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Vecchio F.,Fatebenefratelli Hospital | Babiloni C.,University of Foggia
International Journal of Alzheimer's Disease | Year: 2011

Is directionality of electroencephalographic (EEG) synchronization abnormal in amnesic mild cognitive impairment (MCI) and Alzheimer's disease (AD)? And, do cerebrovascular and AD lesions represent additive factors in the development of MCI as a putative preclinical stage of AD? Here we reported two studies that tested these hypotheses. EEG data were recorded in normal elderly (Nold), amnesic MCI, and mild AD subjects at rest condition (closed eyes). Direction of information flow within EEG electrode pairs was performed by directed transfer function (DTF) at δ(24Hz), θ(48Hz), α1 (8-10Hz), α2 (10-12Hz), β1 (13-20Hz), β2 (20-30Hz), and (30-40Hz). Parieto-to-frontal direction was stronger in Nold than in MCI and/or AD subjects for and rhythms. In contrast, the directional flow within interhemispheric EEG functional coupling did not discriminate among the groups. More interestingly, this coupling was higher at θ, α1, β2, and β1 in MCI with higher than in MCI with lower vascular load. These results suggest that directionality of parieto-to-frontal EEG synchronization is abnormal not only in AD but also in amnesic MCI, supporting the additive model according to which MCI state would result from the combination of cerebrovascular and neurodegenerative lesions. Copyright © 2011 Fabrizio Vecchio and Claudio Babiloni.


Dello Iacono I.,Fatebenefratelli Hospital | Tripodi S.,Sandro Pertini Hospital | Calvani M.,S Camillo Forlanini Hospital | Panetta V.,Laltra statistica srl | And 2 more authors.
Pediatric Allergy and Immunology | Year: 2013

Background: Treatment of severe egg allergy is avoidance of hen's egg (HE) and carrying self-injectable epinephrine. Specific oral tolerance induction (SOTI) seems a promising alternative treatment. However, some aspects of SOTI are still considered experimental. Methods: We evaluated the efficacy and safety of an original 6-month SOTI protocol in children with very severe HE allergy using raw HE emulsion. Twenty children (age range: 5-11yr) were randomized equally into a SOTI treatment group and a control group. The treatment group started SOTI and underwent a second challenge 6months later. Control children were kept on an egg-free diet for 6months and then underwent a second challenge. Results: After 6months, 9/10 children of the SOTI group (90%) achieved partial tolerance (at least 10ml, but <40ml of raw HE emulsion, in a single dose) and 1 (10%) was able to tolerate only 5ml (no tolerance). After 6months, nine control children tested positive to the second challenge at a dose ≤0.9ml of raw HE emulsion, and one reacted to 1.8ml (SOTI vs. control group p<0.0001). All children in the SOTI group had side effects, but no child had a grade 5 reaction according to the Sampson grading. Conclusion: Six months of SOTI with raw HE emulsion resulted in partial tolerance, with regular intake, in a significant percentage of children with severe egg allergy. © 2012 John Wiley & Sons A/S.


Assenza G.,Biomedical University of Rome | Zappasodi F.,University of Chieti Pescara | Pasqualetti P.,Fatebenefratelli Hospital | Vernieri F.,Biomedical University of Rome | And 2 more authors.
Restorative Neurology and Neuroscience | Year: 2013

Background and purpose: Despite similar clinical onset, recovery from stroke can be largely variable. We searched for electrophysiological prognostic indices, believing that they can guide future neuromodulation treatments boosting clinical recovery. Methods: 19-channels resting electroencephalogram (EEG) was collected in 42 patients after 4-10 days (t0) from a unilateral ischemic stroke in the middle cerebral artery (MCA) territory and 20 controls. National Health Institute Stroke Scale (NIHSS) was collected at t0 and 6 months later (t1). Standard spectral band powers and interhemispheric coherences between homologous MCA regions were calculated in both hemispheres. Results: Total spectral, delta and theta band powers were higher bilaterally in patients than in controls and directly correlated with NIHSSt0 in both hemispheres. A linear regression model including each EEG patient's variable differing from those of controls and correlating with effective recovery [ER = (NIHSSt0-NIHSSt1)/(NIHSSt0-NIHSS in healthy conditions)] showed contralesional delta power as the only valid predictor of ER. A further regression model including also NIHSSt0 confirmed that contralesional delta power can add prognostic information to acute clinical impairment. Contralesional delta activity increase was best explained, in addition to the increasing ipsilesional delta activity, by a reduction of interhemispheric functional coupling - which did not explain a significantly portion of effective recovery variability by itself. Conclusions: Contralesional EEG delta activity retains relevant negative prognostic information in acute stroke patients. Present results point to the interhemispheric interplay as a decisive target in setting up enriched rehabilitations. © 2013 IOS Press and the authors. All rights reserved.


Miceli Sopo S.,Sacro Cuore Catholic University | Dello Iacono I.,Fatebenefratelli Hospital | Greco M.,Sacro Cuore Catholic University | Monti G.,University of Turin
Current Opinion in Allergy and Clinical Immunology | Year: 2014

Purpose of review: The article discusses the clinical management of patients affected by food protein-induced enterocolitis syndrome (FPIES), focusing on established therapeutic choices and future options. Recent findings: After FPIES has been diagnosed and avoidance of the culprit food prescribed, the most important management needs are as follows. First, recurrence of acute FPIES episodes due to accidental ingestion of culprit food. It may be useful to give patients' families an action plan. The principal suggested treatments are intravenous fluids and steroids, whereas the use of epinephrine and ondansetron requires further study. In mild-to-moderate cases, oral rehydration should be sufficient. Second, dietary introduction of at-risk foods. In children with FPIES, in addition to that/those identified as culprit(s), some foods may not be tolerated (typically cow's milk, legumes, cereals, poultry). It has been suggested to avoid introducing these foods during the baby's first year. Otherwise, they may be given for the first time in hospital, performing an oral food challenge. Third, acquisition of tolerance. Children affected by cow's milk-FPIES have a good chance of acquiring tolerance by the time they reach age 18-24 months. For other culprit foods, insufficient data are available to indicate the appropriate time, so that it is suggested that an oral food challenge be performed about 1 year after the last acute episode. Summary: Future clinical management of FPIES must take into account, among other factors, improved understanding of pathogenesis, possible detection of different phenotypes, and the introduction of more effective therapies for acute episodes. These factors will undoubtedly influence management decisions, which will become more diversified and effective. Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.


Valensise H.,University of Rome Tor Vergata | Lo Presti D.,University of Rome Tor Vergata | Gagliardi G.,University of Rome Tor Vergata | Tiralongo G.M.,University of Rome Tor Vergata | And 3 more authors.
Hypertension | Year: 2016

The purpose of our study was to assess cardiac function in nonpregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case-control study and submitted to echocardiographic examination in the nonpregnant state 12 to 18 months after the first delivery. All patients included in the study had pregnancy within 24 months from the echocardiographic examination and were followed until term. Twenty-two (29%) of the 75 patients developed recurrent preeclampsia. In the nonpregnant state, patients with recurrent preeclampsia compared with controls and nonrecurrent preeclampsia had lower stroke volume (63±14 mL versus 73±12 mL and 70±11 mL, P<0.05), cardiac output (4.6±1.2 L versus 5.3±0.9 L and 5.2±1.0 L, P<0.05), higher E/E′ ratio (11.02±3.43 versus 7.34±2.11 versus 9.03±3.43, P<0.05), and higher total vascular resistance (1638±261 dyne·s-1·cm-5 versus 1341±270 dyne·s-1·cm-5 and 1383±261 dyne·s-1·cm-5, P<0.05). Left ventricular mass index was higher in both recurrent and nonrecurrent preeclampsia compared with controls (30.0±6.3 g/m2.7 and 30.4±6.8 g/m2.7 versus 24.8±5.0 g/m2.7, P<0.05). Signs of diastolic dysfunction and different left ventricular characteristics are present in the nonpregnant state before a second pregnancy with recurrent preeclampsia. Previous preeclamptic patients with nonrecurrent preeclampsia show left ventricular structural and functional features intermediate with respect to controls and recurrent preeclampsia. © 2016 American Heart Association, Inc.


Pal A.,PGIMER | Siotto M.,Don Carlo Gnocchi Foundation | Prasad R.,PGIMER | Squitti R.,Fatebenefratelli Hospital | Squitti R.,Laboratorio Of Neurodegenerazione
Journal of Alzheimer's Disease | Year: 2015

Copper is an essential micronutrient for physiological cell functioning and central nervous system (CNS) development. Indeed, it is a cofactor of many proteins and enzymes in a number of molecular pathways, including energy generation, oxygen transportation, hematopoiesis, cellular growth and metabolism, and signal transduction. This is because it serves as a catalyst of reduction-oxidation (redox) reactions in these processes. When copper is kept under control, bound to special proteins, it yields key properties. However, when it spirals out of control, it is exchanged among small compounds (it is loosely bound to them), and its redox activity makes it dangerous for cell viability, promoting oxidative stress. Copper homeostasis in the CNS is securely synchronized, and perturbations in brain copper levels are known to underlie the pathoetiology of wide spectrum of common neurodegenerative disorders, including Alzheimer's disease. The main objective of this review is to provide some of the most relevant evidence gleaned from recent studies conducted on animal models and humans, and to discuss the evidence as it pertains to a new concept: Aberrant copper metabolism, which appears to have a genetic basis, is a modifiable risk factor accelerating Alzheimer's disease and initiation/progression of cognitive deficits in a percentage of susceptible persons. © 2015 - IOS Press and the authors. All rights reserved.


Iacono I.D.,Fatebenefratelli Hospital | Verga M.C.,Primary Care Pediatrics ASL
European Annals of Allergy and Clinical Immunology | Year: 2012

The prevalence of food allergy and anaphylaxis in children is reported to be increasing in recent years. Evidence suggests that exposure to large doses of antigen favors the maintenance of tolerance. We report a case of sudden loss of cow's milk tolerance in a long-sensitized girl with celiac disease after a short period of milkless diet.We hypothesize that the continuous intake of high quantities of antigen sustained tolerance despite high levels of specific IgE and that, in the presence of epithelial barrier dysfunction caused by celiac disease, the few weeks of allergenfree diet led to a rapid loss of tolerance.


Finazzi-Agr E.,University of Rome Tor Vergata | Petta F.,University of Rome Tor Vergata | Sciobica F.,University of Rome Tor Vergata | Pasqualetti P.,Fatebenefratelli Hospital | And 2 more authors.
Journal of Urology | Year: 2010

Purpose This is a prospective, double-blind, placebo controlled study, based on an original placebo technique, performed to evaluate the efficacy of percutaneous tibial nerve stimulation in female patients with detrusor overactivity incontinence. Materials and Methods A total of 35 female patients presenting with detrusor overactivity incontinence that did not respond to antimuscarinic therapy were randomly assigned to percutaneous tibial nerve stimulation or to a control group. The percutaneous tibial nerve stimulation group (18 patients) was treated with 12 percutaneous tibial nerve stimulation sessions. The control group (17 patients) received an original placebo treatment using a 34 gauge needle placed in the medial part of the gastrocnemius muscle. The sessions lasted for 30 minutes and were performed 3 times weekly as percutaneous tibial nerve stimulation sessions. All patients were evaluated with bladder diaries as well as quality of life scores before and after treatment. Patients showing a reduction in urge incontinence episodes greater than 50% were considered responders. Results Some patients (1 in the percutaneous tibial nerve stimulation group and 2 in the placebo group) did not complete the study for reasons not related to the technique. Of 17 patients in the percutaneous tibial nerve stimulation group 12 (71%) and of 15 in placebo group 0 were considered responders according to the previously reported definition (p <0.001). Improvement in the number of incontinence episodes, number of voids, voided volume and incontinence quality of life score were statistically significant in the percutaneous tibial nerve stimulation group but not in the placebo group. Conclusions Percutaneous tibial nerve stimulation can be considered an effective treatment for detrusor overactivity incontinence with 71% of patients considered responders, while none of those treated with placebo was considered a responder. The relevance of a placebo effect seems to be negligible in this patient population. © 2010 American Urological Association Education and Research, Inc.


Ascione A.,Fatebenefratelli Hospital
Therapeutic Advances in Chronic Disease | Year: 2012

Boceprevir (Victrelis), from the oral α-ketoamide class of slow-binding reversible hepatitis C virus (HCV)-NS3 protease inhibitors, creates a new class of drugs: direct acting antivirals (DDAs). Boceprevir is highly selective against HCV serine protease. Its use is restricted to genotype 1 HCV infection and it must not be used as monotherapy. Boceprevir is given orally, rapidly absorbed, reaching plasma peak concentration within 1-2 h and is metabolized by aldo-ketoreductase and partly by the cytochrome P450 enzyme CYP3A4/5. Administration with drugs that induce or inhibit CYP3A4/5 could decrease or increase its plasma concentration. The optimal dosage is 800 mg three times daily; capsules should be taken with food. Boceprevir was approved by the US Food and Drug Administration and the European Medicines Agency and is indicated in combination with peginterferon plus ribavirin for the treatment of patients with genotype 1 HCV who have not received previous treatment or whose condition has failed to respond to previous therapy. In the Serine Protease Inhibitor Therapy 2 (SPRINT-2) trial (treatment-naïve patients) and RESPOND-2 trial (patients whose condition relapsed or did not respond to previous treatment), the boceprevir-containing regimen was always more effective than standard of care (SOC). Adverse events were similar in the treatment groups, but in the boceprevir treated group, anemia was more frequent, requiring erythropoietin in nearly 40% of cases. Discontinuation of therapy because of adverse events was identical in all treated groups. As for cost effectiveness, two studies showed that boceprevir plus SOC is cost effective with regard to the lifetime incidence of liver complications, quality of life years, and the incremental cost-effectiveness ratio. The management of this therapy is more complex than before for physicians and patients. The educational role of the physician is crucial for successful therapy and counseling should be carefully given, especially for adherence to the assigned treatment. © The Author(s), 2012.


Frigo M.G.,Fatebenefratelli Hospital
The journal of obstetrics and gynaecology research | Year: 2011

The aim of this study was to examine the pattern of labor progression among nulliparous women under neuraxial analgesia to obtain a new, specific reference labor curve and to compare the different effects of epidural and combined spinal epidural (CSE) analgesia on the progression of labor. This perspective cohort study was carried out in the Obstetrics and Gynecology tertiary care unit. Six hundred nulliparous parturients were enrolled. A total of 545 nulliparous women were assigned to receive either epidural (272) or CSE (273) analgesia during labor. The mean duration of the first stage was 4 h and 30 min (SD 1.52 h) and the mean duration of the second stage was 1 h and 10 min (SD 0.43). In the second stage, the CSE analgesia labors showed an overall faster progression compared to the epidural labors but both lasted longer than the duration reported by Zhang (53 min) and Friedman (39 min). Both the first and the second-stage duration were significantly lower if neuraxial analgesia was performed as a CSE procedure with respect to the simple epidural procedure (first stage 4 h and 1 min vs. 4 h and 60 min, P = 0.043; second stage 1 h and 5 min vs 1 h and 15 min, P = 0.0356). The pattern of labor progression in contemporary obstetrics differs significantly from the Friedman curve. Based on these observations, we can obtain a more comprehensive knowledge of the partogram's modifications due to the analgesia. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

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