IRCCS Policlinico San Matteo

Pavia, Italy

IRCCS Policlinico San Matteo

Pavia, Italy
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Pai M.,Imperial College London | Valek V.,University Hospital Brno Bohunice | Tomas A.,University Hospital Brno Bohunice | Doros A.,Semmelweis University | And 5 more authors.
CardioVascular and Interventional Radiology | Year: 2014

Purpose: The major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter. Methods: Nine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal-external biliary drainage. Results: All nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50-488) days and a median stent patency of 102.5 (range 50-321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation. Conclusions: In this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies. © 2013 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

Morganti S.,University of Pavia | Conti M.,University of Pavia | Aiello M.,IRCCS Policlinico San Matteo | Valentini A.,Institute of Radiology | And 3 more authors.
Journal of Biomechanics | Year: 2014

Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure introduced to treat aortic valve stenosis in elder patients. Its clinical outcomes are strictly related to patient selection, operator skills, and dedicated pre-procedural planning based on accurate medical imaging analysis. The goal of this work is to define a finite element framework to realistically reproduce TAVI and evaluate the impact of aortic root anatomy on procedure outcomes starting from two real patient datasets. Patient-specific aortic root models including native leaflets, calcific plaques extracted from medical images, and an accurate stent geometry based on micro-tomography reconstruction are key aspects included in the present study. Through the proposed simulation strategy we observe that, in both patients, stent apposition significantly induces anatomical configuration changes, while it leads to different stress distributions on the aortic wall. Moreover, for one patient, a possible risk of paravalvular leakage has been found while an asymmetric coaptation occurs in both investigated cases. Post-operative clinical data, that have been analyzed to prove reliability of the performed simulations, show a good agreement with analysis results. The proposed work thus represents a further step towards the use of realistic computer-based simulations of TAVI procedures, aiming at improving the efficacy of the operation technique and supporting device optimization. © 2014 Elsevier Ltd.

Gasparini M.,Electrophysiology and Pacing Unit | Proclemer A.,Azienda Ospedaliera Universitaria S. Maria Della Misericordia | Klersy C.,IRCCS Policlinico San Matteo | Kloppe A.,Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil | And 8 more authors.
JAMA - Journal of the American Medical Association | Year: 2013

Importance: Using more intervals to detect ventricular tachyarrhythmias has been associated with reducing unnecessary implantable cardioverter- defibrillator (ICD) therapies. Objective: To determine whether using 30 of 40 intervals to detect ventricular arrhythmias (VT) (long detection) during spontaneous fast VT episodes reduces antitachycardia pacing (ATP) and shock delivery more than 18 of 24 intervals (standard detection). Design, Setting, and Participants: Randomized, single-blind, parallel-group trial that enrolled 1902 primary and secondary prevention patients (mean [SD] age, 65 [11] years; 84% men; 75% primary prevention ICD) with ischemic and nonischemic etiology undergoing first ICD implant at 1 of 94 international centers (March 2008-December 2010). Interventions: Patients were randomized 1:1 to programming with long- (n=948) or standard-detection (n=954) intervals. Main Outcomes and Measures: Total number of ATPs and shocks delivered for all episodes (primary outcomes) and inappropriate shocks, mortality, and syncopal rate (secondary outcomes). Results: During a median follow-up of 12 months (interquartile range, 11-13), long-detection group had 346 delivered therapies (42 therapies per 100 person-years, 95% CI, 38-47) vs 557 in the standard-detection group (67 therapies per 100 person-years [95% CI, 62-73]; incident rate ratio [IRR], 0.63 [95% CI, 0.51-0.78]; P < .001). The long-vs the standard-detection group experienced 23 ATPs per 100 person-years (95% CI, 20-27) vs 37 ATPs per 100 person-years (95% CI, 33-41; IRR, 0.58 [95% CI, 0.47-0.72]; P < .001); 19 shocks per 100 person-years (95% CI, 16-22) vs 30 shocks per 100 person-years (95% CI, 26-34; IRR, 0.77 [95% CI, 0.59-1.01]; P =.06), with a significant difference in the probability of therapy occurrence (P < .001); and a reduction in first occurrence of inappropriate shock (5.1 per 100 patient-years [95% CI, 3.7-6.9] vs 11.6 [95% CI, 9.4-14.1]; IRR, 0.55 [95% CI, 0.36-0.85]; P =.008). Mortality (5.5 [95% CI, 4.0-7.2] vs 6.3 [95% CI, 4.8-8.2] per 100 patient-years; HR, 0.87; P =.50) and arrhythmic syncope rates (3.1 [95% CI, 2.6-4.6] vs 1.9 [95% CI, 1.1-3.1] per 100 patientyears; IRR, 1.60 [95% CI, 0.76-3.41]; P =.22) did not differ significantly between groups. Conclusions and Relevance: Among patients receiving an ICD, the use of a longvs standard-detection interval resulted in a lower rate of ATP and shocks, and inappropriate shocks. This programming strategy may be an appropriate alternative. Trial Registration: Identifier: NCT00617175 ©2013 American Medical Association. All rights reserved.

Golay J.,Ospedale Papa Giovanni XXIII | Semenzato G.,University of Padua | Rambaldi A.,Ospedale Papa Giovanni XXIII | Foa R.,University of Rome La Sapienza | And 7 more authors.
mAbs | Year: 2013

The anti-CD20 antibody rituximab (RTX; Rituxan®, MabThera®) was the first anti-cancer antibody approved by the US Food and Drug Administration in 1997 and it is now the most-studied unconjugated therapeutic antibody. The knowledge gained over the past 15 y on the pharmacodynamics (PD) of this antibody has led to the development of a new generation of anti-CD20 antibodies with enhanced efficacy in vitro. Studies on the pharmacokinetics (PK) properties and the effect of factors such as tumor load and localization, antibody concentration in the circulation and gender on both PK and clinical response has allowed the design of optimized schedules and novel routes of RTX administration. Although clinical results using newer anti-CD20 antibodies, such as ofatumumab and obinutuzumab, and novel administration schedules for RTX are still being evaluated, the knowledge gained so far on RTX PK and PD should also be relevant for other unconjugated monoclonal antibody therapeutics, and will be critically reviewed here. © 2013 Landes Bioscience.

De Gregori M.,University of Pavia | Allegri M.,IRCCS Policlinico San Matteo | De Gregori S.,Unit of Clinical Pharmacokinetics | Garbin G.,University of Pavia | And 4 more authors.
Current Drug Metabolism | Year: 2010

Cytochromes P450 are members of a superfamily of hemoproteins that catalyze a variety of oxidative reactions in the metabolism of endogenous and exogenous hydrophobic substrates. Fifty-eight cytochrome P450 (CYP) isoenzymes belonging to 18 families have been identified in human cells; the corresponding genes are highly polymorphic, and genetic variability underlies interindividual differences in drug response. The polymorphisms of CYP2D6 significantly affect the pharmacokinetics of about 50% of the drugs in clinical use, which are CYP2D6 substrates. The number of functional CYP2D6 alleles per genome determines the existence of four different phenotypes, i.e. poor, intermediate, extensive, and ultrarapid metabolizers. CYP2D6 genetic variants include copy number variations, single nucleotide substitutions, frameshift and insertion/deletion mutations. This review reports some of the different methodological approaches used to screen for CYP2D6 variants and focuses on methods that have improved variation detection, from conventional techniques to more recent microarray technology and high throughput DNA sequencing. In addition, this review reports some results on clinical relevance of CYP2D6 polymorphisms and provides examples of variability in drug response associated with interindividual phenotypic differences. © 2010 Bentham Science Publishers Ltd.

Gaetani P.,IRCCS Policlinico San Matteo | Klinger M.,IRCCS Instituto Clinico Humanitas | Levi D.,University of Lugano | Bussone G.,IRCCS Instituto Neurologico Carlo Besta | And 4 more authors.
Headache | Year: 2013

Objective. - To test feasibility, safety, and efficacy of local transplant of stromal fraction of adipose tissue in the treatment of chronic headaches of cervical origin. Background. - Chronic headaches of cervical origin (chronic cervicogenic headache and occipital neuralgia) are characterized by persistent pain due to the involvement of the great occipital nerve, with concurrent myofascial spasm and the consequent nerve entrapment within the trapezoid tunnel. Methods. - Tolerability and effectiveness of treatment of chronic cervicogenic headaches refractory to conventional therapies were evaluated in 24 patients. The visual analog scale of pain and the medication use diary were used in the 3 months preceding treatment; moreover, in order to verify the quality of life, patients are required to fill before surgery the Neck Pain Disability Index, the Headache Disability Index, migraine disability assessment scale questionnaire, and the short-form 12 standard v1 questionnaire. Follow-up examination was performed at 3 and 6 months. Results. - In 19 cases (79.2%), a good clinical response was recorded. At 6-month follow-up analysis, recurrence of occipital pain was recorded in 7 cases (29.2%); there is a significant reduction in disability and pain scores, and also a significant reduction of need for pharmacologic treatment and a fast return to previous work capacities. Conclusions. - The key point of our therapeutic strategy might be the regenerative role of stromal fraction of adipose tissue transplanted in the area of the occipital nerve entrapment; the results of the present study are encouraging both in terms of reduction of pain scores and in terms of quality of life improvement. The technique is minimally invasive, and no complications were recorded; indeed, the procedure seems to be safe and effective, and thus, a randomized study with larger follow-up and in a large series will be started. © 2012 American Headache Society.

Salzano A.M.,National Research Council Italy | Novi G.,National Research Council Italy | Arioli S.,University of Milan | Corona S.,IRCCS Policlinico San Matteo | And 2 more authors.
Journal of Proteomics | Year: 2013

Protein interactions are essential elements for the biological machineries underlying biochemical and physiological mechanisms indispensable for microorganism life. By using mono-dimensional blue native polyacrylamide gel electrophoresis (1D-BN-PAGE), two-dimensional blue native/urea-PAGE (2D-BN/urea-PAGE) and two-dimensional blue native/SDS-PAGE (2D-BN/SDS-PAGE), membrane protein complexes of Streptococcus thermophilus were resolved and visualized. Protein complex and oligomer constituents were then identified by nLC-ESI-LIT-MS/MS. In total, 65 heteromeric and 30 homomeric complexes were observed, which were then associated with 110 non-redundant bacterial proteins. Protein machineries involved in polysaccharide biosynthesis, molecular uptake, energy metabolism, cell division, protein secretion, folding and chaperone activities were highly represented in electrophoretic profiles; a number of homomeric moonlighting proteins were also identified. Information on hypothetical proteins was also derived. Parallel genome sequencing unveiled that the genes coding for the enzymes involved in exopolysaccharide biosynthesis derive from two separate clusters, generally showing high variability between bacterial strains, which contribute to a unique, synchronized and active synthetic module. The approach reported here paves the way for a further functional characterization of these protein complexes and will facilitate future studies on their assembly and composition during various growth conditions and in different mutant backgrounds, with important consequences for biotechnological applications of this bacterium in dairy productions. Biological significance: Combined proteomic procedures have been applied to the characterization of heteromultimeric and homomeric protein complexes from the membrane fraction of S. thermophilus. Protein machineries involved in polysaccharide biosynthesis, molecular uptake, energy metabolism, cell division, protein secretion, folding and chaperone activities were identified; information on hypothetical and moonlighting proteins were also derived. This study is original in the lactic bacteria context and may be considered as preliminary to a deeper functional characterization of the corresponding protein complexes. Due to the large use of S. thermophilus as a starter for dairy productions, the data reported here may facilitate future investigations on protein complex assembly and composition under different experimental conditions or for bacterial strains having specific biotechnological applications. © 2013 Elsevier B.V.

Grazioli V.,University of Pavia | Vistarini N.,University of Pavia | Morsolini M.,University of Pavia | Klersy C.,Service of Biometrics and Statistics | And 3 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Objective Primary pulmonary artery sarcoma is a severe and underdiagnosed disease, with the clinical and surgical approach not clearly established. Only a few individual case reports or small series on this topic have been published. The aim of the present study was to report our surgical experience in this field. Methods From March 2004 to December 2012, 13 patients underwent surgery for pulmonary artery sarcoma at our institution. In 7 patients, the sarcoma was unilateral (53.8%), and in 6 (46.2%), the tumor had already extended to both lungs. The surgical strategy evolved over the years, but the 2 techniques used were always the same: pneumonectomy in 5 patients and pulmonary endarterectomy in 8. Results Two patients died in-hospital, both in the pneumonectomy group. The median length of the intensive care unit and hospital stay was 1 day (range, 1-10) and 14 days (range, 11-17) for the pneumonectomy group and 6 days (range, 3-23) and 19 days (range, 10-32) fort the pulmonary endarterectomy group, respectively. The median survival was 26.8 months after pneumonectomy and 6.6 months after pulmonary endarterectomy. Conclusions Primary pulmonary artery sarcoma has a poor prognosis. The surgical strategy at our institution included pneumonectomy, for possible radical resection, and palliative endarterectomy, to reduce symptoms and increase the life expectancy. The correct surgical approach must be evaluated individually, according to the tumor presentation, the presence of pulmonary hypertension, and the patient's clinical condition. © 2014 by The American Association for Thoracic Surgery.

Delbue S.,Health Science Foundation | Elia F.,Health Science Foundation | Carloni C.,University of Milan | Tavazzi E.,Irccs National Neurological Institute C Mondino Foundation | And 7 more authors.
Journal of Cellular Physiology | Year: 2012

Progressive multifocal leukoencephalopathy (PML) is a severe disease of the central nervous system (CNS), caused by infection with the Polyomavirus JC virus (JCV). Because there are no known treatments or prognostic factors, we performed a long-term study focusing mainly on cerebrospinal fluid (CSF) samples from PML patients to describe the virological features akin to the different forms of the disease. Twenty-eight PML patients were enrolled: 10 HIV-1+ patients with classical PML (CPML), 9 HIV-1+ patients with slowly progressing or stable neurological symptoms (benign PML), 3 HIV-1+ asymptomatic patients, and 6 HIV-1-negative patients. CSF, urine, and blood samples were collected at the enrollment (baseline) and every 6 months afterwards when possible. The JCV DNA and HIV-1 RNA loads were determined, and the JCV strains were characterized. At baseline, the mean CSF JCV load was log6.0±1.2copies/ml for CPML patients, log4.0±1.0 copies/ml for benign PML patients, log4.2±0.5 copies/ml for asymptomatic PML patients, and log5.8±1.3copies/ml for HIV-1-negative PML patients (CPML vs. benign: P<0.01; CPML vs. asymptomatic: P<0.05; HIV-1 negative vs. benign: P<0.01). Organization of the JCV transcriptional control region (TCR) showed unusual archetype structures in two long-term survival patients; the NF1 sequence was found most commonly, whereas the Sp1 binding site was the most common for both CPML patients and HIV-1 negative patients. Our results suggest that the JCV load in the CSF and the organization of the TCR should be considered as indicators of PML clinical outcome. J. Cell. Physiol. 227: 3511-3517, 2012. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc.

Melani F.,University of Florence | Mei D.,University of Florence | Pisano T.,University of Florence | Savasta S.,IRCCS Policlinico San Matteo | And 5 more authors.
Developmental Medicine and Child Neurology | Year: 2011

Aim: Cyclin-dependent kinase-like 5 (CDKL5) gene abnormalities cause an early-onset epileptic encephalopathy. We performed video-electroencephalography (video-EEG) monitoring early in the course of CDKL5-related epileptic encephalopathy in order to examine the early electroclinical characteristics of the condition. Method: We used video-EEG to monitor six infants (five females, one male) with CDKL5-related epileptic encephalopathy (five mutations; one deletion), at ages 45days to 12months and followed them up to the ages of 14months to 5years (mean age 23mo). We focused our analysis on the first year of life. The results were evaluated against those of a comparison group of nine infants (aged below 1y) with epileptic encephalography who had tested negative for CDKL5 mutations and deletions. Results: One infant exhibited normal background activity, three exhibited moderate slowing, and two exhibited a suppression burst pattern. Two participants had epileptic spasms and four had a stereotyped complex seizure pattern, which we defined as a 'prolonged' generalized tonic-clonic event consisting of a tonic-tonic/vibratory contraction, followed by a clonic phase with series of spasms, gradually translating into repetitive distal myoclonic jerks. Seizure duration ranged from 2 to 4minutes. The EEG correlate of each clinical phase included an initial electrodecremental event (tonic vibratory phase), irregular series of sharp waves and spike slow waves (clonic phase with series of spasms), and bilateral rhythmic sharp waves (time locked with myoclonus). Interpretation: Infants with CDKL5-related early epileptic encephalopathy can present in the first year of life with an unusual electroclinical pattern of 'prolonged' generalized tonic-clonic seizures. © The Authors. Journal compilation © Mac Keith Press 2011.

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