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Bacigalupo A.,Azienda Ospedaliera Universitaria San Martino | Marsh J.C.W.,Kings College London
Bone Marrow Transplantation | Year: 2013

Currently at least 75% of patients with severe aplastic anaemia can be successfully transplanted using a matched unrelated donor (UD) haematopoietic SCT (HSCT). For children, outcomes are similar to matched sibling donor (MSD) HSCT. This improvement in outcome over time is likely due to improved HLA tissue typing to identify better matched donors, improvements in the conditioning regimen, particularly fludarabine-based regimens, and improved supportive care. Graft rejection occurs in ∼15% of adults, but is less frequent in children. Chronic GVHD remains a concern but may be reduced by using Alemtuzumab instead of ATG. UD HSCT should be considered early after failure to respond to one course of immunosuppressive therapy, but for children who lack a MSD up front matched UD HSCT may be considered. © 2013 Macmillan Publishers Limited All rights reserved.

Paoletti E.,Dialisi | Marsano L.,Dialisi | Bellino D.,Dialisi | Cassottana P.,Azienda Ospedaliera Universitaria San Martino | Cannella G.,Dialisi
Transplantation | Year: 2012

BACKGROUND.: Although conversion from calcineurin inhibitors to mammalian target of rapamycin inhibitors proved to be effective in regressing left ventricular hypertrophy (LVH) in renal transplant recipients (RTRs) with chronic allograft dysfunction, there are currently no reports of randomized trials on this issue involving de novo RTRs administered everolimus (EVL). METHODS.: This randomized, open-label, controlled trial evaluated the effect of EVL on the left ventricular mass index (LVMi) of 30 nondiabetic RTRs (21 men; age 28-65 years). Ten were allocated to EVL plus reduced-exposure cyclosporine A (CsA), and 20 to standard dose CsA. LVMi was assessed by echocardiography both at baseline and 1 year later. Blood pressure (BP), hemoglobin, serum creatinine, lipids, trough levels of immunosuppressive drugs, and daily proteinuria were also evaluated twice monthly. Antihypertensive therapy that did not include renin-angiotensin system blockers was administered to achieve BP less than or equal to 130/80 mm Hg. RESULTS.: Changes in BP were similar in the two groups (between group difference 1.2±5.7 mm Hg, P=0.84 for systolic, and -1.5±3.7, P=0.69, for diastolic BP), whereas LVMi significantly decreased in the EVL group alone (between group difference 9.2±3.1 g/m, P=0.005), due to a reduction in both the interventricular septum and the left ventricular posterior wall thickness. EVL therapy together with baseline LVMi were the only significant predictors of LVH regression according to a multivariate model that explained 49% of the total LVMi variance (P=0.0015). CONCLUSIONS.: An immunosuppressive regimen consisting of EVL plus reduced exposure CsA proved to be effective in regressing LVH in RTRs regardless of BP, mainly by reducing left ventricular wall thickness. Copyright © 2012 by Lippincott Williams & Wilkins.

Rossi T.,Azienda Ospedaliera Universitaria San Martino
Retina | Year: 2015

PURPOSE:: To characterize the fluidics of axial rotating vitreous cutter probe (RT) compared with the standard guillotine (regular blade), when tested in Balanced Salt Solution (Alcon Laboratories, Forth Worth, TX). METHODS:: RT and regular blade (RB) cutter probes connected to the same vitrectomy console used a peristaltic pump. The authors measured instantaneous flow through aspiration tubing proximal to the handpiece, fluid velocity, and acceleration at the port by means of particle image velocimetry. RESULTS:: Average flow at aspiration tubing of RT and RB did not vary significantly. Regular blade probes produced higher instantaneous flow fluctuation than RT at any considered cut rate (RB 1,600 6.4 ± 5.3 mL/minute; RB 3,000 11.8 ± 6.3 mL/minute; RT 1,600 0.9 ± 0.7 mL/minute, and RT 3,000 1.8 ± 0.8 mL/minute, respectively. P < 0.001 in all cases). Regular blade also yield significantly higher fluid velocity at cutter port compared with RT (RB 1,600 85.8 ± 70.1 mm/second; RB 3,000 81.6 ± 66.4 mm/second; RT 1,600 71.9 ± 40.3 mm/second; and RT 3,000 32.9 ± 20.8 mm/second. P < 0.001 in all cases). Fluid acceleration at the cutter port was higher when the RB was used (RB 1,600 26.85 ± 30.18 mm/second; RB 3,000 33.76 ± 34.09 mm/second; RT 1,600 24.01 ± 21.94 mm/second; and RT 3,000 16.62 ± 17.87 mm/second. P < 0.001 in all cases). CONCLUSION:: RT blade design causes less instantaneous flow fluctuation within the aspiration tubing, and also lower fluid velocity and lower acceleration at the cutter port. Fluidics suggests a safer cutting action and a reduced risk of retinal incarceration. © 2015 by Ophthalmic Communications Society, Inc.

Ciprandi G.,Azienda Ospedaliera Universitaria San Martino
Journal of biological regulators and homeostatic agents | Year: 2012

FEV1 is considered an important parameter for asthma diagnosis and follow-up. However, it has been proposed that FEF25-75 could be more sensitive than FEV1 to detect slight airways obstruction. Bronchial reversibility defined by positive response to bronchodilation test. The aim of the present study was to define whether an impaired FEF25-75 value (less than 65 percent of predicted) may be predictive for reversibility in a large cohort of allergic children with rhinitis or asthma. Six hundred allergic children were recruited: 300 with controlled asthma and 300 with allergic rhinitis. All of them were evaluated by performing spirometry, bronchodilation test, and skin prick test. Two predictors were significantly associated with bronchial reversibility: i) an impaired FEF25-75 value (less than 65 percent of predicted), and ii) sensitization to perennial allergens. It was more relevant in children with rhinitis (ORAdj:8.9 and 2.2 respectively). In conclusion, this study, conducted in real life, could suggest that an impaired FEF25-75 value (less than 65 percent of predicted) may be considered a reliable marker of bronchial reversibility, mainly in children with allergic rhinitis.

Marmont Du Haut Champ A.M.,Azienda Ospedaliera Universitaria San Martino
Clinical and Developmental Immunology | Year: 2012

Two streams of research are at the origin of the utilization of hematopoietic stem cell transplantation (HSCT) for severe autoimmune diseases (SADs). The allogeneic approach came from experimental studies on lupus mice, besides clinical results in coincidental diseases. The autologous procedure was encouraged by researches on experimental neurological and rheumatic disorders. At present the number of allogeneic HSCT performed for human SADs can be estimated to not over 100 patients, and the results are not greatly encouraging, considering the significant transplant-related mortality (TRM) and the occasional development of a new autoimmune disorder and/or relapses notwithstanding full donor chimerism. Autologous HSCT for refractory SLE has become a major target. Severe cases have been salvaged, TRM is low and diminishing, and prolonged clinical remissions are obtainable. Two types of immune resetting have been established, re-education and regulatory T cell (Tregs) normalization. Allogeneic HSCT for SLE seems best indicated for patients with disease complicated by an oncohematologic malignancy. Autologous HSCT is a powerful salvage therapy for otherwise intractable SLE. The duration of remission in uncertain, but a favorable response to previously inactive treatments is a generally constant feature. The comparison with new biological agents, or the combination of both, are to be ascertained. © 2012 Alberto M. Marmont du Haut Champ.

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