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Matassini MV, Marini M, Angelozzi A, Angelini L, Shkoza M, Compagnucci P, Falanga U, Battistoni I, Pongetti G, Francioni M, Piva T, Mucaj A, Nicolini E, Maolo A, Di Eusanio M, Munch C, Dello Russo A, Perna G. Clinical outcomes and predictors of success with Impella weaning in cardiogenic shock: a single-center experience. Front Cardiovasc Med 2023; 10:1171956. [PMID: 37416919 PMCID: PMC10321515 DOI: 10.3389/fcvm.2023.1171956] [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: 02/22/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Cardiogenic shock (CS) is a severe syndrome with poor prognosis. Short-term mechanical circulatory support with Impella devices has emerged as an increasingly therapeutic option, unloading the failing left ventricle (LV) and improving hemodynamic status of affected patients. Impella devices should be used for the shortest time necessary to allow LV recovery because of time-dependent device-related adverse events. The weaning from Impella, however, is mostly performed in the absence of established guidelines, mainly based on the experience of the individual centres. Methods The aim of this single center study was to retrospectively evaluate whether a multiparametrical assessment before and during Impella weaning could predict successful weaning. The primary study outcome was death occurring during Impella weaning and secondary endpoints included assessment of in-hospital outcomes. Results Of a total of 45 patients (median age, 60 [51-66] years, 73% male) treated with an Impella device, 37 patients underwent impella weaning/removal and 9 patients (20%) died after the weaning. Non-survivors patients after impella weaning more commonly had a previous history of known heart failure (p = 0.054) and an implanted ICD-CRT (p = 0.01), and were more frequently treated with continuous renal replacement therapy (p = 0.02). In univariable logistic regression analysis, lactates variation (%) during the first 12-24 h of weaning, lactate value after 24 h of weaning, left ventricular ejection fraction (LVEF) at the beginning of weaning, and inotropic score after 24 h from weaning beginning were associated with death. Stepwise multivariable logistic regression identified LVEF at the beginning of weaning and lactates variation (%) in the first 12-24 h from weaning beginning as the most accurate predictors of death after weaning. The ROC analysis indicated 80% accuracy (95% confidence interval = 64%-96%) using the two variables in combination to predict death after weaning from Impella. Conclusions This single-center experience on Impella weaning in CS showed that two easily accessible parameters as LVEF at the beginning of weaning and lactates variation (%) in the first 12-24 h from weaning begin were the most accurate predictors of death after weaning.
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Affiliation(s)
- M. V. Matassini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Marini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Angelozzi
- Unit of Cardiology and Cardiac Intensive Therapy, Cardiovascular Department, G. Mazzini Hospital, Teramo, Italy
| | - L. Angelini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Shkoza
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - P. Compagnucci
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - U. Falanga
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - I. Battistoni
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - G. Pongetti
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Francioni
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - T. Piva
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Mucaj
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - E. Nicolini
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Maolo
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Di Eusanio
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - C. Munch
- Anaesthesia and Cardiac Surgery Intensive Care, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Dello Russo
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - G. Perna
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
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Boriani G, Guerra F, De Ponti R, D'Onofrio A, Accogli M, Bertini M, Bisignani G, Forleo GB, Landolina M, Lavalle C, Notarstefano P, Ricci RP, Zanotto G, Palmisano P, De Bonis S, Pangallo A, Talarico A, Maglia G, Aspromonte V, Nigro G, Bianchi V, Rapacciuolo A, Ammendola E, Solimene F, Stabile G, Biffi M, Ziacchi M, Malpighi PSO, Saporito D, Casali E, Turco V, Malavasi VL, Vitolo M, Imberti JF, Bertini M, Anna AS, Zardini M, Placci A, Quartieri F, Bottoni N, Carinci V, Barbato G, De Maria E, Borghi A, Ramazzini OB, Bronzetti G, Tomasi C, Boggian G, Virzì S, Sassone B, Corzani A, Sabbatani P, Pastori P, Ciccaglioni A, Adamo F, Scaccia A, Spampinato A, Patruno N, Biscione F, Cinti C, Pignalberi C, Calò L, Tancredi M, Di Belardino N, Ricciardi D, Cauti F, Rossi P, Cardinale M, Ansalone G, Narducci ML, Pelargonio G, Silvetti M, Drago F, Santini L, Pentimalli F, Pepi P, Caravati F, Taravelli E, Belotti G, Rordorf R, Mazzone P, Bella PD, Rossi S, Canevese LF, Cilloni S, Doni LA, Vergara P, Baroni M, Perna E, Gardini A, Negro R, Perego GB, Curnis A, Arabia G, Russo AD, Marchese P, Dell’Era G, Occhetta E, Pizzetti F, Amellone C, Giammaria M, Devecchi C, Coppolino A, Tommasi S, Anselmino M, Coluccia G, Guido A, Rillo M, Palamà Z, Luzzi G, Pellegrino PL, Grimaldi M, Grandinetti G, Vilei E, Potenza D, Scicchitano P, Favale S, Santobuono VE, Sai R, Melissano D, Candida TR, Bonfantino VM, Di Canda D, Gianfrancesco D, Carretta D, Pisanò ECL, Medico A, Giaccari R, Aste R, Murgia C, Nissardi V, Sanna GD, Firetto G, Crea P, Ciotta E, Sgarito G, Caramanno G, Ciaramitaro G, Faraci A, Fasheri A, Di Gregorio L, Campsi G, Muscio G, Giannola G, Padeletti M, Del Rosso A, Notarstefano P, Nesti M, Miracapillo G, Giovannini T, Pieragnoli P, Rauhe W, Marini M, Guarracini F, Ridarelli M, Fedeli F, Mazza A, Zingarini G, Andreoli C, Carreras G, Zorzi A, Zanotto G, Rossillo A, Ignatuk B, Zerbo F, Molon G, Fantinel M, Zanon F, Marcantoni L, Zadro M, Bevilacqua M. Five waves of COVID-19 pandemic in Italy: results of a national survey evaluating the impact on activities related to arrhythmias, pacing, and electrophysiology promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing). Intern Emerg Med 2023; 18:137-149. [PMID: 36352300 PMCID: PMC9646282 DOI: 10.1007/s11739-022-03140-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The subsequent waves of the COVID-19 pandemic in Italy had a major impact on cardiac care. METHODS A survey to evaluate the dynamic changes in arrhythmia care during the first five waves of COVID-19 in Italy (first: March-May 2020; second: October 2020-January 2021; third: February-May 2021; fourth: June-October 2021; fifth: November 2021-February 2022) was launched. RESULTS A total of 127 physicians from arrhythmia centers (34% of Italian centers) took part in the survey. As compared to 2019, a reduction in 40% of elective pacemaker (PM), defibrillators (ICD), and cardiac resynchronization devices (CRT) implantations, with a 70% reduction for ablations, was reported during the first wave, with a progressive and gradual return to pre-pandemic volumes, generally during the third-fourth waves, slower for ablations. For emergency procedures (PM, ICD, CRT, and ablations), recovery from the initial 10% decline occurred in most cases during the second wave, with some variability. However, acute care for atrial fibrillation, electrical cardioversions, and evaluations for syncope showed a prolonged reduction of activity. The number of patients with devices which started remote monitoring increased by 40% during the first wave, but then the adoption of remote monitoring declined. CONCLUSIONS The dramatic and profound derangement in arrhythmia management that characterized the first wave of the COVID-19 pandemic was followed by a progressive return to the volume of activities of the pre-pandemic periods, even if with different temporal dynamics and some heterogeneity. Remote monitoring was largely implemented during the first wave, but full implementation is needed.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41121, Modena, Italy.
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo-University of Insubria, Varese, Italy
| | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy
| | | | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara "Arcispedale S. Anna", Cona, Ferrara, Italy
| | - Giovanni Bisignani
- Cardiology Division, Castrovillari Hospital, ASP Cosenza, Castrovillari, Italy
| | | | | | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Rome, Italy
| | | | | | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, Legnago, Verona, Italy
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Belfioretti L, Marini M, Francioni M, Battistoni I, Angelini L, Matassini MV, Angelozzi A, Pongetti G, Shkoza M, Piva T, Compagnucci P, Munch C, Dello Russo A, Di Eusanio M, Perna GP. Temporal trend mortality and in-hospital mortality predictors in an ischemic cardiogenic shock population: a 10 years single-centre retrospective study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiogenic shock (CS) after acute myocardial infarction (AMI) is a life-threatening condition with an high rate of in-hospital mortality.
Purpose
This study aims to 1) describe predictors of in-hospital mortality; 2) evaluate ten years mortality temporal trend in our Cardiac Intensive Care Unit (CICU); 3) assess the feasibility of CARDSHOCK risk score in our population; 4) elaborate a simpler version of CARDSHOCK risk score.
Methods
All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single-centre retrospective study.
Results
We included 167 patients [males 67%; age 71 (61–80) years] with ischemic CS. Patients had severe LV dysfunction in 66%. Baseline serum lactate was 5.2 (3.1–8.8) mmol/L. All patients required inotropes: 71% required dopamine [mean dose 5.6 (2.4–11,3) mcg/kg/min], 65% required noradrenaline [mean dose 0.10 (0.05–0.18) mcg/kg/min], 32% required dobutamine [mean dose 4.5 (2.2–15.9) mcg/kg/min]; 17.4% received levosimendan alone [mean dose 0.1 mcg/kg/min]. Mechanical cardiac support (MCS) was pursued in 91.1% [65% IABP, 23% Impella CP, 4% VA-ECMO]. From March 2012 to July 2021 we observed a significative temporal trend mortality reduction (OR=0.90, 95% CI: 0.84–0.96, p=0.0015), in particular in-hospital mortality has reduced from 57% of first time-quartile to 29% of the fourth quartile (Figure 1). In addition we also noted a significant increase in Impella catheter use (p=0.0005) with a consequent reduction of IABP (p=0.01), a reduction in dopamine administration (p=0.0007) and a greater use of dobutamine and levosimendan (p=0.015 and p=0.0001). In our population of AMI-CS patients CARDSHOCK risk score was a reliable in-hospital mortality predictor tool (OR 1.11; 95% CI, 1.06–1.17; p=0.00011). After the multivariate analysis only ejection fraction (EF) at baseline (OR=0.99, 95% CI: 0.98–0.99, p=0.009), lactate level at presentation (OR=1.03, 95% CI: 1.01–1.06, p=0.015) and presence of three-vessels coronary artery disease (OR=0.73, 95% CI: 0.59–0.90, p=0.0038) resulted to be in-hospital mortality predictors. For this reason, a prediction model composed by those three variables was created which exhibited better predictive performance for in-hospital mortality than Cardshock risk score (AUC of 0.94 vs AUC of 0.72 respectively, p=0.015) (Figure 2).
Conclusions
In our retrospective single-centre study a significant reduction of mortality through the years is observed, probably due to more extensive use of micro axial pumps and better manipulation of inotropic drug therapies. The use of Cardshock risk score has been proven to be a feasible tool in prediction on in-hospital mortality also in our sample composed only of AMI-CS patients. In addition, a more simplified risk score made up of only three clinical variables demonstrates at least the same predictive performance. Future validation in a larger population could be advisable to validate the simplified score.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Belfioretti
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - M Marini
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - M Francioni
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - I Battistoni
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - L Angelini
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - M V Matassini
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - A Angelozzi
- G. Mazzini Hospital, Cardiology , Teramo , Italy
| | - G Pongetti
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - M Shkoza
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - T Piva
- Riuniti Hospital of Ancona, Interventional Cardiology , Ancona , Italy
| | - P Compagnucci
- University Hospital Riuniti of Ancona, Cardiology and Arrhythmology Clinic , Ancona , Italy
| | - C Munch
- Riuniti Hospital of Ancona, Cardiac Anaesthesia and Intensive Care Unit , Ancona , Italy
| | - A Dello Russo
- University Hospital Riuniti of Ancona, Cardiology and Arrhythmology Clinic , Ancona , Italy
| | - M Di Eusanio
- Riuniti Hospital of Ancona, Cardiac Surgery Unit , Ancona , Italy
| | - G P Perna
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
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Maglia G, Giammaria M, Zanotto G, D’onofrio A, Della Bella P, Marini M, Rovaris G, Iacopino S, Calvi V, Pisano’ EC, Caravati F, Balestri G, Giacopelli D, Gargaro A, Biffi M. Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in women: a propensity score-matched analysis. Europace 2022. [DOI: 10.1093/europace/euac053.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The implantable cardioverter-defibrillator (ICD) is an established therapy for the prevention of sudden cardiac death in selected patients. Although current guidelines apply to both women and men, there is a growing awareness that the incidence of cardiac arrhythmias and device interventions is influenced by sex.
Purpose
To investigate sex-specific risk of sustained ventricular arrhythmias (SVAs) and device therapies, using remote monitoring data from ICDs and cardiac resynchronization therapy defibrillators (CRT-Ds).
Methods
Study endpoints were time to the first appropriate SVA, time to the first appropriate device therapy for SVA, and time to the first ICD shock. Appropriateness of device-detected SVAs was adjudicated by three expert electrophysiologists. Results were compared between women and a 1:1 propensity score (PS)-matched subgroup of men.
Results
In a cohort of 2,532 patients with an ICD or CRT-D (median age, 70 years), 488 patients (19.3%) were women. As compared to men, women more frequently had a CRT-D (51% vs. 40%, p<0.001), and nonischemic cardiomyopathy (65% vs. 45%, p<0.001). After a median follow-up of 2.1 years, SVAs occurred in 123 women (25.2%) and in 174 of the 488 PS-matched men (35.6%) with an adjusted hazard ratio (HR) of 0.65 (95% confidence interval [CI], 0.51-0.81; p<0.001). Women also showed a reduced risk of any device therapy (HR, 0.59; CI, 0.45-0.76; p<0.001) and shocks (HR, 0.66; CI, 0.47-0.94, p=0.021). Differences in sex-specific SVA risk profile were not confirmed in CRT-D patients (HR, 0.78; CI, 0.55-1.09; p=0.14) and in those with an ejection fraction <30% (HR, 0.80; CI, 0.52-1.23; p=0.31).
Conclusion
In our analysis of remote monitoring data, women exhibited a lower SVA risk profile than PS-matched men in the subgroup of patients with an ICD or/and ejection fraction ≥30%.
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Affiliation(s)
- G Maglia
- Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | | | - G Zanotto
- Mater Salutis Hospital, Legnago, Italy
| | - A D’onofrio
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | | | - M Marini
- Santa Chiara Hospital in Trento, Trento, Italy
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - V Calvi
- Azienda O.U. Policlinico G. Rodolico - San Marco, Catania, Italy
| | | | - F Caravati
- Circolo Hospital and Macchi Foundation of Varese, Varese, Italy
| | | | | | | | - M Biffi
- S. Orsola-Malpighi Policlinic, Bologna, Italy
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Tedoldi F, Branzoli S, D"onghia G, Fanti D, Sarao E, Guarracini F, Quintarelli S, Graffigna A, Bonmassari R, La Meir M, Monaco C, De Asmundis C, Marini M. Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in af patients with absolute contraindication to oral anticoagulation therapy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Left atrial appendage (LAA) is the source of more than 90% of thrombi in patients with atrial fibrillation (AF). The Totally Thoracoscopic (TT) LAA exclusion with epicardial clip has become a safe and effective procedure, but the effect on left atrial (LA) function remains unknown.
Purpose
The aim of this study was to assess the effect of TT LAA exclusion on LA function.
Methods
20 patients (15 males) with non-valvular AF and contraindication to oral anticoagulation therapy (OAT) or antiplatelet therapy underwent standalone TT LAA exclusion with the Atriclip Pro II device. All patients were screened preoperatively with 3D CT scan, trans-esophageal echocardiography, spirometry and cerebrovascular doppler ultrasound. Intraoperative Atriclip Pro II positioning and LAA exclusion were guided and confirmed by trans-esophageal echo. To objectify LA function, transthoracic echocardiography with 2D Speckle tracking was performed before surgery, at discharge and at 3-month follow-up. All patients were not on anticoagulation nor antiplatelet therapy at the time of surgery, at discharge and at control visit.
Results
Baseline characteristics are reported in Table I. There were no major complications during the procedures. One non cardiovascular death, one minor stroke and 4 hospitalizations occur at 1-year follow up. The reservoir LA function considering the strain measurements dramatically decreased few days after the procedure and it recovered at 3-month follow-up compared to baseline, even though the LA volume is augmented (Table II). Furthermore, NT pro-BNP increased and ventricular strain decreased significantly after the procedure recovering over time.
Conclusion
TT LAA exclusion with Atriclip Pro II device is a safe and effective procedure in preventing AF related stroke in patients with contraindication to OAT. Our findings suggest that the LAA epicardial clip impairs immediately the reservoir LA function that recovers over time. Abstract Table I Abstract Table II
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Affiliation(s)
- F Tedoldi
- Santa Chiara Hospital in Trento, Trento, Italy
| | - S Branzoli
- Santa Chiara Hospital in Trento, Trento, Italy
| | - G D"onghia
- Santa Chiara Hospital in Trento, Trento, Italy
| | - D Fanti
- Santa Chiara Hospital in Trento, Trento, Italy
| | - E Sarao
- Santa Chiara Hospital in Trento, Trento, Italy
| | | | | | - A Graffigna
- Santa Chiara Hospital in Trento, Trento, Italy
| | | | - M La Meir
- Vrije University Brussels, Brussels, Belgium
| | - C Monaco
- Vrije University Brussels, Brussels, Belgium
| | | | - M Marini
- Santa Chiara Hospital in Trento, Trento, Italy
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6
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Branzoli S, Marini M, Guarracini F, D'Onghia G, Penzo D, Graffigna A, Piffer S, Bonmassari R, La Meir M. An heart team stroke prevention decision-making process comparing percutaneous endocardial and thoracoscopic epicardial left atrial appendage occlusion. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Left atrial appendage occlusion (LAAO) is a validated therapeutic option in patients with atrial fibrillation (AF) at high thrombo-embolic risk and contraindication to oral anticoagulation. Large clinical trials have demonstrated excellent efficacy of percutaneous LAAO, but also stand-alone thoracoscopic LAAO has shown promising results with the advantage of absence of antiplatelet therapy. No direct comparison of both strategies has been published yet.
Purpose
To evaluate an Atrial Fibrillation Heart Team guided approach to percutaneous or thoracoscopic left appendage exclusion in patients with non valvular atrial fibrillation (NVAF).
Methods
Forty patients with a contraindication to oral anticoagulation (OAC) were evaluated in the AF Heart Team for LAA exclusion. Contraindication for OAC was based upon a history of cerebral hemorrhages (n=17), non-cerebral life-threatening hemorrhages (n=9), repetitive bleeding (n=8) and having underlying diseases associated to high bleeding risk (n=6). The 20 patients included in the LAAO-Percutaneous group (LAAO-P) were on low molecular weight heparin pre-procedure, whereas in the LAAO-thoracoscopic group (LAAO-TT) none were on low molecular weight heparin nor antiplatelet therapy since the bleeding risk was estimated too high. The LAAO-P group were 70% male, with a mean age of 72.3±7.5 (range 57–82), mean CHA2DS2VASc 4.2 (range 1–6) and a mean HASBLED 3.5 (range 1–5) with an expected risk of bleeding between 3.7–8.7% per year. The LAAO-TT were 72.5% male, with a mean age of 74.9±8 (range 53–87 years), mean CHA2DS2-VASc 6.05 (range 4–8), HASBLED mean 5.4 (range3–8) expected risk of bleeding >12.5% per year. Variables considered were CHA2DS2VASc, HASBLED, documented blood transfusions, comorbidities related risk of bleeding, anatomy of the LAA, lung function, patient quality of life. LAAO-P patients were on dual antiplatelet therapy (DAT) at discharge for the first three months and aspirine 100mg/day thereafter, whereas the LAAO-TT patients were not. Follow up included TEE at 1 months and CT scan at 3 months.
Results
Mean duration of procedures for LAAO-P was 54.4 minutes, for LAAO-TT 52.01 minutes, mean post procedural ventilation time was respectively 11.2±6.4 and 15.8±16.4 minutes. No major complications occurred in both groups. One patient in the LAAO-P crossed over because of an unsuitable anatomy which became apparent intra-operatively. Mean hospital stay were comparable in both groups, 3.4±0.7 and 3.8±0.9 days respectively. At mean follow up of 24.3±10.1 months (range 5–36) all patients had complete exclusion of the appendage, no neurological events were reported.
Conclusions
The Heart Team can improve decision making in complex stroke prevention where LAAO is a therapeutic option, percutaneous and thoracoscopic occlusion seem to be comparably safe and effective. An epicardial LAAO could be advised in patients were the bleeding risk is estimated too high for AP therapy.
Funding Acknowledgement
Type of funding sources: None. Appendage closure: CT scan viewAppendage closure: surgical view
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Affiliation(s)
- S Branzoli
- Santa Chiara Hospital in Trento, Cardiac Surgery Unit, Trento, Italy
| | - M Marini
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
| | - F Guarracini
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
| | - G D'Onghia
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
| | - D Penzo
- Santa Chiara Hospital in Trento, Anesthesiology, Trento, Italy
| | - A Graffigna
- Santa Chiara Hospital in Trento, Cardiac Surgery Unit, Trento, Italy
| | - S Piffer
- Santa Chiara Hospital in Trento, Neurology, Trento, Italy
| | - R Bonmassari
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
| | - M La Meir
- University Hospital (UZ) Brussels, Cardiac Surgery, Brussels, Belgium
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7
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Emanuele M, Nazzaro G, Marini M, Veronesi C, Boni S, Polletta G, D'Ausilio A, Fadiga L. Motor synergies: Evidence for a novel motor signature in autism spectrum disorder. Cognition 2021; 213:104652. [DOI: 10.1016/j.cognition.2021.104652] [Citation(s) in RCA: 2] [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: 11/16/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 12/15/2022]
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8
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Mazzanti M, Shirka E, Marini M, Pottle A, Goda A, Pugliese F. Prognostic value of a normal Artificial Intelligence applicative response in subjects with stable chest pain. From the ARTICA co-operative registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
An innovative artificial intelligence (AI) Decision Support System (DSS) ESC guidelines based has already been used at point of care with efficacy for evaluating subjects with stable chest pain (SCP) and it has been proved to correctly identify absence of significant coronary artery disease (CAD) versus standard care approach (SD) without known prognostic implication yet.
Purpose
The aim is to determine the prognostic value of “no testing/Follow up” AI DSS response in a referral population evaluated for SCP.
Methods
From 2016 to 2019, an AI DSS ESC guidelines based applicative was used on 1.291 subjects with SCP to determine testing appropriateness compared with human specialist standard evaluation. 590 of them, 332 males, mean age 62±11 years deemed to be completely negative – by “no testing/follow up” response - were evaluated. The negative response was defined and confirmed by a normal Coronary Tomography Angiography scan executed in all these subjects. Mean follow-up was 3.46±1.76 years. Two groups based on pre-test likelihood of having CAD were analyzed – low and intermediate. No subjects with high pre-test likelihood were present. The primary endpoint was cumulative incidence of cardiovascular death, hospitalizations for acute coronary syndrome and coronary revascularizations.
Results
The primary endpoints classification is displayed in the Table. The unadjusted hazard ratio for primary endpoint was 3.84 (95% CI 0.32–8.68, p=0.009) in patients with intermediate compared to those with low pre-test likelihood of CAD. Moreover, the “no testing and Follow up” response showed an incremental prognostic value over conventional risk factors (χ2=7, P=0.022) and over a combination of conventional factors and ST-T changes (χ2=9, P=0.014).
Conclusions
In an outpatient population without known CAD evaluated for chest pain, after the administration of AI DSS, a “No tests/Follow up” confers an excellent prognosis regardless of the ESC SCORE Charts and rest ECG abnormalities. These preliminary data confirms the safety of ARTICA AI DSS use in subjects with stable chest pain.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Mazzanti
- St Bartholomews and Queen Mary University, Cardiac Imaging and Cardiology Dept, London, United Kingdom
| | - E Shirka
- University Hospital Center Mother Theresa, Cardiology, Tirana, Albania
| | - M Marini
- University Hospital Riuniti of Ancona, Lancisi Heart Dept., Ancona, Italy
| | - A Pottle
- Harefield Hospital, Nurse in Cardiology, London, United Kingdom
| | - A Goda
- University Hospital Center Mother Theresa, Cardiology, Tirana, Albania
| | - F Pugliese
- St Bartholomews and Queen Mary University, Cardiac Imaging and Cardiology Dept, London, United Kingdom
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9
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Branzoli S, Guarracini F, Pederzolli C, Pomarolli C, D'Onghia G, Centonze M, Casagranda G, Sarubbo S, Fantinel M, Bonmassari R, Graffigna A, La Meir M, Marini M. Standalone totally thoracoscopic left appendage exclusion for stroke prevention and absolute contraindication to anticoagulation: a referral centre experience. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Left atrial appendage is the source of more than 90% of thrombi in patients with atrial fibrillation (AF). ESC guidelines state as class IIB indication left appendage exclusion in patients with contraindication to oral anticoagulation. Here we give our contribute to the issue of safety and efficacy of standalone totally thoracoscopic left appendage exclusion (TT-LAE) for stroke prevention in patients with contraindication to oral anticoagulant or at risk of life threatening hemorrhage on antiplatelet therapy: a large single Centre experience.
Materials and methods
60 patients with non valvular AF and contraindication to oral anticoagulation (25 cerebral hemorrhages,8 GI bleeding, 18 non cerebral/Gi bleeding requiring multiple transfusions, 2 myelodysplastic syndrome, 7 anatomy unsuitable for percutaneous closure, 75%male, patients age ranged 53–87 years,mean CHAD-VASC 6.4,mean HASBLED range 4.7, type of AF permanent 76.6%, 23.4% longstanding persistent), underwent stand alone totally thoracoscopic appendage exclusion. All patinets enrolled after Heart Team evaluation, were screened preoperatively with 3D CT scan, transesophageal echocardiography, spirometry and cerebrovascuar doppler ultrasound. Intraoperative appendage exclusion were guided and confirmed by transesophageal echo. All patients were not on anticoagulation nor antiplatelet therapy at the time of surgery, at discharge and at control visit. Follow up (range 35–1 months) included outpatient visit and CT scan or TEE at 3–6-12 month in all patients to document LAA exclusion. Perioperative mortality and early and late morbidity in addition to freedom from neurological events at follow up were analyzed by chart evaluation and full outpatient neurological examination including including the Questionnaire for Verifying Stroke Free Status (QVSFS) as validated screening tool.
Results
Mean duration of surgery “skin to skin” was 52.4 minutes; all patients were extubated shortly after the procedure. There were no deaths nor need for blood transfusion or pulmonary procedure related morbidities, only three casea of pericarditis treated with colchicine till complete resolution was documented. On CT or TEE follow up 100% of patients had complete exclusion of the left appendage with minimal residual stumps and no dislodgement of the clip detected. Freedom from neurological events in all patients was documented in absence of anticoagulation or antiplatelet regime from the time of surgery to the time of the follow up visit and questionnaire filling.
Conclusion
Standalone totally thoracoscopic left appendage clipping is a safe and effective procedure for stroke prevention in patients with permanent and longstanding persistent atrial fibrillation with contraindication to oral anticoagulation. Longer follow up and an European registry are needed to, possibly, confirm this preliminary results.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Branzoli
- Santa Chiara Hospital in Trento, Trento, Italy
| | - F Guarracini
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
| | - C Pederzolli
- Santa Chiara Hospital in Trento, Cardiac Surgery Unit, Trento, Italy
| | - C Pomarolli
- Santa Chiara Hospital in Trento, Anesthesiology Department, Trento, Italy
| | - G D'Onghia
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
| | - M Centonze
- Santa Chiara Hospital in Trento, Radiology Service, Trento, Italy
| | - G Casagranda
- Santa Chiara Hospital in Trento, Radiology Service, Trento, Italy
| | - S Sarubbo
- Santa Chiara Hospital in Trento, Neurosurgery Unit, Trento, Italy
| | - M Fantinel
- Santa Maria Hospital, Cardiology Unit, Feltre, Italy
| | - R Bonmassari
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
| | - A Graffigna
- Santa Chiara Hospital in Trento, Cardiac Surgery Unit, Trento, Italy
| | - M La Meir
- UZ Brussel, Cardiac Surgery Department, Bruxelles, Belgium
| | - M Marini
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
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10
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Parollo M, Zucchelli G, Guarracini F, Marini M, Di Cori A, Barletta V, De Lucia R, Segreti L, Bongiorni M. The addition of strict stability criteria does not reduce recurrences after atrial fibrillation ablation using ablation index and can impact on procedure efficiency. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Ablation Index (AI) is a proprietary lesion quality marker that combines power, contact force and time. Recent studies showed that radiofrequency (RF) pulmonary vein isolation (PVI) using AI can deliver high arrhythmia-free survival rates at mid-term follow-up in patients with paroxysmal atrial fibrillation.
Purpose
The aim of this multicenter study was to compare the outcome of three different strategies of PVI using AI (group 1 and 2) or VISITAG module with average force and strict criteria of stability as target parameters (group 3).
Methods
We enrolled 132 consecutive naive patients (97 males, mean age 61,03±9,42) affected by paroxysmal atrial fibrillation who underwent PVI at two high volume centres between January 2017 and February 2019. AI target was set at ≥380 at the posterior wall and ≥500 at the anterior wall. A strict stability criteria (VISITALY criteria: 3 mm for a time of 15 s and a FOT >5 g for 60% of the time) was set for Group 1 procedures (65 patients), whereas Group 2 procedures (67 patients) were carried out with standard stability criteria (VISTAX criteria: 3 mm for a time of 3 s and FOT >3 g for 25% of the time). We then compared those strategies with a historical cohort of 72 patients (40 males, mean age 60,74±8,53) treated at our centres with RF PVI using the VISITAG module with average force and strict stability criteria as target parameters. An interlesion distance ≤6 mm was a target parameter for all procedures. Recurrence was defined as any AF, atrial tachycardia (AT) or atrial flutter (AFL) during the 12 months after ablation, excluding a blanking period of 90 days.
Results
There were no significant differences in terms of age (Group 1 59,2±8,97; Group 2 62,81±9,58; Group 3 60,74±8,53 years) and left atrial area (Group 1 24,16±20,46; Group 2 22,55±12,32; Group 3 20,74±3,84 cm2). Group 1 showed a slightly higher number of males (Group 1 78,46%; Group 2 68,66%; Group 3 55,56%; p=0,004). Procedure duration was significantly lower in Group 2 compared to Groups 1 and 3 (176,67±50,88 vs 224,05±47,21 min, p<0,001; 176,67±50,88 vs 203,96±52,38 min p=0,02). Fluoroscopy time was significantly higher in Group 1 compared with Group 2 (11,85±4,38 vs 10,39±6,4 min; p=0,014). There was a slight trend to have a higher freedom from AF/AT/AFL at 12 months in group 2 compared to the others (Group 1 86,15% vs Group 2 91,04% vs Group 3 84,72%; p=0,2).
Conclusion
A strategy of PVI using AI with standard stability criteria performed the best in terms of procedure efficiency, with a significant benefit in terms of procedure duration, delivering a 12 months arrhythmia-free survival rate comparable with other strategies. Combination of AI with strict stability criteria provided no benefit, at a cost of a higher fluoroscopy time and longer procedure duration.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Parollo
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - G Zucchelli
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - F Guarracini
- Santa Chiara Hospital, Department of Cardiology, Trento, Italy
| | - M Marini
- Santa Chiara Hospital, Department of Cardiology, Trento, Italy
| | - A Di Cori
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - V Barletta
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - R De Lucia
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - L Segreti
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - M.G Bongiorni
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
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11
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Iacoviello M, Marini M, Gori M, Gonzini L, Benvenuto M, Cassaniti L, Municino' A, Navazio A, Ammirati E, Catalano M, Floresta M, Scopelliti G, Nassiacos D, Gorini M, De Maria R. Chronic heart failure in younger patients: temporal trends in clinical characteristics, treatment and outcomes over two decades in a nationwide cardiology registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim of the study
We analyzed the temporal trends in characteristics, therapy and outcomes over two decades of younger chronic heart failure (CHF) patients enrolled in our nationwide registry.
Methods
Among the 14823 CHF patients enrolled in the registry since January 1999 through May 2018, 5465 (37%) were aged<65 years (78% men, 54+9 years, left ventricular ejection fraction (LVEF) 36+11%). Patients were divided into 3 cohorts according with the recruitment epoch: 1999–2005; 2006–2011; 2012–2018. We analyzed trends over time of clinical characteristics, therapy, one-year all-cause mortality, all-cause mortality and/or all-cause hospitalization, all-cause mortality and/or CV hospitalization, and all-cause mortality and/or HF hospitalization.
Results
From 1999 to 2018 the proportion of patients <65 years declined: 42% in first (2288/5404), 37% in second (1464/3971), 31% in third period (1713/5448).
As shown in the Table, the proportion of women, diabetes, ischemic etiology and renin-angiotensin system inhibitor prescription did not change significantly among the three enrollment epochs, whereas preserved LVEF phenotype and prevalence of its driving risk factors increased. The proportion of guideline-recommended drug & device therapies significantly rose over time. All-cause mortality at 1-year follow-up decreased significantly across the 3 epochs studied (Figure).
Conclusions
During 20 years, the clinical characteristics, the implementation of recommended treatments and prognosis of patients <65 years enrolled in a nationwide cardiology registry have deeply changed. These modifications reflect the evolution of cardiovascular risk factors and improved management strategies of CV disease.
Figure 1
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Fondazione per il Tuo cuore – HCF onlus
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Affiliation(s)
| | - M Marini
- University Hospital Riuniti of Ancona, Ancona, Italy
| | - M Gori
- Ospedale Papa Giovanni XXIII, Cardiology Unit, Bergamo, Italy
| | - L Gonzini
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | - M Benvenuto
- G. Mazzini Hospital, Cardiology Unit, Teramo, Italy
| | | | - A Municino'
- Padre A Micone Hospital ASL3, Cardiology Unit, Genoa, Italy
| | - A Navazio
- Santa Maria Nuova Hospital, Cardiology Unit, Reggio Emilia, Italy
| | - E Ammirati
- ASST Great Metropolitan Niguarda, Cardiology 2 - Heart Failure and Transplantation, Milan, Italy
| | - M Catalano
- Cannizzaro Hospital, Cardiology Unit, Catania, Italy
| | - M Floresta
- Ospedale Cervello-Villa Sofia, Cardiology Unit, Palermo, Italy
| | - G Scopelliti
- Alta Val d'Elsa Hospital, Cardiology Unit, Poggibonsi, Italy
| | - D Nassiacos
- Saronno General Hospital, Cardiology Unit, Saronno, Italy
| | - M Gorini
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | - R De Maria
- CNR Institute of Clinical Physiology, ASST Metropolitan Hospital Niguarda, Milan, Italy
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12
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De Maria R, Gori M, Marini M, Gonzini L, Benvenuto M, Cassaniti L, Municino' A, Navazio A, Ammirati E, Gorini M, Leonardi G, Pagnoni N, Montagna L, Midi P, Iacoviello M. Chronic heart failure in octogenarians. Temporal trends in clinical characteristics, treatment and outcomes over two decades in a nationwide cardiology registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Elderly >80 years represent the most rapidly expanding population segment in Europe. Chronic heart failure (CHF) affects over 10% of this group and generates a major M&M burden. We analyzed the temporal trends in characteristics, therapy and outcomes over two decades in octogenarians enrolled in our nationwide registry.
Methods
According to the recruitment epoch, among 14.283 CHF patients first enrolled in the registry since 1–1999 through 5–2018, we divided those aged 80+ (2520,17.6%) into 3 cohorts: 1999–2005 (547, 10%); 2006–2011 (659, 16.5%); 2012–2018 (1314, 14.1%). We analyzed trends over time in characteristics, therapy, 1-year all-cause mortality and proportion admitted to hospital.
Results
From 1999 to 2018 the proportion of 80+ CHF patients (60% men, 84±3 years, LVEF 41±1%, HFrEF 49%) rose from 10% to 24%. Across the 3 epochs (Table 1) we observed a shift towards the HFpEF phenotype with an increase in its driving factors (obesity, diabetes, hypertension, AFib). At the same time, the proportion treated with recommended therapies rose. Cumulative 1-year mortality did not differ across the 3 epochs (Fig.1 top), whereas the proportion of 80+ hospitalized overall, for CV causes and for decompensated HF, declined (Fig. 1 bottom).
Conclusions
During 20 years, the clinical characteristics of octogenarians enrolled in a nationwide CHF registry have deeply changed, reflecting demographic variations, the evolution of CV risk factors and improved management. There was a consistent implementation of BB, MRA and devices. Survival of 80+ remained stable, but the proportion of those hospitalized for CV causes, and specifically decompensated HF, declined. These data suggest that cardiologists' input may contribute to decrease the socioeconomic burden of CHF in the elderly.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Fondazione per il Tuo cuore – Heart Care Foundation (HCF) ONLUS
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Affiliation(s)
- R De Maria
- CNR Institute of Clinical Physiology, Milan, Italy
| | - M Gori
- Ospedale Papa Giovanni XXIII, Cardiologia 1, Bergamo, Italy
| | - M Marini
- University Hospital Riuniti of Ancona, Cardiologia Ospedaliera Emodinamica e UTIC, Ancona, Italy
| | - L Gonzini
- ANMCO Foundation For Your Heart, ANMCO Research Center, Florence, Italy
| | - M Benvenuto
- Teramo Hospital, Cardiologia UTIC ed Emodinamica, Teramo, Italy
| | - L Cassaniti
- Ospedale E. Muscatello, Cardiologia - UTIC, Augusta, Italy
| | - A.M Municino'
- Ospedale Padre Antero Micone, Cardiologia – UTIC, Genova, Italy
| | - A Navazio
- Santa Maria Nuova Hospital, Cardiologia, Reggio Emilia, Italy
| | - E Ammirati
- ASST Great Metropolitan Niguarda, Cardiologia 2 -Insufficienza Cardiaca e Trapianto, Milan, Italy
| | - M Gorini
- ANMCO Foundation For Your Heart, ANMCO Research Center, Florence, Italy
| | - G Leonardi
- University Policlinic of Catania, PO Rodolico SSD Scompenso Cardiaco Grave, Catania, Italy
| | - N Pagnoni
- Hospital San Giovanni Addolorata, Cardiologia e Riabilitazione Cardiologica, Rome, Italy
| | - L Montagna
- San Luigi Gonzaga University Hospital, Cardiologia, Orbassano, Italy
| | - P Midi
- Hospital dei Castelli, Cardiologia UTIC, Ariccia, Italy
| | - M Iacoviello
- Polyclinic Hospital of Bari, Cardiologia Universitaria, Bari, Italy
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13
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Di Girolamo E, Appignani M, Furia N, Marini M, De Filippo P, Leidi C, Di Girolamo F, Delana A, Barbareschi A, Andreoli S, Genovesi D, Falco M. Transient ICD malfunctions during oncologic radiotherapy: a multi-centre, randomized, in-vitro study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Direct exposure of implantable cardioverter-defibrillators (ICDs) during radiotherapy is still considered potentially harmful, or even unsafe, by manufacturers and current recommendations. The effects of photon beams on ICDs are unpredictable, depending on multiple factors, and malfunctions may present during exposure.
Purpose
To evaluate transient ICD malfunctions by direct exposure to doses up to 10 Gy during low-energy RT, forty-three contemporary wireless-enabled ICDs, with at least 4 months to elective replacement indicator (ERI) were evaluated in a real-time in-vitro session in three different centres.
Methods
All ICDs had baseline interrogation. Single chamber devices were programmed to the VVI/40 mode and dual or triple chamber devices were programmed to the DDD/40 mode. Rate response function and antitachycardia therapies were disabled, with the ventricular tachycardia (VT)/ventricular fibrillation (VF) detection windows still active. A centring computed tomography was performed to build the corresponding treatment plan and the ICDs were blinded randomized to receive either 2-, 5- or 10-Gy exposure by a low photon-energy linear accelerator (6MV) in a homemade water phantom (600 MU/min). The effective dose received by the ICDs was randomly assessed by an in-vivo dosimetry. During radiotherapy, the ICDs were observed in a real-time session using manufacturer specific programmer, and device function (pacing, sensing, programmed parameters, arrhythmia detections) was recorder by the video camera in the bunker throughout the entire photon exposure. All ICDs had an interrogation session immediately after exposure.
Results
During radiotherapy course, almost all ICDs (93%) recorded major or minor transient electromagnetic interferences. On detail, sixteen ICDs (37.2%) reported atrial and/or ventricular oversensing, with base-rate-pacing inhibition and VT/VF detection. Twenty-four ICDs (55.8%) recorded non clinically relevant noise, and no detections were observed. Only three ICDs (7%) reported neither transient malfunction nor minor noise, withstanding direct radiation exposure. At immediate post-exposure interrogation, the ICDs that recorded major real-time malfunctions had VT/VF detections stored in the device memory. In none of the ICDs spontaneous changes in parameter settings were reported. Malfunctions occurred regardless of either 2-, 5- or 10-Gy photon beam exposure.
Conclusions
Transient electromagnetic interferences were observed in most of the contemporary ICDs during radiotherapy course, regardless of photon dose. To avoid potentially life-threatening ICD malfunctions such as pacing inhibition or inappropriate shock delivery, magnet application on the pocket site or ICD reprogramming to the asynchronous mode are still suggested in ICD patients ongoing even low energy radiotherapy exposure.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Di Girolamo
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Appignani
- Intensive Cardiac Care Unit, SS. Annunziata Hospital, Chieti, Italy
| | - N Furia
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Marini
- Cardiology Unit, S. Chiara Hospital, Trento, Italy
| | - P De Filippo
- Electrophysiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - C Leidi
- Electrophysiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - A Delana
- Medical Physics Unit, S. Chiara Hospital, Trento, Italy
| | - A Barbareschi
- Medical Physics Unit - Tor Vergata University, Rome, Italy
| | - S Andreoli
- Medical Physics Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - D Genovesi
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M.D Falco
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
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14
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Di Girolamo E, Appignani M, Faustino M, Marini M, De Filippo P, Leidi C, Di Girolamo F, Delana A, Barbareschi A, Andreoli S, Genovesi D, Falco M. Permanent CIED malfunctions after oncologic radiotherapy: a multi-centre, randomized, in vitro evaluation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Direct photon exposure of pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs) during oncologic radiotherapy may transiently or permanently affect normal device function. To evaluate potential malfunctions by direct exposure to doses up to 10 Gy in 6-MV oncologic radiotherapy, commonly considered unsafe or even not recommended, 145 PMs and 65 ICDs were observed in three different centres.
Methods
All devices had a baseline interrogation and reprogramming to VVI/40 or to DDD/40 mode, depending on type and model. Rate-adaptive function was disabled in all the devices, whereas in ICDs, even antitachycardia therapies were disabled with the ventricular tachycardia/fibrillation (VT/VF) windows left enabled. To build the corresponding treatment plan, a centring computed tomography was performed with different Treatment Plan Systems among the centres. The devices were blinded randomized to receive either 2-, 5- or 10-Gy direct exposure by a 6-MV linear accelerator (different among the three centres) in a water phantom (600 MU/min). The effective dose received was assessed by a random in-vivo dosimetry. All devices had a telemetry interrogation immediately after exposure and once monthly during a six-month follow-up.
Results
Immediately after photon exposure, no changes in device parameters or software errors were observed in 209 devices (99.5%). A non-reprogrammable reset to emergency back-up mode (VVI/65) occurred in a PM (0.5% overall; 0.7% among PMs). Seven PMs reached the Elective Replacement Indicator immediately after exposure (3.3% overall; 4.8% among PMs). Sixteen ICDs (7.6% overall; 24.6% among ICDs) had multiple VT/VF detections stored in the device memory. Two PMs (1% overall; 1.4% among PMs) reported atrial fibrillation detections.
During a six-month follow-up, a non-reprogrammable software reset (back-up to VVI/65 mode) was reported in one PM three months after a single exposure of 2 Gy (0.5% overall; 0.7% among PMs). Abnormal battery drain was observed in thirteen PMs (6.2% overall; 9% among PMs), and in one ICD (0.5% overall; 1.5% among ICDs). All events presented regardless of exposure dose of either 2, 5, or 10 Gy.
Conclusions
Last-generation devices, both PMs and ICDs, withstood direct 6-MV photon exposure up to 10 Gy, commonly considered not recommended or even unsafe by manufacturer statements and clinical guidelines. The most common failures were referred to battery issues. Malfunctions occurred solely in less recent devices, regardless of photon dose.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Di Girolamo
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Appignani
- Intensive Cardiac Care Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Faustino
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Marini
- Cardiology Unit, S. Chiara Hospital, Trento, Italy
| | - P De Filippo
- Electrophysiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - C Leidi
- Electrophysiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - A Delana
- Medical Physics Unit, S. Chiara Hospital, Trento, Italy
| | - A Barbareschi
- Medical Physics Unit - Tor Vergata University, Rome, Italy
| | - S Andreoli
- Medical Physics Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - D Genovesi
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M.D Falco
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
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15
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Cassanmagnago L, Barsi M, Combi S, Ferrari E, Lanzi P, Marini M, Nicolai E, Masi F, Noè D, Raschioni E, Piazza A, Spiti R, Tagliabue V, Zanoni M. VITAMIN D STATUS IN OBESE ADULTS: CORRELATION WITH BODY COMPOSITION AND LIFESTYLE. Nutrition 2020. [DOI: 10.1016/j.nut.2020.110925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Di Girolamo E, Appignani M, Marini M, De Filippo P, Leidi C, Di Girolamo F, Delana A, Barbareschi A, Andreoli S, Genovesi D, Falco MD. P1134Cardiac pacemakers and transient electromagnetic interferences during radiotherapy courses: a multicentre, real-time, in-vitro evaluation. Europace 2020. [DOI: 10.1093/europace/euaa162.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
None
Background
The effects of high dose oncologic radiotherapy (RT) on cardiac pacemakers (PMs), at even less than 6 MV power, are unpredictable, depending on multiple factors. Normal PM function may be impaired during direct exposure, due to electromagnetic interferences (EMIs). Potentially life-threatening malfunctions may occur, expecially in PM-dependent patients, and both manufacturers and guidelines discourage direct exposure.
Purpose
To evaluate transient EMI-related PM malfunctions during direct exposure to doses up to 10 Gy during radiotherapy course, 17 wireless-telemetry-enabled PMs with sufficient residual battery charge for the purpose of the study (at least 4 months to elective replacement indicator, E.R.I.) were evaluated in three different centres.
Methods
All PMs underwent baseline interrogation. Single chamber devices were programmed in the VVI/40 mode while dual or triple chamber devices were programmed in the DDD/40 mode. To avoid the "run-away" phenomenon during exposure rate-adaptive function was disabled. A centering computed tomography was performed to build the corresponding treatment plan and the PMs were blinded randomized to receive either 2, 5 or 10 Gy exposure by a 6 MV linear accelerator in a homemade water phantom (600 Um/min). The effective dose received by the PMs was randomly assessed by an in-vivo dosimetry. During RT course, the devices were observed in a real-time session using manufacturer specific equipment, and PM function (pacing and sensing, programmed parameters) was recorder by a video camera in the bunker throughout the entire radiation exposure.
Results
During RT course, 13 PMs (76.5%) recorded not clinically relevant minor transient EMIs, and no atrial and/or ventricular oversensing nor base-rate-pacing inhibition were observed. Only 4 PMs (23.5%) reported neither transient malfunction nor minor EMIs, withstanding direct radiation exposure. Transient EMI-related malfunctions were observed regardless of either 2, 5 or 10 Gy exposure.
Conclusions
Minor, not clinically relevant EMI-related interferences were observed in most of the PMs during direct exposure. Nevertheless, to avoid potentially life-threatening PM malfunctions, magnet application on the PM pocket site or reprogramming are still suggested in PM-dependent (high risk) patients ongoing even low energy RT exposure.
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Affiliation(s)
- E Di Girolamo
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Appignani
- Intensive Cardiac Care Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Marini
- Cardiology Unit, S. Chiara Hospital, Trento, Italy
| | - P De Filippo
- Electrophysiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - C Leidi
- Electrophysiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - A Delana
- Medical Physics Unit, S. Chiara Hospital, Trento, Italy
| | - A Barbareschi
- Medical Physics Unit - Tor Vergata University, Rome, Italy
| | - S Andreoli
- Medical Physics Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - D Genovesi
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M D Falco
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
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17
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Di Girolamo E, Appignani M, Marini M, De Filippo P, Leidi C, Di Girolamo F, Delana A, Barbareschi A, Andreoli S, Genovesi D, Falco MD. 910Noise-related malfunctions in modern ICDs during oncologic radiotherapy: a multicentre, real-time, in-vitro observation. Europace 2020. [DOI: 10.1093/europace/euaa162.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
None
Background
Direct photon exposure of implantable cardioverter-defibrillators (ICDs) during radiotherapy is still considered not recommended, or even unsafe, by manufacturers and guidelines. The effects of photon beams on ICDs are unpredictable, depending on multiple factors, and electromagnetic interferences (EMIs) may present during exposure.
Purpose
To evaluate transient ICD malfunctions by direct exposure to doses up to 10 Gy during low-energy radiotherapy, 36 contemporary wireless-enabled ICDs, with at least 4 months to elective replacement indicator (E.R.I.) were evaluated in a realtime in-vitro session.
Methods
All ICDs had baseline interrogation. Single chamber devices were programmed in the VVI/40 mode and dual or triple chamber devices were programmed in the DDD/40 mode. Rate response function and antitachycardia therapies were disabled, with the ventricular tachycardia (VT)/ventricular fibrillation (VF) detection windows still working. A centering computed tomography was performed to build the corresponding treatment plan and the ICDs were blinded randomized to receive either 2, 5 or 10 Gy exposure by a low photon-energy linear accelerator (6MV) in a homemade water phantom (600 MU/min). The effective dose received by the ICDs was randomly assessed by an in-vivo dosimetry. During radiotherapy course, the devices were observed in a real-time session using manufacturer specific programmer, and ICD function (pacing, sensing, programmed parameters, detection) was recorder by the video camera in the bunker throughout the entire photon exposure. All ICDs had an interrogation session immediately after exposure.
Results
During radiotherapy course, almost all ICDs (90.9%) recorded major or minor transient EMIs. On detail, 16 ICDs (44.4%) reported EMI-related atrial and/or ventricular oversensing, with base-rate-pacing inhibition and VT/VF detection. 16 ICDs (44.4%) recorded not clinically relevant minor EMIs, and no detections were observed. Only 4 ICDs (11.2%) reported neither transient malfunction nor minor EMIs, withstanding direct radiation exposure. At immediate post-exposure interrogation, the ICDs that recorded major real-time malfunctions had VT/VF detections stored in the device memory. In none of the ICDs spontaneous changes in parameter settings were reported. EMI-related malfunctions occurred regardless of either 2, 5 or 10 Gy photon beam exposure.
Conclusions
Transient EMIs were observed in most of the contemporary ICDs. To avoid potentially life-threatening ICD malfunctions such as pacing inhibition or inappropriate shock delivery, magnet application on the pocket site or reprogramming in the asynchronous mode are still suggested in ICD patients ongoing even low energy radiotherapy exposure.
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Affiliation(s)
- E Di Girolamo
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Appignani
- Intensive Cardiac Care Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Marini
- Cardiology Unit, S. Chiara Hospital, Trento, Italy
| | - P De Filippo
- Electrophysiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - C Leidi
- Electrophysiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - A Delana
- Medical Physics Unit, S. Chiara Hospital, Trento, Italy
| | - A Barbareschi
- Medical Physics Unit - Tor Vergata University, Rome, Italy
| | - S Andreoli
- Medical Physics Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - D Genovesi
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M D Falco
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
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18
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Di Girolamo E, Faustino M, Furia N, Appignani M, Marini M, De Filippo P, Leidi C, Delana A, Barbareschi A, Andreoli S, Genovesi D, Falco MD. P551Permanent cardiac implantable device damage during direct photon exposure for oncologic radiotherapy: a multicentre, in-vitro observation. Europace 2020. [DOI: 10.1093/europace/euaa162.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
None
Backgroung. Direct photon exposure of cardiac implantable devices (CIEDs), both pacemakers (PMs) or implantable cardioverter defibrillators (ICDs), during oncologic radiotherapy (RT) courses may transiently or permanently affect normal device function.
Purpose
To evaluate CIED damage by direct exposure to doses up to 10 Gy in oncologic RT, commonly considered unsafe or even potentially harmful, 206 CIEDs (143 PMs and 63 ICDs) from three different centres, with at least 4 months to Elective Replacement Indicator (E.R.I.) were observed.
Methods. All CIEDs had a baseline telemetry interrogation. Single chamber devices were programmed in the VVI/40 mode and dual or triple chamber ones were programmed in the DDD/40 mode. Rate adaptive function was disabled. In ICDs, antitachycardia therapies were disabled with the ventricular tachycardia/fibrillation window left enabled. A centering Computed Tomography was performed to build the corresponding treatment plan and CIEDs were blinded randomized to receive either 2, 5 or 10 Gy (direct exposure) by a 6 MV linear accelerator in a home-made water phantom. An in-vivo dosimetry randomly assessed the effective dose received by the CIEDs. All CIEDs were interrogated immediately after exposure and monthly during a three-month follow-up.
Results. Immediately after photon exposure, no changes in device setting or software errors were observed in 205 CIEDs (99·5%). Reset to emergency back-up mode was observed in a PM (0·49% overall; 0·7% among PMs). Seven PMs reached the E.R.I immediately after exposure (3·4% overall; 4·9% among PMs). Sixteen ICDs (7·8% overall; 25·4% among ICDs) reported multiple ventricular tachycardia/fibrillation detections stored in the device memory. During follow-up, a non-reprogrammable software reset (emergency backup VVI/65 mode) was observed in one PM after a single dose of 2 Gy (0·49% overall; 0.7% among PMs), whereas an abnormal battery drain was observed in 6 PMs (2.9% overall; 4.2% among PMs). No battery issues were observed in ICDs. All reported events occurred regardless of either 2, 5, or 10 Gy direct exposure. Malfunctions were observed in only older CIEDs.
Conclusions. Recent CIEDs have shown to be safe during oncologic RT, withstanding direct exposure up to 10 Gy, commonly considered not recommended or even unsafe by manufacturers statements and clinical guidelines. Malfunctions occurred solely in older devices.
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Affiliation(s)
- E Di Girolamo
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Faustino
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - N Furia
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Appignani
- Intensive Cardiac Care Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Marini
- Cardiology Unit, S. Chiara Hospital, Trento, Italy
| | - P De Filippo
- Electrophysiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - C Leidi
- Electrophysiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A Delana
- Medical Physics Unit, S. Chiara Hospital, Trento, Italy
| | - A Barbareschi
- Medical Physics Unit - Tor Vergata University, Rome, Italy
| | - S Andreoli
- Medical Physics Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - D Genovesi
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M D Falco
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
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19
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Frapiccini E, Panfili M, Guicciardi S, Santojanni A, Marini M, Truzzi C, Annibaldi A. Effects of biological factors and seasonality on the level of polycyclic aromatic hydrocarbons in red mullet (Mullus barbatus). Environ Pollut 2020; 258:113742. [PMID: 31855675 DOI: 10.1016/j.envpol.2019.113742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/24/2019] [Revised: 10/17/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
This study evaluates the effects of biological factors of fish and seasonality on Polycyclic Aromatic Hydrocarbon (PAH) accumulation in red mullet (Mullus barbatus) tissue. Specimens were collected monthly with a bottom trawl net in an offshore fishing ground in the Northern and Central Adriatic Sea (Geographical Sub Area 17) throughout 2016. The edible fillets of 380 individuals were analyzed for the concentrations of individual PAH, total PAH, and low, medium and high molecular weight (MW) PAHs. PAH bioaccumulation was related to their physicochemical characteristics (MW, and logarithm of the octanol-water partition coefficient, log Kow), some biological parameters of fish (body size, age, sex, reproductive stage and total lipid content), and catch season. The PAH bioaccumulation pattern and the effects of the different factors varied according to PAH MW. The heavier (medium and high MW) PAHs showed higher levels in winter-autumn and in pre-spawners compared with spawners and post-spawners. Our findings suggest that an important detoxification mechanism, albeit limited to the heavier PAHs, acts in the spawning and post-spawning stage. Low MW PAHs appeared to be unaffected by reproductive stage, lipid content and seasonality. Reproductive stage and seasonality seem to play an important role in the accumulation of heavier PAH, whereas total lipid content and age seem to exert a limited influence, and body size no effect at all.
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Affiliation(s)
- E Frapiccini
- Institute of Biological Resources and Marine Biotechnology (IRBIM), National Research Council (CNR), Largo Fiera della Pesca 2, 60125, Ancona, Italy.
| | - M Panfili
- Institute of Biological Resources and Marine Biotechnology (IRBIM), National Research Council (CNR), Largo Fiera della Pesca 2, 60125, Ancona, Italy
| | - S Guicciardi
- Institute of Biological Resources and Marine Biotechnology (IRBIM), National Research Council (CNR), Largo Fiera della Pesca 2, 60125, Ancona, Italy
| | - A Santojanni
- Institute of Biological Resources and Marine Biotechnology (IRBIM), National Research Council (CNR), Largo Fiera della Pesca 2, 60125, Ancona, Italy
| | - M Marini
- Institute of Biological Resources and Marine Biotechnology (IRBIM), National Research Council (CNR), Largo Fiera della Pesca 2, 60125, Ancona, Italy
| | - C Truzzi
- Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, Ancona, Italy
| | - A Annibaldi
- Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, Ancona, Italy
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20
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Bouzin M, Marini M, Zeynali A, Borzenkov M, Sironi L, D'Alfonso L, Mingozzi F, Granucci F, Pallavicini P, Chirico G, Collini M. Photo-activated raster scanning thermal imaging at sub-diffraction resolution. Nat Commun 2019; 10:5523. [PMID: 31797931 PMCID: PMC6892803 DOI: 10.1038/s41467-019-13447-0] [Citation(s) in RCA: 15] [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] [Received: 02/08/2019] [Accepted: 11/07/2019] [Indexed: 12/01/2022] Open
Abstract
Active thermal imaging is a valuable tool for the nondestructive characterization of the morphological properties and the functional state of biological tissues and synthetic materials. However, state-of-the-art techniques do not typically combine the required high spatial resolution over extended fields of view with the quantification of temperature variations. Here, we demonstrate quantitative far-infrared photo-thermal imaging at sub-diffraction resolution over millimeter-sized fields of view. Our approach combines the sample absorption of modulated raster-scanned laser light with the automated localization of the laser-induced temperature variations imaged by a thermal camera. With temperature increments ∼0.5-5 °C, we achieve a six-time gain with respect to our 350-μm diffraction-limited resolution with proof-of-principle experiments on synthetic samples. We finally demonstrate the biological relevance of sub-diffraction thermal imaging by retrieving temperature-based super-resolution maps of the distribution of Prussian blue nanocubes across explanted murine skin biopsies.
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Affiliation(s)
- M Bouzin
- Physics Department, Università degli Studi di Milano-Bicocca, Piazza della Scienza 3, 20126, Milano, Italy
| | - M Marini
- Physics Department, Università degli Studi di Milano-Bicocca, Piazza della Scienza 3, 20126, Milano, Italy
| | - A Zeynali
- Physics Department, Università degli Studi di Milano-Bicocca, Piazza della Scienza 3, 20126, Milano, Italy
| | - M Borzenkov
- Medicine and Surgery Department, Nanomedicine Center, Università degli Studi di Milano-Bicocca, Piazza della Scienza 3, 20126, Milano, Italy
| | - L Sironi
- Physics Department, Università degli Studi di Milano-Bicocca, Piazza della Scienza 3, 20126, Milano, Italy
| | - L D'Alfonso
- Physics Department, Università degli Studi di Milano-Bicocca, Piazza della Scienza 3, 20126, Milano, Italy
| | - F Mingozzi
- Biotechnology and Biosciences Department, Università degli Studi di Milano-Bicocca, Piazza della Scienza 2, 20126, Milano, Italy
| | - F Granucci
- Biotechnology and Biosciences Department, Università degli Studi di Milano-Bicocca, Piazza della Scienza 2, 20126, Milano, Italy
| | - P Pallavicini
- Chemistry Department, Università degli Studi di Pavia, Viale Taramelli 12, 27100, Pavia, Italy
| | - G Chirico
- Physics Department, Università degli Studi di Milano-Bicocca, Piazza della Scienza 3, 20126, Milano, Italy.
- CNR Institute for Applied Science and Intelligent Systems, Via Campi Flegrei 34, 80078, Pozzuoli, Italy.
| | - M Collini
- Physics Department, Università degli Studi di Milano-Bicocca, Piazza della Scienza 3, 20126, Milano, Italy
- CNR Institute for Applied Science and Intelligent Systems, Via Campi Flegrei 34, 80078, Pozzuoli, Italy
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21
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Abruzzo PM, Matté A, Bolotta A, Federti E, Ghezzo A, Guarnieri T, Marini M, Posar A, Siciliano A, De Franceschi L, Visconti P. Plasma peroxiredoxin changes and inflammatory cytokines support the involvement of neuro-inflammation and oxidative stress in Autism Spectrum Disorder. J Transl Med 2019; 17:332. [PMID: 31578139 PMCID: PMC6775664 DOI: 10.1186/s12967-019-2076-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/21/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND It has been established that children with Autism Spectrum Disorders (ASD) are affected by oxidative stress, the origin of which is still under investigation. In the present work, we evaluated inflammatory and pro-oxidant soluble signature in non-syndromic ASD and age-matched typically developing (TD) control children. METHODS We analyzed leukocyte gene expression of inflammatory cytokines and inflammation/oxidative-stress related molecules in 21 ASD and 20 TD children. Moreover, in another-comparable-group of non-syndromic ASD (N = 22) and TD (N = 21) children, we analyzed for the first time the protein expression of the four members of the antioxidant enzyme family of peroxiredoxins (Prx) in both erythrocyte membranes and in plasma. RESULTS The gene expression of IL6 and of HSP70i, a stress protein, was increased in ASD children. Moreover, gene expression of many inflammatory cytokines and inflammation/oxidative stress-related proteins correlated with clinical features, and appeared to be linked by a complex network of inter-correlations involving the Aryl Hydrocarbon Receptor signaling pathway. In addition, when the study of inter-correlations within the expression pattern of these molecules was extended to include the healthy subjects, the intrinsic physiological relationships of the inflammatory/oxidative stress network emerged. Plasma levels of Prx2 and Prx5 were remarkably increased in ASD compared to healthy controls, while no significant differences were found in red cell Prx levels. CONCLUSIONS Previous findings reported elevated inflammatory cytokines in the plasma of ASD children, without clearly pointing to the presence of neuro-inflammation. On the other hand, the finding of microglia activation in autoptic specimens was clearly suggesting the presence of neuro-inflammation in ASD. Given the role of peroxiredoxins in the protection of brain cells against oxidative stress, the whole of our results, using peripheral data collected in living patients, support the involvement of neuro-inflammation in ASD, and generate a rational for neuro-inflammation as a possible therapeutic target and for plasma Prx5 as a novel indicator of ASD severity.
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Affiliation(s)
- P M Abruzzo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, Bologna, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Via A. Capecelatro, 66, 20148, Milan, Italy
| | - A Matté
- Department of Medicine, University of Verona Medical School, Verona, Italy
| | - A Bolotta
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, Bologna, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Via A. Capecelatro, 66, 20148, Milan, Italy
| | - E Federti
- Department of Medicine, University of Verona Medical School, Verona, Italy
| | - A Ghezzo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, Bologna, Italy
| | - T Guarnieri
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, Italy
| | - M Marini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, Bologna, Italy. .,IRCCS Fondazione Don Carlo Gnocchi, Via A. Capecelatro, 66, 20148, Milan, Italy.
| | - A Posar
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy.,Child Neurology and Psychiatry Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
| | - A Siciliano
- Department of Medicine, University of Verona Medical School, Verona, Italy
| | - L De Franceschi
- Department of Medicine, University of Verona Medical School, Verona, Italy
| | - P Visconti
- Child Neurology and Psychiatry Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
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22
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Branzoli S, Marini M, Guarracini F, Pederzolli C, D'Onghia G, Pomarolli C, Centonze M, Casagranda G, Corsini F, Bonmassari R, Graffigna A. 3050Non valvular atrial fibrillation, contraindication to anticoagulation or antiplatelet therapy and heart team approach: a single centre experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Left atrial appendage is the source of more than 90% of thrombi in patients with atrial fibrillation (AF). Protect-AF and Prevail trials have tested the non inferiority of left appendage percutaneous closure to warfarin for stroke prevention but contraindication to anticoagulation was an exclusion criteria for enrollment. On the surgical side recent studies have shown the efficacy of left appendage exclusion concomitant to open chest cardiac surgery or totally thoracoscopic Maze. In these studies all patients were on anticoagulation or antiplatelet regime at discharge and follow up. Here we give our contribute to the issue of safety and efficacy of stand alone totally thoracoscopic left appendage clipping for non valvular AF related stroke prevention in patients with contraindication to oral anticoagulant or antiplatelet therapy.
Materials and methods
20 patients with non valvular AF and cerebral hemorrhages (16 males, patients age range 53–87, CHAD-VASC range 4–8, HASBLED range 4–7), underwent stand alone totally thoracoscopic appendage exclusion with a clipping device. All patients, after Heart Team evaluation, were screened preoperatively with 3D CT scan, transesophageal echocardiography and cerebrovascular doppler ultrasound. Intraoperative device positioning and atrial appendage exclusion were guided and confirmed by transesophageal echo. All patients were not on anticoagulation nor antiplatelet therapy from the time of surgery to the control visit. Follow up (range 6–21 months) included outpatient visit, CT scan or TEE. Perioperative mortality and early and late morbidity were analyzed by chart evaluation and full outpatient neurological examination including the Questionnaire for Verifying Stroke Free Status.
Results
Mean duration of surgery “skin to skin” was 62 minutes; all patients were extubated shortly after the procedure. There were no deaths or pulmonary procedure related morbidities, only one case of pericarditis treated with colchicine was documented. On CT or TEE follow up 100% of patients had complete exclusion of the left appendage with residual stumps less than 1 cm and no dislodgement of the clip detected. Freedom from neurological events in all patients was documented in absence of anticoagulation or antiplatelet regime from the time of surgery to the time of the follow up visit.
Conclusion
Totally thoracoscopic left appendage exclusion is a safe, expeditous and effective procedure in preventing non valvular AF related strokes in patients with contraindication to oral anticoagulation or antiplatelet therapy. The efficacy of the procedure is comparable to open chest surgery and this procedure may be considered as valid therapeutic option in patients at high risk of hemorrhage if on anticoagulant or antiplatelet therapy. Clearly further data, longer follow up and possibly an European registry are needed to confirm this preliminary results.
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Affiliation(s)
- S Branzoli
- Santa Chiara Hospital in Trento, Cardiac Surgery Unit, Trento, Italy
| | - M Marini
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
| | - F Guarracini
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
| | - C Pederzolli
- Santa Chiara Hospital in Trento, Cardiac Surgery Unit, Trento, Italy
| | - G D'Onghia
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
| | - C Pomarolli
- Santa Chiara Hospital in Trento, Anestesiology Department, Trento, Italy
| | - M Centonze
- San Lorenzo Hospital, Radiology Service, Borgo Valsugana, Italy
| | - G Casagranda
- Santa Chiara Hospital in Trento, Radiology Service, Trento, Italy
| | - F Corsini
- Santa Chiara Hospital in Trento, Neurosurgery Unit, Trento, Italy
| | - R Bonmassari
- Santa Chiara Hospital in Trento, Cardiology Unit, Trento, Italy
| | - A Graffigna
- Santa Chiara Hospital in Trento, Cardiac Surgery Unit, Trento, Italy
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23
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Di Girolamo E, Faustino M, Furia N, Appignani M, Marini M, Genovesi D, Di Carlo C, Delana A, Barbareschi A, Falco MD. 2410Oncologic radiotherapy-induced implantable cardioverter-defibrillator malfunctions: a real-time, in-vitro evaluation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Direct exposure of implantable cardioverter-defibrillators (ICDs) during radiotherapy is still considered not recommended, or even unsafe, by manufacturers and guidelines. The effects of photon beams on ICDs are unpredictable, depending on multiple factors, and malfunctions may occur during exposure.
Purpose
To evaluate transient ICD malfunctions by direct exposure to doses up to 10 Gy during low-energy radiotherapy, 33 contemporary wireless-enabled ICDs, with at least 4 months to elective replacement indicator (E.R.I.) were evaluated in a realtime in-vitro session.
Methods
All ICDs had baseline interrogation. Single chamber ICDs were programmed in the VVI/40 mode and dual or triple chamber ICDs were programmed in the DDD/40 mode. Rate response function and antitachycardia therapies were disabled, with the ventricular tachycardia (VT)/ventricular fibrillation (VF) detection windows still active. A centering computed tomography was performed to build the corresponding treatment plan and the ICDs were blinded randomized to receive either 2, 5 or 10 Gy exposure by a low photon-energy linear accelerator (6MV) in a homemade water phantom (600 MU/min). The effective dose received by the ICDs was assessed by an in-vivo dosimetry. During radiotherapy, the devices were observed in a real-time session using manufacturer specific programmer, and ICD function (pacing, sensing, programmed parameters, detection) was recorder by the video camera in the bunker throughout the entire photon exposure. All ICDs had an interrogation session immediately after exposure.
Results
During radiotherapy course, almost all ICDs (90.9%) recorded major or minor transient electromagnetic interferences. On detail, 13 ICDs (39.4%) reported atrial and/or ventricular oversensing, with base-rate-pacing inhibition and VT/VF detection. 16 ICDs (48.5%) recorded non clinically relevant noise, and no detections were observed. Only 4 ICDs (12.1%) reported neither transient malfunction nor minor noise, withstanding direct radiation exposure. At immediate post-exposure interrogation, the ICDs that recorded major real-time malfunctions had VT/VF detections stored in the device memory. In none of the ICDs spontaneous changes in parameter settings were reported. Malfunctions occurred regardless of either 2, 5 or 10 Gy photon beam exposure.
Conclusions
Transient electromagnetic interferences were observed in most of the contemporary ICDs during radiotherapy course, regardeless of photon dose. To avoid potentially life-threatening ICD malfunctions such as pacing inhibition or inappropriate shock delivery, magnet application on the pocket site or reprogramming devices in the asynchronous mode are still suggested in ICD patients ongoing even low energy radiotherapy exposure.
Acknowledgement/Funding
None
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Affiliation(s)
- E Di Girolamo
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Faustino
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - N Furia
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Appignani
- Intensive Cardiac Care Unit, SS Annunziata Hospital, Chieti, Italy
| | - M Marini
- Cardiology Unit, S. Chiara Hospital, Trento, Italy
| | - D Genovesi
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
| | - C Di Carlo
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
| | - A Delana
- Medical Physics Unit, S. Chiara Hospital, Trento, Italy
| | | | - M D Falco
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
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Romanelli G, Berto D, Calace N, Amici M, Maltese S, Formalewicz M, Campanelli A, Marini M, Magaletti E, Scarpato A. Ballast water management system: Assessment of chemical quality status of several ports in Adriatic Sea. Mar Pollut Bull 2019; 147:86-97. [PMID: 29361280 DOI: 10.1016/j.marpolbul.2017.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/30/2017] [Accepted: 12/11/2017] [Indexed: 06/07/2023]
Abstract
Oxidant treatment of ballast water (BW) is commonly used in BW systems in order to minimize the transport of alien species. The release of disinfection by-products (DBPs) associated to the treatment of BW and cross-contamination of butyltin (BT) compounds through BW discharge is a topic of environmental concern. A chemical port baseline survey has been conducted in seven ports of the Adriatic Sea. Analysis have been performed on transplanted mussels, surface sediment, seawater, BW. Results showed an evidence of BT contamination, particularly in sediments, probably related to their illegal usage or to intensive shipping activities. Therefore, BW may act as a vector and contribute to re-buildup of BT contamination in the coastal regions. A baseline set of data concerning DBPs is provided, showing the preferential distribution of these compounds in the marine environment that will be useful for future considerations on monitoring and assessment of chemical contamination associated with BW.
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Affiliation(s)
- G Romanelli
- Istituto Superiore per la Protezione e la Ricerca Ambientale (ISPRA), via Vitaliano Brancati 48, 00144 Roma, Italy
| | - D Berto
- Istituto Superiore per la Protezione e la Ricerca Ambientale (ISPRA), Brondolo, 30015 Chioggia, Italy.
| | - N Calace
- Istituto Superiore per la Protezione e la Ricerca Ambientale (ISPRA), via Vitaliano Brancati 48, 00144 Roma, Italy
| | - M Amici
- Istituto Superiore per la Protezione e la Ricerca Ambientale (ISPRA), via Vitaliano Brancati 48, 00144 Roma, Italy
| | - S Maltese
- Istituto Superiore per la Protezione e la Ricerca Ambientale (ISPRA), via Vitaliano Brancati 48, 00144 Roma, Italy
| | - M Formalewicz
- Istituto Superiore per la Protezione e la Ricerca Ambientale (ISPRA), Brondolo, 30015 Chioggia, Italy
| | - A Campanelli
- Consiglio nazionale delle Ricerche, Istituto di Scienze Marine (CNR ISMAR), Largo Fiera della Pesca, 60125 Ancona, Italy
| | - M Marini
- Consiglio nazionale delle Ricerche, Istituto di Scienze Marine (CNR ISMAR), Largo Fiera della Pesca, 60125 Ancona, Italy
| | - E Magaletti
- Istituto Superiore per la Protezione e la Ricerca Ambientale (ISPRA), via Vitaliano Brancati 48, 00144 Roma, Italy
| | - A Scarpato
- Istituto Superiore per la Protezione e la Ricerca Ambientale (ISPRA), via Vitaliano Brancati 48, 00144 Roma, Italy
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Di Girolamo E, Furia N, Faustino M, Appignani M, Marini M, Genovesi D, Di Carlo C, Delana A, Barbareschi A, Falco MD. P6553Contemporary pacemakers and oncologic radiotherapy courses: a real-time, wireless-enabled observation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The effects of high dose oncologic radiotherapy on cardiac pacemakers (PMs), at even less than 6MV power, are unpredictable, depending on multiple factors. Normal PM function may be impaired during photon exposure, with potentially life-threatening consequences in PM-dependent patients, and, unlike in magnetic resonance imaging setting, both manufacturer statements and guidelines discourage direct exposure.
Purpose
To evaluate transient PM malfunctions by direct exposure to doses up to 10 Gy during radiotherapy course, actually not recommended or considered even unsafe, 17 wireless-telemetry-enabled PMs obtained after upgrade or extraction of the system, with sufficient residual battery charge for the purpose of the study (at least 1 year to elective replacement indicator, E.R.I.) were evaluated in a real-time in-vitro session.
Methods
All PMs underwent baseline interrogation. Single chamber devices were programmed in VVI/40 mode while dual or triple chamber devices were programmed in DDD/40 mode. Rate adaptive function was disabled to avoid the “run-away” phenomenon during exposure. A centering computed tomography was performed to build the corresponding treatment plan and the PMs were blinded randomized to receive either 2, 5 or 10 Gy exposure by a low photon-energy linear accelerator (6MV) in a homemade water phantom (600 MU/min). The effective dose received by the PMs was assessed by an in-vivo dosimetry. During radiotherapy course, the devices were observed in a real-time session using manufacturer specific equipment, and PM function (pacing and sensing, programmed parameters) was recorder by a videocamera in the bunker before (5 minutes), throughout, and after (5 minutes) the entire radiation exposure.
Results
During radiotherapy course, non of the PMs reported spontaneous changes in parameter settings. 13 PMs (76.5%) recorded non clinically relevant minor transient electromagnetic sensing interferences. No atrial and/or ventricular oversensing nor base-rate-pacing inhibition were observed. Only 4 PMs (23.5%) reported neither transient malfunction nor minor noise, withstanding direct radiation exposure. Transient oversensing-related malfunctions were observed regardless of either 2, 5 or 10 Gy exposure.
Conclusions
Minor, non clinically relevant electromagnetic sensing interferences were observed in most of the PMs during direct exposure. Nevertheless, to avoid potentially life-threatening PM malfunctions, magnet application on the PM pocket site or reprogramming in the asynchronous mode are still suggested in PM-dependent patients ongoing even low energy radiotherapy exposure.
Acknowledgement/Funding
None
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Affiliation(s)
- E Di Girolamo
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - N Furia
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Faustino
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Appignani
- Intensive Cardiac Care Unit - SS. Annunziata Hospital, CHIETI, Italy
| | - M Marini
- Cardiology Unit, S. Chiara Hospital, Trento, Italy
| | - D Genovesi
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
| | - C Di Carlo
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
| | - A Delana
- Medical Physics Unit, S. Chiara Hospital, Trento, Italy
| | - A Barbareschi
- Medical Physics Unit, Tor Vergata University, Rome, Italy
| | - M D Falco
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
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26
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Boriani G, Botto GL, Pieragnoli P, Ricci RP, Biffi M, Marini M, Sagone A, Avella A, Pignalberi C, Ziacchi M, Ricciardi G, Tartaglione E, Grammatico A, Gasparini M. P3746Temporal patterns of premature atrial contractions predict atrial fibrillation occurrence in bradycardia patients continuously monitored through pacemaker diagnostics. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The frequency of premature atrial complexes (PACs) has been indirectly related with atrial fibrillation (AF) occurrence and adverse outcomes.
Objective
To evaluate whether temporal patterns of PACs are directly associated with AF onset in pacemaker patients with continuous monitoring of the atrial rhythm.
Methods
Overall, 193 pacemaker patients (49% female, 72±9 years old), enrolled in a national registry, were analyzed. Frequency of daily PACs was measured in a 14-day initial observation period, during which patients were in sinus rhythm. In the following period, temporal occurrence and frequency of daily PACs and eventual onset of AF were derived by pacemaker diagnostics.
Results
In the run-in period, median PACs frequency was 614 PACs/day (interquartile range=70–3056). Subsequently, in a median follow-up of 6 months, AF occurred in 109 patients, in particular in 37/96 (38.5%) patients with a PAC rate<614 PACs/day and in 72/97 (74.2%) patients with PAC rate≥614 PACs/day (p<0.001). In patients with AF occurrence, the number of daily PACs, normalized by dividing for the average of PACs in 10 preceding days, progressively increased in the 5–6 days preceding AF (Figure). Cox Model predictive analysis showed that the risk of AF was significantly higher in patients with a relative increase of the daily PACs higher than 30% compared with PACs average number in 10 preceding days (hazard ratio (95% confidence interval) = 3.67 (2.40–5.59), p<0.001).
PACs changes daily trend before AF
Conclusion
PACs frequency increases in the 5–6 days preceding AF onset. A relative increase of the daily PACs is significantly associated with the risk of AF occurrence.
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - G L Botto
- Cardiology Dept. Rho Hospital, Rho (MIlan), Italy
| | - P Pieragnoli
- Careggi University Hospital (AOUC), Florence, Italy
| | - R P Ricci
- San Filippo Neri Hospital, Cardiology Dept., Rome, Italy
| | - M Biffi
- Bologna University Hospital, Cardiology Dept., Bologna, Italy
| | - M Marini
- Santa Chiara Hospital in Trento, Cardiology Dept., Trento, Italy
| | - A Sagone
- IRCCS Multimedica of Milan, Cardiology Dept., Milan, Italy
| | - A Avella
- San Camillo Forlanini Hospital, Cardiology Dept., Rome, Italy
| | - C Pignalberi
- San Filippo Neri Hospital, Cardiology Dept., Rome, Italy
| | - M Ziacchi
- Bologna University Hospital, Cardiology Dept., Bologna, Italy
| | - G Ricciardi
- Careggi University Hospital (AOUC), Florence, Italy
| | | | | | - M Gasparini
- Istituto Clinico Humanitas, Cardiology Dept., Milan, Italy
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27
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Di Girolamo E, Marini M, Faustino M, Furia N, Appignani M, Genovesi D, Di Carlo C, Delana A, Barbareschi A, Falco MD. P2858Cardiac implantable device malfunctions during radiotherapy courses up to 10 Gy: a double-center, prospective, randomized, in-vitro evaluation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Exposure to radiotherapy in patients with cardiac implantable electronic devices (CIEDs), both pacemakers (PMs) or implantable cardioverter defibrillators (ICDs), seems to be still troubleshooting. Unlike magnetic resonance imaging, high dose photon radiation at even less than 6MV power, notoriously a non-neutron-producing setting, may transiently or permanently affect normal device function. Malfunctions may be harmfull and life-threatening in high risk patients, such as PM-dependent or ICD ones.
Purpose
To evaluate CIED malfunctions by direct exposure to doses more than 2Gy in oncologic radiotherapy, 162 CIEDs (116 PMs and 46 ICDs) from two different centers, with at least 4 months to Elective Replacement Indicator (E.R.I.) were evaluated.
Methods
All CIEDs had a baseline telemetry interrogation. Single chamber devices were programmed in the VVI/40 mode and dual or triple chamber devices were programmed in the DDD/40 mode. Rate adaptive function was disabled. In ICDs, antitachycardia therapies were disabled with the ventricular tachycardia/fibrillation monitor still enabled. To build the corresponding treatment plan a centering Computed Tomography was performed and CIEDs were blinded randomized (4:4:4) to either 2, 5 or 10 Gy direct exposure by a low photon-energy LINAC (6MV) in a water phantom. An in-vivo dosimetry assessed the effective dose received by the CIEDs. All CIEDs had a telemetry-interrogation, using manufacturer specific equipment, immediately after exposure and monthly for a four-month follow-up.
Results
Immediately after exposure, 1 reset to emergency mode was observed in a PM (0.6% overall; 0.9% among PMs)), while 7 PMs reached the E.R.I immediately after exposure (4.3% overall; 6% among PMs). 10 ICDs (6.2% overall; 21.8% among ICDs) reporded multiple ventricular fibrillation detection stored in the device memory. During follow-up, 3 PMs (1.9% overall; 2.6% among PMs) and 1 ICD (0.6% overall; 2.2% among ICDs) reached the E.R.I. and 1 PM (0.6% overall; 0.9% among PMs) switched to emergency mode. All reported events occurred regardless of either 2, 5, or 10 Gy direct exposure. Malfunctions were observed in only older CIEDs.
Conclusions
Our data suggest recent CIEDs withstanding direct oncologic radiotherapy exposure up to 10 Gy, commonly considered not recommended or even unsafe by manufacturer statements and clinical guidelines. Malfunctions occurred in only older devices.
Acknowledgement/Funding
None
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Affiliation(s)
- E Di Girolamo
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Marini
- Cardiology Unit, S. Chiara Hospital, Trento, Italy
| | - M Faustino
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - N Furia
- Arrhythmology Unit, SS. Annunziata Hospital, Chieti, Italy
| | - M Appignani
- Intensive Cardiac Care Unit, SS Annunziata Hospital, Chieti, Italy
| | - D Genovesi
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
| | - C Di Carlo
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
| | - A Delana
- Medical Physics Unit, S. Chiara Hospital, Trento, Italy
| | - A Barbareschi
- Medical Physics Unit, Tor Vergata University, Rome, Italy
| | - M D Falco
- Radiotherapy Unit, SS. Annunziata Hospital, Chieti, Italy
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28
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Bertaglia E, Reggiani A, Palmisano P, D'Onofrio A, De Simone A, Caico S, Pecora D, Arena G, Ricciardi G, Marini M, Rapacciuolo A, Parisi Q, Maglia G, Malacrida M, Stabile G. P5688Is renal dysfunction associated with the outcome of CRT patients? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The benefit of cardiac resynchronization therapy (CRT) in patients (pts) with chronic kidney disease (CKD) remains controversial despite frequent use. Pts with impaired renal function have systematically been excluded from randomized clinical trials and therefore specific recommendations for the use of CRT in these pts are still lacking.
Purpose
Study objectives were to assess long-term outcomes and clinical/echocardiographic response in a large population of patients with moderate-to-severe impaired renal function implanted with a CRT device in accordance with the current standard of care.
Methods
We prospectively analyzed clinical, instrumental data and survival of pts with CKD who received a CRT device in the CRT-MORE registry from 2011 to 2014. Adverse events for the analysis of clinical outcome comprised death from any cause and nonfatal HF events requiring hospitalization after CRT implantation. LV reverse remodeling and Clinical Response (CR) were also evaluated at 12-month follow-up. Patients were stratified according to current definition of CKD stage: low-moderate CKD with a GFR = 45–59 mL/min (stage 3A); moderate CKD with a GFR = 30–44 mL/min (stage 3B) and severe CKD with a GFR = 15–29 mL/min (stage 4).
Results
Of the 922 consecutive patients enrolled in the registry, 416 (45%) pts had a moderate-to-severe impaired renal function (43% Stage 3A, 43% Stage 3B and 14% Stage 4). The mean follow-up was 935±506 days. By the end of the study, 85 pts had died and 47 pts had been hospitalized for HF. The combined end-point of death or HF hospitalization was reached by 121 (29%) pts. After 12 months the absolute LVEF improvement was greater than 10% in 37% of pts and 58% of pts displayed a positive clinical response. The percentage of pts who died was higher in the group of pts with severe CKD (32.8% vs 18.4%; p=0.012, compared to the group of pts with moderate CKD). On the contrary the percentage of pts who had at least one HF hospitalization was lower in the group with more severe CKD (2% vs 13%; p=0.011). According to CKD stage both LV remodeling (LVEF improvement ranging from 43.7% - 3A - to 30.8% - 4) and CR (positive response ranging from 63.9% - 3A - to 50% - 4) were higher in low-moderate stage and decreased with CKD severity. At multivariate Cox regression analysis adjusted for baseline confounders, CKD class at implantation [HR=1.5; 95% CI: 1.06–2.14; p=0.0219], chronic obstructive pulmonary disease [HR=1.89; 1.18–3.01; p=0.0077], persistent/permanent AF [HR=1.86; 1.15–3.01; p=0.0115] and male gender [HR=1.92; 1.07–3.46; p=0.0301] remained associated with death.
Conclusions
Among CKD patients in the CRT-MORE registry, severity of renal dysfunction at the time of CRT implantation was associated with worse prognosis, lower clinical response and LV reverse remodeling.
Acknowledgement/Funding
None
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Affiliation(s)
| | - A Reggiani
- Hospital Destra Secchia, Pieve Di Coriano, Italy
| | - P Palmisano
- Cardinale G. Panico Hospital, Tricase, Italy
| | - A D'Onofrio
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - S Caico
- Sant Antonio Abate Hospital, Gallarate, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - G Arena
- Apuane Hospital, Massa, Italy
| | - G Ricciardi
- Careggi University Hospital (AOUC), Florence, Italy
| | - M Marini
- Santa Chiara Hospital in Trento, Trento, Italy
| | | | - Q Parisi
- Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche - “Giovanni Paolo II”, Campobasso, Italy
| | - G Maglia
- Civil Hospital of Pugliese, Catanzaro, Italy
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29
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Perini F, Bastianini M, Capellacci S, Pugliese L, DiPoi E, Cabrini M, Buratti S, Marini M, Penna A. Molecular methods for cost-efficient monitoring of HAB (harmful algal bloom) dinoflagellate resting cysts. Mar Pollut Bull 2019; 147:209-218. [PMID: 29910142 DOI: 10.1016/j.marpolbul.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/15/2017] [Revised: 03/13/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
Cyst abundance and identity are essential for understanding and predicting blooms, and for assessing the dispersal of toxic target dinoflagellate species by natural or human mediated ways, as with ballast waters. The aim of this study was to apply rapid, specific and sensitive qPCR assays to enumerate toxic dinoflagellate cysts in sediment samples collected from Adriatic harbours. The molecular standard curves of various target species allowed obtaining the rDNA copy number per cyst. The analytical sensitivity for specific standard curves was determined to be 2 or 10 rDNA copies per reaction. The abundance varied in the range of 1-747 dinoflagellate cysts g-1 dry weight. The assays showed greater sensitivity as compared to counts by light microscopy. This qPCR method revealed a powerful tool for the quantification of cysts from toxic dinoflagellate resting stages in sediment samples from Adriatic ports.
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Affiliation(s)
- F Perini
- Department of Biomolecular Sciences, University of Urbino, Pesaro, Italy
| | - M Bastianini
- ISMAR-CNR, Istituto di Scienze Marine, Consiglio Nazionale delle Ricerche, Venezia, Italy
| | - S Capellacci
- Department of Biomolecular Sciences, University of Urbino, Pesaro, Italy
| | - L Pugliese
- Department of Biomolecular Sciences, University of Urbino, Pesaro, Italy
| | - E DiPoi
- OGS, Istituto Nazionale di Oceanografia e di Geofisica Sperimentale, Sgonico, Italy
| | - M Cabrini
- OGS, Istituto Nazionale di Oceanografia e di Geofisica Sperimentale, Sgonico, Italy
| | - S Buratti
- Fondazione Centro Ricerche Marine, Cesenatico, Italy
| | - M Marini
- ISMAR-CNR, Istituto di Scienze Marine, Consiglio Nazionale delle Ricerche, Ancona, Italy
| | - A Penna
- Department of Biomolecular Sciences, University of Urbino, Pesaro, Italy; ISMAR-CNR, Istituto di Scienze Marine, Consiglio Nazionale delle Ricerche, Ancona, Italy.
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30
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Grümberg U, Marini M, Nalda F, Pini C, Gotta S. Comprehensive treatment approach of the adult patient with Cleft Lip and Palate. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Pecora D, Pepi P, Palmisano P, D'Onofrio A, De Simone A, Caico S, Rapacciuolo A, Arena G, Marini M, Ricciardi G, Migliore F, La Greca C, Malacrida M, Stabile S, Bertaglia E. P1944Cardiac resynchronization therapy in elderly: Predictors of mortality at 12-months follow-up. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - P Pepi
- Hospital Carlo Poma, Mantova, Italy
| | - P Palmisano
- Cardinale G. Panico Hospital, Tricase, Italy
| | - A D'Onofrio
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - S Caico
- Sant' Antonio Abate Hospital, Gallarate, Italy
| | | | - G Arena
- SS. Giacomo e Cristoforo Hospital, Massa, Italy
| | - M Marini
- Santa Chiara Hospital in Trento, Trento, Italy
| | | | | | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
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32
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Noè D, Piazza A, Lanzi P, Nicolai E, Spiti R, Tagliabue V, Combi S, Ferrari E, Marini M, Raschioni E, Zanoni M, Fornasieri A, Gallieni M. Intradialytic parenteral nutrition (IDPN) is useful to fulfill nutritional targets in malnourished uremic patients. Nutrition 2018. [DOI: 10.1016/j.nut.2018.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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33
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Oliva F, Perna E, Marini M, Nassiacos D, Malfatto G, Morandi F, Ciro' A, Caico I, De Maria R. Relevant-HF REpetitive LEVosimendan in AdvaNced refracTory Heart Failure: A Multicenter Collaborative Experience. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.493] [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: 11/30/2022] Open
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34
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Bertaglia E, Pepi P, Palmisano P, D'onofrio A, De Simone A, Caico S, Pecora D, Rapacciuolo A, Arena G, Marini M, Ricciardi G, Migliore F, Ferretto S, Malacrida M, Stabile G. P330Cardiac resynchronization therapy in elderly: predictors of mortality at 12-months follow-up. Europace 2018. [DOI: 10.1093/europace/euy015.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - P Pepi
- Hospital Carlo Poma, Mantova, Italy
| | - P Palmisano
- Cardinale G. Panico Hospital, Tricase, Italy
| | - A D'onofrio
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - S Caico
- Sant' Antonio Abate Hospital , Gallarate, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | - G Arena
- SS. Giacomo e Cristoforo Hospital, Massa, Italy
| | - M Marini
- Santa Chiara Hospital in Trento, Trento, Italy
| | | | - F Migliore
- University Hospital of Padova, Padua, Italy
| | - S Ferretto
- University Hospital of Padova, Padua, Italy
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Marini M. Underweight vs. overweight/obese: which weight category do we prefer? Dissociation of weight-related preferences at the explicit and implicit level. Obes Sci Pract 2017; 3:390-398. [PMID: 29259797 PMCID: PMC5729491 DOI: 10.1002/osp4.136] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/06/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Although stigma towards obesity and anorexia is a well‐recognized problem, no research has investigated and compared the explicit (i.e. conscious) and implicit (i.e. unconscious) preferences between these two conditions. The present study conducted this investigation in a sample of 4,806 volunteers recruited at the Project Implicit website (https://implicit.harvard.edu). Methods Explicit and implicit preferences were assessed among different weight categories (i.e. underweight, normal weight and overweight/obese) by means of self‐reported items and the Multi‐category Implicit Association Test, respectively. Results Preferences for the normal weight category were found both at the explicit and implicit levels when this category was compared with overweight/obese and underweight categories. On the contrary, when the underweight category was contrasted with the obese/overweight category, results differed at the explicit and implicit levels: pro‐underweight preferences were observed at the explicit level, while pro‐overweight/obese preferences were found at the implicit level. Conclusions These results indicate that preferences between overweight/obese and underweight categories differ at the explicit and implicit levels. This dissociation may have important implications on behaviour and decision‐making.
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Affiliation(s)
- M Marini
- Center for Translational Neurophysiology Istituto Italiano di Tecnologia Ferrara Italy.,Department of Neurobiology Harvard Medical School Boston MA USA.,Department of Psychology Harvard University Cambridge MA USA
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Quintarelli S, Marini M, Branzoli S, Pederzolli C, Graffigna A, Coser A, Guarracini F, Moggio P, Bonmassari R, Droghetti A, Valsecchi S, Bottoli M. 073_16762-K3 Minimally Invasive Thoracoscopic Technique for LV Lead Implantation IN CRT: Long-Term Outcome. JACC Clin Electrophysiol 2017. [DOI: 10.1016/j.jacep.2017.09.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Almici C, Skert C, Bruno B, Bianchetti A, Verardi R, Di Palma A, Neva A, Braga S, Piccinelli G, Piovani G, Malagola M, Bernardi S, Giaccone L, Brunello L, Festuccia M, Baeten K, Russo D, Marini M. Circulating endothelial cell count: a reliable marker of endothelial damage in patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant 2017; 52:1637-1642. [PMID: 28892085 DOI: 10.1038/bmt.2017.194] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 12/12/2022]
Abstract
The physio-pathologic interrelationships between endothelium and GvHD have been better elucidated and have led to definition of the entity 'endothelial GvHD' as an essential early phase prior to the clinical presentation of acute GvHD. Using the CellSearch system, we analyzed circulating endothelial cells (CEC) in 90 allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients at the following time-points: T1 (pre-conditioning), T2 (pre-transplant), T3 (engraftment), T4 (onset of GvHD) and T5 (1 week after steroid treatment). Although CEC changes in allo-HSCT represent a dynamic phenomenon influenced by many variables (that is, conditioning, immunosuppressive treatments, engraftment syndrome and infections), we showed that CEC peaks were constantly seen at onset of acute GvHD and invariably returned to pre-transplant values after treatment response. Since we showed that CEC changes during allo-HSCT has rapid kinetics that may be easily missed if blood samples are drawn at pre-fixed time-points, we rather suggest an 'on demand' evaluation of CEC counts right at onset of GvHD clinical symptoms to possibly help differentiate GvHD from other non-endothelial complications. We confirm that CEC changes are a suitable biomarker to monitor endothelial damage in patients undergoing allo-transplantation and hold the potential to become a useful tool to support GvHD diagnosis (ClinicalTrials.gov NCT02064972).
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Affiliation(s)
- C Almici
- Department of Trasfusion Medicine, Laboratory for Stem Cells Manipulation and Cryopreservation, ASST Spedali Civili, Brescia, Italy
| | - C Skert
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - B Bruno
- BMT Unit, Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - A Bianchetti
- Department of Trasfusion Medicine, Laboratory for Stem Cells Manipulation and Cryopreservation, ASST Spedali Civili, Brescia, Italy
| | - R Verardi
- Department of Trasfusion Medicine, Laboratory for Stem Cells Manipulation and Cryopreservation, ASST Spedali Civili, Brescia, Italy
| | - A Di Palma
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - A Neva
- Department of Trasfusion Medicine, Laboratory for Stem Cells Manipulation and Cryopreservation, ASST Spedali Civili, Brescia, Italy
| | - S Braga
- Department of Trasfusion Medicine, Laboratory for Stem Cells Manipulation and Cryopreservation, ASST Spedali Civili, Brescia, Italy
| | - G Piccinelli
- Department of Transfusion Medicine, ASST Spedali Civili, Brescia, Italy
| | - G Piovani
- Biology and Genetics Division, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - M Malagola
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - S Bernardi
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - L Giaccone
- BMT Unit, Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - L Brunello
- BMT Unit, Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Festuccia
- BMT Unit, Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - K Baeten
- Global Scientific and Medical Affairs, Janssen Diagnostics, Beerse, Belgium
| | - D Russo
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - M Marini
- Department of Transfusion Medicine, ASST Spedali Civili, Brescia, Italy
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Tirinato L, Pagliari F, Limongi T, Marini M, Falqui A, Seco J, Candeloro P, Liberale C, Di Fabrizio E. An Overview of Lipid Droplets in Cancer and Cancer Stem Cells. Stem Cells Int 2017; 2017:1656053. [PMID: 28883835 PMCID: PMC5572636 DOI: 10.1155/2017/1656053] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 06/08/2017] [Accepted: 07/05/2017] [Indexed: 02/06/2023] Open
Abstract
For decades, lipid droplets have been considered as the main cellular organelles involved in the fat storage, because of their lipid composition. However, in recent years, some new and totally unexpected roles have been discovered for them: (i) they are active sites for synthesis and storage of inflammatory mediators, and (ii) they are key players in cancer cells and tissues, especially in cancer stem cells. In this review, we summarize the main concepts related to the lipid droplet structure and function and their involvement in inflammatory and cancer processes.
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Affiliation(s)
- L. Tirinato
- German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
- Physical Science and Engineering (PSE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - F. Pagliari
- Biological and Environmental Science and Engineering (BESE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - T. Limongi
- Physical Science and Engineering (PSE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
- Department of Applied Science and Technology (DISAT), Politecnico di Torino, Torino, Italy
| | - M. Marini
- Physical Science and Engineering (PSE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - A. Falqui
- Biological and Environmental Science and Engineering (BESE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - J. Seco
- German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - P. Candeloro
- BioNEM Lab, Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - C. Liberale
- Biological and Environmental Science and Engineering (BESE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - E. Di Fabrizio
- Physical Science and Engineering (PSE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
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Battistoni I, Marini M, Borovac J, Francioni M, Sorini Dini C, Moretti S, Valente S, Niccoli G, Perna G. P1488A simplified risk score inspired by cardshock score to predict short-term mortality in patients with cardiogenic shock. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Botto G, Bertaglia E, Pecora D, Rapacciuolo A, Reggiani A, Marenna B, Marini M, Ferraro A, Maglia G, Badolati S, Spotti A, Ricciardi G, Amadori F, Malacrida M, Stabile G. P5484Adherence to ESC guidelines class I was associated to better prognosis, clinical response and LV reverse remodeling in a large real-world CRT population. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Botto G, Reggiani A, Arena G, Rapacciuolo A, Checchi L, D'Onofrio A, Parisi Q, Marini M, Savarese G, Solimene F, Pierantozzi A, Pasqualini M, Iuele F, Malacrida M, Stabile G. P5474All-cause mortality in cardiac resynchronization therapy is predicted by the degree of LV reverse remodeling at mid-term follow-up. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Botto G, Palmisano P, Pepi P, D'Onofrio A, Marini M, De Simone A, Caico S, Pecora D, Santamaria M, Arena G, Pieragnoli P, Savarese G, Bertaglia E, Malacrida M, Stabile G. P5486Predictors of mortality in CRT patients: results from a large real-world population. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ferraro A, Bertaglia E, Botto GL, Rapacciuolo A, Reggiani A, Marenna B, Marini M, Mazza A, Maglia G, Badolati S, Spotti A, Ricciardi G, Amadori F, Malacrida M, Stabile G. 184Adherence to ESC guidelines class I was associated to better prognosis, clinical response and LV reverse remodeling in a large real-world CRT population. Europace 2017. [DOI: 10.1093/ehjci/eux137.003] [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: 11/13/2022] Open
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Manfrin M, Foco L, Cima A, Oberhollenzer R, Bonmassari R, Pramstaller PP, Marini M, Cemin R. P1586Statins are protective against appropriate ICD intervention in patients with non-ischemic hypokinetic cardiomyopathy. Europace 2017. [DOI: 10.1093/ehjci/eux158.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marini M, Pecora D, De Simone A, Parisi Q, Bertaglia E, Palmisano P, Coser A, Viscusi M, Spotti A, Canciello M, Pani A, Badolati S, Giovannini T, Malacrida M, Stabile G. P1511Electrocardiographic parameters during LV- and RV- pacing predict super-response in cardiac resynchronization therapy. Europace 2017. [DOI: 10.1093/ehjci/eux158.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zucchelli G, Sirico G, Rebellato L, Marini M, Del Greco M, Stabile G, Castro A, De Ruvo E, Soldati E, Zingarini G, Ocello S, Daleffe E, Mantica M, Pandozi C, Bongiorni MG. P900Impact of a novel technology for automatic point annotation during paroxysmal atrial fibrillation ablation with strict criteria of catheter stability. Europace 2017. [DOI: 10.1093/ehjci/eux151.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marini M, Branzoli S, Moggio P, Coser A, Gurracini F, Quintarelli S, Pederzolli C, Graffigna A, Bonmassari R, Bottoli MC, Droghetti A. P1510Minimally invasive thoracoscopic technique for LV lead implantation in CRT: long-term outcome. Europace 2017. [DOI: 10.1093/ehjci/eux158.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marini M, Limongi T, Falqui A, Genovese A, Allione M, Moretti M, Lopatin S, Tirinato L, Das G, Torre B, Giugni A, Cesca F, Benfenati F, Di Fabrizio E. Imaging and structural studies of DNA-protein complexes and membrane ion channels. Nanoscale 2017; 9:2768-2777. [PMID: 28155926 DOI: 10.1039/c6nr07958j] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In bio-imaging by electron microscopy, damage of the sample and limited contrast are the two main hurdles for reaching high image quality. We extend a new preparation method based on nanofabrication and super-hydrophobicity to the imaging and structural studies of nucleic acids, nucleic acid-protein complexes (DNA/Rad51 repair protein complex) and neuronal ion channels (gap-junction, K+ and GABAA channels) as paradigms of biological significance and increasing complexity. The preparation method is based on the liquid phase and is compatible with physiological conditions. Only in the very last stage, samples are dried for TEM analysis. Conventional TEM and high-resolution TEM (HRTEM) were used to achieve a resolution of 3.3 and 1.5 Å, respectively. The EM dataset quality allows the determination of relevant structural and metrological information on the DNA structure, DNA-protein interactions and ion channels, allowing the identification of specific macromolecules and their structure.
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Affiliation(s)
- M Marini
- King Abdullah University of Science and Technology, SMILEs lab, PSE and BESE Divisions, Thuwal, 23955-6900, Kingdom of Saudi Arabia.
| | - T Limongi
- King Abdullah University of Science and Technology, SMILEs lab, PSE and BESE Divisions, Thuwal, 23955-6900, Kingdom of Saudi Arabia.
| | - A Falqui
- King Abdullah University of Science and Technology, NABLA lab, BESE Division, Thuwal, 23955-6900, Kingdom of Saudi Arabia
| | - A Genovese
- King Abdullah University of Science and Technology, NABLA lab, BESE Division, Thuwal, 23955-6900, Kingdom of Saudi Arabia
| | - M Allione
- King Abdullah University of Science and Technology, SMILEs lab, PSE and BESE Divisions, Thuwal, 23955-6900, Kingdom of Saudi Arabia.
| | - M Moretti
- King Abdullah University of Science and Technology, SMILEs lab, PSE and BESE Divisions, Thuwal, 23955-6900, Kingdom of Saudi Arabia.
| | - S Lopatin
- King Abdullah University of Science and Technology, Imaging and Characterization core lab, Thuwal, 23955-6900, Kingdom of Saudi Arabia
| | - L Tirinato
- King Abdullah University of Science and Technology, SMILEs lab, PSE and BESE Divisions, Thuwal, 23955-6900, Kingdom of Saudi Arabia.
| | - G Das
- King Abdullah University of Science and Technology, SMILEs lab, PSE and BESE Divisions, Thuwal, 23955-6900, Kingdom of Saudi Arabia.
| | - B Torre
- King Abdullah University of Science and Technology, SMILEs lab, PSE and BESE Divisions, Thuwal, 23955-6900, Kingdom of Saudi Arabia.
| | - A Giugni
- King Abdullah University of Science and Technology, SMILEs lab, PSE and BESE Divisions, Thuwal, 23955-6900, Kingdom of Saudi Arabia.
| | - F Cesca
- Center for Synaptic Neuroscience and Technology, Istituto Italiano di Tecnologia, Genova, Italy
| | - F Benfenati
- Center for Synaptic Neuroscience and Technology, Istituto Italiano di Tecnologia, Genova, Italy
| | - E Di Fabrizio
- King Abdullah University of Science and Technology, SMILEs lab, PSE and BESE Divisions, Thuwal, 23955-6900, Kingdom of Saudi Arabia.
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Marini M, Musiani D, Raggi MA, Schiavone P, Levine RL. Oxidative stress does not mediate heat shock-induced cell damage and apoptosis. Redox Rep 2016; 3:57-63. [DOI: 10.1080/13510002.1997.11747091] [Citation(s) in RCA: 4] [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: 10/21/2022] Open
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Yao K, Uedo N, Muto M, Ishikawa H, Cardona HJ, Filho ECC, Pittayanon R, Olano C, Yao F, Parra-Blanco A, Ho SH, Avendano AG, Piscoya A, Fedorov E, Bialek AP, Mitrakov A, Caro L, Gonen C, Dolwani S, Farca A, Cuaresma LF, Bonilla JJ, Kasetsermwiriya W, Ragunath K, Kim SE, Marini M, Li H, Cimmino DG, Piskorz MM, Iacopini F, So JB, Yamazaki K, Kim GH, Ang TL, Milhomem-Cardoso DM, Waldbaum CA, Carvajal WAP, Hayward CM, Singh R, Banerjee R, Anagnostopoulos GK, Takahashi Y. Development of an E-learning System for the Endoscopic Diagnosis of Early Gastric Cancer: An International Multicenter Randomized Controlled Trial. EBioMedicine 2016; 9:140-147. [PMID: 27333048 PMCID: PMC4972485 DOI: 10.1016/j.ebiom.2016.05.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/15/2016] [Accepted: 05/16/2016] [Indexed: 01/06/2023] Open
Abstract
Background In many countries, gastric cancer is not diagnosed until an advanced stage. An Internet-based e-learning system to improve the ability of endoscopists to diagnose gastric cancer at an early stage was developed and was evaluated for its effectiveness. Methods The study was designed as a randomized controlled trial. After receiving a pre-test, participants were randomly allocated to either an e-learning or non-e-learning group. Only those in the e-learning group gained access to the e-learning system. Two months after the pre-test, both groups received a post-test. The primary endpoint was the difference between the two groups regarding the rate of improvement of their test results. Findings 515 endoscopists from 35 countries were assessed for eligibility, and 332 were enrolled in the study, with 166 allocated to each group. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group were included in the analysis. The mean improvement rate (standard deviation) in the e-learning and non-e-learning groups was 1·24 (0·26) and 1·00 (0·16), respectively (P < 0·001). Interpretation This global study clearly demonstrated the efficacy of an e-learning system to expand knowledge and provide invaluable experience regarding the endoscopic detection of early gastric cancer (R000012039). This report establishes that an e-learning system on the Internet can improve the diagnostic ability of endoscopists. Countless endoscopists worldwide can access the system to learn how to make an endoscopic diagnosis of early gastric cancer. The e-learning system could be modified to provide education regarding endoscopic diagnosis in other organs.
This is the first report to demonstrate how an e-learning system based on the Internet can improve the diagnostic ability of gastrointestinal endoscopists worldwide. There is no limit to the number of endoscopists who can access the system and benefit from this opportunity to learn how to make an endoscopic diagnosis of early gastric cancer. This e-learning system could be modified to provide education regarding endoscopic diagnosis in other organs such as the large intestine and the esophagus, as well as the stomach. It may contribute to human welfare and health by reducing the mortality from gastrointestinal cancer.
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Affiliation(s)
- K Yao
- Fukuoka University Chikushi Hospital, Chikushino, Japan.
| | - N Uedo
- Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - M Muto
- Kyoto University, Kyoto, Japan
| | - H Ishikawa
- Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | - R Pittayanon
- King Chulalongkorn Memorial Hospital, The Thai Red Cross and Chulalongkorn University, Bangkok, Thailand
| | - C Olano
- Universidad de la República, Montevideo, Uruguay
| | - F Yao
- Peking Union Medical College Hospital, Beijing, China
| | - A Parra-Blanco
- School of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile
| | - S H Ho
- University of Malaya, Kuala Lumpur, Malaysia
| | - A G Avendano
- Hospital Rafael Angel Calderon Guardia, CCSS, San Jose, Costa Rica
| | - A Piscoya
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - E Fedorov
- Russia National Medical University, Moscow University Hospital, N31, Moscow, Russian Federation
| | - A P Bialek
- Pomeranian Medical University, Szczecin, Poland
| | - A Mitrakov
- Nizhniy Novgorod Cancer Hospital, Nizhniy Novgorod, Russian Federation
| | - L Caro
- GEDyt Gastroenterologia diagnostica y tratamiento Inst afiliafa a la UBA Buenos Aires, Argentina
| | - C Gonen
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - S Dolwani
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - A Farca
- The American British Cowdray Medical Center. Mexico City, Mexico
| | - L F Cuaresma
- Hospital Nacional Adolfo Guevara Velasco, Cusco, Peru
| | - J J Bonilla
- i-gastro/Hospital Central de la Fuerza Aerea del Peru, Lima, Peru
| | - W Kasetsermwiriya
- Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - K Ragunath
- NIHR Nottingham Digestive Disease Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospital, Nottingham, United Kingdom
| | - S E Kim
- Kosin University College of Medicine, Busan, Republic of Korea
| | - M Marini
- Gastroenterology and Operative Endoscopy Unit, Siena University Hospital, Siena, Italy
| | - H Li
- Sichuan Provincial People's Hospital, Sichuan, Academy of Medical Sciences, Chengdu, China
| | | | - M M Piskorz
- Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - F Iacopini
- Ospedale S. Giuseppe, ASL Roma 6, Albano L, Rome, Italy
| | - J B So
- National University of Singapore, Singapore, Singapore
| | - K Yamazaki
- University of Sao Paulo, Sao Paulo, Brazil
| | - G H Kim
- Pusan National University School of Medicine, Busan, Republic of Korea
| | - T L Ang
- Changi General Hospital, Singapore, Singapore
| | | | - C A Waldbaum
- Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | | | - C M Hayward
- Derriford Hospital, Plymouth, United Kingdom
| | - R Singh
- Lyell McEwin Hospital & University of Adelaide, Adelaide, Australia
| | - R Banerjee
- Asian Institute of Gastroenterology, Hyderabad, India
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