Brindisi, Italy
Brindisi, Italy

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Latini G.,Perrino Hospital | Latini G.,CNR Institute of Clinical Physiology | De Felice C.,Neonatal Intensive Care Unit | Giannuzzi R.,Perrino Hospital | Del Vecchio A.,Di Venere Hospital
Early Human Development | Year: 2013

Background: Bronchopulmonary dysplasia (BPD) continues to represent a significant cause of morbidity among survivors of severe prematurity in the NICU. The increasing prevalence of BPD over the decades has been suggested to be related to the increased survival of extremely low birthweight infants. Aims: To evaluate differences in prevalence of BPD (BPD28d and BPD36wk) and as a function of survival rate in extremely low birth weight (ELBW) infants over time, and to explore its relationship with known associated risk factors. Methods: Survival rate and prevalence of oxygen-dependency =28 days (BPD28d) and oxygen-dependency =36 weeks postmenstrual age (BPD36wk) were evaluated in ELBW newborns (mean gestational age: 27.12.2 weeks; mean birth weight: 817142 g) consecutively admitted to the Brindisi NICU over the last 26 years. Two arbitrarily chosen time periods were compared: Period 1: July 1st, 1986 to June 30, 2002 vs. Period 2: July 1st, 2002 to December 31, 2012. Analyzed variables included gestational age, birth weight, intubation time, hours of O2 administration, NCPAP, and use of surfactant. Differences between the time periods were assessed by chi-square statistics, Fisher's tests or Mann-Whitney test, as appropriate. A two-tailed p value <0.05 was considered to indicate statistical significance. Results: Survival rate of ELBW infants over the examined time periods dramatically improved from 42.3% to 72.6% (p < 0.0001), whereas changes in the prevalence of BPD28d and BPD36wk were not statistically significant (30.5% vs. 39.3%, p = 0.2137 and 5.5% vs. 13.1%, p = 0.1452, respectively). Likewise, BPD severity was not significantly different between the two time periods (p = 0.1635). Gestational age and birth weight of surviving neonates did not significantly change between the two time periods (p = 0.8050 and p = 0.6986, respectively), whereas significantly increased intubation time (median values: 144 hours vs. 33 hours, p <0.0001) and use of exogenous surfactant (89.3% vs. 48.6%, p < 0.0001) was evidenced for the second time period, as well as NCPAP (median values: 600 hours vs. 377 hours, p = 0.0005). A statistically non-significant trend for a prolonged O2 administration in period 2 (p = 0.0850) was also observed. Conclusion: Our findings indicate that a significantly increased survival is not necessarily associated with a significant difference in the prevalence of BPD among ELBW infants. © 2013 Elsevier Ireland Ltd.


Caiulo V.A.,Perrino Hospital
La Pediatria medica e chirurgica : Medical and surgical pediatrics | Year: 2011

The use of ultrasound for the evaluation of the lung is relatively recent. We describe the case of a newborn with pulmonary atelectasis and shift of the mediastinum underlining both advantages and limits of lung ultrasound (LUS). The baby, 1 month of age, was admitted to our hospital for tachypnoea, vomiting and poor weight gain. Chest X-ray (CXR) showed displacement of the heart to the right, suggesting the presence of atelectasis of the right lung. LUS confirmed the displacement of the mediastinum to the right and atelectasis of the right lung, clearly visible as a consolidation with the presence of air bronchograms. The computed tomography image showed that the lung parenchyma displayed in the right hemithorax could be attributed to the hyperexpanded left lung. However, once this information was acquired, and compared to the ultrasound picture, we were able to monitor the patient by LUS until normalization, thus avoiding further exposure to ionizing radiation. Our case, in accordance with the recent Literature, indicates that LUS can be adopted as a simple and non-invasive method for evaluating children with lung disease. It is easy to perform at bedside, allows a close follow-up and avoids the use of ionizing radiation.


Chiellini F.,University of Pisa | Ferri M.,University of Pisa | Morelli A.,University of Pisa | Dipaola L.,CNR Institute of Clinical Physiology | And 2 more authors.
Progress in Polymer Science | Year: 2013

Poly(vinyl chloride) (PVC) is one of the most important polymeric materials available today and is used to manufacture many items, ranging from packaging and toys to healthcare devices. PVC is per se a rigid material but it is made softer by compounding with plasticizers, particularly phthalate esters such as di-(2-ethylhexyl) phthalate (DEHP). In flexible plasticizer PVC (P-PVC), phthalates are not chemically bound to PVC and they are released into the external environment. In particular, prolonged contact of P-PVC based medical devices with body fluids or tissues has been shown to be associated with severe health risks. Major concerns regarding the safety of P-PVC in medical plastic items have been raised, and several alternatives to phthalates and to P-PVC itself as well as chemical/physical treatments of P-PVC to reduce DEHP migration have been proposed. This review outlines recent scientific approaches for preventing DEHP contamination of humans by P-PVC medical devices, highlighting the impact of the proposed alternative materials on human health and strategies for implementing them. © 2013 Elsevier Ltd.


Mattii M.,University of Naples Federico II | Ayala F.,University of Naples Federico II | Balato N.,University of Naples Federico II | Filotico R.,Perrino Hospital | And 5 more authors.
Experimental Dermatology | Year: 2013

The interleukin (IL)-1 family includes 11 members that are important in inflammatory processes. It includes various agonists and two antagonists, IL-1Ra and IL-36Ra. Our aim was to investigate whether the IL-1 family is involved in allergic contact dermatitis (ACD). The expression of IL-1 family members was evaluated by PCR and immunohistochemistry in the positive patch test reaction site (involved skin) and in the uninvolved skin of ACD patients. We also examined these cytokines in an ex vivo model of ACD. The antagonistic activity of IL-36Ra was evaluated by injecting recombinant IL-36Ra in uninvolved skin biopsies of ACD patients. IL-1Ra and IL-36Ra expression was quantified in mononuclear cells of nickel-sensitized patients challenged in vitro with nickel. IL-33 involvement in ACD was investigated by intra-dermal injection of anti-IL-33 in the uninvolved skin of patients ex vivo. Results showed that IL-1β, IL-1Ra, IL-36α, IL-36β, IL-36γ and IL-33 expression, but not IL-36Ra expression, was enhanced in ACD-involved skin. Immunohistochemical analysis and ex vivo skin cultures confirmed these results. Injection of anti-IL-33 in ACD-uninvolved skin inhibited IL-8 expression, whereas IL-36Ra inhibited IL-36α, IL-36β, IL-36γ and IL-8 expression. Nickel induced IL-1Ra expression in lymphocytes of nickel-sensitized patients. Hence, various IL-1 agonists and antagonists may be involved in ACD pathogenesis. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Caiulo V.A.,Perrino Hospital | Gargani L.,National Research Council Italy | Caiulo S.,University of Milan | Fisicaro A.,University of Milan | And 4 more authors.
European Journal of Pediatrics | Year: 2011

The diagnosis of bronchiolitis is based mainly on the patient's medical history and physical examination. However, in severe cases, a further evaluation including chest X-ray (CXR) may be necessary. At present, lung ultrasound (LUS) is not included in the diagnostic work-up of bronchiolitis. This study aimed to compare the diagnostic accuracy of LUS and CXR in children with bronchiolitis, and to evaluate the correlation between clinical and ultrasound findings. Only patients with a diagnosis of bronchiolitis, who had undergone a CXR, were enrolled in the study. Fifty-two infants underwent LUS and CXR. LUS was also performed in 52 infants without clinical signs of bronchiolitis. LUS was positive for the diagnosis of bronchiolitis in 47/52 patients, whereas CXR was positive in 38/52. All patients with normal LUS examination had a normal CXR, whereas nine patients with normal CXR had abnormal LUS. In these patients, the clinical course was consistent with bronchiolitis. We found that LUS is a simple and reliable tool for the diagnosis and follow-up of bronchiolitis. It is more reliable than CXR, can be easily repeated at the patient's bedside, and carries no risk of irradiation. In some patients with bronchiolitis, LUS is able to identify lung abnormalities not revealed by CXR. Furthermore, there is a good correlation between clinical and ultrasound findings. Given the short time needed to get a US report, this technique could become the routine imaging modality for patients with bronchiolitis. © 2011 Springer-Verlag.


Testa C.,Cergy-Pontoise University | Testa C.,University of Florence | Nuti F.,University of Florence | Hayek J.,University of Siena | And 7 more authors.
ASN Neuro | Year: 2012

ASDs (autism spectrum disorders) are a complex group of neurodevelopment disorders, still poorly understood, steadily rising in frequency and treatment refractory. Extensive research has been so far unable to explain the aetiology of this condition, whereas a growing body of evidence suggests the involvement of environmental factors. Phthalates, given their extensive use and their persistence, are ubiquitous environmental contaminants. They are EDs (endocrine disruptors) suspected to interfere with neurodevelopment. Therefore they represent interesting candidate risk factors for ASD pathogenesis. The aim of this study was to evaluate the levels of the primary and secondary metabolites of DEHP [di-(2-ethylhexyl) phthalate] in children with ASD. A total of 48 children with ASD (male: 36, female: 12; mean age: 11±5 years) and age- and sex-comparable 45 HCs (healthy controls; male: 25, female: 20; mean age: 12±5 years) were enrolled. A diagnostic methodology, based on the determination of urinary concentrations of DEHP metabolites by HPLC-ESI-MS (HPLC electrospray ionization MS), was applied to urine spot samples. MEHP [mono-(2-ethylhexenyl) 1,2-benzenedicarboxylate], 6-OH-MEHP [mono-(2-ethyl-6- hydroxyhexyl) 1,2-benzenedicarboxylate], 5-OH-MEHP [mono-(2-ethyl-5-hydroxyhexyl) 1,2-benzenedicarboxylate] and 5-oxo-MEHP [mono-(2-ethyl-5-oxohexyl) 1,2-benzenedicarboxylate] were measured and compared with unequivocally characterized, pure synthetic compounds (.98%) taken as standard. In ASD patients, significant increase in 5- OH-MEHP (52.1%, median 0.18) and 5-oxo-MEHP (46.0%, median 0.096) urinary concentrations were detected, with a significant positive correlation between 5-OH-MEHP and 5-oxo-MEHP (r s50.668, P,0.0001). The fully oxidized form 5-oxo-MEHP showed 91.1% specificity in identifying patients ith ASDs. Our findings demonstrate for the first time an association between phthalates exposure and ASDs, thus suggesting a previously unrecognized role for these ubiquitous environmental contaminants in the pathogenesis of autism. © 2012 The Author(s).


Latini G.,Perrino Hospital | Latini G.,CNR Institute of Clinical Physiology | Ferri M.,University of Pisa | Chiellini F.,University of Pisa
Current Medicinal Chemistry | Year: 2010

Polymeric materials play a key role in the production of medical and clinical devices thanks to their special features such as flexibility, easy processing and good price/performance ratio. Among the different polymeric matrixes, one of the most used is Poly(vinyl chloride) (PVC). At room temperature PVC is hard and brittle, thus great amounts (4050%) of phthalate esters that act as plasticizers are added to the polymer to make it flexible and appropriate for medical use. Di-(2-ethylhexyl)-phthalate (DEHP) is the most widely used plasticizer in PVC medical devices. However, DEHP is not chemically bound to PVC and migrates from medical devices with time and use. The potential for DEHP to produce adverse effects in humans has been the subject of considerable discussion and debate in the scientific community. In particular, newborns in the new environment have to be considered at particularly increased risk, because of their small body size and the multiple medical device-related to the DEHP exposure. The major factors determining the degree to which DEHP migrates from medical devices are temperature, amount of DEHP in the device, storage time, shaking of the device while in contact with the medical solutions and degree of PVC degradation. The Aim of this review is to present an updated outline of recent ongoing research in the field of PVC degradation and consequent release of phthalates by highlighting their impact on human health, focusing on neonatal exposure. © 2010 Bentham Science Publishers Ltd.


Petruzzelli M.F.,Perrino Hospital
La Clinica terapeutica | Year: 2010

Cancer incidence increases with age and several cancer types are observed in older patients, so the need for radiotherapy (RT) in treatment of older patients with cancer is also on the rise. This study's aims to evaluate retrospectively the pattern of care and the feasibility of RT in elderly patients (80 years old and over) treated with different intents, and the impact of RT prescription on survival. We reviewed 191 patient charts from the years 2005-2007, recording age, intent of treatment, site, and type of RT. Crude and actuarial survival were estimated. One hundred patients were males (M) and 91 females (F); 162 were seen on an outpatient basis, 29 as inpatients. A total of 138 patients were recruited for RT; 113 were treated, 112 completed RT. The ratio to all treated patients was 113/2125 (5.3%). Overall (treated and non-treated) cumulative survival probability was 71% for the first year, 45% for the second and 27% for the third. For treated patients, the cumulative survival probability was 67% for the first year, 43% for the second year and 23% for the third year, while for untreated patients it was 76% for the first year, 47% for the second year and 32% for the third year (Log-rank test: p = 0.23). RT did not decrease survival in elderly patients.


Caiulo V.A.,Perrino Hospital | Gargani L.,National Research Council Italy | Caiulo S.,University of Milan | Fisicaro A.,University of Milan | And 4 more authors.
Pediatric Pulmonology | Year: 2013

Background The diagnosis of community-acquired pneumonia (CAP) is based mainly on the patient's medical history and physical examination. However, in severe cases a further evaluation including chest X-ray (CXR) may be necessary. At present, lung ultrasound (LUS) is not included in the diagnostic work-up of pneumonia. Aim To describe the ultrasonographic appearance of CAP at presentation and during the follow-up. Methods A total of 102 patients with clinical signs and symptoms suggesting pneumonia, who underwent a clinically driven CXR, were evaluated by LUS on the same day. LUS signs of pneumonia included subpleural lung consolidation, B-lines, pleural line abnormalities, and pleural effusion. The diagnostic gold standard was the ex-post diagnosis of pneumonia made by two independent experienced pediatricians on the basis of clinical presentation, CXR and clinical course following British Thoracic Guidelines recommendations. Results A final diagnosis of pneumonia was confirmed in 89/102 patients. LUS was positive for the diagnosis of pneumonia in 88/89 patients, whereas CXR was positive in 81/89. Only one patient with normal LUS examination had an abnormal CXR, whereas 8 patients with normal CXR had an abnormal LUS. LUS was able to detect pleural effusion resulting from complicated pneumonia in 16 cases, whereas CXR detected pleural effusion in 3 cases. Conclusions LUS is a simple and reliable imaging tool, not inferior to CXR in identifying pleuro-pulmonary alterations in children with suspected pneumonia. During the course of the disease, LUS allows a radiation-free follow-up of these abnormalities. Pediatr Pulmonol. 2013; 48:280-287. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc.


Derchi G.,Galliera Hospital | Galanello R.,University of Cagliari | Bina P.,University of Cagliari | Cappellini M.D.,University of Milan | And 8 more authors.
Circulation | Year: 2014

Background-Pulmonary arterial hypertension (PAH) remains a concern in patients with β-thalassemia major (TM) and intermedia (TI); however, studies evaluating its prevalence and risk factors using systematic confirmation on right heart catheterization are lacking. Methods and Results-This was a multicenter cross-sectional study of 1309 Italian β-thalassemia patients (mean age 36.4±9.3 years; 46% men; 74.6% TM, 25.4% TI). Patients with a tricuspid-valve regurgitant jet velocity ≥3.2 m/s (3.6%) on transthoracic echocardiography further underwent right heart catheterization to confirm the diagnosis of PAH (mean pulmonary arterial pressure ≥25 mm Hg and pulmonary capillary wedge pressure ≤15mm Hg). The confirmed PAH prevalence on right heart catheterization was 2.1% (95% confidence interval [CI], 1.4-3.0) and was higher in TI (4.8%; 95% CI, 3.0-7.7) than TM (1.1%; 95% CI, 0.6-2.0). The positive predictive value for the tricuspid-valve regurgitant jet velocity ≥3.2 m/s threshold for the diagnosis of pulmonary hypertension was 93.9%. Considerable functional limitation and decrease in the 6-minute walk distance were noted in patients with confirmed PAH. On multivariate logistic regression analysis, independent risk factors for confirmed PAH were age (odds ratio, 1.102 per 1-year increase; 95% CI, 1.06-1.15) and splenectomy (odds ratio, 9.31; 95% CI, 2.57-33.7). Conclusions-The prevalence of PAH in β-thalassemia patients as confirmed on right heart catheterization was 2.1%, with an ≈5-fold higher prevalence in TI than TM. Advanced age and splenectomy are risk factors for PAH in this patient population. © 2013 American Heart Association, Inc.

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