Passaro A.,Azienda Ospedaliero Universitaria di Ferrara |
Passaro A.,University of Ferrara |
Miselli M.A.,Azienda Ospedaliero Universitaria di Ferrara |
Miselli M.A.,University of Ferrara |
And 10 more authors.
BMC Genomics | Year: 2017
Background: Accumulation of visceral adipose tissue (VAT) is clearly associated with an increased risk of obesity-related diseases and all-cause mortality, whereas gluteal subcutaneous fat accumulation (g-SAT) is associated with a lower risk. The relative contribution, in term of cardiovascular risk, of abdominal subcutaneous adipose tissue (a-SAT) is still controversial with studies showing both a detrimental effect and a protective role. Animal and in vitro studies demonstrated that adipocytes from visceral and subcutaneous depots have distinct morphological, metabolic and functional characteristics. These regional differences have a key role in the pathogenesis of obesity-related diseases. There is recent evidence that differentiation between upper-body and lower-body adipose tissues might be under control of site-specific sets of developmental genes, such as Homebox (HOX) genes, a group of related genes that control the body plan of an embryo along the anterior-posterior axis. However, the possible heterogeneity between different subcutaneous regions has not been extensively investigated. Here we studied global mRNA expression in g-SAT and a-SAT with a microarray approach. RNA was isolated from g-SAT and a-SAT biopsy, from eight healthy subjects, and hybridized on RNA microarray chips in order to detect regional differences in gene expression. Results: A total of 131 genes are significantly and differently (>1.5 fold change, p < 0.05) expressed in a-SAT and g-SAT. Expression profiling reveals significant differences in expression of several HOX genes. Interestingly, two molecular signature of visceral adipocyte lineage, homebox genes HOXA5 and NR2F1, are up-regulated in a-SAT versus g-SAT by a 2.5 fold change. Conclusions: Our study shows that g-SAT and a-SAT have distinct expression profiles. The finding of a different expression of HOX genes, fundamental during the embryo development, suggests an early regional differentiation of subcutaneous adipose depots. Moreover, the higher expression of HOXA5 and NR2F1, two molecular signatures of visceral adipocytes, in a-SAT suggests that this subcutaneous adipose depot could be more similar to VAT than g-SAT. Our data suggest that we should look at SAT as composed of distinct depots with possibly different impact in obesity associated metabolic complications. © 2017 The Author(s).
Rizzo P.,University of Ferrara |
Ferrari R.,Azienda Ospedaliero Universitaria di Ferrara
European Heart Journal, Supplement | Year: 2015
The Notch signalling is a fundamental pathway involved in the modulation of cell proliferation, survival, and in stem cells maintenance. The crucial role played by Notch in tumour onset and progression has made it amenable to cancer therapy. Several clinical trials are currently testing safety and efficacy of combination treatments of existing cancer therapies with Notch inhibitors. Notch receptors and their ligands play a major role in the modulation of a plethora of biological functions of macrophages, endothelial, and vascular smooth muscle cells, particularly under inflammatory conditions. Data obtained by us and other laboratories provide compelling evidence that the Notch signalling, by affecting the biology of each cell type involved in atheromatous plaque formation, has the potential to become a new biomarker and/or therapeutic target in atherosclerosis. © 2015 Published on behalf of the European Society of Cardiology. All rights reserved.
Rossi M.,University of Ferrara |
Buratto M.,University of Ferrara |
Bruni S.,Azienda Ospedaliero Universitaria di Ferrara |
Filieri C.,University of Ferrara |
And 6 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012
Context: Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the most reliable nonsurgical test for distinguishing benign from malignant thyroid nodules. However, there is no consensus on which nodules should undergo FNAB. Aims: The aims of this study were to evaluate the utility of US-guided FNAB in the diagnostic assessment of nodules with or without clinical/US features suggestive for malignancy and to investigate the additional contribution of BRAF V600E mutation analysis in the detection of differentiated thyroid cancer. Design and Methods: Thyroid cytoaspirates from 2421 nodules at least 4 mm in diameter were performed in 1856 patients who underwent cytological evaluation and biomolecular analysis. Results: Cytology showed high positive predictive value and specificity for the diagnosis of malignant lesions. BRAF V600E mutation was found in 115 samples, 80 of which were also cytologically diagnosed as papillary thyroid cancer. BRAF mutation analysis significantly enhanced the diagnostic value of cytology, increasing FNAB diagnostic sensitivity for malignant nodules by approximately 28%. Micro PTC (63% of diagnosed papillary thyroid carcinoma) showed a high prevalence of multifocality, extrathyroidal extension, and lymph node metastases, underlining the malignant potential of thyroid microcarcinomas. Each investigated US/clinical characteristic of suspected malignancy correlated with the presence of a thyroid cancer in thyroid nodules with diameter of at least 4 mm. Conclusions: These data indicate that nodules of at least 4 mm may underlie a thyroid cancer independently of US/clinical characteristics of suspected malignancy, suggesting the need to perform FNAB. The diagnostic sensitivity for thyroid cancer is significantly increased by BRAF V600E mutation analysis, indicating that the screening for BRAF mutation in FNAB samples has a relevant diagnostic potential. Copyright © 2012 by The Endocrine Society.
Bondanelli M.,University of Ferrara |
Ambrosio M.R.,University of Ferrara |
Carli A.,University of Ferrara |
Bergonzoni A.,Azienda Ospedaliero Universitaria di Ferrara |
And 6 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010
Backround: Stroke is a leading cause of death in industrialized countries, representing the main cause of long-term disability. Recent studies indicate that hypopituitarism may be observed after an acute stroke. Objective: The aim was to prospectively investigate incidence and pattern of pituitary dysfunction in patients suffering ischemic stroke and to assess the predictive value of different clinical and radiological parameters for hypopituitarism. Patients and Methods: We assessed endocrine, clinical, radiological, and functional parameters in 56 patients (34 males; mean age, 64.8 ± 1.3 yr; mean body mass index, 25.8 ± 0.45 kg/m2) at 1-3 months (visit 1) and 12-15 months (visit 2) after an ischemic stroke. Results: At visit 1, hypopituitarism was detected in 20 (35.7%) of 56 stroke patients, with multiple deficits in three and isolated deficits in 17. At visit 2, hypopituitarism was detected in 18 (37.5%) of 48 stroke patients, with multiple deficits in two. Four patients with previously diagnosed isolated GH or LH/FSH deficit exhibited normal pituitary function, whereas GH deficiency was newly diagnosed in three cases. Hypopituitarism was associated with worse outcome. We identified both clinical (preexisting diabetes mellitus, medical complications during hospitalization) and radiological (Alberta Stroke Programme Early CT Score ≤ 7) parameters as major risk factors for developing hypopituitarism after ischemic stroke. Conclusions: Hypopituitarism may associate with ischemic stroke in one third of cases and persist in a long-term period, aggravating the functional outcome. We identified specific risk factors for hypopituitarism after stroke, which may help to select patients needing an accurate endocrine evaluation to improve stroke outcome. Copyright © 2010 by The Endocrine Society.
Ferrari R.,Azienda Ospedaliero Universitaria di Ferrara |
Bohm M.,Universitatsklinikum des Saarlandes |
Cleland J.G.F.,Imperial College London |
Paulus W.J.S.,VU University Amsterdam |
And 3 more authors.
European Journal of Heart Failure | Year: 2015
Many uncertainties surround the syndrome of heart failure with preserved ejection fraction (HFpEF), which was the topic reviewed in an Expert Meeting at the University of Ferrara. This concluded that the absence of clear diagnostic clinical criteria was the major barrier to progress. There was general agreement that symptoms or signs of heart failure, normal LVEF despite an elevated plasma concentration of natriuretic peptides, and signs of abnormal LV relaxation, LV filling, LV hypertrophy, or left atrial enlargement, or diastolic dysfunction supported the diagnosis. However, HFpEF, like all heart failure syndromes, is heterogeneous in aetiology and pathophysiology, rather than being a single disease. HFpEF may account for about half of all patients with heart failure. The classical risk factors for developing HFpEF include age and co-morbidities, notably hypertension, atrial fibrillation, and the metabolic syndrome. When complicated by increasing congestion requiring hospital admission, the prognosis is poor; 30% or more of patients will die within 1 year (nearly two-thirds die from cardiovascular causes). Patients with chronic stable symptoms have a much better prognosis. Despite many clinical trials, there is no solid evidence that any treatment alters the natural history of HFpEF. Several treatments have shown promising early results and are now being tested in substantial randomized clinical trials. Further basic research is required to better characterize the disease and accelerate progress. Our review highlights the many difficulties encountered in performing randomized clinical trials in HFpEF, often due to difficulties in characterizing HFpEF itself. © 2015 The Authors. European Journal of Heart Failure European Society of Cardiology.
Dreno B.,Hotel Dieu |
Bettoli V.,Azienda Ospedaliero Universitaria di Ferrara |
Perez M.,Clinica Dermatologica de Moragas |
Bouloc A.,Saint Jacques Clinical Center |
Ochsendorf F.,Goethe University Frankfurt
European Journal of Dermatology | Year: 2015
Background: To date, the term ‘acne mechanica’ defines different cutaneous lesions caused by mechanical injury. Objective: To re-define the spectrum of cutaneous lesions caused by mechanical injury by determining their clinical and histological characteristics, to discuss and identify triggering and pathophysiologic elements. Methods: Clinical, histological and pathophysiological differences of 135 published cases of acne mechanica were analysed and compared to cases provided from our clinics. Results and Conclusions: Mechanical factors cause 2 types of mainly inflammatory cutaneous lesions: one presents with inflammatory papules, open comedones or has no comedonal lesions. We propose using the term ‘folliculitis mechanica’. The second type corresponds to a flare-up of acne in areas prone to the condition. These lesions present the typical clinical and histological features of acne vulgaris, comprising inflammatory and retentional lesions. Treatment may include topical products, including adjunctive care for reconstruction of the cutaneous barrier and the microbiome. Conventional acne medication should be used in cases of acne flare-up. © 2015, John Libbey Eurotext. All rights reserved.
Appropriateness of Prescriptions of Recommended Treatments in Organisation for Economic Co-operation and Development Health Systems: Findings Based on the Long-Term Registry of the European Society of Cardiology on Heart Failure
Maggioni A.P.,Research Center |
Van Gool K.,Oecd Nuclear Energy Agency |
Van Gool K.,University of Technology, Sydney |
Biondi N.,Oecd Nuclear Energy Agency |
And 8 more authors.
Value in Health | Year: 2015
Objective This observational study aimed to identify clinical variables and health system characteristics associated with incomplete guideline application in drug treatment of patients with chronic heart failure (HF) across 15 countries. Methods Three data sets were used: European Society of Cardiology Heart Failure Registry, Organisation for Economic Co-operation and Development's Health System Characteristics Survey, and Organisation for Economic Co-operation and Development Health Statistics 2013. Patient and country variables were examined by multilevel, multiple logistic regression. The study population consisted of ambulatory patients with chronic HF and reduced ejection fraction. Inappropriateness of prescription of pharmacological treatments was defined as patients not prescribed at least one of the two recommended treatments (angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers and beta-blockers) or treated with both medications but at suboptimal dosage and in absence of documented contraindication/intolerance. Results Of 4605 patients, 1097 (23.8%) received inappropriate drug prescriptions with a large variation within and across countries, with 18.5% of the total variability accounted for by between-country health structure characteristics. Patient-level characteristics such as having mitral regurgitation (odds ratio 1.4; 95% confidence interval 1.1-1.7) was significantly associated with inappropriate prescription of recommended drugs, whereas chronic obstructive pulmonary disease (odds ratio 0.7; 95% confidence interval 0.5-0.9) was associated with more appropriate prescriptions. Among the country-level variables, incentives or obligation to comply with guidelines increased the probability of prescription appropriateness. Conclusions Combining clinical variables with health system characteristics is a promising exercise to explain the appropriateness of recommended drug prescriptions. Such an understanding can help decision makers to design more effective policies to improve adherence to guidelines, improve health care outcomes, and potentially reduce costs. © 2015 Published by Elsevier Inc. on behalf of International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
[The path of continuity of care between hospital and territory in patients with severe brain injury. The expectations of caregivers and professionals]. [Il percorso di continuità assistenziale ospedale-territorio nei pazienti con gravi cerebrolesioni acquisite. Le aspettative dei caregiver e dei professionisti.]
Feiroli R.,Azienda Ospedaliero Universitaria di Ferrara.
Professioni infermieristiche | Year: 2013
The present study analyses how continuity of care is perceived by health professionals and GRACER (Gravi Cerebrolesioni Acquisite Emilia Romagna) patients' caregivers, in order to investigate where the gap between expectations and reality is more heavily felt and which dimension of the continuity of care is the most important both for health professionals and GRACER patients' caregivers. The study has been developed following the Gap Analysis theoretical model. A questionnaire, based on ServQual model, was used to collect data about the three dimensions of the construct of continuity of care related to information, management and relation, declined along the lines of expectations and perception of reality. The questionnaire was administered to health professionals and caregivers of GRACER patients (12-36 months after the event) inside 4 healthcare institutes in Emilia Romagna. The PAI (Piano Assistenziale Individuale) approach was the methodology applied in these 4 sites. To both groups the relational continuity was the most important dimension, followed at a long distance by the informational and the management ones. It has also been noted that to professionals reality is always worse than expectations, with the exception of only two items in the dimension of management continuity. To caregivers reality is worse than expectations in some items in the dimensions of information and management The study has shown that the relational dimension of continuity of care should be more investigated, as confirmed by literature. More research is needed about the professionals' dissatisfaction generated by the negative balance between expectations and perception of reality.
PubMed | Lawson Health Research Institute, London Health Sciences Center and Azienda Ospedaliero Universitaria di Ferrara
Type: Journal Article | Journal: European journal of radiology | Year: 2015
Dynamic perfusion CT (PCT) is an imaging technique for assessing the vascular supply and hemodynamics of brain tumors by measuring blood flow, blood volume, and permeability-surface area product. These PCT parameters provide information complementary to histopathologic assessments and have been used for grading brain tumors, distinguishing high-grade gliomas from other brain lesions, differentiating true progression from post-treatment effects, and predicting prognosis after treatments. In this review, the basic principles of PCT are described, and applications of PCT of brain tumors are discussed. The advantages and current challenges, along with possible solutions, of PCT are presented.
PubMed | Azienda Ospedaliero Universitaria di Ferrara.
Type: Journal Article | Journal: Professioni infermieristiche | Year: 2013
The present study analyses how continuity of care is perceived by health professionals and GRACER (Gravi Cerebrolesioni Acquisite Emilia Romagna) patients caregivers, in order to investigate where the gap between expectations and reality is more heavily felt and which dimension of the continuity of care is the most important both for health professionals and GRACER patients caregivers. The study has been developed following the Gap Analysis theoretical model. A questionnaire, based on ServQual model, was used to collect data about the three dimensions of the construct of continuity of care related to information, management and relation, declined along the lines of expectations and perception of reality. The questionnaire was administered to health professionals and caregivers of GRACER patients (12-36 months after the event) inside 4 healthcare institutes in Emilia Romagna. The PAI (Piano Assistenziale Individuale) approach was the methodology applied in these 4 sites. To both groups the relational continuity was the most important dimension, followed at a long distance by the informational and the management ones. It has also been noted that to professionals reality is always worse than expectations, with the exception of only two items in the dimension of management continuity. To caregivers reality is worse than expectations in some items in the dimensions of information and management The study has shown that the relational dimension of continuity of care should be more investigated, as confirmed by literature. More research is needed about the professionals dissatisfaction generated by the negative balance between expectations and perception of reality.