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Tarquini R.,University of Florence | Coletta D.,University of Florence | Mazzoccoli G.,Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza | Gensini G.F.,University of Florence
Internal and Emergency Medicine | Year: 2013

Recently, there is a growing interest in the concept of "continuity of care," since patients, being older and more complex, are increasingly seen by an array of providers in a wide variety of organizations and places. Different models of continuity of care have been proposed, yet no single model of care coordination has been proven to be universally applicable across patient (and disease) populations. In the present paper, we introduce a novel model of continuity of care, the Ospedale Santa Verdiana, in Castelfiorentino (Tuscany, Italy), and its first period (1 year) of implementation, since January 2010. There are two main cornerstones: (a) the clinical and urgent need to bridge the gap between primary care and hospital care; and (b) the development and implementation of a model of continuity and coordination of care, which target the so-called complex patient. It is not specific for a single disease but it works "across diseases." There are three driving forces: (a) "primary care" since one of the two Hospital Coordinators is a primary care physician; (b) "hospital care" since patients in the decompensated phase often require hospitalization; and (c) the "University of Florence", which is the "glue". The duties of the Hospital Coordinator, who is an assistant professor at University of Florence, are to guarantee an efficacious and dynamic communication between primary care physicians and hospitalists, and by creating a school for practitioners of the continuity and coordination of care, to make this model exportable. © 2012 SIMI. Source


Mazzoccoli G.,Scientific Institute and Regional General Hospital | Dagostino M.P.,Scientific Institute and Regional General Hospital | Greco A.,Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza
Biomedicine and Preventive Nutrition | Year: 2012

Background: Epicardial adipose tissue is correlated to the amount of visceral fat and is a marker of metabolic and cardiovascular risk. Aging alters body fat mass and its function. Epicardial fat (EF) thickness, as measured by ultrasonography, reflects intra-abdominal visceral fat and is related to features of the metabolic syndrome and to cardiovascular risk. The aim of our study was to evaluate differences in the EF thickness between young-middle aged and old aged subjects. Methods: We evaluated EF thickness in 26 young-middle aged subjects (age. ±. SD 45.9. ±. 10.3 years) compared to 50 old aged subjects (age. ±. SD 76.1. ±. 7.3 years) with the common cardiovascular risk factors. Each subject underwent transthoracic M-mode echocardiogram to measure EF thickness. Results: Old aged subjects had thicker EF (11.3. ±. 1.9. mm versus 9.3. ±. 2.8. mm, p<. 0.001). A statistically significant positive trend was evidenced between age and epicardial fat thickness (R=0.437, p<. 0.001). Univariate linear regression analyses evidenced that EF correlated positively with age (p<. 0.001), obesity (p=0.003), dyslipidemia (p=0.01), arterial hypertension (p=. 0.047) and multivariate linear regression models showed that EF correlated positively with age (p<. 0.001), male gender (p=. 0.025) and obesity (p<. 0.001). Conclusion: epicardial adipose tissue is more abundant in the elderly and is correlated to visceral adipose tissue depots, indicating a higher cardiometabolic risk especially in male subjects. © 2011 Elsevier Masson SAS. Source


Mazzoccoli G.,Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza | Giuliani F.,Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza | Sothern R.B.,University of Minnesota
Journal of Biological Regulators and Homeostatic Agents | Year: 2011

Spontaneous hormone secretory dynamics include tonic and pulsatile components and a number of periodic processes. Circadian variations are usually found for melatonin, TSH and GH, with peak secretions at night, and in cortisol secretion, which peaks in the morning. Free thyroxine (FT4) and insulin-like growth factor (IGF)1 levels do not always change with circadian rhythmicity or show only minor fluctuations. Fractional variations explore the dynamics of secretion related to time intervals, and the rate of change in serum levels represents a signal for the receptorial system and the target organ. We evaluated time-related variations and change dynamics for melatonin, cortisol, TSH, FT4, GH and IGF1 levels in blood samples obtained every 4 h for 24 h from eleven healthy males, ages 35-53 years (mean±SE 43.6±1.7). Nyctohemeral (i.e., day-night) patterns of hormone secretion levels and the fractional rate of variation between consecutive 4-hourly time-qualified hormone serum levels (calculated as % change from time 1 to time 2) were evaluated for circadian periodicity using a 24 and 12-h cosine model. A circadian rhythm was validated for serum level changes in cortisol with peaks of the 24-h cosine model at 07:48h, and melatonin, TSH and GH, with phases at 01:35h, 23:32h, and 00: 0Oh, respectively. A weak, but significant, 12-h periodicity was found for FT4 serum levels, with minor peaks in the morning (10:00h) and evening (22:00h), and for IGF1, with minor peaks in the morning (07:40h) and evening (19:40h). Circadian rhythmicity was found in the 4-hourly fractional variations with phases of increase or surge at 02:00h for cortisol, 22:29h for melatonin, 05:14h for FT4, and 21: 19h for GH. A significant 12-h periodicity was found for the 4-hourly fractional variations of TSH with two peaks in the morning (decrease or drop at 04:42h) and afternoon (surge at 16:28h), whereas IGF1 fractional variation changes did not show a significant rhythmic pattern. In conclusion, the calculation of the time-qualified fractional rate of variation allows evaluation of the dynamics of secretion and the specification of the timepoint(s) of maximal change of secretion, not only for hormones whose secretion is characterized by a circadian pattern of variation, but also for hormones that show no circadian or only weak ultradian (12 h) variations (i.e., FT4). Copyright © by BIOLIFE, s.a.s. Source


Mazzoccoli G.,Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza | Pazienza V.,Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza | Piepoli A.,Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza | Muscarella L.A.,Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza | And 4 more authors.
Journal of Biological Regulators and Homeostatic Agents | Year: 2010

There is an increased frequency of dysthyroidism in elderly people. We investigated whether there are differences among healthy young-middle-aged and elderly people in the 24-hour secretory profiles of TRH, TSH and free thyroxine. The study was carried out on fifteen healthy young-middle-aged subjects (range 36-55 years, mean age±s.e. 44.1±1.7) and fifteen healthy elderly subjects (range 67-79 years, mean age±s.e. 68.5±1.2). TRH, TSH and free thyroxine serum levels were measured in blood samples collected every four hours for 24 hours. The area under the curve (AUC), the mean of 06:00h-10:00h-14:00h and the mean of 18:00h-22:00h-02:00h hormone serum levels and the presence of circadian rhythmicity were evaluated. A normal circadian rhythmicity was recognizable for TRH and TSH in young-middle-aged subjects and for TSH in elderly subjects. Elderly subjects presented lower TSH levels, whereas there was no statistically significant difference in TRH and free thyroxine serum levels between young-middle-aged and elderly subjects. Aging is associated with an altered TSH secretion. Copyright © by BIOLIFE, s.a.s. Source


Mazzoccoli G.,Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza | Sothern R.B.,University of Minnesota | De Cata A.,Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza | Giuliani F.,Scientific Institute and Regional General Hospital Casa Sollievo della Sofferenza | And 4 more authors.
Journal of Biological Regulators and Homeostatic Agents | Year: 2011

Specific lymphocyte cell surface molecules involved in antigen recognition and cell activation present different circadian patterns, with peaks and troughs reflecting a specific time-related compartment of immune cell function. In order to study the dynamics of variation in expression of cytotoxic lymphocyte cell surface molecules that trigger immune responses, several lymphocyte cell surface clusters of differentiation (CD) and antigen receptors, analyses were performed on blood samples collected every 4 h for 24 h from eleven clinically-healthy men. Assays for serum melatonin (peaking at night) and cortisol (peaking near awakening) confirmed 24-h synchronization of the subjects to the light-dark schedule. A significant (p≤0.05) circadian rhythm could be demonstrated for six of the 10 lymphocyte subpopulations, with midday peaks for CD8+dim (T cytotoxic cells, 11:15 h), γδTCR (gamma-delta T cell receptor-expressing cells, 11:33 h), CD8+ (T suppressor/cytotoxic cells, 12:08 h), and for CD16+ (natural killer cells, 12:59 h), and peaks during the night for CD4+ (T helper/inducer cells, 01:23 h) and CD3+ (total T cells, 02:58 h). A borderline significant rhythm (p = 0.056) was also observed for CD20+ (total B cells), with a peak late in the evening (23:06 h). Acrophases for 3 subsets, CD8+bright (T suppressor cells, 15:22 h), HLA-DR+ (B cells and activated T cells, 23:06 h) and CD25+ (activated T lymphocytes with expression of the α chain of IL2 receptor, 23:35 h), where a 24-h rhythm could not be definitively determined, nevertheless provide information on the location of their highest values and possible physiological significance. Thus, specific lymphocyte surface molecules present distinctly-timed profiles of nyctohemeral changes that indicate a temporal (i.e., circadian) organization of cellular immune function, which is most likely of physiological significance in triggering and regulating immune responses. Such a molecular cytotoxic timetable can potentially serve as a guide to sampling during experimental, diagnostic, therapeutic and/or other medical procedures. Copyright © by BIOLIFE, s.a.s. Source

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