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Rooijakkers MJP, Li WWL, Stens NA, Vis MM, Tonino PAL, Timmers L, Van Mieghem NM, den Heijer P, Kats S, Stella PR, Roolvink V, van der Werf HW, Stoel MG, Schotborgh CE, Amoroso G, Porta F, van der Kley F, van Wely MH, Gehlmann H, van Garsse LAFM, Geuzebroek GSC, Verkroost MWA, Mourisse JM, Medendorp NM, van Royen N. Transcatheter aortic valve implantation amid the COVID-19 pandemic: a nationwide analysis of the first COVID-19 wave in the Netherlands. Neth Heart J 2022; 30:503-509. [PMID: 35648264 PMCID: PMC9158307 DOI: 10.1007/s12471-022-01704-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has put tremendous pressure on healthcare systems. Most transcatheter aortic valve implantation (TAVI) centres have adopted different triage systems and procedural strategies to serve highest-risk patients first and to minimise the burden on hospital logistics and personnel. We therefore assessed the impact of the COVID-19 pandemic on patient selection, type of anaesthesia and outcomes after TAVI. Methods We used data from the Netherlands Heart Registration to examine all patients who underwent TAVI between March 2020 and July 2020 (COVID cohort), and between March 2019 and July 2019 (pre-COVID cohort). We compared patient characteristics, procedural characteristics and clinical outcomes. Results We examined 2131 patients who underwent TAVI (1020 patients in COVID cohort, 1111 patients in pre-COVID cohort). EuroSCORE II was comparable between cohorts (COVID 4.5 ± 4.0 vs pre-COVID 4.6 ± 4.2, p = 0.356). The number of TAVI procedures under general anaesthesia was lower in the COVID cohort (35.2% vs 46.5%, p < 0.001). Incidences of stroke (COVID 2.7% vs pre-COVID 1.7%, p = 0.134), major vascular complications (2.3% vs 3.4%, p = 0.170) and permanent pacemaker implantation (10.0% vs 9.4%, p = 0.634) did not differ between cohorts. Thirty-day and 150-day mortality were comparable (2.8% vs 2.2%, p = 0.359 and 5.2% vs 5.2%, p = 0.993, respectively). Conclusions During the COVID-19 pandemic, patient characteristics and outcomes after TAVI were not different than before the pandemic. This highlights the fact that TAVI procedures can be safely performed during the COVID-19 pandemic, without an increased risk of complications or mortality. Supplementary Information The online version of this article (10.1007/s12471-022-01704-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J P Rooijakkers
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - W W L Li
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - N A Stens
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Physiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M M Vis
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - P A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - L Timmers
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - N M Van Mieghem
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - P den Heijer
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - S Kats
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - V Roolvink
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - H W van der Werf
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - M G Stoel
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - C E Schotborgh
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - G Amoroso
- Department of Cardiology, OLVG Hospital, Amsterdam, The Netherlands
| | - F Porta
- Department of Cardiothoracic Surgery, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - F van der Kley
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M H van Wely
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - H Gehlmann
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L A F M van Garsse
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - G S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M W A Verkroost
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J M Mourisse
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - N M Medendorp
- Netherlands Heart Registration, Utrecht, The Netherlands
| | - N van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Sirotti S, Adinolfi A, Damiani A, Becce F, Cazenave T, Cipolletta E, Christiansen SN, Delle Sedie A, Diaz M, Figus F, Filippucci E, Hammer HB, Mandl P, Maccarter D, Micu M, Möller I, Mortada MA, Mouterde G, Naredo E, Porta F, Reginato A, Sakellariou G, Schmidt WA, Scirè CA, Serban T, Vlad V, Vreju FA, Wakefield R, Zufferey P, Sarzi-Puttini P, Iagnocco A, Pineda C, Keen H, D’agostino MA, Terslev L, Filippou G. OP0168 DEVELOPMENT OF AN ULTRASOUND SCORING SYSTEM FOR CPPD EXTENT: RESULTS FROM A DELPHI PROCESS AND WEB-RELIABILITY EXERCISE BY THE OMERACT US WORKING GROUP. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundUltrasound (US) has proven to be an excellent imaging technique for detecting calcium pyrophosphate (CPP) deposition disease (CPPD); it is also widely available and inexpensive and can be performed during the clinic visit making it the preferred imaging modality for many rheumatologists. However, no validated grading systems have yet been developed allowing for a quantification of the extent of crystal deposition in CPPD.ObjectivesThe aim of this study was to develop a scoring system for the quantification of CPP deposition at a patient level according to the OMERACT framework.MethodsAs part of the OMERACT methodology, we performed a systematic literature review (SLR) and meta-analysis aimed to estimate the prevalence of CPP deposition in peripheral joints by imaging, in order to identify relevant joints for CPPD monitoring. A preliminary survey was also circulated among the members of the OMERACT US – CPPD working group to collect their own suggestions according to their personal experience. Subsequently, a Delphi survey was prepared and circulated between members of the group, including statements that reflected both the results of the SLR and of the preliminary survey. In total, 32 statements were generated regarding the type of scoring for single structures, the sites to be included, the final scoring at patient level, and the scanning technique. Participants were asked to reply on a 5-point Likert scale (1, strongly disagree to 5, strongly agree) and agreement was achieved when 4 and 5 grades reached 75% or more of concordance. In case of disagreement, new statements were proposed according to the members’ suggestions and circulated for voting in a subsequent round. After agreement of a scoring system, the validation process began. Two rounds of a web-based exercise on static images were conducted on 120 images representing equally all sites under investigation and all degrees of crystal deposition, to assess the intra- and inter-reader reliability of the new scoring system. Representative images of the scoring system were visible throughout the entire exercise in order to facilitate the scoring of the lesions.ResultsThree Delphi rounds were needed to reach agreement on all items. 32/41 members of the OMERACT US-CPPD working group replied in the first round, 26/32 in the second, and 25/26 in the third round. Twenty statements were approved in the first round, 3 in the second, and 3 in the third round. Only the knees (menisci and hyaline cartilage) and the triangular fibrocartilage of the wrist were included in the final score, using a four-grade system (0-3). It was decided that each anatomical structure should be scored separately and then also summed in order to define the joint score. The sum of the assessed joints was the total score at patient level. The final scoring system with the definitions and the relative technical notes is represented in Figure 1. 33/41 members participated to the reliability exercise. The inter-reader reliability of the scoring was substantial (kappa of 0.72), and the intra-reader reliability was almost perfect (kappa of 0.82).ConclusionThis is the first study for developing a scoring system for the extent of CPP crystal deposition in patients with CPPD. The scoring system demonstrated to be reliable in static images. The next step of the validation process is to assess the reliability of the scoring system in a patient-based exercise. This study represents a fundamental step in the OMERACT process of validating US as an outcome measure instrument, and above proposed scoring system will hopefully provide a useful tool for clinical practice and research.Disclosure of InterestsNone declared
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Adinolfi A, Sirotti S, Sakellariou G, Cipolletta E, Filippucci E, Porta F, Sarzi-Puttini P, Scirè CA, Keen H, Mandl P, Mouterde G, Pineda C, Terslev L, D’agostino MA, Iagnocco A, Filippou G. POS1141 ASSESSING RELEVANT JOINTS FOR MONITORING CPPD DISEASE: A SYSTEMATIC LITERATURE REVIEW OF IMAGING TECHNIQUES BY THE OMERACT ULTRASOUND – CPPD SUBGROUP. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Imaging has been extensively used for the Calcium Pyrophosphate Deposition Disease (CPPD) diagnosis but the prevalence of joint calcifications at imaging in CPPD patients has not been thoroughly assessed.Objectives:This systematic literature review (SLR) is aimed to estimate the prevalence of calcium crystal deposition in peripheral joints by imaging in suspected or definite CPPD patients to establish relevant joints for CPPD monitoringMethods:After defining PICOs, Pubmed and Embase were searched from inception to October 2020 for identifying studies that evaluated the use of Conventional Radiography (CR), Ultrasound (US), Computed Tomography (CT) and Dual Energy Computed Tomography (DECT) in detecting calcifications at peripheral joints in patients with defined or probable CPPD. Search strategies based on MeSH terms and free text were applied. Six reviewers independently screened titles and abstracts, eligible article full texts were evaluated for inclusion and data extraction.Results:The SLR identified 1149 manuscripts. 524 papers entered in the full text evaluation and 181 articles were finally included. Considering excluded abstracts and full texts, 23 and 17 were excluded as duplicate, 156 and 9 for language, 171 and 48 for population, 171 and 20 for intervention, 57 and 117 for outcome, 47 and 70 for study type and 76 for full text unavailability. Among included, 41 papers considered patients with definite CPPD with a total population of 1239 patients, 908 cases and 331 controls and 140 papers referred to patients with suspected CPPD with a total population of 26785 patients, 2896 affected by CPPD and 23889 controls. The results about all joints are summarized in the Table 1. In patients with definite diagnosis, knee and wrist are the joints with the highest prevalence of calcifications at all imaging types, followed by hip and acromion-clavicular joint while in patients with suspected CPPD, the knee is the most prevalent followed by the wrist, hip and ankle (only sites with more than 50 patients assessed considered). The hand joints are characterized by CPPD lowest prevalence at imaging. Bilateral imaging findings varies depending on the technique used, the site and the patient’s type.Table 1.Definite CPPD DiagnosisKNEEWRISTHANDELBOWSHOULDERACHIPANKLEFOOTTMXRImaging positive cases/all cases330/584 57%214/409 52%43/158 27%54/212 25%65/249 26%37/84 44%140/293 48%30/255 12%15/59 25%0Cases positivebilaterally99/146 68%30/79 38%0/104/12 33%2/2 100%9/17 53%7/10 70%7/10 70%00USImaging positive cases/all cases155/252 62%86/118 75%4/42 9%2/2 100%0/304/30 13%47/80 59%30/255 12%15/59 25%0Cases positivebilaterally83/96 86%33/47 70%1/ 4 25%003/ 4 75%29/47 62%7/10 70%00CTImaging positive cases/all cases41/50 82%22/28 78%00000000Cases positivebilaterally27/30 90%000000000DECTImaging positive cases/all cases8/10 80%9/10 90%1/1 100%0000000Cases positivebilaterally001/1 100%0000000Suspected CPPD diagnosisKNEEWRISTHANDELBOWSHOULDERACHIPANKLEFOOTTMXRImaging positive cases/all cases1989/2442 81%549/1024 54%98/602 16%29/72 40%75/185 41%27/31 87%322/887 36%56/116 48%24/42 57%0Cases positive bilaterally611/1068 57%209/334 63%64/85 75%22/23 96%41/46 89%0/294/196 48%44/53 83%18/19 95%0USImaging positive cases/all cases241/261 93%125/185 68%2/39 5%1/1 100%4/12 33%02/2 100%27/78 35%8/37 22%0Cases positivebilaterally4/9 44%74/93 80%00000000CTImaging positive cases/all cases019/23 83%002/2 100%02/2 100%001/1 100%Cases positivebilaterally0000000001/1 100%DECTImaging positive cases/all cases1/1 100%2/2 100%00000000Cases positivebilaterally1/1 100%000000000Table 1 For each joint, are summarized the ratio between positive joints and overall evaluated joints and the ratio between the joints positive bilaterally and overall joints evaluated bilaterally.AC Acromion Clavicular, TM temporo mandibularConclusion:According to the results of this SLR, knees and wrists could be the sentinel joints for CPPD detection by imaging.Disclosure of Interests:None declared.
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Porta F, Filippou G, Sakellariou G. AB0598 EFFICACY OF ULTRASOUND GUIDED INJECTIONS OF A CROSS-LINKED SODIUM HYALURONATE COMBINED WITH TRIAMCINOLONE HEXACETONIDE FOR OSTEOARTHRITIS OF THE KNEE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:According to guidelines, the use of steroid and/or hyaluronate (HA) intra-articular injections for knee osteoarthritis (KOA) is controversial. Heterogeneity of studies and difference in HAs characteristics does not allow to draw safe conclusions. One of the major concerns is the accuracy of the procedure as up to 1/3 of injections could miss joint space when performed blindly (1), negatively affecting the efficacy of HA that needs to be placed correctly in the joint spaceObjectives:The aim of our study was to evaluate the longterm efficacy of a novel association of a Cross-Linked Sodium Hyaluronate Combined With Triamcinolone Hexacetonide (SHCTH) in patients with KOA in a real life setting.Methods:We retrospectively evaluated the clinical and ultrasonographic (US) data of patients (pts) affected by symptomatic KOA with intra-articular injections of SHCTH (1 injection every 6 months). Pts with concomitant inflammatory arthropaties were excluded. US guidance was carried out with the “in plane” technique choosing either the lateral suprapatellar or midpatellar approach. All pts were evaluated for pain with a VAS 0-10 for pain at baseline and after 2 weeks, 1, 3, 6, 9 and 12 months, with the WOMAC questionnaire and with US, scoring joint effusion, synovial hypertrophy (SH) and power Doppler (PD) synovial signal. Due to the retrospective design, the WOMAC data were available as VAS or Likert scales; to allow comparability these values were standardized. Clinical and US variables at different time points were compared using the Wilcoxon rank sing test, the McNemar test or the paired samples t-test, depending on the variable.Results:49 knees (43 pts, median age 70.6 years, 24 women) were included in the study. Kellgren Lawrence grade was 1 for 5 knees, 2 for 10, 3 for 17 and 4 for 9. SHCTH was delivered correctly in the joint space in all patients as assessed by US check during the injection and no side effects occurred. Of the 49 knees, 28 had an available 6 months follow-up, while 21 completed the 12 months follow-up, with an attrition mostly related to the COVID 19 pandemic. A rapid and sustained statistically significant decrease of both VAS pain and the WOMAC subscales was observed. The reduction of pain was already significant at 2 weeks, probably thanks to the corticosteroid component. At US evaluation, effusion significantly decreased at all time points. Although SH scores also significantly decreased, the effect on the proportion of affected joints was not as relevant. The reduction of PD was significant until month 9. Detailed results are presented in Table 1.Conclusion:Our data show that US guided SHCTH injections provide a rapid and sustained clinical response in patients with symptomatic OA. Besides the effect on pain, the US data confirm the effect of the drug on the inflammation. US guidance guaranteed the correct placement of the product in all patients and eliminated the bias of wrong placement that may occur with blind injections, thus allowing to draw safe conclusions on the efficacy of SHCTH for the treatment of KOA.References:[1]Jones A, Regan M, Ledingham J, et al. Importance of placement of intra-articular steroid injections. BMJ 1993;307:1329–30.Table 1.Table 1. Clinical and US measures. p values refer to the comparison with baseline. WOMAC subscales were compared by paired samples t test. *hypothesis test not applicablebaseline2 weeks1 month3 months6 months9 months12 monthsVAS (median,IQR)6 (5-8)3 (1-4.25) p<0.00012 (0.5-3-5) p<0.00011.5 (0-3) p<0.00011.5 (0-4) p<0.00011 (0-2.75) p<0.00011 (0-3.25) p<0.0001WOMAC pain--p 0.028p 0.0004p 0.0036p 0.0096p 0.0064WOMAC stiffness--p 0.048p 0.040p 0.0388p<0.0001p 0.0083WOMAC function--p 0.043p 0.0005p 0.0014p 0.01p 0.007Effusion 0-3 (median,IQR)2 (1-2)-1 (0-1) p<0.00011 (0-1) p<0.00011 (0-1) p 0.00010 (0-1) p<0.00011 (0-1) p<0.0001Synovial Hypertrophy 0-3 (median,IQR)1 (1-2)-1 (1-1) p 0.0021 (1-1) p 0.00011 (1-1) p 0.00011 (0-1) p 0.00011 (0.5-1) p 0.0001PD 0-3 (median,IQR)0 (0-0)-0 (0-0) p 0.030 (0-0) p 0.030 (0-0) P 0.061 (0-1) p 0.010 (0-0) p 0.31Disclosure of Interests:None declared.
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Al-Farra H, de Mol BAJM, Ravelli ACJ, Ter Burg WJPP, Houterman S, Henriques JPS, Abu-Hanna A, Vis MM, Vos J, Timmers L, Tonino WAL, Schotborgh CE, Roolvink V, Porta F, Stoel MG, Kats S, Amoroso G, van der Werf HW, Stella PR, de Jaegere P. Update and, internal and temporal-validation of the FRANCE-2 and ACC-TAVI early-mortality prediction models for Transcatheter Aortic Valve Implantation (TAVI) using data from the Netherlands heart registration (NHR). Int J Cardiol Heart Vasc 2021; 32:100716. [PMID: 33537406 PMCID: PMC7843396 DOI: 10.1016/j.ijcha.2021.100716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023]
Abstract
Background The predictive performance of the models FRANCE-2 and ACC-TAVI for early-mortality after Transcatheter Aortic Valve Implantation (TAVI) can decline over time and can be enhanced by updating them on new populations. We aim to update and internally and temporally validate these models using a recent TAVI-cohort from the Netherlands Heart Registration (NHR). Methods We used data of TAVI-patients treated in 2013-2017. For each original-model, the best update-method (model-intercept, model-recalibration, or model-revision) was selected by a closed-testing procedure. We internally validated both updated models with 1000 bootstrap samples. We also updated the models on the 2013-2016 dataset and temporally validated them on the 2017-dataset. Performance measures were the Area-Under ROC-curve (AU-ROC), Brier-score, and calibration graphs. Results We included 6177 TAVI-patients, with 4.5% observed early-mortality. The selected update-method for FRANCE-2 was model-intercept-update. Internal validation showed an AU-ROC of 0.63 (95%CI 0.62-0.66) and Brier-score of 0.04 (0.04-0.05). Calibration graphs show that it overestimates early-mortality. In temporal-validation, the AU-ROC was 0.61 (0.53-0.67).The selected update-method for ACC-TAVI was model-revision. In internal-validation, the AU-ROC was 0.63 (0.63-0.66) and Brier-score was 0.04 (0.04-0.05). The updated ACC-TAVI calibrates well up to a probability of 20%, and subsequently underestimates early-mortality. In temporal-validation the AU-ROC was 0.65 (0.58-0.72). Conclusion Internal-validation of the updated models FRANCE-2 and ACC-TAVI with data from the NHR demonstrated improved performance, which was better than in external-validation studies and comparable to the original studies. In temporal-validation, ACC-TAVI outperformed FRANCE-2 because it suffered less from changes over time.
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Key Words
- ACC-TAVI (ACC TVT), American College of Cardiology Transcatheter Valve Therapy
- AU-PRC, Area Under the Precision-Recall Curve
- AU-ROC, Area Under the Receiver Operating-Characteristic Curve
- Amsterdam UMC, Amsterdam University Medical Center - location AMC (Academic Medical Center)
- BSS, Brier-skill score
- Closed-testing procedure
- EuroSCORE, European System for Cardiac Operative Risk Evaluation
- External Validation
- FRANCE-2, French Aortic National CoreValve and Edwards [15]
- LVEF, Left Ventricular Ejection Fraction
- MPM, Mortality Prediction Models
- Model recalibration
- Model updating
- NHR, Netherlands Heart Registration (“Nederlandse Hart Registratie in Dutch”)
- NYHA, New York Heart Association
- Prediction models
- SAVR, Surgical Aortic Valve Replacement
- TAVI (TAVR), Transcatheter Aortic Valve Implantation (Replacement)
- Transcatheter Aortic Valve Implantation (TAVI)
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Affiliation(s)
- Hatem Al-Farra
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Bas A J M de Mol
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anita C J Ravelli
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W J P P Ter Burg
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - José P S Henriques
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M M Vis
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J Vos
- Amphia Hospital, the Netherlands
| | - L Timmers
- St. Antonius Hospital, the Netherlands
| | | | | | | | - F Porta
- Leeuwarden Medical Center, the Netherlands
| | - M G Stoel
- Medisch Spectrum Twente, the Netherlands
| | - S Kats
- Maastricht University Medical Center, the Netherlands
| | - G Amoroso
- Onze Lieve Vrouwe Gasthuis, the Netherlands
| | | | - P R Stella
- University Medical Center Utrecht, the Netherlands
| | - P de Jaegere
- Erasmus University Medical Center, the Netherlands
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Al-Farra H, Abu-Hanna A, de Mol BA, ter Burg W, Houterman S, Henriques JP, Ravelli AC, Vis M, Vos J, Ten Berg J, Tonino W, Schotborgh C, Roolvink V, Porta F, Stoel M, Kats S, Amoroso G, van der Werf H, Stella P, de Jaegere P. External validation of existing prediction models of 30-day mortality after Transcatheter Aortic Valve Implantation (TAVI) in the Netherlands Heart Registration. Int J Cardiol 2020; 317:25-32. [DOI: 10.1016/j.ijcard.2020.05.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/19/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022]
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Carpenito L, D'Ercole M, Porta F, Di Blasi E, Doi P, Fagara GR, Rey R, Bulfamante G. The autopsy at the time of SARS-CoV-2: Protocol and lessons. Ann Diagn Pathol 2020; 48:151562. [PMID: 32653819 PMCID: PMC7334655 DOI: 10.1016/j.anndiagpath.2020.151562] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 01/09/2023]
Abstract
A new viral disease named COVID-19 has recently turned into a pandemic. Compared to a common viral pneumonia it may evolve in an atypical way, causing the rapid death of the patient. For over two centuries, autopsy has been recognized as a fundamental diagnostic technique, particularly for new or little-known diseases. To date, it is often considered obsolete giving the inadequacy to provide samples of a quality appropriate to the sophisticated diagnostic techniques available today. This is probably one of the reasons why during this pandemic autopsies were often requested only in few cases, late and discouraged, if not prohibited, by more than one nation. This is in contrast with our firm conviction: to understand the unknown we must look at it directly and with our own eyes. This has led us to implement an autopsy procedure that allows the beginning of the autopsy shortly after death (within 1–2 h) and its rapid execution, also including sampling for ultrastructural and molecular investigations. In our experience, the tissue sample collected for diagnosis and research were of quality similar to biopsy or surgical resections. This procedure was performed ensuring staff and environmental safety. We want to propose our experience, our main qualitative results and a few general considerations, hoping that they can be an incentive to use autopsy with a new procedure adjusted to match the diagnostic challenges of the third millennium. Early performed autopsy (within 1-2 hour from death) provides tissue samples for diagnosis and research of quality similar to biopsy or surgical resections. Early samples collection reduces post-mortem artifacts, thus preventing the wrong interpretation of the morphological pictures observed. Precise autopsy planning prevents risks for the staff.
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Affiliation(s)
- L Carpenito
- School of Pathology, University of Milan, Milan, Italy.
| | - M D'Ercole
- School of Pathology, University of Milan, Milan, Italy
| | - F Porta
- School of Pathology, University of Milan, Milan, Italy
| | - E Di Blasi
- School of Pathology, University of Milan, Milan, Italy
| | - P Doi
- Complex Unit of Pathological Anatomy and Medical Genetics, San Paolo Hospital, University of Milan, Milan, Italy
| | - G Redolfi Fagara
- Complex Unit of Pathological Anatomy and Medical Genetics, San Paolo Hospital, University of Milan, Milan, Italy
| | - R Rey
- Complex Unit of Pathological Anatomy and Medical Genetics, San Paolo Hospital, University of Milan, Milan, Italy
| | - G Bulfamante
- Complex Unit of Pathological Anatomy and Medical Genetics, San Paolo Hospital, University of Milan, Milan, Italy
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Adinolfi A, Filippou G, Scirè C, Damjanov N, Carrara G, Picerno V, Toscano C, Bruyn G, D'Agostino M, Delle Sedie A, Filippucci E, Gutierrez M, Micu M, Moller I, Naredo E, Pascal Z, Pineda C, Porta F, Schmidt W, Terslev L, Vlad V, Zufferey P, Frediani B, Iagnocco A. FRI0517 The Omeract Ultrasonographic Criteria for Elementary Lesions in Calcium Pyrophosphate Deposition Disease: Results of A Delphi Process by Ultrasound Working Group. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5406] [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: 11/03/2022]
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Filippou G, Scirè C, Damjanov N, Adinolfi A, Carrara G, Picerno V, Toscano C, Bruyn G, D'Agostino M, Delle Sedie A, Filippucci E, Gutierrez M, Micu M, Moller I, Naredo E, Pineda C, Porta F, Schmidt W, Terslev L, Vlad V, Zufferey P, Frediani B, Iagnocco A. OP0122 Inter-Reader and Intra-Reader Reliability of The New Omeract Ultrasonographic Criteria for The Diagnosis of CPPD. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5183] [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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Filippou G, Adinolfi A, Delle Sedie A, Filippucci E, Iagnocco A, Porta F, Sconfienza LM, Tormenta S, Di Sabatino V, Picerno V, Frediani B. Radiologists and rheumatologists on performing and reporting shoulder ultrasound: from disagreement to consensus. Reumatismo 2014; 66:233-9. [PMID: 25376958 DOI: 10.4081/reumatismo.2014.739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 08/16/2014] [Accepted: 08/18/2014] [Indexed: 11/22/2022] Open
Abstract
Shoulder pain is a common condition in the rheumatologist's practice, yet there are no guidelines on how to report shoulder ultrasound (US) examinations. The aim of this study was to compare scanning and reporting techniques performed by radiologists and rheumatologists and identify any discrepancies between the two. The participants in this study were five rheumatologists and two radiologists specialized in musculoskeletal US. The study was divided in 2 phases. In the first phase, each participant performed an US of 3 patients and reported the findings without knowing the patient diagnosis and the findings reported by the other operators. Other three investigators reported the US technique of each operator. Reports and images were subsequently compared to identify any discrepancies and reach consensus on a common approach. In the second phase, a US scan was performed on a fourth patient in a plenary session to assess feasibility and efficacy of the common approach The US scanning technique was similar for all operators. The differences in reporting emerged in the description of the rotator cuff disease. Radiologists provided a detailed description of lesions (measurements along 2 axis and scoring of lesions), whereas rheumatologists described carefully the inflammatory changes. The experts concluded that lesions should be measured along 2 axes and the grade of degeneration and the age of the lesion should be reported. Another difference emerged in the description of the irregularities of the bone surface. The experts concluded that the term erosion should be used only when an inflammatory joint disease is suspected. This study led to the clarification of some inconsistencies in US reporting, and represented an interesting collaborative experience between radiologists and rheumatologists.
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Affiliation(s)
- G Filippou
- Rheumatology Unit, University of Siena, Siena.
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Radunovic G, Porta F, Prodanovic S, Seric S, Gavrilov N, Grujic M, Prodanovic S, Matucci-Cerinic M, Damjanov N. AB0968 Construct Validity of New Ultrasound Score Intended to Measure Damage of Small Joints in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2918] [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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Mascarin M, Elia C, Bianchi M, Bertolini P, Buffardi S, Caniglia M, Caruso R, Cellini M, Cesaro S, Consarino C, D'Amico S, De Santis R, Farruggia P, Cecinati V, Garaventa A, Indolfi P, Moleti ML, Murgia G, Nardi M, Pierani P, Porta F, Rondelli R, Sala A, Santoro N, Todesco A, Zanazzo GA, Zecca M, Burnelli R. Lymphocyte Predominant Hodgkin Lymphoma. A Multicenter Retrospective 30-Year Experience of the Italian Pediatric Hematology and Oncology Association (AIEOP). Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Porta F, Damjanov N, Galluccio F, Iagnocco A, Matucci-Cerinic M. Ultrasound elastography is a reproducible and feasible tool for the evaluation of the patellar tendon in healthy subjects. Int J Rheum Dis 2013; 17:762-6. [PMID: 24286131 DOI: 10.1111/1756-185x.12241] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility and reproducibility of ultrasound elastography (UE) in the assessment of healthy patellar tendon and to describe its UE pattern. METHODS Twenty-two patellar tendons of 11 out of 16 healthy subjects who met the inclusion criteria were evaluated three times by ultrasound (US) and UE at their proximal, middle and distal portions, by two separate sonographers with different experiences in UE. RESULTS In all tendon portions the color map analysis showed a predominance of green (highly elastic), with good values of intra-observer (Operator 1: P-values = 0.790, 0.864, 0.865; Operator 2: P = 0.642, 0.882, 0.613 for proximal, middle and distal portions, respectively) and inter-observer (P = 0.657) agreement. For both operators the intra-observer analysis of the elasticity ratio (ER) between the tendon and the subcutis showed high agreement values (P < 0.001 for both operators). The inter-observer analysis showed also high agreement values (P < 0.001 at proximal, P = 0.001 at middle, P = 0.005 at distal portions). The overall analysis of the ER of the tendon portions showed values of (mean ± SD): 1.47 ± 0.64, 4.38 ± 1.36, 3.32 ± 1.20 for proximal, middle and distal portions, respectively. The mean time to perform the UE evaluation for the inexperienced operator was 5 min at the beginning of the study but decreased to 2 min after a few examinations were done. The mean time for the expert was 2 min for the entire study. CONCLUSIONS UE is a feasible and reproducible tool for the evaluation of the healthy patellar tendon and further data are needed to define its role in the assessment of tendon pathology.
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Affiliation(s)
- F Porta
- Division of Rheumatology AOUC, Department of Sperimental and Clinical Medicine, University of Florence, Florence, Italy
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Iagnocco A, Porta F, Cuomo G, Delle Sedie A, Filippucci E, Grassi W, Sakellariou G, Epis O, Adinolfi A, Ceccarelli F, De Lucia O, Di Geso L, Di Sabatino V, Gabba A, Gattamelata A, Gutierrez M, Massaro L, Massarotti M, Perricone C, Picerno V, Ravagnani V, Riente L, Scioscia C, Naredo E, Filippou G. The Italian MSUS Study Group recommendations for the format and content of the report and documentation in musculoskeletal ultrasonography in rheumatology. Rheumatology (Oxford) 2013; 53:367-73. [DOI: 10.1093/rheumatology/ket356] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Amrane H, Porta F, Head S, van Boven A, Kappetein A. Direct aortic approach for TAVI: a single centre experience. J Cardiothorac Surg 2013. [PMCID: PMC3845699 DOI: 10.1186/1749-8090-8-s1-o316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bardellini E, Schumacher F, Conti G, Porta F, Campus G, Majorana A. Risk factors for oral mucositis in children receiving hematopoietic cell transplantation for primary immunodeficiencies: a retrospective study. Pediatr Transplant 2013; 17:492-7. [PMID: 23750582 DOI: 10.1111/petr.12094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 11/28/2022]
Abstract
OM is a frequent complication for patients undergoing HSCT. The aim of this study was to evaluate the possible risk factors for OM in children undergoing HSCT for PI. A retrospective study was carried out on 55 consecutive medical records of patients with PI (including osteopetrosis) who underwent HSCT. Age at the time of HSCT, gender, diagnosis, type of donor, conditioning regimen, engraftment, graft-versus-host disease, and severity and duration of OM were collected at the beginning of the conditioning until day 100 post-HSCT or death. OM was measured using the WHO scale. Patients' age range at the time of HSCT was quite wide; 59.2% of the patients who were under nine months (n = 13) developed OM vs. 87.8% of the patients older than nine months (n = 29) (p = 0.01). T-cell positive patients had a statistically significant higher risk of developing OM (p = 0.04), as did those receiving a more intensive conditioning regimen (p < 0.01). PI patients undergoing HSCT are at higher risk of developing OM if the PI is a T-lymphocyte-positive disease and/or if the HSCT recipient is over nine months of age.
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Affiliation(s)
- E Bardellini
- Department of Pediatric Dentistry/Oral Medicine, Dental School, University of Brescia, Brescia, Italy
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Adinolfi A, Filippou G, Delle Sedie A, Filippucci E, Iagnocco A, Porta F, Sconfienza LM, Tormenta S, Frediani B. FRI0475 Radiologists against rheumatologists on technical aspects of shoulder ultrasound: from the disagreement to final consensus. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1602] [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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Iagnocco A, Ceccarelli F, Cuomo G, Delle Sedie A, Filippou G, Filippucci E, Grassi W, Porta F, Sakellariou G. Diffusion and applications of musculoskeletal ultrasound in Italian Rheumatology Units. Reumatismo 2013; 65:46-7. [PMID: 23550260 DOI: 10.4081/reumatismo.2013.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/17/2012] [Accepted: 02/13/2013] [Indexed: 11/23/2022] Open
Abstract
The Musculoskeletal Ultrasound Study Group of the Italian Society of Rheumatology (SIR) was founded during the 68th SIR Congress, on November 2011. The request of activation of this group was based on the increasing interest and the widespread diffusion of ultrasound in the scientific rheumatology community and on the solid experience of some Italian rheumatologists in the field. The aims of the Study Group are to stimulate the applications and use of ultrasound in the clinical practice at the level of the Italian rheumatology units and, in addition, to develop research projects at a national level...
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Porta F, Gargani L, Kaloudi O, Schmidt WA, Picano E, Damjanov N, Matucci-Cerinic M. The new frontiers of ultrasound in the complex world of vasculitides and scleroderma. Rheumatology (Oxford) 2012; 51 Suppl 7:vii26-30. [DOI: 10.1093/rheumatology/kes336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mussa A, Porta F, Baldassarre G, Tuli G, de Terlizzi F, Matarazzo P, Einaudi S, Lala R, Corrias A. Phalangeal quantitative ultrasound in 1,719 children and adolescents with bone disorders. Osteoporos Int 2012; 23:1987-98. [PMID: 21947033 DOI: 10.1007/s00198-011-1794-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 09/05/2011] [Indexed: 11/26/2022]
Abstract
SUMMARY We measured bone properties by phalangeal quantitative ultrasound in 1,719 pediatric patients with bone disorders, classifying them according to fracture status. Quantitative ultrasound discriminated fractured and nonfractured pediatric patients and enabled us to stratify fractured patients into classes according to the severity of the causative trauma (spontaneous, minimal trauma, appropriate trauma fractures). INTRODUCTION The correlation between quantitative bone measurements and fractures is poorly established in pediatric patients with bone disorders. We correlated phalangeal quantitative ultrasound (QUS) and fracture history in children and adolescents with bone disorders and evaluated the ability of QUS to recognize fractured patients. METHODS Amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT) were measured in 1,719 pediatric patients with bone disorders and related to fracture history. The patients were classified as (1) spontaneously (77), (2) minimal trauma (101), or (3) appropriate trauma fractured (206), and (4) nonfractured (1,335). The likelihood of fracture according to QUS was calculated as odds ratio per SD decrease (OR/SD), and the effectiveness in discriminating fractured patients was evaluated by receiver operating characteristic (ROC) analysis. The influence of age, sex, puberty, height, and BMI was explored by respective adjustments and multiple logistic regression. RESULTS Fractured patients showed significantly reduced AD-SoS and BTT standard deviation score (-0.32 ± 1.54 and -0.78 ± 1.49) compared to nonfractured subjects (0.43 ± 1.63 and -0.11 ± 1.34). QUS measurements paralleled the causative trauma severity, ranging from the lowest values in spontaneously fractured patients to normal values in appropriate trauma fractured subjects. The OR/SD were increasingly higher in appropriate trauma fractured, minimal trauma fractured, and spontaneously fractured patients. At ROC analysis, both parameters proved to have significant discrimination power in recognizing spontaneously and minimal trauma-fractured patients. CONCLUSIONS QUS identifies fractured pediatric patients with bone disorders, reflecting the severity of the causative trauma with a high discrimination power for fragility fractures.
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Affiliation(s)
- A Mussa
- Division Pediatric Endocrinology, Department of Pediatrics, University of Turin, Turin, Italy.
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Cò E, Coppini S, Schumacher F, Notarangelo L, Porta F. 4123 POSTER “The Breathing Tree Project” Biofeedback and Stress Mitigation in Children With Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71301-6] [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: 11/25/2022]
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Correa T, Kindler R, Brandt S, Gorrasi J, Regueira T, Bracht H, Porta F, Takala J, Pearse R, Jakob SM. Impact of hepatic venous oxygen efflux and carotid blood flow on the difference between mixed and central venous oxygen saturation. Crit Care 2011. [PMCID: PMC3061665 DOI: 10.1186/cc9455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fernandez-Donoso R, Fraccaro M, Lindsten J, Porta F, Scappaticci S, Tiepolo L. The chromosomes of the Alpine marmot Marmota marmota L. (Rodentia: Sciuridae). Hereditas 2009; 63:170-9. [PMID: 5399225 DOI: 10.1111/j.1601-5223.1969.tb02260.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Porta F, Lorenzi L, Bolda F, Bosi A, Gaspar H, Lanfranchi A. In Utero Gene and Cell Therapy for Congenital Diseaases. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.053] [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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Leuzzi V, Carducci CA, Carducci CL, Pozzessere S, Burlina A, Cerone R, Concolino D, Donati MA, Fiori L, Meli C, Ponzone A, Porta F, Strisciuglio P, Antonozzi I, Blau N. Phenotypic variability, neurological outcome and genetics background of 6-pyruvoyl-tetrahydropterin synthase deficiency. Clin Genet 2009; 77:249-57. [PMID: 20059486 DOI: 10.1111/j.1399-0004.2009.01306.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study aimed to investigate the clinical variability and factors implied in the outcome of 6-pyruvoyl-tetrahydropterin synthase deficiency (PTPSd). Biochemical and clinical phenotype, treatment variables, and 6-pyruvoyl-tetrahydropterin synthase (PTS) genotype, were explored retrospectively in 19 Italian patients (12 males and 7 females, aged 4 months to 33 years). According to the level of biogenic amines in cerebrospinal fluid (CSF) at the diagnosis, the patients were classified as mild (6) (normal level) or severe (13) (abnormal low level) form (MF and SF, respectively). Blood Phe ranged from 151 to 1053 micromol/l in MF (mean +/- SD: 698 +/- 403) and 342-2120 micromol/l in SF (mean +/- SD: 1175 +/- 517) (p = 0.063). Patients with MF showed a normal neurological development (a transient dystonia was detected in one), while all SF patients except one presented with severe neurological impairment and only four had a normal neurological development. The outcome of the SF was influenced by the precocity of the treatment. Serial CSF examinations revealed a decline of 5-hydroxyindolacetic acid in MFs and an incomplete restoration of neurotransmitters in SFs: neither obviously affected the prognosis. PTS gene analysis detected 17 different mutations (seven so far unreported) (only one affected allele was identified in three subjects). A good correlation was found between genotype and clinical and biochemical phenotype. The occurrence of brain neurotransmitter deficiency and its early correction (by the therapy) are the main prognostic factors in PTPSd.
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Affiliation(s)
- V Leuzzi
- Department of Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
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Damjanov N, Ostojic P, Kaloudi O, Alari S, Guiducci S, Stanflin N, Nestorovic B, Knezevic J, Camiciottoli G, Porta F, Pistolesi M, Ibba-Manneschi L, Conforti M, Candelieri A, Matucci Cerinic M. Induced Sputum in Systemic Sclerosis Interstitial Lung Disease: Comparison to Healthy Controls and Bronchoalveolar Lavage. Respiration 2009; 78:56-62. [DOI: 10.1159/000164720] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 07/11/2008] [Indexed: 11/19/2022] Open
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Porta F, Roato I, Mussa A, Repici M, Gorassini E, Spada M, Ferracini R. Increased spontaneous osteoclastogenesis from peripheral blood mononuclear cells in phenylketonuria. J Inherit Metab Dis 2008; 31 Suppl 2:S339-42. [PMID: 18923919 DOI: 10.1007/s10545-008-0907-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Revised: 08/07/2008] [Accepted: 08/11/2008] [Indexed: 10/21/2022]
Abstract
Phenylketonuria (PKU) is commonly complicated by a progressive bone impairment of uncertain aetiology. The therapeutic phenylalanine (Phe)-restricted diet and the possible noxious effects of high plasma Phe concentrations on bone have previously been suggested as possible determinant factors. Since osteoclasts are involved in bone reabsorption, they could play a role in determining bone damage in PKU. The reported increased excretion of bone resorption markers in PKU patients is consistent with this hypothesis. Although different diseases characterized by bone loss have been related to increased spontaneous osteoclastogenesis from peripheral blood mononuclear cells (PBMCs), to date there is no evidence of increased osteoclast formation in PKU. In this study, we compared the spontaneous osteoclastogenesis from PBMCs in 20 patients affected by PKU with that observed in age- and sex-matched healthy subjects. Phenylketonuric patients showed the number of osteoclasts to be almost double that observed in controls (159.9 ± 79.5 and 87.8 ± 44.7, respectively; p = 0.001). Moreover, a strict direct correlation between the spontaneous osteoclastogenesis in PKU patients and the mean blood Phe concentrations in the preceding year was observed (r = 0.576; p = 0.010). An imbalance between bone formation and bone resorption might explain, at least in part, the pathogenesis of bone loss in this disease. These findings could provide new insights into the biological mechanisms underlying bone damage in PKU.
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Affiliation(s)
- F Porta
- Department of Pediatrics, University of Turin, Turin, Italy.
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Porta F, Forino C, De Martiis D, Soncini E, Notarangelo L, Tettoni K, D'Ippolito C, Soresina R, Shiha K, Berta S, Baffelli R, Bolda F, Bosi A, Schumacher FR, Lanfranchi A, Mazzolari E. Stem cell transplantation for primary immunodeficiencies. Bone Marrow Transplant 2008; 41 Suppl 2:S83-6. [PMID: 18545252 DOI: 10.1038/bmt.2008.61] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BMT is curative in almost 75% of children affected by severe primary immunodeficiencies (PIDs). Recently, the chance of cure has increased thanks to the availability of matched unrelated donors (MUDs). Nevertheless, besides the conventional indications to BMT (profound or absent T-cell function, profound or absent natural killer function, known syndromes with T-cell deficiencies), indications to BMT for PIDs affecting the quality of life or having an expectation of life that does not exceed the third-fourth decade remain unclear. Infact, if it is evident that the survival rate in an infant grafted for a PID with a MUD is expected to be more than 80%, alternative treatments such as gene therapy are now available.
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Affiliation(s)
- F Porta
- Oncology-Haematology and BMT Unit, Ospedale dei Bambini, Spedali Civili, Brescia.
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Nyberg A, Jakob SM, Seeman-Lodding H, Porta F, Bracht H, Bischofberger H, Jern C, Takala J, Aneman A. Time- and dose-related regional fluxes of tissue-type plasminogen activator in anesthetized endotoxemic pigs. Acta Anaesthesiol Scand 2008; 52:57-64. [PMID: 17999715 DOI: 10.1111/j.1399-6576.2007.01481.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute endotoxinemia elicits an early fibrinolytic response. This study analyzes the effects of the dose and duration of endotoxin infusion on arterial levels of tissue-type plasminogen activator (tPA) and pulmonary, mesenteric and hepatic plasma tPA fluxes. METHODS Pigs were randomized to receive an acute, high-dose (for 6 h, n=13, high ETX) or a prolonged, low-dose (for 18 h, n=18, low ETX) infusion of endotoxin or saline vehicle alone (for 18 h, n=14, control). All animals were fluid resuscitated to maintain a normodynamic circulation. Systemic and regional blood flows were measured and arterial, pulmonary arterial, portal and hepatic venous blood samples were analyzed to calculate regional net fluxes of tPA. Plasma tumor necrosis factor (TNF-alpha) levels were analyzed. RESULTS Mesenteric tPA release and hepatic uptake increased maximally at 1.5 h in ETX groups related to dose. Maximal mesenteric tPA release [high ETX 612 (138-1185) microg/min/kg, low ETX 72 (32-94) microg/min/kg, median+/-interquartile range] and hepatic tPA uptake [high ETX -1549 (-1134 to -2194) microg/min/kg, low ETX -153 (-105 to -307) microg/min/kg] correlated to TNF-alpha levels. Regional tPA fluxes returned to baseline levels at 6 h in both ETX groups and also remained low during sustained low ETX. No changes were observed in control animals. CONCLUSIONS Endotoxemia induces an early increase in mesenteric tPA release and hepatic tPA uptake related to the severity of endotoxemia. The time patterns of changes in mesenteric and hepatic tPA fluxes are similar in acute high-dose endotoxemia and sustained low-dose endotoxemia.
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Affiliation(s)
- A Nyberg
- Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden
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Vertova A, Cucchi I, Fermo P, Porta F, Proserpio D, Rondinini S. Preparation and electrochemical behaviour of {[Ru(bipy)4Cl2Ag]NO3(CHCl3)·6H2O}n obtained from the self-assembly of trans-Ru(bipy)4Cl2 and AgNO3. Electrochim Acta 2007. [DOI: 10.1016/j.electacta.2006.09.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pai SY, DeMartiis D, Forino C, Cavagnini S, Lanfranchi A, Giliani S, Moratto D, Mazza C, Porta F, Imberti L, Notarangelo LD, Mazzolari E. Stem cell transplantation for the Wiskott-Aldrich syndrome: a single-center experience confirms efficacy of matched unrelated donor transplantation. Bone Marrow Transplant 2006; 38:671-9. [PMID: 17013426 DOI: 10.1038/sj.bmt.1705512] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The treatment of Wiskott-Aldrich syndrome (WAS), a once uniformly fatal disorder, has evolved considerably as the use of hematopoietic stem cell transplant has become more widespread. For the majority of patients who lack an human leukocyte antigen-identical sibling, closely matched unrelated donor bone marrow transplant (MUD BMT) at an early age is an excellent option that nevertheless is not uniformly chosen. We retrospectively analyzed our experience with transplantation in 23 patients with WAS from 1990 to 2005 at the University of Brescia, Italy, of whom 16 received MUD BMT. Myeloablative chemotherapy was well tolerated with median neutrophil engraftment at day 18, and no cases of grade III or IV graft-vs-host disease. Overall survival was very good with 78.2% (18/23) of the whole cohort and 81.2% (13/16) of MUD BMT recipients surviving. Among 18 survivors, full donor engraftment was detected in 12 patients, and stable mixed chimerism in all blood lineages in four patients. Deaths were limited to patients who had received mismatched related BMT or who had severe clinical symptomatology at the time of transplantation, further emphasizing the safety and efficacy of MUD BMT when performed early in the clinical course of WAS.
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Affiliation(s)
- S-Y Pai
- Department of Pediatric Hematology-Oncology, Dana-Farber Cancer Institute and Children's Hospital, Boston, MA, USA
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Acquaviva A, Ciccolallo L, Rondelli R, Balistreri A, Ancarola R, Cozza R, Hadjistilianou D, Francesco SD, Toti P, Pastore G, Haupt R, Carli M, Santoro N, Di Cataldo A, Fiorillo A, Indolfi P, Nucci P, Sandri A, Porta F, Porcaro AB, Tamaro P, Morgese G. Mortality from second tumour among long-term survivors of retinoblastoma: a retrospective analysis of the Italian retinoblastoma registry. Oncogene 2006; 25:5350-7. [PMID: 16936757 DOI: 10.1038/sj.onc.1209786] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Survivors of retinoblastoma (Rb) are at high risk of dying from second malignant tumour. The occurrence of second malignant neoplasm (SMN) and related mortality in a cohort of 1111 cases from the Italian Retinoblastoma Registry was analysed, considering the possible role of both genetic and iatrogenic causes. Rb patients had a greater than 10-fold excess in overall mortality compared with the general population (standardized mortality ratio (SMR) 10.73, 95% CI 9.00-12.80). Their excess risk attributable to cancers other than Rb was 14.93 95% CI 10.38-21.49). Survivors of hereditary Rb had an SMR for all causes of 16.25 (95% CI 13.20-20.00), whereas their SMR for all cancers was 25.72 (95% CI 17.38-38.07). Survivors of unilateral sporadic Rb had an SMR of 4.12 from all cancers (95% CI 1.55-10.98) and a much higher excess for overall mortality (SMR 13.34, 95% CI 10.74-16.56). As expected, survivors of hereditary Rb had higher mortality from cancers of the bone (SMR 391.90, 95% CI 203.90-753.20) and soft tissue (SMR 453.00, 95% CI 203.50-1008.40), small intestine (SMR 1375.50, 95% CI 344.00-5499.70), nasal cavity (SMR 13.71, 95% CI 1.93-97.35) and cancers of the brain and central nervous system (SMR 41.14, 95% CI 13.2-127.55).
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Affiliation(s)
- A Acquaviva
- Italian Retinoblastoma Registry, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.
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Paganelli C, Fontana P, Porta F, Majorana A, Pazzaglia UE, Sapelli PL. Indications on suitable scaffold as carrier of stem cells in the alveoloplasty of cleft palate. J Oral Rehabil 2006; 33:625-9. [PMID: 16856961 DOI: 10.1111/j.1365-2842.2005.01594.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Autologous iliac crest bone is used to close the residual alveolar bone defect in cleft palate patients during late mixed dentition. Surgery involves physical and anaesthesiologic risks, long-time hospitalization, high costs and not always good results (15% failure rate). Alternatives to iliac crest bone grafting are going to be evaluated: synthetic, xenograft and allograft matrices combined with platelet-rich plasma or recombined bone morphogenic proteins for osteoinductivity are commercially available. These alternatives have not yet been determined to be equivalent to the previous treatment. A new field of research is represented by stem cells, which have been also used to regenerate ischaemic cardiac tissue after heart attack, to treat hypophosphatasia and osteoporosis. Our aim was to use osteoblasts from stem cells to close the residual palate cleft in association with a suitable carrier. Stem cells are expanded in the Aastrom bioreactor, differentiated into osteoblasts and positioned in the bone defect by means of a Spongostan scaffold. This scaffold has the best characteristics as commercial availability, low cost, good manageability, absence of allergic reactions or other side effects on patient, biocompatibility, imbibition, radiotransparency, reabsorbability and osteoinductivity. Previous studies encourage Spongostan scaffold application.
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Affiliation(s)
- C Paganelli
- Dental Clinic, University of Brescia, Brescia, Italy
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35
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Mussa A, Porta F, Baldassarre G, Corrias A, Bellone J, de Sanctis C. [Congenital hypopituitarism in agenesis of the anterior pituitary gland: immediate management and follow-up]. Minerva Pediatr 2006; 58:385-9. [PMID: 17008848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We report a case of an infant admitted to our division at 50 days of age, who presented acute abdomen, respiratory insufficiency, skeletal abnormalities, craniofacial dismorphism, low gain of weight. Despite negative at neonatal screening for hypothyroidism, laboratory analyses showed marked decrease of all pituitary hormones but ACTH, and low levels of cortisol. Magnetic resonance was indicative of adenohypophysis agenesis with maintained neurohypophysis. Results of substitutive therapy are reported.
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Affiliation(s)
- A Mussa
- Divisione di Endocrinologia Pediatrica, Ospedale Infantile Regina Margherita, Turin, Italy.
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36
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Mazzolari E, Moshous D, Forino C, De Martiis D, Offer C, Lanfranchi A, Giliani S, Imberti L, Pasic S, Ugazio AG, Porta F, Notarangelo LD. Hematopoietic stem cell transplantation in Omenn syndrome: a single-center experience. Bone Marrow Transplant 2005; 36:107-14. [PMID: 15908971 DOI: 10.1038/sj.bmt.1705017] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We retrospectively analyzed the outcome of hematopoietic stem cell transplantations (HSCT) performed at our Center between 1991 and 2002 in 11 unselected patients with Omenn syndrome, a variant of severe combined immunodeficiency. The patients' mean age at the time of the first HSCT was 8.4 months. Two patients received two, and one patient three, HSCT procedures. The resulting 15 HSCT derived in seven cases from HLA-haploidentical parents, in four patients from matched unrelated donors, in three cases from an HLA phenotypically identical related donor, and in one case from an HLA genotypically identical family donor. Nine out of 11 patients are alive and immunoreconstituted 30-146 months after transplantation. At the time of the most recent evaluation, all of the nine survivors had normal T-cell function, and eight of them had developed normal antibody production. This study demonstrates an overall mortality of 18.2%, which is substantially lower than previously reported. Early recognition of OS, rapid initiation of adequate supportive treatment and HSCT lead to improved outcome for this otherwise fatal disease, regardless of the origin and matching of hematopoietic stem cells.
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Affiliation(s)
- E Mazzolari
- Department of Pediatrics, Children's Hospital, University of Brescia, Italy
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Porta F, Takala J, Kolarova A, Ma Y, Redaelli CA, Brander L, Bracht H, Jakob SM. Oxygen extraction in pigs subjected to low-dose infusion of endotoxin after major abdominal surgery. Acta Anaesthesiol Scand 2005; 49:627-34. [PMID: 15836675 DOI: 10.1111/j.1399-6576.2005.00683.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sepsis may impair O(2) extraction due to blood flow redistribution or decreased utilization of the available oxygen. METHODS We assessed the effect of endotoxemia on systemic and regional O(2) extraction and lactate handling in pigs, randomized to receive either endotoxin (0.4 microg kg(-1) h(-1); n = 10) or saline infusion (controls; n = 9) for 12 h. RESULTS High baseline regional and systemic O(2) extraction in the endotoxin group (median 56%, range 45-77%) and in the controls (67%, 49-72%) was maintained until the end of the experiment (endotoxin group: 60%, 50-71%; controls: 60%, 50-74%) despite hypotension and a decrease in stroke volume in endotoxic animals. Hepatic lactate exchange decreased during endotoxemia from 14 micromol kg(-1) min(-1) (range 10-28 micromol kg(-1) min(-1)) to 10 (range 3-15) micromol kg(-1) min(-1); P < 0.01), but remained stable in the controls, with 13 micromol min(-1) (4-18 micromol min(-1)) at baseline and 7 micromol min(-1) (3-17 micromol min(-1)) after 12 h of saline infusion. CONCLUSIONS The high and sustained oxygen consumption and oxygen extraction in this endotoxemic model speak against any major impairment of hepatosplanchnic or systemic oxygen extraction and oxidative metabolism. The reduced hepatic lactate exchange despite an unchanged hepatic lactate influx suggests altered metabolic activities independent of oxygen consumption.
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Affiliation(s)
- F Porta
- Surgical Research Unit, Dept. of Clinical Research and Clinic for Large Animals, University of Berne, CH-3010 Berne, Switzerland
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Iapichino G, Radrizzani D, Pezzi A, Assi E, Di Mauro P, Mistraletti G, Porta F. Evaluating daily nursing use and needs in the intensive care unit: a method to assess the rate and appropriateness of ICU resource use. Health Policy 2004; 73:228-34. [PMID: 15978965 DOI: 10.1016/j.healthpol.2004.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2004] [Accepted: 11/09/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND We designed a tool to measure the rate and appropriateness of intensive care unit (ICU) nursing coverage as a proxy for the use of resources. METHODS We tested the tool in 32 Italian ICUs during a cross-sectional study (4 days/week, October 2001 and April 2002). The level of care was classified as high or low. The appropriate patient-to-nurse ratio for both levels (2/1 and 3/1 in this ICU mix) was defined. The provided and theoretical nurse assistance was computed, the difference between the two quantifying the ICU use of personnel: a positive difference means over-utilization, a negative one under-utilization. We calculated the maximum number of high-level and low-level care days available for ICU and the relative utilization rates. These two rates quantify the appropriateness of resource use in relation to the planned use. RESULTS Analysing 5783 treatment-days, the tool identified units using almost all available resources (five), overcrowded (14: too small units) or empty (16: too big). Units were overcrowded on account of the high-level of care required (five: utilization rate >100%) or reallocated too much of their residual high-care nursing capacity to low-level care (six). In empty units both utilization rates were lower than expected. CONCLUSIONS The method quantifies the rate and appropriateness of resource usage and suggests the best management in units with fixed human resources or a fixed number of beds.
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Affiliation(s)
- G Iapichino
- Istituto di Anestesiologia e Rianimazione dell'Università degli Studi di Milano, Azienda Ospedaliera-Polo Universitario San Paolo, via A. di Rudinì 8, 20142 Milano, Italy.
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Ardizzone S, Bianchi C, Cappelletti G, Porta F. Liquid-phase catalytic activity of sulfated zirconia from sol–gel precursors: the role of the surface features. J Catal 2004. [DOI: 10.1016/j.jcat.2004.07.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Mazzolari E, Porta F, Forino C, Gandellini F, Maffeis B, Caldiani C, Rodriguez C, Lanfranchi A. One hundred children undergoing allogeneic bone marrow transplantation with cyclopsporin (Neoral) by mouth. Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2003.12.199] [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: 11/29/2022]
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41
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Lanfranchi A, Verardi R, Baggio E, Mazzolari E, Porta F. Haploidentical transplants from positively selected bone marrow haematopoietic stem cells: report of 20 cases. Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2003.12.201] [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: 11/16/2022]
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42
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Driessen GJA, Gerritsen EJA, Fischer A, Fasth A, Hop WCJ, Veys P, Porta F, Cant A, Steward CG, Vossen JM, Uckan D, Friedrich W. Long-term outcome of haematopoietic stem cell transplantation in autosomal recessive osteopetrosis: an EBMT report. Bone Marrow Transplant 2003; 32:657-63. [PMID: 13130312 DOI: 10.1038/sj.bmt.1704194] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A retrospective analysis was made of 122 children who had received an allogeneic haematopoietic stem cell transplantation (HSCT) for autosomal recessive osteopetrosis between 1980 and 2001. The actuarial probabilities of 5 years disease free survival were 73% for recipients of a genotype HLA-identical HSCT (n=40), 43% for recipients of a phenotype HLA-identical or one HLA-antigen mismatch graft from a related donor (n=21), 40% for recipients of a graft from a matched unrelated donor (n=20) and 24% for patients who received a graft from an HLA-haplotype-mismatch related donor (n=41). In the latter group, a trend towards improvement was achieved at the end of the study period (17% before 1994, 45% after 1994, P=0.11). Causes of death after HSCT were graft failure and early transplant-related complications. Severe visual impairment was present in 42% of the children before HSCT. Conservation of vision was better in children transplanted before the age of 3 months. Final height was related to height at the time of HSCT and better preserved in children transplanted early. Most children attended regular school or education for the visually handicapped. At present, HSCT is the only curative treatment for autosomal recessive osteopetrosis and should be offered as early as possible.
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Affiliation(s)
- G J A Driessen
- Department of Pediatrics, Medical Center Rijnmond-Zuid, Rotterdam, The Netherlands
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Locatelli F, Zecca M, Messina C, Rondelli R, Lanino E, Sacchi N, Uderzo C, Fagioli F, Conter V, Bonetti F, Favre C, Porta F, Giorgiani G, Pession A. Improvement over time in outcome for children with acute lymphoblastic leukemia in second remission given hematopoietic stem cell transplantation from unrelated donors. Leukemia 2002; 16:2228-37. [PMID: 12399966 DOI: 10.1038/sj.leu.2402690] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2002] [Accepted: 06/05/2002] [Indexed: 11/09/2022]
Abstract
Aims of this study were to verify whether reduction in transplant-related mortality (TRM) of children with acute lymphoblastic leukemia (ALL) in second complete remission (CR) given allogeneic hematopoietic stem cell transplantation (HSCT) from unrelated volunteers has occurred over time and to investigate the role of other variables on the probabilities of relapse, TRM and event-free survival (EFS). We compared results obtained in 26 children given HSCT before January 1998 with those of 37 patients transplanted beyond that date. In all donor-recipient pairs, histocompatibility was determined by serology for HLA-A and -B antigens and by high-resolution DNA typing for DRB1 antigen. High-resolution molecular typing of HLA class I antigens was employed in 20 of the 37 children transplanted more recently. Probability of both acute and chronic GVHD was comparable in the two groups of patients. In multivariate analysis, children transplanted before January 1998, those with T-lineage ALL and those experiencing grade II-IV acute GVHD had a higher relative risk of TRM at 6 months after transplantation. Relapse rate was unfavorably affected by a time interval between diagnosis and relapse <30 months. The 2-year probability of EFS for children transplanted before and after 1 January 1998 was 27% (10-44) and 58% (42-75), respectively (P = 0.02), this difference remaining significant in multivariate analysis. EFS of unrelated donor HSCT in children with ALL in second CR has improved in the last few years, mainly due to a decreased TRM. This information is of value for counseling of patients with relapsed ALL.
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Affiliation(s)
- F Locatelli
- Oncoematologia Pediatrica, IRCCS Policlinico San Matteo, Università di Pavia, Italy
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46
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Proserpio D, Carlucci L, Ciani G, Porta F. New polymeric architectures assembled with tetra(4-pyridyl)porphirine building blocks. Acta Crystallogr A 2002. [DOI: 10.1107/s010876730209342x] [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: 11/10/2022] Open
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47
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Iapichino G, Radrizzani D, Ferla L, Pezzi A, Porta F, Zanforlin G, Miranda DR. Description of trends in the course of illness of critically ill patients. Markers of intensive care organization and performance. Intensive Care Med 2002; 28:985-9. [PMID: 12349820 DOI: 10.1007/s00134-002-1331-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify objective trends of the course of illness that might be used as benchmarks in the auditing of the organization/performance of Intensive Care Units (ICU). DESIGN Retrospective analysis. PATIENTS AND SETTING A group of 12,615 patients and 55,464 patient-days prospectively collected in 89 ICUs of 12 European countries. METHODS The complexity of daily care in the ICU was classified as high (HT) or low (LT), according to six activities registered in NEMS,a daily therapeutic index for ICUs. RESULTS Six trends of clinical course were identified: LT during the whole ICU stay (5,424 patients, mortality 1.8%); HT (3,480 patients, mortality 30.4%); HT followed by LT (2,781 patients, mortality 2.8%); LT followed by HT (197 patients, mortality 39.1%); finally, LT/HT/LT in 298 patients (mortality 10.5%); and HT/LT/HT (mortality 20.1%) in 438 patients. A group of 930 patients had the complexity of treatment increased (mortality 21.1%) and 3,711 patients received both treatments. Low-care before high-care periods had a mean duration of 2.2 +/- 3.5 days, low-care after high-care 2.7 +/- 3.1 days, and between two high-care periods 2.1 +/- 2.2 days. A group of 1,538 'surgical scheduled' patients only received LT, whereas 2,231 received HT (whether or not exclusively). Overall ICU mortality rate was low (3%) and the length of stay short, regardless of diagnosis and complexity of care received. CONCLUSIONS The use of therapeutic indexes help to classify the daily complexity of ICU care. The classification can be used as an indicator of clinical performance and resource utilization.
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Affiliation(s)
- G Iapichino
- Cattedra di Anestesiologia e Rianimazione dell'Università di Milano, Azienda Ospedaliera--Polo Universitario San Paolo, Milan, Italy.
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48
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Fantucci P, Pizzotti M, Porta F. Electronic and geometrical structures of nitroso ligands coordinated to transition-metal atoms. A nonempirical theoretical study of bis(phosphino)(nitrosotrifluoromethane)platinum and bis(phosphine)(nitrosomethane)platinum. Inorg Chem 2002. [DOI: 10.1021/ic00010a011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bartolomé J, Porta F, Lafranchi A, Rodríguez-Molina JJ, Cela E, Cantalejo A, Fernández-Cruz E, Gómez-Pineda A, Ugazio AG, Notarangelo LD, Gil J. B cell function after haploidentical in utero bone marrow transplantation in a patient with severe combined immunodeficiency. Bone Marrow Transplant 2002; 29:625-8. [PMID: 11979315 DOI: 10.1038/sj.bmt.1703410] [Citation(s) in RCA: 20] [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] [Received: 08/30/2001] [Accepted: 01/15/2002] [Indexed: 11/08/2022]
Abstract
An in utero paternal CD34(+) cell transplant was performed in a T-B+NK+ SCID fetus. We report here the results of the 3-year humoral immune reconstitution study. The methods used were ApoB VNTR typing, flow cytometry, nephelometry, hemagglutination, ELISA, ELISPOT and lymphoproliferative assays. The T cells were of donor origin whereas monocytes, B and NK cells were of host origin. Peripheral B cell counts and IgM levels were normal since birth. IVIG therapy was required at 5 months of age until 2 years old. IgA levels > or =20 mg/dl were detected from month 17 post transplantation. Isohemagglutinins were present since month 8 post transplantation, the highest titers (anti-A:1/128, anti-B:1/32) were obtained at month 33 post-transplantation. After immunization with rHBsAg, circulating anti-HBsAg IgG secreting cells and a 7.8-fold increase in serum anti-HBsAg Ab were detected. We conclude that split chimerism following in utero haploidentical BMT allows complete humoral immune reconstitution in a T-B+NK+ SCID patient.
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Affiliation(s)
- J Bartolomé
- Division of Immunology, Hospital General Universitario 'Gregorio Marañón', Madrid, Spain
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50
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Balduzzi A, Valsecchi MG, Silvestri D, Locatelli F, Manfredini L, Busca A, Iori AP, Messina C, Prete A, Andolina M, Porta F, Favre C, Ceppi S, Giorgiani G, Lanino E, Rovelli A, Fagioli F, De Fusco C, Rondelli R, Uderzo C. Transplant-related toxicity and mortality: an AIEOP prospective study in 636 pediatric patients transplanted for acute leukemia. Bone Marrow Transplant 2002; 29:93-100. [PMID: 11850701 DOI: 10.1038/sj.bmt.1703337] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2001] [Accepted: 10/19/2001] [Indexed: 11/08/2022]
Abstract
Hematopoietic stem cell transplantation can cure high-risk acute leukemia (AL), but the occurrence of non-leukemic death is still high. The AIEOP conducted a prospective study in order to assess incidence and relationships of early toxicity and transplant-related mortality (TRM) in a pediatric population. Between 1990 and 1997 toxicities reported in eight organs (central nervous system, heart, lungs, liver, gut, kidneys, bladder, mucosa) were classified into three grades (mild, moderate, severe) and prospectively registered for 636 consecutive children who underwent autologous (216) or allogeneic (420) transplantation, either from an HLA compatible related (294), or alternative (126) donor in 13 AIEOP transplant centers. Overall, 47% of the patients are alive in CR (3-year EFS: 45.2%, s.e.: 2.1), 19% died in CR at a median of 60 days (90-day TRM: 14.3%, s.e.: 1.4), 34% relapsed. Toxicity of any organ, but mucosa and gut, was positively correlated with early death; moderate and severe toxicity to heart, lungs, liver and kidneys significantly increased early TRM, with estimated relative risks of 9.1, 5.5, 2.7 and 2.8, respectively, as compared to absent or mild toxicity. Patients with grade III-IV aGVHD experienced more than double (56% vs. 19%) TRM than patients with grade 0-II aGVHD. A higher cumulative toxicity score, estimating the impact of toxicity on TRM, was significantly associated with transplantation from an alternative donor. Quantitative assessment allowed us to describe the extent to which 'grade' of toxicity and 'type' of involved organs were related to mortality and pre-transplant characteristics and yielded a prognostic score potentially useful to compare different conditioning regimens and predict probability of early death.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Female
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Infant
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Organ Specificity
- Prospective Studies
- Registries
- Risk Factors
- Severity of Illness Index
- Survival Analysis
- Transplantation, Autologous
- Transplantation, Homologous
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Affiliation(s)
- A Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano-Bicocca, Centro Trapianto Midollo Osseo, Monza, Italy
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