San Donato di Ninea, Italy
San Donato di Ninea, Italy

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Sitia S.,IRCCS Galeazzi Orthopedic Institute | Tomasoni L.,IRCCS Galeazzi Orthopedic Institute | Cicala S.,IRCCS Galeazzi Orthopedic Institute | Atzeni F.,University of Milan | And 4 more authors.
International Journal of Cardiology | Year: 2012

Background: Subclinical cardiac involvement diagnosis is important for long term management of rheumatoid arthritis (RA) patients. Recently, 2D speckle tracking echocardiography (STE) allows non invasive and angle-independent measurement of left ventricular (LV) dimensions and regional myocardial strain (ε). The aim of this study was to assess whether STE can be useful to detect subclinical cardiac involvement in RA patients. Methods: We studied 22 RA patients (10 M, 12 F, aged 46 ± 12 years) without clinical evidence of coronary artery disease (CAD) and 20 healthy controls matched for age and sex by STE. LV end-systolic longitudinal and radial ε from apical 4-chamber view were analyzed using available software (QLAB 6.0). Results: Standard echo and Doppler parameters did not differ between the 2 groups. Tissue Doppler Imaging (TDI) showed a significant reduction of S′, E′ and E′/A′ ratio from the basal septum and lateral mitral annulus in RA patients. LV end-systolic radial and longitudinal ε of basal-lateral, basal- and mid-septal, mid-lateral and apical segments were significantly reduced compared to controls. Conclusions: Our data indicate that LV end-systolic radial and longitudinal ε are reduced in RA patients without CAD despite normal standard echo. Non invasive evaluation of LV function by STE appears to be useful to detect subclinical cardiac involvement in comparison to conventional 2D echoDoppler, representing a promising new modality to follow-up RA patients for cardiac involvement. © 2011 Elsevier Ireland Ltd.


Sansone V.A.,University of Milan | Ricci C.,Clinical Epidemiology and Biometry Unit | Montanari M.,Mario Negri Institute for Pharmacological Research | Apolone G.,Mario Negri Institute for Pharmacological Research | And 20 more authors.
European Journal of Neurology | Year: 2012

Background and purpose: Fatigue and pain have been previously shown to be important determinants for decreasing quality of life (QoL) in one report in patients with non-dystrophic myotonia. The aims of our study were to assess QoL in skeletal muscle channelopathies (SMC) using INQoL (individualized QoL) and SF-36 questionnaires. Methods: We administered INQoL and SF-36 to 66 Italian patients with SMC (26: periodic paralysis, 36: myotonia congenita and 4: Andersen-Tawil) and compared the results in 422 patients with myotonic dystrophies (DM1: 382; and DM2: 40). Results: (i) INQoL index in SMC is similar to that in DMs (P = 0.79). (ii) Patients with myotonia congenita have the worst perception of QoL. (iii) Myotonia has the most detrimental effect on patients with myotonia congenita, followed by patients with DM2 and then by patients with DM1 and hyperkalemic periodic paralysis. (iv) Pain is a significant complaint in patients with myotonia congenita, hypokalemic periodic paralysis and DM2 but not in DM1. (v) Fatigue has a similar detrimental effect on all patient groups except for patients with hyperkalemic periodic paralysis in whom muscle weakness and myotonia more than fatigue affect QoL perception. (vi) Muscle symptoms considered in INQoL correlate with physical symptoms assessed by SF-36 (R from -0.34 to -0.76). Conclusions: QoL perception in patients with SMC is similar to that of patients with DMs, chronic multisystem disabling conditions. Our results provide information to target treatment and health care of these patients. The sensitivity of INQoL to changes in QoL in the SMC needs to be further explored in longitudinal studies. © 2012 EFNS.


De Vecchi E.,IRCCS Galeazzi Orthopaedic Institute | Sitia S.,SantAnna Clinic | Romano C.L.,IRCCS Galeazzi Orthopaedic Institute | Ricci C.,Clinical Epidemiology and Biometry Unit | And 3 more authors.
Journal of Medical Microbiology | Year: 2013

Urinary tract infections (UTIs) are a common cause of bacteraemia in the elderly and are associated with a high probability of hospitalization. Despite the impact of UTIs on health status and quality of life, a limited number of studies have evaluated their aetiology in this population. This study aimed to evaluate the microbial aetiology and pattern of susceptibility of bacteria causing UTIs in the elderly. For this purpose, a retrospective cohort study of elderly residents (n=472, aged >65 years) in 14 nursing homes in Milan (Italy) and its province was performed. Globally, 393 micro-organisms from 328 samples were isolated: Escherichia coli was the most prevalent (44.8 %), followed by Proteus mirabilis (20.4 %), Providencia spp. (8.9 %), Klebsiella spp. (6.4 %) and Pseudomonas aeruginosa (4.6 %). Enterococci were the most frequently isolated Grampositive organisms (7.4 %). Almost all Enterobacteriaceae were susceptible to nitrofurantoin, carbapenems and amikacin. Extended-spectrum β-lactamases were detected in 42.1 % of isolates. The most active antibiotics against P. aeruginosa were colistin, amikacin and piperacillin/ tazobactam. All Gram-positive organisms were susceptible to glycopeptides and linezolid, and 90 % were susceptible to nitrofurantoin. Fluoroquinolones showed a limited activity against all the tested micro-organisms. Escherichia coli remains the major micro-organism responsible for UTIs in older people, although to a lesser extent than in a younger population. The high rates of resistance observed in this study make careful use of antibiotics advisable to limit further development of resistance. © 2013 SGM.


Turiel M.,University of Milan | Sitia S.,University of Milan | Cicala S.,University of Milan | Magagnin V.,IRCCS Galeazzi Orthopedic Institute | And 8 more authors.
International Journal of Cardiology | Year: 2011

Background: Body weight supported treadmill training (BWSTT) assisted with a robotic driven gait orthosis (DGO) is an emerging tool in rehabilitating patients with lost sensorimotor function. Few information about the effects of BWSTT on cardiovascular system are available. The purpose of this study was to determine the effects of BWSTT on: 1) left ventricular (LV) systo-diastolic function; 2) coronary flow reserve (CFR); 3) endothelial function in patients with lost sensorimotor function due to neurologic lesions. Methods: Fourteen adults (males 10, age 50.6 ± 17.1 years) with motor incomplete spinal cord injuries (SCI) due to trauma or spondylotic diseases underwent standard echocardiographic examination, non invasive assessment of CFR by dipyridamole stress echo and determination of plasma asymmetric dimethylarginine (ADMA) levels at baseline and after 6 weeks of BWSTT. Results: At post training evaluation we observed lower LV end-diastolic (P = 0.0164) and end-systolic volumes (P = 0.0029) with increased ejection fraction (EF) (P = 0.0266). We also observed a LV interventricular septum (IVS) (P = 0.00469) increase. At the same time, we detected an improvement of LV diastolic function as witnessed by the reduction of isovolumic relaxation time (IVRT) (P = 0.0404) and deceleration time (DT) (P = 0.0405) with an increased E/A ratio (P = 0.0040). Improved CFR (P = 0.020) and reduced plasma ADMA levels (P = 0.0005) have been observed too, in association with a reduction of the inflammatory status (C-reactive protein (CRP) (P = 0.0022) and erythrocyte sedimentation rate (ESR) (P = 0.0005)). Conclusion: For the first time, this study demonstrated that 6 weeks of BWSTT improved not only the sensorimotor function but also systo-diastolic LV function, CFR and endothelial dysfunction associated with a reduction of the inflammatory status in patients with incomplete SCI. © 2010 Elsevier Ireland Ltd. All rights reserved.


Turiel M.,University of Milan | Tomasoni L.,University of Milan | Sitia S.,University of Milan | Cicala S.,University of Milan | And 7 more authors.
Cardiovascular Therapeutics | Year: 2010

Rheumatoid arthritis (RA) is associated with enhanced atherosclerosis and impaired endothelial function early after the onset of the disease and cardiovascular (CV) disease represents one of the leading causes of morbidity and mortality. It is well known that disease modifying antirheumatic drugs (DMARDs) are able to improve the course of the disease and the quality of life of these patients, but little is known about the effects of DMARDs on CV risk and endothelial dysfunction. Our goal was to examine the effects of long-term therapy with DMARDs on endothelial function and disease activity in early RA (ERA). Twenty-five ERA patients (mean age 52 ± 14.6 years, disease duration 6.24 ± 4.10 months) without evidence of CV involvement were evaluated for disease activity score (DAS-28), 2D-echo derived coronary flow reserve (CFR), common carotid intima-media thickness (IMT) and plasma asymmetric dimethylarginine (ADMA) levels at baseline and after 18 months of treatment with DMARDs (10 patients with methotrexate and 10 with adalimumab). DMARDs significantly reduced DAS-28 (6.0 ± 0.8 vs. 2.0 ± 0.7; P < 0.0001) and improved CFR (2.4 ± 0.2 vs. 2.7 ± 0.5; P < 0.01). Common carotid IMT and plasma ADMA levels did not show significant changes. The present study shows that DMARDs, beyond the well known antiphlogistic effects, are able to improve coronary microcirculation without a direct effect on IMT and ADMA, clinical markers of atherosclerosis. Treatment strategies in ERA patients with high inflammatory activity must be monitored to identify beneficial effects on preclinical markers of vascular function. © 2010 Blackwell Publishing Ltd.


Servello D.,Movement Disorders and Tourette Center | Sassi M.,Movement Disorders and Tourette Center | Pacchetti C.,Parkinson Disease and Movement Disorder Center | Mancini F.,Servizio di Neurologia | And 4 more authors.
Neurosurgery Quarterly | Year: 2011

Background: Deep brain stimulation (DBS) is a commonly performed surgical technique used to treat various movement disorders. Despite DBS being nonablative and minimally invasive, numerous complications and side effects have been recorded, the most critical of which are intracranial ischaemic/ hemorrhagic events. Methods: We analyzed this complication in relation to simultaneous multitrack microrecording (MER) as observed in our experience. The possible contribution of MER to the precision of the DBS procedure was also evaluated.From October 1996 to January 2010, 532 consecutive procedures were performed at the Unit of Functional Neurosurgery, Division of Neurosurgery IRCCS Galeazzi in Milan, and at the Istituto Besta IRCCS in Milan by 2 of the Authors (D.S. and M.S.), on a total number of 272 patients. FINDINGS: Ischaemic/hemorrhagic complications were documented in 9 patients (1.6%), and 5 of them presented with a neurological syndrome. Overall mortality was 3 patients (1.1%), and was correlated with intracranial hemorrhage in 1 patient. Repositioning of incorrectly positioned electrodes was deemed necessary in 26 procedures (4.9%) on 23 patients (8.4%). Conclusions: Although no consistent association was documented between the use of simultaneous intraoperative multitrack MER and hemorrhage, a statistically significant association was recorded between an incorrect positioning of the definitive leads, as reported in the postoperative magnetic resonance imaging controls or at the intraoperative computed tomographic (CT) scans, and the lack of intraoperative MER. DBS proves to be a safe and effective procedure even for novel indications. In our experience, no association was found between hemorrhagic risk and simultaneous multitrack MER. © 2011 by Lippincott Williams & Wilkins.


Drago L.,IRCCS Galeazzi Orthopaedic Institute | Drago L.,University of Milan | Mattina R.,University of Milan | Legnani D.,University of Milan | And 4 more authors.
International Journal of Immunopathology and Pharmacology | Year: 2011

The ability of levofloxacin, moxifloxacin, ciprofloxacin, amoxicillin/clavulanic acid and ceftriaxone to interfere on biofilm produced by Pseudomonas aeruginosa, Haemophilus influenzae and Streptococcus pneumoniae isolated from patients with chronic obstructive pulmonary disease was evaluated. The effects of antibiotics were evaluated on formation of biofilm (at 1/2, 1/4 and 1/8 X MIC) and on preformed biofilm (at epithelial lining fluid peak concentrations) by means of a spectrophotometric method. Levofloxacin was the most active compound followed by ciprofloxacin, moxifloxacin and amoxicillin/ clavulanic acid and ceftriaxone. Levofloxacin may contribute to clear the reservoir of pathogens involved in chronic obstructive pulmonary disease, thus leading to decreased occurrence of acute exacerbations. Copyright © by BIOLIFE, s.a.s.


Bernasconi P.,University of Pavia | Klersy C.,Clinical Epidemiology and Biometry Unit | Boni M.,University of Pavia | Cavigliano P.M.,University of Pavia | And 2 more authors.
American Journal of Hematology | Year: 2013

This study evaluated whether the NCCSS truly improves the prognostic stratification of 630 consecutive de novo MDS patients and established which cytogenetic grouping [NCCSS or International Prognostic Scoring System (IPSS)], when combined with the WHO classification, best predicted the clinical outcome of myelodysplastic syndromes (MDS). The frequency of chromosomal defects was 53.8%. Clinical parameters, including number of cytopenias, WHO classification, IPSS cytogenetic categories and scores, NCCSS were all relevant for overall survival (OS) and leukemia-free survival (LFS) and were included in six distinct multivariate models compared by the Akaike Information Criterion (AIC). The most effective model to predict OS included the number of cytopenias, the WHO classification and the NCCSS, whereas the model including the number of cytopenias, blast cell percentage and the NCCSS and the model including the number of cytopenias the WHO classification and the NCCSS were almost equally effective to predict LFS. In conclusion, the NCCS (i) improves the prognostic stratification of the good and poor IPSS cytogenetic categories by introducing the very good and the very poor categories; (ii) is still incomplete in establishing the prognostic relevance of rare/double defects, (ii) applied to patients who receive supportive treatment only identifies five different prognostic subgroups, but applied to patients treated with specific therapies reveals only a trend toward a significantly different OS and LFS when patients of the poor and intermediate cytogenetic categories are compared, (iii) combined with the WHO classification is much more effective than the IPSS in predicting MDS clinical outcome. © 2012 Wiley Periodicals, Inc.

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