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News Article | May 15, 2017

On April 28, 2017 Dr. John Prunskis had the honor of presenting at The PAIN in the Baltics Symposium in Kaunas, Lithuania on the topic "Precise Diagnosis and Treatment of Neck and Back Pain including Stem Cell Therapy". Dr. Prunskis is the co-founder of both Illinois Pain Institute and The Regenerative Stem Cell Institute, with over twenty years of experience offering innovative pain relief options for patients. As the only speaker invited from the United States, the European physician colleagues were very interested in how Dr. Prunskis diagnoses and treats painful conditions, especially in the spine. The European pain physicians were also extremely interested in Dr. Prunskis' research with Stem Cell Deployment Therapy, as it is used in multiple medical conditions including: The Regenerative Stem Cell Institute and Illinois Pain Institute are under the Medical Direction of John V. Prunskis, M.D., F.I.P.P. He has been an eight-time Castle-Connolly "Top Doctor" award recipient as voted by his physician peers and U.S. News & World Report Top Doctor. Dr. Prunskis is leading healthcare with innovative and medically advanced procedures including Adult Stem Cell Therapy with Stromal Vascular Fraction (SVF). Top pain relief treatment along with expert stem cell therapy in Chicago are available by calling (888) 925-0219. Most insurance is accepted, with clinic locations including Elgin, Elmhurst, Lake Barrington, McHenry, Itasca, Libertyville and Huntley. For more information visit .

Cereda E.,Nutrition and Dietetics Service | Klersy C.,Biometry and Statistics Service | Pedrolli C.,Trento Hospital | Cameletti B.,Nutrition and Dietetics Service | And 6 more authors.
Clinical Nutrition | Year: 2015

Background & aims: Nutritional derangements are common in elderly patients, but how nutritional risk affects outcome in this subset of hospital inpatients deserves further investigation. We evaluated the impact of nutritional risk on length of stay (LOS) and in-hospital weight loss (WL) in elderly patients (>65yrs). Methods: Nutritional risk was assessed by the Geriatric Nutritional Risk Index (GNRI) in a prospective multicentre hospital-based cohort study. The outcomes were LOS and in-hospital WL. Results: In the whole sample (N=667), the prevalence of high (GNRI<92) and mild (GNRI: 92-98) nutritional risk were 33% and 25%, respectively. Patients with a high nutritional risk were more likely (OR=1.89; 95%CI: 1.22-2.92) to stay longer in hospital (fourth quartile, LOS≥20 days) compared to those without. Other factors associated with prolonged LOS were cancer diagnosis (OR=2.52; 95%CI: 1.69-3.75), the presence of comorbidities (OR=1.24; 95%CI: 1.11-1.40) and surgical setting (OR=1.65; 95%CI: 1.10-2.47). In-hospital WL≥5% was recorded in 75 ambulant patients from a representative subgroup (N=583). It was independently associated with prolonged LOS (OR=1.80; 95%CI: 1.03-3.06) and was more frequent among cancer patients (OR=1.88; 95%CI: 1.09-3.24), in patients with a high nutritional risk (OR=2.23; 95%CI: 1.20-4.14) or those admitted to surgical units (OR=1.77; 95%CI: 1.02-3.05). Conclusions: Nutritional risk assessed by the GNRI on admission, predicts LOS and in-hospital WL in elderly patients. © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

Introduction: Few validated prognostic factors are available for survival in patients with lung cancer. [18F]-fluoro-2-deoxy-d-glucose positron emission tomography has been shown to be of additional value to conventional imaging for staging lung cancer. The prognostic value of this lung tumor metabolic activity was studied in a first systematic review of studies published until 2006. Methods: As further studies have appeared since 2006, this report has as objective to confirm and to estimate with less variability the prognostic value of primary tumor standardized uptake value (SUV) measured with [ 18F]-fluoro-2-deoxy-d-glucose positron emission tomography on the basis of an updated search of eligible studies. Results: Ten additional studies were eligible for the updated review and eight of them provided, in the publication, data allowing survival results aggregation. All together, 21 studies were analyzed. Comparing patients with low and high SUV, using preferentially the median SUV value of each study as threshold, we obtained a poor prognostic value for high SUV compared with low SUV with an overall combined hazard ratio of 2.08, significantly different from one with a 95% confidence interval ranging from 1.69 to 2.56. No interaction between older and newer studies was detectable (P = 0.60) as well as between studies having selected non metastatic patients or studies without selection criterion related to stage (P = 0.46). Conclusions: We confirmed the results of our previous review showing that SUV is potentially a very interesting factor for predicting patient outcome. We believe that a meta-analysis based on individual patient data would be of great value as allowing to assess the independent prognostic value, to take into account some factors responsible for heterogeneity between studies (SUV assessment method, disease stage, and histology), and to update survival data. We are planning to conduct such a meta-analysis on behalf of the International Association for the Study of Lung Cancer Staging Project. © 2010 by the International Association for the study of lung cancer.

Sale P.,IRCCS San Raffaele Pisana | Mazzarella F.,Medical Direction | Pagliacci M.C.,Perugia Regional Hospital | Aito S.,University of Florence | And 2 more authors.
Spinal Cord | Year: 2012

Study design: Prospective, multicenter follow-up (F-U) observational study. Objectives: To investigate the changes in participation and sports practice of people after spinal cord injury (SCI) and their impact on perceived quality of life (QoL). Methods: The questionnaire investigated the health status and management of clinical conditions and attendance of social integration, occupation, autonomy, car driving, sentimental relationships and perceived QoL in a SCI population 4 years after the first rehabilitation hospitalization. Results: Respondents were 403, 83.4% male; 39% was tetraplegic. At F-U, 42.1% worked and studied, 42.2% still held their jobs or studies, and 69% drove the car. In all, 77.2% had bowel continence and 40.4% urinary continence. The results showed that for the 68.2% of respondents, the attendance of friends, relatives and colleagues during their free time was the same or increased compared with the time before the injury, whereas 31.8% showed a decrease. The amount of time the 52.1% of respondents left home was the same or increased compared with before the trauma, whereas 50.6% of the respondents said that the time they were engaged in hobbies was either the same or increased. Conclusion: SCI people who perceived their QoL as being higher, and whose attendance, autonomy and time was increased in respect to hobbies, were mainly men with an age range between 36 and 40 years, unmarried, paraplegic and with A-B Asia Score. Regarding the amount of time dedicated to practicing sports, the only difference was the most of that respondents, who indicated a decrease, were women. © 2012 International Spinal Cord Society All rights reserved.

Ciofi Degli Atti M.,Bambino Gesu Childrens Hospital | Spila Alegiani S.,National Institute of Health | Raschetti R.,National Institute of Health | Arace P.,Medical Direction | And 3 more authors.
European Journal of Clinical Pharmacology | Year: 2015

Purpose: Surgical antibiotic prophylaxis (SAP) in children is poorly characterized. We investigated SAP for children undergoing elective surgical procedures. Methods: We prospectively investigated elective surgical procedures performed in children <18 years, from November 2012 to February 2013, in three tertiary-care children's hospitals in Italy. Data were derived from clinical records. Antibiotics were considered prophylactic if given by parenteral route during the same day of the procedure. SAP indication was defined according to international guidelines. Whenever SAP was indicated, it was defined appropriate if antibiotic choice was different from third-/fourth-generation cephalosporins, carbapenems, or piperacillin/tazobactam; timing of first dose was within 60 min before incision; and duration of administration was ≤&24 h. Multivariable logistic regression model was used to assess independent predictors of adherence to SAP administration, for procedures with SAP indication performed in all hospitals. Results: Data on 765 procedures were collected. SAP was administered in 81 % of 206 procedures with SAP indication and in 18 % of 559 procedures with no indication. Type of procedure and hospital were significantly associated with adherence of administration to SAP indication. In the 206 procedures where SAP was indicated, overall appropriateness of antibiotic choice, timing, and duration was 8 %. Conclusions: The SAP rate observed in procedures with SAP indication and the appropriateness of drug choice, timing, and duration are reasons of concern. Quality improvement interventions for implementing SAP recommendations in children are strongly needed, and their impact should be evaluated at hospital level. © 2015 Springer-Verlag Berlin Heidelberg.

Fasano A.,Catholic University of the Sacred Heart | Fasano A.,AFaR Fatebenefratelli Hospital | Bove F.,Catholic University of the Sacred Heart | Gabrielli M.,Catholic University of the Sacred Heart | And 15 more authors.
Movement Disorders | Year: 2013

Parkinson's disease is associated with gastrointestinal motility abnormalities favoring the occurrence of local infections. The aim of this study was to investigate whether small intestinal bacterial overgrowth contributes to the pathophysiology of motor fluctuations. Thirty-three patients and 30 controls underwent glucose, lactulose, and urea breath tests to detect small intestinal bacterial overgrowth and Helicobacter pylori infection. Patients also underwent ultrasonography to evaluate gastric emptying. The clinical status and plasma concentration of levodopa were assessed after an acute drug challenge with a standard dose of levodopa, and motor complications were assessed by Unified Parkinson's Disease Rating Scale-IV and by 1-week diaries of motor conditions. Patients with small intestinal bacterial overgrowth were treated with rifaximin and were clinically and instrumentally reevaluated 1 and 6 months later. The prevalence of small intestinal bacterial overgrowth was significantly higher in patients than in controls (54.5% vs. 20.0%; P=01), whereas the prevalence of Helicobacter pylori infection was not (33.3% vs. 26.7%). Compared with patients without any infection, the prevalence of unpredictable fluctuations was significantly higher in patients with both infections (8.3% vs. 87.5%; P=008). Gastric half-emptying time was significantly longer in patients than in healthy controls but did not differ in patients based on their infective status. Compared with patients without isolated small intestinal bacterial overgrowth, patients with isolated small intestinal bacterial overgrowth had longer off time daily and more episodes of delayed-on and no-on. The eradication of small intestinal bacterial overgrowth resulted in improvement in motor fluctuations without affecting the pharmacokinetics of levodopa. The relapse rate of small intestinal bacterial overgrowth at 6 months was 43%. © 2013 Movement Disorder Society.

Sale P.,IRCCS San Raffaele Pisana | Mazzarella F.,Medical Direction | Pagliacci M.C.,Perugia Regional Hospital | Agosti M.,University of Parma | And 2 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2012

Objective: To investigate changes and identify predictors in interpersonal functioning and sexual life after traumatic spinal cord injury (SCI). Design: Prospective, multicenter, follow-up observational study. Setting: Subjects at home, interviewed by phone during a 6-month period, 3.8 mean years after discharge from 24 centers participating in a previous epidemiologic prospective survey. Participants: Subjects (N=403) with traumatic SCI. Interventions: Not applicable. Main Outcome Measures: Dependent variables: satisfaction with sentimental life and satisfaction with sexual life compared with before the injury. Independent variables: demographic (age, sex, marital status, vocational status), SCI related (severity, level, bowel/bladder continence), car-driving ability, perceived quality of life (QoL), and impact of sentimental life, social integration, and vocational status on QoL. Results: Satisfaction with sentimental life was reportedly increased or the same as before SCI in 69% of the sample, but satisfaction with sexual life in only 31%. Lesser satisfaction with sexual life was reported by men than women (P=.002) and by married people than singles (P<.001). Significant predictors of sentimental life were perceived QoL and preserved driving ability (R2=.195). Bladder continence was positively associated with a better satisfaction with sexual life (R2=.368). Bowel continence did not remain a significant predictor of satisfaction with sexual life in multivariate analysis. Conclusions: The challenge of a comprehensive rehabilitation of SCI, addressing the recovery of well-being including a satisfying sentimental and sexual life, requires identifying new issues that should be considered in up-to-date rehabilitation programs. The results indicate associations between driving ability and a better satisfaction with sentimental life. Further investigations are needed to explore whether the relationship is causative. © 2012 American Congress of Rehabilitation Medicine.

PubMed | Medical Direction, National Institute of Health, Childrens Hospital AO Spedali Civili and Bambino Gesu Childrens Hospital
Type: Journal Article | Journal: BMC pediatrics | Year: 2016

Qualitative and quantitative research investigating determinants of adherence to clinical guidelines (GLs) on surgical antibiotic prophylaxis (SAP) are scarce. We conducted a mixed-method study aimed at investigating barriers and at describing attitudes of healthcare professionals (HCPs) regarding SAP in three Italian childrens hospitals.The study comprised two sequential phases: 1) collection of qualitative data through focus groups; 2) conduction of a survey on HCPs attitudes towards SAP. Focus groups were carried out in each hospital with a theoretical convenience sample of 10-15 HCPs. Categorical analysis was conducted. Emerging categories and additional topics derived by literature search were used to develop the survey questionnaire, which included 13 questions expressed through a 4-point Likert scale. Members of surgical teams were invited by e-mail to fill in the questionnaire. We summed up the points assigned to each 4-point Likert scale response and calculated a cumulative score expressing overall concordance to expected HCPs attitudes on SAP. We conducted univariate and multivariate analysis to evaluate the relationship among characteristics of respondents and concordance with expected attitudes.The main categories identified in the qualitative phase included determinants of general adherence to GLs (e.g., relevance of clinical judgment), individual determinants (e.g., poor knowledge on hospital data) and organizational/structural determinants (e.g., patient flows). A total of 357 HCPs participated in the survey (response rate: 82.1%). Among respondents, 75% reported that SAP should be performed with first or second-generation cephalosporins, 44% that 2-3 days of antibiotic administration are useful as a precaution after surgery, 32% that SAP is needed for all surgical procedures. At multivariate analysis, professional category (physicians vs nurses; OR: 3.31; 95%CI: 1.88-5.82), and hospital (hospital 1 and 2 vs hospital 3; ORs: 2.79, 95%CI: 1.22-6.36; 2.40, 95%CI: 1.30-4.43, respectively) were significantly and independently associated with higher concordance with expected attitudes on SAP.Results from this study were useful to identify obstacles to appropriate SAP use in children. In our setting, findings support that a quality-improvement intervention should take into account local contexts, with development of hospital policies, education on SAP recommendations, and dissemination of data on adherence to recommendations.

PubMed | Clinical and Microbiological Laboratory, University of Pisa, University of Naples Federico II and Medical Direction
Type: | Journal: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology | Year: 2016

An accurate estimate of the impact of toxoplasmosis on the population in Italy is not available. We performed a cross-sectional study on individuals living in Italy to assess: (1) differences in access to Toxo testing and in the prevalence of recent and past Toxoplasma gondii infection according to gender and age, and (2) the clinical impact of disease burden on the male patient subset. Reason for testing, condition of in- or outpatient and clinical data were analysed. Between-gender differences were observed in access to the test. Immunoglobulin M (IgM) prevalence was increased in males in the age range 5-34 years [odds ratio (OR)=2.03, 95% confidence interval (CI) 1.18-3.49, p=0.01), with a peak at 25-34 years. In females, it decreased in the age range 20-39 years (OR=0.49, 95% CI 0.32-0.74, p=0.0008). The attack rate of recent infection was twice as high for males than for females. Estimates pointed out 3.3 and 1.7 events in 1000 at-risk person-years in the male and female cohorts, respectively. Most IgM-positive subjects did not experience severe forms of toxoplasmosis, with 35% having lymphadenopathy. Chorioretinitis, systemic and neurological manifestations were also observed. Our findings suggest that the acute phase of toxoplasmosis is largely unapparent or clinically mild in this area. It is also possible that the disease burden for Toxoplasma infection in Italy is underestimated. Further study should focus on information acquisition and Toxo test access in hospital units for a better estimation of the real burden of mild and severe forms of the disease.

Rondanelli M.,University of Pavia | Faliva M.A.,University of Pavia | Perna S.,University of Pavia | Antoniello N.,Medical Direction
Aging Clinical and Experimental Research | Year: 2013

The aim of this article was to perform a systematic review on the role of melatonin in the prevention of cancer tumorigenesis - in vivo and in vitro - as well as in the management of cancer correlates, such as sleep-wake and mood disturbances. The International Agency for Research on Cancer recently classified "shift-work that involves circadian disruption" as "probably carcinogenic to humans" (Group 2A) based on "limited evidence in humans for the carcinogenicity of shift-work that involves night-work", and "sufficient evidence in experimental animals for the carcinogenicity of light during the daily dark period (biological night)". The clinical implications and the potential uses of melatonin in terms of biologic clock influence (e.g. sleep and mood), immune function, cancer initiation and growth, as well as the correlation between melatonin levels and cancer risk, are hereinafter recorded and summarized. Additionally, this paper includes a description of the newly discovered effects that melatonin has on the management of sleep-wake and mood disturbances as well as with regard to cancer patients' life quality. In cancer patients depression and insomnia are frequent and serious comorbid conditions which definitely require a special attention. The data presented in this review encourage the performance of new clinical trials to investigate the possible use of melatonin in cancer patients suffering from sleep-wake and mood disturbances, also considering that melatonin registered a low toxicity in cancer patients. © 2013 Springer International Publishing Switzerland.

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