Schiara Hospital

Trento, Italy

Schiara Hospital

Trento, Italy
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Cosottini M.,University of Pisa | Cosottini M.,Schiara Hospital | Pesaresi I.,Schiara Hospital | Piazza S.,University of Pisa | And 6 more authors.
Experimental Neurology | Year: 2012

The structural and functional data gathered with Magnetic Resonance Imaging (MRI) techniques about the brain cortical motor damage in Amyotrophic Lateral Sclerosis (ALS) are controversial. In fact some structural MRI studies showed foci of gray matter (GM) atrophy in the precentral gyrus, even in the early stage, while others did not. Most functional MRI (fMRI) studies in ALS reported hyperactivation of extra-primary motor cortices, while contradictory results were obtained on the activation of the primary motor cortex. We aimed to investigate the cortical motor circuitries in ALS patients by a combined structural and functional approach.Twenty patients with definite ALS and 16 healthy subjects underwent a structural examination with acquisition of a 3D T1-weighted sequence and fMRI examination during a maximal force handgrip task executed with the right-hand, the left-hand and with both hands simultaneously. The T1-weighted images were analyzed with Voxel-Based Morphometry (VBM) that showed several clusters of reduced cortical GM in ALS patients compared to controls including the pre and postcentral gyri, the superior, middle and inferior frontal gyri, the supplementary motor area, the superior and inferior parietal cortices and the temporal lobe, bilaterally but more extensive on the right side. In ALS patients a significant hypoactivation of the primary sensory motor cortex and frontal dorsal premotor areas as compared to controls was observed. The hypoactivated areas matched with foci of cortical atrophy demonstrated by VBM. The fMRI analysis also showed an enhanced activation in the ventral premotor frontal areas and in the parietal cortex pertaining to the fronto-parietal motor circuit which paralleled with disease progression rate and matched with cortical regions of atrophy. The hyperactivation of the fronto-parietal circuit was asymmetric and prevalent in the left hemisphere.VBM and fMRI identified structural and functional markers of an extended cortical damage within the motor circuit of ALS patients. The functional changes in non-primary motor cortices pertaining to fronto-parietal circuit suggest an over-recruitment of a pre-existing physiological sensory-motor network. However, the concomitant fronto-parietal cortical atrophy arises the possibility that such a hyper-activation reflects cortical hyper-excitability due to loss of inhibitory inter-neurons. © 2011 Elsevier Inc.


Ravanelli D.,University of Rome Tor Vergata | Dal Piaz E.C.,Schiara Hospital | Centonze M.,Schiara Hospital | Casagranda G.,Schiara Hospital | And 5 more authors.
IEEE Transactions on Medical Imaging | Year: 2014

This work presents the results of a new tool for 3-D segmentation, quantification and visualization of cardiac left atrium fibrosis, based on late gadolinium enhancement magnetic resonance imaging (LGE-MRI), for stratifying patients with atrial fibrillation (AF) that are candidates for radio-frequency catheter ablation. In this study 10 consecutive patients suffering AF with different grades of atrial fibrosis were considered. LGE-MRI and magnetic resonance angiography (MRA) images were used to detect and quantify fibrosis of the left atrium using a threshold and 2-D skeleton based approach. Quantification and 3-D volumetric views of atrial fibrosis were compared with quantification and 3-D bipolar voltage maps measured with an electro-anatomical mapping (EAM) system, the clinical reference standard technique for atrial substrate characterization. Segmentation and quantification of fibrosis areas proved to be clinically reliable among all different fibrosis stages. The proposed tool obtains discrepancies in fibrosis quantification less than 4% from EAM results and yields accurate 3-D volumetric views of fibrosis of left atrium. The novel 3-D visualization and quantification tool based on LGE-MRI allows detection of cardiac left atrium fibrosis areas. This noninvasive method provides a clinical alternative to EAM systems for quantification and localization of atrial fibrosis. © 2013 IEEE.


Baussano I.,International Agency for Research on Cancer | Franceschi S.,International Agency for Research on Cancer | Gillio-Tos A.,University of Turin | Carozzi F.,ISPO | And 12 more authors.
BMC Infectious Diseases | Year: 2013

Background: Although among women a decreasing prevalence of human papillomavirus (HPV) infection with increasing age has been consistently observed in high-resource countries, different age profiles have been reported elsewhere.Methods: We compared the age profile of high-risk (HR)-HPV prevalence in nine different areas of Northern and Central Italy by studying the women recruited in the intervention arm of the New Technologies in Cervical Cancer study and tested by Hybrid Capture 2. Differences in the age-distribution of HPV infection were investigated in each centre by the joinpoint approach in a logistic model. 46,900 women aged 25 to 60 years were included in the analysis.Results: The HR-HPV age-standardised (on Italian population) prevalence ranged from 5.7% (Trento) to 10.3% (Ravenna). HR-HPV prevalence decreased as a logistic function of increasing age in 6 of 9 centres (Trento, Verona, Florence, Bologna, Imola, and Viterbo). The effect of age on HR-HPV prevalence slopes did not differ significantly among these 6 centres, whereas significant heterogeneity in intercepts (p < 0.001) was found, reflecting different overall HR-HPV prevalence between centres. One significant joinpoint was observed in 2 centres (Padua and Ravenna), indicating that the decrease in HR-HPV prevalence by age was better described using a function composed with two logistic segments. In Padua HR-HPV prevalence decreased only slightly up to 39 years but showed a steep downturn thereafter. In Ravenna HR-HPV prevalence decreased steeply down to 45 years of age and then showed a plateau. Finally, in Turin two significant joinpoints were observed: prevalence decreased only after age 29 and showed a plateau after age 39.Conclusions: Our results showed substantial differences in overall and age-specific HR-HPV prevalence across Italian areas. These findings may be related to different timing of changes in sexual behaviours across regions. Age-specific HR-HPV prevalence in Italy does not support an influence of age per se. © 2013 Baussano et al.; licensee BioMed Central Ltd.


Stefanelli P.,Instituto Superiore Of Sanita | Fazio C.,Instituto Superiore Of Sanita | Neri A.,Instituto Superiore Of Sanita | Boros S.,Instituto Superiore Of Sanita | And 18 more authors.
Vaccine | Year: 2015

Background: In Italy, the incidence of Invasive Meningococcal Disease (IMD) was around 0.28 per 100,000 over the last years. Since the risk IMD is usually high among infants aged less than 1 year, we decided to evaluate the trend of IMD cases reported between 2006 and 2014 in this age group. In particular, the study aim was to describe the main characteristics of IMD cases in infants following the introduction of MCC vaccine (2005) and to estimate the number of cases which are potentially preventable through early vaccination. Methods: The National Surveillance System of Bacterial Meningitis was established in 1994 and in 2007 was extended to all invasive bacterial diseases. Clinical data and isolates and/or clinical samples are collected from hospitalized patients throughout the country. IMD cases are reported by clinicians to the local health authorities, and samples are sent to the Reference Laboratory at the Istituto Superiore di Sanità for further characterization and storage at -80 °C. In particular, serogroup identification is obtained by agglutination with commercial antisera or by multiplex PCR. Results: The annual incidence for infants <1 year old remained rather stable of 3.6 per 100,000, with several upward and downward oscillations and a peak in 2010. The incidence of IMD among infants was more than 10 times higher than the overall rate of IMD observed in Italy. Finally, serogroup B was more frequently detected among infants aged <1 year, accounting for 65% of the total (p < 0.01). Conclusions: During the study period, IMD incidence reported among infants aged less than one year old was 10 times higher than the overall rate, and serogroup B was the most commonly detected over time. The long-term impact of meningococcal C conjugate vaccine and the effect of the introduction of meningococcal B vaccination among infants need to be evaluated. © 2015 Elsevier Ltd.


Eccher C.,FBK | Ferro A.,Schiara Hospital | Pisanelli D.M.,CNR Institute of Cognitive Sciences and Technologies
Lecture Notes of the Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering | Year: 2010

Ontologies are the essential glue to build interoperable systems and the talk of the day in the medical community. In this paper we present the ontology of medical therapies developed in the course of the Oncocure project, aimed at building a guideline based decision support integrated with a legacy Electronic Patient Record (EPR). The therapy ontology is based upon the DOLCE top level ontology. It is our opinion that our ontology, besides constituting a model capturing the precise meaning of therapy-related concepts, can serve for several practical purposes: interfacing automatic support systems with a legacy EPR, allowing the automatic data analysis, and controlling possible medical errors made during EPR data input. © 2010 Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering.


Cosottini M.,University of Pisa | Cosottini M.,Schiara Hospital | Cecchi P.,University of Pisa | Cecchi P.,Schiara Hospital | And 7 more authors.
PLoS ONE | Year: 2013

Pathological and imaging data indicate that amyotrophic lateral sclerosis (ALS) is a multisystem disease involving several cerebral cortical areas. Advanced quantitative magnetic resonance imaging (MRI) techniques enable to explore in vivo the volume and microstructure of the cerebral cortex in ALS. We studied with a combined voxel-based morphometry (VBM) and magnetization transfer (MT) imaging approach the capability of MRI to identify the cortical areas affected by neurodegeneration in ALS patients. Eighteen ALS patients and 18 age-matched healthy controls were examined on a 1.5T scanner using a high-resolution 3D T1 weighted spoiled gradient recalled sequence with and without MT saturation pulse. A voxel-based analysis (VBA) was adopted in order to automatically compute the regional atrophy and MT ratio (MTr) changes of the entire cerebral cortex. By using a multimodal image analysis MTr was adjusted for local gray matter (GM) atrophy to investigate if MTr changes can be independent of atrophy of the cerebral cortex. VBA revealed several clusters of combined GM atrophy and MTr decrease in motor-related areas and extra-motor frontotemporal cortex. The multimodal image analysis identified areas of isolated MTr decrease in premotor and extra-motor frontotemporal areas. VBM and MTr are capable to detect the distribution of neurodegenerative alterations in the cortical GM of ALS patients, supporting the hypothesis of a multi-systemic involvement in ALS. MT imaging changes exist beyond volume loss in frontotemporal cortices. © 2013 Cosottini et al.


Eccher C.,Fondazione Bruno Kessler | Scipioni A.,University of Trento | Miller A.A.,Illawarra Cancer Care Center | Ferro A.,Schiara Hospital | Pisanelli D.M.,CNR Institute of Cognitive Sciences and Technologies
Computers in Biology and Medicine | Year: 2013

Ontologies can formally describe the semantics of the medical domain in an unambiguous and machine processable form, acting as a conceptual interface between different applications that must interoperate.In this paper we present an ontology of cancer therapies originally developed to bridge the gap between an oncologic Electronic Patient Record (EPR) and a guideline-based decision support system. We show an application of the ontology complemented by rules to classify therapies recorded in the EPR. The results show how such an ontology can be used also to discover possible problems of data consistency in the EPR. © 2013 Elsevier Ltd.


Disertori M.,Schiara Hospital | Quintarelli S.,Schiara Hospital
Journal of Atrial Fibrillation | Year: 2011

Atrial fibrillation (AF) arises as a result of a complex interaction of triggers, perpetuators and the substrate. The recurrence of AF may be partially related to a biologic phenomenon known as remodeling, in which the electrical, mechanical, and structural properties of the atrial tissue and cardiac cells are progressively altered, creating a more favorable substrate. Atrial remodeling is in part a consequence of arrhythmia itself. Therefore, to prevent and to treat AF, much attention has been directed to upstream therapies to alter the arrhythmia substrate and to reduce atrial remodeling. The renin-angiotensin- aldosterone system (RAAS) plays a key role in these strategies. In this review we analyze the experimental and clinical evidence regarding the efficacy of RAAS inhibitors in AF treatment. In the primary prevention of AF, meta-analyses have shown that risk of new-onset AF in patients with congestive heart failure and left ventricular dysfunction is reduced by RAAS inhibitors, whereas in hypertensive and post-myocardial infarction patients, the results are less evident. In the secondary prevention of AF, some large, prospective, randomized, placebo-controlled studies with angiotensin II-receptor blockers returned negative results. Unfortunately, the approach of using RAAS inhibitors as antiarrhythmic drugs to prevent both new-onset and recurrent AF is in decline because negative trial results are accumulating, with the exception of the results in patients with congestive heart failure.


Faes L.,University of Trento | Erla S.,University of Trento | Tranquillini E.,Schiara Hospital | Orrico D.,Schiara Hospital | Nollo G.,University of Trento
2010 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC'10 | Year: 2010

We present a new approach for the investigation of Granger causality in the frequency domain by means of the partial directed coherence (PDC). The approach is based on the utilization of an extended multivariate autoregressive (MVAR) model, including instantaneous effects in addition to the lagged effects traditionally studied, to fit the observed multiple time series prior to PDC computation. Model identification is performed combining standard MVAR coefficient estimation with a recent technique for instantaneous causal modeling based on independent component analysis. The approach is first validated on simulated MVAR processes showing that, in the presence of instantaneous effects, only the extended model is able to interpret the imposed Granger causality patterns, while the traditional MVAR approach may yield strongly biased PDC estimates. The subsequent application to multichannel EEG time series confirms the potentiality of the approach in real data applications, as the importance of instantaneous effects led to significant differences in the PDC estimated after traditional and extended MVAR identification. © 2010 IEEE.


Twenty-30% of women affected by vulvo-vaginal Candidiasis frequently develops recurrences. Therapy and pharmacology prophylaxis have shown a high percentage of insuccess. Objective of the study was the evaluation of immunotherapy to prevent the recurrences of candida vaginitis. 74 women between 20-50 years old underwent treatment with an autogenous vaccine. Treated women had been suffering, from at least, four vaginitis episodes/year for at least 2 years and therapy and long-term pharmacological prophylaxis had any result during the year after the suspension. Sintomatology disappeared in 62 of the patients and 6 reported a relevant improvement. Laboratory follow-up showed absence of Candida in the vaginal secretion of 64 of 68 women who reported recovery or improvement. The approach with autovaccination may be an excellent alternative in recurrent vulvovaginal candidiasis. The results achieved are encouraging for the prosecution of the study based on the immunological approach to therapy and prophylaxis in fungal infections. ©2011 Pharma Project Group srl.

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