 patients (26.5%) Gunther filters were used, in 16 cases (53.5%) Filcard filters (4 DF-01 and 12 DF-04) and finally the last 6 patients (20%) were treated with LGM filters. In 18 cases (60%) the filters were positioned through right common femoral vein, whereas in the remaining 12 patients (40%) they were placed through the right internal jugular vein. Early complications were 1 mispositioning (3.3%) with a LGM filter, 2 incomplete opening (6.6%) of Filcard DF-01 filters, 3 significant tiltings (10%) with Filcard DF-04 filters. One patient (3.3%) died one week after the placement of a Gunther filter. The radiologic follow-up, which included controls with conventional radiology, US, cavography, MR and CT revealed no later complications. All the filters exhibited both advantages and disadvantages. Although all the filters commonly in use are effective to prevent pulmonary embolism, further experience is necessary to find out the "ideal" filter.
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Affiliation(s)
- S Mosca
- Istituto di Radiologia, Università degli Studi, Perugia
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Lupattelli L, Barzi F, Mosca S, Maselli A, Pozzilli P. [Strecker vascular prostheses. The median- and long-term results]. Radiol Med 1992; 84:602-7. [PMID: 1475424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Between September 1989 and October 1991, 37 patients were treated with percutaneous transluminal angioplasty (PTA) and the insertion of a Strecker stent. The patients--35 men and 2 women, mean age 61 years, range 41-47--had 39 lesions in 39 arteries--30 iliac arteries, 8 femoral arteries and 1 popliteal artery. The lesions included 19 dissections after PTA (48%), 13 residual stenoses > 30% after PTA (34%), 7 restenoses (18%) and 4 total occlusions (10%). The stents were successfully inserted in 37/39 cases (95%). Complications occurred in 4 patients: 2 acute thromboses (resolved with local infusion of urokinase), 1 distal embolization and 1 pseudoaneurysm. Distal embolization, despite aspiration and local fibrinolysis, required leg amputation after about 1 month. The max follow-up period was 2 years (average 15 months): patency was 97% at 1 and 3 months, 100% at 6 and 12 months, 95% at 18 months and 100% at 24 months. Total patency was 85% at 24 months. Four patients were lost to follow-up, and 1 patient died. Four stents failed: 2 of them at 1 and 3 months, and surgery was performed, and 2 at 18 months. Intimal hyperplasia of minimum grade occurred in 2 vessels. There was no evidence of stent migration. The authors believe that the placement of Strecker stents is a valuable approach to the treatment of PTA complications.
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Affiliation(s)
- L Lupattelli
- Istituto di Radiologia, Università degli Studi, Perugia
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Lupattelli L, Barzi F, Mosca S, Maselli A, Pozzilli P, Farsini D, Cao PG, Verzini F. [Loco-regional fibrinolysis in peripheral arterial bypasses. Our experience]. Radiol Med 1992; 83:535-41. [PMID: 1631328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Thirty-one patients (29 males and 2 females) with 34 thrombosed grafts were treated by direct intra-arterial infusion of urokinase; the lesions were acute in 27 cases and chronic (2-4 months) in 4. Urokinase was infused in doses of 50,000 UI/h. Angiographic follow-up exams were performed every 12 hours. The infusion was stopped when lumen patency was re-established and there was no significant mural thrombus or peripheral embolus. Treatment usually lasted 4-72 hours (average: 18 hours). The hematological status was controlled by measuring plasma fibrinogen, coagulation time, partial thromboplastin time, prothrombin and antiplasmin time. Initial success rate was 76% (23 patients). Overall 1-year patency was 56% in 23 cases: 85% in the patients with correctable lesions by means of surgery or PTA, and 46% in the patients with non-correctable lesions. After the first period, patency remained high in the patients followed up to 5 years. Our experience confirms that lysis of a thrombosed graft is possible by the local infusion of a low-dose fibrinolytic agent and exhibits high success rate and low complication rate in acute and chronic obstructions.
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Maselli A. Tips for becoming a thrifty buyer. Dent Assist (1931) 1991; 60:35-6. [PMID: 1815987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Barzi F, Lupattelli L, Corneli P, Mosca S, Lemmi A, Maselli A, Pozzilli P, Agnelli G, Nenci G. [Impedance plethysmography, Doppler echography and phlebography in deep venous thromboses of the lower limbs]. Radiol Med 1990; 79:224-7. [PMID: 2186445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Computerized impedance plethysmography (CIP) and phlebography were performed on 165 consecutive outpatients with clinical suspicion of deep venous thrombosis (DVT) and on 220 consecutive asymptomatic patients hospitalized for hip fracture. Ninety-two asymptomatic patients were examined also with real-time B-mode US. In orthopedic patients CIP sensitivity, specificity, accuracy, positive and negative predictive values were 19.4%, 90.5%, 64.4%, 53.8% and 66.3%, respectively, for proximal and distal DVT, versus 19.7%, 88%, 77.5%, 77% and 86% for proximal DVT. In symptomatic patients CIP sensitivity, specificity, accuracy, positive and negative predictive values were 83%, 87%, 85%, 87% and 82%, respectively, for proximal and distal DVT, versus 91%, 88%, 89%, 82% and 94% for proximal DVT. CIP had great diagnostic utility in symptomatic DVT, whereas its diagnostic efficacy was low in asymptomatic patients. In orthopedic patients US sensitivity, specificity positive and negative predictive values were 44%, 99.2%, 95.7% and 81.6%, respectively. US diagnostic value was relatively high, but further investigation is needed. To date, phlebography seems to be the only effective method in the diagnosis of DVT in asymptomatic high risk patients.
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Affiliation(s)
- F Barzi
- Istituto di Radiologia, Università, Perugia
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Cignarella G, Cerri R, Savelli F, Maselli A. On the behavior of α-brominated dimethylo-benzenediacetate toward nitrogen nucleophiles. Part II. Reaction of dimethyl α-bromo-o-benzenediacetate with hydrazines. J Heterocycl Chem 1977. [DOI: 10.1002/jhet.5570140322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pugliese A, Martinez M, Maselli A, Zalick DH. Treatment of alcoholic methadone-maintenance patients with disulfiram. J Stud Alcohol 1975; 36:1584-8. [PMID: 557 DOI: 10.15288/jsa.1975.36.1584] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Coppi G, Maselli A, Monti L. [New antimicrobial agents: quaternary ammonium salts of basic esters of trans-beta-(1-naphthyl)acrylic acid. 3. Action on pathogenic staphylococci, antiseptic activity on skins and behavior in presence of antibiotics, of trans-beta-(1-naphthyl)acrylate of 2-(N-pyrrolidino) ethyl (DA 1543)]. Boll Soc Ital Biol Sper 1965; 41:1209-12. [PMID: 5879052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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