Azienda Ospedaliera San Giovanni Battista

San Giovanni al Natisone, Italy

Azienda Ospedaliera San Giovanni Battista

San Giovanni al Natisone, Italy

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Kramer B.K.,University of Mannheim | Kramer B.K.,University of Regensburg | Klinger M.,Wroclaw Medical University | Vitko S.,Institute for Clinical and Experimental Medicine | And 21 more authors.
Transplantation | Year: 2012

BACKGROUND: Long-term use of corticosteroids is associated with considerable morbidity, including cardiovascular and metabolic adverse effects. METHODS: This study evaluated the long-term efficacy and safety of two steroid-free regimens compared with a triple immunosuppressive therapy in renal transplant recipients. This was a 3-year follow-up to a 6-month, open-label, randomized, multicenter study. RESULTS: Data from 3 years were available for 421 (93.3%) of 451 patients in the original intent-to-treat population (143 tacrolimus/basiliximab [Tac/Bas], 139 tacrolimus/mycophenolate mofetil [Tac/MMF], and 139 tacrolimus/MMF/steroids [triple therapy]). In the time interval from 6 months to 3 years after transplantation, the incidence of biopsy-proven acute rejection was low and similar (Tac/Bas, 2.1%; Tac/MMF, 2.2%; triple therapy, 2.2%); Most rejection episodes occurred during the first 6 months of the study. Graft survival was high (Kaplan-Meier estimates: 92.7%, 92.5%, and 92.5%), as was patient survival (93.1%, 96.4%, and 97.0%). There were 10 graft losses (n=2, 4, and 4) and 12 patient deaths (n=5, 2, and 5). Renal function was well preserved throughout the study and similar between groups. There was a trend toward improved cardiovascular risk factors in the Tac/Bas group, including reduced total and low-density lipoprotein cholesterol and lower new-onset insulin use. There were no between-group differences in the incidence or type of adverse events. CONCLUSION: Higher rates of acute rejection early in treatment were seen with the steroid-free regimens, but this did not translate into poorer long-term outcomes, such as graft and patient survival and renal function. A trend for a more favorable cardiovascular risk profile was observed for steroid-free immunosuppression with Tac/Bas. Copyright © 2012 Lippincott Williams &Wilkins.


Galassi C.,Azienda Ospedaliera San Giovanni Battista | Baldini M.,Osservatorio Epidemiologico Ambientale della Regione Marche | Serinelli M.,Centro Regionale Aria | Pandolfi P.,UOC Epidemiologia | And 18 more authors.
Epidemiologia e Prevenzione | Year: 2013

OBJECTIVE: to evaluate the relationship between air pollution and hospital admissions in 25 Italian cities that took part in the EpiAir (Epidemiological surveillance of air pollution effects among Italian cities) project. DESIGN: study of time series with case-crossover methodology, with adjustment for meteorological and time-dependent variables. The association air pollution-hospitalisation was analyzed in each of the 25 cities involved in the study; the overall estimates of effect were obtained subsequently by means of a meta-analy-sis. The pollutants considered were PM10, PM2.5 (in 13 cities only), NO2 and ozone (O3); this last pollutant restricted to the summer season (April-September). SETTING AND PARTICIPANTS: the study has analyzed 2,246,448 urgent hospital admissions for non-accidental diseases in 25 Italian cities during the period 2006-2010; 10 out of 25 cities took part also in the first phase of the project (2001-2005). MAIN OUTCOMEMEASURES: urgent hospital admissions for cardiac, cerebrovascular and respiratory diseases, for all age groups, were considered. The respiratory hospital admissions were analysed also for the 0-14-year subgroup. Percentage increases risk of hospitalization associated with increments of 10 μg/m 3 and interquartile range (IQR) of the concentration of each pollutant were calculated. RESULTS: reported results were related to an increment of 10 μg/m3 of air pollutant. The percent increase for PM10 for cardiac causes was 0.34% at lag 0 (95%CI 0.04-0.63), for respiratory causes 0.75% at lag 0-5 (95%CI 0.25-1.25). For PM2.5, the percent increase for respiratory causes was 1.23% at lag 0-5 (95%CI 0.58-1.88). For NO2, the percent increase for cardiac causes was 0.57%atlag 0 (95%CI 0.13-1.02); 1.29% at lag 0-5 (95%CI 0.52-2.06) for respiratory causes. Ozone (O3) did not turned out to be positively associated neither with cardiac nor with respiratory causes as noted in the previous period (2001-2005). CONCLUSION: the results of the study confirm an association between PM10, PM2.5, and NO2 on hospital admissions among 25 Italian cities. No positive associations for ozone was noted in this period.


Palumbo A.,University of Turin | Larocca A.,University of Turin | Genuardi M.,University of Turin | Kotwica K.,University of Turin | And 14 more authors.
Haematologica | Year: 2010

Background Defibrotide is a novel orally bioavailable polydisperse oligonucleotide with anti-thrombotic and anti-adhesive effects. In SCID/NOD mice, defibrotide showed activity in human myeloma xenografts. This phase I/II study was conducted to identify the most appropriate dose of defibrotide in combination with melphalan, prednisone and thalidomide in patients with relapsed and relapsed/refractory multiple myeloma, and to determine its safety and tolerability as part of this regimen. Design and Methods This was a phase I/II, multicenter, dose-escalating, non-comparative, open label study. Oral melphalan was administered at a dose of 0.25 mg/kg on days 1-4, prednisone at a dose of 1.5 mg/kg also on days 1-4 and thalidomide at a dose of 50-100 mg/day continuously. Defibrotide was administered orally at three dose-levels: 2.4, 4.8 or 7.2 g on days 1-4 and 1.6, 3.2, or 4.8 g on days 5-35.Results Twenty-four patients with relapsed/refractory multiple myeloma were enrolled. No dose-limiting toxicity was observed. In all patients, the complete response plus very good partial response rate was 9%, and the partial response rate was 43%. The 1-year progression-free survival and 1-year overall survival rates were 34% and 90%, respectively. The most frequent grade 3-4 adverse events included neutropenia, thrombocytopenia, anemia and fatigue. Deep vein thrombosis was reported in only one patient. Conclusions This combination of melphalan, prednisone and thalidomide together with defibrotide showed anti-tumor activity with a favorable tolerability. The maximum tolerated dose of defibrotide was identified as 7.2 g p.o. on days 1-4 followed by 4.8 g p.o. on days 5-35. Further trials are needed to confirm the role of this regimen and to evaluate the combination of defibrotide with new drugs (ClinicalTrials.gov Identifier: NCT00406978). © 20-10 Ferrata Storti Foundation.


Piovesan L.,University of Turin | Molino G.,Azienda Ospedaliera San Giovanni Battista | Terenziani P.,University of Piemonte Orientale
HEALTHINF 2015 - 8th International Conference on Health Informatics, Proceedings; Part of 8th International Joint Conference on Biomedical Engineering Systems and Technologies, BIOSTEC 2015 | Year: 2015

Clinical practice guidelines are widely used to support physicians, but only on individual pathologies. The treatment of patients affected by multiple diseases (comorbid patients) requires the development of new approaches, supporting physicians in the detection of interactions between guidelines. We propose a new methodology, supporting flexible and physician-driven search and detection. In particular, we provide a flexible and interactive mechanism to navigate guidelines and our ontology of interactions (between drugs, or between actions' goals) at multiple levels of detail, focusing on specific parts of it (e.g., on a specific pair of actions, or of drugs) to look for interactions. We introduce the notion of "navigation tree", as the basic data structure to support multiple-level interaction analysis, and describe navigation and focusing algorithms operating on it. We also introduce a visualization tool that is based on the "navigation tree", and further enhances the user-friendliness of our approach.


Bottrighi A.,University of Piemonte Orientale | Giordano L.,University of Piemonte Orientale | Molino G.,Azienda Ospedaliera San Giovanni Battista | Montani S.,University of Piemonte Orientale | And 2 more authors.
Artificial Intelligence in Medicine | Year: 2010

Objectives: Clinical guidelines (GLs) are assuming a major role in the medical area, in order to grant the quality of the medical assistance and to optimize medical treatments within healthcare organizations. The verification of properties of the GL (e.g., the verification of GL correctness with respect to several criteria) is a demanding task, which may be enhanced through the adoption of advanced Artificial Intelligence techniques. In this paper, we propose a general and flexible approach to address such a task. Methods and materials: Our approach to GL verification is based on the integration of a computerized GL management system with a model-checker. We propose a general methodology, and we instantiate it by loosely coupling GLARE, our system for acquiring, representing and executing GLs, with the model-checker SPIN. Results: We have carried out an in-depth analysis of the types of properties that can be effectively verified using our approach, and we have completed an overview of the usefulness of the verification task at the different stages of the GL life-cycle. In particular, experimentation on a GL for ischemic stroke has shown that the automatic verification of properties in the model checking approach is able to discover inconsistencies in the GL that cannot be detected in advance by hand. Conclusion: Our approach thus represents a further step in the direction of general and flexible automated GL verification, which also meets usability requirements. © 2009 Elsevier B.V. All rights reserved.


Bottrighi A.,University of Piemonte Orientale | Torchio M.,Azienda Ospedaliera San Giovanni Battista | Montani S.,University of Piemonte Orientale | Molino G.,Azienda Ospedaliera San Giovanni Battista | Terenziani P.,University of Piemonte Orientale
Studies in Health Technology and Informatics | Year: 2010

Clinical guidelines (GL) play an important role in medical practice: the one of optimizing the quality of patient care on the basis of the best and most recent evidence based medicine. In order to achieve this goal, the interaction between different actors, who cooperate in the execution of the same GL, is a crucial issue. As a matter of fact, in many cases (e.g. in chronic disease treatment) the GL execution requires that patient treatment is not performed/completed in the hospital, but is continued in different contexts (e.g. at home, or in the general practitioner's ambulatory), under the responsibility of different actors. In this situation, the correct interaction and communication between the actors themselves is critical for the quality of care, and human resources coordination is a key issue to be addressed by the managers of the involved healthcare service. In this paper we describe how computerized GL management can be extended in order to support such needs, and we illustrate our approach by means of a practical case study. © 2010 IMIA and SAHIA. All rights reserved.


Bottrighi A.,University of Piemonte Orientale | Molino G.,Azienda Ospedaliera San Giovanni Battista | Montani S.,University of Piemonte Orientale | Terenziani P.,University of Piemonte Orientale | Torchio M.,Azienda Ospedaliera San Giovanni Battista
Computer Methods and Programs in Biomedicine | Year: 2013

Clinical guidelines (GL) play an important role in medical practice: the one of optimizing the quality of patient care on the basis of evidence based medicine. In order to achieve this goal, the interaction between different agents, who cooperate in the execution of the same GL, is a crucial issue. As a matter of fact, in many cases (e.g. in chronic disorders) the GL execution requires that patient treatment is not performed/completed in the hospital, but is continued in different contexts (e.g. at home, or in the general practitioner's ambulatory), under the responsibility of different agents. In this situation, the correct interaction and communication between the agents themselves is critical for the quality of care, and human resources coordination is a key issue to be addressed by the managers of the involved healthcare services. In this paper we describe how GLARE (Guideline Acquisition, Representation, and Execution), a computerized GL management system, has been extended in order to support such a need. In particular, we have provided: (i) an extension to GL actions representation languages, (ii) proper scheduling and (iii) querying services. By means of these enhancements we aimed at guaranteeing (1) treatment continuity and (2) responsibility assignment support in the various steps of a coordinated and distributed patient care process. We illustrate our approach by means of a practical case study. © 2013 Elsevier Ireland Ltd.


PubMed | Azienda ospedaliera San Giovanni Battista
Type: Journal Article | Journal: Therapeutic advances in hematology | Year: 2013

The identification of patients at high risk of relapse is a critical goal of modern translational research in oncohematology. Minimal residual disease (MRD) detection by polymerase chain reaction-based methods is routinely employed in the management of patients with acute lymphoblastic leukemia. Current knowledge indicates that it is also a useful prognostic tool in several mature lymphoproliferative disorders and particularly in follicular lymphoma (FL). Based on this evidence clinical trials employing MRD-based risk stratification are currently ongoing in FL. In this review the state of the art of MRD evaluation in FL is discussed. A short description of technical issues and recent methodological advances is provided. Then, the bulk of the review focuses on critical take-home messages for clinicians working in the field. Finally, we discuss future perspectives of MRD detection and more generally outcome prediction in FL.

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