Santa Maria Nuova, Italy
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Giaccardi M.,San Giovanni Of Dio Hospital | Del Rosso A.,San Giuseppe Hospital | Guarnaccia V.,San Giuseppe Hospital | Ballo P.,Santa Maria Annunziata Hospital | And 3 more authors.
Heart Rhythm | Year: 2016

Background Radiation exposure related to conventional tachyarrhythmia radiofrequency catheter ablation (RFCA) carries small but not negligible stochastic and deterministic effects on health. These effects are cumulative and potentially more harmful in younger individuals. Nonfluoroscopic mapping systems can significantly reduce the radiological exposure and in some cases it can completely eliminate it. Objective The aim of this study was to assess the safety, feasibility, and efficacy of a complete nonfluoroscopic approach for RFCA compared with ablation procedures performed under fluoroscopic guidance. Methods RFCA was performed in 442 consecutive patients (mean age 58 ± 19 years). The first 145 patients (group 1) were treated only under fluoroscopic guidance, and the following 297 patients (group 2) were treated using a nonfluoroscopic electroanatomic mapping system (EnSite Velocity). RFCA was completely performed without fluoroscopy in 255 of 297 patients in group 2 (86%). Results The acute success rate did not differ between group 1 and group 2 (97% vs 96%; P =.46), and there were no differences in either procedure time (87 ± 57 minutes vs 91 ± 52 minutes; P =.41) or complication rate. Fluoroscopic exposure in group 2 was significantly reduced in comparison with group 1 (14 ± 6 seconds vs 1159 ± 833 seconds; P <.0001). Conclusion Compared with the conventional fluoroscopic technique, the near-zero radiation (RX) approach provides similar outcomes and may significantly reduce or eliminate ionizing radiation exposure in RFCA. These reductions are achieved without altering the duration or compromising the safety and effectiveness of the procedure. © 2016 Heart Rhythm Society.


Siniscalchi A.,Annunziata Hospital | Gallelli L.,University of Catanzaro | Malferrari G.,Santa Maria Nuova Hospital | Pirritano D.,San Giovanni Of Dio Hospital | And 3 more authors.
Journal of Basic and Clinical Physiology and Pharmacology | Year: 2014

Stroke represents the most frequent cause of permanent disability in adults worldwide. Cerebral ischemia triggers the pathological pathways of the ischemic cascade and causes irreversible neuronal injury in the ischemic core within minutes of the onset. Elements of the immune system are involved in all stages of ischemic cascade from acute intravascular events triggered by the interruption of blood supply, to the parenchymal processes leading to brain damage and to the ensuing tissue repair. In this review, we will provide a brief overview of current understanding of the role of cytokines and brain inflammation during acute ischemic stroke. © 2014 by Walter de Gruyter Berlin/Boston.


Trotman J.,University of Sydney | Luminari S.,University of Modena and Reggio Emilia | Boussetta S.,Center Hospitalier Lyon Sud | Versari A.,Santa Maria Nuova Hospital | And 14 more authors.
The Lancet Haematology | Year: 2014

Background: The value of 18F-fl uorodeoxyglucose (FDG) PET-CT (PET) imaging in response assessment after fi rst-line rituximab chemotherapy for follicular lymphoma has been documented. We analysed the application of the fi ve-point Deauville scale (5PS; used to score FDG uptake on PET images) in a large cohort derived from three studies, to assess the correlation between post-induction PET status and survival in patients with follicular lymphoma. Methods: In this pooled analysis, we used data from three multicentre prospective studies of fi rst-line rituximab chemotherapy for patients with high-tumour-burden follicular lymphoma (the PRIMA study, the PET-Folliculaire study, and the Fondazione Italiana Linfomi FOLL05 study). Patients included in this analysis received at least six cycles of rituximab and chemotherapy before response assessment with conventional contrast-enhanced CT and PET low-dose CT (PET). We included only patients who had a PET scan within 3 months of the last dose of induction rituximab. Patient data, including conventional CT-based response assessment, were recorded for all patients undergoing PET review. Scans undergoing central PET review were scored independently by three reviewers according to the 5PS. The primary endpoints were progression-free survival and overall survival according to the 5PS score of post-induction PET scan (ie, positive [≥4 points] or negative [<4 points]), analysed in the central review population. Findings: Between Dec 24, 2004, and Sept 22, 2010, 439 of the patients enrolled in the three studies underwent local PET assessment, 246 of whom had centrally reviewed post-induction scans. 41 (17%) of 246 patients had a positive post-induction PET scan according to a cutoff of 4 or higher on the 5PS, with substantial reporter concordance. With a median follow-up of 54.8 months (IQR 39.7-68.5; range 7.7-90.1), the hazard ratio (HR) for progression-free survival for patients with a positive PET scan versus those with a negative PET scan was 3.9 (95% CI 2.5-5.9; p<0.0001), and for overall survival was 6.7 (2.4-18.5; p=0.0002). For patients with a positive PET scan, 23.2% (95% CI 11.1-37.9) of patients were progression free at 4 years compared with 63.4% (55.9-70.0) of those who had a negative PET scan (p<0.0001); 4-year overall survival was 87.2% (95% CI 71.9-94.5) versus 97.1% (93.2-98.8), respectively (p<0.0001). Conventional CT-based response (ie, complete response or unconfi rmed complete response vs partial response) was weakly predictive of progression-free survival (HR 1.7 [95% CI 1.1-2.5]; p=0.017). Interpretation: PET-CT rather than contrast-enhanced CT scanning should be considered as a new standard for response assessment of follicular lymphoma in clinical practice, and could help guide response-adapted therapy. Funding: Groupe d'Etude des Lymphomes de l'Adulte (Paris, France), now LYSA (Lymphoma Study Association), Direction de la Recherche Clinique de l'Assistance Publique-Hôpitaux de Paris, Fondazione Italiana Linfomi, and the Italian Ministry of Health.


Zaccherotti G.,S Stefano Hospital | Olmastroni M.,Santa Maria Nuova Hospital
Journal of Sports Sciences | Year: 2015

Twenty consecutive, chronic and isolated anterior cruciate ligament (ACL) lesions that underwent reconstruction with quadrupled semitendinosus (ST) and gracilis (G) were prospectively examined to compare tendon regeneration and muscle strength recovery. Twenty consecutive axial nuclear magnetic resonance (NMR) scans were done after 1 month, 6 months and 2 years from surgery. A CybexII was used to evaluate concentric strength deficits both in flexion and in internal tibia rotation at 6 months and 2 years. At 2 years, an NMR signal comparable to the contralateral was present in 14 (70%) cases and absent in 6 (30%). Semitendinosus tendon exceeded the meniscal plateau since the first month, while the G tendon crossed the joint line only after 6 months. However, the distal-end insertions of both tendons were always significantly more proximal than the contralateral normal side (ST: P = .002; G: P = .003). In case of tendon regeneration, flexion deficit was not significant after 6 months, while internal tibia rotation deficit became not significant only after 2 years. In case of non-regeneration, a flexion deficit was present after 6 months [15.5% (P = .05)] but not after 2 years, while internal tibial rotation deficit was significant both after 6 months [30.3% (P < .001)] and 2 years [24.3% (P = .03)]. In case of tendon regeneration, isokinetic evaluation showed a non-significant deficit in both flexion and internal rotation strength after ACL reconstruction with ST and G. At the 2-year follow-up, none of the 6 patients without tendon regeneration found any impairment in their sport activities despite the loss of internal rotation strength. © 2015 Taylor & Francis.


Oberaigner W.,Tyrolean State Hospitals Ltd. | Oberaigner W.,University Institute of Health Sciences | Minicozzi P.,Fondazione IRCCS Instituto Nazionale Dei Tumori | Bielska-Lasota M.,National Institute of Public Health NIH | And 4 more authors.
Acta Oncologica | Year: 2012

Background. Survival for ovarian cancer is the poorest of all gynaecological cancer sites. Our aim was to present the most up-to-date survival estimate for ovarian cancer by age and morphology and to answer the question whether survival for ovarian cancer improved in Europe during the 1990s. Material and methods. This analysis was performed with data from the EUROCARE database. We considered all adult women diagnosed with ovarian cancer between 1995 and 2002 and life status followed up until the end of 2003. A total of 97 691 cases were contributed by 72 European cancer registries in 24 countries. We estimated the most up-to-date relative survival for a mean of 23 661 patients followed up in 20002003 using the period hybrid approach and described the relative survival trends from the beginning of 1990s. Results and conclusion. Overall, the European age-standardised one-year, five-year and five-year conditional on surviving one-year relative survival were 67.2% (95% CI 66.667.8), 36.1% (95% CI 35.436.8) and 53.7% (95% CI 52.854.7), respectively. Five-year relative survival was 58.6% (95% CI 57.459.8), 37.1% (95% CI 36.138.1) and 20.5% (95% CI 19.121.9) in women aged 1554, 5574 and 7599 years, respectively. The age-standardised five-year relative survival was 38.1% (95% CI 36.939.3) for serous tumours and 51.9% (95% CI 49.054.9) for mucinous cancers and the crude five-year relative survival was 85.6% (95% CI 81.290.0) for germ cell cancers. Overall, the age-standardised five-year relative survival increased from 32.4% (95% CI 31.733.2) in 19911993 to 36.3% (95% CI 35.537.0) in 20002003. There is a need to better understand the reasons for the wide variation in survival of ovarian cancer in Europe. Actions aiming to harmonise the protocols for therapy should contribute to narrowing the wide gap in survival and research on screening and early detection of ovarian cancer should be enforced. © 2012 Informa Healthcare.


Pengo V.,University of Padua | Ruffatti A.,University of Padua | Legnani C.,University of Bologna | Testa S.,District Hospital | And 11 more authors.
Blood | Year: 2011

Persistent antiphospholipid (aPL) antibodies are occasionally found in subjects without prior history of thromboembolic events (TEs), raising the dilemma of whether to initiate or not a primary thromboprophylaxis. A first TE is considered rare in aPL carriers, but previous studies did not consider the aPL profile nor was the test positivity confirmed in a reference laboratory. In this study, 104 subjects with high-risk aPL profile (positive lupus anticoagulant, anticardiolipin, and anti-β 2-glycoprotein I antibodies, triple positivity) confirmed in a reference laboratory, were followed up for a mean of 4.5 years. There were 25 first TEs (5.3% per year): the cumulative incidence after 10 years was 37.1% (95% confidence interval [CI], 19.9%-54.3%). On multivariate analysis, male sex (hazard ratio = 4.4; 95% CI, 1.5-13.1, P = .007) and risk factors for venous thromboembolism (hazard ratio = 3.3; 95% CI, 1.3-8.5, P = .01) were independent predictors for TEs. Aspirin did not significantly affect the incidence of TE. In conclusion, the occurrence of a first TE in carriers of high-risk aPL profile is considerable; it is more frequent among male subjects and in the presence of additional risk factors for venous TE. These data can help in the decision to initiate primary thromboprophylaxis in these subjects. © 2011 by The American Society of Hematology.


Rossitto G.,University of Padua | Regolisti G.,Santa Maria Nuova Hospital | Rossi E.,Santa Maria Nuova Hospital | Negro A.,Santa Maria Nuova Hospital | And 7 more authors.
Hypertension | Year: 2013

The mechanisms of excess aldosterone secretion in primary aldosteronism (PA) remain poorly understood, although a role for circulating factors has been hypothesized for decades. Agonistic autoantibodies against type-1 angiotensin-II receptor (AT1AA) are detectable in malignant hypertension and preeclampsia and might play a role in PA. Moreover, if they were elevated in aldosterone- producing adenoma (APA) and not in idiopathic hyperaldosteronism (IHA), they might be useful for discriminating between these conditions. To test these hypotheses, we measured the titer of AT1AA in serum of 46 patients with PA (26 with APA, 20 with IHA), 62 with primary hypertension (PH), 13 preeclamptic women, and 45 healthy normotensive blood donors.We found that the AT1AA titer was higher (P<0.05) in both PA and PH patients (2.65±1.55 and 1.86±0.63, respectively) than in normotensive subjects (1.00±0.20). In APA, it was 2-fold higher than in IHA patients (3.43±1.20 versus 1.64±1.39, respectively, P<0.001), despite similar blood pressure values. Of note, it allowed effective discrimination of APA from either PH or IHA, as shown by Receiver Operator Characteristics curve analysis. Moreover, after captopril challenge, plasma aldosterone concentration fell more in AT1AA-positive than in AT1AA-negative PA patients (-32.4% [21.1-42.9] versus 0.0% [0.0-22.6], P=0.015), suggesting an agonistic role for these autoantibodies. Thus, a higher serum AT1AA titer in patients with APA than in IHA and PH patients can be useful in differentiating APA patients from either PH or IHA, and thus in selecting PA patients to be submitted to adrenal vein sampling. © 2012 American Heart Association, Inc.


Facchiano E.,Santa Maria Nuova Hospital | Leuratti L.,Santa Maria Nuova Hospital | Veltri M.,Santa Maria Nuova Hospital | Lucchese M.,Santa Maria Nuova Hospital
Obesity Surgery | Year: 2016

Background: One anastomosis gastric bypass (OAGB) demonstrated similar results to traditional Roux-en-Y procedures. A possible concern is how to manage a chronic bile reflux when medical therapy results ineffective. Revision of the gastro-jejunal anastomosis, obtaining a Roux-en-Y reconstruction, has already been proposed, but technical details have not been elucidated yet. This video shows how to revise a 200-cm OAGB to treat chronic bile reflux, by converting the procedure to Roux-en-Y, having a short gastric pouch and a long efferent limb. Methods: A 51-year-old patient complained of recurrent heartburns 2 months after OAGB. A gastroscopy witnessed the presence of a 6-cm long gastric pouch with pouchitis and bile reflux in esophagus. Specific medications were ineffective. He underwent a revisional laparoscopic procedure. The efferent limb was measured and consisted of 650 cm. The afferent limb was then divided next to the previous gastro-jejunal anastomosis and a jejuno-jejunal anastomosis was performed distally at 70 cm on the alimentary limb. Results: Total operative time was 50 min. The postoperative stay was uneventful and the patient was discharged in postoperative day four. At 6 months follow-up he is still free of medications without symptoms. Conclusions: The ideal scenario for the presented technique is the finding of a long efferent limb, in order to fashion a Roux-en-Y limb without the risk of postoperative malabsorption. To reach this goal, we suggest the measurement of the whole small bowel intra-operatively, in order to assess the length of the common channel left in place. © 2016, Springer Science+Business Media New York.


Iaboli L.,Santa Maria Nuova Hospital | Caselli L.,University of Ferrara | Filice A.,Santa Maria Nuova Hospital | Russi G.,Santa Maria Nuova Hospital | Belletti E.,S Anna Hospital
PLoS ONE | Year: 2010

Background: Although being an important source of science news information to the public, print news media have often been criticized in their credibility. Health-related content of press media articles has been examined by many studies underlining that information about benefits, risks and costs are often incomplete or inadequate and financial conflicts of interest are rarely reported. However, these studies have focused their analysis on very selected science articles. The present research aimed at adopting a wider explorative approach, by analysing all types of health science information appearing on the Italian national press in one-week period. Moreover, we attempted to score the balance of the articles. Methodology/Principal Findings: We collected 146 health science communication articles defined as articles aiming at improving the reader's knowledge on health from a scientific perspective. Articles were evaluated by 3 independent physicians with respect to different divulgation parameters: benefits, costs, risks, sources of information, disclosure of financial conflicts of interest and balance. Balance was evaluated with regard to exaggerated or non correct claims. The selected articles appeared on 41 Italian national daily newspapers and 41 weekly magazines, representing 89% of national circulation copies: 97 articles (66%) covered common medical treatments or basic scientific research and 49 (34%) were about new medical treatments, procedures, tests or products. We found that only 6/49 (12%) articles on new treatments, procedures, tests or products mentioned costs or risks to patients. Moreover, benefits were always maximized and in 16/49 cases (33%) they were presented in relative rather than absolute terms. The majority of stories (133/146, 91%) did not report any financial conflict of interest. Among these, 15 were shown to underreport them (15/146, 9.5%), as we demonstrated that conflicts of interest did actually exist. Unbalanced articles were 27/146 (18%). Specifically, the probability of unbalanced reporting was significantly increased in stories about a new treatment, procedure, test or product (22/49, 45%), compared to stories covering common treatments or basic scientific research (5/97, 5%) (risk ratio, 8.72). Conclusions/Significance: Consistent with prior research on health science communication in other countries, we report undisclosed costs and risks, emphasized benefits, unrevealed financial conflicts of interest and exaggerated claims in Italian print media. In addition, we show that the risk for a story about a new medical approach to be unbalanced is almost 9 times higher with respect to stories about any other kind of health science-related topics. These findings raise again the fundamental issue whether popular media is detrimental rather than useful to public health. Copyright: © 2010 Iaboli et al.


Bianchin G.,Santa Maria Nuova Hospital | Russi G.,Santa Maria Nuova Hospital | Romano N.,Santa Maria Nuova Hospital | Fioravanti P.,Santa Maria Nuova Hospital
Laryngoscope | Year: 2010

Objectives/Hypothesis: This study's aim was to verify whether, in patients affected by sudden sensorineural hearing loss (SSHL) with high plasmatic levels of low-density-lipoprotein (LDL) cholesterol and/or fibrinogen, the therapeutic approach with a single selective plasmapheresis (HELP-apheresis) followed by 10 days of standard treatment (glycerol and dexamethazone) is more effective than 10 days of standard treatment. Study Design: Randomized, superiority study (difference ≥30%). Methods: One hundred thirty-two patients were admitted to the trial and randomly allocated to two different arms; 60 were given standard treatment and 72 were treated with HELP-apheresis plus standard treatment. Patients showed a value of LDL cholesterol >120 mg/dL and/or fibrinogen >320 mg/dL. Results: In the HELP-apheresis plus standard therapy group, we observed a hearing recovery in 75% of the patients 24 hours after treatment and in 76.4% of the patients 10 days after treatment. Only 25% of the patients after 24 hours and 23.6% of the patients after 10 days showed no change. In the standard therapy group, the percentage of patients with hearing recovery was 41.7% after 24 hours and 45% after 10 days, whereas 58.3% after 24 hours and 55% after 10 days had no change. Conclusions: The analysis enabled us to consider HELP-apheresis as the element that makes a difference in hearing recovery. In a specific group of patients, with alterations in cholesterol and/or fibrinogen, the HELP-apheresis treatment is a further option available in SSHL therapy. © 2010 The American Laryngological, Rhinological and Otological Society, Inc.

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