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Milani P.,University of Pavia | Graziani M.S.,Laboratorio Of Analisi Chimico Cliniche Ed Ematologiche | Merlini G.,University of Pavia
Biochimica Clinica | Year: 2010

Kidney diseases represent an important clinical problem, with increasing incidence and high mortality rate. Despite encouraging results on acute kidney injury (AKI) treatment in animals studies, no specific treatment has yet been successful in humans. One of the important factors contributing to this problem is the lack of an early AKI diagnostic test. Serum creatinine, the current diagnostic test for kidney disease, rises late in AKI and is inaccurate as marker of acute changes in glomerular filtration rate. The application of innovative technologies, such as functional genomics and proteomics, to human and animal AKI models has revealed promising novel biomarkers, with potentially higher sensitivity and specificity. These include plasma [neutrophil gelatinaseassociated lipocalin (NGAL) and cystatin C] and urine markers [NGAL, interleukin 18 and kidney injury molecule-1(KIM-1)]. Because they represent sequential biomarkers, it is likely that an AKI panel will be useful for timing the initial insult, assessing the duration of AKI, and predicting overall prognosis with respect to dialysis requirement and mortality. It is also likely that these biomarkers will help to distinguish between various types of renal dysfunction. Source


Vidali M.,University of Piemonte Orientale | Verzotti E.,University of Piemonte Orientale | Cabraz N.,University of Piemonte Orientale | Santi F.,University of Piemonte Orientale | And 6 more authors.
Biochemia Medica | Year: 2015

Introduction: The aim of this study was to identify clinical variables which may be independently associated with positivity of a cardiac troponin I (cTnI) assay in a large population of patients admitted to the emergency department (ED). Materials and methods: 3166 subjects, with at least two troponin I tests ordered within 6 hours in the ED, were studied. Patient data were statistically analyzed to identify clinical associations with increased values of Troponin I. Results: Although patients with diagnosis of acute coronary syndrome displayed troponin I values significantly higher than those of other groups, positivity to troponin I (> 40 ng/L) was also observed in patients with other clinical conditions. In multivariate analysis, age, elevated heart rate and electrocardiographyc changes were independently associated with troponin I positivity at admission. In the whole study population troponin I positivity exhibited high sensitivity and negative predictive value, counterbalanced by low specificity and limited positive predictive value. Conclusions: Troponin I positivity should be combined with history and clinical evaluation and cautiously interpreted in the ED, especially in patients exhibiting factors associated with higher troponin I levels such as older age, elevated heart rate or ECG changes. © Croatian Society of Medical Biochemistry and Laboratory Medicine. Source


Di Francesco V.,Clinica Geriatrica | Antonioli A.,Clinica Geriatrica | Fantin F.,Clinica Geriatrica | Bissoli L.,Clinica Geriatrica | And 2 more authors.
Biochimica Clinica | Year: 2010

The "anorexia of aging" is defined as a condition associated with reduced appetite and consequent decrease in food intake in apparently healthy elderly people; this may lead to malnutrition. It is still unclear if meal composition can affect this condition. The aim of this study was to evaluate satiety and hunger sensation as well as hormone concentrations after meals with different fat contents. Twelve aged healthy community-dwelling subjects and twelve younger controls were asked to score their hunger sensation, using a visual analogical scale, under fasting condition and at 30-min interval for up to 4 h after two 800-kcal meals, where 20% and 40% of the calories were derived from fats, respectively. Serum samples were collected at -30, 60, 120, and 240 min after meal to measure glucagon-like peptide 1 (GLP-1), acylated and desacylated ghrelin, triglycerides, glucose, and insulin. In the elderly group serum concentrations of GLP-1 were higher after the 40% fat meal than after the 20% fat meal. In this group, after the 40% fat meal a lower acylated to desacylated ghrelin ratio, higher triglycerides and a lower hunger sensation were also observed. In conclusion, in apparently healthy elderly people larger amounts of fat in meals increase the satiety signal from GLP-1 and lower the acylated to desacylated ratio of ghrelin, consequently decreasing hunger. These data may explain the reduction in calory intake often observed in elderly people and should be taken into account in planning their diet composition. Source


Sorio A.,Laboratorio Of Analisi Chimico Cliniche Ed Ematologiche | Pighi M.,Divisione di Cardiologia | Pesarini G.,Divisione di Cardiologia | Yabarek T.,Azienda Ospedaliera Universitaria Integrata di Verona | And 3 more authors.
Biochimica Clinica | Year: 2010

The aims of this work are twofold: to verify if biochemical markers are able to predict contrast-induced nephropathy after angiography and to check if these markers can also predict renal damage at 30 days. The prognostic value of any early shift of serum creatinine concentrations compared to baseline was investigated. 216 patients at risk for contrast-induced nephropathy were prospectively evaluated at baseline, 12, 24, and 48 h after exposure to contrast media. 190 (88%) of those were evaluated again one month after discharge. Contrast-induced nephropathy occurred in 39 patients (18%) and 30-day renal damage was detected in 15 (7%). Percent change of creatinine 12 h from baseline was significantly higher in patients with nephropathy (P <0.001) and, at multivariate analysis, was the best predictor of nephropathy (P <0.001). A 5% increase yields 75% sensitivity and 72% specificity [area under the ROC curve (AUC), 0.80; odds ratio (OR), 7.4, 95% confidence interval (CI): 3.3-16.2)] for early detection of contrast-induced nephropathy. Furthermore, a 5% creatinine increase was strongly correlated with the development of renal impairment at 30 days (P=0.002) (sensitivity, 87%; specificity 70%; AUC, 0.85; OR, 13.3: 95%CI, 2.9-60.6). In conclusion, minimal elevations of serum creatinine at 12 h are highly predictive of contrastinduced nephropathy and 30-day renal damage after exposure to contrast media. Source


Balboni F.,Laboratorio Analisi Chimico Cliniche | Graziani M.S.,Laboratorio Of Analisi Chimico Cliniche Ed Ematologiche
Biochimica Clinica | Year: 2010

Several decades ago it was suggested that individuals with elevated concentrations of plasma homocysteine, a sulphur-containing amino acid, have an increased risk of coronary heart disease. Observational studies confirmed the association, although its strength has recently been reconsidered. Whether this association is causal is still uncertain; however, it is highly relevant to answer the clinical question if treatments with B-type vitamins and folate, known to lower plasma homocysteine concentrations, may reduce vascular risk. The present paper reviews the evidence in a historical perspective, from observational studies to randomized controlled trials. Results from recent metanalyses are also presented and discussed. Laboratory professionals should be aware that, although "homocysteine lowering" trials showed no effects on vascular outcomes, the measurement of plasma homocysteine concentrations is still of some value as diagnostic (homocysteinuria, vitamin B deficiencies) and prognostic (cardiovascular disease) tool. Source

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