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Bolognini N.,University of Milan Bicocca | Bolognini N.,Neuropsychological Laboratory | Olgiati E.,University of Milan Bicocca | Maravita A.,University of Milan Bicocca | And 2 more authors.
Pain | Year: 2013

Limb amputation may lead to chronic painful sensations referred to the absent limb, ie phantom limb pain (PLP), which is likely subtended by maladaptive plasticity. The present study investigated whether transcranial direct current stimulation (tDCS), a noninvasive technique of brain stimulation that can modulate neuroplasticity, can reduce PLP. In 2 double-blind, sham-controlled experiments in subjects with unilateral lower or upper limb amputation, we measured the effects of a single session of tDCS (2 mA, 15 min) of the primary motor cortex (M1) and of the posterior parietal cortex (PPC) on PLP, stump pain, nonpainful phantom limb sensations and telescoping. Anodal tDCS of M1 induced a selective short-lasting decrease of PLP, whereas cathodal tDCS of PPC induced a selective short-lasting decrease of nonpainful phantom sensations; stump pain and telescoping were not affected by parietal or by motor tDCS. These findings demonstrate that painful and nonpainful phantom limb sensations are dissociable phenomena. PLP is associated primarily with cortical excitability shifts in the sensorimotor network; increasing excitability in this system by anodal tDCS has an antalgic effect on PLP. Conversely, nonpainful phantom sensations are associated to a hyperexcitation of PPC that can be normalized by cathodal tDCS. This evidence highlights the relationship between the level of excitability of different cortical areas, which underpins maladaptive plasticity following limb amputation and the phenomenology of phantom limb, and it opens up new opportunities for the use of tDCS in the treatment of PLP. © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Franchini M.,Azienda Ospedaliera Carlo Poma | Liumbruno G.M.,Transfusion Medicine and Clinical Pathology Units
Clinical Chemistry and Laboratory Medicine | Year: 2013

Human blood group antigens are glycoproteins and glycolipids expressed on the surface of red blood cells and a variety of human tissues, including the epithelium, sensory neurons, platelets and the vascular endothelium. Accumulating evidence indicate that ABO blood type is implicated in the development of a number of human diseases, including cardiovascular and neoplastic disorders. In this review, beside its physiologic role in immunohematology and transfusion medicine, we summarize the current knowledge on the association between the ABO blood group and the risk of developing thrombotic events and cancers. © 2013 by Walter de Gruyter Berlin Boston 2013.

Mazziotti G.,University of Brescia | Porcelli T.,University of Brescia | Patelli I.,University of Brescia | Vescovi P.P.,Azienda Ospedaliera Carlo Poma | Giustina A.,University of Brescia
Bone | Year: 2010

Introduction: There is evidence that variations of thyrotropin (TSH) even in its reference range may influence bone mineral density (BMD). In fact, low-normal TSH values have been associated with high prevalence of osteoporosis in post-menopausal women. However, data associating TSH and risk of fractures are scanty and limited to subjects with subclinical thyrotoxicosis. Materials and methods: In this observational study, we investigated the correlation between serum TSH and prevalence of radiological vertebral fractures in a cohort of 130 post-menopausal women with normal thyroid function. Results: Osteoporosis was observed in 80 women (61.5%), whereas 49 women (37.7%) had osteopenia. Vertebral fractures were found in 49 women (37.7%), who were significantly older, with higher prevalence of osteoporosis and with lower serum TSH values as compared with women who did not fracture. Stratifying the patients according to serum TSH values, vertebral fractures were found to be significantly (p= 0.004) more prevalent in first tertile (56.8%) of TSH values as compared with the second (23.3%) and third tertiles (32.6%). Multivariate logistic regression analysis demonstrated that low serum TSH maintained a significant correlation with vertebral fractures (odds ratio 2.8, C.I. 95% 1.20-6.79) even after correction for age, BMD, BMI and serum free-thyroxine values. Discussion: Low-normal TSH values are associated with high prevalence of vertebral fractures in women with post-menopausal osteoporosis or osteopenia, independently of thyroid hormones, age and BMD. © 2009 Elsevier Inc.

Dentali F.,University of Insubria | Sironi A.P.,University of Insubria | Gianni M.,Tradate Hospital | Orlandini F.,Ligurian East Hospital | And 5 more authors.
Seminars in Thrombosis and Hemostasis | Year: 2015

Introduction Limited information exists on gender-related differences in the safety and efficacy of non-vitamin K antagonist oral anticoagulants (NOACs). Aim of the StudyTo assess the safety and efficacy of direct oral anticoagulants (DOACs)/NOACs in men and women pooling data from randomized controlled trials on the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF) and on the acute and extended treatment of venous thromboembolism (VTE). MethodsMEDLINE and EMBASE databases were searched up to June 2014. The efficacy outcome was defined as the prevention of stroke and systemic embolism (AF studies), or as the prevention of recurrent VTE or VTE-related death (VTE studies). The safety outcome was defined as the occurrence of major and/or clinically relevant nonmajor bleeding. Differences in the efficacy and safety outcomes were expressed as risk ratio (RR) with pertinent 95% confidence intervals (95% CI). ResultsA total of 13 studies (> 100,000 patients) were included. DOACs appeared to have a similar efficacy and safety compared with vitamin K antagonists in female and male patients treated for nonvalvular AF and acute VTE. In the extended treatment of VTE NOACs had a RR of bleeding of 4.97 (95% CI 1.06, 23.41) in males and 1.33 (95% CI 0.63, 2.83) in females compared with placebo (subgroup difference chi-square test: 2.25, p=0.13). ConclusionsNo gender-related difference in the efficacy and safety of NOACs in patients with AF or acute VTE was found. A trend toward an increased risk of bleeding in male patients as compared with female patients was detected in the extended treatment of VTE. © 2015 by Thieme Medical Publishers, Inc.

Lippi G.,Laboratory of Clinical Chemistry and Hematology | Danese E.,University of Verona | Favaloro E.J.,Institute of Clinical Pathology and Medical Research ICPMR | Montagnana M.,University of Verona | Franchini M.,Azienda Ospedaliera Carlo Poma
Seminars in Thrombosis and Hemostasis | Year: 2015

Venous thromboembolism (VTE) is a prevalent and life-threatening condition that requires an accurate and timely diagnosis. The current diagnostic approach to this condition, entailing an efficient integration of clinical judgment, diagnostic imaging, and laboratory testing, is the result of decades of scientific and medical research. This article aims to present and discuss the major breakthroughs that have occurred in the diagnostic imaging of both deep vein thrombosis and pulmonary embolism, along with the various biological markers that have emerged from the laboratory bench and which have only marginally migrated to the bedside. Despite decades of research, the current diagnostic armamentarium for an efficient diagnosis of VTE remains suboptimal, and some wiggle room remains for the development of more efficient diagnostic tools, which may include thrombus-targeted molecular imaging, infrared thermal imaging, thrombin generation, and proteomics. Copyright © 2015 by Thieme Medical Publishers, Inc.

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