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Siniscalchi A.,Annunziata Hospital | Iannacchero R.,Pugliese Ciaccio Hospital | De Sarro G.,University of Catanzaro | Gallelli L.,University of Catanzaro
Current Vascular Pharmacology | Year: 2016

Stroke is an acute condition characterized by a sudden decrease in blood flow to brain tissue, resulting in immediate deprivation of both glucose and oxygen. Different mechanisms are involved in the pathogenesis of stroke, but increasing evidence suggests that one of the processes worsening clinical outcome is inflammation with the synthesis and the release of pro-inflammatory cytokines that activate several cells contributing to the progression of brain injury. Monoclonal antibody therapy has proved useful and safe for the treatment of several systemic diseases. In contrast, the evidence is limited for the treatment of stroke. More studies are needed in order to standardize the method of treatment and establish if it is safe and effective. © 2016 Bentham Science Publishers.


Rusconi F.,University of Florence | Da Fre M.,Regional Health Agency of Tuscany | Mello G.,University of Florence | Carnielli V.,Marche University and Salesi Hospital | And 5 more authors.
Pediatric Research | Year: 2013

Background:We examined the relationships between pregnancy disorders leading to very preterm birth (spontaneous preterm labor, prelabor premature rupture of membranes (PPROM), hypertension/preeclampsia, intrauterine growth restriction (IUGR), antenatal hemorrhage, and maternal infection), both in isolation and grouped together as "disorders of placentation" (hypertensive disorders and IUGR) vs. "presumed infection/ inflammation" (all the others), and several unfavorable neonatal outcomes.Methods:We examined a population-based prospective cohort of 2,085 singleton infants of 23-31 wk gestational age (GA) born in six Italian regions (the Accesso alle Cure e Terapie Intensive Ostetriche e Neonatali (ACTION) study).Results:Neonates born following disorders of placentation had a higher GA and better overall outcomes than those born following infection/inflammation. After adjustment for GA, however, they showed higher risk of mortality (odds ratio, OR: 1.4; 95% confidence interval, CI: 1.0-2.0), bronchopulmonary dysplasia (BPD) (OR: 2.5; CI: 1.8-3.6), and retinopathy of prematurity (ROP) (OR: 2.0; CI: 1.1-3.5), especially in growth-restricted infants, and a lower risk of intraventricular hemorrhage (IVH) (OR: 0.5; CI: 0.3-0.8) and periventricular leukomalacia (PVL) (OR: 0.6; CI: 0.4-1.1) as compared with infants born following infection/inflammation disorders.Conclusion:Our data confirm the hypothesis that, in very preterm infants, adverse outcomes are both a function of immaturity (low GA) and of complications leading to preterm birth. The profile of risk is different in different pregnancy disorders. Copyright © 2013 International Pediatric Research Foundation, Inc.


Sebastiani M.,University of Modena and Reggio Emilia | Manfredi A.,University of Modena and Reggio Emilia | Vukatana G.,Rheumatology Unit | Moscatelli S.,University of Perugia | And 11 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Introduction: The early detection of systemic sclerosis (SSc) patients at high risk of developing digital ulcers could allow preventive treatment, with a reduction of morbidity and social costs. In 2009, a quantitative score, the capillaroscopic skin ulcer risk index (CSURI), calculated according to the formula 'D×M/N 2', was proposed, which was highly predictive of the appearance of scleroderma digital ulcers within 3 months of capillaroscopic evaluation. Objectives: This multicentre study aims to validate the predictive value and reproducibility of CSURI in a large population of SSc patients. Methods: CSURI was analysed in 229 unselected SSc patients by nailfold videocapillaroscopy (NVC). All patients were re-evaluated 3 months later with regard to the persistence and/or appearance of new digital ulcers. Results: 57 of 229 patients presented with digital ulcers after 3 months. The receiver operating characteristic curve analysis showed an area under the curve of 0.884 (95% CI 0.835 to 0.922), with specificity and sensitivity of 81.4% (95% CI 74.8 to 86.89) and 92.98% (95% CI 83.0 to 98.0), respectively, at the cut-off value of 2.96. The reproducibility of CSURI was validated on a random sample of 81 patients, with a κ-statistic measure of interrater agreement of 0.8514. Conclusions: The role of CSURI was confirmed in detecting scleroderma patients with a significantly high risk of developing digital ulcers within the first 3 months from NVC evaluation. CSURI is the only method validated to predict the appearance of digital ulcers and its introduction into routine clinical practice might help optimise the therapeutic strategy of these harmful SSc complications.


Tagliaferri A.,University of Parma | di Perna C.,University of Parma | Santoro C.,University of Rome La Sapienza | Schinco P.,University of Turin | And 5 more authors.
Journal of Thrombosis and Haemostasis | Year: 2012

Summary. Background:The increased life expectancy of the hemophilia population, primarily as a result of advances in factor replacement therapy, has enabled hemophiliacs to reach an older age. Consequently, age-related diseases, such as cardiovascular disorders and cancers, are being increasingly recognized in such patients. However, only few data are available on such co-morbidities, their management and impact on the primary bleeding disorders. Objectives:With the aim of investigating several still unclear issues regarding cancers in hemophilia patients, we conducted, on behalf the Italian Association of Hemophilia Centers (AICE), a study on cancers among Italian hemophiliacs. Patients:Data pertaining to 122 hemophiliacs with 127 cancers between 1980 and 2010 were retrospectively collected in 21 centers of the AICE which chose to participate. Results: Sixty-nine percent of cancers were recorded during the decade 2001-2010. Eighty-three percent of patients were infected with hepatitis C virus (HCV) and 22% of them were also co-infected with human immunodeficiency virus (HIV). Forty-three percent of cancers were HCV-related, whereas 9% were HIVrelated. Virus-related cancers were more frequent and non-virus-related cancers less frequent in patients with severe hemophilia than in those with mild/moderate forms (P=0.0004). The non-virus-related standardized mortality ratio (SMR) was 0.3. Hemorrhagic complications occurred more frequently in patients undergoing chemotherapy (14%) or radiotherapy (19%). Conclusions:The results of the present study confirm that cancers have become a new challenge for physicians working in hemophilia centers and underline the need for prospective trials to better assess the epidemiology and to optimize the management of hemophiliacs with cancer. © 2011 International Society on Thrombosis and Haemostasis.


Palomba S.,University of Modena and Reggio Emilia | Russo T.,University of Modena and Reggio Emilia | Falbo A.,University of Modena and Reggio Emilia | Di Cello A.,University of Catanzaro | And 4 more authors.
Human Reproduction | Year: 2013

STUDY QUESTIONDo patients with polycystic ovary syndrome (PCOS) have macroscopic and/or microscopic placental alterations?SUMMARY ANSWERThe placental structure in patients with PCOS, even in those with uncomplicated pregnancy, is altered.WHAT IS KNOWN ALREADYThe spectrum of pregnancy complications seems to have a common denominator: a defective trophoblast invasion and placentation. In women with PCOS, alterations in endovascular trophoblast invasion related to insulin resistance and hyperandrogenism have been observed.STUDY DESIGN, SIZE, DURATIONFor this prospective case-control study, 30 pregnant patients with PCOS (cases) and 60 healthy pregnant women without PCOS features (controls) were enrolled and studied until delivery. Clinical, biochemical, ultrasonographic and obstetric data were recorded. The baseline clinical and biochemical data for screening for PCOS and for inclusion/exclusion were obtained before the seventh week of gestation. At delivery, placentas were collected and detailed macroscopic and microscopic analyses were performed.PARTICIPANTS, SETTING, METHODSCases and controls were matched for age and BMI (all <30 kg/m 2). The matching procedure was one-to-two. Only subjects with spontaneous conception and uncomplicated pregnancies were included in the final analysis.MAIN RESULTS AND THE ROLE OF CHANCEPlacental weight (P = 0.04), thickness (P = 0.02), density (P = 0.02) and volume (P = 0.01) were significantly inferior in women with, compared with those without PCOS. The placentas from patients with PCOS more frequently had an irregular shape (P = 0.03) and a higher cord coiling index (P = 0.02). Differences between cases and controls also concerned the extent of villous (P = 0.04) and intervillous (P = 0.01) spaces, the extent of fibrosis (P = 0.03), endovascular trophoblast (depth, extension and morphometry) (P < 0.05) and mitotic activity (P = 0.01). The percentage of patients with lesions [22/30 (73.3%) versus 25/60 (41.7%), respectively; P = 0.01] and the mean number of placental lesions (3.5 ± 2.1 versus 1.4 ± 1.1, respectively; P = 0.02) were higher in the PCOS than the control group. The odds ratio for placental alterations, adjusted for weight gain, was 2.8 (95% confidence interval 1.3-9.9).LIMITATIONS, REASONS FOR CAUTIONThe main limitation of the study was the selection of a specific PCOS sample, which is probably not representative of the PCOS phenotype as a whole. In fact, we excluded patients with PCOS who were obese and who achieved a pregnancy following the use of ovulation inductors or assisted reproduction techniques.WIDER IMPLICATIONS OF THE FINDINGSThe present study is the first to demonstrate that the morphology and microscopic structure of placenta in patients with PCOS with an uncomplicated pregnancy are altered. Further studies are needed to assess a correlation of these changes with the increased risk of obstetric complications observed in some pregnancies of women with PCOS. © The Author 2013.


Falcone D.,University of Catanzaro | Gallelli L.,University of Catanzaro | Di Virgilio A.,Pugliese Ciaccio Hospital | Tucci L.,Pugliese Ciaccio Hospital | And 4 more authors.
Cell Proliferation | Year: 2013

Objectives: In this study, we have evaluated effects of 24-hour treatments with simvastatin or rosuvastatin on RAS protein, NF-κB and MMP expression in LC tissues obtained from 12 patients undergoing thoracic surgery. Materials and methods: Normal and lung tumour tissues obtained from each sample were exposed to simvastatin (2.5-30 μm) or rosuvastatin (1.25-30 μm) and western blot analysis was then performed. Results: We documented increased expression of proteins, MMP-2, MMP-9 and NF-κB-p65 in LC tissues, with respect to normal tissues (P < 0.01). In the malignant tissues, simvastatin and rosuvastatin significantly (P < 0.01) and dose-dependently reduced RAS protein, MMP-2/9 and NF-κB-p65 expression. Conclusions: In conclusion, our results suggest that simvastatin and rosuvastatin could play a role in LC treatment by modulation of RAS protein, MMP-2/9 and NF-κB-p65. © 2013 Blackwell Publishing Ltd.


Cantiello F.,University of Catanzaro | Cicione A.,University of Catanzaro | Salonia A.,Vita-Salute San Raffaele University | Autorino R.,Cleveland Clinic | And 4 more authors.
Urology | Year: 2013

Objective: To investigate the role periurethral fibrosis secondary to chronic prostatic inflammation as a potential contributing factor to the etiology of lower urinary tract symptoms (LUTS) in male patients. Methods: Periurethral prostate tissue from 30 consecutive patients who underwent retropubic radical prostatectomy for prostate cancer was analyzed. We circumferentially performed 16 periurethral core bench biopsies on each radical prostatectomy specimen to evaluate the extent of periurethral inflammatory infiltrate and collagen and elastin amount. The clinical and urodynamic findings and the collagen and elastin periurethral amount in patients with or without inflammation were compared using the Mann-Whitney U test and the Pearson χ2 test. Spearman correlation analysis tested the association between variables. Results: Of the 30 patients, 21 (70%) presented with inflammatory infiltration and 9 (30%) had no inflammation. A significant difference was found between the 2 groups in International Prostate Symptom Score (IPSS; P =.03) and in urodymanics findings by Schafer class (P =.01) and Abrams Griffiths number (P =.002). The histologic evaluation showed a higher collagen quantity (P =.04) and lower, albeit not statistically significant, elastin amount (P =.19) in the inflammation group. A positive association was observed between IPSS with inflammation grading (r = 0.507; P =.004) and collagen content (r = 0.649; P <.001), whereas IPSS was correlated negatively with elastin content (r = -0.565; P =.001). Conclusion: Prostate inflammation may induce fibrotic changes in periurethral prostatic tissues, and this may eventually promote urethral stiffness and LUTS. Patients experiencing prostate-related LUTS could benefit from anti-inflammatory therapies, used alone or combined with the currently prescribed regimen. © 2013 Elsevier Inc. All Rights Reserved.


Palomba S.,University of Modena and Reggio Emilia | Russo T.,University of Modena and Reggio Emilia | Falbo A.,University of Modena and Reggio Emilia | Di Cello A.,University of Catanzaro | And 6 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Previous experimental and clinical data suggest impaired decidual trophoblast invasion in patients with polycystic ovarian syndrome (PCOS). Objective: Theobjective ofthestudywasto testthehypothesis that decidual endovascular trophoblast invasion in pregnant patients with PCOS is impaired and to clarify the potential mechanisms involved. Design: This was an experimental case-control study. Setting: The study was conducted at the academic Departments of Obstetrics and Gynecology and the Unit of Pathology (Italy). Patients: Forty-five pregnant subjects screened from a wide population ofwomenwaiting for legal pregnancy termination were included in the final analysis. Specifically, 15 pregnant patients with PCOS were enrolled as cases and another 30 age- and body mass index (BMI)-matched healthy pregnant women without any feature of PCOS were enrolled as the controls. Intervention: Interventions included the collection of trophoblastic and decidual tissue at the 12th week of gestation. Main Outcome Measures: Clinical, ultrasonographic, and biochemical data as well as the histological analysis of decidual endovascular trophoblast invasion. Results: The rate of implantation site vessels with endovascular trophoblast invasion (ratio between total number of implantation site vessels and total number of vessels with endovascular trophoblast invasion) and the extent of endovascular trophoblast invasion (proportion between immunoreactive areas to cytokeratin 7 and to CD34) were significantly lower in patients with PCOS compared with healthy non-PCOS controls. Endovascular trophoblast invasion data were significantly and indirectly related to the markers of insulin resistance and testosterone concentrations in PCOS patients. Conclusions: Pregnant patients with PCOS patients have impaired decidual trophoblast invasion. Further studies are needed to evaluate the exact mechanisms through which insulin resistance and hyperandrogenemia exert this effect. Copyright © 2012 by The Endocrine Society.


Serra R.,University of Catanzaro | Buffone G.,University of Catanzaro | Dominijanni A.,Pugliese Ciaccio Hospital | Molinari V.,University of Catanzaro | And 2 more authors.
International Wound Journal | Year: 2013

Transmetatarsal amputation (TMA) represents an effective surgical procedure used to treat several clinical conditions such as forefoot infection, gangrene and chronic ulceration in diabetic patients. TMA permits walking without the need for prosthesis, but nevertheless is burdened with a high complications rate. The aim of this study was to evaluate the possibility to use platelet gel (PG) as an adjuvant therapy when performing TMA procedure in diabetic patients. In a 6-year period, 26 diabetic patients had undergone TMA procedure followed by autologous PG applications (group A) and 32 patients had undergone TMA as sole procedure (group B). After TMA procedure, the treatment is based on outpatient management and consists of a weekly platelet-rich plasma gel application on the surgical wound for 1month in group A and on clinical evaluation only for group B. For group A, healing rate was of 96·15% and one patient (3·84%) presented wound dehiscence, and no postoperative wound infections occurred. For group B, healing rate was of 59·37%; severe infection of the stump prompted to the proximal amputations in 40·62% of patients during the follow-up period. PG application may be an effective adjuvant treatment to improve wound healing in diabetic dysvascular patients. © 2013 John Wiley & Sons Ltd and Medicalhelplines.com Inc.


Capula C.,Pugliese Ciaccio Hospital | Chiefari E.,University of Catanzaro | Vero A.,Pugliese Ciaccio Hospital | Foti D.P.,University of Catanzaro | And 2 more authors.
Diabetes Research and Clinical Practice | Year: 2014

Aims: To determine the prevalence of both prediabetes and type 2 diabetes mellitus (T2DM) by postpartum oral glucose tolerance test (ppOGTT) in Italian women diagnosed with gestational diabetes mellitus (GDM), and identify antepartum predictors of glucose intolerance. Methods: Retrospective study of 454 Caucasian women that underwent a 75. g OGTT between 6 and 12 weeks postpartum in Calabria (Southern Italy) between 2004 and 2012. Prediabetes and T2DM were diagnosed according to the American Diabetes Association (ADA) criteria. Data were examined by univariate analysis and multiple regression analysis. Results: 290 women (63.9%) were normal, 146 (32.1%) had prediabetes (85 impaired fasting glycemia; 61 impaired glucose tolerance), and 18 (4.0%) had T2DM. Of the continuous variables, pre-pregnancy body mass index (BMI), age at pregnancy, fasting plasma glucose (FPG) at gravid OGTT, and week at diagnosis of GDM were associated with prediabetes and T2DM, whereas the parity was associated with T2DM only. For categorical traits, pre-pregnancy BMI ≥25 and previous diagnosis of polycystic ovary syndrome (PCOS) emerged as the strongest predictors of prediabetes whereas the strongest predictors of T2DM were FPG ≥100. mg/dl (5.6. mmol/l) at GDM diagnosis and pre-pregnancy BMI ≥25. Moreover, FPG at GDM screening was a good predictor of T2DM after receiver-operating-characteristic analysis. Conclusions: Our findings confirm the high prevalence of glucose intolerance in the early postpartum period in women with previous GDM. PCOS emerges as a new strong antepartum predictor of prediabetes. © 2014 Elsevier Ireland Ltd.

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