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De Paolis P.,Polo Ospedaliero Interaziendale Trapianti POIT | Favaro A.,Polo Ospedaliero Interaziendale Trapianti POIT | Piola A.,Polo Ospedaliero Interaziendale Trapianti POIT | Martini F.,Cellular Immunological Laboratory Unit | And 4 more authors.
Transplantation Proceedings | Year: 2011

The aim of this preliminary, observational study was to evaluate the value of ImmuKnow (IK), a new tool to measure the net state of immunefunction among renal transplant recipients, in correlation with clinical and laboratory data among unselected renal transplant recipients. Forty-nine recipients of mean age of 51 years were enrolled and followed for 1 year after transplantation. All subjects received the same immunosuppressive strategy with basiliximab induction and tacrolimus, mycophenolate mofetil and steroid maintenance therapy. Samples for IK were collected before transplantation as well as at 7, 14, 21 and 42 days and after 3, 6, and 12 months. There were 54 samples with IK <225 ng/mL, 201 samples with normal IK values, and 135 samples with >525 ng/mL. We divided recipients into 3 groups with respect to their basal IK values: Group 1 (Gr1; IK <225 ng/mL); Group 2 (Gr2; normal values of IK between 226 and 524 ng/mL); and Group 3 (Gr3; IK >525 ng/mL). At 1 year, we observed a significant difference among IK values at the start and the end of the study: Gr1 vs Gr2, P < .0001; Gr2 vs Gr3, P < .06 and Gr 1 vs Gr 3, P < .01). We observed reduced IK values to predict an increased risk of infection, particularly with cytomegalovirus (CMV) replication while higher IK value did not correlate with an increased risk of acute rejection episodes. Reduction of serum creatine levels occurred within 1 year in all groups (P < .005), but there was a significant difference between Gr 2 versus Grs 1 and 3 (P < .0001 and P < .0005, respectively). There findings suggested that more stable IK values were associated with clinical quiescence and laboratory stability. In conclusion, our preliminary analysis showed a beneficial capacity of this assay to represent the global depression of the immune system. We noted that reduced IK values, as a sign of excessive immunosuppressive therapy, were associated with an increased risk of infection. We did not confirm the predictive value of higher IK values for an increased risk of an acute rejection episode.

Tubili C.,Polo Ospedaliero Interaziendale Trapianti POIT | Morviducci L.,Polo Ospedaliero Interaziendale Trapianti POIT | Nardone M.R.,Polo Ospedaliero Interaziendale Trapianti POIT | Altieri N.,Polo Ospedaliero Interaziendale Trapianti POIT | Clementi A.,Polo Ospedaliero Interaziendale Trapianti POIT
Giornale Italiano di Diabetologia e Metabolismo | Year: 2011

Use of pedometers in an intensive educational programme in patients with type 2 diabetes In patients with type 2 diabetes, change of lifestyle achieved through an intensive educational approach, including targeted adjustments to dietetic behaviors, can significantly improve metabolic compensation and reduce cardiovascular risk. The use of pedometer can be useful to increase the effectiveness of such a change. The effectiveness of an intensive educational program based on: dietary prescription and counseling, behavioral therapy, use of pedometers, control of diabetes and associated cardiovascular risk factors (in the context of SM) has been assessed in patients with type 2 diabetes with metabolic syndrome (SM). Forty patients with type 2 diabetes were randomized into two groups: 20 patients treated with intensive approach and 20 with a standard approach (control). The input data (T0) did not show significant differences between the two groups of patients. The intensive therapy group has shown a statistically significant change in BMI (p < 0.05), waist circumference (p = 0.01), glucose (p < 0.05), HbA1c (p = 0.01). In terms of triglycerides, LDL cholesterol, HDL cholesterol no significant change, despite an improving trend, has been revealed. 17% of patients treated intensively at T1 can no longer be assessed on the basis of the diagnostic criteria of SM (ATP III and IDF). The use of simple tools such as pedometer allows for obtaining objective data, provided that physical activity is prescribed, as well as for monitoring the compliance with the semistructured programs and for stimulating active and conscious participation of the patients.

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