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Zaja F.,Azienda Ospedaliero Universitaria S. Maria Della Misericordia | Baccarani M.,Institute Of Hematology L A Seragnoli | Mazza P.,Ospedale Nord | Bocchia M.,Ematologia e Trapianti | And 16 more authors.
Blood | Year: 2010

Previous observational studies suggest that rituximab may be useful in the treatment of primary immune thrombocytopenia (ITP). This randomized trial investigated rituximab efficacy in previously untreated adult ITP patients with a platelet count of 20 × 109/L or less. One hundred three patients were randomly assigned to receive 40 mg/d dexamethasone for 4 days with or without 375 mg/m2 rituximab weekly for 4 weeks. Patients who were refractory to dexamethasone alone received salvage therapy with dexamethasone plus rituximab. Sustained response (ie, platelet count ≥ 50 × 10 9/L at month 6 after treatment initiation), evaluable in 101 patients, was greater in patients treated with dexamethasone plus rituximab (n = 49) than in those treated with dexamethasone alone (n = 52; 63% vs 36%, P = .004, 95% confidence interval [95% CI], 0.079-0.455). Patients in the experimental arm showed increased incidences of grade 3 to 4 adverse events (10% vs 2%, P = .082, 95% CI, -0.010 to 0.175), but incidences of serious adverse events were similar in both arms (6% vs 2%, P = .284, 95% CI, -0.035 to 0.119). Dexamethasone plus rituximab was an effective salvage therapy in 56% of patients refractory to dexamethasone. The combination of dexamethasone and rituximab improved platelet counts compared with dexamethasone alone. Thus, combination therapy may represent an effective treatment option before splenectomy. This study is registered at http://clinicaltrials.gov as NCT00770562. © 2010 by The American Society of Hematology.


Rigolin G.M.,University of Ferrara | Cibien F.,University of Ferrara | Martinelli S.,University of Ferrara | Formigaro L.,University of Ferrara | And 16 more authors.
Blood | Year: 2012

It is unclear whether karyotype aberrations that occur in regions uncovered by the standard fluorescence in situ hybridization (FISH) panel have prognostic relevance in chronic lymphocytic leukemia (CLL). We evaluated the significance of karyotypic aberrations in a learning cohort (LC; n = 64) and a validation cohort (VC; n = 84) of patients with chronic lymphocytic leukemia with "normal" FISH. An abnormal karyotype was found in 21.5% and 35.7% of cases in the LC and VC, respectively, and was associated with a lower immunophenotypic score (P = .030 in the LC, P = .035 in the VC), advanced stage (P = .040 in the VC), and need for treatment (P = .002 in the LC, P = < .0001 in the VC). The abnormal karyotype correlated with shorter time to first treatment and shorter survival in both the LC and the VC, representing the strongest prognostic parameter. In patients with chronic lymphocytic leukemia with normal FISH, karyotypic aberrations by conventional cytogenetics with novel mitogens identify a subset of cases with adverse prognostic features. © 2012 by The American Society of Hematology.


PubMed | Azienda Ospedaliero Universitaria S. Maria della Misericordia, University of Chieti Pescara and Presidio
Type: Journal Article | Journal: Journal of clinical nursing | Year: 2016

The aims of the study were to describe which of the core techniques of the physical assessment are regularly performed by a sample of Italian nurses, and to investigate the potential predictors of a more complete examination.Physical examination is among the essential tasks of nursing professionals, who are requested to perform a correct and complete physical assessment.Cross-sectional survey.The study was performed between August 2013 and January 2014 in 17 Italian regions. A total of 1182 questionnaires were collected.Most participants were females (age range 41-50 years), and worked in Internal Medicine, Intensive Care and Surgical hospital units. Of the 30 core techniques that are currently taught and performed according to the Italian Baccalaureate degree requirements, 20 were routinely performed, 6 were seldom used and 4 were learnt but almost never performed (auscultation of lung, heart and bowel sounds and spine inspection). Graduate and postgraduate nurses, working in Intensive Care Units and Nursing Homes, were more prone than the others to carry out a more complete physical assessment.The skills to perform a physical assessment are suboptimal among this sample of Italian nurses. Health and educational providers should pose more attention and efforts to provide nurses with an acceptable training in physical examination practice.This study describes the specific physical techniques performed by nurses in real practice and provides information on which skills require more attention in nursing educational programmes.


Kloppe A.,Ruhr University Bochum | Proclemer A.,Azienda Ospedaliero Universitaria S. Maria della Misericordia | Arenal A.,Hospital General Universitario Gregorio Maraon | Lunati M.,Azienda Ospedaliera Niguarda Ca Granda | And 8 more authors.
Circulation | Year: 2014

BACKGROUND - : Three trials demonstrated recently that a long detection window reduces implantable cardioverter-defibrillator (ICD) therapy in primary prevention patients. Avoid Delivering Therapies for Nonsustained Arrhythmias in ICD Patients III (ADVANCE III) was the only trial that enrolled both primary and secondary prevention patients. METHODS AND RESULTS - : Of the 1902 patients enrolled in the ADVANCE III trial, 477 received a defibrillator for secondary prevention; 248 patients were randomly assigned to a long detection setting (30 of 40 intervals) and 229 to the nominal setting (18 of 24 intervals) for ventricular arrhythmias with cycle length ≤320 ms. Eight-five percent of patients were men, with a mean age of 65±12 years, a previous history of ventricular fibrillation in 37% of the cases, and a mean ejection fraction of 38±13%. The ICD device mix was 37% single chamber, 47% dual chamber, and 16% triple chamber. Over a median period of 12 months, the long detection period was associated with a 25% reduction in the number of overall therapies (115.6 versus 86.8 per 100 patient-years; incidence rate ratio, 0.75; 95% confidence interval, 0.61-0.93; P=0.008) and a 34% reduction in the number of shocks (rate per 100 patient-years, 51.2 versus 38.1; incidence rate ratio, 0.66; 95% confidence interval, 0.48-0.89; P=0.007). Appropriate therapies (89.7 versus 67.7; incidence rate ratio, 0.77; 95% confidence interval, 0.60-0.97; P=0.029) and appropriate shocks (37.1 versus 28.1; incidence rate ratio, 0.64; 95% confidence interval, 0.45-0.93; P=0.018) were also reduced. CONCLUSIONS - : ADVANCE III is the first randomized trial to assess a long detection window setting in ICDs in both primary and secondary prevention populations and demonstrates a reduction of overall therapies and shocks in the subgroup of secondary prevention patients. These data suggest that even the secondary prevention population may benefit from programming that combines a long detection period with antitachycardia pacing during charging. CLINICAL TRIAL REGISTRATION - : URL: http://www/clinicaltrials.gov. Unique identifier: NCT00617175. © 2014 American Heart Association, Inc.


Cattarossi L.,Azienda Ospedaliero Universitaria S. Maria della Misericordia
Early Human Development | Year: 2013

Background: Lung ultrasound (LUS) has become more and more popular in the first decade of the 21st century, both in neonatal and in pediatric age groups. Several papers addressed the usefulness of this procedure mainly because of its possibility to be utilised at the bedside, without risk of irradiation along with simple and immediate interpretations of the images. Aims: The purpose of this paper is to update the knowledge on LUS related to the most common neonatal respiratory diseases and some pediatric acute lung diseases. Study design: We describe the technique of LUS execution, the normal LUS appearance and the LUS findings in the most common neonatal and pediatric acute diseases. Subjects: LUS findings related to neonates of different gestational age as well as of pediatric patients from infancy to childhood are shown. Outcome measures: Issues on the evolution and effect of treatment related to LUS findings of neonatal and pediatric respiratory diseases are discussed. Results: LUS depicted peculiar and reproducible patterns in all the lung diseases described. Conclusions: The use of LUS in the clinical field seems to be a reasonable and easy-to-use practice that can be considered an extension of the clinical exam. As a consequence of this feature, LUS, to fully express its potential, must be performed by the clinician in charge of the patient. © 2013 Elsevier Ireland Ltd.


Cattarossi L.,Azienda Ospedaliero Universitaria S. Maria della Misericordia
Acta Biomedica | Year: 2014

Background: Lung ultrasound (LUS) is becoming more and more utilised in the clinical field in adults, children and neonates in course of respiratory diseases. It can be done at bed side and repeated as much is needed without risks (namely irradiation). Methods: The technique of LUS execution and the normal and pathologic patterns of LUS in neonates are described. Results: The LUS findings in the different respiratory neonatal diseases are peculiar and consistently repeatable. Conclusion: The use of LUS in neonates may indicate in real time the diagnosis of the respiratory disease. Should be considered as an extension of the clinical exam and must be done by the clinician in charge of the patient. © Mattioli 1885.


Arnold F.W.,University of Louisville | Brock G.N.,University of Louisville | Peyrani P.,University of Louisville | Rodriguez E.L.,Hospital Espanol Of La Plata | And 3 more authors.
Respiratory Medicine | Year: 2010

Background: The Pneumonia Severity Index (PSI) and CRB-65 are scores used to predict mortality in patients with community-acquired pneumonia (CAP). It is unknown how well either score predicts time to clinical stability in hospitalized patients with CAP. Thus, it is also not known which score predicts time to clinical stability better. Methods: A secondary analysis of 3087 patients from the Community-Acquired Pneumonia Organization (CAPO) database was performed. Time-dependent receiver-operator characteristic (ROC) curves for time to clinical stability were calculated for the PSI and CRB-65 scores at day seven of hospitalization. Secondary outcomes were to assess the relationship of the PSI and CRB-65 to in-hospital mortality and length of stay (LOS). ROC curves for LOS and mortality were calculated. Results: The area under the ROC curve (AUC) for time to clinical stability by day seven was 0.638 (95% CI 0.613, 0.660) when using the PSI, and 0.647 (95% CI 0.619, 0.670) while using the CRB-65. The difference in AUC values was not statistically significant (95% CI for difference of -0.03 to 0.01). However, the difference in the AUC values for discharge within 14 days (0.651 for PSI vs 0.63 for CRB-65, 95% CI for difference 0.001-0.049), and 28-day in-hospital mortality (0.738 for PSI vs 0.69 for CRB-65, 95% CI for difference 0.02-0.082) were both statistically significant. Conclusions: This study demonstrates a moderate ability of both the PSI and CRB-65 scores to predict time to clinical stability, and found that the predictive accuracy of the PSI was equivalent to that of the CRB-65 for this outcome. © 2010 Elsevier Ltd. All rights reserved.


Orsaria M.,Azienda Ospedaliero Universitaria S. Maria Della Misericordia | Khelifa S.,Yale University | Buza N.,Yale University | Kamath A.,Yale University | Hui P.,Yale University
Journal of Clinical Pathology | Year: 2013

Aims: HER2NEU gene amplification is present in the majority of invasive breast carcinomas that have HER2 protein overexpression. A subset of breast cancers harbour an increased chromosome 17 (CEP17) copy number (polysomy 17). We investigated the clinicopathologic significance of polysomy 17 in correlation with various histological parameters and HER2NEU gene amplification. Methods: We collected the surgical specimens of 266 consecutive cases of primary invasive breast carcinomas. HER2NEU gene status and CEP17 copy numbers were assessed by fluorescent in situ hybridisation (FISH). Chromosome 17 polysomy was determined by the presence of ≥3 average CEP17 signals per nucleus. Results: 63 tumours (23.7%) harboured polysomy 17. Carcinomas with polysomy 17 were associated with adverse histological indicators including high histological grade, high nuclear grade, poor Nottingham Prognostic Index, advanced local tumour extent and progesterone receptor negativity. Polysomy 17 was common to HER2NEU amplified and unamplified tumours, and more frequently observed in HER2NEU unamplified (71.4%) cases. Conclusions: In the absence of the gene amplification, HER2 protein overexpression may be explained by other mechanisms including polysomy 17.


PubMed | Amsterdam Medical Center, National Hospital for Neurology and Neurosurgery, Westmead Hospital, Nijmegen Medical Center and 8 more.
Type: | Journal: JIMD reports | Year: 2016

There are few centres which specialise in the care of adults with inborn errors of metabolism (IEM). To anticipate facilities and staffing needed at these centres, it is of interest to know the distribution of the different disorders.A survey was distributed through the list-serve of the SSIEM Adult Metabolic Physicians group asking clinicians for number of patients with confirmed diagnoses, types of diagnoses and age at diagnosis.Twenty-four adult centres responded to our survey with information on 6,692 patients. Of those 6,692 patients, 510 were excluded for diagnoses not within the IEM spectrum (e.g. bone dysplasias, hemochromatosis) or for age less than 16 years, leaving 6,182 patients for final analysis. The most common diseases followed by the adult centres were phenylketonuria (20.6%), mitochondrial disorders (14%) and lysosomal storage disorders (Fabry disease (8.8%), Gaucher disease (4.2%)). Amongst the disorders that can present with acute metabolic decompensation, the urea cycle disorders, specifically ornithine transcarbamylase deficiency, were most common (2.2%), followed by glycogen storage disease type I (1.5%) and maple syrup urine disease (1.1%). Patients were frequently diagnosed as adults, particularly those with mitochondrial disease and lysosomal storage disorders.A wide spectrum of IEM are followed at adult centres. Specific knowledge of these disorders is needed to provide optimal care including up-to-date knowledge of treatments and ability to manage acute decompensation.


PubMed | Emergency Medicine Unit, University of Louisville, University of Milan Bicocca, IRCCS Humanitas Research Hospital and 4 more.
Type: Journal Article | Journal: ERJ open research | Year: 2016

The aim of the present study was to define the prevalence, characteristics, risk factors and impact on clinical outcomes of acute myocardial infarction (AMI)

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