IRCCS Policlinico S. Donato

Milano, Italy

IRCCS Policlinico S. Donato

Milano, Italy
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Barbagallo I.,University of Catania | Galvano F.,University of Catania | Frigiola A.,IRCCS Policlinico S. Donato | Cappello F.,University of Palermo | And 8 more authors.
Antioxidants and Redox Signaling | Year: 2013

Significance: Many physiological effects of natural antioxidants, their extracts or their major active components, have been reported in recent decades. Most of these compounds are characterized by a phenolic structure, similar to that of α-tocopherol, and present antioxidant properties that have been demonstrated both in vitro and in vivo. Polyphenols may increase the capacity of endogenous antioxidant defenses and modulate the cellular redox state. Such effects may have wide-ranging consequences for cellular growth and differentiation. Critical Issues: The majority of in vitro and in vivo studies conducted so far have attributed the protective effect of bioactive polyphenols to their chemical reactivity toward free radicals and their capacity to prevent the oxidation of important intracellular components. One possible protective molecular mechanism of polyphenols is nuclear factor erythroid 2-related factor (Nrf2) activation, which in turn regulates a number of detoxification enzymes. Recent Advances: Among the latter, the heme oxygenase-1 (HO-1) pathway is likely to contribute to the established and powerful antioxidant/anti-inflammatory properties of polyphenols. In this context, it is interesting to note that induction of HO-1 expression by means of natural compounds contributes to prevention of cardiovascular diseases in various experimental models. Future Directions: The focus of this review is on the role of natural HO-1 inducers as a potential therapeutic strategy to protect the cardiovascular system against various stressors in several pathological conditions. © Mary Ann Liebert, Inc.


Marrazzo G.,University of Catania | Barbagallo I.,University of Catania | Galvano F.,University of Catania | Malaguarnera M.,University of Catania | And 4 more authors.
Critical Reviews in Food Science and Nutrition | Year: 2014

Diabetes affects different people of all ages, race, and sex. This is a condition characterized by a state of chronic hyperglycaemia that leads to an increase of intracellular oxidative stress linked to the overproduction of free radicals. In the present review, we focus our attention on the molecular mechanisms leading to oxidative stress-mediates complications with particular regard to central nervous system (CNS). Furthermore, the present review reports the effects of different kind of antioxidants with enzymatic and nonenzymatic action that may significantly decrease the intracellular free radicals' overproduction and prevents the hyperglycaemia-mediated complications. © 2014 Copyright Taylor & Francis Group, LLC.


Riccioni G.,San Camillo Of Lellis Hospital | Frigiola A.,IRCCS Policlinico S. Donato | Pasquale S.,University of Chieti Pescara | De Massimo G.,University of Chieti Pescara | D'Orazio N.,University of Chieti Pescara
Frontiers in Bioscience - Elite | Year: 2012

Atherosclerotic cardiovascular diseases (CVD) are a major source of mortality and morbidity in general population. Oxidative modification of low density lipoprotein (LDL) represent the most important determinant factor in the development and progression of atherosclerotic lesions. Oxidative damage and the production of free radicals (FRs) in the endothelium are some of the main factors involved in the pathogenesis of the atherosclerotic process which causes CVD. Appropriate nutritional practices are of central importance in managing risk and treatment of CVD; indeed, many current guidelines contain nutritional recommendations to reduce the risk of these diseases. In observational studies vitamin C and E, the most prevalent natural antioxidant vitamins, have suggested that supplemental users have lower rate of coronary events. Despite these data, several large randomized controlled trials (RCTs) have failed to confirm the benefits for vitamin C and E in cardiovascular (CV) prevention. The aim of this review is to examine the studies published in literature which report the effect of supplementation with antioxidant vitamins (C,E) in the primary and secondary prevention of CVD in men due to atherosclerotic process.


Mehta R.H.,Duke University | Lopes R.D.,Duke University | Ballotta A.,IRCCS Policlinico S. Donato | Frigiola A.,IRCCS Policlinico S. Donato | And 3 more authors.
American Heart Journal | Year: 2010

Background: Despite advances in treatment of cardiogenic shock (CS), the incidence of this serious complication of acute ST-elevation myocardial infarction (STEMI) has stayed relatively constant, and rates of mortality, although somewhat improved in recent decades, remain dauntingly high. Although both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used in patients with CS with multivessel coronary disease, the optimal revascularization strategy in this setting remains unknown. Methods: We conducted a literature search and review of English language publications on CS in multiple online medical databases. Studies were included if they were (1) randomized controlled trials or observational cohort studies, (2) single-center or multicenter reports, (3) prospective or retrospective studies, and (4) contained information on PCI and CABG. Non-English language studies were excluded. Results: Our search retrieved no published findings from randomized clinical trials, and only 4 observational reports evaluating PCI versus CABG. Our review of the limited available data suggests similar mortality rates with CABG and PCI in patients with STEMI and multivessel coronary disease complicated by CS. Conclusions: Limited data from observational studies in patients with CS and multivessel disease suggest that CABG should be considered a complementary reperfusion strategy to PCI and may be preferred, especially when complete revascularization with PCI is not possible. Our data highlight the need for large randomized trials to further evaluate the relative benefit of PCI versus CABG in patients with multivessel coronary disease and CS using contemporary surgical and percutaneous techniques. © 2010 Mosby, Inc. All rights reserved.


Ranucci M.,Intensive Care Unit | Conti D.,Intensive Care Unit | Castelvecchio S.,Intensive Care Unit | Menicanti L.,IRCCS Policlinico S. Donato | And 3 more authors.
Annals of Thoracic Surgery | Year: 2010

Background: Preoperative anemia and the lowest registered hematocrit value on cardiopulmonary bypass are recognized risk factors for morbidity and mortality after coronary operations. A low hematocrit often results in blood transfusions with all of the associated possible complications. The relative contribution of these three factors to long-term outcome is still not well established. This study aimed to identify the role of preoperative anemia and hemodilution during cardiopulmonary bypass as determinants of morbidity and mortality after coronary operations. Methods: A consecutive series of 3,003 patients was analyzed. They had all undergone isolated coronary operations without receiving blood transfusions during their hospital stay. The preoperative hematocrit and the lowest hematocrit on cardiopulmonary bypass were analyzed in a multivariable model as predictors of major morbidity and operative mortality. Results: After adjustment for the other explanatory variables, both the preoperative hematocrit and the lowest hematocrit on cardiopulmonary bypass were found to be independent risk factors for major morbidity, but not for operative mortality. However, low values of preoperative hematocrit were not associated with an increased morbidity, provided that the lowest hematocrit on cardiopulmonary bypass was maintained above 28%. Median values of the lowest hematocrit on cardiopulmonary bypass below 25% were associated with an increased major morbidity rate. Conclusions: Excessive hemodilution during cardiopulmonary bypass is a risk factor for major morbidity even in the absence of blood transfusions. Techniques that aim to reduce the fall in hematocrit during cardiopulmonary bypass, including blood cardioplegia, may be useful, especially in patients with a low preoperative hematocrit. © 2010 The Society of Thoracic Surgeons.


Godos J.,Jagiellonian University | Pluchinotta F.R.,IRCCS Policlinico S. Donato | Marventano S.,University of Catania | Buscemi S.,University of Palermo | And 3 more authors.
International Journal of Food Sciences and Nutrition | Year: 2014

Coffee consists of several biological active compounds, such as caffeine, diterpenes, chlorogenic acids, and melanoidins, which may affect human health. The intake of each compound depends on the variety of coffee species, roasting degree, type of brewing method and serving size. The bioavailability and the distribution of each compound and its metabolites also contribute to coffee mechanisms of action. The health benefits of coffee consumption regarding cardiovascular system and metabolism mostly depend on its antioxidant compounds. In contrast, diterpenes and caffeine may produce harmful effects by raising lipid fraction and affecting endothelial function, respectively. Studying the mechanism of action of coffee components may help understanding weather coffee's impact on health is beneficial or hazardous. In this article, we reviewed the available information about coffee compounds and their mechanism of action. Furthermore, benefits and risks for cardiovascular system associated with coffee consumption will be discussed. © 2014 Informa UK Ltd.


Barbagallo I.,University of Catania | Marrazzo G.,University of Catania | Frigiola A.,IRCCS Policlinico S. Donato | Zappala A.,University of Catania | Volti G.L.,University of Catania
Current Pharmaceutical Biotechnology | Year: 2012

During the degradation of heme by the enzyme heme oxygenase (HO), Carbon monoxide (CO) is generated. Although it is considered as a non - significant and potentially toxic waste gas of heme catabolism, CO is a key signaling molecule used to regulate different cardiovascular functions. In this review, we focus the protective roles of CO in vascular injury/disease, which may be important to explore the overall protective roles of HO-1/CO system in the pathogenesis of human vascular disease. © 2012 Bentham Science Publishers.


Colazzo F.,IRCCS Policlinico S. Donato | Colazzo F.,Imperial College London | Chester A.H.,Imperial College London | Taylor P.M.,Imperial College London | Yacoub M.H.,Imperial College London
Journal of Heart Valve Disease | Year: 2010

Background and aim of the study: Adipose tissue is a readily available source of multipotent adult stem cells for use in tissue engineering and regenerative medicine. Adipose-derived stem cells (ADSCs) are currently being investigated as a source of interstitial cells to populate tissue-engineered heart valve constructs. However, the ability of these cells to differentiate into endothelial cells that would be required to cover the surface of the valve cusps has not been fully investigated. Methods: ADSCs were isolated and characterized using immunofluorescence and flow cytometry. Endothelial differentiation was promoted by culturing confluent cells in the presence of 2% fetal calf serum and 50 ng/ml vascular endothelial growth factor. Differentiation was evaluated by immunofluorescence staining for endothelial markers, and an analysis of acetylated low-density lipoprotein (AcLDL) uptake. An assessment of tubular formation was performed using an in vitro angiogenesis assay. Results: Isolated ADSCs were positive for the mesenchymal markers CD105, CD73, CD29, CD90 and CD44, and negative for hematopoietic and endothelial markers. After a seven-day treatment period, approximately 15% of ADSCs expressed the endothelial marker von Willebrand factor, and 70% had lost the expression of smooth muscle α-actin. Treated cells also were able to incorporate Ac-LDL, and also to form tubular structures on Matrigel, unlike control cells. Conclusion: Based on these results, ADSCs are capable of differentiating into cells with phenotypic and functional features of endothelial cells. These predifferentiated cells provide new options for the tissue engineering of heart valves, based on autologous mesenchymal stem cells. © Copyright by ICR Publishers 2010.


Ranucci M.,IRCCS Policlinico S. Donato | Carlucci C.,IRCCS Policlinico S. Donato | Isgro G.,IRCCS Policlinico S. Donato | Baryshnikova E.,IRCCS Policlinico S. Donato
Minerva Anestesiologica | Year: 2012

Background. Postoperative bleeding is a major problem in pediatric cardiac surgery with cardiopulmonary bypass (CPB). It recognizes a multifactorial cause, inclusive of coagulation factors consumption, hyperfibrinolysis, incomplete heparin reversal, and platelet consumption. Limited information on platelet function is available. This pilot study investigates platelet function changes in pediatric cardiac operations and their relationship with postoperative bleeding. Methods. A cohort of 22 patients aged four years or less were prospectively analyzed. Besides the usual coagulation tests, they were studied for platelet function at four points in time: preoperative, arrival in the intensive care unit, first and second postoperative day. Platelet function was measured with multiple electrode aggregometry TRAP-test. Results. After the cardiac operation there was a non-significant decrease in platelet function, with 36% of the patients demonstrating increased aggregability. Platelet count demonstrated a significant (P=0.001) decrease related to the CPB duration. The International Normalized Ratio (INR) was significantly (P=0.001) increased after the operation. Postoperative bleeding was associated with the degree of thrombocytopenia (P=0.014), the increase in INR (P=0.001), and the prolongation of the activated partial thromboplastin time (P=0.002). Conclusion. In this pilot study, platelet function in pediatric patients undergoing cardiac surgery demonstrates a variable pattern and no association with postoperative bleeding. Confounding factors like age and cyanosis should be addressed with larger patient populations. © 2012 Edizioni Minerva Medica.


Ranucci M.,IRCCS Policlinico S. Donato | Castelvecchio S.,IRCCS Policlinico S. Donato | Menicanti L.,IRCCS Policlinico S. Donato | Frigiola A.,IRCCS Policlinico S. Donato | Pelissero G.,Scientific Directorate
European Journal of Cardio-thoracic Surgery | Year: 2010

Background: The European system for cardiac operative risk evaluation (EuroSCORE) is currently used in many institutions and is considered a reference tool in many countries. We hypothesised that too many variables were included in the EuroSCORE using limited patient series. We tested different models using a limited number of variables. Methods: A total of 11 150 adult patients undergoing cardiac operations at our institution (2001-2007) were retrospectively analysed. The 17 risk factors composing the EuroSCORE were separately analysed and ranked for accuracy of prediction of hospital mortality. Seventeen models were created by progressively including one factor at a time. The models were compared for accuracy with a receiver operating characteristics (ROC) analysis and area under the curve (AUC) evaluation. Calibration was tested with Hosmer-Lemeshow statistics. Clinical performance was assessed by comparing the predicted with the observed mortality rates. Results: The best accuracy (AUC 0.76) was obtained using a model including only age, left ventricular ejection fraction, serum creatinine, emergency operation and non-isolated coronary operation. The EuroSCORE AUC (0.75) was not significantly different. Calibration and clinical performance were better in the five-factor model than in the EuroSCORE. Only in high-risk patients were 12 factors needed to achieve a good performance. Conclusions: Including many factors in multivariable logistic models increases the risk for overfitting, multicollinearity and human error. A five-factor model offers the same level of accuracy but demonstrated better calibration and clinical performance. Models with a limited number of factors may work better than complex models when applied to a limited number of patients. © 2009 European Association for Cardio-Thoracic Surgery.

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