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Maria Grazia Z.,Endocrinology and Metabolic Diseases | Maria Grazia Z.,University of Rome La Sapienza | Claudia S.,University of Rome La Sapienza
Cytokine | Year: 2011

Therapeutic plasmapheresis is a recognized medical procedure in which various techniques are used to separate and remove undesirable or excessively elevated plasma elements from blood. The main purpose of the procedure is to remove the substances responsible for the disease (autoantibodies, circulating immune complexes, lipoproteins and other molecules) from the patient's blood. Low-Density-Lipoproteins-apheresis (LDL_a) is the selective removal of all apolipoprotein-B100-containing lipoproteins: LDL, very low-density lipoprotein, and lipoprotein (a). They are lowered acutely by 65-75%. There is little effect on other plasma lipidic and non-lipidic components. LDL_a was reported to increase resistance of LDL to oxidation, counteract procoagulatory state and relief disturbances of hemorheology associated with atherosclerosis. These effects are likely to be regarded as to be pleiotropic effects. In the sense that they are not necessarily related to the apolipoprotein-B100-containing lipoproteins level in plasma. There is robust evidence that LDL_a can induce the stabilization of atherosclerotic plaques through its lipid-lowering action. However, other effects unrelated to the apolipoprotein-B100-containing lipoproteins extracorporeal removal, such as the decrease of cytokines and adhesion molecules induced by LDL_a were also reported. Altogether these actions are thought to favorably influence regression of florid, nonfibrous atherosclerotic lesions through a blockade of lipid deposition in the vessel wall, plaque stabilization, and ultimately, coronary and extracoronary artery disease progression. This brief review provides some indication on existing evidence of Heparin-induced Extracorporeal Low-density-lipoprotein Precipitation LDL_a effects on plasma mediators of inflammation. © 2011 Elsevier Ltd.

Rossi E.D.,Catholic University of the Sacred Heart | Bizzarro T.,Catholic University of the Sacred Heart | Fadda G.,Catholic University of the Sacred Heart | Pontecorvi A.,Catholic University of the Sacred Heart | And 2 more authors.
Cytopathology | Year: 2016

Objective: In fine needle aspiration cytology (FNAC), the category of benign thyroid lesions (BTL), which constitutes 65-70% of all thyroid FNAC, and can be correctly diagnosed by morphology alone, is an important entity. A diagnosis of BTL denotes a lesion managed with follow-up unless found in conjunction with compressive symptoms. Although this diagnosis can be quite simple, there are cases in which the scant cellular or colloid component may pose diagnostic issues. Herein, we describe the experiences of evaluating BTL at two large academic institutions. We evaluated the clinical importance of a correct diagnosis of BTL to define the exact inherent risk of a false-negative result (FNR). Methods: From January 2008 through to June 2013, 506 (3.6%) out of 15 850 patients with BTL underwent surgery. All nodules were sampled under sonographic guidance (US) and processed either with liquid-based cytology (LBC), Diff-Quik® smears or alcohol-Papanicolaou staining methods. Results: The histological follow-up of 506 BTL series included 493 benign and 13 malignant lesions. The latter group included four follicular carcinomas (FC), two classic variants of papillary thyroid carcinoma (PTC), one macrofollicular PTC and six follicular variants of PTC (FVPC). The malignancy rate for the BTL category was 2.5%. Conclusions: When diagnosed by expert cytopathologists, BTL represents a robust diagnosis and might reduce the number of FNR. Additional diagnostic experience and a large case series could enable cytopathologists to recognise all the morphological entities of BTL. An important additional aid is the extensive sampling of the lesions to reduce issues related to a low cellularity. © 2016 John Wiley & Sons Ltd.

Viereck C.,Quadratum Consulting Services LLC | Boudes P.,Endocrinology and Metabolic Diseases
Contemporary Clinical Trials | Year: 2011

We examined the impact of FDA's 2008 guidelines for addressing cardiovascular risks of new therapies for type 2 diabetes on clinical trials. We focused on the new class of incretin-modulating drugs, exenatide, sitagliptin, saxagliptin and liraglutide, which were approved in 2005-2010. We contrasted these findings with those from 2 different groups: 1. diabetes drugs approved in the same timeframe but with a non-incretin mechanism of action (colesevelam HCl and bromocriptine mesylate) and 2. diabetes drugs with NDAs delayed and not yet approved within the same time frame (vildagliptin, alogliptin, insulin inhalation powder, and exenatide long acting release). The new guidelines have had an important impact on clinical development. Review time has increased over 2-fold. The increase is seen even if a drug with the same mechanism of action has been already approved. Whereas exenatide (approved in 2005) required 10. months of regulatory review, the approval of liraglutide in 2010 required more than twice as long (21. months). In contrast, the marketing authorization of liraglutide in the EU required 14. months. Additionally, the manufacturer of vildagliptin announced in June 2008, 30. months after the NDA was filed, that a re-submission to meet FDA's demands was not planned. The drug however received marketing authorization in the EU in 2007. The number of randomized patients and patient-years in NDAs increased more than 2.5 and 4 fold, respectively since the guidelines. The significant cost increases and negative publicity because of rare adverse reactions will adversely affect future clinical research in type 2 diabetes and not address its burgeoning health care impact. © 2011 Elsevier Inc.

Giovanella L.,Oncology Institute of Southern Switzerland | Giovanella L.,Clinical Chemistry and Laboratory Medicine | Suriano S.,Oncology Institute of Southern Switzerland | Keller F.,Clinical Chemistry and Laboratory Medicine | And 2 more authors.
European Journal of Clinical Investigation | Year: 2011

Background: Hypercalcemia occurs in 10-20% of patients with hyperthyroidism, but its pathogenesis is still unclear.Aim: To evaluate changes in parathyroid hormone-related peptide (PTH-rP) concentration in hyperthyroid patients compared with healthy controls.Methods: We studied PTH-rP, parathormone (PTH) and ionized calcium levels in 153 hyperthyroid patients, and 89 control subjects. These variables were revaluated after attainment of euthyroidism with the antithyroid drug carbimazole for 6 months in a subgroup of 47 patients.Results: Pretreatment PTH-rP and ionized calcium level were significantly higher in hyperthyroid patients than in controls, whereas an opposite trend occurred for PTH. All parameters normalized after carbimazole therapy.Conclusion: Untreated hyperthyroid patients exhibited a significant elevation in serum ionized calcium and PTH-rP and a significant reduction in serum PTH levels when compared with healthy controls. Our data favoured the hypothesis of a direct involvement of PTH-rP in the pathogenesis of hypercalcemia in hyperthyroid patients. © 2010 The Authors. European Journal of Clinical Investigation © 2010 Stichting European Society for Clinical Investigation Journal Foundation.

Aamir A.H.,Endocrinology and Metabolic Diseases | Jan S.,Khyber Institute of Ophthalmic Medical science
Journal of Postgraduate Medical Institute | Year: 2012

Objective: The objective of this study was to determine the frequency of diabetic retinopathy in a tertiary care hospital using digital retinal imaging technology. Methodology: This descriptive study was carried out in the department of Diabetes, Endocrinology and Metabolic Diseases, Hayatabad medical complex Peshawar. Patients referred from outpatient department, general practitioners and from private clinics were included and after taking their basic demographic data were referred to the department of Diabetes for Fundus Photograph using Canon CR1 non- mydriatic digital retinal camera. Photographs were analyzed first by Endocrinologist and later by an Ophthalmologist to assess the severity of retinopathy. Results: Two thousand one hundred and twenty three patients with type 2 diabetes were evaluated clinically followed by fundus photography by retinal digital imaging The frequency retinopathy and maculopathy was 32.03% and 6.31% respectively (both retinopathy and maculopathy 38.34%). Three seventy four patients (17.6% patients) received laser treatment for prevention of blindness. Conclusion: Screening for Diabetic retinopathy using digital camera is a useful technique and detects DR effectively in diabetic patients in a tertiary care setting. This technique is useful in mass screening and can detect, reduce and prevent blindness due to diabetes in our population.

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