Rehabilitation Institute of Telese

Benevento, Italy

Rehabilitation Institute of Telese

Benevento, Italy
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Di Minno M.N.D.,Reference Center for Coagulation Disorders | Iervolino S.,Rehabilitation Institute of Telese | Peluso R.,University of Naples Federico II | Di Minno A.,Reference Center for Coagulation Disorders | And 2 more authors.
Journal of Rheumatology | Year: 2014

Objective. To prospectively evaluate the effect of tumor necrosis factor TNF-alpha; inhibitors on hemostatic and fibrinolytic variables in subjects with psoriatic arthritis (PsA). Methods. Among subjects with PsA who were taking traditional disease-modifying antirheumatic drugs (DMARD), 98 patients with active disease who switched to treatment with TNF-alpha; inhibitors were enrolled in this study (Group 1). In parallel, 98 matched subjects with minimal disease activity (MDA) and treated with DMARD were enrolled (Group 2). In all patients, hemostatic and fibrinolytic variables were evaluated at enrollment and after a 6-month followup. Results were stratified according to treatment and to MDA achievement. Results. Seventy-six Group 1 and 80 Group 2 subjects completed the 6-month followup. During the followup, significant changes in hemostatic and fibrinolytic variables were found in Group 1, but not in Group 2 subjects. At the end of the followup, patients treated with TNF-alpha; inhibitors showed significantly lower levels of hemostatic and fibrinolytic variables as compared to those treated with traditional DMARD. Among Group 1 subjects, changes in hemostatic and fibrinolytic variable levels were significantly higher in those who achieved MDA versus in those who did not. Multivariate analyses showed that a treatment with TNF-alpha; blockers affected fibrinolytic variables [plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA)] and some acute-phase proteins (D-dimer, coagulation factor VIII, and von Willebrand factor). In contrast, the MDA achievement during treatment with TNF-alpha; blockers maximally affected fibrinolytic variables (PAI-1 and t-PA). Conclusion. TNF-alpha; inhibitors brought about a significant improvement of hemostatic and fibrinolytic balance in subjects with PsA. Maximal changes were found in patients achieving MDA. Copyright © 2014. All rights reserved.


Arpaia P.,University of Sannio | Manna C.,University of Naples Federico II | Montenero G.,University of Sannio | D'Addio G.,Rehabilitation Institute of Telese
IEEE Sensors Journal | Year: 2012

A swarm intelligence-based procedure to detect critical conditions of a patient, affected by a specific disease, at an early stage in absence of clinician, is proposed. The procedure is to be integrated inside a remote health care system for patients at home, where some physiological parameters related to a specific disease are being monitored. A significant variation in the monitored parameters can lead the patient to a critical state, thus the proposed method is aimed at predicting a possible future bad condition of the patient on the basis of past measurements. Moreover, different physiological parameters contribute to diverse degrees in dissimilar diseases; consequently, a swarm intelligence-based method is proposed for optimizing the weight of each parameter for a more accurate diagnosis. The proposed approach has been validated experimentally under the framework of the industrial research project Patient Diagnosis and Monitoring at Domicile (PADIAMOND: co-funded by EU and the company Filia srl, Caserta, Italy). © 2011 IEEE.


Fuschillo S.,Rehabilitation Institute of Telese | Martucci M.,Rehabilitation Institute of Telese | Donner C.F.,Mondo Medico | Balzano G.,Rehabilitation Institute of Telese
Respiratory Medicine | Year: 2012

Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide and, according to the World Health Organization, its prevalence will double by 2020. COPD is a chronic inflammatory disease of the lung characterized by poorly reversible airflow limitation and, frequently, by extrapulmonary manifestations. In particular, the cardiovascular manifestations are responsible for high morbidity and mortality. Methods and results: A systematic literature search was performed of studies published in Medline until December 2010, using the key-words: COPD, bacterial colonization, COPD exacerbation, atherosclerosis, systemic inflammation, cardiovascular event and risk factors. In addition to the studies identified in the primary search, reference lists of included articles were analyzed for additional papers related to the topic. The pathogenetic mechanisms underlying atherosclerosis - namely inflammation, oxidative stress and endothelial dysfunction - are in common with COPD. Moreover, they are increased in the presence of COPD, especially in patients who present airway bacterial colonization, increased rate of exacerbations and elevated levels of both airway and systemic inflammation. Conclusion: COPD is associated with an increased burden of atherosclerotic disease. Systemic inflammation and oxidative stress play key roles in this association. COPD patients with airway bacterial colonization, as compared to patients without airway colonization, generally present more frequent exacerbations and higher levels of both airway and systemic inflammation. This COPD subgroup should be considered at particularly increased risk of developing cardiovascular complications and receive more attention concerning diagnosis, treatment, prevention and research. © 2012 Elsevier Ltd. All rights reserved.


Di Minno M.N.D.,University of Naples Federico II | Peluso R.,University of Naples Federico II | Iervolino S.,Rehabilitation Institute of Telese | Russolillo A.,University of Naples Federico II | And 2 more authors.
Annals of the Rheumatic Diseases | Year: 2014

Objectives: To evaluate prospectively the effect of weight loss on the achievement of minimal disease activity (MDA) in overweight/obese patients with psoriatic arthritis (PsA) starting treatment with tumour necrosis factor α (TNFα) blockers. Methods: Among subjects with PsA starting treatment with TNFα blockers, 138 overweight/obese patients received a concomitant dietary intervention (69 a hypocaloric diet (HD) and 69 a free-managed diet (FD)). Changes in metabolic variables were measured and a complete clinical rheumatological evaluation was made in all patients at baseline and after a 6-month follow-up to define the achievement of MDA. Results: 126 subjects completed the study. MDA was more often achieved by HD than by FD subjects (HR=1.85, 95% CI 1.019 to 3.345, p=0.043). A diet was successful (≥5% weight loss) in 74 (58.7%) patients. Regardless of the type of diet, after 6 months of treatment with TNFα blockers, ≥5% of weight loss was a predictor of the achievement of MDA (OR=4.20, 95% CI 1.82 to 9.66, p<0.001). For increasing weightloss categories (<5%, 5-10%, >10%), MDA was achieved by 23.1%, 44.8% and 59.5%, respectively. A higher rate of MDA achievement was found in subjects with 5-10% (OR=3.75, 95% CI 1.36 to 10.36, p=0.011) and in those with >10% (OR=6.67, 95% CI 2.41 to 18.41, p<0.001) weight loss in comparison with those with <5% weight loss. Conclusions: Regardless of the type of diet, a successful weight loss (≥5% from baseline values) is associated with a higher rate of achievement of MDA in overweight/obese patients with PsA who start treatment with TNFα blockers.


Ambrosino P.,University of Naples Federico II | Lupoli R.,University of Naples Federico II | Di Minno A.,University of Naples Federico II | Iervolino S.,Rehabilitation Institute of Telese | And 3 more authors.
Annals of Medicine | Year: 2014

Several studies reported on the association between antiphospholipid syndrome (APS) and venous thrombosis. In contrast, little is known about cardiovascular (CV) risk in APS. We performed a meta-analysis on the impact of APS on major markers of CV risk. Studies on the relationship between APS and common carotid artery intima-media thickness (CCA-IMT), internal carotid artery IMT (ICA-IMT), carotid bifurcation IMT (BIF-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), and ankle-brachial index (ABI) were systematically searched in PubMed, Web of Science, Scopus, and EMBASE databases. Twenty case-control studies (668 cases, 678 controls) were included. Compared to controls, APS patients showed a higher CCA-IMT (mean difference [MD] 0.11 mm; 95% CI 0.07, 0.14), ICA-IMT (MD 0.08 mm; 95% CI 0.05, 0.11), BIF-IMT (MD 0.09 mm; 95% CI 0.06, 0.12) and a higher frequency of carotid plaques (OR 3.87; 95% CI 1.61, 9.31). Moreover, a lower FMD was found in APS subjects than in controls (MD-4.49%; 95% CI-6.20,-2.78), with no differences in NMD (MD-1.80%; 95% CI-4.01, 0.42). Finally, an increased prevalence of pathological ABI was found in APS patients compared to controls (OR 7.26; 95% CI 1.77, 29.71). Despite heterogeneity among studies, APS appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings can be useful to plan adequate prevention strategies and therapeutic approaches.


Cesarelli M.,University of Naples Federico II | Romano M.,University of Naples Federico II | Bifulco P.,University of Naples Federico II | Improta G.,University of Naples Federico II | D'Addio G.,Rehabilitation Institute of Telese
Studies in Health Technology and Informatics | Year: 2012

Fetal heart rate variability is surely one of the most important parameters to monitor fetal wellbeing. Linear studies, widely employed to study fetal heart variability and its correlations with the development of the autonomous nervous system, have shown some limitations in highlight dynamics potentially relevant. During the last decades, therefore, nonlinear analysis methods have gained a growing interest to analyze the chaotic nature of cardiac activity. Techniques investigating nonlinear dynamics have been already successfully employed in adults, to analyze different physiological and pathological states. Concerning fetal monitoring, instead, a smaller number of papers is available in the literature; even if symbolic dynamics was recently employed to quantify fetal heart rate regularity, demonstrating that the use of this technique may lead to a better and more differentiated understanding of normal fetal physiological development. In this work, we applied the symbolic dynamics to analyze fetal heart rate variability in healthy fetuses at the end of a physiological pregnancy. Our results confirmed the potentiality of the technique to highlight differences between signals characterized by more or less variability. © 2012 European Federation for Medical Informatics and IOS Press. All rights reserved.


Cusenza M.,University of Trieste | Accardo A.,University of Trieste | D'Addio G.,Rehabilitation Institute of Telese | Corbi G.,University of Molise
Computing in Cardiology | Year: 2010

Among the plethora of indices that can describe the fractal-like behaviour of heart rate variability (HRV), the fractal dimension (FD) and the power-law exponent (β) have gained wide acceptance. Since HRV is generally modelled with fractional Brownian motion (fBm), the linear scaling relationship between β and FD, valid for fBm, is often applied to HRV series to derive one index from the other. In this paper the relationship between β and FD is calculated in normal (NR) and heart failure (HF) HRV series. Results revealed that a linear dependence between β and FD can be found only when the slope of the spectral density is calculated over the whole spectrum instead of considering more widespread very low frequency ranges. Moreover, the relationship is slightly different from that characterizing fBm and is not unique for the two categories of subjects. The common practice of estimating β from FD for HRV applying the theoretical relationship should be reconsidered.


Grossi D.,The Second University of Naples | De Lucia N.,The Second University of Naples | Milan G.,Geriatric Center Frullone | Trojano L.,The Second University of Naples | Trojano L.,Rehabilitation Institute of Telese
Journal of the International Neuropsychological Society | Year: 2015

Environmental dependency (ED) phenomena, including utilization behavior and imitation behavior, are clinical manifestations typically observed in patients with the behavioral variant of fronto-temporal dementia (bvFTD), who may also show the closing-in (CI) phenomenon. Here, we explored the neuropsychological correlates of ED and CI in bvFTD, and the association of ED with CI to clarify the mechanisms underlying these clinical manifestations. Thirty-one bvFTD patients underwent a wide cognitive assessment in addition to special tasks to detect occurrence of CI and ED phenomena. Both ED and CI phenomena were present in more than half of the sample. Logistic regression analyses revealed that both ED and CI phenomena were significantly associated with poor scores on frontal neuropsychological tests. Although ED and CI often co-occurred, 3/12 patients with CI did not show ED, and 5/18 patients with ED did not show CI. A logistic regression model showed that the presence of ED was not significantly associated to CI. CI and ED are associated to progressive derangement of frontal functions in bvFTD. However, specific frontal dysfunctions might explain the occurrence of either phenomenon in isolation. (JINS, 2015, 21, 1-7) © INS. 2014 The International Neuropsychological Society.


D'Addio G.,Rehabilitation Institute of Telese
Studies in health technology and informatics | Year: 2013

Obstructive sleep apnea syndrome (OSAS) is characterized by repeated upper-airway obstruction during sleep. It is diagnosed by polysomnographic studies, scoring OSAS severity by an apneas/hypopneas index associated to worse prognosis, mainly for an increased cardiovascular morbidity. Cardiac autonomic impairments involved in the development of cardiovascular disease in OSAS can be assessed by heart rate turbulence (HRT) analysis and aim of the paper is to show the increased medical decision support by HRT evaluation in OSAS patients. HRT has been assessed in 274 polysomnographic recordings of mild-to-severe OSAS patients and an overall cardiorespiratory risk scoring (CRRIS) index has been proposed on the base of both OSAS severity and HRT assessment. Results showed that, while the only polysomnografic analysis would have equally ranked OSAS patients within their mild-to-severe classification, CRRIS index allows to identify a 19% of severe-OSAS patients at very high risk of sudden cardiac death, a 13% of moderate-OSAS patients with a risk level comparable to those of severe, and a 17% of mild-OSAS patients with evidence of an autonomic impairment. CRRIS index, detecting patients at greater probability of worsening could give to the physician a very useful medical decision support in the follow up of this particular chronic disease.


Franchignoni F.,Rehabilitation Institute of Telese | Munoz Lasa S.,University of Madrid | Ozckar L.,Hacettepe University | Ottonello M.,Rehabilitation Institute of Genoa
European Journal of Physical and Rehabilitation Medicine | Year: 2011

Aim: The aim of this paper was to explore the validity and practical usefulness of a set of bibliometric indicators with a focus on the scientific production of influential European researchers in Physical and Rehabilitation Medicine (PRM). Methods: We randomly selected 24 European PRM specialists from the list of invited lecturers or chairpersons at the 17 th ESPRM Congress in 2010. Using the time window 1996-2010, we recorded the number of papers published, total number of citations, and h-index from Web of Science (WoS) and Publish or Perish (PoP) databases. We also noted the journals in which the papers were published. Ranking the 24 authors into two groups according to higher vs. lower research productivity, we compared the frequency of Editorial Board membership of at least one of the 5 most influential journals in PRM. Results: Median values (WoS, PoP) for papers, citations, and h-index were respectively: (31, 46); (171, 317); and (6.5, 8.5). High correlations were found among different indicators, and also between the same indicators calculated in the two different databases. However, the Bland-Altman plot indicated that the two databases could not be considered interchangeable. Twelve PRM specialists were Editorial Board members: 11 of them were in the first 10 ranking positions for at least one of the 6 indicators analysed. Conclusion: There is need to better understand the characteristics of bibliometric indicators and we retain that the information they provide is insufficiently valid to justify their use as the sole objective criterion for career assessment.

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