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Milano, Italy

The Vita-Salute San Raffaele University is a private university in Milan, Italy. It was founded in 1996 and is organized in three departments; Medicine, Philosophy and Psychology. Wikipedia.

OBJECTIVE:: Noninvasive ventilation is increasingly applied to prevent or treat acute respiratory failure, but its benefit on survival is still controversial for many indications. We performed a meta-analysis of randomized controlled trials focused on the effect of noninvasive ventilation on mortality.DATA SOURCES:: BioMedCentral, PubMed, Embase, and the Cochrane Central Register of clinical trials (updated December 31, 2013) were searched.STUDY SELECTION:: We included all the randomized controlled trials published in the last 20 years performed in adults, reporting mortality, comparing noninvasive ventilation to any other treatment for prevention or treatment of acute respiratory failure or as a tool allowing an earlier extubation. Studies with unclear methodology, comparing two noninvasive ventilation modalities, or in palliative settings were excluded.DATA EXTRACTION:: We extracted data on mortality, study design, population, clinical setting, comparator, and follow-up duration.DATA SYNTHESIS:: Seventy-eight studies were analyzed. Noninvasive ventilation was associated with a reduction in mortality (12.6% in the noninvasive ventilation group vs 17.8% in the control arm; risk ratio = 0.73 [0.66–0.81]; p < 0.001; number needed to treat = 19 with 7,365 patients included) at the longest available follow-up. Mortality was reduced when noninvasive ventilation was used to treat (14.2% vs 20.6%; risk ratio = 0.72; p < 0.001; number needed to treat = 16, with survival improved in pulmonary edema, chronic obstructive pulmonary disease exacerbation, acute respiratory failure of mixed etiologies, and postoperative acute respiratory failure) or to prevent acute respiratory failure (5.3% vs 8.3%; risk ratio = 0.64 [0.46–0.90]; number needed to treat = 34, with survival improved in postextubation ICU patients), but not when used to facilitate an earlier extubation. Overall results were confirmed for hospital mortality. Patients randomized to noninvasive ventilation maintained the survival benefit even in studies allowing crossover of controls to noninvasive ventilation as rescue treatment.CONCLUSIONS:: This comprehensive meta-analysis suggests that noninvasive ventilation improves survival in acute care settings. The benefit could be lost in some subgroups of patients if noninvasive ventilation is applied late as a rescue treatment. Whenever noninvasive ventilation is indicated, an early adoption should be promoted. © 2015 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins Source

Benedetti F.,Vita-Salute San Raffaele University
Dialogues in Clinical Neuroscience | Year: 2012

Chronotherapeutics refers to treatments based on the principles of circadian rhythm organization and sleep physiology, which control the exposure to environmental stimuli that act on biological rhythms, in order to achieve therapeutic effects in the treatment of psychiatric conditions. It includes manipulations of the sleep-wake cycle such as sleep deprivation and sleep phase advance, and controlled exposure to light and dark. The antidepressant effects of chronotherapeutics are evident in difficult-totreat conditions such as bipolar depression, which has been associated with extremely low success rates of antidepressant drugs in naturalistic settings and with stable antidepressant response to chronotherapeutics in more than half of the patients. Recent advances in the study of the effects of chronotherapeutics on neurotransmitter systems, and on the biological clock machinery, allow us to pinpoint its mechanism of action and to transform it from a neglected or "orphan" treatment to a powerful clinical instrument in everyday psychiatric practice. © 2012, LLS SAS. Source

Filippi M.,Vita-Salute San Raffaele University
Journal of Neurology | Year: 2015

Magnetic resonance imaging (MRI) techniques, such as T2-weighted and gadolinium-enhanced T1-weighted sequences, have long been used to diagnose multiple sclerosis (MS). However, these methods are limited in their ability to depict underlying disease pathology. A PubMed literature search was conducted to identify the publications discussing MRI in MS from 2010 to 2013, using the medical subject heading terms: ‘‘multiple sclerosis’’ and ‘‘grey/gray matter’’, ‘‘brain atrophy’’, ‘‘grey/gray matter atrophy’’, ‘‘normal appearing white matter,’’ and ‘‘cortical lesions.’’ Recent proceedings of conferences on MRI were also used to identify emerging techniques. MRI-derived metrics can assess the microstructural, metabolic, and functional changes that occur in newly formed lesions and allow further characterization of diffuse degeneration in different central nervous system compartments across MS phenotypes. Advanced imaging techniques aim to complement our understanding of MS disease pathophysiology, which may facilitate the identification of markers that could be used to predict the clinical outcomes of agents in development. © Springer-Verlag Berlin Heidelberg 2014. Source

Hershko C.,39 Health | Camaschella C.,Vita-Salute San Raffaele University
Blood | Year: 2014

Endoscopic gastrointestinal workup fails to establish the cause of iron deficiency anemia (IDA) inasubstantial proportion of patients. In patients referred for hemato-logic evaluation with unexplained or refractory IDA, screening for celiac disease, autoimmune gastritis, Helicobacter pylori, and hereditary forms of IDA is recommended. About 4% to 6% of patients with obscure refractory IDA have celiac disease, and autoimmune gastritis is encountered in 20% to 27% of patients. Stratification by age cohorts in autoimmune gastritis implies a disease presenting as IDA many years before the establishment of clinical cobalamin deficiency. Over 50% of patients with unexplained refractory IDA have active H pylori infection and, after excluding all other causes of IDA, 64% to 75% of such patients are permanently cured by H pylori eradication. In young patients with a history suggestive of hereditary iron deficiency with serum ferritin higher than expected for IDA, mutations involving iron trafficking and regulation should be considered. Recognition of the respective roles of H pylori, autoimmune gastritis, celiac disease, and genetic defects in the pathogenesis of iron deficiency should have a strong impact on the current diagnostic workup and management of unexplained, or refractory, IDA. © 2014 by The American Society of Hematology. Source

Comi G.,Vita-Salute San Raffaele University
Multiple Sclerosis Journal | Year: 2013

The last 20 years have seen major progress in the treatment of relapsing-remitting multiple sclerosis (RRMS) using a variety of drugs targeting immune dysfunction. In contrast, all clinical trials of such agents in primary progressive multiple sclerosis (PPMS) have failed and there is limited evidence of their efficacy in secondary progressive disease. Evolving concepts of the complex interplay between inflammatory and neurodegenerative processes across the course of multiple sclerosis (MS) may explain this discrepancy. This paper will provide an up-to-date overview of the rationale and results of the published clinical trials that have sought to alter the trajectory of both primary and secondary MS, considering studies involving drugs with a primary immune target and also those aiming for neuroprotection. Future areas of study will be discussed, building on these results combined with the experience of treating RRMS and new concepts emerging from laboratory science and animal models. © 2013 The Author(s). Source

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