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Milano, Italy

Navarese E.P.,Azienda Ospedaliera Ospedale Civile di Legnano | Servi S.D.,Azienda Ospedaliera Ospedale Civile di Legnano | Politi A.,Ospedale Meriggia Pelaschi | Martinoni A.,Azienda Ospedaliera Ospedale Civile di Legnano | And 7 more authors.
Journal of Thrombosis and Thrombolysis | Year: 2011

The exact relationship between primary percutaneous coronary intervention (PCI) volume and mortality remains unclear. No data are available on how this relationship could be affected by time-to-presentation. The primary aim of this study was to evaluate the impact of hospital primary PCI volume on in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients depending on time-to-presentation. The impact of primary PCI volume on in-hospital mortality was investigated in a prospective registry of the Lombardy region in Northern Italy, deriving data on mortality rates and number of primary PCIs from a cohort of 2,558 patients. We also explored this relationship at different times-to-presentation (≤90 min,>90 min-180 min,>180 min) and risk profiles assessed with the TIMI Risk Index. A strong inverse relationship was found between primary PCI hospital volume and risk-adjusted mortality (r = -0.9; P<0.001). High primary PCI volumes best predicted the improvement of survival when the time-to-presentation was ≤90 min (area under the curve = 0.73, P<0.0001). At this time, the best primary PCI threshold to provide benefit was>66 primary PCIs/year (OR = 0.21 [95% CI 0.10-0.47], P<0.001) and those with high TIMI Risk Index achieved the greatest benefit (P<0.001). At>90 min-180 min, the model was less significant (P = 0.02) with a higher threshold of procedures (>145 primary PCIs/year) required to provide benefits. The model was not predictive of survival for time-to- presentation>180 min (P = 0.30). The reduction of mortality of STEMI patients treated at high-volume primary PCI centers is time-dependent and affected by risk profile. The greatest benefit was observed in high-risk patients presenting within 90 min from symptoms onset. © Springer Science+Business Media, LLC 2011. Source

Svetlich C.,Osp. della Versilia Lido di Camaiore | Occhetta E.,A.O. Maggiore della Carita | Catanzariti D.,P.O. S. Maria Del Carmine | Cantau F.,Ospedali Riuniti | And 7 more authors.
PACE - Pacing and Clinical Electrophysiology | Year: 2011

Introduction: In the right ventricle, selective site pacing (SSP) has been shown to avoid detrimental hemodynamic effects induced by right ventricular apical pacing and, in the right atrium, to prevent the onset of atrial fibrillation and to slow down disease progression. The purpose of our multicenter observational study was to describe the use of a transvenous 4-French catheter-delivered lead for SSP in the clinical practice of a large number of centers. Methods: We enrolled 574 patients in whom an implantable device was indicated. In all patients, SSP was achieved by using the Select Secure System TM (Medtronic Inc., Minneapolis, MN, USA). Results: In 570 patients, the lead was successfully implanted. In 125 patients, atrial SSP was performed: in 75 (60%) the lead was placed in the interatrial septum, in 31 (25%) in the coronary sinus ostium, and in 19 (15%) in the Bachman bundle. Ventricular SSP was undertaken in 138 patients: in 105 (76%) the high septal right ventricular outflow tract (RVOT) position was paced, in seven (5%) the high free-wall RVOT, in 25 (18%) the low septal RVOT, and in one (1%) the low free-wall RVOT. In the remaining 307 patients, the His zone was paced: in 87 (28%) patients, direct His-bundle pacing and in 220 (72%) patients para-hisian pacing was achieved. Adequate pacing parameters and a lead-related complication rate of 2.6% were recorded during a follow-up of 20 ± 10 months. Conclusions: Our results demonstrated that many sites, in the right atrium, in the right ventricle, and in His-bundle region, can be paced using the Select Secure System TM. (PACE 2011; 34:339-347) © 2010 Wiley Periodicals, Inc. Source

Cimmino M.A.,University of Genoa | Cimmino M.A.,Epidemiology Study Group of the Italian Society of Rheumatology SIR | Scarpa R.,Epidemiology Study Group of the Italian Society of Rheumatology SIR | Scarpa R.,University of Naples Federico II | And 3 more authors.
Clinical and Experimental Rheumatology | Year: 2013

Objective: To define the relationship between body mass index (BMI) and pain due to osteoarthritis (OA) of the hand, hip, and knee in patients seen in general practice; to evaluate if overweight is related to co-morbidity and education, and influences the prescription patterns of GPs.Methods: 2,764 Italian GPs recruited 10 consecutive patients with symptomatic OA, diagnosed according to the ACR criteria. Pain intensity on a visual analogue scale, BMI, years of formal education, comorbidities, pharmacological and non-pharmacological interventions, and referral to specialists were recorded.Results: The most painful joints were the knee in 12,827 patients (53.6%), the hip in 5,645 (23.6%), and the hand in 5,467 (22.8%). A BMI indicative of overweight or obesity was found in 74.8% of men and in 68.3% of women. Mean BMI was higher in knee OA (27.9±3.9), in generalised OA (27.5±4.2), and hip OA (27±3.7) than in hand OA (25.5±3.4). The prevalence of obesity for hip and knee OA was higher than that reported for the general Italian population. Obesity was an important risk factor for pain in all OA localisations. Co-morbidities and lower education were associated with obesity and more intense pain (p<0.0001). Obesity and overweight were less frequent in institutionalised patients.Conclusion: Our study confirms that more than two thirds of Italian patients with symptomatic OA seen by GPs are overweight or obese. Obesity is clearly associated with OA pain, a finding which is probably underestimated by GPs who are not used to modulate treatment and specialist referral according to patients' BMI. © Clinical and Experimental Rheumatology 2013. Source

Salvatore S.,University of Insubria | Salvatoni A.,University of Insubria | Ummarino D.,University of Naples Federico II | Ummarino D.,Vrije Universiteit Brussel | And 7 more authors.
Diseases of the Esophagus | Year: 2016

Esophageal multiple intraluminal impedance baseline is an additional impedance parameter that was recently related to esophageal integrity. The aim of this study was to assess the relationship between mean esophageal impedance value and endoscopic findings in a large group of children. Children with symptoms of gastroesophageal reflux submitted to both endoscopy and impedance were included. Esophagitis was graded according to the Los Angeles classification. Mean impedance value was automatically calculated over 24-hour tracings. Data were adjusted for age through z-score transformation using percentiles normalized by the LMS (Lambda for the skew, Mu for the median, and Sigma for the generalized coefficient of variation) method. Nonparametric Mann-Whitney and Kruskal-Wallis tests, multiple, and stepwise regression were used. P-value <0.05 was considered as statistically significant. A total of 298 impedance tracings were analyzed. Endoscopic and histological esophagitis were detected in 30 and 29% patients, respectively. Median baseline z-score was significantly decreased both in proximal (P = 0.02) and distal (P = 0.01) esophagus in patients with endoscopic (but not histological) esophagitis. Patients with more severe esophagitis showed the lowest z-score. Bolus exposure index and the number of reflux episodes were the variables that were significantly associated with the baseline z-score. Impedance z-score is significantly decreased in infants and children with endoscopic esophagitis. Severity of esophagitis, bolus exposure index, and number of reflux episodes are factors influencing mean esophageal impedance. © 2016 International Society for Diseases of the Esophagus. Source

Leone M.A.,NeuroLogica | Leone M.A.,Laboratorio Of Malattie Neurologiche | Ivashynka A.V.,NeuroLogica | Tonini M.C.,Laboratorio Of Malattie Neurologiche | And 6 more authors.
Swiss Medical Weekly | Year: 2011

PRINCIPLES: The risk of seizures increases in patients with brain tumours (BT) and brain vascular malformations (BVM), but not all risk factors are known. We aimed to identify factors that increase the risk of a first seizure in patients with BT or BVM. METHODS: Multicentre case-control study; 102 cases with a first seizure as a presenting symptom of BT or BVM; 121 hospital controls with BT or BVM, but without seizures, matched by centre, gender and age. RESULTS: In the univariate analysis, the risk of first seizure (Odds Ratio, 95% Confidence Limits) was 6.4 (2.3-17.6) for supratentorial lesions, 4.7 (2.4-9.3) for cortical involvement, 2.5 (1.0-7.7) for family history of seizures, and 2.1 (1.2-4.1) for frontal location. The types of lesion with higher risk were low grade glioma (4.7; 1.7-13.9) and cavernous malformations (13.2; 2.1-58.0). After multivariate analysis, including all the imaging characteristics and family history, the strongest independent predictors of first seizure were cortical involvement (OR 4.0; 2.0-8.1) and type of lesion (low grade glioma: 4.0; 1.3-12.8; cavernous malformations: 12.6 (1.5-103.5). CONCLUSIONS: Cortical involvement and type of lesion are the independent risk factors for a first-ever seizure as a presenting symptom of BT or BVM. Source

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