Santa Maria Nuova, Italy
Santa Maria Nuova, Italy

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PubMed | Associazione Italiana Contro lArtrite AICA, L Sacco Hospital Milan Italy, Chief Of Rheumatology Unit L Sacco Hospital Milan Italy, Orthopedic Unit and University of Milan
Type: Journal Article | Journal: Journal of translational medicine | Year: 2016

Our previous results showed that intrasynovial Rifamycin SV caused the lysis of synoviocites and freed the autoantigens which in turn stimulated the immunoregulatory rather than autoreactive T cell response in rheumatoid patients. Here, we hypothesize that disruption in vitro of peripheral blood mononuclear cells, by freeze/thawing or by lytic action of Rifamycin SV, would induce the release of endosomal pathogenic autoantigens from APCs present in the circulation, which could then be isolated from degrading enzymes by ultrafiltration.The preparation of the ultrafiltrates are based on the rupture of PBMCs (510(6) cells/mL) by the addition of Rifamycin SV in culture (250g/mL), which causes the lysis of 90% of the cells in 3h, or by three cycles of freeze/thawing of the PBMC, from -80C to room temperature. The lysate and the fragmented cells were then centrifuged and ultrafiltered by passage through a filtration device with a cut-off of 10kDa. Also the synovial fluid was subjected to ultrafiltration.At clinical monitoring of the 30thday, 22/58 (38%) patients subcutaneously treated with the autologous ultrafiltrate prepared by the freeze/thawing of PBMCs reached an ACR20. Comparable results were obtained with the other two ultrafiltrates. Cell cultures The addition of ultrafiltrates to rheumatoid PBMCs cultures led to the upregulation of a marker for T-regulatory cells, and downregulation of a cell proliferation marker; changes that together have the meaning of a global immunomodulatory response and that only a specific antigen (ultrafiltrate UF-f/t) might induce in the rheumatoid patient, probably by activating pre-existing protective network. Experimental arthritis All the ultrafiltrates except that prepared by Rifamycin SV were able to modulate the adjuvant arthritis in rats. In particular, longlasting synovial fluid induced a significant reduction of the severity of subsequent arthritis (p<0.01) while SF from recent RA effusion (5-10days after a previous complete extraction) and knee osteoarthrosis were ineffective. It is reasonable to assume there are at least two unknown endosomal immunoactive epitopes; one developing its immunotherapeutic property in RA, and the other, related to the molecule of HSP60, reduces the severity of oncoming arthritis. Both epitopes are present in humans, have a molecular weight of 10kDa and do not appear to be bystander antigens. Please see Additional file 1 for the abstract in Italian.


Pioli G.,Gerontology Unit | Pellicciotti F.,Gerontology Unit | Davoli M.L.,Gerontology Unit | Pignedoli P.,Orthopedic Unit | And 2 more authors.
European Geriatric Medicine | Year: 2010

Hip fractures are a major health care problem in Italy since more than 90,000 such fractures per year occur among elderly people. Nowadays, in several boroughs, orthopaedic wards are being restructured, overcoming the traditional model of care towards heterogeneous liaison models between the orthopaedic staff and medical-geriatric staff. However, the care pathway changes considerably from one area to another of the country. Wide differences in the choice of treatment, surgical delays, length of in-hospital stay and the availability of rehabilitation services and intermediate care in the sub-acute period have been reported over the country. The authors described the orthogeriatric model of Arcispedale Santa Maria Nuova (ASMN) Hospital, the main hospital of the province of Reggio Emilia (Emilia-Romagna region), implemented in 2007 for all patients aged 75 years and older admitted with a hip fracture. During hospital stay each patient is comanaged by an orthopedic surgeon and a geriatrician with different responsibility and using a number of evidence-based protocols and standardized procedures. Even without dedicated trauma theatre, comparing data before and after the implementation of the Ortho-Geriatric model, a 50% reduction of waiting time to surgery was observed and the mean hospital stay decreased about 5 days. The Ortho-Geriatric approach should include all those strategies and interventions that have been shown to improve outcomes in well-designed and strictly evidence-based studies and the ASMN model need to be improved in several critical aspects such as standardized approaches in the management of the patients with very high level of comorbidity in the preoperative phase and the coordination of all the medical staff in the presurgical period. © 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society.


Olswang-Kuz Y.,Chaim Sheba Medical Center | Liberman B.,Orthopedic Unit | Weiss I.,Orthopedic Unit | Ramu E.,Orthopedic Unit | And 7 more authors.
Clinica Chimica Acta | Year: 2011

Background: Procollagen C-proteinase enhancer 1 (PCPE1), a glycoprotein secreted from differentiating osteoblast, enhances the rate-limiting step of collagen type I fibrillar formation. It is expressed and secreted by cells that produce collagen type I and has the potential to be a marker for bone pathologies. Methods: We developed an assay to quantify PCPE glycopattern based on isoelectric focusing (IEF) and detection with a bio-imaging camera (coefficient of variation within and between assays, 15% and 20%, respectively). Results: PCPE was quantified in 39 serum samples from healthy subjects (17 females and 22 males). The concentration in the serum was 305(274) ng/ml, median(IQR). The level of the PCPE isoforms and their relative distribution were altered in patients with bone disorders. Conclusions: The data generated by our system, support our hypothesis that combined data on PCPE concentration and isoforms may be useful for the diagnosis and follow-up of bone diseases. Further research, on larger cohorts of both normal subjects and patients, must be done. © 2011 Elsevier B.V.


Pioli G.,ASMN Hospital | Davoli M.L.,ASMN Hospital | Pellicciotti F.,ASMN Hospital | Pignedoli P.,Orthopedic Unit | Ferrari A.,ASMN Hospital
European Journal of Physical and Rehabilitation Medicine | Year: 2011

Comprehensive care (CC) represents the basic approach of orthogeriatric comanaged care with the overall objectives of improving results regarding physical and psychological functions and reducing hospitalization, long-term care placement and mortality. It is a two-stage process that includes the Comprehensive Geriatric Assessment (CGA) and the development and implementation of an interdisciplinary treatment plan based on priority interventions and unmet needs. In older hip fracture patients CC has to face crucial issues such as treatment choice and surgical options, clinical stabilization of patients before surgery and the prevention and treatment of complication in the postoperative phase. The main aim are to avoid inappropriate surgical delays and reduce the overall number of days of immobility endorsing an early ambulation with full weight bearing as tolerated. Multiprofessional CC must also ensure uninterrupted care for transition between the different care levels that patients need after fracture before returning home. Therefore another important issue is a structured discharge plan tailored to the individual patient identifying subjects that could benefit from a skilled or more intensive rehabilitation, identifying patients and family that will probably need a higher level of care even after rehabilitation, determining timing of discharge, defining the continuing care that needs to be provided and finally ensuring the patient has access to available services and resources. However, the implementation of a comprehensive and multidisciplinary co-care model in an orthopedic unit is a difficult task because it is necessary a great effort to change cultural attitudes related to traditional model of care.


Filippou G.,University of Siena | Adinolfi A.,University of Siena | Bozios P.,University of Siena | Lorenzini S.,University of Siena | And 6 more authors.
The Scientific World Journal | Year: 2013

Purpose. Ultrasonography (US) has been demonstrated to be an important tool in the diagnosis of calcium pyrophosphate (CPP) crystal deposition disease. The aim of our study was to individuate and describe possible pitfalls in US detection of such deposits in menisci. Patients and Methods. We enrolled all patients waiting to undergo knee replacement surgery due to osteoarthritis, for one-month period. Each patient underwent US examination of the knee, focusing on the menisci. After surgery, the menisci were examined by US, macroscopically and microscopically, using the microscopic analysis as the gold standard for CPP deposition. Results. 11 menisci of 6 patients have been studied. Ex vivo examination of menisci performed better in CPP identification than in vivo examination. The possible reasons of misinterpretation or misdiagnosis of the in vivo exam were identified and are extensively described in the paper. Also a new sign of CPP crystal deposits was found. Conclusions. This study permitted to highlight some difficulties in CPP crystal detection by US in menisci. Further studies are needed to define completely US CPP crystal aspect and to improve the sensibility and specificity of US in CPP deposition diagnosis. © 2013 Georgios Filippou et al.


Brown A.,Orthopedic Unit | Boshers B.,Orthopedic Unit | Chapman L.F.,Orthopedic Unit | Huckaba K.,Orthopedic Unit | And 7 more authors.
Orthopaedic Nursing | Year: 2015

BACKGROUND: Although prior studies have shown patientcontrolled analgesia (PCA) to be appropriate for use by children and adults, no studies have specifically evaluated the ability of elderly patients to use the technology correctly. PURPOSE: To determine whether elderly, postoperative patients can properly use PCA devices. METHODS: Using a descriptive study design, a convenience sample of elderly, postoperative orthopedic patients was observed while using a PCA device and surveyed about the proper use of the device. Participants were observed and surveyed 12 to 20 hours after admission to the postoperative patient care unit. Frequency and amount of analgesic medication administration over the postoperative time period were also recorded. Data were summarized with descriptive statistics and multiple regression analysis was used to determine whether confounding variables explained problems using the PCA device correctly. RESULTS: A total of 58 orthopedic patients were studied during the first day after surgery. Patients had used the PCA device for 16.6 ± 3.0 (mean ± SD) hours at the time of the observation and survey. Virtually all patients correctly identified and depressed the PCA activation button when instructed, knew when to use the PCA device, and who was allowed to depress the PCA button. Slightly more than half of the patients (57%) correctly identified how often they could have PCA medication, with 38% not sure of PCA medication frequency. The PCA medication was requested an average of 23.3 ± 52.7 times during the study period. The majority of the patients (86%) requested PCA medication less than 25% of the times that they could receive PCA medication. All patients in the study had PCA devices programmed to deliver up to 5 doses per hour of PCA medication, yet an average of 11.2 ± 10.8 doses of PCA medication were actually delivered during the entire study period (average 16.6 hours). Average doses of fentanyl and morphine sulfate received by patients were 13.5 μ g/hour and 1.0 mg/hour, respectively. CONCLUSION: Elderly patients were very knowledgeable about how to use the PCA device but not about how often they could receive PCA medication. This lack of knowledge may have influenced how often they requested pain medication, because almost 90% of patients received less than 25% of the PCA allowable medication dose. This low usage of PCA medication delivery calls into question the cost-effectiveness of this method of medication delivery for the elderly. Additional studies are needed to verify these findings in other elderly patients. © 2015 by National Association of Orthopaedic Nurses.

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